Oral Diagnosis: Chapter 7 – Examination of Tissues
O
Clinical exam begins with GENERAL APPRAISAL including a brief
survey of oral hygiene, state of the teeth, presence of tissue lesions,
acute/chronic distress, prosthetic appliances, edentulous area,
calculus, steins on the teeth of halitosis.
GENERAL APPRAISAL
 To inform the examiner how extensive the examination will be
and how much time will be required perform it.
 Indicates what instruments will be needed.
 Suggests the necessity for special examination order.
 To establish general outline of the areas.
 Point out immediately the necessity for referral and
consultation.
 Use and evaluation of carious alternative tests-control of
preventions of decay.
 Radiographs may be taken at this time.
 For screening purposes.
 For evaluating emergency complaints – history of exam may be
omitted temporarily until relief of acute symptoms can be
accomplished.
 Odor of garlic, onions, alcohol of tobacco may be readily
recognized.
 Disagreeable order may be associated with poor oral hygiene,
periodontal disease, rhinitis, sinusitis, tonsillitis, necrotizing
gingivitis – fetid odor (strong and unpleasant smell).
 Full breath – accompanies bronchiectasis, lung abscess, and GI
upset.
 Fruity odor – recognized on Px with diabetes milletus of
acetone but hit a constant finding only when Px is in diabetic
comma.
INSTRUMENTS NEEDED:
 Mouth Mirror
 Periodontal Probe
 Cotton
 Cotton Pliers
 Sponges (2x2)
 Finger Cots
 Dental Floss
 Water Syringe
 Articulating Paper
 Disclosing Solution
 Tongue Depressor
 Good illumination, Px sits properly and comfortable for proper
instrumentation & access to all areas.
LIPS
 Inspected & palpated for variations of normal & evidence of a
disease.
 Inspection for = color, form, texture, & obvious lesions.
 Palpation = bidigitally to determine texture pliability and
firmness of underlying of surface tissues.
 Induration, hyperkeratosis, & glandular mov’t are
determined by this procedure.
 Lips unopened are to be examined first because lips are te first
structure that attracts examiners attention.
Normal – smooth a pink in color, fissuring is minimal in younger
individuals.
 Advancing age curl develops in the corners of the
mouth. (labiomarginal sulcus) because of loss of tone in
the tissue and decrease of fat it becomes more
prominent as the person edges.
 Patients open his mouth/ups slightly
 Lower edge of the upper lip – relationship of the teeth.
 Patient smile to show his teeth to note what portion of teeth
are readily by seen important consideration in dental
restoration.
Pepito, R.C.
 Test the cranial nerve VII - by letting the Px smile w/a show of
teeth.
 Shows symmetric position of the lips &contours of the
jaws & teeth, toxicity of the muscles & siza of the lips.
 Mandible is in tones rest position – lips should be in
approximation w/o undue strain on the lip muscle.
 Lips of upper & lower part the color is the same except on Px
exposed to air or sunlight.
 Excessive exposure may level to permanent changes of the lips.
 Mucous membrane becomes thickened & is bluish to
purplish in color.
 In histoogic section = scarring & chronic inflammation due to
UV & dehydration.
 Clinically, red sprouts on the lips.
 Mouthbreather Px w/ lips chapped & dry.
 Sucking & chewing on the upper or lower lip causes excessive
desquamation of the epithelium & increased circulation of that
particular lip color is more red than the other.
 Color of lips is more important than the color of other areas.
 Disease that affects the RBC, hemoglobin & O2 carrying blood
causes various changes in the normal color of the ups.
 Cardiac Failure = bluish tint – purple
 Emphysema, increased bv, increased viscosity of blood,
disturbances of hemoglobin – produces blue color of cyanosis.
 Palpated between the index finger & the thumb
 Relaxed lips – soft & resistant, bands of orbicularis oris
can be felt in the body of the lips.
 Tensed lips = called “second lip” extensive that that
causes esthetic problem.
 Ectopic sebaccous – seen in the vermillion border of the
upper lip; considered variation of normal.
 Lips exposed wind & sunlight are not pathologic onditions but
may be significant in the diagnosis of orthodontic & periodontal
problem.
 Posture, color, form, texture, tonus & activity of the lips may
relate to mouth breathing or undue pressure on teeth –
significant in the diagnosis of malocclusion & gingivitis.
FINDINGS OF DISEASE:
 Size or form of the lips are examined for evidence of the
disease.
 Large lips
o may be a variation of normal
o may be caused by angioedema or neoplasm.
 Cretinism = frequently thickened lips
 Acromegaly = appear protruded lips.
 Swelling of lips = most commonly a result of edema associated
w/ injury or exposure to an offending allergen.
 Sudden enlargement of lips suggests an allergic etiologic agent.
 Elimination of the suspected agent & the use of the
antihistamines should be noted.
 Vary within the normal units with the ff: Age, sex, race &
exposure to weather
 Obvious signs of disease such as primary & secondary are best
evaluated on the basis of the type of lesion on its history.
FIRST STEP: Determine if the lesion is developmental, dermatologic,
traumatic, metabolic, allergic or neoplastic disease.
Primary evidence = history & location of the lesion.
o Traumatic lesion
 related to their history of occurrence
 biopsy is done to differentiate it from neoplastic
disease.
o Fissuring of the corners of the mouth may be related to vitamin
deficiencies or/in elderly Px w/ deep labiomarginal and
excessive salivation or xerostomia, towards ulceration sulcus
and infection of yeast/bacteria.
Oral Diagnosis: Chapter 7 – Examination of Tissues
o Accentration of the labiomarginal sulcus = results in extension
of the commisures of the upper & lower lips into the skin that
are not suited to continuous wetting/drying ( areas are prone
to chelitis.)
o Fissuring may develop form extensive stretching of the mouth
during the dental procedures,
o Secondary ulcerative lesions of herpes simplex one also seen at
the commisure after dental procedure.
o Longitudinal fissuring should direct examiner’s attention to the
possibility actinic chelitis, dehydration, & mouth breathing.
o Fissures that have been present for a long time have the
tendency to bleed, if indurated they are evaluated for
neoplastic disease.
o Ulceration characterized by chronicity, failure to heal,
induration & lymphadenophathy suggests neoplastic disease.
o Hyperpigmentation accompanied by other signs of the
symptoms of a systemic nature should suggests the possibility
of Metabolic Disorder such as Addisons Disease.
LABIAL AND BACCAL MUCOSAE
 Examination begins w/ the reflection of the upper lip & lower
lips & inspection of color & texture of the labial surfaces.
 Lips are palpated in systematic manner, a routine part of the
examination.
 Palpation starts from the outer edge of the lp, proceeds to the
vestibule. (BILATERAL/BIDIGITAL)
 Inspection and palpation will show varying degrees of
nodularity associated w/ numerous mucous glands siluated in
the submucous tissue – degree of nodularity may be increased
by chronic irritation, esp. w/ the use of tobacco.
FRENA/FRENULA- several folds to tissue transverse the vestibular
fornix.
o In the midline, sagittal folds connect alveolar process w/ the
upper & lower lips.
o In children, before the eruption of teeth, superior labial
frenulum is attached to the chest of the alveolar process &
form a raphe that may reach to the incisive papilla.
o With the eruption of the teeth, and vertical growth of the
alveolar process, it migrates superioly & normally found on
the attached gingival restricted to the alveolar mucosa of the
vestibule.
o In a adult, attachment is found at the jxn of the attached
gingiva & alveolar mocusa.
o Inferior Labial Frenum = attached in the jxn of the alveolar &
attached gingival.
o Position of attachment related to corruption of teeth &
vertical growth of the alveolar process.
o Bicuspid & cusppid area – lateral trenula is present ; more
prominent in the lower arch.
o Retraction of lips & cheeks are best in inspecting and
palpating the frenula = studied on stone cast/ models for
their position.
o Juncture of the alveolar mucosa and gingiva is indicated by
sharp scalloped line that vaguiely parallels the free margin
of gingiva.
o Alveolar mucosa – appears dark red when compared to
the normal pale pink gingiva.
 More pale gingiva = more/greater is in the contrast in color.
 Retromolar papilla – behind the most distal molars of the
upper & lower arches, soft tissue prominences.
o In maxilla = continuous w/ the gingiva causes the
termination of the maxillary tuberosity and
alveolar tubercle.
o In mandible = accentuation of the gingival
margin and is continuous w/ retromolar pad.
 Attached ginigiva & cheek mucosa = site of an
agdregation of buccal glands.
Pepito, R.C.O
Buccal glands- gives pad like appearance and has been called
retromolar pad.
Retromolar pad
 significant in periodontal therapy and placement of wearing
dentures.
 form may be dependent in a certain extent upon position and
eruption of the most distal teeth and form of the alveolar
process.
 In older person, tendency for atrophy of the mucous glands it
becomes move firm than younger person & as a result the
color appears more pale pink or white.
 Exo of the most distal molars a new retromolar papilla is
established behind the remaining molar but retromolar pad in
its original position.
Findings in Disease:
o Inspection & palpation of labial of buccal mucosa, frenula &
retromolar pad should be routine in the examination of the
mouth.
o Must be remembered that many disease show their
symptoms in the labial and buccal mucosae.
Color of Mucosae:
 May be altered by keratinization, pigmentation, scarring
inflammatory changes, changes in no. of hemoglobin, reduced
haemoglobin & RBC their hemoglobin content.
 Keratinisation may be detected by gray-white or silver lesions.
 Most frequent deviation from the normal pink color is related
to varying degrees of white associated lichen planus, focal
keratosis, chronic cheek biting, chemical burns & leukoplakia.
 While appearing lesions are found in these area.
 Pallor of anemia & yellow tint of jaundice are noted in the labial
and buccal mucosa & used as (+) correlative data. BUT these
are only symptoms of disease when present suggest are need
of evaluation & search it cause.
o Complete study of blood should be done with a complete
examination of the body before concluding that Px has a
certain disease.
 Hyperpigmentation is evaluated for recent onset, distribution,
change in intensity, & relationship to pigmentation in the
mouth & body.
 Melanin-pigmentation = vary intensity from light brown to a
dark blue-black & be localized to very small islands/ be diffused
through large areas, is significant when it is recent in a normally
bond Px.
 Increased in pigmentation may be exogerous or endogerous in
character and systemic or local in origin.
 Normal pigmentation increases in intensity with age.
 In Addisons Disease brown to brownish black dots of pigment
or a diffuse bluish black pigmentation may occur on the Buccal
& Labial mucosae, palate, lips, gums or tongue.
 Heavy metal intoxication may also cause pigmentation on
these areas.
 Not unusual for The Petechiae Emboli in subacute bacterial
endocarditis to be present here as well as n the inferior surface
of the tongue and in conjunetiva.
 Mucosae shows the the Petechial haemorrhages & ecchymores
or pulpuras & leukemia.
 Trauma produces ulcerations, fibromas, & mucous retention
cyst.
 Tentative diagnosis can be based upon the clinical history and
appearance and consistency of the lesion.
 Final identification whose diagnosis is not obvious should be
based on biopsy.
 Ulceration may be caused by chronic irritation such as sharp
edges of teeth, rough dental fillings, or ill-fitting dentures,
traumatic ulcers may have a superimposed malignancy present.
Oral Diagnosis: Chapter 7 – Examination of Tissues
 Parotid papilla & stensen’s duct – are palpated w/ the index
finger of one hand insideyhe mouth that of the outer hand are
placed outside.
 Inflammation of the incisive pailla, expression of the purulent
saliva, and presence of a hard mass in stensen’s duct suggest a
sialotith in the duct.
 Inflammation of parotid gland - inflammation of papilla
coupled w/ turbid saliva expressed. From a duct w/ a signs &
symptoms of swelling and pain.
 Tumor/neoplasm – enlargement of gland w/o visible signs or
symptoms of changes in saliva or the parotid papilla.
 Xerostemia may be local or systemic.
 Sialorrhea may be psychogenic, systemic o local
 Obstruction of on duct of a gland is no sufficient to cause
obvious signs of dry mouth.
 May be related fear, dehydration, drugs or dentures.
 Excessive salivation – associated with faulty dentures, pain in
the mouth, metal intoxication, or substances giving an
unpleasant taste.
o Determine duration and degree of incapacitation and
review the history, which might reveal the etiologic agent
o Normal on px undergoing dental procedure
Sialorrhea – tends to slow down dental procedures; a dry field of
working and vision is necessary.
Sialorrhea + metallic taste = possibility of metal
intoxication.
 Large Buccal Fat Pad is significant to the dentist, not
considered as pathologic, but does affect dental procedures.
Concern to the prosthodontic treatment as it tends to be
chronically irritated by cheek bitting.
 Diagnosis of chronic cheek chewing
o Alignment of teeth
o Correct amount of maxillary over jet
o Sharp edges of teeth
o Prominence of buccal fat pad
 Position of frenula interferes with the eruption of teeth or
position attachment is because of periodontal disease may be
changed a pathologic significant.
 Abnormally large and attached frenulum causes or maintain the
diastema between central inussors and may be a secondary
factor such as congenital absence of lateral inusors & various
type of genetic bone patterns in the midline of Maxilla.
Palate
 Mucous membrane of hard palate is firmly attached to the
underlying bon & presents some degree of keratonization.
 Pale pink color often w/ a bluish gray blue
 Peripheral zone of hard palate are firm but resilient &
connects tissue to the palate proper to the teeth.
 Palatine Raphe
 Narrow whitish streak in the midline of the palate.
 Extends from a small projection, incisive papilla,
posteriorly over the entire length of the hard
palate
 Ridge-like in the anterior & groove going
posterior.
 Palatine Rugae
 Irregular branching ridges that radiates from the
incisive papilla & anterior position of the palatine
raphe.
 Palatine Forea
 Small visible depression on each side of the raphe
at the jxn of soft & hard.
 Palatal nerves, glands & blood vessels
 Found in the lateral positions of the tissues bet.
palatine raphe & alveolar ginigiva.
Pepito, R.C.O
 Compensssibilty of these tissues are significant in the
design of dentures.
 Area of the hard palate into which large amount of fluid be
injected w/o causing tissue damage.
 Upon palpation tissues are soft & more resistant than
alveolar mucosa / the medial portion of hard palate.
 Palation of this band of gingiva is firm but somewhat
movable; exo of adjacent molars may let the tissue
become more/bigger in size & less pronounced.
 Surgical removal of the tissues is meaning for proper
treatment & removal of periodontal pockets even when
shallow.
 Hand of tissue may caused complications w/ the adequate
adaptation of teeth then the tissues becomes flabby &
even more hyperplastic than originally then further
complicates the proper seating of dentures.
Soft Palate
 Covered with thin mucous membrane
 No lining epithelium
 Contains numerous glands & clood vessels which gives
the soft palate a darker red color.
 Boundary of Soft & Hard Palate is seen when Px says
“AHHH” important in the proper retention of dentures.
Findings in Disease:
o Color of hard and soft palate may be changed by:
 Localized or diffuse increase in pigmentation
 Change in the integrity and permeability of the BV’s
 Change in the hemoglobin content of the
blood/increase in the amount of reduced
hemoglobin present
 Change in the character of the epith. of the mucosa
 Changes in density and attachment of these tissues
o Most common change in color is associated with the
process of inflammation from traumatic agents →
localized or may involve the whole soft and hard patalates
o Pressure from full dentures/palatal bars may be seen
frequently → produce color changes from bluish white to
brilliant red
o Soft palate may show varying degrees of red resulting
from engorgement of the BV’s that traverse it
o Active hyperemia, frequently accompanied by petechiae
and ecchymosis, is seen quite often in association w/ colds
and coughing episodes and allergic manifestations
o Soft palate – common site for traumatic injuries, herpetic
ulcers and purpuric manifestations; and a large ulcer may
be found on it in Vincent’s agina
o Excessive smoking
 Produce hyperkeratinization (less resilient and
coarser texture) of the palatal mucosa and
metaplasia of the ducts of the mucous glands
 Palatal appearance – characterized by a diffuse
silver-white color from hyperkertinization &
scattered punctate red areas indicating the
orifices of the ducts of the mucous glands
 Smoker’s patch – a brown staining of the
keratinized surface, esp. in areas where the
pipestem or a cigar rests
 Nicotine Stomatitis – extensive keratinization of
the palate w/ involvement of the orifices of
mucous glands
o Middle portion of the palatine raphe will show a firm bony
enlargement
 Color: Mucosa on the surface is pale pink to
white
Oral Diagnosis: Chapter 7 – Examination of Tissues
 Size & form: May vary from slight flat elevation
of the median portion of the palatine raphe
(normal) to a large nodular mass (walnut sized)
o Torus palatinus
 Clinically significant bec. of its relationship to the
construction of full dentures and palatal bars on
RPD & bec. of its blastomatoid characteristics
 Not neoplasm, only significant when it interferes
with mastication, speaking & swallowing or
when the px has cancerphobia
o All primary and secondary lesions occur in the palate
 Ulceration – most frequent type
 Etiologic agents : hard toast, chicken bones,
toothbrush bristles
o Incisive papilla
 Inflammatory changes are fairly frequent and
may be assoc. with traumatic agents that is the
same with the ulcerations mentioned above
 Cyst – result from extensive enlargement of
incisive papilla; no radiographic evidence of
bone involvement
 Malocclusion of anterior teeth – results in
impingement of food of mandibular central
incisors upon the incisive papilla; chronic trauma
of this may give rise→ hyperplastic enlargement
of this tissue
o Deep gingival sulcus and periodontal pockets – difficult to
treat by conservative means → tendency of tissue to
persist
o Ill-fitting denture
 Will produce an inflammatory hyperplasia of the
palate and is characterized by localized or diffuse
small red nodular elevations of mucosa
 Elevations may be polypoid or papillomatous –
termed “Palatal papillomatosis” or “Polypoid
hyperplasia of the palate”
o Movement of soft palate – dependent upon the function
of the 9th and 10th CN
o In presence of paralysis → soft palate sags on the affected
side and uvula is pulled to the unaffected side
o Hysteria
 Absence of a palatal reflex
 Paralysis of the palate
 Anesthesia resulting from disease of the second
division of the 5th CN
o Palatal reflex
 Significant in construction of full dentures and in
many other dental procedures
 Many individuals→ Palatal reflex is so
hypersensitive that the least manipulation in
posterior portion of mouth will produce gagging
o Clefts of the roof of the mouth and lip
 Present serious phonetic, esthetic and functional
problems
o Uvula
 Vary in size in every individual
 May be barely present or extend to the tongue
 May be congenitally absent or lost by surgical
removal (accident)
 Rarely it may be bifid and represent a mild form
of cleft palate
Pepito, R.C.O
OROPHARYNX
 Tonsillar are and oropharynx must be inspected by use of
tongue depressor
 Tonsils
o Children: Large and project toward the midline
of the tonsillar fossa
 Passavant’s bar – in the plane with the soft palate and on
the posterior wall of the pharynx is the ridge of tissue
o This functional landmark closes off the nasal
cavity during deglutition
o In cleft palate – location of this ridge is
significant to the prosthodontist in the
construction of obturator bulbs
 Size and form of oral cavity and oropharynx:
o May vary and are often related to the character
of the facies
o Broad-faced child – has a broad and large
oropharynx
o Narrow-faced child – narrow and small
 Normal appearance: Moist and bright pink, few dilated
vein and nodular prominences are present
 There is a physiologic enlargement in childhood and
diminution in adulthood
Findings in disease:
 Causes of mouth breathing:
- Enlarged pharyngeal and palatine tonsils – cause
by by blocking the nasol pharynx and may give
rise to acquired swallowing reflex causing an
undesirable thrusting of the tongue
- Paranasal sinus infection
- Engorged turbinates
- Septal deviations
- Nasal obstruction
 Chief characteristics of chronically infected tonsil
- Persistent redness of tonsil and adjacent mucosa
with repeated attacks of the tonsillitis
- Presence of lymphadenopathy
FLOOR OF THE MOUTH
 Includes the sublingual glands and ducts, lingual nerves
and branches, lymph nodes along inferior border of the
mandible
 Sublingual caruncle
- Close to the lingual frenulum and on each side it
lies a small round nodule
- Contains openings of the submaxillary gland duct
 Examination of the floor of the mouth can be best
accomplished by inspection and palpation (read pp. 139-
140 for further details about examination)
Findings in disease:
o Changes in color on floor of the mouth may present with
inflammatory changes, hyperkeratotic changes and
retention cysts
o Ulcerations – occur as result of trauma or in assoc. with
primary or secondary herpes
o Soft fluctuant masses – cystic in nature
o Hard boardlike manifestations – assoc. w/ cellulitis of
sublingual space
o Hard, firmly attached enlargement – assoc. w/ the
sublingual glands may be inflammatory or neoplastic
o Occlusal radiography – helpful in determining presence or
absence of stones in Wharton’s duct
Oral Diagnosis: Chapter 7 – Examination of Tissues
o Enlargement of floor of the mouth assoc. w/ cystic lesions
– often assoc. w/ periods of remission → inc. flow of
saliva, occur at mealtime
o Cellulitis – assoc. w/ pulpal disease
TONGUE
 Sensitive to gastrointestinal disturbances
 Clinical examination of tongue includes:
- Visual inspection of as much surface as possible
o To ensure, the tip should be grasped in a
piece of gauze between the examiner’s
index finger and thumb and gently pulled
forward so that lateral surface, base and
dorsal surface can be inspected
- Tongue is observed in its normal position and
extended
- Anatomic landmarks to be considered:
1. Papillae (filiform, fungiform,
circumvallate, foliate)
2. Foramen cecum
3. Lingual tonsil or tissue
4. Ventral surface – plica fimbriata and
varicosities
 Circumvallate
- Largest of the papillae
- Number from 6 to 16
- Situated almost parallel with and in front of the
terminal sulcus, forming a V or Y
 Foramen Cecum
- Small depression at the junction of the terminal
sulcus just behind the circumvallate papillae at
the apex of the V formed by these papillae
 Lingual tonsils
- Accumulations of lymphoid tissue on the root of
the tongue
- May extend as far back as the epiglottis and
laterally through the palatine tonsil
 Lymphoid tissue
- Seen commonly on the posterolateral borders of
tongue assoc. w/ the foliate papillae
- Px may complain of soreness of these areas
 Anterior lingual glands (glands of Blandin and Nuhn)
- Lie close to the inferior surface and tip of the
tongue
- Their ducts (5-7), open on small protuberances
of the mucous membrane under the tongue in
the plica fimbriata
- The glands occasionally give rise to mucoceles
 Lingual frenulum
- A fold of tissue that is on the inferior surface of
the tongue in the median plane and extending
from the inferior surface of the tongue to the
gums or alveolar ridge
- Abnormally broad lingual frenulum may result in
ankyloglossia
 Median lingual sulcus
- A shallow groove in the median plane of the
tongue can be seen on the dorsal surface
- Furrowed tongue is just developmental origin,
but grooves deepened as person grows older
- Deep grooves may accumulate food debris →
unpleasant odor and inflammation
 Phlebectasia linguae
- Dilation of the lingual veins on the inferior
surface of the tongue
Pepito, R.C.O
 Median rhomboid glossitis
- A minor developmental disturbance of the
tongue located just anterior to the foramen
cecum in the middle of the dorsal third of the
tongue
- Has a rhomboid and red appearance→ absence
of papillae
Findings in disease:
o Disturbances may be congenital, traumatic, infectious,
metabolic, hormonal, allergic, hematologic,
neuromuscular, and neoplastic
o Trauma – most common cause of lesions
o Growth disturbances:
 Bifid tongue
 Ankyloglossia
 Furrowed tongue
 Median rhomboid glossitis
 Thyroglossal duct cysts
 Macroglossia (Cretinism and Infantile
myxedema)
 Macroglossia (Neoplastic, inflammatory or
retrogressive changes)
o Changes of surface of tongue and papillae but not
involving deep-seated lesions or induration
 Drug reactions
 Vitamin-deficiency
 Anemias
 Dermatologic diseases
 Geographic tongue
o Changes in consistency, function and sensations
 Chronic infective granulomas
 Traumatic lesions
 Neoplasms
o Infective granulomas – lesions are deep seated, change in
consistency of tongue, functional problems for long
duration.
o Primary lesions of chronic infective granuloma (Syphilis) –
short duration, little change in sensation of tongue unless
in an advanced stage
o Mucous patches of secondary syphilis
 Special significance of dentist
 May rise as a macule, papule or vesicle that
ulcerates to form a lesion
 Appears grayish white, slightly elevated lesions
 Mucous patch is highly infective
o Developmental lesions
- Characteristic bec. of location (eg. lines of
fusion)
- Failure to obliterate embryonic structures
- Uncomplicated anomalies of size
o Traumatic lesions
- Recognized bec. of positive history of trauma
o Dermatologic lesions
- Skin manifestations
o Single lesions
- Traumatic or local neoplastic origin
o Multiple lesions
- Manifestations of systemic diseases, dermatoses
or allergic disorders
o Superficial lesions
- Either localized or diffuse
- Changes in papillae and size and consistency of
tonue as a result of edema suggest possibility of
anemias, vitamin deficiences and drug reactions
Oral Diagnosis: Chapter 7 – Examination of Tissues Pepito, R.C.O