ORAL PATHOLOGY
CASE PROJECT
BY: BRITTANY HORRIGAN
PATIENT PERSONAL DATA
• AGE: 39
• GENDER: MALE
• RACE: WHITE CAUCASIAN WITH SMALL
PERCENTAGE OF NATIVE AMERICAN
• COUNTRY OF ORIGIN: UNITED STATES OF
AMERICA
PATIENT INFORMATION
HISTORICAL DATA
FAMILY HISTORY:
MEDICAL HISTORY:
- MOTHER HAS DIABETES TYPE 2
- HISTORY OF ACL INJURY, TREATED WITH SURGERY,
CURRENTLY HAS NO RESIDUAL EFFECTS
- SISTER HAS CEREBRAL PALSY
- OCCASIONAL DRINKER
DENTAL HISTORY:
- NON-SMOKER
- MOST RECENT DENTAL EXAM
- BASELINE VITALS
- 1 YEAR AGO
- MOST RECENT DENTAL HYGIENE APPOINTMENT
- OCTOBER 2014
- ADEQUATE ORAL HYGIENE
- MOST RECENT DENTAL X-RAYS
- FMX IN MAY 2014
- BP 122/58
,
PULSE
60 , RESPIRATION 16
DRUG INGESTION:
- PATIENT IS NOT PRESCRIBED ANY MEDICATIONS
HISTORY PERTAINING TO SPECIFIC LESION:
- PRESENT FOR ENTIRE LIFE
- HAS NOT INCREASED OR DECREASED IN SIZE
INTRA-ORAL EXAMINATION
CLINICAL FEATURES
CLINICAL APPEARANCE:
-
LOBULATED
-
BILATERAL
CONSISTENCY:
-FIRM TO PALPATION
COLOR:
-
GENERALIZED PINK W/ LOCALIZED AREAS OF
REDNESS DUE TO IRRITATION OF
TOOTHBRUSH- AS STATED BY PATIENT
SIZE:
-PATIENTS LEFT SIDE IS MODERATE IN SIZE- 2CM BY
3CM
-PATIENTS RIGHT SIDE IS SMALL IN SIZE – 1CM BY
3CM
SURFACE TEXTURE:
-
SMOOTH
PATIENT INFORMATION
SIGNS AND SYMPTOMS
SIGNS:
SYMPTOMS:
- OVERGROWTHS OF DENSE BONE
- NO REPORTED PAIN
- BILATERAL
- NO DYSPHAGIA
- LOBULATED
- WNL- OROPHARYNX, SALIVARY GLANDS,
LARYNX, LYMPHNODES, MUCOUSA
- PRESENT FOR AS LONG AS PATIENT CAN
REMEMBER
- LINGUAL ASPECT OF THE MANDIBLE IN THE
PREMOLAR REGION
PATIENT INFORMATION
RADIOGRAPHIC DATA
• RADIOPAQUE
• ANATOMICAL LANDMARKS ALSO WITHIN THIS REGION
• MENTAL FORAMEN, MYLOHYOID RIDGE, EXTERNAL OBLIQUE RIDGE, FOSSA OR DEPRESSION
WHATS NEXT…?
• MEASUREMENTS
• INTRAORAL PHOTOGRAPHS
• CONTINUED WITH TREATMENT AS
PLANNED
• DENTAL HYGIENE REPORT WAS
COMPLETED AND GIVEN TO PATIENT
• KEEP A WATCHFUL EYE AT RE-CARE
APPOINTMENTS
DIFFERENTIAL DIAGNOSIS
1)MANDIBULAR TORI , 2)PERIPHERAL OSTEOMA, 3) EXOSTOSES
DIFFERENTIAL DIAGNOSIS
(1)
MANDIBULARUS TORUS/ MANDIBULAR TORI
ETIOLOGY: GENETICS
DESCRIPTION: VARIANT OF
NORMAL, TYPICALLY BILATERAL
AND LOBULATED, CAN APPEAR
FUSED TOGETHER. SYMPTOMLESS
COMPOSITION: OUTGROWTHS
OF DENSE BONE
LOCATION: MANDIBLE, LINGUAL
ASPECT, PREMOLAR AREA,
ABOVE MYLOHYOID RIDGE
DIAGNOSIS: CLINICAL
APPEARANCE, HISTORICAL DATAHAS THE CONDITION CHANGED
IN SIZE OVER TIME
DIAGNOSTIC PROCESS AND DIAGNOSIS
• CLINICAL:
• EOE
• OBSERVATION
• PALPATION
• IOE
• CLINICAL APPEARANCE
• COLOR, SHAPE, LOCATION, SIZE, TEXTURE
• CONSISTENCY
- FIRM, SOFT, SEMIFIRM, FLUID FILLED
• HISTORICAL:
• IMPORTANT COMPONENT TO ANY DIAGNOSIS
• PERSONAL, FAMILY, PAST PLUS PRESENT MEDICAL OR DENTAL HISTORIES,
PAST DRUG INGESTION, HISTORY PERTAINING TO SPECIFIC LESION IN
QUESTION
HEALTH PROMOTION METHODS
TREATMENT, PROGNOSIS, PREVENTION
TREATMENT
PROGNOSIS
- NOT REQUIRED UNLESS PATIENT IS AND
THE TORI INTERFERE WITH IN NEED OF A
PROSTHODONTIC APPLIANCE
FABRICATION OR PLACEMENT
- I EXPECT THAT THE SHORT TERM
PROGNOSIS WILL BE GOOD.
- I EXPECT THAT THE LONG TERM
PROGNOSIS WILL BE DEPENDENT UPON
THE NEED FOR A PROSTHODONTIC
DEVICE LATER IN LIFE THE PRESENCE OF
SUCH LARGE TORI MAY BECOME AN ISSUE
PREVENTION
-NO PREVENTION TECHNIQUE
- A PATIENT CAN ONLY MAINTAIN
METICULOUS OHI TO DECREASE THE
BACTERIA ACCUMULATION
ETIOLOGY: NUMEROUS
NEOPLASTIC CELLS
DESCRIPTION: BENIGN- RAISED,
ROUNDED, WELL
CIRCUMSCRIBED MARGINS.
SLOW GROWING AND
PAINLESS. BEYOND CONFINES
OF PARENT BONE
DIFFERENTIAL DIAGNOSIS
(2)PERIPHERIAL OSTEOMA
COMPOSITION: BENIGNNEOPLASTIC CELLS, GROWS
SLOWLY, LESS AGGRESSIVE.
COMPACT OR CANCELLOUS
BONE
LOCATION: POSTERIOR
MANDIBLE OR CONDYLE
DIAGNOSIS: CLINICAL
APPEARANCE, HISTORICAL DATAHELP TO FIND CAUSATIVE
FACTORS, LABORATORY
CULTURE, MICROSCOPIC BIOPSY
DIFFERENTIAL DIAGNOSIS
(3)EXSTOSES
ETIOLOGY: GENETICS
DESCRIPTION: SINGLE,
MULTIPLE, UNILATERAL, BILATERAL
COMPOSITION: OVERGROWTH
OF BONE
LOCATION: BUCCAL ASPECT,
MAXILLAE, ALVEOLAR RIDGE,
MOLAR/PREMOLAR REGION
DIAGNOSIS: CLINICAL
APPEARANCE, HISTORICAL DATAHAS THE CONDITION CHANGED
OVER TIME
BIBLIOGRAPHY
•
•
LANGLAIS, ROBERT E., CRAIG S. MILLER, AND JILL S. NIELD GEHRIG. COLOR ATLAS OF COMMON ORAL DISEASES. 4TH ED.
PHILADELPHIA: LIPCOTT WILLIAMS AND WILKINS, 2009. PRINT.
IBSEN, OLGA A.C., AND JOAN A. PHELAN. ORAL PATHOLOGY FOR THE DENTAL HYGIENIST. 6TH ED. ST. LOUIS: LINDA DUNCAN,
2014. PRINT.
•
"WHAT ARE TORI, AND WHY DO I HAVE THEM? « JULIE M. GILLIS, DDS." JULIE M GILLIS DDS. N.P., N.D. WEB. 01 OCT. 2014.