Oral Pathology Diagnosis

Diagnostic Considerations

• Differentiate solitary ulcers from traumatic ulcers, aphthous ulcers, or squamous cell carcinoma.
• Key elements during patient history: P, Q, R, S, T.
  • P: Palliative factors affecting pain.
  • Q: Quality of pain description.
  • R: Region of pain.
  • S: Severity of pain intensity.
  • T: Temporal aspect of pain.

Clinical Examination Components

• Inspection: Assess sounds produced by tissues, noting joint noises (e.g., cracking, crepitation).
• Palpation: Evaluate tissue texture aiding in diagnosis.
• Olfaction: Identify diseases through smell such as periodontal disease or malignancies.
• Percussion: Technique to assess abnormalities in tissue or organ density.
• Auscultation: Listening for abnormal sounds, although less common in oral examinations.

Learning Resources

• Utilize the "Mini-Atlas" and "Oral and Maxillofacial Pathology" by Neville (5th edition) for comprehensive understanding.
• Review previous year's notes for potential exam topics, including lesion descriptions and correlations with pathological reports.

Primary Lesions

• Macule: Flat color change, can be any color.
• Papule: Slightly raised, no fluid, less than 5 mm.
• Plaque: Raised area bigger than 5 mm.
• Nodule: Raised tissue mass, larger than a papule, with depth.
• Tumefaction: Pathological volume increase without a palpable mass.
• Vesicle: Fluid-filled elevation, less than 5 mm in size.
• Bulla: Larger fluid-filled elevation, more than 5 mm in size.
• Pustule: Contains pus.
• Keratosis: White lesion from keratin buildup.

Secondary Lesions

• Erosion: Superficial tissue loss, does not involve the basal epithelial layer, usually no scar.
• Ulceration: Deeper loss of epithelial continuity, may scar.
• Fissure: Linear loss of continuity in epithelium.
• Pseudo-membrane: Mucous reaction from necrosis, often present in ulcers.
• Eschar: Tissue necrosis from thermal or chemical injury.
• Scales: Accumulation of cell fragments from the stratum corneum.
• Desquamation: Shedding of superficial epithelial cells.
• Crusts: Dried exudates on lesion surfaces.
• Scar: Fibrous tissue replacing lost tissue.

Demographic Data

• Age Influence:
  • Primary herpetic gingivostomatitis more common in children than adults.
  • Recurrent oral herpes more common in adults than children.
• Sex Influence:
  • Oral cancer and leukoplakias more prevalent in women than men.
  • Lichen planus more prevalent in men than women.
• Race Influence:
  • Cemento-osseous dysplasia more common in Black individuals.
  • Paget's disease and lupus erythematosus more common in White individuals.
• Anatomical Sites:
  • Oral cancer predominantly affects the floor of the mouth and lateral borders, less so the hard palate.
  • Hairy leukoplakia is more common laterally.
  • Fibroepithelial polyps often located on the cheek, while minor salivary gland tumors on the palate.

Prevalence and Comparison

• Lichen planus is more prevalent than lupus erythematosus.
• Leukoedema is more common than white spongy nevus.

Signs vs Symptoms

• Signs: Objective findings detectable by examination.
• Symptoms: Subjective experiences reported by the patient.

This quiz covers diagnostic considerations for differentiating various types of ulcers, including solitary and traumatic ulcers, aphthous ulcers, and squamous cell carcinoma. It also highlights key elements during patient history and the components of clinical examination, like inspection, palpation, and more. Prepare to test your knowledge on these essential oral pathology concepts.