Intraoral Exam Flashcards
Most primary medical care providers still not
comfortable performing basic oral health
assessments. Why?
Many consider oral health outside their
realm of practice
Look for… (7)
Cancer •Signs of systemic ds. •Tissue trauma •Infections •Pain •Esthetic concerns •Occlusal dysfunction •Etc
90% of cancer is
squamous cell
oral cancer accounts for –% of all cancers
3%
•~36,000 cases / yr.
•>8,000 deaths / yr.
Overall, –% have a 5-yr survival rate
57
oral cancer men vs women
men 2x more than women
–% are found in Stages I or II
•–% survival
40
80-90
–% are found in Stages III or IV
•–% survival (3 yrs.)
•–% = recurrence in 2 yrs.
60
33
67
Lesion Description (8)
- number
- size
- shape
- color
- profile
- base
- border
- texture
Risk factors: Oral Cancer (9)
- Tobacco (#1 overall)
- Alcohol (#2 overall)
- Viruses: HIV+, HPV
- Sun exposure
- Inadequate nutrition
- Genetic predisposition
- Chronic inflammation
- Radiation exposure
- Carcinogen exposure
prevention of oral cancer (4)
~75% could be prevented by eliminating tobacco
and alcohol use
• 35% reduction after 5 years w/o tobacco
• Lip balm w/ sunscreen
• HPV vaccine (avoid HPV exposure)
• Diet rich in fresh fruit and vegetables
High-risk areas for oral cancer (4)
floor of mouth
lateral border of tongue
ventral surface of tongue
oropharynx
Signs and symptoms: oral cancer (6)
- nonhealing ulcer
- bleeding
- lymphadenopathy
- hardness
- paresthesia
- drooling
Routine Oral Cancer Exam:
Question pt. about risk factors such as (4)
Tobacco, alcohol, sunlight, HPV
Routine Oral Cancer Exam:
examine face for (3)
discolorations
swellings
asymmetry
Routine Oral Cancer Exam:
palate (3)
lymph nodes
lips
labial and buccal mucosa (vestibule, mucobuccal folds, frenums, buccal mucosa)
Routine Oral Cancer Exam:
examine (4)
- Examine and bimanually palpate floor of mouth
- Examine / palpate tongue (dorsal, ventral, lateral borders, base)
- Examine hard and soft palate (palpate hard)
- Examine tonsils and oropharynx
Basic Techniques (2)
inspection, eyes
palpation, fingers
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
Spongy =
returns quickly to original shape
Pitting =
soft and leaves indentation -edema
Collapsing =
contents expressed –usually fluid
like-abscess
Blanching =
color change
ex. anesthetic, tissue turns white
Discrete
separate, not running together or blending
CONFLUENT
Running together, merging, blended.
Originally separate but now formed into one.
Papillary
having small bump-like elevations or projections
VERRUCOSE (AKA VERRUCOUS) LESION
covered with or full of wart-like growths; cauliflower-like surface.
Sessile
attached to the surface on a broad base.
•Immobile, fixed, firmly attached
Pedunculated lesion
elevated lesions having a narrow stem
which acts as a base. Elongated stalk
Pedunculated squamous papilloma usually
occur on the (3)
soft palate, tonsil, or epiglottis.
•These lesions are sometimes fatal
Erythema:
red area of variable size and shape
erythema is usually in
patches
PETECHIA(E)
round red pinpoint areas of hemorrhage
PETECHIA(E) is usually caused by (3)
trauma
vital infection
bleeding problems
skipped
Saw an increased number of petechiae(e) reports
re: Cutaneous manifestations with COVID.
Erosions, ulcerations, petechia, and blood crusts on the
inner surface of lips
Macule. (4)
Small (<1 cm) circumscribed area of color change
•Brown, black, blue, red
•Not elevated or depressed
•Ex: freckle (=ephelis)
Eschar
a sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn•i.e., aspirin burn
Torus
bony elevation or prominence
Patch (3)
- 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
Ulcer (4)
- A denuded area extending below the basal layer
- Gradual tissue disintegration
- Usually, painful
- Ex: aphthous or herpes simplex
Crust
an outer layer, covering, or scab, from a
coagulation of blood, serum, pus, or any
combination
Plaque (3)
- A solid, flat, raised area >1cm.
- Often keratinized (white)
- Ex: Snuff dipper’s lesion
Papule (4)
- A superficial, elevated, solid lesion <1 cm.
- Any color
- Solid base or pedunculated
- Ex: parulis (“gum boil”)
Vesicle (3)
- Small (<1 cm) fluid filled, elevated lesion with a thin surface covering = Small blister
- Lymph or serum
- Ex: Herpes simplex (before it bursts)
Pustule (3)
- Small (<1 cm.) vesicular-type lesion containing purulent material rather than clear fluid
- Creamy white or yellow
- Ex: dental abscess
Nodule (3)
- An elevated, deep solid lesion .5 –2.0 cm
- Overlying mucosa not fixed
- Ex: fibroma
Bulla (4)
- A large vesicle >1 cm = large blister
- Contains serum
- Usually at the mucosal –submucosal junction
- Ex: Pemphigus, 2nd degree burn
Sample Intraoral Sequence (8)
- Lips
- Buccal mucosa
- Buccal vestibules
- Tongue
- Oropharynx
- Palate
- Floor of mouth
- Lymph nodes
Lips (4)
- Outside = extraoral
- evert (inside)
- palpate
- lumps, bumps, etc
Linea Alba (4)
- white line
- parallel to occlusal plane
- Asymptomatic
- Caused by trauma (ex. chewing cheek)
Leukoedema (6)
- More common in African-Americans
- “milky” white surface or blue-grey
- Symmetrical
- Doesn’t rub off
- Disappears / decreases when stretched
- normal
LICHEN PLANUS (4)
•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.
LICHEN PLANUS
Interlacing white striae(Wickham) usually appears —
bilaterally
Fordyce granules (5)
- Sulfur-colored
- Very common
- Asymptomatic
- 1-3mm papules in the oral cavity
- Or lip vermillion
Hard Palate: Anterior palate
•Look for: (4)
- Rugae (normal) = Horizontal ridges
- Torus palatinus (normal) = Bony lump
- Ulcerations
- Lesions
Torus Palatinus (2)
- Bony lump(s)
* Asymptomatic
Torus Palatinus prevalence
20-30% of people
females: males= 2:1
treatment of Torus Palatinus
no treatment of necessary -unless need dentures, partials, or interferes with speech, chewing, homeware, etc
Torus Mandibularis (3)
- Bony lump(s)
- Asymptomatic
- More common w/ bruxism?
Torus Mandibularis prevalence
8-16% of people
•Males = females
Torus Mandibularis Treatment
No Tx necessary
•Unless need dentures, partials, or interferes with speech, chewing, homecare etc.
Soft Palate (3)
- Depress tongue
- Say “Ah”
- Look for: Ulcers, Patches, Etc.
NICOTINE STOMATITIS (4)
•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
BENIGN MIGRATORY GLOSSITIS (3)
•THE LESIONS OFTEN HEAL IN ONE AREA AND THEN
MOVE (MIGRATE) TO A DIFFERENT PART OF THE TONGUE
•ERYTHEMATOUS, WELL DEMARCATED ARES OF
PAPILLARY ATROPHY
•USUALLY ASYMPTOMATIC BUT CAN CAUSE
DISCOMFORT, PAIN OR BURNING SENSATION IN
SOME CASES, OFTEN RELATED TO EATING SPICY OR
ACIDIC FOODS
BENIGN MIGRATORY GLOSSITIS is also called
geographic tongue
Leukoplakia
White or grayish thick keratotic patch-like lesion on the mucosa which cannot be rubbed off
Hairy Leukoplakia is caused by
Epstein-Barr virus and is usually associated HIV infection or other immunosuppressive conditions
Hairy Leukoplakia typically occurs on the
lateral border of the tongue
Hairy Leukoplakia is either
unilateral or bilateral
Hairy Leukoplakia looks like
white rough patches
