Dentists - each a "Dr. Gregory House" of the dental world

 

I LOVE the show House on USA- I'm sure you've seen it. I saw the first entire season in two days on DVD the first time I saw it. You see Dr. Gregory House, a brilliant yet poor bed-side-manner doctor, with his team of doctors be presented with a very unique case and they are trying to figure out exactly what the patient has, usually life threatening. If you notice, they go through many different diagnoses before finally reaching the correct one. Well, tonight, I truly related that to dentistry and oral lesions!! We each are like the "Dr. Gregory House" in the dental world (most of us are MUCH nicer with excellent chairside manner) but we are similar in that we are trying to help you find out exactly what you have so we can treat it appropriately.

Tonight we had a Dental Society meeting and we had the pleasure of having an excellent speaker. He was an oral pathologist from the University of the Pacific and he gave a presentation about common oral lesions -signs, symptoms, diagnosis and the recommended treatment.His presentation was wonderful - replete with pictures (I am a visual learner) and examples of the various lesions and he had all of us give suggestions of what we thought those lesions were.
While many of the lesions he discussed were familiar - many a review of my dental school oral pathology class - one thing that I was reminded of is that many times patients come in with an oral lesion and many of the lesions look VERY SIMILAR to each other - meaning the diagnosis could be a NUMBER of things. When we ask you to open your mouth and we look around -we are looking for all lesions - from the most benign lesions to the most severe lesions (oral cancer - please see my "let us pull your tongue" dental post http://www.adentalperspective.com/2011/08/25/youre-pulling-my-leg-er-tongue/).
Burn lesions can resemble herpes lesions. Herpes lesions can look like Shingles (chicken pox re-manifestation). The little white and red patches on your tongue can be benign geographic tongue (which is a variation of normal) or a fungal infection (candida) or possibly even premalignant/precancerous lichen planus. The most severe traumatic lesions can even look like oral cancer!! Inflamed gums and pregnancy gingivitis can be mistaken for "desquamative gingivitis". Sometimes lesions on the skin can also be seen in the mouth and it means a more serious medical condition - such as target lesions (sometimes called erythema multiforme)
As general dentists we will do the best we can when you present with a lesion (or lesions) - step one is even recognizing that you have the lesion and start the diagnosis process and prescribe the best medication we feel is best. If the lesion remains or looks very suspicious we can send you to our colleagues (oral surgeons and oral pathologists) and they can continue to help you to perform evaluations and at the most severe - biopsy or surgically remove a lesion if it isn't eliminated. This is not done to scare you - it is done to help you and prevention and recognizing a lesion is the best first step.
In the end, I am reminded again that the oral cavity is the gateway to the rest of the body. Oral lesions can show systemic conditions - and sometimes are the first signs of an overlying and more severe systemic health issue. I will continue to educate myself - hopefully through such informative lectures like the one tonight, and hopefully be better able to recognize a suspicious lesion first so we can address it as soon as possible. It's 9.999 times out of 10 that it is nothing serious! But it's the other small percentage that is important!! Each of us are the "Dr. Gregory House" of the dental world - one oral lesion, one differential diagnosis at a time until we will get it right!!!