1/8: Intraoral Exam Flashcards
What age of patients have we started to notice an increase of oral cancer diagnoses?
40 with no known risk factors
HPV 16 included in this age group is a significant increase in cancer of the tongue
What should you look for in an intraoral exam?
Cancer
Signs of systemic dis.
Tissue trauma
Infections
Pain
Esthetic concerns
Occlusal dysfunction
What is the underlying cause of many oropharyngeal squamous cell carcinomas with a predominate increase seen in younger white men?
HPV
Cancer in what kind of populations tend to be much more aggressive and have a poorer prognosis?
Younger populations
What is the gold standard for determining a definitive diagnosis?
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
When does there tend to be a misdiagnosis of oral lesions by dental practitioners?
When they based their diagnosis on clinical observations alone
What is the most common oral cancer?
Squamous cell
Who does squamous cell carcinoma affect more often?
Men 2x more than women
What percent of oral cancer is found in stages I or II and III or IV?
40% - I or II
60% - III or IV
How should you describe a lesion?
Number
Size
Shape
Color
Profile
Base
Border
Texture
What are risk factors for oral cancer?
Tobacco (#1 overall)
Alcohol (#2 overall)
Viruses: HPV & HIV
Sun exposure
Inadequate nutrition
Genetic predisposition
Chronic inflammation
Radiation exposure
Carcinogen exposure
75% of oral cancer can be prevented how?
By eliminating tobacco and alcohol use
How can you prevent oral cancer?
Lip balm w/ sunscreen
HPV vaccine (avoid HPV exposure)
Diet rich in fresh fruit and vegetables
What are high risk areas for oral cancer?
Floor of mouth
Lateral border of tongue
Ventral surface of tongue
Oropharynx
What are tonsil stones?
arge crypts in the tonsils that collect food debris, bacteria and hardened material
What may happen after tonsillectomy?
Regrowth of lymph tissue
What can a bifid uvula an indiciation of?
submucous clef palate
- can cause speech and swallowing difficulties
What are signs and symptoms of oral cancer?
nonhealing ulcer
bleeding
lymphadenopathy
hardness
paresthesia
drooling
What consists of a routine oral cancer exam?
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
What are the basic techniques for examination?
Inspections (eyes)
Palpation (fingers)
What are palpation terminology?
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)
What does it mean when something returns quickly to original shape?
Spongy
What does it mean when something is soft and leaves indentation - edema?
Pitting
What does it mean when contents are expressed - usually fluid like - abscess?
Collapsing
What does it mean when something has a color change?
Blanching
What does it mean when something is separate, not running together or blending?
Discrete
What does it mean when something runs together, merging, blended; originally separate but now formed into one?
Confluent
What does it mean when something has small bump-like elevations or projections?
Papillary
What does it mean when something is covered with or full of wart-like growths; cauliflower like surface?
Verrucose (aka Verrucous) lesion
What does it mean when something is attached to the surface on a broad base. Immobile, fixed, firmly attached. Lacks a stalk?
Sessile
What does it mean when something has an elecated lesion having a narrow stem which acts as a base. Elongated stalk?
Pedunculated lesion
What is erythema?
Red area of variable size and shape usually in patches
What is petechia?
Round red pinpoint areas of hemorrhage
What is macule?
Small (<1 cm) circumscribed area of color
change
Brown, black, blue, red
Not elevated or depressed
Ex: freckle (=ephelis)
What is eschar?
a sloughing (shedding) of
epithelium caused by disease, trauma, or chemical burn
i.e., aspirin burn
What is torus?
Bony elevation or prominence
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
What is an ulcer?
A denuded area extending below the basal
layer
Gradual tissue disintegration
Usually, painful
Ex: aphthous or herpes simplex
What is papule?
A superficial, elevated, solid lesion <1 cm.
- Any color
- Solid base or pedunculated
Ex: parulis (“gum boil”)
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)
What is a pustule?
Small (<1 cm.) vesicular-type lesion containing purulent material rather than clear fluid
Creamy white or yellow
Ex: dental abscess
What is a nodule?
An elevated, deep solid
lesion .5 – 2.0 cm.
Overlying mucosa not fixed
Ex: fibroma
What is irritation fibroma?
A large vesicle
>1 cm.
= large blister
- Contains serum
- Usually at the mucosal
– submucosal junction
Ex: Pemphigus, 2nd
degree burn
What is a minor salivary gland fibrosis?
Accumulation of saliva into a bump on the lip
What is a linea alba?
- white line
- parallel to occlusal
plane - Asymptomatic
- Atypical
- Caused by trauma
- Chewing cheek
What is leukoedema?
“milky” white surface or blue-grey
- Symmetrical
- Atypical
- Doesn’t rub off
- Disappears / decreases Whwhen stretched
- normal
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.
What is fordyce granules?
Sulfur-colored
Very common
Asymptomatic
Atypical
1-3mm papules in the oral cavity Or lip vermillion
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
What does benign migratory glossitis cause?
Asymptomatic, causes discomfort, pain or burning sensation in some cases often related to eating spicy or acidic foods
What is leukoplakia?
White or grayish thick
keratotic patch-like
lesion on the mucosa
which cannot be rubbed off
What does hairy leukoplakia look like?
White rough patches
What is hairy tongue?
Trapped debris
- Bacteria
- Fungus
- Coffee
- Tobacco
- Antibiotics and other drugs can cause
