Oral Mucosal Disease Flashcards

1
Q

In what circumstances do you refer a mucosal lesion to Oral Med for an opinion?

A
  • Anything the dentist thinks might be cancer or dysplasia
  • Any symptomatic lesion that has not responded to standard txt
  • Any Benign lesion that pt can’t be persuaded is not cancer
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2
Q

If you think a mucosal lesion might be cancer or dysplasia what guidelines can you consult for what to do next?

A
  • NICE and SIGN Head and Neck cancer guidance
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3
Q

What epithelium is this diagram and is it keratinised or non-keratinised?

A
  • Buccal mucosa
  • Non-keratinised
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4
Q

What epithelium is this and is it keratinised or non keratinised?

A
  • Palate
  • Thick Keratinised layer sitting on surface
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5
Q

Label this diagram and explain

A
  • Lamina propria with blood vessles
  • Basal layer with epithelial progenitor cells (essentially stem cells)
  • As you go up through spinosum the cells are undergoing maturation , become less purple staining suggesting they are losing their cell organelles
  • Eventually becomes stratum corneum where cells have lost all organelles except cell wall and becomes the flattened keratin of the surface
  • Mitosis should only occur in basal membrane layer, any other mitosis occurring could be dysplastic
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6
Q

How is the oral mucosa histologically set up?

A
  • Stratified squamous epithelium
  • Lamina propria
  • 3 gross types depending on function so can be lining, masticatory, gustatory
  • Keratinised or non keratinised
  • Keratinised can be orthokeratosis or parakeratosis
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7
Q

What are some reactive changes that can occur in the oral epithelium?

A
  • Keratosis on nonkeratinsed site called parakeratosis
  • Acanthosis (hyperplasia of stratum spinosum)
  • Elongated rete ridges (hyperplasia of basal cells)
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8
Q

What is an atrophy mucosal reaction?

A
  • Reduction in viable layers
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9
Q

What is erosion mucosal reaction?

A
  • Partial thickness loss
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10
Q

What is ulceration mucosal reaction?

A
  • Fibrin on surface
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11
Q

What is oedema mucosal reaction?

A
  • Intracellular or intercellular (spongiosis)
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12
Q

What is blister mucosal reaction?

A
  • Vesicle or bulla depending on size of lesion
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13
Q

What is commonly seen with age in regard to mucosa?

A
  • Progressive mucosal atrophy
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14
Q

What does this picture show and what can cause this?

A
  • Smooth tongue
  • Mucosal atrophy on dorsal of tongue
  • Nutritional deficiency of iron or B group vitamins
  • Predisposed to infection
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15
Q

What does this image show?

A
  • Geographic tongue
  • Alteration to maturation and replacement of normal epithelial tissues at different rates
  • Makes some areas appear redder due to closer proximity to lamina dura (blood vessels)
  • Will resolve as epithelium is then replaced
  • pt may complain to sensitivity from spicy or very flavoured foods
  • Requires no txt and can be started at any age (feels worse in children)
  • BENIGN with no symptoms
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16
Q

What does this image show? Describe the condition

A
  • Brown/black hairy tongue
  • Can be due to bacterial colonisation but most commonly due to elongation of surface papilla - then becoming stained with food or drink or chlorhexidine
  • Benign
17
Q

What is the management of black/brown hairy tongue?

A
  • Can be done with tongue scraper
  • Can also be done with nectarine or peach stone (suck the stone for an hour a day) improve appearance
18
Q

What does this image show? Describe the condition

A
  • Fissured tongue
  • Unsure as to why it is fissured
  • Fissures aren’t usually painful but if deep food can become trapped and cause local inflammation - use a soft brush to clean daily
  • If fissures are painful consider another disease like LP or Candida which is causing the symptoms
19
Q

What does this picture show? Describe the condition

A
  • Glossitis
  • Inflammation of the tongue
  • Investigate with haematinics and small biopsy to diagnose whether due to deficiencies or other disease like LP
20
Q

When should a swelling be refered to OM?

A
  • Symptomatic (pain is a feature of salivary gland malignancy)
  • Abnormal overlying and surrounding mucosa
  • Increasing in size
  • Rubbery consistency
  • Trauma from teeth
  • Unsightly
21
Q

What are some things you usually would not refer in regard to swellings?

A
  • Tori (small bony swelling usually in lingual; aspect of mandible or palate )
  • Small polyps
  • Mucoceles
22
Q

Describe this picture

A
  • Multiple Small swellings in vault of palate
  • Same coloured tissue as surrounding
  • Multiple fibrous enlargement caused by ill fitting denture wearing
  • Papillary hyperplasia of palate and usually get better fitting denture
23
Q

Describe this picture

A
  • Leaf fibroma
  • Polyp instead of becoming round lesion has been squashed by denture wear
  • Now have thin and elongated lesion
  • Remove and give time to not wearing a denture to allow site to heal
24
Q

Describe this picture

A
  • Simple fibre epithelial polyp
  • Mucosal covering is same as surrounding mucosa
  • No signs of inflammation
  • Could be left alone but due to size of this it may cause difficulty in closing teeth together causing more trauma
  • remove
25
Q

Describe this picture

A
  • Parafunctional habit of child sticking tongue between teeth has caused polyp to grow on apex of tongue
  • Use appliance to stop tongue or close the gap with ortho with stop the polyp
26
Q

Describe this picture

A
  • Small mucocele in palate
27
Q

Describe this picture

A
  • Large fixed mucocele that has filled with saliva
  • Possible to remove the extravasated mucous and associated gland
28
Q

Describe what you see in these pictures

A
  • Tori which are bony swellings
  • Benign
  • Common with pts with parafunctional clenching habits - present with TMD pain
29
Q

For pts taking bisphonates what do you need to consider in regard to Tori?

A
  • Tori considered risk factor for necrosis due to limited blood supply from periosteum in pts taking bisphophonates
  • Removal of Tori is not recommended though
30
Q

What does this picture show?

A
  • Pyogenic granuloma
  • Inflamed granulation tissues with no epithelial covering
  • Has fibrinous yellow appearance or red lesion
  • Can occur on any mucosal site and is a response to trauma
    Not a granuloma and not pyogenic
31
Q
A