Oral Mucosal Disease Flashcards
In what circumstances do you refer a mucosal lesion to Oral Med for an opinion?
- 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
If you think a mucosal lesion might be cancer or dysplasia what guidelines can you consult for what to do next?
- NICE and SIGN Head and Neck cancer guidance
What epithelium is this diagram and is it keratinised or non-keratinised?
- Buccal mucosa
- Non-keratinised
What epithelium is this and is it keratinised or non keratinised?
- Palate
- Thick Keratinised layer sitting on surface
Label this diagram and explain
- 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
How is the oral mucosa histologically set up?
- 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
What are some reactive changes that can occur in the oral epithelium?
- Keratosis on nonkeratinsed site called parakeratosis
- Acanthosis (hyperplasia of stratum spinosum)
- Elongated rete ridges (hyperplasia of basal cells)
What is an atrophy mucosal reaction?
- Reduction in viable layers
What is erosion mucosal reaction?
- Partial thickness loss
What is ulceration mucosal reaction?
- Fibrin on surface
What is oedema mucosal reaction?
- Intracellular or intercellular (spongiosis)
What is blister mucosal reaction?
- Vesicle or bulla depending on size of lesion
What is commonly seen with age in regard to mucosa?
- Progressive mucosal atrophy
What does this picture show and what can cause this?
- Smooth tongue
- Mucosal atrophy on dorsal of tongue
- Nutritional deficiency of iron or B group vitamins
- Predisposed to infection
What does this image show?
- 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