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
Median Rhomboid Glossitis
-Considered to be a clinical manifestation of chronic erythematous candidiasis
-red patch devoid of Filiform papillae on the midline dorsal of the tongue
-antifungal
Bifid Tongue
-lack of fusion of embryonic tissues
-V-shaped notch
Ankyloglossia
-short lingual frenum
-tongue-tied
-affect suckling, speech
-treatment surgery
Microglossia
-very small tongue
-other developmental anomalies
Macroglossia
-large tongue
-over incisal edges, above the occlusal plane
causes:
-benign cyst deep hemangioma
- muscular hypertrophy
- Down’s syndrome
- Acromegaly
- speech, displaced teeth
Fissured/Furrowed Tongue
deep folds
food retention, halitosis
good oral hygiene important
Anemia
-decreased oxygen delivery
-lack of iron (vitamin B12)
-bald, burning – no papillae
Hairy Tongue (black/white)
-overgrowth of papillae
-smoking
-chemotherapy, white coating
-antibiotic therapy
-improve OH
Geographic Tongue (benign migratory glossitis)
-benign inflammatory condition
-loss of Filiform papillae – red and white patches
-areas at different stages, healing
-gives geographic appearance
-spontaneous emissions and reoccurrence
Xerostomia
dry fissured tongue
pale, red, atrophic
Pathology of the Floor of the Mouth
Sublingual Gland Ducts
Prominent Veins
Mandibular Tori
Sublingual Gland Ducts
- Wharton’s Duct
It has one major duct which opens with the submandibular duct and several smaller ducts which open in a line along the sublingual fold
Prominent Veins
-mistaken for hemangiomas
-sublingual veins (tongue also)
Mandibular Tori
-lingual
-overgrowth of bone/bilateral
-normal
-lower denture, radiographs
Pathology of Hard and Soft Palate
Torus Palatinus (Maxi Torus)
Nicotine Stomatitis
Torus Palatinus (Maxillary Torus)
-bony outgrowth on the palate
-bilateral or in the midline
-lobulated
-exostosis
-bony outgrowth on the buccal surface
Nicotine Stomatitis
-smoker’s palate (long-term)
-white papules, red centers
-inflamed minor salivary ducts
-regression with cessation
Oropharynx Pathology
Herpangina
Tonsillar Tissue
Herpangina
-highly contagious
-coxsackie virus
-light grey vesicles – ulcers
-red shiny, soft palate
-sore throat, fever (1 - 2 wks)
Tonsillar Tissue
-lymphoid tissue
-enlarge during infections
-hyperplastic - removed
Clinical Considerations Regarding the Oral Mucosa
The oral mucosa is an excellent indicator of an individual’s health.
Numerous diseases manifest themselves by causing alterations in the oral tissues, which may be of diagnostic benefit to the dental professional.
Cyanosis
The blueness of the lips, cyanosis, indicates reduced blood oxygen content.
Lead poisoning
Lead poisoning imparts a characteristic blue line to the gingival margin.
Vitamin C deficiency
Vitamin C deficiency → scurvy, whose earliest manifestations are swollen, bleeding gingivae, and loosened teeth.
Lack of Vitamin D
Lack of Vitamin D → rickets which results in lesions of the permanent dentition, such as dimpled or furrowed enamel, and poorly calcified hard tissues.
Leukemias
Leukemias manifest by gingival infiltration, ulceration, and bleeding.
Measles
may be diagnosed very early by observing “Kolik’s Spots” (yellow spots on a red surface) on the buccal mucosa in the area of the maxillary molars.
Syphilis
is observed as mucous patches on the oral mucosa during its secondary stage.
Herpes infections
appear as fever blisters on the lips and gingiva which may rupture and ulcerate
Aphthous Ulcers
resemble herpes infections but are believed to be caused by different organisms.
Leukoplakia
is irregular opaque, whitish regions on the oral mucosa which are believed to be precancerous lesions.
AIDS
Some signs of AIDS are seen in the mouth, for example, Kaposi’s Sarcoma (a tumor or blood vessel) often occurs in the mouth. Thrush, a fungal infection causes thick milk-like plaques to form on the tongue, the roof of the mouth, and inside of the cheeks. Leukoplakias, gingival infections, herpetic lesions and oral cancers have also been seen in patients with AIDS
Pathalogies specific to the oral cavity
Pathologies specific to the oral cavity are dental caries, gingivitis, periodontitis, and periapical cysts. Gingivitis and periodontitis are the most common of all oral diseases, while dental caries, especially in areas of fluoridated water, have been greatly reduced.
Clinical Features and Considerations of Candidiasis
-fungal infection caused by the yeast-like fungus candida albicans
-opportunistic infection
-change in normal oral flora (overgrowth of oral flora)
Three Types of Candidiasis
Pseudomembranous Candidiasis
Hyperplastic Candidiasis
Atrophic Candidiasis
Pseudomembranous Candidiasis
-also, known as thrush
-C. Albicans – normal in the oral cavity
-infants – more vaginal thrush
-adults – antibiotics, steroids, immunocompromised, chemotherapy
-diffuse, white mucosal plaque
-rubbed off, red underneath
-2 weeks of antifungal medication
Hyperplastic Candidiasis
-chronic irritation, poor OH
-smokers, dentures
-white patch, red areas
-cannot be rubbed off (leukoplakia)
-biopsy for diagnosis (antifungal/surgery)
Atrophic Candidiasis
-also, known as erythematous candidiasis
-antibiotic sore mouth
-antibiotics wide spectrum, long term, steroids
-lactobacillus vs c. albicans (↓ lactobacillus)
-red patches, painful
-remove the cause
-antifungal
-chronic – under dentures (ill-fitting, not being removed)
Clinical Features and Considerations of Aphthous Ulcers:
-cannot be considered an infectious disease since its etiology is unknown
-confusion exists because both HSV and RAU share the following characteristics:
*they are painful, recurrent, superficial oval ulcers that heal spontaneously in 8-14 days
*they heal spontaneously without sequelae (progression)
*they are associated with a tender regional lymphadenitis
Aphthous Ulcers has been associated with numerous causes including
bacterial
allergic
psychological
nutritional
traumatic
endocrine
heredity
stress
autoimmune disease with poorly understood trigger (T cell-mediated)
Aphthous Ulcers - Several varieties exist including:
-recurrent aphthous ulcer (aphthous minor) – the most common form known as the “canker” sore by the public which will be described below
-recurrent aphthous major – a more severe form characterized by large, very painful ulcers which recur often and persist for a long period of time, then leave a scar upon healing
Signs and symptoms of Aphthous Ulcers
-a prodromal period from several hours – 2 days during which time the patient experiences an itching or burning sensation at the site where the lesion will occur
-the initial lesion begins as a red, swollen macule or papule that eventually necroses and ulcerates
-the ulcer is shallow with a yellow necrotic center, usually less than 1 cm, and surrounded by an intense erythematous halo. The base of the ulcer is covered with a yellow-gray necrotic slough. One to several ulcers in an area
-lesion tends to establish itself on freely movable (nonkeratinized) mucosa
-ulcer tends to resolve within 2 weeks without scar formation
Treatment suggestion for Aphthous Ulcers
Topical anesthetics for pain control
Prevention:
-avoid trigger foods (nuts, chocolate, acidic fruit)
-avoid trauma (toothbrush, cheek bite)
-avoid sodium lauryl sulfate – soap in most toothpaste and mouthwash
Primary Herpetic Gingivostomatitis
-initial infection with the herpes simplex virus
-occurs between the ages of 6 mos. and 6 yrs
-usually more serious and more painful than recurrent herpes
-usually contracted by direct contact with an active lesion or contaminated saliva
-systemic manifestations include high fever, irritability, malaise, headache, nausea, dehydration, dysphagia (difficulty in swallowing), regional lymphadenopathy
Clinical Characteristics of Primary Herpetic Gingivostomatitis
- asymptomatic with flu-like symptoms
- symptomatic
-marginal gingiva fiery red, swollen Interdental papillae
-widespread inflammation
-clusters of yellow vesicles throughout the mouth
-an outbreak generally lasts 2 - 10 days
Primary Herpetic Gingivostomatitis - Treatment for a primary infection includes:
-soft diet, rest, maintenance of good oral hygiene
-analgesics as needed and possibly a mouth rinse
-fluids should be encouraged to prevent dehydration
-antiviral agents
Herpetic Whitlow/Herpetic Conjunctivitis
Herpes simplex virus can develop as an occupational hazard on the hands; i.e., Herpetic Whitlow, or on the eyes; i.e., Herpetic conjunctivitis.
The virus has the potential to spread from the infected patient and infect such areas as the eyes, mouth or fingers and hands.
Clinical features of Herpetic Whitlow include:
-intense itching pain
-vesicles that are filled with a clear fluid that eventually turn yellow
-possibly flu-like symptoms
The importance of an infection control protocol cannot be overemphasized.
Two types of Recurrent or Secondary Herpes Simplex Lesions
- Recurrent Herpes labialis
-more frequent
-typically same area on the lip - Recurrent herpetic stomatitis
-less visible and frequent
-on attached gingival
Recurrent or Secondary Herpes Simplex Lesions - recurrence is associated with:
stress: mental or physical
the onset of menstruation
flu; fever
cold
overexposure to the sun
improper diet; change in diet; stress
inadequate rest (fatigue)
overall lowered resistance
tissue manipulation:
that is experienced in a lengthy dental appointment
careless manipulation of the oral tissues
post scale/root plane
illness
upper respiratory tract or G.I. infections
allergies
Recurrent or Secondary Herpes Simplex Lesions signs/symptoms
-burning sensation, swelling, and soreness at the site where the vesicles will appear
-vesicle formation
-thin-walled blister which ruptures and becomes a small shallow ulcer
-a crust forms 2 - 3 days later and then the lesions dry up
-an outbreak generally lasts 5 - 7 days
infectivity period: experts disagree on the length of time a lesion remains contagious. Thus, to be safe, it can be assumed that the contagious period lasts from the first sign of the virus (tingling sensations) until the lesions are completely healed (new skin)
Treatment of Recurrent or Secondary Herpes Simplex Lesions
varies with the type and location of the infection
Prevention of Recurrent or Secondary Herpes Simplex Lesions
healthy body
decrease stress
a daily log for triggers
