Miscellaneous Disorders of

Oral Mucosa

Frenal Tag
Lingual Tonsil, Foliate Papillitis
Geographic Tongue
Orofacial Granulomatosis
Crohn’s Disease
Sarcoidosis
Pyostomatitis Vegetans
Wegener’s Granulomatosis
Progressive Systemic Sclerosis
Verruciform Xanthoma
Oral Submucous Fibrosis
Amyloidosis
Oral Pigmentation
Age Changes
 *Frenal Tag

• A redundant piece of mucosal

tissue that projects from the
maxillary labial frenum.

* Not in textbook
 Lingual Tonsil, Foliate Papillitis

• Lingual tonsillar tissue is located on

posterior part of lateral aspect of
tongue, with overlying vertical folds
known as foliate papillae.

• Inflammation or reactive
hyperplasia of this tissue causes
enlargement known as foliate
papillitis.

• Obstruction of tonsillar crypts may

cause cyst formation resulting in
oral lymphoepithelial cyst.

• Occasional accessory oral tonsils

are found elsewhere in the oral
cavity.
 Geographic Tongue
))Benign Migratory Glossitis
• Common condition of unknown etiology,
affecting ~1% of population.

• Irregular, partially depapillated, red areas

on anterior 2/3rds of dorsal tongue.

• Margins often outlined by a thin white

line.

• Frequently associated with fissured

tongue.

• Appears as small, gradually enlarging

lesion)s), which heal and reappear in
another location )migratory).

• Usually asymptomatic, sometimes

sensitive to acidic & spicy foods.
 Geographic Tongue
))Benign Migratory Glossitis

• Similar lesions occasionally affect

other parts of oral mucosa
)migratory or geographic stomatitis
or erythema migrans).

• Debatable association with

psoriasis in view of histopathologic
similarity.

• Histopathologic features:
- acanthosis at edges.
- dense neutrophil infiltration of
epithelium )microabscesses) &
lamina propria, with underlying
chronic inflammation.
Orofacial Granulomatosis
• A clinical term used to describe common
clinicopathological manifestations of a
variety of disorders.

• Clinically: recurrent or persistent diffuse

enlargement of lips and cheeks or as
diffuse facial swelling.

• Histopathologically: non-caseating
chronic granulomatous inflammation with
or without giant cells, and edema of
tissue.

• Possible causes:
8. Crohn’s disease
9. Sarcoidosis
10.Infective granulomas
11.Foreign bodies
12.Melkersson-Rosenthal syndrome
13.Allergies
14.Idiopathic.
 Crohn’s Disease
• A chronic granulomatous disease
involving any part of GIT, most
commonly terminal ileum.

• Oral lesions may occur in

established intestinal disease, or
may be the presenting feature.

• Chronic course with periods of

quiescence interrupted by episodes
of varying severity & duration.

• Unknown etiology, possibly

reaction to external agent, may be
infective.

• Abdominal pain & nutritional

deficiencies due to malabsorption.
 Crohn’s Disease

• Oral manifestations:
2. Diffuse swellings of lips & cheeks
)orofacial granulomatosis).
3. Edematous hyperplastic
buccolabial mucosa with fissuring
)cobblestone appearance).
4. Edematous hyperplastic
enlargements of buccolabial
mucosa involving sulci, with
polypoid tag-like lesions or deep
folds.
5. Aphthous or linear fissure-like
ulcers.
6. Atrophic glossitis due to vitamin
B12 malabsorption.
 Sarcoidosis

• Systemic chronic granulomatous

disorder of unknown etiology.

• Suggested unusual response to

exogenous agent.

• Young adults.

• Bilateral hilar lymphadenopathy,

pulmonary infiltration, skin or eye
lesions.

• Insidious onset, signs & symptoms

disappear in time but sometimes
leave residual swelling.
 Sarcoidosis

• Oral mucosal & GI involvement

rare.

• May present as submucosal,

painless red nodules and as
erythema, granularity, or
hyperplasia of gingiva.

• May present as orofacial

granulomatosis.

• Salivary gland involvement, usually

parotid.

• Minor salivary gland biopsy is

sometimes a helpful diagnostic tool.
 Sarcoidosis
• Heerfordt syndrome )uveoparotid
fever):
- uveitis
- parotitis
- facial paralysis.

Histopqathologic Features:

• Small non-caseating granulomas

consisting of macrophages &
epithelioid histiocytes, often with
Langhans-type giant cells.

Laboratory Findings:

• Raised ESR, hyperproteinemia,

elavated ACE, & hypercalciuria.
 Pyostomatitis Vegetans
• Rare disorder associated with
inflammatory bowel disease,
especially UC.

• Lips & cheeks diffusely inflamed

with erosions, fissured ulcers,
pustules and vegetations.

• Cervical lymphadenitis & pyrexia.

• Skin lesions )pyodermatitis) may

occur at the same time.

• Severity of oral lesions varies with

that of bowel involvement.

• UC also predisposes to recurrent

aphthous stomatitis.
 Wegener’s Granulomatosis
• Necrotizing, destructive granulomatous
inflammation of respiratory tract, and
generalized necrotizing vasculitis.

• Rhinitis, sinusitis, cough, & hemoptysis.

• Autoantibodies against cytoplasmic

components of neutrophils and
monocytes )c-ANCA).

• May be controlled with corticosteroids &

cytotoxic medications, otherwise fatal due
to renal failure.

• Oral involvement common and may be

the presenting feature in the form of:

- characteristic hyperplastic gingivitis

)strawberry gingivitis).

- heavily inflamed granular exophytic

lesions.

- deep necrotic oral ulceration.

Progressive Systemic Sclerosis
))Scleroderma

• Chronic multi-system disease

characterized by diffuse fibrosis of
skin and internal organs.

• Facial involvement results in

restricted mouth opening &
expressionless )mask-like) face.

• Females aged 20-50 years.

• Generalized widening of PDL

space on oral radiographs.

• Association with other autoimmune

diseases : LE, RA, Sjögren’s
syndrome suggests autoimmune
etiology.
 Verruciform Xanthoma
• Uncommon lesion mostly occurring
on gingiva and hard palate.

• Flat or slightly raised lesion with

papillary surface.

• Probably occurs in reaction to

release of lipid from degenerating
epithelial cells.

• Histopathologic Features:

- hyperplastic epithelium with

papillary projections.

- CT papillae infiltrated by lipid-

containing foam cells )xanthoma
cells).
Oral Submucous Fibrosis
• Insidious chronic disease which
affects any part of oral mucosa and
may extend to pharynx and
esophagus.

• Progressive stiffening of oral

mucosa associated with underlying
fibrosis.

• Exclusively limited to Asiatic

Indians.

• Strongly linked to areca nut

chewing habits )betel quid, betel
nut) with possible genetic
susceptibility.

• Regarded as a premalignant
condition often associated with
epithelial atrophy and dysplasia.
 Amyloidosis

• Extracellular deposition of fibrillar

proteinaceous material-amyloid- in
various tissues.

• AL type: fragments of
immunoglobulin light chains in
primary )idiopathic) amyloidosis
and amyloidosis associated with
multiple myeloma.

• AA type: amyloid A protein in

secondary or reactive amyloidosis
which complicates chronic
inflammatory lesions and some
malignancies.
 Amyloidosis

• Oral manifestations described with

primary amyloidosis and MM:

- Macroglossia.

- Petechiae, ecchynoses, hemorrhagic

bullae, ulcers.

- Localized amyloid deposits in the form

of yellowish macules or papules.

- Widespread symptomless infiltration of

oral tissues.

- Involvement of salivary glands may

result in xerostomia.
 Amyloidosis

• Diagnosis is confirmed by
biopsy )Congo red stain).

• Even without apparent oral

involvement, biopsy of tongue
or gingiva may be a useful
diagnostic test.

• Diagnosis for generalized

amyloidosis is poor and death
results from organ failure.
Oral Pigmentation:
I. Exogenous Pigmentation

• Superficial staining of mucosa.

• Black hairy tongue.

• Foreign bodies: amalgam

tattoo, miscellaneous.

• Heavy metal salts.

Oral Pigmentation:
II. Endogenous Melanin
Pigmentation
• Developmental causes: racial
pigmentation, pigmented nevi, Peutz-
Jeghers syndrome.

• Acquired causes:
- associated with systemic disease:
Addison’s disease, pulmonary disease,
HIV infection.
- associated with hyperkeratosis, chronic
inflammation, and lichen planus.
- smoker’s melanosis.*

• Acquired causes:
- drug-induced.
- idiopathic oral melanotic macule )oral
freckle).
- lentigo simplex.

• Neoplastic causes: melanoma in situ and

melanoma.
 Oral Pigmentation:
III. Other endogenous
pigments

• blood breakdown products and

disturbances of iron
metabolism.
 Age Changes in the Oral
Mucosa

• Atrophy of lingual mucosa.

• CT becomes more fibrosed, less

vascular, & less cellular.

• Atherosclerotic changes in arteries.

• Sublingual varices.

• Increased prominence of Fordyce’s

granules.

• Foliate papillitis.

• Effects of systemic disease, nutritional

deficiences, & side-effects of medications
are more frequent in the elderly.