Reactive Lesions Of Oral Mucosa

Question 1

Layers of Oral Mucosa

Answer 1

• stratified squamous epithelium
• lamina propria
• gross types: lining, masticatory, gustatory
• microscopic: keratinised and non- keratinised
• Keratinised: orthokeratosis/ parakeratosis

Question 2

What is orthokeratosis

Answer 2

thickening of the keratin layer with preserved keratinocyte maturation

Question 3

What is parakeratosis

Answer 3

retained nuclei as a sign of delayed maturation of keratinocytes

Question 4

Histology of cheek

Answer 4

non- keratinised

Question 5

Histology of palate

Answer 5

• keratinised
• cells that produce large amounts of a protein called keratin, making them strong and better at forming barriers

Question 6

Strata and Compartments

Answer 6

cell division in basal and suprabasal cells

Question 7

Reactions of oral epithelium

Answer 7

Question 8

What is acanthosis?

Answer 8

• thickening of the epidermis and elongation of the rete ridges due to thickening of the spinous layer +/- enlargement of rete pegs

Question 9

What is keratosis?

Answer 9

• a growth of keratin on the skin or on mucous membranes stemming from keratinocytes, the prominent cell type in the epidermis

Question 10

Epithelial reactions

Answer 10

1. atrophy: reduction in viable layers
2. erosion: partial thickness loss
3. ulceration: full thickness loss with fibrin on surface
4. oedema- intracellular and intercellular (spongiosis)
5. blister - vesicle or bulla

Question 11

Epithelial reactions on cheek

Answer 11

Question 12

Dysplasia

Answer 12

• disordered maturation/ growth in tissue

atypia: describes changes in cells

Question 13

What causes dysplasia?

Answer 13

• age: progressive atrophy
• nutrition deficiency: Iron, Vit B12, Folate atrophy

** predisposes to infection

Question 14

How does oral mucosa react to trauma?

Answer 14

Depends on:
- irritation
- time
- person

Reactions may be in form of
- inflammation
- keratosis
- ulceration
- fibrous tissue formation
- vesicles and bullae

Question 15

What is fibrous lesions?

Answer 15

• known as fibrous overgrowth
• true benign fibroma rare in oral cavity

Question 16

What is Epulides?

Answer 16

• soft tissues swellings only on gingiva
• reaction to chronic inflammation/ trauma
• can reoccur after removal if stimulus persist
• may have odontogenic tumours and cysts present
• describe lesions as peripheral (meaning originates from gingiva not jaw bone)
• benign tumours may present

Question 17

Fibrous overgrowths

Answer 17

• localised gingival hyperplasia
• fibrous epulis

1. clinical presentation
2. aetiology
3. histology
4. recurrence

Question 18

Histology of fibrous overgrowth

Answer 18

Question 19

Vascular epulis

Answer 19

• also known as pyogenic granuloma
• lobular capillary hemangioma is a form of epulide which is marked by an inflammatory infiltrate rich of blood vessels

Question 20

Pyogenic Granuloma

Answer 20

• granulation tissue
• any mucosal site
• response to trauma

** on gingiva - vascular epulis (most frequent)
** on gingiva during pregnancy - pregnancy epulis

Question 21

Giant cell lesions

Answer 21

• if on gingiva/ alveolus = epulis
  1. check clinical presentation
  2. histology
  3. recurrence

Peripheral giant cell granuloma
- central lesion in bone

Question 22

Giant cell epulis

Answer 22

Question 23

Why called Giant cell lesions?

Answer 23

• encountered in the head and neck region, particularly within the jaw bones
• fused macrophages

Question 24

Causes of Giant cell lesions?

Answer 24

• unphagocytosable material
• local chronic irritation
• infective agents, ie: TB bacillus
• hormonal stimulation of cells, ie: osteoclast
• autoimmune sarcoidosis

Question 25

What to exclude for GCL?

Answer 25

- any systemic disease 1. raised parathyroid hormone 2. low Vit D diet 3. malabsorption 4. renal disease

Question 26

Reactive hyperplastic lesions

Answer 26

- traumatic fibroma - also known as fibroepithelial polyp - other sites are cheek, lip and tongue

Question 27

Photos of Fibroepithelial polyp

Answer 27

Question 28

Fibrous overgrowths and dentures

Answer 28

- denture induced hyperplasia - "leaf fibroma" - papillary hyperplasia of palate - pseudo-epitheliomatous hyperplasia - candida infection

Question 29

Pseudo-epitheliomatous hyperplasia

Answer 29

Question 30

Papillary hyperplasia of palate

Answer 30

- associated with upper denture use - candidal infection may be present

Question 31

Drug induced fibrous overgrowth

Answer 31

1. anti-hypertensives - calcium channel blockers 2. anti-epileptics - phenytoin 3. immunosuppresants - cyclosporin ** may need repeated gingivectomy

Question 32

Pregnancy gingivitis

Answer 32

- hormonal - due to increased progesterone levels - possible with OCP - not seen in HRT - poor oral hygiene with exagerrated plaque responses

Question 33

Vascular lesions

Answer 33

- haemangioma present at brith - sturge weber syndrome - vascular malformation becomes evident in adult life Microscopically 2 types 1. cavernous 2. capillary

Question 34

Carvenous vs Capillary vascular lesions

Answer 34