Reactive and Benign Lesions

Question 1

what is a reactive lesion

Answer 1

non-cancerous tissue growth in response to chronic irritation or injury

e.g. ill fitting dentures, sharp rests

Question 2

pt presents with a polyp in the buccal mucosa, firm/soft, painless, isolated

what is your diagnosis
cause
histology
management

Answer 2

fibre-epithelial polyp

overproduction of granulation + fibrous tissue due to trauma

fibrous tissue, interlacing collagen, normal adjacent epithelium

photos, correct cause
excisional biopsy - confirms diagnosis and removes but risks

Question 3

what is a fibre-epithelial polyp called if it is on the gingiva

Answer 3

fibrous epulis

Question 4

pt presents with red/purple lesion interdentally

what is your diagnosis
management

Answer 4

giant cell epulis

excision biopsy, OPT/CBT, bone profile, parathyroid hormone assay
[browns tumour/hyperparathyroidism]

Question 5

pregnant woman presents with a soft, bright red lesion on the gingiva

what is your diagnosis
histology
management

Answer 5

pyogenic granuloma / pregnancy epulis

vascular proliferation, variable inflammatory infiltrate

observe, excise after birth, photos

Question 6

describe geographic tongue
histology
management

Answer 6

normal anatomy
white/red patches, smooth, irregular, comes and goes
hereditary

loss of filiform papillae, areas of atrophy + hyperkeratinisation

reassure, difflam, avoid triggers

Question 7

pt presents with horrible black covered tongue

what is diagnosis
cause
pathophysiology
management

Answer 7

black hairy tongue

unknown, smoking, chx. abx, poor OH

hyperplasia filiform papillae, commensal bacteria build up, pigment inducing bacteria/fungi

reassure, stop smoking, OHI, gently exfoliate, pineapple

Question 8

what are causes of gingival overgrowth

how can it be managed

Answer 8

drug induced - Ca channel blockers, cyclosporin, phenytoin
chronic hyperplastic gingivitis - mouth breathing
granulomatosis
LEUKAEMIA

plaque control, change meds,
if unsure then GP for bloods

Question 9

pt presents with cauliflower flower like white wart

what is diagnosis
cause
histology
management

Answer 9

squamous cell papilloma

HPV infection, immuncompromised

finger-like projections of hyperplastic epithelium, thin vascular connective tissue

observe, excision biopsy

Question 10

what are fordyce spots

Answer 10

yellow/white bumps on buccal mucosa +m lips
sebaceous glanfs

normal anatomy
60-75% of adults, later in life