Veidlapa Nr. M-3 (8)

Study Course Description

Oral Medicine and Pathology

Main Study Course Information

Course Code

RMS_039

Branch of Science

Anatomy; Clinical medicine

ECTS

5.00

Target Audience

Medicine

LQF

Level 8

Study Course Implementer

Course Supervisor

Ingrīda Čēma

Residency Speciality

Speciality

Maxillofacial Surgeon

Supervisor of Medical Speciality

Ģirts Šalms

Contacts

About Study Course

Objective

Get acquainted with the latest science-based oral mucosa disease development theories, investigation, diagnosis and treatment options, and prevention measures.

Learning Outcomes

Knowledge

1.Knows disease groups, incl. precancers, which can clinically appear with pathological changes in the color of the oral mucous membrane: red, white, mixed white-red and pigmented. To assess the clinical nature and course of oral mucosa pathologies, to set their differential diagnosis. To describe the morphological picture and to understand the severity of clinical picture of the ongoing process, considering the type of pathological color changes in the mucous membrane. To explain and interpret recommended investigations and the data obtained in connection with the specific disease. To describe activity of administered medicines (local and systemic) recommended in Oral medicine, their potential side effects, contraindications, and mutual interactions. To describe the normal oral microflora and potentially pathogenic microorganisms, describe the acute or reactivated clinical signs caused by them in the oral mucosa, necessary investigations and treatment. To describe the oral mucosa response to traumatic or pathological stimuli; describe clinical manifestation and set differential diagnosis. To name and describe systemic diseases, incl. dermatological, that can give an early and late expression in the oral cavity. To explain the causes of paraneoplastic syndromes. To describe the clinical manifestation of paraneoplastic syndrome in the oral cavity, pharynx and jaw bones. To describe and set differential diagnosis of facial skin tumors (benign/malignant). Recommend an adequate method of diagnosis and treatment of facial skin tumors (malignant/benign).

Skills

1.Will be able to perform clinical examination of perioral and oral cavity tissues, evaluation of local and general disease risk factors, recommending examination of other body systems if necessary. Palpate pathological formations in the neck region, including lymph nodes, evaluate their consistency, size, perform differential diagnosis Take cellular material for cytological examination or tissue biopsies for morphological examination from the pathological area in the perioral or oral mucosa area. Carry out appropriate anamnesis data interpretation in cases of bacterial and viral diseases, recommend microbiological and serological examinations. Creating, justifying and explaining an evidence-based treatment plan to the patient. Communicate with patients and their relatives of all ages and religions.

Competences

1.Interpret disease development and clinical manifestations based on perioral incl. anatomical, morphological and functional characteristics of the tissues of the lips and oral cavity. Recommend and apply modern methods of investigation and diagnosis of diseases of the perioral region, lips and oral mucosa. Assess the condition of the pathological process of the perioral region, lips and oral mucosa, where necessary conservative or surgical treatment; permissible treatment with laser therapy or cryotherapy; tissue morphological examination is required to rule out malignancy. Perform clinical evaluation, set differential diagnosis and treatment of "ulcers", "white", "red", “mixed white-red” and "pigmented" formations of the labial mucosa and oral mucous membrane. Recognize and evaluate system diseases, including manifestations of symptoms (syndromes) caused by dermatological diseases and malignant tumors in the oral mucosa, recommend consultation and treatment by the relevant specialist. Communicate with patients and their relatives, of any age and religious affiliation, explaining disease prevention options and their feasible measures.

Assessment

Individual work

Title	% from total grade	Grade
1. Individual work	-	-
1. Assessment after each seminar 2. Prepare one presentation of your choice related to the seminar topic.

Examination

Title	% from total grade	Grade
1. Examination	-	-
1. Discussion on the topics of the respective seminar, at the scheduled time for each of the seminars (n=3) (see topic annotations and questions of discussion) 2. Discussion about the pathologies seen during the consultations of the oral mucosa specialist at the Oral Medicine Center of RSU SI. 3. Powerpoint presentation of oral mucosa pathology choosed and prepared by the resident.
2. Examination	-	-
Activity in the seminar, solving the relevant problem issue. During the practical classes, the student's ability to communicate with the patient, document the anamnesis data and describe the pathology is observed. During the lessons, the student's ability to properly examine the patient in oral medicine, is observed: extra-oral, intra-oral examination, palpation of the neck lymph nodes, to take a smear for microscopic examination, cytological material, biopsy. Observes the student's ability to recommend a correct treatment plan Assesment of the prepared presentation with a mark in a 10-point system. At the end of the course - exam.

Study Course Theme Plan

FULL-TIME

Part 1

Seminar

Modality	Location
On site	Auditorium

Topics

Differential diagnosis of "white", "red" diseases and pigmentation. Manifestations of internal diseases in the oral mucosa. Groups of pathologies, mixed with white-reddish color manifestation - precancerous disases, autoimmune diseases, hyperergic reactions, chronic skin-mucous inflammatory diseases; groups of pathologies with red color manifestation - traumatic ulcers and burns, bacterial and spirochetal infections, inflammatory and immunological dysfunctions, glossitis, red changes affecting

Description

Annotation: The course covers the clinical examination of "red" and "white" diseases of the oral mucosa, it differential diagnosis of manifestations. Manifestations of internal diseases in the oral mucosa. Considered pathologies manifested by white and red visual changes: erythroleikoplakia, oral lichen planus erosiva, reactio lichenoidea, discoid lupus erythematosus; with red color changes – traumatic ulcers, burns, Candidiasis erythematosa, Fungal denture stomatitis, tongue papilla atrophy, tuberculosis, secondary syphilis, Erythema multiforme, Steven – Johnson syndrome, Lyel Syndrome, Lichen planus atrophica et bullosa, Lupus erythematosus, Pemphigus, Transplant disease against the host (GvHD), Drug-induced stomatitis oral allergy syndrome, Psoriatic mucositis, Inflamed tongue tonsil; Glossitis rhomboidea, Migratory glossitis benignum, Anemias, Fibrosis submucosa, Papillitis, Plasma cell gingivitis, Gingivitis desquamative, Hemangioma, Telangiectasia, Varices liguae, arterio-venous malformations, Erythroplakia, Carcinoma in situ, Squamous cell carcinoma, Kaposi sarcoma; with white discoloration - leukoplakia simplex, leukoplakia verrucosa et nodosa, leucoedaema, white spongy nevus, candidosis pseudomembranosa, candida hyperplastica chronica, oral lichen planus papulosa, reticulosa et plaque form,.morsicatio, keratosis irritans, hairy leukoplakia. Pigmentations - physiological, tobacco/smoking induced, amalgam and graphite tattoos, heavy metal salt induced pigmentation, chromogenic bacteria, medications, contraceptives and hormonal agents induced pigmentation, pregnancy, hyperthyroidism, diabetes, Addison's disease, pigmentation accompanying Nelson's, Peutz-Jeghers Syndrome, Laugier-Hunziker, LAMB and LEOPARD Syndrome, hemochromatosis, HIV/AIDS, post-traumatic, post-inflammatory pigmentation, lentigo, melanotic maculae, oral melanoacanthoma, oral pigmented nevus, pigmented and non-pigmented melanoma. Topics covered during the class: 1. Clinical manifestations and diagnostic possibilities of the considered pathologies (Velscope, Oral Rapid test and others) 2. Ethiological factors and morphological manifestations of the mentioned pathologies. 3. Methods and medications recommended for treatment. Possible side effects. 4. Localization and main functions of melanocytes. 5. Types and functions of melanin. 6. Reasons of pigmented lesions in oral cavity 7. Amalgam tattoo diagnostic options (x-ray) 8. Main criteria for the clinical diagnosis of melanoma. Literature: 1. Jessri, M., Mawardi, H., Farah, C.S., Woo, SB. (2019). White and Red Lesions of the Oral Mucosa. In: Farah, C., Balasubramaniam, R., McCullough, M. (eds) Contemporary Oral Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-72303-7_16 2. Malamos, D., & Scully, C. (2021). Clinical Guide to Oral Diseases (1st ed.). Wiley. Retrieved from https://www.perlego.com/book/2068075/clinical-guide-to-oral-diseases-pdf (Original work published 2021) 3. McNamara KK, Kalmar JR. Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities. Head Neck Pathol. 2019 Mar;13(1):4-15. doi: 10.1007/s12105-019-01002-8. Epub 2019 Jan 29. PMID: 30693460; PMCID: PMC6405795. 4. Wetzel SL, Wollenberg J. Oral Potentially Malignant Disorders. Dent Clin North Am. 2020 Jan;64(1):25-37. doi: 10.1016/j.cden.2019.08.004. PMID: 31735231. 5. Warnakulasuriya S. White, red, and mixed lesions of oral mucosa: A clinicopathologic approach to diagnosis. Periodontol 2000. 2019 Jun;80(1):89-104. doi: 10.1111/prd.12276. PMID: 31090142. 6. Mortazavi H, Safi Y, Baharvand M, Jafari S, Anbari F, Rahmani S. Oral White Lesions: An Updated Clinical Diagnostic Decision Tree. Dent J (Basel). 2019 Feb 7;7(1):15. doi: 10.3390/dj7010015. PMID: 30736423; PMCID: PMC6473409 7. Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: A review. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S403-8. doi: 10.4103/0975-7406.163471. PMID: 26538887; PMCID: PMC460

Seminar

Modality	Location
On site	Auditorium

Topics

Symptoms and syndromes caused by malignant tumors , manifesting in the oral cavity. Paraneoplastic syndrome. Its possible forms of expression. Types of cancer that most likely cause paraneoplastic syndromes. Clinical manifestation of paraneoplastic syndrome in the mouth and throat area. Squamous cell carcinoma of the mouth and pharynx. Symptoms of paraneoplastic syndromes. The type of tumor and the manifestation of its symptoms and syndromes in the oral cavity and jaw.

Description

Annotation: Definition of paraneoplastic syndrome. Metabolites produced by tumor cells. Risk groups and prevalence. Paraneoplastic syndrome symptoms manifested as endocrine anomalies, dermatological, hematological, neurological, rheumatological and eye anomalies. Cancer types most likely to cause paraneoplastic syndromes (breast, gastric, leukemia, lymphoma, lung, especially small cell lung cancer, ovarian, pancreatic, kidney, squamous cell carcinoma). Endocrine manifestations caused by oropharyngeal squamous cell carcinoma (ADH, HHM), clinical manifestations of hypercalcemia, neuromuscular manifestations, Eaton-Lambart myasthenic syndrome, paraneoplastic encephalomyelitis, manifestations in eyes and skin, rheumatological manifestations, Sweet's syndrome, paraneoplastic pemphigus, hematological manifestations, Paraneoplastic symptoms of syndromes (fever, loss of appetite and weight, night sweats, endocrine, neurological, skin), manifestations in the oral cavity - osteomas, Gardner's syndrome, pathology in the gastrointestinal tract, multiple endocrine neoplasias, mucous neuromas, multiple endocrine neoplasias, Cowden's disease, Peutz -Jeghers syndrome, Muir-Torre syndrome, Odontogenic keratocysts, Nevoid basal cell carcinoma syndrome or Gorlin syndrome. Topics covered during the class: 1. Factors causing the paraneoplastics syndrome. 2. Metabolites produced by tumor cells. 3. Risk groups and distribution. 4. Possible types of manifestations of symptoms of paraneoplastic syndromes. 5. Types of cancer most likely to cause paraneoplastic syndromes 6. Symptoms and syndromes caused by oropharyngeal squamous cell carcinoma. 7. Symptoms of paraneoplastic syndromes. 8. The type of tumor and the manifestation of its symptoms and syndromes in the oral cavity and jaw bone. Literature: 1. Diao W, Liang Y, Gao L, et al. Clinical characteristics of paraneoplastic syndromes in patients with head and neck cancer.Laryngoscope InvestigativeOtolaryngology. 2022;7(4):1002‐1010. doi:10.1002/lio2.8491010DIAOET AL. 2. Rashid H, Lamberts A, Diercks GFH, Pas HH, Meijer JM, Bolling MC, Horváth B. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol. 2019 Dec;20(6):847-861. doi: 10.1007/s40257-019-00461-7. PMID: 31313078; PMCID: PMC6872602. 3. Paolino G, Didona D, Magliulo G, Iannella G, Didona B, Mercuri SR, Moliterni E, Donati M, Ciofalo A, Granata G, Ranuzzi P, Falasca V, Calvieri S. Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy. Int J Mol Sci. 2017 Nov 26;18(12):2532. doi: 10.3390/ijms18122532. PMID: 29186863; PMCID: PMC5751135. 4.Mathew DG, Rooban T, Janani V, Joshua E, Rao U K, Ranganathan K. Review of paraneoplastic syndromes associated with oropharyngeal squamous cell carcinoma. J Oral Maxillofac Pathol 2010;14:41-7 5. Woo VL, Abdelsayed R. Oral manifestations of internal malignancy and paraneoplastic syndromes. Dent Clin North Am. 2008 Jan;52(1):203-30, x. doi: 10.1016/j.cden.2007.09.005. PMID: 18154871. 6. Zhu X, Zhang B. Paraneoplastic pemphigus. J Dermatol. 2007 Aug;34(8):503-11. doi: 10.1111/j.1346-8138.2007.00322.x. PMID: 17683379. 7. Baijens LW, Manni JJ. Paraneoplastic syndromes in patients with primary malignancies of the head and neck. Four cases and a review of the literature. Eur Arch Otorhinolaryngol. 2006; 263(1): 32- 36. 8.Oral Manifestations of Internal Malignancy and paraneoplastic syndromes - Pocket Dentistry https://pocketdentistry.com/oral-manifestations-of-internal-malignancy-and-paraneoplastic-syndromes/

Seminar

Modality	Location
On site	Auditorium

Topics

Precancers and squamous cell carcinoma of the lip. Benign and malignant diseases of the face. Malignant diseases of the oral cavity.Differential diagnosis of pathological formations in the neck region Lip precancers and squamous cell carcinomas. Macular or slightly raised papular formations on the skin of the face. Papular – exophytic growths on the skin of the face. Subepidermal formations. Rare benign skin growths. Malignant skin tumors. Diagnostics and treatment methods. Oral squamous cell ca

Description

Annotation: Precancerous lesions of the lip – Manganoti cheilitis, demarcated hyperkeratosis, nodular precancerous lesions. Squamous cell cancer of the lip, diagnosis and treatment options. Macular or slightly raised papular formations on the skin of the face - Naevi, nevusmelanocystic nevi, undeveloped pathological abnormalities - junctional nevus, compound and intradermal nevus, blue nevus. Campbell de Morgan spots, Sebaceous (senile) hyperplasia, Actinic keratoses. Papular - exophytic growing formations on the facila skin - Seborrheic keratosis, Leser-Trélat's sign, Inverted follicular keratosis, keratoacanthoma, acrochordoni, pyogenic granuloma, cutaneous horn. Subepidermal formations – lipoma, atheroma, epidemoid cysts, dermocysts. Rare benign skin formations - Jadassohn naevus sebaceous, trichoepithelioma, trichilemmoma, pilomatrixoma. malignant skin tumors -basal cell carcinoma and its types, squamous cell cancinoma and its histological variants, Bowen's disease, melanoma. Clark and Breslow values. Diagnostic capabilities and the importance of the sentinel node. Treatment options - systemic therapy; immunotherapy; targeted therapy; chemotherapy. Etiological factors of oral squamous cell carcinoma – smoking, synergistic association with alcohol consumption, Human Papillomavirus. Subtypes of Squamous cell carcinoma – basaloid, spindle cell carcinoma, adenosquamous, carcinoma cuniculatum, verrucous, papillary, acantholytic, lymphoepithelial. The importance of the differentiation degree in the choice of treatment tactics. TNM classification and the importance of invasion depth. Clinical classification of enlarged neck masses. Groups of lymph nodes in the neck. Acutely enlarged lymph nodes and their differential diagnosis. Enlarged lymph nodes - Inflammatory nature (viral, bacterial - odontogenic). Reactive lymphadenopathy. Nonspecific enlarged lymph nodes - Sialadenitis, Specific - Sarcoidosis, Tuberculosis, Cat scratch disease. Enlarged formations - formation of hematoma, p Topics covered during the class: Precancerous lesions of the lips, types, diagnosis and treatment. 2. Squamous cell cancinoma of the lip, diagnosis and treatment options 3. Differentialdiagnosis of benign formations of the skin. 4. Malignant formations of the skin, diagnosis and treatment options. 5. Precancers of oral cavity. Dysplasias of leukoplakia and the latest classification (2017) 6. Etiology of oral malignant tumors. 7. Subtypes of oral squamous cell carcinoma 8. Significance of differentiation degree of squamous cell carcinoma. 9. TNM classification and the importance of invasion depth. 10. Clinical classification of enlarged neck formations. 11. Groups of neck lymph nodes. 12. Main locations of malignant tumor in Head and Neck region and their regional metastases. Literature: 1. Peter A. Brennan, Tom Aldridge, Raghav C. Dwivedi, Rehan Kazi (2019) Premalignant Conditions of the Oral Cavity, Springer Singapore https://doi.org/10.1007/978-981-13-2931-9 2. Contemporary Oral Medicine: A Comprehensive Approach to Clinical Practice 1st ed. 2019 Edition, by Camile S. Farah, Ramesh Balasubramaniam, Michael J. McCullough, Springer International Publishing 3. Ganesh D, Sreenivasan P, Öhman J, Wallström M, Braz-Silva PH, Giglio D, Kjeller G, Hasséus B. Potentially Malignant Oral Disorders and Cancer Transformation. Anticancer Res. 2018 Jun;38(6):3223-3229. doi: 10.21873/anticanres.12587. PMID: 29848669. 4. Jing M, Cai Y, Shi J, Zhang X, Zhu B, Yuan F, Zhang J, Xiao M and Chen M (2022) Adjuvant Treatments of Adult Melanoma: A Systematic Review and Network Meta-Analysis. Front. Oncol. 12:926242. doi: 10.3389/fonc.2022.926242 5. Tamas C, Hreniuc IMJ, Tecuceanu A, Ciuntu BM, Ibanescu CL, Tamas I, Ianole V, Stanescu C, Pintilie CT, Zamfir CL, Moraru DC. Non-Melanoma Facial Skin Tumors—The Correspondence between Clinical and Histological Diagnosis. Applied Sciences. 2021; 11(16):7543. https://doi.org/10.3390/app11167543 6. Rahaf A., Reshale J. Lip cancer

Total ECTS (Creditpoints):

5.00

Number of Residency Seminars:

Length (weeks):

Final Examination:

Residency exam (Theory and practice)

Bibliography

Required Reading

Jessri, M., Mawardi, H., Farah, C.S., Woo, SB. (2019). White and Red Lesions of the Oral Mucosa. In: Farah, C., Balasubramaniam, R., McCullough, M. (eds) Contemporary Oral Medicine. Springer, Cham.

Malamos, D., & Scully, C. (2021). Clinical Guide to Oral Diseases (1st ed.). Wiley.

McNamara KK, Kalmar JR. Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities. Head Neck Pathol. 2019 Mar;13(1):4-15

Wetzel SL, Wollenberg J. Oral Potentially Malignant Disorders. Dent Clin North Am. 2020 Jan;64(1):25-37.

Warnakulasuriya S. White, red, and mixed lesions of oral mucosa: A clinicopathologic approach to diagnosis. Periodontol 2000. 2019 Jun;80(1):89-104.

Mortazavi H, Safi Y, Baharvand M, Jafari S, Anbari F, Rahmani S. Oral White Lesions: An Updated Clinical Diagnostic Decision Tree. Dent J (Basel). 2019 Feb 7;7(1):15.

Diao W, Liang Y, Gao L, et al. Clinical characteristics of paraneoplastic syndromes in patients with head and neck cancer.Laryngoscope InvestigativeOtolaryngology. 2022;7(4):1002‐1010.

Oral Manifestations of Internal Malignancy and paraneoplastic syndromes - Pocket Dentistry

Woo VL, Abdelsayed R. Oral manifestations of internal malignancy and paraneoplastic syndromes. Dent Clin North Am. 2008 Jan;52(1):203-30, x.

10.

Baijens LW, Manni JJ. Paraneoplastic syndromes in patients with primary malignancies of the head and neck. Four cases and a review of the literature. Eur Arch Otorhinolaryngol. 2006; 263(1): 32- 36.

11.

Mathew DG, Rooban T, Janani V, Joshua E, Rao U K, Ranganathan K. Review of paraneoplastic syndromes associated with oropharyngeal squamous cell carcinoma. J Oral Maxillofac Pathol 2010;14:41-7

12.

Peter A. Brennan, Tom Aldridge, Raghav C. Dwivedi, Rehan Kazi (2019) Premalignant Conditions of the Oral Cavity, Springer Singapore

13.

Contemporary Oral Medicine: A Comprehensive Approach to Clinical Practice 1st ed. 2019 Edition, by Camile S. Farah, Ramesh Balasubramaniam, Michael J. McCullough, Springer International Publishing

14.

Ganesh D, Sreenivasan P, Öhman J, Wallström M, et.al. Potentially Malignant Oral Disorders and Cancer Transformation. Anticancer Res. 2018 Jun;38(6):3223-3229.

15.

Jing M, Cai Y, Shi J, Zhang X, Zhu B, Yuan F, Zhang J, Xiao M and Chen M (2022) Adjuvant Treatments of Adult Melanoma: A Systematic Review and Network Meta-Analysis. Front. Oncol. 12:926242.

16.

Tamas C, Hreniuc IMJ, Tecuceanu A, et.al. Non-Melanoma Facial Skin Tumors—The Correspondence between Clinical and Histological Diagnosis. Applied Sciences. 2021; 11(16):7543.

17.

Rahaf A., Reshale J. Lip cancer prevalence, epidemiology, diagnosis, and management: A review of the literature. Advances in Oral and Maxillofacial Surgery, Volume 6, 2022, 100276, ISSN 2667-1476

18.

K. Chorath, A. Prasad, N. Luu, B.Go, A. Moreira, K. Rajasekaran. Critical review of clinical practice guidelines for evaluation of neck mass in adults, Brazilian Journal of Otorhinolaryngology, Volume 88, Issue 4, 2022, Pages 625-632,ISSN 1808-8694

19.

Haynes J, Arnold KR, Aguirre-Oskins C, Chandra S. Evaluation of neck masses in adults. Am Fam Physician. 2015 May 15;91(10):698-706. PMID: 25978199.

20.

Pynnonen MA, Gillespie MB, Roman B, Rosenfeld RM, Tunkel DE, et.al. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults. Otolaryngol Head Neck Surg. 2017 Sep;157(2_suppl):S1-S30.

21.

Oral and Maxillofacial Pathology, 4th Edition - May 4, 2015, by Brad Neville, Douglas D. Damm, Carl Allen, Angela Chi

Additional Reading

Journal of Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha I, Vijayabanu B. Oral pigmentation: A review. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S403-8.

Binmadi NO, Bawazir M, Alhindi N, et.al. Medication-Induced Oral Hyperpigmentation: A Systematic Review. Patient Prefer Adherence. 2020;14:1961-1968

Rashid H, Lamberts A, Diercks GFH, et.al. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol. 2019 Dec;20(6):847-861.

Paolino G, Didona D, Magliulo G, Iannella G, et.al. Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy. Int J Mol Sci. 2017 Nov 26;18(12):2532