Intraoral Exams Flashcards
What should you look for during an intraoral exam?
Cancer
Signs of systemic ds.
Tissue trauma
Infections
Pain
Esthetic concerns
Occlusal dysfunction
HPV is an underlying cause of as many as _____ percent of oropharyngeal squamous cell carcinomas
72%
What is a biopsy?
involving the removal of part or all of the suspicious area of tissue and microscopic evaluation by a pathologist to determine its histological makeup
What is the gold standard for determining a definitive diagnosis?
biopsy
What percent of oral cancers are squamous cell?
90%
What percent of all cancer is squamous cell?
3%
What is the 5-year survival rate of oral cancer?
57%
Oral cancer affects men __ times more than women
2 times
What percent of oral cancers are found in stages I and II?
40%
What percent of oral cancers are found in stages III or IV?
60%
What is the survival rate of cancers found in stage I and II?
80-90%
What is the survival rate of cancers found in stage III and IV?
33% survival for 3 years
67% recurrence in 2 years
What words do you use to describe a lesion?
number
size
shape
color
profile
base
border
texture
What are the risk factors for developing oral cancer?
- Tobacco (#1 overall)
- Alcohol (#2 overall)
- Viruses: HPV & HIV
- Sun exposure
- Inadequate nutrition
- Genetic predisposition
- Chronic inflammation
- Radiation exposure
- Carcinogen exposure
What percent of oral cancer could be prevented by eliminating tabacco and alcohol use?
75%
What can help prevent oral cancer?
- eliminate tobacco (35% reduction after 5 years) and alcohol
- lip balm
- sunscreen
- HPV vaccine
- diet rich in fresh fruits and veggies
What are the four high risk areas for oral cancer?
- floor of mouth
- lateral border of tongue
- ventral surface of tongue
- oropharynx
What is a possible issue with tonsillar crypts?
they can collect food debris, bacteria, and hardened material (tonsil stones)
What should you be aware of when a patient has a bifid uvula or no uvula?
speech and swallowing difficulties
- don’t lay them all the way back
What are some signs and symptoms of oral cancer?
- nonhealing ulcer
- bleeding
- lymphadenopathy
- hardness
- paresthesia
- drooling
What is the sequence for a routine oral cancer exam?
- ask about risk factors
- examine face
- palpate lymph nodes
- palpate lips
- palpate labial and buccal mucosa
- examine/palpate tongue
- examine hard/soft palate
- examine tonsils and oropharynx
What is induration?
firm but not as hard as bone
What is compressible?
pressure alters its shape
What is doughy?
returns slowly to original shape
What is spongy?
returns quickly to original shape
What is pitting?
soft and leaves indentation
What is collapsing?
contents expressed (usually fluid like abscess)
What is blanching?
color change
What is discrete?
separate, not running together or blending
What is confluent?
running together, merging, blended (originally separate but now formed into one)
What is papillary?
having small bump-like elevations or projections
What is verrucose (verrucous lesion)?
covered with or full of wart-like growths; cauliflower like surface
What is sessile?
attached to the surface on a broad base (immobile, fixed, firmly attached, no stalk)
What is pedunculated lesion?
elevated lesions having a narrow stem which acts as a base (elongated stalk)
- can be fatal
What is erythema?
red area of variable size and shape (patches)
What are petechia?
round red pinpoint areas of hemorrhage (caused by trauma, viral infection, or bleeding problems)
What are macule?
small circumscribed area of color change (not elevated or depressed; freckle)
What is eschar?
a sloughing (shedding) of epithelium cuased by disease, trauma, or chemical burn
What does asprin burn or an electrical burn cause?
eschar (shedding of epithelium)
What are tori (torus)?
bony elevation or prominence
What is a patch?
large circumscribed area of color or texture change (not elevated or depressed)
What is an ulcer?
a denuded area extending below the basal layer (gradual tissue disintegration; usually painful)
What is crust?
outer layer, coverign, or scab, from a coagulation of blood, serum, pus, or any combination
What is plaque?
- solid, flat, area
- often keratinized (white)
- can be caused by chewing tabacco
What is a papule?
- superficial, elevated, solid lesion
- any color
- solid base or penduculated
What is a vesicle?
- small fluid filled
- elevated lesion with a thin covering
- lymph or serum
- ex: herpes
What is a pustule?
- small vesicular-type lesion
- contains purulent material
- creamy white or yellow
- ex: dental abscess
What is a nodule?
- elevated, deep solid lesion
- overlying mucosa not fixed
- ex: fibroma
What is an irritation fibroma classified as?
a tumor because the lesion is persistent and progressively increases in size (not truly pathogenic)
What is a bulla?
- large vesicle
- contains serum
- usually at mucosal/submucosal junction
- ex: 2nd degree burn
What is a sample intraoral sequence?
- Lips
- Buccal mucosa
- Buccal vestibules
- Tongue
- Oropharynx
- Palate
- Floor of mouth
- Lymph nodes
What is a linea alba?
- white line on cheek
- parallel to occlusal plane
- asymptomatic
- atypical
- caused by trauma
What is leukoedema?
- more common in african-americans
- milky white surface on blue-grey
- atypical (but normal)
- disappears when stretched
What is lichen planus?
- common inflammatory disease
- interlacing white striae (Wickham) with erythema on mucosa
- painful erosions and ulcers can occur
- also can appear on skin as purple, itchy, flat bumps
What are fordyce granules?
- sulfer-colored
- very common
- asymptomatic
- atypical
- in oral cavity or on lip vermillion
When checking the hard palate look for…
rugae
torus palatinus
ulcerations
lesions
How many people have tori on the hard palate and is it higher in men or women?
20-30% of people
females 2x more likely
How many people have tori on the mandibular/floor of mouth and is it higher in men or women?
8-16%
men=women
- more common with bruxism
What should you look for on the soft palate?
ulcers
patches
etc
What are nicotine stomatitis?
- lesions on hard palate
- white, rough, asymptomatic, leathery
- numerous red dots or macules
- caused by extreme heat
Where is the most common place for oral cancer on the tongue?
later border and base of tongue
What technique should you use to check tongue for oral cancer?
- use direct and indirect vision
- bidigital technique to palate tongue
What is a benign migratory glossitis (geographic tongue)?
- lesions heal in one area and then move to a different part
- usually asymptomatic but can cause discomfort
What is leukoplakia?
- white or grayish thick keratotic patch-like lesion
- cannot be rubbed off
What is hairy leukoplakia?
- occurs on lateral border of the tongue
- white rough patches
- caused by epstein-barr virus or HIV or other immunosuppressive conditions
What is hairy tongue?
trapped debris (bacteria, fungus, coffee, tobacco)
- can be caused by antibiotics
What should you visualize on the floor of the mouth?
- tongue to palate
- lumps, bumps, and swellings
- mandibular tori
- submandibular salivary duct (wharton’s)
- lingual varicosities (normal with age)
