Oral Pathology

Oral Pathology Review
LECTURE #4
DR. CHRIS VAN KESTEREN
4-3-14
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