Oral Pathology DH 180Oral Pathology DH 180

Ms. Louann Ross, RDHMs. Louann Ross, RDH

VocabularyVocabulary

• Necessary to be able to Necessary to be able to communicate intelligentlycommunicate intelligently

• Necessary to be able to documentNecessary to be able to document

• Necessary to be able to referNecessary to be able to refer

BullaBulla

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

Lobula=A segment or lobe that Lobula=A segment or lobe that is a part of the whole; these is a part of the whole; these lobes sometimes appear fused lobes sometimes appear fused togethertogether • (adj.= lobulated) Made up of lobules, (adj.= lobulated) Made up of lobules,

which are smaller divisions of lobes. which are smaller divisions of lobes. Many structures are divided into Many structures are divided into lobes and lobules, such as the brain, lobes and lobules, such as the brain, lung, and salivary glands. Some lung, and salivary glands. Some pathologic lesions are described as pathologic lesions are described as lobulated when the lesion is divided lobulated when the lesion is divided into smaller parts. into smaller parts.

MaculeMacule

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

Pustules-Variously sized Pustules-Variously sized circumscribed elevations circumscribed elevations containing puscontaining pus

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

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

Soft Tissue Consistency- pg.3 Soft Tissue Consistency- pg.3

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

• Palpation-To examine by hand, to feel.Palpation-To examine by hand, to feel.

Nodular MelanomaNodular Melanoma

Color of LesionColor of Lesion

• Colors- Red, pink, salmon, white, Colors- Red, pink, salmon, white, blue-black, gray, brown, and black.blue-black, gray, brown, and black.

• Erythema- an abnormal rednessErythema- an abnormal redness

• Pallor- Paleness of the skin or Pallor- Paleness of the skin or mucosal tissuesmucosal tissues

Size of the lesionSize of the lesion

• Centimeter-a little less than one-half Centimeter-a little less than one-half inchinch

• Millimeter-perio probe can be used to Millimeter-perio probe can be used to measure lesionmeasure lesion

Surface texture-text pg. 3Surface texture-text pg. 3

• Corrugated-WrinkledCorrugated-Wrinkled• Fissure-A cleft or groove, normal or Fissure-A cleft or groove, normal or

otherwise, showing prominent depth.otherwise, showing prominent depth.– Atlas pg’s 16,17(fissured tongue-pg.4,5)Atlas pg’s 16,17(fissured tongue-pg.4,5)

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

• Smooth, rough, folded-terms used to Smooth, rough, folded-terms used to describe the surface texture of a lesion.describe the surface texture of a lesion.

FissuredFissured

PapillaryPapillary

Radiographic Terms Used to Radiographic Terms Used to Describe lesions in Bone-pg3Describe lesions in Bone-pg3

• DiffuseDiffuse-can be a -can be a radiographic or a radiographic or a general descriptive general descriptive term of a lesion.term of a lesion.

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

MultilocularMultilocular

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

MultilocularMultilocular

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

MultilocularMultilocular

• Description:Description: Large Large multilocular multilocular radiolucent lesion radiolucent lesion of the posterior of the posterior body and ramus of body and ramus of the mandible the mandible (Ameloblastoma)(Ameloblastoma)Location:Location: Posterior Posterior body and ramus of body and ramus of the mandible, left the mandible, left sideside

More terms-pg’s 3 & 4More terms-pg’s 3 & 4

• Radiolucent-describes Radiolucent-describes the black or dark the black or dark areas on a radiograph; areas on a radiograph; radiant energy can radiant energy can pass through these pass through these structures; less dense structures; less dense tissue, such as the tissue, such as the pulp, is seen as a pulp, is seen as a radiolucent structureradiolucent structure

• Radiopaque-describes Radiopaque-describes the light or white area the light or white area on a radiograph that on a radiograph that results from the inability results from the inability of radiant energy to of radiant energy to pass through the pass through the structure; the more structure; the more dense the structure, the dense the structure, the more light or white it more light or white it appears on the appears on the radiograph; this is radiograph; this is illustrated in Fig 1-10 illustrated in Fig 1-10 pg.6 in textpg.6 in text

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

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

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

The Diagnostic ProcessThe Diagnostic Process

• Eight pieces to the puzzle of data Eight pieces to the puzzle of data collection.collection.

• Comes from various sources.Comes from various sources.1.1. ClinicalClinical2.2. RadiographicRadiographic3.3. Historical (personal history, family Historical (personal history, family

history, past and present mediccal and history, past and present mediccal and dental histories, histor of drug ingestion, dental histories, histor of drug ingestion, and history of the presenting disease or and history of the presenting disease or lesionlesion

Eight Diagnostic pieces Eight Diagnostic pieces continuedcontinued

4.Laboratory-blood and urine samples4.Laboratory-blood and urine samples

5. Microscopic5. Microscopic

6.Surgical 6.Surgical

7. Therapeutic7. Therapeutic

8. Differential findings.8. Differential findings.

1. Clinical—color, shape, 1. Clinical—color, shape, location and history of the location and history of the lesionlesion

• Fordyce granules - Collection of Fordyce granules - Collection of sebaceous glands that occur in sebaceous glands that occur in various locations within the oral various locations within the oral cavity. cavity.

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

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

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

torustorus palatinuspalatinus

mandibular torimandibular tori

melanin pigmentationmelanin pigmentation

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

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

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

Fissured tongueFissured tongue

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

2. Radiographic2. Radiographic

Complex OdontomaComplex Odontoma

3.Historical3.Historical

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

4. Laboratory Diagnosis4. Laboratory Diagnosis

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

5.Microscopic 5.Microscopic

• White lesions, as an example may White lesions, as an example may look similar if it is hyperkeratosis or look similar if it is hyperkeratosis or epithelial dysplasiaepithelial dysplasia

6. Surgical Diagnosis6. Surgical Diagnosis

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

7.Therapeutic7.Therapeutic• Conditions to be Conditions to be

diagnosed by diagnosed by therapeutic means. therapeutic means.

• Nutritional-correct the Nutritional-correct the imbalance and see if imbalance and see if the problem subsides.the problem subsides.

8. Differential 8. Differential DiagnosisDiagnosis

• The differential The differential diagnosis is that point diagnosis is that point in the diagnostic in the diagnostic process when the process when the practitioner decides practitioner decides which test or procedure which test or procedure is required to rule out is required to rule out the conditions originally the conditions originally suspected and suspected and establish the definitive establish the definitive or final diagnosis.or final diagnosis.

Variants of NormalVariants of Normal

• Fordyce GranulesFordyce Granules

• torus palatinustorus palatinus

• mandibular torimandibular tori

• melanin pigmentationmelanin pigmentation

• retrocuspid papillaretrocuspid papilla

• lingual varicositieslingual varicosities

• linea albalinea alba

• leukoedemaleukoedema

Variants of normalVariants of normal

• Linea Alba- “white line”Linea Alba- “white line”• soft linear streak of soft linear streak of

parakeratinized tissue parakeratinized tissue on the buccal mucosa on the buccal mucosa at the occlusal line. The at the occlusal line. The line may be initiated by line may be initiated by irritation from rough irritation from rough buccal cusps, bruxism buccal cusps, bruxism or habitual clenching of or habitual clenching of teeth.teeth.

LeukoedemaLeukoedema

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

Benign Conditions of Unknown Benign Conditions of Unknown CauseCause

• Lingual thyroid noduleLingual thyroid nodule

• Median rhomboid glossitisMedian rhomboid glossitis

• Geographic tongueGeographic tongue

• Fissured tongueFissured tongue

• Hairy tongueHairy tongue

Lingual Thyroid NoduleLingual Thyroid Nodule

Hairy TongueHairy Tongue

Hairy TongueHairy Tongue

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

Benign Migratory GlossitisBenign Migratory Glossitis(Geographic Tongue)(Geographic Tongue)

• Multiple sensitive Multiple sensitive irregularly shaped irregularly shaped erythematous erythematous patches on the patches on the tongue with arcuate tongue with arcuate white rims that white rims that enlarge and change enlarge and change shape daily.shape daily.