VARIATIONS OF THE NORMAL ORAL MUCOSA

Oedijani-Santoso Bagian/SMF Gigi dan Mulut Fk Undip/RS dr Kariadi

Oral Mucosa
tissue which lines the mouth protection for the body from infection and debris producing secretions such as mucus absorbing materials introduced into the mouth The color of the oral mucosa can vary, depending on the skin color of the body Pale pink darker pink - brown

Oral Mucosa : mucous membrane epithelium of

the mouth
Masticatory mucosa : para-keratinized stratified squamous epithelium dorsum of the tongue, hard palate and attached gingiva Lining mucosa: non-keratinized stratified squamous epithelium almost everywhere else in the oral cavity. = Buccal mucosa: part of the lining mucosa the inside lining of the cheeks Specialized mucosa: specifically in the regions of the taste buds dorsum of the tongue.

Oral Mucosa
1. Str. Basale
2. Str. Spinosum 3. Str. Granulosum 4. Str. Corneum

Keratinization
The hard surface of some mucosa: the top of the mouth (hard palate), the gums (gingivae), the bottom of the tongue (dorsum of the tongue) = inflexible, tough, resistant to abrasion, and tightly bound to the underlying tissue.

Non-keratinization
The process of keratinisation does not take place in all areas of the mouth : the lips, soft palate (back of the mouth), floor of the mouth, ventral surface of tongue (top of the tongue), alveolar mucosa (near the gums)

Cheek Biting
a person has a chronic habit biting the buccal mucosa lines the inner surface of the cheek, thickness inculcate quite early on in life

Chronic Cheek Biting

Tx : - Eliminate the lesion - Diasepam 5-10 mg at bedtime - Plastic occlusal nightguard DD : - White sponge nevus - Chemical burn

Linea Alba
Depend on degree of keratinization & thickness of str. Corneum hard palate, gingiva (mucosa overlies bone), soft palate, cheeks, lips, ventral surface of tongue (mucosa does not overlies bone) Exception buccal mucosa : line keratinization parallel to the line of occlusion Degree of keratinization : effect of smoking, food texture, environmental irritant

Linea alba

White Sponge Nevus

= Cannon's disease, Hereditary leukokeratosis of mucosa congenital it can first occur in childhood or adolescence. most frequently as a thick bilateral white plaque with a spongy texture on the buccal mucosa, the labial mucosa, alveolar ridge or floor of the mouth.

 gingival margin and dorsum of the tongue are almost never affected. There is no treatment, but because there are no serious clinical complications, the prognosis is excellent

White Sponge Nevus

Fordyce Spot/ Fordyce Granule

Normaly: oral mucosa contain tubulo acinar sebaceous gland produced by ectopic sebaceous glands small white /yellowish raised areas on the vermilion border and the inner surface of the lips that appear on different areas of the body where sebaceous glands exist.

 untreated and should not cause any strong concerns considered normal, 80% of adults have these granules Increases with age and is not correlated with systemic atherosclerosis or smoking do not cause pain, if become painful check with a doctor or dentist

Fordyce Granule/ Fordyce Spot

 Alpha hydroxyl medications Eating a healthy diet and having enough vitamin intake daily could help with the condition the condition under control by having good oral hygiene vitamin (such as E, A, or K) natural ingredients such as sage extract, vitamin E acetate, and sesame extract eliminates the excess secretions daily use it smoothes the skin

Leukoedema
Variation of normal anatomy Normally palpasion, exhibit grayish white, slightly folded, opalecent appearance Change temporarily eliminate by stretching Histo : epithel thicker, cell superficial str, spinosum contain glycogen/ mucopolysacharide H&E vacuolated

 Occasional patients show fine grooves or folds crisscrossing the macule Prevalence : adult 15-35 years old (begin early as 3-5 years of age) Males 2x females tobacco use & smoking DD : white sponge nevus, leukoplakia biopsy

Leukoedema

Benign Migratory Glossitis = Geographic tongue

idiopathic disorder characterized by the loss of filiform papillae reddened areas of circinate macules bound by a white band

The lesions heal, then others erupt.

Benign Migratory Glossitis

Brown Melanotic lesion/macule

melanin pigment synthesis basal layer , without number of melanocyte Lower lip being the favored site Equally men & women, rare in children Oval, irregular, brown-black, gingiva, palate, buccal DD: nevus, amalgam tatto, focal ecchymosis If pigmented > 2week biopsy Micros : normal ep. layer, basal cell contain melanin pigment granules without melanocyte proliferation

Melanotic lesion

Labial Melanotic Macule

-Asymptomatic -Primarily found on vermilion border of the lower lip -Usually solitary -Less than 5 mm in diameter -Flat -Brown to brownish - black

Nevus (Nevocellular)- Blue N

Proliferation of melanocyte Arise from basal layer Blue nevus : melanocytic cell reside deep in the connective tissue and overlying vessels Frequently palate, gingiva, buccal mucosa, lip Tx: exicion

Prevalence
Diag Fordyce Number 17.7 per 1,000 Males 5.2 Females 9.7 BMG Cheek bt Leuko 3.4 1.7 0.4 3.0 3.1 1.4 1.2 0.3 0.3

The Elderly
Biologic factors adaptive mechanism & tissue regenerative The jaws, the tooth supporting str, oral mucosa, the tongue, salivary gland The changes in reaction of stress and process of healing The soft oral tissue: tolerance to irritant ; adaptive capacity ; repair potentialities Elasticity mucosa more friable & easily injured

Excess deposits of melanin can cause dark spots or patches on the gums (melanin gingival hyperpigmentation)

reflection of pathologic influences, such as the melanin pigmentation associated with hypoadrenocorticism (Addison's disease), nevi, and depositions of heavy metals. See also melanin and melanosis.

Pigmentation/ discoloration

Arteria coronaria

Scalloped tongue

Dilated and tortuous veins of the tongue

Varicocities lingual

Fissure Tongue

Varicosities, lingual 3.5 3.4 3.5 Fissured tongue 3.5 3.1 3.2 Benign migratory glossitis 3.4 3.0 3.1Chronic cheek bite 0.7 1.4 1.2 Leukoedema 0.4 0.3 0.3