Oral Mucosal Disease Flashcards
How long is the cancer referral pathway for acute malignancies
All potential oral cancer lesions should be seen within 2 weeks by a specialist team
When are three circumstances that a mucosal lesion should be referred to oral medicine for an opinion
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
What kind of epithelium is the oral mucosa
Stratified squamous epithelium
What is parakeratosis
Usually where the keratin change is a result of alterations to the standard mucosal type e.g. lichen planus
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
Potentially dysplasia
What is acanthosis
Hyperplasia of stratum spinosum
Thickening of the epithelium usually as a reactive change e.g. trauma/immunological damage
If there are elongated rete ridges on a histology slide of oral mucosa what is this
Hyperplasia of basal cells
What is spongiosis
This is intercellular oedema - there is fluid between the cells
How common is geographic tongue
1-2% of the population
Essentially what is geographic tongue
It is an alteration to the maturation and replacement of the normal epithelium surface
Why may someone with a geographic tongue experience sensitivity/ redness
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
Why does black Hairy tongue happen
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
Give some reasons that you would refer a swelling?1
Symptomatic
Abnormal overlying and surrounding mucosa
Increasing in size
Rubbery consistency
What medications are tori known as a risk factor for and why
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
How does a pyogenic granuloma differ from other swellings
This is because it does NOT have an epithelial surface
It is an inflammatory lesion with inflamed granulation tissue but without epithelial surface
Why are white lesions white?
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
What is leukoplakia
A white patch which cannot be scraped off or attributed to any other cause
Diagnosis of exclusion
No histopatholgical connotation
What percentage of leukplakia become malignant
1%
How many times more likely are smokers to have leukplakia
6x
Why do smokers get keratosis
Trauma from thermal gases - reactive change
K
Histologically what is happening in white sponge naevua to make it so white?
There is fluid accumulating between the epithelial cells increasing the opacity of the epithelium therefore making it white
What features would make you not worry about a white lesion
Clearly defined white lesion with normal mucosal covering is less worrying
Must biopsy to confirm
What is idiopathic keratosis
When there is no obvious cause
Genetic programming in the cells structures producing more keratin
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
This is now more likely seen with alendronc acid
Reduced cognitive function may not swallow it properly and it prolongs in the mouth
What is hairy leukoplakia
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
What are some key features of pseudomembranous acute ) thrush)
Can be scraped off as it is not firmly attached to the mucosa
Will leave a red bleeding area underneath
What clinical presentation would you expect to see in denture associated Candidas - chronic
Red erethymaous change - due to constant contact from the candida
Any white lesions without a cause should be referred
What are three areas in the oral Mucosa that are unlikely to have a cause
Lateral tongue - without parafunction
Anteior floor of mouth
Soft palate area
Why are red lesions red
Blood flow increases due to inflammation or dysplasia
Reduced thickness of the epithelium
What is erythroplakia
A red patch that cannot be attributed to any other cause
More concern for a malignancy than leukoplakia
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
Dark - slow moving blood - variosties
Veins or cavernous haemangioma
Light - clear fluid
Saliva ( mucocele) or lymph (lymphangioma)
What are the two types of haemangioma
Capillary
- lots of little blood vessels very red lesion
Cavernous
- slow moving blood and rapid deoxygenation giving blue appearance
What is a lymphangioma
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
What is reactive melanosis
This is a normal no.of melanocytes producing TOO much melanin
What is melanotic macule
Increased deposition of pigmentation around melanocyte giving small focal area of melanosis and can happen in the mouth
What is melanocytic naevus
Increased amount of melanocytes producing same anout of melanin
What is a melanoma
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.
Why might someone with Addison’s disease have increased pigmentation
This is because the raised ACTH conditions cause stimulation of melanocytes
Why may an amalgam tattoo be spread out further away from the tooth with the amalgam restoration
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
What are some characteristics of a melanoma?
Variable pigmentation
Irregular outline
Raised surface
Symptomatic - itchy/ bleeding
What are the papules with distinctive white lines in lichen planus called
Wickmans striae
