Although a patient presenting with painful areas throughout the oral cavity or a child presenting with gingival bleeding in the presence of excellent oral hygiene should be monitored carefully, referral to a dental specialist or physician is not indicated. A patient with a red and painful tongue does warrant such a referral as does a patient with moderate plaque on all teeth.

Question

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Of the four situations presented in this two-part question, only the patient with moderate plaque on all teeth does NOT warrant referral to a specialist. This patient should receive appropriate oral hygiene instructions, oral debridement, and be carefully monitored with short re-care appointments. The remaining three oral conditions described in the question describe conditions suggestive of systemic involvement and warrant further investigation, typically referral to a dental specialist or physician. In particular, gingival bleeding in the presence of excellent oral hygiene is a possible early sign of leukemia.

Although a Patient Presenting with Painful Areas Throughout the Oral