The examination of the oral mucosa - PowerPoint Presentation

1. The examination of the oral mucosa Stomato-oncological screeningProf. Dr. Katalin Nagy DMD; PhD; DscUniversity of szegedUniversity of semmelweis1

2. DEATH RATES FROM HEAD AND NECK CANCER (WHO, 2O17)2

3. Mandatory by Hungarian Laws & regulations rendelet: 51/1997. (XII. 18.)3

4. Patient-examinationSelf-examinationProfessional examinationBy medical doctorBy dentistBy dental-hygienistBy highly educated nurse4

5. Examination in oral diseases5

6. ExaminationsAnamnesis (Patient history – disease history)General anamnesisOral anamnesisClinical examinationScreening: stomato-oncological screening!6

7. Anamnesis (general)Medical history: thorough/extensive, meticulous/carefulQuestions:Current complaints? (Main symptoms)General symptoms? (fever, fatigue, pain, vomiting)Earlier diseases/morbid conditions, previous surgeries?General diseases? What medication does the patient take? Drug history – pharmacological anamnesisAllergies, pregnancySubstance abuse/bad habits: smoking, alcohol, coffee (since when? quantity?)Family background (genetic and/or tumorous diseases/cancers)Occupational backgroundSocial background7

8. Anamnesis (oral mucosa)Smoking – tobacco consumptionAlcohol consumptionSunshine – solar UV-radiationGenetic predispositionAgePhysical and chemical injuries, atmospheric pollutionInfections (HPV, EBV), ImmunosuppressionNutrition, dietary habitsPoor oral hygieneSystemic diseases (e.g.: AIDS)8

9. ExaminationsAnamnesis (Patient history – disease history)General anamnesisOral anamnesisClinical examinationScreening: stomato-oncological screening!9

10. Clinical examinations10

11. Clinical examinationsClinical examination of the oral cavity is simple, easy, yet the oral cavity cancer is 5th, 6th most common malignancy.Recognition/detection of oral cancer in an early stage has a good prognosis, can be cured well. Long-term survival can be achieved. Regular dental examinations: semi-annually. AT THIS TIME: stomato-oncology screening!!11

12. Clinical examinationInstruments: dental mirror, wooden spatulaLight source - illuminationMagnifying loupesDentist’s attitude!12

13. ExaminationsAnamnesis (Patient history – disease history)General anamnesisOral anamnesisClinical examinationScreening: stomato-oncological screening!13

14. Screening-Early detectionIn case of preventive complaints and asymptomatic patients: inspection and palpation.Individual/Organized (Institutional, occupational/workplace, target groups, related to other medical/dental screenings)14

15. EARLY DETECTION!!!15

16. Detailed clinical examination16

17. Intra-oral examinationExtra-oral examination17

18. Clinical examinations18

19. Intraoral examinationLipsBuccal mucosa of the cheeksTongueFloor of the mouthHard and soft palate19

20. Intraoral examinationLips:Lower lip, upper lip (hands, mirror)Palpation/feeling: index-, thumb finger consistency, pain, size, lip’s relation to surrounding tissuesObserve and look for: ulcers, crusty areas/slough, alterations in color, texture, exophytic-elevated or infiltrating alterations of the lip.20

21. Intraoral examinationBuccalis nyálkahártya:From labial comissure (angle of mouth) till the retromolar regionBidigital or bimanual palpationWarning signs: Ulcers (traumatic, tumorous)White lesions (leukoplakia, lichen oris, frictional keratosis (morsication))Red areas (erythroplakia)Tissue hyperplasia/growth/proliferationInfiltrations, outgrowths, lumps21

22. Intraoral examinationTongue:Can be grabbed and retracted with gauze.Tongue tip(apex), dorsum of the tongue, lateral side of tongue, root of the tongue, ventral surface of the tongueWarning signs: AsymmetryAlterations/changes of the lingual papillaeVascular , color changesUlcersTissue proliferation, increased keratinization, nodular lesions/alterations.22

23. Intraoral examinationFloor of the mouth:Touching the palate with the tip of the tongueBimanual palpation: intra-, and extraoral palpation(salivary gland inflammation-sialadenitis, lymphadenitis)Functioning of the submandibular and sublingual salivary glands: pressure, sublingual carunculaWarning signs: Tongue tie - AnkyloglossiaBulging/swelling of the floor of the mouth (ranula, cyst)Ulcers, infiltrations23

24. Intraoral examinationHard and soft palate:Can be examined while the head is tilted backwardsWarning signs:Color changes (white lesions, red lesions)Petechias, hemorrhagic lesionsUlcersSwelling/bulging: soft- abscess, inflammation, elastic- salivary gland, hard- bony origin/osseous alteration24

25. Extraoral examinationAs soon as the patient enters the office/door!Orofacial regionSubmandibular, submental and the peri-mandibular regionPeriauricular region (around the auricle / ear)Occipital regionNeck regionSupraclavicular region25

26. Extraoral examinationOrofacial region:Shape of the face: asymmetrySkin colorSkin texture/palpationHead, neck, eye lids, eyes, nose, ears, lips26

27. Extraoral examinationSubmandibular, submental and peri- mandibular region:Head forward, tilted downwardexamining bimanually while standing behind the patient’s backObservation signs:Lymph nodes, salivary glandsSwelling, pain27

28. Extraoral examinationPeriauricular region (around the ear):From the front, from behindTMJ examination: during mouth closure and during movementWarning/observational signs:TMJ: joint dysfunctionParotid gland: inflammation, tumorRetroauricular lymph nodesSkin alterations: basalioma, basal cell carcinoma28

29. Extraoral examinationOccipital region:Patient’s head can be examination by tilting it forward and downwardBidigitally or bimanuallyWarning signs: Painful or painless lymph nodes (infection or malignant tumor, lymphoma)29

30. Extraoral examinationNeck/cervical region:From behind or from the side of the patientPalpation of the sternocleidomastoid muscle and deeper anatomical neck (cervical) structures.Palpation of thyroid glandWarning signs: Painful lymph nodes - infectionPainless lymph nodes: malignancies/ malignant tumors - metastasis, lymphomasOthers: cysts30

31. Extraoral examinationSupraclavicular region:Anatomical borders: lower neck region, clavicle, sternocleidomastoid muscleImportant: examination of the region lateral and anterior to the sternocleidomastoid muscleBimanuallyWarning signs:Cysts (soft on palpation)Painful and painless lymph nodes31

32. Additional examinations/supplementary tests32

33. Additional examinationsLaboratory testsMicrobiological diagnosticsHistological examinationCytological examinationHematological examinationAllergy/hypersensitivity examinationImmunological examinationRadiological examinationSalivary gland examination33

34. Additional examinationsSupplementary assaysLaboratory examination:Hematological, serological, virological, mycological, histologic, bacteriological examinationBlood tests: anemia, leukopenia, myeloma, leukemia, DMSerum assays/tests: iron, folic acid, vitamin B12 levels, rheumatoid factors, HSV, EBV, HIV, SLE, mumps, varicella (Chickenpox, VZV).34

35. Additional examinationsMicrobiological diagnostics:Bacterial: sample swab in testing tubeVirological: Changes/alterations in laboratory values over timeElectron microscopic examinationDetection of viral antigensMycology:Candida albicans: present in normal commensal oral flora, but can also be come pathogenic.35

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37. Additional examinationsHistological examination:Histological confirmation/verificationBenign, malignant lesionEvaluation of therapyRequired/necessary in the case of:Chronic ulcers of unknown originWhite lesionsColor changesTissue proliferations/hyperplasiasNon-healing chronic inflammationsPresumed/suspected premalignant, malignant lesions37

38. Additional examinationsBiopsy: sample excisionTypes: Incisional biopsyExcisional biopsy„punch” biopsy (soft tissue punch): from hard to reach areas, in small detailsExploratory biopsy: surgical exploration of a specific areae.g.: From the maxillary sinus through a bony windowFrozen section (freeze-dried): intraoperative method for rapid and immediate information on tumor borders/boundaries and properties.Needle biopsy (aspiration cytology)salivary gland, lymph node, cyst38

39. Diagnostic imaging examination methodsUltrasound diagnostics:Differentiation between cystic and solid lesionsLymphadenopathies, lymphadenomegaliesSalivary glands, sialoliths (salivary gland stones)Examination of blood vessels39

40. Diagnostic imaging examination methodsComputed tomography (CT)Cross-sectional views of different parts of the bodyBone structures are shown/depicted precisely, soft tissues less, uncertain.Higher radiation exposureTumors, trauma, implantation (CBCT)40

41. Diagnostic imaging examination methodsMagnetic Resonance Imaging (MRI)Soft tissue contrast scans of each areaJoint examination, examination of vascular blood supply before reconstructive surgeryHead and neck tumors, lymph nodes, salivary glandsNo x-ray radiation, no contrast fluid/medium41

42. Diagnostic imaging examination methodsPositron emission tomograph (PET)Early detection of tumor proliferation using positron emitting isotopesTumor size and localizationMetastates, recurrence (recidivation)Oncological patients: Staging42

43. Additional examinationsSalivary gland examination methods:Degree of salivation – saliva productionSialometry, SialochemistrySialographySmall salivary gland - biopsy43

44. Patient follow-up44

45. DOCUMENTATION!Patient card and patient historyDigital-computer based information storagePhoto documentation: monitoring/follow-up control and case presentations45

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