Common Intraoral Findings

Hypoplasia (amelogenesis imperfecta; hypoplastic enamel)

- Under-developed tissue/organ that has a decreased number of cells

Lichen planus

-A benign, chronic disease affecting skin and oral mucosa -Characteristic pattern of interconnecting white lines and circles are seen on buccal mucosa -Most affected are nervous, high strung people with Hep C, over the age of 40, and women

Petechiae

-A minute red spot on the skin or mucous membrane caused by escape of a small amount of blood

Ecchymosis

-A small, flat hemorrhagic patch on skin or mucous membrane -Larger than petechiae

Sinus (sinus tract)

-Abnormal dilated channel or fistula that leads from a cyst or abscess to the surface of the skin -Example: channel that leads from tooth to a parulis

Hairy tongue

-Abnormal elongation of filiform papillae -Treated by cleansing the tongue

Macroglossia

-Abnormal enlarged tongue

Patch (amalgam tattoo)

-An area larger than a macule and differentiated from the surrounding area by color, texture, or both -More examples would be lichen planus or snuff-dippers patch

Palatal torus (torus palatinus)

-Bony swelling located in midline of the hard palate -Inherited, greater in women than in men

Mandibular tori

-Bony swelling on lingual aspect of mandible around the premolars -Hereditary, affects more women than men

Morsicatio buccarum

-Cheek biting/chewing -Raised white plaques on the side of the cheeks

Cyst (lateral periodontal cyst)

-Closed sac lined by epithelium in skin and bone -Caused by entrapment of epithelium

Nicotine stomatitis

-Cobblestone appearance on hard palate -Associated with smoking -Raised red dots seen at opening of minor salivary glands on palate

Clinical

-Describing symptoms or course of a disease -Usually symptoms you can see or from conditions observed through laboratory findings (blood tests, etc)

Subclinical

-Describing the presence of a disease without manifest (not being obvious) symptoms

Varicosity (lingual varicosities)

-Dilated veins frequently seen in the elderly (result of aging) -Caused by reduced elasticity of the vascular wall

Nonvital teeth

-Discolored brown/yellow/gray due to loss of pulpal fluid and darkening of dentin OR -Discolored pink due to escape of blood fluids into surrounding fluids

Normal tissue

-Doesn't deviate from the average

Tetracycline staining (intrinsic)

-Due to ingestion of the drug during tooth development -Chemically binds to dentin -Ranges from yellow, green, to dark gray -Permanent discoloration

Papule (fibroepithelial polyp)

-Elevated, solid lesion that is less than 1cm in diameter -Can be any color -Usually benign and slow growing

Enamel Hypoplasia

-Enamel that is decreased in quality -Occurs from a disturbance while enamel matrix is being laid down -Causes discolorations, pitting, and grooves

Hypertrophy

-Enlargement or overgrowth of cells, tissues, or organs

Pyogenic granuloma (pregnancy tumor)

-Excessive mass of young capillaries and fibroblasts (granulation tissue) -Painless but bleeds profusely when touched -Occur in people with poor hygiene OR in 1% of pregnant women -Treat with surgical excision

Macule (freckle)

-Flat area distinguished by color, usually blue, brown, or black -Usually 1cm or smaller

Nevus

-Flat or raised growth of cells in the epithelium or dermis of the skin -Commonly dark

Vesicle (herpes simplex)

-Fluid filled lesions less than 1cm in diameter -Can contain serous fluid or blood -Common in viral infections (highly infectious)

Drug-induced gingival hyperplasia

-Gingival enlargement that begins at the interdental papillae -Usually on facial aspects of anterior teeth -Pink and firm -Treated by changing drugs or surgical excision

Dentinogenesis imperfecta

-Hereditary disorder of faulty development of the dentin -Enamel is normal but chips off due to abnormal dentin -No treatment required unless requested for aesthetics

Amelogenesis imperfecta

-Hereditary disorder where teeth have thin enamel portions or no enamel at all -Crowns are yellow and made of dentin -No treatment required unless requested for aesthetics -Cavities usually not a problem

Scalloped tongue

-Indentation on lateral margins of the tongue

Pericoronitis

-Inflammation of soft tissue surrounding crown of a partially erupted or impacted tooth (usually 3rd molars) -Develops from bacterial contamination beneath operculum -Treated by extraction of the tooth

Angular cheilitis

-Inflammation of the corner of the mouth occurring in elderly persons, usually denture wearers -Caused by repeated pooling of saliva

Cheilitis

-Inflammation of the lip

Parulis aka fistula or gum boil

-Inflammatory response that occurs at the end point of a sinus tract -Soft, reddish papule, sometimes yellow in the center -Usually located apical to a chronically abscessed tooth

Tattoo

-Ink tattoo on the mucosa (see photo) -Amalgam tattoo is the entrapment of amalgam in the soft tissue (see photo for "Patch")

Geographic tongue

-Involves dorsal and lateral borders of the tongue -Scattered areas of shedding of filiform papillae -Unknown cause, may be due to stress

Ranula

-Large mucocele of the floor of the mouth -Caused by interruption of salivary flow of major salivary glands (submandibular and sublingual) -Caused by trauma

Hematoma

-Lesions that results from accumulation of blood within tissue due to trauma -Aka a bruise

Abrasion

-Loss of tooth structure caused by abnormal and repetitive wear -Most common form is toothbrush abrasion and causes dentin sensitivity

Erosion of tooth structure

-Loss of tooth structure due to chemicals

Abfraction

-Means "break away" -Loss of tooth structure at or under the CEJ caused by abnormal flexion of the tooth

Mucocele

-Mucous retention sac associated with minor salivary glands -Soft, bluish-gray, less than 1cm in diameter -Common on lower lip -Caused by trauma

Fissure

-Normal or abnormal cleft in the skin of the tongue, lips, or perioral tissue -Ranges from normal to disease

Fordyce's granules

-Oil glands in the mouth -Small yellow/white spots on buccal mucosa -Occur in 80% of adults

Intrinsic staining

-Permanent change in tooth color resulting from genetic or acquired factors that allow stains to be incorporated into the tooth structure

Atrophy

-Persistent conditions that lead to hypotrophy

Erythroplakia

-Persistent red patch that cannot be characterized clinically as any other condition

Erosion (chronic lemon sucking)

-Produces horizontal ridges

Hypotrophy

-Progressive/ongoing degeneration of an organ/tissue -Caused by loss in cell size

Nodule (fibroma)

-Raised solid mass less than 1cm in diameter that extends deeper into the dermis -Usually slow-growing

Linea alba

-Raised white line on buccal mucosa -Usually bilateral and cannot be rubbed off -Caused by bruxism or sucking side of cheeks

Candidiasis aka Thrush

-Result of an overgrowth of yeast-like fungus Candida albicans -Most common oral fungal infection -Appears as a white, curdy plaque than CAN be wiped off, leaving a red, raw, bleeding surface behind -Found on buccal mucosa, tongue, and soft palate

Fluorosis

-Results from too much fluoride in the drinking water -Ranges from white flecks and chalky areas to brown/black staining with surface pitting

Sialolith

-Salivary stone -Can obstruct salivary flow -Treated by surgical removal

Erosion of epithelium (erosive lichen planus)

-Shallow defect in the surface that does not extend through the epithelium into the underlying tissue -Usually occurs from trauma or broken vesicle

Solar cheilitis (actinic cheilosis/cheilitis)

-Skin changes on sun-exposed areas of the lips -Precancerous

Plaque (leukoplakia)

-Slightly raised area larger than 1cm in diameter -Irregular borders -Superficial -more examples are lichen planus or senile keratosis (liver spots) if keratinized

Ephelis (Freckle)

-Small, light to dark brown mucocele that appears on lips or skin after sun exposure

Tumor (squamous cell carcinoma)

-Solid mass of tissue larger than 1cm in diameter and extends into the dermis -Any color or location -Can be benign (slow growing with well defined borders) or malignant (rapid spread with ill-defined borders)

Ankyloglossia

-Tongue tied -Lingual frenum is fused to the floor of the mouth, ventral gingiva, or ventral tip of the tongue -Tongue cannot be extended or retracted

Tonsilloliths

-Tonsil stones -Bacteria, dead cells, and mucous trapped in tonsils that calcifies to form a white lump

Ulcer (lateral tongue)

-Trauma that is better defined than erosion -More examples are herpes simplex or chickenpox

Pustule (periodontal abscess)

-Vesicle filled with pus -Often seen as a parulis or "gum boil"

Bulla (bulbous lichen planus)

-Vesicle that exceeds 1cm -Another example is blisters from sunburns

Attrition

-Wearing away of tooth surface due to tooth-to-tooth contact

Leukoplakia

-White patch or plaque that cannot be scraped off or classified as any other disease

Hairy leukoplakia

-White raised folds on the lateral border of the tongue that do not rub off -Usually confined to people HIV+

Tobacco chewer's white lesion (Snuff dipper's patch)

-Wrinkled yellow-white area on buccal or labial mucosa -Often disappears when tobacco is no longer placed there -If it doesn't disappear, biopsy required