Oral mucosal disease/ reactive lesions of the oral mucosa/soft tissue lesions Flashcards
2 histological features of white lesions in general?
- Keratosis
- Acanthosis
Why are white lesions white?
- Thickening of the mucosa
- Keratosis
- Less blood in tissues - vasoconstriction
Define leukoplakia?
A white patch that cannot be scrapped off or attributed to any other cause
Malignancy rate of leukoplakia?
1-5% become malignant
What is this ?
Smoker’s keratosis
What are 2 histological features of smoker’s / traumatic keratosis?
- Keratosis
- Melanin pigment
How many times are smokers more likely to have leukoplakia?
6 times
What is this?
Hereditary keratosis (white spong naevus)
What might have caused this?
Aspirin burn
When would you refer a white lesion ? (3)
- If it is becoming more raised and thickened
- If the cause in unknown
- If it is in a high risk area in the mouth
What are the high risk areas in the mouth?
- Lateral border of the tongue
- Soft palate
- Anterior floor of the mouth
Why are red lesions red?
- Blood flow increases due to inflammation or dysplasia
- Reduced thickness of the epithelium
What is erythroplakia?
A red patch does not have a known cause , more malignancy rate than leukoplakia
Why might a lesion appear blue/red?
- Due to fluid in the connective tissue
Why might a lesion appear dark blue?
Due to slow moving blood (enlarged veins)
What are examples of dark blue lesions?
Veins or cavernous haemangioma
Why might a lesion appear light blue?
filled with clear fluid
Examples of light blue lesions?
- Mucoceles - saliva
- Lymphangioma - Lymph
What are the two types of haemangioma?
- Capillary
- Cavernous
What is this?
Lymphangiom - most are cavernous
Give 3 examples of vasculitic diseases?
- Large vessel disease - Giant cell arteritis
- Medium vessel disease - Kawasaki disease
- Small vessel disease - Granulomatosis with polyangitis
What are the 3 general causes of mucosal pigmentation?
- Exogenous
- Intrinsic pigmentation
- Intrinsic foreign body
4 exogenous causes of mucosal pigmentation?
- Tea
- Coffee
- Chlorhexidine
- Bacterial overgrowth
4 intrinsic causes of mucosal pigmentation?
- Melanotic macule
- Melanoma
- Melanotic Naevus
- Effect of systemic disease Addison disease
What 2 forgein bodies that usually cause pigmentation in the oral cavity?
- Amalgam
- Arsenic
Give a disease that may cause localised brown or black lesions in the oral mucosa?
- Kaposi’s sarcoma
Give a disease that may cause generalised pigmentation and why?
Addison’s disease due to raised ACTH
What 2 investigations might be carried out when you see mucosal pigmentation with a patient with addison’s disease?
- Check BP
- Electrolyte test
When to refer a mucosal pigmentation?
- Increasing in size
- Increasing in colour
- Increasing in quantity
- Cause not known
3 common causes of mucosal inflammation?
- Trauma - physical or chemical
- Infection - viral, bacterial or fungal
- immunological
What 4 things would make you suspect that a pigmentation is a melanoma?
- variable pigmentation
- irregular outline
- Raised surface
- Symptomatic
When should you must biopsy a red, pigmented or white patch?
If it is unexplained
Name these arrows?
- Stratum corneum
- Stratum granulosim
- Stratum Spinosum
- Basal
In the epithelial layers, where does cell division occur?
Basal and suprabasal cells
What does parakeratosis mean?
Keratinisation of nonkeratinised site
What does acanthosis mean?
Hyperplasia of stratum spinosum
What does elongated rete ridges indicate?
Hyperplasia of basal cells
What does epithelium atrophy?
Reduction in viable layers
What does epithelium erosion mean?
Partial thickness loss
What does epithelium ulceration mean?
Fibrin on surface due to full thickness loss of epithelium
What are the 2 types of blisters?
Vesicle or bulla
What are three symptoms of geographic tongue?
- Sensitivity to acidic and spicy food
- Can be intermittent
- Worse in younger children
- Most patients have no symptoms
Give 3 conditions which can cause geographic tongue?
- haematininc deficiency
- Parafunctional trauma
- Oral dysaesthesia
What might cause this?
- Bacterial accumulation
- Thickening and elongation of filiform papila
How can you manage this? (2)
- Tongue scrub - peach stone
- Chlorhexidine
What is this?
Fissured tongue
How to manage fissured tongue?
Brush with soft brush
If a patient had a fissured tongue give rise to symptoms what 2 conditions might cause these symptoms?
- Candida infection
- Lichen planus
What is this?
Glossitis - inflammation of the tongue
A patient present with glossitis, what 2 special investigations would you take?
- Haematinics
- Fungal cultures - oral swab or rinse
- Biopsy
When would you refer a mucocele?
When it becomes fixed in size
When would you refer a swelling in the oral mucosa? give 4 cases
- Symptomatic
- Trauma from teeth
- Increasing in size
- Rubbery consistency
What 3 things would you not consider referral for (swellings)
- Tori
- Small polyps - would cause more damage if removed
- mucoceles
What is this?
Papillary hyperplasia of the palate caused by ill fitting dentures
What do we call this?
Leaf fibroma - a polyp that is flattened due to denture wearing
What is this?
A fibroepithelial polyp
What is this? how would manage?
A mucocele, leave as it is small
What is this? how would you manage?
A mucocele , excision of mucocele and gland causing it
What is this? how might it happen?
Tori , clenching , not recommended to remove
What is this?
Pyogenic granuloma
What is this?
Cellular atypia
What is a fibrous epulis?
- A fibrous overgrowth that can be described as a localised gingival hyperplasia which forms as a reaction to chronic irritation
3 histological features of fibrous epulis?
- Ulceration
- Granulation tissue
- Metaplastic bone formation
What is this?
Vascular epulis as a response to trauma
2 histological featured of vascular epulis?
- Blood vessels
- Granulation tissue
What do we call a vascular epulis on the tongue?
- Pyogenic granuloma
What are these?
Giant cell lesions
What is this?
Giant cell epulis
Histological feature of giant cell epulis?
The presence of giant cells
What are giant cells?
Fused macrophages
What is this?
Fibroepithelial polyp ( traumatic fibroma)
What is this?
Thick fibrous tissue in fibroepithelial polyp
A patient wears a denture and is present with a fibrous overgrowth under the denture area , what do we call this and what causes it ?
Leaf fibroma
What is this?
Denture induced hyperplasia
What is this?
Papillary hyperplasia of the palate associated with upper denture use
What is this ?
Pseudo-epitheliomatous hyperplasia
What is this?
Drug induced fibrous overgrowth
What 4 drugs might induce this?
- Anti-hypertensives - Calcium channel blockers
- Anti-epileptics - phenytoin
- Immunosuppressant - cyclosporine
This patient is pregnant and presents with this, what do we call it and what might have caused it ?
- Pregnancy gingivitis due to increased progesterone hormone levels leading to exaggerated response to plaque
- Can be reduced by OHI
Which syndrome is associated with vascular lesions?
Sturge weber syndrome
What are the two types of haemangiomas? and how do they differ histologically?
- Capillary - multiple capillaries , small vessels
- Cavernous - veins , large vessels
What is the advantage of punch biopsy?
- minimal damage
- may not require suturing
It consist of a hollow trephine 4,6,8mm in diameter
What might have caused the problem with this histological sample?
Crushing
What may have caused the problem with this sample?
Tear
How would you manage a haemangioma?
- Surgical removal
- Cryotherapy
How would you manage a pregnancy epulis?
- if small leave as may regress after birth
- if large excision
What is this?
Squamous cell papilloma neoplasm
3 classical descriptions of squamous cell carcinoma?
- Ulcerated
- Rolled margin
- Induration
