intraoral exam Flashcards by Madyson Flax

what are you looking for with intraoral exams

cancer
signs of systemic ds
tissue trauma
infections
pain
esthetic concerns
occlusal dysfunction

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we continue to see an increase of oral cancer diagnoses in patients under the age of:
with no known risk factor.
what is included in this age group which is a significant increase in cancer of the tongue

40
HPV 16

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current research implicates the what as the underlying cause of as many as 72% of oropharngeal squamous cell carcinomas with a predominate increase seen in YOUNGER:

HPV- human papillomavirus
younger white men

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biopsy involving the removal of part or all of suspicious area of tissue and microscopic evaluation by a pathologist to determine its histological makeup is the ______ ______ for determining a definitive diagnosis

gold standard

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what percent of misdiagnosis of oral lesions by dental practitioners when they based their diagnosis on clinic observations alone

43%

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Oral cancer is 90%:

squamous cells

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what percent is oral cancer of all cancers?

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overall, what percent have a 5-year survival rate

57%

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oral cancer affects (men/women) 2x more

men

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what percent of oral cancer are found in stages I or II?

what is the % survival rate?

40%
80-90% survival rate

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what percent of oral cancers are found in stage III or IV?

what is the 3 year survival rate?
what is the % recurrence in 2 years?

60%
33% survival (3 yrs)
67% recurrence in 2 years

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list lesion descriptions

number
size
shape
color
profile
base
border
texture

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list the risks for oral cancer.
what are the top 2 overall risks?

top 2:
tobacco #1
alcohol #2
viruses: HPV and HIV
sun exposure
inadequate nutrition
genetic predisposition
chronic inflammation
radiation exposure
carcinogen exposure

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75% of oral cancer can be prevented by

eliminating tobacco and alcohol use

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what percent of reduction after 5 years w/o tobacco?

35%

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list the prevention of oral cancers:

eliminating tobacco and alc use
lip balm with sunscreen
HPV vaccine (avoid exposure too)
diet rich in fresh fruit and vegetables

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what are the 4 high risk areas for oral cancer?

floor of mouth
lateral border of tongue
ventral surface of tongue
oropharynx

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individuals have large crypts in the tonsils that collect food debris, bacteria, and hardened material (tonsil stones). these patients often complain of:
also what is this

tonsillar crypt
complain of bad breath aka halitosis

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what must you do after a tonsilllectomy

one may observe residual tonsil tissue or a regrowth of lymph tissue

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what is a bifid uvula an indication for?
what can this cause

indication of submucous clef palate
can cause speech and swallowing difficulties

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signs and symptoms with oral cancer:

nonhealing ulcer
bleeding
lymphadenopath
hardness
parasthesia
drooling

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routine oral cancer exam:

questions 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/palpate tongue
(dorsal, ventral, lateral borders, base)
hard and soft palate (palpate hard)
examine tonsils and oropharynx

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what risk factor questions do you ask with oral cancer exam

tobacco, alc, sunlight, HPV

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when examining face, what are you looking for

discolorations, swellings, asymmetry

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what do you palpate with the labial and buccal mucosa?

vestibule, mucobuccal folds, frenums, buccal mucosa

what do you examine on the tongue

dorsal, ventral, lateral borders, base

palpation terminology. bony hard=

torus

palpation terminology. induration=

firm but not as hard as bone (solid rubber ball)

palpation terminology. commpressible=

pressure alters its shape

palpation terminology. doughy

returns slowly to original shape

palpation terminology. spongy=

returns quickly to original shape

palpation terminology. pitting=

soft and leaves indentation aka edema

collapsing=

contents expressed -usually fluid like abscess

palpation terminology. blanching=

color change

separate, not running together or blending

discrete

running together, merging, blended. originally separate but now formed into one

confluent

having small bump-like elevations or projections

papillary

covered with or full of wart-like growths; cauliflower-like surface

verrucose (aka verrucous) lesion

attached to the surface on a broad base. immobile, fixed, firmly attached. lacks a stalk

sessile

elevated lesions having a narrow stem which acts as a base. elongated stalk these are sometime fatal!

pedunculated lesion

red area of variable size and shape usually in patches

erythema

round red pinpoint areas of hemorrhage

petechiae

what is petechiae usually caused by

trauma, viral infection or bleeding problems

small (<1cm) circumscribed area of color change brown, black blue, red not elevated or depressed ex. freckle (ephelis)

macule

sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn ex. aspirin burn

eschar

bony elevation or prominence

torus

Large (>1 cm) circumscribed area of color or texture change (or both) not elevated or depressed ex. portwine stain-caused by abnormal formation of tiny blood vessels in the skin

vascular birthmark???

denuded area extending below the basal layer -gradual tissue disintegration usually painful ex. herpes simplex

ulcer

outer layer, covering, or scab from a coagulation of blood, serum, pus or any combination

crust (outer covering)

solid, flat area >1cm often keratinized (white) ex. snuff dipper's lesion

plaque

superficial elevated, SOLID lesion <1cm any color solid base or pedunculated Ex. parulis (gum boil)

papule

small <1cm FLUID FILLED elevated lesion with a thin surface covering =small blister lymph or serum ex. herpes simplex (before it bursts)

vesicle ("cold sore")

small <1cm vesicular-type lesion -containing purulent material rather than clear fluid cream white or yellow ex. dental abcess

pustule

elevated, deep SOLID LESION .5-2.0 cm -overlying mucosa not fixed ex. fibroma

nodule

classified as tumor because this lesion is persistent and progressively increases in size

irritation fibroma

large vessicle >1cm =large blister contains serum usually at the mucosal -submucosal junction ex. pemphigus, 2nd degree burn

bulla

where are bulla's usually

submucosal junction at mucosal

sample intraoral sequence

lips buccal mucosa buccal vestibules tongue oropharynx palate floor of mouth lymph nodes

lips. outside= evert= how to check lips?

outside=extraoral evert=inside palpate and feel/look for bumps/lumps

-white line -parallel to occlusal plane -asymptomatic -atypical -caused by trauma -chewing cheek

linea alba

"milky" white surface or blue-grey -symmetrical -atypical

leukoedema

leukoedema (does/doesn't) rub off

doesnt

who is leukoedema most common in?

african americans

how does leukoedema disappear/decrease

when stretched normal

common inflammatory disease involving the skin and mucous membranes -involving white straie (wichkam) with erythema of the surrounding mucosa -appears bilateral -painful erythematous erosions may also occur

lichen planus

does lichen planus affect men or women more?

equally but more common in women

how does lichen planus appear as

purplish, itchy, flat bumps and bilateral

-sulfur-colored very common -asymptomatic atypical (multicolored)

fordyce granules

how large or fordyce granules and where

1-3mm papules in the oral cavity or lip vermillion

most often affects the hard and soft palate, gingiva, and dorsal tongue with plaques or tumors of coloration ranging from non-pigmented to brownish-red or violaceou -such as buccal vestibule sarcoma flate or slightly elevated

kaposi's sarcoma-flat or slightly elevated

what to look for with hard palate:

anterior palate look for: rugae (normal)= horizontal lines torus palatinus (normal)= bony lump ulcerations lesions

bony lump(s) asymptomatic atypical 20-30% of peeps no treatment necessary unless what?

torus palatinus unless need dentures, partials or interferes with speech, chewing, homecare etc

what is the ratio of female to male with torus palatinus

2:1

bony lumps asymptomatic atypical 8-16% no treatment needed unless need dentures, partials or interferes with speech, chewing, homecare

torus mandibularis

what is the ratio male to female with torus mandibularis? what is this most common with?

male-female more common with bruxism

depress tongue and say AH when checking

soft palate

what to look for with soft palate

ulcers patches etc

lesion of the hard palate. white, rough, asymptomatic and leathery appearing

nicotine stomatitis

contains numerous red dots or macules caused by extreme heat in the mouth

nicotine stomatitis

where is the most common place for cancer to occur?

lateral border of tongue and base of tongue

examine tongue using both

indirect and direct vision

atypical findings on the dorsal surface of the tongue are

common fissuring, scalloping, enlarged papilla and benign migratory glossitis

these lesions often heal in one area and then move (migrate) to a different part of the tongue

benign migratory glossitis

also called geographic tongue

benign migratory glossitis

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

white or grayish thick keratotic patch-like lesion on the mucosa which CANT be rubbed off

leukoplakia

leukoplakia (can/cant) be rubbed off

cant

caused by the epstein-Barr virus and is usually associated with HIV infection or other immunosuppressive conditions

hairy leukoplakia

typically occurs on the lateral border of the tongue either unilateral or bilateral white rough patches

hairy leukoplakia

trapped debris, bacteria, fungus, coffee, tobacco, antibiotics and other drugs can cause

hairy tongue

drains saliva from submandibular and sublingual glands. accounts for 60% OF SALIVA (why patient's have so much plaque on lower ant mandibulars)

wharton's ducts also called submandibular duct