Appendix 4 Flashcards

1
Q
A

Dentigerous cyst description; unilocular radiolucency- pericoronal

etiology; cyst that develops by the separation of the follicle from around the crown of an unerupted tooth, develops by fluid accumulation between reduced enamel epithelium (REE) and the tooth crown

Tx; enucleation of cyst along with unerupted tooth

other; Most common developmental cyst, most often involves mandibular 3rd molars

VS Hyperplastic Dental Follicle- upon biopsy there is no cyst

(normal dental folcile- no tx-1-3mm)

(3-5mm could be a dentigeours cyst- biopsy to find out)

(5 or above mm its a dentigerous cyst)

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2
Q
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Periapical Granuloma; unilocular radiolucency-periapical location

Description; radiographic pattern- Radiolucent lesion, Variable size, Symmetrical, Well defined, Loss of lamina dura, root resorption can be seen.

clinically- Most are asymptomatic, insensitive to percussion, no response to thermal or electric pulp test

etiology; prostaglandins activate osteoclasts to resorb surrounding bone, leading to periapical radiolucency. With time chronic inflammatory cells begin to dominate. granulation tissue- dense lymphocytic infiltrate (blue) that is intermixed with plasma cells (clock face nuclei).

tx; RCT, or extractaction followed by curettage of all apical soft tissue.

other;the most common periapical pathosis

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3
Q
A

Periapical cyst-Unilocular Radiolucencies: Periapical Location

Description; radiographic pattern- identical to that of a periapical granuloma, Radiolucent lesion, Variable size, Symmetrical, Well defined, Loss of lamina dura, root resorption can be seen. Significant growth is possible, May show static behavior or very slow growth, can be residual upon affected tooth removal

clinically- Most are asymptomatic, insensitive to percussion, no response to thermal or electric pulp test

histology- spiderweb epithelium

etiology; Inflammatory stimulation of epithelium in the area (Rests of Malassez)

tx; RCT, or extractaction followed by curettage of all apical soft tissue.

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4
Q
A

Antral Pseudocyst

Common finding on panoramic radiographs on 2-15% of population.

Mostly asymptomatic.

Increased prevalence during winter months.

Appears as dome-shaped, faintly radiopaque lesion arising from floor of maxillary sinus.

Develops due to accumulation of serum exudate (not mucous) beneath maxillary sinus mucosa, causing sessile elevation.

No treatment necessary.

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5
Q
A

Condensing Osteitis/Focal Sclerosing Osteomyelitis

Localized area of bone sclerosis associated with apices of teeth with pulpitis.

Association with inflammation distinguishes it from idiopathic osteosclerosis diagnosis.

Increased RO adjacent to tooth apex that has a thickened PDL.

No RL border distinguishes it from cemento-osseous dysplasia.

No clinical expansion of bone.

85% regress after odontogenic infection is eliminated.

Associated with teeth that have had extensive treatment i.e. using condenser.

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6
Q
A

Idiopathic Osteosclerosis

Etiology: Focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else

Tx: - no tx indicated. Only biopsy if there are symptoms, continued growth or cortical expansion

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7
Q
A

Odontoma-Complex

Most common odontogenic tumor, but once removed it won’t come back.

Complex; Conglomerate mass of enamel and dentin that bears no resemblance to a tooth.

Asymptomatic, usually discovered on radiograph taken to diagnose failure of a tooth to erupt.

Average age is 15.

Considered developmental anomalies (hamartomas) not true neoplasms.

Tx is simple local excision; once removed it won’t come back.

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8
Q
A

Odontoma-Compound

Most common odontogenic tumor, but once removed it won’t come back.

Compound; Composed of multiple tooth like structures.

Asymptomatic, usually discovered on radiograph taken to diagnose failure of a tooth to erupt.

Average age is 15.

Considered developmental anomalies (hamartomas) not true neoplasms.

Tx is simple local excision; once removed it won’t come back.

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9
Q
A

Tonsilloliths

Pharyngeal tonsillar crypts which are filled with desquamated keratin and foreign material.

Usually discovered as ROs in the midportion of the ascending ramus.

Secondarily become colonized with bacteria, calcify and develop foul smell.

Can promote recurrent tonsillar infections.

Usually asymptomatic.

Tx:

At home: Gargle warm salt water and/or use water jet. Bathroom surgery.

In office: Enucleation, local excision, or tonsillectomy is definitive.

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10
Q
A

Torus/Exostoses

Etiology: localized bony protuberance arising from cortical plate

  • Best Known: Torus Palatinus, Torus Mandibularis
  • Other Types: Buccal Exostoses, Palatal Exostoses, Solitary Exostoses

Tx: No tx except removal if trauma is an issue

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11
Q
A

Traumatic Bone Cyst

Description: “Scalloping.” Not true “cyst” - no epithelial lining.

Etiology: Trauma-Hemorrhage Theory is most widely accepted theory.

  • Trauma to the bone which is insufficient to cause a fracture results in intraosseous hematoma
  • If the hematoma does not undergo organization & repair, it may liquefy and result in a defect

Tx: surgical exploration and curettage

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12
Q

Provide a Differential Diagnosis

A

CEOT/AFO/COC/AOT

DDx: Mixed RL/RO

CEOT - Calcifying Epithelial Odontogenic Tumor

Description:

AKA Pindborg Tumor

“Driven-Snow Pattern”

Avg age 40

Md>Mx, F = M, Post > Ant

Liesegang rings (amyloid-like areas), Positive for Congo Red Test

Etiology: Tumor of Odontogenic Epithelium

Tx: Conservative Local resection with a narrow rim of bone or curettage

COC - Calcifying Odontogenic Cyst

Description:

AKA Gorlin Cyst

Avg Age 35

Etiology: Unknown. Classified by WHO as odontogenic tumor but listed under developmental odontogenic cyst in book

Tx: Simple enucleation or simple surgical excision

AOT - Adenomatoid Odontogenic Tumor

Description:

“Snowflake Calcifications”

Avg age 10 - 20 (uncommon over 30)

Mx>Md, F>M (2:1)

Etiology: Tumor of odontogenic epithelium

Tx: Enucleation

AFO - Ameloblastic Fibro-Odontoma

Description:

Avg age 10

Post Jaw

Etiology: Mixed Odontogenic Tumor (odontogenic epithelium + odontogenic ectomesenchyme)

Tx: Conservative Curettage

AOT - Adenomatoid Odontogenic Tumor

Description:

“Snowflake Calcifications”

Avg age 10 - 20 (uncommon over 30)

Mx>Md, F>M (2:1)

Etiology: Tumor of odontogenic epithelium

Tx: Enucleation

AFO - Ameloblastic Fibro-Odontoma

Description:

Avg age 10

Post Jaw

Etiology: Mixed Odontogenic Tumor (odontogenic epithelium + odontogenic ectomesenchyme)

Tx: Conservative Curettage

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13
Q
A

Stafne defect

aka Lingual Mandibular Salivary Gland Depression

Focal concavity of the cortical bone on the lingual surface of the mandible caused by a portion of the submandibular salivary gland

Treatment-None

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14
Q

What is this?

A

Ameloblastoma

Most common clinically significant odontogenic tumor

85% occur in mandible molar-ascending ramus region (except desmoplastic which occurs in anterior maxilla)

Multilocular RL

Buccal-Lingual cortical expansion

Histopathologic features-Palisading basal layer, Reverse polarity

Treatment

Varies from enucleation and curettage to en bloc resection

Marginal resection is the most widely used treatment-1.5 cm beyond what is visible radiographically

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15
Q

What is this?

A

Central Giant Cell Granuloma

Non-neoplastic lesion

**More common in the anterior jaw; frequently cross the midline**

Cherubism

Treatment is curettage with a recurrence of 20%

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16
Q

What is this?

A

Focal Cemento-Osseous Dysplasia

90% females

Average age = 40

More common in Caucasians

17
Q

What is this?

A

Periapical Cemento-Osseous Dysplasia

90% female

70% African American

Periapical region of anterior mandible

PDL will be intact, lesion will not fuse to roots

18
Q

What is this?

A

Florid Cemento-Osseous Dysplasia

90% Female

90% African American

Tendency to be bilateral and symmetrical

19
Q

What is the treatment for cemento-osseous dysplasia?

A

For Florid and Periapical, diagnosis can be made from distinctive clinical and radiographic features-No biopsy required

Focal may require surgical investigation because features are less specific

When lesions are in RL phase they usually don’t cause any problems

Once in the RO phase lesions are hypovascular and prone to necrosis and secondary infection-frequent recall

20
Q

Identify etiology/TX/other important info.

A

Nasoplatine Duct Cyst

ETIOLOGY

-Two passageways persist in midline between the primary and secondary palates

IMPORTANT INFO

  • MOST COMMON NON-ODONTOGENIC cyst
  • Radiolucency in/near anterior maxilla between apical central incisors (NO RESORPTION)

TX

  • NEVER sit and watch
  • Biopsy is mandatory (cannot diagnose radiographically)
  • Surgical enucleation
21
Q

Identify etiology/TX/other important info.

A

Residual Cyst

ETIOLOGY

  • Cyst that persist at the site of a previous tooth extraction.
  • inflammation and infection that stimulate rests of malassez

IMPORTANT INFO

-As the cyst ages, cellular components degenerate and can lead to dystrophic calcification and central luminal radiolucency

TX

-Surgical Excision

22
Q

Identify etiology/TX/other important info.

A

Odontogenic Keratocyst

ETIOLOGY

Arises from cell rests of the dental lamina

IMPORTANT INFO

30% recurrence rate (up to 10 yrs after surgery)

Unilocular (smaller lesions)/Multilocular (larger lesions)

CAN CROSS MIDLINE

Young patients (<20 yrs) with OKC, should be evaluated/questioned for GORLIN SYNDROME

HISTO!!!

Basal cell layer shows palisading and is hyperchromatic

Epithelial surface is 6-8 layer thick and is corrugated

TX

Enucleate and curettage

23
Q

Identify etiology/TX/other important info.

A

Lateral Periodontal Cyst

ETIOLOGY

Arises from rests of the dental lamina (rest of Serres)

Developmental odontogenic cyst along lateral root surface

IMPORTANT INFO

Intrabony counterpart of the gingival cyst of an adult

MANDIBULAR PREMOLAR-CANINE-LATERAL INCISOR area

TX

Conservative enucleation