Oral Pathology: Chapter 1 Introduction To Preliminary Diagnosis Of Oral Lesions

Front 1

Back 1

Bulla

* A circumscribed, elevated lesion that is more than 5 mm in diameter
* Usually contains serous fluid, and looks like a blister
* This photograph is of bullae associated with erythema multiforme

Front 2

Back 2

Lobule

* A segment or lobe that is part of a whole
* These lobes sometimes appear fused together
* This photograph is of lobulated torus palatinus

Front 3

Back 3

Macule

* 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

Front 4

Back 4

Papule

* A small, circumscribed lesion usually less than 1 cm in diameter
* It is elevated or protrudes above the surface of normal surounding tissue

Front 5

Back 5

Pustule

* Variously sized circumscribed elevations containing pus

Front 6

Back 6

Vesicle

* A small, elevated lesion less than 1 cm in diameter that contains serous fluid

Front 7

Back 7

Pedunculated

* Attached by a stemlike or stalklike base similar to that of a mushroom

Front 8

Back 8

Sessile

* Describing the base of a lesion that is flat or broad instead of stemlike

Front 9

Back 9

Nodule

* A palpable solid lesion up to 1 cm in diameter found in soft tissue
* Can occur above, level with, or beneath the skin surface

Front 10

Back 10

Palpation

* The evaluation of a lesion by feeling it with the fingers to determine the texture of the area
* Descriptive terms for palpation are soft, firm, semifirm, and fluid filled
* These terms also describe the consistency of a lesion

Front 11

An abnormal redness of the mucosa or gingiva

Back 11

Erythema

Front 12

Paleness of the skin or mucosal tissues

Back 12

Pallor

Front 13

Back 13

Erythroplakia

* A clinical term used to describe an oral lesion that appears as a smooth red patch or granular red and velvety patch
* Less common than leukoplakia
* 90% of erythroplakias demonstrate epithelial dysplasia or squamous cell carcinoma

Front 14

Back 14

Leukoplakia

* A clinical term for a white, plaquelike lesion on the oral mucosa that cannot be rubbed off or diagnosed as a specific disease
* This photograph is of leukoplakia associated with chewing tobacco

Front 15

Back 15

Corrugated

* Wrinkled

Front 16

Back 16

Fissured

* A cleft or groove, normal or otherwise, showing prominent depth
* This photograph is a fissured tongue

Front 17

Back 17

Papillary

* Resembling small, nipple-shaped projections or elevations found in clusters

Front 18

Back 18

Coalescence

* The process by which parts of a whole join together, or fuse, to make one

Front 19

Back 19

Diffuse

* Describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion
* Can make treatment more difficult and, depending on the biopsy results, more radical

Front 20

Back 20

Mulitilocular

MACHO- Myxoma- Ameloblastoma- Central giant cell granuloma- Hemangioma- Odontogenic keratocyst

* Describes a lesion that extends beyond the confines of one distinct area
* Defined as many lobes or parts that are somewhat fused together
* A multilocular radiolucency is sometimes described as resembling soap bubbles
* This photograph is of odontogenic keratocyst

Front 21

Back 21

Radioucent

* 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

Front 22

Back 22

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

Front 23

Back 23

Radiolucent and Radiopaque

* A mixture of light and dark areas within a lesion
* Denotes a stage in lesion development

Front 24

Back 24

Root Resorption

* Radiographically, the apex of the tooth appears shortened or blunted and irregularly shaped
* Occurs as a response to stimuli, which can include a cyst, tumor, or trauma

Front 25

Back 25

External Root Resorption

* Arises from tissue outside the tooth, such as the periodontal ligament

Front 26

Back 26

Internal Root Resorption

* Triggered by pulpal tissue reaction from within the tooth
* The pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area

Front 27

Back 27

Scalloping Around the Root

* A radiolucent lesion that appears to extend up the periodontal ligament and between the root

Front 28

Back 28

Unilocular

* Having one compartment or unit that is well defined or outlined as in a simple radicular cyst

Front 29

Back 29

Well Circumscribed

* Used to describe a lesion with borders that are specifically defined and in which one can clearly see the exact margins and extent

Front 30

Back 30

Fordyce Granules

Clinical Diagnosis

Front 31

Back 31

Torus Palatinus

Clinical Diagnosis

Front 32

Back 32

Mandibular Tori

Clinical Diagnosis

Front 33

Back 33

Melanin Pigmentation

Clinical Diagnosis

Front 34

Back 34

Retrocuspid Papillae

Clinical Diagnosis

Front 35

Back 35

Fissured Tongue

Clinical Diagnosis

Front 36

Back 36

Median Rhomboid Glossitis and Geographic Tongue

Clinical Diagnosis

Front 37

Back 37

Geographic Tongue

Clinical Diagnosis

Front 38

Back 38

White Hairy Tongue

Clinical Diagnosis

Front 39

Back 39

Circumvallate Papilla

Clinical Diagnosis

Front 40

Back 40

Black Hairy Tongue

Clinical Diagnosis

Front 41

Back 41

Amalgam Tattoo (Focal Argyrosis)

Clinical Diagnosis

Front 42

Back 42

Periapical Pathosis

Radiographic Diagnosis

Front 43

Back 43

External Resorption

Radiographic Diagnosis

Front 44

Back 44

Heavy Interproximal Calculus

Radiographic Diagnosis

Front 45

Back 45

Caries

Radiographic Diagnosis

Front 46

Back 46

Compound Odontoma

*Easily Diagnosed from Radiograph Alone*

Radiographic Diagnosis: Pathology

Front 47

Back 47

Compound Odontoma

* Easily Diagnosed from the Radiograph Alone*

Radiographic Diagnosis: Pathology

Front 48

Back 48

Mesiodens / Supernumerary Tooth

Radiographic Diagnosis: Abnormality

Front 49

Back 49

Supernumerary Tooth (Dentigerous Cyst)

Radiographic Diagnosis: Abnormality

Front 50

Back 50

Impacted Mandibular Cuspid

Radiographic Diagnosis: Abnormality

Front 51

Back 51

Complex Odontoma

*Not Diagnosed from the Radiograph Alone*

Radiographic Diagnosis: Pathology

Front 52

Back 52

Impacted Maxillary Cuspid

Radiographic Diagnosis: Abnormality

Front 53

Back 53

Calcified Pulp

Radiographic Diagnosis

Front 54

Back 54

Nutrient Canals

Radiographic Diagnosis: Normal Anatomic Landmark

Front 55

Back 55

Nutrient Canals

Radiographic Diagnosis: Normal Anatomic Landmark

Front 56

Back 56

Mixed Dentition

Radiographic Diagnosis: Normal Anatomic Landmark

Front 57

Back 57

Cubic Zirconia

Radiographic Diagnosis: Unusual Findings

Front 58

Back 58

Amalgam Fragment

Radiographic Diagnosis: Unusual Findings

Front 59

Back 59

Overhang

Radiographic Diagnosis: Unusual Findings

Front 60

Back 60

Broken Instrument

Radiographic Diagnosis: Unusual Findings

Front 61

Back 61

Eyeglass Frames

Radiographic Diagnosis: Unusual Findings

Front 62

Back 62

Piercing

Radiographic Diagnosis: Unusual Findings

Front 63

Back 63

Retained Deciduous Tooth with an Amalgam Restoration

Radiographic Diagnosis: Unusual Findings

Front 64

Back 64

Shotgun Pellet

Radiographic Diagnosis: Unusual Findings

Front 65

Back 65

Shrapnel

Radiographic Diagnosis: Unusual Findings

Front 66

Back 66

Amelogenesis Imperfecta

*Radiographic Aspect*

Historical Diagnosis: Family History

Front 67

Back 67

Amelogenesis Imperfecta

*Clinical Appearance*

Historical Diagnosis: Family History

Front 68

Back 68

Dentinogenesis Imperfecta

*Clinical Appearance*

Historical Diagnosis: Family History

Front 69

Back 69

Dentinogenesis Imperfecta

*Radiographic Appearance*

Historical Diagnosis: Family History

Front 70

Back 70

Ulcerative Colitis

Historical Diagnosis: Medical or Dental Status

Front 71

Back 71

Gingival Enlargement

*Patient is Taking a Calcium Channel Blocker*

Historical Diagnosis: Medical or Dental Status

Front 72

Back 72

Hives/Urticaria from an Allergic Reaction

Historical Diagnosis: Medical or Dental Status

Front 73

Back 73

Skin Graft: White Patient

*The same anomaly can look different with different pigmentation*

Historical Diagnosis: Medical or Dental Status

Front 74

Back 74

Skin Graft: Black Patient

*The same anomaly can look different with different pigmentation*

Historical Diagnosis: Medical or Dental Status

Front 75

Back 75

Paget Disease

"Cotton-Wool Effect"

*Elevated Serum Alkaline Phosphatase Level*

Laboratory Diagnosis

Front 76

Blood Chemistries, Urinalysis, and Cultures

Back 76

Laboratory Diagnosis

Front 77

* Often the main component of the definitive diagnosis
* Adequate tissue sample is necessary

Back 77

Microscopic Diagnosis

Front 78

Back 78

White Lesion

* A white lesion cannot be diagnosed on the basis of clinical appearance alone
* The microscopic appearance can vary from a thickening of the epithelium to epithelial dysplasia, which can be premalignant

Microscopic Diagnosis

Front 79

Diagnosis is made using the information gained during the surgical procedure.

Back 79

Surgical Diagnosis

Front 80

Back 80

Traumatic Bone Cyst

* May appear as a radiolucency that scallops around the roots
* When the lesion is opened surgically, an empty void is found

Surgical Diagnosis

Front 81

Back 81

Static Bone Cyst

* Surgical examination of the well-circumscribed, radiolucent area reveals salivary gland tissue entrapped during development

Surgical Diagnosis

Front 82

Back 82

Angular Cheilitis

* May be associated with a deficiency of B-complex vitamins
* Most commonly a fungal condition and responds to topical application of an antifungal cream or ointment such as Nystatin

Therapeutic Diagnosis

Front 83

Back 83

Necrotizing Ulcerative Gingivitis (NUG)

*Responds to Hydrogen Peroxide*

Therapeutic Diagnosis

Front 84

Back 84

Fordyce Granules

*No Treatment*

* Clusters of ectopic sebaceous glands
* Appear as yellow lobules in clusters
* Commonly observed on vermillion border of lips and buccal mucosa

Variant of Normal

Front 85

Back 85

Torus Palatinus

*No Treatment Unless they Interfere with Speech, Swallowing, or a Prosthetic Appliance*

* An exophytic growth of normal compact bone
* Observed clinically in the midline of the hard palate
* Inherited, gradual formation
* Occurs more commonly in women
* May take on various shapes and sizes, may be lobulated, and is covered by normal soft tissue

Variant of Normal

Front 86

Back 86

Torus Palatinus: Radiographic Appearance

Front 87

Back 87

Mandibular Tori

*No Treatment Unless Bothersome or in the Way*

* Outgrowths of dense bone found on the lingual aspect of the mandible in the area of the premolars above the mylohoid ridge
* Usually bilateral
* Often lobulated or nodular
* Can appear fused together
* Have no predilection for either sex

Variant of Normal

Front 88

Back 88

Melanin Pigmentation

* The pigment that gives color to skin, eyes, hair, mucosa, and gingiva
* Most commonly observed in dark-skinned individuals

Variant of Normal

Front 89

Back 89

Retrocuspid Papilla

* A sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids

Variant of Normal

Front 90

Back 90

Lingual Varicosities

* Clinical appearance: red-to-purple enlarged vessels or clusters
* Usually observed on the ventral and lateral surfaces of the tongue
* Most commonly observed in individuals older than 60 years of age

Variant of Normal

Front 91

Back 91

Linea Alba

* A "white line" that extends anteroposteriorly on the buccal mucosa along the occlusal plane
* May be bilateral
* May be more prominent in patients who have a clenching or bruxing habit

Variant of Normal

Front 92

Back 92

Leukoedema

*No Treatment*

* A generalized opalescence on the buccal mucosa
* Most commonly observed in black adults
* If the mucosa is stretched, the opalescence becomes less prominent

Variant of Normal

Front 93

Back 93

Lingual Thyroid Nodule

*Treatment includes evaluation to determine whether the thyroid gland is present in its normal location*

* Undescended, trapped remnants of thyroid tissue
* Clinical Appearance: A mass in the midline of the dorsal surface of the tongue posterior to the circumvallate papillae in the are of the foramen cecum; usually has a sessile base and is 2 to 3 cm in width
* Predilection in females; linked to hormonal changes

Benign Conditions of Unknown Cause

Front 94

Back 94

Median Rhomboid Glossitis

*No Treatment Necessary, but Antifungal Treatment may be Used*

* Clinical Appearance: Flat or slightly raised oval or rectangular erythematous area in center of tongue
* May be associated with a chronic infection with Candida albicans

Benign Condition of Unknown Cause

Front 95

Back 95

Geographic Tongue

*No Treatment Usually*

Clinical Appearance:

* Eryhematous patches surrounded by a white or yellow border
* Diffuse areas devoid of filiform papillae
* Distinct presence of fungiform papillae
* There appear to be remission and changes in the depapillated areas
* Genetic factors may play a role in presence
* May be exacerbated by stress
* Ocasionally, the patient may complain of a burning discomfort
* No treatment usually indicated

Benign Condition of Unknown Cause

Front 96

Back 96

Ectopic Geographic Tongue

* Term used to describe geographic tongue found on mucosal surfaces other than tongue

Benign Conditions of Unknown Cause

Front 97

Back 97

Fissured Tongue

*No Treatment Necessary*

* Clinical Appearance: The dorsal surface of the tongue appears to have deep fissures or grooves
* Cause: Unknown. Probably involves genetic factors. Seen in about 5% of the population
* Home Care: Direct the patient to brush the tongue gently with a toothbrush to remove debris

Benign Conditions of Unknown Cause

Front 98

Back 98

White Hairy Tongue

* Clinical Appearance: Elongated filiform papillae are white
* Result of either an increase in keratin production or a decrease in normal desquamation
* Home Care: Direct the patient to brush the tongue gently with a toothbrush to remove debris

Benign Conditions of Unknown Cause

Front 99

Back 99

Black Hairy Tongue

* Clinical Appearance: Papillae are brown-to-black because of chromogenic bacteria
* Contributing Factors: Tobacco, foods, hydrogen peroxide, alcohol, and chemical rinses
* Home Care: Direct the patient to brush the tongue gently with a toothbrush to remove debris

Benign Condition of Unknown Cause