Oral Mucosa Coloration

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Questions and Answers

What is the normal color of the oral mucosa?

Pink (correct)

Red

White

Yellow

What is a factor that contributes to the color of the oral mucosa?

Presence of collagen fibers

Thickness of oral mucosa (correct)

Amount of keratinization

Presence of melanin pigmentation

What is the cause of white color of the oral mucosa?

Hyperplasia and acanthosis

Presence of vascularity

Intracellular edema

Keratin or Para keratin (correct)

What type of white lesions can be scraped off with a tongue blade?

Sloughing Signup and view all the answers

What is a characteristic of the normal oral mucosa?

It is translucent and vascular Signup and view all the answers

What is not a factor that contributes to the color of the oral mucosa?

Presence of collagen fibers Signup and view all the answers

What is a precancerous lesion?

A morphologically altered tissue in which cancer is more likely to occur Signup and view all the answers

What is the most common age group affected by Leukoplakia?

Adults older than 50 years of age Signup and view all the answers

What is the most common site for Leukoplakia lesions?

Buccal mucosa and alveolar mucosa Signup and view all the answers

What percentage of cases show dysplasia or carcinoma in the tongue and floor of the mouth?

More than 90% Signup and view all the answers

What is the appearance of an early Leukoplakia lesion?

A slightly elevated greyish-white plaque Signup and view all the answers

What is a common etiological factor for Leukoplakia?

All of the above Signup and view all the answers

What is the most common area of involvement in smokeless tobacco-induced keratosis?

Anterior mandibular vestibule Signup and view all the answers

What is the characteristic surface appearance of smokeless tobacco-induced keratosis?

White and granular Signup and view all the answers

What is actinic keratosis related to?

Long-term exposure to ultraviolet light Signup and view all the answers

What is the typical location of actinic keratosis on the lip?

Lower lip Signup and view all the answers

What is idiopathic keratosis also known as?

True leukoplakia Signup and view all the answers

What is the risk of oral leukoplakia transforming into a malignant lesion?

Recognizable risk Signup and view all the answers

What is the characteristic of oral leukoplakia?

White keratotic patches that cannot be rubbed off Signup and view all the answers

What is the characteristic appearance of the flat-surfaced papules in oral lichen planus?

Whitish striae and punctuations Signup and view all the answers

What is the current understanding of oral lichen planus?

A T-cell-mediated disorder Signup and view all the answers

What type of cells trigger apoptosis of oral epithelial cells in oral lichen planus?

Autocytotoxic CD8 and T cells Signup and view all the answers

What is a possible factor that triggers the immune system in oral lichen planus?

Interactions among genetic, environmental and lifestyle factors Signup and view all the answers

What is the association between HLA antigen and oral lichen planus?

Weak association Signup and view all the answers

What is the association between psychological factors and erosive oral lichen planus?

Strong association Signup and view all the answers

What is the age of onset for oral lichen planus?

40-70 Signup and view all the answers

What is the female to male ratio in oral lichen planus?

2:1 Signup and view all the answers

What is the characteristic of the epithelium in atrophic type of Oral Lichen Planus?

Thin epithelium with little surface keratinization Signup and view all the answers

What is the characteristic of the Civatte bodies in Oral Lichen Planus?

They are phagocytosed by macrophages or coated with IgM Signup and view all the answers

What is the characteristic of the direct immunofluorescent studies in Oral Lichen Planus?

It is characteristic but not diagnostic Signup and view all the answers

What is the diagnosis of the patient with severe pain and a white and red lesion on the buccal mucosa bilaterally?

Oral Lichen Planus Signup and view all the answers

What is the location of the lesion in Oral Hairy Leukoplakia?

Lateral or ventral surfaces of the tongue Signup and view all the answers

What is the causative agent of Oral Hairy Leukoplakia?

Epstein-Barr virus (EBV) Signup and view all the answers

What is the method of definitive diagnosis of Oral Hairy Leukoplakia?

Demonstrating the presence of EBV by electron microscopy or PCR Signup and view all the answers

In what location is Hairy Leukoplakia found in AIDS?

Lateral border of tongue Signup and view all the answers

Study Notes

Normal Color of the Oral Mucosa

The normal color of the oral mucosa is pink due to the passage of light through the translucent superficial layer of soft tissue.
Factors that contribute to the color of the oral mucosa include:
- Amount of vascularity
- Thickness of oral mucosa
- Presence of melanin pigmentation
- Degree of keratinization
- Presence of pseudomembrane

White Color of the Oral Mucosa

The white color of the oral mucosa is due to:
- Keratin or Para keratin (hyperkeratosis or hyperparakeratosis)
- Hyperplasia and acanthosis (increase in thickness of epithelium and prickle cell layer)
- Intracellular edema (spongiosis)
- Intercellular edema
- Increased collagen fibers (fibrosis)
- Necrosis and pseudomembrane formation
- Lack of vascularity
- Submucosal deposits of ectopic sebaceous glands

White Lesions of the Oral Cavity

White lesions of the oral mucosa can be divided into two groups:
- Keratotic lesions that cannot be scraped off with a tongue blade
- Sloughing, pseudomembranous, and necrotic lesions that can be scraped off with a tongue blade

Smokeless Tobacco-Induced Keratosis

Typical features:
- Seen in the area contacting the tobacco
- Most common area of involvement is the anterior mandibular vestibule, followed by the posterior vestibule
- The surface of the mucosa appears white and is granular or wrinkled
- These lesions are accepted as precancerous

Actinic Keratosis

Secondary to long-term exposure to ultraviolet light in white patients
Appear as wrinkled, dry, atrophic, erythematous, keratotic, and crusted
Actinic cheilitis: the lower lip becomes cracked, atrophic, and ulcerated with areas of hyperpigmentation and scaling and indistinct mucocutaneous junction

Reactive and Inflammatory White Lesions

Examples include:
- Lichen planus
- Leukoplakia
- Keratosis
- Squamous cell carcinoma
- Erythema multiforme
- Lichenoid reaction
- Pemphigus
- Bullous pemphigoid

Idiopathic Keratosis ("True" Leukoplakia)

Oral leukoplakia is the most common precancerous lesion of the oral mucosa
Leukoplakia is a white keratotic patch that cannot be rubbed off and is a precancerous lesion with a recognizable risk for malignant transformation
WHO defines leukoplakia as "a white patch or plaque that cannot be characterized clinically or pathologically as any other disease"

Etiology of Leukoplakia

Unknown
Tobacco usage
Alcohol consumption
Sunlight
Candida albicans
Human papilloma virus (HPV)
Electrogalvanic current
Chemical irritation
Systemic predisposing factors (nutritional deficiency, Vit B12, Iron deficiency)

Clinical Features of Leukoplakia

Leukoplakia occurs in adult men older than 50 years of age
The most common sites are the buccal mucosa, alveolar mucosa, floor of the mouth, lateral border of the tongue, lips, and palate
Lesions of the tongue and the floor of the mouth account for more than 90% of cases that show dysplasia or carcinoma
By far the most affected oral sites are the commissures (60-90%)
Early lesion appears as a slightly elevated greyish-white plaque that may be well-defined or may gradually blend into the surrounding normal mucosa
As the lesion progresses, it becomes thicker and whiter, sometimes developing a leathery appearance with surface fissures and showing evidence of loss of elasticity and flexibility

Oral Lichen Planus (OLP)

A chronic immunologic inflammatory mucocutaneous disorder
The exact aetiology is still unknown
The most accepted and current data suggest that OLP is a T-cell-mediated disorder in which there is production of cytokines, leading to apoptosis
Autocytotoxic CD8 and T cells trigger apoptosis of oral epithelial cells (basal cell damage)
The immune system is triggered because of the interactions among genetic, environmental, and lifestyle factors
Another possible theory includes the genetic background, with a weak association between HLA antigen and LP
Strong association with psychological factors such as higher levels of anxiety, greater depression, and psychic disorders in patients suffering from erosive LP
Lichnoid reaction: drug-induced or graft versus host disease (It is an immunologically mediated reaction where lymphocytes in the donor graft mount an immunological response against the recipient keratinocytes)

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Description

Learn about the normal color of the oral mucosa, the factors that influence its color, and the reasons behind white discoloration.