Week 8 - Oral Mucous Membranes II Flashcards
When does gingival pigmentation vary?
due to differences in melanocyte activity in the basal cell layer. Melanin granules vary in density person to person
What is attached gingiva?
(tissue directly attached to alveolar bone)
thickness
- some pts have significant amounts of attached gingiva
What does it mean if someone has less attached gingiva?
More non-keratinized unattached gingiva
What does the lip contain?
Capillary loops (close to the surface, and especially close to vermillion border)
Thin para-keratinized layers
Mucous secreting glands
What is the vermillion border?
line between keratinized and non-keratinized tissue on the inside of the lip
What does the vermillion border have increased amounts of?
Capillary loops
What is filiform papillae?
“Hair-like” papillae
Most numerous
Highly keratinized
Where is filiform papillae located?
over the entire dorsal surface of the tongue
What is fungiform papilale?
“Fungus-like” papillae
Small round, red surface projections (color is due to highly vascular connective tissue core)
Tend to contain taste buds
Where is fungiform papillae located?
At the tip of the tongue
What does fungiform papillae best respond to?
Salt and sweet stimuli
What is foliate papillae?
“’Leaf-like” papillae
**Contain lymphoid nodules with germinal centers
Tend to contain taste buds
What does foliate papillae form part of?
Waldeyer’s ring
What is waldeyer’s ring?
(lymphoid pathway that consists of 1. palatine tonsils, 2. pharyngeal tonsils and 3. lingual lymphoid nodules on the foliate papillae)
Where is foliate papillae located?
posterior lateral margins of the tongue
What does foliate papillae show bias to?
Sweet stimuli
What is circumvallate papillae?
“Walled” papillae
Generally only about 6-8 per tongue
Lightly keratinized
Contain taste buds
How are circumvallate papillae cleared of taste stimuli?
by serous salivary glands of Von Ebner
Where are circumvallate papillae located?
Located just anterior to the sulcus terminalis on the posterior dorsal tongue surface
What are circumvallate papillae sensitive to?
Bitter compounds
Where are taste buds located?
line inside of papillae and usually contain glands of Von Ebner’s
What are the functions of von ebner’s glands?
Sit inside crevice and pump out fluid to wash away stimulus from taste bud so you can continue to taste over and over again
What are taste cells?
neuroepithelial cells, specialized epithelial cells that can detect different taste sensation
Where do taste fibers from all three nerve converse in?
Tractus solitarius in the brain stem
What CN is responsible for anterior 2/3 of the tongue?
CN VII (Facial) via chorda tympani branch
What CN is responsible for posterior 1/2 of the tongue?
CN IX (Glossopharyngeal)
What CN is responsible for the soft palate?
CN VII (Facial) via the greater petrosal branch
What CN is responsible for the walls of the pharynx and epiglottis?
CN X (Vagus)
What occurs when the tongue has coffee coating?
foliate papillae are coated
What is drug induced linchenoid reaction?
can be ulcerative (seen), leukoplakic (contain white plaques), or hypertrophic (thickening of skin)
What is lichen planus?
unknown etiology, but T-lymphocytes infiltrates with Langerhans cell hyperplasia are characteristic
- cell mediated immune injury to basal cells is suspected
In lichen planus, ulceration/loss of tissue above the basal cell later is seen due to?
lymphocyte attraction from Langerhans cells
What is treatment for lichen planus?
steroids are given to decrease immune response. Can be stress induced
What is candidiasis caused by?
Candida albicans
Fungal infection
What is treatment for candidiasis?
Anti-fungal agents
- typically asymptomatic
- can be wiped off
What is fissured tongue?
thickened tongue, multiplied epithelial layers causes swelling and deep fissures
What is fissured tongue connected to?
Age related (seen more in older patients) and connected to xerostomia patients
What is hairy tongue?
abnormal growth of the filiform papillae and delayed shedding of the keratin layer
What is treatment for hairy tongue?
can be remedied with tongue scraper
What is normal variant geographic tongue?
Benign inflammation and desquamation of filiform papillae
What is the treatment for geographic tongue?
Asymptomatic
Doesn’t need treatment
- Idiopathic, could be stress, nutritional, and genetically induced
What is hyperkeratosis?
thickening of stratum corneum often with aberrant keratinization. Once keratin gets wet, it usually turns white
What is leukoplakia?
white plaque of the oral mucous membranes that cannot be removed by scraping and cannot be classified histologically as another disease entity
- considered precancerous (should biopsy)
What is the most common oral cancer?
Squamous cell carcinoma
Who does squamous cell carcinoma affect?
o The highest incidence is in middle aged African American males
o Male to female gender ration = 3:1
Where is the most common site for squamous cell carcinoma?
- posterior lateral border of the tongue
- Floor of the mouth and ventral tongue surface are also common sites
What does squamous cell carcinoma have a strong relationship with?
tobacco smoking, chewing tobacco, alcohol consumption, phenol exposure, oncogenic viruses (HPV), immunosuppression (AIDS), oncogenes and tumor suppressor genes
What is the histopathology of squamous cell carcinoma (is characterized by)?
The lesion arises from dysplastic surface epithelium and features alterations in size, shape, and organization of the cellular components, including nucellar pleomorphism
What does a squamous cell carcinoma lesion exhibit?
invasive islands and cords of malignant squamous epithelial cells
- There is often a strong inflammatory or immune cell response to the invading epithelium, and focal areas of necrosis may be present (due to blood supply being cut off from immune response)
How is abnormal production of keratin seen in squamous cell carcinoma?
form of keratin pearls (round focus of concentrically layered keratinized cells) is a frequent finding
What is mucosal pemphigoid?
autoimmune disease, issue with adhesion of connective tissue and epithelium
What does the antigen do in mucosal pemphigoid?
Antigen attacks lamina lucida which contains pemphigoid receptors
What is the antigen in mucosal pemphigoid?
Antigen is the adhesion protein epiligrin found in the lamina lucida
What is mucosal pemphigoid characterized by?
linear accumulations of IgG and C3 along the basement membrane
Who does mucosal pemphigoid affect?
o Affects older adults nearing 50-60 age range
o Females are affected more often than males by a 2:1 ratio
What is cicatrical?
form of mucosal pemphigoid involving scarring (derived from the word cicatrix which means “scar”)
What is cicatrical characerized by?
Characterized by BMMP involvement of the conjunctiva of the eye results in scaring (symblepharon)
When is nikolysky’s sign positive?
positive if there is separation from the epithelial layer from connective tissue underneath
What are examples of a nikolysky’s sign being positive?
What is ectodermal dysplasia?
syndrome involving abnormal lack of development of ectodermal structures such as hair, eyebrows, eyelashes, and teeth
What is the genetics of ectodermal dysplasia affect?
Typically X-linked receive
What are clinical features of ectodermal dysplasia?
o Patients commonly have hypohidrosis (don’t have sweat glands, tend to overheat very quickly because they cannot regulate own body temperature
o Clinical features: depressed ridge of the nose, pronounced supraorbital arches, severe xerostomia, and lack of development of teeth
What is peripheral ossifying fibroma?
considered to be reactive (non-cancerous/non-neoplastic)
- The lesion is thought to represent the maturation of pyogenic granuloma
Where is peripheral ossifying fibroma present exclusively?
On the gingiva
What is the occurrence of ossifying fibroma?
- Predominantly a lesion of teenagers and young adults with peak prevalence between ages of 10 and 19 years (due to hormonal changes during this time frame)
- 60-65% of cases occur in females
What is treatment for ossifying fibroma?
surgical excision (will reoccur if not cut out all the way)
What is the histology of ossifying fibroma?
reveals a gingival mass with islands of calcified material (derived from periosteum)
