Oral Mucosal Disease Flashcards
When and where is referral needed for oral medicine?
Anything dentist believes may be cancer or dysplasia
- must be put through 2 week cancer referral pathway
Any symptomatic lesion that has not responded to treatment
- hospital referral criteria
Any benign lesions the patient cannot be persuaded is not cancer
Describe the structure of the oral mucosa
Stratified squamous epithelium
Stratum corneum - cornified cells
Stratum granulosum - maturation cells
Stratum spinosum - progenitor cells
Basal layer
Lamina propria
Submucosa
What is acanthosis?
Hyperplasia of stratum spinosum
Give some mucosal reactions to pathology / trauma / disease etc
Keratosis
Acanthosis
Ulceration
Erosion
Oedema - intra or intercellular
Blister
What may cause a loss of papillae on tongue - smooth surface
Any issues?
Iron or b group vitamin deficiency
Atrophy
Predisposition to infection ?
Give some benign mucosal changes
Geographic tongue
1-2 % pop
Black hairy tongue
- papillae hyperplasia and bacterial pigment
Fissured tongue
Diagnose and what is aetiology and symptoms
Geographic tongue
Alteration in maturation and replacement of normal epithelial surface - in random areas
Works in young children, intermittent symptoms that can be sensitive with acidic or spicy foods
Symptoms only when geographic tongue? Take photo of tongue when symptoms arise
Diagnosis, aetiology, tx?
Black / brown hairy tongue
Often soft, or liquid diet can cause thickening and then staining from chlorhexadine, tea, coffee etc
Improved by removing elongated surface with tongue scraper, or harder natural item such as a peach stone sucked round mouth for her a day etc.
Diagnosis, aetiology, tx?
Fissured tongue
Tongue just can naturally be fissured
Deep fissures can cause bacterial build up/ candida or lichen planus in fissures so soft brush needed to clean them
Diagnosis? Aetiology and tx? Any symptoms?
Glossitis - inflammation of the tongue
- Smooth and red atrophy tongue
- Haemotinics taken as often caused by vitamin deficiencies
- Also biopsy to see if any other issues
Tx include
- identification of underlying cause
- topical anaesthetics e.g. lidocaine mouthwash
- OTC meds such as ibuprofen
- avoidance of triggers
- hydration
When should / shouldn’t swellings be referred
Refer if
- symptomatic - pain is feature of salivary gland malignancy
- abnormal overlying and surrounding mucosa
- increase in size
- rubbery consistency
- trauma from teeth
- unsightly
Usually dont refer
- tori
- Small polyps
- mucoceles - unless they become fixed in size
Give some causes of oral white lesions?
Hereditary
Smoking / frictonal
Lichen planus
Candida leukoplakia
Carcinoma
Why are white lesions white?
Loss of blood circulation to the tissues - vasoconstriction
Thickening of mucosa or keratin - less visibility of the blood vessels through tissue
Define leukoplakia
A white patch which cannot be scraped off or attributed to any other cause
Diagnose, aetiology, symptoms and tx?
Fordyces spots
Ectopic sebaceous glands, benign, not any malignant potential
Diagnosis, cause? Symptoms and tx?
Frictional kerotosis
- often a direct traumatic cause
- often in those with parafunctional habits with buccinator contraction causing cheeks to rub against buccal cusps
Diagnosis? Cause?
Symptoms? Tx?
White sponge Naevus
- hereditary keratosis
- obviously not trauma as teeth wont cause trauma right in sulcus
- often starts in childhood and within families history
Monitor, refer for biopsy if spreading to other areas of body e.g. genitalia
caused by fluid filled areas between epithelial layers
What features of white spots spark warning signs?
Reactionary border around the white lesion, indicating it is malignant
Mucosal changes to the type epithelium
Diagnose these two cases and give causes?
Pseudomembranous acute candidosis - thrush
Denture associated chronic candidosis
When refer a white lesion?
If red and white, concentrate on red part
If lesion is becoming raised and thickened
If lesion is ‘without cause’
- lateral tongue
- anterior FOM
- soft palate area
Why are red lesions red?
Blood flow increases
- inflammation
- dysplasia
Reduced thickness of the epithelium
What is erythroplakia?
Unexplained reddening change of the oral mucosa
Cannot be attributed to other causes
More of a concern for malignancy than Leukoplakia
What may cause a dark red/blue lesion?
Dark - slow moving blood due to varicosities
Light blue - clear fluid such as saliva (mucocele) or lymph (lymphangioma)
Give some possible causes of mucosal pigmentation
Exogenous staining of
- tea, coffee, smoking, chlorhexadine
Intrinsic pigmentation
- reactive Melanosis
- melanocytic naevus
- melanoma
Foreign body
- amalgam
