LECTURE #4

DR. CHRIS VAN KESTEREN

4-3-14

Oral Pathology Review

Oral Pathology Keys

1. Review medical history: smoking, diabetes, medications, radiation therapy, cancer history

2. Review dental history: look for causes of tissue trauma

3. Extraoral and Intraoral Exams (palpation of lymph nodes, lesions): size, soft, firm, fixed

4. Etiology: calculus, plaque, habits, appliances

5. Pain: If no pain and it looks like it should hurt, this can be a red flag.

6. Duration: new; present longer than 2 weeks

7. Frequency: new or recurring

8. Pattern: localized or generalized; unilateral

9. Location: attached gingiva, mucosal tissue, tongue, FOM, retromolar pad

10. Palpation: does surface wipe off, bleeding, soft, firm, fixed

11. Radiographic findings: crestal bone loss, -luscency, -opacity, calculus present

Head and Neck Examination

EOE

Face

Hairline

Ears

Lips

TMJ

Lymph Nodes

Thyroid

Oral Cancer Screening

IOE

Lips

Buccal Mucosa

Attached/Keratinized Tissue

Mucosal Tissue

Retromolar pads

Roof the Mouth

Tongue

Floor of the Mouth

Throat

Take Home Messages

1. Complete extraoral checks. Ask patient about any changes or irregularities.

2. Check all intraoral features. Have a standard protocol to prevent missing anything. Check lymph nodes; lateral border of tongue; floor of the mouth; hard palate; and retromolar pad.

3. If you find a lesion, ask about it. Look for explainable causes. Rule out trauma.

4. Do not wait until next cleaning to check lesion. Bring back in 2 weeks if necessary.

5. If you have no idea, ask your dentist to evaluate. May need to refer to a Periodontist or OMS.

6. Always be looking. If you are not looking, you may not notice a lesion until it has progressed too far.

Considerations for when to biopsy

1. You did not find a plausible reason for why the lesions has occurred.

2. Characteristics: firm and fixed

3. Location: Not limited by location; check problem areas noted above.

4. Duration: More than two weeks

5. Worsening symptoms: Enlargement, increased pain

6. Bone loss

Erythematous Lesions

White Lesions

Fibroma

Epulis fissuratum

Squamous Cell Carcinoma

Leukoedema

Salivary Duct Cyst

Mucoepidermoid carcinoma

Melanoma

Oral hairy leukoplakia

Linea Alba

Traumatic Granuloma

Squamous Cell Carcinoma

Pyogenic Granuloma

Recurrent Apthous Ulcers

Wegener’s Granulomatosis

Reaction to Dental Amalgam

Actinomycosis

Squamous Cell Carcinoma

Amalgam tattoo

OKC; LPC; Dentigerous cyst; residual cyst

Hodgkin’s lymphoma

Oral Squamous Papilloma

Necrotizing Sialometaplasia

Oral Squamous Papilloma

Fordyce Granules

Mucocele

Condyloma Acuminatum

Lichen Planus

Blue nevus

Inflammatory papillary hyperplasia

Pleomorphic Adenoma

Hairy Leukoplakia

Nicotine Stomatitis

Fibroma

Squamous Cell Carcinoma

Peripheral Giant Cell Granuloma

Verrucous Carcinoma

Basal Cell Carcinoma

Multiple Myeloma

Candida Pseudomembranous

Canalicular Adenoma

Recurrent Herpes Labialis

Basal Cell Carcinoma

Oral Lymphoepithelial Cyst

Candidiasis

Gumma

Tobacco Pouch Keratosis

Varicosities

Melanoma

Contact Stomatitis - Acrylic

Kaposi’s Sarcoma

Metastases to the oral soft tissues

Melanoma

Torus Palatinus

Central giant cell granuloma

Florid Cemento-Osseous Dysplasia

Benign Cementoblastoma

Pemphigus Vulgaris

Denture Stomatitis

Erythema migrans

Primary herpetic gingivostomatitis

Ranula

Lichen Planus

Keratocanthoma

Leukemia

Non-Hodgkin’s Lymphoma

Focal epitheliam hyperplasia

Pleomorphic Adenoma

Pyogenic Granuloma