hey what about my two doctors and doctors is welcome to another video at the tooth Factory today we're going to be continuing with our oral pathology series of important terminologies of lesions now we need to understand that before we get into the depths of oral pathology specific lesions say for example dentiger assist the infamous lesion of world pathology we need to understand how to classify it we need to know where it fits in into these different terminologies so that when we talk about the future lesions in the future lectures we know what exactly we're getting into for example this one shows there is a discontinuity in the epithelial layer correct fair enough but what is it called when there is a break in the epithelium that break is referred to as simply and ulcer so when we can conceptually clarify our doubts to the fundamental levels that is when we can approach exams like AFK inbde and perhaps Dentistry whether it is BDS or DDS in general so with Dr Khan and Shah's presentation and my voice let's get on with today's show let's get into the ABCDs of oral pathology today we're going to be talking about the 13 different types of classifications that any histological or pathological lesion can fall into you know macule patch erosion ulcer Fisher Papio plaque nodule vesicle pustuobola cyst and tumor now some of these may be overlapping right however they have their own significance especially when we talk about number 14 biopsies of course we'll have a separate lecture on biopsies but we'll introduce the concept today in the end so please stick to the end here we go macule what's a macule it is a non-raised so flat pigmented area Which is less than one centimeters in diameter fairly simple what can this be well a Nevis right that's a macule a patch what's a patch non-raised so still flat pigmented absolutely however it is something that is more than one centimeter what can this be well an example is when you bleed under your tissue your echymosis is generally pretty big right now the counterpart as echymosis is more than one centimeter patekie Pete are less than one centimeter right so you're looking at flat surfaces pigmented very important to classify and then a dimension right so we're looking at horizontal Dimension vertical Dimension and a clinical feature that's how we're going to look into all our oral pathology lesions in the upcoming lectures moving on erosion erosion is the epithelium which is denuded above the basal layer now epithelium above the basal layer so this is connective tissue this right here this is the basal layer adjoining the epithelium with the connective tissue however Whenever there is loss of tissue or so we called a a break in tissue epithelium however when it doesn't extend all the way down to the basal and through to the connective tissue we call it simply erosion when the same same type of adeneration of epithelium extends into the basal layer and breaks it and enters into the connective tissue that specifically is Ulcer now clinically we said earlier that a break in the epithelium can be referred to as ulcer because until we do a histological analysis A histological featured analysis we cannot determine what the exact diagnosis is so erosion and ulcer be very careful when defining the two moving on fisher fisher is a linear crack we can see these generally at the heels right of our feet when they're extremely dry you can see a vertical crack in the epidermis papule on the other hand we're getting into vertical lesions there's an elevated solid lesion that is less than one centimeter in diameter so this is going to be less than one centimeter now solid and elevated are two new new words for us solid because there are some fluid filled this one is a solid okay let's keep that in mind because fluid fill can be referred to as a cyst we'll get into that in just a second okay moving on nodule a nodule is similar to a papule right because it is raised however nodules are extremely deep as well and when we talk about nodules we'll notice that we can get into things like I are they benign are they malignant you know we're talking cancers and so on they're more than one centimeter wide so the diameter whether you consider it vertical or horizontal is going to be more than one centimeter that's a nodule plaque now plaque is raised however flat there is no vertical Dimension if there is a horizontal dimension in black and it's a little bit raised more than one centimeter in diameter but it's only little raised vesicles now we're getting into fluid-filled vesicles are elevated so vertical Dimension small fluid filled by small we mean less than one centimeter fluid-filled skin lesions so by skin we mean that the basal layer has not been crossed so there is a chapter coming up in the future lectures and it's called vesiculobolus lesions and the whole chapter has various amazing topics such as pemphigus pemphigoid and multiple other topics so that's a vesicle what is it it's less than one centimeter and fluid filled with vertical dimension Ebola same thing except it is greater than one centimeter and it is mucocutaneous in nature posture is same it is filled it is fluid however it's turbulent by purulent all we mean is us it's an exudate right Which is less than one centimeter in size so anything that's got pustules will have pus also known as purulent exudates it is a vesicle and it is less than one centimeter in its diameter the big one cyst it is an epithelial cavity which means it's a cavity lined by epithelium so let's keep that in mind containing fluid air and other substances such as gas so why would we say epithelial by definition a cyst is something that is lined by epithelium however when the same type of lesion you can tell it on x-ray you can say it on his histology when it is not lined by epithelium we call it a pseudocyst and we could see actually a pseudocyst of jaw as a lesion when we'll talk about cystic lesions in dentistry and last but not the least the big gun the tumors deep solid Mass more than one centimeter either with well or ill-defined borders by well we refer to as benign on a normal basis not black or white there are some gray areas but malignancy has a feature of ill-defined borders and they of course they're destructive so you're going to see a huge diameter with destructive connective tissue broken and basically layer broken and that's tumor so it is solid okay however where do biop series fit into all of this let's take a look so back to our whiteboard guys let's talk about biopsies in dentistry first of all why do we need biopsies biopsies does two things it takes us from a differential diagnosis to a definitive diagnosis right definitive diagnosis is one type of a question that AFK or inbd can ask you but differentials are also important they are determined by clinical features definitive histological features and how do we attain that is through biopsies so there's two major types of biopsies we got incisional and we got excisional I'm sure we are normally aware of the terms but let's break it down into much easier format incisional means you have the whole lesion but you're only going to take this much out of it why would we do that well there's multiple reasons why first of all it's a lesion that is very large if you take it out you can damage say for example the ladder of border of tongue or floor of the mouth so sensitive area the third reason that you would want incisional biopsy is because you suspect a malignancy remember this word very important when you suspect a malignancy you want incision because then you can reach a definitive diagnosis and then treat it using excisional okay when would you choose excisional basically when this is your entire lesion you will take out an extensive amount of tissue even healthy tissue surrounding the lesion so that any cells that have might have proliferated wouldn't spread underneath so this now becomes a treatment measure right so what's the first reason that excisional can take place well there's a vascular lesion when there's a vascular lesion we're not going to puncture it like this it'll bleed so we're going to take it out such as Hemangioma or a pyogenic granuloma we're not going to treat it with incisional we're going to take the lesion out second is when it's in a location of the cheek the ventral tongue where it's not going to damage the surrounding too often so we need to understand the geographic area of it too and third is it is definitively diagnosed as a malignancer as a malignancy so remember the word suspect that's incisional but when it's a definitive diagnosed malignancy yes we're going to take it out for sure we're going to remove it well then one may ask what happens between suspecting malignancy and diagnosing malignancy that's where no biopsy comes into play by no biopsy I mean no treatment oriented biopsy see for example let's take leukoplakia leukoplakia as an example we can suspect that oh my God this could be a malignancy this could be a squamous cell carcinoma should we do an excision well not really our first instinct is going to be incisional biopsy incisional biopsy will confirm that it is benign normal malignancy then we're not going to do any excisional we're going to leave it and we're going to observe for the future say up to six months for example and then we're going to do another incisional biopsy and then we're going to verify that a girl did the other treatment modalities work or has this now become an SCC that we need to remove so in essence incisional versus excisional this is a diagnostic measure and this is a treatment measure so I hope a little bit of clarification has been given between the biopsies again we will have an entire lecture with examples for incisional and excisional biopsies and diagnosis and definitive diagnosis and differential and so on however for now this is what we need to understand when it comes to the terminologies of oral pathology so we thank you for attending the lecture it was pretty short and sweet and we'll see you in the next oral pathology lecture guys please study really well and if you have any questions or concerns please reach out to us in the comments section and we would love to help you