Appendix 3 Flashcards
PYOGENIC GRANULOMA
- aka “Pregnancy tumor” or Granuloma Gravidarum. Female predilection. Pregnancy in 1st trimester.
- Not true granuloma- reactive lesion to local irritation or trauma (poor oral hygine).
Appearance:
- often rapid growth with proliforating capillaries.
- Gingival (75%) smooth or lobulated mass, often pedunculated.
- Surface is ulcerated & bleeds easily
- Young lesions: RED. Older lesions: PINK
Tx: Surgical Excision, extending down to periosteum & adjacent teeth scaled.
-Pregnancy: defer tx unless esthetic problem.
**Bump on the gums Dx: 3 P’s & IFH**
PERIPHERAL OSSIFYING FIBROMA
- Usually originates from interdental papilla. Age 15, ⅔ Female
- 50% occur in incisor- canine region
- Nodular mass EXCLUSIVELY on gingiva. More PINK in color.
Tx: Excision down to periosteum & scale adjacent teeth. 15% recur b/c it wasn’t completely removed.
**Bump on the gums Dx: 3 P’s & IFH**
PERIPHERAL GIANT CELL GRANULOMA
- Reactive lesion caused by irritation/ trauma. 35yr, 60% female.
- EXCLUSIVELY on gingiva, may have “cupping” resorption of alveolar bone
Appearance: Erythematous mass, looks like PG but more BLUE or PURPLE.
Tx: Surgical excision down to bone, scale adjacent teeth. 10% recur
**Bump on the gums Dx: 3 P’s & IFH**
Mucocele
Cause:
- trauma
- rupture of salivary gland duct
Clinical Appearance:
- dome-shaped mucosal swelling
- mucin-filled
- most common on lower lip
Treatment:
- surgical excision of duct and minor salivary gland
Fibroma
Cause:
Reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma
Clinical Appearance:
Sessile, asymptomatic, smooth-surfaced nodule
Most common tumor of the oral cavity
Most common location is the buccal mucosa along the bite line
Treatment:
Conservative surgical excision
MUST submit the excised tissue for microscopic examination
Parulis
Cause:
When a periapical abscess forms pus, it will follow the path of least resistance, find a point of exit, and drain the purulent material
Clinical Appearance:
The parulis marks the exit point of the sinus tract on the oral mucosa
Subacutely inflamed granulation tissue
Also called “gum boil” or “intraoral sinus tract”
Treatment:
Drainage and elimination of the focus of the infection
Gutta Percha is often placed in the parulis in order to enter the fistula to find the source of the infection radiographically
The sinus tract usually resolves spontaneously after the offending tooth is extracted or endodontically treated
Epulis Fissuratum
Cause:
Tumorlike hyperplasia of fibrous connective tissue that develops in association with the flange of an ill-fitting complete or partial denture
Clinical Appearance:
Single or multiple folds of hyperplastic tissue in the alveolar vestibule
Usually firm and fibrous, but can be ulcerated and erythematous
Usually develops on the facial aspect of the alveolar ridge
Also called Inflammatory Fibrous Hyperplasia (IFH)
Treatment:
Surgical removal
Ill-fitting denture should be remade or relined to prevent a recurrence of the lesion
**Bump on the gums Dx: 3 P’s & IFH**
SIALOLITH
Cause:
Calcifications developed in the salivary duct
Risk factors: mucous plug, bacteria, chronic duct blockage, xerostomia
Clinical Appearance:
Most common location: Submandibular gland - Long and tortuous duct with thick secretions
Symptoms: Pain or swelling at meal time
Dx: Radiograph, ultrasound, CT
Treatment:
Gentle massage
Increased fluid intake
Moist heat
Sialogogue
Surgery
Drug Related Gingival Hyperplasia
Cause:
Gingival overgrowth secondary to systemic medication use
Most common medications:
Phenytoin (50%): Anticonvulsant, common in young patients
Nifedipine (25%): Calcium channel blocker
Cyclosporine (25%): Transplant therapy
Treatment:
Brushing and flossing can help
Change medication if possible
Squamous Papilloma
Cause:
HPV- types 6,11
Clinical Appearance:
Pedunculated (cauliflower stalked)
Exophytic
White, red, mucosal colored
Enlarges to 5mm
Tongue, lips, and soft palate
Treatment:
Conservative surgical excision
Inflammatory Papillary Hyperplasia
Cause:
Ill-fitting denture
Poor denture hygiene
Wearing denture 24 hr/day
Clinical Appearance:
Asymptomatic, erythematous tissue with a pebbly or papillary surface
Hard palate
Treatment:
Removal of denture for early lesions
Antifungal therapy may show improvement
Advanced lesions require surgical removal
Dentigerous Cyst
Hyperplastic Dental Follicle <5mm vs DC >5mm
-Cause:
-Cyst that originates by separation of the follicle from around the crown of an unerupted tooth -Apparently develops by accumulation of fluid between the reduced enamel epithelium
(REE) and the tooth crown
-Clinical Appearance:
- Most common developmental cyst
- Most often involves mandibular 3rd molars
- Unilocular radiolucency associated with crown of unerupted tooth
- Radiolucency usually has a well-defined and often corticated border
-Treatment:
-Treatment is enucleation of the cyst together with unerupted tooth
Periapical Granuloma
Cause:
95% of all lesions found at the periapical region are pulpal in etiology
Pulpal irritants include bacteria, mechanical, thermal, etc.
Clinical Appearance:
The most common periapical pathosis!
Most are asymptomatic, insensitive to percussion, no response to thermal or electric pulp test
Mass of inflamed granulation tissue at the apex of a nonvital tooth
Chronic inflammation (plasma cells and lymphocytes)
Radiolucent lesion, variable size, symmetrical, well defined, punched out border
Loss of lamina dura at the root tip in the area of the radiolucency, root resorption can be seen
Treatment:
RCT or extraction
Periapical Cyst
Cause:
Inflammatory stimulation of epithelium in the area
Rests of Malassez
Clinical Appearance:
Most are asymptomatic, insensitive to percussion, no response to thermal or electric pulp test
Radiographic pattern is identical to that of a periapical granuloma
May show very slow growth or be static
Can be residual upon affected tooth removal
Can be found on side of root: lateral apical periodontal cyst
Treatment:
Treated by RCT or extraction
