Chapter 1 - Diagnosis of Oral Lesions Flashcards
_________ describes a lesion that extends beyond the confines of one distinct area. It is defined as many lobes or parts that are somewhat fused together
On an x-ray it is characterized by a radiolucency is sometimes described as resembling soap bubbles.
Multiocular
The pathologic lesion seen on the dorsal surface of the tongue is characteristic of
a. fissured tongue.
b. hairy tongue.
c. median rhomboid glossitis.
d. migratory glossitis.
c. median rhomboid glossitis.
Median rhomboid glossitis appears as a flat or slightly raised oval or rectangular erythematous area in the midline of the dorsal surface of the tongue. Fissured tongue is characterized by deep fissures or grooves. Hairy tongue has the appearance of white, elongated filiform papillae. Migratory glossitis is another name for geographic tongue and appears as patches on the lateral and dorsal surfaces of the tongue.
A _______ is a segment or lobe that is part of a whole. These lobes sometimes appear fused together.
Lobule
In a _______ diagnosis, the radiograph provides sufficient information to establish the diagnosis.
radiographic
Papillae are brown-to-black because of chromogenic bacteria.
Contibuting fators are tobacco, foods, hydrogen peroxide, alcohol or chemical rinses.
Black Hairy Tongue
_______ is a clinical term used to describe an oral lesion that appears as a smooth red patch or granular red and velvety patch.
It is less common than leukoplakia.
___ % demonstrate dysplasia or squamous cell carcinoma.
Erythroplakia; 90
The eight categories that provide information leading to a definitive diagnosis are as follows: microscopic, clinical, laboratory, surgical, differential findings, radiographic, therapeutic, and
a. etiology.
b. historical.
c. chief complaint.
d. treatment.
b. historical.
Historical information reveals past experiences that may be relevant to the diagnosis. Etiology is not a component of the definitive or final diagnosis. The chief complaint may be helpful in understanding the patient’s perspective but is not considered a diagnostic tool. Treatment is decided after the definitive or final diagnosis is made, and it is not part of the information leading to the diagnosis.
Another term for an amalgam tattoo is a
a. melanoma.
b. focal argyrosis.
c. nevus.
d. multiple myeloma.
b. focal argyrosis.
Focal argyrosis is a synonym for amalgam tattoo. A melanoma is a malignant tumor. A nevus is a benign overgrowth of melanocytes. Multiple myeloma is a malignant proliferation of plasma cells.
Which statement about a palatal torus is true?
a. A palatal torus is symptomatic.
b. A palatal torus appears as a radiolucent mass on a radiograph.
c. Palatal tori are typically bilateral, seen along the lingual side of the maxilla.
d. Palatal tori are inherited.
d. Palatal tori are inherited.
Palatal tori are inherited. Palatal tori are asymptomatic. A palatal torus appears as a radiopaque mass on a radiograph. Palatal tori can take on various shapes and sizes yet occur in the midline of the palate.
What is the radiographic appearance of periapical cemento-osseous dysplasia in its earliest stage?
a. Radiolucent
b. Radiopaque
c. Radiolucent and radiopaque
d. Cotton-wool radiolucencies
a. Radiolucent
In stage I of periapical cemento-osseous dysplasia, the appearance is radiolucent. Radiopacities are not seen in the early stage of perioapical cemento-osseous dysplasia. In stage II, the appearance is radiolucent and radiopaque. Cotton-wool radiopacities are seen in patients with Paget disease.
Which term is used to describe a radiographic lesion with borders that are specifically defined, revealing the exact margins and extent of the lesion?
a. Unilocular
b. Well circumscribed
c. Diffuse
d. Multilocular
b. Well circumscribed
Well circumscribed defines a lesion with borders that are specifically defined and in which one can see the exact margins and extent of the lesion. Unilocular means having one compartment or unit that is well defined (as in a radicular cyst). Diffuse describes a lesion with borders that are not well defined. Multilocular lesions are described radiographically as resembling “soap bubbles” (i.e., a lesion with many lobes beyond the confines of one distinct area).
Radiographic features, including cotton-wool radiopacities and hypercementosis, are especially helpful in the diagnosis of
a. Paget disease.
b. dentinogenesis imperfecta.
c. anemia.
d. diabetes.
a. Paget disease.
Paget disease is a chronic metabolic bone disease. Radiographically, cotton-wool radiopacities and hypercementosis are characteristic features. Dentinogenesis imperfecta is a genetic condition involving a defect in the development of dentin. Anemia, a decrease in red blood cells, requires blood tests to determine the etiologic factors. Diabetes is a chronic disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels.
Which condition is not considered a variant of normal?
a. Fordyce granules
b. Leukoedema
c. Linea alba
d. Pyogenic granuloma
d. Pyogenic granuloma
Pyogenic granuloma is a reactive inflammatory response to injury. It is not a variant of normal. Fordyce granules are seen in more than 80% of adults over 20 years of age and are considered a variant of normal. Leukoedema is observed in about 85% of black individuals and is considered a variant of normal. Linea alba is located on the buccal mucosa along the occlusal plane of the teeth. It is most prominent in patients who have a clenching or bruxism habit. It is so common that it is considered a variant of normal.
Ø
Genetic factors may play a role in presence
May be exacerbated by stress
Occasionally, the patient may complain of a burning discomfort
No treatment usually indicated
Ø
Ø
Geographic Tongue
Your patient is diagnosed with a lingual thyroid. What is the next step on the treatment plan?
a. Biopsy
b. Surgical removal
c. Thyroid scan
d. Radiographic evaluation
c. Thyroid scan
A thyroid scan should be performed to determine if the thyroid gland is functioning normally. A biopsy is not needed for a lingual thyroid because it is composed of normal thyroid tissue. Surgical removal is not recommended since this may represent the patient’s functioning thyroid. Radiographic evaluation is not helpful in the confirmation of a lingual thyroid.
Which term describes a lesion that displays a color different from surrounding tissue?
a. Bulla
b. Lobule
c. Macule
d. Papule
c. Macule
Macules are areas distinguished by a different color than the surrounding tissue. Bullae are circumscribed, elevated lesions that usually contain serous fluid and resemble a blister. Lobules are segments or lobes that are part of a whole. Papules are small, circumscribed lesions that protrude above the surface.
Nutritional deficiencies are common conditions to be diagnosed by therapeutic means. An example of a _______ diagnosis is angular cheilitis.
This deficiency may be associated with a deficiency of _____ vitamins. and is most commonly a fungal condition that will respond to topical antifungal creams such as Nystatin.
NUG is another example of a therapeutic diagnosis. (Responds to hydrogen peroxide)
therapeutic; B-complex
______ is a clinical term for a white, plaquelike lesion on the oral mucosa that cannot be rubbed off or diagnosed as a specific disease.
Leukoplakia
A _____ is a circumscribed, elevated lesion that is more than 5 mm in diameter. It usually contains serous fluid, and looks like a blister
Bulla
Fordyce granules
a. are ectopic sebaceous glands.
b. are seen on the dorsal surface of the tongue.
c. require antibiotic treatment.
d. are lesions that require biopsy for diagnosis.
a. are ectopic sebaceous glands.
Fordyce granules are ectopic sebaceous glands. Fordyce granules are seen on the buccal and labial mucosa, not the dorsal tongue. Fordyce granules require no treatment. Fordyce granules are diagnosed through clinical appearance. Biopsy is not necessary.
Which descriptive term is described as a segment that is part of the whole?
a. Bulla
b. Vesicle
c. Lobule
d. Pustule
c. Lobule
A lobule is described as a segment or lobe that is part of a whole. A bulla is a large, elevated lesion that contains serous fluid and may look like a blister. A vesicle is a small, elevated lesion that contains serous fluid. Pustules are circumscribed elevations containing pus.
The human papillomavirus (HPV) is associated with what condition?
a. Thrush
b. Tuberculosis
c. Verruca vulgaris
d. Herpangina
c. Verruca vulgaris Verruca vulgaris (the common wart) is caused by a low-risk type of the human papillomavirus. Thrush, or pseudomembranous candidiasis, is a superficial fungal infection seen in the oral cavity. Tuberculosis is a bacterial infection caused by inhalation of airborne droplets from someone with active disease. Herpangina is caused by a coxsackie virus and is characterized by fever, sore throat and oral lesions.
An elevated serum alkaline phosphate level, significant in the diagnosis of Paget disease, is determined from which diagnostic category?
a. Laboratory
b. Therapeutic
c. Clinical
d. Surgical
a. Laboratory
Laboratory tests, including blood chemistries, can provide information that contributes to a diagnosis. Therapeutic testing applies the principle of diagnosis based on clinical and historical information with confirmation by the response of the condition to therapy. Clinical diagnosis suggests that the strength of the diagnosis comes from the clinical appearance of the lesion. Surgical diagnosis is based on information about a lesion gained during surgical intervention.
______ describes a lesion with borders that are not well defined, making it impossible to detect the exact parameters of the lesion.
This type of lesion can make treatment more difficult and, depending on the biopsy results, more radical.
Diffuse
Which finding is not apparent in leukoedema?
a. Intracellular edema in the spinous cells
b. Acanthosis of the epithelium
c. Generalized opalescence of the buccal mucosa
d. A white diffuse material on the buccal mucosa that can be wiped off
d. A white diffuse material on the buccal mucosa that can be wiped off
A white diffuse material that can be wiped off is significant in diagnosing pseudomembranous candidiasis. Intracellular edema in the spinous cells is found in leukoedema. Acanthosis of the epithelium is found in leukoedema. Generalized opalescence of the buccal mucosa is seen in leukoedema.
A ________ may appear as a radiolucency that scallops around the roots. When the lesion is opened surgically, an empty void is found.
traumatic bone cyst
______ is when you have one compartment or unit that is well defined or outlined.
An example ot his is a simple radicular cyst.
Unilocular
The base of this lesion is correctly described as
a. pedunculated.
b. lobule.
c. bulla.
d. sessile.
d. sessile.
The base of this lesion is sessile, or broad and flat. A pedunculated lesion has a stemlike base similar to that of a mushroom stem. A lobule is a segment or lobe that is part of the whole. A bulla usually contains serous fluid and looks like a blister.
An exophytic growth of normal compact bone observed clinically in midline of hard palate is referred to as ______.
This condition is more common in women.
palatal tori
Trying to establish the correct number of primary and permanent teeth present in a 7-year-old child may best be accomplished by which diagnostic component?
a. Clinical
b. Historical
c. Radiographic
d. Differential
c. Radiographic
A radiographic examination including intraoral and extraoral images would provide sufficient information to establish the correct number of teeth present. The clinical diagnosis would be adequate to view only the erupted teeth, not the unerupted permanent teeth. Some historical data might be helpful in this case but would not be considered the best diagnostic component. Enough information should be present in the clinical and radiographic examinations that a differential diagnosis is not necessary.
_______ is the term used to describe “geographic tongue” found on mucosal surfaces other than tongue.
Ectopic Geographic Tongue
(in photo, erythema migrans is seen in the mandibular anterior mucobuccal fold.)
Where is the common intraoral location for leukoedema?
a. Lateral borders of the tongue
b. Soft palate and uvula
c. Floor of the mouth
d. Buccal mucosa
d. Buccal mucosa
A generalized opalescence is imparted to the buccal mucosa in leukoedema. Leukoedema is not evident on the lateral borders of the tongue. The soft palate and uvula is not a location to find leukoedema. The floor of the mouth is not a location to see leukoedema.
Benign migratory glossitis is a condition that does not remain static. What does this statement mean?
a. A variety of over-the-counter treatments are available for this condition.
b. Surgical intervention may be required.
c. Remission and changes in the surface of the tongue occur.
d. An intraoral habit is responsible for this condition.
c. Remission and changes in the surface of the tongue occur.
Benign migratory glossitis (geographic tongue) is a condition that does not stay the same over time; remission and changes in the surface of the tongue occur. A condition that does not remain static does not refer to treatment protocol. A condition that does not remain static does not refer to treatment protocol. Intraoral habits are not related to benign migratory glossitis.
All conditions are associated with lingual varicosities except one. Which is the exception?
a. Red to purple enlarged vessels
b. May be associated with varicosities in the legs
c. Age-related condition
d. May swell during eating
d. May swell during eating
Lingual varicosities do not swell during the eating process. Red to purple enlarged vessels are seen with lingual varicosities. Lingual varicosities may be associated with varicosities in the legs. Lingual varicosities are considered an age-related condition, often seen in individuals over the age of 60.
Which condition is considered a genetic/inherited disorder?
a. Linea alba
b. Amelogenesis imperfecta
c. Necrotizing ulcerative gingivitis
d. Internal resorption
b. Amelogenesis imperfecta
Amelogenesis imperfecta represents a group of inherited conditions affecting the enamel of teeth. Linea alba is a variant of normal characterized by the white line that extends anteroposteriorly on the buccal mucosa, along the occlusal plane. Necrotizing ulcerative gingivitis is an ulcerating gingival condition caused by anaerobic bacteria. Internal resorption is usually a ssociated with an inflammatory response in the pulp.
_______ describes the evaluation of a lesion by feeling it with the fingers to determine the texture of the area.
Descriptive terms for palpation are soft, firm, semifirm, and fluid filled.
These terms also describe the consistency of a lesion.
Palpation
______ arises from tissue outside the tooth, such as the periodontal ligament.
External root resorption
The most frequent _________ are red, pink, salmon, white, blue-black, gray, brown, and black.
color descriptions
**Good to Know**
90% of erythroplakias demonstrate epithelial dysplasia or squamous cell carcinoma
Color can help determine if a lesion is in a acute or chronic state.
______ is triggered by pulpal tissue reaction from within the tooth.
The pulpal area can be seen as a diffuse radiolucency beyond the confines of the normal pulp area.
Internal root resorption
The lingual thyroid is most often found in which intraoral location?
a. Posterior to the circumvallate papillae in the midline of the tongue
b. Along the occlusal plane on the buccal mucosa
c. At the junction of the hard and soft palate
d. At the labial commissures
a. Posterior to the circumvallate papillae in the midline of the tongue
The lingual thyroid is seen as a mass in the midline of the dorsal surface of the tongue, posterior to the circumvallate papillae. The lingual thyroid is not seen on the buccal mucosa. The lingual thyroid is not found at the junction of the hard and soft palate. The lingual thyroid is not found at the labial commissures.
When geographic tongue occurs on the dorsal tongue, the erythematous areas are described as
a. inflamed.
b. depapillated.
c. allergic.
d. fungal.
b. depapillated.
In geographic tongue, the erythematous areas on the dorsal tongue are devoid of filiform papillae and therefore are appropriately described as depapillated. The erythematous areas seen on the dorsal tongue in geographic tongue are not caused primarily by inflammation. Geographic tongue is not an allergic reaction. Geographic tongue is not a fungal infection.
_____ are variously sized circumscribed elevations containing pus.
Pustules
Various sizes of circumscribed elevations that contain pus are termed
a. vesicles.
b. pustules.
c. papules
d. lobules
b. pustules.
Pustules are variously sized circumscribed elevations containing pus. Vesicles are elevated lesions that contain serous fluid. Papules are elevated lesions that protrude above the surface of normal surrounding tissue. Lobules are segments or lobes that are part of the whole.
If the base of a lesion that is flat or broad instead of stemlike it is ______.
sessile
The radiographic appearance of a simple radicular cyst is best described as
a. coalescence.
b. diffuse.
c. multilocular.
d. unilocular.
d. unilocular.
Unilocular means having one compartment or unit that is well defined. This term is often used to describe a radicular cyst. Coalescence refers to the process by which parts of a whole join together, or fuse, to make one. Diffuse describes a lesion with ill-defined borders, making it impossible to detect the exact parameters of the lesion. A multilocular lesion has also been described as “soap bubble”–like; the lobes appear to fuse together to make up the lesion.
_________ = wrinkled
_________ = A cleft or groove, normal or otherwise, showing prominent depth
_________ = Resembling small, nipple-shaped projections or elevations found in clusters
_________ = Smooth, Rough, Folded
Corrugated; Fissure; Papillary; Texture descriptions
This torus palatinus is correctly described as
a. bullous.
b. papular.
c. lobulated.
d. nodular.
c. lobulated.
This torus palatinus is lobulated (i.e., lobes that are fused together). Bullous lesions contain serous fluid and resemble blisters. A papule is a soft tissue lesion that is elevated above the surface of normal surrounding tissue. A nodule is a palpable solid lesion found in soft tissue.
________ around the root is a radiolucent lesion that appears to extend up the periodontal ligament and between the roots.
Scalloping
Radiographically, _______ is visible when the apex of the tooth appears shortened or blunted and irregularly shaped.
This occurs as a response to stimuli, which can include a cyst, tumor, or trauma.
Root resorption
_______ is the process by which parts of a whole join together, or fuse, to make one.
Coalescence
Outgrowths of dense bone found on the lingual aspect of the mandible in the area of the premolars above the mylohyoid ridge are referred to as _____. This growth is usually bilateral and often lobulated or nodular. It can appear fused together and has no predilection for either sex.
Mandibular tori
Red-to-purple enlarged vessels or clustes usually observed on the ventral and lateral surfaces of the tongue are called ________.
Most commonly observed in individuals older than 60 years, and may be associated with a history of smoking or cardiovascular disease.
Lingual Varicosities
A ______ (static bone cyst or Stafne bone cyst) may be indicative of a well-circumscribed, radiolucent area that reveals salivary gland tissue entrapped during development.
Double check this info!
Lingual mandibular bone cavity
_________ is present when elongated filiform papillae are white as a result of either an increase in keratin production or a decrease in normal desquamation.
White Hairy Tongue
If a lesion is attached by a stemlike or stalklike base similar to that of a mushroom it is _______.
pedunculated
Clusters of ectopic sebaceous glands that appear as yellow lobules in clusterrs, that are commonly observed on vermilion border of lips and buccal mucosa but require no treatment are called _____
Fordyce granules
A ______ is a small, circumscribed lesion usually less than 1 cm in diameter. It is elevated or protrudes above the surface of normal surrounding tissue.
papule
_______ are erythematous patches surrounded by a white or yellow border.
Diffuse areas devoid of filiform papillae
Distinct presence of fungiform papillae
There appear to be remission and changes in the depapillated areas
Genetic factors may play a role in presence
May be exacerbated by stress
Occasionally, the patient may complain of a burning discomfort
No treatment usually indicated
Erythema Migrans
A lesion with borders that are specifically defined and in which one can clearly see the exact margins and extent is called ____________.
well circumscribed
_________ appears as a flat or slightly raised oval or rectangular erythematous area in center of tongue. It may be associated with a chronic infection with Candida albicans.
No treatment necessary, but antifungal treatment may be used.
Median Rhomboid Glossitis
_______ is found on the dorsal surface of the tongue appears to have deep fissures or grooves. Its cause is unknown, however it probably involves genetic factors.
Seen in about 5% of the population.
Fissured Tongue
A “white line” extends anteroposteriorly on the buccal mucosa along the occlusal plane is referred to as _______.
May be more prominent in patients who have a clenching or bruxing habit.
linea alba
A sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids is referred to as _______.
retrocuspid papilla
_______ is a generalized opalescence on the buccal mucosa commonly observed in black adults.
No treatment required.
Leukoedema
