Chapter 16 - Oral Cavity and Salivary Glands Flashcards
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
Periodontitis
Normal oral flora vs. Bacteria associated with periodontitis
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]
Intraoral hyperemic ulcerations on thin overlying yellow fibrinopurulent exudate
Aphthous ulcers
Disease associations with aphthous ulcers
Sprue, celiacs, IBD, Behcet’s disease
May persist in immunocompromised
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
Pyogenic granuloma (pregnancy tumor)
What type of oral lesion arises from long-standing pyogenic granuloma or de novo from cells of the periodontal ligament?
Peripheral ossifying fibroma
Striking aggregation of multinucleate, foreign body-like giant cells separated by fibroangiomatous stroma; not encapsulated but usually well dermarcated and easily excised
Peripheral giant cell granuloma
2 possible complications of oral HSV-1
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
Diagnostic test for HSV
Tzanck test
A raspberry- or strawberry-tongue is associated with the pyrogenic toxin with what type of infection?
Group A beta hemolytic streptococcus —> Scarlet fever
Small red ulcerations on buccal mucosa above Stensen (parotid) duct along with symptoms of cough, coryza, and conjunctivitis may indicate infection with what?
Measles; Koplik spots are pathognomonic
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?
EBV
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
Stevens Johnson syndrome
Oral manifestation of phenytoin (dilantin) ingestion
Striking fibrous enlargement of gingivae (gingival hyperplasia)
Fluffy oral lesions on lateral border of tongue caused by EBV and microscopically characterized by balloon cells in upper spinous layer
Hairy leukoplakia
~95% of cancers in the head and neck are what type?
SCC; high rate of multiple primary tumors
HPV’s expression of E6 leads to inactivation of ____ while E7 is associated with inactivation of ___
p53; RB
Unilocular lesions originating near crown of unerupted teeth, most often associated with impacted 3rd molars (wisdom teeth)
Dentigerous cyst
What type of odontogenic cyst must be differentiated from others because of its aggressive behavior?
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]
Inflammatory lesion at apex of teeth that commonly comes from the chronic inflammation of the tooth (pulpitis) due to caries or trauma
Periapical cyst — can progress to periapical granuloma
2 most common odontogenic tumors
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
___ ____drains saliva from each bilateral submandibular and sublingual glands to the sublingual caruncle at the base of the tongue
Wharton’s duct
Causes of Sialadenitis
Autoimmune: Sjogrens (dx Abs to Ro and La)
Viral: mumps
Trauma: mucocele (most common) or ranula
Mucocele of sublingual gland
Ranula
Organisms most often implicated in unilateral, nonspecific sialadenitis
Staphylococcus aureus
Streptococcus viridans
The smaller the salivary gland, the ____ likely the lesion is to be malignant
more
Benign tumors that consist of mixture of ductal (epithelial) and myoepithelial cells, and therefore show both epithelial and mesenchymal differentiation
Pleomorphic adenoma
Risk factors and genetic association with pleomorphic adenoma
Ionizing radiation
PLAG1 overexpression
Benign tumor occurring almost exclusively in parotid gland associated with 8x increased risk in smokers
Warthin tumor (papillary cystadenoma lyphomatosum)
Notes: more common in males, smokers, may be bilateral
Morphology of Warthin tumors
Distinctive double layer of neoplastic epithelial cells resting on a dense lymphoid stroma, sometimes bearing germinal centers (oncocytic)
Most common primary malignant salivary tumor
What determines prognosis?
Mucoepidermoid carcinoma
Prognosis depends on grade of neoplasm
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
Adenoid cystic carcinoma
Possible causes of oral melanotic pigmentation
Addison disease
Hemochromatosis
Fibrous dysplasia of bone (Albright syndrome)
Peutz-Jeghers syndrome (GI polyposis)
Autosomal dominant disorder with multiple congenity aneurysmal telangiectasias beneath mucosal surfaces of oral cavity and lips
Rendu-osler-weber syndrome
