Introduction to Soft Tissue Diseases

Introduction to Soft Tissue Diseases

• Module: Oral & Dental Sciences
• Lecturer: Mariya Mahmood

GDC Learning Outcomes

• Describe oral diseases and their relevance to prevention, diagnosis, and treatment
• Explain the etiology and pathogenesis of oral diseases
• Recognise the importance of and carry out an appropriate systematic intra- and extra-oral clinical examination
• Recognise the importance of and record a comprehensive and contemporaneous patient history
• Recognise abnormalities of the oral cavity and the rest of the patient and raise concerns where appropriate
• Recognise the need for and make arrangements for appropriate follow-up care

SPF Learning Outcomes

• Clinical Knowledge and Skills: C1.1, C1.2, C1.17, C1.25, C1.31, C1.38, C2.1.1, C2.1.11
• Interpersonal Skills: I(B)1, I 1.6
• Self-management: S(B)2

Intended Learning Outcomes

• Outline the significance of a soft tissue examination and linked history taking in identifying signs of disease
• Describe influencing factors that may exacerbate soft tissue conditions
• Demonstrate accurate history taking and recording of soft tissues conditions
• Identify the first considerations of supporting/managing and treating patients with soft tissue conditions
• Reflect on experience of learning

Scope of a DH/DT

• What is your remit?
• What manifests in the mouth?
• What is your level of responsibility?

Examining Soft Tissues and Their Diseases

• What is the purpose of intraoral and extraoral examination?
• Preparation for Year 2 Oral Medicine – conditions explained in more depth

What are the Soft Tissues?

• When does the examination begin?
• Who holds responsibility?

Benefits of Early Detection

• Preventable
• Easily treated
• Slow down progression
• Fatality prevented
• Early identification improves prognosis

Factors Hindering Screening

• Awkward conversations
• Self-doubt
• Assumption of providing diagnosis
• Competency
• Assumption another will identify

Most Common Conditions

• Cancer
• Lichen Planus
• Pemphygoid
• Candida
• Pemphigus
• Leukoplakia
• Ulcers
• Herpes

Common Conditions Continued

• Oral Cancer: Cancerous lesions of 3 distinct sites: oral cavity (mouth), oropharynx (throat), and lip (outer)
• Lichen planus: Chronic, cell-mediated inflammatory disease affecting the oral mucosa (<3% turns cancerous)
• Ulcers: Loss or erosion of the delicate mucous membrane; repeat ulcers can be a manifestation of other diseases

Individual Disease Susceptibility

• Predisposed to developing a certain disease
• Individual's disease susceptibility influenced by a combination of genetic and environmental factors
• Host factors
• Acquired immune response
• Environmental influences

Influencing Factors With Soft Tissue Diseases

• Immuno-compromised (e.g., Lupus, HIV, Diabetes)
• Stressed?
• Tired?
• Nutritionally deficient (e.g., Vit D risk factor for oral cancer)
• These issues impact patient response to pathology

Exacerbating Factors

• Alcohol
• Smoking
• Beta nut
• Vaping
• Human papillomavirus (HPV 16)
• Nutritional deficiency
• Spicy food
• Poor oral hygiene

How would you describe the oral environment?

• Plaque: Exacerbates most oral conditions

Dental Diversity

• Physiological/racial pigmentation of gingivae
• Soft tissue size
• Differing anatomy
• Gingival biotypes

Is self-screening important?

• Self-screening can be important, though professional screening is necessary

Screening for oral cancer

• Self-examination guide available
• 8-step oral cancer screening process

Clinician Considerations for Soft Tissue Diseases

• Clear and accurate record keeping
• Clinical photos
• History taking
• Referral to Oral Medicine Specialist for diagnosis confirmation
• Maintaining optimum health for the whole mouth
• Dietary/lifestyle advice
• Specific and tailored oral hygiene advice
• Specific adjunct requirements if needed

Descriptive Language

• Size (mm x mm)
• Location
• Raised/elevated lesion
• Blister/vesicle/bulla
• Crusty edges
• Borders (poorly/well defined)
• Shallow/deep crater
• Color (white/red/speckled, etc)
• Painful/not painful

Communicating with the patient

• Avoid "C" word
• Remain calm, composed
• Avoid subjectiveness
• Inform patient of urgent referral pathway
• Remember you have not diagnosed a patient
• You are not trained to counsel patients with a cancer diagnosis

Suspected Pathway

• Urgent Suspected Cancer (USC) referral forms
• NHS fast-track two-week referral policy
• Can a DH/DT refer?

Activity – How would you describe this?

• Describe the clinical presentation of the lesion
• Questions to ask the patient for a history
• Are you concerned? Why/why not?

Holistic Approach

• Identify abnormality
• Consider relevant histories
• Predisposing/host factors
• Communication and documentation
• Referral/support/maintenance

Case Study Examples

• Condition
• Definition
• Photograph
• Descriptors
• Patient management

Cancer (Squamous Cell Carcinoma)

• Classic descriptors
• Most common location (floor of mouth/lateral side of tongue)
• Ragged ulcer (slow to heal)
• Raised, poorly defined borders
• Classically not painful
• Malodor/halitosis
• Stiffness of the tongue
• Lymphadenopathy
• Change in color

Cancer Management

• Urgent Suspected Cancer (USC) referral forms
• Diagnosis and patient impact determine care
• DH/DT involvement pre- and post-surgery to ensure optimal dental health
• Oral health advice
• Debridement
• Dietary advice
• Adjunct suggestions as needed

Lichen Planus

• Classic descriptors (painless white lines)
• Red painful erosions or ulcers on attached gingivae
• Appearance of mucosa loss (desquamative gingivitis)
• Skin lesions tend to appear purple, raised, and sometimes itchy

Lichen Planus Management

• Regular supportive periodontal therapy
• Dietary support
• Guidance on mouthwash/toothpaste adjuncts if needed
• Possible medications (e.g., Betamethasone)
• Malignant transformation possible (reported as 1%)

Importance of Thorough Examination

• Describe soft tissues in image B
• Compare soft tissues in B and C
• How could this be missed?

Activity – Soft Tissue Lesions

• Select a condition
• Describe its appearance
• Management
• Present

Reflect

• 3 things learned
• 3 things known
• 3 things you would like to know

References (Images and Studies)

• List of referenced image sources