bulla
a circumscribed, elevated lesion that is more than 5 mm in diameter, usually contains serous fluid, and looks like a blister
lobule
a segment or lobe that is a part of the whole; these lobes sometimes appear fused together
macule
an area that is usually distinguished by a color different from that of the surrounding tissue; it is flat and does not protrude above the surface of the normal tissue. a freckle is an example
papule
a small, circumscribed lesion usually less than 1 cm in diameter that is elevated or protrudes above the surface of normal surrounding tissue
pedunculated
attached by a stemlike or stalklike base similar to that of a mushroom
pustule
variously sized circumscribed elevations containing pus
sessile
describing the base of a lesion that is flat or broad
vesicle
a small, elevated lesion less than 1 cm in diameter that contains serous fluid
nodule
a palpable solid lesion up to 1 cm in diameter found in soft tissue; it can occur above, level with, or beneath the skin surface
palpation
the evaluation of a lesion by feeling it with the fingers to determine the texture of the area, the descriptive terms are soft, firm, semi-firm, and fluid filled; these terms also describe the consistency of a lesion
colors
red, pink, salmon, white, blue-black, gray, brown, and black are used most frequently to describe oral lesions; they can be used to identify specific lesions and may also be incorporated into general descriptions
erythema
an abnormal redness of the mucosa or gingiva
pallor
paleness of the skin or mucosal tissues
centimeter
one hundredth of a meter; equivalent to a little less than 1/2 inch
millimeter
one thousandth of a meter
corrugated
wrinkled
fissure
a cleft or groove, normal or otherwise, showing prominent depth
papillary
resembling small, nipple-shaped projections or elevations found in clusters
smooth, rough, folded
terms used to describe the surface texture of a lesion
coalescence
the process by which parts of a whole join together, or fuse, to make one
diffuse
describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion; this may make treatment more difficult and, depending on the biopsy results, more radical
multilocular
describes a lesion that extends beyond the confines of one distinct area and is defined as many lobes or parts that are somewhat fused together, making up the entire lesion; sometimes described as resembling soap bubbles; an odontogenic keratocyst often p
radiolucent
describes the black or dark areas on a radiograph; radiant energy can pass through these structures; less dense tissue such as the pulp is seen as this structure
radiolucent and radiopaque
to describe a mixture of light and dark areas within a lesion, usually denotic a stage in the development of the lesion
radiopaque
describes the light or white area on a radiograph that results from the inability of radiant energy to pass through the structure; the denser the structure, the lighter or whiter it appears on the radiograph
root resorption
observed radiographically when the apex of the tooth appears shortened or blunted and irregularly shaped; occurs as a response to stimuli, which can include a cyst, tumor, or trauma
external resorption
arises from tissues outside the tooth
internal resorption
triggered by pulpal tissue reaction from the within the tooth, the pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area
scalloping around the root
a radiolucent lesion that extends between the roots, as seen in a traumatic bone cyst; this lesion appears to extend up the periodontal ligament
unilocular
having one compartment or unit that is well defined or outlined, as in a simple radicular cyst
well circumscribed
term used to describe a lesion with borders that are specifically defined and in which one can clearly see the exact margins and extent
clinical, radiographic, historical, laboratory, microscopic, surgical, therapeutic, differential findings
eight categories that contribute information leading to a defintivie disagnosis
does not provide sufficient information to make a diagnosis
usually one area alone . . .
clinical diagnosis
suggests that strength of diagnosis comes from appearance of lesion
components of clinical diagnosis
well-illuminated
palpation
color
shape
location
history
biopsy or surgical intervention is not necessary
when a diagnosis can be made on the basis of unique clinical features . . .
fordyce granules
torus palatinus
mandibular tori
melanin pigmentation
retrocuspid papillae
lingual varicosities
fissured tongue
median rhomboid glossitis
hairy tongue
lesions that can be clinically diagnosed
radiographic diagnosis
provides significant info on its own to establish diagnosis
periapical pathosis
internal resorption
external resorption
heavy interproximal calculus
dental caries
compound odontoma
complex odontoma
supernumerary teeth
impacted or unerupted teeth
calcified pulp
radiographic diagnosis conditions
Amelogensis imperfecta, dentinogenesis imperfecta
Pathologic conditions in which the family history contributes a significant role in the diagnosis include?
historical diagnosis
important in every diagnosis
-includes personal, family, past & present medical & dental, drug ingestion, disease or lesion
-review carefully & update each visit
laboratory diagnosis
blood chemistries
urinalysis
microbiologic cultures
microscopic diagnosis
form of laboratory diagnosis
contributes significant information
needs adequate tissue sample
sometimes a second biopsy is needed
three types of biopsies
brush, excision, incision
brush test
used to obtain information from oral mucosal epithelium
-uses circular brush to obtain cells from full thickness of epithelium
-results may help determine if scalpel biopsy is needed
scalpel biopsy
considered gold standard used to provide microscopic analysis that will establish definitive diagnosis of lesion
based on clinical appearance alone
white lesion cannot be diagnosed
surgical diagnosis
provides conclusive evidence
therapeutic diagnosis
confirmation of diagnosis by response of condition to therapy
differential diagnosis
ruling out conditions originally suspected and establish definitive or final diagnosis
fordyce granules
clusters of ectopic sebaceous glands on lips and buccal mucosa; tiny yellow lobules in clusters are usually distributed over the buccal mucosa or vermilion border of the involved lips
-more than 80% of adults over 20
-asymptomatic and require no treatment
torus palatinus
exophytic growth of normal compact bone in midline of hard palate; various shapes and sizes; lobulated & covered by normal soft tissue
-inherited
-inherited occurs frequently in women
-asymptomatic
mandibular tori
outgrowths of normal dense bone; found on lingual aspect of mandible; usually bilateral; lobulated or nodular
-no higher incidence in either men or women
-no treatment needed except for prosthesis
melanin pigmentation
commonly observed in the oral mucosa or gingival in dark skinned individuals
retrocuspid papilla
sessile nodule of the gingival margin of the lingual aspect of mandibular cuspids
lingual varicosities
prominent lingual veins on ventral and lateral surfaces of tongue
- red to purple enlarged vessels or clusters are seen
- more common in people over 60; related to aging process
linea alba
a white line that extends anteroposteriorly on the buccal mucosa along occlusal plane; may be bilateral
- results of clenching or bruxism
leukoedema
gray-white film diffused throughout the buccal mucosa; opaque quality
-less prominent if mucosa is stretched
-more pronounced in smokers
- Part of the buccal tissue and cannot be removed
-histologically, intracellular edema in the spinous cells and acanth
lingual thyroid nodule
when thyroid tissue doesn't descend or remnants become trapped in the tissue that makes up the tongue, a lingual thyroid remains
median rhomboid glossitis
cause unknown but may be associated with a chronic fungal infection by Candida albicans
-clinically appears as a flat or raised oval or rectangular erythematous area in midline of dorsal surface of tongue
-no specific treatment but sometimes antifungal wo
geographic tongue
cause unknown but can be genetics or stress
-associated with psoriasis
-on dorsum or lateral border of tongue
-erythematous patches that are surrounded by white or yellow perimeter
- A patient complains of a burning disconfort associated with this conditi
fissured tongue
cause unknown; genetics are involved
-seen in 5% of population
-dorsal surface has deep fissures or grooves that become irritated
-no treatment indicated
-brush tongue gently to keep it clean
hairy tongue
increased accumulation of keratin on filiform papillae that results in white, hairy appearance
-may be increased keratin production or decrease in normal desquamation
-with black, papillae are colored due to chromogenic bacteria; tobacco and certain foods
After arriving at a differential diagnosis, information from which one of the following categories will best establish a final or definitive diagnosis?
A. Clinical
B. Historical
C. Microscopic
D. Radiographic
Microscopic
the descriptive term that would best be used for a freckle is a:
Macule
What term describes the base of a lesion that is stalk like?
Pedunculated
Clinical diagnosis can be used to determine the final or definitive diagnosis of all of the following EXCEPT?
A. Fordyce granules
B. Unerupted supernumerary teeth
C. Mandibular tori
D. Geographic tongue
Unerupted supernumerary teeth
Radiographic diagnosis would contribute to the definitive diagnosis of all of the following EXCEPT?
A. Internal resorption
B. Periapical cemento-osseous dysplasia
C. Odontomas
D. A retained deciduous tooth
Periapical cemento-osseous dysplasia
To determine the presence of blood dyscrasias, what would provide the most definitive information?
A. Laboratory blood tests
B. Bleeding during probing
C. Pallor of the gingiva and mucosa
D. Patient complaint of weekness
Laboratory blood tests
When an antifungal ointment or cream is used to treat suspected angular cheilitis, which diagnostic category is being used?
Therapeutic
Yellow clusters of ectopic sebaceous glands commonly observed on the buccal mucosa and evaluated through clinical diagnosis are most likely?
A. Lipomas
B. Fibromas
C. Fordyce granules
D. Linea alba
Fordyce granules
A slow-growing, bony hard exophytic growth on the midline of the hard palate is developmental and hereditary in origin. the diagnosis is determined through clinical evaluation. You suspect:
A. Torus palatinus
B. Mixed tumor
C. Palatal cyst
D. Nasopalatine
Torus palatinus
The "white line" observed clinically on the buccal mucosa that extends from anterior to posterior along the occlusal plane is:
Linea alba
What occurs as an erythematous area, is devoid of filiform papillae, is oval to rectangular in shape, and is on the midline of the dorsal surface of the tongue?
Median rhomboid glossitis
Which one of the following diagnostic categories would the dental hygienist most easily apply to the preliminary evaluation of oral lesions?
A. Microscopic
B. Clinical
C. Therapeutic
D. Differential
Clinical
These examples of exotoses are found on the lingual aspect of the mandible in the area of the premolars. They are benign, bony hard, and require no treatment. Radiographically they appear as radiopaque areas and are often bilateral. You suspect:
Mandibular tori
What term is most often used when describing mandibular tori?
Lobulated
What condition is a benign anomaly, has a diffuse gray-to-white opaque appearance on the buccal mucosa, and is most commonly seen in adult black individuals?
Leukoedema
A patient has the clinical signs of necrotizing ulcerative gingivitis. the hygienist has the patient begin hydrogen peroxide rinses without culturing the bacterial flora. this action applies to which one of the following diagnostic categories?
Therapeutic
A small circumscribed lesion usually less than 1 cam in diameter that is elevated and protrudes above the surface of normal surrounding tissue is called a:
A. Papule
B. Bulla
C. Vesicle
D. Macule
Papule
The base of a sessile lesion is:
Broad an flat
The identification of which one of the following is not determined by clinical diagnosis?
A. Fordyce granules
B. Tori
C. Compound odontoma
d. Retrocuspid papilla
Compound odontoma
Another term for geographic tongue is:
Median rhomboid glossitis
The cause of supernumerary teeth is most likely:
A. Genetic
B. Traumatic
C. Cystic
D. Systemic
Genetic
Historical diagnosis can include the patient's?
A. Age and sex
B. Family history
C. Medical history
D. All of the above
All of the above
Which condition is most often seen on the buccal mucosa?
A. Melanin pigmentation
B. Fordyce granules
C. Nicotine stomatitis
D. Angular cheilitis
Fordyce granules
Which one of the following is not considered a variant of normal?
A. Migratory glossitis
B. White hairy tongue
C. Fissured tongue
D. Hairy leukoplakia
Hairy leukoplakia
Which cyst is often described as a radiolucency that scallops around the roots of the teeth involved?
Traumatic bone cyst
History of ulcerative colitis may contribute to the diagnosis of?
Oral ulcers
Found most frequently in black women in the third decade of life, it is asymptomatic and that the teeth involved are vital?
Periapical cemento-osseous dyspasia (cementoma)
An elevated serum alkaline phosphatase level is significant in the diagnosis of?
Paget's disease: Radiographic appearance that includes a "cotton-wool effect
Lingual madibular bone concavity is a developmental anomaly that is often bilateral. The radiolucent area is oval or eliptical in shape and is found anterior to the angle of the ramus and inferior to the mandibular canal?
Static bone cyst or Stafne bone cyst
_____________ deficiencies are common conditions to be diagnosed by therapeutic means.
Nutritional
What may be associated with a deficiency of the B-complex vitamins, it is commonly a fungal condition and responds to topical application of an antifungal cream or ointment such as nystatin?
Angular cheilitis
What is the term used to describe the condition when geographic tongue is found on mucosal surface other than the tongue?
Ectopic geographic tongue