Oral Pathology

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Author:
pcandrin
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236417
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Oral Pathology
Updated:
2013-09-22 22:26:36
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Part Ibsen Phelan
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Description:
(8) Diagnostic Categories, Variants of Normal, Benign Conditions of Unknown Cause
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  1. List the (8) Diagnostic Categories
    • 1. Clinical
    • 2. Radiographic
    • 3. Historical
    • 4. Laboratory
    • 5. Microscopic
    • 6. Surgical
    • 7. Therapeutic
    • 8.  Differential
  2. Clinical Diagnosis
    • Ability to diagnose lesions based on the basis of:
    • -color,
    • -shape,
    • -location, &
    • -history of lesion  (sometimes historical information is needed for clinical diagnosis)
  3. Lesions that can be clinically diagnosed
    • -fordyce granules
    • -torus palatinus
    • -mandibular Tori
    • -melanin pigmentation
    • -retrocuspid papillae
    • -lingual varicosities.
  4. Benign Conditions of Unknown Cuase:
    • -Fissured Tongue
    • -Median Rhomboid Glossitis
    • -Geographic tongue
    • -Hairy tongue
  5. Radiographic Diagnosis
    • Radiograph provides sufficient information to establish diagnosis.
    • -IE:  Periapical pathosis
    • --Internal resporption
    • --External resporption
    • --Heavy Interproximal calculus
    • --Dental Caries
    • --Compound Odontoma
    • --Complex Odontoma
    • --Supernumerary Teeth
    • --Impacted Teeth
    • --Calcified Pulp
    • --Unerupted Teeth
  6. Historical Diagnosis
    • -Historical data constitutes important information in every diagnosis. 
    • --Personal history
    • --Family history
    • --Past, Present, Medical & Dental histories
    • --History of drug ingestion
    • --History of presenting disease/lesion
  7. Examples of Pathologic conditions in which family history contributes in diagnosis:
    • -Amelogenisis Imperfecta
    • -Dentinogenisis Imperfecta
    • -Other Genetic Disorders
  8. Laboratory Diagnosis
    • -Lab tests that provide information & contribute to a diagnosis
    • --Blood Chemistries
    • --Urinalysis
  9. Microscopic Diagnosis
    • -Form of laboratory diagnosis
    • -Main component of definitive diagnosis
    • -Biopsy is taken-->
    • --skill of practitioner taking biopsy is important
    • ---Brush Test
  10. Brush Test
    • Formerly known as:  Brush Biopsy
    • -Uses circular brush to obtain cells from the full thickness of the epithelium. 
    • -Includes ceslls from the keratin layer through the basal layer
    • -Assess whether normal, abnormal, or dysplastic cells are present. 
    • -Results help determine if scalpel biopsy is needed to establish definitive diagnosis.
  11. Surgical Diagnosis
    -Diagnosis is made using the information gained during the surgical procedure
  12. Therapeutic Diagnosis
    • -Rx meds & observing the results w/out culturing the bacteria applies the principle of therapeutic diagnosis
    • -It is based solely on clinical & historical information w/confirmation by the response of the condition to therapy
  13. Differential Diagnosis
    • -The point in the process when the practitioner decides which test or procedure is required to rule out the conditions originally suspected
    • --Establish the definitive or final diagnosis
  14. (8) Variants of Normal
    • 1. Fordyce Granules
    • 2. Torus Palatinus
    • 3. Mandibular Tori
    • 4. Melanin Pigmentation
    • 5. Retrocuspid Papilla
    • 6. Lingual Varicosities
    • 7. Linea Alba
    • 8. Leukoedema
  15. (5) Benign Conditions of Unknown Cause
    • 1.Lingual Thyroid Nodule
    • 2.Median Rhomboid Glossitis
    • 3.Geographic Tongue
    • 4.Fissured Tongue
    • 5.Hairy Tongue
  16. Fordyce Granules
    • -Clusters of ectopic sebaceous glands
    • -Most commonly observed on the lips and buccal mucosa
    • -Clinically:  tiny yellow lobules distributed over buccal mucosa and vermillion border of lips
    • -80% of adults over the age of 20 have fordyce granules
    • -asymptomatic
    • -require no treatment
  17. Torus Palatinus
    • -Exophytic growth of normal compact bone
    • -Inherited
    • -Occur more often in women
    • -Asymptomatic
    • -Develop gradually
    • -Occur at the midline of the hard palate
    • -Take on various shapes, sizes
    • -May be lobulated
    • -Covered by normal soft tissue
    • -when large enough may be seen as radiopaque mass on radiograph
    • -No treatment indicated unless interferes with:
    • --speech,
    • --swallowing or
    • --prosthetic appliance
  18. Mandibular Tori
    • -Outgrowths of normal dense bone
    • -Found on the lingual aspect of the mandible --(premolars above the mylohyoid ridge)
    • -Usually bilateral
    • -Often lobulated or nodular
    • -Can appear fused
    • -No predilection for either sex
    • -No Tx required unless patient needs prosthontic appliance & interferes w/fabrication and placement
  19. Melanin Pigmentation
    • -pigment that gives color to:
    • --skin,
    • --eyes,
    • --hair,
    • --mucosa,
    • --gingiva

    **In oral mucosa normally observed in dark-skinned individuals
  20. Retrocuspid Papilla
    -sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids.
  21. Lingual Varicosities
    • -Prominent lingual veins
    • -Usually observed on the lateral and ventral aspects
    • -Red to purple vessels or clusters
    • -Thought to be related to the aging process.
  22. Linea Alba
    • -"white line" that extends anteroposteriorly on the buccal mucosa along the occlusal plate
    • -May be bilateral
    • -Can be prominent  in Pts who clench or brux
  23. Leukoedema
    • -Generalized opalescence imparted to the buccal mucosa
    • -Most commonly observed in black adults (85%(
    • -Gray-White film diffused throughout the buccal mucosa, giving opaque quality.
    • --If mucosa is stretched becomes less prominent. 
    • -More pronounced in smokers
    • -Integral part of buccal mucosa and cannot be removed.
    • -Benign anomaly
    • -Requires No Tx.
  24. Lingual Thyroid Nodule
    • -Thyroid gland develops in 1st month of fetal life.
    • -Located initially in the foramen cecum on posterior of tongue.
    • -Normal development descends to the neck
    • -Does not DESCEND--Lingual Thyroid Nodule results.
    • --HIGH Predilection in females
    • --emergence linked with:
    • ---Hormonal Changes
    • ---Puberty
    • ---Pregnancy
    • ---Menopause
    • *Usually sessile base 2-3cm wide
    • **Tx requires careful evaluation of the patient to determine whether thyroid gland is present in normal location
    • ****Surgical intervention not always required.
  25. Median Rhomboid Glossitis
    • -Cause not clear
    • --Associated w/chronic  Candida albicans
    • --Appears flat, or slightly raised oval or rectangular erythematous area in the midline of the dorsal surface of the tongue. 
    • --Devoid of filiform papillae
    • --Texture is smooth

    • **No specific Tx
    • **antifungal agent can be applied
    • **Sometimes resolves with no specific Tx.
  26. Geographic Tongue
    • -Genetic factor suggested
    • -Exacerbated by stress
    • -Histologic factors w/those found in psoriasis
    • -Involves the dorsal and lateral borders of the tongue
    • -Diffuse areas devoid of filiform papillae can be observed.
    • -Erythematous patches that are surrounded by a white or yellow perimeter
    • -Does not remain static
    • -Burning discomfort associated
    • **No Tx indicated
    • **ECTOPIC GEOGRAPHIC TONGUE:  found on mucosal surfaces other than the tongue.
  27. Fissured Tongue
    • -Cause unknown
    • -Seen in about 5% of the population
    • -Genetic patterns probably involved
    • -Dorsal surfaces appear to have deep fissures or grooves
    • -Fissures can become irritated if food debris collects
  28. Hairy Tongue
    • -Increased accumulation of keratin on the filiform papillae resulting in white "hairy" appearance
    • -Tobacco and certain foods may discolor papillae
    • -Hydrogen peroxide, alcohol, or chemical rinses have been suggest to stimulate elongation of the filiform papillae
    • ** Direct Pt to brush tongue gently w/ toothbrush wet with water only.

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