reactive lesions of the oral mucosa

Question 1

What type of epithelium is found in the oral mucosa and what is under this

Answer 1

The oral mucosa is made of stratified squamous epithelium and lamina propria.

Question 2

Name the different types of mucosa in the mouth

Answer 2

Lining
Masticatory
Gustatory

Question 3

Describe the difference between non-keratinised and keratinised mucosa and give examples of each

Answer 3

Non-keratinised mucosa is redder and examples include the buccal mucosa, floor of mouth, soft palate, and ventral surface of the tongue
Keratinised tissue is paler, with examples including the hard palate

Question 4

What are the layers of the non-keratinised epithelium?

Answer 4

Superficial
Intermediate
Progenitor

Question 5

What are the reactions of oral epithelium?

Answer 5

Keratosis
Acanthosis
Elongated rete ridges
Atrophy
Erosion
Ulceration
Oedema
Blister

Question 6

What is the difference between orthokeratosis and parakeratosis?

Answer 6

Parakeratosis contains dark dots in the keratin - the remains of nuclei of squamous cells
Only seen microscopically, not clinically

Question 7

What are the layers of the epithelium?

Answer 7

Stratum corneum - most superficial
Stratum granulosum
Stratum spinosum
Stratum basale
Lamina propria is deep to this

Question 8

In what layer of the epithelium does cell division occur?

Answer 8

Basal and suprabasal cells

Question 9

What is keratosis?

Answer 9

The formation of a keratin layer
In a non-keratinised site this is always parakeratosis

Question 10

What is acanthosis?

Answer 10

Hyperplasia of the stratum spinosum

Question 11

How will the epithelium appear in keratosis and acanthosis and why is this?

Answer 11

White as it is thickened and is blocking the underlying blood vessels

Question 12

What is elongated rete ridges?

Answer 12

Hyperplasia of basal cells

Question 13

What is atrophy and how does it appear?

Answer 13

Reduction in viable layers
Appears as red lesion as thinner epithelium causes blood vessels to show through

Question 14

What is erosion and how does it appear?

Answer 14

Partial thickness loss
Generally appears red

Question 15

What is ulceration and how does it appear?

Answer 15

Full thickness loss with fibrin on the surface, exposing the underlying lamina propria
May appear yellow as fibrin is yellow

Question 16

What is oedema?

Answer 16

A build up of fluid, can be intracellular or intercellular (spongiosis)

Question 17

How are blisters categorised?

Answer 17

If small then called a vesicle
If larger then called a bulla

Question 18

Define dysplasia in the context of oral epithelium.

Answer 18

Disordered maturation or growth in a tissue
It is microscopic and cannot be seen clinically
The more severe the dysplasia, the more likely to become malignant

Question 19

What is atypia?

Answer 19

Changes in cells at a cellular level

Question 20

What are the common causes of oral tissue atrophy?

Answer 20

Commonly progresses with age
Nutritional deficiencies - haematinics

Question 21

What determined the oral mucosa reaction to trauma?

Answer 21

Irritation
Time
Person

Question 22

How may the oral mucosa react to trauma?

Answer 22

Inflammation
Keratosis
Ulceration
Fibrous tissue formation
Formation of vesicles and bullae
Other

Question 23

What are epulides and what causes them?

Answer 23

Soft tissue swellings on the gingiva only
Caused by a reaction to chronic inflammation or chronic trauma
Can reoccur after removal is the stimulus persists

Question 24

Why should unexplained tooth mobility be investigated?

Answer 24

In case of a malignancy

Question 25

Describe localised gingival hyperplasia histologically?

Answer 25

Metaplastic bone formation over granulation tissue

Question 26

Describe localised gingival hyperplasia clinically?

Answer 26

Mostly in posterior teeth
Can get a fibrous epulis
Can be removed but may persist if stimulus is not removed

Question 27

What is a pyogenic granuloma?

Answer 27

Granulation tissue on any mucosal site
A response to trauma

Question 28

What is a giant cell lesion?

Answer 28

Fused macrophages caused by either unphagocytosable material, chronic infection, infective agents or hormonal stimulation of osteoclasts

Question 29

Describe a giant cell epulis histologically?

Answer 29

Bleeding into the granulation tissue
No capsule present

Question 30

What is a traumatic fibroma and where are they commonly seen?

Answer 30

Also called fibroepithelial polyp
Fibrous tissue covered in epithelium
Often seen in the lip, cheeks and tongue

Question 31

What different fibrous overgrowths are associated with dentures?

Answer 31

Denture induced hyperplasia (can be a flabby ridge)
Leaf fibroma - fibroepithelial polyp that gets squashed under patients denture
Papillary hyperplasia of palate

Question 32

Describe papillary hyperplasia of the palate?

Answer 32

Also called pseudo-epitheliomatous hyperplasia
A reaction to trauma, infections and other pathogens
A candida infection

Question 33

What drugs commonly cause fibrous overgrowths?

Answer 33

Anti-hypertensives - calcium channel blockers
Anti-epileptics - phenytoin
Immunosuppressants - cyclosporin

Question 34

Describe pregnancy gingivitis

Answer 34

A hormonal condition - not just seen in pregnancy
Caused by increased progesterone levels
Responds to oral hygiene measures

Question 35

What is a haemangioma?

Answer 35

Fibrotic growth generally present at birth
Becomes more fibrotic and less likely to bleed as child ages

Question 36

What is Sturgeon weber syndrome?

Answer 36

A large haemangioma that runs along a reticular nerves
Unilaterally affects a patient

Question 37

Describe vascular malformations

Answer 37

Very common coloured lesion
Becomes evident in adult life
Considered to be a hamartoma
Microscopically there are two types - capillary and cavernous

Question 38

What is a hamartoma?

Answer 38

Normal tissue structure but number increased or in different location in body