2017 Oregon Dental Conference Course Handout

Size: px

Start display at page:

Download "2017 Oregon Dental Conference Course Handout"

Alexandra Wiggins
6 years ago
Views:

1 2017 Orego Detal Coferece Course Hadout Jim Kratochvil, DDS Course 8118: Cliical Approach to the Diagosis of Oral Lesios Thursday, April 6 10:30 am - 12 pm

2 Cliical Approach to Diagosis of Oral Lesios Jim Kratochvil Northwest Oral Pathology Tigard, Orego Older Populatio is at Risk Oral carcioma about 4-5% of all cacers Oral carcioma primarily over age of 40 Average age of 60 at time of diagosis 40-45% of all oral carciomas i patiets over the age of 65 Average age for maligat salivary glad tumors is 47 with peak i 7th & 8th decades Must Recogize Abormalities Must be able to distiguish what is abormal or pathologic Must kow what is ormal for a give situatio Importat that carciomas be diagosed at the earliest, most treatable stage Describe the Lesio Givig a iitial descriptio of a lesio allows the cliicia to approach diagosis i a orgaized ad systematic way A good descriptio of the lesio will allow the cliicia to write a meaigful record etry or cosult Describig a Soft Tissue Lesio Whe describig a lesio, give: Locatio Size or extet Color Morphology Describig a Radiographic Lesio Whe describig a lesio, give: Locatio Size or extet Radiodesity Border of the lesio or how it iteracts with adjacet structures Page 1

3 Developig a Differetial Diagoses Developig a Differetial Diagoses Try to cosider diseases that could produce a idividual lesio Try to develop a reasoable cliical differetial diagoses of at least three disease etities that could coceivably cause a lesio such as is beig evaluated After developig the differetial diagoses, arrage them i order of liklihood Cosider tissues i the area: Nerve: euromas, schwaommas, eurofibromas Fibrous coective tissue: fibromas Fat: lipoma Gladular tissue: salivary eoplasm, Fordyce spots, etc. Epithelium: papilloma, carcioma, hyperkeratosis Cosider the color of the lesio: Red: icreased vascularity, thied epithelium Pale: decreased vascularity White: hyperkeratosis, forieg material Pigmeted: melai, hemosideri, forieg material Did I Make Necessary Muster? Kee-jerk Cliical Differetials Developmetal Iflammatory or Ifectious Metabolic Neoplastic Miscellaeous Mass i the togue Mass i the lower lip Mass i the upper lip Growth o the gigiva Pale odule i aterior floor of the mouth Ulcers Leukoplakias i differet locatios Mucocele-like lesios o the lower lip ad the i other locatios Mass i the togue Mass i the lower lip Fibroma Graular cell tumor Beig erve sheath tumor Mucus escape reactio (mucocele) Fibroma Beig erve sheath tumor Page 2

Mass i the upper lip Growth o the gigiva Salivary glad eoplasm Fibroma Salivary duct cyst Pyogeic grauloma Peripheral giat cell grauloma Peripheral ossifyig fibroma Fibroma Cliical Lesios of Cocer Is

Ulcers that ca t be related to trauma or ifectio Leukoplakia i the floor of the mouth Erythroplakias Mucocele-like lesios i locatios other tha lower lip, floor of mouth, or aterior vetral togue

4 Mass i the upper lip Growth o the gigiva Salivary glad eoplasm Fibroma Salivary duct cyst Pyogeic grauloma Peripheral giat cell grauloma Peripheral ossifyig fibroma Fibroma Cliical Lesios of Cocer Is Oral Cacer is a public health problem i Orego? Ulcers that ca t be related to trauma or ifectio Leukoplakia i the floor of the mouth Erythroplakias Mucocele-like lesios i locatios other tha lower lip, floor of mouth, or aterior vetral togue Palatal soft tissue masses A. Yes. It is a the major problem. All smokers will get it ad it is almost impossible to treat. B. No. It is ot a problem. It hardly ever occurs i Orego. C. It is a problem ad more commo tha other cacers such as leukemia, brai cacer, or cervical cacer. Cacer i Orego Is oral cacer a problem i Orego? Yes! Average of 476 cases per year Average of 101 deaths per year Orego State Cacer Registry (OSCaR) Orego State Cacer Registry (OSCaR) Page 3

491 Cacer i Orego 2007-2011 476 476 Average Cases/Year Is oral cacer a problem

32 - Average aual female deaths from oral cacer 42 - Average aual female

2014 Orego State Cacer Registry (OSCaR) Is oral cacer a problem i Orego?

Wome ad me are just as likely to get oral cacer or die from it. B.

Me are more likely to get oral cacer ad die from it.

100,000) Huma Papilloma Virus Orego State Cacer Registry (OSCaR) September

5 491 Cacer i Orego Average Cases/Year Is oral cacer a problem i Orego? Yes! 32 - Average aual female deaths from oral cacer 42 - Average aual female deaths from cervical cacer Orego State Cacer Registry (OSCaR) September 2014 Orego State Cacer Registry (OSCaR) Is oral cacer a problem i Orego? Is Oral Cacer a equal opportuity cacer? A. Yes. Wome ad me are just as likely to get oral cacer or die from it. B. Wome are more likely to get oral cacer ad die from it. C. Me are more likely to get oral cacer ad die from it. Orego State Cacer Registry (OSCaR) Cacer i Orego (Average Rates per 100,000) Huma Papilloma Virus Orego State Cacer Registry (OSCaR) September 2014 Icreasig awareess of a subset of oral SCC Ted to be youger with less alcohol & tobacco Distict molecular profile similar to cervical SCC High risk subtypes (HPV 16, 18, 31, 33, 45) Sexually trasmitted Ofte diagosed at a late stage Affiity for oropharyx (tosils, base of togue) Ted to show low differetiatio Better progosis HPV vaccies appear to offer some protectio Page 4

Progosis of HPV positive HNSCC Leukoplakias Multiple studies demostrate that patiets with HPV positive oropharygeal cacer are more resposive to treatmet ad have a better progosis tha HPV egative

6 Progosis of HPV positive HNSCC Leukoplakias Multiple studies demostrate that patiets with HPV positive oropharygeal cacer are more resposive to treatmet ad have a better progosis tha HPV egative oropharygeal cacer P16 overexpressio as marker of trasciptioally active HPV Floor of the mouth Epithelial dysplasia or worse Hyperkeratosis Liche plaus Togue - lateral or vetral Epithelial dysplasia or worse Liche plaus Oral hairy leukoplakia Togue - dorsal Cadidiasis Liche plaus Hyperkeratosis Mucocele-Like Lesios at Uusual Locatios Look at the Ski Mucoepidermoid adeocarcioma Mucus escape reactio (mucocele) Mucus duct cyst Basal cell carcioma Squamous cell carcioma Melaoma Other cutaeous pathology Page 5

2018 Oregon Dental Conference Course Handout

2018 Oregon Dental Conference Course Handout 2018 Orego Detal Coferece Course Hadout James Kratochvil, DDS Course 9173: Not Your Typical Gigivitis Saturday, April 7 1-2:30 pm Not your Typical Gigivitis Jim Kratochvil We are all very familiar with