Diagnosis and Treatment Flashcards
Identify the lesion in the picture, what you would tell the patient, and the management of the lesion.
Fordyce Spots
Small sebacious glands, which are present in about 60-75% of adults.
There is no management required as there is no associated pathology.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Linea Alba
Horizontal, asymptomatic, white lesion, along the occlusal plane,
No management required, asymptomatic friction based lesion typically resulting from parafunctional habit.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Geographic tongue (benign migratory glossitis)
Asymptomatic, and is relatively rare.
No major management required, however sometimes can cause sensitivity to toothpaste and hot/spicy food.
Check for nutrient deficiencies (B12, Folate, ferritin)
Use SLS free toothpaste.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Fissured tongue
Variation in normal anatomy, can sometimes be related to geographic tongue.
Encourage good oral hygiene and lightly brushing tongue.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Black Hairy Tongue
Hyperplasia of filiform papillae, resulting from build up of bacteria, food debris, and pigment inducing microbes.
Associated with smoking, anti-biotics, chlorhexidine mouthwash, and poor OH.
Generally asymptomatic, but can advise smoking cessation, brushing the tongue, exfoliating the surface with peach stones, and eating fresh pineapple.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
No pathology obvious
Heathy gingiva
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Desquamative gingivitis, associated with a number of conditions such as, lichen planus, pemphigoid, pemphigus, lupus.
Not caused by plaque, but can be exacerbated by it
Also interdental papilla loss, indicating periodontal disease, and management of this can help manage desquamative gingivitis.
Identify any causative conditions, however it cannot be identified in about a third of cases.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Palatal Torus
Relatively common (30-40% of population)
A bony exostosis, a benign overgrowth of calcified bone which can be associated with parafunction. Rarely a manifestation of Gardner’s syndrome (ask about GI symptoms).
Typically asymptomatic, however can interfere denture placements and masticatory function.
Management rarely indicated, however could consider surgical removal.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Mandibular Tori
Relatively common (30-40% of population)
A bony exostosis, a benign overgrowth of calcified bone which can be associated with parafunction. Rarely a manifestation of Gardner’s syndrome (ask about GI symptoms).
Typically asymptomatic, however can interfere denture placements and masticatory function.
Management rarely indicated, however could consider surgical removal.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Pigmentation of the mucosa
More common in non-white ethnicity due to increased melanin pigmentation.
Can make diagnosis of mucosal disease more challenging.
No associated pathology, however consider Addison’s, smokers melanosis, and drug related pigmentation.
Describe how this histology sample is typical of an oral ulcer.
It is a localized defect, where there is destruction of epithelium exposing underlying connective tissue.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: The lesion is soft, mobile, and not fluid filled.
Traumatic Ulcer
White keratinized borders, surrounding mucosa normal, ulcer soft.
Identify causative agent, such as a fractured cusp.
Management:
- Consider causative agents (trauma, stress, viral infection)
- Simple HSMW
- Antiseptic mouthwash
- LA spray or mouthwash
- Steroid moutwash (betamethasone)
- Steroid Inahler (beclomethasone)
- Onward referal
Likely no maangement needed.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Lesion is soft, painful, less than 1cm wide, and has not occured before.
Oral Ulcer
Common ulcerative condition, erythematous halo, yellow/white fibrinous center.
Likely not reccurant, however could be first instance of recurrent apthous stomatitis.
Management not necissarily needed, as most resolve themselves within 2-3 weeks.
Management:
- Consider referal to GP for haemanitics/coeliac screen
- Consider causative agents (trauma, stress, viral infection)
- Simple HSMW
- Antiseptic mouthwash
- LA spray or mouthwash
- Steroid moutwash (betamethasone)
- Steroid Inahler (beclomethasone)
- Onward referal
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: the lesions are soft, painful, less than 1cm wide, and have occured previously in the same spots.
Recurrent apthous stomatitis - herpetiform
Multiple small ulcers, with classic apthous appearance
Management:
- Consider referal to GP for haemanitics/coeliac screen
- Consider causative agents (trauma, stress, viral infection)
- Simple HSMW
- Antiseptic mouthwash
- LA spray or mouthwash
- Steroid moutwash (betamethasone)
- Steroid Inahler (beclomethasone)
- Onward referal
Generally work down this list depending on severity, see what works.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Lesion is soft, painful, is more than 1cm wide, and has occured previously in the same location.
Recurrent apthous stomatitis - Major
Classic apthous appearance, has occured before, and is larger than 1cm which indicates major not minor RAS.
Expect a long time to heal, longer than typical 2-3 weeks expected of ulcers.
Management:
- Consider referal to GP for haemanitics/coeliac screen
- Consider causative agents (trauma, stress, viral infection)
- Simple HSMW
- Antiseptic mouthwash
- LA spray or mouthwash
- Steroid moutwash (betamethasone)
- Steroid Inahler (beclomethasone)
- Onward referal
Generally work down this list depending on severity, see what works.
Identify and describe the lesion in the picture, what you would tell the patient.
Note: Hard on palate, not cancerous, wider than 1cm.
Inflammatory/immunological ulcer
Rolled border with white and red surrounding mucosa
Mixed yellow/white and red core
Large, greater than 1cm
Could be caused by:
- Behcet’s syndrome
- Necrotisising sialometaplasia
- Lichen planus
- Vesicobullous disease
- Connective tissue disease
Referal to oral med specialist, consider normal treatment options for ulceration.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Patient has fever, headache, malaise, cervial lymphadenopathy, short lasting vesciles, multiple sites in mouth, patient is aged 4.
Primary herpes simplex viral infection
Short lasting vesicles on multiple sites within the mouth, systmeic involvement.
Age of patient is also an indication that this is a systemic herpes simplex infection, as it generally affects patient between 2-5 years old.
Seek advice from GP and onward referal on how to resolve systemic infection, manage oral symptoms. Consider systemic aciclovir.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Patient has history of childhood chicken pox.
Varicella-zoster viral infection (shingles)
Latent reactivation of primary infection (chicken pox), due to patient being immunocompromised or from other accute infection.
Liase with GP, patient may need further investigation.
Provide analgesia and difflam if painful.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Patient has previously recieved chemotherapy, and is taking potassium channel blockers.
Iaterogenic ulcer
Large patches of tongue mucosa with apthous appearance.
Ulcer induced from chemotherapy and potassium blockers, which are the likely causes of this. Can also be from radiotherapy, GVH disease, or other drugs such as NSAIDS and bisphosphonates.
Follow normal protocols for managing ulcers, refer to oral med if unresolved.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Exophytic, non-movable, hard to touch, not painful but causing sensory distrubance.
Neoplastic lesion (oral cancer)
Rolled borders, raised from the mucosa, larger than 1cm, white outer ring with a darkened center.
Immediate referal to oral medicine using oral cancer pathway.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Patient has poorly maintained upper denture, and the white patches can be wiped away.
Pseudomebranous candidal infection.
Leukoplakia and erythema on majority of hard palate, covering most of the denture bearing area.
Likely induced by poor hygiene of denture, but can also be due to immune health, smoking, and inhaler use.
Consider anti-fungals (fluconazole, miconazole, nystatin)
Local measures:
- Rinse after inhalers or use spacer
- Denture hygiene instruction
- Smoking cessation
Will return unless underling cause treated
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Asymptomatic.
Reticular lichenoid reaction
White patches on buccal mucosa, forming web of white tissue.
Results from T Cell-mediated destruction of basal keratinocytes, from chornic inflammatory condition or medication.
Management:
- Simple mouthwash (HSMW )
- Local anaesthetic (Benzydamine or lidocaine)
- Avoid trigger factors: Spicy foods, fizzy drinks
- Steroid mouthwash (Betamethasone m/w, beclometasone inhaler)
- Change restorations
- Onward Referral- Biopsy, inform of increased cancer risk (1% go on to malignancy)
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Burning sensation of the oral mucosa, patient is on allopurinol.
Atrophic Lichenoid reaction
Results from T Cell-mediated destruction of basal keratinocytes, from chornic inflammatory condition or medication. In this case allopurinol is the likely trigger.
Management:
- Simple mouthwash (HSMW )
- Local anaesthetic (Benzydamine or lidocaine)
- Avoid trigger factors: Spicy foods, fizzy drinks
- Steroid mouthwash (Betamethasone m/w, beclometasone inhaler)
- Onward Referral- Biopsy, inform of increased cancer risk (1% go on to malignancy)
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Asymptomatic
Papular Lichenoid reaction
Results from T Cell-mediated destruction of basal keratinocytes, from chornic inflammatory condition or medication.
Management:
- Simple mouthwash (HSMW )
- Local anaesthetic (Benzydamine or lidocaine)
- Avoid trigger factors: Spicy foods, fizzy drinks
- Steroid mouthwash (Betamethasone m/w, beclometasone inhaler)
- Onward Referral- Biopsy, inform of increased cancer risk (1% go on to malignancy)
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Burning sensation from lesion.
Erosive lichenoid reaction
Results from T Cell-mediated destruction of basal keratinocytes, from chornic inflammatory condition or medication.
Management:
- Simple mouthwash (HSMW )
- Local anaesthetic (Benzydamine or lidocaine)
- Avoid trigger factors: Spicy foods, fizzy drinks
- Steroid mouthwash (Betamethasone m/w, beclometasone inhaler)
- Onward Referral- Biopsy, inform of increased cancer risk (1% go on to malignancy)
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Asymtomatic.
Plaque like lichenoid reaction
Results from T Cell-mediated destruction of basal keratinocytes, from chornic inflammatory condition or medication.
Management:
- Simple mouthwash (HSMW )
- Local anaesthetic (Benzydamine or lidocaine)
- Avoid trigger factors: Spicy foods, fizzy drinks
- Steroid mouthwash (Betamethasone m/w, beclometasone inhaler)
- Onward Referral- Biopsy, inform of increased cancer risk (1% go on to malignancy)
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Asymtomatic.
Bullous lichenoid reaction
Results from T Cell-mediated destruction of basal keratinocytes, from chornic inflammatory condition or medication. In this case allopurinol is the likely trigger.
Management:
- Simple mouthwash (HSMW )
- Local anaesthetic (Benzydamine or lidocaine)
- Avoid trigger factors: Spicy foods, fizzy drinks
- Steroid mouthwash (Betamethasone m/w, beclometasone inhaler)
- Onward Referral- Biopsy, inform of increased cancer risk (1% go on to malignancy)
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Patient is a smoker.
Traumatic Keratossis
Dry, whitened epithelium, due to increased karatin production
Increased keratin deposition at a site of trauma, can also be due to smoking. It is a protective response of the mucosa.
Management involves trying to reverse traumatic element, and encourage smoking cesation.
If it is a high risk site or individual is high risk consider secondary care referal.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: White patch does not rub off, and there are finger-like projections of leukoplakia.
Hairy Leukoplakia
White patch on lateral border of the tongue, with para-keratinised tissue, and finger like projections of para-keratin.
Triggered by EBV, and found in immunocompromised patients.
Seen in about 20-25% of patients with HIV
Management involves excluding other causes for white lesion, including lichen planus. Does have malignant potential so could be cause for biopsy.
Describe the lesion in the picture, the reasoning for its colour, and the likelyhood of malignancy.
Note: There are no obvious causes or reasons in the medical history related to this lesion.
Desquamative gingivits
Erythema around gingival margin of 11, 12, 13, exteneding to middle of the labial mucosa. Surounding mucosa looks healthy, there could be loss of interdentall papilla.
The tissue has become thinned, due to atrophy of the epithelium. A red patch with no clear cause has a high likelyhood of being dysplastic or malignant.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Patient also presents with fever, weight loss, and manifestations in the ear, nose, and throat.
Granulomatosis with polyangiitis (Wegner’s Granulomatosis)
Systemic vasculitis affecting other body systems.
Potnetially fatal complications, refer urgently to A+E, oral med, or other urgent healthcare.
Immunosupressants will be used to manage this.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Note: Lesion appears velvety, fiery, and not attributed to any other disease.
Erythroplakia
Exclude other possible diagnosis, such as lichenoid reaction or traumatic injuiry.
Most will have dysplasia or malignancy, very high malignant transformation rate, very hard to predict which ones will transform.
Urgent oral med referal.
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Orofacial granulomatosis (if Crohn’s present, then termed oral Crohn’s)
Non-necrotising granuloma formation.
Clinically very similar to Crohn’s disease, and is present in patient with Crohm’s so a GI investigation could be indicated.
Management principles
- Topical steroids
- Avoidance diets
- Intralesional steroid
- Biologics for Crohn’s disease
Identify and describe the lesion in the picture, what you would tell the patient, and the management of the lesion.
Erythroleukoplakia
Specked white and red patches on the dorsum of the tongue.
High risk of malignancy or complications, and aetiology is the same as that of both leukoplakia/eryhtroplakia.
Urgent referal to oral medicine, and biopsy for histopathology.
Describe the lesion in the picture, identify it, explain its aetiology, and how it can be managed.
Round lesion on anterior dorsum of the tongue. Large than 1cm wide, white and red tissue present. Raised of the mucosa, surrounding tissue looks healthy.
Pyogenic granuloma.
Localised gingival hyperplasia, which can occur on any mucosal site as a result of trauma.
Excision of the lesion is the main treatment, however if painful then provide analgesia until resolved.
Describe the lesion in the picture, identify it, explain its aetiology, and how it can be managed.
Round lesion on anterior tip of the tongue. Large than 1cm wide, white and red tissue present. Raised of the mucosa, surrounding tissue looks healthy.
Pyogenic granuloma.
Localised gingival hyperplasia, which can occur on any mucosal site as a result of trauma.
Excision of the lesion is the main treatment, however if painful then provide analgesia until resolved.
Describe the lesion in the picture, identify it, and explain its aetiology.
Round lesion in site between 22 and 25, on the upper arch ridge. Red and purple patches present, and is clearly raised off gingiva. Larger than 1cm.
Giant cell epulis
Peripheral giant cell granuloma, caused by fused macrophages resisting phagocytosis. Can be triggered by local chronic infection, infective agents (such as TB), and hormonal stimulation of cells.
Can also be related to autoimmune-sarcoidosis.
Describe the lesion in the picture, identify it, and explain its aetiology.
Round lesion on right buccal musosa, midway between the mucosal planes, appears like normal tissue with slightly inflamed border. Raised of the mucosa, bigger than 1cm.
Fibroepithelial polyp
Reaction to trauma from mastication or parafunctional habit, causing hyperplastic fiberous tissue formation.
Describe the lesion in the picture, identify it, and explain its aetiology.
Large hyperplastic lesion in right buccal sulcus, extending from midline to maxillary tuberosity. Red and white patches, larger than 1cm, surrounding erythema.
Denture induced hyperplasia.
Chronic irriation of the soft tissue from ill fitting denture has caused this.
Describe the lesion in the picture, identify it, and explain its aetiology.
Flat projection of tissue, looks to be a flap larger than 1cm attached to palatal anterior mucosa.
Leaf fibroma
Chronic irration from denture has caused fiberous hyperplasia of the tissue.
Describe the lesion in the picture, identify it, and explain its aetiology.
Small irregular bumps on vast majority of hard palate, little surrounding erythema, not fluid filled, whole lesion is larger than 1cm.
Papillary hyperplasia of the palate.
Induced by irration from denture.
Describe the lesion in the picture, identify it, explain its aetiology and how to manage this.
Hyperplasia of the gingival tissue, surrounding all teeth shown.
Drug inducded fiberous overgrowth of the gingiva.
Inducded by Ca channel blockers, Phenytoin, ciclosporin. Repated gingivectomy may be indicated if medication cannot be changed.
Describe the lesion in the picture, identify it, explain its aetiology and how to manage this.
Note: Patient is pregnant.
Widspread gingivitis and hyperplasia of the mouth.
Pregnancy gingivitis
Results due to increased progesterone levels, and can also occur from oral contraceptive pill. Note: does not normally occur if patients are going through HRT.
Response to typical OHI, but there is an exaggerated plaque response.
Describe the lesion in the picture, identify it, and explain its aetiology.
Round lesion around 1cm wide on lower labial mucosa. Red in appearence, surround tissue looks healthy, and is raised of the mucosa.
Hameangioma, a vascular lesion.
Harmatoma (non-cancerous tumor), due to vascular malformation. Can be capillary or cavernous.
Give a probable diagnosis of this lesion on the scalp. What reasons have led you to that diagnosis?
Note: It is itchy, and raised off the surface.
Melanoma
Variable pigmentation
Irregular outline
Raised surface
Symptomatic
Give a probable diagnosis for the white lesion on the hard palate. What is the malignant potential of the lesion?
Note: Patient is a smoker.
Smokers Keratosis
Traumatic keratin build up from smoke inhalation. Low malignant potential from this lesion, but higher overal oral cancer risk from smoking.
Give a probable diagnosis for the white lesion on the buccal mucosa.
Note: Lesion occured after patient took chewable aspirin.
Chemical aspirin burn.
Give a probable diagnosis for the lesion on the soft palate/uvula.
Note: Only occured over the last three days, white patches can be wiped away, patient does not wear a denture.
Acute Pseudomembranous Candidosis (Thrush)
Give a probable diagnosis for the white lesion on tongue. Explain why it appears the colour it does.
Lymphangioma
Build up of lymph fluid in the connective tissue, leading to swelling.
Give a probable diagnosis for this lesion. Explain why it has occured.
Note: Patient had composite/amaglam restorations in the area for many years before they were extracted.
Amalgam tattoo
Small fragments of amalgam penetrate the mucosa, condition is relatively benign.
