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BDS4 > Oral mucosal disease/ reactive lesions of the oral mucosa/soft tissue lesions > Flashcards

Oral mucosal disease/ reactive lesions of the oral mucosa/soft tissue lesions Flashcards

1
Q

2 histological features of white lesions in general?

A
  • Keratosis
  • Acanthosis
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2
Q

Why are white lesions white?

A
  • Thickening of the mucosa
  • Keratosis
  • Less blood in tissues - vasoconstriction
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3
Q

Define leukoplakia?

A

A white patch that cannot be scrapped off or attributed to any other cause

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4
Q

Malignancy rate of leukoplakia?

A

1-5% become malignant

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5
Q

What is this ?

A

Smoker’s keratosis

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6
Q

What are 2 histological features of smoker’s / traumatic keratosis?

A
  • Keratosis
  • Melanin pigment
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7
Q

How many times are smokers more likely to have leukoplakia?

A

6 times

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8
Q

What is this?

A

Hereditary keratosis (white spong naevus)

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9
Q

What might have caused this?

A

Aspirin burn

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10
Q

When would you refer a white lesion ? (3)

A
  • If it is becoming more raised and thickened
  • If the cause in unknown
  • If it is in a high risk area in the mouth
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11
Q

What are the high risk areas in the mouth?

A
  • Lateral border of the tongue
  • Soft palate
  • Anterior floor of the mouth
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12
Q

Why are red lesions red?

A
  • Blood flow increases due to inflammation or dysplasia
  • Reduced thickness of the epithelium
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13
Q

What is erythroplakia?

A

A red patch does not have a known cause , more malignancy rate than leukoplakia

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14
Q

Why might a lesion appear blue/red?

A
  • Due to fluid in the connective tissue
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15
Q

Why might a lesion appear dark blue?

A

Due to slow moving blood (enlarged veins)

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16
Q

What are examples of dark blue lesions?

A

Veins or cavernous haemangioma

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17
Q

Why might a lesion appear light blue?

A

filled with clear fluid

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18
Q

Examples of light blue lesions?

A
  • Mucoceles - saliva
  • Lymphangioma - Lymph
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19
Q

What are the two types of haemangioma?

A
  • Capillary
  • Cavernous
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20
Q

What is this?

A

Lymphangiom - most are cavernous

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21
Q

Give 3 examples of vasculitic diseases?

A
  • Large vessel disease - Giant cell arteritis
  • Medium vessel disease - Kawasaki disease
  • Small vessel disease - Granulomatosis with polyangitis
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22
Q

What are the 3 general causes of mucosal pigmentation?

A
  • Exogenous
  • Intrinsic pigmentation
  • Intrinsic foreign body
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23
Q

4 exogenous causes of mucosal pigmentation?

A
  • Tea
  • Coffee
  • Chlorhexidine
  • Bacterial overgrowth
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24
Q

4 intrinsic causes of mucosal pigmentation?

A
  • Melanotic macule
  • Melanoma
  • Melanotic Naevus
  • Effect of systemic disease Addison disease
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25
Q

What 2 forgein bodies that usually cause pigmentation in the oral cavity?

A
  • Amalgam
  • Arsenic
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26
Q

Give a disease that may cause localised brown or black lesions in the oral mucosa?

A
  • Kaposi’s sarcoma
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27
Q

Give a disease that may cause generalised pigmentation and why?

A

Addison’s disease due to raised ACTH

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28
Q

What 2 investigations might be carried out when you see mucosal pigmentation with a patient with addison’s disease?

A
  • Check BP
  • Electrolyte test
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29
Q

When to refer a mucosal pigmentation?

A
  • Increasing in size
  • Increasing in colour
  • Increasing in quantity
  • Cause not known
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30
Q

3 common causes of mucosal inflammation?

A
  • Trauma - physical or chemical
  • Infection - viral, bacterial or fungal
  • immunological
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31
Q

What 4 things would make you suspect that a pigmentation is a melanoma?

A
  • variable pigmentation
  • irregular outline
  • Raised surface
  • Symptomatic
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32
Q

When should you must biopsy a red, pigmented or white patch?

A

If it is unexplained

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33
Q

Name these arrows?

A
  • Stratum corneum
  • Stratum granulosim
  • Stratum Spinosum
  • Basal
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34
Q

In the epithelial layers, where does cell division occur?

A

Basal and suprabasal cells

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35
Q

What does parakeratosis mean?

A

Keratinisation of nonkeratinised site

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36
Q

What does acanthosis mean?

A

Hyperplasia of stratum spinosum

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37
Q

What does elongated rete ridges indicate?

A

Hyperplasia of basal cells

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38
Q

What does epithelium atrophy?

A

Reduction in viable layers

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39
Q

What does epithelium erosion mean?

A

Partial thickness loss

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40
Q

What does epithelium ulceration mean?

A

Fibrin on surface due to full thickness loss of epithelium

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41
Q

What are the 2 types of blisters?

A

Vesicle of bulla

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42
Q

What are three symptoms of geographic tongue?

A
  • Sensitivity to acidic and spicy food
  • Can be intermittent
  • Worse in younger children
  • Most patients have no symptoms
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43
Q

Give 3 conditions which can cause geographic tongue?

A
  • haematininc deficiency
  • Parafunctional trauma
  • Oral dysaesthesia
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44
Q

What might cause this?

A
  • Bacterial accumulation
  • Thickening and elongation of filiform papila
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45
Q

How can you manage this? (2)

A
  • Tongue scrub - peach stone
  • Chlorhexidine
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46
Q

What is this?

A

Fissured tongue

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47
Q

How to manage fissured tongue?

A

Brush with soft brush

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48
Q

If a patient had a fissured tongue give rise to symptoms what 2 conditions might cause these symptoms?

A
  • Candida infection
  • Lichen planus
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49
Q

What is this?

A

Glossitis - inflammation of the tongue

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50
Q

A patient present with glossitis, what 2 special investigations would you take?

A
  • Haematinics
  • Fungal cultures - oral swab or rinse
  • Biopsy
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51
Q

When would you refer a mucocele?

A

When it becomes fixed in size

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52
Q

When would you refer a swelling in the oral mucosa? give 4 cases

A
  • Symptomatic
  • Trauma from teeth
  • Increasing in size
  • Rubbery consistency
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53
Q

What 3 things would you not consider referral for (swellings)

A
  • Tori
  • Small polyps - would cause more damage if removed
  • mucoceles
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54
Q

What is this?

A

Papillary hyperplasia of the palate caused by ill fitting dentures

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55
Q

What do we call this?

A

Leaf fibroma - a polyp that is flattened due to denture wearing

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56
Q

What is this?

A

A fibroepithelial polyp

57
Q

What is this? how would manage?

A

A mucocele, leave as it is small

58
Q

What is this? how would you manage?

A

A mucocele , excision of mucocele and gland causing it

59
Q

What is this? how might it happen?

A

Tori , clenching , not recommended to remove

60
Q

Which group of patients get necrosis of the mucosa overlying a tori?

A
  • Patients taking bisphosphonates , this happens due to poor blood supply
61
Q

What is this?

A

Pyogenic granuloma

62
Q

What is a pyogenic granuloma?

A
  • A swelling that does not have an epithelial surface with inflamed granulation tissue which have a fibro-vascular background
63
Q

What might cause pyogenic granuloma?

A

Trauma

64
Q

What do we call a pyogenic granuloma of the gingivae?

A

Vascular epulis

65
Q

What do we call a pyogenic granuloma on the gingivae during pregnancy?

A

Pregnancy epulis

66
Q

What are the 3 types of mucosa ?

A
  • Lining
  • Masticatory
  • Gustatory
67
Q

What type of epithelium is present on the cheek?

A

Non-keratinised

68
Q

What type of epithelium is present on the palate?

A

Keratinised

69
Q

What is the definition of dysplasia?

A

Abnormal maturation in a tissue

70
Q

What is this?

A

Cellular atypia

71
Q

What does Atypia describes?

A

changes in cells

72
Q

What can nutritional deficiency cause in the oral mucosa?

A
  • Atrophy
  • Predisposition to infection
73
Q

The oral mucosa can react to trauma , what 3 things does this depend on?

A
  • Irritation
  • Time
  • Person
74
Q

What are 6 forms of oral mucosa reactions?

A
  • Inflammation
  • Keratosis
  • Ulceration
  • Formation of vesicles or bullae
  • Fibrous tissue formation
75
Q

What are epulides?

A
  • Soft tissue swellings on the gingivae only
76
Q

What might cause epulides?

A

A reaction to chronic inflammation or trauma

77
Q

What 2 other types of soft tissue swellings are present in the gingivae other than epulides?

A
  • Odontogenic tumours
  • Cysts
78
Q

How would you describe a lesion on the gingivae that does not originate from jaw bone?

A

Peripheral

79
Q

What is a fibrous epulis?

A
  • A fibrous overgrowth that can be described as a localised gingival hyperplasia which forms as a reaction to chronic irritation
80
Q

3 histological features of fibrous epulis?

A
  • Ulceration
  • Granulation tissue
  • Metaplastic bone formation
81
Q

What is this?

A

Vascular epulis as a response to trauma

82
Q

2 histological featured of vascular epulis?

A
  • Blood vessels
  • Granulation tissue
83
Q

What do we call a vascular epulis on the tongue?

A
  • Pyogenic granuloma
84
Q

What are these?

A

Giant cell lesions

85
Q

What do we call a giant cell granuloma in the bone?

A

Central giant cell granuloma

86
Q

What do we call a giant cel granuloma on the soft tissues?

A

Peripheral giant cell granuloma

87
Q

What do we call a giant cell granuloma on the gingivae/alveolus

A

Epulis

88
Q

What is this?

A

Giant cell epulis

89
Q

Histological feature of giant cell epulis?

A

The presence of giant cells

90
Q

What are giant cells?

A

Fused macrophages

91
Q

What 3 things might cause giant cell lesions?

A
  • local chronic irritation
  • infections - such as tuberculosis bacillus
  • Hormonal stimulation of cells - osteoclasts
  • Autoimmune-sarcoidosis
92
Q

What systemic disease should you exclude when investigating giant cell lesions ?

A
  • Hyperparathyroidism because it may present the same lesions as giant cell lesions
  • may caused by low vit D , malabsorption and renal disease
93
Q

What is this?

A

Fibroepithelial polyp ( traumatic fibroma)

94
Q

What is this?

A

Thick fibrous tissue in fibroepithelial polyp

95
Q

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 ?

A

Leaf fibroma

96
Q

What is this?

A

Denture induced hyperplasia

97
Q

What is this?

A

Papillary hyperplasia of the palate associated with upper denture use

98
Q

What might be present with papillary hyperplasia of the palate?

A

Candida infection

99
Q

What is this ?

A

Pseudo-epitheliomatous hyperplasia

100
Q

What is this?

A

Drug induced fibrous overgrowth

101
Q

What 4 drugs might induce this?

A
  • Anti-hypertensives - Calcium channel blockers
  • Anti-epileptics - phenytoin
  • Immunosuppressant - cyclosporine
102
Q

What treatment option might be suitable for drug induced fibrous overgrowth?

A
  • Repeated gingivectomy
103
Q

This patient is pregnant and presents with this, what do we call it and what might have caused it ?

A
  • Pregnancy gingivitis due to increased progesterone hormone levels leading to exaggerated response to plaque
  • Can be reduced by OHI
104
Q

What is a haemangioma?

A

A hamartoma which is a vascular malfomation

105
Q

Which syndrome is associated with vascular lesions?

A

Sturge weber syndrome

106
Q

What are the two types of haemangiomas? and how do they differ histologically?

A
  • Capillary - multiple capillaries , small vessels
  • Cavernous - veins , large vessels
107
Q

Why is a biopsy useful?

A
  • Can confirm or establish a diagnosis
  • Can determine prognosis
108
Q

4 ways of tissue sampling?

A
  • Fine needle aspiration - Salivary gland lesions
  • Punch biopsy -
  • Incisional biopsy (type of incisional)
  • Excisional biopsy
109
Q

2 advantages of aspirational biopsy?

A
  • Avoid contamination with oral commensals
  • Protect anaerobic species
110
Q

When would you use an excisional biopsy?

A

when you are sure about the provisional diagnosis or in descrete lesions

111
Q

When would you use an incisional biopsy?

A
  • uncertain diagnosis
  • large lesions
112
Q

What is the advantage of punch biopsy?

A
  • minimal damage
  • may not require suturing
    It consist of a hollow trephine 4,6,8mm in diameter
113
Q

When you take a biopsy of an ulcer , from where would you take the biopsy?

A

the edge of the ulcer to include periolesional tissue

114
Q

When you send a biopsy to the lab , in what solution would place it and what concentration?

A

10% formalin

115
Q

What might you do the biopsied lesion to help the pathologist orientate the sample?

A

Suture it

116
Q

What would avoid using on the sample and why?

A

Gauze as it can distort the sample
* use filter paper instead

117
Q

What might have caused the problem with this histological sample?

A

Crushing

118
Q

What may have caused the problem with this sample?

A

Tear

119
Q

What 4 areas you want to avoid when taking a biopsy?

A
  • Salivary gland ducts
  • Tip of the tongue
  • areas close to nerves
  • areas close to larger blood vessels
120
Q

What might have caused a fibrous epulis?

A
  • overhanging restorations
  • subgingival calculus
121
Q

How would you manage a fibrous epulis?

A
  • Excisional biopsy and coe back dressing
  • remove source of irritation
122
Q

What are the most two common places of a fibroepithelial poly?

A
  • buccal mucosa
  • inner surface of the lip
123
Q

Where is a common place for giant cell epulis?

A

Anterior regions of the mouth in teenagers

124
Q

A patient present with a giant cell epulis, why would you take a radiograph?

A

To ensure it is not centrally originated

125
Q

How would you manage a giant cell epulis?

A
  • Surgical excision with curettage of base
  • coe pack dressing
126
Q

How would you manage a haemangioma?

A
  • Surgical removal
  • Cryotherapy
127
Q

What is the disadvantage of cryotherapy?

A

No histological examination

128
Q

What is a lipoma?

A

A benign neoplasm of fat , excise

129
Q

What two things may be related to pregnancy epulis?

A
  • Hormonal changes
  • Calculus - often bleed easily
130
Q

How would you manage a pregnancy epulis?

A
  • if small leave as may regress after birth
  • if large excision
131
Q

how does pyogenic granuloma form?

A
  • Trauma to soft tissue leads to failure of normal healing resulting in overgrowth of granulation tissue
132
Q

What is this?

A

Squamous cell papilloma neoplasm

133
Q

Which 3 surfaces do squamous cell papilloma affect?

A
  • Buccal mucosa
  • Lips
  • Palate
134
Q

Most common region of denture hyperplasia?

A

Lower labial sulcus

135
Q

How would you manage denture hyperplasia?

A
  • Adjust denture
  • remove excess tisse
136
Q

What is the most common problem associated with salivary gland?

A

Mucocele

137
Q

What so we call a mucocele at the floor of the mouth?

A
  • Ranula
138
Q

3 classical descriptions of squamous cell carcinoma?

A
  • Ulcerated
  • Rolled margin
  • Induration

BDS4 (63 decks)

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