Exam 3 Flashcards
Name the three factors in making a differential diagnosis of an oral lesion
- Lesion site
- Lesion morphological characterists
- Color of lesion
Name of morphological categories of oral lesions
Elevated
Depressed
Flat
Define elevated lesions
surface above the normal mucosa plane
Define coalescing
Clustered/Clumped/blend into one another
Define blisterform lesions
translucent
soft rebounding
Three types of blisterform lesions
vesicle
pustules
bulla
Define vesicles
> 5mm lesion
Clear fluid
Define pustule
greater or less than 5mm
yellowish color
Define bulla
lesion >5mm
may contain serum mucin or extavaasated blood
pink red or blue
Define nonblisterform lesion
firm and solid
contain NO fluid
opaque in appearance
Four types of nonblisterform lesions
papule
nodule
tumor
plaque
Define papule
size
Tissue
Define nodule
size
Tissue>5mm
Define tumor
term
size
tumescence (swelling)
>2cm
Define plaque
shape
size
slightly raised lesion with a broad flat toppasted or stuck on appearance
>5mm
Define Sessile nonblisterform lesion
papule nodule or tumor whose attachment to the normal mucosa is the greatest diameter of the lesion
Define Pedunculated nonblisterform lesion
papule nodule or tumor whose attachment to the normal mucosa is smaller than the greatest diameter of the lesion itself
Name of the four characteristics to describe depressed lesions
Outline-Oh
Margin-My
Depth-Double
Diameter- D’s
Define ulcer
definition
center
periphery
loss in the continuity of the oral epithelium
yellow
red
The normal viewing distance to determine the outline of lesions
30-40cm
Describe the depth of a superficial and deep depressed lesions
3mm
Define flat lesions
located on the same plane as normal oral mucosa
How are flat lesions detected
change in color
Define macule
a flat lesion of abnormal color
Why is the loss of a papillae on the tongue considered a flat lesion
Loss of papillae results in what looks like a depressed lesion however since it doesn’t involve the mucosal surface it is a flat lesion. Because it doesn’t involve an abnormality in color it is not considered a macule
Name the three most prominent colors of oral soft tissue lesions
Red
Pink
White
Name the four primary endogenous pigments of normal tissue
Oxyhemoglobin
Reduced hemoglobin
Melanin
Carotene
Define oxyhemoglobin
define
color
more oxygen
bright red
Define reduced hemoglobin
define
color
less oxygenated
bluish
Define melanin
define
color
formed by malanocytes, pigment particles transferred to malpighian cells of epithelium
brown
Define carotene
location
color
cornified superficial layer of the epithelium, sebaceous glands and blood plasma
yellow
Soft tissue lesions are rarely seen as single colors. The predominant color involves the greatest surface area first
Soft tissue lesions are rarely seen as single colors. The predominant color involves the greatest surface area first
Predominant color of the oral mucosa
pink
Location of Red mucosa
vermillion border, alveolar mucosa, soft palate, pharynx
Location of Melanin
buccal mucosa, attached gingiva, hard palate
Pink lesions
characteristic
normally appear as
types-4 and describe
normally elevated
nonblisterform (papules,nodules, tumors)
- hyperplasia-increased quantity of normal connective or bone tissue
- neoplasia-abnormal growth of tissue or cellular infiltrate
- fluid accumulation-edema, Mucin- localized lesion (the more superficial the fluid accumulation the more translucent it will appear)
- cyst- fluid filled epithelial lined cavities that are well localized
Red lesins
formed by-2 types
increased quantity of blood to an area via erythema
Intravascular changes and extravascular changes
Define intravascular changes
result from dilation of blood vessels or proliferation of new vessels via hyperemia
use diascopic examination to determine (blanching=positive indication)
Define extravascular changes
due to the escape of RBC’s into the surrounding tissue via extravasation leading to discoloration of skin known as purpura
Three types of extravascular changes and their definitions
- petechiae-small red macule 1-5mm sharply outlined
- Ecchymosis-macule larger and slightly deeper than petechiae
- hematoma- lesion involving large area casing tumescence
what is the most common condition resulting in abnormal redness
inflammation resulting from trauma or infection
White lesions
result from
Four types and define
alteration of the epithelium and connective tissue
- hyperkeratinization- thickening of the outer surface of the epithelium via chronic irritation
- acanthosis- increased thickening via hyperplasia of prickle cell layer
- necrosis- death of cells in a localized area resulting in epithelial sloughing
- Fluid accumulation- intra or extracellular edema appearing pale white
Red and White Lesions
commonly include
morphology
inflammation
large ulcers and depressed lesions
Gray Lesions
caused by
morphology
foreign matter (metals) associated with macules
Blue Lesions
caused by
Morphology
reduced hemoglobin
bullae
Purple Lesions
morphology
caused by
bullae, nodules or hematomas
vascular lesion breakdown products
Brown Lesions
caused by
morphology
characteristic
melanin and hemosiderin
macules
crusting and drying of ulcerated lesions (scabs)
Black Lesions
caused by-4
foreign body deposition, altered blood pigments, necrosis/gangrene or melanin
Yellow Lesions
caused by-6
morphology
1.carotene via puss, 2.lymphoid tissue, 3.serum exudate, 4.breakdown of blood pigments, 5.lipids, 6.neoplasms
ulcers of pustules
Rough white lesion cause
mechanical friction (frictional keratosis)
Corrugated white lesion cause
long term tobacco use
Irregular, shaggy, sloughing or desquamating lesion cause-4
collapsed bullae, chemical burns, candidiasis, allergies
TMD definition
problems involving the masticatory musculature, temporomandibular joint or both
Synovial joint definition
synovial membrane that exudes synovial fluid to provide lubrication, and nutrients
Complex joint definition
has an articular disk that separates the join into a superior and inferior compartment and has articular disk
Articular disc definition
dense fibrous connective tissue that is saddle shaped containing a thick anterior band, thicker posterior band and a central zone that is non-innervated and avascular
Fibers of lateral pterygoid muscles attach to
anterior portion of articular eminence, retrodiscal tissue (vascular and innervated) and posterior aspect of the articular disc behind the condylar head
Primary function of muscles masseter- medial pterygoid- lateral pterygoid- temporalis-
elevation of mandible
elevation of mandible
protrusion and lateral excursion of the mandible
elevation of mandible
Masticatory muscles
masseter
medial pterygoid
lateral pterygoid
temporalis
Define internal derangement
the location of the articular disc is displaced from its normal seated position on the condylar head
Define disc displacement WITH reduction type most common painful? click? mouth opening mandible deviation
internal derangement anteromedial very painful reciprocal click during closing and opening within normal limits towards the affected side
Define disc displacement WITHOUT reduction type most common painful? click? mouth opening mandible deviation
internal derangement anteromedial very painful in acute phase no joint noise limited mouth opening called "closed lock" towards the affected side
Define Open Lock
hyper translation of the disc-condyle complex past the peak of the articular eminence with simultaneous contraction of the elevator muscles
Define Retrodiscitis/Capsulitis
inflammation of the vascular bed of the retrodiscal tissue and inflammation of the capsular tissue/synovial membrane resulting in edema that can “throw off” the normal bite of the patient
Define Osteoarthritis
3 characterists
inflammatory degenerative process of the articular surface of the condyle and articular eminence
1. roughened articular surface
2.pain
crepitus (crunchy) joint noise
Define Myalgia
local muscle soreness via overuse
Define odontalgia
referred false tooth pain
Define Obstructive Sleep Apnea (OSA)
repetitive episodes of complete (apnea) or partial (hypopnea) upper airway obstruction via the soft palate or tongue
Prevalence of hypertension
25%
True or False:
“Data Suggests that a person with high blood pressure yields poorer results in dentistry”
False-the disease itself does not pose a risk to treatment rather the systemic cardiovascular, renal, near, and retinal cause increased risk during treatment.
Medicines used to treat hypertension cause-5
- orthostatic hypotension
- labial blood pressure during general anesthesia
- gingival hyperplasia
- xerostomia
what % of hypertension is known?
*5%- caused by catecholamine secreting tumors and kidney disease
95% considered essential hypertension
at what age should the diagnosis of hypertension be based solely on systemic blood pressure?
age 50
When should blood pressure be checked?
prior to giving a local anesthetic
What is white coat hypertension
a raise in blood pressure due to fear of medical practitioners including dentists
Define One MET
3.5ml of O2/Kg/min (ability of patient to perform physical work)
1-4 MET
eating, dressing, walking around, washing dishes
4-10 MET
climbing stairs, short run, game of golf
> or = 10 MET
swimming, long distance running, singles tennis, football, Friday dental basketball=12
Sedation does what to BP
lowers it
