Soft tissue Lesions
Traumatic Neuroma
Etiology: result from chronic or acute trauma that severs nerve tissue. One of the most common causes of traumatic neuroma is the injection of local anesthetics prior to dental procedures
Method of transmission: not applicable
Characteristics: although not always present pain on palpation is characteristic of this lesion and may help differentiate it from similar lesions. They are firm small nodules covered by normal mucosa
Dental implications: Careful avoidance of the area during dental or dental hygiene therapy is indicated to reduce the chance of electing or exacerbating pain
Treatment and prognosis: surgical removal of the neuroma is the usual treatment. There is a low rate of reoccurrence therefore prognosis is excellent
Fibroma
Etiology: fibromas are not considered true neoplasm’s, but rather reactive responses to chronic trauma or irritation.
Method of transmission: not applicable
Characteristics: fibromas can look like any other soft tissue tumor. However denture induced fibrous hyperplasia is always associated with a denture, which can help in developing a differential diagnosis
Dental implications the most important dental implication is determining the cause of the irritation or trauma and removing it
Treatment and prognosis: surgical removal of the fibroma is the treatment of choice. However reoccurrence is likely if the source of the trauma is not removed. The prognosis for both forms of this lesion is excellent if the source of irritation is removed
Peripheral ossifying fibroma
Etiology: A reactive hyper plastic lesion that appears exclusively on the gingiva and is thought to originate from sub mucosal connective tissue or the PDL
Method of transmission not applicable
Characteristics: the peripheral ossifying fibroma is found exclusively on the attached gingiva. Well defined, firm, pedunculated or sessile, exophytic mass on the attached gingiva
Dental implications: the peripheral ossifying fibroma is a reactive lesion; thus, it is important to try to identify the source of irritation or trauma and eliminated
Treatment and prognosis: this lesion is treated by local excision with no recurrence usually expected. The prognosis is good if the underlying local factors are removed
Generalized gingival hyperplasia
Etiology: most common cause of hyper plastic gingiva is an exuberant response to chronic inflammation associated with dental biofilm or other local factors such as calculus. Some cases of gingival hyperplasia is associated with specific drugs like anti-convulsant and calcium channel blocker‘s and cyclosporine
Method of transmission not applicable
Characteristics: The clinical appearance of generalized gingival hyperplasia, coupled with a history of taking specific drugs or hormonal changes, distinguishes this condition from others
Dental implications: The clinician should obtain the thorough medical history and identify risk factors associated with this condition. Dental biofilm is associated with exacerbation of this condition, so patient instruction oral hygiene is crucial
Treatment and prognosis: discontinuance of the offending drug, especially cyclosporine, often results in reduction of hyperplasia. There is high probability that the hyperplasia will reoccur even after surgical removal
Lymphoid hyperplasia
Etiology: is a reactive response of the immune system caused by infectious agents or foreign substances or invade the body
Method of transmission: the infectious agents are transmitted according to their individual characteristics.
Characteristics: the location of the hyperplastic tissue in areas associated with lymphoid tissue suggests lymphoid hyperplasia but other entities should be ruled out
Dental implications: identification of the hyper plastic tissue is important to rule out more serious conditions such as cancer. The tonsillar region should always be included in the oral cancer examination. Any abnormality that is observed should be followed with further evaluation on a periodic basis
Treatment and prognosis: treatment is not necessary unless the tissue becomes large enough to impede oral functions such as eating or is chronically traumatized. The prognosis is good
Sarcoidosis
Etiology: this is a multi system inflammatory disease of unknown ideology that results in the formation of granulomas within affected organs and tissues
Method of transmission: it is unknown whether or not this disease is transmissible
Characteristics: the respiratory system is the main target respiratory manifestations include shortness of breath and a persistent cough. Ocular involvement can cause cataracts, glaucoma, or blindness
Dental implications: the patient should be encouraged to adhere to good oral hygiene regimen because of the potential for involvement of ginger or tissues. If xerostomia is present the patient should be Canceled on how to manage the associated symptoms
Treatment and prognosis: patients often experience spontaneous resolution of disease many other patients moving on productive lies with if any symptoms. Topical steroids may help manage her and the prognosis is good for those affected
Mumps
Etiology: paramyxovirus
Method of transmission: mops is transmitted by direct contact with the saliva or saliva droplets of an infected person
Characteristics: the presence of swelling of the salivary gland‘s in addition to the systemic manifestations associated with the viral infection strongly suggest this condition. The parotid gland is affected more than the others the classic presentation in the parotid gland include swelling that lives the ear lobe upward and outward
Dental implications: it is important to recognize the manifestations Of this infection so that the patient can be referred for medical evaluation
Treatment and prognosis: treatment is focused on relieving the general symptoms associated with a viral infection that includes bed rest, plenty of fluids, and analgesics. Prognosis is excellent
Pleomorphic adenoma
Neurilemmoma
Neurofibroma
Acinic cell carcinoma
Mucoepidermoid carcinoma
Papillary cystadenoma
Polymorphous low grade adenocacinoma
Fibromatosis
Sjogren syndrome
Bacterial sialadenitis
Fibrosarcoma
Rhabdomyosarcoma
Etiology: pathogens that have been associated with This disease staphylococcus, streptococcus viridans, Among others
Method of transmission: this infection is not transmitted from person to person
Characteristics: information of the salivary ducks and the presence of purulent exudate of this infection
Dental implications: Xerostomia is one of the major risk factors for developing at this infection. Patients who have zero stamina should be monitored closely
Treatment and prognosis: this infection may be difficult to treat. The egg today coming from the gland should be cultured it to determine the specific bacteria responsible and the appropriate anabiotic can be prescribed
Etiology: Auto immune disease
Method of transmission not applicable
Characteristic: the most common clinical presentation of secondary sjogren syndrome is a triad manifestation of rheumatoid arthritis, xerostomia, and keratoconjunctivitis
Dental implications: zero stormier increases the patient’s risk for they don’t Caries, perio disease, and infections such as candidiasis.
Treatment and prognosis are usually treated by managing the symptoms of the disease. This includes artificial saliva and tears, extensive use of fluoride for Caries prevention, and home care and diet modifications.
Etiology: No known, but they are considered uncommon and likely invasive tumors
Method of transmission: several forms of Fibromatosis are considered inherent conditions
Characteristics: slowly enlarging soft tissue mass when observed in the oral cavity. Facial asymmetry can be expected As the lesions in large. The soft tissue surrounding the mandible are commonly affected
Dental implications: early diagnosis of any enlarging mass is crucial to obtain a favorable treatment outcome
Treatment and prognosis: the treatment of choice is aggressive surgical excision with wide margins, anti-inflammatory medications, chemotherapy, and radiation therapy.
Etiology: The development of fibrosarcoma may be linked to previous radiation therapy and tissue trauma such as a burn injury
Method of transmission not applicable
Characteristics: most of these lesions present as a graduate enlarging, painless masses. Ulceration of the surface, secondary to trauma, may occur as a lesion in larges. With enlargement the patient may complain of pain swelling paresthesia and loosening of the teeth
Dental implications: early identification of emerging soft tissue masses is of utmost importance in obtaining a favorable treatment outcome
Treatment and prognosis: the treatment of choice is surgical excision with wide margins. The prognosis is guarded
Etiology: arises from proliferation of the Schwann cells of the nerve sheath
Method of transmission not applicable
Characteristics: smooth surface submucosal masses the lesions can occur anywhere in the mouth but occur most frequently on the tongue or on the maxilla or mandible where they appear as well defined radiolucencies
Dental implications: accurate interpretation of radiographic findings in areas where a patient reports pain or paresthesia may be essential to detect this neoplasm when it arises in Bone
Treatment and prognosis: the treatment of choice is surgical excision. There is little chance of reoccurrence with malignancy so prognosis is excellent
Etiology: benign neoplasm that originates from the Schwan cells and or connective tissue that supports peripheral nerves
Method of transmission not applicable
Characteristics: the tumor manifests as a slow growing, smooth surface, asymptomatic mass. It is most commonly located on the tongue or buccal mucosa
Dental implications: the presence of multiple neurofibromas may indicate a relatively common genetic disorder the dental hygienist may be in a unique position to detect these lesions
Treatment and prognosis: surgical excision is the preferred treatment solitary neurofibromas have a little chance of reoccurrence and those have excellent prognosis
Etiology: This is a malignant tumor of striated muscle that has an unknown ideology
Method of transmission: not applicable
Characteristics: rapidly growing soft tissue masses in the orbital region should alert the definition to the possibility of this disease When this lesion develops intraorally it is found on the hard and soft palate and become more frequently than in other areas
Dental implications: any soft tissue enlargement that has not been identified and does not resolve over a two-week period should be biopsied
Treatment and prognosis: the standard treatment for this disease is complete the surgical removal combined with chemotherapy and radiation therapy the prognosis varies widely
Etiology: A benign neoplasm that arises from the proliferation of two different types of salivary gland sales, ductal and myoepithelial
Method of transmission: not applicable
Characteristics: this neoplastic growth affects the parotid gland more often than any of the other major salivary gland‘s, but it is not uncommon to find it in the other major salivary gland‘s
Dental implications: these are difficult to remove completely therefore it is essential to monitor these patients periodically for reoccurrences
Treatment and prognosis: complete surgical removal is recommended, with enough adjacent tissue removed with the tumor to ensure that there are no remaining nest of cells
Etiology: unknown although multiple studies have shown a strong relationship of up to eight times in normal risk between smoking and the development of this tumor
Method of transmission: not applicable
Characteristics: the tumors usually are bilateral the patient may complain of tinnitus, pain in the ear, and deafness depending upon the stage of growth
Dental implications: patients who have a history of smoking have a much higher risk for developing this neoplasm. Dental professional should take this into consideration when performing extra oral and perioral palpitations
Treatment and prognosis: surgical removal of the tumor is the treatment of choice. The prognosis is excellent
Etiology: not known
Method of transmission is not applicable
Characteristics: found most often on the parotid gland where it manifests as an asymptomatic swelling. The lesion make exist for several years before it is reported by the patient or before it comes to the attention of a healthcare provider
Dental implications: these tumors can be present for several years before they are noticed by the patient therefore oral cancer screening exams should include palpation of all the major salivary gland’s
Treatment and prognosis: treated by surgical removal if there is any evidence of metastasis lymph nodes in the neck may have to be removed post surgical radiation is often indicated the prognosis depends primarily on the grade of the tumor
Etiology: unknown
Method of transmission: not applicable
Characteristics: one found in the parotid or submandibular gland’s these tumors present as a slow growing hard masses. In parotid tumor‘s facial nerve paralysis occurs in frequently but indicates a less than favorable prognosis
Dental implications: as noted above these tumors are slow growing and the dental hygienist may be the first person to detect this neoplasm
Treatment and prognosis: low grade carcinoma with a relatively good chance of local reoccurrence but only a slight chance of distant metastasis. Prognosis is similar to that of Mucoepidermoid carcinoma which is generally good
Etiology: various genetic mutations and the overproduction of specific gene products this tumor is one of the more common minor salivary malignancies
Method of transmission Not applicable
Characteristics: deduct all sales of this malignant neoplasm display different growth patterns it’s the name polymorphous
Dental implications: One of the first signs of a palatable growth might be a denture that starts to feel uncomfortable or lose. A patient who wears dentures should be encouraged to have periodic oral exams to detect abnormalities
Treatment and prognosis: surgical excision with wide margins is the treatment of choice metastasis is considered an uncommon occurrence
Adenoid cystic carcinoma
Etiology: unknown
Method of transmission not applicable
Characteristics: intro oral lesions often manifest with pain as an early symptom. Parotid gland tumors presented as firm well-defined masses within the gland. They are slow growing and may be tender on palpation
Dental implications: radiation therapy is almost always recommended therefore all dental procedures need to be accomplished prior to radiation therapy
Treatment and prognosis: surgical excision is the treatment of choice for this. Removal of tumors with in the parotid gland may require sacrifice of the facial nerve
Neurofibromatosis, type 2B
Etiology: inherited disorder that is associated with a mutation of the NF1 gene
Method of transmission: is transmitted through an autosomal dominant inheritance pattern or it occurs as a new mutation
Characteristics: the cutaneous manifestations include multiple macules nodules and auxiliary or inguinal freckling are characteristic of this disease
Dental implications: the appearance of neurofibromas in the oral and perioral areas Is common. Problems associated with the development of these lesions include impaired mastication and swallowing and speaking lesions can become chronically traumatized if they are near the plane of occlusion
Treatment and prognosis: A genetic disorder and therefore cannot be treated in these strict sense of the word. Management of this includes frequent examination of the scan for new lesions and assessment of already present lesions for the development of malignant changes
Multiple endocrine neoplasia syndrome
Etiology: genetic disorders caused by mutation of a RET located on chromosome 10
Method of transmission: autosomal trait
Characteristics: patients commonly exhibit a wide eyed expression and mandibular prognathism as well as malocclusion and diasthema between the maxillary central incisors
Dental implications: the dental hygienist may be the first healthcare provider to detect the mucosal neuromas in a young child during a routine oral exam. Prompt diagnosis of this condition is crucial in preventing thyroid cancer
Treatment and prognosis: treatment of these syndrome includes prophylactic removal of the thyroid removal of the thyroid is followed by continually monitoring of blood calcitonin levels increased levels of calcitonin indicate a reoccurrence of the thyroid tumor. The prognosis is good if the disease is identified early and the thyroid is removed
Lymphangioma
Etiology: unknown
Method of transmission: may have genetic tendencies
Characteristics: the Pebley surface texture of superficial lesions and evidence of crepitus on palpation are significant features that can help identify this lesion
Dental implications: patients who have had surgical removal of a lymphangioma may have damage to the facial lingual or hypoglossal nerve
Treatment and prognosis: treatment depends on the size location and composition of the malformation. Small lesions may not need to be treated at all unless they create a cosmetic problem. The prognosis for small isolated lesions is excellent
Cervical lymphoepithelial cyst
Etiology: historically this lesion was taught to develop from remnants of the second branchial arch. More recent theory suggest that it arises from parotid gland epithelium
Method of transmission not applicable
Characteristics: the intro oral lesions often have a pale yellow hue. These cysts are normally located along the anterior border of the sternocleidomastoid muscle
Dental implications: it is essential for the dental health care provider to consistently provide examinations that include palpation of the neck and soft tissues of the face to detect abnormalities at any early stage
Treatment and prognosis complete surgical excision is recommended. The prognosis is good
Thyroglossal tract cyst
Etiology: Results from a proliferation of remnants of epithelial cells that line the thyroid tract during development
Method of transmission None
Characteristics: most of the cysts are found in the midline of the neck where they appear as well circumscribed nontender mobile masses usually between two and 4 cm often dysphasia accompany larger lesions
Dental implications lesions located on the posterior dorsal surface of the town that should not be removed until it is known what they are
Treatment and prognosis: complete surgical excision using the Sistrunk procedure is the treatment of choice after testing to determine the presence of other functioning thyroid issues in the normal location
Dermoid cyst
Dermoid cyst result from the entrapment of epithelial cells along the lines of embryonic closure or fusion
Method of transmission not applicable
Characteristics: developed as a painless slow-growing solved Dowie midline mass primarily in the floor of the mouth it can be located superior she mylohyoid muscle and caused the tone to be displaced superiorly and posteriorly
Dental implications: if this lesion is located in the floor of the mouth it can impair chewing swallowing and speaking
Treatment and prognosis: treatment is surgical excision. The prognosis is excellent
RESOURCES: DELONG and BURKHART Chapter 16