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
2
Q
Why are white lesions white?
A
- Thickening of the mucosa
- Keratosis
- Less blood in tissues - vasoconstriction
3
Q
Define leukoplakia?
A
A white patch that cannot be scrapped off or attributed to any other cause
4
Q
Malignancy rate of leukoplakia?
A
1-5% become malignant
5
Q
What is this ?
A
Smoker’s keratosis
6
Q
What are 2 histological features of smoker’s / traumatic keratosis?
A
- Keratosis
- Melanin pigment
7
Q
How many times are smokers more likely to have leukoplakia?
A
6 times
8
Q
What is this?
A
Hereditary keratosis (white spong naevus)
9
Q
What might have caused this?
A
Aspirin burn
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
11
Q
What are the high risk areas in the mouth?
A
- Lateral border of the tongue
- Soft palate
- Anterior floor of the mouth
12
Q
Why are red lesions red?
A
- Blood flow increases due to inflammation or dysplasia
- Reduced thickness of the epithelium
13
Q
What is erythroplakia?
A
A red patch does not have a known cause , more malignancy rate than leukoplakia
14
Q
Why might a lesion appear blue/red?
A
- Due to fluid in the connective tissue
15
Q
Why might a lesion appear dark blue?
A
Due to slow moving blood (enlarged veins)
16
Q
What are examples of dark blue lesions?
A
Veins or cavernous haemangioma
17
Q
Why might a lesion appear light blue?
A
filled with clear fluid
18
Q
Examples of light blue lesions?
A
- Mucoceles - saliva
- Lymphangioma - Lymph
19
Q
What are the two types of haemangioma?
A
- Capillary
- Cavernous
20
Q
What is this?
A
Lymphangiom - most are cavernous
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
22
Q
What are the 3 general causes of mucosal pigmentation?
A
- Exogenous
- Intrinsic pigmentation
- Intrinsic foreign body
23
Q
4 exogenous causes of mucosal pigmentation?
A
- Tea
- Coffee
- Chlorhexidine
- Bacterial overgrowth
24
Q
4 intrinsic causes of mucosal pigmentation?
A
- Melanotic macule
- Melanoma
- Melanotic Naevus
- Effect of systemic disease Addison disease
25
What 2 forgein bodies that usually cause pigmentation in the oral cavity?
* Amalgam
* Arsenic
26
Give a disease that may cause localised brown or black lesions in the oral mucosa?
* Kaposi's sarcoma
27
Give a disease that may cause generalised pigmentation and why?
Addison's disease due to raised ACTH
28
What 2 investigations might be carried out when you see mucosal pigmentation with a patient with addison's disease?
* Check BP
* Electrolyte test
29
When to refer a mucosal pigmentation?
* Increasing in size
* Increasing in colour
* Increasing in quantity
* Cause not known
30
3 common causes of mucosal inflammation?
* Trauma - physical or chemical
* Infection - viral, bacterial or fungal
* immunological
31
What 4 things would make you suspect that a pigmentation is a melanoma?
* variable pigmentation
* irregular outline
* Raised surface
* Symptomatic
32
When should you must biopsy a red, pigmented or white patch?
If it is unexplained
33
Name these arrows?
* Stratum corneum
* Stratum granulosim
* Stratum Spinosum
* Basal
34
In the epithelial layers, where does cell division occur?
Basal and suprabasal cells
35
What does parakeratosis mean?
Keratinisation of nonkeratinised site
36
What does acanthosis mean?
Hyperplasia of stratum spinosum
37
What does elongated rete ridges indicate?
Hyperplasia of basal cells
38
What does epithelium atrophy?
Reduction in viable layers
39
What does epithelium erosion mean?
Partial thickness loss
40
What does epithelium ulceration mean?
Fibrin on surface due to full thickness loss of epithelium
41
What are the 2 types of blisters?
Vesicle or bulla
42
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
43
Give 3 conditions which can cause geographic tongue?
* haematininc deficiency
* Parafunctional trauma
* Oral dysaesthesia
44
What might cause this?
* Bacterial accumulation
* Thickening and elongation of filiform papila
45
How can you manage this? (2)
* Tongue scrub - peach stone
* Chlorhexidine
46
What is this?
Fissured tongue
47
How to manage fissured tongue?
Brush with soft brush
48
If a patient had a fissured tongue give rise to symptoms what 2 conditions might cause these symptoms?
* Candida infection
* Lichen planus
49
What is this?
Glossitis - inflammation of the tongue
50
A patient present with glossitis, what 2 special investigations would you take?
* Haematinics
* Fungal cultures - oral swab or rinse
* Biopsy
51
When would you refer a mucocele?
When it becomes fixed in size
52
When would you refer a swelling in the oral mucosa? give 4 cases
* Symptomatic
* Trauma from teeth
* Increasing in size
* Rubbery consistency
53
What 3 things would you not consider referral for (swellings)
* Tori
* Small polyps - would cause more damage if removed
* mucoceles
54
What is this?
Papillary hyperplasia of the palate caused by ill fitting dentures
55
What do we call this?
Leaf fibroma - a polyp that is flattened due to denture wearing
56
What is this?
A fibroepithelial polyp
57
What is this? how would manage?
A mucocele, leave as it is small
58
What is this? how would you manage?
A mucocele , excision of mucocele and gland causing it
59
What is this? how might it happen?
Tori , clenching , not recommended to remove
60
Which group of patients get necrosis of the mucosa overlying a tori?
* Patients taking bisphosphonates , this happens due to poor blood supply
61
What is this?
Pyogenic granuloma
62
What is a pyogenic granuloma?
* A swelling that does not have an epithelial surface with inflamed granulation tissue which have a fibro-vascular background
63
What might cause pyogenic granuloma?
Trauma
64
What do we call a pyogenic granuloma of the gingivae?
Vascular epulis
65
What do we call a pyogenic granuloma on the gingivae during pregnancy?
Pregnancy epulis
66
What are the 3 types of mucosa ?
* Lining
* Masticatory
* Gustatory
67
What type of epithelium is present on the cheek?
Non-keratinised
68
What type of epithelium is present on the palate?
Keratinised
69
What is the definition of dysplasia?
Abnormal maturation in a tissue
70
What is this?
Cellular atypia
71
What does Atypia describes?
changes in cells
72
What can nutritional deficiency cause in the oral mucosa?
* Atrophy
* Predisposition to infection
73
The oral mucosa can react to trauma , what 3 things does this depend on?
* Irritation
* Time
* Person
74
What are 6 forms of oral mucosa reactions?
* Inflammation
* Keratosis
* Ulceration
* Formation of vesicles or bullae
* Fibrous tissue formation
75
What are epulides?
* Soft tissue swellings on the gingivae only
76
What might cause epulides?
A reaction to chronic inflammation or trauma
77
What 2 other types of soft tissue swellings are present in the gingivae other than epulides?
* Odontogenic tumours
* Cysts
78
How would you describe a lesion on the gingivae that does not originate from jaw bone?
Peripheral
79
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
80
3 histological features of fibrous epulis?
* Ulceration
* Granulation tissue
* Metaplastic bone formation
81
What is this?
Vascular epulis as a response to trauma
82
2 histological featured of vascular epulis?
* Blood vessels
* Granulation tissue
83
What do we call a vascular epulis on the tongue?
* Pyogenic granuloma
84
What are these?
Giant cell lesions
85
What do we call a giant cell granuloma in the bone?
Central giant cell granuloma
86
What do we call a giant cel granuloma on the soft tissues?
Peripheral giant cell granuloma
87
What do we call a giant cell granuloma on the gingivae/alveolus
Epulis
88
What is this?
Giant cell epulis
89
Histological feature of giant cell epulis?
The presence of giant cells
90
What are giant cells?
Fused macrophages
91
What 3 things might cause giant cell lesions?
* local chronic irritation
* infections - such as tuberculosis bacillus
* Hormonal stimulation of cells - osteoclasts
* Autoimmune-sarcoidosis
92
What systemic disease should you exclude when investigating giant cell lesions ?
* Hyperparathyroidism because it may present the same lesions as giant cell lesions
* may caused by low vit D , malabsorption and renal disease
93
What is this?
Fibroepithelial polyp ( traumatic fibroma)
94
What is this?
Thick fibrous tissue in fibroepithelial polyp
95
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
96
What is this?
Denture induced hyperplasia
97
What is this?
Papillary hyperplasia of the palate associated with upper denture use
98
What might be present with papillary hyperplasia of the palate?
Candida infection
99
What is this ?
Pseudo-epitheliomatous hyperplasia
100
What is this?
Drug induced fibrous overgrowth
101
What 4 drugs might induce this?
* Anti-hypertensives - Calcium channel blockers
* Anti-epileptics - phenytoin
* Immunosuppressant - cyclosporine
102
What treatment option might be suitable for drug induced fibrous overgrowth?
* Repeated gingivectomy
103
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
104
What is a haemangioma?
A hamartoma which is a vascular malfomation
105
Which syndrome is associated with vascular lesions?
Sturge weber syndrome
106
What are the two types of haemangiomas? and how do they differ histologically?
* Capillary - multiple capillaries , small vessels
* Cavernous - veins , large vessels
107
Why is a biopsy useful?
* Can confirm or establish a diagnosis
* Can determine prognosis
108
4 ways of tissue sampling?
* Fine needle aspiration - Salivary gland lesions
* Punch biopsy -
* Incisional biopsy (type of incisional)
* Excisional biopsy
109
2 advantages of aspirational biopsy?
* Avoid contamination with oral commensals
* Protect anaerobic species
110
When would you use an excisional biopsy?
when you are sure about the provisional diagnosis or in descrete lesions
111
When would you use an incisional biopsy?
* uncertain diagnosis
* large lesions
112
What is the advantage of punch biopsy?
* minimal damage
* may not require suturing
It consist of a hollow trephine 4,6,8mm in diameter
113
When you take a biopsy of an ulcer , from where would you take the biopsy?
the edge of the ulcer to include periolesional tissue
114
When you send a biopsy to the lab , in what solution would place it and what concentration?
10% formalin
115
What might you do the biopsied lesion to help the pathologist orientate the sample?
Suture it
116
What would avoid using on the sample and why?
Gauze as it can distort the sample
* use filter paper instead
117
What might have caused the problem with this histological sample?
Crushing
118
What may have caused the problem with this sample?
Tear
119
What 4 areas you want to avoid when taking a biopsy?
* Salivary gland ducts
* Tip of the tongue
* areas close to nerves
* areas close to larger blood vessels
120
What might have caused a fibrous epulis?
* overhanging restorations
* subgingival calculus
121
How would you manage a fibrous epulis?
* Excisional biopsy and coe back dressing
* remove source of irritation
122
What are the most two common places of a fibroepithelial poly?
* buccal mucosa
* inner surface of the lip
123
Where is a common place for giant cell epulis?
Anterior regions of the mouth in teenagers
124
A patient present with a giant cell epulis, why would you take a radiograph?
To ensure it is not centrally originated
125
How would you manage a giant cell epulis?
* Surgical excision with curettage of base
* coe pack dressing
126
How would you manage a haemangioma?
* Surgical removal
* Cryotherapy
127
What is the disadvantage of cryotherapy?
No histological examination
128
What is a lipoma?
A benign neoplasm of fat , excise
129
What two things may be related to pregnancy epulis?
* Hormonal changes
* Calculus - often bleed easily
130
How would you manage a pregnancy epulis?
* if small leave as may regress after birth
* if large excision
131
how does pyogenic granuloma form?
* Trauma to soft tissue leads to failure of normal healing resulting in overgrowth of granulation tissue
132
What is this?
Squamous cell papilloma neoplasm
133
Which 3 surfaces do squamous cell papilloma affect?
* Buccal mucosa
* Lips
* Palate
134
Most common region of denture hyperplasia?
Lower labial sulcus
135
How would you manage denture hyperplasia?
* Adjust denture
* remove excess tisse
136
What is the most common problem associated with salivary gland?
Mucocele
137
What so we call a mucocele at the floor of the mouth?
* Ranula
138
3 classical descriptions of squamous cell carcinoma?
* Ulcerated
* Rolled margin
* Induration
