White & Red patches

Question 1

Describe the layers of oral epithelium from Ep-CT

Answer 1

Stratum corneum-granulosum-basale then lamina propria

Question 2

Epithelial reaction definitions

• Atrophy
• Erosion
• Ulceration

Answer 2

Atrophy - reduction in viable layers
Erosion - partial thickness loss
Ulceration - full thickness loss with fibrin on surface

Question 3

What is dysplasia

What is atypia

Answer 3

Dysplaia - dirrupted maturation in a tissue

Atypia - changes in cells

Question 4

Nutrition effects on oral cavity

Answer 4

Age - progressive atrophy
Nutritional deficiency - iron, folate, vit B12 - atrophy and predisposes to infection
Iron - Dysaesthesia, glossitis
Vit B12 - glossitis- BEEFY tongue, burning and lingual discomfort

Question 5

Causes of vit B12 def

Answer 5

absorption defect - stomach bypass, use of PPIs, crohn’s disease, metformin (T2 diab), antibiotics long term, Grave’s disease (thyroid), Pernicious anaemia (lack of intrinsic factor)

Question 6

Causes of white lesions in mouth- benign/normal

Part 1

Answer 6

• Fordyce spots - inactive sebaceous glands
• Frictional keratosis - trauma/irritation from denture or sharp cusp
• Linea alba - cheek biting often seen in parafunction
• Leukoplakia - a white patch that cannot be rubbed off
• Stomatitis nicotina (smoker’s keratosis) - white patch on palate with red spots (inflamed opening of minor salivary glands

Question 7

Features of oral hairy leukoplakia

Tests to confirm this

Answer 7

Oral hairy leukoplakia - EPSTEIN BARR VIRUS, in immunosuppressed patients. HIV associated
Asymptomatic vertically corrugated/soft keratosis of lateral border of tongue

Koilocyte-like cells - prinkle cells with shrunken nuclei
To detect Epstein barr - immunohistochemistry to detect virus particles

Question 8

White patch causes

Answer 8

Hereditary/smoker/trauma/lichen planus/lupus erythematous/chronic hyperplastic candidosis/carcinoma

Question 9

Why would a lesion be pigmented

Answer 9

Melanoma/smoking/race/Steroid use/chronic trauma/pregnancy/Melanocytic macule
Drug use - OCP/AZT/antimalarials
Addison’s disease/kaposi’s sarcoma

Question 10

What is erythroplakia

Answer 10

Atrophic - red patch not attributed to other cause

Question 11

Leukoplakia chance of malignancy

Answer 11

1-5% in 20 yrs

Question 12

White spongy naevus features and treatment

Answer 12

Hereditary developmental abnormality (autosomal dominant) - alteration in keratin genes

Lining mucosa becomes soft, thickened and white. Bilateral. No defined border.

Epithelium thickened, uniform acantholysis, no dysplasia or inflammation

NO treatment just reassurance

Question 13

Treatment of frictional keratosis

Answer 13

Reaassurance and removal of irritant. If parafunction - splint therapy

Question 14

Features of smokers keratosis

Malignancy potential

Answer 14

white patch on palate with red spots indicating inflamed opening of minor salivary glands

• hyperkeratosis, minimal infiltration, variable dysplasia
• LOW malignancy potential

Question 15

Types of lichen planus

Answer 15

Plaque/reticular/atrophic/erosive/bullous/papular/

desquamative gingivitis

Question 16

Description of LP types

• reticular
• papular
• plaque
• bullous
• atrophic
• erosive
• Desquamative gingivitis

Malignancy potential

Answer 16

-Reticular - lacy spiderweb asump bilateral
-Papular - small white dots enlarge to form reticular
-Plaque - homogenous well demarcated white patch surrounded by striae
-Bullous - bulla surrounded by striae, burst not long after appearing
-Atrphic - homogoneous red area in buccal mucosa, palate-white border
-Erosive - fibrincoated ulcer surrounded by erythematous zone and striae
Desquamative gingivitis - diffuse gingival erythema, mucosal slough. red atrophic mucosa, PAINFUL.
1% MALIGNANCY POTENTIAL

Question 17

Histological features of Lichen planus

Answer 17

Chronic inflammatory autoimmune condition
Hyper/parakeratosis
Saw tooth rete pegs
liquifaction degeneration of basal cell layer
Compact lymphocytic band infiltration
CD8 cells predominate

Basal cells in epidermis destroyed by immunomodulated process (CD8/4 cells). These cells migrate to basal cell layer. Basal cells die by apoptosis, thinning of epithelium. Weakens intercellular attachment

Question 18

Candidal leukoplakia (Chronic hyperplastic leukoplakia)
features

Answer 18

Commisures, speckled lesion in smokers and uncontrolled diabetes.
Stain used to identify candidal hyphae

Question 19

Treatment of Chronic hyperplastic leukoplakia

Answer 19

Systemic antifungal, biopsy, smoking cessation and observe for changes (pictures)