the 30 most comon oral lesions make up ___% of all reported lesions
- white plaque that does not rub off
- cannot be identified as any other well known entity
the fact that the lesion starts and stops is more worrisome than if it were one discontinuous lesion; you would want to take multiple incisional biopsies in this case
5 white lesions that can be scraped off
- materia alba
- white coated tongue
- burn (thermal, chemical, cotton roll, etc.)
- pseudomembranous candidiasis
- toothpaste or mouthwash overdose
can be scraped off
is white coated tongue symptomatic or asymptomatic? what is the treatment?
- treatment is tongue scraping or brushing
- wipes off
white coated tongue
can be wiped off
history of placing aspirin in this area
history of recent dental work, where cotton rolls were used, wipes off
cotton roll burn
generalized throughout the mouth, history of toothpaste irritation, wipes off
bilateral on buccal mucosa at occlusal plane, does not wipe off
- linea alba
- no treatment necessary
- can be from friction or sucking
goes away when stretched
leukoedema is bilaterally present in what percent of african american patients?
what is the treatment for leukoedema?
no treatment necessary
history of smoking
what do the red spots represent?
salivary gland duct openings
this is bilateral; what is the etiology?
oral hairy leukoplakia, etiology is EBV (patients are usually immunocompromised, and this is often seen in HIV patients)
tobacco pouch keratosis
treatment is to move tobacco pouch to a different location or stop using smokeless tobacco
does not wipe off
take incisional biopsy
what are the four possibilities of a leukoplakia biopsy?
- dysplasia (mild, moderate, severe)
- squamous cell carcinoma
what are the 3 high risk sites for leukoplakia?
floor of mouth > tongue > lip
what is the best guide to potential progression of oral lesions?
degree of dysplasia
severe dysplasia has ___% transformation rate
moderate dysplasia has ___% transformation rate
mild dysplasia has ___% transformation rate
16%, 3-15%, <5%
a dx of mild dysplasia does not necessarily warrant excisional biopsy; you can watch it and determine treatment from there
in any case, excision significantly reduces the transformation rate
what is the average transformation time for leukoplakia?
what are some cases where you would recommend removing tori?
- causing problems
- cosmetics/personal preference
what percent of the population has torus palatinus? are they more common in males or females? caucasians or african americans?
- 2:1 F:M
what percent of the population has torus mandibularis? more common in males or females? caucasians or african americans? what percent is bilateral?
- 90% bilateral
what is kenalog-10 (or kenalog-40) used for?
treats traumatic ulcers
when using kenalog-10, how many mg do you need for a 1cm lesion?
in kenalog-10, there is 10mg per 1ml of fluid, so for a 1cm lesion, you'd need 10mg, or 1ml
so if the lesion is 3cm, you need 30mg or 3ml kenalog-10
when using kenalog-40, how many mg do you need for a 1cm lesion?
in kenalog-40, there is 40mg per 1ml of fluid, so for a 1cm lesion, you'd need 10mg (0.25ml)
for a 3cm lesion, you'd need 30mg or 0.75ml of kenalog-40
hx of trauma
operculum - fragment of oral soft tissue that overlies some of the occlusal table
how can you test whether this is a periodontal abscess or endo?
use gutta percha to track it
most common location is the buccal mucosa along the occlusal table
what is the most common benign neoplasm of the oral cavity? most common locations?
buccal mucosa > labial mucosa > tongue > gingiva
what is the treatment for a fibroma?
ectopic sebaceous glands
___% of the population has fordyce granules
what are the most common locations for fordyce granules? what is the treatment?
buccal mucosa > lips
clinically blanches under pressure
what is a hemangioma caused by?
benign proliferation of blood vessels
hemangiomas affect ___% of children
what is the treatment for hemangioma?
- clinical observation
- removal - surgery, laser, embolization
painful, history of recurrence
recurrent apthous ulcer, major
recurrent aphthous ulcers affect what percent of the population?
recurrent aphthous ulcers occur on __keratinized/non-keratinized__ tissues, and on __bound/non-bound___ mucosa
non-keratinized, non-bound mucosa
recurrent apthout ulcers are usually how large in diameter? how many lesions are usually present?
0.5-1 cm in diameter
what is the treatment for recurrent aphthous ulcers?
what 3 pieces of information do you need to make a successful diagnosis of recurrent aphthous ulcers?
location + size + number of lesions
what is the etiology of recurrent aphthous ulcers?
- "different things in different people"
- 3 theories - autoimmune, hypersensitivity, and stress
what are 7 examples of prescriptions used to treat recurrent aphthous ulcers?
what lesion can have a cauliflower appearance?
___ is a benign proliferation of squamous epithelium
what locations are squamous papillomas most common on?
tongue > soft palate
are squamous papilloma lesions usually solitary or are there multiple? are they sessile or pedunculated?
they are solitary pedunculated wart-like lesions
what is the treatment for squamous papilloma lesions?
what is the differential for a papillary lesion?
- squamous papilloma
- verruca vulgaris (wart)
- condyloma acuminatum (venereal wart)
- focal epithelial hyperplasia (heck's disease)
- verucciform xanthoma
- *sinonasal papilloma is also a variation of a papilloma but would not be included on a differential based on location
focal epithelial hyperplasia
what is the viral etiology for squamous papilloma?
HPV 6 and 11
what is the viral etiology for condyloma accuminatum?
HPV 16, 18
what is the viral etiology for focal epithelial hyperplasia (heck's disease)?
HPV 13, 32