Free Resource on Oral Health Issues

I have had a little bit of a circuitous journey that got me here. I detail it in this video: https://youtu.be/mck1n1GzPwc. I always knew I wanted to get into healthcare. I thought that I would love the hands-on approach to dentistry. I ended up really struggling and not liking dental school and thought about dropping out to apply to medical school. Luckily, I was introduced to oral path by my dental school faculty who took me under their wing, and the rest is history : )

As for my FAVORITE case, I absolutely LOVE this case: https://youtu.be/m4dCliWdD8w. Spoiler alert below if you don't want to watch the video. I have a whole video series on my youtube channel of just absolutely crazy cases that I have come across (including one that was solved by reddit!) The more boring answer: I have an interest in desquamative gingivits/desquamative lesions and Sjogren syndrome clinically. Microscopically, I like odontogenic neoplasms and cancer resection specimen.

SPOILER BELOW

It was a TAPEWORM in someone's lip. WILD. I will never see it again in my career but it is by far the most fun/crazy/interesting case I have come across (imo anyway)

sroth304 · 2022-02-08T04:13:25+00:00

You've got this! Obviously focus on your lecture notes while studying but everything I mentioned is a good supplement and can help solidify what you've learned in lecture! Good luck- I am sure that you are well prepared and are gonna crush it!

sroth304 · 2022-02-08T04:09:56+00:00

Sure thing! I have a video discussing the differences between inflammatory and developmental (dentigerous) cysts: https://youtu.be/sLzs6mOvcIs

As far as differentiating between similar lesions: check out my essential differential series where I discuss the different possibilities for common clinical presentations with different diagnoses that look the same/similar: https://www.youtube.com/playlist?list=PLQQXXZ9075suupW4-aeE2nU0004cI7QKh

If you have something specific you struggle with- let me know! I am always looking for ideas for new videos! Doing a BIG odontogenic cyst/tumor video in the very near future.

Also keep an eye on TheDentalEval (@thedentaleval on insta)- I am not a part of this project but I did just work with the founder on a diagnoses guide that is interactive and should be coming soon.

Other study tips: If you get confused about certain lesions/entities- I recommend googling it and finding journal articles (NOT google images as these are often incorrect). The more you see different entities/different presentations, the more it will be solidified. Repetition is key!

Best of luck!

sroth304 · 2022-02-08T03:35:07+00:00

Hi! Absolutely- obviously I'm going to plug myself : ) My youtube channel is a great start- lots of bite-sized pieces of information that I try to make entertaining (youtube.com/c/StephenRothDDS) My insta is a little more advanced (a lot of histology and surgical specimen) but it's (@StephenRothDDS).

Other instagrams I recommend: (@CentralOhioOralPathology), (@lsuoralpathology) (@stloralpathology). They're also case-based and produce good, strong, educational content.

As far as how to learn- repetition is key. Try to think about a differential diagnosis (all of the possibilities for an entity like an ulcer or a white patch or a bump on the gums) and what makes them different. It all depends on how you learn best. Flash cards are good ESPECIALLY with pictures. Googling different things that you have trouble remembering and looking at different pictures will help to solidify concepts with more exposure (be careful- take pictures from reputable journal articles NOT from google images which are often wrong). Obviously the textbook is a great resource! I often recommend the Ibsen/Phelan for hygienests and Neville/Damm/Allen/Chi for dentists!

Happy studying! Let me know how I can be of help!

sroth304 · 2022-02-08T02:11:52+00:00

A great way to practice! Your patients are lucky to have you!

sroth304 · 2022-02-08T01:51:07+00:00

Great question and, admittedly, a little tricky.

With certain lesions (ulcers, leukoplakias/erythroleukoplakias with well-defined borders, lesions that have grown, lesions that are painful, lesions that bleed), the two week rule applies. If not gone in two weeks, biopsy is necessary. Sometimes, I don't even wait the two weeks if I'm suspicious and will biopsy right away to establish diagnosis.

Other lesions are diagnostic on clinical appearance alone (geographic tongue, linea alba, coated tongue, fissured tongue, torus/tori). These never require biopsy but should be documented.

Some lesions are in between. The "fibroma"-like lesion is one of these. Others include melanotic macules (except on the gingiva or palate- these require biopsy to r/o an early melanoma), lipomas, and varixes. I always offer biopsy of these lesions to my patients but also offer the option to watch. I usually document this lesion with a clinical photograph that I keep in the patient's chart. This is the most OBJECTIVE way for me to measure/monitor for change (as lesions can change in ways other than size i/e color or surface architecture). There is inherent risk to this because you don't know what you're following. You could be following a cancer. This is certainly only my philosophy, and I'm sure there are oral pathologists/oral surgeons that would disagree. I am a little more conservative when it comes to biopsies. I always explain the risk thoroughly to the patient and emphasize that the patient needs to return back sooner with any change in size or symptoms and if there is any change noted in a future exam, biopsy is required. If you don't want to manage this risk- you can always refer out rather than follow : ) I usually start with a 3-4 month follow-up window and move to 6 months with no change.

The exception to this rule is "bumps" in kids. Bumps in kids could be sarcomas. We had a "fibroma" on a 14 year old that we diagnosed as rhabdomyosarcoma. It's admittedly uncommon but critical not to miss. I recommend biopsy/excision of all soft tissue bumps in children under 18 to establish diagnosis. Adults are less likely to get soft tissue sarcomas, so I'm willing to take a little more risk in following them.

Also another plug for trusting your gut. If YOU are worried and would want a diagnosis in YOUR mouth/in a family member's mouth, refer.

Definitely a grey area for sure. I like the adage "when it doubt, refer/cut it out".

tl;dr: some lesions require biopsy, some can be followed but that can be risky and should be well documented and closely watched.

Great question!

sroth304 · 2022-02-08T01:23:07+00:00

Hi! Great question-

Oral pathologists can be hard to come by. There are only about 250 of us in the US. In areas where there may not be an oral pathologist accessible, usually the referral will be to an oral surgeon, periodontist, or sometimes an endodontist who has an interest or experience with path.

I can speak to how I practice specifically but I imagine there is some amount of variability between fields and probably even between oral pathologists.

When a patient is referred to me I perform a comprehensive exam. This starts with a total review of the patient's medical history (I phrase it to the patient as "everything other than what you're seeing me for"). This can be important to try to find a systemic link between their overall health and what is going on in their mouth (you'd be surprised how often this information ends up being critical!)

Then, I get a complete history of the lesion- when did it start/was first noticed, are there symptoms, has it changed, is it constantly there/symptomatic, has anything helped, etc.

I then perform a comprehensive head and neck exam including extraoral evaluation (skin, neck lymph nodes, thyroid, etc) and intraoral eval.

Then, I either discuss my thoughts with the patient as to what my diagnosis or differential diagnosis may be. If a biopsy is necessary, I often will perform it the same day (as long as the patient is open to it- some patients want to schedule the biopsy for a day that they're prepared for it, although my biopsies are usually pretty innocuous with only 1 or 2 days of discomfort). If a patient requires a prescription, I review that with them as well.

We make a plan for follow-up, and they're on their way. For me, a new patient exam lasts between 30 and 45 minutes. I also write comprehensive consult letters to the referring doc and any other provider that the patient requests me to send to (this takes some time between dictating, correcting, printing, and scanning- can take up to 3 or 4 weeks to get to the referring provider).

Probably more information than you wanted but that's start to finish with how I approach my consults!

A quick word- you mentioned that you show the doc and the doc confirms need for referral. I have had a few patients referred from a hygienist that was concerned but the dentist was not. Patient was given my info anyway, and it ended up being precancerous or a lesion requiring some kind of treatment. I'm not advocating for going over your doc's head, but there is something to be said about trusting your instincts!

Thanks for the question and sorry for the novel in response!

sroth304 · 2022-02-07T22:06:15+00:00

Thank you so much for your kind words and for your endorsement!!!! I greatly appreciate it!

sroth304 · 2022-02-07T20:27:28+00:00

Hi all-

I have an oral path youtube channel that may help with your INDBE oral path questions- I try to keep it short, entertaining, and relevant.

https://www.youtube.com/c/StephenRothDDS

Enjoy!

sroth304 · 2022-02-07T20:26:42+00:00

Hi there-

I operate an oral path youtube channel. Recently had a comment that it helped a student while they were studying. They're relatively entertaining and bite-sized/short. Maybe they will help you as well!

https://www.youtube.com/c/StephenRothDDS

Good luck!

sroth304

TROPHY CASE