Oral Pathologies Study Guide eerk15

Introduction to Oral Pathology

  • Definition: Oral pathology is the study of diseases in the oral cavity.
  • Relation to Systemic and Infectious Diseases: Many systemic diseases and infectious diseases have oral signs and symptoms.
  • Diagnosis: Only a dentist or physician can diagnose pathological (disease) conditions (Robinson, 2024).

The Making of a Diagnosis

  • Methods of Diagnosis:
    • Historical
    • Clinical
    • Radiographic
    • Microscopic
    • Laboratory
    • Therapeutic
    • Surgical
    • Differential

Role of the Dental Assistant in Oral Pathology

  • Understanding Effects: The dental assistant should understand how oral abnormalities can affect the patient’s general health and planned dental treatment.
    • Essential to recognize abnormal conditions by having a solid understanding of normal oral conditions (Bird and Robinson, 2021).
  • Terminology and Communication: The dental assistant should understand terms used to describe pathological conditions and record preliminary identification and descriptions of lesions.
    • This understanding allows effective communication with other professionals (Bird and Robinson, 2021).

Oral Lesions

  • Definition: A lesion is a broad term for abnormal tissues in the oral cavity.
    • Lesions can be wounds, sores, or any other tissue damage caused by injury or disease.
  • Classification, based on their extension:
    • Lesions that extend below the mucosal surface
    • Lesions that extend above the mucosal surface
    • Lesions that lie flat or even with the mucosal surface (Bird and Robinson, 2021).

Lesions Extending Below Mucosal Surface

  • Types of Lesions:
    • Ulcer: A defect or break in continuity of the mucosa resulting in a punched-out area similar to a crater.
    • Erosion of Soft Tissue: A shallow defect in the mucosa caused by mechanical trauma.
    • Abscess: A localized collection of pus in a circumscribed area.
    • Cyst: A closed sac or pouch lined with epithelium, containing fluid or semisolid material (Bird and Robinson, 2021).

Lesions Extending Above Mucosal Surface

  • Types of Lesions:
    • Blisters (Vesicles): Filled with watery fluid; a blister greater than an inch is referred to as a bulla (Singhal, 2023).
    • Pustule: Similar to a blister but filled with pus (Bird and Robinson, 2021).
    • Hematoma: Similar to a blister but filled with blood (Bird and Robinson, 2021).
    • Plaque: A slightly raised, flat area on an oral surface (Bird and Robinson, 2021).

Lesions Even with Mucosal Surface

  • Characteristics: Lesions lie flat or even with the mucosal surface and are well-defined areas of discoloration.
  • Types of Lesions:
    • Purpura: Red or purple spots on the skin or mucosa caused by localized bleeding; pinpoint size called petechiae (Singhal, 2023).
    • Ecchymosis: Medical term for bruising (Bird and Robinson, 2021).
    • Macule: A flat pigmented spot (e.g., mole, freckle) on the skin, lips, or inside mucosa (Singhal, 2023).
    • Patch: An area on the skin that is a different color (Singhal, 2023).

Raised or Flat Lesions

  • Nodules: Small, round, solid lesions that may appear below the surface or may be slightly elevated; feels like a pea when palpated.
  • Granuloma: In dentistry, often used to describe a nodule containing granulation tissue.
  • Tumors: Also known as neoplasms; tumors may be benign or malignant (Bird and Robinson, 2021).

Key Responsibilities of a Dental Assistant

  • Identifying Clinical Features:
    • Describe observed lesions (including location, size, shape, color, consistency/texture).
  • Clinical Implications Considerations:
    • Identify possibilities, understand causes, consider clinical implications, ensure patient comfort, infection prevention and control, and explore treatment options.

Causes and Mechanisms of Disease

  • Cause Classifications:
    • Intrinsic Factors: Related to nature (e.g., genetic, hereditary).
    • Extrinsic Factors: Related to nurture (e.g., environmental, lifestyle).

Inflammation in Response to Tissue Injury

  • Definition: Inflammation is the body's protective response to irritation or injury.
  • Types of Inflammation:
    • Acute Inflammation: Occurs with minimal, short-lasting tissue injury when repair begins quickly.
    • Chronic Inflammation: Occurs with continuous injury or irritation (Bird & Robinson, 2021).
  • Common Symptoms of Inflammation:
    • Redness (erythema)
    • Heat
    • Pain
    • Swelling (Singhal, 2023).

Cellulitis

  • Description: An inflammation that spreads through soft tissue or an organ, causing rapid swelling, and often accompanied by high fever and severe pain.
  • Risks: Cellulitis associated with oral infections may be dangerous as it can quickly affect sensitive tissues, such as the eye or brain (Bird and Robinson, 2021).

Labial and Buccal Pathologies

  • Leukoplakia:
    • Definition: Means white patch; lesions vary in appearance from fine white transparency to thick, warty plaques.
    • Causes: Unknown, but may be linked to chronic irritation or trauma; often precedes malignant tumors (Bird and Robinson, 2021).
  • Sialolith:
    • Definition: Salivary stones formed from calcium deposits causing obstructions in glands; may necessitate antibiotics or surgery.
  • Mucocele:
    • Description: Swelling of the lower lip often resulting from biting; may require surgery or could regress on their own.
  • Amalgam Tattoo:
    • Definition: Amalgam particles trapped in tissue creating a blue-gray appearance resembling a tattoo, often due to sialolith or trauma.
  • Linea Alba:
    • Description: A raised, wavy line at the level of occlusion on buccal mucosa, hyperkeratotic, and can be caused by cheek biting.
  • Aspirin Burn:
    • Definition: Tissue burn resulting from placing aspirin for toothache, leading to necrotic tissue that could heal in 7-14 days upon discontinuation (Singhal, 2023).

Pathologies of the Tongue and Adjacent Areas

  • Glossitis:
    • Description: Inflammation causing atrophy of the papillae, resulting in a smooth erythematous tongue.
    • Causes: Allergic reactions, irritations from foods, nutritional deficiencies (Singhal, 2023).
  • Median Rhomboid Glossitis: Described in Bird & Robinson (2021).
  • Black Hairy Tongue:
    • Definition: Elongated filiform papillae resembling hairs, discolored by food debris and tobacco.
    • Causes: Imbalance of oral flora post-antibiotic use (Singhal, 2023; Bird & Robinson, 2021).
  • Fissured Tongue:
    • Description: Variant of normal with deep fissures on the tongue's top surface.
    • Management: Regular cleaning of the fissures to prevent irritation (Bird and Robinson, 2021).
  • Bifid Tongue:
    • Definition: Rare condition with partial fusion occurring during development.
  • Ankyloglossia:
    • Description: Also known as tongue tie; limits tongue movement; may disrupt speech.
    • Treatment: Frenectomy (surgical removal of limited frenum) (Singhal, 2023).

Clinical Considerations in Oral Diseases

  • Importance of Oral Mucosa: The oral mucosa is a significant indicator of health or disease; many diseases manifest in some way through oral tissues.
  • Role of the Dental Team: Early detection of diseases is key in managing a patient’s health.
  • Example: Pernicious Anemia:
    • Description: Condition of vitamin B12 malabsorption leading to anemia and symptoms such as weakness, pallor, and fatigue.
    • Oral Manifestations: Include angular cheilitis, mucosal ulceration, loss of papillae, and burning sensations in the tongue (Bird and Robinson, 2021).

HIV and AIDS Related Oral Pathologies

  • Oral Lesions in HIV/AIDS:
    • Development: Due to the breakdown of the immune system and depletion of T-helper cells (Bird and Robinson, 2021).
    • Opportunistic Infections: Infections that are typically controlled by a healthy immune system, which may worsen in immunocompromised patients.
    • Symptoms of HIV Gingivitis: Bright red line along the free gingival margin, progressing from margin to the attached gingival (Bird and Robinson, 2021).
  • HIV Periodontitis:
    • Characteristics: Resembles acute necrotizing ulcerative gingivitis with pronounced swelling, necrosis, and pain (Bird and Robinson, 2021).
  • Candidiasis: Often the first oral sign indicating progression from HIV-positive status to AIDS; can become debilitating in immune-compromised individuals.
  • Lymphadenopathy: Enlargement of cervical nodes frequently associated with AIDS (Bird and Robinson, 2021).

Lymphoma and Oral Health

  • Definition of Lymphoma: A term for malignant disorders of lymphoid tissue, which can present as a lump, swelling, or nonhealing ulcer in the oral cavity.
  • Symptoms: Lesions that grow rapidly and usually painful, which may be the first evidence of lymphoma (Bird and Robinson, 2021).

Hairy Leukoplakia and Kaposi Sarcoma

  • Hairy Leukoplakia: An early manifestation of AIDS with filamentous white plaques found on the tongue sides which may cover the entire dorsal surface (Bird and Robinson, 2021).
  • Kaposi Sarcoma: Appears as flat lesions with bluish, blackish, or reddish blotches; a significant diagnostic marker for AIDS (Bird and Robinson, 2021).

Herpes Simplex and Human Papillomavirus (HPV)

  • Herpes Simplex: Lesions usually found on the lips, but may appear throughout the mouth in immunocompromised patients; persistent ulcers may indicate AIDS (Bird and Robinson, 2021).
  • Human Papillomavirus (HPV): Most commonly seen in immunocompromised individuals, with spiky warts that often arise in early HIV infection (Bird and Robinson, 2021).

References

  • Bird, D.L., & Robinson, D.S. (2021). Modern Dental Assisting (13th ed.). Elsevier.
  • SAIT. (2021). DENT 237: Oral Anatomy & Histology [Outcome 13: oral pathology]. Available at: https://learn.sait.ca/d2l/home/206101
  • Singhal, V., Kantz, S., Damatta, M., Phinney, D., & Halstead, J. (2023). Dental Assisting: A Comprehensive Approach (6th ed.). Cengage.