Differential diagnosis The differential diagnosis of oral lesions includes Behçet . The mean age wa 18.04 years (range, 6 days to 78 years) and about o . Failure to carry out differential diagnosis of severe periodontal lesions has resulted in the instigation of periodontal therapy for many lesions of non‐gingival origin. Differential diagnosis: The clinical features may be diagnostic of the typical reticular form of OLP. The clinical differential diagnosis most often includes other reactive lesions of the gingiva including pyogenic granuloma and peripheral giant cell granuloma. These lesions can be associated with chronic irritation, infections, or they can represent benign or malignant tumors that can either be primary or metastatic. vi. These lesions are clinically indistinguishable from pyogenic granulomas; however, on microscopic examination, the presence of multinucleated giant cells within the granulation tissue is diagnostic. The lesion does not respond to plaque control measures or root planing and scaling. The goal of differential diagnosis is to determine the nature of the enlargement as a basis for formulating a rational treatment approach. 1. Step 2. Gingival enlargement is one of the frequent features of gingival diseases. Apr 2010. Elapsed time between recurrences is extremely variable; some unfor-tunate patients have almost continuous disease whereas others go from months to years between episodes. Between 1996-2000, 6 out of 406 excised gingival lesions were diagnosed as POT (1.5%). This article revises the existing knowledge of different types of enlargements and highlights some important diagnostic . Cases 1 and 2 . Differential diagnoses include metastatic tumours in the oral cavity, angiosarcomas, gingival non-Hodgkin's lymphoma, Kaposi's sarcoma and haemangioma. Gingival lesions of pemphigus. Palatal and mandibular . Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. These characteristic components may be obvious in conjunction with plaque-like, erythematous, bullous, or ulcerative lesions. Phenytoin-related gingival hyperplasia. A clinical term defined as a predominantly white lesion of the oral mucosa that cannot be characterized clinically and pathologically as any other disease; a diagnosis of exclusion. Final diagnosis often takes more than 5 months from the onset of disease. Soft tissue lesions of the oral cavity in children may be normal/developmental findings or indicative of gingivitis, periodontal disease, local or systemic infection, benign tumors, or life-threatening systemic conditions ().The clinical features and management of common soft tissue lesions of the oral cavity in children will be reviewed here. The etiology of these lesions is multifactorial, but the most prevalent cause is reactive hyperplasia and inflammation induced by dental plaque. Fibrous epulis: A tumorlike gingival lesion The diagnosis of peripheral giant cell granuloma, a benign reactive gingival lesion, is confirmed by histopathologic examination. VOGEL HB. Recognition and diagnosis require . Differential Diagnoses. The diagnosis of these lesions is essential for their successful management and of the patient as a whole. racial pigmentation) to manifestations of systemic illnesses (e.g. Treatment 13. Share this article Share with email Share . Classification of jaw cysts ODONTOGENIC CYSTS (arise from odontogenic . Failure to carry out differential diagnosis of severe periodontal lesions has resulted in the instigation of periodontal therapy for many lesions of non-gingival origin. Reactive Lesions of the Gingiva • All tend to occur during 2nd/3rd decades Whenever severe localized lesions of the periodontium are detected, the differential diagnosis between pulpal and periodontal origins should be made. Shklar G, Frim S, Flynn E. J Periodontol, 49(8):428-435, 01 Aug 1978 . Diagnosis cannot be made on a clinical basis, when DG is the only clinical feature: histopathologic and immunopathologic studies are required. Certain common oral lesions appear as masses, prompting concern about oral carcinoma. Differential Diagnosis 10. REVIEW OF ORAL LESIONS ETIOLOGY, DIFFERENTIAL DIAGNOSIS AND TREATMENT AUGUST 20,2014 Disney's Coronado Springs Resort Lake Buena Vista, FL. For patients presenting with the symptoms described above, a number of conditions must be considered in the differential diagnosis. Discolouration and swelling of alveolar mucosa can be, indeed, OMs of CD7 and enter differential diagnosis with manifestations of many other systemic diseases, such as ulcerative colitis, granulomatosis with polyangiitis, leukae - lesion with opacities. Gingival Swellings Differential diagnosis Amer Ali College of dentistry, university of Kufa Powerpoint Templates Page 1 Infections • Gingival abscess • Periodontal abscess • Pericoronal abscess • Acute osteomyelitis • Acute herpetic gingivostomatitis Powerpoint Templates Page 2 Infection Gingival abscess Powerpoint Templates Page 3 infection Periodontal abscess Powerpoint Templates . D esquamative gingivitis is a clinical term used to describe an erythematous, erosive and ulcerated appearance of the gingiva. The recommended treatment … Plasma cell gingivitis [PCG] is a rare benign condition of the gingiva characterized by sharply demarcated erythematous and edematous gingivitis often extending to the mucogingival junction. 2014 National Primary Oral . 54 (2):313-324. Gingival involvement might be in the form of desquamative gingivitis, which is a characteristic feature for PV . Meanwhile, coexisting candidiasis may mask the typical features of PV lesions. Differential Diagnoses of Oral Lesions. The differential diagnosis in such lesions should include PG, POF, metastatic cancer, fibroma, hyperplastic gingival inflammation, hemangioma and angiosarcoma. Early detection and excision of this hyperplastic nodule is important to minimize potential dentoalveolar complications. Differential considerations could include salivary gland lesions (mucocele, salivary duct cyst, benign and malignant salivary tumors), gingival cyst, amalgam tattoo and blue nevus. Not to be mistaken Gingival growths, barring a few are mostly reactive and seldom exhibit significant true neoplastic potential. Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. The differential diagnosis of these lesions should be considered for accurate diagnosis Dr. Buket Acar, and . Other gingival conditions, such as medication-influenced overgrowth, certain neoplasms, or a hemangioma, can clinically resemble the lesions described. We present a previously . These pigmented lesions should be biopsied and carefully analyzed under the microscope to rule out a diagnosis of a malignant lesion such as melanoma. The differential diagnosis should include peripheral fibroma, peripheral ossifying fibroma, peripheral giant cell granuloma, and pyogenic granuloma. Herpes simplex virus is the most common cause of genital ulcers in the . 2 SCC of the oral cavity can mimic a variety of benign conditions occurring at multiple sites. White Lesions Rubbed away 1-‐ Infective Etiology: i. 1 Patients with desquamative gingival lesions will often complain of mucosal sloughing, gingival bleeding and oral discomfort, especially when . 5th ed. The treatment of desquamative gingival lesions is dependent on the correct diagnosis of the underlying disease, which is frequently dermatologic. The relationship of pulp polyp with the presence and concentration of . However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Sridharan G. Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India. 172 Seminars in Cutaneous Medicine and Surgery, Vol 34, December 2015 n n n Differential diagnosis and management of oral ulcers cancers have nodal metastases at time of diagnosis contributing to the poorer 5-year survival rate. Many are benign, although some (e.g., leukoplakia) may represent neoplasia or cancer. The differential diagnosis for purpura is broad, but it can be quickly narrowed by classifying the lesions based on their morphology, as well as other clinical and laboratory findings. Pyogenic Granuloma (Lobular Capillary Hemangioma) Workup. Red lesions are a large, heterogeneous group of disorders of the oral mucosa. Sattari M, Haghighi AK, Tamijani HD. The red color of the lesions may be due to thin epithelium, inflammation, dilatation of blood vessels or increased . infective/periodontal causes of gingival inflammation and focused on oral manifestations of systemic diseases. According to site Gingiva Redness • Plaque-induced gingivitis • Trauma • Odontogenic infections • Desquamative gingivitis - lichen planus - pemphigoid - pemphigus • Granulomatous disorders - Crohn's disease and other related conditions - orofacial granulomatosis - sarcoidosis • Medication - plasma cell gingivitis • Erythroplakia • Kaposi's sarcoma […] • Differential diagnosis: 1) Vascular neoplasm (e.g. Metastatic lesions in the oral cavity may be the first indication of an undiscovered malignancy at a distant site 32 . 14 years. Such lesions are easily distinguishable and categorized into diagnoses such as pyogenic granuloma, peripheral ossifying fibroma, etc. Differential Diagnosis; Red or Purple-Blue Lesions: Port-wine stain (capillary vascular malformation) Infancy No gender predilection: Localized to diffuse, red to purple macular lesions; variable blanching; bleeds freely; gingival and bony enlargement; grows with child Differential diagnosis Plaque-related chronic . Early diagnosis of non plaque-related causes of gingival lesions can be vital for affected patients. Differential diagnosis should include mainly squamous papilloma, verruca vulgaris, spongiotic gingival hyperplasia, verrucous hyperplasia and early verrucous carcinoma and papillary squamous cell carcinoma 2-4,7,8. However, lesions on the palms and soles are typical for HFM disease, and ulcers located only in the posterior oral cavity are typical for herpangina. Powerpoint Templates Page 36 Gingival fibromatosis Gingival fibromatosis. Case #2 . A gingival lesion may appear as a gingival enlargement with a smooth or ulcerated surface and may be the first manifestation of the disease. There are many oral lichen planus-like or "lichenoid" lesions which can confuse the diagnosis of OLP. Discuss diagnosis, testing, and treatment of desquamative gingival lesions. gingival inflammation.10 Other oral mucosal sites may also Indian J Cancer. Differential Diagnosis and Treatment Proposal for Acute Endodontic Infection The Journal of Contemporary Dental Practice, December 2015;16(12):977-983 977 JCDP ABSTRACT The objective of this study was to describe the main lesions that simulate clinically and propose a treatment protocol for acute endodontic infection. Everyday Lumps and Bumps . However, the ability to formulate a . The differential diagnosis of the palatal mass includes the palatal abscess, benign and malignant salivary gland neoplasms, the benign neural tumors, and the traumatic or irritation fibroma. 6Benign Lesions of the Oral Cavity and the Jaws A. Ross Kerr, DDS, MSD Denise A. Trochesset, DDS VARIANTS OF NORMAL Tori/Exostoses Unencapsulated Lymphoid Aggregates Fordyce Spots BENIGN SOFT TISSU… Stages for Evaluation of Oral Lesions 8. 3 Radiographic, . Localized gingival overgrowths (LGOs) are relatively common clinical findings. The primary goal of this course is to help you learn the process of clinical differential diagnosis of diseases and lesions of the oral mucosa. Whenever severe localized lesions of the periodontium are detected, the differential diagnosis between pulpal and periodontal origins should be made. 2014 Jan-Mar. Definitive Diagnosis 11. As final diagnosis is based on histological analysis, suspicion of VX when dealing with the differential diagnosis of oral . RADIOGRAPHIC FEATURES The lesions appear well defined with a multilocular pattern DIFFERENTIAL DIAGNOSIS Lateral periodontal cyst 37. Herpes simplex virus is the most common cause of genital ulcers in the . Bright red and painful gingiva also characterize primary HSV infection, and . Core tip: In clinical dentistry, patients frequently report with isolated/regional or generalized gingival enlargements, which could fall under varied presentations. 51(1):80-5. . While histopathologic assessment is often required for diagnosis, diascopy (as described above) can also be helpful in discriminating vascular processes from non . Differential Diagnosis - "The 3 P's" . Peripheral odontogenic tumours (POT) are rare benign focal overgrowths of the oral soft tissue, usually occurring in the gingiva. It may range from physiologic reasons (e.g. It is considered that inflammation from local trauma can be exacerbated by poor plaque control and cause these lesions. Case #1 •This patient presented with the gingival swelling seen here . . INTRODUCTION. Oral lesions appear several months predating skin lesions [3, 27]. Multiple white lesions that do not rub off should be noted in patient records, including the location of the lesions. Background: The aim of this study was to review the clinicopathologic features of focal reactive gingival lesions at the Lagos University Teaching Hospital, Nigeria.Methods: A retrospective review of cases of different focal reactive gingival lesions from the records of the Departments of the Oral Biology/Oral Pathology and Oral and Maxillofacial Surgery of the Lagos University Teaching . [15,16] Depending on its duration, PG will vary in texture from soft to firm and can be suggestive of fibroma, and also, peripheral odontogenic or ossifying fibroma may be another . The first part of this compendium covers immune-mediated and hereditary conditions as causes of gingival lesions, which can resemble those caused by dental plaque. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Case #1 . Gingival pigmentation is a discoloration of the gingiva due to a variety of lesions and conditions associated with several endogenous and exogenous etiologic features . The differential diagnosis of the palatal mass includes the palatal abscess, benign and malignant salivary gland neoplasms, the benign neural tumors, and the traumatic or irritation fibroma. Emphasis is placed on the importance of obtaining a thorough . Differential Diagnosis of Oral Masses Gingival Lesions. The patient had a . Conclusions: In our study, neoplastic lesions were detected in 12.2% of patients and the risk of malignancy was determined as 5.5% in lesions presented by epulis. When it develops directly from the lower wisdom tooth, it's termed 'retro-molar' . St Louis: Mosby-Year Book, Inc;1997. However, a small group are distinct from these … The differential diagnosis in such lesions should include PG, POF, metastatic cancer, fibroma, hyperplastic gingival inflammation, hemangioma and angiosarcoma. Wood NK, Goaz PW. The lip vermillion, gingiva, and buccal mucosa are the sites of predilection; the tongue, lip vermillion, and floor of the mouth lesion account for 90 % of . Reticular symptomless type of OLP requires no treatment. [15,16] Depending on its duration, PG will vary in texture from soft to firm and can be suggestive of fibroma, and also, peripheral odontogenic or ossifying fibroma may be another . Emphasis is placed on the importance of obtaining a thorough . Gingival enlargement is one of the frequent features of gingival diseases. Based on the existing knowledge and clinical experience, a differential . Differential diagnosis of Jaw lesions GROUP 22 Differential diagnosis of Jaw lesions GROUP 22. The differential diagnosis . This test consists of pressuring apparently normal skin or mucosa in the area adjacent to the lesion. This case report highlights the important role of dentists to include oral melanoacanthoma in the differential diagnosis of diffuse gingival pigmented lesions. Case #2 •A 14 year old female presented with this lesion of the gingiva . Therefore, dental practitioners should be aware of the various manifestations of systemic . Patil PB, Bathi R, Chaudhari S. Prevalence of oral mucosal lesions in dental patients with tobacco smoking, chewing, and mixed habits: A cross-sectional study in South India. The first step in successful therapeutic management of a patient with an oral mucosal disease or lesion depends upon creating a differential diagnosis. Whenever severe localized lesions of the periodontium are detected, the differential diagnosis between pulpal and periodontal origins should be made. Common superficial oral lesions include candidiasis, recurrent herpes labialis, recurrent aphthous stomatitis, erythema migrans, hairy tongue, and lichen planus. NPDs have three typical features: pain, bleeding, and ulceration of the gingival interdental papilla . Aphthous lesions affect all age groups from young to old but young adults and females are more affected. Dent Clin N Am. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized (isolated, discrete, regional . • Gingival lesions respond to oral hygiene measures frequent prophys • Sulca brush daily . Tumours included peripheral odontogenic fibroma (2 patients), peripheral calcifying odontogenic cyst (2 patients), peripheral . CLINICAL FEATURES A slight male predilection Common site is anterior mandible Lesion shows slow progressive growth, painless and locally destructive 36. along the margin of the gingiva and a punctate or diffuse erythema of the attached gingival. Histopatho- logic examination is a gold standard for differentiation of such lesions.and 25 were male (27.8%). . Treatment is excision. In these cases, Nikolsky's sign test can be used to differentially diagnose benign mucous membrane pemphigoid. Lesions of both HFM disease and herpangina may resemble primary herpetic gingivostomatitis. Gingival enlargement present predominantly in the interdental papillae. attached gingival, hard palate and dorsal tongue are seldom affected. localised near the gingival edge of a lateral/distal surface of a tooth root. TREATMENT AND PROGNOSIS The differential diagnosis of lesions or abnormalities of the oral cavity will help non-dental healthcare providers (HCPs) to refer at-risk patients to the appropriate provider so they can be re-examined more closely. Annals of Dentistry, 01 Sep 1951, 10(3): 99-102 PMID: 14868993 . gingival lesions. There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Localised gingival overgrowth may present as a fibrous epulis. Considerations in more generalised lesions include hereditary gingival fibromatosis, which may occur as an isolated lesion or as part of a syndrome. [Medline]. GINGIVAL CYST of newborn or adult Not seen radiologically. Step 3. Step 1. The symptoms, growth rate, palpation characteristics, surface morphology, and lesion site allow for categorization of the soft tissue lesions into one of the five lesion groups as outlined in Differential Diagnosis of Oral Pigmented Lesions Evaluation of a patient presenting with a pigmented lesion should include a full medical and dental history, extraoral and intraoral examinations, and laboratory tests.2 . The lesions have many characteristics in common and may appear clinically indistinguishable. Differential Diagnosis Many of the lesions discussed in this chapter should be considered in the differential diagnosis: erythema from mechanical trauma, purpuric macule, cellulitis (nonpyogenic . A biopsy is mandatory in gingival erythematous lesions with no obvious striae or papules to achieve a correct diagnosis [4,17]. Gingival bleeding is rare. Surgical biopsy-‐ consideration 12. The differential diagnosis includes pyogen-ic granuloma, peripheral giant cell granuloma, fi broma, peripheral odontogenic fi broma, fi - brosarcoma, and squamous cell carcinoma.1,3,5 A slowly growing mass on the interdental pa- . hemangioma, KS) ** Hemangiomas and PGs are likely related entities 2) Peripheral giant cell granuloma 3) Peripheral ossifying fibroma 4) Fibroma 5) Metastatic lesion Metastatic lesion Pyogenic granuloma • Histology: - vascular proliferation (granulation tissue) - mixed inflammatory infiltrate References. Contemp Clin Dent 2017;8:182‑4. Gingival enlargements are a common clinical finding and most represent a reactive hyperplasia as a direct result of plaque related inflammatory gingival disease. However, biopsy is necessary if the form is atypical or if clinical features suggest the possibility of dysplasia or malignancy. However, typical and distinctive oral and/or skin lesions, sometimes with a characteristic location, can be observed and represent a valuable aid in guiding the differential diagnosis. . Differential Diagnosis . Traumatic lesions, infections, developmental anomalies, allergic reactions, immunologically mediated diseases, premalignant lesions, malignant neoplasms, and systemic diseases are included in this group. This is determined by clinical observations, as well as by histologic and immunologic examination of gingival biopsy specimens. Significant erythematous gingival hyperplasia is covering portions of the crowns of numerous teeth. 36. REFERENCES. Differential Diagnosis partially calcified odontoma, adenomatoid odontogenic tumor, ossifying fibroma; ameloblastic fibro-odontoma, calcifying epithelial odontogenic tumor. As . Common Lesions and Conditions of the Oral Cavity K. Mark Anderson DDS, MS . The common etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth.
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