by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
News Bulletin : ADA News Bulletin June 2011
12 JUNE 20 11 and fungal ulcers are even less common. Viral ulcers are usually caused by herpes simplex virus1 which, when occurring intraorally, as opposed to cold sores or herpes labialis, are more likely to present on the attached mucosa covering the hard palate and gingiva (Fig 2). LOCALISED LUMPS OR SWELLINGS Many localised lumps or swellings that occur in the mouth are reactive lesions. They can occur in areas of the mouth subjected to mild trauma such as the buccal mucosa and form fibroepithelial polyps (Fig 3). Alternatively, pyogenic granulomas are another common localised swelling that occurs usually on the gingivae (Fig 4).3 These lesions are most often a reaction to local factors such as subgingival calculus or overhanging restorations. However, their development may also be related to hormonal changes, hence the fact that they can also present in pregnancy. Removal of the local aggravating factors can in some cases lead to resolution of the lesion or at least a reduction in size. Surgical removal of these lesions is sometimes necessary. WHITE AND RED PATCHES Alterations in the thickness of the epithelium or areas of inflammation can lead to white and red patches occurring on the oral mucosa. With respect to white patches, the aetiology can be varied and include such things as trauma, infections, mucocutaneous diseases (such as lichen planus) or even neoplastic disease. On the buccal mucosa, a white 'occlusal line' may be seen as a result of mild occlusal trauma in this area. In patients with a more enthusiastic bruxing or cheek biting habit more obvious reactive thickening of the epithelium may be seen (Fig 5). Fig 4. Pyogenic granuloma in the gingival interproximal area between lower central incisors. Fig 5. White patch on the buccal mucosa due to cheek biting. Fig 6. Candida infection on the soft palate in a patient undergoing radiotherapy. Fig 7. Oral squamous cell carcinoma on the lateral border of the tongue. It's important to rule out these reactive lesions from other aetiologies; clinical features of the lesion can be useful to help differentiate lesions, for example whether the white patch can be easily removed from the underlying mucosa may indicate a fungal infection, pseudomembranous candidosis (Fig 6). Alternatively, fixed white patches occurring in specific locations in the mouth such as the floor of mouth, retromolar area and ventrolateral aspect of the tongue may raise suspicion that the lesion may be neoplastic in nature. The definitive diagnosis in these lesions requires a biopsy and subsequent histological examination of the tissue.4 Likewise, red lesions in the mouth can also have a varied aetiology, including fungal infections and neoplasia. ORAL CANCER Oral cancer can have variable clinical presentations in the mouth, for example, as a non-healing ulcer, a lump, a white patch or as an area of redness (Fig 7). Obviously oral cancer, which in the majority of cases is a squamous cell carcinoma, is more common in 'high- risk sites' such as the floor of the mouth, the ventrolateral surface of the tongue and retromolar area. Also, oral cancer is more likely to occur in older patients who smoke and consume increased amounts of alcohol.5 However, like most things rules are made to be broken, and there have been a small group of patients without obvious identifiable risk factors who have been diagnosed with oral cancer.6 Fortunately, these patients are in the minority, but it pays to remember that any lesion in any patient that doesn't respond to treatment needs to be thoroughly investigated to ensure that serious pathology, such as oral cancer, does not inadvertently go untreated. CONCLUSION These examples are by no means all encompassing but rather illustrate the diversity of pathology that can occur in the mouth. It is always important for dentists to be aware of any soft tissue pathology. Examination of the oral soft tissues, as well as the dentition, should be a routine part of a patient's oral examination. As well as lesions that specifically occur in the mouth, oral pathology may be the first indication of systemic disease. With respect to oral cancer, whilst it is fortunately not seen every day in general dental practice, when patients do present with suspicious pathology, it needs to be accurately differentiated from other forms of pathology so that treatment delays do not occur and patients receive optimal treatment. Richard M Logan Associate Professor, Oral Pathology School of Dentistry, Faculty of Health Science, The University of Adelaide On behalf of the Oral Health Committee REFERENCES References supplied by the author are available on request from email@example.com committee report
ADA News Bulletin May 2011
ADA News Bulletin July 2011