The ambulatory treatment of patients with oral pathologies

Lecture 1 – Oral Pathology examination by Dr. Franchini

The main object of this first video lecture is to highlight the importance of bringing oral medicine protocols in general dentistry offices to start handling patients with oral lesions and oral pathologies properly, so as to avoid referring them to other professionals.

Dr. Franchini explains you that it is mandatory to analyse not only the oral cavity but also several extraoral significant factors such as lymph nodes.

In particular, this lesson covers the following topics:

• The importance of performing a systemic and methodical examination
• What is the main goal of an oral examination?

• How to identify lesions that could be carcinomas
• The proper tongue palpation protocol
• Which are the most difficult areas to inspect
• The correct procedure to examine and analyse the functionality aspects of salivary glands
• The Virchow node: an important lymph node to observe frequently

Duration: 20 min

Lecture 2 - “The Fourteen Days” rule by Dr. Franchini

In this video lecture, Dr. Franchini shows the proper path that dentists should follow when facing lesions of the oral mucosa.

In particular, the specialist shows an innovative protocol named the “14 Days Rule” that is very useful for diagnosing oral pathologies without the help of other medical specialists.

The “14 Days Rule” says that if we find an oral lesion during a medical examination, we have to recheck the patient again in two weeks. If that lesion persists, it should be considered a suspicious lesion and a biopsy should be performed.

In particular, this lesson covers the following topics:

• The fundamentals of different diagnosis
• What to do and what to say to your patients when finding a potentially pathological lesion
• How to approach the 14 days of wait in an active way performing anamnesis, literature researches and photo-discussions
• How to determine if an ulcer is a common, a traumatic or a neoplastic one?

Is the lesion removable or not?

The difference between an incisional or an excisional biopsy

Duration: 36 min

Lecture 3 - The risk factors for oral cancer and its occurrence nowadays by Prof. Lodi

In this video lecture, Prof. Lodi discusses the risk factors that a dentist should know to early detect oral cancers. Particular attention is paid to the relationship between cigarette smoke and oral cancer, and a series of tools to help patient quit smoking is presented.

In the second part of this lecture, the specialist discusses the need to inform people that oral cancer is not a rare disease and that general dentists also have an increasing need to keep updated on this important topic due to the increased number of diagnoses in recent years.

In particular, this lesson covers the following topics:

• The relationship between cigarette smoke and the incidence of cancer, oral cancer and death rate
• The negative role of passive smoking in the development of oral cancers
• Other risk factors related to oral cancer (alcohol, inactivity, poor oral hygiene, poor diet)
• Potentially malignant disorders
• Why is oral cancer not a rare disease?

Duration: 33 min

Lecture 4 - Mouth cancer: how to detect it by Prof. Lodi

In this video lecture, Prof. Lodi talks about the different manifestations of mouth cancer, paying specific attention to the tools required to properly diagnose them. Participants will see different types of squamous cell carcinomas, the most frequent epithelium tumor of the oral cavity.

Prof. Lodi discusses in detail the fact that invisible oral cancers don’t exist, which means that it’s always possible to early detect them.

In particular, this lesson covers the following topics:

• Mouth cancers: how do they occur and how to diagnose them?
• Which factors allow to perform a quick, definitive diagnosis
• Which are the different treatment options once the mouth tumor is detected?

More visible vs. less visible mouth tumors manifestations

Duration: 28 min

Lecture 5 - Oral mucosa: mirror of systemic health by Dr. Franchini

The oral cavity is part of the systemic health spectrum and often shows the very first symptoms of systemic diseases, including potentially fatal ones. Dr. Franchini speaks about what a general dentist must know, do and say to their patients when they detect risk factors of oral cavity pathology. Participants will discover that it’s crucial to examine the current and past anamnesis of the patient, collaborate with other professionals, and eliminate local irritating factors by performing pharmacological and periodontal therapies.

In particular, this lesson covers the following topics:

• The elimination of causative factors by performing periodontal treatments
• Inflammation, tissues necrosis and bleeding areas analysis
• The importance of investigating the current and past anamnesis of the patient
• The effects of different medications and drugs on oral cavity health
• How to identify desquamative gingivitis and how to treat it

Duration: 34 min

Lecture 6 - Incisional and excisional biopsies by Dr. Pispero

In this video lecture, Dr. Pispero addresses the different surgical aspects of oral pathologies and the indications to properly perform incisional and excisional biopsy, which represents a crucial phase of the diagnostic protocol.

Participants will be provided with all the information they need to correctly choose when to perform a biopsy how to perform it correctly.

In the second part of the lecture, Dr. Pispero explains the different treatment options that follow this stage of histological analysis of the lesion.

In particular, this lesson covers the following topics:

• When to perform an incisional biopsy or an excisional one: the rationale behind this choice
• Which are the information that the mucosa offers us?

How to perform an incisional or excisional biopsy?

When is it necessary to perform an incisional biopsy or another histological examination?

Duration: 44 min

Lecture 7 - Leucoplakia: from early diagnosis to its treatment by Prof. Lodi

In this video lecture, Prof. Lodi speaks about an oral mucosal abnormality that is frequently associated with the risk of developing mouth cancers: leucoplakia. Participants will discover that this disease is often asymptomatic and that it can affect any spot of the oral cavity.

Prof. Lodi discusses early diagnostic protocols for leucoplakia and its different treatment options.

In particular, this lesson covers the following topics:

• Periodic checks and excisional biopsies
• Which characteristics of the patient may influence the probability to develop oral cancer?

• The analysis of the localization, size and dysplasia of the lesions
• Different treatment options: surgical biopsies, systemic treatments or simple surveillance
• The rationale behind the choice between medical or surgical treatments

Duration: 41 min

Lecture 8 - Lichen Planus: all you need to know to manage this potentially malignant disorder by Prof. Lodi

In this presentation, Prof. Lodi talks about oral lichen planus, a rather common condition whose consequences for the patient’s general health are often underestimated.

Participants will notice that the diagnosis of oral lichen planus can be challenging, as this disorder may appear in very different ways. The goal of this video lecture is to provide participants with all the necessary information to be able to early spot and treat this malignant disorder.

In particular, this lesson covers the following topics:

• The different forms of the lichen planus: atrophic, papular, ulcer and bubble form
• Clinical and histological diagnosis
• What you should say to your patients when spotting oral lichen planus
• The analysis of the symptoms of oral lichen planus

Duration: 38 min

Lecture 9 - Maxillary bones osteonecrosis by Dr. Pispero

In this video lecture, Dr. Pispero highlights the importance of understanding the pharmacological and medical history of our patients to avoid the risk of maxillary bones osteonecrosis.

Particular attention is paid to the negative role of bisphosphonate on the development of osteonecrosis.

Dr. Pispero explains how to manage patients with maxillary bones osteonecrosis with a comprehensive treatment plan that respects the patient’s overall quality of life.

In particular, this lesson covers the following topics:

• Analysis of drugs that may cause osteonecrosis of the maxillary bones
• The use of chlorhexidine and antibiotics to prevent bone infection
• Anamnestic data collection and complete intraoral examination
• Infection control and the proper follow-up protocol

Duration: 54 min

Lecture 10 - Human Papillomavirus (HPV) by Prof. Lodi

Papillomavirus infection is a very feared and discussed oral pathology.

Prof. Lodi leads participants in an in-depth analysis of this large family of viruses that can manifest with different kinds of lesions and in different sizes. The specialist debunks several clichés about this infection by explaining that HP

Vs have no malignant potential and have a small role in cancer development.

In particular, this lesson covers the following topics:

• How can the infection manifest itself in the oral cavity?
• The relation between HPV and cancer
• Modalities of transmission of HPV lesions
• Sexual transmission of oral HPV infection among men

Duration: 22 min

Lecture 11 - ReLIVE Surgery - Excisional biopsy by Dr. Pispero

In this first ReLIVE Surgery, Dr. Pispero shows an excisional biopsy of a pseudofibroma on the lower lip. Special attention is paid to the removal of this small traumatic lesion and to the management of the soft tissues of the lip.

In particular, this ReLIVE Surgery covers the following topics:

• Anesthetic protocol
• How to stretch the lesion with a thread
• Excisional biopsy protocol
• The exposure of the mucosa under the lesion
• Follow-up to verify the quality of soft tissues healing

Duration: 10 min

Lecture 12 - ReLIVE Surgery - Excisional biopsy of a giant cell granuloma by Dr. Pispero

In this second ReLIVE Surgery, Dr. Pispero performs an excisional biopsy of an extravasation cyst also known as mucocele.

Even if the lesion is very small, it should not be underestimated but always taken out and analysed.

In particular, this lesson covers the following topics:

• Control of the lower lip functionality and aesthetic
• How to identify the limits of the lesion
• Why remove this small and probably benignant lesion?

• Anaesthetics infiltration procedure in the soft tissues of the lip
• Analysis of the lesion

Duration: 17 min

Lecture 13 - ReLIVE Surgery - Lipoma management by Dr. Pispero

Lipoma is a lesion that can occur in all body areas.

It’s simple to distinguish it in the oral cavity because of its yellow colour.

Lipoma is a benignant lesion that becomes pathological when it reaches a volume that can cause discomfort during chewing or induce a trauma during intercuspation. Fortunately, it can be easily managed in the dental practice.

In particular, this lesson covers the following topics:

• Lipoma texture characteristics
• Where may lipoma occur?

How to pull out the entire body of the lesion?

Duration: 13 min

Lecture 14 - ReLIVE Surgery - White lesion incisional biopsy by Prof. Lodi and Dr. Pispero

This ReLIVE Surgery shows an incisional biopsy of a white lesion of unspecified origin in the oral cavity.

Unlike previous ReLIVE Surgeries, in which the entire lesions were extracted, the protocol of an incisional biopsy, i.e. the taking of a small sample of the lesion, is now shown.

In particular, this lesson covers the following topics:

• Lesion sample harvesting
• The use of mucosal punch scalpels
• Which quantity of soft tissue do we have to harvest to be able to perform a diagnosis?

• How to properly handle a bioptic sample
• Suture protocol and case finalization

Duration: 15 min

Lecture 15 - ReLIVE Surgery - Incisional biopsy of a white lesion in the lingual margin by Prof. Lodi and Dr. Pispero

In this ReLIVE Surgery, Prof. Lodi and Dr. Pispero will describe the performance of multiple incisional biopsies at the level of the lingual margin of a patient with a severe leucoplakia.

The specialists show the necessary precautions for the management of the lining tissues of the lingual body, the need to reduce lingual muscle movements during the operative phases, and the importance of identifying the correct sampling depth.

Duration: 23 min

Lecture 16 - Giant cell granuloma treatment

This ReLIVE Surgery shows the treatment of a giant cell granuloma, a lesion of vascular nature that also involves the bone base.

In the course of this intervention, cautery instruments will be used.

Duration: 27 min

Lecture 17 – Osteonecrosis management

This ReLIVE Surgery presents a case of a drug-induced mandibular bone necrosis. The patient had been treating severe osteoporosis for several years with drugs and following a tooth extraction a large area of necrosis appeared.

The ReLIVE Surgery allows a full description of the surgical steps necessary to remove the necrosis.

Duration: 33 min