Ch 1: intro to preliminary diagnosis of oral lesions

bulla

-A circumscribed, elevated lesion that is more than 5 mm in diameter

-Usually contains serous fluid, and looks like a blister

lobule

-It is a segment or lobe that is part of a whole.

-These sometimes appear fused together

macule

-An area that is usually distinguished by a color difference from that of the surrounding tissue

-It is flat and does not protrude above the surface of the normal tissue

-A freckle is an example

papule

-A small, circumscribed lesion usually less than 1 cm in diameter

-It is elevated or protrudes above the surface of normal surrounding tissue

pustules

Variously sized circumscribed elevations containing pus

vesicle

A small, elevated lesion less than 1 cm in diameter that contains serous fluid

pedunculated

Attached by a stemlike or stalk like base similar to that of a mushroom

sessile

Describes the base of a lesion that is flat or broad instead of stemlike

nodule

-A palpable solid lesion up to 1 cm in diameter found in soft tissue

-Can occur above, at level with, or beneath the skin surface

palpation

-The evaluation of a lesion by feeling it with the fingers to determine the texture of the area

-Descriptive terms are soft, firm, semifirm, and fluid filled (Fluctuant)

-These terms also describe the consistency of a lesion

colors of lesions

-most frequent: Red, pink, salmon, white, blue-black, gray, brown, and black

-May be incorporated into general descriptions

erythema

An abnormal redness of the mucosa or gingiva

erythroplakia

-A clinical term used to describe an oral lesion that appears as a smooth red patch or granular red and velvety patch, cannot be rubbed off or diagnosed as an specific disease.

-Less common than leukoplakia

pallor

Paleness of the skin or mucosal tissues

leukoplakia

A clinical term for a white, plaquelike lesion on the oral mucosa that cannot be rubbed off or diagnosed as a specific disease

size of lesions are measured in:

-centimeter (cm)

-millimeter (mm)

centimeter

-One hundredth of a meter; equivalent to a little less than one-half inch.

-ex: When a lesion is described as being 3 cm, it is really about one and one half inches

millimeter

-One thousandth of a meter

-The periodontal probe is of great assistance in documenting the size or diameter of a lesion that can be measured in millimeters

surface texture of lesions

-corrugated

-fissure

-papillary

-verrucous

-smooth

-rough

corrugated

wrinkled

fissure

A cleft or groove, normal or otherwise, showing prominent depth

papillary

Resembling small, finger-like projections or elevations found in clusters

verrucous

Warty, often rough surface

radiographic terms used to describe lesions in bone

-coalescence

-diffuse

-multilocular

-radiolucent

-radiolucent and radiopaque

-radiopaque

-root resorption (internal and external)

-scalloping around the root

-unilocular

-well circumscribed

coalescence

The process by which parts of a whole join together, or fuse, to make one. (Joining or blending to form one mass)

diffuse

Describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion

multilocular

-Describes a lesion that extends beyond the confines of one distinct area

-Defined as many lobes or parts that are somewhat fused together

-sometimes described as resembling soap bubbles

radiolucent

-Describes the black or dark areas on a radiograph

-Radiant energy can pass through these structures

-ex: Less dense tissue, such as pulp

radiolucent and radiopaque

-A mixture of light and dark areas within a lesion

-Denotes a stage in lesion development

radiopaque

-Describes the light or white area on a radiograph that results from the inability of radiant energy to pass through the structure

-The denser the structure, the lighter or whiter it appears on the radiograph

root resorption

-Radiographically, the apex of the tooth appears shortened or blunted and irregularly shaped

-Occurs as a response to stimuli, which can include a cyst, tumor, or trauma

external root resorption

Arises from tissue outside the tooth, such as the periodontal ligament

internal root resorption

-Triggered by pulpal tissue reaction from within the tooth

-The pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area

scalloping around the root

A radiolucent lesion that appears to extend up the periodontal ligament and between the roots

unilocular

Having one compartment or unit that is well defined or outlined as in a simple radicular cyst

well circumscribed

Used to describe a lesion with borders that are specifically defined and in which one can clearly see the exact margins and extent

anomaly

Something that deviates from what is standard or normal

Dysphagia

difficulty swallowing

Dysphonia

difficulty speaking

Dyspnea

difficulty breathing

pathognomic

-means "characteristic for a particular disease".

-a particular sign whose presence means that a particular disease is present beyond any doubt.

description

is the basis for scientific communication, by which we are able to share information about lesions or disease

lesions are described in terms of:

-location

-size

-number

-extent

-shape

-color

-consistency

-texture/ surface

process of diagnosis

requires gathering information that is relevant to the patient and the lesion being evaluated

8 categories that contribute info leading to a final diagnosis:

1. Clinical diagnosis

2. Radiographic diagnosis

3. Historical diagnosis

4. Laboratory diagnosis

5. Microscopic diagnosis

6. Surgical diagnosis

7. Therapeutic diagnosis

8. Differential diagnosis

clinical diagnosis

-Suggests that the strength of the diagnosis comes from the clinical appearance of the lesion.

-The clinician can establish a diagnosis for some lesions

-ex: How does the lesion present?

• Color, Shape, Location, History of lesion

historical diagnosis

-Historical data constitute an important component in every diagnosis;

-occasionally when historical information is combined with observation of the clinical appearance of the lesion, the historical information constitutes the most important contribution to the diagnostic process

• Personal history

• Family history

• Past and present medical and dental histories

• History of drug ingestion

• History of the presenting disease or lesion

-All these can provide information necessary for the final diagnosis

radiographic diagnosis

-the radiograph provides sufficient information to establish the diagnosis.

-The diagnosis is obtained from the radiograph.

-Conditions for which the radiograph provides the most significant information is the periapical pathosis.

laboratory diagnosis

-Lab test can contribute information that leads to a diagnosis.

-Ex: An elevated serum alkaline phosphatase level is significant of Paget’s disease of bone.

-Laboratory cultures are helpful in determining the diagnosis of oral infections; an elevated white count cell is often a sign of infection.

microscopic diagnosis

-It’s a form of laboratory diagnosis, it involves a biopsy specimen

-Often the main component of the definitive diagnosis

-Skill of practitioner is important: an adequate tissue sample needs to be provided for evaluation.

-Additional screening technologies can also be used to detect changes in tissues, but the scalpel biopsy is considered the gold standard to establish a definite diagnosis

-A white lesion cannot be diagnosed on the basis of clinical appearance alone

• The microscopic appearance can vary from a thickening of epithelium to epithelial dysplasia, which can be premalignant

surgical diagnosis

-Diagnosis is made using the information gained during the surgical procedure

-Ex: Traumatic bone cyst

• May appear as a radiolucency that scallops around the roots

• When the lesion is opened surgically, an empty void is found

-ex: Lingual mandibular bone cavity (static bone cyst or Stafne bone cyst)

• Surgical examination of the well-circumscribed, radiolucent area reveals salivary gland tissue entrapped during development

therapeutic diagnosis

-The principle is based solely on clinical and historical information with confirmation by the response of the condition to the therapy.

-Nutritional deficiencies are common conditions to be diagnosed by therapeutic means.

-EX: Angular cheilitis

• May be associated with a deficiency of B-complex vitamins

• Most commonly a fungal condition and responds to topical application of an antifungal cream or ointment such as Nystatin

-Ex: Necrotizing ulcerative gingivitis (NUG)

• Responds to hydrogen peroxide

differential diagnosis

-That point in the diagnostic process when the practitioner decides which test or procedure is required to rule out other conditions and to establish the definitive or final diagnosis.

-All previously discussed components are applied

Hygienists’ Role in Differential Diagnosis

-Be observant!

-To arrive at a diagnosis, Collect all data:

• Patient’s medical and dental health histories

• History of lesion

• Clinical description and evaluation

• Biopsy and microscopy reports

-The diagnostic progress can be thought of as a puzzle because the information from each diagnostic category becomes part of it

variants of normal

-Fordyce granules

-Torus palatinus

-Mandibular tori

-Melanin pigmentation

-Retrocuspid papilla

-Lingual varicosities

-Linea alba

-Leukoedema

fordyce granules

-Clusters of ectopic sebaceous glands

-Appear as yellow lobules in clusters

-Commonly observed on vermilion border of lips and buccal mucosa

-No treatment

torus palatinus

-An exophytic growth of normal compact bone

• Observed clinically in midline of hard palate

• Inherited, gradual formation

• More common in women

• May take on various shapes and sizes, may be lobulated, and is covered by normal soft tissue

-Treatment

• None, unless they interfere with speech, swallowing, or a prosthetic appliance

mandibular tori

-Outgrowths of dense bone found on the lingual aspect of the mandible in the area of the premolars above the mylohyoid ridge

• Usually bilateral

• Often lobulated or nodular

• Can appear fused together

• Have no predilection for either sex

-No treatment unless they interfere with fabrication and placement of a prosthodontic appliance

melanin pigmentation

-The pigment that gives color to skin, eyes, hair, mucosa, and gingiva

-Most commonly observed in dark-skinned individuals

retrocuspid papilla

-A sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids

-Only a few millimeters in size

-Observed more often in young people

-Resolves with age

lingual varicosities

-Red-to-purple enlarged vessels or clusters

-Usually observed on the ventral and lateral surfaces of the tongue

-Most commonly observed in individuals older than 60 years

linea alba

-A “white line” extends anteroposteriorly on the buccal mucosa along the occlusal plane

-May be bilateral

-May be more prominent in patients who have a clenching or bruxing habit

leukoedema

-A generalized opalescence on the buccal mucosa

-Most commonly observed in black adults (90%)

-If the mucosa is stretched, the opalescence becomes less prominent

-No treatment

other benign conditions with unique clinical features

-Lingual thyroid

-Median rhomboid glossitis (central papillary atrophy)

-Erythema migrans (geographic tongue)

-Fissured tongue

-Hairy tongue

lingual thyroid

-Undescended, trapped remnants of thyroid tissue

clinical appearance of lingual thyroid

-A mass in the midline of the dorsal surface of the tongue posterior to the circumvallate papillae in the area of the foramen cecum

-Usually has a sessile base and is 2 to 3 cm in width

-Clinical symptoms may include dysphasia, dysphonia and dyspnea

predilection of lingual thyroid

-females

-linked to hormonal changes

treatment for lingual thyroid

-Evaluation of the patient to determine whether the thyroid gland is present in its normal location

-No treatment is required if it is the patient’s only functional thyroid tissue

Median Rhomboid Glossitis (Central Papillary Atrophy)

-Flat or slightly raised oval or rectangular erythematous area in center of tongue

-May be associated with a chronic infection with Candida albicans (Fungus)

-No treatment necessary, but antifungal treatment may be used

Erythema Migrans (Geographic Tongue)

-unclear cause

-Erythematous patches surrounded by a white or yellow border

-Diffuse areas lacking filiform papillae

-Distinct presence of fungiform papillae

-Involves the anterior two thirds and lateral borders of the tongue

-Lesion does not remain static, there appears to be remission and changes in the depapillated areas every few days

-Genetic factors may play a role in presence

-Histological findings are associated to those found in psoriasis. (Human Leukocyte antigen HLA)

-May be exacerbated by stress

-Occasionally, the patient may complain of a burning discomfort or sensitivity to spicy foods

-No treatment usually indicated, unless burning discomfort becomes severe then topical corticosteroids maybe helpful

Ectopic Geographic Tongue

-Term used to describe “geographic tongue” found on mucosal surfaces other than tongue.

-It is seen in the mandibular anterior mucobuccal fold and lower lip

fissured tongue

-The dorsal surface of the tongue appears to have deep fissures or grooves from 2 to 6 mm deep, may become irritated if food debris becomes trapped in them.

-Cause: Unknown

• Probably involves genetic factors

• Seen in about 5% of the population

-Home care

• Direct the patient to brush the tongue gently with a toothbrush to remove debris. Tongue scrapers may not reach bottom of it

-No treatment necessary

white hairy tongue

-Elongated filiform papillae are white

-Result of either an increase in keratin production or a decrease in normal desquamation

-Home care

• Direct the patient to brush the tongue gently with a toothbrush to remove debris

clinical appearance of black hairy tongue

Papillae are brown-to-black because of chromogenic bacteria

contributing factors to black hairy tongue

-Tobacco

-Foods

-Hydrogen peroxide

-Alcohol

-Chemical rinses

home care for black hairy tongue

-Direct the patient to brush the tongue gently with a toothbrush to remove debris

-Although the cause is unknown, hydrogen peroxide, alcohol and other chemical rinses, has been suggested to stimulate the elongation of the filiform papillae that results in the appearance of hairy tongue