Oral Mucosal Disease

Question 1

How long is the cancer referral pathway for acute malignancies

Answer 1

All potential oral cancer lesions should be seen within 2 weeks by a specialist team

Question 2

When are three circumstances that a mucosal lesion should be referred to oral medicine for an opinion

Answer 2

ANYTHING the dentist thinks might be oral cancer or dysplasia

Any SYMPTOMATIC lesion that has not responded to standard treatment

Any BENIGN lesion that the patient cannot be persuaded isn’t cancer

Question 3

What kind of epithelium is the oral mucosa

Answer 3

Stratified squamous epithelium

Question 4

What is parakeratosis

Answer 4

Usually where the keratin change is a result of alterations to the standard mucosal type e.g. lichen planus

Question 5

When looking at a histology slide of tje epithelium if you can see mitosis further up towards the surface what is this altering you to

Answer 5

Potentially dysplasia

Question 6

What is acanthosis

Answer 6

Hyperplasia of stratum spinosum

Thickening of the epithelium usually as a reactive change e.g. trauma/immunological damage

Question 7

If there are elongated rete ridges on a histology slide of oral mucosa what is this

Answer 7

Hyperplasia of basal cells

Question 8

What is spongiosis

Answer 8

This is intercellular oedema - there is fluid between the cells

Question 9

How common is geographic tongue

Answer 9

1-2% of the population

Question 10

Essentially what is geographic tongue

Answer 10

It is an alteration to the maturation and replacement of the normal epithelium surface

Question 11

Why may someone with a geographic tongue experience sensitivity/ redness

Answer 11

This is because the replacement of the epithelium layer is not happening, the tongue appears redder as the blood vessels are now closer to the surface and they experience sensitivity as they are closer to the nerve

Question 12

Why does black Hairy tongue happen

Answer 12

Can be due to bacterial colonisation but in many cases it is simply the elongation of the surface papillae which then become stained from surfaces of foo stuff

Question 13

Give some reasons that you would refer a swelling?1

Answer 13

Symptomatic
Abnormal overlying and surrounding mucosa
Increasing in size
Rubbery consistency

Question 14

What medications are tori known as a risk factor for and why

Answer 14

Bisphosphonate Medication

This is because they are more likely to get avascular necrosis in mucosa over the tori rather than the other bits of the mandible because blood supply of the mucosa largely coming from the periosteum

Question 15

How does a pyogenic granuloma differ from other swellings

Answer 15

This is because it does NOT have an epithelial surface

It is an inflammatory lesion with inflamed granulation tissue but without epithelial surface

Question 16

Why are white lesions white?

Answer 16

Red colour of the mucosa comes from the connective tissue where the blood vessels run and there colour is diluted by the transparent and slightly opaque layers of epithelium.

Increase in the thickness of the keratin layer of the mucosa will cause obstruction of the view of the blood vessels in the connective tissue - causing the generation of the white colour

Question 17

What is leukoplakia

Answer 17

A white patch which cannot be scraped off or attributed to any other cause

Diagnosis of exclusion

No histopatholgical connotation

Question 18

What percentage of leukplakia become malignant

Answer 18

1%

Question 19

How many times more likely are smokers to have leukplakia

Answer 19

6x

Question 20

Why do smokers get keratosis

Answer 20

Trauma from thermal gases - reactive change
K

Question 21

Histologically what is happening in white sponge naevua to make it so white?

Answer 21

There is fluid accumulating between the epithelial cells increasing the opacity of the epithelium therefore making it white

Question 22

What features would make you not worry about a white lesion

Answer 22

Clearly defined white lesion with normal mucosal covering is less worrying

Must biopsy to confirm

Question 23

What is idiopathic keratosis

Answer 23

When there is no obvious cause
Genetic programming in the cells structures producing more keratin

Question 24

Chemical burns in the oral mucosa where historically seen with aspirin, what drugs is this now more commonly seen with and what kinds of patients

Answer 24

This is now more likely seen with alendronc acid

Reduced cognitive function may not swallow it properly and it prolongs in the mouth

Question 25

What is hairy leukoplakia

Answer 25

Elongation of the papillae on the side of the tongue and thickening of the surface

Due to the incorporation of the Epstein Barr virus into the genetic code of the cells so they reproduce at a faster rate

Question 26

What are some key features of pseudomembranous acute ) thrush)

Answer 26

Can be scraped off as it is not firmly attached to the mucosa
Will leave a red bleeding area underneath

Question 27

What clinical presentation would you expect to see in denture associated Candidas - chronic

Answer 27

Red erethymaous change - due to constant contact from the candida

Question 28

Any white lesions without a cause should be referred
What are three areas in the oral Mucosa that are unlikely to have a cause

Answer 28

Lateral tongue - without parafunction
Anteior floor of mouth
Soft palate area

Question 29

Why are red lesions red

Answer 29

Blood flow increases due to inflammation or dysplasia

Reduced thickness of the epithelium

Question 30

What is erythroplakia

Answer 30

A red patch that cannot be attributed to any other cause

More concern for a malignancy than leukoplakia

Question 31

Red blue lesions tend to come from fluid in the connective tissu
What would you expect it to be if it is;
- dark fluid
- light fluid

Answer 31

Dark - slow moving blood - variosties
Veins or cavernous haemangioma

Light - clear fluid
Saliva ( mucocele) or lymph (lymphangioma)

Question 32

What are the two types of haemangioma

Answer 32

Capillary
- lots of little blood vessels very red lesion

Cavernous
- slow moving blood and rapid deoxygenation giving blue appearance

Question 33

What is a lymphangioma

Answer 33

When the lymph has meant to have been taken from the tissues back to circulation it has instead proliferated in the fluid spaces

Can be indistinguishable from a cavernous haemangioma before a biopsy is carried out

Question 34

What is reactive melanosis

Answer 34

This is a normal no.of melanocytes producing TOO much melanin

Question 35

What is melanotic macule

Answer 35

Increased deposition of pigmentation around melanocyte giving small focal area of melanosis and can happen in the mouth

Question 36

What is melanocytic naevus

Answer 36

Increased amount of melanocytes producing same anout of melanin

Question 37

What is a melanoma

Answer 37

Cancer producing pigment

Less developed lesion is less likely to produce pigment - so you’ can get melanoma that are pigment free however these are more diffuckt to find.

Question 38

Why might someone with Addison’s disease have increased pigmentation

Answer 38

This is because the raised ACTH conditions cause stimulation of melanocytes

Question 39

Why may an amalgam tattoo be spread out further away from the tooth with the amalgam restoration

Answer 39

This is because amglam is an external pigment, the metal is a forgein body and is phagocytosed by giant cells to be removed and taken elsewhere in the mucosa, therefore it spreads out

Question 40

What are some characteristics of a melanoma?

Answer 40

Variable pigmentation
Irregular outline
Raised surface
Symptomatic - itchy/ bleeding

Question 41

What are the papules with distinctive white lines in lichen planus called

Answer 41

Wickmans striae