This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
This slide is about oral hairy leukoplakia. it is basically a type of oral manifestation of some viral disease like HIV and HSV 4 (Epstein Barr virus )
Leukoplakia can be defined as a “white patch” or “plaque” in the oral cavity, which cannot be scrapped off and which cannot be characterized clinically or pathologically as any other disease.
This excludes lesions such as lichen planus, candidiasis, leukoedema, white spongy nevus, and obvious frictional keratosis.
The term leukoplakia should be used to recognise white plaques of questionable risk having excluded (other) known diseases or disorders that carry no risk for cancer-WHO 2005.
Cancer of the oral cavity accounts for approximately 3% of all malignancies diagnosed annually in 270,000 patients world-wide. Oral cancer is the 12th most common cancer in women and the 6th in men. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs). Lack of awareness about the signs and symptoms of oral PMDs in the general population and even healthcare providers is believed to be responsible for the diagnostic delay of these entities.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Leukoplakia can be defined as a “white patch” or “plaque” in the oral cavity, which cannot be scrapped off and which cannot be characterized clinically or pathologically as any other disease.
This excludes lesions such as lichen planus, candidiasis, leukoedema, white spongy nevus, and obvious frictional keratosis.
The term leukoplakia should be used to recognise white plaques of questionable risk having excluded (other) known diseases or disorders that carry no risk for cancer-WHO 2005.
Cancer of the oral cavity accounts for approximately 3% of all malignancies diagnosed annually in 270,000 patients world-wide. Oral cancer is the 12th most common cancer in women and the 6th in men. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs). Lack of awareness about the signs and symptoms of oral PMDs in the general population and even healthcare providers is believed to be responsible for the diagnostic delay of these entities.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
'Oral Potentially Malignant Disorders' includes a variety of lesions with risk of progression to malignancy. It is widely prevalent in the Indian population, and early diagnosis and management is the need of the hour.
Here's a discussion of the same with methods of early diagnosis of such lesions.
Congenital True Leukonychia Totalis Case Report, Beyond The Skinkomalicarol
Congenital true leukonychia is an infrequent disorder characterized by a white coloration of the nail since birth without organ or
syndromic abnormalities. We present the case of a 16 years old
boy with isolated white nail coloration with psychological impact,
no syndromic or organ alterations were found.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. What is a premalignant lesion?
A premalignant lesion is "a morphologically altered tissue in which
oral cancer is more likely to occur than its apparently normal
counterpart."
These precancerous lesions mainly include
Leukoplakia
erythroplakia
3. Premalignant condition
A premalignant condition is "a generalized state associated with significantly
increased risk of cancer."
The precancerous conditions include
Submucous fibrosis,
Lichen planus,
Epidermolysis bullosa,
Discoid lupus erythematous.
4. What is dysplasia?
• If cell division becomes poorly regulated, cells may lose some of their
morphological characteristics and/or functions. The tissue becomes
disordered in appearance, often with an increase in the numbers of
immature cells, and greater variability between cells. This appearance is
called dysplasia.
• It should be emphasized that dysplasia does not necessarily show that the
cells have become cancerous; however, it does suggest underlying changes
in the cells, which may predispose to cancer.
• In this sense dysplasia may be a stage on the way to cancer development.
7. Neoplasia is the term used to describe the development of tumours or
cancerous tissue.
The development of a tumour requires a series of changes in the biology of
the cell, with progressive loss of the controls that limit cell division. Even a
cell which is undergoing uncontrolled proliferation will not necessarily be
malignant. Malignancy typically arises when the dividing cells invade the
normal tissue and move away from their site of origin.
8. Leukoplakia
The term leukoplakia was first used by schwimmer in 1877 to describe a white
lesion of tongue
A whitish patch or plaque that cannot be characterized clinically or pathologically
as any other disease.
It is most common percancerious lesion ,in which between 5% and 25% of these
lesions are premalignant
In Indian studies the rate of malignant transformation ranges from 0.13 to 2.2% per
yr.
9. Leukoplakia: Etiology
No etiologic factor can be identified for most persistent oral leukoplakias
(idiopathic leukoplakia). Known causes of leukoplakia include the following:
– Trauma (eg, chronic trauma from a sharp or broken tooth or from mastication may
cause keratosis)
– Tobacco use: Chewing tobacco is probably worse than smoking.
– Alcohol
– Infections (eg, candidosis, syphilis, Epstein-Barr virus infection): Epstein-Barr
virus infection causes a separate and distinct non–premalignant lesion termed hairy
leukoplakia.
– Chemicals (eg, sanguinaria)
– Immune defects: Leukoplakias appear to be more common in transplant patients.
10. Classification
There are 3 clinical forms of oral leukopliakia
1. Homogenious
2. Speckeled
3. Proliferative verrucous.
13. SPECKLED
Red background with multiple small white macules.
C. Albicans infection is often present.
High risk for malignant transformation (20-30%)
Rare form.
14.
15. PROLIFERATIVE VERRUCOUS
White exophytic papillary surface.
Tendency for prompt extension.
High risk of malignancy transformation (30-40%).
Very rare form.
17. Leukoplakia- Histopathology
Features highly variable
Ranging from hyperkaratosis and hyperplasia to atrophy and severe
dysplasia.
Significant intrapathologist and interpathologist variation in diagnosing
dysplasia.
Molecular studies indicated.
18. Diagnosis
Biopsy and histological examination is the key to define the nature
and relative risk of leukoplakia
Molecular biological and immunohistochemical techniques(p53
antigen, HPV 16,18,33) are important for detection of leukoplakia
with high risk of malignant transformation.
20. Treatment plan
Surgical excision is the mainstay of the treatment of leukoplakia
Co2 laser surgery may be used as an alternative test.
In wide spread or multiple leukoplakia oral administration of 13-cis
retinoic acid ( 1 mg / kg of body weight daily for 2-3 months) may be used
with limited success
Topical application of retinoic acid has been used in the treatment of
selective cases
Homogenous leukoplakia without epithelial dysplasia may disappear or
diminish in size with in 2-3 months after cessation of habit.
21. Erythroplakia (Erythroplasia)
Erythroplakia or Erythroplasia of Queyrat is a rare and dangerous precancerous
lesion characterized by red non specific plaque on oral mucosa that cannot be
attributed to any other known disease.
Red oral lesions usually are more dangerous than white oral lesions.
Carcinomas are seen 17 times more frequently in erythroplakias than in
leukoplakias, but leukoplakias are far more common.
23. Etiology
Etiology of erythroplakia is unknown.
Predisposing factors are mainly smoking, alcohol, and HPV
24. Clinical features
Erythroplakia mainly involves glance penis . Oral involvement is
rare
Fiery red, slightly elevated or flat plaque of varying size
Usually asymptomatic
More than 90-95% of cases of erythroplakia demonstrate
histologically severe epithelial dysplasia, carcinoma in situ or
invasive squamous cell carcinoma at the times of diagnosis.
26. Diagnosis
Biopsy and hispathologic examination conforms the diagnosis and
determines the risk of carcinoma
DIFFRENTIAL DIAGNOSIS
1. Speckeled leukoplakia
2. Erythematous candidiasis
3. Early sq. cell carcinoma
4. Local irritation
5. Drug reaction
27. Treatment plan
Surgical management is the mainstay of treatement of erythroplakia.
The extent of excision depends on histopathologic findings.
Interventional laser surgery is an alternative treatement for oral
erythroplakia.
Topical 5% imiquimod cream and 5- aminolevulinic acid has been
used with for success of traetement.
28. Smokeless tobacco keratosis
Smokeless tobacco keratosis is white keratotic lesion of mandibular
vestibule encountered in user of smokeless tobacco or snuff.
ETIOLOGY
Mucosal contact with smokeless tobacco stored in vesibular area.
29. Clinical features
Thin gray-white translucent plaque that appers fissured or rippled
It usually takes 1-5 yrs for the lesion to develop
The white plaque may thicken gradually to the point of appearing
nodular
The lesion is usually confined to the area of placement of smokeless
tobacco, and does not detach
Gingival recession and staining of the roots of the teeth in the area
may be present as well.
30. Diagnosis
The diagnosis is based on the history and the clinical features.
Biopsy is occasionally necessary to rule out premalignant and
malignant changes.
DIFFRENTIAL DIAGNOSIS
1. LEUKOPLAKIA
2. CANDIDIASIS
3. LICHEN PLANUS
32. WHAT IS A BIOPSY?
Biopsy is the removal of tissue for the purpose of
diagnostic examination.
33. CLINICAL EVALUATION
The anatomic location of the lesion/mass
The physical character of the lesion/mass
The size and shape of the lesion/mass
Single vs. multiple lesions
The surface of the lesion
The color of the lesion
The sharpness of the boundaries of the lesion
The consistency of the lesion to palpation
Presence of pulsation
Lymph node examination
34. LABORATORY INVESTIGATION
Complete heamogram
HIV HbsAg
BTCT
BSL
PTINR
Determination of serum calcium, phosphorus, and
alkaline phosphatase and protein can be very useful in
excluding certain pathological processes.
35. INDICATIONS FOR BIOPSY
Any lesion that persists for more than 2 weeks with no
apparent etiologic basis.
Any inflammatory lesion that does not respond to local
treatment after 10 to 14 days.
Persistent hyperkeratotic changes in surface tissues.
Any lesion that has the characteristics of malignancy
37. WHEN TO REFER FOR BIOPSY
When the health of the patient requires special management
that the dentist feel unprepared to handle.
The size and surgical difficulty is beyond the level of skill that
the dentist feels he/she possesses.
If the dentist is concerned about the possibility of malignancy.
38. ORAL CYTOLOGY
Developed as a diagnostic screening procedure to
monitor large tissue areas for dysplastic changes.
Most frequently used to screen for uterine cervix
malignancy
May be helpful with monitoring post radiation changes,
herpes, pemphigus.
39. THE DISADVANTAGE OF ORAL
CYTOLOGICAL PROCEDURES
INCLUDE:
Not very reliable with many false positives.
Expertise in oral cytology is not widely available
The lesion is repeatedly scraped with a moistened
tongue depressor or spatula type instrument. The cells
obtained are smeared on a glass slide and immediately
fixed with a fixative spray or solution.
40. ASPIRATION CYTOLOGY
Aspiration cytology is the use of a needle and syringe to
penetrate a lesion for aspiration if its contents.
Indications:
To determine the presents of fluid within a
lesion
To a certain the type of fluid within a lesion
When exploration of an intraosseous lesion
is indicated
41. ASPIRATION CYTOLOGY
An 18 gauge needle on a 5 or 10 ml syringe is
inserted into the area under investigation after
anesthesia is obtained.
The syringe is aspirated and the needle redirected if
necessary to find the fluid cavity.
42. INCISIONAL BIOPSY
An incisional biopsy is a biopsy that samples only a
particular portion or representative part of a lesion.
If a lesion is large or has different characteristics in
various locations more than one area may need to be
sampled
43. Indications:
Size limitations
Hazardous location of the lesion
Great suspicion of malignancy
Technique:
Representative areas are biopsied in a wedge fashion.
Margins should extend into normal tissue on the deep
surface.
Necrotic tissue should be avoided.
A narrow deep specimen is better than a broad shallow
one.
45. EXCISIONAL BIOPSY
An excisional biposy implies the complete
removal of the lesion.
Indications:
Should be employed with small lesions.
Less than 1cm
The lesion on clinical exam appears benign.
When complete excision with a margin of
normal tissue is possible without mutilation.
47. PUNCH BIOPSY
A punch biopsy is a type of biopsy where a
round area of skin and underlying tissue is
removed using a sharp hollow cutting
instrument.
Punch biopsy is done to diagnose certain types
of cancer that appear on or in the skin – most
common use
basal cell carcinoma
squamous cell carcinoma
50. ANESTHESIA
Block anesthesia is preferred to infiltration
When blocks are not possible distant
infiltration may be used
Never inject directly into the lesion
52. HEMOSTASIS
Suction devices should be avoided.
Gauze compresses are usually adequate.
Gauze wrapped low volume suction may be
used if needed.
53. INCISION
Incisions should be made with a scalpel.
They should be converging
Should extend beyond the suspected depth of the lesion
They should parallel important structures
Margins should include 2 to 3mm of normal appearing tissue if the
lesion is thought to be benign.
5mm or more may be necessary with lesions that appear malignant,
vascular, pigmented, or have diffuse borders.
54. HANDLING OF THE TISSUE
SPECIMEN
Direct handling of the lesion will expose it
to crush injury resulting in alteration the
cellular architecture.
55. SPECIMEN CARE
The specimen should be immediately placed in
10% formalin solution, and be completely
immersed.
56. MARGINS OF THE BIOPSY
Margins of the tissue should be identified to
orient the pathologist. A silk suture is often
adequate. Illustrations are also very helpful
and should be included.
57. SURGICAL CLOSURE
Primary closure of the wound is usually possible
Mucosal undermining may be necessary
Elliptical incision on the hard palate or attached
gingiva may be left to heal by secondary intention.
58. Incisional biopsies only require removal of a section of tissue
Soft tissue overlying the lesion should be reapproximated
following thorough irrigation of the operative site.
The specimen should be handled as previously described