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.