Algorithm Method of Managing Oral Lesions Flashcards
Name the phases in the algorithmic method of managing oral lesions
- Phase One: Categorization
- Phase Two: Clinical Impression
- Phase Three: Definitive diagnosis & Treatment
What steps are part of Phase I (categorization)?
- Step 1: Find lesion(s) from patient’s chief complaint and/or screening examination
- Step 2: Take radiographs of jaw lesions and bone underlying mucosal lesions
- Step 3: Categorize lesion(s) according to table 1
What steps are part of Phase II (clinical impression)?
- Step 1: Look at differential diagnosis table for each category of lesions
- Step 2: Obtain clinical data from history, inspection, palpation, and radiographs
- Step 3: Use clinical data to reduce entities in tables to clinical impression
What steps are part of Phase III (Definitive diagnosis & treatment)?
- Step 1: Diagnostic tests
- Step 2: Definitive diagnosis
- Step 3: Treatment and follow up
What does step 1 in phase 1 (categorization) entail?
Find lesion(s) from the patient's chief complaint and/or screening examination: • The initial step is to find lesion(s). In some cases, the patient will have a specific complaint such as an enlargement, ulcer, sore, area of discoloration, swelling of the lymph "glands" under the jaw, pain, tenderness, or difficulty speaking, chewing or swallowing. • Whether or not the patient mentions a specific problem, a thorough examination should be performed. The single most critical step is finding small lesions particularly those which are not readily visible on the ventral surface of the tongue and floor of the mouth.
What does step 2 of phase I (categorization) entail?
Radiographs:
• Radiographs should be taken of bone underlying any soft tissue lesion.
• Radiographs should be taken of regions of the jaws where there is evidence of pathology (pain, paresthesia, anesthesia, swelling, teeth which are malpositioned or loose, etc.
• Disturbances in radiodensity may be found on radiographs taken as part of a comprehensive oral examination.
• Radiographs much show the full extent of lesions (areas of altered radiodensity) in at least two dimensions. (The borders must be visible.)
What does step 3 of phase I (catergorization) entrail?
Once a lesion (or lesions) has been located it should be placed in one of several cagories listed in table 1.
Major categories within table 1.
• Mucosal
- Flat lesion
- Raised lesion
• Major salivary glands
• Jaw
- Radiolucencies
- Mixed or radiopaque lesionsList those categorized as “Mucosal - Flat lesions” from table 1.
A. Solitary ulcers B. Multiple ulcers C. White plaques and patches D. Red macules and patches E. Red and white macules and patches F. Pigmented macules and patches
List those categorized as “Mucosal - Raised lesions” from table 1.
G. Normal-colored well-defined nodules H. Discolored well-defined nodules I. Irregular ulcerated enlargements J. Verrucous enlargements K. Multiple enlargements L. Generalized gingival enlargement
List those categorized as “Major Salivary Glands” from table 1.
M. Parotid gland enlargements
List those categorized as “Jaw - Radiolucencies” from table 1.
N. Solitary unilocular apical radiolucencies
O. Solitary unilocular interradicular radiolucencies
P. Solitary unilocular pericoronal radiolucencies
Q. Solitary unilocular well-defined radiolucencies in other locations
R. Multilocular radiolucencies
S. Irregular and/or ill-defined radiolucencies
T. Multiple radiolucencies
List those categorized as “Jaw - Mixed or Radiopaque lesions” from table 1.
U. Well-defined apical radiopaque or mixed lesions
V. Well-defined non-apical radiopaque or mixed lesion
W. Irregular and/or ill-defined radiopaque or mixed lesion
X. Multiple opacities
What does step 1 of phase II (Clinical empression), entail?
Differential diagnosis tables
• Once the condition has been categorized, refer to the table which lists the lesions in that category.
• Each table compares the clinical features of the various lesions which comprise the category. (The tables are not comprehensive; many entities are not listed. Also, the comments refer to the most common or typical features of each condition and do not represent the full spectrum of clinical characteristics of the lesion).
• The relatively large number of entities in the table will be reduced to a short list of one or several items on the basis of the data obtained from clinical and radiographic examinations.
What does step 2 of phase II (clinical impression) entail?
Clinical & Radiologic Data Collection:
• Clinical features are obtained by a series of procedures: History Inspection, Palpation, Percssion and Auscultation (“HIPPA”).
• Intraosseous jaw lesions and mucosal lesions which are associated with jaw lesions are revealed by radiographs.
• Pulp vitality testing and aspiration are often used for intraosseous lesions.
• This section describes a full range of data collection procedures. They are not all used for any given case. The data needed for each category of lesions is much less extensive and should be tailored to facilitate reaching a clinical impression expeditiously for the particular category.
