White

Question 1

List two red flags that would raise your suspicion for a potentially malignant white lesion in the oral cavity.

Answer 1

Presence of keratosis in non-keratinized mucosa (e.g., lips, buccal mucosa, underside of the tongue, floor of the mouth).
Current or historical use of tobacco products.
No obvious reason for hyperkeratosis (e.g., trauma/sharp teeth).
Presence of oral potentially malignant disorders (OPMDs).

Question 2

Provide four differential diagnoses for a persistent white patch on buccal mucosa.

Answer 2

Leukoplakia
Morsicatio Buccarum
Oral Lichen Planus - Plaque type
Hyperplastic Candidosis
White Spongy Nevus
Leukoedema

Here’s the shortened table with abbreviated details for each white oral lesion.

Question 3

Explain the key clinical difference between Leukoedema and Morsicatio Buccarum.

Answer 3

Leukoedema: Characterized by a milky white or grayish film that disappears with stretching; asymptomatic and a normal variation.
Morsicatio Buccarum: Due to repetitive cheek biting; presents as rough, shaggy, whitish surfaces that do not disappear with stretching.

Question 4

What three actions should you prioritize before referring a patient with a suspected potentially malignant disorder?

Answer 4

Comprehensive History and Assessment: Gather detailed history and perform thorough clinical examination.
Identify Red Flags: Look for red flags associated with malignancy.
Call a Specialist: Contact an oral medicine specialist to discuss the case.

Question 5

Name three other clinical patterns of Oral Lichen Planus (OLP) that can be observed.

Answer 5

Plaque-like
Erythematous
Erosive/Ulcerative
Papular
Bullous

Question 7

What are the physiological and structural changes that can cause an oral lesion to appear red?

Answer 7

Oral lesions can appear red due to several physiological and structural changes: Increased dilation of blood vessels, reduced thickening or break in the epithelium lining, alteration in structure of blood vessels, molecular changes to hemoglobin, and decreased keratinization or loss of papillae.

Question 8

What is the systematic approach an Oral Health Therapist should take when encountering a red lesion?

Answer 8

A systematic approach includes: See & Describe, Ask & Listen, Spot RED FLAGS, Document, Refer Urgently If, and Communicate Clearly.

Question 9

What does the ‘RED FLAGS’ mnemonic indicate for red lesions in the oral cavity?

Answer 9

The ‘RED FLAGS’ mnemonic includes: Mixed lesions (white & red), tobacco use, persistence of lesions, unclear cause, history of oral potentially malignant disorders, other health issues, unexplained weight loss, temperature spikes/sweats at night, and bothersome symptoms.

Question 10

Name three potential differential diagnoses for desquamative gingivitis and/or blisters.

Answer 10

Three potential differential diagnoses are: Oral Lichen Planus (Bullous form), Pemphigus Vulgaris (PV), and Mucous Membrane Pemphigoid (MMP).

Question 11

What is a key distinguishing feature of Oral Lichen Planus?

Answer 11

It presents with blisters or raw areas alongside characteristic white, lacy patterns (Wickham’s striae) elsewhere in the mouth.

Question 12

What is a key distinguishing feature of Pemphigus Vulgaris?

Answer 12

It is an autoimmune blistering disease where blisters are typically fragile and break easily, leaving painful sores.

Question 13

What is a key distinguishing feature of Mucous Membrane Pemphigoid?

Answer 13

It is an autoimmune subepithelial blistering disease where blisters tend to be tighter and stronger, commonly affecting the gums and other mucous membranes.

Question 14

What does the ‘P.R.I.A.’ approach stand for in managing suspicious red oral lesions?

Answer 14

The ‘P.R.I.A.’ approach stands for: Pause & Protect, Refer Urgently, Inform & Integrate, and Aims of Management.

Question 15

Where does oral lichen planus most commonly occur?

Answer 15

b) Bi-lateral buccal mucosa

Question 16

Which condition is characterized by mixed red and white lesions and requires biopsy?

Answer 16

c) Erythroleukoplakia

Question 17

What does Pemphigus Vulgaris attack?

Answer 17

b) The ‘glue’ that holds cells together within the top layer of the skin or mouth lining.

Question 19

What is the differential diagnosis for a pigmented lesion on the right retromolar pad?

Answer 19

1. Mucosal Melanoma: Malignant, Dark, Rare
2. Melanotic Macule: Flat, Brown, Benign
3. Melanoacanthoma: Pigmented, Benign, Proliferative
4. Adrenal Insufficiency (e.g., Addison’s Disease): Diffuse, Hyperpigmented, Systemic

Question 20

How would you manage a pigmented lesion with a history of SCC?

Answer 20

1. Initial Assessment: Confirm onset, duration, changes in size, shape, or color; ask about symptoms and sun exposure history.
2. Further Assessments: Perform thorough oral assessment, take photographic record, educate on self-checks, consider ABCDE checklist.
3. Referral: Prompt referral to an Oral Medicine Specialist or Multi-disciplinary Expert Melanoma Unit; inform GP for comprehensive health assessment.
4. Interim Management: Place on a 3-month recall for ongoing assessment and provide sun exposure counselling.

Question 21

What are three red flags for pigmented lesions during history taking?

Answer 21

1. History of mucosal melanoma: Increases risk of recurrence.
2. Family history of melanoma: Indicates increased genetic predisposition.
3. Lesion is new, changing, or unusual: Any evolving lesion should be considered suspicious.

Question 22

What are three red flags for pigmented lesions during clinical inspection?

Answer 22

1. Lesion is new or changing: Aligns with ‘Lately appeared or Looking different’ aspect of the LOOK OUT mnemonic.
2. Prominent and pigmented: Stands out from other moles (‘Odd one out’).
3. Rapidly growing nodule: Significant concern, even if not deeply pigmented (‘Outgrowing quickly’).
4. Irregular borders and/or pigmentation: Key features of the ABCDE checklist.