VARIATIONS OF THE NORMAL ORAL MUCOSA Oedijani-SantosoBagian/SMF Gigi dan Mulut Fk Undip/RS dr Kariadi

Oral Mucosatissue which lines the mouthprotection for the body from infection and debrisproducing secretions such as mucusabsorbing materials introduced into the mouthThe color of the oral mucosa can vary, depending on the skin color of the bodyPale 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 gingivaLining 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 MucosaStr. BasaleStr. SpinosumStr. GranulosumStr. 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 Bitinga 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 lesionDiasepam 5-10 mg at bedtimePlastic occlusal nightguardDD :White sponge nevusChemical burn

Linea AlbaDepend 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 occlusionDegree of keratinization : effect of smoking, food texture, environmental irritant

Linea alba

White Sponge Nevus= Cannon's disease, Hereditary leukokeratosis of mucosacongenital 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 GranuleNormaly: 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 lipsthat appear on different areas of the body where sebaceous glands exist.

untreated and should not cause any strong concernsconsidered normal, 80% of adults have these granulesIncreases with age and is not correlated with systemic atherosclerosis or smokingdo not cause pain, if become painful check with a doctor or dentist

Fordyce Granule/ Fordyce Spot

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

LeukoedemaVariation of normal anatomyNormally palpasion, exhibit grayish white, slightly folded, opalecent appearanceChange temporarily eliminate by stretchingHisto : epithel thicker, cell superficial str, spinosum contain glycogen/ mucopolysacharide H&E vacuolated

Occasional patients show fine grooves or folds crisscrossing the maculePrevalence : adult 15-35 years old (begin early as 3-5 years of age) Males 2x females tobacco use & smokingDD : 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 bandThe lesions heal, then others erupt.

Benign Migratory Glossitis

Brown Melanotic lesion/maculemelanin pigment synthesis basal layer , without number of melanocyteLower lip being the favored siteEqually men & women, rare in childrenOval, irregular, brown-black, gingiva, palate, buccalDD: nevus, amalgam tatto, focal ecchymosisIf pigmented > 2week biopsyMicros : normal ep. layer, basal cell contain melanin pigment granules without melanocyte proliferation

Melanotic lesion

Labial Melanotic MaculeAsymptomaticPrimarily found on vermilion border of the lower lipUsually solitaryLess than 5 mm in diameterFlatBrown to brownish - black

Nevus (Nevocellular)- Blue NProliferation of melanocyteArise from basal layerBlue nevus : melanocytic cell reside deep in the connective tissue and overlying vesselsFrequently palate, gingiva, buccal mucosa, lipTx: exicion

PrevalenceDiag Fordyce BMG Cheek bt LeukoNumber 17.7 3.4 1.7 0.4per 1,000Males 5.2 3.0 1.4 0.3Females 9.7 3.1 1.2 0.3

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

Pigmentation/discolorationExcess 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.

Arteria coronaria

Scalloped tongue

Varicocities lingualDilated and tortuous veins of the tongue

Fissure Tongue

Varicosities, lingual3.53.43.5Fissured 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

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