Preclinical Lab PAT Modules 11-15

An area of abnormal-appearing skin or oral mucosa that does not resemble the soft tissue surrounding it

What is a soft tissue lesion?

Early detection
Appropriate treatment
Referral

The most effective approach to decreasing the number of deaths associated with soft tissue cancers is ?

Color, texture, form

A skin lesion can be detected based on a variation in ______, ______, & ________ of an area of skin or oral mucosa

Present at birth�such as a birthmark
Associated with an infection�such as a wart or acne
Associated with an allergic reaction�such as hives
Associated with an injury�such as a blister or scar

A soft tissue lesion may be:

Dental professionals to examine patients for signs of soft tissue lesions

In June 2003, the ADA launched a campaign urging ?

Skin

______ is the most common of all cancer types.

Melanomas
Non-melanomas

What are the two main types of skin cancer?

Melanomas

_________ are much more likely to spread to other parts of the body and account for over 60% of skin cancer deaths

The first statement is false. The second statement is true.

More than 2 million skin cancers are diagnosed each year in the United States. The number of skin cancers has been on the rise steadily for the past 30 years.

The first statement is true. The second statement is false.

Melanoma is almost always curable in its early stages. It is the most common skin cancer type.

Basal cell
Squamous cell

What are two of the most common types of non-melanomas?

Non-melanomas

________ are the most common cancers of the skin

Both statements are true

Non-melanomas rarely spread elsewhere in the body. They are less likely than melanomas to be fatal.

Oral cancer

More than one in four people affected with ______ will die.

The first statement is true. The second statement is false.

Approximately 30,000 new cases of oral and pharyngeal cancers are diagnosed each year in the United States. Oral cancer claims almost as many lives as non-melanoma.

Head and neck examination
Oral examination
Patient history
Knowledge of alcohol and tobacco use

What tools can we use for the prevention and detection of Soft Tissue Lesions?

Both statements are true

Clinicians should be particularly vigilant with patients who use tobacco and alcohol. Tobacco and alcohol use dramatically increases the risk of soft tissue cancer

A dental professional's role in cancer detetction

These are are examples of what?

Oral cancer
Systemic disease

Dental clinicians can assist patients in reducing risk for ________ and ________.

False; ALL dental health care providers must know the terminology

Most of the dental health care providers must know the terminology related to lesions in order to communicate effectively, true or false.

To document the finding to meet standards of care
To assist other clinicians in quickly locating the lesion
For referrals to dental specialists
To allow comparison of today's findings with those of a week ago or months ago

Why should a precise description of the lesion be recorded in a patient record?

A�Anatomic location
B�Border
C�Color and configuration
D�Dimension
T�Type

What is the formula for describing lesions?

True

Since each lesion has so many different characteristics, it is common for clinicians to feel overwhelmed when trying to create a written description of a lesion, true or false.

Regular

The border of a lesion is _______ if it resembles a symmetrical circle or an oval shape.

Irregular

The border of a lesion is _________ if it is not uniform or has deviations from a circular or oval shape.

Smooth

The margin of a lesion is _______ if it is level with the surface of the lesion.

Raised

The margin of a lesion is ______ if it is above the level of the surface of the lesion.

Red
White
Red & White
Blue
Yellow
Brown
Black

Lesions can vary in color. Which colors can lesions be?

Configuration

_________ refers to the way that multiple lesions are arranged.

Discrete

________ lesions are individual lesions that are separate and distinct from one another.

Grouped

________ lesions are clustered together.

Confluent

________ lesions have merged together so that individual lesions are not distinguishable.

Linear

________ lesions that form a line

Flat

A ________ lesion is one in which the surface of the lesion is the same as the normal level of the skin or oral mucosa.

Macule

A ________ is a small flat, discolored spot on the skin or mucosa that does not include a change in skin texture or thickness.

Patch

A _______ is a flat, discolored spot on the skin or mucosa.

Both statements are false

A macule is more than 1 cm in size. A patch is less than 1 cm in size.

Elevated

An ________ lesion is one in which the surface of the lesion is above the normal level of the skin or oral mucosa.

Papule

A _________ is a solid raised lesion that is usually less than 1 cm in a diameter and may be any color.

Plaque

A _________ is a superficial raised lesion often formed by the joining of closely grouped papules.

Both statements are true

An elevated mole is an example of a papule lesion. Leukoplakia and psoriasis are both examples of a plaque lesion.

Nodule

A ________ is a raised marble-like lesion detectable by touch, usually 1 cm or more in diameter.

Wheal

A _______ is a raised, somewhat irregular area of localized edema and are often itchy, they are usually due to an allergic reaction.

Fluid-filled

A ________ lesion is an elevated lesion filled with clear fluid or pus.

Vesicle

A ________ is a smaller blister filled with fluid, usually is 1 cm or less in diameter.

Bulla

A ________ is a large blister filled with fluid, usually over 1 cm in diameter.

Pustule

A _______ is a small raised lesion filled with pus.

The first statement is true. The second statement is false.

Acne, boil, and an abscess are examples of a pustule. Mosquito bites and hives are examples of a vesicle.

Depressed

A ________ lesion is one which the surface of the lesion is below the normal level of the skin or oral mucosa.

Ulcers

Most depressed lesions are ________.

Ulcer

An ______ is crater-like lesion of the skin or mucosa where the top two layers of the skin are lost.

Both statements are false

The depth of an ulcer that is less than 3 mm is considered deep. The depth of an ulcer that is more than 3 mm is considered superficial.

Both statements are true

The depth of a depressed lesion is the distance from the base to the top of the lesion's margin. The depth of a lesion may be superficial or deep.

Linear crack

A _______ is a long, narrow break in the surface of the skin or mucosa

Fissure

A _________ is a linear crack in the top two layers of the skin or mucosa.

True

Primary types of lesions are flat, elevated, fluid-filled, and depressed lesions, true or false.

False; MEDICAL history should include questions about tobacco and alcohol as well as smoking cessation programs

Dental history questionnaires should include questions that elicit information about tobacco and alcohol use as well as interest in smoking cessation programs, true or false.

Sun exposure
Smoking
Alcohol consumption

Dental health care providers can promote health wellness by counseling patients about the THREE primary controllable risk factors for skin and oral cancer, what are they?

Oral

The ______ examination provides the perfect opportunity to discuss smoking cessation with your patient.

Head & neck examination

A ___________ is a physical examination technique consisting of a systematic visual inspection of the skin of the head and neck combined with palpation of the lymph nodes, salivary glands, thyroid glands, and TMJ.

B; head and neck examination

Of the following procedures, which once could save a patient's life?
a. Periodontal debridement
b. Head and neck examination
c. Fluoride treatment
d. Bitewing radiographs

C; the ear drum

Which of the following structures usually is NOT assessed during the head and neck examination?
a. Skin of the face and neck'
b. Temporomandibular joint (TMJ)
c. The eardrum
d. Lymph nodes of the head and neck

While greeting and seating the patient

The head and neck examination begins when?

Inspection
Palpation

What are the two primary examination techniques?

Consistent sequence to include all structures
Good palpation technique
Careful documentation of all findings

What is the keys to an effective examination?

The cervical lymph nodes lie above, beneath, and posterior to this muscle

The ability to locate the sternomastoid muscle is significant because?

Against a firm structure, such as bone OR between the examiner's fingers

To detect abnormalities such as swelling, tumors, or enlarged lymph nodes, the structure must be compressed:

D; lymph nodes

Which of the following plays an important part in the body's defense against infection?
a. Thyroid gland
b. Parotid gland
c. Submandibular gland
d. Lymph nodes

Lymphadenopathy

Term for enlarged lymph nodes

Parotid

The ________ glands are the largest of the salivary glands

Thyroid

The ________ gland, one of the endocrine glands, secretes thyroid hormone, which controls the body's metabolic rate

Goiter

A _______ is an enlarged thyroid gland

Overall appraisal of head, neck, face, and skin
Lymph nodes of head and neck
Salivary and thyroid glands
Temporomandibular joint

It is helpful to organize the structures to be examined into FOUR subgroups:

Lymph nodes

A ________ are bean-shaped structures that filter and trap bacteria, fungi, viruses, and waste

False; there are 170 to 200 in the neck

There are 400 to 700 lymph nodes in the neck, true or false.

Involves lightly "walking" or "dancing" the fingertips over a structure

What is the incorrect palpation technique that often contributes to missing important findings in patients?

Circular motion

Use ____________ to compress tissues against the underlying bone

Behind

Visually inspect head, scalp, and ears from ________ patient

Swollen, feels a bit like a grape
Firm
Tender
Enlarged and warm
Bilateral swelling (on both sides of head or neck)
Freely moveable from underlying structures

Findings of infected lymph nodes include what?

Enlarged
Firm
Nontender
Matted (stuck to each other)
Fixed (stuck to underlying tissue)
Unilateral (enlarged on only one side of head or neck)

Findings of malignant lymph nodes include what?

Parotid
Submandibular
Sublingual

Salivary glands produce saliva and release it into the mouth through ducts, name the three main pairs:

Oral examination

A ________ is a physical examination technique consisting of a systematic inspection of the oral structures.

A; 24 people die each day

According to the Oral Cancer Foundation, what is the death rate from oral cancer in the United States?
a. 24 people die each day
b. 365 people die each year
c. One person dies each month
d. 265 people die each year

Tongue

Of all the oral structures the ______ has the highest incidence rate of cancer.

A routine part of each patient's dental visit

The ADA recommends that a thorough oral examination should be ?

True

Failure to detect oral cancer is one of the top ten reasons for dental malpractice lawsuits, true or false.

Age
Gender
Sunlight
Alcohol and tobacco use

Risk factors for oral cancer include:

The first statement is true. The second statement is false.

Using tobacco and alcohol in combination poses a much higher risk than using either substance alone. Tobacco and alcohol use increases the risk of skin cancer.

Leukoplakia (white lesions)
Erythroplakia (red lesions)

Lesions that might signal oral cancer include:

Both statements are false

Leukoplakia has a greater potential for becoming cancerous. Erythroplakia is a possible precursor to cancer and are less common.

Vermilion border
Commissures

Two important landmarks of the lips are the _________ & _________, both of these landmarks are useful when recording the location of a soft tissue lesion or other notable findings.

Two

A white or red lesion that does not resolve in _____ weeks should be biopsied to obtain a definitive diagnosis

Soreness

Any symptom, such as __________, that persists for more than 2 weeks indicates the need for a referral to a specialist

Oral

When detected at the earliest stages, ______ cancer has an 80% survival rate

Lips and vermillion border
Oral cavity and mucosal surfaces
Underlying structures of lips and cheeks
Floor of the mouth
Salivary gland function
Tongue
Palate, tonsils, and oropharynx

What are the 7 subgroups of an oral examination?

Angioedema

___________ is swelling of lower lip caused by allergy to latex gloves

True

When inspecting the labial mucosa and lower lip Use index fingers inside the mouth, thumbs on outside.
Evert and retract the lip fully away from teeth and alveolar ridge, true or false.

Sublingual caruncle

Located on either side of the lingual frenum

Circumvallate

The largest and most posterior papillae of the tongue are the ____________ papillae.

Fungiform

The ___________ papillae are broad, round, red, mushroom-shaped papillae.

Foliate

The _________ papillae are three to five large, red, leaf-like projections on the lateral border of the posterior third of the tongue.

Ankyloglossia

A _________ is a short lingual frenum that limits tongue movement.

Color
Size
Position of margin
Shape of margins in papillae
Texture and consistency
Bleeding and/or exudate

What characteristics of the gingiva should assessed?

Both statements are true

Healthy gingival tissue fits snugly around the tooth. Diseased gingival tissue is enlarged.

The first statement is true. The second statement is false.

The position of the gingival margin often changes in disease. The shape of a papilla rarely changes due to disease.

Both statements are true

Areas of the gingival tissue may have a bluish color in disease. The tissue may be a pale pink or white in disease

Uniform pink color
Pigmented

Healthy gingival tissue color is?

Bright red, bluish-purple, white, or pale pink

Diseased gingival tissue color is?

Fits snugly around the tooth

Healthy gingival tissue size is?

Enlarged

Diseased gingival tissue size is?

Marginal gingiva: meets the tooth in a tapered or slightly rounded edge
Interdental papillae: flat, pointed papillae fills the embrasure space between two adjacent teeth

Healthy gingival tissue shape is?

Normal
Stippled

Healthy gingival tissue texture is?

Smooth, shiny, no stippling
Firm and nodular (fibrotic)

Diseased gingival tissue texture is?

Firm
Resilient under compression

Healthy gingival consistency is?

Soft, flaccid
Spongy, puffy
Leathery, not resilient

Diseased gingival consistency is?

Mixed dentition

A combination of some primary teeth and some permanent teeth

Primary

The _________ teeth usually erupt between ages 2 1/2 and 5 1/2 years

13

The primary canines and the primary second molars are the last to exfoliate. Normally all primary teeth are exfoliated by age _____.

Occlusion

The relationship of the teeth to each other when the incisal and occlusal surfaces of the mandibular arch contact those of the maxillary arch.

Malocclusion

The improper positioning of the teeth and jaws.

Overbite
Overjet

A healthy occlusion normally exhibits _______ and _______.

Overbite

The amount of vertical overlap is known as the ________.

Overjet

The horizontal distance between the incisal edges of the maxillary teeth and the mandibular teeth is known as the ________.

Angle's classification

A system for classifying the relationship of the mandibular teeth to the maxillary teeth.

The position of the buccal groove of the mandibular permanent first molar in relation to the maxillary teeth

What is the key to understanding Angle's classification?

Class 1

According to Angle's classification, The buccal groove of the mandibular first molar is directly in line with the mesiobuccal cusp of maxillary first molar is which class?

Class 2
Division 1

According to the Angle's classification, The buccal groove of the mandibular first molar is distal to the mesiobuccal cusp of maxillary first molar by at least the width of a premolar (all four maxillary incisors are protruded) is which class?

Class 2
Division 2

According to the Angle's classification, The buccal groove of the mandibular first molar is distal to the mesiobuccal cusp of maxillary first molar by at least the width of a premolar (both maxillary lateral incisors protrude while both central incisors r

Class 3

According to the Angle's classification, The buccal groove of the mandibular first molar is mesial to the mesiobuccal cusp of maxillary first molar by at least the width of a premolar, is which class?