oral mucous membrane -DR Pooja

ORAL MUCOUS
MEMBRANE
PRESENTED BY:
DRPOOJA

CONTENTS
DEFINITION
DEVELOPMENT
CLASSIFICATION
STRUCTURE OF ORAL MUCOSA
NON KERATINIZED EPITHELIUM
TASTE BUDS
AGE CHANGES OF ORAL MUCOSA
DEVELOPMENTAL DISTURBANCES OF ORAL MUCOSA.
WHITE AND RED LESIONS OF ORAL CAVITY.

DEFINITION
The term mucous membrane is used to describe the moist lining of the
gastrointestinal tract, nasal passages, and other body cavities that communicate
with the exterior. In the oral cavity this lining is referred to as the oral mucous
membrane, or oral mucosa. At the lips the oral mucosa is continuous with the
skin; at the pharynx the oral mucosa is continuous with the mucosa lining the
rest of the gut. Thus the oral mucosa is located anatomically between skin
and gastrointestinal mucosa and shows some of the properties of each.
Page No-260,Orbans Oral Histology & Embryology.13/E

CLASSIFICATION
The classification based on these functional
criteria, divides the oral mucosa into three
major types:
1. Masticatory mucosa 25% (gingiva and
hard palate)
2. Lining or reflecting mucosa 60% (lip,
cheek, vestibular fornix, alveolar mucosa,
floor of mouth and soft palate)
3. Specialized mucosa 10% (dorsum of the
tongue and taste buds)

Based on keratinization:
KERATINIZED MUCOSA—
MASTICATORY MUCOSA
VERMILLION BORDER OF LIPS
NON KERATINIZED MUCOSA–
LINING MUCOSA
SPECIALIZED MUCOSA

DEVELOPMENT OF ORAL MUCOSA
The epithelium of the oral cavity is derived from both the ectoderm and the endoderm.
The anterior part of the oral cavity is lined by the epithelium derived from the ectoderm.
By 13–20 weeks differences between keratinized and nonkeratinized mucosa becomes
apparent. Keratohyaline granules in the keratinized mucosa and region specific cytokeratin
appear.
Lingual papillae appear early at about 7th week; the circumvallate and foliate papillae appear
earlier than filiform papillae, which can be recognized by 10–12 weeks.

FUNCTIONS OF ORAL MUCOSA
DEFENSE
1.Effective barrier for the entry of the microorganisms.
2.The oral mucosa is impermeable to bacterial toxins. It also secretes antibodies
and has an efficient humoral and cell mediated immunity.

LUBRICATION
The secretion of salivary glands keeps the oral cavity moist and thus prevents
the mucosa from drying and cracking thereby ensuring an intact oral
epithelium.
A moist oral cavity helps in speech, mastication, swallowing and in the
perception of taste.

SENSORY
The oral mucosa is sensitive to touch, pressure, pain and temperature.
The sensation of taste is a unique sensation, felt only in the anterior 2/3rd
of the dorsum of the tongue.
Swallowing, gagging, retching and salivating reflexes are initiated by
receptors in the oral mucosa.
Touch sensations in the soft palate results in gag reflex.

PROTECTION
• The oral mucosa protects the deeper tissues from
mechanical forces resulting from mastication and from
abrasive nature of foodstuffs.

STRUCTURE OF ORAL MUCOSA
1.EPITHELIUM
2.LAMINA PROPRIA
3.SUBMUCOSA

EPITHELIUM
• The epithelium of the oral mucous membrane is of the stratified squamous
variety. It may be keratinized (orthokeratinized or parakeratinized) or
nonkeratinized, depending on location.
In orthokeratinization, nuclei is lost in
keratinized surface layer.
 In parakeratinization, the cells retain
pyknotic and condensed nuclei and
other partially lysed cell organelles until
they desquamate.

Interphase of epithelium and lamina
propria:
Epithelium form projections called
epithelium ridges and connective tissue
extentions called papilla.
Ridges fit well with the papilla and has a
corrugated appearance called serpentine
appearance.
Interlocking arrangement increases the
area of contact between lamina propria and
epithelium. Also, facilitates exchange of
material between epithelium and blood
vessels in C.T.

BASEMENT MEMBRANE
Under light microscopy-- The interface
between the connective tissue and the
epithelium called basament membrane,
appears thick and it includes the reticular
fibers.
 It is a zone that is 1 to 4 μ m wide .
 This zone stains positively with the
periodic acid-Schiff method, indicating that it
contains neutral mucopolysaccharides.

• Under Electron Microscope-- It is called Basal
Lamina.
Ultrastructural level consists of zones:
• LAMINA LUCIDA: clear zone, 20-40nm wide
glycoprotein layer, Contain type 4 collagen and
laminin.
• LAMINA DENSA: Dark zone,type 4 collegen coated
with heparan sulfate in chicken wire (net like)
confriguration. ANCHORING FIBERS consisting of
collagen type 7,forms loops and insert into lamina
densa and forms flexible attachment between the
basal lamina and subjacent C.T.
Page 293, tencate

LAMINA PROPRIA
Page No-260,Orbans Oral Histology & Embryology.13/E, page293, tencate
- Connective tissue that supports epithelium.
- Consists of blood vessels, nerve, fibers
embedded in amorphous ground substance.
- type 1 and 3 collagen fibers
- cells- fibroblast, macrophages, mast cells etc.

PAPILLARY LAYER
-Superficial layer,between the
epithelial ridges and the
reticular portion is below it.
-collegen fibers are thin and loosely
arranged.
RETICULAR LAYER
-Collegen fibers are thicker bundles that lie
parallel to the surface plane. The reticular
layer was thought to contain fine immature
argyrophilic (silver staining) reticular fibers.
The reticular layer contains netlike
arrangement of collagen fibers.

SUBMUCOSA
The submucosa consists of connective
tissue of varying thickness and density.
 It attaches the epithelium and lamina
propria to the underlying structures.
 Whether this attachment is loose or firm
depends on the character of the
submucosa.
Glands, blood vessels, nerves , adipose
tissue +nt.

KERATINIZED EPITHELIUM
 Stratum basale
Stratum spinosum
Stratum granulosum
Stratum corneum

STRATUM BASALE
The basal layer is low cuboidal cells
made up of single layer that
synthesize DNA and undergo
mitosis.
New cells are generated in the
basal layer.
The basal cell and the para basal
cells together called STRATUM
GERMINATIVAM, but only Basal
cell can divide.

Basal cells are made up
of 2 population:
Serrated: low cuboidal,
numerous protoplasmic
processes,heavily
packed with
tonofilament.
Non Serrated:
slow type: protect the
genetic information
Fast type: increases the
Mitotic figures
Microfilaments
RER

STRATUM SPINOSUM
The spinous cells which make up this
layer are irregularly polyhedral and
larger than the basal cells.
 On the basis of light microscopy, it
appears that the cells are joined by
“intercellular bridges.
Page No-268,Orbans, tencate

electron microscopy, show that intercellular bridges are Desmosomes And
Tonofibrils( bundle of tonofilaments)
Tonofilament Network and desmosomes appear To make up the tensile
support stucture of the epithelium.
The spiny appearance of Spinous layer Is due to the shrinkage of cells during
tissue preparations causing them to seprate at points Where desmosomes
don’t attach them.
It resembles the COCKLEBUR OR POSTAL STICKER appearance

STRATUM GRANULOSUM
This layer contains flatter and wider cells.
These cells are larger than the spinous cells.
This layer is named for the basophilic
keratohyalin granules that it contains.
The nuclei show signs of degeneration and
pyknosis. This layer still synthesizes protein,
but reports of synthesis rates at this level
differ.
Page No-303,Tencate’s

• Odland bodies are lamellated structure made up of glycoproteins.
• Present near cell membrane.
• OD Bodies secrete glycolipid into intercellular space - impermeable
cellmembrane is formedThicking of the cells of the st.granulosum
cross linking of proteinCalcium depostion cell death occurs
Thickened keratin layer Is layed down.
KERATINOSOMES/ ODLAND BODIES/ MEMBRANE COATING GRANULES forms in
the upper Spinous and granular layer.
In keratinized: these are enlongated and lamellar.
In non keratinized: circular and amorphous.

STRATUM CORNEUM
The stratum corneum is made up of
keratinized squamae, which are larger and
flatter than the granular cells.
Thickness of stratum corneum varies at
different sites in the oral cavity and is
thicker than most areas of the skin.
Here all of the nuclei and other organelles
such as ribosomes and mitochondria have
disappeared.

NON KERATINIZED EPITHELIUM
• In nonkeratinized oral epithelium the events taking place in the upper cell layers are far less
dramatic than those in keratinized epithelium.
Page No-306,Tencate’s 8th Edition , page,225 orbans
• Different layers :
• Stratum basale: cells are simillar to that of
keratinized epithelium.
• Stratum intermedium: have larger cells than
spinosum, also the intercellular spaces are not that
distended hence the cells donot have prickly
appreance.
• Stratum Superficale: clntain nucleated cells. Contain
less amount of tonofilaments and lack keratohyline

KERATINOCYTES
These are epidermal/epithelial cell that synthesizes keratin and its characteristic
intermediate filament protein is cytokeratin.
 Keratinocytes increase in volume in each successive layer from basal to superficial. The
cells of each successive layer cover a larger area than do the cells of the layers.
NON-KERATINOCYTES
The epithelium contains a smaller population of cells that do not possess cytokeratin
filaments, hence they do not have the ability to keratinize.
Do not show mitotic activity, undergo maturative changes or desquamate. They are not
arranged in layers and do not form desmosomal attachments with adjacent keratinocytes.

Page No-305,Tencate’s oral histology ,Development,structure &function.8th Edition

DIFFERENCE
Page No-302,Tencate’s oral histology ,Development, structure &function.8th Edition

The epithelium of lining mucosa can attain a larger thickness than
that of masticatory mucosa, sometimes exceeding 500 µm in the
cheek, and is nonkeratinized.
The surface is thus flexible and able to withstand stretching.
The lamina propria is generally thicker than in masticatory mucosa
and contains fewer collagen fibers.
LINING MUCOSA

LINING MUCOSA
Labial and buccal
mucosa
Very thick, nonkeratinized,
stratified squamous
Epithelium.
Long, slender papillae;
dense
fibrous connective tissue
containing collagen and
some
elastic fibers; rich vascular
supply giving off
anastomosing
capillary loops into papillae
Mucosa firmly attached to
underlying
muscle by collagen and
elastin;
dense collagenous
connective tissue
with fat, minor salivary
glands,
sometimes sebaceous
glands
EPITHELIUM LAMINA PROPRIA SUB MUCOSA

REGION COVERING
EPITHELIUM
LAMINA PROPRIA SUBMUCOSA
Alveolar mucosa Thin, nonkeratinized,
stratified
squamous epithelium
Short papillae,
connective
tissue containing many
elastic
fibers; capillary loops
close to
the surface supplied by
vessels running
superficially
to the periosteum
Loose connective tissue,
containing
thick elastic fibers
attaching it to
periosteum of alveolar
process;
minor salivary glands.

REGION COVERING EPITHELIUM LAMINA PROPRIA SUBMUCOSA
Ventral surface of
tongue
Thin, nonkeratinized,
stratified
squamous epithelium.
Thin with numerous short
papillae and some elastic
fibers; a few minor salivary
glands; capillary network
in sub papillary layer;
reticular layer relatively
avascular.
Thin and irregular; may
contain fat and
small vessels; where
absent, mucosa
is bound to connective
tissue
surrounding tongue
musculature.

Floor of mouth Very thin, nonkeratinized,
stratified squamous
Epithelium.
Short papillae; some
elastic fibers; extensive
vascular
supply with short
anastomosing capillary
loops.
Loose fibrous connective
tissue
containing fat and minor
salivary
glands.

Lining Mucosa
Soft palate Thin, nonkeratinized
stratified squamous
epithelium;
Thick with numerous short
papillae; elastic fibers
forming
on elastic lamina; highly
vascular with well-defined
capillary network.
Diffuse tissue containing
numerous
minor salivary glands
taste
buds present.

Specialized Mucosa
Dorsal surface of
tongue
Thick, keratinized and
nonkeratinized, stratified
squamous epithelium
forming
three types of lingual
papillae, some bearing
taste
buds
Long papillae; minor
salivary
glands in posterior portion;
rich innervation especially
near taste buds; capillary
plexus in papillary layer;
large
vessels lying deeper
No distinct layer; mucosa
is bound to
connective tissue
surrounding
musculature of tongue
SPECIALIZED MUCOSA

Different papillae-
FILIFORM PAPILLAE- Most numerous ,
cone shaped,+nt on dorsum of tongue,
keretanized epithelium, no taste buds +nt.
FUNGIFORM PAPILLAE- appear as red
prominence on tongue, rich capillary
network inside, 1-3 taste buds +nt.
Tencate’s

• VALLATE PAPILLAE- 8-10 in no, +nt in front
of sulcus terminalis, deep circular groove into
which open the ducts of von ebners salivary
gland( contain salivary lipase enzyme), contain
taste buds.
• FOLIATE PAPILLAE- leaflike, taste buds +nt.

TASTE BUDS
Taste buds are small ovoid or barrel-shaped intraepithelial
organs about 80 μ m high and 40 μ m thick.
Their outer surface is almost covered by a few flat epithelial
cells, which surround a small opening, the taste pore. It leads
into a narrow space lined by the supporting cells of the taste
bud. The outer supporting cells are arranged like the staves of a
barrel.
The inner and shorter ones are spindle shaped. Between the
latter are arranged 10 to 12 neuroepithelial cells, the receptors
of taste stimuli.

VALLA
TE
FUNGIFOR
M
FOLIAT
E
FUNGIFOR
M
• NERVE SUPPLY OF TONGUE
• Sensory:
ant 2/3 – lingual branch of trigeminal nerve
post 1/3- glossopharyngeal nerve
• Taste senation:
Ant2/3 – chorda tympani branch of facial nerve.
Post-1/3- glossophangeal nerve.
• Motor senstation:
hypoglossal nerve except palatoglossus which
is supplied by vagus nerve.
TASTE
SENSATION

MASTICATORY MUCOSA
It covers hard palate and gingiva that are exposed to compressive
and shear forces and to abrasion during the mastication of food.
The epithelium of masticatory mucosa is moderately thick and
frequently is orthokeratinized, although normally parakeratinized
areas of the gingiva and occasionally of the palate do occur.

Hard palate Thick, orthokeratinized
(often
parakeratinized in parts),
stratified squamous
epithelium thrown into
transverse palatine ridges
(rugae)
Long papillae; thick, dense
collagenous tissue,
especially
under rugae; moderate
vascular supply with short
capillary loops.
Dense collagenous
connective tissue
attaching mucosa to
periosteum
(mucoperiosteum); fat and
minor salivary glands are
packed into connective
tissue in regions where
mucosa overlies lateral
palatine
neurovascular bundles.
MASTICATORY MUCOSA
EPITHELIUM LAMINA PROPRIA SUB MUCOSA

REGION COVERING
EPITHELIUM
LAMINA PROPRIA SUBMUCOSA
Gingiva Thick, orthokeratinized or
parakeratinized, stratified
squamous epithelium
often
showing stippled surface
Long, narrow papillae;
dense collagenous
connective tissue;
not highly vascular but
has
long capillary loops with
numerous anastomoses
No distinct layer; mucosa
firmly
attached by collagen
fibers to
cementum and
periosteum of
alveolar process
(mucoperiosteum)

GINGIVA
• The gingiva eXtends from the dentogingival junction to the alveolar mucosa.
• It can be orthokeratinized (15%) , parakertinized(75%), nonkeratinized (10%)
• Can be divided into:

GINGIVAL LIGAMENTS:
• Collagen fibers present in lamina propria are arranged in various groups:

VERMILLION BORDER OF LIP
• The trasitional zone between
the skin and the lip. Found
only in humans.

GINGIVAL SULCUS AND
DENTOGINGIVAL JUNCTION
• Gingival sulcus: it’s a narrow space between inner
aspect of gingiva and the tooth.
• It is V-shaped.
• The sulcus extends from the free gingival margin to
dentogingival junction.
• Sulcular epithelium is non keratinized, lacks
epithelium ridges , forms a smooth interface with
lamina propria, depth of gingival sulcus is 0.5 to
1.8mm ( ~2mm).
• It Acts as semi permeable membrane.
Page 240, tencate

DENTOGINGIVAL JUNCTION
• Junction between the gingiva and the tooth.
• Epithelium which gets attached to tooth called
JUNCTIONAL or ATTACHMENT EPITHELIUM.
• Juctional epithelium is collar like St. Sq. Non kerat.
Epithelium.
• Length- 0.25 to 1.35mm, hight turnover rate 5-6days.
• It is permeable, heavily infiltrated by NEUTROPHIL
CELLS
• It is 3-4 layer thick in early life, But no. Of layer
increases with age to 10-20 layers.
• JE tapers from its coronal end which may be 10-29
cells Wide to 1-2 cells wide at its Apical termination.
Page 241 orbans

JE formed by the confluence of the Oral
epithelium and the Reduced enamel
epithelium (REE ) during tooth eruption.
• JE attached to the tooth surface by the
Means of INTERNAL BASAL LAMINA and
attached to the Gingival C.T by EXTERNAL
BASAL LAMINA.
• Attachment of JE is reinforced by Gingival
fibers, Which brace the marginal gingiva
against the tooth surface and for this reason
the JE and Gingival fibers Are considerd as
a functional unit Called DENTOGINGIVAL
UNIT. Page 241, orbans

DEVELOPMENT OF DGJ
REE covers the
entire surface of
Enamel, extending to
CEJ.
During eruption, tip of th tooth
approaches the oral mucosa,,
REE and oral epithelium meet
and fuses.
Epithelium the covers the tip of crown
degenrates in its center, tooth emerges out
into oral cavity.
REE remains organically attached to the part
of enamel that has not yet erupted.
Once tip of crown emerged, REE termed as
A shallow groove (gingival
sulcus) may develop
between gingiva and
surface of tooth
Page 242, orbans

SHIFT OF DGJ
• Active eruption is actual movement of tooth towards occlusal plane.
• Once reached to the occlusal plane, sepration of PAE from tooth called Passive eruption.
REE
Tooth erupts in oral
cavity
PAE
GINGIVAL EPITHELIUM
Attaches. gingiva to tooth,
also called as
SECONDARY ATTACHMENT
EPITHELIUM
Gradually, REE is lost
A

AGE CHANGES
With age the oral mucosa becomes smooth and dry.
These are due to epithelium becoming thin mainly due to the reduction in the
thickness of epithelial ridges and decrease in the salivary secretion.
The filiform papilla becomes reduced and the tongue appears smooth owing to
the reduction in the thickness of the epithelium.
Nutritional deficiencies may also be a contributing factor for this change. Varicose
veins on the ventral aspect of tongue are often seen and these are termed as
lingual varices.
Langerhans cells include a progressive loss of sensitivity to thermal, chemical and
mechanical stimuli, and with decline in taste perception.

•DEVELOPMENTAL
DISTURBANCES
OF ORAL MUCOSA.

FORDYCES GRANULES
Fordyce’s granules appear as small yellow spots, either discretely separated or
forming relatively large plaques, often projecting slightly above the surface of the
tissue.
• They are found most frequently in a bilaterally
symmetrical pattern on the mucosa of the cheeks
opposite the molar teeth but also occur on the inner
surfaces of the lips, in the retromolar region lateral to
the anterior faucial pillar, and occasionally on the
tongue, gingiva, frenum, and palate.
Page 127,

TREATMENT
• These glands are innocuous, have no clinical or functional significance, and
require no treatment. However, very rarely a benign sebaceous gland
adenoma may develop from these intraoral structures, such as in the case
involving the buccal mucosa.
Page No-127,Shafer’s Textbook of Oral Pathology.7th edition.

FOCAL EPITHELIAL HYPERPLASIA
(HECK’S DISEASE)
One of the most contagious of the oral papillary lesions is focal epithelial
hyperplasia.
It is also known as Heck’s disease or multifocal papilloma is a rare benign
lesion of the oral mucosa produced by the subtypes 13 or 32 of human
papillomavirus.

CLINICAL FEATURES
Primarily occurs in children, but lesions may occur
in young and middle-aged adults.
Hyperplastic lesions are small (0.3–1.0
cm),discrete, and well-demarcated, but they
frequently cluster so closely together that the
entire mucosal area takes on a cobblestone or
fissured appearance.

TREATMENT
Conservative excisional biopsy may be required to establish the proper
diagnosis, but additional treatment is unnecessary, except perhaps for
esthetic reasons relating to visible labial lesions. Spontaneous regression
has been reported after months or years, and the disease is rather rare in
adults.

RED AND WHITE
LESION OF ORAL
MUCOSA

RED AND WHITE TISSUE
REACTIONS
INFECTIOUS DISEASE
Oral Candidiasis
Hairy Leukoplakia
PREMALIGNANT LESION
Oral Leukoplakia and Erythroplakia
Oral Submucous Fibrosis.
IMMUNOPATHOLOGIC DISEASES
Oral Lichen Planus
Drug-Induced Lichenoid Reactions
Lichenoid Reactions of Graft- versus-Host
Disease
Lupus Erythematosus
ALLERGIC REACTIONS
Lichenoid Contact Reactions
Reactions to Dentifrice and
Chlorhexidine
TOXIC REACTIONS
Reactions to Smokeless Tobacco
Smoker’s Palate
REACTIONS TO MECHANICAL
TRAUMA
Morsicatio
OTHER RED AND WHITE
LESIONS
Benign Migratory Glossitis)
Leukoedema
White Sponge Nevus
Hairy Tongue
CLASSIFICATION
Page no-92,Burket’s Oral Medicine,11th edition.

ORAL CANDIDIASIS
PREDISPOSING FACTORS
Denture wearing
Smoking
Atopic constitution
Inhalation steroids
Topical steroids
Imbalance of oral microflora
Quantity and quality of saliva
Immunosuppressive disease
Chemotherapy
Endocrine deficiency
ETIOLOGY
C. albicans,
C.tropicalis, and
C.glabrata comprise
together over 80% of
the species isolated
from human Candida
infections.

CANDIDIASIS
CHRONIC PLAQUE TYPE NODULAR TYPE

ERYTHEMATOUS TYPE
PSEUDOMEMBRANOUS CANDIDIASIS

TREATMENT
Identify any predisposing factor.
Polyenes such as nystatin and amphotericin B are the first alternatives in
treatment of primary oral candidiasis and are well tolerated.
Topical treatment with azoles such as miconazole is the treatment of
choice in angular cheilitis often infected by both S. aureus and Candida.
Systemic azoles may be used for deeply seated primary candidiasis,
such as as chronic hyperplastic candidiasis, denture stomatitis, and
median rhomboid glossitis .

LEUKOEDEMA
Leukoedema is an abnormality of the buccal
mucosa which clinically resembles early
leukoplakia, but appears to differ from it in
certain respects.
Wood & Goaz.Differential diagnosis of oral &maxillofacial lesions.5/Edition

CLINICAL FEATURES
• The gross appearance varies from a filmy opalescence of the mucosa in the early
stages to a more definite greyish-white cast with a coarsely wrinkled surface in the
later stages.
• Lesions occur bilaterally in the majority of cases and frequently involve most of
the buccal mucosa, extending onto the oral surface of the lips.
• Most noticeable along the occlusal line in the bicuspid and molar region.

LEUKOPLAKIA
(LEUKOKERATOSIS)
The World Health Organization defined leukoplakia as "a white patch or
plaque that cannot be characterized clinically or pathologically as any
other diseases as with other keratotic lesions, it cannot be scraped off with
a tongue blade.
Shafer’s Textbook of Oral Pathology.7th Edition

ETIOLOGY
Tobacco products
 Ethanol
Hot, cold, spicy, and acidic foods and beverages
 Alcoholic mouth rinse
Occlusal trauma
Sharp edges of prostheses or teeth
 Actinic radiation
 Syphilis
Presence of Candida albicans
 Presence of viruses

CLINICAL FEATURES
Leukoplakic lesions are characteristically asymptomatic and are most often discovered during a
routine oral examination.
 Frequent sites are the lip vermilion, buccal mucosa, mandibular gingiva, tongue, oral floor,
hard palate, maxillary gingiva, lip mucosa, and soft palate.
The lesions may vary greatly in size, shape, and distribution. The borders may be distinct or
indistinct and smoothly contoured or ragged.
The lesions may be solitary, or multiple plaques may be scattered through the mouth.
Shafer’s Textbook of Oral Pathology.7th Edition

CLINICAL TYPES OF LEUKOPLAKIA
Homogeneous type
Speckled type
White and red patches
Verrucous type

TREATMENT
For low-risk lesions, every effort must be made to identify local and chronic
causative irritants. The cause may be obvious from the location of the lesion.
 A simple procedure for small lesions is, however a relatively complicated
operation if the lesions are large, involve many surfaces, or are in a surgically
delicate site. A"ridge callus" is an exception and would not require excision in
most cases.

ERYTHROPLAKIA
• The term ‘erythroplakia’ is used analogously to leukoplakia to
designate lesions of the oral mucosa that present as bright red
velvety plaques which cannot be characterized clinically or
pathologically as due to any other condition.
Page 420-Shafers Textbook of oral pathology.7th edition

SMOKER’S PALATE
Nicotine stomatitis is a specific type of leukoplakia seen
mostly in men who are pipe smokers.
 The etiology is probably more related to the high
temperature rather that the chemical composition of the
smoke, although there is a synergistic effect of the two.
It begins as a reddish stomatitis of the palatal mucosa,
and as the irritation is continued, keratotic changes occur
and the lesion becomes slightly opalescent and finally
white in colour.

ORAL SUBMUCOUS FIBROSIS
It is a chronic disease that affects the oral mucosa as well as the
pharynx and the upper two-thirds of the esophagus. There is
substantial evidence that lends support to a critical role of areca
nuts in the etiology behind submucous fibrosis.
Page no-103,Burket’s Oral Medicine,11th edition

The onset is insidious, over a two to five years.
This includes a burning sensation in the mouth when consuming spicy
food, appearance of blisters especially on the palate, ulcerations or
recurrent generalized inflammation of the oral mucosa, excessive
salivation, defective gustatory sensation and dryness of the mouth.
Page no-445,Shafer’s Textbook of Oral Pathology.7th Edition

(A) Horizontal fibrosis traversing at the junction of hard
and soft palate. (B)Involvement of pterygomandibular
raphae compounding the difficulty of mouth opening.
Advanced OSF with difficulty in
opening the mouth.
Page no-98,Shafer’s Textbook of Oral Pathology.7th Edition

TREATMENT
Nutritional support.- vit A, B complex, c, iron.
Physiotherapy.
Prescription of chewable pellets of hydrocortisone
( 1pellet to be chewed 3,4 hours for 3 to 4 weeks)
Local drug delivery.-0.5ml intralesional inj
HYALURONIDASE 1500IU mixed in 1ml of
LIGNOCAINE/ 0.5ml of HYDROCORTISONE ACETATE
into each buccal mucosa once a week for 4 weeks
or more.
Surgical management. Recommended in
interincisor distance is less than 2 cm.
Multiple Z shaped incisions are made into fibrotic
tissue then sutured in a straighter fashion.
PAGE No-446.Shafer’s Textbook of Oral Pathology.7th Edition

GEOGRAPHIC TONGUE
Annular lesion affecting the dorsum and margin of
the tongue.
Geographic tongue is circumferentially migrating and
leaves an erythematous area behind, reflecting
atrophy of the filiform papillae.
Geographic tongue may regress, but it is not possible
to predict when and to which patient this may happen.
The prevalence of the disease seems to decrease with
age, which supports spontaneous regression over
time.
Page no-119,Burkit Oral Medicine,11th edition.

HAIRY TONGUE
Hairy tongue is characterized by an impaired
desquamation of the filiform papilla, which
leads to the hairy-like clinical appearance.
The elongated papillae have to reach lengths in
excess of 3 mm to be classified as “hairy,”
although lengths of more than just 15 mm have
been reported in hairy tongue.
Patients should be informed about the
benign and noncontagious nature of hairy
tongue.
Page no-121,Burkit Oral Medicine,11th edition.

CONCLUSION
Oral mucosa lines the oral cavity. It is continuous with skin of the lip through the
vermilion border and with the mucosa of pharynx posteriorly.
Mucosa consists of a stratified squamous epithelium and the connective tissue
called lamina propria. The mucosa is attached to the underlying structure, which is
either bone or muscle, by a loose connective tissue called the submucosa.
The masticatory mucosa is tightly bound to the bone while the lining mucosa is
loosely attached to muscles to allow distention.

REFERENCES
1.Orbans Oral Histology & Embryology.13/Edition.
2.Tencate’s oral histology ,Development,structure &function.8th Edition
3.Wood & Goaz.Differential diagnosis of oral &maxillofacial lesions.5/Edition.
4.Burkit Oral Medicine,11th edition.
5.Shafer’s Textbook of Oral Pathology.7th Edition

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