2015 self-study course one course

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Q: Who can earn FREE CE credits? . READ the MATERIALS. Read and review the course materials. A: EVERYONE - All dental professionals in your office may earn free CE . COMPLETE the TEST. Answer the credits. Each person must read the eight question test. A total of 6/8 course materials and submit an questions must be answered correctly online answer form independently. contact for credit. . SUBMIT the ANSWER FORM Q: What if I did not receive a ONLINE. You MUST submit your confirmation ID? answers ONLINE at: A: Once you have fully completed your us http://dentistry.osu.edu/sms-continuing-education answer form and click “submit” you will be directed to a page with a . RECORD or PRINT THE unique confirmation ID. phone CONFIRMATION ID This unique ID is displayed upon successful submission Q: Where can I find my SMS number? of your answer form. 614-292-6737 A: Your SMS number can be found in the upper right hand corner of your

ABOUT your monthly reports, or, imprinted on the toll free back of your test envelopes. The SMS FREE CE… number is the account number for 1-888-476-7678 your office only, and is the same for everyone in the office. . TWO CREDIT HOURS are issued for Q: How often are these courses fax successful completion of this self- available? study course for the OSDB 2015-2016 614-292-8752 biennium totals. A: FOUR TIMES PER YEAR (8 CE credits). . CERTIFICATE of COMPLETION is used to document your CE credit and e-mail is mailed to your office. [email protected] . ALLOW 2 WEEKS for processing and mailing of your certificate. . The Ohio State University is a web recognized provider for ADA CERP dentistry.osu.edu/sms and AGD fellowship, Mastership, and Maintenance credit. Page 1 PIGMENTED LESIONS OF THE 2015 ORAL MUCOSA course This course will help dental professionals to familiarize themselves with common pigmented lesions of the oral mucosa and to derive a differential one diagnosis for various pigmented lesions. INTRODUCTION clinical appearance. No treatment is necessary, unless for aesthetic Pigmented lesions of the oral reasons. mucosa are one of the leading causes for which patients seek POST-INFLAMMATORY professional treatment. These PIGMENTATION lesions can have a wide spectrum of diagnoses and can be physiologic or Post-inflammatory pigmentation pathologic in origin. A variety of occurs on the oral mucosa which discoloration, including brown, gray, had previous injury or black, blue, purple, and yellow, can inflammation. occur on oral mucosa. Patient history, clinical presentation, and Clinical Features: location can be very helpful in narrowing down the differential Like physiologic pigmentation, diagnosis of these various post-inflammatory pigmentation pigmented lesions. is seen more often in dark-skinned individuals. The discoloration can BROWN, GRAY, AND/OR be focal or diffuse and is commonly seen in patients with BLACK LESIONS chronic mucosal conditions such as lichen planus, pemphigus, and PHYSIOLOGIC PIGMENTATION mucous membrane pemphigoid.

Physiologic pigmentation usually Treatment: occurs as diffuse discoloration of oral mucosa in dark-skinned The pigmentation may resolve individuals and it is considered a gradually, once the condition is normal variation. treated.

written by Clinical Features: SMOKER’S MELANOSIS neetha santosh, dds The discoloration is usually seen on Smoker’s melanosis is a diffuse the gingiva, but can also involve the pigmentation of the oral mucosa edited by labial mucosa, buccal mucosa, and seen among heavy smokers. the tip of the fungiform papillae of Chemicals in tobacco smoke, such rachel a. flad, bs the tongue. The color can range as nicotine, increases melanin karen k. daw, mba, cecm from light brown to black and is due production which causes the to an increased melanin deposition pigmentation. in the basal layer of oral epithelium.

Clinical Features: Treatment:

Smoker’s melanosis is frequently Diagnosis is made by a typical seen in light-skinned individuals. Page 2

Females are more likely to be affected due to the Gradual fading of the pigmentation is seen once influence of female sex hormones along with the offending drug is discontinued. smoking. The anterior facial gingiva is the most common location and presents as diffuse, light HAIRY TONGUE brown pigmentation. Hairy tongue is described as a hair-like Treatment: appearance due to the elongation and keratin accumulation on the filiform papillae of the dorsal History of smoking, along with clinical tongue. It can be due to an increase in keratin presentation, is usually sufficient to make a production or a decrease in keratin removal from diagnosis. Smoker’s melanosis will resolve the dorsal surface of the tongue. gradually once the person quits smoking. A biopsy of the area may be required if Clinical Features: pigmentation is in an unusual area, such as the hard palate, or if there are any sudden changes in Hairy tongue is mostly seen in heavy smokers or clinical presentation. people with poor oral hygiene. The midline of the tongue, anterior to the circumvallate papillae, is DRUG-INDUCED PIGMENTATION the most frequent location. Brown, yellow, or black discoloration of elongated filiform papillae A variety of medications such as antimalarial is due to stains from tobacco and food or agents (chloroquine, hydroxychloroquine, and pigment-producing bacteria. quinidine), tranquilizers (chlorpromazine), chemotherapeutic agents, minocycline, estrogen, Treatment: or medications to treat AIDS can cause drug- induced pigmentation of the oral mucosa. The Hairy tongue is diagnosed by its characteristic pigmentation can be due to drug-induced clinical appearance. Scraping the tongue and melanin production or by the deposition of drug improving oral hygiene are the recommended metabolites. treatments.

Clinical Features: AMALGAM TATTOO

Drug-induced pigmentation can cause the skin An amalgam tattoo is the pigmentation of the and mucosal surfaces to have a diffuse or specific oral mucosa due to the implantation of amalgam. pattern of pigmentation depending on the Amalgam particles can be embedded into the oral medication. Females are more prone to be mucosa during restoration or removal of an affected due to the interaction with sex hormones. amalgam filling, or during the extraction of an Minocycline can cause blue-gray discoloration of amalgam-filled tooth. the bone and developing teeth. It usually affects the hard palate and the facial surface of the Clinical Features: alveolar bone and can also cause rare pigmentation of soft tissues such as the lips, An amalgam tattoo usually appears as a black, tongue, eyes, and skin. Antimalarial drugs and blue, or gray macule and commonly occurs on the tranquilizers can cause blue-black discoloration of gingiva, alveolar mucosa, and buccal mucosa. the hard palate. Estrogen, chemotherapeutic Usually an amalgam-filled tooth can be seen in agents, and medications to treat AIDS can cause the vicinity of the lesion, unless the tooth has diffuse brown pigmentation of the skin and oral been extracted. Amalgam material, which has mucosa. been embedded in the alveolar ridge, can be seen as radiopaque fragments in radiographs of the Treatment: area.

Diagnosis can be made by the history of onset of the pigmentation shortly after drug usage. Page 3 Treatment: Treatment:

Diagnosis is usually made by the clinical Diagnosis is typically made by the characteristic appearance of the lesion and can be confirmed by clinical presentation of a flat, well-demarcated the presence of radiopaque amalgam fragments brown macule. No treatment is necessary unless in radiographs. If a clinical correlation cannot be for aesthetic reasons. If there is any change in size made or metallic fragments are not detected in a or appearance of the lesion, surgical excision is radiograph, a biopsy of the lesion is the treatment of choice. Excised tissue must be recommended to rule out melanocytic lesions. No submitted for histopathological examination treatment is necessary unless there are aesthetic since the differential diagnosis of an oral reasons. melanotic macule includes the oral melanocytic nevus, amalgam tattoo, and melanoma. NON-AMALGAM TATTOO ORAL MELANOCYTIC NEVUS Graphite tattoos and intentional tattoos are some types of intraoral exogenous pigmentations. The melanocytic nevus, also known as the common mole, is a benign proliferation of nevus Clinical Features: cells. They can be congenital or acquired, depending on the time of occurrence. An Graphite tattoos are commonly seen on the palate intraoral melanocytic nevus is much less common and occur from the accidental embedding of compared to its cutaneous counterparts. graphite particles from a pencil. The hard palate is the most common site of graphite tattoos and an Clinical Features: isolated grayish macule of mucosa (similar to an amalgam tattoo) is seen. Intentional tattoos can The oral melanocytic nevus is more commonly be cultural tattoos seen on the maxillary facial seen in females and is a well-demarcated macule. gingiva or amateur tattoos on the lower labial The color can range from brown to black, mucosa. although it can sometimes present as a non- pigmented macule. Most of them are seen on the Treatment: palate, mucobuccal fold, and the gingiva. A congenital melanocytic nevus is larger in size No treatment is usually necessary. Corticosteroids compared to an acquired nevus. and laser therapy may be used to remove intentional tattoos. Treatment:

ORAL MELANOTIC MACULE Generally, no treatment is required for oral melanocytic nevus except for aesthetic reasons. Oral melanotic macules are the most common Since the early stages of melanoma can mimic a melanocytic lesion affecting the oral cavity. It melanocytic nevus, histopathological appears as a flat, uniformly pigmented, well- examination of a surgically excised nevus is demarcated brown macule. mandatory.

Clinical Features: ORAL MELANOACANTHOMA

Oral melanotic macules can affect people of all Oral melanoacanthoma is a benign, rapidly ages, but females are more frequently affected. enlarging melanocytic lesion in the oral cavity. The vermillion zone of the lower lips is the most Some studies have shown association of trauma common site of occurrence, and it can also affect with these lesions. Cutaneous melanoacanthoma the buccal mucosa, gingiva, and palate. It occurs is not related to oral melanoacanthoma, which is due to an increase in brown melanin deposition in a pigmented seborrheic keratosis seen in older the basal layer of the oral epithelium. Caucasians.

Page 4 Clinical Features: radiolucent defects on a radiograph. Sometimes, oral melanomas develop with little or no Oral melanoacanthoma almost always occurs in pigmentation. These are called amelanotic African-Americans, with females more commonly melanomas and are difficult to diagnose clinically, affected than males, and usually occurs during as they may mimic a pyogenic granuloma. their 30s and 40s. Although the buccal mucosa is the most common site of oral melanoacanthoma, any oral mucosal site can be affected. It appears as an asymptomatic, smooth, dark-brown to black colored macule which rapidly grows in size over the duration of a few weeks.

Treatment:

A biopsy is usually performed to rule out a differential diagnosis of early melanoma. There is no need for subsequent treatment after confirming the diagnosis of oral melanoacanthoma, as most of the lesions will Oral Melanoma Dr. Carl Allen, The Ohio State gradually resolve on their own. University College of Dentistry Treatment: MELANOMA Any suspicious pigmented lesion on the hard Melanoma is a malignant neoplasm of palate and maxillary gingiva should be biopsied. melanocytes. Most of the melanomas are Oral melanomas are usually treated by surgical cutaneous lesions, but can occur at any location in excision with wide margins. Sometimes a the body where melanocytes are present. hemimaxillectomy is performed on patients Cutaneous melanoma is the third most common whose maxillary bone is also involved. Once the type of skin cancer, after basal cell carcinoma and diagnosis of oral melanoma is established, depth cutaneous squamous cell carcinoma. Acute of invasion of the lesion is measured, as oral damage by UV radiation is the most common melanomas deeper than 0.5 mm have a poor etiologic factor for cutaneous lesions. The risk factors also include familial history of melanoma, prognosis. The prognosis of oral melanomas are personal history of melanoma, congenital nevus very poor, due to difficulty in obtaining a clear or dysplastic nevus, fair skin, light hair and eye surgical margin during the initial treatment and color, and higher frequency of sunburn. Oral early chances of distant metastasis. Old age, male melanomas are comparatively rare and are less gender, and amelanotic melanomas are other than one percent of all melanomas; however, they factors contributing to a bad prognosis. Periodic act more aggressively than cutaneous melanomas. follow-up of melanoma patients are very important as they have higher chances of Clinical Features: recurrence.

Melanomas are usually seen in older adults, with PEUTZ-JEGHERS SYNDROME the average age being 40 to 70 years old. They are more common in Caucasians and have a male Peutz-Jeghers syndrome is an autosomal predilection. The maxillary gingiva and the hard dominant inherited condition and is manifested palate are the most common sites of occurrence in by multiple freckle-like lesions of the hand, the oral cavity. Oral melanomas usually start as periorificial skin (mouth, nose, anus, and genital irregular, brown- to black-colored macules. With skin) and the oral mucosa, and multiple polyps of time, they increase in size and become exophytic the intestine. Patients with this syndrome are in appearance. Often, these exophytic masses can more susceptible to develop cancer. get ulcerated and become painful. It can destroy the underlying bone and can produce irregular Page 5 Clinical Features: BLUE AND/OR PURPLE LESIONS

Multiple dark freckle-like lesions on perioral skin is MUCOCELE the most characteristic presentation of this syndrome. Even though they resemble freckles, Mucocele is a dome-shaped lesion of the oral intensity of these lesions does not change with mucosa which forms due to damage of the salivary sun exposure. Similarly, bluish-gray macules are also seen on the vermilion zone of the lips, the gland duct and the release of mucin into the labial and buccal mucosa, and the tongue. surrounding soft tissues. Trauma is the most common etiologic factor of a mucocele. Treatment: Clinical Features: Since patients with Peutz-Jeghers syndrome have higher chances of developing cancer, they should A mucocele is usually seen in children and young be referred to a gastroenterologist to monitor for adults, as they are more prone to biting the oral the development of intestinal intussusception and mucosa. Mucoceles have a bluish hue due to the cancer. spilled mucin content within the lesion. A mucocele is most often located on the lower lips, ADDISON’S DISEASE but can also be seen on the buccal mucosa, the (HYPOADRENOCORTICISM) floor of the mouth, the anterior ventral tongue, the palate, and the retromolar pad. Patients often Addison’s disease is a condition characterized by report a history of periodic rupturing and re- decreased production of adrenal corticosteroid formation of the mucocele. hormones due to damage of the adrenal cortex. Autoimmune diseases, infections (such as tuberculosis and deep fungal infections), and metastatic tumors are some of the etiologic factors for adrenal cortex destruction.

Clinical Features:

Gradual development of weakness, fatigue, depression, and hypotension are a few of the symptoms seen with Addison’s disease. Hyperpigmentation of the skin, known as bronzing, is one of the characteristic Mucocele Dr. Neetha Santosh, The Ohio State presentations. In the oral cavity, diffuse or patchy University College of Dentistry brown pigmentation may be seen. Treatment: Treatment: The majority of mucoceles break and heal by Oral pigmentation can be one of the first signs of themselves. Some long-standing lesions may Addison’s disease. History of recent appearance of require surgical excision. Care should be taken to oral pigmentation should raise the suspicion for remove the offending salivary gland along with Addison’s disease and the patient should be the mucocele to avoid chances of recurrence. The referred to his/her general physician for a surgically removed lesion should be submitted for complete physical work-up and laboratory studies microscopic examination to rule out a salivary of serum cortisol and ACTH. Addison’s disease is gland tumor. typically treated by corticosteroid replacement therapy. In an event of a lengthy surgical SALIVARY GLAND TUMORS procedure, the dose of corticosteroids should be increased to meet the body’s high stress level. Salivary gland tumors can be benign or malignant lesions. They can affect either the major salivary Page 6 glands (parotid, submandibular, and sublingual the facial gingiva of the mandibular canine and salivary glands) or the minor salivary glands seen in premolar. Clinically, they appear as a dome- the oral cavity on the soft palate, tongue, labial shaped, painless, bluish or blue-gray swelling. The mucosa, buccal mucosa or the retromolar pad area. lesions are usually less than 1 cm in diameter.

Clinical Features: Treatment:

Salivary gland tumors are seen in middle aged or The diagnosis is usually confirmed by a older adults with females having a higher chance histopathologic examination and an absence of of developing them. Inside the oral cavity, the jaw involvement. Gingival cysts of the adult are palate is the most common location to develop usually treated by surgical excision and have an salivary gland tumors, followed by the lip, buccal excellent prognosis. mucosa, tongue, and retromolarpad area. They usually present as a slow-growing, painless, ERUPTION CYST (ERUPTION HEMATOMA) fluctuant mass. Most of them have a bluish discoloration and can be ulcerated due to trauma. An eruption cyst is a cyst that forms in the soft tissue that lies above an erupting crown. It Treatment: represents the soft tissue counterpart of dentigerous cysts. A biopsy of any bluish pigmented mass should be done to achieve the correct diagnosis, as certain Clinical Features: salivary gland tumors can mimic a mucocele clinically. Treatment of salivary gland tumors Eruption cysts usually occur in children under 10 varies based on diagnosis of a benign or malignant years of age. Deciduous central incisors and condition. permanent first molars are the most prone to acquiring an eruption cyst. Clinically, the cyst GINGIVAL CYSTS OF THE ADULT appears as a soft, clear swelling on the gingiva of erupting teeth. Eruption cysts are prone to Gingival cysts of the adult is a developmental cyst trauma, which gives them a blue or purple color on the gingiva, arising from the remnants of dental due to blood in the cystic fluid. lamina. It represents the soft tissue counterpart of lateral periodontal cysts, which have the same Treatment: clinical and microscopic features, but occurs within the jaw. No treatment is usually required, as eruption cysts normally break by themselves once the tooth erupts. Resilient cysts can be treated by excising the superficial portion of the cyst.

VARICOSITIES (VARICES)

Varices are abnormally dilated veins with a

tortuous course. They are considered to arise due

to age-related degeneration of connective tissue

that surrounds the blood vessels.

Gingival Cyst Dr. Carl Allen, The Ohio State Clinical Features: University College of Dentistry

Varices are commonly seen in adults 60 years of Clinical Features: age or older. A sublingual varix is the most

common of the oral varices. They are most often Gingival cysts of the adult usually affect adults over seen as multiple, painless, bluish-purple elevated 40 years of age. The cysts are commonly found on Page 7 blebs on the lateral border and ventral surface of HEMANGIOMA the tongue. They can also be seen as single lesions on the labial and buccal mucosa. Hemangiomas are benign developmental vascular neoplasms. They are the most common tumors Treatment: seen in infants and children.

No treatment is usually required for sublingual Clinical Features: varices. Isolated lesions on the labial and buccal mucosa can be surgically excised for aesthetic Hemangiomas are more common in females. reasons. Caucasians are more prone to develop this lesion. The head and neck area manifests 60% of all SUBMUCOSAL HEMORRHAGE hemangiomas occurring in the body. Intraorally, the tongue is the most common site of occurrence A submucosal hemorrhage occurs in the oral cavity and usually presents as a red or blue-purple mass. due to trauma, which results in bleeding and Hemangiomas can be of two types depending on extravasation of blood within the mucosa. Based the time of occurrence, namely congenital and on the size of the hemorrhage, it can be referred to infantile hemangiomas. Congenital hemangiomas as a petechiae, purpura, ecchymosis, or a are formed completely at the time of birth, while hematoma. Petechiae are tiny pinpoint infantile hemangiomas usually develop in the first hemorrhages smaller than 3 mm in diameter. few weeks after birth. 50% of the hemangiomas Purpuras are slightly larger than petechiae, often resolve by themselves by age 5 and 90% will be between 3 mm and 1 cm in diameter. Ecchymosis resolved by age 9. Occasionally, intraosseous is a submucosal hemorrhage greater than 2 cm. hemangiomas can be diagnosed in the jaws. The When a hemorrhage produces a mass, it is then mandible is more commonly affected than the called a hematoma. maxilla and a radiographic examination shows a multilocular radiolucent defect. Clinical Features: Treatment: A submucosal hemorrhage presents as a reddish- purple, flat or elevated lesion, mostly on the labial Hemangiomas are diagnosed by the clinical history or buccal mucosa. Blunt trauma, cheek biting, of the presence of the lesion and by clinical violent coughing, upper respiratory infections, appearance. A diascopy can be performed to see if anticoagulant medication usage, and coagulation the red or purple lesion is caused by either blood disorders are some of the common causes of a within the blood vessels or leaked blood. A submucosal hemorrhage. diascopy is performed by firmly pressing a glass slide against the lesion and if the lesion is caused Treatment: by blood within the blood vessels, as in hemangioma, the lesion will blanch. Hemorrhagic A diagnosis is made by the correlation of trauma lesions such as petechial, purpura, or ecchymosis history or medication usage and clinical will not blanch, since those are caused by leaked or presentation. If a diascopy is performed, these extravasated blood. Hemangiomas usually require lesions should not blanch, as blood is entrapped no treatment, since the majority will resolve by within the mucosa and not within the blood vessel. themselves. Sclerotherapy, with ethanol or Usually, treatment is not required for a submucosal corticosteroids, can be used to decrease the size of hemorrhage and lesions should completely resolve the lesion and the remaining lesion can be within two weeks. If they do not heal within two removed by surgical excision or cryotherapy. Any weeks, a coagulation disorder or other systemic surgically excised tissue should be submitted for disease should be ruled out by laboratory histopathologic examination to confirm the investigations. diagnosis.

Page 8 KAPOSI’S SARCOMA

Kaposi’s sarcoma is a malignant vascular neoplasm. Human herpes virus 8 (HHV-8) is the causative factor for Kaposi’s sarcoma.

Clinical Features:

Kaposi’s sarcoma usually has four different clinical presentations: classic, endemic, iatrogenic (transplantation associated), and AIDS-related. The classic form of Kaposi’s sarcoma usually affects Blue Nevus Dr. Carl Allen, The Ohio State elderly men on the lower extremities. The endemic University College of Dentistry form of Kaposi’s sarcoma is seen in young children living in Equatorial Africa and affects various lymph Clinical Features: nodes in the body. The iatrogenic form is seen in renal transplant patients and arises due to the loss Blue nevus is commonly seen in children and of immunity caused by immunosuppressive drugs young adults. Females are more prone to develop taken following renal transplantation. AIDS-related this nevus. It is usually seen on the hard palate as Kaposi’s sarcoma is seen in the end stages of HIV a small, blue or bluish-black macule. infection and its incidence is decreasing due to anti-AIDS therapy. Oral lesions are seen in almost Treatment: 50% of AIDS-related Kaposi’s sarcoma. In the oral cavity, Kaposi’s sarcoma commonly affects the hard A biopsy is usually performed to rule out a palate, gingiva, and the tongue. It usually starts as differential diagnosis of an early melanoma, a purple patch, evolves into a plaque stage, and because of the similar clinical location and finally develops into purple nodular masses. appearance. Once the blue nevus is surgically removed, chance of recurrence is rare. Treatment: YELLOW LESIONS The diagnosis of Kaposi’s sarcoma is achieved by examining the tissue under a microscope. The FORDYCE GRANULES HHV-8 virus can be identified by immunohistochemical staining. The treatment of Fordyce granules are ectopic sebaceous glands Kaposi’s sarcoma depends on the clinical seen on the oral mucosa. presentation. Surgical excision, systemic or intralesional chemotherapy, and radiation therapy Clinical Features: are various choices of treatment for Kaposi’s sarcoma. Fordyce granules are more commonly seen in

adults. They present as multiple yellow papules BLUE NEVUS on the buccal mucosa or vermilion zone of the lip.

The lesions are normally asymptomatic. Blue nevus is a benign proliferation of nevus cells deep within the tissue. Blue nevus gets its name Treatment: from the blue color of the lesion due to the Tyndall effect. Since the nevus is located deep within the The diagnosis of Fordyce granules is made by tissue, when the light is reflected back, colors with typical clinical location and presentation. No longer wavelengths, such as red and yellow, will be treatment is required for Fordyce granules. absorbed by the tissue and colors with shorter wavelengths, such as blue, will be reflected back.

Page 9 PARULIS Clinical Features:

Parulis (gum boil) is a focal collection of pus on Lipoma is commonly seen in adults over 40 years alveolar or palatal mucosa, formed due to a sinus of age. The buccal mucosa and the buccal tract draining dental abscess. vestibule are the most common sites for occurrence, followed by the tongue, the floor of Clinical Features: the mouth, and the lips. Clinically, it presents as a painless, soft, yellow nodular mass which is Parulis usually presents as small, yellow-red usually less than 3 cm in size. nodules on the alveolar or palatal mucosa of a the non-vital tooth. The lesion periodically ruptures Treatment: and discharges a foul-tasting pus. It can be asymptomatic or painful, depending on the Conservative surgical excision is the treatment of amount of pus accumulated within the alveolar choice and the chance of recurrence is very rare. bone. JAUNDICE (ICTERUS) Treatment: Jaundice is a condition characterized by yellowish Pulp testing or radiographic evaluation following pigmentation of skin and mucosa, due to insertion of a gutta-percha point into sinus tract increased bilirubin in the blood. The increase can can help in determining the responsible non-vital be due by the rapid break down of red blood cells tooth. Parulis will be completely resolved in disorders such as autoimmune hemolytic following endodontic therapy or extraction of the anemia, or due to decreased processing of responsible non-vital tooth. bilirubin by the liver in conditions such as viral infections and alcohol induced hepatotoxicity. ORAL LYMPHOEPITHELIAL CYST Jaundice can also be seen in newborn babies or individuals having gall stones or cancer. Oral lymphoepithelial cysts are developmental cysts that arise in oral lymphoid tissue. Clinical Features:

Clinical Features: Jaundice is characterized by diffuse, yellowish pigmentation of the skin and mucosa, with the Oral lymphoepithelial cysts are common in young severity depending on the blood bilirubin count. adults. The floor of the mouth, ventral surface and Tissues with a higher amount of elastin, like lateral border of the tongue, the soft palate, and sclera, the soft palate, and the lingual frenulum the area of the palatine tonsil are the most will have greater yellow pigmentation, since common locations to develop this cyst. Clinically, it elastin fibers have a higher tendency to bind with presents as small, yellow-white nodules on the oral bilirubin. mucosa. Treatment: Treatment: Treatment of jaundice depends on the underlying Oral lymphoepithelial cysts are usually treated by cause of hyperbilirubinemia. Patients with surgical removal and they do not recur. jaundice should be referred to their general physician for a complete physical work-up and LIPOMA laboratory investigations to determine the exact cause. Lipoma is a benign neoplasm of adipose tissue. Lipoma is the most common soft tissue neoplasm in the body, but its occurrence in the oral cavity is not as common. Although this lesion is seen more in obese individuals, a decrease in calorie consumption does not decrease the size of lipoma. Page 10 CONCLUSION CE COURSES AVAILABLE FOR

Pigmented lesions can have various clinical PURCHASE presentations ranging from physiologic pigmentation to malignant conditions such as Need additional Continuing Education melanoma. A correct diagnosis of a pigmented credits before you renew your license? lesion is very important as it can change previous treatment plans. A biopsy of the lesion and Realized that you missed an SMS CE submission of the tissue for histopathological course? All of our CE courses are examination is mandatory if clinical diagnosis is in available once the due date has passed doubt. for only $25 per course.

REFERENCES Courses Available for Purchase: 1) Neville B, Damm D, Allen C, Bouqot J. Oral & Maxillofacial Pathology. 3rd ed. Philadelphia, 2013 PA: Saunders Company; 2009. Course 1 – Workplace Violence 2) Greenberg M, Glick M, Ship J. Burket’s Oral Course 2 – Human Immunodeficiency Medicine. 11th ed. Hamilton, Ontario: BC Decker Virus Inc.; 2008. Course 3 –GI Disease and Oral Lesions Course 4 – Human Papillomavirus

ABOUT THE AUTHOR 2014 Course 1 – Orofacial Pain NEETHA S ANTOSH Course 2 – Gingival Pathology NEETHA SANTOSH GRADUATED SUMMA CUM LAUDE FROM Course 3 – Panoramic Radiography CHRISTIAN DENTAL COLLEGE, INDIA, WHERE SHE FURTHER COMPLETED HER GENERAL PRACTICE RESIDENCY. SHE THEN and Radiolucencies of the Jaws PURSUED A POSTDOCTORAL FELLOWSHIP IN ORAL BIOLOGY AT INDIANA UNIVERSITY SCHOOL OF DENTISTRY. CURRENTLY, SHE IS Course 4 – White Lesions of the Oral DOING HER RESIDENCY IN ORAL AND MAXILLOFACIAL PATHOLOGY Cavity AT THE OHIO STATE UNIVERSITY. HER RESEARCH AT OSU PRIMARILY FOCUSES ON IDENTIFYING BIOMARKERS THAT CAN PREDICT THE PROGRESSION OF ORAL PREMALIGNANT LESIONS TO Please contact the SMS office if you are SQUAMOUS CELL CARCINOMA. HER FUTURE CAREER PLAN IS TO JOIN ACADEMICS WHERE SHE CAN TEACH AND PRACTICE ORAL AND interested in purchasing any of these MAXILLOFACIAL PATHOLOGY. courses.

NEETHA SANTOSH CAN BE CONTACTED AT [email protected]. 888-476-7678 (toll-free) [email protected]

Page 11 post-test instructions - answer each question ONLINE - press “submit” - record your confirmation id - deadline is February 15, 2015

The most common site of occurrence of oral 1 T F melanomas are the hard palate and the maxillary gingiva.

2 T F Hemangiomas are most commonly seen in SUBMITadults.

Eruption cysts typically occur in children over 10 3 T F years of age.

Pigmented lesions of the oral mucosa are one of 4 T F the leading causes for which patients seek ONLINEprofessional treatment.

Patients with Peutz-Jeghers syndrome have 5 T F higher chances of developing gastrointestinal cancer. d i r e c t o r john r. kalmar, dmd, phd Although lipomas are most commonly seen in [email protected]

6 obese individuals, a decrease in caloric SUBMITT F consumption will not decrease the size of the a s s i s t a n t d i r e c t o r lipoma. karen k. daw, mba, cecm [email protected] Estrogen, chemotherapeutic agents, and 7 T F medications to treat AIDS can cause diffuse channel coordinator brown pigmentation of the skin and oral mucosa. rachel a. flad, bs [email protected]

ONLINEFordyce granules are melanocytic lesions and 8 T F always require treatment.

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