Oral Pathology Session #1 SLO & PowerPoint ✅

clinical, radiographic, historical, laboratory, microscopic, surgical, therapeutic, differential findings.

what are the 8 diagnostic areas that aid in determining/identifying pathological conditions?

clinical diagnosis

this is how the lesions presents. Ex. color, shape, location

radiographic diagnosis

a radiograph provides sufficient information to establish the diagnosis

historical diagnosis

personal and family history, past and present medical and dental history, history of drug ingestion, history of the presenting disease/lesion is used to determine the diagnosis of the lesion

laboratory diagnosis

blood chemistries, urinalysis, cultures, etc. are used to determine the diagnosis.

microscopic diagnosis

this type of diagnosis is the main component of definitive diagnosis? A skilled practitioner, adequate tissue sample is needed!

surgical diagnosis

diagnosis made during the information gained during the surgical procedure

therapeutic diagnosis

nutritional deficiencies are commonly diagnosed by __________ means.

differential findings

this is the point in the diagnostic process where the practitioner decides what procedure is required in order to rule out conditions originally suspected to establish a definitive diagnosis.

each category of diagnosis is used together to gather information for a differential diagnosis

Why do the 8 diagnostic areas help develop the differential diagnosis?

macule

an area that is distinguished by a color different that the surrounding tissue, typically flat and non-protruding. Ex. freckle

papule

- small circumscribed lesion

-different in color than surrounding tissue

-well defined borders

-typically protruding

-less than 1 mm in diameter

-soft and spongy to palpation.

vesicle

-less than 1 cm in diameter

-contains serous fluid, appears clear like a blister

bulla

-more than 5mm in diameter

-typically contains serous fluid and appears as a blister.

-elevated and circular

pustule

-variously sized

-circular and elevated

-contains pus colored fluid

Ex. pimple

pallor

paleness of skin/mucosal tissues

indurated

hard, firm, and stiff tissue

coalesce

process where parts of a whole join together/fuse to make one.

sessile

describes the base of a lesion that is flat or broad

pedunculated

attached by a stemlike or stalk like base similar to a mushroom.

lobulated

lesion is clustered and joined

exophytic

growth/lesion that grows/projects outward from surface of oral mucosa.

plaque

-broad

-slightly raised

-flat

-typically, larger than 1 cm

-has different color &/or texture than the surrounding tissue

crenated

indentions//grooves as seen on the side of the tongue.

scalloping around roots

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

nodular

-lesion/growth

-firm

-greater than 1 cm in diameter

-found in soft tissue

cyanosis

bluish/blackish/purplish discoloration of the oral mucosa.

erythema

an abnormal redness of the mucosa or gingiva

fissured

a cleft/groove with prominent depth

corrugated

wrinkled

papillary

resembling small, nipple or hairlike projections or elevations found in clusters

diffuse

not defined borders making it impossible to detect exact parameters of a lesion (diffused)

radiopaque

light/white area on a radiograph resulting from the inability of radiant energy to pass throught the structure (dense)

Ex. restorations, enamel, subgingival calc

radiolucent

dark/black areas on a radiograph. Radiant energy can pass through (less dense) Ex. pulp, decay

uniocular

having one compartment/unit that is well defined or outlined Ex. simple radicular cyst

multiocular

many lobed lesion that extends beyond the confines of one distinct area. Can appear like soap bubbles.

well circumscribed

clearly seen borders, very defined margins.

root resorption

apex of root appears short/blunt and irregularly shaped on radiograph. Caused by traumas. Shorter root = less stability.

Fluctuant

lesion that feels soft/compressible during palpation and feels like it "gives" some. NOT solid tissue. Indicating that the lesion may be fluid filled.

visual observation

______________ is important for description of the lesion (color, surface texture, shape, grooves, location, etc.)

palpation

_____________ (touching the lesion) is important to understand the consistency, mobility, temperature, and tenderness of the lesion.

measurments

__________________ are important because they give us the ability to document and keep track of the size of the lesion's length, width, height.

fordyce granules

yellow clusters of ectopic sebaceous glands on the border of the lips and buccal mucosa. Common. No TX needed.

mandibular torus (tori)

outgrowths of bone found on the lingual aspect of the mandibular premolar area above the mylohyoid ridge, typically bilateral lobulated or nodular. Common in both males and females. No TX necessary.

torus palatinus

exophytic growth of normal compact bone on the midline of the hard palate. Genetic and common in women. No TX needed unless it affects restorative care.

exostosis

benign bony growth (tori) found on the alveolar ridges. Can be caused by genetics, bruxism, grinding, or age

gingival melanin pigmentation

normal pigmentation (darker-black). Common in darker skinned individuals.

Retrocuspid papilla

sessile nodule on the gingival margin (lingual aspect) of the mandibular cuspids/canines. Only a few mm's in size and commonly found in young people.

lingual varicosities

red/purple enlarged vessels or clusters typically found on the ventral (bottom) and lateral surfaces (sides) of the tongue. Common and found mainly in older patients 60+ years old

linea alba

white line that extends Anterio-posteriorly on the buccal mucosa along the occlusal plane. May be bilateral. More prominent in patients with bruxism or clenching habit.

Lingual Thyroid Nodule

undescended and trapped remnants of thyroid tissue that appear as a mass in the midline of the dorsal (top) portion of the tongue posterior to the circumvallate papillae in the foramen cecum.

-Typically, 2-3cm in width.

-Common in women due to hormonal changes.

fissured tongue

dorsal surface of tongue has deep fissures/grooves.

- Cause: unknown, maybe genetic.

-No TX needed, but direct pt to keep tongue clean

median rhomboid glossitis

flat or slightly raised oval or rectangular erythematous area in the center of the dorsal surface of the tongue.

-May be associated with Candida Albicans

-TX not necessary, but antifungal meds may be prescribed.

Geographic tongue (migratory glossitis)

(aka erythema migrans). Appears as erythematous patches surrounded by a yellow or white border, diffuse areas of filiform papillae and distinct presence of fungiform papillae.

-May be due to genetics.

-Stress worsens

-Typically asymptomatic but some pt's may complain of a burning sensation.

-No TX typically needed

black hairy tongue

papillae are brown-black due to chromogenic bacteria. Can be caused from tobacco, foods, hydrogen peroxide, alcohol, chemical rinses.

-Recommended TX: brush tongue

brown hairy tongue

early stage before black hairy tongue. tongue appears brown. Can be from coffee, tea, mild tobacco use, etc.

White hairy tongue

elongated white filiform papillae. From an increase in keratin production or a decrease in normal desquamation (shedding) of the lingual papillae.

leukoedema

generalized opalescence (can appear purple) on buccal mucosa.

-most common in black adults

-When the mucosa is stretched the opalescence becomes less prominent.

-No TX necessary

Leukoplakia

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

Centimeter (cm)

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

Millimeter (mm)

-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 _________

external root resorption

resorption that 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

Anomaly

Something that deviates from what is standard or normal

Dysphagia

difficulty swallowing

Dysphonia

difficulty speaking

Dyspnea

difficulty breathing

color, shape, location, and history of lesion

Clinical Diagnosis

How does the lesion present?

This includes?

personal history, family history, past and present medical and dental histories, history of drug ingestion, history of the presenting disease/lesion

Historical Diagnosis can include?

brush test

(Microscopic Diagnosis)

A _______ can be used to obtain information from oral mucosal epithelium. During this test, a circular brush is used to obtain cells from the full thickness of the epithelium. The results aid in determining if a surgical biopsy is needed to establish a definitive diagnosis

can not

A white lesion ________ be diagnosed on the basis of clinical appearance alone

unerupted supernumerary teeth

Clinical diagnosis can be used to determine the final or definitive diagnosis of all the following except?

fordyce granules

unerupted supernumerary teeth

mandibular tori

geographic tongue

lobulated

Which of the following terms is most often used when describing mandibular tori?

bullous

lobulated

sessile

pedunculated

torus palatinus

a slow-growing, bony, hard exophytic growth on the midline of the hard palate is developmental and hereditary in origin. The diagnosis is determined through clinical evaluation. You suspect?

torus palatinus

mixed tumor

palatal cyst

Nasopalatine cyst

theraputic

when an antifungal ointment or cream is used to treat suspected angular chellitis, which one of the diagnostic categories is being used?

clinical

therapeutic

laboratory

differential

linea alba

The white line observed clinically on the buccal mucosa that extends from anterior to posterior along the occlusal plane is?

leukoedema

leukoplakia

linea alba

lichen planus

a retained deciduous tooth

Radiographic diagnosis would contribute to the definitive diagnosis of all of the following except?

internal resorptions

periapical cemento-osseous dysplasia

odontomas

a retained deciduous tooth

fordyce granules

which condition is most often seen on the buccal mucosa?

melanin pigmentation

fordyce granules

nicotine stomatitis

angular chellitis

central papillary atrophy (median rhomboid glossitis)

Because it is associated with candidiasis, an antifungal medication is sometimes used to help in the diagnosis or treatment of?

lingual thyroid

erythema migrans

central papillary atrophy

black hairy tongue

3 inches

a lesion is measured at 6 cm. What is the approximate size of the lesion?

microscopic

after arriving at a differential diagnosis, information from which of the following categories will best establish a final or definitive diagnosis?

clinical

historical

microscopic

radiographic

laboratory blood tests

to determine the presence of blood dyscrasias, which of the following would provide the most definitive information?

laboratory blood tests

bleeding during probing

pallor of the gingiva and mucosa

patient complaint of weakness

thyroid scan

the best way to determine whether lingual thyroid contains the patient's functioning thyroid tissue is?

thyroid scan

blood test

biopsy

medication

geographic tongue

another term for erythema migrans is?

mandibular tori

These examples of exostoses are found on the lingual aspect of the mandible, in the area of the premolars. They are benign, bony hard, and require no treatment. Radiographically, they appear as radiopaque areas and are often bilateral. You suspect?

retrocuspid papilla

lingual mandibular bone concavity

genial tubercules

mandibular tori

compound odontoma

the identification of which one of the following is NOT determined by clinical diagnosis?

fordyce granules

tori

compound odontoma

retrocuspid papilla

erythroplakia

All of the following are diagnosed without biopsy, except one. Which one is the exception?

fissured tongue

erythroplakia

central papillary atrophy

erythema migrans

papule

A small circumscribed lesion usually less than 1 centimeter in diameter that is elevated and protrudes above the surface of normal surrounding tissue is called a?

bulla

macule

vesicle

papule

between the foramen cecum and epiglottis

the most common location for lingual thyroid is?

ventral tongue

dorsal of anterior third of tongue

in the neck

between the foramen cecum and epiglottis

lingual thyroid

which of the following is characterized by symptoms including dysphagia, dysphonia, and dyspnea?

median rhomboid glossitis

erythema migrans

lingual thyroid

fissured tongue

clinical

which of the following diagnostic categories would the dental hygienist most easily apply to the preliminary evaluations of oral lesions?

clinical

microscopic

therapeutic

differential

clinical

which of the following terms best describes leukoplakia?

clinical

histologic

historical

microscopic

calcium channel blockers

gingival enlargement is caused by which of the following groups of drugs?

antiviral

calcium channel blockers

antibiotics

hypersensitivity

broad and flat

the base of a sessile lesion is?

broad and flat

stemlike

corrugated

lobulated

130

which of the following best describes the number of types of HPV? more than:

35

75

100

130

odontogenic keratocyst

osseous curretage and surgical excision

treatment of a odontogenic keratocyst involves?

microscopic, the epithelium distinguishes it from other jaw cysts

What diagnostic process contributes most significantly to the definitive diagnosis of odontogenic keratocyst?

internal resorption

gingival enlargement