Oral Mucosal Disease Flashcards
When should referral of an oral mucosal lesion to oral medicine be made?
- any symptomatic lesion that has not responded to standard treatment
- must meet hospital referral criteria
- follow SDCEP guidance
- any benign lesion that the patient can’t be persuaded isn’t cancer
When should referral of an oral mucosal lesion to maxillofacial specialists be made?
- anything the dentist thinks might be cancer or dysplasia
- 2 week cancer referral pathway for malignancies
What kind of epithelium is the oral mucosa?
stratified squamous
What are the 3 gross types of oral mucosa?
- lining
- masticatory
- gustatory
What are the microscopic categories of oral mucosa?
- non keratinised
- keratinised
- orthokeratosis
- parakeratosis
Where is keratin visible histologically for buccal mucosa?
thin keratin layer on the surface of stratified squamous epithelium
Where is keratin visible histologically for buccal mucosa?
thick layer of keratin on surface
What are the 5 strata and compartments that make up keratinised epithelium?
- stratum corneum
- granulosum
- spinousum
- basal
- lamina propria
What 3 categories make up the keratinised layer of oral mucosa?
- cornified
- maturation
- progenitor
What type of cells are present in the basement membrane?
- epithelial progenitor cells
- mature and progress up epithelium
Why does keratin stain purple?
- loss of organelles
- cell wall left behind
- keratin layer stains purple
Where does mitosis occur in keratinised epithelium and what does mitosis outwit this region indicate?
- occurs in the basal and suprabasal layers
- in higher layers could indicate dysplasia
- may be basement membrane from adjacent mucosa
- serial sections required
What are 3 reactive changes that can be seen in oral epithelium?
- keratosis
- non-keratinised site
- parakeratosis
- usually due to trauma
- increased surface protection
- acanthosis
- hyperplasia of stratum spinous
- thickening of epithelium
- trauma, immune change, reaction to disease
- elongated rete ridges
- hyperplasia of basal cells
What is atrophy?
reduction in viable layers
What is erosion?
partial thickness loss
What is ulceration?
loss of epithelial covering with fibrin exudate on top of connective tissue
What is oedema?
- swelling
- intracellular
- cells appear bigger
- intercellular
- spongiosis
What is a blister?
- vesicle or bulla
- depends on size of lesion
What mucosal changes are commonly seen associated with age?
- progressive mucosal atrophy
- appearance should still be normal
What mucosal changes are commonly seen wiyj nutritional deficiencies?
- iron or B group vitamins
- atrophy
- predisposed to infection
- loss of tongue papillae
- easier for microbes to penetrate mucosa
- atrophy
What is the prevalence of geographic tongue?
- 1-2% of population
- less common in children
Provide 3 examples of benign tongue lesions
- geographic tongue
- black hairy tongue
- fissured tongue
What is geographic tongue?
- desquamation of mucosa
- varied pattern and timing
- alteration to maturation and replacement
- entire areas of epithelial surface replaced on single occasion
- replication halted
- epithelial layer thins
- tongue appears more red
- replication restarts
- new cells produced
- thickness increases
- appearance returns to normal
- replication halted
What are the symptoms of geographic tongue?
- usually asymptomatic
- patient may be concerned about appearance
- intermittent tissue sensitivity
- nerve has less protection
- avoid spicy and strong flavoured foods
- more likely in children
- usually for around a week
- can be up to a month before next
What are the two ways in which geographic tongue can present?
- many areas of change
- red and white margins
- often crescent shaped areas
- dorsal and lateral margin most common
- large area of change
- central area of normal epithelium
- erythematous margin
Can any other tissues be affected by geographic tongue?
- buccal mucosa and palate
- rare
How is geographic tongue treated?
- disorder of maturation, not disease
- no treatment required
How can it be determined if geographic tongue is symptomatic and what are the other possible causes?
- determine whether symptoms occur during change of appearance of all the time
- take photos when symptomatic
- other causes
- haematinic deficiencies
- B12
- folate
- ferritin
- parafunctional trauma
- trauma to tip of tongue
- dysaesthesia
- haematinic deficiencies
What is brown/black hairy tongue?
- aesthetic problem
- tongue looks dirty/unhygienic
- bacterial colonisation
- possible cause
- elongation of surface papillae
- stained by food stuffs/tobacco
- tea
- coffee
- soft/liquid diet thickens papillae
- stained by food stuffs/tobacco
How can black/brown hairy tongue be managed?
- removal of elongated papillae
- tongue scraper
- peach stone
- suck for 1 hour daily
What is fissured tongue?
- tongue has normal appearance then fissure pattern appears
- not constantly present
- aetiology unconfirmed
What are the symptoms of fissured tongue?
- often asymptomatic
- localised inflammation
- deep fissures can trap food/debris
- soft bristle brush to clean fissures
- deep fissures can trap food/debris
- other disease processes may cause symptoms
- candida
- lichen planus
What is glossitis?
- smooth red appearance of tongue
- atrophy of mucosa
What are the possible causes of glossitis?
- haematinic deficiency
- check for angular cheilitis
- lichen planus
What investigations should be carried out when a patient presents with suspected glossitis?
- haematinics
- fungal cultures
- biopsy
When should swellings be referred?
- symptomatic
- possibly underlying disease process
- pain may be salivary gland malignancy
- possibly underlying disease process
- abnormal overlying or surrounding mucosa
- increasing in size
- rubbery consistency
- trauma from teeth
- removal of entire swelling
- removal of edge of swelling
- unsightly
What kind of swellings are not usually referred?
- tori
- bony swellings
- lingual aspect of mandible
- palate
- bony swellings
- small polyps
- causes more damage to remove
- mucoceles
- extraversion of mucus into tissues
- from minor salivary glands
- difficult to find surgically
- causes more damage to remove
- if fixed in size should refer
- extraversion of mucus into tissues
What is a leaf fibroma and how should it be managed?
- fibrous polyp squashed under denture
- thin and elongated
- should be removed and allowed to heal
- can then construct new denture
What are fibroepithelial polyps and how should they be managed?
- polyp with same mucosal covering as surrounding tissue
- no inflammation at base of lesion
- can be removed
- size may be causing catching between teeth
- trauma causes enlargement
- only remove if causing problems
- size may be causing catching between teeth
How are polyps formed parafunctionally and how can they be managed?
- formed by parafunctional habit
- sticking tongue through diastema
- polyp on tongue edge
- managed by closing gap or blocking diastema
What are mucoceles and how can they be managed?
- clear swelling associated with minor salivary gland
- surgical removal
- if fixed and remains filled with saliva
- possible to remove mucus and gland
- if small and bursts
- impossible to tell where swelling is
- surgical removal close to impossible
- if fixed and remains filled with saliva
What are tori and what are the management options?
- benign bony protrusions
- mandibular tori
- thin, non-keratinised mucosal covering
- palatal tori
- keratinised mucosal covering
- mandibular tori
- associated with parafunctional clenching habits
- may present with TMJ problems
- removal is not recommended
- only in unusual circumstances
What types of medications are a risk factor for tori and why?
- bisphosphonates
- increased risk of avascular necrosis
- affecting mucosal covering
- blood supply reduced as from bone
- increased risk of avascular necrosis
- consider risk for bisphosphonate patients
What is a pyogenic granuloma?
- granulation tissue
- mixed inflammatory infiltrate
- fibro-vascular background
- no epithelial surface
- fibrinous yellow or red appearance
- can be present on any mucosal site
- response to trauma
- other names
- vascular epulis
- pregnancy epulis
