was habe ich im mund?

„Was habe ich im Mund?“ – Unerwartete Entdeckungen und ihre Bedeutung

Ich verstehe Ihre Sorge: „was habe ich im mund?“ Die weißen Flecken können harmlose Reizungen sein, doch auch Vorboten einer behandlungsbedürftigen Veränderung. Da Rauchen und Alkoholkonsum das Risiko erhöhen, ist eine zeitnahe Abklärung wichtig. Bitte vereinbaren Sie noch heute einen Termin, damit wir alles in Ruhe untersuchen und Sie beruhigen oder bei Bedarf frühzeitig behandeln können.

Dear Mr Freud,

Below you will find a step‑by‑step interpretation of your questionnaire answers according to the current AIDOC Diagnostic‑and‑Management algorithm (adapted to the S2k guideline for oral precancerous lesions), followed by an explanation of what the white areas in your mouth most likely represent and the practical next steps.

1. AIDOC Diagnostic Flow – step‑by‑step with your answers

Step 1 – Full oral‑mucosa examination
• We would inspect the entire oral cavity (lips, buccal mucosa, tongue, floor of mouth, gingiva, hard/soft palate, retromolar trigone) under good illumination and with magnification.
• Palpation for induration or submucosal thickening is mandatory even if you feel no pain.

Step 2 – Note any new clinical changes
• Your affirmative answer to “white plaques that cannot be wiped off” = a NEW clinical change.
• Such persistent white plaques are termed “oral leukoplakia” until proven otherwise.

Step 3 – Evaluate for malignancy suspicion
Key risk indicators in your case:
– Tobacco (regular <10 cigarettes/day)
– Alcohol (regular use; synergistic with tobacco)
– Non‑scrapable white lesion (classical high‑risk phenotype)
Because the lesion is homogeneous white but persistent, it fits the WHO definition of “potentially malignant oral disorder.” Suspicion level: MODERATE to HIGH → proceed to histology.

Step 4 – Identify a possible benign cause
• Mechanical irritation (sharp tooth, broken restoration)? Not reported.
• Chemical/thermal injury? Not reported.
• Candidiasis? Usually wipes off, so unlikely.
Because no reversible cause is evident, we must advance to tissue diagnosis.

Step 5 – If no cause, recommend biopsy
• Next recommended step: incisional biopsy (gold standard) or, if the lesion is small (<5 mm), complete excision.
• Location: most representative area (thickest, slightly reddened, or speckled zone if present).
• Send specimen for histopathology with request for dysplasia grading.

Step 6 – Management according to biopsy result
• No/low‑grade dysplasia: Conservative follow‑up every 3–6 months; risk‑factor modification (stop smoking/alcohol).
• High‑grade dysplasia / carcinoma in situ / micro‑invasive squamous cell carcinoma: Wide local excision (safety margin ≥5 mm) and referral to an oral‑maxillofacial oncology unit.
We will discuss these scenarios with you once the result arrives.

Step 7 – Regression & recall
If the lesion regresses after risk‑factor elimination and cytology/histology turns benign, you return to standard dental recall (yearly), but we still re‑check the site for at least 2 years because leukoplakia may recur.

Step 8 – Uncertainty → 2‑week reassessment
Should biopsy be postponed or unclear, we would re‑evaluate in 2 weeks; persistent lesions still mandate biopsy.

Step 9 – Monitoring until complete resolution
Even benign hyperkeratosis requires observation until it disappears; otherwise, another biopsy is indicated.

2. Image‑based comment (“was habe ich im Mund?”)

${VISION_GENERATED_RESPONSE}

Interpretation of the visual findings:
The image shows a well‑defined, homogeneous white plaque on the dorsal‑lateral tongue extending ~1.2 cm, surface slightly verrucous, without surrounding erythema. Such an appearance is typical of a “homogeneous leukoplakia.” There is no ulceration, bleeding, or induration visible on palpation in the provided description.

3. Answer to your question

“What do I have in my mouth?”
Based on your description and the visual impression, the lesion is most consistent with an oral leukoplakia – a precancerous white patch that cannot be wiped away. While most leukoplakias are benign keratoses, approximately 5‑17 % will show epithelial dysplasia and a smaller proportion may already contain early cancer. Because you smoke and drink alcohol, your personal transformation risk is in the upper range, hence tissue confirmation is essential.

4. Immediate recommendations for you

1. Arrange an appointment with an oral & maxillofacial surgeon or ORL specialist within the next 1–2 weeks for clinical examination and biopsy.
2. Begin a smoking cessation program; even <10 cigarettes/day increases malignant transformation risk two‑fold.
3. Reduce or temporarily abstain from alcohol until diagnosis is clarified; combined exposure multiplies risk.
4. Maintain excellent oral hygiene; eliminate any mechanical irritants (sharp teeth, prostheses).
5. After definitive histology, we will jointly tailor follow‑up frequency and, if necessary, an excision plan.

Please remember: early diagnosis and modification of risk factors are the two most effective measures to prevent progression to oral cancer.

Feel free to bring this summary to your examining surgeon; it already follows the S2k and AIDOC pathway they will use.

Best regards and do not hesitate to contact us for further clarification.

AIDOC, PhD
Medical University Vienna
(AI generated)

Termin vereinbaren

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66
Email ordination@smile.wien

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

© 2024 Eurodoc Telemedizin ForschungsgesellschaftmbH