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(BQ) Part 1 book “The ADA practical guide to soft tissue oral disease” has contents: The extraoral and intraoral soft tissue head and neck screening examination, soft tissue head and neck pathology description and documentation, common oral soft tissue lesions.
The ADA Practical Guide to Soft Tissue Oral Disease The ADA Practical Guide to Soft Tissue Oral Disease Second Edition Michael A Kahn, DDS Diplomate and Director, American Board of Oral and Maxillofacial Pathology Professor Emeritus and Chair (ret.), Department of Oral and Maxillofacial Pathology, Oral Medicine, and Craniofacial Pain Tufts University School of Dental Medicine Boston, MA J Michael Hall, DDS, MABMH Diplomate, American Board of Oral and Maxillofacial Pathology Associate Professor (ret.), Department of Oral and Maxillofacial Pathology, Oral Medicine, and Craniofacial Pain Tufts University School of Dental Medicine Boston, MA 1st Edition © 2014 by John Wiley & Sons, Inc 2nd Edition © 2018 by the American Dental Association Edition History John Wiley & Sons, Inc and the ADA (1e, 2014) All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions The right of Michael A Kahn and J Michael Hall to be identified as the author(s) of this work has been asserted in accordance with law Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA Editorial Office 111 River Street, Hoboken, NJ 07030, USA For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand Some content that appears in standard print versions of this book may not be available in other formats Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make This work is sold with the understanding that the publisher is not engaged in rendering professional services The advice and strategies contained herein may not be suitable for your situation You should consult with a specialist where appropriate Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages Library of Congress Cataloging‐in‐Publication Data Names: Kahn, Michael A., author | Hall, J Michael, author | American Dental Association, issuing body Title: The ADA practical guide to soft tissue oral disease / Michael A Kahn, J Michael Hall Other titles: American Dental Association practical guide to soft tissue oral disease | Practical guide to soft tissue oral disease Description: Second edition | Hoboken, NJ : Wiley, 2018 | Includes bibliographical references and index | Identifiers: LCCN 2017057994 (print) | LCCN 2017060299 (ebook) | ISBN 9781119437598 (pdf) | ISBN 9781119437307 (epub) | ISBN 9781119437338 (pbk.) Subjects: | MESH: Mouth Diseases | Soft Tissue Neoplasms | Diagnosis, Oral Classification: LCC RK529 (ebook) | LCC RK529 (print) | NLM WU 140 | DDC 617.5/22–dc23 LC record available at https://lccn.loc.gov/2017057994 Cover Design: Wiley Cover Images: ©Michael A Kahn Set in 9.5/12pt Palatino by SPi Global, Pondicherry, India Printed and bound in Singapore by Markono Print Media Pte Ltd 10 9 8 7 6 5 4 3 2 1 Contents Preface to the Second Edition vii Preface to the First Edition ix Acknowledgmentsxi Section I Detection and Documentation 1 The Extraoral and Intraoral Soft Tissue Head and Neck Screening Examination Soft Tissue Head and Neck Pathology Description and Documentation 23 Section II Diagnosis and Management 35 Common Oral Soft Tissue Lesions 37 Differential Diagnosis of Common Oral Soft Tissue Lesions 115 Guidelines for Observation and/or Referral of Patients’ Lesions 129 The Art and Science of Biopsy and Cytology 137 Section III Clinicopathologic Exercises 147 Sample Patient Histories and Discussion 149 v vi Contents Appendix A: Glossary of Descriptive Terminology 221 Appendix B: Formulary of Over‐the‐Counter and Prescription Medications Based on Disease Classification: Common Errors of Prescription Writing 225 Answers to End‐of‐Chapter Questions 245 Index259 Preface to the Second Edition We are grateful for the positive reception within the dental and medical communities of this textbook’s first edition In this second edition its intention remains the same – to be a practical guide and reference source for the basic clinical aspects of soft tissue oral and maxillofacial disease We also appreciate the constructive feedback received by colleagues that aided in this edition’s revisions The names and organization of the book’s chapters remain the same Within each chapter the cited references and/or recommended readings have been updated; however, in addition, the end of each chapter now contains self‐ assessment multiple‐choice questions with feedback comments on the correct answer and distractors The revisions of Chapter 1 notably include a number of newly marketed diagnostic adjunctive devices and methods Chapter 3 provides updated information on some of its pathologic conditions, particularly the nature of hemangiomas versus vascular malformations and the increasing clinical impact the human papillomavirus type 16 has on malignant transformation (i.e squamous cell carcinoma) of specialized oropharyngeal epithelium as opposed to the oral cavity proper Chapter 5 introduces the term “oral potentially malignant disorders” and initial commercial products designed to add additional information to their predicted clinical behavior and management Appendix B has been extensively updated to reflect the ever‐changing drug formulary available to the clinician to treat oral soft tissue diseases Lastly, some of the photographic images have been added or updated to enhance a lesion’s features We hope our efforts have enhanced the utility of this textbook for your chairside evaluation, differential diagnosis formulation, establishment of provisional and final diagnosis, and management of your patient’s diagnosed oral mucosal diseases Michael A Kahn J Michael Hall vii Preface to the First Edition This textbook is intended to be a practical guide and reference source for the basic clinical aspects of soft tissue oral and maxillofacial disease It is not intended to be an all‐encompassing tome of oral pathology but rather to include those aspects of this dental specialty that are its most important foundational information and the most frequently encountered orofacial soft tissue diseases The book is intended for health‐care practitioners whose occupation involves encountering a variety of conditions and diseases of the oral cavity and its contiguous anatomic structures; it is not intended to be a reference source for oral medicine (i.e details of the medical aspects of a particular disease within the oral cavity) We envision this book not as one to reside on a clinician’s library shelf gathering dust and rarely referred to, but rather one used regularly within the dental operatory to help the clinician’s decision making: that is, deciding what is the best thing to for the patient when a pathologic condition is initially discovered, how to determine its most likely provisional diagnosis or differential diagnosis, whether to biopsy or refer for consultation by a dental or medical specialist, and how to most accurately and effectively communicate that information to the patient so the patient can give informed consent about his or her treatment course and management Since 1984, when we began our residency training in oral pathology at Emory University’s School of Dentistry (Atlanta, GA), we have increasingly recognized specific essentials of oral pathology that need to be learned, understood, and used by all dentists; furthermore, we have witnessed common diagnostic pitfalls and management mistakes This book is the culmination of our cumulative and collective experiential wisdom gained during our training as well as our subsequent years of being in teaching institutions By interacting with dentists, with dental and dental hygiene students, and with physicians and patients in clinical and educational settings as well as by participation in active oral pathology biopsy services and clinical consultation clinics, we have become aware of the lesions commonly encountered but misunderstood by them or unknown to them Michael A Kahn J Michael Hall ix Acknowledgments We are deeply indebted to the team at Wiley Blackwell who initiated contact with us to consider this endeavor: to Ms Shelby Allen and Rick Blanchette, whose vision and interest in our continuing education materials sparked an interest to share its content with a wider audience of dental practitioners and whose shepherding of the first edition resulted in its enthusiastic use and opportunity to create a second edition For this second edition we give thanks to the guidance of Ms Erica Judisch (Executive Editor, Veterinary Medicine and Dentistry), Ms. Anupama Sreekanth (Project Editor), Ms Susan Engelken for cover design, and Ms Natasha Wu (Assistant Production Editor) At the American Dental Association (ADA), we thank Dr Pamela Porembski (DDS, Senior Manager, Council on Dental Practice), Carolyn Tatar (Senior Manager, Product Development), and Dr Kathleen O’Laughlin (DMD, Executive Director) for their belief in this initial endeavor, supplying support and assistance and working with many other members of the ADA to gain the project’s acceptance and affiliation We also thank our colleagues at the various institutions we have worked at, as they have shared their knowledge and teaching materials with us In particular, Drs Robert Goode, Lynn Solomon, and Eleni Gagari were involved in many of the materials used in constructing the content of Chapter 7 In addition, we are very grateful to our colleagues throughout the world who have shared their unrestricted‐use clinical images with us at regional and national oral pathology meetings We thank Ms Heidi Price for creating the original line drawings of Chapters and Last, we thank our many patients and their clinicians who shared their patients and/or their biopsied tissue with us and our students, whose pathology questions spurred us to either respond from memory or seek additional references in order to answer M.A.K J.M.H xi Section I Detection and Documentation The Extraoral and Intraoral Soft Tissue Head and Neck Screening Examination It is paramount that the dental clinician establishes a repeatable, logical, s equentially organized, and systematic approach to screening the soft tissues of the head and neck region It should be understood that this is not an “oral cancer s creening,” since all abnormal conditions should be detected Performing an oral cancer screening means looking for a single condition, cancer, at a single point in time; the dental clinician performs a complete exam, looking for all soft tissue abnormalities at a single point in time There is no universally acknowledged step‐by‐step approach; therefore, the following is the one we adhere to and it can be modified as desired The important point is that, whatever sequence is established, it should be strictly adhered to each time to ensure that no step is omitted A suggested ideal sequence of steps for a complete oral mucosal screening procedure of a new patient includes the following: • • • • • • • • Introduction to the patient Patient’s chief complaint History of the present illness Medical (including social) and dental histories Physical examination (to detect the site, morphology, and color of abnormalities) Review of data and formulation of a clinical differential diagnosis Additional clinical and laboratory tests ordered, as indicated Final definitive diagnosis with a treatment/management plan formulated Certainly, the clinician should establish a pleasant rapport with the patient so that excellent communication and trust are established Often, the most critical or important piece of information a patient possesses does not get transmitted to The ADA Practical Guide to Soft Tissue Oral Disease, Second Edition Michael A Kahn and J Michael Hall © 2018 by the American Dental Association Published 2018 by John Wiley & Sons, Inc Common Oral Soft Tissue Lesions 99 (a) (b) (c) Figure 3.75 (a) Traumatic (irritation) fibroma of the buccal mucosa secondary to accidental biting (b) Traumatic fibroma of the tip of the tongue secondary to biting (c) Traumatic fibroma slightly inferior to the right occlusal plane of the buccal mucosa 100 Diagnosis and Management (a) (b) (c) Figure 3.76 (a) Large, firm swelling of mucoepidermoid carcinoma of the buccal mucosa (b) Large, unilateral, firm, and slightly tender posterior swelling of the hard palate near the junction with the soft palate diagnosed as adenoid cystic carcinoma (c) Firm, mobile submucosal swelling of the upper lip’s midline diagnosed as monomorphic adenoma (canalicular adenoma) Common Oral Soft Tissue Lesions 101 • Treatment – Complete excision with conservative normal tissue margin for benign tumors and wider excision for malignant lesions Sialolith, minor and major salivary glands (Fig. 3.77a,b,c) • Site – Floor of the mouth (submandibular gland – Wharton’s duct > sublingual gland); upper lip and buccal mucosa (parotid gland – Stensen’s duct) • Morphology – Small hard submucosal mass; sometimes palpable • Color – Pink to yellow white • Signs and symptoms – Calcium salt deposition with nidus of debris, bacteria, and so on Sialolith is usually painless but the patient can have sensation of fullness or tenderness, especially prior to eating (i.e episodic); severity of swelling and/or pain depends on degree of obstruction Secondary ascending acute sialadenitis may occur Radiopaque mass is seen on radiographic image • Treatment – Removal of the large stone by surgery; if small, sometimes it can be “milked” to extrude it through the duct’s orifice Lithotripsy has also been effective Parulis (gum boil, abscess) (Fig. 3.78) • Site – At the terminus of a fistula that has perforated, the cortical bone in the area of a nonvital tooth; facial usually, or lingual or palatal gingiva/alveolar mucosa is the most common site; also vestibule depending on tooth root’s length and/or muscle insertion points • Morphology – Papule/pustule • Color – Pink (fibrotic) to yellow (purulent exudate) to red (if active inflammation) • Signs and symptoms – Painless If pain is present, then it is from infection associated with the nonvital tooth; establishment of drainage will relieve pain • Treatment – Establish drainage and eliminate the source of infection by extraction or root canal therapy on the infected, nonvital tooth Epulis fissuratum (Fig. 3.79) • Site – Vestibule adjacent to ill‐fitting denture flange • Morphology – Multiple nodules, tumor (hyperplastic tissue folds); may have secondary ulceration • Color – Pink to pink red • Signs and symptoms – Painless; composed of epithelial and fibrous hyperplasia due to reactive growth from low‐grade chronic trauma • Treatment – Remake/reline/rebase denture and surgically remove excess tissue Pyogenic granuloma (Fig. 3.80) • Site – Gingiva at interdental papilla is the most common site; any other oral mucosal site • Morphology – Papule and nodule; may be secondarily ulcerated • Color – Red • Signs and symptoms – Painless, red, firm, vascular reactive growth that easily bleeds; secondary to chronic irritant such as restoration overhang, calculus, 102 Diagnosis and Management (a) (b) (c) Figure 3.77 (a) Focal swelling of the right anterior floor of the mouth adjacent to the midline with salivary stone and acute sialadenitis (b) Patient reported a sense of floor‐of‐ mouth fullness prior to eating; biopsy yielded Wharton’s duct sialolith (c) Sialolith of Stensen’s duct near the buccal mucosal orifice Common Oral Soft Tissue Lesions 103 Figure 3.78 Nonvital right mandibular canine with associated parulis (gum boil) Figure 3.79 Ill‐fitting complete maxillary removable denture with epulis fissuratum of the vestibule foreign body material, or nonspecific traumatic event Pyogenic granuloma occurs more frequently in pregnant woman • Treatment – Complete removal and elimination of the trigger factor Peripheral ossifying fibroma (Fig. 3.81) • Site – Exclusively on attached gingiva, usually interdental papilla • Morphology – Papule and nodule; may be secondarily ulcerated • Color – Pink to red • Signs and symptoms – Firm, painless reactive lesion • Treatment – Complete removal (to periosteum) and elimination of the trigger factor from the adjacent tooth 104 Diagnosis and Management Figure 3.80 Semifirm and hemorrhagic pyogenic granuloma of the left anterior maxillary gingiva Figure 3.81 Large peripheral ossifying fibroma of the anterior mandibular gingiva Peripheral giant cell granuloma (Fig. 3.82) • Site – Exclusively on attached gingiva/edentulous alveolar mucosa, especially anterior to first molars • Morphology – Papule and nodule; frequently secondarily ulcerated • Color – Red blue to purple • Signs and symptoms – Firm, painless reactive (nonneoplastic) lesion • Treatment – Complete removal (to periosteum) and elimination of the trigger factor from the adjacent tooth Common Oral Soft Tissue Lesions 105 Figure 3.82 Peripheral giant cell granuloma of the left facial mandibular alveolar mucosa and vestibule Figure 3.83 Non‐Hodgkin’s lymphoma of the hard palate 10 Non‐Hodgkin’s lymphoma (Fig. 3.83) • Site – Lymph nodes of head and neck; hard palate most often when extranodal • Morphology – Nodule, tumor, and ulcer • Color – Pink or blue • Signs and symptoms – Painless usually, or painful especially if continued growth puts pressure on adjacent structures; often boggy and edematous; unilateral lesion that may cross midline, rarely arises bilaterally; becomes fixed, immovable with enlargement A rare hard palate midline, a highly destructive T‐cell type variant is known as midline lethal granuloma 106 Diagnosis and Management Figure 3.84 Reactive lymphoid aggregate (hyperplasia) of the right ventral tongue • Treatment – Typically radiation and chemotherapy; sometimes total surgical removal Complete medical workup is needed to rule out metastasis 11 Reactive lymphoid hyperplasia (Fig. 3.84) • Site – Lymph nodes or any oral site but particularly Waldeyer’s ring– soft palate complex, tonsils, floor of the mouth/ventral tongue, and oropharynx • Morphology – Papule/nodule; soft or firm • Color – Pink to yellow • Signs and symptoms – Asymptomatic, movable; nontender, but often tender to palpation when inflamed; secondary enlargement due to infection (stimulation from antigens) • Treatment – Excisional biopsy to confirm diagnosis, if necessary 12 Generalized gingival enlargement (non‐plaque‐related) (Fig. 3.85a,b) • Site – Marginal/papillary gingiva; when drug induced, it begins in papilla and spreads across teeth • Morphology – Firm nodular, tumorous • Color – Pink; secondarily red if inflammation present • Signs and symptoms – Facial more often than lingual or palatal surfaces; multiple etiologies including red, edematous, and fibrotic hyperplastic due to puberty, pregnancy, and diabetes mellitus; drug induced (esp phenytoin, cyclosporine, and nifedipine); hereditary fibromatosis; granulomatous inflammation • Treatment – change drug; gingivectomy sometimes needed, especially with fibromatosis 13 Benign mesenchymal neoplasms (e.g lipoma, neurofibroma, schwannoma, hemangioma) (Fig. 3.86a,b) • Site – Any oral mucosal site • Morphology – Papule, nodule, and tumor • Color – Pink, yellow, blue, and red, depending on the type of proliferating mesenchymal tissue Common Oral Soft Tissue Lesions 107 (a) (b) Figure 3.85 (a) Generalized hereditary gingival fibromatosis partially obscuring the clinical crowns (b) Generalized gingival hyperplasia induced by patient’s use of the anticonvulsant phenytoin • Signs and symptoms – Painless; slow growth and then static • Treatment – Complete excision 14 Hematoma (Fig. 3.87) • See “Red Lesions,” point (extravasated blood), for description and treatment 15 Papilloma (Fig. 3.88) • Site – Soft palate, tongue, and buccal mucosa most often • Morphology – Papule and nodule; rough “cauliflower” surface usually pedunculated • Color – Pink to white • Signs and symptoms – painless; presumed to be caused by nononcogenic HPV types and 11 in approximately 50% of cases; no malignant transformation potential • Treatment – Complete excision 108 Diagnosis and Management (a) (b) Figure 3.86 (a) Peritonsillar swelling that when biopsied proved to be a benign nerve sheath tumor, schwannoma (neurilemoma) (b) Schwannoma of the upper lip 16 Inflammatory papillary hyperplasia (Fig. 3.89) • Site – Hard palate and alveolar mucosa beneath denture base • Morphology – Coalescing papules • Color – Red • Signs and symptoms – Asymptomatic; arises secondary to ill‐fitting denture with poor denture hygiene • Treatment – Remove denture at night for limited lesions For advanced and irreversible lesions, surgically excise and then reline/remake denture to improve adaptation Common Oral Soft Tissue Lesions Figure 3.87 Large hematoma of the ear’s pinna Figure 3.88 Squamous papilloma of the lateroventral tongue 109 110 Diagnosis and Management Figure 3.89 Inflammatory papillary hyperplasia of the hard palate associated with a removable full denture’s base Cited References Holmstrup, P., Vedtofte, P., Reibel, J., and Stoltze, K (2007) Oral premalignant lesions: is a biopsy reliable? J Oral Pathol Med 36: 262–266 Speight, P.M (2007) Update on oral epithelial dysplasia and progression to cancer Head Neck Pathol 1: 61–66 van der Waal, I and Axell, T (2002) Oral leukoplakia: a proposal for uniform reporting Oral Oncol 38: 521–526 Cleveland, J.L., Junger, M.L., Saraiya, M et al (2011) The connection between human papillomavirus and oropharyngeal squamous cell carcinoma in the United States: implication for dentistry JADA 142(8): 915–924 D’Souza, G., Kreimer, A.R., and Viscidi, R (2007) Case–control study of human papillomavirus and oropharyngeal cancer NEJM 356: 1944–1956 El‐Mofty, S.K (2007) Human papillomavirus (HPV) related carcinoma of the upper aerodigestive tract Head Neck Pathol 1: 181–185 Gillison, M.L., Koch, W.M., Capone, R.B et al.(2000) Evidence for a causal association between human papillomavirus and a subset of head and neck cancers J Natl Cancer Inst 92(9): 709–720 8 Kahn, M.A (2011) The emerging role of human papillomavirus in oropharyngeal squamous cell carcinoma Inside Dentistry, special issue 2, 32: 1–7 Chaturvedi, A.K., Engels, E.A., Pfeiffer, F.M et al.(2011) Human papillomavirus and rising oropharyngeal carcinoma incidence in the United States J Clinic Oncol 29: 4294–4301 10 Wei, W., Shi, Q., Guo, F et al (2012) The distribution of human papillomavirus in tissues from patients with head and neck squamous cell carcinoma Oncol Rep 28: 1750–1756 11 Morbini, P., Dal Bello, B., Alberizzi, P et al (2013) Oral human papillomavirus infection and persistence in patients with head and neck cancer Oral Surg Oral Med Oral Pathol Radiol 116: 474–484 12 Solomon, L.W (2008) Chronic ulcerative stomatitis Oral Dis 14: 383–389 Common Oral Soft Tissue Lesions 111 Recommended Reading Cawson, R.A., Binnie, W.H., Barret, A.W., and Wright, J.M (2001) Oral Disease, 3e St. Louis, MO: Mosby Eversole, L.R (2011) Clinical Outline of Oral Pathology, 4e Shelton, CT: People’s Medical Publishing House – USA Eversole, L.R (1996) Oral Medicine: A Pocket Guide Philadelphia, PA: W.B Saunders Hupp, J.R., Williams, T.P., and Firriolo, J.F (2006) Dental Clinical Advisor St Louis, MO: Mosby Elsevier Neville, B.W., Damm, D.D., Allen, C.M., and Chi, A.C (2015) Oral and Maxillofacial Pathology, 4e St Louis, MO: Elsevier Newland, J.R., Meiller, T.F., Wynn, R.L., and Crossley, H.L (2013) Oral Soft Tissue Diseases, 6e Hudson, OH: Lexi‐Comp, Inc Regezi, J.A., Sciubba, J.J., and Jordan, R.C.K (2016) Oral Pathology: Clinical Pathologic Correlations, 7e St Louis, MO: Saunders Elsevier Sapp, J.P., Eversole, L.R., and Wysocki, G.P (2004) Contemporary Oral and Maxillofacial Pathology, 2e St Louis, MO: Mosby Scully, C., Bagan, J.V., Carrozzo, M et al (2013) Pocketbook of Oral Disease Edinburgh, UK: Churchill Livingstone Elsevier Silverman, S., Eversole, L.R., and Truelove, E.L (2002) Essentials of Oral Medicine Hamilton, ON: BC Decker, Inc Woo, S (2017) Oral Pathology: A Comprehensive Atlas and Text, 2e Philadelphia, PA: Elsevier Saunders Wood, N.K and Goaz, P.W (1997) Differential Diagnosis of Oral and Maxillofacial Lesions, 5e St Louis, MO: Mosby Self‐Assessment Multiple‐Choice Questions and Answers/Explanations What is the cause of the red component in geographic tongue? a Superficial ulceration b Loss of the filiform papillae c Vascular malformation d Fungal infection What the multiple, red, punctate lesions associated with nicotine stomatitis represent? a Inflamed minor salivary gland ducts b Precancerous erythroplakia c Candida spp colonies d Allergic reaction to tobacco What is the cause of median rhomboid glossitis? a Epstein–Barr virus infection b Ectopic thyroid gland c Developmental malformation d Infection with Candida albicans What is the most common cause for oral erythroplakia? a Allergic reaction b Epithelial dysplasia 112 Diagnosis and Management c Vascular malformation d Petechia What is the elevated submucosal entrapment of extravasated blood called? a Hematoma b Telangiectasia c Purpura d Ecchymosis 6 What is the most common site for the development of intraoral primary malignant melanoma? a Lateral tongue b Labial mucosa c Hard palate d Buccal mucosa 7 What is a common oral site for the development of recurrent aphthous stomatitis? a Maxillary tuberosity b Hard palate c Buccal mucosa d Attached gingiva What is the condition caused by an enterovirus that results in acute ulcerations (erosions) and vesicles limited to the soft palate and tonsillar pillars, usually with concomitant subclinical to mild pain? a Herpangina b Erythema multiforme c Primary herpes simplex d Herpes zoster A solitary ulceration of months duration is found on the posterior lateral tongue of a 48‐year‐old woman What is the most likely diagnosis? a Mucous membrane pemphigoid b Pemphigus vulgaris c Squamous cell carcinoma d Erosive lichen planus 10 What is a serious possible sequela of mucous membrane pemphigoid? a Kidney failure b Ocular involvement leading to blindness c Formation of secondary lymphoma d Loss of intestinal villi 11 What is the cause of necrotizing sialometaplasia? a Varicella‐zoster infection b Traumatic burn c Severe dysplasia d Focal ischemia 12 What is the likely diagnosis of a red interdental gingival nodule that bleeds easily upon manipulation? a Fibroma b Pyogenic granuloma c Epulis fissuratum d Parulis Common Oral Soft Tissue Lesions 113 13 What is the cause of the normal white coating frequently seen on the dorsal tongue? a Candidiasis b Inflammatory exudate c Retained food d Sloughed keratin 14 What type of candidal infection appears as a white plaque that cannot be scraped off? a Acute pseudomembranous b Chronic hyperplastic c Acute atrophic d Chronic atrophic 15 What is the shaggy white lesion caused by an Epstein–Barr infection found on the lateral tongue of an immunocompromised patient? a Hairy leukoplakia b Linea alba c Morsicatio linguarum d Leukoedema 16 Choose the correct statement about actinic cheilitis a Occurs from excess exposure to dental X‐rays b Most common in teenaged males c Frequently occurs on the upper lip d Can undergo malignant transformation 17 What is the most common location for the hypertrophic type of oral lichen planus? a Alveolar mucosa b Buccal mucosa c Dorsal tongue d Hard palate ... Title: The ADA practical guide to soft tissue oral disease / Michael A Kahn, J Michael Hall Other titles: American Dental Association practical guide to soft tissue oral disease | Practical guide. .. LCCN 2 017 060299 (ebook) | ISBN 97 811 19437598 (pdf) | ISBN 97 811 19437307 (epub) | ISBN 97 811 19437338 (pbk.) Subjects: | MESH: Mouth Diseases | Soft Tissue Neoplasms | Diagnosis, Oral Classification:... capped Then, with the second brush, the lesion Figure 1. 4 A brush biopsy (cytology) kit as supplied by OralCDx (Oral Scan Laboratories, Suffern, NY) The Extraoral and Intraoral Soft Tissue