April 24, 2007
I can't say I've really seen any lesions in the mouth this year. Good for the patients, bad for me! What I have seen is a palatal torus, madibular tori, and linea alba. I've actually seen linea alba a few times. Most of the time it was bilaterl and very obvious. I made the patient aware and showed them the "marks" on their cheeks that was due to cheek biting. There isn't much you can do for it besides stop biting you cheeks. For the mandibular tori and the palatal torus, the patient was already aware. There isn't anything you can do about it besides get it removed if it bothers you, otherwise, it isn't harmful. Surprisingly, I've seen this in a few people and it was kind of exciting because I didn't think I'd see it in many when we first leared about it!
April 19, 2007
The only oral pathology I have seen this semester in clinic was a teenager with noctine stomatits, which was located on the hard palate. I wasn't sure what it was when I saw it, it looked like there was just a white coating on the palate with a bunch of little red dots. After looking at the extra-oral exam form, and being told by her dental student, I realized it was nicotine stomatits. Her dental student pulled me aside and asked me to really try and put an important emphasis on tobacco cessation since she was so young, and this was already developing. He said he has been trying for two years, but hoped that being a female, and someone new I might be able to change her mind. She was very open and willing to listen to what I had to say and said it was something to consider but that it wasn't the right time. It really makes you wonder what the right time would be..
April 18, 2007
The only oral pathology that I've witnessed in clinic was an atypical dysplasia. During the first week of clinic I was performing my intra-oral exam on a lady who was my first patient. As I began to palpate the lower lip for abnormalities, I noticed an area that was located inside the mouth near the labial commissure. The lesion was raised and viewed as a wart. When my instructor performed the oral exam check, I mentioned this area and her reply was it’s a growth that developed from the patient grinding her teeth at night. I noted this on the blue form for further evaluations and asked the patient did she have any questions or concerns with the lesion. Her reply was no and that she had the lesion examined by a specialist who stated she could keep it or leave it.
April 17, 2007
So my dad was patient and while I was cleaning (I do not know how I did not catch this during the oe) I found red, raised lesions under his tongue. I went into a total panic!! I measured it, it was 3 by 5 mm, and got dawn over to check it out. I thought for sure my dad had oral cancer and they were going to have to remove his jaw and peel back his face and he was going to look like the people in the pictures we saw in specialties! turns out, it was broken blood vessels!! which made me feel completely stupid, but that was the only abnormality I found in any of my patients mouth. I think I scared my dad too, which I hopefully I won't do to patients that I do not know.
April 16, 2007
I had a patient with a white lesion in the dorsal surface of his tongue. My instructor was scared it might be oral cancer and had a specialist come over and take a look at it. The specialist dug at the lesion to see if it went below the surface papilla, if it did then the patient had cancer. It was not cancer! The patient had bit himself while playing hockey a few years ago, leaving a white 3x4mm flat lesion on right side of his tongue. I am happy that not all suspicious spots in the oral cavity is cancer.
April 15, 2007
On two occasions I have seen draining fistulas. In both cases, the patient was aware of the problem before the examination. Each of these patients had been told by their dental student that a fistula was likely to form due to existing infection in the tooth. Each of these patients decided to wait until the problem worsened to take action due to finances. Neither of the patients reported any pain associated with the infection or fistula. On examination, the gingiva appeared red and quite shiny. There was a raised area that came to almost a point where in one case there appeared to be a white mass or "head". In the other case there was a little whole (pin like). One of the patients opted to have the tooth in question extracted a few days later, and was put on an antibiotic in the mean time. The other patient decided to wait it out, and the dental student did not put this patient on antibiotics due to the unknown time frame.
Sorry left a few things out on the last blog....
I forgot to describe how my bite marks and sores on the tongue looked. The bite marks looked like a little sore almost that kind of protruded out the side of the cheek. It was a pinkish almost white in color. The sores that I have seen on patients tongues were like a big circle outline that was many different colors from the rest of the tongue. It looked very painful. I just wanted to describe in more detail about the things that I saw because I forgot to do that in my last blog for oral pathology.
April 14, 2007
Oral Lesion- Fistula
I had a patient that reported having months of periodic discomfort with tooth #14. Aside from coming in for a cleaning, this was a chief concern she had, just wanting to know if there was a reason for her concern. As I did her oral exam, I paid careful attention to that area of her mouth, looking for any signs that might be associated and explain the discomfort she had been experiencing.
This is when I saw for the first time... a draining fistula. Her tooth #14 had some broken down restorations and we predicted that it was infected. To confirm our findings we had Dr. Richards come over to take a look and he continued with a consultation of the patient's options- either extraction or a root canal.
Fistulas are openings on the gingiva or oral mucosa, a passage that leads from an abscess, to drain the pus discharge from an infected tooth. This fistula had a white circling of pus and was about 2mm x 2mm. It was located on the buccal mucosa adjacent to tooth #14.
As we've talked about in Mrs. Kerschbaum's, "Head & Neck Anatomy" course, the body works in amazing ways! The fistula is created by the body, as a self-regulation of pain! Without the formation of a fistula, drainage from an abscessed tooth would continue to build up and cause considerable pain! The fistula allows a passageway for drainage.
April 12, 2007
Remember to carefully look through your patient's history. One of my patients was in a bad car accident and had to have major reconstructive surgery on her maxilla. Looking at her face you wouldn't be able to tell she was had the operation, but the gingiva above her maxillary anteriors had an irregular texture and markings. This was obviously due to the surgery, but I was unsure until I found a note about it in her medical history.
April 10, 2007
Findings in clinic
I have not had a patient yet that has had a lesion in their mouth but I have had many patients with bite marks around the cheek area. I think a lot of people tend to bite on their cheeks and not even notice that they are doing it. I know I do that all the time. It is always good to notice these findings in clinic and document them so next time they come back in you can check to see if it healed up. If not you know you should take further action to see what is going on. I am sure you would do the same thing for a lesion to make sure it is not serious.
I have also seen sore spots or little sores on the dorsal of the tongue area. It has been from a burn to a painful cold sore on the tongue. These areas are all things that I take a close look at and make sure I point them out to my instructor for the health of my patient.
I actually thought I found a lesion one time but it was just food that my patient ate for lunch that day. Ha Ha I had to laugh at myself.
April 09, 2007
Something that I have seen in clinic this semester is herpes on the hard and soft palate. It looked like raised redish/purple bumps, in small multiple patches. However I was told that usually herpes presents in larger patches. These patches had uneven edges and ranged from 3mm to about 6mm they were soft and the patient didn't even realize that he had a problem. The patches were on the hard and soft palate but did extend down the palatalglossal arch to the uvula. This was one thing that helped rule out trauma from his denture because the redish/purple bumps went beyond his denture. One thing to remember is if the patient does have herpes present do not work on the patient because you may spread it around on the patient.
When I think of oral lesions the first thing that comes to mind is a fistula. The patient developed a fistula that was about 3x3mm located just parallel and anterior to the apex of one of her mandibular canines. It was kind of gross, but at the same time fascinating! The body naturally created a pathway for the release of infection. The infection exiting was not great to look at....pretty much just a creamy whitish yellow pus that oozed out.... : O ......Cool, huh?? lol.
April 08, 2007
I had an elderly gentlemen with a fistula. It was roughly 7-8mm long and located on the mucosa surface of the mandibular anterior teeth. It was between #23 and #24. it was whitish-yellow with yellow drainage (exudate). A fistula is the permissible drainage from an abscess. My patient reported that he has had it for a couple of years and it does not hurt. However, the oral pathology doctor said "if it was contained, it would hurt severely".
April 04, 2007
After reviewing many patients, the most interesting and unusual oral lesion that I have found was on a female patient that had a varicosity on the area between her mandibular lip and labial mucosa. It was a circular bluish red lesion. It was approximately 4mm in diameter. The lesion looked like a varicose vein located on the patients lip. When asked, the patient replied that it was not painful and has had the lesion for many years. The lesion can be due to systemic health but do not necessarily have a direct relation with systemic conditions.
I had two female patients that had Oral Lichen Planus. Lichen planus is an inflammatory disease of the skin and mouth. It is commonly seen inside of the cheeks, but also effects the lips, tongue and the gums. My first patient had lichen planus on her gums and my second patient had it on her cheeks and around her tounge. It looks like fine white lines and sometimes white dots as well. My patients told me that it is very painful when it gets inflammed. They do not know what causes it and it occurs randomly.
When their lichen planus does act up, the places in the oral cavity where it is found becomes very red. For example, one patient of mine had extremely red gingiva, but it wasn't painful. The other patient told me she gets sores because of her lichen planus and it is extremely painful. None of my patients took medication for their lichen planus, but medication is available to reduce the sores and the pain. There is no cure for lichen planus and all you can do is make sure your patient is comfortable and avoid touching those areas during treatment.
April 03, 2007
Lesions in clinic
Along with everyone else's entry that I have read, the most exciting lesion for me has been a wonderful cheek bite and if I'm lucky - some linea alba. Sort of a random fact about the linea alba and cheek bites I have seen, is that a good majority of the patients have them on their left buccal mucosa - or is more prominent on this side.
Another thing I observed in MDENT last week wasn't so much a lesion, but just a very interesting couple of things going on with the patient. I observed black-line stain on the lingual of just about all of her teeth, which was something that looked odd to me. Her teeth were very white and from the front, looked excellent! Also, with this same patient, she had a burn trauma from when she had eaten or drank something hot a while ago. It was on the facial gingiva above #9 and 10. When the student I was observing asked her if she had recently burned herself, the patient replied "No, that was forever ago! I can't believe you can still see that!"
April 01, 2007
My first couple weeks into seeing patients I experienced a patient who wore a partial denture on the mandibular posterior teeth. During my extra oral exam I noticed what looked like a white/red lesion on the surface of the gingiva where the denture is sitting. After having a clinic instructor take a look we both agreed it would be a great idea for Dr. Brooks to take a look! Dr Brooks examined the white area and after questioning the patient on his oral habits diagnosed the lesion as an irritation from eating hot potato chips. The patient noted that he will continue eating those chips because he loves them and will deal with a little bit of irritation on the gingiva.
A week and a half ago in clinic I had a patient with a unilateral oral lesion located anteriorly on the lateral border of the left-side of her tongue. I did not have to guess what caused this lesion because the patient informed me before she even opened her mouth for the exam that she had biten her tongue. The lesion was white and slightly raised and reminded me of a canker sore. It had an oval shape with smooth edges and the surrounding tissue was red and inflamed. After locating the lesion, I used my probe to measure it and it was 3 x 3 mm. The lesion looked painful and the patient confirmed that it was! Due to its location, it was continually being irritated when she talked or ate.
March 31, 2007
Clinic as far as oral lesions has not been too exciting which is a good thing for my patients but as far as experience for me is bad. The closest thing I have seen to a "lesion" was a simple cheekbite. It was on the right buccal mucosa and ranged from the canine area to the 2nd molar. It looked as though it was not new and seemed to be healing. It resembled a dotted line only a deep red color almost like someone took a needle and took stabs at the cheek. The patient recalls doing it but said it did not hurt or anything. It is always interesting when you get your first look into your patients mouth because you never know what you will find.
March 30, 2007
I have not witnessed any oral lesions or serious oral conditions. What I did see a couple weeks ago was an amalgam tattoo. It was pretty cool, what it looked like was a shaded area of gray on the gingiva close by the amalgam on that tooth. At first when I saw it I was scared that it was something serious. Then Ms. Esch explained to me what an amalgam tattoo is. Last week, I was doing an intraoral exam on the tongue and I saw enlarged circles on the side of the tongue and I got very nervous and scared. What it ended up being was enlarged foliate papillae.
March 29, 2007
I really have not seen any lesions either. I saw a small one today that was located just ligual to tooth #13. It was on the attached gingiva near #13. It was approximately 1mm by 1mm, circular in shape, and white in color. It had a flat texture.
That is the only lesion I have seen in clinic. Luckily for my patients that I have seen, there were no others to observe.
The Exciting Lesions of Clinic :)
During my clinic experiences I have not seen any very unusual lesions. (Which for my patients sake, is good news.) I have seen a rather large cheek bite though, it was approximately 4-5 mm in diameter. When I asked the patient how it happened they said they were chewing gum, and their cheek just got in the way. The lesion was on the left mandibular buccal mucosa. This lesion was oval in shape and more red then the rest of the cheek. The patient said it hurt at first, but only hurts now when something touches it. The lesion looked almost rough, but the mucosa was soft when I touched it. I instructed the patient that if the lesion did not heal within 2-3 weeks then contact their dental student to have it checked again.
Oral Lesion found in clinic...
Two weeks ago, I was helping a dental student out with a treatment plan for a patient that I would be seeing. Not only did I learn a lot from this student but we also found an interesting lesion in the mouth! The lesion was located under the tongue near the salivary caruncle on the left side. It looked like a little cyst, and it is called a ranula, I believe it can also be called a mucoecele, which is something we had just learned about in Head and Neck Anatomy-- so I even had a some what of an idea about what it was! We called oral medicine up to make sure we had the diagnosis correct. This wasn't a big problem, just something we noted in the chart and will keep an eye on at future appointments; also if the patient experiences any pain associated with it. The patient was surprised to see what we had found because it wasn't bothering him at all and he never noticed it; but we got out the mirror and showed him and told him all about what it was. I recently saw this patient yesterday for his cleaning, and I checked on the lesion and measured it because that was something we hadn't done at the treatment plan, it was about 5-6mm. in diameter. The patient reported no pain. When I showed me instructor, she said it wouldn't hurt just to have it removed, so that is something the patient will consider while getting his extractions in the near future. I also think that this was another contributing factor to the patient's dry mouth!
My oral condition
So far in clinic, I haven't really experienced any oral lesion thats too exciting. I have seen linea alba. It was white, went from the start of the tissue on the buccal and extended until the last molars in the mouth. It was flat, but had a little roughness/texture to it. The patient admitted that they bite their cheek every now and then, but reported no pain with it. I've also seen my share or mandibular and maxillary tori. I found some on the right side under the tongue and it was hard, bumpy, raised, and the color of the tissue and the patient had no pain. For the maxillary tori, it was pretty much the same. It looked like a thin rod that ran from a little past the palatine rugae to the soft palate. It was hard, raised, the color of the tissue and once again caused no pain to the patient.
A lesion observed in clinic
So far in clinic I have not observed any lesion that was too exciting or interesting. The only thing that I have encountered is the occasional cheek bite. One cheek bite that I saw was towards the back of the cheek on the left side near where the 2nd molars come together. This was a pretty small bite, there were a few red spots that were about the size of the head of a pin. The area was a dark red color and had the same consistency as the cheek itself. It was a little rough when I felt it with my finger. The lesion was just slightly raised. It was only located on the left side of the mouth. The patient did not report any pain. He didn't even know that it was there until I mentioned something to him about it. I asked him if he noticed himself biting his cheeks lately and he said no. I also asked if there was any added stress in him life that might cause him to bite his cheeks and he said there was none that he could think of.