Chapter 16 - Oral Cavity and Salivary Glands

Question 1

Inflammatory process that affects supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum; thought to be caused by poor oral hygiene and resultant change in oral flora

Answer 1

Periodontitis

Question 2

Normal oral flora vs. Bacteria associated with periodontitis

Answer 2

Normal oral flora = facultative gram positive

Plaque within areas of active periodontitis: anaerobic and microaerophilic gram-negative flora [aggregatibacter (actinobacillus) actinomycetemcomitans, porphyroonas gingivalis, prevotella intermedia]

Question 3

Intraoral hyperemic ulcerations on thin overlying yellow fibrinopurulent exudate

Answer 3

Aphthous ulcers

Question 4

Disease associations with aphthous ulcers

Answer 4

Sprue, celiacs, IBD, Behcet’s disease

May persist in immunocompromised

Question 5

Inflammatory oral lesion typically found in gingiva of children, young adults, and pregnant women; surface of lesion is often ulcerated and red-purple, described as erythematous, hemorrhagic, and exophytic mass arising from gingival mucosa

Answer 5

Pyogenic granuloma (pregnancy tumor)

Question 6

What type of oral lesion arises from long-standing pyogenic granuloma or de novo from cells of the periodontal ligament?

Answer 6

Peripheral ossifying fibroma

Question 7

Striking aggregation of multinucleate, foreign body-like giant cells separated by fibroangiomatous stroma; not encapsulated but usually well dermarcated and easily excised

Answer 7

Peripheral giant cell granuloma

Question 8

2 possible complications of oral HSV-1

Answer 8

Acute herpetic gingivostomatitis (fever, LAD, anorexia, irritability)

Recurrent herpetic stomatitis (i.e., reactivation) — occurs at site of primary inoculation or in adjacent mucosa associated with same trigeminal ganglion

Question 9

Diagnostic test for HSV

Answer 9

Tzanck test

Question 10

A raspberry- or strawberry-tongue is associated with the pyrogenic toxin with what type of infection?

Answer 10

Group A beta hemolytic streptococcus —> Scarlet fever

Question 11

Small red ulcerations on buccal mucosa above Stensen (parotid) duct along with symptoms of cough, coryza, and conjunctivitis may indicate infection with what?

Answer 11

Measles; Koplik spots are pathognomonic

Question 12

Infectious mono may present as acute pharyngitis and tonsilitis with gray-white exudative membrane as well as cervical LAD and palatal petechiae. What virus causes this?

Answer 12

EBV

Question 13

Erythema multiforme and widespread skin/mucosal lesions including oral maculopapular, vesiculobullous eruptions that sometimes follow infection elsewhere, drugs, cancer, or collagen vascular disease; can be life threatening

Answer 13

Stevens Johnson syndrome

Question 14

Oral manifestation of phenytoin (dilantin) ingestion

Answer 14

Striking fibrous enlargement of gingivae (gingival hyperplasia)

Question 15

Fluffy oral lesions on lateral border of tongue caused by EBV and microscopically characterized by balloon cells in upper spinous layer

Answer 15

Hairy leukoplakia

Question 16

~95% of cancers in the head and neck are what type?

Answer 16

SCC; high rate of multiple primary tumors

Question 17

HPV’s expression of E6 leads to inactivation of ____ while E7 is associated with inactivation of ___

Answer 17

p53; RB

Question 18

Unilocular lesions originating near crown of unerupted teeth, most often associated with impacted 3rd molars (wisdom teeth)

Answer 18

Dentigerous cyst

Question 19

What type of odontogenic cyst must be differentiated from others because of its aggressive behavior?

Answer 19

Keratocystic odontogenic tumor

[most common in 10-40 y/o males, morphologically characterized by prominent basal layer and corrugated epithelial surface; association with Gorlin syndrome - mutations in PTCH]

Question 20

Inflammatory lesion at apex of teeth that commonly comes from the chronic inflammation of the tooth (pulpitis) due to caries or trauma

Answer 20

Periapical cyst — can progress to periapical granuloma

Question 21

2 most common odontogenic tumors

Answer 21

Ameloblastoma — true neoplasm of odontogenic epithelium; no ectomesenchymal differentiation; typically cystic, slow growing, and locally invasive with indolent course

Odontoma — most common odontogenic tumor, arises from odontogenic epithelium with deposition of enamel and dentin - likely a hamartoma

Question 22

___ ____drains saliva from each bilateral submandibular and sublingual glands to the sublingual caruncle at the base of the tongue

Answer 22

Wharton’s duct

Question 23

Causes of Sialadenitis

Answer 23

Autoimmune: Sjogrens (dx Abs to Ro and La)
Viral: mumps
Trauma: mucocele (most common) or ranula

Question 24

Mucocele of sublingual gland

Answer 24

Ranula

Question 25

Organisms most often implicated in unilateral, nonspecific sialadenitis

Answer 25

Staphylococcus aureus

Streptococcus viridans

Question 26

The smaller the salivary gland, the ____ likely the lesion is to be malignant

Answer 26

more

Question 27

Benign tumors that consist of mixture of ductal (epithelial) and myoepithelial cells, and therefore show both epithelial and mesenchymal differentiation

Answer 27

Pleomorphic adenoma

Question 28

Risk factors and genetic association with pleomorphic adenoma

Answer 28

Ionizing radiation

PLAG1 overexpression

Question 29

Benign tumor occurring almost exclusively in parotid gland associated with 8x increased risk in smokers

Answer 29

Warthin tumor (papillary cystadenoma lyphomatosum)

Notes: more common in males, smokers, may be bilateral

Question 30

Morphology of Warthin tumors

Answer 30

Distinctive double layer of neoplastic epithelial cells resting on a dense lymphoid stroma, sometimes bearing germinal centers (oncocytic)

Question 31

Most common primary malignant salivary tumor

What determines prognosis?

Answer 31

Mucoepidermoid carcinoma

Prognosis depends on grade of neoplasm

Question 32

Malignant tumor of salivary glands that is uncommon, slow growing, and grows along nerves (perineural); associated with poorer prognosis if found in minor salivary glands

Answer 32

Adenoid cystic carcinoma

Question 33

Possible causes of oral melanotic pigmentation

Answer 33

Addison disease
Hemochromatosis
Fibrous dysplasia of bone (Albright syndrome)
Peutz-Jeghers syndrome (GI polyposis)

Question 34

Autosomal dominant disorder with multiple congenity aneurysmal telangiectasias beneath mucosal surfaces of oral cavity and lips

Answer 34

Rendu-osler-weber syndrome