DIFFERENTIAL

DIAGNOSIS
ORAL PATHOLOGY
By: Danielle Cowdrey
 PATIENT HISTORY
 26 year old • Dental History
 Male • Brushes 2-3 x per day

 Calculus II • Water flosses 1x per day

• Braces covering entire dentition
 Gingivitis
• Last dental cleaning 6mo ago
 Vital signs
 BP:118/72
• Social History
 R: 14 • Single
 P: 80 • College student
 T: 98.2 • Business management

 ASA I • Lives with 1 roommate

 Dental Anxiety

 Medication
 Multivitamin
 CLINICAL ASSESSMENT
 The lesion in question is a 2x2 mm, poorly-circumscribed and ulcerated located on the right buccal
mucosa, adjacent to buccal of tooth #2. The lesion is pallor in color with erythematous borders and feels
sore to the patient. The patient is unaware of when the lesion first appeared.
 COMPARISON OF CONDITIONS
Trauma Ulcer Squamous Cell Carcinoma Herpes Simplex Type I
Clinical Erythematous raised edges Area of leukoplakia or erythroplakia and Painful clusters of tiny vesicles that can
appearance with a yellowish-white may be exophytic or ulcerated. Often coalesce to form a single ulcer with an
necrotic pseudo membrane. indurated and firm with a rolled border. irregular border. Usually patients experience
prodromal symptoms of pain, burning or tingling in
the area the vesicle will develop .

Radiographic N/A Diffuse radiolucency with irregular borders N/A

appearance
Locations Within the oral cavity-most Within the oral cavity- most commonly on Vermillion border of the lips. Intraorally is
commonly on the tongue, lips, the floor of the mouth, ventrolateral tongue, seen on keratinized mucosa that is fixed to
buccal mucosa soft palate and tonsillar pillar. bone most commonly on the hard palate and
gingiva

Cause Traumatic source. Can be Changes to DNA. Predisposing factors HSV-1 viral transmission via contact with the
physical, chemical, thermal or include- smoking and drinking alcohol. virus in sores, saliva or surfaces in or around
electrical the mouth.

Treatment Remove irritant to allow for Surgical excision or surgical excision in Topical or systemic antiviral medications with
self-healing. Topical addition to radiation therapy, chemo therapy 48 hours of when symptoms begin (acyclovir,
corticosteroid or both. Docosanol etc.).

Prevalence Anyone Typically >40 yrs. old Adults (1/3 to 1/2 of the U.S. population)
 TRAUMA ULCER
 Reactive lesion

 Occur because of some sort of trauma including

physical, electrical, chemical or thermal.
 Most commonly found on the lips, tongue or
buccal mucosa
 Diagnosed clinically and on the basis of the
history to the lesion
 Healing usually occurs in 7-14 days unless the
trauma persist.
 Persistent trauma may result in a raised lesion –
traumatic granuloma. Clinically these lesions
resemble squamous cell carcinoma, therefore a
biopsy and microscopic evaluation is important.

TX PLAN
• Factors to consider when
presenting to the patient
• Dental Anxiety
• Orthodontic brackets
• History of lesion
• Building our relationship
• The next 2 weeks
 Inform the patient of the location, size, color
and shape of the lesion (Visually)
 Ask Questions
 Inform him of the possible diagnosis of
traumatic ulcer.
 Communicate about the options:
 Remove traumatic source by apply orthodontic
wax to the brackets on the UL molar regions
after brushing and flossing.
 Meticulous oral hygiene
 Monitor lesion for any changes
 If in 7-14 days, lesion does not heal or becomes
worse. Come back for re-evaluation (biopsy and
microscopic evaluation may be needed)
 Documentation
 Lesion description
 Conversation with the patient
 Chosen plan of action