Introduction to oral lesions

Question 1

Explain the following normal variations in the oral cavity:
Fordyce granules

Melanin pigmentation

Linea alba

Fissured tongue

Exostoses

Torus palatinus

Mandibular torus

Less common:
Retrocuspid papilla

Amalgam tattoo

Hairy tongue

Geographic tongue

Varicosities

Hemoangioma

Leukodema

Lingual thyroid

Answer 1

Fordyce granules
* Small sebaceous glands on the buccal mucosa

Melanin pigmentation
* Duh

Linea alba
* Keratinised tissue that is inline with the occlusal plane, running from the last molar to the labial commissure

Fissured tongue
* Fissured tongue on the lingual surface

Exostoses
* Bone growth on the alveolar ridges on the maxilla and mandible

Torus palatinus and mandibular torus
* Bone growths in palate and mandible

Less common:
Retrocuspid papilla
* Small elevated nodules mostly behind the lower canines

Amalgam tattoo

Hairy tongue

Geographic tongue

Varicosities
* Twisted, enlarged veins at the skin surface

Hemoangioma
* Rubbery bump and is made up of extra blood vessels in the skin

Leukodema
* Leukoedema is the normal anatomic variant of the oral mucosa which has clinical appearance similar to potentially malignant white lesions such as leukoplakia

Lingual thyroid
* Abnormal mass of ectopicthyroidtissue seen in base of tongue

Question 2

Demonstrate the ability to accurately describe oral lesions with respect to size.

Answer 2

Using a probe to measure
○ length and width in millimetres
○ for elevated lesion measure height

Question 3

Demonstrate the ability to accurately describe oral lesions with respect to shape.

Answer 3

• Round, raised (elevated), depressed or flat
• Defined or undefined borders
• Pedunculated: lesion is attached to a stalk
Sessile: lesion has a base that is as wide as the lesion itself

Question 4

Demonstrate the ability to accurately describe oral lesions with respect to colour.

Answer 4

• Red, white, mixed (red and white) are most common

* Blue, purple, grey, yellow, black and brown

Question 5

Demonstrate the ability to accurately describe oral lesions with respect to consistency.

Answer 5

• Soft, spongy
• Resilient
• Hard or indurated (abnormally hard)
• Fluid filled

Question 6

Demonstrate the ability to accurately describe oral lesions with respect to texture.

Answer 6

○ Smooth

If an irregular surface:
□ Corrugated- wrinkled
□ Fissured- grooved
□ Papillary
□ Verrucous - wartlike
□ Crusted

Question 7

Demonstrate the ability to accurately describe oral lesions with respect to location.

Answer 7

○ Is it localised or generalised?
○ Is it a single lesion?
○ Is it multiple lesions?

Borders/ characteristics:
□ separate- discrete, not running together
□ coalescing- close to one another with margins that merge

Question 8

Identify and demonstrate the ability to use appropriate terminology to describe lesions in or around the oral cavity and in radiographs.

Answer 8

Describe borders:

• Coalescence
• Diffuse
• Well defined

Describe amount:

• Multilocular: many cysts
• Unilocular: only singular

Describe shape, size, colour, consistency

Radiographs

• Radiolucent
• Radiopaque

Question 9

Define neoplasm

Answer 9

Any new or abnormal growth exhibiting uncontrolled proliferation.

Question 10

Understand characteristics of malignant lesions

Answer 10

Common sites

• Floor of the mouth
• Lateral borders of the tongue
• Lower lip
• Soft palate

• Can appear as:
○ White lesions (leukoplakia)
○ Red lesions (erythroplakia)
○ Ulcers
○ Masses

Question 11

Discuss the stages of cancer as determined by TMN.

Answer 11

Staging based on TNM
• T = size of tumor
• N = lymph node involvement
• M = metastasis (the mass of abnormal tissue enlarges and sheds cells that spread the disease)

Question 12

Discuss the stages of cancer

Answer 12

• Stage 0 means there’s no cancer, only abnormal cells with the potential to become cancer. This is also called carcinomain situ.
• Stage I means the cancer is small and only in one area. This is also called early-stage cancer.
• Stage II and III mean the cancer is larger and has grown into nearby tissues or lymph nodes.
• Stage IV means the cancer has spread to other parts of your body. It’s also called advanced or metastatic cancer.

Question 13

Discuss the oral sides effects of chemotherapy

Answer 13

• Mucositis
• Xerostomia
• Abnormal enamel & root development
• Jaw pain
• Delayed eruption

Question 14

Discuss the oral sides effects of radiation therapy

Answer 14

Oral side effects
• Reduced salivary flow
• Mucositis
• Trismus
• Candidiasis
• Dysgeusia- distorted taste
• Osteoradionecrosis

Question 15

Discuss the oral management of patients with cancer prior to treatment

Answer 15

Prior
• Eliminate sources of infections
• Reduce biofilm
• Improve conditions for healing
• Preventive dental therapies
• Preventive homecare instructions

Question 16

Discuss the oral management of patients with cancer during cancer treatment

Answer 16

During and after:
• Evaluate periodontal health
• Examine for dental caries
• Assess salivary flow
• Provide preventive homecare instructions
	• Toothbrushing
	• Mouth rinses
	• Diet

Question 17

List the things you need to describe when talking about a lesion

Answer 17

• Size
• Colour
• Consistency
• Location
• Texture
• Shape