Preliminary Diagnosis of Oral Lesions (2) 口腔病理學 Preliminary Diagnosis of Oral Lesions (2) 口腔病灶之初步診斷 (2) 陳玉昆教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

學 習 目 標 Understanding: 1. List the diagnostic categories contribute to the diagnostic process 2. Lesions of variant of normal 3. Lesions of benign conditions of unknown causes

參考資料 References: Oral Pathology for the Dental Hygienist. Olga AC Ibsen, Joan Anderson Phelan, 4th edition, p. 2-29, 2004 Kaohsiung Medical University, Oral Pathology Department

The Diagnostic Process Clinical Diagnosis Radiographic Diagnosis Historical Diagnosis Laboratory Diagnosis Microscopic Diagnosis Surgical Diagnosis Therapeutic Diagnosis Differential Diagnosis

The Diagnostic Process 1. Clinical Diagnosis The strength of the diagnosis: Clinical appearance of the lesion Palpating the lesion On the basis of color, shape, location & history of the lesion Fordyce granules Torus palatinus Ref. 1

The Diagnostic Process 1. Clinical Diagnosis Mandibular tori Melanin pigmentation Ref. 1

The Diagnostic Process 1. Clinical Diagnosis Retrocuspid papillae Fissured tongue Ref. 1

The Diagnostic Process 1. Clinical Diagnosis Circumvallate papilae Black hairy tongue White hairy tongue Amalgam tatto Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Periapical pathosis (PAP) Fistula Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Internal root resorption External root resorption Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Interproximal caries Interproximal calculus Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Compound odontoma Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Complex odontoma Supernumerary tooth Compound Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Impaction Impactions Calcified pulp Refs. 1, 2

The Diagnostic Process 2. Radiographic Diagnosis Nutrient canal Mixed dentition Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Coin Amalgam fragment Overhang amalgam Glass lens Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Broken instrument Curet Retained deciduous tooth with amalgam restoration Ref. 1

The Diagnostic Process 2. Radiographic Diagnosis Nose ring Bullet Retained piece of shrapnel Ref. 1

The Diagnostic Process 3. Historical Diagnosis The strength of the diagnosis: Combined with clinical appearance of the lesion Personal, family, past & present medical & dental histories, history of drug ingestion Amelogenesis imperfecta Ref. 1

The Diagnostic Process 3. Historical Diagnosis Ulcerative colitis Nifedipine Ulceration Gingival hyperplasia Skin graft Ref. 1

The Diagnostic Process 4. Laboratory Diagnosis The strength of the diagnosis: Laboratory test: blood chemistries, urinalysis Elevated serum alkaline phosphatase level indicate Paget’s disease Cotton-wool appearance Ref. 2

The Diagnostic Process 5. Microscopic Diagnosis The strength of the diagnosis: Microscopic evaluation of the biopsy specimen taken from the lesion 2. H&E or other special stainings 切片檢查 Refs. 1, 2

The Diagnostic Process 6. Surgical Diagnosis The strength of the diagnosis: Surgical intervention Information of the lesion gained during the surgical procedure Stafne cyst Traumatic bone cyst Ref. 1

The Diagnostic Process 7. Therapeutic Diagnosis Angular chelitis - Anti-fungual cream- Nystatin ANUG - Hydrogen peroxide Ref. 1

Variants of Normal 1. Fordyce granules Ectopic sebaceous glands: Commonly noted on lips (vermilion) buccal mucosa 2. Yellow lobules in clusters Ref. 1

Variants of Normal 2. Torus palatinus Exophytic growths of normal compact bone: Inherited, more frequently in women Asymptomatic, develop gradually Torus palatinus: midline of hard palate of various size, shape or lobulated, covered with normal mucosa Ref. 1

Variants of Normal 3. Mandibular tori Dense bone on lingual mandible: Premolar areas above mylohyoid ridge Bilateral, lobulated or nodular Ref. 1

Variants of Normal 4. Melanin pigmentation Pigment gives color to: Skin, hair, mucosa, gingiva Usually dark-skinned individuals Ref. 1

Variants of Normal 5. Retrocuspid papilla A sessile nodule: Gingival margin Lingual aspect of mandibular cuspids Ref. 1

Variants of Normal 6. Lingual varicosities Prominent lingual veins: On ventral & lateral surfaces of tongue Red to purple enlarged vessels Ref. 1

Variants of Normal 7. Linea albea White line: Extend anteroposteriorly on buccal mucosa Along the occlusal plane, bilaterally More prominent in clenching or bruxing patients Ref. 1

Variants of Normal 8. Leukoedema A generalized opalescence: On buccal mucosa A gray-white film Opalescence less prominent when mucosa is stretched Ref. 1

1. Lingual thyroid nodule Benign conditions of unknown cause 1. Lingual thyroid nodule Thyroid tissue entrapped in tongue: A remnant from developmental anomaly A high predilection in females Ref. 1

Benign conditions of unknown cause 2. Fissured tongue Deep fissures on dorsal tongue: Associated with vitamin deficiency or chronic trauma over a long period Ref. 1

3. Median rhomboid glossitis Benign conditions of unknown cause 3. Median rhomboid glossitis In the past, it has been regarded as a developmental anomaly that occurs as a result of entrapment of tuberculum impar during fusion of lateral portions of tongue, now associated with candida albicans Ref. 1

Benign conditions of unknown cause 4. Geographic tongue Diffuse areas of desquamation of filiform papillae Cause is unknown, may be induced by stress Does not remain static Associate with histology of psoriasis Involves dorsal & lateral border of tongue Ref. 1

Benign conditions of unknown cause Elongated filiform papillae: Appear white, yellow, brown or black Color is due to chromogenic bacteria 5. White hairy tongue 5. Black hairy tongue Ref. 1

Summaries Knowing: List the eight diagnostic categories contribute to the diagnostic process 2. Define “variant of normal” and give examples of such lesions 3. List and describe clinical pictures of benign conditions of unknown causes