oral mucosal disease Flashcards
When should a mucosal lesion be referred to oral medicine?
Anything the dentist thinks might be cancer or dysplasia
Any symptomatic lesion that has not responded to standard treatment
Any benign lesion that the patient can’t be persuaded is not cancer
What are the strata layers of the epithelium?
Stratum corneum - most superficial
Stratum granulosum
Stratum spinosum
Stratum basale
Where does cell division occur in the strata?
Suprabasal cells only
What is acanthosis?
Hyperplasia of the stratum spinosum
What are elongated rete ridges?
Hyperplasia of basal cells
What is atrophy?
Reduction in viable layers
What is erosion?
Partial thickness loss of epithelium
What is ulceration?
Complete loss of epithelium with fibrin on the surface
What is oedema and what are the 2 types?
Swelling
Intracellular - each cell is slightly bigger
Intercellular (spongiosis) - fluid between epithelial cells
What is a blister?
Collection of fluid within or just below the epithelium
Called vesicle or bulla depending on size
How does the mucosa change with age?
Progressive mucosal atrophy
How does the mucosa change with nutritional deficiency?
Iron or B vitamins - predisposes to infection
Give 3 examples of benign mucosal conditions
Geographic tongue
Black hairy tongue
Fissured tongue
What is geographic tongue and what is the prevalence?
Alteration in maturation and replacement of normal epithelial surface
Affects 1-2% of population, less in children
What are the symptoms of geographic tongue?
Sensitive with acidic/spicy foods - intermittent
Much worse in young children
Most patients have no symptoms
What other things may cause geographic tongue?
Haematinic deficiency
Parafunctional trauma
Dysaesthesia
How is geographic tongue managed?
Benign condition managed by eating foods that don’t cause irritation during episodes
What is brown/black hairy tongue?
Hyperplasia of papillae
Stains caused by bacterial pigment from foods
How is black hairy tongue treated?
Remove elongated surface from tongue:
- tongue scraper
- natural scraper like peach or nectarine stone
What is fissured tongue?
Occasionally fissures become deep and trap foods causing inflammation
May be another disease present such as candida or lichen planus
What causes fissured tongue?
No answer as to what causes it
How is fissured tongue treated?
Clean with a soft bristled brush
What is glossitis?
Inflammation of the tongue
What investigations are needed for glossitis?
Haematinics
Fungal culture
When should swellings be referred to oral medicine?
Symptomatic - pain is a feature of salivary gland malignancy
Abnormal overlying and surrounding mucosa
Increasing in size
Rubbery consistency
Trauma from teeth
Unsightly
What is papillary hyperplasia and how is it treated?
Multiple small swellings caused by an ill fitting denture
No treatment
What is a pyogenic granuloma?
Granulation tissue with no epithelial surface
A response to trauma
Can be found on any mucosal site
What are other names for a pyogenic granuloma?
If on gingiva - a vascular epulis
If on gingiva during pregnancy - a pregnancy epulis
How should potential malignancies be referred?
2 week cancer referral pathway
