Diagnostic Tests for Cheilitis
Cheilitis Tests: Book Excerpts
Cheilitis Diagnosis: Book Excerpts
Diagnostic Tests for Cheilitis: Online Medical Books
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LIP PAIN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, and culture of any material that can be obtained from an ulceration if present. A therapeutic trial of antibiotics or antiviral medication can be done at this point. If this is unsuccessful, the patient should be referred to an oral surgeon or dermatologist.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
LIP SWELLING:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine laboratory tests include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, and culture of any material that can be obtained from an ulcer if present. An x-ray of the teeth and jaw may be necessary also. A therapeutic trial of antibiotics or antiviral therapy can be tried. If this is unsuccessful, a referral to an oral surgeon or dermatologist should be made.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Mouth lesions:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, the frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Mouth lesions:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed any pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially any malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially any painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Stomatitis:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Head, eyes, ears, nose, and throat (HEENT). Based on the history, a focused physical examination of the HEENT is necessary. Look for signs of trauma. Examine the conjunctiva and nasal mucosa for inflammatory changes or ulcerations. Evaluate the patient for coexisting upper respiratory signs and symptoms such as rhinorrhea, sinus tenderness to palpation, and otitis media. Inspect facial skin for vesicles from HSV or varicella-zoster or other lesions such as echymoses, malar rash, or viral exantham. Look for facial asymmetry. Varicella-zoster can cause facial nerve paralysis, called the “Ramsay Hunt syndrome.” Evaluate preauricular, postauricular, and cervical lymph node chains. Finally, evaluate the oral cavity, documenting the size, location, and appearance of the lesion.
B. Additional physical examination. Based on findings from the HEENT examination, additional physical examination might include (a) pulmonary examination for viral pneumonitis or pulmonary findings in autoimmune diseases; (b) abdominal and rectal examination for Crohn’s disease or ulcerative colitis; (c) genitourinary examination for mucosal ulcers in Behçet’s disease and Stevens–Johnson syndrome, and for signs of syphilis or gonorrhea; (d) a general skin examination looking for viral exanthemas, drug eruptions, lichen planus, pemphigus, pemphigoid, and SLE; and (e) a musculoskeletal examination for signs of SLE, Reiter’s syndrome, or other autoimmune diseases (3).
Testing
A. Clinical laboratory testing should be guided by history and physical findings. A potassium hydroxide wet mount is useful in the diagnosis of candidiasis. Viral and bacterial cultures can be obtained from swabs of oral lesions, but viral cultures are usually more helpful than bacterial cultures. Darkfield microscopy can be performed from swabs of syphilis chancres or plaques. Cytologic scrapings of premalignant or malignant lesions, prepared in a manner similar to a Pap smear, are not a substitute for biopsy of suspected oral neoplasia (2,4).
B. Diagnostic imaging is indicated only in selected cases such as coexisting sinus disease [“mini” sinus computed tomogram (CT)], coexisting neck mass or lymphadenopathy suggestive of malignant disease (head and neck CT), suspected metastatic disease (chest x-ray study; CT of the head, abdomen, and chest), or trauma (cervical spine series; cranial CT; dental Panorex films). If HSV is suspected, cranial magnetic resonance imaging (MRI) may be useful to evaluate the temporal lobes. A chest x-ray study is also indicated in suspected lower respiratory tract disease such as viral or autoimmune pneumonitis or secondary bacterial pneumonia. If a severe lip laceration has occurred, plain films can help to rule out mandibular condylar fractures or tooth fractures.
Diagnostic assessment
The diagnosis of stomatitis depends on synthesis of the aforementioned key historical, physical examination, laboratory, and imaging elements. All oral ulcers that do not heal, as well as white or reddish-white lesions that do not resolve in 2 weeks, need biopsy to rule out malignancy (2,4).
References
1. Yeatts D, Burns JC. Common oral mucosal lesions in adults. Am Fam Physician 1991;44:2043–2050.
2. Silverman S. Oral cancer, 4th ed. Hamilton, Ontario: BC Decker, 1998.
3. Salisbury PL, Jorizzo JL. Oral ulcers and erosions. Adv Dermatol 1993;8:31–79.
4. Mashberg A, Samit A. Early diagnosis of asymptomatic oral and oropharyngeal squamous cell cancer. CA Cancer J Clin 1995;45:328–351.
5. Laskaris G. Oral manifestations of infectious diseases. Dent Clin N Am 1996;40:
395–423.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Mouth lesions:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; especially note any painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Mouth lesions:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed odor or drainage or experienced pain. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, the frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient's lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums. Note any odor.
Palpate the neck for adenopathy, especially in patients who use tobacco or ingest alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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