TANYA A. WRIGHT, DDS OBJECTIVES One will be able to recognize pathological entities One will be able to establish a reasonable differential diagnosis One will be able to identify various types of lesions including squamous cell carcinoma One will be able to learn about different treatment options and medications to utilize for patients 1
BIOPSY TECHNIQUES Cytology smear (least invasive) Fine needle aspiration Incisional biopsy (lesion greater than 1 cm) Excisional biopsy (lesion smaller than 1 cm) Biopsy aids Brush biopsy VELscope Vizilite Plus 2
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Courtesy of Kevin D. Huff, DDS, Dover, OH CIRCUMVALLATE PAPILLAE NORMAL ANATOMY NO NEEDED 5
BENIGN MIGRATORY GLOSSITIS (GEOGRAPHIC TONGUE) NO NEEDED HAIRY TONGUE BRUSH TONGUE TO REMOVE DISCOLORATION 6
AMALGAM TATTOO CONFIRM BY RADIOGRAPH ADVISE PATIENT OF LESION LEUKOEDEMA NO NEEDED 7
MORSICATIO BUCCARUM (CHEEK BITING) MOUTHGUARD CAN BE USED PALATAL TORI NO NEEDED UNLESS FABRICATING DENTURE 8
STATIC BONE CYST NO NEEDED MONITOR WITH RADIOGRAPHS ANGULAR CHEILITIS MEDICATION WITH ANTIFUNGAL/BACTERIAL COMPONENTS (VYTONE CREAM) 9
DENTURE STOMATITIS ANTIFUNGAL THERAPY TREAT DENTURE AS WELL PARULIS ENDODONTIC THERAPY OR EXTRACTION 10
PERIAPICAL CYST DIFFERENTIAL DIAGNOSIS ODONTOGENIC KERATOCYST PERIAPICAL ABSCESS AMELOBLASTOMA CENTRAL GIANT CELL GRANULOMA ENDO THERAPY/BIOPSY FIBROMA BIOPSY REMOVE TONGUE PIERCING 11
LIPOMA DIFFERENTIAL DIAGNOSIS FIBROMA BIOPSY MUCOCELE DIFFERENTIAL DIAGNOSIS HEMANGIOMA MUCOEPIDERMOID CARCINOMA BIOPSY 12
APHTHOUS ULCER (CANKER SORE) IF FREQUENT OUTBREAKS REFER TO GI SPECIALIST TO RULE OUT CROHN S, ULCERATIVE COLITIS PERIPHERAL OSSIFYING FIBROMA DIFFERENTIAL DIAGNOSIS PYOGENIC GRANULOMA PERIPHERAL GIANT CELL GRANULOMA BIOPSY REMOVE IRRITANTS BY SCALING 13
NICOTINE STOMATITIS TOBACCO CESSATION ERYTHEMA MULTIFORME DETERMINE UNDERLYING CAUSE (MEDICATIONS OR HERPES SIMPLEX) PREDNISONE FOR SEVEN DAYS 14
SMOKER S KERATOSIS SMOKELESS TOBACCO CESSATION PALATAL SWELLING DIFFERENTIAL DIAGNOSIS PLEOMORPHIC ADENOMA ADENOID CYSTIC CARCINOMA LYMPHOMA BIOPSY 15
WELL DEFINED UNILOCULAR RADIOLUCENCY DIFFERENTIAL DIAGNOSIS DENTIGEROUS CYST AMELOBLASTOMA ODONTOGENIC KERATOCYST BIOPSY DESQUAMATIVE GINGIVITIS INCLUDES PEMPHIGUS VULGARIS BULLOUS PEMPHIGOID EROSIVE LICHEN PLANUS 16
OTHER EXAMPLES OF DESQUAMATIVE GINGIVITIS TRAUMATIC ULCER DIFFERENTIAL DIAGNOSIS SQUAMOUS CELL CARCINOMA TUBERCULOSIS DEEP FUNGAL INFECTION PRIMARY SYPHILIS BIOPSY REMOVE IRRITANT 17
EXAMPLE OF TRAUMATIC LESION PROLIFERATIVE VERRUCOUS LEUKOPLAKIA FOLLOW UPS WITH BIOPSY TO RULE OUT CHANGE TO SQUAMOUS CELL CARCINOMA (SCCA) 18
EROSIVE LICHEN PLANUS BIOPSY TO RULE OUT SCCA TOPICAL STEROIDS FOR SQUAMOUS CELL CARCINOMA SURGERY/CHEMOTHERAPY/ RADIATION 19
SQUAMOUS CELL CARCINOMA SURGERY/CHEMOTHERAPY/ RADIATION OSTEONECROSIS/ OSTEORADIONECROSIS DEBRIDE AREA ENFORCE GOOD ORAL HYGIENE INSTRUCTIONS RESTORE/EXTRACT TEETH 20
TAKE HOME POINTS Biopsy any suspicious red/white/pigmented lesion Scalpel biopsy is gold standard Aids are beneficial to help with oral exam Talk and teach patients to perform exams at home Early detection is key, oral exam takes only a few minutes to perform at each appointment 21
REFERENCES Ibsen, O. and Phelan, J. Oral Pathology for the Dental Hygienist. 5 th ed. Saunders Elsevier. Kahn, Michael. Role of the Oral Health Care Specialists in the Diagnostic Process for Oral Cancer. The Inside Summit on Oral Cancer Discovery and Management: The Technologies and the Role of Dental Clinicians. 2007. 27 29. Solomon, Lynn. Oral Cancer Screening. Inside Dentistry. March 2010. 58 66. 22