Anatomy - Outcome 13 Flashcards
Oral Pathology Defined
Oral Pathology is the study of diseases in the oral cavity
only a dentist or physician may diagnose pathological conditions
Disease is produced by a wide variety of etiologic factors (causes) which can be divided into two groups:
- Intrinsic Factors (Nature)
- Extrinsic Factures (Nurture)
In some instances, both intrinsic and extrinsic factors play a part.
Intrinsic Factors
-“nature”
-disease resulting from changes in the germ plasma (hereditary, metabolic, dysfunction, mutations)
Examples include:
-color blindess
-hemophilia
-absensce of parts (failure of teeth, toes, and fingers to develop)
Extrinsic Factors
-“nurture”
-diseases produced by eitological factors brought to the cell from its environment (physical or chemical agents, living agents, nutritional deficiency, stress)
- the extrinsic factors producing disease are more numerous than intrinsic factors and therefore are demonstrated more often in relation to disease (consider the absence of fundamental needs of the body - oxygen, heat, water, and food)
Developmental Factors
-intrinsic/extrinsic or both
-diseases that result from a disturbance in the development of a tissue or a part of the body
If some cells of a developing tissue are injured, further development may be limited, resulting in abnormal or defective tissue. The defect may be large in magnitude and incompatible with life, or it may be minor and of little consequence as far as the organism’s function is concerned.
Developmental Anomaly
Minor developmental defects
A developmental anomaly is usually the result of an alteration in anatomic form, but disturbances in function, such as the failure of an organ to carry out the metabolism of a particular substance, may also occur.
Congenital Anomaly
- present at birth
Hereditary vs Developmental Disease
Hereditary and developmental disease processes may be easily confused. The presence of disease at birth does not necessarily indicate it to be genetic in origin, as many developmental disturbances are also present at birth. Improper development of tissue may occur sometime after birth and be a late manifestation of a developmental disturbance.
Developmental anomalies sometimes seen at birth must be distinguished from disease processes occurring after the complete development of a tissue or part of the body.
Developmental Defect Examples
Many developmental defects of the head and neck region result from the failure of embryonic processes to unite. Examples include clefts of the face, lips, alveolus, hard or soft palate, and the incomplete union of the maxillary and mandibular process.
Cleft Lip & Palate
-factors causing the failure of embryonic processes to unite
-extrinsic – fever
-intrinsic – genetic, cell mutation
-hereditary – genetic lines
Labial Mucosa Pathology
- Angular Cheilitis
-Mucocele
-Ranula
-Traumatic Lip Biting
Angular Cheilitis
-an infection of the mucosa at the corners of the mouth caused by the fungus, candida Albicans (or related species such as aureus)
-cracks/fissures at the corner of the mouth
-ulcerated – splitting crusts
-contributing factors - dry mouth, poor oral hygiene
-dentures – loss of vertical dimension
-nutritional deficiency (iron, vitamin B, and complex vitamins)
-chronic irritation
Mucocele (Mucous Retention Lesion)
-local trauma damages the excretory duct of a minor salivary gland
-saliva escapes into the adjacent connective tissue causing a chronic inflammatory reaction
-most common swelling of the lower lip (kids)
-solitary nodule
-asymptomatic
-regress spontaneously
Ranula
-usually caused by a sialolith (salivary duct stone) or local trauma to the duct
-saliva escapes into the connective tissue of the floor of the mouth
-arise from the submandibular salivary gland (Wharton’s duct)
-trauma (may be a cause)
-removal of the submandibular glandular tissue may be necessary
Traumatic Lip Biting
-kids
-ulceration/scarring
-↑ swelling – ice/stitches
-local anesthetic
Buccal Mucosa Pathology
Fordyce Spots
Linea Alba
Leukoedema
Morsicatio Buccarum
Sialoliths
Leukoplakia
Lichen Planus
Squamous Cell Carcinoma
Squamous Papilloma
*Chicken Pox (Varicella)
Herpes Zoster (Shingles)
Pigmentation of the Oral Mucosa
Amalgam Tattoo
Hematoma (submucosal hemorrhages)
Hemangioma
Fordyce Spots
-ectopic sebaceous glands
-asymptomatic – creamy raised papules
-found in 80% of adults
-inside lip/buccal mucosa
Linea Alba
-raised wavy line
-level of occlusion or buccal mucosa
-not rubbed off
-hyperkeratotic – trauma, frictional activity
-cheek biting
Leukoedema
-a developmental variation, caused by thickening of the epithelium and the accumulation of fluid within the epithelial cells
-milky white /grayish hue to the buccal mucosa
-occurs bilaterally
-white opalescent thickening often with a filmy corrugated surface
-disappears when stretched
-no treatment required
Morsicatio Buccarum
-mucosal cheek biting
-raised irregular white plaques
-anterior and buccal
-leukoplakia and candidiasis
Sialoliths
-salivary stones of calcium deposits
-may cause obstruction of the involved gland
-submandibular/lingual or parotid
-extraoral swellings
-painful – antibiotics/surgery
Leukoplakia
-white plaque/patch cannot be rubbed off
-a protective reaction against chronic irritants
-unknown cause, often linked with chronic irritation, trauma, tobacco, cheek biting
-10% precancerous
-tongue, gingiva, buccal mucosa
-resolve if removal of the irritant
Lichen Planus
-benign, chronic disease
-affects the skin and oral mucosa
-unknown etiology
Five types (appears clinically as interlacing, white striations, that occur most frequently on the buccal mucosa most common form)
5 types of Lichen Planus
- Reticular – lattice-like, raised, fine white lines
- Atrophic – appears as red patches with very fine white straie
often forms on the gingiva - Erosive – appears as mucosal erosions that slough to form alterations
pain helps differentiate from leukoplakia and candidiasis - Plaque-like - least common
appears clinically as solid white plagues that most often occur on the dorsal of the tongue - Bullous blister which - ranges from a few millimeters to centimeters, may present with other forms
blisters will quickly form ulcerations
Treatment of Lichen Planus
Treatment (mostly atrophic and erosive)
Topical steroids
cancerous link – currently investigated
Squamous Cell Carcinoma
-chronic non-healing
-non-painful
-common floor of mouth, lateral tongue, and oropharynx
-risk factors: tobacco, alcohol, solar radiation, genetics, nutritional deficiency, immunosuppression, and infections
-deep ulcerated mass with red, raw, raised borders
-surgery, radiation, and chemotherapy
Squamous Papilloma
-etiology: trauma, human papilloma-virus
-usually solitary, white, papillary lesions attached with a pedunculated base
-occurs most often on the soft palate and ventral surface of the tongue
- local excision required
*Chicken Pox (Varicella)
-contagious, children
-red, itchy rash
-vesicles, pustules
-oral manifestations
-vaccine (Varivax)
Herpes Zoster (Shingles)
-infection of chickenpox in adults
-reactivation of dormant virus due to immune changes, aging, cancer, unknown
-painful vesicles
-trunk and face are the most common sites
Pigmentation of the Oral Mucosa
-natural (melanin)
-smokers – darkened epithelium
Amalgam Tattoo
-amalgam interproximal
-old silverpoint endodontics
Hematoma (submucosal hemorrhages)
-a swelling containing effused (fluid from blood vessels which has escaped into the tissues or a cavity) blood
-bruising from trauma, eruption, infection
Hemangioma
-benign, neoplasm of the endothelial cells that form blood vessels
-can be present at birth or form later in life
-red, blue, and purple nodule with a broad base occurs most often on the tongue, lips, and buccal mucosa
-Kaposi’s sarcoma - malignancy of blood vessels (most often occurs on the hard palate/gingival)
-local excision, laser therapy
-solitary or multiple
Pathology of the Tongue
Median Rhomboid Glossitis
Bifid Tongue
Ankyloglossia
Microglossia
Macroglossia
Fissured/Furrowed Tongue
Amenia
Hairy Tongue
Geographic Tongue
Xerostomia
