Common Lesions Competency

1. Sebherroic Keratosis -stuck-on appearance but looks like you can flick it off -#1 bengign neoplasm on skin (no chance of malignancy) -candle wax dripping or wart-like appearance (does not fleck off, stuck on) -Treatment no treatment necessary; excision can be done for esthetics

2. Incisive canal cyst (naso-palatine duct cyst) -use vitality test to dx (teeth will be vital) -well de-lineated, developmental cysts that are the most common nonodontogenic cyst -100% benign -Must be bigger than 6mm in order to be a cyst (smaller can just be a large incisive canal) -Treatment curettage

3. ANUG (acute necrotizing ulcerative gingivtis) -Common, non-contagious infection of the gums with sudden onset -Symptoms include painful, bleeding gums, fever, and loss of interproximal papilla

-Caused by spirocetes and fusobacterium -Patient will never have interproximal papilla again -Treatment irrigation and debridement, prescribe antibiotics (Metronidazole/amoxicillin) and NSAID for fever

4. Papilloma -A slow growth, usually single lesion with frawns -Caused by low-risk strains of HPV which also causes genital warts, received by sexual contact -If patient has multiple papillomas patient can have condyloma accumlatum cauliflower appearance -Treatment excision, excellent prognosis

5. Angular Cheillitis -Inflammation of one or both of the commissures of the lips -Caused by Candiasis or Staph infections (pus). Also caused by decrease in VDO -Treatment only external problem (Vytone cream mixture of iodine and corticosteroid). If it is an inside problem (some kind of azole or trichote candy with antifungal medication)

6. Melanotic macule -Asymptomatic, usually solitary, flat, brown spot that is less than 5mm in diameter -Primarily found on the vermilion border of the lip -No treatment necessary

7. Morsicatio Buccarum (cheek chewing) -Chronic irritation and trauma to the buccal mucosa caused by biting or nibbling -No treatment is necessary. At the patients request, a bite splint can be made to stop the habit

8. Dentigerous Cyst (follicular cyst/odontogenic cyst) -Thought to be a developmental cyst involving an impacted or partially erupted tooth. These rarely involve deciduous teeth -Do vitality test to diagnose (teeth will be vital)

-If big enough, patient can have mandibular fracture -Before you cut into this (or any central giant radiolucency) you 1. Auscultate, 2. Aspirate, 3. Thrill (pulse) -This will help rule out AV malformation (potentially lethal) -Treatment enucleation of the cyst and removal of the affected tooth

9. Intradermal Nevus (mole) -Asymptomatic, brown bump on the skin that never changes, doesnt bleed, patient probably has more of these in other areas -no malignant transformation -A classic way to distinguish a nevus is that if it has hair growing from it, it is a mole -Treatment none necessary; can be removed for esthetic reasons

10. Fibroma -Benign tumors composed of fibrous or connective tissues -Treatment - May require occlusal adjustment. Can be left alone, or conservative excision can be used

11. Basal cell carcinoma -Most common type of skin cancer -Def want a biopsy (Mohs microscoptic surgery) -After you are 40, nevi stop appearing so you can rule that out -Surface ulceration and tethered appearance (cant move it) are very characteristic for this malignancy -These dont metastasize but you should use Mohs to prevent continued growth -Treatment - patient should avoid the sun from 10am-2pm, Mohs surgical removal, other surgical removal. May need chemotherapy and radiation

12. Mucocele -Swelling of connective tissue consisting of collected mucin due to a ruptured salivary gland duct usually caused by local trauma -Treatment - enucleation and biopsy including minor salivary gland (trauma to ducts is cause of these) -Remember a ranula is only in the floor of the mouth (mucocele can be on labial and buccal mucosa)

13. Lichen Planus -Not cancerous, rather it is an autoimmune disease that resembles lichens -Will be on bilateral buccal mucosa and probably on the gingiva as well, appears when patient is under stress -Spider-web appearance -Treatment there is no cure, the symptoms can only be managed. Patients with the erosive form of this may need a corticosteroid

14. Denture Stomatitis -A condition where mild inflammation and redness of the oral mucosa occurs beneath a new denture or a denture that is not well taken care of Treatment - use antifungal rinse with partials (metal will pit with bleach). Take denture out at night, soak in bleach (1 part bleach, 9 parts water) -Candida albicans is the causative fungus

15. Leukoedema -Caused by water in the cells of the buccal mucosa -Key diagnostic test stretch the buccal mucosa and lines will disappear -Mucosa is often tinted blue -No treatment necessary

16. Amalgam tattoo -A bluish-gray lesion of the oral mucosa caused by accidental implantation of amalgam into the tissue during a restoration -Treatment - PA x-ray to confirm and to rule out melanoma (extremely aggressive in the mouth); once confirmed, no other treatment is necessary

17. Actinic Keratosis -Is a premalignant condition that consists of thick, crusty, or scaly patches of skin -Has a 20% chance to become malignant and cancerous (cutaneous squamos cell carcinoma) -Sandpaper feel and patient may just think its dry skin -Called actinic chelitis when it appears on the lip -Treatment cyrotherapy and creams (such as 5-FU or Imiquimod), liquid nitrogen can also be used

18. Inflammatory papillary hyperplasia -An overgrowth of tissue usually beneath a denture. It is associated with poor denture hygiene, ill fitting dentures, or overwearing of a denture -Can wax and wane -Cobblestone appearance of the palate -Treatment conservative excision (laser ablation) depending upon how unstable the denture would be on these. If mild, treatment may solely consist of taking denture out until tissue is healed.

19. Periapical Cyst (radicular cyst, dental cyst) -Most common odontogenic cyst -Caused by pulpal necrosis secondary to caries or trauma -Treatment Endo or extraction if cannot be saved; antibiotics can be prescribed along with treatment -A cyst can still remain after healing of a periapical cyst (called a residual cyst)

20. Minor Apthous Ulcer -Key diagnostic located on non-keratinized movable tissue and less than 10mm diameter -Recurrent intraoral herpes occurs on keratinized non-movable tissue -Recur under stress or immunocompromise -No scarring, heal in 7-10 days, no treatment required