DHY 207

Introduction to Preliminary Diagnosis of Oral Lesions Vocabulary

Describing and Recording Clinical Findings

• Detailed descriptions

• History

• Location

• Distribution

• Definition

• Size

• Shape

• Color

• Consistency

• Surface texture

• Photographs

• History

• Location

Terminology: Clinical Appearance of Soft Tissue Lesions

• Distribution

• Localized vs generalized

• Margins

• Well-defined vs poorly defined

• Regular vs irregular

• Number multiple configuration

• discrete vs coalescing

Size of Lesion

• Centimeter (cm)

• one hundredth of a meter; equivalent to a 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 millimeters

Size and Shape

• Note general shape, measure size of lesion with a probe

• Measure diameter of round lesions

• Measure width and length of square, rectangular, and oval lesions

• Record measurements- width first then length

• Height is listed after the length of the lesion

• Relate size of a large lesion to the area it cover

Size and Shape: Flat

• Macule: Flat lesion differentiated from. the surrounding tissue b color alone (less than 1 cm in diameter)

• Patch: May also describe area with a different surface texture with or without a color change (more than 1 cm)

Size and Shape: Elevated Fluid Filled

• Vesicle: A small (0.5 cm or less) elevated lesion filled with clear fluid. It is a small, elevated lesion that contains serous fluid

• Bulla: Larger (larger than 0.5 cm) elevated lesion filled with clear fluid. It is a circumscribed, elevated lesion that is more than 5 mm in diameter. It usually contains serous fluid, and looks like a blister

• Pustule: A raised lesion filled with pus or purulent exudate like an acne pimple It is various sized circumscribed elevations containing pus

Size and Shape: Elevated Solid

• Papule: Solid raised lesion 0.5 cm or less

• Nodule: Solid raised lesion larger than 0.5 cm but less than 2 cm

• Tumor: Solid raised lesion larger than 2 cm

• Lobule: An elevated solid segment or lobe that is part of a whole. These lobes sometimes appear fused together

Size and Shape: Plaque Broad Flat

• The slightly raised and flat configuration of this white lichen planus lesion covering a relatively broad area is indicative of a plaque. Also note the well-defined irregular margin

Size and Shape: Base/Attachment

• Sessile: Describing the base of a lesion that is flat or broad instead of stemlike

• Pedunculated: Attached by a stemlike or stalklike base similar to that of a mushroom

Size and Shape: Depressed

• Ulcers

• Erosions/abrasions

Direction of Growth

• Endophytic: Grow into the surrounding tissues with little or no observable swelling

• Exophytic

Color of Lesion

• Most frequent color descriptions:

• Red

• Pink

• Salmon

• White

• Blue-black

• Gray

• Brown

• Black

• Used to identify specific lesions

• may be incorporated into general descriptions

Color: White

• White lesions usually involve excess keratin in the tissues, making them more opaque

• 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

• Pallor: Paleness of the skin or mucosal tissues

Color: Red

• Erythema is an abnormal redness of the mucosa or gingiva

• Erythroplakia: A clinical term used to describe an oral lesion that appears as a smooth red patch or glandular red and velvety patch

• less common than leukoplakia

• 90% of erythroplakias demonstrate epithelial dysplasia or squamous cell carcinoma

Color: Yellow

• Xanthelasma: A yellowish plaque located around the eyelids, is associated with high levels of cholesterol

Color: Pigmented

• Endogenous: Come from within the body- melanin pigmentations

• Exogenous: Come from outside the body- lead, amalgam, and others

• Black

• Brown

• Blue

Consistency

• The consistency of soft tissue abnormalities is often soft or normal feeling

• Indurated soft tissue lesions, such as an inflamed lymph node, feel quite hard

• Fluctuate is used to describe a fluid-filled lesion that moves fluid from one area to another when the lesion is pressed

Surface Texture

• Corrugated: Wrinkled

• Fissure: A cleft or groove, normal or otherwise, showing prominent depth

• Papillary: Resembling small, nipple-shaped projections or elevations found in clusters

• Smooth

• Rough

• Folded

Describing Radiographic Findings/Lesions in Bone

• History-aware/not aware

• Location and size

Opacity

• Radiopaque

• Describes the light or white area on a radiograph that results from the inability of radiant energy to pass through the structure

• the more dense the structure, the more light or white it appears on the radiograph

• Radiolucent

• Describes the black or dark areas on a radiograph

• Radiant energy can pass through these structures

• Less dense tissue, such as pulp, is seen as a radiolucent structure

Radiolucent and Radiopaque

• A mixture of light and dark areas within a lesion

• Denotes a stage in lesion development

Inner Appearance

• Unilocular: Having one compartment or unit that is well defined or outlined as in a simple radicular cyst

• Multilocular: Describes a lesion that extends beyond the confines of one distinct area. Defined as many lobes or parts that are somewhat fused together. A multilocular radiolucency is sometimes described as resembling soap bubbles

• Coalescence: The process by which parts of a whole join together, or fuse, to make one

Radiographic Terms Used to Describe Lesions in Bone

• Diffuse

• Describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion

• Can make treatment more difficult and depending on the biopsy results, more radical

• Margins

• Well-defined vs poorly defined

• Well circumscribed: Used to describe a lesion with borders that are specially defined and in which one can clearly see the exact margins and extent

Surrounding Tissues

• Root resorption

• Radiographically, the apex of the tooth appears shortened or blunted and irregularly shaped

• Occurs as a response to stimuli, which can include a cyst, tumor, or trauma

• External root resorption

• Arises from tissue outside the tooth, such as the PDL

• Internal root resorption

• Triggered by pupal tissue reaction from within the tooth

• The pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area

• Scalloping around the root

• A radiolucent lesion that appears to extend up the PDL and between the roots

Additional Vocabulary Words

• Anomaly: Something that deviates from what is standard or normal

• Dysphasia: Difficulty swallowing

• Dysphonia: Difficulty speaking

• Dyspnea: Difficulty breathing

Reactive Tissue Responses: Hyperplasia, Hypertrophy, and Atrophy

• Hyperplasia: An increase in the number of cells, often in response to chronic irritation or abrasion. May return to normal if the insult subsides, or may persist after removal of the irritant

• Hypertrophy: An increase in the size of cells. May be seen in cardiac muscle as a response to hypertension

• Atrophy: A decrease in size or function of a cell, tissue, organ, or entire body