Oral Pathologies

Introduction to Oral Pathology

  • Oral pathology is the study of diseases in the oral cavity.
    • Many systemic diseases and infectious diseases exhibit oral signs/symptoms.
    • Only a dentist or physician may diagnose pathological (disease) conditions (Robinson, 2024).

The Making of a Diagnosis

  • Various methods used for diagnosis:
    • Historical
    • Clinical
    • Radiographic
    • Microscopic
    • Laboratory
    • Therapeutic
    • Surgical
    • Differential

The Role of the Dental Assistant

  • Understanding the impact of oral abnormalities on general health and planned dental treatment is essential for dental assistants.
    • Key to recognition of abnormal conditions is having knowledge of normal oral appearances (Bird and Robinson, 2021).
  • Dental assistants should understand the terms used to describe pathologic conditions.
    • They should record preliminary identification and descriptions of lesions using professional vocabulary for effective communication with other professionals (Bird and Robinson, 2021).

Oral Lesions

  • Definition: Lesion is a broad term for abnormal tissues in the oral cavity.
    • Possible forms include wounds, sores, or other tissue damage caused by injury or disease.
    • Classification based on
    • Extension below or above the mucosal surface.
    • Being flat or even with the mucosal surface. (Bird and Robinson, 2021).

Lesions Extending Below Mucosal Surface

  1. Ulcer
    • A defect or break in continuity of the mucosa that creates a crater-like area.
  2. Erosion of the soft tissue
    • A shallow defect in the mucosa caused by mechanical trauma.
  3. Abscess
    • A localized collection of pus in a circumscribed area.
  4. Cyst
    • A closed sac or pouch lined with epithelium containing fluid or semisolid material (Bird and Robinson, 2021).

Lesions Extending Above Mucosal Surface

  1. Blisters/Vesicles
    • Filled with watery fluid; larger blisters known as Bulla (greater than one inch) (Singhal 2023).
  2. Pustule
    • Similar to a blister but containing pus (Bird and Robinson, 2021).
  3. Hematoma
    • Contains blood, akin to a blister (Bird and Robinson, 2021).
  4. Plaque
    • Any patch or flat area that is slightly raised from the surface (Bird and Robinson, 2021).

Lesions Even with Mucosal Surface

  • Characteristics: lie flat or even with oral mucosa, well-defined areas of discoloration.
  1. Purpura
    • Red or purple spots on skin/mucosa from localized bleeding; pinpoint size referred to as petechiae (Singhal, 2023).
  2. Ecchymosis
    • Medical term for bruising (Bird and Robinson, 2021).
  3. Macule
    • Flat pigmented spot on skin, lips, or mucosa (e.g., mole/freckle) (Singhal, 2023).
  4. Patch
    • Area of different color on skin (Singhal, 2023).

Raised or Flat Lesions

  • Nodules grown slightly elevated or beneath the surface
    • Described as small, round, solid lesions; feel like peas beneath the surface.
  • Granuloma refers to nodules containing granulation tissue.
  • Tumors
    • Known as neoplasms; may be benign or malignant (Bird and Robinson, 2021).

Assistant's Duties

  • As a dental assistant, you must:
    • Describe lesions observed.
    • Identify possibilities for diagnosis.
    • Understand causes of lesions.
    • Consider clinical implications:
    • Patient comfort
    • Infection Prevention and Control (IPC)
    • Treatment options

Describing Observations

  • Essential factors to describe include:
    • Location
    • Size
    • Shape
    • Colour
    • Consistency/Texture

Causes and Mechanisms of Disease

  • Two categories of causes:
    • Intrinsic (Nature)
    • Extrinsic (Nurture)

Inflammation

  • Definition: Inflammation is the body’s protective response to irritation or injury.
    • May be acute or chronic:
    • Acute: minimal and short-lasting injury, tissue begins to repair quickly.
    • Chronic: continual injury or irritation persists (Bird & Robinson, 2021).
Symptoms of Inflammation
  • Common symptoms include:
    • Redness (erythema)
    • Heat
    • Pain
    • Swelling (Singhal, 2023)

Cellulitis

  • Definition: Inflammation in soft tissue or an organ with rapid swelling, high fever, and redness.
  • Severity: Cellulitis from oral infections can be particularly dangerous; it may spread quickly to vital areas (Bird and Robinson, 2021).

Labial and Buccal Pathologies

Leukoplakia

  • Description: Known as a white patch, with lesions varying in appearance and texture.
    • Often associated with chronic irritation/trauma.
    • Potential precursor to malignant tumors (Bird and Robinson, 2021).

Sialolith / Mucocele

  • Definition: Salivary stones formed from calcium deposits.
    • May block the involved gland leading to extraoral swelling and pain requiring antibiotics/surgery.
  • Mucocele: Blocked/broken minor salivary duct may result in swelling of the lower lip, common in children or due to lip biting.

Amalgam Tattoo

  • Description: Amalgam particles may become trapped in tissue leading to the appearance of blue-grey gingival tissue (like a tattoo) often due to sialolith or local trauma.

Linea Alba

  • Description: A raised, wavy line on buccal mucosa corresponding to occlusion level, which may be hyperkeratotic, often due to cheek biting.

Aspirin Burn

  • Description: Occurs when aspirin is placed on a toothache and results in a tissue burn (necrotic white tissue), which can cause painful ulceration and usually heals within 7-14 days post-aspirin use (Singhal, 2023).

Pathologies of the Tongue and Oral Cavity

Glossitis

  • Description: General term for inflammation and altered topography of the tongue.
    • Often leads to atrophy of the papillae and smooth erythematous appearance (Singhal, 2023).
    • Causes: Allergic reactions, food irritants, nutritional deficiencies (Singhal, 2023).

Black Hairy Tongue

  • Description: Elongation of filiform papillae resembling hair and stained by food, tobacco, or chromogenic bacteria.
    • Can arise after antibiotic use or mouth rinses affecting oral flora (Bird & Robinson, 2021).

Fissured Tongue

  • Description: Characterized by deep fissures or grooves on the dorsal surface; possibly due to chronic trauma or vitamin deficiency, leading to irritation (Bird and Robinson, 2021).

Bifid Tongue

  • Description: A rare condition with partial fusion of the tongue during development, often requiring no treatment (Singhal, 2023).

Ankyloglossia (Tongue Tie)

  • Description: Condition where the lingual frenum attaches near the tip of the tongue, sometimes restricting movement, which can disrupt speech.
    • Treatment involves Frenectomy (surgical removal of part of the lingual frenum) (Singhal, 2023).

Clinical Considerations and Diseases

Overview

  • Oral mucosa serves as an indicator of overall health or disease.
  • Numerous conditions manifest orally, and early detection by the dental team is crucial.

Pernicious Anemia

  • Definition: A condition characterized by the body's inability to absorb Vitamin B12.
  • Symptoms include anemia, weakness, fatigue, nausea, diarrhea, abdominal pain, and loss of appetite.
    • Oral manifestations include angular cheilitis, mucosal ulceration, loss of tongue papillae, and burning sensations in the tongue (Bird and Robinson, 2021).

HIV and AIDS

  • Oral lesions are significant distinguishers in AIDS and HIV infections due to the breakdown of the immune system as T-helper cells deplete (Bird and Robinson, 2021).
  • Opportunistic infections occur as the immune system fails to control them.
    • Oral manifestations including HIV-associated gingivitis, periodontitis, candidiasis, and cervical lymphadenopathy.

Specific Oral Conditions

  1. HIV Gingivitis
    • Bright red line along free gingival margin; associated with atypical gingivitis (Bird and Robinson, 2021).
  2. HIV Periodontitis
    • Symptoms: Interproximal necrosis, marked swelling, intense pain, and bad breath (Bird and Robinson, 2021).
  3. Candidiasis
    • Initial oral sign of progression from HIV-positive status to AIDS; severe in immunocompromised patients.
  4. Cervical Lymphadenopathy
    • Enlargement of cervical nodes, often associated with AIDS (Bird and Robinson, 2021).

Lymphoma

  • Definition: General term for malignant lymphoid tissue disorders that may present as nodules or ulcers in the oral cavity, usually painful and can signify serious conditions (Bird and Robinson, 2021).

Hairy Leukoplakia

  • Description: A filamentous white plaque often present bilaterally on the sides of the anterior tongue; may spread across the dorsal surface (Bird and Robinson, 2021).

Kaposi Sarcoma

  • One of the opportunistic infections in HIV, appears as multiple bluish, blackish, or reddish blotches, flat in early stages, and serves as a diagnostic indicator for AIDS (Bird and Robinson, 2021).

Herpes Simplex

  • Typically found on the lip; may present throughout the mouth in immunocompromised patients, and persistent ulcers longer than a month may indicate AIDS (Bird and Robinson, 2021).

Human Papillomavirus (HPV)

  • Appears mostly in immunocompromised individuals, diagnosed based on clinical appearance and biopsies; HPV lesions are often spiky and can have a cauliflower appearance (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].
    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.