13. Oral Pathology Flashcards
What is inflammation?
The local physiological response to tissue injury. Can be acute or chronic.
Signs of Inflammation:
Redness
Heat
Swelling
Pain
Loss of function
What are the 4 steps to scarring?
- Angiogenesis
- Migration and proliferation of fibroblasts
- Collagen deposition
- Maturation and organisation of fibrous tissue
What 4 local factors affect wound healing?
Infection
Physical movement
Foreign bodies
Type of wound
What 4 systemic factors affect wound healing?
Nutrition
Metabolic status
Circulatory status
Hormones
What are the 5 steps to processing a specimen sample?
- Specimen received fresh or fixed in formalin
- Specimen described, directed and placed in cassette
- Specimen dehydrated in alcohol
- Specimen embedded in hot paraffin wax
- Section cuts, mounted and stained
Hyperplasia
Increased in cell numbers
Hypertrophy
Increased in cell size
Atrophy
Decreases in cell size
Metaplasia
One cell replaces another cell
Epithelial dysplasia
Altercation in epithelial cells
Ulceration
Loss of surface epithelium
Apoptosis
Programmed cell death
Necrosis
Cell death by injury or disease
List a developmental white patch:
Fordyce granulues
List a normal variation white patch:
Leukoedema
List hereditary white patches:
White sponge naevus
Pachyonychia congenita
Dyskeratosis congenita
List traumatic white lesions:
Mechanical
Frictional
Chemical
Thermal
List dermatological white patches:
Licken planus
Lupus Erythematous
List Infective white patches:
Candidosis
Syphilitic leukoplakia
Oral hairy leukoplakia
List idiopathic white patches:
Leukoplakia
Proliferation verrucous leukoplakia
List neoplastic white patches:
Dysplastic lesions
Squamous cell carcinoma
White Sponge Naevus:
Hereditary white patch
Non defined
Shaggy surface
Tx: nil
Frictional Keratosis:
Traumatic white patch
Rough white patch at the site of trauma
Tx: removal of trauma cause
Licken Planus:
Chronic inflammatory disease of skin and mucous membranes
Unknown cause
Skin lesions and oral lesions
OMPD
Oral Hairy Leukoplakia
Infective white patch on lateral border of the tongue
Asymptomatic
Caused by Epstein Barr virus
Tx: nil required
Leukoplakia
Idiopathic white patch
Range of different white patches
Proliferation verrucous leukoplakia
Idiopathic white patch
List 3 infective causes of red patches:
Bacterial
Fungal
Viral
List 2 dermatological red patches:
Erosive licken planus
Lupus Erythematous
List 2 idiopathic red patches:
Geographic tongue
Erythroplakia
List 2 neoplastic red lesions:
Dysplastic lesions
Squamous cell carcinoma
Median rhomboid glossitis:
Infective red patch
Rhomboid red patch on posterior aspect of tongue
Asymptomatic
Unknown cause
Tx: antifungals
Erythroplakia:
Idiopathic red patch
Red, velvety appearance
Unknown cause
OMPD
Tx: biopsy
List 3 examples of pigmented exogenous lesions:
Staining
Black hairy tongue
Foreign bodies
List 3 examples of endogenous pigmented lesions:
Melantoic macules
HIV infection
Mucosal melanoma
Amalgam Tattoo:
Blue/black pigmented lesion caused by amalgam
Asymptomatic
Tx: nil
Melantoic macule:
Benign pigmented lesion
Flat
Brown/black
Tx: excision
Mucosal melanoma:
Brown/black lesion if pigmented
Red if not
Asymptomatic initially
Tx: surgical resection and radiotherapy
What is an ulcer?
A localised surface defect with loss of epithelium exposing underlying connective tissue.
What are the 7 causes of ulcers?
Infection
Trauma
Medications
Idiopathic
Systemic disease
Dermatological
Neoplastic
What medications cause ulcers?
Nicorandil
NSAID’s
What 3 systemic diseases cause oral ulcers?
Haematological
GI
HIV
What dermatological diseases cause oral ulcers?
Licken planus
Lupus Erythematous
What neoplastic conditions cause oral ulcers?
Oral squamous cell carcinoma
List the 12 Oral Potentially Malignant Disorders:
Leukoplakia
Erythroplakia
Erythroleukoplakia
Oral submous fibrosis
Syphilitic glossitis
Dyskeratosis glossitis
Chronic candidosis
Licken planus
Discoid lupus Erythematous
Smokeless Tabacco keratosis
Palatial lesions associated with reverse smoking
Actinic keratosis of the lip
Oral submucous fibrosis
Pale, firm mucosa
Can lead to Trismus
Progresses
Chronic Candidiasis
White patch that cannot be removed
Epithelial dysplasia:
Changes to surface epithelium
Can indicate risk of carcinoma
Can be mild/moderate/severe
Tx: modify risk factors, biopsy, excision, review
Oral Cancers
Cancer of the oral cavity and external lip
Most commonly squamous cell carcinomas
List 10 signs and symptoms of oral cancer:
Lumps and bumps
Ulcers
White patches
Red patches
White and red patches
Non healing sockets
Unexplained tooth mobility
Dysphagia
Pain
Bleeding
List the 6 red flags of oral cancer that warrant an urgent referral:
Unexplained lump
Unexplained ulcers
Unexplained swelling
Unexplained white, red or red and white patches
Persistent hoarseness
Persistent throat pain
What causes periapical pathology?
Inflammation due to bacterial infection following pulpal death
What are the possible outcomes of a non vital tooth?
Periapical Peridontitis > Acute or chronic >
Acute > Acute abscess
Chronic > periapical granuloma > radicular cyst
Periapcial Granuloma:
A mass of inflamed granulation tissue at the apex of a non vital tooth
What is a cyst?
A pathological cavity with fluid or semi fluid contents that is lined or partially lined with epithelium.
What are the 2 types of cyst?
ODONTOGENIC
Non - ODONTOGENIC
What are the 2 types of ODONTOGENIC cyst?
Inflammatory
Developmental
List the 5 inflammatory ODONTOGENIC cysts:
Radicular cyst - arises from a pa granuloma
Lateral radicular cyst - arises from lateral canal
Residual cyst - persists after Xla of associated tooth
Paradental cysts - associated with 3rd molars
Mandibular bifurcation cyst - associated with lower 1st and 2nd molars
List the 3 main developmental ODONTOGENIC cysts:
odontogenic keratocyst
Dentigerous cyst - associated with crown of unerupted tooth
Eruption cyst - associated with crown of erupting tooth
List the 3 NON- ODONTOGENIC cysts:
Nasopaltine duct cyst
Surgical ciliated cyst
Nasiolabial cysts
List the 5 soft tissue cysts:
Salivary mucocoeles
Epidermoid cyst
Dermoid cyst
Lymphoepithelial cyst
Thyroglossal cysts
List the 2 bone cysts:
Simple bone cyst
Aneurysmal bone cyst
List the 4 main benign bone tumours:
Ameloblastoma
Adenomatoid tumour
Odontoma
Cementablastoma
Ameloblastoma:
Benign slow growing jaw swelling
Adenomatoid tumour:
Benign tumour associated with an Unerupted tooth
Odontoma:
Benign malformation of dental tissues
Cementoblastoma
Benign painful swelling associated with a vital tooth
Chondrosarcoma
Malignant Cartilage tumour
Osteosarcoma
Malignant bone tumour
List 4 inflammatory bone pathologies:
Alveolar osteitis
Osteomyelitis
Osteoradionecrosis
MRONJ
What causes soft tissue lesions?
Hyperplasia in response to trauma and inflammation
Fibrous epulis:
Firm pink mass on gingivae
Pyogenic granuloma:
Soft red/purple swelling on gingivae
- also known as pregnancy epulis if occurs in pregnancy
Giant cell epulis
Soft purple swelling on gingivae
Fibroepithelial polyps
Smooth mucosal polyps of pink colour
Denture hyperplasia
Pale, fibrous, swollen mucosa
Hyperplasia of the palate:
Numerous, small, tightly packed nodular lesions
Neoplasm:
An abnormal mass of tissue that form when cells grow and divide more than they should.
Can be benign or malignant
List tumour of fibrous tissue:
Fibrosarcoma (malignant)
List tumours of adipose tissue:
Lipoma (benign)
Liposarcoma (malignant)
List tumours of vascular tissue:
Haemangioma
Lymphagioma
Kaposi sarcoma
Angiosarcoma
List tumours of peripheral nerves:
Neurofibroma
Neurilemmoma
Traumatic neuroma
Peripheral nerve sheath tumour
List smooth muscle tumours:
Leiomyoma
Leiomyosarcoma
List skeletal muscle tumours:
Rhabdomyoma
Rhabdomyosarcoma
List 3 types of salivary gland pathology:
Salivary mucocoeles
Sialadenitis
Salivary gland tumours
Salivary mucocoeles
Salivary cyst like swelling
Sialadenitis
Chronic bacterial infection of salivary glands
List the 3 malignant salivary gland tumours:
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Actinic cell carcinoma
List the 3 benign salivary gland tumours:
Pleomorphic adenoma
Warthin tumour
Canalicular adenoma