Oral Mucosa.pdf

Oral Mucosa [Oral and Dental Sciences] Miss H Rogers 1 GDC ILOs 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management 1.1.6 Describe relevant and appropriate physiology...

Oral Mucosa [Oral and Dental Sciences] Miss H Rogers 1 GDC ILOs 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management 1.1.6 Describe relevant and appropriate physiology and explain its application to patient management Related topics ▪ Epithelium ▪ Connective Tissue ▪ Intra-oral examination 2 1 3 Aim To gain an overview of the structure and function of the oral mucosa Learning Outcomes By the end of this lecture you should be able to: 1. Describe the different types of mucosa and their histopathology in health 2. Identify the areas of the oral cavity each type of mucosa is associated with 3. Identify changes in the appearance of the oral mucosa 3 4 What is it? What do you understand by the term oral mucosa? 4 2  Protection Functions Secretion Sensation 5 6 Structure 6 3 7 Have a look at your mouth in the mirror: ▪ What does the mucosa look like? ▪ How would you describe it- smooth/rough, pink/red, firm/soft? ▪ Does the appearance change depending on the area? 7 8 Classification Based on their histological features, the oral mucosa can be divided into three main types: Lining mucosa Masticatory mucosa Specialised mucosa 8 4  Lining Mucosa 9 9 1 0 The structures covered by lining mucosa include: Alveolar mucosa Buccal mucosa Labial mucosa Ventral surface of the Floor of the mouth Soft Palate tongue Can you identify these areas in your own mouth? How would you describe the appearance of these areas? 10 5 1 1 In health, the lining mucosa’s clinical appearance generally has: A softer surface texture A moist surface An ability to be stretched and compressed (acting like a cushion for the underlying structures) 11 1 2 12 6 1 3 Histology Think back to what you’ve learnt on epithelium… Can you remember the three types stratified squamous epithelium? Out of these three, and based on what you could see, which do you think is most associated with the lining mucosa? Why? 13 1 4 Answer: Nonkeratinised 14 7 1 5 Additional features Surgical incisions in these areas often requires sutures Local anaesthetic injections are easier in these areas with less discomfort. Infection can spread rapidly Why do you think these may be? 15 Masticatory Mucosa 16 16 8 1 7 The structures covered by masticatory mucosa include: Attached gingivae Hard palate Dorsum of tongue Can you identify these areas in your own mouth? How would you describe the appearance of these areas? 17 1 8 In health, the masticatory mucosa’s clinical appearance generally has: Rubbery surface texture Resiliency (firm base) 18 9 1 9 Histology Which do you think is most associated with the masticatory mucosa, nonkeratinised or keratinised epithelium? Why? 19 2 0 Additional features Sutures are rarely needed in these areas following surgical procedures Local anaesthetic injections are more difficult and cause more discomfort Swellings in these tissues caused by infections cause greater discomfort Why do you think these may be? 20 10  Specialised Mucosa 21 21 2 2 The structures associated with specialised mucosa include: Lingual papillae 22 11 2 3 Which do you think is most associated with the specialised mucosa, nonkeratinised or keratinised epithelium? Why? 23 Changes in appearance: Hyperkeratinisation 24 24 12 2 5 Nonkeratinised epithelium may transform into a keratinising type in response to frictional or chemical trauma. It has therefore become hyperkeratinised. Histologically the tissue will resemble orthokeratinised epithelium with a keratin and granular layer 25 2 6 1. Can you identify the hyperkeratinised area? 2. How would you describe this area? 3. Which type of mucosa has it occurred on? 4. What do you think the possible cause may be and why? 26 13 2 7 1. Can you identify the hyperkeratinised area? 2. How would you describe this area? 3. Which type of mucosa has it occurred on? 4. What do you think the possible cause may be and why? 27 2 8 1. Can you identify the hyperkeratinised area? 2. How would you describe this area? 3. Which type of mucosa has it occurred on? 4. What do you think the possible cause may be and why? 28 14  Changes in appearance: Oral Pigmentation 29 29 3 0 30 15 3 1 As the tissue ages, these epithelial cells migrate to the surface of the oral mucosa and appear as localised flat pigmented areas, ranging from brown to brownish-black 31 3 2 Other colour changes may also occur to the oral mucosa, some of which may be covered in more detail in Dental Specialities in Year 2. Here are a few examples… 32 16 3 3 Drug Induced 33 3 4 Infection 34 17 3 5 Iatrogenic 35 3 6 Self-inflicted 36 18 3 7 Additional resources YouTube Dental Education Hub- Oral Mucosa Playlist https://www.youtube.com/playlist?list=PLjIUkW- fumBz9qmi_3pw_5uWVN6Rt-tb_ Website Geeky Medics- Pigmented lesions of the oral cavity https://geekymedics.com/pigmented-lesions-of-the-oral- cavity/ 37 3 8 References Bath-Balogh, M. & Fehrenbach, M.J. Dental Embryology, Histology, and Anatomy. Elsevier 2006. Royal Berkshire NHS Foundation Trust. Oral frictional hyperkeratosis (May 2022). Available at: https://www.royalberkshire.nhs.uk/media/jt0fzg2w/oral- frictional-hyperkeratosis-fk-_may22.pdf [Accessed 26th September 2022]. 38 19