Oral Pathology-Dr. Wright - Tennessee Primary Care Association
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7/20/2010 1 TANYA A. WRIGHT, DDS OBJECTIVES One will be able to recognize pathological entities One will be able to recognize pathological entities One will be able to establish a reasonable differential diagnosis One will be able to identify various types of lesions including squamous cell carcinoma One will be able to learn about different treatment options and medications to utilize for patients
Transcript of Oral Pathology-Dr. Wright - Tennessee Primary Care Association
7/20/2010
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TANYA A. WRIGHT, DDS
OBJECTIVES One will be able to recognize pathological entitiesOne will be able to recognize pathological entities
One will be able to establish a reasonable differential diagnosis
One will be able to identify various types of lesions including squamous cell carcinoma
One will be able to learn about different treatment options and medications to utilize for patients
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BIOPSY TECHNIQUES Cytology smear (least invasive)Cytology smear (least invasive)
Fine‐needle aspiration
Incisional biopsy (lesion greater than 1 cm)
Excisional biopsy (lesion smaller than 1 cm)
Biopsy aids
Brush biopsyBrush biopsy
VELscope
Vizilite Plus
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Courtesy of Kevin D. Huff, DDS, Dover, OH
CIRCUMVALLATE PAPILLAE
NORMAL ANATOMY
NO TREATMENT NEEDED
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BENIGN MIGRATORY GLOSSITIS
(GEOGRAPHIC TONGUE)
NO TREATMENT NEEDED
HAIRY TONGUE
TREATMENT
BRUSH TONGUE TO REMOVE DISCOLORATION
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AMALGAM TATTOO
TREATMENT
CONFIRM BY RADIOGRAPH
ADVISE PATIENT OF LESION
LEUKOEDEMA
NO TREATMENT NEEDED
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MORSICATIO BUCCARUM
(CHEEK BITING)
TREATMENT
MOUTHGUARD CAN BE USED
PALATAL TORI
NO TREATMENT NEEDED UNLESS FABRICATING
DENTURE
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STATIC BONE CYST
NO TREATMENT NEEDED
MONITOR WITH RADIOGRAPHS
ANGULAR CHEILITIS
TREATMENT
MEDICATION WITH ANTIFUNGAL/BACTERIAL
COMPONENTS
(VYTONE CREAM)
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DENTURE STOMATITISTREATMENT
ANTIFUNGAL THERAPY
TREAT DENTURE AS WELL
PARULIS
TREATMENT
ENDODONTIC THERAPY
OR
EXTRACTION
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PERIAPICAL CYSTPERIAPICAL CYST
DIFFERENTIAL DIAGNOSIS
ODONTOGENIC
KERATOCYST
PERIAPICAL ABSCESS
AMELOBLASTOMA
CENTRAL GIANT CELL GRANULOMA
TREATMENT
ENDO THERAPY/BIOPSY
FIBROMA
TREATMENT
BIOPSY
REMOVE TONGUE PIERCING
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LIPOMA
DIFFERENTIAL DIAGNOSIS
FIBROMA
TREATMENT
BIOPSY
MUCOCELE
DIFFERENTIAL DIAGNOSIS
HEMANGIOMA
MUCOEPIDERMOID CARCINOMA
TREATMENT
BIOPSY
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APHTHOUS ULCERAPHTHOUS ULCER (CANKER SORE)
IF FREQUENT OUTBREAKS
REFER TO GI SPECIALIST
TO RULE OUT CROHN’S, ULCERATIVE COLITIS
PERIPHERAL OSSIFYING FIBROMAOSSIFYING FIBROMA
DIFFERENTIAL DIAGNOSIS
PYOGENIC GRANULOMA
PERIPHERAL GIANT CELL GRANULOMA
TREATMENT
BIOPSY
REMOVE IRRITANTS BY SCALING
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NICOTINE STOMATITIS
TREATMENT
TOBACCO CESSATION
ERYTHEMAERYTHEMA MULTIFORME
DETERMINE UNDERLYING CAUSE
(MEDICATIONS OR HERPES SIMPLEX)
TREATMENT
PREDNISONE FOR SEVEN DAYSDAYS
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SMOKER’S KERATOSIS
SMOKELESS TOBACCO CESSATION
PALATAL SWELLING
DIFFERENTIAL DIAGNOSIS
PLEOMORPHIC ADENOMA
ADENOID CYSTIC CARCINOMA
LYMPHOMA
TREATMENT
BIOPSY
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WELL‐DEFINED UNILOCULARUNILOCULAR
RADIOLUCENCY
DIFFERENTIAL DIAGNOSIS
DENTIGEROUS CYST
AMELOBLASTOMA
ODONTOGENIC KERATOCYST
TREATMENT
BIOPSY
DESQUAMATIVE GINGIVITIS
INCLUDES
PEMPHIGUS VULGARIS
BULLOUS PEMPHIGOID
EROSIVE LICHEN PLANUS
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OTHER EXAMPLES OF DESQUAMATIVE GINGIVITIS
TRAUMATIC ULCER
DIFFERENTIAL DIAGNOSIS
SQUAMOUS CELL CARCINOMA
TUBERCULOSIS
DEEP FUNGAL INFECTION
PRIMARY SYPHILIS
TREATMENT
BIOPSYBIOPSY
REMOVE IRRITANT
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EXAMPLE OF TRAUMATIC LESION
PROLIFERATIVE VERRUCOUSVERRUCOUS LEUKOPLAKIA
TREATMENT
FOLLOW‐UPS WITH BIOPSY TO RULE OUT
CHANGE TO SQUAMOUS CELL CARCINOMA (SCCA)
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EROSIVE LICHENEROSIVE LICHEN PLANUS
TREATMENT
BIOPSY TO RULE OUT SCCA
TOPICAL STEROIDS FOR TREATMENT
SQUAMOUS CELLSQUAMOUS CELL CARCINOMA
TREATMENT
SURGERY/CHEMOTHERAPY/
RADIATION
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SQUAMOUS CELLSQUAMOUS CELL CARCINOMA
TREATMENT
SURGERY/CHEMOTHERAPY/RADIATION
OSTEONECROSIS/OSTEONECROSIS/OSTEORADIONECROSIS
TREATMENT
DEBRIDE AREA
ENFORCE GOOD ORAL HYGIENE INSTRUCTIONS
RESTORE/EXTRACT TEETH
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TAKE HOME POINTS
Biopsy any suspicious red/white/pigmented lesion
“Scalpel” biopsy is gold standard
“Aids” are beneficial to help with oral exam
Talk and teach patients to perform exams at home
Early detection is key oral exam takes only a few Early detection is key, oral exam takes only a few minutes to perform at each appointment
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REFERENCES Ibsen, O. and Phelan, J. Oral Pathology for the Dental
Hygienist 5th ed Saunders ElsevierHygienist. 5th ed. Saunders Elsevier.
Kahn, Michael. “Role of the Oral Health Care
Specialists in the Diagnostic Process for Oral
Cancer.” The Inside Summit on Oral Cancer
Discovery and Management: The TechnologiesDiscovery and Management: The Technologies
and the Role of Dental Clinicians. 2007. 27‐29.
Solomon, Lynn. “Oral Cancer Screening.” Inside
Dentistry. March 2010. 58‐66.
