Clinical decision-making in oral medicine : a concise guide to diagnosis and treatment

Accurately diagnosing the myriad of diseases that can affect the mouth, guiding patients correctly, and offering treatment with competence is a permanent challenge for dental surgeons and health professionals. Often, the diagnosis of these diseases is neglected or wrongly performed. This concise book guides health professionals in clinical decision making in oral diseases, assisting them not only on the diagnosis and treatment of oral and maxillofacial diseases, but also in terms of value and benefit of who treats the condition and, above all, who will be treated. The work provides guidelines formulated by a compilation of specific protocols of conduct, focusing on the scientific evidence and enriched by the authors’ critical analyses. The book is divided into eight main sections that include twenty-eight chapters. Most of them have no more than 5 pages and follow the same format to standardize their use. Each chapter begins with a summary of the topic, a brief description of the main disease that fall into this diagnostic category, and their main definitions. Then, the clinical characteristics, ways of making the diagnosis, and a protocol for treatment for each lesion are presented. Additionally, the experienced authors interestingly discuss their perceptions on how to give bad news in the Oral Medicine setting; and the last section is especially dedicated to the dental management of medically complex patients or with little-known diseases, such as Burning Mouth Syndrome and COVID-19. More than 140 high resolution clinical images illustrate the book. Clinical Decision-Making in Oral Medicine targets is designed for health professionals and physicians from various specialties, who are interested in diseases with systemic repercussions that affect the oral and maxillofacial complex and in oral repercussions of treatments for complex diseases such as head and neck cancer. Students in dentistry may also find the book of value. Foreword Contents Part I: Clinical Protocols for Oral Diagnosis History Taking and Physical Examination 1 History Taking 2 Physical Examination 2.1 Extraoral Physical Examination 2.2 Intraoral Physical Examination (VOE) Sources Standardization in Oral Photography 1 Fundamentals 1.1 General 1.1.1 Color 1.1.2 Resolution 1.1.3 Lighting 1.2 Equipment and Accessories 1.3 Camera Setup and Calibration 1.4 Image Standardization 1.4.1 Extraoral Photographs 1.4.2 Intraoral Photographs 2 Technical Sequence for Photographing Oral Lesions 3 Care 4 Storage Sources Fine-Needle Aspiration Cytology and Exfoliative Cytology 1 Exfoliative Cytology 1.1 General Principles 1.2 Indications 1.3 Materials 1.4 Technique 2 Fine-Needle Aspiration (FNA) 2.1 General Principles 2.2 Indications 2.3 Contraindications 2.4 Materials 2.5 Technique Sources Biopsy of the Oral Mucosa and Histological Assessment 1 General Aspects 2 Instruments and Materials 3 Guidelines 4 Surgical Technique 5 Bone Biopsy 6 Information Shared with the Oral Pathologist Sources Protocol for Breaking Bad News 1 Planning the Consultation 2 Understanding Patient Perception 3 Assessing the Patient’s Desire to Know 4 Transmitting the Information 5 Management of Emotions 6 Summarize and Strategize Sources Part II: Reactive Lesions and Non-Neoplastic Proliferative Processes Traumatic Oral Ulcer 1 Clinical Characteristics 1.1 Traumatic Ulcers 1.2 Eosinophilic Ulcer 1.3 Riga-Fede Disease 2 Diagnosis 3 Treatment Sources Recurrent Aphthous Stomatitis 1 Clinical Characteristics 1.1 Minor RAS 1.2 Major RAS 1.3 Herpetiform Ulceration 2 Diagnosis 3 Treatment Sources Desquamative Gingivitis 1 Clinical Characteristics 2 Diagnosis 3 Treatment Sources Non-neoplastic Proliferative Processes 1 Clinical Characteristics 1.1 Pyogenic Granuloma 1.2 Fibrous Hyperplasia 1.3 Peripheral Ossifying Fibroma 1.4 Diagnosis 1.5 Treatment Sources Giant Cell Granuloma 1 Clinical Characteristics 1.1 Peripheral Giant Cell Granuloma 1.2 Central Giant Cell Granuloma 2 Diagnosis 3 Differential Diagnoses 4 Treatment 4.1 Peripheral Giant Cell Granuloma 4.2 Central Giant Cell Granuloma Sources Part III: Common Oral Infections Oral Candidiasis 1 Clinical Characteristics 1.1 Pseudomembranous Candidiasis 1.2 Erythematous candidiasis 1.2.1 Acute Atrophic Candidiasis 1.2.2 Chronic Atrophic Candidiasis 1.2.3 Rhomboid Median Glossitis 1.2.4 Angular Cheilitis 1.3 Chronic Hyperplastic Candidiasis 1.4 Mucocutaneous Candidiasis 2 Diagnosis 3 Treatment 3.1 First Line of Treatment 3.2 Second Line of Treatment 3.2.1 Third Line of Treatment Sources Oral Herpes 1 Clinical Characteristics 1.1 Primary Herpetic Gingivostomatitis 1.2 Recurrent Herpes 2 Diagnosis 3 Treatment Sources Part IV: Salivary Gland Diseases and Tumors Xerostomia (Dry Mouth) 1 Clinical Characteristics 2 Diagnosis 3 Treatment Sources Mucus Extravasation and Retention Phenomena 1 Clinical Characteristics 1.1 Mucocele 1.2 Ranula 1.3 Mucocele and Ranulas Related to Systemic Disorders 1.4 Lesions Similar to a Ranula 2 Treatment 2.1 Mucocele/Ranula Sources Minor Salivary Gland Tumors 1 Clinical Characteristics 1.1 Pleomorphic Adenoma 1.2 Canalicular Adenoma 1.3 Mucoepidermoid Carcinoma 1.4 Adenoid Cystic Carcinoma 1.5 Polymorphous Adenocarcinoma 2 Diagnosis 3 Treatment Sources Part V: Vascular Diseases Vascular Anomalies of the Oral Mucosa 1 Clinical Characteristics 1.1 Hemangiomas 1.2 Vascular Malformation 1.3 Arteriovenous Malformation 1.4 Lymphatic Malformation (Oral Lymphangioma) 1.5 Varices (Varicose Veins) 2 Diagnosis 3 Treatment 3.1 Hemangioma 3.2 Vascular Malformations, Hemangioma, and Varices (Varicose Veins) 3.3 Lymphatic Malformation (Oral Lymphangioma) Sources Part VI: Mucocutaneous Diseases Oral Lichen Planus 1 Clinical Characteristics 1.1 Reticular 1.2 Papular 1.3 Plaque-Like 1.4 Erosive 1.5 Atrophic 1.6 Bullous 2 Diagnosis 2.1 Clinical Evaluation 2.2 Incisional Biopsy 3 Treatment Sources Pemphigus and Mucous Membrane Pemphigoid 1 Clinical Characteristics 1.1 Pemphigus Vulgaris 1.2 Pemphigoid of the Mucous Membranes 2 Diagnosis 3 Treatment 3.1 Pemphigus Vulgaris 3.1.1 Lesions Restricted to the Oral Mucosa 3.1.2 Lesions Disseminated to Extraoral Sites 3.2 Mucous Membrane Pemphigoid 3.2.1 Lesions Restricted to the Oral Mucosa 3.2.2 Lesions Disseminated to Extraoral Sites Sources Part VII: Oral Potentially Malignant Disorders and Cancer Actinic Cheilitis 1 Clinical Characteristics 2 Diagnosis 3 Treatment Sources Oral Leukoplakia and Erythroplakia 1 Clinical Characteristics 2 Diagnosis 3 Treatment Sources Oral Cavity Squamous Cell Carcinoma 1 General Aspects 1.1 Squamous Cell Carcinoma of the Lip 1.2 Oral Squamous Cell Carcinoma 2 Clinical Characteristics 2.1 Squamous Cell Carcinoma of the Lip 2.2 Oral Squamous Cell Carcinoma 3 Diagnosis 4 Treatment Sources Part VIII: Oral Management Strategies for Patients with Special Needs Oral Management of Cancer Patients After Multimodality Therapy 1 Clinical Characteristics of the Toxicities of Antineoplastic Therapy 1.1 Trismus 1.2 Mucositis 1.3 Hemorrhage 1.4 Candidiasis 1.5 Alteration in Taste (Dysgeusia) 1.6 Hyposalivation/Xerostomia 1.7 Osteoradionecrosis 1.8 Caries 2 Dental Treatment in Patients Submitted to RDT 2.1 General Principles and Philosophy of Treatment 2.2 Oral Conditioning Protocols 2.3 Trismus 2.4 Oral Mucositis 2.5 Candidiasis 2.6 Alteration in taste (Dysgeusia) 2.7 Hyposalivation 2.8 Osteoradionecrosis 2.9 Caries 2.10 Exodontia 3 Dental Treatment in Patients Undergoing CT 3.1 General Principles and Philosophy of Treatment 3.2 Oral Conditioning Protocols 3.3 Mucositis 3.4 Hemorrhage 3.5 Candidiasis 3.6 Hyposalivation 3.7 Invasive Dental Procedures Sources Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw 1 The Drugs Involved with MRONJ 2 Antiresorptive Agents 3 Angiogenic Inhibiting Agents 4 Additional Risk Factors 5 Clinical Features: What Is the Procedure to Diagnose MRONJ? 6 Clinical Management to Prevent MRONJ 7 Clinical Management to Treat MRONJ Sources Oral Management of the Organ and Tissue Transplant Patient 1 Clinical Considerations in Transplant Patients 2 Dental Evaluation 2.1 Pretransplant 2.2 Posttransplant 3 Dental Treatment in Solid Organ Transplant Recipients 3.1 Pretransplant Dental Treatment Guidelines and Philosophy 3.2 Posttransplantation Dental Treatment Guidelines and Philosophy 3.2.1 Immediate Posttransplant Period 3.2.2 Period of Graft Stability 3.2.3 Period of Chronic Rejection 4 Dental Treatment in Patients Submitted to Hematopoietic Stem Cell Transplantation (HSCT) 5 Treatment Guidelines and Philosophy 5.1 Pre-HSCT 5.2 During HSCT 5.3 Post-HSCT Sources Oral Management of Patients Undergoing Antithrombotic Therapy 1 Antithrombotic Agents 2 Antiplatelet Agents 3 Anticoagulants 3.1 Oral Anticoagulants 3.2 Heparins 4 Perioperative Management of Patients with AT 4.1 Evidence on the Suspension and Maintenance of AT 4.2 Perioperative Recommendations 4.2.1 Clinical Evaluation 4.3 Dental Treatment 4.4 Local Hemostatic Plan (LHP) Sources Management of Oral Lesions in HIV-Positive Patients 1 Oral Lesions Associated with HIV 1.1 Candidiasis 1.2 Oral Hairy Leukoplakia 1.3 Kaposi’s Sarcoma 1.4 Non-Hodgkin Lymphoma 1.5 Periodontal Diseases 1.6 Oral Hyperpigmentation 2 Treatment 2.1 Candidiasis 2.2 Oral Hairy Leukoplakia 2.3 Kaposi’s Sarcoma 2.4 Non-Hodgkin Lymphoma 2.5 Periodontal Diseases 2.6 Oral Hyperpigmentation Sources Management of Patients with Burning Mouth Syndrome 1 Clinical Characteristics 1.1 Diagnosis 1.2 Diagnostic Tests 2 Treatment Sources Management of Oral Lesions in COVID-19 Patients 1 Salivary and Taste Disorders 2 Oral Mucosal Lesions 3 Clinical Management of Patients with COVID-19 Presenting with Oral Lesions Sources Index