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Dental EmergenciesDental Emergencies
Brian Bast D.M.D., M.D.Brian Bast D.M.D., M.D.
Assistant Clinical ProfessorAssistant Clinical Professor
UCSF/SFGHUCSF/SFGH
Department of Oral and MaxillofacialDepartment of Oral and MaxillofacialSurgerySurgery
Dental EmergenciesDental Emergencies
PainPain
TraumaTrauma
InfectionInfection
PathologyPathology
Dental EmergenciesDental Emergencies
PainPain
TraumaTrauma
InfectionInfection
PathologyPathology
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Dental EmergenciesDental Emergencies
Dental EmergenciesDental Emergencies
Dental EmergenciesDental Emergencies
Dental EmergenciesDental Emergencies
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Dental EmergenciesDental Emergencies
Dental EmergenciesDental Emergencies
Normal AnatomyNormal Anatomy
Normal AnatomyNormal Anatomy
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Normal AnatomyNormal Anatomy Normal AnatomyNormal Anatomy
Normal AnatomyNormal Anatomy Normal AnatomyNormal Anatomy
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AbAb--Normal AnatomyNormal Anatomy Normal AnatomyNormal Anatomy
Fordyces SpotsFordyces Spots
Palatal ToriPalatal Tori Mandibular ToriMandibular Tori
Dental PainDental Pain
Dental PainDental Pain
Trigeminal NerveTrigeminal Nerve
AA (small myelinated)(small myelinated)
C (unmyelinated)C (unmyelinated)
Transmits only PainTransmits only Pain
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Dental PainDental Pain Dental PainDental Pain
AnalgesicsAnalgesics NSAID, Tyelenol/NarcoticNSAID, Tyelenol/Narcotic
AntibioticAntibiotic Penicillen, ClindamycinPenicillen, Clindamycin
Dental CareDental Care Filling, Root Canal etc.Filling, Root Canal etc.
Dental PainDental Pain
AnalgesicsAnalgesics NSAID, Tyelenol/NarcoticNSAID, Tyelenol/Narcotic
AntibioticAntibiotic Penicillen, ClindamycinPenicillen, Clindamycin
Dental CareDental Care Filling, Root Canal etc.Filling, Root Canal etc.
Dental PainDental Pain
AnalgesicsAnalgesics NSAID, Tyelenol/NarcoticNSAID, Tyelenol/Narcotic
AntibioticAntibiotic Penicillen, ClindamycinPenicillen, Clindamycin
Dental CareDental Care Filling, Root Canal etc.Filling, Root Canal etc.
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Dental PainDental Pain
AnalgesicsAnalgesics NSAID, Tyelenol/NarcoticNSAID, Tyelenol/Narcotic
AntibioticAntibiotic Penicillen, ClindamycinPenicillen, Clindamycin
Dental CareDental Care Filling, Root Canal etc.Filling, Root Canal etc.
Mucosal PainMucosal Pain
UlcerationUlceration
DifferentialDifferential Neoplasm, Immune, InfectionNeoplasm, Immune, Infection
TraumaTrauma
Biopsy Directed TreatmentBiopsy Directed Treatment
Mucosal PainMucosal Pain
Aphthous Ulcer /canker soreAphthous Ulcer /canker sore
EtiologyEtiology Immune MediatedImmune Mediated
IncidenceIncidence 40% Population40% Population
MinorMinor Small (3Small (3--10mm)10mm)
SuperficialSuperficial
Short Duration (7Short Duration (7--14d)14d)
MajorMajor Larger (greater than 10mm)Larger (greater than 10mm)
Deep (submucossal and mucsle)Deep (submucossal and mucsle)
Longer LastingLonger Lasting
Mucosal PainMucosal Pain
Aphthous Ulcer / StagesAphthous Ulcer / Stages
ProPro--dromaldromal tingling, burningtingling, burning
Pre UlcerPre Ulcer red papulesred papules
UlcerUlcer superficial, white basesuperficial, white base
HealingHealing granulation, no scar/scargranulation, no scar/scar
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Mucosal PainMucosal Pain
Aphthous Ulcer / TreatmentAphthous Ulcer / Treatment
No TreatmemtNo Treatmemt
Topical AnestheticsTopical Anesthetics
Topical AntibioticsTopical Antibiotics TetracyclineTetracycline
CorticosteroidsCorticosteroids topical, intratopical, intra--lesional,lesional,
systemicsystemic
Mucosal PainMucosal Pain
Dental TraumaDental Trauma
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral LuxationAvulsionAvulsion
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Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral Luxation
AvulsionAvulsion
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
Dental EvaluationDental Evaluation
Good PrognosisGood Prognosis
Root CanalRoot CanalAnalgesics/AntibioticsAnalgesics/Antibiotics
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
Dental EvaluationDental EvaluationGood PrognosisGood Prognosis
Root CanalRoot Canal
Analgesics/AntibioticsAnalgesics/Antibiotics
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral LuxationAvulsionAvulsion
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Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral Luxation
AvulsionAvulsion
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral Luxation
AvulsionAvulsion
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Dental TraumaDental Trauma
ExtrusionExtrusion
Lateral LuxationLateral Luxation
Repositioning and SplintingRepositioning and Splinting
Dental EvaluationDental Evaluation
Analgesics/AntibioticsAnalgesics/Antibiotics
Guarded PrognosisGuarded Prognosis
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral Luxation
AvulsionAvulsion
Dental TraumaDental Trauma
ConcussionConcussion
SubluxationSubluxation
IntrusionIntrusion
ExtrusionExtrusion
Lateral LuxationLateral LuxationAvulsionAvulsion
Dental TraumaDental Trauma
AvulsionAvulsion
Time LimitationsTime Limitations 1h1h
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Dental TraumaDental Trauma
AvulsionAvulsion
Time LimitationsTime Limitations 1h1h
Storage MediumStorage Medium
tissue culture, socket,tissue culture, socket,saliva, milk, salinesaliva, milk, saline
Dental TraumaDental Trauma
AvulsionAvulsion
Time LimitationsTime Limitations 1h1h
Storage MediumStorage Medium
tissue culture, socket,tissue culture, socket,saliva, milk, salinesaliva, milk, saline
Health of the ToothHealth of the Tooth
Dental TraumaDental Trauma
Avulsion/ReplantationAvulsion/Replantation
1.1. Irrigate ToothIrrigate Tooth
2.2. Local AnestheticLocal Anesthetic
3.3. Irrigate SocketIrrigate Socket
4.4. Replant ToothReplant Tooth
5.5. SplintSplint6.6. XX--RayRay
Dental TraumaDental Trauma
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Dental TraumaDental Trauma Dental TraumaDental Trauma
Dental TraumaDental Trauma
AvulsionAvulsion
Dental EvaluationDental Evaluation
Poor PrognosisPoor Prognosis
Analgesics/AntibioticsAnalgesics/Antibiotics
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Dental TraumaDental Trauma
Crown FractureCrown Fracture
Root FracturesRoot Fractures
Dental AlveolarDental Alveolar
Dental TraumaDental Trauma
Crown FractureCrown Fracture
Root FracturesRoot Fractures
Dental AlveolarDental Alveolar
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Dental TraumaDental Trauma
Crown FractureCrown Fracture
Root FracturesRoot Fractures
Dental AlveolarDental Alveolar
Dental TraumaDental Trauma
Crown FractureCrown Fracture
Ellis ClassificationEllis Classification
Class IClass I Enamel OnlyEnamel Only
Class IIClass II Enamel and DentinEnamel and Dentin
Class IIIClass III Enamel, Dentin and PulpEnamel, Dentin and Pulp
Class IVClass IV Root FracturesRoot Fractures
Dental TraumaDental Trauma
Crown FractureCrown Fracture
Ellis ClassificationEllis Classification
Class IClass I Enamel OnlyEnamel Only
Class IIClass II Enamel and DentinEnamel and Dentin
Class IIIClass III Enamel, Dentin and PulpEnamel, Dentin and Pulp
Class IVClass IV Root FracturesRoot Fractures
Dental TraumaDental Trauma
Crown FractureCrown Fracture
Ellis ClassificationEllis Classification
Class IClass I Enamel OnlyEnamel Only
Class IIClass II Enamel and DentinEnamel and Dentin
TreatmentTreatment
Dental ReferralDental ReferralFilling, Root Canal/CrownFilling, Root Canal/Crown
AnalgesicsAnalgesics
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Dental TraumaDental Trauma
Crown FractureCrown Fracture
Ellis ClassificationEllis Classification
Class IClass I Enamel OnlyEnamel Only
Class IIClass II Enamel and DentinEnamel and Dentin
TreatmentTreatment
Dental ReferralDental Referral
Filling, Root Canal/CrownFilling, Root Canal/Crown
AnalgesicsAnalgesics
Dental TraumaDental Trauma
Crown FractureCrown Fracture
Ellis ClassificationEllis Classification
Class IIIClass III Enamel, Dentin and PulpEnamel, Dentin and Pulp
TreatmentTreatment
Dental ReferralDental Referral
Root Canal/ CrownRoot Canal/ Crown
Possible ExtractionPossible Extraction
AnalgesicsAnalgesicsAntibioticsAntibiotics Penicillen, ClindamycinPenicillen, Clindamycin
Dental TraumaDental Trauma
Crown FractureCrown Fracture
Ellis ClassificationEllis Classification
Class IIIClass III Enamel, Dentin and PulpEnamel, Dentin and Pulp
TreatmentTreatment
Dental ReferralDental Referral
Root Canal/ CrownRoot Canal/ CrownPossible ExtractionPossible Extraction
AnalgesicsAnalgesics
AntibioticsAntibiotics Penicillen, ClindamycinPenicillen, Clindamycin
Dental TraumaDental Trauma
Root FractureRoot Fracture
Ellis ClassificationEllis Classification
Class IVClass IV Root FracturesRoot Fractures
TreatmentTreatment
Dental ReferralDental Referral
ExtractionExtractionAnalgesicsAnalgesics
AntibioticsAntibiotics Penicillen, ClindamycinPenicillen, Clindamycin
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Oral InfectionsOral Infections
Oral InfectionsOral Infections
Periodontal Disease and Tooth DecayPeriodontal Disease and Tooth Decay
are the most common infectiousare the most common infectiousdiseases in the United states.diseases in the United states.
Over 95% of the Population.Over 95% of the Population.
Oral InfectionsOral Infections
Periodontal Disease and Tooth DecayPeriodontal Disease and Tooth Decayare the most common infectiousare the most common infectiousdiseases in the United states.diseases in the United states.
Over 95% of the Population.Over 95% of the Population.
Oral InfectionsOral Infections
Periodontal Disease and Tooth DecayPeriodontal Disease and Tooth Decayare the most common infectiousare the most common infectiousdiseases in the United states.diseases in the United states.
Over 95% of the Population.Over 95% of the Population.
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Oral InfectionsOral Infections
Odontogenic InfectionsOdontogenic Infections
Most common cause of an abscess in theMost common cause of an abscess in thedeep spaces of the Head and Neckdeep spaces of the Head and Neck
Spread of Infection depends onSpread of Infection depends on
-- Thickness of bone adjacent to toothThickness of bone adjacent to tooth
-- Position of muscle attachment inPosition of muscle attachment inrelation to root apexrelation to root apex
-- Host DefenseHost Defense-- Virulence of bacteriaVirulence of bacteria
Oral InfectionsOral Infections
Odontogenic InfectionsOdontogenic Infections
Most common cause of an abscess in theMost common cause of an abscess in thedeep spaces of the Head and Neckdeep spaces of the Head and Neck
Spread of Infection depends onSpread of Infection depends on
-- Thickness of bone adjacent to toothThickness of bone adjacent to tooth
-- Position of muscle attachment inPosition of muscle attachment inrelation to root apexrelation to root apex
-- Host DefenseHost Defense-- Virulence of bacteriaVirulence of bacteria
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
PalatePalateSublingualSublingual
SubmandibularSubmandibular
VestibularVestibular
BuccalBuccalCanineCanineSubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
PalatePalateSublingualSublingual
SubmandibularSubmandibular
VestibularVestibular
BuccalBuccalCanineCanineSubmentalSubmental
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Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
PalatePalate
SublingualSublingualSubmandibularSubmandibular
VestibularVestibular
BuccalBuccalCanineCanine
SubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
SublingualSublingualSubmandibularSubmandibular
SubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
SublingualSublingual
SubmandibularSubmandibular
SubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
SublingualSublingual
SubmandibularSubmandibular
SubmentalSubmental
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Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
PalatePalate
SublingualSublingualSubmandibularSubmandibular
VestibularVestibular
BuccalBuccalCanineCanine
SubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
SublingualSublingualSubmandibularSubmandibular
SubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
PalatePalateSublingualSublingual
SubmandibularSubmandibular
VestibularVestibular
BuccalBuccalCanineCanineSubmentalSubmental
Oral InfectionsOral Infections
Primary SpacesPrimary Spaces
PalatePalateSublingualSublingual
SubmandibularSubmandibular
VestibularVestibular
BuccalBuccalCanineCanineSubmentalSubmental
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Oral InfectionsOral Infections
Secondary SpacesSecondary Spaces
PterygomandibularPterygomandibular-- spread fromspread from
submandibularsubmandibularMassetericMasseteric
TemporalTemporal
All above+ Masticator spaceAll above+ Masticator spaceSignSign-- TrismusTrismus
OrbitalOrbitalInfratemporalInfratemporal
Lateral PharyngealLateral PharyngealRetropharyngealRetropharyngeal
PrevertebralPrevertebral
Oral InfectionsOral Infections
Secondary SpacesSecondary Spaces
PterygomandibularPterygomandibular-- spread fromspread from
submandibularsubmandibularMassetericMasseteric
TemporalTemporal
All above+ Masticator spaceAll above+ Masticator spaceSignSign-- TrismusTrismus
OrbitalOrbitalInfratemporalInfratemporal
Lateral PharyngealLateral PharyngealRetropharyngealRetropharyngeal
PrevertebralPrevertebral
Oral InfectionsOral Infections
Secondary SpacesSecondary Spaces
OrbitalOrbitalPeriPeri--OrbitalOrbital
Oral InfectionsOral Infections
Secondary SpacesSecondary Spaces
OrbitalOrbitalPeriPeri--OrbitalOrbital
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Oral InfectionsOral Infections
Secondary SpacesSecondary Spaces
OrbitalOrbital
PeriPeri--OrbitalOrbital
Oral InfectionsOral Infections
Secondary SpacesSecondary Spaces
OrbitalOrbital
PeriPeri--OrbitalOrbital
OphthoOphthoacuity, eom, pupilsacuity, eom, pupils
CT with contrastCT with contrast
TreatmentTreatment
Drainage, AntibioticsDrainage, Antibiotics
Oral InfectionsOral Infections
Most odontogenic infections are caused by multipleMost odontogenic infections are caused by multiplebacterial species.bacterial species.
PrimarilyPrimarilyAerobic gram (+) cocciAerobic gram (+) cocci
Anaerobic gram (+) cocciAnaerobic gram (+) cocci
Anaerobic gram (Anaerobic gram (--) rods) rods
Aerobic / Anaerobic characteristicsAerobic / Anaerobic characteristicsAerobic InfectionAerobic Infection 55--7%7%
Anaerobic InfectionAnaerobic Infection 30%30%
Combination InfectionCombination Infection 70%70%
Oral InfectionsOral Infections
Aerobic SpeciesAerobic Species
Gram + rodsGram + rodsCorynebacterium, DiptheroidsCorynebacterium, Diptheroids
GramGram rodsrodsE. corrodensE. corrodens
HaemophilusHaemophilus
EnterobacteriaceaeEnterobacteriaceaeGram + cocci (strep, staph)Gram + cocci (strep, staph)GramGram cocci (cocci (NeisseriaNeisseria))
SpirochetesSpirochetes
FungiFungi
Anaerobic SpeciesAnaerobic Species
Gram + rodsGram + rodsActinomyces, Lactobacillus,Actinomyces, Lactobacillus,
Propionbacterium acnes, ClostridiaPropionbacterium acnes, Clostridia
GramGram rodsrodsBacteroides, Fusobacterium,Bacteroides, Fusobacterium,
WollinellaWollinellaGram + cocciGram + cocci
Streptococcus, PeptostreptococcusStreptococcus, Peptostreptococcus
GramGram -- coccicocciVeillonellaVeillonella
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Oral InfectionsOral Infections
Trends Microbiology of Maxillofacial InfectionsTrends Microbiology of Maxillofacial Infections
Increase inBeta-Lactamase, E. Corrodens, S. Aureus , questionabledecrease in Bacteroides
*Storoe et al; The changing face of odontogenic infection, JOMS, 2001: 59,
739-48
Unlikely shift in the types of bacteria seen in odontogenic infections in the
last decade*Haug RH, The changing microbiology of maxillofacial infections, Oral
Maxillofacial Surg N Am, 2003: 15, 1-15.
Oral InfectionsOral Infections
Management of OdontogenicManagement of OdontogenicInfectionsInfections
Determine severityDetermine severityHistory and PhysicalHistory and Physical
Imaging StudiesImaging Studies
--PanorexPanorex--CT with contrast:CT with contrast:
Oral InfectionsOral Infections
Management of Odontogenic InfectionsManagement of Odontogenic InfectionsDetermine severityDetermine severity
Identifying drainable fluid collection inIdentifying drainable fluid collection inface and neck regionsface and neck regions
Clinical exam: sensitivityClinical exam: sensitivity55%, specificity 73%55%, specificity 73%
CT : sensitivity 95%,CT : sensitivity 95%,specificity 53%specificity 53%
CT and Clinical exam:CT and Clinical exam:sensitivity 95%, specificitysensitivity 95%, specificity80%80%
Miller et al., Laryngoscope, 109 (11)1999:1873-1879.
Oral InfectionsOral Infections
Hospital AdmissionHospital Admission
AirwayAirway
Trismus, Floor of MouthTrismus, Floor of MouthLateral PharynxLateral Pharynx
FeverFeverWBCWBC
ImmunocompImmunocompDM, HIV, EtOHDM, HIV, EtOH
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Oral InfectionsOral Infections
Hospital AdmissionHospital AdmissionAirwayAirway
Trismus, Floor of MouthTrismus, Floor of Mouth
Lateral PharynxLateral PharynxFeverFever
WBCWBCImmunocompImmunocomp
DM, HIV, EtOHDM, HIV, EtOH
TreatmentTreatment
AirwayAirwayDrainageDrainage
ExtractionExtractionAntibioticsAntibiotics
Oral InfectionsOral Infections
OralOral 24h24h 1wk1wk
PenicillinPenicillin VV $0.56$0.56 $9.99$9.99
AmoxicillinAmoxicillin $0.93$0.93 $13.89$13.89
AugmentinAugmentin $10.95$10.95 $104.99$104.99
CephalexinCephalexin $4.28$4.28 $24.89$24.89
ClindamycinClindamycin $3.92$3.92 $31.29$31.29
$16.88$16.88 $118.27$118.27
MetronidazoleMetronidazole $2.88$2.88 $10.02$10.02
CiprofloxacinCiprofloxacin $8.30$8.30 $80.59$80.59
**Flynn et al., Oral Maxillofacial Surg Clin N Am 15 (2003), 34.Flynn et al., Oral Maxillofacial Surg Clin N Am 15 (2003), 34.
Oral InfectionsOral Infections
IntravenousIntravenous
24h24h 1wk1wk
Penicillin GPenicillin G $21.28$21.28 $148.96$148.96
AmpicillinAmpicillin $21.24$21.24 $148.68$148.68
UnasynUnasyn $73.80$73.80 $516.60$516.60
CefazolinCefazolin $17.70$17.70 $123.90$123.90
ClindamycinClindamycin $53.64$53.64 $375.68$375.68
MetronidazoleMetronidazole$77.36$77.36 $541.52$541.52
CiprofloxacinCiprofloxacin $68.00$68.00 $476.00$476.00
**Flynn et al., Oral Maxillofacial Surg Clin N Am 15 (2003), 34.Flynn et al., Oral Maxillofacial Surg Clin N Am 15 (2003), 34.
Oral InfectionsOral Infections
PericornitisPericornitis
Bacterial infection andBacterial infection andinflammation of the soft tissueinflammation of the soft tissuearound a partiallly eruptedaround a partiallly erupted
third molar.third molar.
Pain, Trismus, FeverPain, Trismus, Fever
FOM SoftFOM Soft
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Oral InfectionsOral Infections
PericornitisPericornitis
Bacterial infection andBacterial infection andinflammation of the soft tissueinflammation of the soft tissue
around a partiallly eruptedaround a partiallly eruptedthird molar.third molar.
TreatmentTreatment
ExtractionExtraction
AntibioticsAntibiotics PCN, ClindamycinPCN, Clindamycin
Chlorhexidine(.12%)/H2O2Chlorhexidine(.12%)/H2O2
Oral InfectionsOral Infections
PericornitisPericornitis
Bacterial infection andBacterial infection andinflammation of the soft tissueinflammation of the soft tissue
around a partiallly eruptedaround a partiallly eruptedthird molar.third molar.
TreatmentTreatment
ExtractionExtraction
AntibioticsAntibiotics PCN, ClindamycinPCN, Clindamycin
Chlorhexidine(.12%)/H2O2Chlorhexidine(.12%)/H2O2
Oral InfectionsOral Infections
Acute Necrotizing Ulcerative GingivitisAcute Necrotizing Ulcerative Gingivitis
Trench MouthTrench Mouth
Putrid Sore MouthPutrid Sore Mouth
Gilmers DiseaseGilmers Disease
Vincents InfectionVincents Infection
Diphtheroid AnginaDiphtheroid Angina
Oral InfectionsOral Infections
Acute Necrotizing Ulcerative GingivitisAcute Necrotizing Ulcerative Gingivitis
Fusiform and Spirochete BacterialFusiform and Spirochete Bacterialinfection of the gingiva.infection of the gingiva.
Signs and SymptomsSigns and Symptoms
Pain, bleeding, gingival necrosis, fever,Pain, bleeding, gingival necrosis, fever,
Foul oral odor.Foul oral odor.
TreatmentTreatment
AntibioticAntibiotic PCN, ClindamycinPCN, Clindamycin
Chlorhexidine/H2O2Chlorhexidine/H2O2
Dental CleaningDental Cleaning
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Oral PathologyOral Pathology
Oral PathologyOral Pathology
Bone PathologyBone Pathology
CystsCysts
TumorsTumors
Oral PathologyOral Pathology
Bone PathologyBone Pathology
CystsCysts
TumorsTumors
Oral PathologyOral Pathology
Bone PathologyBone Pathology
CystsCysts
TumorsTumors
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Oral PathologyOral Pathology
Soft Tissue PathologySoft Tissue Pathology
MucoceleMucocele
Mucus ExtravisationMucus Extravisation
Mucus RetentionMucus Retention
Painless, recurrent swelling withPainless, recurrent swelling withperiods of drainageperiods of drainage
TreatmentTreatment: excision of gland.: excision of gland.
Oral PathologyOral Pathology
Soft Tissue PathologySoft Tissue Pathology
CarcinomaCarcinoma
90% SCCa90% SCCa
Painful, nonhealing ulcerPainful, nonhealing ulcer
WhiteWhite leukoplakialeukoplakia
RedRed erythroplakiaerythroplakia
Oral PathologyOral Pathology
Soft Tissue PathologySoft Tissue Pathology
CarcinomaCarcinoma
90% SCCa90% SCCa
Painful, nonhealing ulcerPainful, nonhealing ulcer
WhiteWhite leukoplakialeukoplakia
RedRed erythroplakiaerythroplakia
AdenopathyAdenopathy
Oral PathologyOral Pathology
Soft Tissue PathologySoft Tissue Pathology
CarcinomaCarcinoma
90% SCCa90% SCCa
Painful, nonhealing ulcerPainful, nonhealing ulcer
WhiteWhite leukoplakialeukoplakia
RedRed erythroplakiaerythroplakia
Risk Factors:Risk Factors:
Tobacco, EtohTobacco, Etoh
No Risk FactorsNo Risk Factors
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Oral PathologyOral Pathology
Soft Tissue PathologySoft Tissue Pathology
CarcinomaCarcinoma
90% SCCa90% SCCa
Painful, nonhealing ulcerPainful, nonhealing ulcer
WhiteWhite leukoplakialeukoplakia
RedRed erythroplakiaerythroplakia
Biopsy Directed TreatmentBiopsy Directed Treatment
See Ya Later Alligator !!!!See Ya Later Alligator !!!!
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