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D1 Spring - Patient Care II > 1/8: Intraoral Exam > Flashcards

1/8: Intraoral Exam Flashcards

1
Q

What age of patients have we started to notice an increase of oral cancer diagnoses?

A

40 with no known risk factors
HPV 16 included in this age group is a significant increase in cancer of the tongue

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2
Q

What should you look for in an intraoral exam?

A

Cancer
Signs of systemic dis.
Tissue trauma
Infections
Pain
Esthetic concerns
Occlusal dysfunction

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3
Q

What is the underlying cause of many oropharyngeal squamous cell carcinomas with a predominate increase seen in younger white men?

A

HPV

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4
Q

Cancer in what kind of populations tend to be much more aggressive and have a poorer prognosis?

A

Younger populations

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5
Q

What is the gold standard for determining a definitive diagnosis?

A

A biopsy involving the removal of part or all of the suspicious area of tissue and microscopic evaluation by a pathologist to determine its histological makeup

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6
Q

When does there tend to be a misdiagnosis of oral lesions by dental practitioners?

A

When they based their diagnosis on clinical observations alone

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7
Q

What is the most common oral cancer?

A

Squamous cell

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8
Q

Who does squamous cell carcinoma affect more often?

A

Men 2x more than women

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9
Q

What percent of oral cancer is found in stages I or II and III or IV?

A

40% - I or II
60% - III or IV

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10
Q

How should you describe a lesion?

A

Number
Size
Shape
Color
Profile
Base
Border
Texture

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11
Q

What are risk factors for oral cancer?

A

Tobacco (#1 overall)
Alcohol (#2 overall)
Viruses: HPV & HIV
Sun exposure
Inadequate nutrition
Genetic predisposition
Chronic inflammation
Radiation exposure
Carcinogen exposure

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12
Q

75% of oral cancer can be prevented how?

A

By eliminating tobacco and alcohol use

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13
Q

How can you prevent oral cancer?

A

Lip balm w/ sunscreen
HPV vaccine (avoid HPV exposure)
Diet rich in fresh fruit and vegetables

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14
Q

What are high risk areas for oral cancer?

A

Floor of mouth
Lateral border of tongue
Ventral surface of tongue
Oropharynx

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15
Q

What are tonsil stones?

A

arge crypts in the tonsils that collect food debris, bacteria and hardened material

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16
Q

What may happen after tonsillectomy?

A

Regrowth of lymph tissue

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17
Q

What can a bifid uvula an indiciation of?

A

submucous clef palate
- can cause speech and swallowing difficulties

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18
Q

What are signs and symptoms of oral cancer?

A

nonhealing ulcer
bleeding
lymphadenopathy
hardness
paresthesia
drooling

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19
Q

What consists of a routine oral cancer exam?

A

Question pt about risk factors (tobacco, alcohol, sunlight, HPV)
Examine face (discolorations, swellings, asymmetry)
Palpate lymph nodes
Palpate lips
Palpate labial and buccal mucosa (vestibule, mucobuccal folds, frenums, buccal mucosa)
Examine and bimanually palpate floor of mouth
Examine/palate tongue (dorsal, ventral, lateral borders, base)
Examine hard and soft palate (palpate hard)
Examine tonsils and oropharynx

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20
Q

What are the basic techniques for examination?

A

Inspections (eyes)
Palpation (fingers)

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21
Q

What are palpation terminology?

A

Bony hard ( torus)
Induration = firm but not as
hard as bone (solid rubber
ball)
Compressible (pressure
alters its shape)
Doughy (returns slowly to
original shape)

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22
Q

What does it mean when something returns quickly to original shape?

A

Spongy

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23
Q

What does it mean when something is soft and leaves indentation - edema?

A

Pitting

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24
Q

What does it mean when contents are expressed - usually fluid like - abscess?

A

Collapsing

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25
What does it mean when something has a color change?
Blanching
26
What does it mean when something is separate, not running together or blending?
Discrete
27
What does it mean when something runs together, merging, blended; originally separate but now formed into one?
Confluent
28
What does it mean when something has small bump-like elevations or projections?
Papillary
29
What does it mean when something is covered with or full of wart-like growths; cauliflower like surface?
Verrucose (aka Verrucous) lesion
30
What does it mean when something is attached to the surface on a broad base. Immobile, fixed, firmly attached. Lacks a stalk?
Sessile
31
What does it mean when something has an elecated lesion having a narrow stem which acts as a base. Elongated stalk?
Pedunculated lesion
32
Where do pedunculated lesions occur?
Soft palate, tonsil, epiglottis - sometimes fatal
33
What is erythema?
Red area of variable size and shape usually in patches
34
What is petechia?
Round red pinpoint areas of hemorrhage
35
What is petechia caused by?
Trauma, viral infection or bleeding problems - saw an increased number of reports in COVID
36
What is macule?
Small (<1 cm) circumscribed area of color change Brown, black, blue, red Not elevated or depressed Ex: freckle (=ephelis)
37
What is eschar?
a sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn i.e., aspirin burn
38
What is torus?
Bony elevation or prominence
39
What is patch?
- Large (>1 cm) circumscribed area of color or texture change (or both) - Not elevated or depressed Ex: port wine stain-caused by an abnormal formation of tiny blood vessels in the skin
40
What is an ulcer?
A denuded area extending below the basal layer Gradual tissue disintegration Usually, painful Ex: aphthous or herpes simplex
41
What is an outer layer, covering, or scab, from a coagulation of blood, serum, pus, or any combination?
Crust
42
What is plaque?
A solid, flat, area >1cm. - Often keratinized (white) Ex: Snuff dipper’s lesion
43
What is papule?
A superficial, elevated, solid lesion <1 cm. - Any color - Solid base or pedunculated Ex: parulis (“gum boil”)
44
What is a vesicle?
Small (<1 cm) fluid filled, elevated lesion with a thin surface covering = Small blister Lymph or serum Ex: Herpes simplex (before it bursts)
45
What is a pustule?
Small (<1 cm.) vesicular-type lesion containing purulent material rather than clear fluid Creamy white or yellow Ex: dental abscess
46
What is a nodule?
An elevated, deep solid lesion .5 – 2.0 cm. Overlying mucosa not fixed Ex: fibroma
47
What is irritation fibroma classified as?
a tumor because this lesion is persistent and progressively increases in size
48
What is irritation fibroma?
A large vesicle >1 cm. = large blister - Contains serum - Usually at the mucosal – submucosal junction Ex: Pemphigus, 2nd degree burn
49
What is the intraoral sequence?
Lips Buccal mucosa Buccal vestibules Tongue Oropharynx Palate Floor of mouth Lymph nodes
50
What is the sequence of examination for the lips?
Outside = extraoral Evert (inside) Palpate Lumps, bumps, etc
51
What is a minor salivary gland fibrosis?
Accumulation of saliva into a bump on the lip
52
What is a linea alba?
- white line - parallel to occlusal plane - Asymptomatic - Atypical - Caused by trauma - Chewing cheek
53
What is leukoedema?
“milky” white surface or blue-grey - Symmetrical - Atypical - Doesn’t rub off - Disappears / decreases Whwhen stretched - normal
54
Who is leukoedema more common in?
African americans
55
What is lichen planus?
Common inflammatory disease involving the skin and mucous membranes - Interlacing white striae (Wickham) with erythema of the surrounding mucosa. - usually appearing bilaterally - Painful erythematous erosions and ulcers may also occur. - On the skin, usually appears as purplish, itchy, flat bumps - Affects men and women equally but oral lichen planus is more common in women.
56
What is fordyce granules?
Sulfur-colored Very common Asymptomatic Atypical 1-3mm papules in the oral cavity Or lip vermillion
57
What should you look for on the hard palate?
Rugae (normal) = horizontal ridges Torus palatinus (normal) = bony lump Ulcerations Lesions
58
What should you look for on the soft palate?
Ulcers Patches
59
What is nicotine stomatitis?
- Lesion of the hard palate. - Lesion is white, rough, asymptomatic, and leathery appearing - Contains numerous red dots or macules - Caused by extreme heat in the mouth
60
Where is the most common place for cancer to occur on the tongue?
Lateral border and the base of the tongue
61
What kind of technique should be used to palpate the entire tongue?
Bidigital technique to palpate the entire tongue between the finger and thumb of one hand
62
What are atypical findings on the dorsal surface of the tongue?
Common-fissuring Scalloping Enlarged papilla Benign Migratory glossitis
63
What is benign migratory glossitis?
Lesions that heal and often migrate to a different part of the tongue (also called geographic tongue)
64
What does benign migratory glossitis cause?
Asymptomatic, causes discomfort, pain or burning sensation in some cases often related to eating spicy or acidic foods
65
What is leukoplakia?
White or grayish thick keratotic patch-like lesion on the mucosa which cannot be rubbed off
66
What is hairy leukoplakia caused by?
Epstein-barr virus and is usually associated with HIV infection or other immunosuppressive conditions
67
Where does hairy leukoplakia typically occur?
On the lateral border of the tongue (either unilateral or bilateral)
68
What does hairy leukoplakia look like?
White rough patches
69
What is hairy tongue?
Trapped debris - Bacteria - Fungus - Coffee - Tobacco - Antibiotics and other drugs can cause
70
What are visual observations to look for on the floor of the mouth?
Tongue to palate Lumps, bumps, swellings Mandibular tori Submandibular duct (Wharton's duct)
71
What does the submandibular duct (wharton's duct) drain?
saliva from the submandibular and sublingual glands - Accounts for 60% of saliva
72
What may the ventral surface of the tongue contain?
Lingual varicosities (normal w/ age)
73
What is the process of palpation of the floor of the mouth?
1. Have pt lift tongue up 2. One finger under one side of tongue 3. Have pt close down ½ way 4. One finger of other hand goes under chin 5. Gently press two fingers together 6. “Walk” fingers to posterior - “Walk” external finger farther
74

D1 Spring - Patient Care II (10 decks)

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