OP Chapter 1 Preliminary Diagnosis

Bulla

a circumscribed, elevated lesion that is more than 5 mm in diameter, usually contains serous fluid like a blister.

Lobule

A segment or lobe that is part of the whole; these lobes sometimes appear fused together.

Nodule

a palpable solid lesion up to or greater than 1 cm in diameter found in soft tissue; can occur above, level with, or beneath the skin surface.

Macule

an area that is usually distinguished by a color different from that of the surrounding tissues it is flat and does not protrude above the surface of the normal tissue, i.e. a freckle.

Papule

a small, circumscribed lesion usually less than 1 cm in diameter that is elevated or protrudes above the surface of the normal surrounding tissue.

pedunculated

attached by a stemlike or stalklike base similar to that of a mushroom.

sessile

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

erythroplakia

an oral mucosal lesion that appears as a red patch or granular, red and velvety patch and cannot be rubbed off or diagnosed as a specific disease.

leukoplakia

a white patch or plaquelike lesion on the oral mucosa that CANNOT be rubbed off or diagnosed as a specific disease.

verrucous

warty, often rough surface.

coalescence

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

diffuse

a lesion with borders that are not well defined making it impossible to detect the exact parameters of the lesion; this may make treatment more difficult, and depending on the biopst results, more radical.

multiocular

describes a lesion that extends beyond the confines of one distinct area and is defined as many lobes or parts that are somewhat fused together, making up the entire lesion.

radiolucency sometimes described as resembling soap bubbles, i.e. odontogenic keratocyst

root resorption

when the apex of the tooth appears shortened or blunted and irregularly shaped.

cyst, tumor, or trauma

What stimuli are associated with root resorption?

external resorption

root resorption that arises from tissues outside the tooth, such as the periodontal ligament.

internal resorption

root resorption that is triggered by pulpal tissue reaction from within the tooth.

scalloping around the root

a radiolucent lesion that extends between the roots, as seen in a traumatic bone cyst; this lesion appears to extend up the periodontal ligament.

uniocular

having one compartment or unit that is well defined or outlined, i.e. simple radicular cyst

dysphagia, dysphonia, dyspnea

• difficult swallowing

• difficulty speaking

• difficultly breathing

Clinical, Radiographic, Historical, Laboratory, Microscopic, Surgical, Therapeutic, and Differential.

What are the eight diagnostic categories?

Clinical Diagnosis

• suggest that the strength of the diagnosis comes from the clinical appearance of the lesion.

• includes shape, location, and history of the lesion.

• examples: Fordyce Granules, Torus Palatinis, Mandibular Tori, Melanin Pigmentation, Retrocuspid Papillae, and Lingual Vuscosities.

A prodromal period of pain is typically followed by the eruption of vesicles with a unilateral distribution along a sensory nerve.

How can Herpes Zoster be Clinically Diagnosed?

Radiographic Diagnosis

• radiograph provides sufficient information to establish diagnosis in addition to clinical and historical information.

• examples: periapical pathosis, internal resorption, external resorption, heavy interproximal calculus, dental caries, compound/complex odontoma, supernumerary/unerupted teeth, and calcified pulp.

• can also identify normal anatomical landmarks and mixed dentitions; as well as unusual radiographic findings.

Historical Diagnosis

• at times this information constitutes the most important contribution to the diagnostic process.

• includes personal, family, past/present medical information, history of drug ingestion and history if presenting disease or lesion.

• Family histories can contribute a significant role in diagnosis for conditions such as amelogenesis imperfecta, dentinogenesis imperfecta, and other genetic disorders.

• allergic reactions may also be part of this information.

The first statement is true, the second statement is false.

Sometimes hypersensitivity reactions may be delayed. However, in any case, each time the patient comes in contact with the allergen, the reaction may be less severe.

Sjogren Syndrome

A cobblestone appearance of the tongue due to xerostomia may indicate the patient has a history of which autoimmune condition?

Periapical Cemento-osseous Dysplaysia

Which condition, most commonly seen in black women in the third decade of their life, with lesions presenting in the anterior mandible; lesions typically appear radiolucent and overtime will develop a mixed radiolucent-radiopaque appearance. These lesions are also asymptomatic, however are vital and will respond normally on pulp testing.

aka Cementoma

NO treatment necessary

Laboratory Diagnosis

• includes results of blood chemistires, organizmal cultures, and urinalysis that help contribute to diagnosis.

Paget Disease of Bone

An elevated serum alkaline phosphatase level is significant in the diagnosis of which disease?

HINT: radiographic appearance of “cotton-wool effect” and hypercementosis

Complete Blood Cell Count

What is the most common laboratory test used in dentistry?

HINT: helpful in diagnosing infections.

Microscopic Diagnosis

• technically a form of laboratory diagnosis- the microscopic examination of the biopsy specimen taken from the lesion in question.

• this procedure is often the main component of the definitive diagnosis.

an adequate tissue sample must be removed from the lesion by the practitioner for microscopic evaluation.

What is the most important part of performing a biopsy procedure?

Scalpel Biopsy

What procedure is considered the Gold Standard for microscopic analysis that will establish the definitive diagnosis of a lesion?

thickened epithelium or surface keratin layers

How does Leukoplakia appear micrscopically?

Squamous Cell Carcinoma

Leukoplakia’s are commonly diagnosed as ‘what’ when examined microscopically?

Squamous Cell Carcinoma

Most Erythroplakia’s (90%) are microscopically diagnosed as as severe epithelial dysplasia or what?

high

HPV associated with squamous cell carcinoma of the oropharynx are considered _____ risk.

2, 6, 11, 27, and 57

Examples of of low-risk types of HPV are types…?

Surgical Diagnosis

• diagnosis via surgical intervention; provides conclusive evidence when the lesion is opened and an empty void within the bone is found.

Static Bone Cyst

A _______ ____ ___, or lingual mandibular bone concavity, is a developmental anomaly most often identified in older adults and is an oval or elliptical shape found anterior to the angle of the ramus. This condition requires NO surgical intervention.

Therapeutic Diagnosis

• which diagnostic category is used commonly to diagnose Nutritional Deficiencies.

• prescribing treatments and observing results without culturing the bacteria is a method of this type of diagnosis; based solely on clinical and historical information with confirmation by response of the condition to therapy.

Angular Cheilitis

This condition is typically associated with a deficiency in B-complex vitamins , and is a commonly found fungal condition which responds to topical application of antifungal cream or oitment like Nyastatin.

the anearobic bacteria that causes this condition cannot survive an oxygenated environment.

Why is Hydrogen Peroxide used in treatment of NUG?

Differential Diagnosis

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

• data collection includes the patients medical and dental histories, the history of the lesion in question, a clinical description and evaluation, and biopsy reports.

Fordyce Granules

clusters of ectopic sebaceous glands more commonly observed on the lips and buccal mucosa; appear clinically as tiny yellow papules in clusters.

Torus Palatinus

exopathic growth of normal compact bone; asymptomatic and develop gradually and are observed clinically in the midline of the hard palate.

Mandibular Tori

outgrowths of normal dense bone found on the lingual aspect of the mandible in the area of the premolars above the mylohyoid ridge

Asian, Native Americans, and the Inuit.

Tori in the mandible and palate are more common in which ethnicities?

The patient needs a prosthodontic appliance and the tiro interfere with proper fabrication and placement.

Patients with mandibular tori usually do not need treatment unless what?

Retrocuspid Papilla

A sessile papule found on the gingival margin of the lingual aspect of the mandibular cuspids; observed more often in the young and resolves with age.

Clinically resemble squamous papillomas in appearance.

Lingual Varicosities

prominent lingual veins on the ventral and lateral surfaces of the tongue; appear clinically as red-to-purple enlarged vessels or clusters.

both statements are true.

A relationship between varicosities in the legs and prominent lingual veins has been reported. A recent study suggested that they may be associated with a history of smoking or cardiovascular disease, as well as the aging process.

clench or “brux”

Linea Alba is a bump or ridge of keratinized tissue that runs along the buccal mucosa, often more prominent in patients who..?

Leukoedema

a generalized opalescence is imparted tot he buccal mucosa and appears clinically as a gray-whitish pigmentation of mucosa that becomes less prominent when stretched.

FALSE

Leukoedema may become more pronounced in smokers while they are smoking versus when they stop.

Lingual Thyroid

The thyroid gland begins development in the first month of fetal life and is located initially in the foramen cecum, and descends into its normal location in the neck.

When the thyroid either does not descend into the neck or remnants become entrapped in the tissue that makes up the tongue- a developmental anomaly results called…?

Appears clinically as a mass in the midline in the of the dorsal surface of the tongue posterior to the circumvallate papillae between the foramen cecum and the epiglottis; usually has a sessile base and is 2-3cm in width; clinical symptoms can include dysphagia, dysphonia, and dyspnea.

This may be the patient’s only functioning thyroid tissue and is highly vascular which may pose a significant bleeding risk.

Why should biopsy of a Lingual thyroid be avoided?

Median Rhomboid Glossitis

While the cause for this condition is unknown, research has suggested that it mat be associated with a chronic fungal infection by Candida Albicans.

Appears clinically as a flat or slightly raised, oval or rectangular, erythematous area in the midline of the dorsum of the tongue, often lacking papillae and may cause discomfort or a burning sensation.

On occasion this condition spontaneously resolves or can be treated with topical anti-fungal medication.

Erythema Migrans (geographic tongue; benign migratory glossitis)

This condition is thought to have a genetic etiology, as well as a link to psoriasis. Some researchers suggest it can exacerbated by stress.

Clinical appearance involves the anterior two-thirds of the dorsal and lateral borders of the tongue. It is characterized by irregularly shaped, smooth, red patches on the tongue, surrounded by white or yellow borders. These patches can change location and size, leading to the term "migratory."

Usually no treatment is indicated. On occasion the patient may complain of a burning discomfort or sensitivity to spicey foods- if this burning discomfort becomes severe, topical corticosteroid treatment may be helpful.

Ectopic Geographic Tongue

If erythema migrans is found on mucosal surfaces other than the tongue (i.e. the lower lip or mandibular anterior mucobuccal fold) it is known as…?

Fissured Tongue

This condition is seen in about 5% of the population. Clinically, the dorsal surface of the tongue appears to have deep fissures or grooves from 2-6mm that may become irritated if food debris collects in them.

one third of patients.

About how many patients with fissured tongue ALSO have erythema migrans?

Tongue scraping may remove surface debris, but does not reach the depth of the deep grooves and fissures; brushing gently with a soft toothbrush can help keep the fissures clean of debris and irritants.

Why is tongue scraping not and an ideal hygiene habit for patients with fissured tongue? What is recommended instead?

Hairy Tongue

A condition in which the patient has an increased accumulation of keratin on the filiform papillae that results in a white, hairy appearance, however the elongated filiform papillae may be pigmented brown-to-black due to discoloration by tabaco and certain food types.

Treatment involves directing the patient to brush the tongue gently with a soft toothbrush (wet with water only) to remove debris.