Chapter 1

1Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 1

Introduction to Preliminary Diagnosis of Oral Lesions


Outline Outline VocabularyVocabulary The diagnostic processThe diagnostic process Variants of normalVariants of normal Benign conditions of unknown causeBenign conditions of unknown cause


VocabularyVocabulary (pgs. 1-7)(pgs. 1-7)

Clinical Appearance of Soft Tissue LesionsClinical Appearance of Soft Tissue Lesions Soft Tissue ConsistencySoft Tissue Consistency Color of LesionColor of Lesion Size of LesionSize of Lesion Surface TextureSurface Texture Radiographic Terms Used to Describe Radiographic Terms Used to Describe

Lesions in BoneLesions in Bone


Clinical Appearance of Soft Tissue Clinical Appearance of Soft Tissue LesionsLesions

(pgs. 1-2)(pgs. 1-2) BullaBulla

A circumscribed, elevated lesion that is more A circumscribed, elevated lesion that is more than 5 mm in diameter, usually contains serous than 5 mm in diameter, usually contains serous fluid, and looks like a blisterfluid, and looks like a blister

LobuleLobule A segment or lobe that is a part of the whole; A segment or lobe that is a part of the whole;

these lobes sometimes appear fused togetherthese lobes sometimes appear fused together


Clinical Appearance of Soft Tissue Clinical Appearance of Soft Tissue Lesions (cont.)Lesions (cont.)



(pgs. 1-2)(pgs. 1-2) MaculaMacula

An area that is usually distinguished by a color An area that is usually distinguished by a color different from that of the surrounding tissue; it different from that of the surrounding tissue; it is flat and does not protrude above the surface is flat and does not protrude above the surface of the normal tissue. A freckle is an example of of the normal tissue. A freckle is an example of a macule.a macule.

PapulePapule A small, circumscribed lesion usually less than A small, circumscribed lesion usually less than

1 cm in diameter that is elevated or protrudes 1 cm in diameter that is elevated or protrudes above the surface of normal surrounding above the surface of normal surrounding tissue.tissue.



(pg. 2)(pg. 2) PedunculatedPedunculated

Attached by a stemlike or stalk base similar to Attached by a stemlike or stalk base similar to that of a mushroomthat of a mushroom

PustulesPustules Variously sized circumscribed elevations Variously sized circumscribed elevations

containing puscontaining pus





(pgs. 2-3)(pgs. 2-3) SessileSessile

Describing the base of a lesion that is flat or Describing the base of a lesion that is flat or broad instead of stemlikebroad instead of stemlike

VesicleVesicle A small, elevated lesion less than 1 cm in A small, elevated lesion less than 1 cm in

diameter that contains serous fluiddiameter that contains serous fluid




Soft Tissue ConsistencySoft Tissue Consistency

(pg. 2)(pg. 2) NoduleNodule

A palpable solid lesion up to 1 cm in diameter A palpable solid lesion up to 1 cm in diameter found in soft tissue; it can occur above, level found in soft tissue; it can occur above, level with, or beneath the skin surface.with, or beneath the skin surface.

PalpationPalpation The evaluation of a lesion by feeling it with the The evaluation of a lesion by feeling it with the

fingers to determine the texture of the area; the fingers to determine the texture of the area; the descriptive terms for palpation are descriptive terms for palpation are soft, firm, soft, firm, semifirm, semifirm, andand fluid fluid filledfilled; these terms also ; these terms also describe the consistency of a lesion.describe the consistency of a lesion.


Color of LesionColor of Lesion (pg. 2)(pg. 2)

ColorsColors Red, pink, salmon, white, blue-black, gray, Red, pink, salmon, white, blue-black, gray,

brown, and black are the colors used most brown, and black are the colors used most frequently to describe oral lesions; they can be frequently to describe oral lesions; they can be used to identify specific lesions and may also be used to identify specific lesions and may also be incorporated into general descriptions.incorporated into general descriptions.

ErythemaErythema An abnormal redness of the mucosa or gingivaAn abnormal redness of the mucosa or gingiva

PallorPallor Paleness of the skin or mucosal tissuesPaleness of the skin or mucosal tissues


Size of LesionSize of Lesion (pgs. 2-3)(pgs. 2-3)

Centimeter (cm)Centimeter (cm) One hundredth of a meter; equivalent to a little One hundredth of a meter; equivalent to a little

less than one-half inchless than one-half inch Millimeter (mm)Millimeter (mm)

One thousandth of a meter; the periodontal One thousandth of a meter; the periodontal probe is of great assistance in documenting the probe is of great assistance in documenting the size or diameter of a lesion that can be size or diameter of a lesion that can be measured in millimetersmeasured in millimeters


Size of Lesion (cont.)Size of Lesion (cont.)


Surface TextureSurface Texture (pg. 3)(pg. 3)

CorrugatedCorrugated WrinkledWrinkled

FissureFissure A cleft or groove, normal or otherwise, showing A cleft or groove, normal or otherwise, showing

prominent depthprominent depth PapillaryPapillary

Resembling small, nipple-shaped projections Resembling small, nipple-shaped projections or elevations found in clustersor elevations found in clusters


Radiographic Terms Used to Radiographic Terms Used to Describe Lesions in BoneDescribe Lesions in Bone

(pgs. 3, 5)(pgs. 3, 5) CoalescenceCoalescence

The process by which parts of a whole join The process by which parts of a whole join together, or fuse, to make one.together, or fuse, to make one.

DiffuseDiffuse Describes a lesion with borders that are not Describes a lesion with borders that are not

well defined, making it impossible to detect the well defined, making it impossible to detect the exact parameters of the lesion; this may make exact parameters of the lesion; this may make treatment more difficult and, depending on the treatment more difficult and, depending on the biopsy results, more radicalbiopsy results, more radical


Radiographic Terms Used to Radiographic Terms Used to Describe Lesions in Bone Describe Lesions in Bone (cont.)(cont.)


(pgs. 3, 5)(pgs. 3, 5) MultilocularMultilocular

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

RadiolucentRadiolucent Describes the black or dark areas on a radiograph; Describes the black or dark areas on a radiograph;

radiant energy can pass through these structures; less radiant energy can pass through these structures; less dense tissue, such as pulp, is seen as a radiolucent dense tissue, such as pulp, is seen as a radiolucent structurestructure





(pgs. 4, 6)(pgs. 4, 6) Radiolucent and radiopaqueRadiolucent and radiopaque

Terms used to describe a mixture of light and dark areas Terms used to describe a mixture of light and dark areas within a lesion usually denoting a stage in the lesion’s within a lesion usually denoting a stage in the lesion’s development; for example, in a stage I periapical development; for example, in a stage I periapical cemento-osseous dysplasia (cementoma), the lesion is cemento-osseous dysplasia (cementoma), the lesion is radiolucent; in stage II it is radiolucent and radiopaqueradiolucent; in stage II it is radiolucent and radiopaque

RadiopaqueRadiopaque Describes the light or white area on a radiograph that Describes the light or white area on a radiograph that

results from the inability of radiant energy to pass results from the inability of radiant energy to pass through the structure; the more dense the structure, the through the structure; the more dense the structure, the more light or white it appears on the radiograph more light or white it appears on the radiograph

(Note: Caries 4(Note: Caries 4MOMO, 5, 5DODO, 28, 28DODO))





(pgs. 4-6)(pgs. 4-6) Root resorptionRoot resorption

Observe radiographically when the apex of the tooth Observe radiographically when the apex of the tooth appears shortened or blunted and irregularly shaped; it appears shortened or blunted and irregularly shaped; it occurs as a response to stimuli, which can include a occurs as a response to stimuli, which can include a cyst, tumor, or traumacyst, tumor, or trauma

External resorption arises from tissue outside the tooth, External resorption arises from tissue outside the tooth, such as the periodontal ligament, whereas internal such as the periodontal ligament, whereas internal resorption is triggered by pulpal tissue reaction from resorption is triggered by pulpal tissue reaction from within the tooth; in the latter the pulpal area can be seen within the tooth; in the latter the pulpal area can be seen as a diffuse radiolucency beyond the confines of the as a diffuse radiolucency beyond the confines of the normal pulp area.normal pulp area.





(pgs. 5, 7)(pgs. 5, 7) Scalloping around the rootScalloping around the root

A radiolucent lesion that extends between the roots, as A radiolucent lesion that extends between the roots, as seen in a traumatic bone cyst; this lesion appears to seen in a traumatic bone cyst; this lesion appears to extend up the periodontal ligamentextend up the periodontal ligament

UnilocularUnilocular Having one compartment or unit that is well defined or Having one compartment or unit that is well defined or

outlined as in a simple radicular cystoutlined as in a simple radicular cyst Well circumscribedWell circumscribed

Term used to describe a lesion with borders that are Term used to describe a lesion with borders that are specifically designed and in which one can clearly see specifically designed and in which one can clearly see the exact margins and extentthe exact margins and extent





The Diagnostic ProcessThe Diagnostic Process (pg. 8)(pg. 8)

Making a DiagnosisMaking a Diagnosis The process of diagnosis requires gathering The process of diagnosis requires gathering

information that is relevant to the patient and information that is relevant to the patient and the lesion being evaluated; this information the lesion being evaluated; this information comes from various sourcescomes from various sources

There are eight distinct diagnostic categories There are eight distinct diagnostic categories that contribute segments of information leading that contribute segments of information leading to a definitive or final diagnosisto a definitive or final diagnosis


The Diagnostic Process (cont.)The Diagnostic Process (cont.) (pgs. 8-23)(pgs. 8-23)

Clinical diagnosisClinical diagnosis Radiographic diagnosisRadiographic diagnosis Historical diagnosisHistorical diagnosis Laboratory diagnosisLaboratory diagnosis Microscopic diagnosisMicroscopic diagnosis Surgical diagnosisSurgical diagnosis Therapeutic diagnosisTherapeutic diagnosis Differential diagnosisDifferential diagnosis


Clinical DiagnosisClinical Diagnosis (pgs. 8-10) (pgs. 8-10)

The strength of the diagnosis comes from The strength of the diagnosis comes from the clinical appearance of the lesion.the clinical appearance of the lesion. The clinician can establish a diagnosis for The clinician can establish a diagnosis for

some lesions based on color, shape, location, some lesions based on color, shape, location, and history of the lesion.and history of the lesion.


Clinical Diagnosis (cont.)Clinical Diagnosis (cont.) (pgs. 8-10)(pgs. 8-10)

Examples of lesions that may be clinically Examples of lesions that may be clinically diagnosed include Fordyce granules, torus diagnosed include Fordyce granules, torus palatinus, mandibular tori, melanin pigmentation, palatinus, mandibular tori, melanin pigmentation, retrocuspid papillae, and lingual varicosities.retrocuspid papillae, and lingual varicosities.

Other benign conditions of unknown cause that Other benign conditions of unknown cause that are recognized by their distinct clinical are recognized by their distinct clinical appearance include fissured tongue, median appearance include fissured tongue, median rhomboid glossitis, geographic tongue, and hairy rhomboid glossitis, geographic tongue, and hairy tongue.tongue.


Clinical Diagnosis (cont.)Clinical Diagnosis (cont.)








Clinical Diagnosis (cont.)Clinical Diagnosis (cont.) (pgs. 8, 10)(pgs. 8, 10)

The diagnostic process may require The diagnostic process may require historical information in addition to the historical information in addition to the clinical findings.clinical findings. An example is an amalgam tattoo.An example is an amalgam tattoo. Any history in the area can be very helpful in Any history in the area can be very helpful in

confirming the clinical impression.confirming the clinical impression.




Radiographic DiagnosisRadiographic Diagnosis (pgs. 10-14)(pgs. 10-14)

In a radiographic diagnosis, the radiograph In a radiographic diagnosis, the radiograph provides sufficient information to establish provides sufficient information to establish the diagnosis.the diagnosis. Examples of conditions for which the radiograph Examples of conditions for which the radiograph

provides the most significant information include provides the most significant information include periapical pathosis, internal resorption, external periapical pathosis, internal resorption, external resorption, heavy interproximal calculus, dental resorption, heavy interproximal calculus, dental caries, compound odontoma, complex caries, compound odontoma, complex odontoma, supernumerary teeth, impacted or odontoma, supernumerary teeth, impacted or unerupted teeth, and calcified pulp unerupted teeth, and calcified pulp


Radiographic Diagnosis (cont.)Radiographic Diagnosis (cont.)








Radiographic Diagnosis (cont.)Radiographic Diagnosis (cont.) (pgs. 10, 14, 15-17)(pgs. 10, 14, 15-17)

Normal anatomic landmarks are also easily Normal anatomic landmarks are also easily observed radiographically.observed radiographically. In some cases, the radiograph may show very distinct In some cases, the radiograph may show very distinct

and well-defined structures, such as nutrient canals and and well-defined structures, such as nutrient canals and mixed dentition.mixed dentition.

Unusual radiographic findings are illustratedUnusual radiographic findings are illustrated These include cubic zirconia, amalgam fragment, These include cubic zirconia, amalgam fragment,

eyeglasses, amalgam overhang, instruments from root eyeglasses, amalgam overhang, instruments from root canal procedures, curette, retained primary tooth, canal procedures, curette, retained primary tooth, shotgun pellet, and nose ring.shotgun pellet, and nose ring.






Historical DiagnosisHistorical Diagnosis (pgs. 14-18)(pgs. 14-18)

Personal history, family history, past and Personal history, family history, past and present medical and dental histories, present medical and dental histories, history of drug ingestion, and history of the history of drug ingestion, and history of the presenting disease or lesion can provide presenting disease or lesion can provide information necessary for the final information necessary for the final diagnosis.diagnosis. Pathologic conditions in which the family history Pathologic conditions in which the family history

contributes a significant role in diagnosis include contributes a significant role in diagnosis include amelogenesis imperfecta, dentinogenesis amelogenesis imperfecta, dentinogenesis imperfecta, and other genetic disorders.imperfecta, and other genetic disorders.


Historical Diagnosis (cont.)Historical Diagnosis (cont.)


Historical Diagnosis (cont.)Historical Diagnosis (cont.) (pgs. 18-19)(pgs. 18-19)

A patient’s medical or dental status, A patient’s medical or dental status, including drug history, can also contribute including drug history, can also contribute significant information to a diagnosis.significant information to a diagnosis.


Historical Diagnosis (cont.)Historical Diagnosis (cont.)


Historical Diagnosis (cont.)Historical Diagnosis (cont.) Examples includeExamples include

A history of ulcerative colitis may contribute to the A history of ulcerative colitis may contribute to the diagnosis of oral ulcers.diagnosis of oral ulcers.

Gingival enlargement due to treatment with a calcium Gingival enlargement due to treatment with a calcium channel blockerchannel blocker

A history of a skin graft from the hip to the ridge and A history of a skin graft from the hip to the ridge and mucobuccal fold area can provide significant information mucobuccal fold area can provide significant information relevant to the diagnosis of a white- or brown-pigmented relevant to the diagnosis of a white- or brown-pigmented area on the mandibular ridge and vestibule.area on the mandibular ridge and vestibule.

Periapical cemento-osseous dysplasia, which is found Periapical cemento-osseous dysplasia, which is found most frequently in black women in the third decade.most frequently in black women in the third decade.


Laboratory DiagnosisLaboratory Diagnosis (pgs. 18, 20)(pgs. 18, 20)

Clinical laboratory tests, including blood Clinical laboratory tests, including blood chemistries and urinalysis, can provide chemistries and urinalysis, can provide information that contributes to a diagnosis.information that contributes to a diagnosis. An example is an elevated serum alkaline An example is an elevated serum alkaline

phosphatase level, significant in the diagnosis phosphatase level, significant in the diagnosis of Paget’s disease.of Paget’s disease.

Laboratory cultures are helpful in Laboratory cultures are helpful in determining the diagnosis of oral determining the diagnosis of oral infections.infections.


Laboratory Diagnosis (cont.)Laboratory Diagnosis (cont.)


Microscopic DiagnosisMicroscopic Diagnosis (pgs. 18-20)(pgs. 18-20)

The microscopic examination of the biopsy The microscopic examination of the biopsy specimen taken from the lesion in question specimen taken from the lesion in question contributes significant information.contributes significant information. It is most important that an adequate tissue It is most important that an adequate tissue

sample be removed for microscopic evaluation.sample be removed for microscopic evaluation.


Microscopic Diagnosis (cont.)Microscopic Diagnosis (cont.) (pg. 19)(pg. 19)

Brush test can be used to obtain Brush test can be used to obtain information from oral mucosal epithelium.information from oral mucosal epithelium. A circular brush is used to obtain cells from the A circular brush is used to obtain cells from the

full thickness of epithelium.full thickness of epithelium. The results of this test may help determine if a The results of this test may help determine if a

scalpel biopsy is needed to establish a scalpel biopsy is needed to establish a definitive diagnosis.definitive diagnosis.


Microscopic Diagnosis (cont.)Microscopic Diagnosis (cont.) (pgs. 19-20)(pgs. 19-20)

A white lesion cannot be diagnosed based A white lesion cannot be diagnosed based on clinical appearance alone.on clinical appearance alone. The microscopic appearance of this type of The microscopic appearance of this type of

white lesion can vary from a thickening of white lesion can vary from a thickening of epithelium to epithelial dysplasia, which can be epithelium to epithelial dysplasia, which can be premalignant. premalignant.


Microscopic Diagnosis (cont.)Microscopic Diagnosis (cont.)


Surgical DiagnosisSurgical Diagnosis (pgs. 20-21)(pgs. 20-21)

Diagnosis is made using the information gained Diagnosis is made using the information gained during the surgical procedure.during the surgical procedure.

Examples includeExamples include Traumatic bone cystTraumatic bone cyst

• May appear as a radiolucency that scallops around the May appear as a radiolucency that scallops around the rootsroots

• When the lesion is opened surgically, an empty void is When the lesion is opened surgically, an empty void is found.found.

Lingual mandibular bone cavityLingual mandibular bone cavity• Surgical examination of the well-circumscribed, radiolucent Surgical examination of the well-circumscribed, radiolucent

area reveals salivary gland tissue entrapped during area reveals salivary gland tissue entrapped during development.development.


Surgical Diagnosis (cont.)Surgical Diagnosis (cont.)


Therapeutic DiagnosisTherapeutic Diagnosis (pgs. 20-21) (pgs. 20-21)

Nutritional deficiencies are common conditions to Nutritional deficiencies are common conditions to be diagnosed by therapeutic means.be diagnosed by therapeutic means.

Examples includeExamples include Angular cheilitisAngular cheilitis

• May be associated with a deficiency of B-complex vitaminsMay be associated with a deficiency of B-complex vitamins• Most commonly a fungal condition and responds to topical Most commonly a fungal condition and responds to topical

application of an antifungal cream or ointment such as application of an antifungal cream or ointment such as NystatinNystatin

ANUGANUG• Responds to hydrogen peroxideResponds to hydrogen peroxide


Therapeutic Diagnosis (cont.)Therapeutic Diagnosis (cont.)


Differential DiagnosisDifferential Diagnosis (pgs. 21-23) (pgs. 21-23)

That point in the diagnostic process when That point in the diagnostic process when the practitioner decides which test or the practitioner decides which test or procedure is required to rule out the procedure is required to rule out the conditions originally suspected and conditions originally suspected and establish the definitive or final diagnosisestablish the definitive or final diagnosis See Box 1-1: Case study illustrating how the See Box 1-1: Case study illustrating how the

diagnostic processes work together and how diagnostic processes work together and how differential diagnosis is used.differential diagnosis is used.


Variants of NormalVariants of Normal (pgs. 23-25)(pgs. 23-25)

Fordyce GranulesFordyce Granules Torus PalatinusTorus Palatinus Mandibular ToriMandibular Tori Melanin PigmentationMelanin Pigmentation Retrocuspid PapillaRetrocuspid Papilla Lingual VaricositiesLingual Varicosities Linea AlbaLinea Alba LeukoedemaLeukoedema


Fordyce GranulesFordyce Granules (pgs. 22-23)(pgs. 22-23)

Clusters of ectopic sebaceous glandsClusters of ectopic sebaceous glands Most commonly observed on lips and buccal Most commonly observed on lips and buccal

mucosamucosa Appear as yellow lobules in clusters and are Appear as yellow lobules in clusters and are

usually distributed over the buccal mucosa or usually distributed over the buccal mucosa or vermilion border of the involved lipsvermilion border of the involved lips

Considered a variant of normalConsidered a variant of normal TreatmentTreatment

NoneNone


Fordyce Granules (cont.)Fordyce Granules (cont.)


Torus PalatinusTorus Palatinus (pg. 23)(pg. 23)

An exophytic growth of normal compact boneAn exophytic growth of normal compact bone Inherited and occurs more commonly in womenInherited and occurs more commonly in women Asymptomatic, develop gradually, and are observed Asymptomatic, develop gradually, and are observed

clinically in the midline of the hard palateclinically in the midline of the hard palate May take on various shapes and sizes, may be May take on various shapes and sizes, may be

lobulated, and are covered by normal soft tissuelobulated, and are covered by normal soft tissue TreatmentTreatment

None, unless they interfere with speech, swallowing, or None, unless they interfere with speech, swallowing, or a prosthetic appliancea prosthetic appliance


Torus Palatinus (cont.)Torus Palatinus (cont.)


Mandibular ToriMandibular Tori (pgs. 23-24)(pgs. 23-24)

Outgrowths of normal, dense bone found Outgrowths of normal, dense bone found on the lingual aspect of the mandible in the on the lingual aspect of the mandible in the area of the premolars above the mylohyoid area of the premolars above the mylohyoid ridgeridge Usually bilateral, often lobulated or nodular, Usually bilateral, often lobulated or nodular,

can appear fused together, and have no can appear fused together, and have no predilection for either sexpredilection for either sex

Treatment Treatment None, unless they interfere with fabrication and None, unless they interfere with fabrication and

placement of a prosthetic applianceplacement of a prosthetic appliance


Mandibular Tori (cont.)Mandibular Tori (cont.)


Melanin PigmentationMelanin Pigmentation (pgs. 9, 23-24)(pgs. 9, 23-24)

The pigment that gives color to skin, eyes, The pigment that gives color to skin, eyes, hair, mucosa, and gingivahair, mucosa, and gingiva Most commonly observed in dark-skinned Most commonly observed in dark-skinned

individualsindividuals


Melanin Pigmentation (cont.)Melanin Pigmentation (cont.)


Retrocuspid PapillaRetrocuspid Papilla (pgs. 9, 23)(pgs. 9, 23)

A sessile nodule on the gingival margin of A sessile nodule on the gingival margin of the lingual aspect of the mandibular the lingual aspect of the mandibular cuspidscuspids


Retrocuspid Papilla (cont.)Retrocuspid Papilla (cont.)


Lingual VaricositiesLingual Varicosities (pg. 24)(pg. 24)

Usually observed on the ventral and lateral Usually observed on the ventral and lateral surfaces of the tonguesurfaces of the tongue Clinically, red-to-purple enlarged vessels or Clinically, red-to-purple enlarged vessels or

clusters are seen.clusters are seen. Most commonly observed in individuals older Most commonly observed in individuals older

than 60 years of age; thought to be related to than 60 years of age; thought to be related to the aging processthe aging process


Lingual Varicosities (cont.)Lingual Varicosities (cont.)


Linea AlbaLinea Alba (pg. 25)(pg. 25)

A “white line” that extends A “white line” that extends anteroposteriorly on the buccal mucosa anteroposteriorly on the buccal mucosa along the occlusal planealong the occlusal plane May be bilateral May be bilateral May be more prominent in patients who have a May be more prominent in patients who have a

clenching or bruxing habitclenching or bruxing habit


Linea Alba (cont.)Linea Alba (cont.)


LeukoedemaLeukoedema (pg. 25)(pg. 25)

A generalized opalescence on buccal A generalized opalescence on buccal mucosamucosa Most commonly observed in black adultsMost commonly observed in black adults If the mucosa is stretched, the opalescence If the mucosa is stretched, the opalescence

becomes less prominent.becomes less prominent. TreatmentTreatment

NoneNone


Leukoedema (cont.)Leukoedema (cont.)


Benign Conditions of Unknown Benign Conditions of Unknown CauseCause

(pgs. 25-26)(pgs. 25-26) Lingual Thyroid NoduleLingual Thyroid Nodule Median Rhomboid GlossitisMedian Rhomboid Glossitis Geographic TongueGeographic Tongue Fissured TongueFissured Tongue Hairy TongueHairy Tongue


Lingual Thyroid NoduleLingual Thyroid Nodule (pg. 25)(pg. 25)

When thyroid tissue does not descend or When thyroid tissue does not descend or remnants become trappedremnants become trapped A high predilection for femalesA high predilection for females Emergence linked with hormonal changes Emergence linked with hormonal changes


Lingual Thyroid Nodule (cont.)Lingual Thyroid Nodule (cont.)

Clinically, a mass in the midline of the Clinically, a mass in the midline of the dorsal surface of the tongue posterior to the dorsal surface of the tongue posterior to the circumvallate papillae in the area of the circumvallate papillae in the area of the foramen cecumforamen cecum Usually has a sessile base and is 2 to 3 cm in Usually has a sessile base and is 2 to 3 cm in

width width Upon histological examination, normal thyroid Upon histological examination, normal thyroid

tissue is found.tissue is found. TreatmentTreatment

Evaluation of the patient to determine whether Evaluation of the patient to determine whether the thyroid gland is present in its normal locationthe thyroid gland is present in its normal location


Median Rhomboid GlossitisMedian Rhomboid Glossitis (pgs. 25-26)(pgs. 25-26)

Cause is not clear.Cause is not clear. May be associated with a chronic infection of May be associated with a chronic infection of

Candida albicansCandida albicans Clinically, appears as a flat or slightly raised Clinically, appears as a flat or slightly raised

oval or rectangular erythematous area in the oval or rectangular erythematous area in the midline of the dorsal surface of the tongue, midline of the dorsal surface of the tongue, beginning at the junction of the anterior and beginning at the junction of the anterior and middle thirds and extending posterior to the middle thirds and extending posterior to the circumvallate papillae.circumvallate papillae.


Median Rhomboid Glossitis (cont.)Median Rhomboid Glossitis (cont.)


TreatmentTreatment No specific treatment exists.No specific treatment exists. An antifungal treatment works sometimes.An antifungal treatment works sometimes. May resolve spontaneouslyMay resolve spontaneously

Median Rhomboid Glossitis (cont.)Median Rhomboid Glossitis (cont.)


Geographic TongueGeographic Tongue (pgs. 25-26)(pgs. 25-26)

The cause is not clear.The cause is not clear. Genetic factors may play a role.Genetic factors may play a role. May be exacerbated by stressMay be exacerbated by stress Clinically, involves dorsal and lateral areas of Clinically, involves dorsal and lateral areas of

the tonguethe tongue Diffuse areas devoid of filiform papillae may be Diffuse areas devoid of filiform papillae may be

observedobserved There appears to be remission and changes in There appears to be remission and changes in

the depapillated areasthe depapillated areas


Geographic Tongue (cont.)Geographic Tongue (cont.)


Geographic Tongue (cont.)Geographic Tongue (cont.) (pg. 26)(pg. 26)

TreatmentTreatment Usually none indicatedUsually none indicated Occasionally, the Occasionally, the

patient may complain patient may complain of a burning discomfort.of a burning discomfort.

Ectopic geographic Ectopic geographic tonguetongue It may be found on It may be found on

areas other than the areas other than the tongue.tongue.


Fissured TongueFissured Tongue (pgs. 9, 26)(pgs. 9, 26)

The cause is unknown.The cause is unknown. Seen in about 5% of the populationSeen in about 5% of the population Probably involves genetic factorsProbably involves genetic factors Clinically, the dorsal surface of the tongue Clinically, the dorsal surface of the tongue

appears to have deep fissures or grooves.appears to have deep fissures or grooves. TreatmentTreatment

NoneNone


Fissured Tongue (cont.)Fissured Tongue (cont.)


Hairy TongueHairy Tongue (pgs. 26-27)(pgs. 26-27)

An increased accumulation of keratin on An increased accumulation of keratin on the filiform papillae resulting in a white, the filiform papillae resulting in a white, “hairy” appearance“hairy” appearance The elongated filiform papillae are white.The elongated filiform papillae are white. In black hairy tongue, the papillae are black In black hairy tongue, the papillae are black

due to chromogenic bacteria.due to chromogenic bacteria. TreatmentTreatment

Directing the patient to brush the tongue gently Directing the patient to brush the tongue gently with a toothbrush to remove debriswith a toothbrush to remove debris


Hairy Tongue (cont.)Hairy Tongue (cont.)


Discussion Questions Discussion Questions What is the difference between a macule and a What is the difference between a macule and a

papule?papule? What are the elements of the diagnostic What are the elements of the diagnostic

process?process? What variants of normal may be found within What variants of normal may be found within

the oral cavity?the oral cavity?

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