Introduction to Soft Tissue Diseases

Introduction to Soft Tissue Diseases

• The module is about Oral & Dental Sciences
• The lecturer is Mariya Mahmood
• The location is Eastman Dental Hospital LSBU Education Centre

GDC Learning Outcomes

• Describe oral diseases and their relevance to prevention, diagnosis and treatment
• Explain the aetiology and pathogenesis of oral disease
• 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 intra oral and extra oral 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
• Pemphigoid
• 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 are manifestation of other disease

Individual Disease Susceptibility

• Predisposed to developing a certain disease
• Individual's disease susceptibility is influenced by a combination of genetic and environmental factors
• Host Factors
• Acquired Immune Response
• Environmental Influences

Influencing Factors With Soft Tissue Diseases

• The host response is crucial in onset and influenced by:
  • Immunocompromised (e.g., Lupus, HIV, Diabetes)
  • Stress
  • Tiredness
  • Nutritional deficiency (e.g., vitamin D risk factor for oral cancer)
• These issues impact how the patient responds to pathology, affecting the onset, duration, and outcome of the disease.

Exacerbating factors related to soft tissue disease

• Alcohol
• Smoking
• Betal 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?

• Yes, self-screening is valuable.

Screening for oral cancer

• Follow the steps as pictured.
• Examine yourself monthly using a mirror, a good light source, and clean fingers to find anything unusual (especially any lumps, red or white patches, changes in colour/texture or lingering ulcers.)
• If concerned, contact a dentist or doctor immediately.

Clinician considerations for soft tissue diseases

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

Descriptive Language

• Size measured in millimeters (e.g., 7mm x 5mm)
• Location (e.g., Dorsal tongue, adjacent)
• Raised/Elevated lesion
• Blister/Vesicle/Bulla
• Crusty edges
• Borders (poorly/well defined)
• Shallow/Deep crater
• Red/white halo
• Colour (e.g., white/red/speckled)
• Painful/Not painful

Communicating with the patient

• Avoid "C" word
• Remain calm and composed
• Avoid subjectivity in response
• Inform patients about urgent referral to ensure appropriate care pathway
• Remind patients that you haven't diagnosed them
• Emphasize your lack of training to counsel or deliver cancer diagnoses

Suspected Pathway

• Urgent suspected cancer (USC) referral forms (previously known as "Two Week Wait")
• 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
• What questions would you ask the patient for a history?
• Are you concerned? Why or why not?

Holistic Approach

• Identify abnormality
• Consider relevant histories
• Communication and documentation
• Predisposing/Host factors
• Referral/Support/Maintenance

Case Study Examples

• Condition
• Definition
• Photograph
• Descriptors
• Patient Management

Cancer

• A malignancy
• Most common type: 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 colour

Management (Cancer)

• Urgent Suspected Cancer (USC) referral forms
• Depending on diagnosis, impact on patient care differs
• DH/DT involvement: Pre/post surgery to ensure optimal dental health prior
• Oral health advice
• Debridement
• Dietary advice
• Adjunct suggestions as needed

Lichen Planus

• Classic descriptors:
  • Painless white lines (striae)
  • Red painful erosions/ulcers on attached gingivae
  • Mucosa loss, desquamative gingivitis
  • Purple, raised skin lesions, sometimes itchy

Management (Lichen Planus)

• Regular supportive periodontal therapy
• Dietary support
• Guidance on mouthwash/toothpaste adjuncts as needed
• Possible medications prescribed by oral medicine specialists (e.g., Betamethasone)
• Malignant transformation possible, approximately 1%

Importance of Thorough Examination

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

Activity - Soft Tissue Lesions

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

Reflect

• 3 things learnt
• 3 things known
• 3 things would like to know

This quiz covers essential aspects of oral and dental sciences focusing on soft tissue diseases. Topics include the aetiology, pathogenesis, and clinical examination techniques necessary for diagnosing and treating oral diseases. Understanding the significance of comprehensive patient history and follow-up care is also emphasized.