Bdent3 Pathology: Inflammatory And Reactive Lesions Of The Oral Mucosa

Front 1

What are the 3 elements that make up the structure of I&R Lesions?

Back 1

1. Angioblastic elements
eg Capillaries and endothelial cell proliferation

2. Inflammatory Cells
Chronic - lymphocytes, macrophages, plasma cells
Acute - neutrophils
Foreign body giant cells

3. Fibroblastic elements
Fibroblasts and collagen

Front 2

What is the cause of most I&R Lesions?

Back 2

chronic irritation

Front 3

What is Chronic Hyperplastic Gingivits and what is its cause?
(1)

Back 3

It is a hyperplastic tissue response to chronic inflammation associated with local factors such as plaque, calculus and bacteria

Front 4

Why and with What drugs does Drug-Mediated Gingival Hyperplasia occur?

Back 4

There is an increased production of extra-cellular ground substance in the crevicular fluid which causes inflammation and subsequantly hyperplasia.

Some examples are:
Phenytoin (Dilatin) for epilepsy
Ca Channel Blockers (treat HT) eg Nifedipine
Cyclosporin (immunosupressant for organ transplants)

Also dependent on patient's oral hygiene

Front 5

What are the clinical signs of Drug-Mediated Gingival Hyperplasia? (6)

Back 5

- Marked localised or generalised gingival hyperplasia which appears to originate from an overgrowth of the interdental papillae

- Spreads over the labial/buccal/lingual/palatal surfaces of the crowns of the teeth

- More prominent anteriorly

- Firm tissue, show prominent stippling

- normal colour unless markedly inflamed

-Pseudopockets may result in plaque accumulation

Front 6

What is the histology of DMGH?

Back 6

- covered by overlying gingival SS
- underlying collagenous fibrous CT
- interspersed blood vessels
- variable chronic inflammatory cell infiltrate

Front 7

What is the treatment of DMGH?

Back 7

- Discontinue offending medication (under supervision of the attending MD)

- Substitution another drug

-Gingivectomy and vigorous oral hygiene, prevent re-development

Front 8

What is a Pyogenic Granuloma?

Back 8

A common, reapidly growing, painless, reddish mass, which appears tumour like. Its NOT due to pyogenic organisms, but rather an exuberant response to local irritation or trauma.

Can be anywhere on the body, bleeds easily. Gingiva, lips, tongue are all common sights.

Frequently occurs during pregnency

Front 9

What is another name for a granuloma on the gingiva

Back 9

Epulis

Front 10

What is the treatment for a PG?

Back 10

Remove the irritant. Can excise, but best wait until it becomes fibrous, or better let a surgeon do it due to the heavy bleeding expected.

15% recur - this is due to not removing the cause/initiating factor

Front 11

What is in a PG?

Back 11

Granulation tissue = vessels + inflammatory cells + collagen

Front 12

If women get a Pregnancy Granuloma, when is it most likely, and why does it ocur?

Back 12

Begins in first trimester. Increases to the seventh month.

May be related to increasing levels of oestrogen and progesterone

Front 13

What is the tx for a Pregnancy Granuloma?

Back 13

May resolve post-partum. Will undergo fibrous maturation and develop into a fibrous epulis, can excise then.

Front 14

Whats another name for Fibroepithelial Polyp?

Back 14

Irritation Fibroma!!!

Front 15

Whats another name for an Irritation Fibroma?

Back 15

Fibroepithelial polyp!

Front 16

What do PGCG's look like?

Back 16

Usually less than 2cm, sessile or pedunculated, red-blue nodular mass similar to a Pyogenic Granuloma

Front 17

What is the epidemiology of a PGCG?

Back 17

60% in females. Mandible>Maxilla.
Peak incidence in 5th/6th decades

Front 18

What are some histological aspects of a PGCG?

Back 18

The (possibly ulcerated) SSE is seperated from the rest of the lesion by dense fibrous CT called the Grenz Zone

The core contains Fibrovascular stroma containing plump spindle shaped cells, osteoclast-like giant cells, erythrocytes and haemosiderin pigment

There may be reactive woven bone

Front 19

What is the Treatment for a PGCG?

Back 19

Conservative local excision.

10-15% recur. Scaling and polishing of adjacent teeth to remove source of irritation

Front 20

What are other names for denture epulis?

Back 20

Epulis fissuratum
Denture-induced fibrous hyperplasia
Inflammatory Fibrous Hyperplasia

Front 21

What is Inflammatory Fibrous Hyperplasia/Epulis Fissuratum?

Back 21

Usually single or multiple folds of hyperplastic tissue caused by the flange of an ill fitting denture

Can also take on a leaf like form, called Leaflike Denture Fibroma.

Front 22

Describe Leaf-like Denture Fibroma

Back 22

Usually found beneath a denture. Pedunculated with a serrated edge. Resembles a leaf, oddly enough

Front 23

What is the histology of Inflammatory Denture Hyperplasia?

Back 23

Elongated mucosal covered soft tissue containing a core of hyperplastic fibrous CT and possibly inflammation and salivary glands.

Front 24

What is the treatment for Epulis Fissuratum?

Back 24

Conservative excision, remake denture

Front 25

What is Inflammatory Papillary Hyperplasia? What is it associated with?

Back 25

Numerous asymptomatic red papules on the central region of the hard palatal mucosa.

It is associated with Candida infection

Front 26

What is the histology of Inflammatory Papillary Hyperplasia?

Back 26

Pseudoepitheliomatous hyperplasia may be seen.

Fine papillary projections with central connective tissue cores

Front 27

Treatment of Inflammatory Papillary Hyperplasia???

Back 27

Excision???