Papilloma

Description:
- A benign tumor derived from epithelium.papillomatous.
- Cauliflower-like projections that arise from the mucosal surface.
- It may appear white or normal colored.
- It may be pedunculated or sessile.
- The average size is less than 2.0 cm.
- No strong sex preference.
- The most common site was the palate-uvula area followed by tongue and lips.
- The durations ranged from weeks to 10 years.

Etiology:
- Immunoperoxidase stains have identified antigens of the "human papilloma virus" (HPV) types 6 and 11 in approximately 50% of cases.

Prognosis:
- Good, there is no evidence that papillomas are premalignant.

Differential Diagnosis:
- Intraoral verruca vulgaris,
- Condyloma acuminatum, and
- Focal epithelial hyperplasia.
Note: differentiation is done accurately by Microscopic Examination ONLY ...

Treatment:
- Conservative surgical excision, recurrence is rare.

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Mucocele (Mucous Cyst Of The Oral Mucosa)

Description:
- Benign lesion that appears in oral cavity "Oral Mucosa" causing elevation.
- The colour is somehow normal as the surrounding mucosa but can exhibit some bluish-white colour and sometimes it appears white.
- Other Term of the phenonmena ": mucus extravasation phenomenon, and mucus retention cyst.
- The mucocele is referred to as a ranula, when found in the floor of the mouth.
- More commonly found in children and young adults.
- It can be considered a polyp or a cyst.
- size ranges from 1 mm to several centimeters.
- On palpation, it may be fluctuant but can also be firm.

Etiology:
- Traumatic severance of salivary ducts permitting salivary escape into mucosa is the accepted etiology.
- ruptured salivary gland duct
- obstructed or ruptured salivary duct (Parotid duct) in the case of a mucus retention cyst.
- Inflammation of sinuses can also cause this condition

Location:
- Most commonly found in the surface of the lower lip.
- Inner side of the cheek (known as the buccal mucosa)
- On the anterior ventral tongue
- The floor of the mouth.

Histology:
Microscopically, mucoceles appears as granulation tissue surrounding mucin. Since inflammation occurs concurrently, neutrophilsand foamy histiocytes usually are present.

Prognosis:
Good

Differential Diagnosis:
- Salivary gland neoplasms (especially mucoepidermoid carcinoma).
- varix.
- hemangioma.

Treatment:
Surgical excision deep enough to include the underlying gland that feeds it.

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Irritation Fibroma (Traumatic Fibroma)

Description:
- Slow-growing fibrous, localized, peripheral, tumorlike enlargement of connective tissue appear as nodules on the oral mucosa, resulting from irritation caused by cheek biting or objects such as dentures and fillings.
- Most commonly occurs in the Buccal Mucosa "Especially along the line of occlusion" but can also be found on the tongue and the lips.
- It's considered to be the most common Oral Soft tissue Lesion.
- The colour will be such as the surrounding mucosa "No Inflammation are noticed around".
- The consistency is surprisingly soft.
- Another unique variant of denture-related fibromas is the epulis fissuratum. "Press to read more about it".
- Another rather unique fibrous hyperplasia is the giant cell fibroma.

Histology:
- Histologically, they exhibit fibrous hyperplasia that is collagenous and acellular.

Radiography:

- Soft Tissue Lesions do not appear in radiographs.

Prognosis:
- Good.


Differential Diagnosis:
- Salivary gland tumors and other soft tissue tumors may have a similar appearance but are usually more firm. - Other lesions such as mucocele may also resemble traumatic fibroma.


Treatment:
- Irritation fibroma and other localized fibrous hyperplasias are easily removed by conservative surgical excision, with no need to remove a margin of surrounding normal mucosa.
- Recurrence is unlikely unless the inciting trauma continues or is repeated.

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Dental Anxiety (Fear Or Phobia)

Description:

- It's the fear of dentistry and of receiving dental care. A severe form of this fear (specific phobia) is variously called Dental Phobia, Odontophobia, Dentophobia, Dentist Phobia, or Dental Anxiety.
- Make sure, never to Misdiagnose between Dental phobia and post-traumatic stress disorder.
- In U.S.A, Dental Fear contributes 75% of adults ranging from Mild too Severe, However, Severe Dental Phobia Contributes 5-10% of the population.

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Causes of Dental Fear, Anxiety and Phobia:

- Direct:
1- Previous Dental Trauma, Pain or difficulty.
2- Impersonal, Uncaring, Uninterested or Cold Dentists.

- Indirect:
1- Children will pick the fear up from horror Dental experience of parents.
2- Children and adults will pick the fear up from horror Dental experience of other people. (Vicarious learning)
3- The Embarrassment when you feel the your teeth are the worst in the world and the dentist will give negative reaction when he sees you.
4- The negative portrayal of dentistry in mass media and cartoons.
5- Traumatic Experience in Non-dental treatments, makes the dental patient fears of the white coats and antiseptic smells. (Stimulus Generalization)
6- If a person believes that they have no means of influencing a negative event, they will experience helplessness. and an incident where a dentist wouldn't stop even when the person was in obvious pain. (Helplessness and Perceived Lack of Control).

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Diagnosis:
- Fear measurement instrument like Corah’s Dental Anxiety Scale or the Modified Dental Anxiety Scale.

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Treatment:
- Treatments for dental fear often include a combination of behavioral and pharmacological techniques.
- Behavioral such as:
1- Relaxation Techniques (Diaphragmatic Breathing and Progressive Muscle Relaxation).
2- Cognitive, or Thought-Based Techniques (Cognitive Restructuring and Guided Imagery).
- Pharmacological such as:
1- Sedation.
2- General Anesthesia.
3- Nitrous Oxide.

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