1. Oral Pathology DH 180 Ms. Louann Ross, RDH

2. Vocabulary Necessary to be able to communicate intelligently Necessary to be able to communicate intelligently Necessary to be able to document Necessary to be able to document Necessary to be able to refer Necessary to be able to refer

3. Bulla Bulla-adjective, bullous; plural, bullae) A circumscribed elevated lesion that is more than 5 mm in diameter, usually contains serous fluid, and looks like a blister. Bulla-adjective, bullous; plural, bullae) A circumscribed elevated lesion that is more than 5 mm in diameter, usually contains serous fluid, and looks like a blister.

4. Lobula=A segment or lobe that is a part of the whole; these lobes sometimes appear fused together (adj.= lobulated) Made up of lobules, which are smaller divisions of lobes. Many structures are divided into lobes and lobules, such as the brain, lung, and salivary glands. Some pathologic lesions are described as lobulated when the lesion is divided into smaller parts. (adj.= lobulated) Made up of lobules, which are smaller divisions of lobes. Many structures are divided into lobes and lobules, such as the brain, lung, and salivary glands. Some pathologic lesions are described as lobulated when the lesion is divided into smaller parts.

7. Macule

9. Pedunculated=Attached by a stem- like or stalk base similar to that of a mushroom.

10. Pustules-Variously sized circumscribed elevations containing pus

11. Sessile-Describing the base of a lesion that is flat or broad

12. Vesicle-A well-defined lesion of the skin and mucous membranes that resembles a sac, contains fluid, and is less than 1 cm in diameter.

13. Soft Tissue Consistency- pg.3 Nodule-A palpable solid lesion up to 1 cm in diameter found in soft tissue. It can occur above, level with, or beneath the skin surface. Nodule-A palpable solid lesion up to 1 cm in diameter found in soft tissue. It can occur above, level with, or beneath the skin surface. Palpation-To examine by hand, to feel. Palpation-To examine by hand, to feel. Nodular Melanoma Nodular Melanoma

14. Color of Lesion Colors- Red, pink, salmon, white, blue- black, gray, brown, and black. Colors- Red, pink, salmon, white, blue- black, gray, brown, and black. Erythema- an abnormal redness Erythema- an abnormal redness Pallor- Paleness of the skin or mucosal tissues Pallor- Paleness of the skin or mucosal tissues

15. Size of the lesion Centimeter-a little less than one-half inch Centimeter-a little less than one-half inch Millimeter-perio probe can be used to measure lesion Millimeter-perio probe can be used to measure lesion

16. Surface texture-text pg. 3 Corrugated-Wrinkled Corrugated-Wrinkled Fissure-A cleft or groove, normal or otherwise, showing prominent depth. Fissure-A cleft or groove, normal or otherwise, showing prominent depth. –Atlas pg’s 16,17(fissured tongue-pg.4,5) Papillary-Resembling small, nipple-shaped projections or elevations found in clusters Papillary-Resembling small, nipple-shaped projections or elevations found in clusters Smooth, rough, folded-terms used to describe the surface texture of a lesion. Smooth, rough, folded-terms used to describe the surface texture of a lesion.

17. Fissured

18. Papillary

19. Radiographic Terms Used to Describe lesions in Bone-pg3 Diffuse-can be a radiographic or a general descriptive term of a lesion. Diffuse-can be a radiographic or a general descriptive term of a lesion.

20. Diffuse-In the description of a lesion, borders of the lesion are not well defined, and it is not possible to detect the exact parameters of the lesion.

21. Multilocular Describes a lesion that extends beyond the confines of one distinct area and is defined as many lobes or parts a\that are somewhat fused together, making up the entire lesion; a multilocular radiolucency is sometimes described as resembling soap bubbles; an odontogenic keratocyst often presents as a multilocular radiolucent lesion. Describes a lesion that extends beyond the confines of one distinct area and is defined as many lobes or parts a\that are somewhat fused together, making up the entire lesion; a multilocular radiolucency is sometimes described as resembling soap bubbles; an odontogenic keratocyst often presents as a multilocular radiolucent lesion.

22. Multilocular Description: Large well- delineated multilocular radiolucent lesion of the body of the mandible. Note the displaced unerupted permanent teeth. Location: Body of the left mandible extending from the anterior teeth to the first molar Description: Large well- delineated multilocular radiolucent lesion of the body of the mandible. Note the displaced unerupted permanent teeth. Location: Body of the left mandible extending from the anterior teeth to the first molar

23. Multilocular Description: Large multilocular radiolucent lesion of the posterior body and ramus of the mandible (Ameloblastoma) Location: Posterior body and ramus of the mandible, left side Description: Large multilocular radiolucent lesion of the posterior body and ramus of the mandible (Ameloblastoma) Location: Posterior body and ramus of the mandible, left side

24. More terms-pg’s 3 & 4 Radiolucent-describes the black or dark areas on a radiograph; radiant energy can pass through these structures; less dense tissue, such as the pulp, is seen as a radiolucent structure Radiolucent-describes the black or dark areas on a radiograph; radiant energy can pass through these structures; less dense tissue, such as the pulp, is seen as a radiolucent structure Radiopaque-describes the light or white area on a radiograph that results from the inability of radiant energy to pass through the structure; the more dense the structure, the more light or white it appears on the radiograph; this is illustrated in Fig 1-10 pg.6 in text Radiopaque-describes the light or white area on a radiograph that results from the inability of radiant energy to pass through the structure; the more dense the structure, the more light or white it appears on the radiograph; this is illustrated in Fig 1-10 pg.6 in text

25. Root resorption - Breakdown or destruction of root structure; loss of root structure. The apex of the tooth appears shortened or blunted and irregularly shaped

26. Unilocular - A term used to describe a radiographic appearance of a single, rounded compartment or lobule.

27. Well circumscribed - Term used to describe a lesion whose borders are specifically defined, and in which one can clearly see the exact margins and extent; well defined (well delineated) border.

28. The Diagnostic Process Eight pieces to the puzzle of data collection. Eight pieces to the puzzle of data collection. Comes from various sources. Comes from various sources. 1.Clinical 2.Radiographic 3.Historical (personal history, family history, past and present mediccal and dental histories, histor of drug ingestion, and history of the presenting disease or lesion

29. Eight Diagnostic pieces continued 4.Laboratory-blood and urine samples 5. Microscopic 6.Surgical 7. Therapeutic 8. Differential findings.

30. 1. Clinical—color, shape, location and history of the lesion Fordyce granules - Collection of sebaceous glands that occur in various locations within the oral cavity. Fordyce granules - Collection of sebaceous glands that occur in various locations within the oral cavity.

31. Fordyce granules: Note the yellow plaques with a smooth surface. Fordyce granules represent sebaceous glands and are not pathologic.

32. Here is another clinical example of Fordyce granules, with the arrow pointing to one discrete lesion of many

33. Microscopically, Fordyce granules are entrapped sebaceous glands similar to those seen in association with hair follicles in the skin. Clusters of gland cells drain their secretions through a short duct into the oral cavity.

34. torus palatinus

35. mandibular tori

36. melanin pigmentation A normal variant found predominantly in dark skinned individuals. The melanin produced by melanocytes is deposited extracelluarly. An increase in the number of melanocytes produces melanin resulting in clinically visible pigmentation of skin, eyes, hair, mucosa and gingiva. A normal variant found predominantly in dark skinned individuals. The melanin produced by melanocytes is deposited extracelluarly. An increase in the number of melanocytes produces melanin resulting in clinically visible pigmentation of skin, eyes, hair, mucosa and gingiva.

37. Retrocuspid Papilla - A sessile nodule on the gingival margin of the lingual aspect of the mandibular canines.

38. Lingual Varicosities-A normal variant in adults over 60 years of age. Enlarged veins usually purple or red on ventral and lateral surface of the tongue.

39. Fissured tongue

40. Median rhomboid glossitis- An asymptomatic, elongated, erythematous patch of atrophic mucosa of the middorsal surface of the tongue due to a chronic C. albicans infection.

41. 2. Radiographic

42. Complex Odontoma

43. 3.Historical Amelogenesis imperfecta- A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only. Amelogenesis imperfecta- A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only.

44. 4. Laboratory Diagnosis Paget disease- Uncoordinated increase in the osteoclastic and osteoblastic activity of the bone cells of older adults producing larger but weaker bones, extensive pain, high levels of serum alkaline phosphatase and urinary hydroxyproline, and an increased tendency to develop malignant bone neoplasms. Paget disease- Uncoordinated increase in the osteoclastic and osteoblastic activity of the bone cells of older adults producing larger but weaker bones, extensive pain, high levels of serum alkaline phosphatase and urinary hydroxyproline, and an increased tendency to develop malignant bone neoplasms.

45. 5.Microscopic White lesions, as an example may look similar if it is hyperkeratosis or epithelial dysplasia White lesions, as an example may look similar if it is hyperkeratosis or epithelial dysplasia

46. 6. Surgical Diagnosis Traumatic Bone Cyst- Asymptomatic intraosseous empty cavity of young patients located primarily within the mandible, lined by a thin loose connective tissue membrane and is adequately treated when blood enters the space during an intraosseous biopsy. Traumatic Bone Cyst- Asymptomatic intraosseous empty cavity of young patients located primarily within the mandible, lined by a thin loose connective tissue membrane and is adequately treated when blood enters the space during an intraosseous biopsy.

47. 7.Therapeutic Conditions to be diagnosed by therapeutic means. Conditions to be diagnosed by therapeutic means. Nutritional-correct the imbalance and see if the problem subsides. Nutritional-correct the imbalance and see if the problem subsides. 8. Differential Diagnosis The differential diagnosis is that point in the diagnostic process when the practitioner decides which test or procedure is required to rule out the conditions originally suspected and establish the definitive or final diagnosis. The differential diagnosis is that point in the diagnostic process when the practitioner decides which test or procedure is required to rule out the conditions originally suspected and establish the definitive or final diagnosis.

48. Variants of Normal Fordyce Granules Fordyce Granules torus palatinus torus palatinus mandibular tori mandibular tori melanin pigmentation melanin pigmentation retrocuspid papilla retrocuspid papilla lingual varicosities lingual varicosities linea alba linea alba leukoedema leukoedema

49. Variants of normal Linea Alba- “white line” Linea Alba- “white line” soft linear streak of parakeratinized tissue on the buccal mucosa at the occlusal line. The line may be initiated by irritation from rough buccal cusps, bruxism or habitual clenching of teeth. soft linear streak of parakeratinized tissue on the buccal mucosa at the occlusal line. The line may be initiated by irritation from rough buccal cusps, bruxism or habitual clenching of teeth.

50. Leukoedema Accumulation of fluid within the epithelial cells of the buccal mucosa. asymptomatic bilateral, diffuse, grayish-white, milky, opalescet appearance of the mucosa will disappear when applying the clinical "stretch test" Accumulation of fluid within the epithelial cells of the buccal mucosa. asymptomatic bilateral, diffuse, grayish-white, milky, opalescet appearance of the mucosa will disappear when applying the clinical "stretch test"

51. Benign Conditions of Unknown Cause Lingual thyroid nodule Lingual thyroid nodule Median rhomboid glossitis Median rhomboid glossitis Geographic tongue Geographic tongue Fissured tongue Fissured tongue Hairy tongue Hairy tongue

52. Lingual Thyroid Nodule

53. Hairy Tongue

54. Elongation and hyperparakeratosis of filiform papillae many microbial colonies on epitheliial surface Elongation and hyperparakeratosis of filiform papillae many microbial colonies on epitheliial surface

55. Benign Migratory Glossitis (Geographic Tongue) Multiple sensitive irregularly shaped erythematous patches on the tongue with arcuate white rims that enlarge and change shape daily. Multiple sensitive irregularly shaped erythematous patches on the tongue with arcuate white rims that enlarge and change shape daily.