Red and white patches Flashcards
what is a problem with the oral mucosa?
that it can only react in so many ways -> u tend to get ulcers, white patches, red patches, lumps, blisters, erosions (shallow ulcer)»_space; there is a whole host of different conditions that can cause oral soft tissue lesions but there is a limited way in which the oral soft tissues can present (limited way in which they can change).
= This means that just by looking at a lesion its quite often the case that u won’t able to tell
what exactly it is, it also means that u can get a variety of presentations in the same lesion
- So when talking about WP, RP, blisters, lumps, ulcers -> u may well sometimes get a lesion which is just WP, u may as well sometimes get a lesion which is just a lump, but very often things will change.
slide 7 Top RHS
Top RHS=an ulcer but that ulcer is on top of a lump so both a lump and an ulcer
slide 7 top middle
fairly benign looking aphthous ulcers (they are white in the middle but around the edge they are red)
slide 7 top LHS
bigger nastier more “chronic looking” ulcer with irregular edges and it is white in the middle but red around the edges
slide 7 second row middle
reticular lichen planus
which is typically both white and red
slide 7 bottom LHS
desquamative gingivitis with a mixture of white and red
slide 7 bottom RHS
some erosions or some blisters which are red in the middle
but also have an element of white around them
what can happen to lesions as time goes?
they can change
for ex slide 7 top RHS
that lesion probably started as a lump then got bigger then turned into a lump with an ulcer on top
bottom RHS- was probably a blister that then bursted to leave a shallow ulcer or erosion
how can we categorise oral soft tissue lesions?
1) appearance (what we will deal with)
2)causes
what are some descriptions of appearances of oral soft tissue lesions?
1- white patches
2- red/purple patches
3- mixed white + red/purple patches
4- pigmented lesions
5- blisters
what are some causes of oral soft tissue lesions?
1- infections
2-trauma
3- granulomatous disease (post-grad level)
4- immune-mediated diseases (oral lichen planus , pemphigoid, pemphigus)
5- oral epithelial dysplasia (v. important)
what is oral epithelial dysplasia ?
harmful changes in the cells that make up the epithelium (lining) of the mouth
earliest form of precancerous lesion
slide 9 basic histology pf the epithelium
explain basal membrane and basal cell of layers
the wavy blue line = basement membrane
that separates the epithelium from the underlying oral soft tissues
on top of the basement membrane
we’ve got the basal cell of layers-
these basal cells replicate, they replicate on a continuous basis and as they replicate they pile up on top of each other.
slide 10
what cells replicate in the epithelium?
Only the basal cells in health are replication
therefore that is the only place you would expect to see cellular evidence of cell replication
slide 11
what would the cells on top be doing in health?
maturing
not replicating
they mature and stack on top of each other
they go from squamous (rounded appearance) > to a more flat appearance
slide 12
what do these layers of old mature cells do for the epithelium?
they give the epithelium its robustness
(there may be some keratin production depending on the type of epithelium but not always)
slide 13
what is underneath the basement membrane?
slide 14
Stroma
and in it there are blood vessels arteries and veins
and then fat
slide 15 what else is there
Glands - minor salivary glands
depending on the tissue there can be sebaceous glands (glands that produce more oily thick secretions)
slide 16
what are melanocytes ?
the epithelium we also have melanocytes that are producing melanin= pigment.
* We all have the same number of melanocytes and if there is any difference in skin tones between us it’s bec of the way our skin handles that melanin, not a difference in number of melanocytes
- Melanocytes will also be subject to local stimulating, trauma, & hormones -> so one of the signs of untreated Addison’s disease is darkening of the skin related to production of hormones that are supposed to stimulate the adrenal glands but also stimulate melanocytes or melanin production. (important to notice in pt examination)
when do you a thinner epithelium ?
when do you get cells produced at a slower rate
or an increased rate of loss
= that is why you get white patches
when do we get a thicker epithelium?
- when squamous cells heap up and the cells and are not being lost.
-when cells are produced at a faster rate
why do white patches form?
heaped up epithelium which isn’t being scrapped away- either bc cells being produced at an increased rate or being lost at a decreased rate then that thickened epithelium soaked in saliva will turn white
what does VITAMINS CDS allow you to do?
allows you to talk about any presentation or any sign or symptom or any kind of pathology & breaks down it possible causes
-not in the order of the likely-hood (just help u remember).
-there’s a reasonable argument for including VITAMINS CDE in our deferential diagnostic list for oral soft tissues.
what is VITAMINS CDS
- Vascular
-Infective/inflammatory
-trauma (most common)
-Auto-immune\Metabolic
-Idiopathic/iatrogenic
-Neoplastic (related to cancer)
-Social (smoking/ alcohol, non accidental injuries ig trauma in mouth)
-congenital
-Degenerative
-endocrine
what are the 2 types of trauma ?
- chronic= trauma sustained break in epithelium
-acute=overrides mechanical strength of epithelium
what is a blister?
result of trauma
fluid filled lumps under the skin
tend to be delicate/burst easily
intact epithelium no break in continuity
in the mouth the mucosa is not keratinised therefore we rarely see them there
usually evidence of a burst blister would be seen
(shallow erosion with some ragged edges
slide 22
bottom LHS
what is this lesion?
blood blister on tongue
what is an ulcer?
if the trauma is more sustained and causes a break in the continuity of the epithelium
slide 23
what is this lesion?
Ulcer
breaking the continuity of the epithelium with a white area around it suggesting the area is a bit thicker
what is frictional keratosis? (white patch)
give an example
when there is chronic trauma
keeps up with the epithelium (could be from denture/position of teeth) slide 24
(heaping up of epithelium)
ex
linear alba -
occlusal line on buccal mucosa (or side of tongue)
area that is frequently caught between the teeth
chronic trauma dein broken teeth
broken restorations
denture clasp (slide 28)
what is smokers keratosis?
slide 27
WP in the palate
caused by inhaling hot cigarette smoke
thermal damage
(staining of teeth will also be seen from nicotine)
what white patches are from “normal anatomy”
-Fordcyce’s spots (little suits underneath the mucosa in the mouth slide 30)
-sebaceous glands (can be on the lips slide 29)
they will be smooth with no ulceration
what is Mid-line rhomboid glossitis ?
slide 31+32+33
normal red patch lesion
middle of tongue RP
rhomboid shape
loss of papilla
if biopsied - candidal hyphae could be seen
no clear cause - could be developmental
what is geographic tongue ?
slide 34+35+36
Normal mixed red and white patch
asymptomatic (can be tender)
common
depopulation can be seen in red areas
what are vascular lesions?
caused by changes underneath the epithelium (not in the epithelium/mucosa)
mucosa over the top - looks normal
common in the floor of the mouth - dilated vessels (normal)
vascular malformation/ haemangioma - developmental abnormality
(slide 37)
slide 38- red arterial blood - haemangioma
slide 39 normal vascular malformation lower lip (common)
they can be inherited or congenital (kids are more likely to develop them) slide 40
old people can get them in the lower lip as well - no need tx but can bleed if traumatised
what is a pyogenic granuloma (vascular epulis)
slide 42+43
RP
reactive vascular lesion commonly in gingiva
reactive lesion - related to local inflammation (plaque trap?)
what is desquamative gingivitis ?
-erosion of gingiva around the margins of teeth
intact but inflamed epithelium
not related to OH (not marginal gingivitis)
common in oral lichen planus
responds to topical steroids
what is angular cheilitis (stomatitis)?
slide 46
RP
bilateral lesion
saliva trapping in corner of mouth
