View
3
Download
0
Category
Preview:
Citation preview
Examination of the Oral Cavity
Eric T. Stoopler, D.M.D., FDSRCS, FDSRCPSProfessor of Oral Medicine
University of Pennsylvania School of Dental MedicineAttending, Division of Oral Medicine
University of Pennsylvania Health Systemets@upenn.edu
www.aaom.com
Disclosures
• Employment, University of Pennsylvania
• Executive Committee, American Academy of Oral Medicine
• Board of Trustees, American Academy of Oral Medicine
• Textbook preparation, Elsevier, Inc.
• Monograph preparation, Metropolitan Life Insurance Co.
• Course Director, Coursera Online Learning Platform
• Honoraria, Continuing Education
• Become familiar with intraoral and extraoral examination
techniques
• Describe how to document lesions of the oral cavity
• Generate an appropriate differential and working diagnosis
www.cancer.gov
Bruch JM, Treister NS. Eds. Clinical Oral Medicine and Pathology, 2nd Ed., Springer, 2017 Yasney JS, et al. Mt Sinai J Med 2012
• 60% of total mucosa
• Non-keratinized
• Lips, cheeks, alveolar
mucosa, ventral tongue,
floor-of-mouth, soft palate • 25% of total mucosa
• Keratinized
• Gingiva, hard palate
• 15% of total mucosa
• Papillae
• Dorsal tongueCruchley AT, Bergmeier LA. Structure and Functions of the Oral Mucosa. In: L.A. Bergmeier (ed.),
Oral Mucosa in Health and Disease, Springer International Publishing, 2018
Documentation of Oral Lesion(s)
A. Site
• Exact anatomical site(s) the lesion occupies
• Avoid colloquial / layman’s terms
• Ex: Right posterior lateral border of the tongue
Kahn MA, Hall JA (eds.), The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
Documentation of Oral Lesion(s)
B. Morphology
Blisterform – contains fluid
• Vesicle - < 0.5cm
– serum / mucin
• Bulla - > 0.5cm;
– serum / mucin / blood
• Pustule – any size
– contains purulent exudate
Nonblisterform - solid
• Papule - < 0.5cm
• Nodule – 0.5cm - < 2cm
– Sessile – broad-based
– Pedunculated – stalk
• Tumor - > 2cm
• Plaque - > 0.5cm
– “pasted on”
Elevated – surface is above the normal plane of mucosa
Kahn MA, Hall JA (eds.), The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
Documentation of Oral Lesion(s)
B. Morphology
Ulcer
• Number: solitary v. multiple (separate vs. coalesced)
• Outline: regular v. irregular
• Margins: raised v. smooth
• Depth: superficial v. deep
• Diameter: 0.5cm (< or >)
• Scarring / atrophy / pitting / pouching may be present
Depressed – surface is below the normal plane of mucosa
Kahn MA, Hall JA (eds.), The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
Documentation of Oral Lesion(s)
B. Morphology
Macule / Patch (except dorsolateral tongue)
Flat lesion of abnormal color
Macule: < 1.0 cm
Patch: > 1.0 cm
Dorsolateral tongue (Depapillation)
Mimics depressed lesion
Flat – surface is level with the normal plane of mucosa
Kahn MA, Hall JA (eds.), The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
Documentation of Oral Lesion(s)
C. Color
• White
• Pink
• Red
• Red and white
• Blue
• Purple
• Gray
• Yellow
• Brown
• Black
• Translucent
Kahn MA, Hall JA (eds.), The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
Documentation of Oral Lesion(s)
D. Size
• Measured by greatest
dimension in length and
width
• Expressed in metric units
(e.g. cm)
E. Consistency
• Fixed
• Freely moveable
• Indurated
• Firm, doughy, rubbery
• Soft
• Fluid, fluctuant, rebounding
Kahn MA, Hall JA (eds.), The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
Differential Diagnosis
• Generated by patient history and physical exam findings
• Most likely dx (working dx)→ least likely dx
• Definitive dx (diagnostic test results + clinical exam findings)
• Dx algorithms
– Etiology (e.g. infectious vs. immune-mediated)
– Clinical appearance (e.g. white vs. red)
– Location (e.g. tongue vs. hard palate)
– Clinical behavior (e.g. localized acute vs. multiple chronic)
Idahosa CN, Kerr AR. Clinical Evaluation of Oral Diseases. In: Contemporary Oral Medicine, 2017
Idahosa CN, Kerr AR. Clinical Evaluation of Oral Diseases. In: Contemporary Oral Medicine, 2017
Clin
ica
l Ap
pe
ara
nce D
iffere
ntia
l Dx
The Concise Oral Examination
www.nidcr.nih.gov
Conclusions
• Develop a consistent approach to physical examination
• Appropriately document lesions of the oral cavity
• Develop an appropriate differential and working diagnosis
based on medical history and physical examination
findings
Thank You
• www.cancer.gov
• Bruch JM, Treister NS. Eds. Normal anatomy. In: Clinical Oral Medicine and Pathology, 2nd Ed., Springer, 2017
• Yasney JS, Herlich A. Perioperative dental evaluation. Mt Sinai J Med 2012; 79: 34-45.
• Cruchley AT, Bergmeier LA. Structure and Functions of the Oral Mucosa. In: L.A. Bergmeier(ed.), Oral Mucosa in Health and Disease, Springer International Publishing, 2018
• Kahn MA, Hall JA (eds.), Soft Tissue Head and Neck Pathology: Description and Documentation. In: The ADA Practical Guide to Soft Tissue Oral Disease (2nd Ed.); John Wiley and Sons, 2018.
• Idahosa CN, Kerr AR. Clinical Evaluation of Oral Diseases. In: Farah CS, et al. (eds.) Contemporary Oral Medicine; Springer International Publishing AG 2017; DOI 10.1007/978-3-319-28100-1_3-1.
• www.nidcr.nih.gov
References
Recommended