ORAL PIGMENTATION Flashcards
1
Q
What is Black Hairy Tongue
A
- Elongation of filiform papillae
- Due to extrinsic staining
- e.g. xs smoking, chx, poor OH, wine, broad spectrum antibiotics
- overgrowth of pigment producing bacteria/fungi
- areas of white tongue are possible
- low fibre and dehydration
2
Q
Black hairy tongue management
A
- Reassure patient and inform them about BHT
- OHI
- Diet high in fibre and hydration
- Smoking VBA/drinking
- Avoid XS tongue brushing as this can exacerbate it
- Oxidising mouthwash (Peroxyl)
3
Q
What is Amalgam tattoo
A
- common in mandibular gingiva and alveolar mucosa
- May be due to XLA of tooth or removal of restoration made of amalgam
- Oral pigmentation of slate grey/blue black macule
- No elevation
- No change in size but margins will blur
4
Q
What is a Graphite tattoo
A
- Common in the palate of children
- second most common cause of exogenous localised oral pigmentation
- Biopsy to eliminate malignancy
5
Q
Mangement of amalgam/graphite tattoo
A
- Radiograph would show amalgam in tissue, depending on the density of surrounding bone and KV exposure/voltage
- Biopsy to eliminate malignancy
- Reassure patient
- Can be removed with Q-switch ruby laser (shatters tattoo and particles removed by lymphatics)
6
Q
Metal salt deposition
A
- Metal sulphides along the gingival margin
- Bismuth, lead, mercury
- present in crevicular fluid and precipitate as sulphides by hydrogen sulfide by plaque microorganisms
- Linear grey/black lines along gingiva as lead/burtons lines
- can be confused as subgingival calculus
7
Q
Ethnobotanical tattoo
A
- common in africa
- females as a rite of passage
- Thought to improve OH and eliminate bad breath
- tattoo of gingiva with soot covered thorns
- thought to be used as a remedy for dental pain
8
Q
Oral melanotic macule
A
- Benign localised area of increased melanin
- effects any mucosal surface but skin is more common
- common in F
- Lesion on lip due to sun damage
- Homogenous flat brown/black regular border
- <5mm
9
Q
Management of a oral malenotic macule
A
- Biopsy to eliminate malignancy and avoid long term follow up
- Lip lesions could be monitored if not suspicious
10
Q
Oral melanoma
A
- rare
- palate is most common but can effect anywhere (lip/gingiva)
- brown/black but 30% as amelanotic
- irregular border and colour (non-homogeneous)
- can be nodular (alarm bells for malignancy)
11
Q
Differential diagnosis for oral melanoma
A
- oral melanotic macule
- amalgam tattoo
- graphite tattoo - palate is common here
12
Q
Oral melanoma prognosis + metastasis
A
- oral melanoma has a poor prognosis 5-20% 5year survival
- metastasis to lymph, lungs, liver (3Ls)
13
Q
Ecchymosis aetiology
A
- blue/black/purple bruising due to:
1) trauma e.g. fracture mandible
2) underlying palatal/coagulation disorder
14
Q
Varcies
A
- Lower lip/sublingual
- vein dilation
- blue & lobulated
- blanch on pressure
- may have hard areas due to thrombosis/ clacified phleboliths forming
15
Q
Localised oral pigmentation
A
black hair tongue amalgam/graphite tattoo metalic salts alcohol eg. red wine tobacco/betel use melanotic macules malignant melanoma kaposi sarcoma
