Reactive Lesions Of Oral Mucosa Flashcards
Layers of Oral Mucosa
- stratified squamous epithelium
- lamina propria
- gross types: lining, masticatory, gustatory
- microscopic: keratinised and non- keratinised
- Keratinised: orthokeratosis/ parakeratosis
What is orthokeratosis
thickening of the keratin layer with preserved keratinocyte maturation
What is parakeratosis
retained nuclei as a sign of delayed maturation of keratinocytes
Histology of cheek
non- keratinised
Histology of palate
- keratinised
- cells that produce large amounts of a protein called keratin, making them strong and better at forming barriers
Strata and Compartments
cell division in basal and suprabasal cells
Reactions of oral epithelium
What is acanthosis?
- thickening of the epidermis and elongation of the rete ridges due to thickening of the spinous layer +/- enlargement of rete pegs
What is keratosis?
- a growth of keratin on the skin or on mucous membranes stemming from keratinocytes, the prominent cell type in the epidermis
Epithelial reactions
- atrophy: reduction in viable layers
- erosion: partial thickness loss
- ulceration: full thickness loss with fibrin on surface
- oedema- intracellular and intercellular (spongiosis)
- blister - vesicle or bulla
Epithelial reactions on cheek
Dysplasia
- disordered maturation/ growth in tissue
atypia: describes changes in cells
What causes dysplasia?
- age: progressive atrophy
- nutrition deficiency: Iron, Vit B12, Folate atrophy
** predisposes to infection
How does oral mucosa react to trauma?
Depends on:
- irritation
- time
- person
Reactions may be in form of
- inflammation
- keratosis
- ulceration
- fibrous tissue formation
- vesicles and bullae
What is fibrous lesions?
- known as fibrous overgrowth
- true benign fibroma rare in oral cavity
What is Epulides?
- 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
Fibrous overgrowths
- localised gingival hyperplasia
- fibrous epulis
- clinical presentation
- aetiology
- histology
- recurrence
Histology of fibrous overgrowth
Vascular epulis
- also known as pyogenic granuloma
- lobular capillary hemangioma is a form of epulide which is marked by an inflammatory infiltrate rich of blood vessels
Pyogenic Granuloma
- granulation tissue
- any mucosal site
- response to trauma
** on gingiva - vascular epulis (most frequent)
** on gingiva during pregnancy - pregnancy epulis
Giant cell lesions
- if on gingiva/ alveolus = epulis
1. check clinical presentation
2. histology
3. recurrence
Peripheral giant cell granuloma
- central lesion in bone
Giant cell epulis
Why called Giant cell lesions?
- encountered in the head and neck region, particularly within the jaw bones
- fused macrophages
Causes of Giant cell lesions?
- unphagocytosable material
- local chronic irritation
- infective agents, ie: TB bacillus
- hormonal stimulation of cells, ie: osteoclast
- autoimmune sarcoidosis
What to exclude for GCL?
- any systemic disease
1. raised parathyroid hormone
2. low Vit D diet
3. malabsorption
4. renal disease
Reactive hyperplastic lesions
- traumatic fibroma
- also known as fibroepithelial polyp
- other sites are cheek, lip and tongue
Photos of Fibroepithelial polyp
Fibrous overgrowths and dentures
- denture induced hyperplasia
- “leaf fibroma”
- papillary hyperplasia of palate
- pseudo-epitheliomatous hyperplasia
- candida infection
Pseudo-epitheliomatous hyperplasia
Papillary hyperplasia of palate
- associated with upper denture use
- candidal infection may be present
Drug induced fibrous overgrowth
- anti-hypertensives - calcium channel blockers
- anti-epileptics - phenytoin
- immunosuppresants - cyclosporin
** may need repeated gingivectomy
Pregnancy gingivitis
- hormonal
- due to increased progesterone levels
- possible with OCP
- not seen in HRT
- poor oral hygiene with exagerrated plaque responses
Vascular lesions
- haemangioma present at brith
- sturge weber syndrome
- vascular malformation becomes evident in adult life
Microscopically 2 types
1. cavernous
2. capillary
Carvenous vs Capillary vascular lesions
