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Diseases of Oral Mucosa

The normal color of the OM range from pink to slightly red according to the site.In general the oral mucosa divided into 3 types:1- keratinized mucosa (masticatory mucosa) which appear pink.2- non keratinized mucosa (lining mucosa) which appear red.3- specialized mucosa, that cover the dorsum s

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Diseases of Oral Mucosa

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    1. Diseases of Oral Mucosa

    2. The normal color of the OM range from pink to slightly red according to the site. In general the oral mucosa divided into 3 types: 1- keratinized mucosa (masticatory mucosa) which appear pink. 2- non keratinized mucosa (lining mucosa) which appear red. 3- specialized mucosa, that cover the dorsum surface of the tongue. However, many factors may cause change in color of oral mucosa like: A- vascularity B- keratin C- melanin pigment Any variation in these factors lead to changing of the color of OM , e.g.: inflammation ---- redness increase in thickness of keratin or epith layer----- white or grayish color.

    3. *White Lesions Classification of white lesions:- There are 3 different classifications: 1- according to clinical consideration: this depend on that the lesion can be scraped off or not. e.g.: candidiasis can scraped off 2-according to histopathology: if there is epith dysplasia or not 3-according to aetiology: it is the most common & important There are many etiological factors: A-developmental : e.g.: white spongy nevus B-traumatic: e.g.: mechanical, chemical , thermal C-infective : e.g.: candidiasis D-idiopathic: e.g.: leukoplakia E-dermatological or immunological: e.g.: lichen planus, lupus erythematosus F-neoplastic: e.g.: squamous cell carcinoma

    4. Special terms related to White Lesions 1-orthokeratosis: type of epith where the superficial layer become flattened without clear cell boundaries & the cells contain no nucleus. 2-parakeratosis: the cells in the superficial layer of epith become flattened, but it still contain small nucleus. 3-keratosis: mean keratinization of epith which is normally non-keratinized 4-hyperkeratosis: increase the thickness of keratin in already keratinized epith. 5-acanthosis: it is a type of epith hyperplasia where there is increase the thickness of epith layer due to increase the number of the cells in prickle cell layer (stratum spinosum). 6-cellular atypia: mean abnormal cytological change in the cells, which represent a sign of pre-malignancy or malignancy. 7-epithelial dysplasia: a pre-malignant change in epith, characterized by a combination of individual cell alteration (atypia) & architectural abnormality.

    5. 1- Developmental Lesions: Leukoedema is a common developmental alteration of the oral mucosa appears as a filmy, opaque, white to gray discoloration of mucosa, chiefly buccal mucosa. Redundancy of the mucosa may impart a folded or wrinkled appearance to the relaxed mucous membrane. It partially disappears when the mucosa is stretched. It is stated to be seen in 90% of Blacks and 40% of Whites. Histopathology Leukoedema is characterized by a variable intracellular edema of the superficial half of the epithelium. The vacuolated cells are large and often have pyknotic nuclei. They may extend to the basal layer and may cluster into inverted wedge-shaped regions separated by normal spinous epithelial cells. The epithelium is hyperplastic and rete ridges are often broad and elongated. Parakeratosis is commonly seen but is not pronounced unless there has been chronic trauma. Treatment: reassurance of the patient, because the condition requires no treatment.

    6. 2- traumatic white lesions The epith react to irritants depend on the severity of the irritant, if the irritant of acute & sever type usually there will be blasty ulceration & bleeding. While mild, chronic irritation lead to epith thickening & may be keratosis. A- mechanical type: Like sharp tooth, ill fitting denture, cheek biting etc The lesion appear as white, rough surface, because it due to frictional irritation. The lesion disappear when the irritant is removed. Histologically, there is hyperkeratosis, acanthosis. B- chemical type: e.g.: aspirin burn, when applied on the carious tooth lead to sloughing & ulceration of the area because of acid effect of aspirin. Histologically, like the mechanical type C- thermal type: as in pipe smoking (nicotine stomatitis) which is a specific type of epith hyperplasia that primarily involves the hard palate of long-term pipe smoker. The palate is usually whiter than normal, with multiple red spots on the soft palate represent the opening of minor salivary glands. Histologically, same as mechanical & chemical

    7. 3-Infective white lesions Candida albicans: is present as normal commensally in oral cavity, the pathogenesity of the fungi depend on the alteration between the micro-organism & the immunity of the host. When there is a defect in the host defence mechanism the fungi act as opportunistic to cause disease. We have 5 clinical pattern when the candidal infection present: A-acute pseudomembraneous candidiasis (Thrush) B-acute atrophic candidiasis C-chronic atrophic candidiasis D-chronic hyperplastic candidiasis E-chronic mucocutaneous candidiasis

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