TO INTRODUCE MYSELF

ELEANA STOUFI DDS, MSc, PhD

Eleana Stoufi, D.M.D., M.Sc.(Harvard University), Ph.D. Completed her postgraduate studies in Oral Medicine
and Oral Pathology at Harvard University of Boston, USA, and received her Ph.D from the University of Athens.
She is Part time Lecturer at Harvard School of Dental Medicine and Honorary Associate Professor at University
of Rwanda where she has served as HRH (Human Resources for Health) Harvard faculty member for 4 years
(2016-2019) teaching the Oral Medicine / Oral Pathology curriculum. She is Head of the Oral Medicine dpt of
the “Euroclinic Hospital” in Athens, and has been scientific Associate of the Dental School, University of Athens.
She has served as Scientific Director of a two year program for “Oral Cancer Prevention” sponsored by the EU,
the Greek Ministry of Health and the Greek Dental Association (2015-2016). Since 2019 is member of the
National Committee of the Greek Ministry of Health for strategic campaign against smoking and since 2020 is
elected Secretary of the Scientific Committee of the Greek Dental Association. Since 2022 has been external
contributor of the FDI tobacco cessation project task team. She has over 80 scientific publications and over 200
presentations at national and international meetings. She is the co-author of the book “Pocket Atlas of Oral
Diseases” in Greek (2019) and co-author of the new 2nd edition of the book “Periodontal Manifestations of
Local and Systemic Diseases” (2023) in English by Springer.

• Email: eleanastoufi@yahoo.com
• Address: Eleana Stoufi
Al. Soutsou 19, Athens 10671
• Tel: +30 6973407150
The Normal Oral
Mucosa
 NORMAL ORAL MUCOSA
• It is defined as a moist lining of oral cavity that communicates with the
exterior

• The oral mucosa consists of two layers:

✓ epithelium (stratified squamous epithelium)
✓ underlying layer of connective tissue,
(which contains capillaries, nerves, minor salivary glands).

• There are 3 main types of mucosa:

• Masticatory mucosa. (attached gingiva, hard palate, dorsum of tongue)
• Lining Mucosa. (floor of the mouth, ventral surface of the tongue,
buccal mucosa)
• Lingual Mucosa.( filiform, fungi form and circumvallate papillae-taste
buds)

• Vermilion Border It is the junction between the skin & mucous membrane.

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 Functions of oral mucosa

The oral mucosa shows specializations which allow it to fulfill several roles:

• It is protective mechanically against both compressive and shearing

forces.
• It provides a barrier to micro-organisms, toxins and various antigens.
• It has a role in immunological defense, both humoral and cell-mediated.
• Minor glands within the oral mucosa provide lubrication and buffering as
well as secretion of some antibodies.
• The mucosa is richly innervated, providing input for touch, sensor
feeling, pain and taste.

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Normal Mucosal
Variants
 Leukoedema

• It is a common normal variation of the oral

mucosa, due to increased thickness of the
epithelium and intracellular edema of the
spinous layer cells
• Presents with diffuse, filmy grayish surface
with white streaks, wrinkles, or milky
alteration, usually on the buccal mucosa,
frequently bilaterally and rarely on the
lateral border of the tongue.
• At rest, has an opaque appearance.
When stretched disappears
 Linea Alba
• Linea alba is a common linear
elevation of the buccal
mucosa, usually bilateral,
located at the level of the
occlusal line. It presents with
normal or whitish color and
normal consistency on
palpation.
• Mechanical pressure or
irritation from the buccal
surface of the teeth is the
etiologic factors.
 Fordyce Granules

• Fordyce’s granules represent a normal

anatomic variation characterized by
collections of ectopic, inactive
sebaceous glands on the oral mucosa.
• They occur in about 70-80% of the
population.
• Present as multiple small, slightly raised
whitish-yellow spots, well circumscribed
• The upper lip, commissures, buccal
mucosa and retromolar area are the
most frequently affected.
 Normal Tongue Variants

In this group are included ▪ Crenated Tongue

normal anatomical
elements and mildly ▪ Tongue Varices
abnormal and innocent
conditions of the tongue: ▪ Filiform Papillae

▪ Fungiform Papillae

▪ Foliate Papillae

▪ Circumvallate Papillae
 Crenated Tongue
• Crenated tongue is a normal
phenomenon on the lateral borders
of the tongue, caused by
misarranged teeth, the habit of
strong pressing the tongue against
the teeth or pathologic edema of the
tongue
• Clinically, it consists of shallow
asymptomatic impressions, covered
by normal mucosa, on the lateral
border of tongue due to the
neighboring teeth
• Systemic diseases such as
myxedema, acromegaly, primary
systemic amyloidosis, angioedema,
and lipoid proteinsis, may cause
megaloglossia and subsequently a
crenated tongue.
 Tongue Varices

• Varices are abnormally dilated veins

and are common finding related to
older age
• The ventral surface of the tongue is
most frequently involved
• Clinically, tongue varices typically
appear as multiple sublingual
widened elevated nodule-like,
blue-purple lesions, usually bilateral
at the ventral surface and the lateral
border of the tongue and less
frequently at the floor of the mouth
DIAGRAM OF
TONGUE,
WITH
SPECIALIZED
MUCOSA
SHOWN ON
DORSUM OF
TONGUE
 Filiform Papillae
Fungiform Papillae

• The filiform papillae are normal physiologic

elements that cover the anterior two-thirds of
the dorsum, including the tip, of the tongue. It
forms an abrasive surface to control the food
bolus as it is pressed to the palate.

• Fungiform papillae, are normal, multiple,

small, round, and slightly elevated red nodules,
scattered between the filiform papillae, along
the anterior portion of the dorsum of the
tongue. They consist of vessels and connective
tissue and multiple thin neural ends (taste
buds).
 Foliate Papillae
Circumvallate Papillae
• Foliate papillae, 4-10 in size, are a normal
anatomical element at the base of the
posterior, lateral borders, of the tongue,
bilateral and symmetrical, which also
have taste buds. Hypertrophy of the
foliate papillae, usually results from
chronic or acute irritation, as the
substratum of them is lymphoid tissue

• Circumvallate papillae, 8-12 in size, are

normal anatomical elements at the
posterior dorsal surface of the tongue,
arranged in a V-shaped pattern. In the
deep groove surrounding the papillae,
numerous taste buds are present.
Clinically, they appear as flattened
nodules. Hypertrophy of the papillae
results in red, well-circumscribed, raised,
asymptomatic nodules
 Terminology of the lesions
Elementary lesion morphology

• Macule. Flat, non-palpable lesion smaller than 1 cm in diameter. It is due to

color or fine texture change.
• Papule. Small, elevated palpable lesion less than 1 cm in diameter.
• Plaque. Palpable elevated lesion, 1 cm or more in diameter.
• Tumor. Indurated, elevated lesion over 1 cm in diameter due to epithelium or
to mesenchyma or both changes.
• Vesicle (or blister). Elevated, oval lesion that contains clear fluid, less than 1 cm
in diameter.
• Bulla. Elevated lesion that contains clear or bloody fluid, over 1 cm in diameter.
• Pustule. Elevated lesion that contains pus (yellowish fluid), smaller than 1 cm in
diameter.
• Ulcer. Loss at least of all epithelial layers, with variable size.
• Erosion. Superficial loss of epithelium with variable size.
• Papillary lesion. Exophytic growth with a verrucous of cauliflower surface.
• Cyst. A soft or fluctuant swelling, usually filled with fluid or semisolid material
• Abscess. A localized collection of pus in a circumscribed area
 References

– Ten Cate's Oral Histology, Nanci, Elsevier, 2013, page 280

– Christopher A. Squier and Mary J. Kremer, Biology of Oral
Mucosa and Esophagus, Oxford Journals, JNCI
Monographs,Volume 2001, Issue 29, Pp. 7-15 at http://intl-
jncimonographs.oxfordjournals.org/content/2001/29/7.full
– University of Michigan Health System, Learning Resource Center
at http://histology.med.umich.edu/node/2
– Luiz Carlos Junquiera et al (2005), Basic Histology, p. 282, ISBN
0-07-144116-6
– Illustrated Dental Embryology, Histology, and Anatomy, Bath-
Balogh and Fehrenbach, Elsevier, 2011, page 106
– Ten Cate's Oral Histology, Nanci, Elsevier, 2013, page 285
– Ten Cate's Oral Mucosa, Nanci, Elsevier, 2013, page 278

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