Basic Disease ProcessesBasic Disease Processes

Etiology Etiology (Cause ex.mycobact. Tuberc.)(Cause ex.mycobact. Tuberc.)

Clinical Features Clinical Features ((Signs and SymptomsSigns and Symptoms))Fever, cough, sputum, abnormal xrayFever, cough, sputum, abnormal xray

PathogenesisPathogenesis`̀

))Mechanisms:inflammationMechanisms:inflammation((

SignsSigns of Disesaseof Disesase

Measurable / ObservableMeasurable / Observable

Examples: Fever, Bleeding, Examples: Fever, Bleeding, “Lesions“Lesions””

““LesionsLesions””Clinical Area of Abnormality Associated Clinical Area of Abnormality Associated

with Disease / Disease Processwith Disease / Disease Process

SymptomsSymptoms of Diseaseof Disease

SubjectiveSubjective

Example: Pain, ParesthesiaExample: Pain, Paresthesia

Basic Disease ProcessesBasic Disease ProcessesPathogenetic MechanismsPathogenetic Mechanisms

- M I N D- M I N D- - M M etabolic - etabolic - Hormonal; NutritionalHormonal; Nutritional

Example: Diabetes MellitusExample: Diabetes Mellitus

I I nflammatory - nflammatory - Infection, ImmunologicInfection, ImmunologicExamples: Tuberculosis, PemphigusExamples: Tuberculosis, Pemphigus

N N eoplastic - eoplastic - Any Neoplasm, Benign or MalignantAny Neoplasm, Benign or MalignantExamples: Papilloma, Squamous Cell CarcinomaExamples: Papilloma, Squamous Cell Carcinoma

D D evelopmental - evelopmental - Genetic or Acquired MalformationGenetic or Acquired Malformation

Example: Mandibular TorusExample: Mandibular Torus

Evaluation and Characterization of Evaluation and Characterization of Soft Tissue Soft Tissue “Lesions“Lesions””

11.. TypeType of “Lesion of “Lesion””

22.. ColorColor of “Lesion” of “Lesion” (Be Specific)(Be Specific)

33.. Surface CharacteristicsSurface Characteristics of “Lesion of “Lesion””

44.. Palpable FeaturesPalpable Features of “Lesions of “Lesions””

55.. AttachmentAttachment of “Lesions of “Lesions””ALSO NOTEALSO NOTE::

11.. Size (in mm. or cm. or compared to known object - Size (in mm. or cm. or compared to known object - “dime-sized” or “dime-sized” or “grape sized”)“grape sized”)

22.. Specific Location of Lesion Specific Location of Lesion (Using Oral Togography)(Using Oral Togography)

33.. Number of lesions (if more than one)Number of lesions (if more than one)ANDAND::

11 . .History : Duration and Changes and Rate of ChangesHistory : Duration and Changes and Rate of Changes

22 . .Symptoms: Asymptomatic (ASX), Pain, TendernessSymptoms: Asymptomatic (ASX), Pain, Tenderness

TypesTypes of “Lesions of “Lesions””FLAT LESIONSFLAT LESIONS

MaculeMacule

PlaquePlaque

UlcerUlcerSwellings (Solid Tissue)Swellings (Solid Tissue)

PapulePapule

NoduleNodule

TumorTumorSwellings (Fluid-Filled)Swellings (Fluid-Filled)

VesicleVesicle

BullaBulla

Pustule/AbscessPustule/Abscess

CystCystCombinations of TypesCombinations of Types

plaque

nodule

cyst

FLAT FLAT LESIONSLESIONS

MaculeMacule

PlaquePlaque

UlcerUlcer

TYPE - TYPE - MaculeMaculeA flat lesion - color change A flat lesion - color change ONLY - ONLY - Not paplable at allNot paplable at all!! !!

When examining Indicate When examining Indicate Specific ColorSpecific Color

This This maculemacule is an is an Amalgam Tattoo Amalgam Tattoo

Description: A Single 8x10 mm. Bluish-Grey pigmented maculeof the left mandibular buccal edentulous alveolar ridge mucosa (missing #19 area)

8 mm.

10 mm.

TYPE - TYPE - PlaquePlaqueA flat and slightly raised lesion: palpableA flat and slightly raised lesion: palpable

Some may be Wiped OffSome may be Wiped Off

Usually whiteUsually white

Often a thickening of the keratin surfaceOften a thickening of the keratin surface

ThisThis plaque plaque is a “pre-cancerous” is a “pre-cancerous” epithelial epithelial dysplasiadysplasia

Description: A single 8x12 mm. irregular shaped rough surfaced leukoplakia (non-wipable white plaque) of the right lateral tongue.

TYPE - TYPE - UlcerUlcerLocalized area of Localized area of complete loss of surface epitheliumcomplete loss of surface epithelium

Crusted/Scabbed on skin - Pseudomembrane intraorallyCrusted/Scabbed on skin - Pseudomembrane intraorally

Often PainfulOften Painful

May be result of trauma, infection, cancer or other diseaseMay be result of trauma, infection, cancer or other diseaseThese two These two ulcersulcers are are “Canker Sores / Aphthous Ulcers“Canker Sores / Aphthous Ulcers””

Pseudomembrane overlyingPseudomembrane overlyingExposed Connective TissueExposed Connective Tissue

TYPE - TYPE - Ulcer / Other ExamplesUlcer / Other Examples

Both of these lesions areBoth of these lesions areSquamous Cell CarcinomasSquamous Cell Carcinomas

SWELLINGS SWELLINGS (Solid Tissue)(Solid Tissue)Categorized by SizeCategorized by Size

PapulePapule~~1-21-2 mmmm

NoduleNodule < <11 cmcm

TumorTumor > >11 cmcm

Papule Papule (Solid Tissue Swelling)(Solid Tissue Swelling)

Small (1-2 mm) Swelling of Solid TissueSmall (1-2 mm) Swelling of Solid Tissue

These These PapulesPapules are are Fordyce GranulesFordyce Granules (Ectopic Sebaceous Glands)(Ectopic Sebaceous Glands)

Nodule Nodule (Solid Tissue Swelling)(Solid Tissue Swelling)““Larger” ( up to 1 cm.) Swelling of Solid TissueLarger” ( up to 1 cm.) Swelling of Solid Tissue

May be Hyperplasia, benign of malignant neoplasmMay be Hyperplasia, benign of malignant neoplasm

This This NoduleNodule is Hyperplasia - is Hyperplasia - “Pyogenic Granuloma“Pyogenic Granuloma””

Tumor Tumor (Solid Tissue Swelling)(Solid Tissue Swelling)

Larger still (< 1 cm) Swelling of Solid TissueLarger still (< 1 cm) Swelling of Solid Tissue

May be Hyperplasia or Neoplasm of Epithelium or of May be Hyperplasia or Neoplasm of Epithelium or of Connective TissueConnective Tissue

This This TumorTumor is a Benign Neoplasm of Accessory is a Benign Neoplasm of Accessory Salivary Gland Origin - a Salivary Gland Origin - a Pleomorphic AdenomaPleomorphic Adenoma

TYPE - Vesicle TYPE - Vesicle (Fluid Filled (Fluid Filled Swelling)Swelling)

Intraepithelial Fluid

““Small” > 2 mm. Blister Small” > 2 mm. Blister (Fluid Filled (Fluid Filled and Intraepithelial)and Intraepithelial)

Most commonly the result of viral Most commonly the result of viral (Herpes) infection or allergy(Herpes) infection or allergy

These These VesiclesVesicles are due to are due to Recurrent Recurrent Herpes simples infectionHerpes simples infection

TYPE - Bulla TYPE - Bulla (Fluid Filled Swelling)(Fluid Filled Swelling)

Intraepithelial Fluid

““Large” Blister - Large” Blister - Fluid Filled and Fluid Filled and IntraepithelialIntraepithelial

Usually Immunopathic Disease - Usually Immunopathic Disease - Pemphigus, etcPemphigus, etc..

This This BullaBulla is the result of is the result of Pemphigus Pemphigus VulgarisVulgaris

Collapsed Bulla (Ruptured and Fluid has Escaped)

Residual Ulcers

TYPE - Cyst TYPE - Cyst (Fluid Filled Swelling)(Fluid Filled Swelling)

Fluid

Epithelial Lining

Cyst

Pathologic Cavity / SpacePathologic Cavity / Space

Lined by EpitheliumLined by Epithelium

Usually Filled with FluidUsually Filled with Fluid

Swelling in soft tissue -Radiolucency in Swelling in soft tissue -Radiolucency in JawsJaws

This This CystCyst is a is a Mucous Retention CystMucous Retention Cyst

Fluid

Epithelial Lining

Surface CharacteristicsSurface Characteristics of “Lesions of “Lesions””

SmoothSmooth

Papillary / Papillary / VerrucousVerrucous

UlceratedUlcerated

Smooth

VerrucousPapillary

Ulcerated

SmoooooothSmooooooth

PapillaryPapillary

UlceratedUlceratedLoss of Area of Surface EpitheliumLoss of Area of Surface Epithelium

Ulcerated

Palpable CharacteristicsPalpable Characteristics of “Lesions of “Lesions””

CompressibleCompressibleFluctuantFluctuant

Pressure Displaces FluidPressure Displaces FluidSoft Soft (Solid Tissue)(Solid Tissue)Firm Firm (Solid Tissue)(Solid Tissue)

HardHardIndurated Indurated (Usually applies (Usually applies

to Malignancy)to Malignancy)Bony Bony (Hard as Bone)(Hard as Bone)

Fluctuant

Indurated

Fluid

AttachmentAttachment of “Lesions” of “Lesions”- Soft Tissue Masses- Soft Tissue Masses- -

AttachmentAttachmentPedunculatedPedunculated

Attached by a Attached by a Narrow StalkNarrow Stalk

SessileSessileAttached by a Attached by a Broad BaseBroad Base

PalpationPalpationMovableMovable

FixedFixed

Pedunculated

Sessile

Movable

Fixed

PedunculatedPedunculatedAttached by a Narrow StalkAttached by a Narrow Stalk

Pedunculated

SessileSessileAttached to Normal Tissue by a Broad Attached to Normal Tissue by a Broad

BaseBase

Sessile

ORAL “CANCER”ORAL “CANCER”- Any Malignant Neoplasm- Any Malignant Neoplasm

--

96%96%“ “ Carcinoma” (Epithelial)Carcinoma” (Epithelial)

91%91%“ “ Squamous Cell CarcinomaSquamous Cell Carcinoma

ORAL CANCERORAL CANCERSquamous Cell CarcinomaSquamous Cell Carcinoma

Invasive Neoplasm of Malignant Squamous Epithelium

Malignant Squamous Cells Invading Muscle

Clinical Clinical Features Features

- Oral SCCA- Oral SCCA- - Leukoplakia - White Plaque

Erythroleukoplakia - Red and White Plaque

Ulcer with Crust / Scab

Tumor with Surface Ulcer

Erythroplakia - Red Plaque

ORAL CANCERORAL CANCER“TNM”“TNM” Classification Classification and Stagingand Staging

Primary Cancer - “T”“T”

Local Metastasis - “N”“N”

(Such as Lung)

(Regional LymphNodes)

ORAL CANCERORAL CANCERPre-Malignant LesionsPre-Malignant Lesions

“Pre-malignant” = Any Lesion with Increased Potential to Become Malignant

““Premalignant” LesionsPremalignant” Lesions ” ”

LeukoplakiaLeukoplakia8080 % % HyperkeratosisHyperkeratosis

Transformation ~ 6Transformation ~ 6% % 17-1917-19 % % DysplasiaDysplasia

Increased Transformation RiskIncreased Transformation Risk))1-31-3“ % “ % Early” SCCAEarly” SCCA((

Erythroplakia/ ErythroleukoplakiaErythroplakia/ Erythroleukoplakia8080 % + % + Dysplasia Dysplasia (or SCCA)(or SCCA)

Much Greater Risk of Cancer or Much Greater Risk of Cancer or TransformationTransformation

LeukoplakiaLeukoplakia

ErythroLeukoplakiaErythroLeukoplakia

ErythroplakiaErythroplakia