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News Bulletin : ADA News Bulletin September 2011
18 SePtember 2011 Oral mucosal lesions WHAT SHOULD i DO? committee report There are numerous different lesions that can occur in the oral cavity requiring different treatments. It is impossible for dentists to know every type and all suitable treatments. Furthermore, in many cases a diagnosis can only be established via histological diagnosis. Therefore, it is important to have a practical approach to handling oral lesions, whether they are discovered during a routine examination or are the reason for the consultation. In the majority of cases when patients visit the surgery regarding a lesion, it is because they are experiencing symptoms, mostly soreness or irritation. In many cases this is caused by inflammation, with or without infection. TYPICAL CASES The minor aphtous lesion is a typical example of a sore lesion without infection (Fig 1). It occurs spontaneously and is associated with different sorts of stress. Usually, it presents as localised erosion, with red surface in level and is quite painful. They can be single or multiple. Patients often report that eating makes it more painful. Treatment is symptomatic, topical application of anaesthetic preparations will give some relief, as will avoiding spicy or acidic food. These lesions usually heal after two weeks. An example of a sore lesion with infection is thrush. It is characterised by whitish grey surface alterations which can be removed and the exposed red surface underneath will often bleed. A common reason for this infection is antibiotic treatment causing a shift of the oral mucosal flora, leading to suppression of bacterial colonisation and growth of local fungal organisms. Another typical cause is denture stomatitis, where fungal growth is facilitated in deposits on the denture. A swab would show candida infection, and treatment is typically local with antimycotica such as Nystatin. In case of denture stomatitis, the treatment would have to include the denture with removal of any deposits and antimicrobial treatment, commonly performed with Milton’s solution. In both cases outlined above, the lesions should subside and finally disappear within a limited time. If not, further investigation will be needed. Therefore, a very useful rule is that any lesion that has not disappeared after six weeks should be investigated further, which in most cases would require a biopsy. Other types of lesions can be discovered during routine examination. They are not usually painful and, in most cases, patients are not able to tell you how long the lesion has been there for as they were not aware of it. This makes for a different situation and dentists have to rely more on the clinical picture than history to decide upon further treatment indication. Experience in this field will lead the practitioner in the right direction. Any lesion that can be clearly identified and classified as harmless can be handled in the surgery. A typical example would be a fibroepithelial polyp on the cheek, a very common lesion resulting from biting trauma (Fig 2). In many cases, patients are not aware of these lesions if they do not repeatedly bite them. If this is the case, the surface of those polyps usually presents as normal mucosa and you can easily decide to monitor the clinical course. If nothing changes, the lesions can be followed up without any treatment. Fig 1. Minor aphtous lesions lower lip. Fig 2. Fibroepithelial polyp with hyperkeratinisation.
ADA News Bulletin August 2011
ADA News Bulletin October 2011