Primary lesions of the oral mucosa are primarily: abrasions, lumps, blisters, vesicles, lumps, bumps, spots, pustules, blisters. Secondary eruptions: erosions, ulcers, fissures, scales, scabs and scars are the decay of primary eruptions in their further duration or in the period of disease recovery.
Primary eruptions of the oral mucosa
STAIN (macula) this is a discoloration with a limited outline that remains in line with the adjacent mucosa. There are different types of stains:
I. Vascular, caused by active hyperemia during dilatation
1. vascular, increased blood flow, may also arise after vessel damage; they are vivid red in color, this type of stains appear in infectious and allergic diseases, also in the vicinity of vesicles or erosions, more extensive stains appear on the palate, e.g. under the denture plate.
2. Formed as a result of passive hyperemia with stenosis and slowing of blood flow, this blue color occurs in the presence of insufficiency of the circulatory system, also with venous dilatations on the lower surface of the tongue.
3. Of the nature of permanent vasodilation (telangiectasia), eg in Rendu-Osler disease.
4. Formed after extravasation of blood to the oral mucosa in the form of a linear streak (vibices), punctate, oval (petechiae), variously shaped, irregular (ecchymoses) spots; Unlike vascular spots, they do not fade when pressed with a slide; in Werlhof’s disease there are vascular lesions of a staining character (purple).
II. Dye-based. They are associated with an excessive accumulation of dye in the base layer; in freckle spots (lentigines) the changes are multiple, but limited, in pigmentation spots (melanoplakia) they are diffuse.
III. Deposits. Mainly of extracorporeal origin, in chronic poisoning with heavy metals (silver, bismuth, lead, mercury), which in the form of sulphides are deposited in the form of a limb in the marginal gingiva.
IV. Associated with disorders of the oral mucosa keratosis, characteristic of leukoplakia.
GRUDKA (papula) is an eruption in relation to the adjacent mucosa, usually of a cohesive consistency, and disappears without leaving a scar. The papules vary in size, shape, color, and surface morphology. Due to the histopathological structure, it is distinguished epithelial papules (from enlarged epithelial elements) most often originating from the spinous layer, connective tissue (from elements of connective tissue) i mixed epithelial-connective tissue, for example, lichen planus eruptions. When irritated, they may become overgrown (genital warts).
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CATE BUBBLE (urtica) it is well demarcated from the environment, elevated in relation to the adjacent mucosa. Appears quickly and disappears quickly. Nettle rash may spread peripherally. They occur in hives. When pressed with a slide, they disappear. The appearance of eruptions is accompanied by itching.
BUBBLE (vesicula) it is a small eruption raised above the surface of the mucosa. It can be filled with serous, purulent or bloody content. The bubbles vary in size, shape and color. The accumulation of inflammatory fluid in the intercellular spaces takes place in eczema, intracellularly in the course of herpes, herpes zoster and chicken pox. The bubbles disappear without leaving a scar or an erosion is formed when the cover is peeled off.
Bladder (bull) it is an exanthema above the mucosa, larger than a vesicle and filled with fluid. It can arise on unchanged or inflamed ground. The blisters vary in size, shape, color, cohesiveness, quality and composition of the liquid content, surface morphology, and cover thickness. They usually break quickly in the mouth due to trauma such as chewing.
Depending on their location, the following types of blisters are distinguished:
1) podrogowe (bulla subcornealis),
2) intraepithelial (bulla intraepithelialis) occur within the spinous layer, the degenerative changes and decay of which give the characteristic results of the Tzanck test (acantholytic cells), characteristic for pemphigus proper (primary acantholysis) and herpetic lesions (secondary acantholysis); these blisters burst fairly quickly,
3) subepithelial (bulla subepithelialis), causing the detachment of the epithelium from the lamina propria and its elevation; such blisters are observed in the erosive form of lichen planus, pemphigus and exudative erythema multiforme.
BUMP (tuberculum, nodulus) is an exanthema above the adjacent mucosa, similar to a papule but located deeper in the connective tissue. The nodules differ in cohesiveness, surface structure, size (small nodules in lupus tuberculosis), shape and color (brown-red in lupus tuberculosis, gray-white in tuberculosis proper). Healing nodules leave scars. They may be invisible but palpable.
GUZ (nodus, tuber) it is an eruption larger than a nodule and deeper into the connective tissue. Tumors differ in size, shape (uneven in hemangiomas), cohesiveness (significant in neoplastic tumors, fibromas, actinomycetes), pedicle (narrow or wide base), surface morphology (polypoid, papillary), greater or lesser demarcation from the environment (clear demarcation, e.g. fibroma). Taking into account the etiopathogenesis, tumors are distinguished:
- inflammatory,
- specific,
- non-specific,
- cancerous.
KROSTA (pustules) it is a small eruption well demarcated from the surroundings, in which there is purulent content. Pustules may be sterile at first.
OPENING (excoriatio) belongs to superficial epithelial damage. It is most often caused by a mechanical injury, often of iatrogenic origin, for example when grinding teeth with carborundum or diamond stones. The defect may be superficial, it may concern only the stratum corneum or the entire epithelium.
Secondary eruptions of the oral mucosa
CROSSING (erosio) is a superficial defect in the epithelium formed secondary to mechanical trauma, after rupture (spontaneous or traumatic) of the cover of the vesicle, bladder or papule. Erosions heal without leaving scars and are often covered with a fibrin coating, e.g. aphthae. They may differ:
- size,
- shape (most often they are oval or round),
- edges (quite even, e.g. in aphthae, or uneven, e.g. in pemphigus),
- penetration of the base or substrate,
- the appearance of the bottom,
- color,
- environment (unchanged or inflamed, in aphthae it depends on their duration),
- soreness (e.g. aphthas show soreness in the first period).
Often, erosions are covered with a fibrinous bloom.
SOILING (ulcus, ulceratio) is a deep loss of epithelial and connective tissue. Heals leaving a scar. It arises as a result of the breakdown of primary eruptions (nodules, tumors, pustules) or as a result of physical injuries (mechanical, thermal, chemical, electrical or radiation), in some systemic diseases (blood diseases, bacterial, fungal, viral, trophic disorders, Cancer).
The diagnosis of mouth ulcers must take into account some characteristic features for specific disease entities:
- location,
- the shape of the bloom,
- extent,
- attachment of necrotic changes (agranulocytosis, leukemia),
- depth,
- digging into depth (neoplastic lesion),
- the presence or absence of an inflammatory reaction (absent in agranulocytosis),
- tendency to bleed,
- morphology of the edges of the exanthema (irregular, sharply cut, shaft in syphilis, infiltrated or curled outwards in tumors),
- morphology dna,
- the tenderness and behavior of the surrounding lymph nodes.
SPLIT, CRACK (rhagas, fissura) is a defect in the mucosa of a linear nature. The efflorescence may be shallow and affect only the epithelium or deeper, including the lamina propria. It is usually located on the lips or tongue, in places exposed to stretching, tightening in the corners of the mouth, or as a result of an injury. The factors predisposing to cracks are:
- drying of the mucosa,
- epithelial keratosis disorders,
- inflammations.
After healing, linear scars are visible (e.g. Parrot scars in congenital syphilis). Cracks may vary in size, depth and color; they can also show soreness.
HUSK (squama) it is a flap of keratinized epithelium that separates. Mostly dry scales are visible on the dermal part and red lips.
Hive (scab) it is formed as a result of drying of the secretions: serous, purulent or bloody, on the pathological surface. The secretions usually contain exfoliated fragments of the epithelium and bacteria. Scabs form only on the red lips and the skin part, including the corners of the mouth. Quite typical scabs are formed on the lips in the case of herpes and exudative erythema multiforme. The constant humidity in the mouth prevents the formation of scabs in it. A red discoloration of the surface persists for some time after the scab has fallen off.
BLIZNA (scar) it is a newly formed connective tissue that is formed at the site of a defect in the mucosa. It has much less elasticity. less blood supply, less nutrition. It is usually thin and has no mucosal appendages. Scars differ:
- size,
- shape,
- discoloration (fresh scars are redder, older scars are whitish),
- cohesion,
- surface morphology.
There are scars:
1) atrophic, with a smooth surface, e.g. in lupus erythematosus or scleroderma,
2) overgrown, uneven, thickened, e.g. scars from tuberculous ulcers or burns.
LITERATURE
1. Berkovitz B. i wsp.: Oral Anatomy, Histology & Embryology. Lippincott, Philadelphia 2007.
2. Górska R .: Diseases of the oral mucosa. Med Tour Press, Otwock 2007.
3. Knychalska-Karwan Z .: Physiology and pathology of the oral mucosa. Czelej, Lublin 2002.
4. Prabhu S.: Textbook of oral diagnosis. University Press, Oxford 2006.
5. Scheid C.: Dental Anatomy. Lippincott, Philadelphia 2007.
Source: Z. Knychalska-Karwan , PHYSIOLOGY AND PATHOLOGY OF THE ORAL Mucosa; Czelej Publishing House