Lesiones de cavidad oral 1

Introduction to Inflammatory Lesions of Cavities

Overview of Inflammatory Lesions

• Carlos Abascal Quintana introduces the topic of inflammatory lesions in oral cavities, emphasizing their complexity and the need for specialized knowledge in dentistry.

• He highlights the importance of recognizing these lesions as indicators of potential malignancy, which is crucial for early detection.

Anatomy and Characteristics of Oral Cavity

• The oral cavity is defined by its anatomical boundaries, including the inner surface of teeth and oropharyngeal limits, extending from the vermilion border to the hard-soft palate junction.

• The oral mucosa is primarily composed of stratified squamous epithelium, with variations based on location and function; masticatory mucosa is thicker due to trauma exposure.

Mucosal Coloration Factors

• Mucosal coloration varies based on three factors: keratinization level (more keratinized areas appear whiter), pigmentation (melanin contributes to darker hues), and extracellular matrix density.

• These factors influence how different regions within the mouth present visually, impacting diagnosis and treatment approaches.

Classification of Oral Lesions

Types of Lesions

• Oral lesions are categorized into several types: inflammatory, infectious, neoplastic, autoimmune, and those related to systemic diseases. Understanding this classification aids in diagnosis.

Evaluation Criteria

• Key evaluation criteria include lesion localization, duration in the mouth, patient symptoms, color description, shape, size consistency, etc., which are essential for accurate assessment.

• It’s important to inquire about aggravating factors such as dietary influences (e.g., citrus consumption) that may exacerbate symptoms related to salivary gland lesions.

Trauma and Risk Factors

Impact of Trauma on Oral Health

• Trauma can lead to specific oral lesions; for instance, biting injuries may result in white fibrinous lesions that heal naturally over time. Understanding trauma's role helps differentiate between lesion types.

Lifestyle Factors Contributing to Cancer Risk

• Alcohol and tobacco use are significant risk factors for oral cancer; thus patient history should include inquiries about these habits alongside other systemic disease manifestations visible in the mouth.

Describing Oral Lesions

Detailed Description Techniques

• Accurate descriptions involve identifying features such as macules or papules; distinguishing between flat versus elevated lesions is critical for proper categorization during examination.

Size Classification

• Elevated lesions are classified by size: nodules (<1 cm), tumors (>3 cm), with clear definitions aiding clinical communication regarding findings during examinations.

Case Study: Papules on Tongue

Visual Examination Insights

• A case study presents a photo showing asymptomatic papules at the back of the tongue; they appear smooth and shiny but require careful differentiation from pathological conditions based on their characteristics like size and distribution pattern (inverted V).

Diagnosis Considerations

Oral Lesions and Their Characteristics

Overview of Asymptomatic Oral Conditions

• The discussion begins with the observation of asymptomatic bone characteristics in patients, indicating that lesions should not be removed unless they cause symptoms.

• Granules of Fordyce are identified as normal anatomical variants due to sebaceous gland hyperplasia, characterized by yellow papules forming plaques.

Geographic Tongue and Other Variants

• Geographic tongue is described as atrophy of filiform papillae on the tongue's dorsum, presenting island-like appearances; it requires no treatment.

• Black hairy tongue (lingua pilosa) is noted for its black papules and is also a benign variant caused by defective desquamation; no treatment is necessary.

• Fissured tongue appears with multiple fissures on the dorsum; like other variants, it does not require treatment.

White Lesions: Leucoplasia

• Leucoplasia is defined as a white lesion in the oral cavity that cannot be attributed to any other disease; it is a common premalignant condition.

• The risk of malignant transformation in leucoplasia ranges from 20% to 25%, particularly prevalent among men over 80 years old who consume alcohol and tobacco.

• Trauma can lead to frictional keratosis, often seen along the buccal mucosa corresponding with dental occlusion lines.

Risk Factors and Biopsy Considerations

• A localized leukoplakic lesion on the lower lip may indicate actinic keratosis due to sun exposure, necessitating biopsy due to potential malignancy risks.

• Various morphologies exist for leukoplakic lesions, which can range from smooth to ulcerated forms; changes in appearance warrant biopsy consideration.

Neoplastic Lesions and Treatment Approaches

• Ulcerated leukoplakia raises suspicion for premalignancy; verrucous leukoplakia presents as a warty surface formed by confluent papules.

• Treatment decisions depend on biopsy results; large lesions may require multiple biopsies from different areas due to variability in histological findings.

Red Lesions: Erythroplakia

• Erythroplakia presents as red lesions that may appear granular or ulcerative; these are also considered premalignant conditions requiring careful evaluation.

Specific Conditions Related to Viral Infections

Understanding Lichen Planus and Its Differential Diagnosis

Overview of Lichen Planus

• The discussion begins with the potential for in situ hybridization to demonstrate the virus, particularly focusing on histopathological observations such as hyperkeratosis and irregular surfaces in patients.

• It is noted that lichen planus typically does not require treatment; improvement in leukocyte counts can lead to resolution of lesions, especially with antiretroviral therapy.

Characteristics and Malignancy Risk

• Lichen planus is described as an autoimmune disease with a low malignancy risk (1-3%). The etiology remains unclear, necessitating consideration of leukoplakia as a differential diagnosis.

• Biopsy is essential for accurate diagnosis. In this case, a biopsy confirmed lichen planus, which has an immunological basis and a low prevalence (0.2% - 3%).

Clinical Presentation

• Patients are often asymptomatic; however, some variants may ulcerate and cause pain. Lesions are mediated by T-cell lymphocytic reactions to epithelial surface antigens.

• The demographic most affected includes middle-aged women. A reticular form of lichen planus presents as white striae resembling branches or arborized patterns.

Variants of Lichen Planus