P1-ORAL PATH 2 SAS 3 and PPT

oral cancer

applies to malignancies occurring distant to the vermilion border of the lips in the oral cavity and some pharyngeal sites such as the oropharynx and tonsils

90 seconds

comprehensive oral cancer examination takes for how many seconds only?

-review of patient's medical and dental history

-extraoral and intraoral inspections of head and neck

-manual a palpation of related specific sites

comprehensive oral cancer examination includes?

comprehensive oral cancer examination

based on the standardized oral examination method recommended by the WHO

Step 1, Face and Neck

-visually inspect face, head and neck

-special attention to patient exposed a lot to the sun

-note any assymetry/lesions on the skin such as crusts, fissuring and growths

-BILATERALLY, palpate the regional lymph nodes in the submandibular and neck areas to detect any enlarged nodes

-if enlargement is detected assess their mobility and consistency

Step 2, Lips

-observe lips both closed and open

-note the color texture any surface abnormalities of the vermilion borders

Step 1, face and neck

Step 2, lips

steps in intraaoral examination

Step 3, Labial Mucosa

with the patient's mouth partially open visually examine the labial mucosa and sulcus of the maxillary vestibule and frenum as well as the mandibular vestibule

Step 4, Buccal Mucosa

-retract the buccal mucosa

-examine first the right then left buccal mucosa extending from the labial commissure and back to the anterior tonsilar pillar

Step 5, Gingiva

-examine the buccal and labial aspects of the gingival and alveolar ridges

-start from right maxillary posterior gingiva and alveolar ridge to the left and drop left mandibular posterior gingiva and alveolar ridge and to the right

-examine the palatal in a maxillary and lingual in the mandibular aspect S

Step 6, Tongue

-tongue at rest and mouth partially open, inspect dorsum of the tongue for any swelling ulceration or variation in size, color or texture

-protrude his or her tongue examine for abnormality of mobility or positioning

-grass tip of tongue with goes to assist for protrusion of the tongue

-use mouth mirror for more posterior areas

-gently run index finger along the lateral borders of tongue to feel for any hard tissues

-examine ventral surface. palpate tongue to detect growths. the tongue should feel soft and palpable.

Step 7, Floor of the Mouth

-tongue still elevated inspect the floor of the mouth for changes in color texture swelling or other surface abnormalities

by manually palpate the floor of the mouth and if any abnormalities is detected, it should be more carefully palpated

gauze

it is used to wipe the floor of the mouth dry and keeps the tongue out of the way thus, making irregularities more easily detected

Step 8, Palate

-patient's mouth wide open and head tilted back gently depressed the base of the tongue with a mouth mirror

-inspect the hard and soft palate

Step 3, Labial Mucosa

Step 4, Buccal Mucosa

Step 5, Gingiva

Step 6, Tongue

Step 7, Floor of the mouth

Step 8, Palate

steps in extracoronal examination

Toluidine Blue (TB) staining

simple and inexpensive diagnostic tool that uses a blue dye to highlight abnormal areas of mucosa

Toluidine Blue (TB) staining

basic metachromatic nuclear stain which stains nuclear material of malignant lesions and PML but not normal mucosa

Pap Smear

time-honored, effective tool for finding dysplastic cells of the uterine cervix but lost popularity among dentists in 1960s because it seemed unable to find dysplastic cells in oral leukoplakias

thicker

oral white patches has ______ keratin layer than their cervical counterparts

dysplastic/immature epithelial cells

they arise from the bottom of the squamous epithelium and is not expected to be found by scraping a thick surface layer of keratin

Pap smear

used effectively for oral red lesions and oral ulcers to identify infections especially candidiasis and atypical cells in erythroplakia

erythroplakia

a disease where the dysplastic epithelial cells near the surface

white keratotic lesions

pap smear is seldom used for this kind of lesions

Brush biopsy

-screwing a bristle covered wire through the thick surface keratin to the basal layer of the epithelium

-captures the deeper epithelial cells on the bristles and the entire brush is sent to the lab where cells are removed and plated on a microscopic slide

Liquid-Based Cytology (LBC)

-a principle methodology in cytopathology replacing conventional smears

- provides better cell recovery and morphologic preservation

1. filtration and computer-assisted thin layered deposition of cells

2. sedimentation process

FDA approved to lbc methods and these are

2 LBC methods (filtration & sedimentation)

produce an evenly distributed thin layer of epithelial cells devoid of blood and ubiquitous inflammatory cells that may interfere with cytologic examination

Liquid-Based Cytology

-it analyzes the brush biopsy samples of oral mucosa

-not only increase the sensitivity and specificity of cytologic diagnosis but also provides additional samples for immunohistochemical and other molecular studies that are not possible for conventional cytologic smears

Liquid-Based Cytology

a good tool in an experience knowledgeable hand with very few false positive or negative results when used appropriately

The ViziLite (R) System

-utilizes acetic acid and adds bright blue light to even further enhance keratin detection

-uses reflected light solely

ViziLite System

can only give information from the most superficial cell layers and has a very high ability to enhance identification of keratotic patches

-chemical tubes (chemiluminescence)

-laser

the light from the ViziLite system is derived from

Toluidine Blue

it is recently added to ViziLite system for identification of superficial nuclear abnormalities

ViziLite System

-identifying dysplastic cells or immature cells when they are close enough to the surface

-increases awareness of oral cancer and pre cancer detection dilemma

-should detect hyperkeratotic patches that may have been missed with routine visual inspection

Vel scope

-a handheld device approved by fda for direct visualization of auto fluorescence in the oral cavity

-only recently it was introduced in the market as a diagnostic adjunct for oral cancer detection

Vel scope

one of the most powerful tools available today for assisting oral abnormalities especially oral cancer

Vel scope

the distinctive blue spectrum light causes the soft tissues of the mouth to naturally flouresce

Vel scope

-safe simple technique

-entire examination can be done in about 2 minutes

-limited number of studies on its effectiveness

Lymph nodes

-must be larger than 1 cm

-feel like peas or grapes under the skin

-usually hard, non-tender and fixed the surrounding tissues (malignancy)

-lateral borders of the tongue

-floor of the mouth

-lips

-retromolar trigone

most oral cancers are located on the?

biopsy

this should be taken if the abnormality or the lesions is already more than 2 weeks

ViziLite

fda cleared as an adjunct to the standard oral examination to improve evaluation and monitoring of white mucosal abnormalities

Chemiluminescence

the test in ViziLite is based on this low energy blue white light (which is called?) after the patient has rinsed oral cavity with dilute acetic acid for 60 seconds

Toluidine Blue

vital stain that is rapidly absorbed into actively dividing cells

anderson model of total patient delay, 1995

four time intervals that make up total time between appearance of signs and symptoms of cancer to the start of treatment

-appraisal

-help seeking

-diagnosis

-pre-treatment

what are the four time intervals according to andersen model of total patient delay?