Chapter 1: Diagnosis of oral lesions

What to note for vocabulary

-clinical appearance of lesion

-consistency

-color

-size

-surface texture

-radiographic terms to describe the lesion in the bone

Bulla

-circumscribed elevated lesion

-5mm or more in diameter

-usually contains serous fluid (looks like a blister)

lobule

-a segment or lobe that is part of a whole

-can be fused together

macule

-an area distinguished by color different from the surrounding tissues

-flat and doesn't protrude above the tissue

-example is a freckle

papule

-small circumscribed lesion

-less than 1 cm in diameter

-elevated or protrudes above the surface of the surrounding tissue

pustules

-variously sized circumscribed evaluations containing pus

vesicle

-small elevated lesion

-less than 1 cm in diameter

-contains serous fluid

pedunculated

-attached by a stemlike or stalklike base

sessile

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

nodule

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

-can be above, level with, or beneath the skin surface

Palpation

-evaluation of a lesion by feeling it to determine texture

-descriptive terms include (also describe consistency): soft, firm, semifirm, fluid filled

colors

-frequent descriptors: red, pink, salmon, white, blue-black, brown, black

erythema

abnormal redness

pallor

paleness

erythroplakia

-smooth red patch or granular red velvety patch

-less common than leukoplakia

-90% of erythroplakias demonstrate epithelial dysplasia or squamous cell carcinoma

leukoplakia

-white plaquelike lesion that cannot be rubbed off or diagnosed as a specific disease

size of lesions

-cm: one hundredth of a meter

-mm: one thousandth of a meter (perio probe is useful to describe lesions in mm)

corrugated

wrinkled

fissure

a cleft or groove showing prominent depth

papillary

resembling small, nipple-shaped projections or elevations found in clusters

other terms used to describe texture

-smooth

-rough

-folded

coalescence

The process by which parts of a whole join together, or fuse, to make one

diffuse

-describes a lesion with borders that are not well defined (impossible to detect exact parameters of the lesion)

-can make tx difficult

multiocular

-extends beyond the confines of one distinct area

-many lobes or parts somewhat fused together

-resembles soap bubbles

external root resorption

arise from the tissue outside the tooth, such as PDL

internal root resorption

-triggered by pulpal tissue reaction from within the tooth

-pulpal area is seen as a diffuse radiolucency beyond the confines of normal pulp area

scalloping around the root

radiolucent lesion that appears to extend up the PDL and between the roots

unilocular

-having one compartment or unit that is well defined or outlined

-ex: radicular cyst

well circumscribed

describes a lesion with specific borders that are defined and have exact margins and extent

diagnostic process

-clinical diagnosis

-radiographic diagnosis

-lab diagnosis

-microscopic diagnosis

-surgical diagnosis

-therapeutic diagnosis

-differential diagnosis

clinical diagnosis includes

-color

-shape

-location

-hx of lesion

fordyce granules

-cluster of ectopic sebaceous glands

-appears as yellow lobules in clusters

-commonly observed on the vermilion border of the lips and buccal mucosa

-no tx

torus palatinus

-exophytic growth of normal compact bone

-clinically in the midline of the hard palate

-inherited, gradual formation

-occurs more commonly in women

-may have various shapes and sizes, lobulated, covered by normal soft tissue

-no tx unless interfere with speech, swallowing, or prosthesis is needed

mandibular tori

-outgrowth of dense bone found on lingual aspect of the mandible in the premolar and mylohyoid ridge area

-usually bilateral

-often lobulated or nodular

-can appear fused

-no predilection for either sex

Melanin pigmentation

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

-Most commonly observed in dark-skinned individuals

retrocuspid papillae

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

lingual varicosities

-appear red to purple enlarged vessels or clusters

-usually on ventral and lateral surfaces of the tongue

-most common in pts 60 years and older

linea alba

-white line that extends anteroposteriorly on buccal mucosa along the occlusal plane

-may be bilateral

-may be prominent in pts who clench or bruxism habit

leukoedema

-generalized opalescence on the buccal mucosa

-most commonly found in black adults

-when mucosa is stretched, opalescence is less prominent

-no tx

unusual findings in radiographic diagnoses

-piercings

-impacted teeth

-retained metals (shotgun shrapnel/pellets)

historical diagnosis

-Personal history

-Family history

-Past and present medical and dental histories

-History of drug ingestion

-History of the presenting disease or lesion

lab diagnosis

-blood chemistries

-urinalysis

-cultures

-radiographic appearance: "cotton-wool effect" + elevated serum alkaline phosphate levels = pagets disease

microscopic diagnosis

-often the main component of definitive diagnosis

-adequate tissue sample is necessary

-brush test can be used (can determine the need of a scalpel biopsy)

surgical diagnosis

-surgery preformed to gain info and diagnose

-traumatic bone cyst: may appear as RL that scallops around the roots, when the lesion is opened surgically, an empty void is found.

therapeutic diagnosis

-nutritional deficiencies are common conditions to be diagnosed by therapeutic means

-ex: angular cheilitis associated w vitamin B complex deficiency, commonly a fungal condition tx with nystatin

-necrotizing ulcerative gingivitis: responds to hydrogen peroxide

hygienists role in differential diagnosis

-be observant

-data collection: pts MDHX, history of lesion, clinical description and evaluation, biopsy and microscopy reports

variants of normal

-Fordyce granules

-Torus palatinus

-Mandibular tori

-Melanin pigmentation

-Retrocuspid papilla

-Lingual varicosities

-Linea alba

-Leukoedema

benign conditions w unknown causes

-lingual thyroid nodule

-median rhomboid glossitis

-geographic tongue

-fissured tongue

-hairy tongue

lingual thyroid nodule

-trapped remnants of thyroid tissue

-mass in the midline of the dorsal of the tongue posterior to circumvallate papillae, usually a sessile base and is 2-3 cm in width

-predilection: females and linked to hormonal changes

-tx: eval the pt to determine whether the thyroid gland is present in the normal location

Median Rhomboid Glossitis

-flat or slightly raised oval or rectangular erythema area in center of tongue

-may be associated with Candida albicans

-no tx necessary but antifungal can be used

geographic tongue

-erythema patches surrounded by a white or yellow border

-diffuse areas devoid of filiform papillae

-distinct fungiform papillae

-remission and depapillated areas

-aka migratory glossitis

-genetic factors can play a role

-stress may exacerbate

-burning or discomfort can be related

-no tx indicated

ectopic geographic tongue

geographic tongue used to describe areas found on mucosal surfaces other than the tongue

fissured tongue

-dorsal surface has deep grooves

-probably involves genetic factors, seen in about 5% of population

-homecare: have pt brush tongue gently

-no tx necessary

white hairy tongue

-elongated filiform papillae that are white, results from increased keratin or decrease in normal desquamation

-home care: have pt brush tongue gently

black hairy tongue

-black to brown chromogenic bacteria

-contributing factors: tobacco, foods, hydrogen peroxide, alcohol, chemical rinses

-home care: have pt brush tongue gently