Steps for Oral Pathology Consultation
1. Consult your clinical instructor to determine necessity of consultation.
- As in private practice, many conditions are handled by the general dentist and are not referred for consultation. This streamlining of patients to a specialty clinic is meant only for what would be considered a true consultation in private practice.
2. Open and attempt to complete an oral pathology consultation form (ODTPOR).
- Include accurate descriptions, relevant clinical information and a reasonable differential diagnosis. Do not have the clinical instructor swipe the form. That will be completed when the oral pathologist sees the patient.
3. Make an appointment with the schedulers in OS for Oral Pathology on a Thursday afternoon.
- If possible, attend this appointment with your patient.
Cases That Do Not Need Consultation
In order to avoid the time and financial inconvenience to have the patient visit the oral surgery clinic multiple times, lesions that have clear clinical features of a benign/reactive process and that the treatment is known to be surgical excision should be directly treatment planed for Oral Surgery Excision with a oral surgery resident without the need for a prior oral pathology consultation. The following are classic examples of such lesions:
- Traumatic fibroma
- Gingival lumps: Pyogenic Granuloma, Peripheral Ossifying Fibroma, Peripheral Giant Cell Granuloma
Oral Pathology Descriptors
- Macule: Flat lesion, usually pigmented (ie freckle)
- Plaque: Raised, rough surfaced lesion (ie callous)
- Papule: Dome-shaped, firm mass <5 mm
- Nodule: Dome-shaped, firm mass > 5mm
- Vesicle: Fluid mass < 5mm (ie blister)
- Bulla: Fluid mass > 5mm
- Papillary or Verrucous: Mass with finger-like projections
- Pedunculated: Attached by stalk
- Purpura (petechiae or ecchymoses): Leakage of RBCs into subepithelial connective tissue, do not blanch on application of pressure
- Varicose vein/varix: Enlarged vein
- Hyperkeratosis: Thickening of keratin layer, also epithelial hyperplasia
- Fordyce Granules: Ectopic sebaceous glands in mucosa, multiple aggregates or confluent white and yellowish spots
Morphology of Oral Lesions
- Sessile = broad attachment
- Pedunculated = stalk attachment
- Macula = flat
- Plaque = raised flat-topped
- Bony hard