1. 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
~2755

2. 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

3. 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

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

5. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

19. 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

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

21. 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

22. 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

23. 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

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

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

26. 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

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

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

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

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

31. 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

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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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