Nội dung của công việc này chỉ nhằm mục đích nghiên cứu, hiểu biết và thảo luận về khoa học nói chung chứ không nhằm mục đích và không được dựa vào đó là khuyến nghị hoặc quảng bá phương pháp khoa học, chẩn đoán hoặc điều trị của bác sĩ cho bất kỳ bệnh nhân cụ thể nào. Theo quan điểm của nghiên cứu đang diễn ra, sửa đổi thiết bị, thay đổi trong các quy định của chính phủ và luồng thông tin liên tục liên quan đến việc sử dụng thuốc, thiết bị và dụng cụ, người đọc được khuyến khích xem xét và đánh giá thông tin được cung cấp trong tờ hướng dẫn sử dụng hoặc hướng dẫn cho mỗi loại thuốc, thiết bị hoặc dụng cụ, trong số những thứ khác, bất kỳ thay đổi nào trong hướng dẫn hoặc chỉ dẫn sử dụng cũng như các cảnh báo và biện pháp phòng ngừa bổ sung. Mặc dù nhà xuất bản và tác giả đã nỗ lực hết sức để chuẩn bị tác phẩm này, nhưng họ không tuyên bố hoặc bảo đảm về tính chính xác hoặc hoàn chỉnh của nội dung tác phẩm này và từ chối đặc biệt mọi bảo đảm, bao gồm nhưng không giới hạn bất kỳ bảo đảm ngụ ý nào về khả năng bán được hoặc tính phù hợp cho một mục đích cụ thể. Không có bảo hành nào có thể được tạo ra hoặc mở rộng bởi các đại diện bán hàng, tài liệu bán hàng bằng văn bản hoặc tuyên bố quảng cáo cho công việc này. Việc một tổ chức, trang web hoặc sản phẩm được đề cập đến trong tác phẩm này như một nguồn trích dẫn và hoặc nguồn thông tin tiềm năng không có nghĩa là nhà xuất bản và các tác giả xác nhận thông tin hoặc dịch vụ mà tổ chức, trang web hoặc sản phẩm có thể cung cấp hoặc các khuyến nghị mà nó có thể đưa ra. Tác phẩm này được bán với sự hiểu biết rằng nhà xuất bản không tham gia vào việc cung cấp các dịch vụ chuyên nghiệp. Những lời khuyên và chiến lược trong tài liệu này có thể không phù hợp với tình huống của bạn. Bạn nên tham khảo ý kiến của bác sĩ chuyên khoa nếu thích hợp. Hơn nữa, độc giả nên biết rằng các trang web được liệt kê trong tác phẩm này có thể đã thay đổi hoặc biến mất giữa thời điểm tác phẩm này được viết và khi nó được đọc. Nhà xuất bản và các tác giả đều không chịu trách nhiệm về bất kỳ thiệt hại nào về lợi nhuận hoặc bất kỳ thiệt hại thương mại nào khác, bao gồm nhưng không giới hạn ở các thiệt hại đặc biệt, ngẫu nhiên, do hậu quả hoặc các thiệt hại khác.
www.pdflobby.com The ADA Practical Guide to Soft Tissue Oral Disease www.pdflobby.com www.pdflobby.com The ADA Practical Guide to Soft Tissue Oral Disease Michael A Kahn, DDS Diplomate and Director, American Board of Oral and Maxillofacial Pathology Professor and Chair, Department of Oral and Maxillofacial Pathology, Oral Medicine, and Craniofacial Pain Tufts University School of Dental Medicine Boston, MA J Michael Hall, DDS Diplomate, American Board of Oral and Maxillofacial Pathology Associate Professor, Department of Oral and Maxillofacial Pathology, Oral Medicine, and Craniofacial Pain Tufts University School of Dental Medicine Boston, MA www.pdflobby.com This edition first published 2014 © 2014 by John Wiley & Sons, Inc Editorial offices: 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/ wiley-blackwell Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-1-1182-7797-3/2014 Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book 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 a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author 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 fitness for a particular purpose 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 Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Kahn, Michael A., author The ADA practical guide to soft tissue oral disease / Michael A Kahn and J Michael Hall online resource American Dental Association practical guide to soft tissue oral disease Practical guide to soft tissue oral disease Includes bibliographical references and index Description based on print version record and CIP data provided by publisher; resource not viewed ISBN 978-1-118-27798-0 (Adobe PDF) – ISBN 978-1-118-27800-0 (ePub) – ISBN 978-1-118-27797-3 (pbk.) I. Hall, J Michael, author. II. American Dental Association. III. Title. IV. Title: American Dental Association practical guide to soft tissue oral disease. V. Title: Practical guide to soft tissue oral disease [DNLM: 1. Mouth Diseases. 2. Diagnosis, Oral. 3. Soft Tissue Neoplasms. WU 140] RK307 617.5′22–dc23 2014001140 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover image: iStock/© Tjerrie Cover design by Nicole Teut Set in 9.5/12 pt PalatinoLTStd by Toppan Best-set Premedia Limited 1 2014 www.pdflobby.com To our families and mentors for their support, patience, dedication, and lessons taught www.pdflobby.com www.pdflobby.com Contents Preface ix Acknowledgment of a Career xi Acknowledgments xiii Section I Detection and Documentation 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 113 Guidelines for Observation and/or Referral of Patients’ Lesions 127 The Art and Science of Biopsy and Cytology 133 Section III Clinicopathologic Exercises 143 Sample Patient Histories and Discussion 145 vii www.pdflobby.com viii Contents Appendix A: Glossary of Descriptive Terminology 217 Appendix B: Formulary of Over-the-Counter and Prescription Medications Based on Disease Classification; Common Errors of Prescription Writing 221 Index 241 www.pdflobby.com Formulary Based on Disease Classification; Common Errors 233 Acyclovir 5% and hydrocortisone 1% cream (Xerese, Xerclear) Dsp: tube Sig: Apply to sore five times daily for days Use: Recurrent herpes labialis Note: Therapy is most effective if started within 48 hours after the onset of symptoms It is probably not indicated if the patient has been symptomatic for days or longer Patient must maintain good hydration (64 fluid ounces per day Famciclovir 500 mg (Famvir; generic available); also available in 125 mg and 250 mg Dsp: #21 Sig: Take tablet three times a day for days Use: Acute herpes zoster (shingles) infection; recurrent herpes labialis (off-label use) Note: This is the prodrug of penciclovir, with approximately the same efficacy and safety as acyclovir Famciclovir is equivalent to acyclovir in the duration of acute pain, but more effective for duration of postherpetic neuralgia Start soon after symptoms appear (within 48 hours); efficacy after 72 hours is questionable Caution: Reduce doses in patients with renal impairment Drug interactions occur with cimetidine, digoxin, and theophylline products This medication has not been studied in children less than 18 years old and there are no randomized controlled studies with proof of efficacy for chronic recurrent herpes labialis Famciclovir 500 mg (Famvir; generic available) Dsp: #3 Sig: Take tablets for day or 1½ tablets twice for day Use: Recurrent herpes labialis (off-label use) Note: This is the prodrug of penciclovir, with approximately the same efficacy and safety as acyclovir Famciclovir is equivalent to acyclovir in the duration of acute pain, but more effective for duration of postherpetic neuralgia Start soon after symptoms appear (within 48 hours); efficacy after 72 hours is questionable Caution: Reduce doses in patients with renal impairment Drug interactions occur with cimetidine, digoxin, and theophylline products This medication has not been studied in children less than 18 years old Penciclovir 1% cream (Denavir) Dsp: 2 g tube Sig: Apply thin amount to herpetic lesion every hours during waking hours for a period of days Treatment should be started as early as possible (i.e., during the prodrome or when lesions appear) Use: Recurrent herpes simplex infection (studies indicate decreased pain and mean duration of lip lesions reduced by ½ day) Note: Do not apply with fingertip No studies of primary HSV labialis or immunocompromised patients Valacyclovir HCl 500 mg (Valtrex; generic available) Dsp: #42 or #14 Sig: Take caplets three times a day for days without regard to meals or take tablet twice a day for days www.pdflobby.com 234 Formulary Based on Disease Classification; Common Errors Use: Herpes zoster (shingles) in immunocompetent individuals Note: Not for use in immunocompromised patients A prodrug of acyclovir that is three to five times more bioavailable than acyclovir Valacyclovir is more effective than acyclovir for acute pain cessation and duration of postherpetic neuralgia Start soon after symptoms appear (48 hours); efficacy after 72 hours is questionable It has the lowest cost among prescription antivirals listed Caution: Reduce doses in patients with renal impairment This medication has not been studied in children less than 18 years old Avoid use in patients with HIV or bone marrow or renal transplants due to risk of hemolytic uremic syndrome Miscellaneous Over-the-Counter 10% Docosanol cream (Abreva) Dsp: 2 g tube Sig: Apply to herpetic lesion five times a day as soon as possible after detection Use: Recurrent orofacial herpes simplex infections (i.e., cold sores, fever blisters) Caution: Local application must be done with a cotton-tipped applicator to prevent viral transmission and autoinoculation Antianxiety Alprazolam 0.25 mg (Xanax) Dsp: #20 Sig: Take tablet three times daily or tablet hour prior to dental appointment Use: Tension reduction prior to appointments; myogenic facial pain Chlordiazepoxide 10 mg (Librium) Dsp: #20 Sig: Take tablet twice daily Use: Tension reduction prior to appointments; myogenic facial pain Diazepam 5 mg (Valium) Dsp: #20 Sig: Take tablet before bedtime day prior to surgery, then tablet hour prior to surgery Use: Tension reduction prior to appointments; myogenic facial pain Caution: Contraindications are similar to codeine Do not use in the presence of cimetidine or any other H2-blocker Hydroxyzine 25 mg (Atarax) Dsp: #10 Sig: Take tablets hour before dental procedure Use: Anxiety and anxiety-related skin eruptions; sedation and antiemetic action Hydroxyzine pamoate 25 mg (Vistaril) Dsp: #20 www.pdflobby.com Formulary Based on Disease Classification; Common Errors 235 Sig: Take tablet 15–30 minutes before dental appointment Use: Short-term relief of anxiety; sedative when used as premedication Lorazepam 1 mg (Ativan) Dsp: #20 Sig: Take tablet daily or tablet hour prior to dental appointment Use: Tension reduction prior to appointments; myogenic facial pain Prochlorperazine maleate 5 mg (Compazine) Dsp: #20 Sig: Take tablet twice daily Use: Short-term relief of anxiety; severe nausea and vomiting Antixerostomics Some of the Drugs Reported to Frequently Cause Xerostomia Anticholinergics and antiparkinsonian agents—benztropine mesylate, dicyclomine, flavoxate, methantheline bromide, oxybutynin Antidepressants—amitriptyline, desipramine, imipramine, MAOIs, all tricyclic antidepressants (TCAs), trazadone Antipsychotics—chlorpromazine, haloperidol, prochlorperazine, thioridazine, thiothixene, trifluoperzine Antihypertensives—beta blockers, captopril, clonidine, guanethidine, methyldopa, reserpine Central nervous system (CNS) stimulants—amphetamines, dethylproprion, phentermine, phenylpropranolamine, pseudoephedrine Diuretics—calcium sparing diuretics, carbonic anhydrase inhibitors, chlorthalidone, loop diuretics, thiazides Miscellaneous—atropinics, hypotensive agents, narcotics, muscle relaxants, systemic bronchodilators Prescription Saliva Substitutes Aquoral artificial saliva [oxidized glycerol triesters, silicon dioxide, aspartame, and artificial flavoring] Dsp: bottle Sig: sprays (0.1 mL/spray), three or four times daily Use: Relieves symptoms of dry mouth that may be the result of Sjögren’s syndrome, oral inflammation, medication, chemo- or radiotherapy, and stress or aging Maxisal liquid Dsp: bottle Sig: Use as needed Use: Enhance salivary function; also can be used for patient with burning mouth syndrome www.pdflobby.com 236 Formulary Based on Disease Classification; Common Errors Neutral calcium2+/PO43− rinse (Caphosol®) Calcium2+ 4.74 mM, PO43− 2.96 mM, Na+ 97.67 mM, Cl− 116.6 mM and pH 7.1 Dsp: 30 mL per dose Sig: Four times a day rinse with 30 mL of solution Use: Reduce frequency, intensity, and duration of oral mucositis in patients undergoing hematopoietic stem cell transplantation Note: A neutral supersaturated solution used in combination with topical fluoride treatments Numoisen liquid and lozenge Liquid—water, sorbitol, linseed extract, Chondrus crispus, methylparaben, sodium benzoate, potassium sorbate, dipotassium phosphate, propylparaben (300 mL) Lozenge—sorbitol 0.3 g/lozenge, polyethylene glycol, malic acid, sodium citrate, calcium phosphate dibasic, hydrogenated cottonseed oil, citric acid, magnesium stearate, silicon dioxide (100s) Oasis® mouthwash and mouth spray Mouthwash—water, glycerin, sorbitol, poloxamer 338, PEG-60, hydrogenated castor oil, copovidone, sodium benzoate, carboymethylcellulose (473 mL) [alcohol free, sugar free; mild mint flavor] Spray—glycerin, cetylpryridinium, copovidone (30 mL) [alcohol free, sugar free; contains sodium benzoate; delivers ∼150 sprays, mild mint flavor] Burning Mouth Syndrome and Other Neuralgias Consider prescribing a tricyclic antidepressant or benzodiazepines in low dose when a psychogenic or idiopathic case is suspected The dosage should be adjusted according to the individual response of the patient, and maintenance doses may have to be continued for many months Alprazolam 0.5 mg extended-release (Xanax XR; generic available) Dsp: #20 Sig: Take ½ tablet three times daily or ½ tablet hour prior to dental appointment Use: Burning mouth syndrome Caution: Side effects expected include dry mouth and morning drowsiness; adjust dosage according to patient reaction and clinical symptomatology Amitriptyline 25 mg (Elavil) Dsp: #50 Sig: Take tablet at bedtime for week, then tablets at bedtime; increase to tablets after weeks and maintain at that dosage Use: Burning mouth syndrome, neuralgia, myofascial pain, and headache Caution: Side effects expected include dry mouth and morning drowsiness; adjust dosage according to patient reaction and clinical symptomatology Contraindicated in patients with a history of ischemic cardiovascular disease and myocardial infarction www.pdflobby.com Formulary Based on Disease Classification; Common Errors 237 Carbamazepine ER 200 or 300 mg (Carbatrol) Dsp: #30 Sig: Take caplet at bedtime Use: Neuralgia and myofascial pain Note: This gives more even blood levels than an immediate-release product Clonazepam 0.25 mg (Klonopin) Dsp: #21 Sig: Take tablet at bedtime for week Increase the daily dose by as much as 0.25 mg each week, up to a total dosage of 3 mg Use: Burning mouth syndrome; bad taste in mouth Note: If the burning subsides at any point, that dose can be maintained Reevaluate after weeks of medication Caution: Physician consultation and oversight is strongly recommended Clonazepam may cause significant sedation Doxepin HCl 25 mg (Sinequan) Dsp: #45 Sig: Take tablet each evening for days, then tablets each evening for days, then tablets each evening for days Use: Atypical facial pain of psychogenic origin and burning mouth syndrome; most effective in depressed patients with anxiety Caution: A dexamethasone suppression test is advisable initially Maintenance dose varies from 100 to 200 mg daily Fluoxetine HCl 20 mg (Prozac) Dsp: #30 Sig: Take tablet daily in the morning Use: Atypical facial pain of psychogenic origin and burning mouth syndrome; most effective in depressed patients Gabapentin 100 mg (300 mg, 400 mg) (Neurontin) Dsp: #30 Sig: Take capsule at bedtime Use: Neuralgia and myofascial pain Note: Gabapentin has fewer side effects and causes less drowsiness than carbamazepine Safe for cardiac patients Nortriptyline 10 or 25 mg (Pamelor) Dsp: #90 Sig: Take tablet at bedtime for week, then tablets at bedtime Increase to tablets at bedtime after weeks and maintain that dosage, if needed Use: Burning mouth syndrome, neuralgia, and myofascial pain Note: Nortriptyline has twice the potency of amitriptyline and causes less drowsiness and xerostomia so it may be better tolerated in the elderly Caution: There is an increased risk of suicidal thinking and behavior (suicidality) associated with use in children and adolescents www.pdflobby.com 238 Formulary Based on Disease Classification; Common Errors Prescription Writing Requirements and Safe Writing Practices Doctor’s Name Address Phone Number Patient’s Name Date Patient’s Address Age Rx: Drug Name Dosage/Size Dsp: Number of tablets, capsules, ounces (oz) to be dispensed Sig: Direction on how drug is to be taken Doctor’s Signature State License Number DEA Number (if required) Fill Generic: This note, if added to the prescription, allows the pharmacist to fill with the least expensive generic drug available Prescription Writing Always include the following: Date Full name and address of patient Name and address of prescriber Signature of prescriber If prescribing a Class II drug, then the Drug Enforcement Agency (DEA) number is necessary If prescribing a Class II or Class III narcotic, then a triplicate prescription form (in the state of California) is necessary and it must be handwritten by the prescriber Safe Writing Practices • There should be a space between a number and its units as it is easier to read There should be no period after the abbreviation mg or mL • Never place a decimal and a zero after a whole number If the decimal point is not seen because it falls on a line or because individuals are working from copies where the decimal point is not seen, this causes a 10-fold overdose • Just the opposite is true for numbers less than one Always place a zero before a naked decimal • Never abbreviate the word “unit.” The handwritten U or u looks like a (zero) and may cause a 10-fold overdose error to be made • Q.D is not a safe abbreviation for “once daily” as, when the Q is followed a sloppy dot, it looks like QID, which means four times daily • O.D is not a safe abbreviation for “once daily” as it is properly interpreted as meaning “right eye” and has caused liquid medications such as saturated solution of potassium iodide and Lugol’s solution to be administered incorrectly There is no safe abbreviation for “once daily.” It must be written out in full www.pdflobby.com Formulary Based on Disease Classification; Common Errors 239 • Do not use chemical names such as 6-mercaptopurine, as sixfold overdoses have been given when these were not recognized as chemical names The proper name of this drug is mercaptopurine • Do not abbreviate drug names because they are misinterpreted and cause error • Do not use the apothecary system or symbols • When writing an outpatient prescription, write a complete prescription A complete prescription can prevent the prescriber, the pharmacist, and/or the patient from making a mistake and can eliminate the need for further clarification The legible prescription should contain the following: a Patient’s full name b For pediatric or geriatric patients: the patient’s age (or weight where applicable) c Drug name, dosage form, and strength (If a drug is new or rarely prescribed, print this information.) d Number or amount to be dispensed e Complete instructions for the patient, including the purpose of the medication f Contraindications (When there are recognized contraindications for a prescribed drug, indicate to the pharmacist that you are aware of this fact.) Recommended Reading Ciancio SG, editor The ADA/PDR Guide to Dental Therapeutics, 5th edition Chicago, IL: American Dental Association; 2009 Cohen MR, Davis NM Avoid dangerous Rx prescriptions Am Pharm 1992;NS32:112–113 Eversole LR Oral Medicine: A Pocket Guide Philadelphia: W.B Saunders; 1996 Jeske AH, editor Mosby’s Dental Drug Reference, 8th edition St Louis, MO: Mosby Elsevier; 2008 Kahn MA Your Pocket-Size Dental Drug Reference Shelton, CT: People’s Medical Publishing House—USA; 2012 Siegel MA, Silverman S, Sollecito TP, editors Clinician’s Guide to Treatment of Common Oral Conditions, 5th edition Hamilton, Ontario, Canada: BC Decker; 2001 Wynn RL, Meiller TF, Crossley HL, editors Drug Information Handbook for Dentistry, 17th edition Hudson, OH: LexiComp; 2011 www.pdflobby.com www.pdflobby.com Index Note: Page numbers in italics refer to figures and photos Abscess, 75, 101, 123, 123 Acanthosis, 30 Accessory lymphoid aggregate (reactive hyperplasia), 75, 76, 77, 123, 123 Acquired melanocytic nevus, 69–70, 70, 125, 125 Actinic cheilitis (cheilosis), 45, 46, 120, 120 Acute necrotizing ulcerative gingivitis, 82, 84, 84, 114, 115, 115 Acute pseudomembranous candidiasis, 120, 120 Acyclovir, 232–233 Addisonian pigmentation, 74 Adenoid cystic carcinoma, 68, 98, 100 AIDS medications, pigmentation related to, 74 Allergic reactions, 53, 53, 62, 63, 84, 85, 85, 86, 115, 115, 122, 122, 122 Alprazolam, 234, 236 Alveolar ridge keratosis, 48, 48, 121, 120 Amalgam tattoo, 63, 71, 123, 125, 124, 130, 134 American Academy of Oral and Maxillofacial Pathology (AAOMP), 136, 140 American Association of Endodontists, 136 American Association of Oral and Maxillofacial Surgeons, 136 Amitriptyline, 236 Amlexanox oral paste, 231 Anatomical site of lesions, 24–25 Anesthetics, topical, 223–224 Angular cheilitis (perleche), 55–56, 56, 121 Antianxiety agents, 234–235 Antifungals, 224–226 Antihistamine agents, 222–223 Antimicrobials, 222 Antivirals, 232–234 Antixerostomics, 235–237 ANUG See Acute necrotizing ulcerative gingivitis Aphthous ulcers, 78, 80, 114, 115 Aquoral artificial saliva, 235 Aspirin burn, 39, 41–42, 42, 120, 120 Azathioprine, 230–231 Behcet’s disease, 81 The ADA Practical Guide to Soft Tissue Oral Disease, First Edition Michael A Kahn and J Michael Hall © 2014 John Wiley & Sons, Inc Published 2014 by John Wiley & Sons, Inc 241 www.pdflobby.com 242 Index Benign mesenchymal neoplasms, 106–107, 108, 118, 119 Benign migratory glossitis, 49–50, 49, 56, 57, 121, 121 Benign nerve sheath tumor, 108 Benzocaine, 223, 224 Betamethasone dipropionate, 227 Betamethasone valerate ointment, 228 Biochromes, 29 Biopsies decision-making related to, 128–129 incisional and excisional, 137, 138 indications and contraindications, 136–137 lesions, monitoring, 12–130 punch biopsy dos and don’ts, 140 scalpel biopsy, dos and don’ts, 137–140 soft tissue, indications for, 128 Biopsy kit, typical, 139 Bite, traumatic, 98 Black lesions, 31, 69–74, 125–126, 125 Blind pouches, 28 Blisterform lesions, 25–26 Blue and/or purple lesions, 63–69, 124 Blue lesions, 30–31, 123–125 Blue nevus, 68, 69, 125, 124 Brown lesions, 31–32, 69–74, 125–126, 125 Brush biopsy, 129, 133, 134 Brush biopsy (cytology) kit, 12, 13 Buccal mucosa, lesions of, 25 Bullae, 26, 26, 31, 32, 115, 116–119, 116, 118, 123, 124, Burning mouth syndrome, 236–237 Canalicular adenoma, 98, 100 Cancer, biopsy and diagnosis of, 136 Candida albicans, 43, 52, 55 Candidal leukoplakia, 38, 39 Candidiasis, 37, 38 acute pseudomembranous type, 38 chronic atrophic type, 53–54, 54 chronic erythematous type, 54–55, 55, 56, 56, 121, 121 chronic hyperplastic (hypertrophic) type, 38, 39 chronic multifocal type, 50, 50, 122 Canker sores, 78, 80, 114, 115 Carbamazepine, 237 Carotene, lesion color and, 29 Celiac disease, 81 Cervical lymph node levels, Chemical burn (aspirin burn), 39, 41–42, 42, 120, 120 Chemical cauterizers, 224 Chemiluminescent screening devices, 14–15 Chicken pox (varicella), 88, 89, 115, 116 Chlordiazepoxide, 234 Chlorhexidine gluconate, 222 Chromophores, 17–18 Chronic erythematous candidiasis, 54–55, 55, 56, 56, 121 Chronic hyperplastic type of candidiasis, 38, 39 Chronic vesiculoerosive and ulcerative lesions answers to study questions, 203–204 sample case histories, 166–171 Clobetasol propionate cream or ointment, 228 Clonazepam, 237 Clotrimazole, 224–225 Cold sores, 81, 83 Color of lesions, 29–32 black, 31 blue, 30–31 brown, 31–32 gray, 31 pink, 30 purple, 31 red, 29–30 red-and-white, 30 translucent, 32 white, 30 yellow, 31 Consistency of lesions, 32 Corticosteroids, topical, classes of relative potencies, 227 Cyclic neutropenia, 81 Cytology oral mucosal, indications and contraindications, 133–135 technique tips and pitfalls, 135–136 Debacterol, 224 Dental history, DentLight D.O.E Oral Exam System, 17, 18 www.pdflobby.com Index 243 Depressed lesions, 23, 27–28 Dexamethasone, 231, 232 Dexamethasone elixir, 228–229 Diazepam, 234 Differential diagnosis, of common oral soft tissue lesions, 113–126 prioritized ranking list, 113–114 tips and pitfalls, 114–126 Diphenhydramine, 222–223, 232 Docosanol cream, 234 Doxepin, 237 Drug ingestion, 72–73, 74, 126, 125 Dysplasia, cytology procedures and, 134 Ecchymosis, 29, 60, 61 Edentulous alveolar ridge mucosa, lesions of, 25 Elevated lesions, 23 Epulis fissuratum, 101, 103, 118, 118 Erosions, acute, 114–115, 115, 116 Erosive lichen planus, 50, 51, 116, 116, 122, 122 Eruption cyst (eruption hematoma), 65, 67, 124, 124 Erythema migrans, 49–50, 49, 56, 57, 121, 121 Erythema multiforme, 84, 86, 87, 115, 115 Erythroleukoplakia, 52, 52–53, 122, 122 Erythroplakias, 56, 57–58, 121 biopsied, continued monitoring of, 130–131 oral mucosa cytology indications/ contraindications, 134 Excisional biopsy, 137 Exfoliative cytology, 12 Extraoral sites, physical examination, 7–8 Extravasated blood, 59–60, 121 Facial rash, secondary to latex allergy, 85–86 Factitial ulcers, 95, 98, 116, 117 Famciclovir, 233 Fever blister, 81, 83 Fibroma, 95, 97, 99, 117, 134 Flat lesions, 23, 28–29 Floor of mouth examining, 11 lesions of, 24 Fluconazole, 225 Fluocinonide gel or ointment, 229 Fluoxetine, 237 Fordyce granules, 75, 122, 123 Formalin, 139 Formulary of OTC and prescription medications, 221–239 antianxiety, 234–235 antifungals, 224–226 antihistamine and palliative coating agents, 222–223 antimicrobials, 222 antivirals, 232–234 antixerostomics, 235–237 chemical cauterizers, 224 disclaimer, 221–222 immunosuppressives alternative to steroids, 231 occlusive dressings, 231–232 selected topical corticosteroids, 227–230 used in conjunction with a lowered dose of steroids, 230–231 miscellaneous, 234 prescription writing requirements and safe writing practices, 238–239 topical anesthetics, 223–224 Gabapentin, 237 Generalized gingival enlargement, 106, 107, 118 Geniohyoid muscles, Geographic tongue, 49–50, 49, 56, 57, 121, 121 Gingiva, lesions of, 24–25 Gingival cyst, of the adult, 68, 69, 124, 124 Gingival enlargement, generalized, 106, 107 Gingival vesicles, erosions, and ulcerations, 94 Gray lesions, 31, 69–74, 125–126, 125 Gum boil, 101, 103 “Hairy” leukoplakia, 43 Hairy tongue, 72, 72, 125, 125 Hamular notch, lesions of, 25 Hard palate examining, 10–11 lesions of, 25 Head and neck soft tissue pathology, descriptive features of, 23 Hemangiomas, 56, 59, 59, 65, 67, 106, 124, 124 www.pdflobby.com 244 Index Hematomas, 29, 60, 61, 107, 109, 118, 121 Hemosiderin, 31 Herpangina, 86, 88, 115–116, 115 Herpes simplex type 1, 81 Herpes zoster (“shingles”), 88, 90, 90, 115, 116 Herpetic gingivostomatitis, 81, 82, 114 Herpetiform type ulcer, 81 HIV infection, oral manifestation of, 74 HIV-positive patients, “hairy” leukoplakia in, 43 HPV 16, 19, 43, 52 HPV 18, 43, 52 Hues, of lesions, 23 Hydrocortisone, 225 Hydrocortisone acetate ointment, 227 Hydroxyzine, 234–235 Hyperkeratosis, 30 Hyperplastic/hypertrophic candidiasis, 38, 39, 120 Hyperplastic/hypertrophic lichen planus, 48, 121 Identafi, 16, 18 Imatinib, palatal pigmentation and treatment with, 74 Incisional biopsy, 137, 138 Inflammatory papillary hyperplasia, 108, 110, 118, 119 Intraoral sites, physical examination of, 8–11 Kaposi’s sarcoma, 65, 67, 124, 124 Keloid, 28 Labels, biopsy specimens, 139 Laser biopsies, 138 Latex allergy, facial rash secondary to, 85–86 Lesions anatomical site of, 24–25 atrophy and scarring and, 28 biopsied, monitoring, 129–130 biopsied leukoplakias and erythroplakias, continued monitoring of, 130–131 blue and/or purple, 63–69, 123–125, 124 brown, gray, and/or black, 69–74, 125–126, 125 chronic vesiculoerosive and ulcerative, 166–171, 203–204 color of, 29–32 consistency of, 32 depressed, 23, 27–28 elevated, 23, 25–27 extraoral or intraoral, documenting, 32–33 flat, 28–29 indications for soft tissue biopsy, 128 morphological types of, 23 morphology of, 25–29 nonbiopsied, with low index of suspicion, 129 papillary, 172–178, 205–208 pigmented, 130, 178–183, 208–210 precise and accurate clinical descriptions of, 24 red, 53–63, 121–122, 121, 154–161, 198–201 red-and-white, 49–53, 122, 122, 154–161, 198–201 size of, 23–24, 32 white, 37–48, 120–121, 120, 145–153, 195–197 yellow, 122–123, 123 Leukoedema, 43, 44, 120, 120 Leukoplakias, 43, 120, 120 biopsied, continued monitoring of, 130–131 candidal, 38, 39 keratotic, 45 oral mucosal cytology indications/ contraindications, 134 Lichen planus, 92, 92 atrophic and erosive, 50, 51, 116, 116, 122, 122 hyperplastic/hypertrophic, 47–48, 48, 121 reticular, 45, 47, 47, 120, 120 Lichenoid contact allergic reaction, 53 Lidocaine, 223–224, 231 Linea alba, 42, 43, 120, 120 Lipomas, 78, 78, 106, 123, 123 Lips examining, 8–9 lesions of, 24 Liquid-based cytology process, 129, 134 Liquid cytology kit, 15, 135, 135 Lorazepam, 235 Lumps and bumps, 95–110, 117–119, 118 www.pdflobby.com Index 245 Lymph nodes, 7–8 Lymphoepithelial cysts, 77, 77–78, 123, 123 Lymphoma (non-Hodgkin’s), 105, 105–106, 118, 119 Macules, 26, 28, 31, 120, 121, 122, 123, 124, 125 Malignant melanoma, 68–69, 70, 71, 124, 125, 125 Maxillary tuberosity, 25 Maxisal liquid, 235 Median rhomboid glossitis, 121 Medical history, Melanin, lesion color and, 29, 30, 31 Melanoma (malignant), 68–69, 70, 71, 124, 125, 125 Melanocytic nevus, 69–70, 70, 125, 125 Melanotic macule, 72, 73, 125, 125 Methylprednisolone, 229 Microlux DL oral mucosa reflectance adjunctive light-emitting diagnostic device, 15, 15 Miles’ mixture, 227 Monomorphic adenoma, 100 Morphology of lesions, 25–29 Morsicatio (nibbling habit), 39, 40, 120, 120 Mucocele (mucous extravasation phenomenon; mucous retention phenomenon), 64–65, 66, 95, 98, 117, 124, 124, 134 Mucoepidermoid carcinoma, 98, 100 Mucous membrane pemphigoid, 94–95, 116, 117 Mycoplasma pneumoniae, 86 Mylohyoid muscle, Narrow-spectrum (band) fluorescence, 16–18, 129 Necrosis, 30 Necrotizing sialometaplasia, 90, 91, 92, 115, 116 Neuralgias, 236–237 Neurilemoma, 106, 108 Neurofibroma, 106 Neuromas, 134 Neutral calcium, 236 Nicotine stomatitis, 51, 52, 122, 122 Nodules, 26, 27, 31, 32, 117, 118, 123, 124, 125 Non-Hodgkin’s lymphoma, 105, 105–106, 118, 119 Nonbiopsied lesions, with low index of suspicion, 129 Nonblisterform lesions, 26–27 Nonsteroidal anti-inflammatory medications, 140 Nortriptyline, 237 Numoisen liquid and lozenge, 236 Nutritional deficiency disorders, 81 Nystatin, 225–226, 231 Oasis mouthwash and mouth spray, 236 Occlusive dressings, 231–232 Oral cancer screening, Oral cavity, major components of, Oral CDx brush biopsy, 12, 13, 133, 134 Oral mucosal cytology indications and contraindications, 133–135 uterine cervical cytology compared with, 133 Oral mucosal screening, complete, sequence of steps, OraRisk HPV, 19 Orascoptic DK, 15 Oropharynx examining, 11 frontal and sagittal views, 10 lesions of, 25 Oxyhemoglobin, lesion color and, 29 Palliative coating agents, 222–223 Pap smears,of oral cavity, 133 Papillary lesions, 172–178, 205–208 answers to case study questions, 205–208 sample case histories, 172–178 Papilloma, 107, 109, 118, 119, 135 Papules, 26, 27, 30, 118, 120, 121, 122, 123, 124, 125 Parulis, 118, 123, 123 gum boil, 101 103 yellow, 75, 76 Patches, 28 Pedunculated, 27 Pemphigoid, 94–95, 116, 117 Pemphigus, 116 www.pdflobby.com 246 Index Pemphigus vulgaris, 95, 96–97 Penciclovir, 233 Perioral skin, lesions of, 24 Peripheral giant cell granuloma, 104, 105, 118, 119 Peripheral ossifying fibroma, 103, 104, 118 Perleche, 55–56, 56, 121 Petechiae, 29, 60, 60, 61 Phenytoin, generalized gingival hyperplasia and use of, 107 Physical examination, 6–11 extraoral sites, 7–8 intraoral sites, 8–11 Physiologic pigmentation, 125, 125 Pigmented lesions, 29, 74, 130 answers to case study questions, 208–210 sample case histories, 178–183 Pink lesions, 30 Pits, 28 Plaques, 26, 27, 30, 120, 121, 122, 123, 124 Plasma cell gingivitis, 61–62, 62, 121 Pleomorphic adenoma, 98 Polymorphous low-grade adenocarcinoma, 98 Prednisolone syrup, 230 Prednisone, 226, 229–230 Prescriptions, writing requirements and safe writing practices, 238–239 Primary herpes simplex infection (herpetic gingivostomatitis), 81, 82, 114, 115 Prochlorperazine maleate, 235 Pseudomembranous candidiasis, of buccal mucosa, 38 Punch biopsy, dos and don’ts, 140 Purple lesions, 31 Purpura, 29, 60, 60 Purpuric lesions, 154–161, 198–201 answers to case study questions, 198–201 sample case histories, 154–161 Pustules, 26, 26, 118, 123 Pyogenic granulomas, 101, 103, 104, 118, 118 Racial pigmentation, 70–71, 71 Reactive lymphoid hyperplasia, 106, 106, 118 Recurrent herpes labialis, 81, 83 Recurrent herpes simplex infection, 81, 83, 115, 115 Red-and-white lesions, 30, 49–53, 122, 122 answers to case study questions, 198–201 sample case histories, 154–161 Red lesions, 29–30, 53–62, 121–122, 121 answers to case study questions, 198–201 sample case histories, 154–161 Reduced hemoglobin, lesion color and, 29 Reticular lichen planus, 45, 47, 47, 120, 120 Retromolar pad(s), lesions of, 25 Rovers cellular collection device, 14, 14 Saliva samples, 18–20 Saliva substitutes, prescription, 235–236 Salivary gland tumors, 65, 68, 68, 97–98, 101, 117–118, 118, 124, 124, 134 Sapphire Plus LD, 16 Scalpel biopsy, dos and don’ts, 137–140 Schwannomas, 106, 108 Sessile, 27 “Shingles” (herpes zoster), 88, 90, 90, 115, 116 Sialadentitis, acute, 102 Sialoliths, 101, 102, 118 Size of lesions, 32 Smoker’s melanosis, 73, 74, 125, 126 Snuff dipper’s keratotic leukoplakia, 45 Soft tissue masses, 183–195, 210–215 answers to case study questions, 210–215 sample case histories, 183–195 Speckled leukoplakia, 52, 52, 53, 57, 122, 122 Squamous cell carcinoma, 18, 19, 20, 92, 93, 94, 116, 116, 134 Squamous papilloma, 107, 109, 118, 119, 135 Staphylococcus aureus, 55, 56 Stensen’s duct, sialolith of, 102 Steroids, systemic, contraindications, 226 Stevens-Johnson syndrome, 86 Stomatitis medicamentosa, 84 Stomatitis venenata, 84 Sturge-Weber syndrome, unilateral hemangioma with, 59 Sucralfate, 231 Telangiectasia, 61, 62, 121 Tetracaine, 231 Tetracycline, 231, 232 Thermal burn, 39, 41, 120, 120 www.pdflobby.com uploaded by [stormrg] Index 247 Thrush, 37, 38, 120, 120 Tissue reflectance, 14–16 Tobacco cessation programs, 131 Tongue dorsal, hyperplastic lichen planus of, 48 dorsal, white coating of, 38, 120 dorsolateral, macule or patch of, 29 examining, 11 geographic, 49, 49–50, 56, 57, 121, 122 lesions of, 24 Transepithelial (full-thickness sampling) cytology, 12, 14 Translucent lesions, colors of, 32 Traumatic ulcerative granuloma with stromal eosinophilia, 95, 97, 115, 116, 117 Traumatic ulcers, 78, 79, 114 Treponema pallidum, 43, 52 Triamcinolone acetonide ointment or suspension, 230 Trigone area, lesions in, 25 TUGSE See Traumatic ulcerative granuloma with stromal eosinophilia Tumors, 26, 27, 31, 32, 117, 118, 121 Ulcerative allergic reactions, 84, 85 Ulcers, 26 acute, 78–92, 114–116, 115, 116, 161–166, 201–203 answers to case study questions, 201–203 sample case histories, 161–166 biopsies of, 138 chronic (erosions), 92–95, 116–117, 116 chronic vesiculoerosive and ulcerative lesions, 166–171, 203–204 diagnostic tips and pitfalls, 114–116 factitial, 95, 98, 116, 117 margins, depth, and diameter of, 28 number and outline of, 27 traumatic, 78, 79, 114 Uterine cervical cytology, oral mucosal cytology compared with, 133 Valacyclovir, 233–234 Varicella (chicken pox), 88, 89, 115, 116 Varix (varices), 63, 64, 123, 124 VELscope, 16, 17, 18 Verruca vulgaris, 118, 119, 135 Vesicles, 26, 26, 32, 118, 123 acute, 78–92, 114–116, 115 chronic, 92–95, 116–117 Vesiculoerosive lesions, chronic, 166–171, 203–204 Vesiculoulcerative allergic reaction, 85 Vestibule, mucobuccal fold, lesions of, 25 Vizilite, 15 Vizilite Plus, 16, 16 Warthin’s tumor, 98 Wharton’s duct sialolith, 102 White coated tongue, 37, 120 White lesions, 30, 37–48, 120–121, 120 answers to case study questions, 195–197 sample case histories, 145–153 Xerostomia, drugs related to, 235 Yellow lesions, 31, 75–78, 122–123, 123 www.pdflobby.com ...www.pdflobby.com The ADA Practical Guide to Soft Tissue Oral Disease www.pdflobby.com www.pdflobby.com The ADA Practical Guide to Soft Tissue Oral Disease Michael A Kahn, DDS Diplomate and Director, American... Dental Association practical guide to soft tissue oral disease. V. Title: Practical guide to soft tissue oral disease [DNLM: 1. Mouth Diseases. 2. Diagnosis, Oral. 3. Soft Tissue Neoplasms. ... soft tissue oral disease / Michael A Kahn and J Michael Hall online resource American Dental Association practical guide to soft tissue oral disease Practical guide to soft tissue oral disease