Oral mucosal disease is an integral part of the dental practice. Dental practitioners are the first-line providers a patient sees for an evaluation of oral lesions, so they must know the basics of oral pathology and forming a differential diagnosis. Knowing the difference between benign and malignant lesions can save lives. Accurate diagnosis not only leads to early intervention or specialist referral, but also avoids unnecessary office visits and inappropriate treatments. So, let’s see if you can name that lesion!
Here’s an image of the left buccal mucosa. A 65-year-old patient who presented to the dental clinic for a hygiene visit states he has a “sore” in his mouth that has been there for a month. He also broke a tooth around the same time. The lesion has not changed in size over the past month and causes a mild level of pain.
A healthy 22-year-old patient presents with a growth on her lip. She reports a history of biting on it, which causes pain. Clinical exam shows a soft, ulcerated, well-defined growth on the lower left labial side of the lip. When the patient closes, the lesion approximates the occlusal line.
A 72-year-old patient presents with pink areas on the tongue and hard palate that were noticed at a routine dental recall appointment. He is asymptomatic. The clinical exam reveals a large, well-defined, depapillated pink area on the dorsal surface of the tongue, as well as a diffuse erythematous region on the hard palate. Both lesions are located near the midline of the sites. The patient is a smoker and has medication-induced xerostomia. His medications include cyclobenzaprine for back-muscle spasms and tamsulosin for benign prostatic hyperplasia.
A healthy 60-year-old patient presents for a routine dental recall visit; on examination, you find a well-defined sessile vascular lesion on the left lateral border of the tongue. She tells you it’s been there for decades. It has not changed in size and does not cause any pain. Upon palpation, it does not blanch.
A 76-year-old patient presents for an evaluation of the right side of his tongue. The right side of the tongue shows a large erythematous, keratotic, firm, verrucoid mass. He has severe pain over the tongue mucosa and has restricted range of motion of the tongue musculature. When he protrudes his tongue, it deviates to the right side. He smokes a pack of cigarettes a day, and has done so for the last 45 years.
A 65-year-old patient presents with ulcers all over his mouth. He reports these lesions began two years ago. He’s already seen another dentist, an oral surgeon, and an ear, nose and throat physician, and reports having had two biopsies done with a nonspecific
histopathologic diagnosis. He states he was diagnosed with burning mouth syndrome—he experiences pain and cannot eat spicy foods. His medical history is noncontributory. He denies oral blisters preceding the ulcerations. The lesions are constant, but they can wax and wane in severity.
An 85-year-old patient presents with a persistent, painful lesion on his lower lip that began two years ago. A few months ago, he noticed involvement of the upper lip as well. Local treatments such as lip balm application and sunscreen are not helping.
A 56-year-old female was referred to the clinic with a lesion on the gingiva. She feels a rough area there but otherwise does not report any symptoms. She denies any trauma to the site and is not aware of any pattern to the lesion. She has never smoked and does not drink any alcoholic beverages.
A 66-year-old female presents for an evaluation of a white lesion on the right side of the tongue, which was noticed by her hygienist at a routine dental recall. She is not sure how long it’s been there, and does not experience pain. All adjacent teeth are smooth. She has never smoked and occasionally drinks alcoholic beverages (one glass of wine, once a month). Her medical history is noncontributory.