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BDS4 Tutorials > Reactive lesions of Oral Mucosa > Flashcards

Reactive lesions of Oral Mucosa Flashcards

1
Q

What is an epulis?

A

Soft tissue swelling on gingiva only
 Called a polyp if located anywhere else
 Exaggerated response to irritation and inflammation causing hyperplasia (perhaps from gingivitis/periodontitis)
 Easy to remove, but if stimulus is not removed they reoccur
 Bleeds sometimes

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2
Q

What are the other causes of soft swellings on gingivae?

A

Odontogenic tumours

Cysts

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3
Q

What malignancy is most likely to arise from gingivae?

A

SSC

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4
Q

What are the histological features of fibrous epulis?

A

 Fibrous tissue forms bulk of swelling
 Keratinised epithelium SSE as on gingiva
 Hyperplastic areas- thicker than normal
 On part with no epithelium- this is due to ulceration (occurs because of trauma from food and toothbrushing)
 Fibrin- appears pink
 Granulation tissue under fibrous layer
 Bone may form within- due to metaplasia (dycastic bone- stem cells are reprogrammed to produce bone)
 Plasma cells (chronic inflammatory cells)- form immunoglobulins (may be present due to ulceration- as pathogens will be trying to get into tissue or due to periodontal disease)

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5
Q

What cells are generally responsible for phagocytosis?

A

Macrophages

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6
Q

How is a fibrous epulis/polyps treated?

A

Excision biopsy

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7
Q

What are the histological features of Granulation tissue? (first stage in healing)

A

Many blood vessels (appear red on stain)

Fibroblasts (form collagen)

Inflammatory cells- mostly macrophages (remove debris, prevent against inflammation)

Neutrophils

-> Chronic inflammation subsides giving fibrous tissue

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8
Q

What are the features of giant cell epulis?

A

Peripheral giant cell granuloma- deep red/purple colour

Bleeds

Tends to happen anterior to molars

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9
Q

What are the histological characteristics of GC epulis?

A

Multi nucleated Giant cells (formed by fusion of macrophages)

No capsule (obviously different from healthy tissues)

Granulation tissue

Presence of capillaries and BV- bleeding into tissues

Hourglass appearance

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10
Q

How are giant cell epulides treated?

A

Excision biopsy

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11
Q

What are the types of giant cells?

A

Osteoclasts- bone resorption

Langherans giant cells- respond to trauma and inflammation

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12
Q

What do giant cells left at margin of lesion suggest?

A

That it has not been fully excised and may recur

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13
Q

What are the histological features of granulomatous inflammation?

A

Multi-nucleated giant cells

Lymphocytes

Macrophages (epithelioid cells appear like epithelium)

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14
Q

What condition is a central giant cell granuloma associated with? (central lesion that presents as epulis)

A

Hyperparathyroidism

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15
Q

What conditions is granulomatous inflammation associated with?

A

OFG

Crohns

Sarcoidosis

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16
Q

What are the features of a vascular epulis?

A

Yellow fibrinous surface- ulceration

Bleeds easily

Soft mass

Exaggerated repose to tissue insult

Can be caused by hormonal changes in pregnancy or OCP use

Occurs at any age

Presence of connective tissue- fibroblasts and collagen

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17
Q

Why is it better to leave a pregnancy epulis until baby is born?

A

Tend to become more fibrous and shrink when hormones go back to normal

-> if not exisional biopsy

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18
Q

What causes bubbles to be present in fibrous tissue?

A

Oedema

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19
Q

What is a pyogenic granuloma?

A

Failure of normal healing at wound site
-> overgrowth of granulation tissue
-> appears red
-> may have pus

“vascular epulis not on gingiva”

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20
Q

What is vascular hamartoma?

A

Developmental vascular malformation (appear when skin thins)
-> Exophytic blood filled lesions

21
Q

What is a vascular hamartoma in new-born child called?

A

Hameangioma- bunch of grapes appearance

22
Q

What is a hamartoma of the dental tissues?

A

Odontome

23
Q

What are the types of haemangioma?

A

 Capillary type- lots of capillaries
 Cavernous type- large blood filled space

24
Q

What is lymphangioma?

A

Benign mass of lymphatic tissue/vessels

25
Q

What is a Haematoma?

A

Bleeding into tissues- can be associated with fracture
-> gradually disappears

26
Q

How are haemangiomas treated?

A

Cryotherapy

Excision biopsy

27
Q

What are the histological features of fibroepithelial polyp?

A

Collagen- pink wavy structures

Fibroblasts

Lacking BVs/inflammatory cells

Keratin layer- thicker this is means polyp appears paler

28
Q

How are fibrous polyps under dentures managed?

A

Tissue conditioner

Excision biopsy (especially if it persists for 3 weeks)

29
Q

What special stain is used for melanin?

A

Silver satin- has affinity for melanin (appears black)

H and E- appears brown

30
Q

What are the exogenous sources of pigementations?

A

Amalgam
-> giant cell lesions around these as it is dealt with as foreign object- foreign body giant cell granuloma

Smoking (irritates melanocytes),

Increased lead/bismuth (appears as black line on gingivae)

Tattoos

31
Q

What is occurring histologically in reactive melanosis?

A

Keratosis of NK epithelium

Acanthosis

Melanocytes- no desmosomes

32
Q

What is meant by para-keratosis?

A

Nuclei are present in keratin

33
Q

What are desmosomes/hemidesmosomes?

A

Desmosomes- attach epithelium together- appear as prickles

Hemi- attaches epithelial cells to BM

34
Q

What may reactive melanosis occur as a result of?

A

Smoking

Inflammation

LP

Drugs- antimalarials

Addisons

Following surgery

35
Q

What is a lipoma?

A

Benign neoplasm of fat

36
Q

How is lipoma treated?

A

Excisonal biopsy

37
Q

What is squamous cell papilloma?

A

A viral wart caused by HPV 6/11 (pendunculated)
-> benign neoplasm
-> exophytic, cauliflower appearance
-> may get lesions on fingers

38
Q

What are the oncogenic types of HPV?

A

16/18
-> OPC, oral cancer, cervical cancer

39
Q

What are the histological characteristics of SCP?

A

 Finger like projections
 Has stalk
 Epithelium on outside
 Core- BV, fibroblasts, inflammatory cells due to viral infection of epithelium
 Keratin on surface- thicker the lesion the more keratin
 koilocytes- means virus present within epithelial cells (clear cytoplasm and dark nucleus)

40
Q

How is SCP treated?

A

Exisional biopsy

41
Q

What is denture hyperplasia?

A

Roll of excessive tissue between denture periphery and residual ridge
-> caused by chronic irritation/trauma due to poor fitting denture

42
Q

How is denture hyperplasia treated?

A

Remove excess tissue

Reduce denture flange

43
Q

What is a leaf fibroma? How is it treated?

A

FE polyp that has been squashed by denture
-> excision biopsy

44
Q

What is a mucocele?

A

Mucous extravasation cyst
-> caused by damage to salivary glands
-> saliva leaks into submucosal area

45
Q

What is a mucocele in floor of mouth called?

A

Ranula

46
Q

What is a plunging ranula?

A

Mucocele occurring below mylohyoid muscle in submandibular/lingual space

47
Q

How are mucoceles treated?

A

Excision
-> whole gland may have to be removed

48
Q

What are the features of SSC?

A

Persisting non-healing ulcer type lesion
-> uneven rolled margins
-> exophytic
-> fixed
-> indurated
-> may have speckled appearance

49
Q

How is SSC treated?

A

Incisional biopsy
-> urgent cancel referral pathway

BDS4 Tutorials (9 decks)

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