Oral Pathology and Oral Medicine
Oral pathology and oral medicine: describe, then decide
Oral medicine begins with a systematic description: location, size, color, shape, border, texture, duration, and symptoms. Red and white lesions are not diagnoses. Leukoplakia is a clinical term for a predominantly white patch that cannot be characterized as another disease; erythroplakia is red and carries a higher risk of dysplasia or carcinoma. Any nonhealing ulcer, induration, fixation, or unexplained bleeding warrants biopsy or referral.
Know common entities: recurrent aphthous ulcers, herpes simplex, candidiasis, lichen planus, nicotine stomatitis, and geographic tongue. Vesiculobullous diseases such as pemphigus and mucous membrane pemphigoid require biopsy and immunofluorescence. Odontogenic cysts and tumors are diagnosed by location and histology; do not biopsy a suspected vascular lesion without imaging.
Traps: calling every white patch leukoplakia without ruling out friction, candidiasis, or lichen planus; treating a chronic ulcer with a mouthrinse instead of biopsy; and missing systemic disease presenting orally, such as diabetes, anemia, or HIV.
Rule of thumb: the mouth is a window-if a lesion persists beyond two weeks after removing an irritant, biopsy or refer. Example: a 1-cm indurated ulcer on the lateral tongue in a smoker that has lasted six weeks is suspicious for squamous cell carcinoma and should be referred promptly.