Reactive Oral Mucosal Lesions Flashcards
What epithelium is found in the oral cavity ?
Stratified squamous epithelium.
What subtypes of stratified squamous epithelium are found in the oral cavity ?
Lining, masticatory, gustatory.
Sites of non-keratinised mucosa ?
Soft palate, ventral surface of the tongue, buccal mucosa.
Site of keratinised mucosa ?
Hard palate, gingivae.
Why does non-keratinised tissues have little uptake of stain histologically ? i.e. features of non-keratinised tissues ?
Glycogen store in intermediate layer.
Spacing between cells - mobile tissue.
Will have underlying muscle.
Where does cell division occur ?
Basal and suprabasal cell layers i.e. where progenitor cells are found.
Where does cell maturation occur ?
Stratum spinosum (prickle cell layer).
What are the four epithelial cell layers ?
Stratum corneum.
Stratum granulosum.
Stratum spinosum.
Basal cell layer.
Lamina propria.
Define parakeratosis.
Reactive epithelial change characterised by excessive keratin formation. Will appear white (example - linea alba).
What are examples of reactive changes of the oral mucosa ? Clinical and histological.
HISTOLOGICAL
Keratosis.
Acanthosis.
Elongated rete ridges.
CLINICAL
Atrophy.
Erosion.
Ulceration.
Oedema.
Blister formation.
Define acanthosis.
Hyperplasia of stratum spinosum.
What do elongated rete ridges signify ?
Hyperplasia of basal cells.
Define atrophy.
Reduction in viable cell layers.
Causing thinner mucosa, red in colour, can see blood vessels through.
Define erosion.
Partial thickness loss of epithelium.
Define ulceration.
Full thickness loss with fibrin on surface (appears as yellow) to prevent exposure of underlying cell layers to oral cavity.
Define cellular atypia.
DESCRIPTIVE TERM ONLY, NOT A DIAGNOSIS.
Changes which occur in cells.
What are examples of cellular atypia ?
Larger or smaller in size - pleomorphism.
Increased DNA content in nuclei - will stain darker.
Change in order of epithelial cells - disordered looking cells.
BENIGN LESIONS OF THE GINGIVA
What is the cause of an epulis ? And how should they be managed ?
Reaction to chronic inflammation/trauma i.e. subgingival calculus or defective restoration margin causing inflammation of the soft tissue.
Remove cause and monitor.
BENIGN LESIONS OF THE GINGIVA
What are the characteristics of fibrous epulis ?
Found on gingivae.
Firm nodule covered with tissue of normal colour.
Can have overlying ulceration.
Histology - granulation tissue covered by hyper plastic epithelial tissue.
BENIGN LESIONS OF THE GINGIVA
What is the difference between pyogenic granuloma and fibrous epulis ?
Same histologically and same process.
Just found in different locations in the mouth -
- Fibrous epulis - gingivae only.
- Pyogenic granuloma - anywhere in mouth (inc. tongue).
BENIGN LESIONS OF THE GINGIVA
Common sites for fibroepithelial polyps.
Cheek, lip, tongue.
Reactive lesions to trauma.
BENIGN LESIONS OF THE GINGIVA
How should a fibroepithelial polyp be managed ?
Can be left and monitored.
Concerns with appearance or annoying patient - can be removed.
BENIGN LESIONS OF THE GINGIVA
What are three denture induced fibrous overgrowths ?
Denture induced hyperplasia - should regress after 4 weeks.
Leaf fibroma - compressed fibroepithelial polyp.
Papillary hyperplasia of palate - can look dysplastic, normal on bx.
BENIGN LESIONS OF THE GINGIVA
What medications can cause gingival overgrowth ?
Calcium channel blockers.
Anti-convulsants - i.e. phenytoin.
Ciclosporin - immunosuppressants.
BENIGN LESIONS OF THE TONGUE
Define geographic tongue and what does it look like.
Idiopathic altered maturation and replacement of cells distinct locations of the tongue, resulting in loss of filiform papillae.
Areas of atrophy and keratinisation in semi-circular patterns.
BENIGN LESIONS OF THE TONGUE
You have diagnosed a patient with geographic tongue, what advice would you now give them ?
Reassure benign.
Avoid spicy, citrus and SLS toothpaste.
Will be an intermittent conditions but will subside itself.
Maintain fluid uptake and OH.
BENIGN LESIONS OF THE TONGUE
Define glossitis and its presentation.
Atrophy of cells of the tongue.
Smooth, glossy appearance to tongue.
BENIGN LESIONS OF THE TONGUE
What investigations would you consider carrying out for a patient presenting with glossitis ?
Haematinic blood tests.
Fungal cultures.
BENIGN LESIONS OF THE TONGUE
You have diagnosed a patient with fissured tongue, what advice would you give them ?
Reassure benign.
Encourage good OH.
Soft bristle toothbursh on tongue surface to prevent food trapping and bacteria which can cause localised inflammation.
Maintain fluid uptake.
BENIGN LESIONS OF THE TONGUE
Define black/brown hairy tongue, its characteristic appearance and its causes.
Black/brown pigmentation due to staining of elongated filiform papillae (due to hyperplasia).
Pigmentation can be caused by commensal bacteria, antibiotic use, chlorhexidine use, smoking and diet.
BENIGN LESIONS OF THE TONGUE
You have diagnosed your patient with black/brown hairy tongue, what advice would you give them ?
Reassure benign.
Use tongue scraper.
Peach stone.
Eat pineapple (contains enzymes which breakdown pigment build up).
Smoking cessation.
BENIGN LESIONS OF THE GINGIVA
What is desquamative gingivitis ?
Full thickness erythema extending beyond marginal gingivae, includes gingivae and alveolar mucosa.
It is not caused by plaque but can be worsened by it.
BENIGN LESIONS OF THE GINGIVA
What are the symptoms of desquamative gingivitis ?
Mucosal gingival bleeding.
Oral discomfort.
Exacerbated by spicy or acidic foods.
BENIGN LESIONS OF THE GINGIVA
What are the four most commonly associated conditions with desquamative gingivits ?
Lichen planus.
Linear IgA bullous disease.
Mucous membrane pemphigoid.
Pemphigus vulgaris.
BENIGN LESIONS OF THE GINGIVA
What treatment would you provide for a patient with desquamative gingivitis ?
Supra and subgingival scaling.
Encourage to continue OH using soft bristle toothbrush.
Can prescribe 0.2% chlorhexidine mouthrinse to help where suboptimal OH.
Topical corticosteroid therapy - 0.1% tacrolimus gel.
Review within 1-2 weeks.
BENIGN LESIONS OF THE GINGIVA
What % of population have tori ?
30-40%
BENIGN LESIONS OF THE GINGIVA
Define tori (torus mandibularis and palatinus).
Benign overgrowth of calcified bone.
BENIGN LESIONS OF THE GINGIVA
What problems are associated with tori ?
Denture construction.
Prone to ulceration.
Risk for MRONJ/ORN patients with traumatised.
BENIGN LESIONS OF THE GINGIVA
What syndrome is associated with bony exotosis/tori ?
Gardner’s syndrome.
Ask about GI symptoms, growing lesions, asymmetrical lesions and unsual sites.
BENIGN LESIONS OF THE GINGIVA
What investigations can you use to monitor tori ?
Clinical photos.
Study models.
X-rays.
COLOUR CHANGES OF ORAL MUCOSA
What are some localised causes of oral pigmentation ?
Melanotic macule.
Melanocytic naevus.
Amalgam tattoo.
SDF.
Malignant melanoma.
Kaposi’s sarcoma.
COLOUR CHANGES OF ORAL MUCOSA
What are some generalised causes for oral pigmentation ?
Racial genetic tendencies.
Smoking.
Drugs - tetracyclines, oral contraceptives.
Addison’s disease.
Cushing’s disease.
COLOUR CHANGES OF ORAL MUCOSA
What two drugs can cause oral pigmentation ?
Tetracyclines.
Oral contraceptives.
COLOUR CHANGES OF ORAL MUCOSA
Define melanotic macule.
Normal number of melanocytes, producing increased amount of melanin.
COLOUR CHANGES OF ORAL MUCOSA
Define melanocytic naevus.
Increased number of melanocytes producing normal melanin.
COLOUR CHANGES OF ORAL MUCOSA
What are features of malignant melanoma ?
Variable pigmentation.
Irregular outline.
Raised surface.
Symptomatic - itch/bleeding.
COLOUR CHANGES OF ORAL MUCOSA
What are some causes of white patches in oral mucosa ?
Oral white sponge naevus (hereditary).
Smoker’s keratosis.
Lichen planus, SLE, GVHD.
Carcinoma.
Fordyce spots.
Linea alba.
Aspirin/alendronic acid burn.
Herpes simplex.
Candidosis.
COLOUR CHANGES OF ORAL MUCOSA
What causes the mucosa to turn white ?
Thickening of mucosa/keratin. Less blood in tissues (vasoconstriction). Increased fluid.
COLOUR CHANGES OF ORAL MUCOSA
Define leukoplakia.
White patch which cannot be scrapped off or attributed to any other cause.
i.e. no histopathological connotation or malignancy.
COLOUR CHANGES OF ORAL MUCOSA
What are some causes for red patches to arise in the mouth ?
Haemangioma.
Desquamative gingivitis.
Denture-related irritation.
Lymphangioma.
Giant cell (temporal) arteritis.
Kawaski disease.
COLOUR CHANGES OF ORAL MUCOSA
What are the three types of haemangioma ?
Capillary, cavernous, papillary.
COLOUR CHANGES OF ORAL MUCOSA
How should haemangiomas be managed ?
Do nothing and monitor.
Cryotherapy if frequent bleeding.
COLOUR CHANGES OF ORAL MUCOSA
Why does the mucosa turn red ?
Increased blood flow due to inflammation or dysplasia.
Reduced thickness of epithelium.
COLOUR CHANGES OF ORAL MUCOSA
Define erythroplakia.
Atrophic or non-keratotic patch which cannot be attributed to any cause.
COLOUR CHANGES OF ORAL MUCOSA
What is Kaposi sarcoma ?
Malignant cancer cells found on the skin and in the mucous membranes which line the GI tract.
Presents as purple lesions on the skin or white on oral mucosa.
