White Patches - When to Refer + Diagnoses ORAL MED

Are you confident in diagnosing white patches? Which white patches need an URGENT referral? How do you tell the difference between lichen planus, lichenoid reactions, and other common lesions? Dr. Amanda Phoon Nguyen is back with another amazing episode, this time diving deep into the world of oral white patches.

Jaz and Amanda explore the most common lesions you’ll encounter, breaking down their appearance, diagnosis, and management. They also discuss key strategies to help you build a strong differential diagnosis, because identifying the right lesions early can make all the difference in patient care.

Protrusive Dental Pearl: A new infographic summarizing Dr. Amanda Phoon Nguyen’s key teachings. Jaz describes it as an easy-to-follow "cheat sheet" designed to simplify complex ideas and make it easier to apply the concepts discussed in the episode. You can download the Infographic for free inside Protrusive Guidance ‘Free Podcasts + Videos’ section: https://protrusive. app/spaces/13135447/content

Key Takeaways

- White patches in the oral cavity can be classified into normal variants, non-pathological patches, and potentially malignant disorders.

- It is important to identify the cause of the white patch and differentiate between different types.

- Referrals should be made based on the characteristics of the white patch and the urgency of the situation.

- Clinical photographs are valuable in referrals and can aid in triaging patients.

- Ongoing monitoring is important for potentially malignant disorders. Lichen planus can have different types and presentations, and a biopsy may be necessary for certain cases. 

- Enlarged taste buds, particularly in the foliate papillae, are usually bilateral and not a cause for concern.

- Oral lichenoid lesions can be triggered by dental restorative materials or medications, and a change in dental material may sometimes improve the condition.

- Smoker's mouth can present with white patches and inflammation in areas where smoke gathers, and counseling patients to reduce smoking is important.

- Oral submucous fibrosis, often caused by areca nut chewing, requires regular review and counseling patients to stop chewing the nut.

Highlights for this episode:

0:00 Introduction

01:22 Protrusive Dental Pearl

05:13 Dr. Amanda Phoon Nguyen Introduction

07:39 White Patches Introduction

09:16 Understanding Geographic Tongue

12:44 Keratosis vs. Leukoplakia

19:02 Proliferative Verrucous Leukoplakia

22:18 Referral Tips for General Dentists

29:56 Understanding Leukoplakia

33:17 Urgent and Non-Urgent Referrals

34:37 Patient Communication

39:17 Discussing Erythroplakia

41:03 Oral Lichen Planus: Diagnosis and Management

47:50 Enlarged Taste Buds

49:47 Oral Lichenoid Lesions vs Oral Lichen Planus

53:43 Smoker's Mouth

55:14 Oral Submucous Fibrosis

57:23 Learning more from Dr. Amanda Phoon Nguyen

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. https://protrusive.app

This episode meets GDC Outcomes B and C.

AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Diagnosis, management and treatment of oral pathologies)

Dentists will be able to:

1. Identify the cause of a white patch and differentiate between different types.

2. Understand when and how to make referrals based on the characteristics of the white patch and the urgency of the situation.

3. Appreciate the importance of ongoing monitoring for potentially malignant disorders, including when to consider a biopsy.

For those interested in visual case studies and deeper insights into oral lesions and conditions, follow Dr. Amanda on Instagram and Facebook!

If you loved this episode, be sure to check out another epic episode with Dr. Amanda - Prescribing Antifungals as a GDP – Diagnosis and Management – PDP151: https://protrusive.  co.uk/151