Intraoral Exam Flashcards
What are some things to keep in mind while preforming intraoral exams?
Don’t lean too far forward, don’t use patient’s chest as table, and keep your patient informed or what you are doing
Are physicians comfortable with doing oral health assessments?
NO
What should you look for during intraoral exam?
Cancer
Signs of systemic ds.
Tissue trauma
Infections
Pain
Esthetic concerns
Occlusal dysfunction
Etc
What is the underlying cause of 72% of oropharyngeal squamous cell carcinomas?
HPV
How does cancer behave in younger populations?
tends to be much more aggressive and have a poorer prognosis
How should you write your treatment notes?
With professional language (vs. speaking with patient in lay language)
What is a biopsy?
the removal of part or all of the suspicious area of tissue and microscopic evaluation by a pathologist
What is the gold standard for determining a diagnosis?
Biopsy
What is the misdiagnosis rate of oral lesions?
43% based on clinical observations alone
What % of oral cancers are squamous cell?
90%
What percent of all cancers is oral cancer?
3%
What is the 5-year survival rate of oral cancer?
57%
Who does oral cancer affect the most?
men 2x more than women
How many of diagnoses occur at stage I or II?
40%
How many of diagnoses occur at stage III or IV?
60%
What is the survival rate for stage I or II?
80-90%
What is the survival rate for stage III or IV?
33% (3 years); 67% (recurrence in 2yrs)
How should you describe a lesion?
number
size
shape
color
profile
base
border
texture
What are the risk factors of oral cancer?
Tobacco (#1 overall)
Alcohol (#2 overall)
Viruses: HPV & HIV
Sun exposure
Inadequate nutrition
Genetic predisposition
Chronic inflammation
Radiation exposure
Carcinogen exposure
What is the #1 risk factor for oral cancer?
Tobacco
What is the #2 risk factor for oral cancer?
Alcohol
How much oral cancer could be prevented by eliminating tobacco and alcohol use?
75%
What are some ways to prevent oral cancer?
Lip balm w/ sunscreen
HPV vaccine
(Avoid HPV exposure)
Diet rich in fresh fruit and vegetables
What is the reduction rate after 5 yrs without tobacco?
35%
What are the high risk areas for oral cancer?
Floor of mouth
lateral border of tongue
ventral surface of tongue
oropharynx
What is a tonsillar crypt?
individuals have large crypts in the tonsils that collect food debris, bacteria and hardened material ( tonsil stones). These patients often complain of halitosis.
What is a bifid uvula?
sometimes a bifid uvula is an indication of a 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 is the process 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 / palpate tongue
(Dorsal, ventral, lateral borders, base)
Examine hard and soft palate (palpate hard)
Examine tonsils and oropharynx
What is the basic techniques of an intraoral exam?
Inspection and palpation
What is erytherma?
Red area of variable size and shape.
Usually in patches
What is petechiae?
round red pinpoint areas of hemorrhage.
Usually cause by trauma, viral infection or bleeding problems
When did we see an increased number of reports of petechiae?
During covid
What are 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
What can cause eschar?
Aspirin burn
What are tori?
bony elevation or prominence
What is a patch?
Large (>1 cm) circumscribed area of color or texture change (or both)
Not elevated or depressed
What is an ulcer?
A denuded area extending below the basal layer
Gradual tissue disintegration
Usually, painful
Ex: aphthous or herpes simplex
What is an apthous ulcer?
Caused by trauma, very painful
What is crust?
an outer layer, covering, or scab, from a coagulation of blood, serum, pus, or any combination
What is plaque?
A solid, flat, area >1cm.
Often keratinized (white)
What is a papule?
A superficial, elevated, solid lesion <1 cm.
Any color
Solid base or pedunculated
What is a vesicle?
Small (<1 cm) fluid filled, elevated lesion with a thin surface covering
= Small blister
Lymph or serum
What is a pustule?
Small (<1 cm.) vesicular-type lesion containing purulent material rather than clear fluid
Creamy white or yellow
What is a nodule?
An elevated, deep solid lesion .5 – 2.0 cm.
Overlying mucosa not fixed
What is an irritation fibroma?
classified as a tumor because this lesion is persistent and progressively increases in size; typically due to chronic irritation
What is a bulla?
A large vesicle
>1 cm.
= large blister
Contains serum
Usually at the mucosal – submucosal junction
What is the intraoral sequence?
Lips
Buccal mucosa
Buccal vestibules
Tongue
Oropharynx
Palate
Floor of mouth
Lymph nodes
How should you examine the lips?
Outside = extraoral
evert (inside)
palpate
lumps, bumps, etc
What is linea alba?
white line
parallel to occlusal plane
Asymptomatic
Atypical
Caused by trauma
Chewing cheek
What does leukoedema look like?
More common in African-Americans
“milky” white surface or blue-grey
Symmetrical
Atypical
Doesn’t rub off
Disappears / decreases when stretched
normal
What is lichen planus?
Common inflammatory disease involving the skin and mucous membranes
What does licen planus look like?
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 are fordyce granues?
Sulfur-colored
Very common
Asymptomatic
Atypical
1-3mm papules in the oral cavity
Or lip vermillion
When inspecting the soft palate, what should you do?
Depress tongue
Say “Ah”
Look for:
Ulcers
Patches
Etc.
What should you do when inspecting the hard palate?
Anterior palate
Look for:
Rugae (normal) = Horizontal ridges
Torus palatinus (normal) = Bony lump
Ulcerations
Lesions
What are torus palatinus?
Bony lump(s)
Asymptomatic
Atypical
20-30% of people
Females: males = 2:1
No tx necessary
What are torus mandibularis?
Bony lump(s)
Asymptomatic
Atypical
More common w/ bruxism?
8-16% of people
Males = females
No Tx necessary
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
Where is the most common place for cancer to occur on the tongue?
the lateral border and the base of the tongue.
What are atypical findings that can occur on the tongue?
the dorsal surface of the tongue are common-fissuring, scalloping, enlarged papilla and benign migratory glossitis
What is benign migratory glossitis?
THE LESIONS OFTEN HEAL IN ONE AREA AND THEN MOVE (MIGRATE) TO A DIFFERENT PART OF THE TONGUE.
ALSO CALLED GEOGRAPHIC 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
What is leukoplakia?
White or grayish thick keratotic patch-like lesion on the mucosa which cannot be rubbed off
What is hairy leukoplakia caused by?
Caused by the Epstein-Barr virus and is usually associated HIV infection or other immunosuppressive conditions
Where does hairy leukoplakia occur?
Typically occurs on the lateral border of the tongue. Either unilateral or bilateral.
White rough patches.
What is a hairy tongue caused by?
Trapped debris
Bacteria
Fungus
Coffee
Tobacco
Antibiotics and other drugs can cause.
What should you look for on the floor of the mouth?
Tongue to palate
Lumps, bumps, swellings
Mandibular tori
Submandibular duct is also called-Wharton’s duct. Drains saliva from the submandibular and sublingual glands. Accounts for 60% of saliva.
What are lingual varicosities?
Normal w/ age
