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Bulla
- A circumscribed, elevated lesion that is more than 5 mm in diameterUsually contains serous fluid, and looks like a blister

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Vesicle
- A small, elevated lesion less than 1 cm in diameter that contains serous fluid

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Lobule
- A segment or lobe that is part of a whole
- These lobes sometimes appear fused together

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Macule
- An area that is usually distinguished by a color different from that of the surrounding tissue
- It is flat and does not protrude above the surface of the normal tissue
- A freckle is an example of a macule

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Papule
- A small, circumscribed lesion usually less than 1 cm in diameter
- It is elevated or protrudes above the surface of normal surrounding tissue
- Can be sessile or pedunculated
- no fluid

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Pedunculated
- Attached by a stemlike or stalklike base similar to that of a mushroom

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Sessile
- Describes the base of a lesion that is flat or broad instead of stemlike

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Pustules
- Variously sized circumscribed elevations containing pus

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Blister form (containing fluid)
- Vesicle: less than 5mm
- Bulla: more than 5mm
- Pustule: filled with pus
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Non blister form (not containing fluid)
- Papule: less than 5mm
- Nodule: more then 5mm and less than 2cm
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nodule
- A palpable solid lesion up to 1 cm in diameter found in soft tissue
- Can occur above, level with, or beneath the skin surface
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Palpation
- The evaluation of a lesion by feeling it with the fingers to determine the texture of the area
- Descriptive terms for palpation are soft, firm, semifirm, and fluid filled
- These terms also describe the consistency of a lesion
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Erythema
An abnormal redness of the mucosa or gingiva
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Erythroplakia
- A clinical term used to describe an oral lesion that appears as a smooth red patch or granular red and velvety patch
- Less common than leukoplakia
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Pallor
Paleness of the skin or mucosal tissues
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Leukoplakia
A clinical term for a white, plaquelike lesion on the oral mucosa that cannot be rubbed off or diagnosed as a specific disease
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Centimeter (cm)
lOne hundredth of a meter; equivalent to a little less than one-half inch
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Millimeter (mm)
One thousandth of a meterlThe periodontal probe is of great assistance in documenting the size or diameter of a lesion that can be measured in millimeters
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Fissure
A cleft or groove, normal or otherwise, showing prominent depth
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Papillary
Resembling small, nipple-shaped projections or elevations found in clusters
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Coalescence
The process by which parts of a whole join together, or fuse, to make one
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Diffuse
- Describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion

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Multilocular
- Describes a lesion that extends beyond the confines of one distinct area
- Defined as many lobes or parts that are somewhat fused together
- A multilocular radiolucency is sometimes described as resembling soap bubbles

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Radiolucent
- Describes the black or dark areas on a radiograph
- Radiant energy can pass through these structures
- Less dense tissue, such as pulp, is seen as a radiolucent structure
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Radiopaque
- Describes the light or white area on a radiograph that results from the inability of radiant energy to pass through the structure
- The denser the structure, the lighter or whiter it appears on the radiograph
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Root resorption
- Radiographically, the apex of the tooth appears shortened or blunted and irregularly shaped
- Occurs as a response to stimuli, which can include a cyst, tumor, or trauma

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External root resorption
- Caused by cells in the periodontal ligament.

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Internal root resorption
- Triggered by pulpal tissue
- reaction from within the tooth
- The pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area

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Scalloping around the root
- A radiolucent lesion that appears to extend up the periodontal ligament and between the roots

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Unilocular
- Having one compartment or unit that is well defined or outlined as in a simple radicular cyst

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Well circumscribed
- Used to describe a lesion with borders that are specifically defined and in which one can clearly see the exact margins and extent

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Anomaly
Something that deviates from what is standard or normal
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Dysphagia
Difficulty swallowing
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Dysphonia
Difficulty speaking
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Dyspnea
Difficulty breathing
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Four conditions for which the radiograph provides the most significant information include:
PAP, internal resorption, external resorption, and heavy interproximal calculus
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Clinical diagnosis
- suggests that the strength of the diagnosis comes from the clinical appearance of the lesion.
- Color
- Shape
- Location
- History of lesion
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The diagnosis is obtained from the ___
Radiographs
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A fistula is usually an indication of ______
periapical pathosis (PAP
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Compound odontoma
- rather easily diagnosed from the radiograph alone

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Complex odontoma
- not diagnosed from the radiograph alone.

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Historical data
- constitute an important component in every diagnosis; occasionally when historical data are combined with observation of the clinical appearance of the lesion, the historical information constitutes the most important contribution to the diagnostic process.
- Personal history
- Family history
- Past and present medical and dental histories
- History of drug ingestion
- History of the presenting disease or lesion
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Laboratory Diagnosis:
- Blood Chemistries, Urinalysis, and Cultures
- Laboratory cultures are helpful in determining the diagnosis of oral infections.
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Microscopic Diagnosis
- Often the main component of the definitive diagnosis
- Skill of practitioner is important
- Adequate tissue sample is necessary
- Additional screening technologies can also be used to detect changes in tissues
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Surgical Diagnosis
Diagnosis is made using the information gained during the surgical procedure
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Traumatic bone cyst
- May appear as a radiolucency that scallops around the roots
- When the lesion is opened surgically, an empty void is found

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Therapeutic Diagnosis
Nutritional deficiencies are common conditions to be diagnosed by therapeutic means
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Angular cheilitis
- May be associated with a deficiency of B-complex vitamins
- Most commonly a fungal condition and responds to topical application of an antifungal cream or ointment such as Nystatin

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Necrotizing ulcerative gingivitis (NUG)l
- Responds to hydrogen peroxide

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Differential Diagnosis
That point in the diagnostic process when the practitioner decides which test or procedure is required to rule out the conditions originally suspected and to establish the definitive or final diagnosis
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Hygienists’ Role in Differential Diagnosis:
- Be observant!
- Collect data
- Patient’s medical and dental health histories
- History of lesion
- Clinical description and evaluation
- Biopsy and microscopy reports
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Fordyce Granules
- Clusters of ectopic Sebaceous Glands
- Clinical Appearance: tiny, yellow lobules in clusters
- Area: buccal mucosa and vermillion border of lips
- Treatment: none

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Torus Palatinus
- An exophytic growth of normal compact bone
- Observed clinically in midline of hard palate
- Inherited, gradual formation
- More common in women
- May take on various shapes and sizes, may be lobulated, and is covered by normal soft tissue
- Treatment: None, unless they interfere with speech, swallowing, or a prosthetic appliance

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Mandibular Tori
- Outgrowths of dense bone found on the lingual aspect of the mandible in the area of the premolars above the mylohyoid ridge
- Usually bilateral
- Often lobulated or nodular
- Can appear fused together
- Have no predilection for either sex
- No treatment unless they interfere with fabrication and placement of a prosthodontic appliance

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Melanin Pigmentation
- The pigment that gives color to skin, eyes, hair, mucosa, and gingiva
- Most commonly observed in dark-skinned individuals

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Retrocuspid Papilla
- A sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids
- Only a few millimeters in size
- Observed more often in young
- Resolves with age

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Lingual Varicosities
- Clinical appearance
- Red-to-purple enlarged vessels or clusters
- Usually observed on the ventral and lateral surfaces of the tongue
- Most commonly observed in individuals older than 60 years

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Linea Alba
- A “white line” extends anteroposteriorly on the buccal mucosa along the occlusal plane
- May be bilateral
- May be more prominent in patients who have a clenching or bruxing habit

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Leukoedema
- A generalized opalescence on the buccal mucosa
- Most commonly observed in black adults
- If the mucosa is stretched, the opalescence becomes less prominent
- No treatment

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Lingual Thyroid
- Undescended, trapped remnants of thyroid tissue
- Clinical appearance: A mass in the midline of the dorsal surface of the tongue posterior to the circumvallate papillae in the area of the foramen cecum. Usually has a sessile base and is 2 to 3 cm in width
- Predilection: Females, Linked to hormonal changes
- Treatment: Evaluation of the patient to determine whether the thyroid gland is present in its normal location

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Median Rhomboid Glossitis
- Clinical appearance: Flat or slightly raised oval or rectangular erythematous area in center of tongue
- May be associated with a chronic infection with Candida albicans
- No treatment necessary, but antifungal treatment may be used

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Erythema Migrans
- Clinical appearance:
- Erythematous patches surrounded by a white or yellow border
- Diffuse areas devoid of filiform papillae
- Distinct presence of fungiform papillae
- There appear to be remission and changes in the depapillated areas
- Also knows as “geographical tongue”
- Genetic factors may play a role in presence
- May be exacerbated by stress
- Occasionally, the patient may complain of a burning discomfort
- No treatment usually indicated

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Fissured Tongue
- Clinical appearance: The dorsal surface of the tongue appears to have deep fissures or grooves
- Cause: Unknown
- Probably involves genetic factors
- Seen in about 5% of the population
- Home care
- Direct the patient to brush the tongue gently with a toothbrush to remove debris
- No treatment necessary

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White Hairy Tongue
- Clinical appearance: Elongated filiform papillae are white
- Result of either an increase in keratin production or a decrease in normal desquamation
- Home care: Direct the patient to brush the tongue gently with a toothbrush to remove debris

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Black Hairy Tongue
- Clinical appearance: Papillae are brown-to-black because of chromogenic bacteria
- Contributing factors: Tobacco, Foods, Hydrogen peroxide, Alcohol, Chemical rinses.
- Home care: Direct the patient to brush the tongue gently with a toothbrush to remove debris

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