Chapter 1 Introduction to Preliminary Diagnosis of Oral Lesions

1. Chapter 1 Introduction to Preliminary Diagnosis of Oral Lesions

2. Outline Vocabulary The diagnostic process Variants of normal Benign conditions of unknown cause

3. Vocabulary (pgs. 1-7) Clinical Appearance of Soft Tissue Lesions Soft Tissue Consistency Color of Lesion Size of Lesion Surface Texture Radiographic Terms Used to Describe Lesions in Bone

4. Clinical Appearance of Soft Tissue Lesions (pgs. 1-2) Bulla A circumscribed, elevated lesion that is more than 5 mm in diameter, usually contains serous fluid, and looks like a blister Lobule A segment or lobe that is a part of the whole; these lobes sometimes appear fused together

5. Clinical Appearance of Soft Tissue Lesions (cont.)

6. Clinical Appearance of Soft Tissue Lesions (cont.) (pgs. 1-2) Macula An area that is usually distinguished by a color different from that of the surrounding tissue; it is flat and does not protrude above the surface of the normal tissue. A freckle is an example of a macule. Papule A small, circumscribed lesion usually less than 1 cm in diameter that is elevated or protrudes above the surface of normal surrounding tissue.

7. Clinical Appearance of Soft Tissue Lesions (cont.) (pg. 2) Pedunculated Attached by a stemlike or stalk base similar to that of a mushroom Pustules Variously sized circumscribed elevations containing pus

8. Clinical Appearance of Soft Tissue Lesions (cont.)

9. Clinical Appearance of Soft Tissue Lesions (cont.) (pgs. 2-3) Sessile Describing the base of a lesion that is flat or broad instead of stemlike Vesicle A small, elevated lesion less than 1 cm in diameter that contains serous fluid

10. Clinical Appearance of Soft Tissue Lesions (cont.)

11. Soft Tissue Consistency (pg. 2) Nodule A palpable solid lesion up to 1 cm in diameter found in soft tissue; it can occur above, level with, or beneath the skin surface. Palpation The evaluation of a lesion by feeling it with the fingers to determine the texture of the area; the descriptive terms for palpation are soft, firm, semifirm, and fluidfilled; these terms also describe the consistency of a lesion.

12. Color of Lesion (pg. 2) Colors Red, pink, salmon, white, blue-black, gray, brown, and black are the colors used most frequently to describe oral lesions; they can be used to identify specific lesions and may also be incorporated into general descriptions. Erythema An abnormal redness of the mucosa or gingiva Pallor Paleness of the skin or mucosal tissues

13. Size of Lesion (pgs. 2-3) Centimeter (cm) One hundredth of a meter; equivalent to a little 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

14. Size of Lesion (cont.)

15. Surface Texture (pg. 3) Corrugated Wrinkled Fissure A cleft or groove, normal or otherwise, showing prominent depth Papillary Resembling small, nipple-shaped projections or elevations found in clusters

16. Radiographic Terms Used to Describe Lesions in Bone (pgs. 3, 5) Coalescence The process by which parts of a whole join together, or fuse, to make one. Diffuse Describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion; this may make treatment more difficult and, depending on the biopsy results, more radical

17. Radiographic Terms Used to Describe Lesions in Bone (cont.)

18. (pgs. 3, 5) Multilocular Describes a lesion that extends beyond the confines of one distinct area and is defined as many lobes or parts that are somewhat fused together, making up the entire lesion; a multilocular radiolucency is sometimes described as resembling soap bubbles; an odontogenic keratocyst often presents as a multilocular radiolucent lesion 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 Radiographic Terms Used to Describe Lesions in Bone (cont.)

19. Radiographic Terms Used to Describe Lesions in Bone (cont.)

20. (pgs. 4, 6) Radiolucent and radiopaque Terms used to describe a mixture of light and dark areas within a lesion usually denoting a stage in the lesion’s development; for example, in a stage I periapical cemento-osseous dysplasia (cementoma), the lesion is radiolucent; in stage II it is radiolucent and radiopaque 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 (Note: Caries 4MO, 5DO, 28DO) Radiographic Terms Used to Describe Lesions in Bone (cont.)

21. Radiographic Terms Used to Describe Lesions in Bone (cont.)

22. (pgs. 4-6) Root resorption Observe radiographically when the apex of the tooth appears shortened or blunted and irregularly shaped; it occurs as a response to stimuli, which can include a cyst, tumor, or trauma External resorption arises from tissue outside the tooth, such as the periodontal ligament, whereas internal resorption is triggered by pulpal tissue reaction from within the tooth; in the latter the pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area. Radiographic Terms Used to Describe Lesions in Bone (cont.)

23. Radiographic Terms Used to Describe Lesions in Bone (cont.)

24. (pgs. 5, 7) Scalloping around the root A radiolucent lesion that extends between the roots, as seen in a traumatic bone cyst; this lesion appears to extend up the periodontal ligament Unilocular Having one compartment or unit that is well defined or outlined as in a simple radicular cyst Well circumscribed Term used to describe a lesion with borders that are specifically designed and in which one can clearly see the exact margins and extent Radiographic Terms Used to Describe Lesions in Bone (cont.)

25. Radiographic Terms Used to Describe Lesions in Bone (cont.)

26. The Diagnostic Process (pg. 8) Making a Diagnosis The process of diagnosis requires gathering information that is relevant to the patient and the lesion being evaluated; this information comes from various sources There are eight distinct diagnostic categories that contribute segments of information leading to a definitive or final diagnosis

27. The Diagnostic Process (cont.) (pgs. 8-23) Clinical diagnosis Radiographic diagnosis Historical diagnosis Laboratory diagnosis Microscopic diagnosis Surgical diagnosis Therapeutic diagnosis Differential diagnosis

28. Clinical Diagnosis (pgs. 8-10) The strength of the diagnosis comes from the clinical appearance of the lesion. The clinician can establish a diagnosis for some lesions based on color, shape, location, and history of the lesion.

29. Clinical Diagnosis (cont.) (pgs. 8-10) Examples of lesions that may be clinically diagnosed include Fordyce granules, torus palatinus, mandibular tori, melanin pigmentation, retrocuspid papillae, and lingual varicosities. Other benign conditions of unknown cause that are recognized by their distinct clinical appearance include fissured tongue, median rhomboid glossitis, geographic tongue, and hairy tongue.

30. Clinical Diagnosis (cont.)

31. Clinical Diagnosis (cont.)

32. Clinical Diagnosis (cont.)

33. Clinical Diagnosis (cont.)

34. Clinical Diagnosis (cont.) (pgs. 8, 10) The diagnostic process may require historical information in addition to the clinical findings. An example is an amalgam tattoo. Any history in the area can be very helpful in confirming the clinical impression.

35. Clinical Diagnosis (cont.)

36. Radiographic Diagnosis (pgs. 10-14) In a radiographic diagnosis, the radiograph provides sufficient information to establish the diagnosis. Examples of conditions for which the radiograph provides the most significant information include periapical pathosis, internal resorption, external resorption, heavy interproximal calculus, dental caries, compound odontoma, complex odontoma, supernumerary teeth, impacted or unerupted teeth, and calcified pulp

37. Radiographic Diagnosis (cont.)

38. Radiographic Diagnosis (cont.)

39. Radiographic Diagnosis (cont.)

40. Radiographic Diagnosis (cont.)

41. Radiographic Diagnosis (cont.) (pgs. 10, 14, 15-17) Normal anatomic landmarks are also easily observed radiographically. In some cases, the radiograph may show very distinct and well-defined structures, such as nutrient canals and mixed dentition. Unusual radiographic findings are illustrated These include cubic zirconia, amalgam fragment, eyeglasses, amalgam overhang, instruments from root canal procedures, curette, retained primary tooth, shotgun pellet, and nose ring.

42. Radiographic Diagnosis (cont.)

43. Radiographic Diagnosis (cont.)

44. Historical Diagnosis (pgs. 14-18) Personal history, family history, past and present medical and dental histories, history of drug ingestion, and history of the presenting disease or lesion can provide information necessary for the final diagnosis. Pathologic conditions in which the family history contributes a significant role in diagnosis include amelogenesis imperfecta, dentinogenesis imperfecta, and other genetic disorders.

45. Historical Diagnosis (cont.)

46. Historical Diagnosis (cont.) (pgs. 18-19) A patient’s medical or dental status, including drug history, can also contribute significant information to a diagnosis.

47. Historical Diagnosis (cont.)

48. Historical Diagnosis (cont.) Examples include A history of ulcerative colitis may contribute to the diagnosis of oral ulcers. Gingival enlargement due to treatment with a calcium channel blocker A history of a skin graft from the hip to the ridge and mucobuccal fold area can provide significant information relevant to the diagnosis of a white- or brown-pigmented area on the mandibular ridge and vestibule. Periapical cemento-osseous dysplasia, which is found most frequently in black women in the third decade.

49. Laboratory Diagnosis (pgs. 18, 20) Clinical laboratory tests, including blood chemistries and urinalysis, can provide information that contributes to a diagnosis. An example is an elevated serum alkaline phosphatase level, significant in the diagnosis of Paget’s disease. Laboratory cultures are helpful in determining the diagnosis of oral infections.

50. Laboratory Diagnosis (cont.)