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Pediatric Dentistry Handbook > Chapter 3: Oral Pathology and Associated Syndromes > Flashcards

Chapter 3: Oral Pathology and Associated Syndromes Flashcards

1
Q

where are epstein pearls located?

A

the palatal midline

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2
Q

where are Bohn nodules found?

A

on the junction of hard and soft palate, remnant of minor salivary glands

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3
Q

where are dental lamina cysts found?

A

occurs on alveolar mucosa, remnants of dental lamina

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4
Q

How common are palatal cysts of the newborn?

A

55-85%

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5
Q

Gingival (alveolar) cyst of the newborn occurs in what % of newborns

A

50%

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6
Q

Sucking pads and calluses

A

anatomical variant from sucking trauma
site labial-vermillion border
swollen, translucent to opaque white to pigmented scaly patches, may peel and recur, non-render
mimics chapped lips, breastfeeding keratosis

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7
Q

Concurrent conditions with sucking pads and calluses

A

Leukoedema, labial vesicles, bullae, erythema of nasiolabial folds and lips

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8
Q

Treatment of sucking pads and calluses

A

resolves, feeding position, lip emollient, such as lanolin

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9
Q

What organism causes pseudomembranous candidiasis

A

Candida albicans

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10
Q

Contributing factors toward pseudomembranous candidiasis

A

Maternal vaginal or breast infection, prematurity, immunosuppression, antibiotics

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11
Q

Appearance of pseudomembranous candidiasis

A

white nonadherent papules and plaques with a curdled milk appearance

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12
Q

Treatment of pseudomembranous candidiasis

A

nystatin, fluconazole

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13
Q

What conditions mimic pseudomembranous candidiasis

A

Coated tongue, materia alba, oral cyst of the newborn, mucosal sloughing, breastfeeding keratosis

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14
Q

what can cause riga-fede disease

A

chronic trauma from the primary incisors

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15
Q

what does Riga-Fede disease appear as?

A

represents a traumatic granuloma, ulcerated lesion or mass on the anterior ventral tongue

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16
Q

Treatment of Riga-Fede disease

A

Identify the cause, modify feeding position and bottle used, smooth incisal edges, apply Chlorhexidine rinse to ulcer for secondary infection, evaluation of ankyloglossia

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17
Q

What does Riga-Fede disease mimic

A

neuropathologic chewing, factitial injury, trauma from child abuse

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18
Q

Tongue trauma in infants may occur from

A

neuropathologic chewing, seizure disorder, incorrect usage of pacifier, bottle, teething rings

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19
Q

Conditions with neuropathologic ulcers

A

familial dysautonomia

  • Lesch-Nyhan syndrome
  • Gaucher disease
  • Cerebral palsy
  • Tourette syndrome
  • Rhett syndrome
  • Autism
  • Cornelia de Lange syndrome
  • Traumatic brain injury
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20
Q

Types of vascular tumors

A

Infantile hemangioma, congenital hemangioma, pyogenic granuloma (lobular capillary hemangioma)

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21
Q

Types of vascular malformations

A

capillary malformation, venous malformation, lymphatic malformation, arteriovenous malformation, combined malformation

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22
Q

when do vascular malformations appear

A

at birth, and is persistent, occurs in 0.3% of infants

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23
Q

do vascular malformations grow

A

tends to grow with the child

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24
Q

where do vascular malformations appear

A

occurs in the head and neck region, including facial skin

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25
Q

what are vascular malformations associated with

A

skeletal changes, may be intrabony

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26
Q

what do vascular malformations look like

A

red, purple, blue macule, nodule or diffuse swelling

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27
Q

what is the difference between low-flow and high-flow vascular malformations

A

low-flow is a venous malformation

high-flow: arteriovenous malformation with bleeding, pain warmth, palpable thrill or bruit

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28
Q

Name the syndrome associated with vascular lesion of face and brain, port-wine nevus, risk for seizure disorder

A

Sturge-Weber syndrome

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29
Q

Treatment of vascular malformations

A

surgery, embolization, laser treatment for port wine nevus

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30
Q

what do vascular malformations mimic

A

hemangioma, varix, eruption cyst/hematoma, blue nevus, ecchymosis

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31
Q

types of hemangioma

A

infantile and congenital

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32
Q

how common are hemangiomas

A

neoplasm of vascular origin affecting 5% of infants

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33
Q

what percent occur of hemangiomas occur in the head and neck region

A

60%

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34
Q

what major salivary gland might hemangiomas be associated with?

A

parotid

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35
Q

common oral sites for hemangiomas

A

lip and tongue

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36
Q

appearance of hemangiomas

A

normal or reddish-blue skin coloration with swelling

rubbery to palpation and may not blanch

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37
Q

treatment of hemangiomas

A

observe, propranolol, steroids

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38
Q

hemangiomas may mimic

A

vascular malformation, pyogenic granuloma, hematoma, mucocele

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39
Q

lympathic malformation represent what type of growth

A

hamartomatous growth of lymphatic vessels

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40
Q

what percent of lympathic malformations occur in the head and neck

A

50-75%

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41
Q

what age do most lympathic malformations appear

A

90% develop by the age of 2

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42
Q

appearance of lympathic malformations

A

superficial lesions are pink, red, or purple with pebbly vesicular surfaces

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43
Q

appearance of cystic hygroma

A

diffuse swelling of cervical region of neck, parotid gland, tongue

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44
Q

lympathic malformation may cause

A

compromised airway, and rarely regress

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45
Q

treatment of lympathic malformation

A

surgery, sclerotherapy, drugs

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46
Q

lympathic malformations may mimic

A

venous malformation, squamous papilloma, mucocele

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47
Q

when does neonatal alveolar lymphangioma appear

A

present at birth

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48
Q

what demographic is usually affected by neonatal alveolar lymphangiomas

A

African American Males

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49
Q

appearance of neonatal alveolar lymphangioma seen intraorally

A

alveolar ridge, mandible>maxilla

translucent pink to blue, fluctuant swelling

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50
Q

treatment for neonatal alveolar lymphangioma

A

none, resolves spontaneously

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51
Q

neonatal alveolar lymphangioma may mimic

A

gingival cyst of the newborn, eruption cyst

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52
Q

what is congenital epulis

A

soft tissue tumor of unknown origin

firm, pink to red mass arising from alveolar mucosa at birth

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53
Q

congenital epulis is seen more in which gender

A

occurs in females 90%

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54
Q

which arch is congenital epulis most commonly found

A

maxilla>mandible

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55
Q

most common site intraorally for congenital epulis

A

maxillary lateral and canine region

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56
Q

what does congenital epulis mimic

A

eruption cyst, gingival hamartoma, pyogenic granuloma, fibrous epulis

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57
Q

what is congenital hamartoma

A

overgrowth of normal tissue that belongs at that site

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58
Q

what is congenital choristoma

A

overgrowth of normal tissue that does not belong to that site

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59
Q

most common location of congenital hamartoma/choristoma

A

tongue and alveolar mucosa

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60
Q

what do congenital hamartoma/choristomas appear as

A

firm, pink nodules, single or multiple; non-tender

soft-tissue tumor-like enlargement

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61
Q

treatment of congenital hamartoma/choristoma

A

excisional biopsy, exclude syndromes such as orofacial digital syndrome

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62
Q

congenital hamartoma/choristomas may mimic

A

irritation fibromas, congenital epulis, lipoma, peripheral ossifying fibroma

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63
Q

melanotic neuroectodermal tumor of infancy originates from what structure

A

neural crest origin

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64
Q

at what age does a melanotic neuroectodermal tumor of infancy usually occur

A

usually occurs in the first year of life

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65
Q

where is a melanotic neuroectodermal tumor of infancy usually found?

A

anterior maxilla is the most common site

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66
Q

appearance of melanotic neuroectodermal tumor of infancy

A

rapidly expanding mass of alveolus, displacement of teeth

frequently pigmented blue or black

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67
Q

lab signs of melanotic neuroectodermal tumor of infancy

A

elevated urinary levels of vanillylmandelic acid

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68
Q

radiographic signs of melanotic neuroectodermal tumor of infancy

A

poorly circumscribed radiolucency with floating teeth, may have sun ray pattern

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69
Q

treatment of melanotic neuroectodermal tumor of infancy

A

prognosis, excision with margins, 20% recur

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70
Q

melanotic neuroectodermal tumor of infancy may mimic

A

congenital epulis, intrabony vascular malformation, malignancy

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71
Q

hemifacial hyperplasia signs and symptoms

A

unilateral oral and facial enlargement, usually evident at birth
involves soft tissues, bone, tongue, palate teeth
teeth may exfoliate and erupt prematurely

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72
Q

hemifacial hyperplasia is often seen on which side of the face

A

right side> left side

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73
Q

hemifacial hyperplasia may be associated with other findings like

A

increased incidence of abdominal tumors (Wilms tumor, hepatoblastoma, cortical carcinoma)
Intellectual disability in 20%

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74
Q

treatment for hemifacial hyperplasia

A

evaluate for syndrome, cosmetic surgery, orthodontics

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75
Q

syndromes associated with hemifacial hyperplasia

A

neurofibromatosis, Beck-with-Wiedemann, McCune-Albright, others

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76
Q

hemifacial hyperplasia may mimic

A

segmental odontomaxillary dysplasia

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77
Q

Which brachial arches are associated with hemifacial microsomia

A

anomalies of the first and second brachial arches

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78
Q

inheritance pattern of hemifacial microsomia

A

unilateral microtia, microstomia and failure of formation of mandibular ramus and condyle

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79
Q

other systems affected by hemifacial microsomia

A

frequent eye and skeletal involvement

50% have cardiac pathology (VSD, PDA)

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80
Q

cause of hemifacial microsomia

A

unknown etiology

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81
Q

treatment of hemifacial microsomia

A

orthognathic surgery, distraction osteogenesis

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82
Q

syndrome of hemifacial microsomia

A

goldenhar syndrome

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83
Q

hemifacial microsomia may mimic

A

localized scleroderma, unilateral TMJ ankylosis, fracture

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84
Q

white wipable lesions

A 
coated tongue
pseudomembranous candidiasis
morsicatio (cheek or lip chewing)
chemical burn 
toothpaste or mouthwash reaction
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85
Q

white non-wipable, bilateral lesions

A

bilateral/symmetrical: linea alba, leukoedema, reticular lichen planus, white sponge nevus

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86
Q

white non-wipable, unilateral lesions

A

smokeless tobacco keratosis, pachyonychia congenita, dyskeratosis congenita, hereditary benign intraepithelial dyskeratosis

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87
Q

What causes pseudomembranous candidiasis

A

caused by candida species, especially Candida albicans, which usually does not cause infection unless host is immunocompromised

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88
Q

how may a newborn acquire pseudomembranous candidiasis

A

a newborn’s mother may have untreated vulvovaginitis

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89
Q

what increases susceptibility of pseudomembranous candidiasis

A

long term antibiotics, corticosteroids, drugs that cause xerostomia, oral appliances

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90
Q

intraoral presentation of pseudomembranous candidiasis

A

multifocal white papules and plaques that wipe off and red patches that may burn
It is white and wipes off

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91
Q

treatment of pseudomembranous candidiasis

A

tx: nystatin, clotrimazole, fluconazole, itraconazole

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92
Q

what is coated tongue made up of and where is it located?

A

collection of bacterial and sloughed epithelial cells on the dorsal tongue
contributes to halitosis
may be diffuse or localized to the posterior tongue

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93
Q

contributing factors of coated tongue

A

xerostomia, mouth-breathing, sinusitis, poor OH, febrile conditions, dehydration

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94
Q

treatment of coated tongue

A

improve hydration, gently debride dorsal tongue, improve OH

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95
Q

what is leukoedema? where is it located?

A

variation of normal oral mucosa
bilateral diffuse, filmy white, adherent, wrinkled mucosa,
most obvious on the buccal mucosa
stretching of the mucosa causes it to be less prominent
increase thickness of mucosa, intracellular edema of spinous layer

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96
Q

who does leukoedema often effect?

A

most commonly observed in blacks, occurring in 50% of children

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97
Q

treatment for leukoedema

A

none indicated

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98
Q

what causes frictional keratosis (morsicatio) lesions?

A

caused by low-grade chronic irritation that is usually obvious, especially chronic nibbling of the mucosa

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99
Q

where is frictional keratosis (morsicatio) lesions usually seen?

A

gingiva, buccal mucosa, and lateral tongue

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100
Q

what does frictional keratosis (morsicatio) lesions look like?

A

white, smooth to shaggy non-tender, adherent patches

may observe a prominent linea alba on buccal mucosa

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101
Q

treatment for frictional keratosis (morsicatio) lesions

A

none, habit modification

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102
Q

where are mucosal burns (thermal) observed and what are their typical causes?

A

thermal burn is common due to pizza, soup, and hot beverages
usually seen on the palate and tongue

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103
Q

where are mucosal burns (chemical) observed and what are their typical causes?

A

chemical burn is caused by a number of different agents, including: aspirin, formocresol, ferric sulfate, phosphoric acid, phenol
usually seen on gingiva, buccal, labial mucosa, perioral skin

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104
Q

what do mucosal burns look like?

A

irregular, white necrotic patch that wipes off or red erosion, tender

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105
Q

treatment of mucosa burns

A

palliative treatment only

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106
Q

what causes mucosal sloughing (toothpaste/mouthwash reaction)

A

etching of superficial oral mucosa from contact allergy or irritation
temporal relationship with irritant
toothpaste and mouthwash are common causes but other products can cause problems

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107
Q

site of (toothpaste/mouthwash reaction)

A

usually the buccal and labial mucosa and floor of the mouth

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108
Q

treatment of (toothpaste/mouthwash reaction)

A

discontinue causative agents, palliative treatment if needed, most resolve in several days

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109
Q

signs and symptoms of (toothpaste/mouthwash reaction)

A

burning sensation, peeling of filmy white material, may be associated with erythema, ulcers and vesicles.

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110
Q

other names for benign migratory glossitis

A

geographic tongue, erythema migrans

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111
Q

cause of benign migratory glossitis

A

unknown, association with atopy

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112
Q

what does benign migratory glossitis look like and where does it appear?

A

dorsal tongue,
multiple oval to circular, red to pink patches of desquamated filiform papillae, may be surrounded by white border, does not wipe off, pattern moves around
may be tender, especially with acidic or spicy foods
may be seen with transient lingual papillitis

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113
Q

treatment for benign migratory glossitis

A

palliative treatment as needed, persistent condition

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114
Q

what are fordyce granules and where/when do they appear?

A

ectopic sebaceous glands in oral mucosa
becomes more prominent during puberty, common sites are buccal mucosa and lips
flat to slightly elevated, submucosal yellow-white papules or plaques

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115
Q

treatment for fordyce granules

A

none

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116
Q

causes of smokeless tobacco keratosis

A

chewing tobacco, snuff, snus

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117
Q

location/appearance of smokeless tobacco keratosis

A

occurs in vestibular mucosa

white, wrinkled, adherent plaque, gingival recession, stained, sensitive teeth, root caries, halitosis

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118
Q

treatment of smokeless tobacco keratosis

A

discontinue the habit, biopsy persistent lesions

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119
Q

chances of malignancy with smokeless tobacco keratosis

A

rare malignant transformation

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120
Q

white hairy tongue appearance/location

A

accumulation of keratin filiform papillae
occurs on dorsal tongue
multiple cream-colored to brown, slender surface projections; may not have a thick-matted appearance

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121
Q

cause of white hairy tongue

A

cause is unknown,

xerostomia, poor OH, tobacco smoking in adolescence

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122
Q

treatment of white hairy tongue

A

improve hydration, brush tongue, discontinue cigarette smoking

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123
Q

what is lichen planus

A

chronic mucocutaneous disease, rare in children

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124
Q

cause of lichen planus

A

t-cell mediated autoimmune disease, some cases represent a contact allergy (lichenoid reaction)

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125
Q

intraoral appearance of lichen planus

A

white lacy lines with red background, bilateral and symmetrical, burns, WAXES and WANES

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126
Q

sites, and oral sites of lichen planus

A

oral sites include buccal mucosa, gingiva and tongue
affects both skin, especially extremities, and oral mucosa
may have a secondary candidal infection

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127
Q

treatment of lichen planus

A

incisional biopsy, topical steroids, and antifungal agents

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128
Q

What disease is Chronic hyperplastic candidiasis associated with

A

a chronic mucocutaneous disease that are sometimes associated with endocrine disease and autoimmune disorders

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129
Q

location of Chronic hyperplastic candidiasis

A

site: anterior buccal mucosa and tongue, may have nail involvement

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130
Q

appearance of Chronic hyperplastic candidiasis

A

white, wrinkled adherent plaques that are adherent, may be tender

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131
Q

treatment of chronic hyperplastic candidiasis

A

incisional biopsy, antifungal agents

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132
Q

contributing factors/cause of hairy leukoplakia

A

cause by latent infection of Epstein Barr Virus

contributing factors: immunosuppression, especially HIV

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133
Q

site and appearance of hairy leukoplakia

A

site: ventrolateral tongue
white, shaggy plaques that are adherent, may be tender
superimposed candidal infection

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134
Q

treatment of hairy leukoplakia

A

incisional biopsy if cause is not evident, antiviral and antifungal agents if problematic

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135
Q

what is white sponge nevus and what does it look like?

A

autosomal dominant mucocutaneous disease
Diffuse, white, thickened, adherent and wrinkled oral mucosa, becomes more prominent in adolescence
may be present at birth, may involve other mucosal sites

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136
Q

treatment of white sponge nevus

A

none, persistent condition

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137
Q

what is hereditary benign intraepitherlial dyskeratosis (HBID)

A

autosomal dominant mucocutaneous disease

appears similar to white sponge nevus but affects eyes, may cause visual impairment

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138
Q

who does hereditary benign intraepitherlial dyskeratosis (HBID) effect?

A

affects individuals of mixed white, American Indian, and black ancestry living in North Carolina.

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139
Q

What are Koplik spots, and where do they appear?

A

Oral manifestation of measles (rubeola), observed in the initial stage of viral infection.
site: buccal mucosa and soft palate
Multiple, tiny white macules that wipe off (grains of sand appearance)

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140
Q

treatment of Koplik spots

A

referral to the pediatrician

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141
Q

types of red lesions

A

vascular-diascopy positive (blanch with pressure)
vascular-diascopy negative (does not blanch with pressure)
non-vascular

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142
Q

acute gingivitis cause

A

plaque induced inflammatory lesion

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143
Q

description of acute gingivitis

A

lesions may blanch with pressure to due vascular dilation

non-tender, red, swollen lesions that may bleed with toothbrushing

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144
Q

treatment of acute gingivitis

A

improve OH, reversible lesion

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145
Q

description of submucosal hemorrhage

A

entrapment or pooling of blood in tissue
lesions do not blanch with pressure
petechiae, purpura, ecchymosis, hematooma
pinpoint to macular to diffuse red, purple or blue lesions, usually non-tender

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146
Q

most common cause for submucosal hemorrhage

A

trauma

some may be associated with child abuse

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147
Q

non-traumatic causes of submucosal hemorrhage (rare)

A

blood dyscrasia, viral infection (infectious mononucleosis, measles), anticoagulants

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148
Q

treatment of submucosal hemorrhage

A

resolves in 1-2 weeks, if recurrent, identify cause

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149
Q

description of traumatic erythema

A

irritation resulting in erosion of mucosa, lesions do not blanch with pressure
red macule with irregular margins, usually tender
can occur on any mucosal site
may suspect child abuse

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150
Q

tx of traumatic erythema

A

palliative treatment, if tender, resolves in less than 1 week

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151
Q

other causes of erythema

A

vascular malformations and thermal burns (more commonly leukoplakic)

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152
Q

description of glossitis

A

redness due to thinning of the oral mucosa
generalized erythema and depilation of dorsal tongue, may appear normal
burning sensation

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153
Q

causes of glossitis

A

anemia, candidiasis, vitamin B deficiency, factitial injury, xerostomia, allergies, diabetes, hypothyroidism

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154
Q

treatment of glossitis

A

treat underlying cause

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155
Q

what is hereditary hemorrhagic telangiectasia

A

an autosomal dominant disorder
multiple dilated capillaries (telangiectasia) of skin and mucous membranes
lesions blnach with pressure
ateriovenous fistulas of the lung, liver, brain, increased risk for abscesses
prophylactic antibiotics may be indicated with AV fistulas

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156
Q

prominent signs of hereditary hemorrhagic telangiectasia

A

epistaxis and oral bleeding

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157
Q

what is sturge-weber angiomatosis

A

congenital port wine stains of upper face that includes forehead
leptomeningeal angiomas
ipsilateral facial angiomatosis usually
ipsilateral gyriform calcifications of cerebral cortex

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158
Q

sturge-weber angiomatosis may be affected with (systemically)

A

intellectual disability, seizures, strokes, ocular defects

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159
Q

oral findings for sturge-weber angiomatosis

A

oral bleeding, pyogenic granulomas, gingival hyperplasia, alveolar bone loss, diffuse vascular lesions

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160
Q

treatment for sturge-weber angiomatosis may include

A

aspirin for stroke prevention

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161
Q

other rare causes of oral erythema

A

acquired coagulation disturbance, plasminogen deficiency, thrombocytopenia, hemophilia

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162
Q

types of hemophilia associated with oral erythema

A

Factor VIII, FACTOR IX, von Willebrand disease, vitamin K deficiency, hepatobiliary disease

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163
Q

most common types of red and white lesions

A

geographic tongue and candidiasis

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164
Q

geographic tongue (benign migratory glossitis) description/location

A

may be associated with atopy
primarily on the dorsal and ventrolateral tongue, rarely on other mucosa
focal loss of filiform papillae on dorsal tongue
oval red patches that move around
may be sensitive and persistent
may be associated with fissured tongue and transient lingual papillae

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165
Q

what percent of the population does geographic tongue (benign migratory glossitis) affect

A

affects 2% of the population

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166
Q

cause and treatment of geographic tongue (benign migratory glossitis)

A

unknown cause

palliative treatment

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167
Q

cinnamon contact mucositis cause

A

cause-flavoring agent in oral hygiene products, candy, gum

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168
Q

cinnamon contact mucositis location and appearance

A

occurs on buccal mucosa and lateral tongue

white, shaggy, adherent patches with erythema, tender

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169
Q

treatment of cinnamon contact mucositis

A

identify cause and discontinue offending agent

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170
Q

lichen planus description and location

A

chronic mucocutaneous disease, rare in children
affects both skin, especially extremities, and oral mucosa
white lacy lines with red background, bilateral and symmetrical
burns, WAXES AND WANES,
oral sites include buccal mucosa, gingiva, and tongue

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171
Q

lichen planus cause

A

t-cell mediated autoimmune disease, some cases represent a contact allergy (lichenoid reaction)

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172
Q

treatment of lichen planus

A

incisional biopsy, topical steroids, antifungal agents (may have secondary candidal infection)

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173
Q

syndromes associated with diffuse brown/black/grey lesions

A

Peutz-Jegher’s

Addison’s disease

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174
Q

why would a submucosal hemorrhage (petechiae, purpura, ecchymoses) may be blue-gray in color

A

hemosiderin deposition
suspect repeated trauma or chronic condition if multiple colors of bruising are present
late or resolving traumatic lesion

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175
Q

site and description of a melanotic macule

A

common lesion due to focal increase in melanin
Site: lip, buccal mucosa, gingiva, palate
solitary, round to oval macule, brown, grey, black in color

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176
Q

treatment of melanotic macule

A

none required, no malignant potential

excise if sudden onset and large

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177
Q

description of an ephelis (freckle)

A

occurs on the skin
similar to melanotic macule,
common lesion due to focal increase in melanin
genetic predisposition for some
occurs on sun-exposed skin, face commonly affected
round to oval macule, tan, brown, grey in color
may be solitary but can be multiple

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178
Q

treatment of an ephelis (freckle)

A

none required, sunscreen to prevent more lesions and darkening of lesions

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179
Q

site and description of amalgam/graphite tattoo

A

grey or blue macule on gingiva and palate
entrapped foreign body, history supports lesion
large particles may be seen on radiographs

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180
Q

treatment for amalgam/graphite tattoo

A

none required

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181
Q

description of melanocytic nevus

A

benign proliferation of nevus cells
may be congenital
common in skin and uncommon in mouth

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182
Q

oral site/description of melanocytic nevus

A

usually on the palate
oral type: blue and intramucosal are most common
site: palate, buccal mucosa, lip, gingiva
blue, brown, black macule of nodule
85% pigemented, 70% are elevated

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183
Q

treatment of melanocytic nevus

A

excisional biopsy, rare malignant potential

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184
Q

where is a melanoma usually found intraorally

A

on the palate and gingiva

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185
Q

who does oral melanoacanthoma usually affect

A

rapidly enlarging lesion that occurs in blacks

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186
Q

what is melanotic neuroectodermal tumor of infancy

A

expansile destructive tumor of the anterior maxilla

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187
Q

where is physiologic (racial) pigmentation usually found?

A

most prominent on the attached gingiva

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188
Q

description of brown hairy tongue

A

exogenous staining of elongated filiform papillae

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189
Q

what is post-inflammatory pigmentation

A

hyperpigmentation in response to chronic mucosal trauma

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190
Q

what is acanthosis nigricans and what systemic conditions is it associated with in children

A

associated with obesity and diabetes in children
often seen in children with obesity
marker for diabetes
velvety brown to black papules and plaques on neck, axilla, and flexural skin
refer to pediatrician for evaluation of endocrine disease

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191
Q

what is smoker’s melanosis

A

brown patch on the anterior gingiva and labial mucosa

usually in females, may be localized

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192
Q

what is melasma

A

symmetrical pigmentation of face and neck associated with pregnancy and oral contraceptives

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193
Q

describe the generalized pigmentation seen in patient’s with Addison disease

A

oral: diffuse gray patches

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194
Q

what is addision’s disease and common signs/symptoms

A

adrenal insufficiency

weakness, nausea, vomiting, low blood pressure, oral and cutaneous pigmentation

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195
Q

describe Peutz-Jegher’s syndrome and the generalized pigmentation seen in these patients

A

autosomal dominant
melanin hyperpigmentation of lips
benign polyposis of small intestine, up to 9% become malignant
buccal lesions less likely to fade than lip lesions

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196
Q

medications associated with generalized pigmentation and location of pigmentation (usually)

A

antimalarial drugs (chloroquine)
antibiotics (minocycline)
hormones (strogen)
may produce gray coloration of mucosa
patient must take drugs for an extended period of time
pigmentation usually on hard palate and gingiva

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197
Q

heavy metal toxicity from Bismuth may cause

A

gingivostomatitis similar to necrotizing ulcerative gingivitis
blue-black pigmentation of interdental papillae

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198
Q

heavy metal toxicity from Lead may cause

A

salivary gland swelling and dysphagia

grey pigmentation of marginal gingiva

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199
Q

heavy metal toxicity from Mercury may cause

A

ropy, viscous saliva,
faint grey alveolar gingival pigmentation
gingivostomatitis similar to necrotizing ulcerative gingivitis

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200
Q

heavy metal toxicity from Silver may cause

A

skin is slate gray

diffuse pigmentation

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201
Q

heavy metal toxicity from copper may cause

A

blue-green gingiva and teeth

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202
Q

heavy metal toxicity from Zinc may cause

A

blue-grey line on gingiva

periodontal involvement

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203
Q

Hemochromatosis may cause what type of pigmentation

A

iron storage disease

bronzing of skin and gray pigmentation of palate

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204
Q

Neurofibromatosis may cause what type of pigmentation

A

multiple cafe au lait macules and pigmented neurofibromas

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205
Q

McCune-albright syndrome may cause

A

Large cafe au lait macules, endocrine disease, polyostotic fibrous dysplasia

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206
Q

description of a parulis (color, cause, feel)

A

odontogenic or gingival infection, or entrapped foreign body
red or pinkish white nodule with purulence, fluctuates in size
soft and tender to palpation

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207
Q

treatment of a parulis

A

treat source of infection, currette lesions, antibiotics may be indicated

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208
Q

description and site of a pyogenic granuloma

A

reactive lesion due to irritation
occurs anywhere in mouth, but gingiva is common site
sessile, red nodule that bleeds freely
surface ulceration is common
soft, friable, and nontender to palpation

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209
Q

treatment of pyogenic granuloma

A

surgical excision, removal of irritant

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210
Q

origin of localized juvenile spongiotic gingival hyperplasia

A

sulcular, junctional epithelial

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211
Q

what is localized juvenile spongiotic gingival hyperplasia

A

distinct subtype of gingivitis
anterior facial gingiva, especially maxillary, may be multifocal
papillary or velvety, red nodule that bleeds easily
soft, friable, and non-tender to palpation

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212
Q

localized juvenile spongiotic gingival hyperplasia treatment

A

does not respond to local plaque control

tx: surgical excision, may resolve spontaneously

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213
Q

cause, description, and location of irritation fibroma

A

reactive hyperplasia due to chronic trauma
occurs on buccal and labial mucosa, gingiva and tongue
pink, smooth nodule, non-tender

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214
Q

treatment of irritation fibroma

A

surgical excision

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215
Q

description of peripheral ossifying fibroma

A

reactive lesion
occurs ONLY on the gingiva
firm, pink, or red nodule that begins in interdental papilla, usually ulcerated
may displace of loosen teeth

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216
Q

radiographic findings of peripheral ossifying fibroma

A

may show foci of dystrophic calcification

may displace teeth

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217
Q

treatment of peripheral ossifying fibroma

A

surgical excision down to periosteum

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218
Q

recurrence rate of peripheral ossifying fibroma

A

up to 16%

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219
Q

description of eruption cyst/hematoma

A

soft tissue dentigerous cyst, associated with eruption of permanent and primary teeth
red, purple swelling of alveolar mucosa

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220
Q

radiographic findings for eruption cyst/hematoma

A

may show an enlarged follicular space that extends to alveolar mucosa

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221
Q

treatment for eruption cyst/hematoma

A

none, unless delayed eruption, or symptomatic

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222
Q

squamous papilloma cause

A

caused by human papillomavirus

occurs on soft palate tongue and labial mucosa, uncommon on gingiva

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223
Q

squamous papilloma location

A

occurs on soft palate tongue and labial mucosa, uncommon on gingiva

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224
Q

squamous papilloma description

A

pink, or white papillary, pedunculated nodule

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225
Q

treatment of squamous papilloma

A

excisional biopsy

if multiple lesions, rule out verruca vulgaris and condyloma acuminatum

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226
Q

giant cell fibroma description and cause

A

fibrous hyperplasia of unknown cause

pink, smooth to stippled nodule, non-tender

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227
Q

giant cell fibroma location

A

occurs on gingiva, hard palate, and tongue

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228
Q

treatment of giant cell fibroma

A

surgical excision

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229
Q

peripheral giant cell granuloma cause

A

reactive lesion caused by local irritation

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230
Q

peripheral giant cell granuloma description and location

A

occurs on gingiva and alveolar mucosa only
red or purple nodule that may bleed
may cause superficial bone resorption

231
Q

treatment of peripheral giant cell granuloma

A

surgical excision and remove local irritation

rare cases represent central bony lesion with soft tissue extension

232
Q

recurrence rate of peripheral giant cell granuloma

A

10%

233
Q

examples of neoplastic lesions that cause localized gingival enlargement

A 
benign neoplastic lesions
langerhans cell histiocytosis
aggressive fibromatosis
malignant disease, like lymphoma
metastatic disease
234
Q

3 most Common types of generalized gingival enlargements (types of gingivitis)

A

chronic hyperplastic gingivitis (plaque induced)
mouth-breathing gingivitis
puberty (hormonal induced) gingivitis

gingival fibromatosis
giant cell fibroma
leukemic infiltrates (AML, or CML)
ganulomatous gingivitis

235
Q

types of medications which cause drug induced gingival hyperplasia and the prevalence

A

phenytoin (prevalence 50%)
cyclosporine (prevalence 25%)
calcium channel blockers (prevalence 25%)

236
Q

linear gingival erythema cause/assocation

A

appears to be associated with candidal infection

HIV related or immunosuppressed children

237
Q

key findings and description of linear gingival erythema

A

distinct linear band of fiery red and edematous attached gingiva that may extend beyond mucogingival junction
key finding: does not respond to normal plaque control measures

238
Q

treatment of linear gingival erythema

A

tx: local debridement, chlorhexidine rinse, with or without antifungal agents

239
Q

cause of plasma cell gingivitis

A

allergic reaction to multiple allergens including those found in toothpaste, candy, chewing gum, and mouthwash

240
Q

appearance and location of plasma cell gingivitis

A

diffusse enlargement of the attached gingiva of sudden onset, often extends to palate
other sites include concurrent tongue and lip involvement
bright red and swollen tissues with lack of stippling that burn

241
Q

diagnosis and treatment of plasma cell gingivitis

A

dx: incisional biopsy, dietary history, allergy testing if persistent
tx: identify and eliminate the allergen, topical steroids

242
Q

inheritance pattern of gingival fibromatosis

A

may be familial or idiopathic

autosomal dominant if familial

243
Q

what is gingival fibromatosis

A

diffuse, multinodular overgrowth of fibrous tissue of gingiva
may have a localized variant, especially tuberosity-palatal area
may be associated with several syndromes
may be associated with hypertrichosis
clinically similar to phenytoin-induced gingival overgrowth

244
Q

gingival fibromatosis may have what impact on eruption

A

may delay eruption and cause malocclusion

245
Q

treatment and recurrence of gingival fibromatosis

A

routine dental prophylaxis if mild, surgical excision (gingival recontouring if severe)
recurrence is common

246
Q

cause of gingivitis secondary to leukemia

A

gingivitis secondary to neutropenia

gingival enlargement due to leukemic infiltrates especially in myelomonocytic types

247
Q

other oral signs of leukemia

A

other signs include spontaneous gingival bleeding, mucosal petechiae and ecchymosis, ulcerations, tumor-like growths, mobility of teeth

248
Q

radiographic findings associated with leukemia

A

multifocal alveolar bone loss, loss of lamina dura

249
Q

oral treatment of leukemia

A

oral hygiene measures tolerated by lab studies

250
Q

systemic factors associated with gingivitis (syndromes, diet, etc)

A 
hormonal changes (pregnancy)
diabetes mellitus
systemic lupud erythematosus
autoimmune disease
scurvy (vit C deficiency)
Down syndrome and other syndromes
Immune dysfunction (neutropenia)
heavy metal poisoning
251
Q

granulomatous gingivitis may be associated with

A 
foreign body gingivitis
orofacial granulomatosis
Crohn disease
Sarcoidosis 
Granulomatosis with polyangiitis (Wegener granulomatosis)
252
Q

where are mucoceles usually located

A

lower lip

253
Q

where is squamous papilloma usually located

A

soft palate, tongue

254
Q

where are fibromas usually located

A

buccal mucosa, lower lip, tongue

255
Q

where are ranulas found

A

floor of the mouth

256
Q

where are lymphoepithelial cyst usually located

A

floor of the mouth

257
Q

cause of mucocele

A

due to severance of duct and spillage of mucin into tissues

258
Q

location of mucocele

A

most frequent on the lower lip, but may occur on the palate or tongue, floor od the mouth, buccal mucosa

259
Q

appearance of mucocele

A

fluid-filled, translucent blue nodule, fluctuates in size, may be tender

260
Q

treatment of mucocele

A

tx: excisional bipsy; ay spontaneously resolve

261
Q

soft tissue abscess location and cause

A

more common on the upper lip
caused by extension of odontogenic infection or entrapped foreign body
radiograph if trauma, foreign body or dental source suspected

262
Q

treatment of soft tissue abscess

A

treat cause, may require incision and drainage

263
Q

cause of verruca vulgaris

A

caused by HPV 2 and others

264
Q

oral and other site of verruca vulgaris (common wart)

A

common on skin but uncommon in mouth
occurs on skin, especially hands, face
oral site include lip vermillion, labial mucosa, anterior tongue

265
Q

appearance of verruca vulgaris

A

pink or white stippled to papillary nodules; usually multiple

266
Q

treatment of verruca vulgaris

A

exisional biopsy in mouth, refer skin lesions to prevent spread

267
Q

description of lipoma

A

well circumscribed submucosal mass less
soft, freely movable
yellow in color

268
Q

location of lipoma

A

common on buccal mucosa, tongue, floor of mouth

269
Q

treatment of lipoma

A

surgical excision

270
Q

what is a traumatic neuroma

A

reactive lesion that may be tender
focal reactive lesion due to a local injury
clinically resembles a fibroma
may be tender to palpation

271
Q

treatment of traumatic neuroma

A

excisional biopsy

272
Q

types of vascular lesions

A

hemangioma, vascular malformation, lymphatic malformation

273
Q

what is multifocal epithelial hyperplasia (Heck disease) caused by

A

caused by HPV 13, 31

274
Q

risk factors for multifocal epithelial hyperplasia (Heck disease)

A

risk factors include genetics, ethnicity, poverty, malnutrition, poor hygiene, HIV, infection
occurs usually in children

275
Q

appearance of multifocal epithelial hyperplasia (Heck disease)

A

numerous pink nodular lesions with a stippled, flat-topped to papillary surface
may be mistaken for condylomas

276
Q

sites of multifocal epithelial hyperplasia (Heck disease)

A

labial and buccal mucosa, tongue are common sites

277
Q

angioedema cause

A

allergic and hereditary forms

multiple allergens and physical stimuli can trigger reaction

278
Q

what happens when agioedema occurs

A

acute onset of swelling and itching
swelling of face, kips, tongue, pharynx, extremities
may be life threatening with laryngeal involvement

279
Q

treatment of angioedema (both hereditary and allergic form)

A

allergic form– antihistmines, steroids, epinephrine,

hereditary form-androgens and esterase-inhibiting drugs

280
Q

orofacial granulomatosis cause/trigger

A

granulomatous disease due to abnormal immune reaction
ford allergens are trigger for children
may have GI problems

281
Q

site of orofacial granulomatosis

A

lip, buccal mucosa, gingiva and tongue

282
Q

appearance of orofacial granulomatosis

A

persistent swelling, erythema, ulvers, cobblestone pattern, fissured tongue

283
Q

treatment of orofacial granulomatosis

A

incisional biopsy, identify the allergen, steroids, other

rule out Chron’s disease

284
Q

multiple endocrine neoplasia, type 2B inheritance pattern

A

autosomal dominant

285
Q

appearance of multiple endocrine neoplasia, type 2B

A

Marfanoid body, narrow facies, full lips,

mucosal neuromas of lips, tongue, buccal mucosa, and gingiva

286
Q

multiple endocrine neoplasia, type 2B may cause

A

medullary carcinoma of the thyroid

pheochromocytoma

287
Q

treatment of multiple endocrine neoplasia, type 2B

A

biopsy to confirm diagnosis, early evaluation of thyroid is important

288
Q

types of benign mesenchymal neoplasms

A

neurilemmoma, neurofibroma

289
Q

benign and malignant salivary gland tumors

A

canalicular adenoma found on upper lip

malignant salivary gland tumors of the posterior buccal mucosa

290
Q

most common reason for tongue swelling

A

traumatic injury
usually involves tongue laceration and submucosal hemorrhage
localized and diffuse swelling
bleeding is a problem due to vascularity
for severe trauma, healing takes 4-6 weeks

291
Q

another common reason for tongue swelling

A

hyperplastic foliate papilla
benign lymphoid hyperplasia of lingual tonsil
enlargement triggered by infection or trauma to the area

292
Q

site and appearance of hyperplastic foliate papilla swelling

A

site: posterior lateral tongue, often bilateral
yellow-pink to red enlargement with irregular surface, may be tender
important oral cancer site

293
Q

treatment of hyperplastic foliate papilla

A

tx: none except treat the source of irritation if present, may spontaneously resolve

294
Q

other less common reasons for tongue swelling

A

irritation fibroma, pyogenic granuloma, mucocele of Blandin-Nuhn, entrapped foreign body, tongue piercing, giant cell fibroma

295
Q

rare reasons for tongue swelling

A

vascular malformation, hemangioma, lymphatic malformation

granular cell tumor

296
Q

what is a granular cell tumor and where is it found

A

granular cell tumor: benign neoplasm of Schwann cells, dorsal tongue most common oral site, pale/smooth or slightly stippled nodule

297
Q

treatment for granular cell tumor

A

excisional biopsy

298
Q

micro findings for granular cell tumor

A

pseudoepitheliomatous hyperplasia of surface epithelium and sheets of granular cells

299
Q

hamartoma and choristoma location

A

tongue is the most common site

300
Q

hamartoma and choristoma may be associated with what syndrome

A

may be associated with syndromes such as oral-facial-digital syndrome

301
Q

treatment of hamartoma and choristoma

A

surgical excision

302
Q

lingual thyroid origin, location, and appearance

A

developmental lesion
ectopic thyroid tissue in the tongue
located midline base of the tongue

303
Q

what percentage of lingual thyroid is associated with hypothyroidism

A

33%

304
Q

treatment for lingual thyroid

A

thyroid replacement therapy; may require surgery

305
Q

what is cretinism

A

congenital hypothyroidism (myxedema in adults)

306
Q

what does cretinism cause

A

intellectual disability, poor somatic growth, generalized edema
shortening of cranial base–retraction of nose with flaring
mandible underdeveloped
maxilla overdeveloped
tongue enlargement secondary to edema, delayed tooth eruption, exfoliation
progressive infiltration of skin and mucous membranes by glycoaminoglycans

307
Q

treatment for cretinism

A

thyroid replacement therapy

308
Q

syndromes associated with macroglossia

A 
down syndrome
neurofibromatosis type 1
mucopolysaccharidosis (multiple types)
Multiple endocrine neoplasia type 2B
Beckwith-Weidemann syndrome
Duchenne muscular dystrophy (hypotonicity of tongue)
309
Q

most common reason for submucosal swelling

A

enlarged varices

310
Q

description of a ranula

A

mucous retention in oral floor
dome shaped, painless, soft swelling of normal or blue color
unilateral; fluctuates in size
arises from the sublingual gland

311
Q

treatment for a ranula

A

excisional biopsy, marsupialization of small lesions

312
Q

causes of sialolithiasis (salivary stone)

A

calcium slats around focal debris in duct

313
Q

symptoms associated with sialolithiasis (salivary stone)

A

episodic pain and swelling when eating

314
Q

appearance of sialolithiasis (salivary stone)

A

xray may aid in detection

yellow-white mass may be seen close to ductal orifice

315
Q

usually sialolithiasis (salivary stone) involves what duct

A

usually involves Wharton’s duct

316
Q

treatment of sialolithiasis (salivary stone)

A

tx: gentle massage, salivary stimulation, surgery

317
Q

what is oral lymphoepithelial cyst

A

entrapped epithelium within lymphoid tissue
undergoes cystic degeneration
persistent yellow-white nodule

318
Q

where are oral lymphoepithelial cysts found

A

occurs in oral floor, soft palate, tonsillar region and lateral tongue

319
Q

treatment for oral lymphoepithelial cysts

A

observe or excisional biopsy

320
Q

location of epidermoid/dermoid cyst

A

midline floor of the mouth

rare sublingual swelling

321
Q

salivary gland tumors causing sublingual swelling are usually benign or malignant

A

most likely malignant

322
Q

What is Ludwig’s angina

A

life-threatening infection, may cause sublingual swelling

usually of odontogenic origin

323
Q

Common causes of palatal swelling

A

benign lymphoid hyperplasia
palatal abscess
torus palatinus
squamous papilloma

324
Q

benign lymphoid hyperplasia appearance and origin

A

oral tonsil tissue
yellow pink to red nodules
may be tender

325
Q

treatment for benign lymphoid hyperplasia

A

none

326
Q

palatal abscess origin

A

odontogenic and gingival in origin

327
Q

torus palatinus description, and treatment

A

bony exostosis that occurs in the midline of the hard palate
nodular to lobular in appearance
no treatment required

328
Q

HPV strains which cause squamous papilloma

A

caused by HPV 6 and 11

329
Q

location of squamous papilloma

A

occurs on tongue, labial mucosa and soft palate

most common mass of the soft palate

330
Q

description of squamous papilloma

A

solitary pink or white nodule with multiple fingerlike projections

331
Q

treatment for squamous papilloma

A

tx: excisional biopsy

332
Q

what is a nasopalatine duct cyst

A

arises from remnants of nasopalatine duct

located in midline between roots of maxillary incisors

333
Q

effects of nasopalatine duct cyst

A

may cause root divergence

may cause fluctuant swelling

334
Q

radiographic appearance of nasopalatine duct cyst

A

oval to heart shaped radiolucency

335
Q

treatment of nasopalatine duct cyst

A

surgical excision/curretage

336
Q

causes of inflammatory papillary hyperplasia

A

reactive hyperplasia of the hard palatal mucosa

337
Q

inflammatory papillary hyperplasia may be associated with

A

associated with dentures, palatal coverage appliances, high palatal vault, mouth-breathing
may associated with candidal infection, alongside trauma from appliance

338
Q

appearance of inflammatory papillary hyperplasia

A

red or pink sheets of papules, non-tender

339
Q

treatment of inflammatory papillary hyperplasia

A

antifungal agent, disinfect appliance, may need to decrease the wearing of the appliance, surgical excision

340
Q

oral lymphoepithelial cyst is common seen sublingually or in this location

A

the soft palate

341
Q

condyloma acuminatum is associated by which strains of what virus

A

caused by HPV 6, 11, 16, 18

342
Q

how is condyloma acuminatum acquired

A

sexually transmitted disease

may be infected at birth

343
Q

location and description of condyloma acuminatum

A

oral sites: palate, tongue, oral floor, labial mucosa

multiple coalescing, pink nodules, cauliflower like surface

344
Q

treatment of condyloma acuminatum

A

excisional biopsy

345
Q

salivary gland tumors intraoral site

A

both benign and malignant

most common intraoral site is posterior hard palate

346
Q

cause of necrotizing sialometaplasia

A

cause: trauma, dental injections, upper respiratory infection
reactive lesion of minor salivary glands due to ischemia and infarction

347
Q

description of necrotizing sialometaplasia

A

may start as a swelling that progresses to a cratered, irregular ulcer
usually unilateral but may be bilateral
ranges from non-tender to painful

348
Q

treatment of necrotizing sialometaplasia

A

incisional biopsy to confirm diagnosis, resolves in 6 weeks.

349
Q

types of single ulcerations

A

apthous ulcers, traumatic ulcer (riga-fede, iatrogenic, self-induced), recurrent herpes labialis, angular chelitis, behcet syndrome, chron’s disease

350
Q

types of acute, multiple ulcerations

A

primary herpetic gingivostomatitis, coxsackie virus (herpangina, hand/foot/mouth disease), intraoral recurrent herpes simplex, erythema multiforme, necrotizing ulcerative gingivitis, varicella

351
Q

types of chronic single ulceration

A

chronic traumatic ulcer, infections (deep fungal or tuberculosis), squamous cell carcinoma

352
Q

types of chronic multiple ulcerations

A

erosive/ulcerative lichen planus, systemic lupus erythematous, chronic graft vs host disease

353
Q

prevalence of apthous ulcers

A

20-30% of US children

354
Q

what are apthous ulcers (description, etiology/cause)

A

t-cell mediated immunologic reaction
familial tendency
site-non-keratinized mucosa

355
Q

signs and symptoms of apthous ulcers

A

single or multiple, painful ulcers, recurrent lesions of sudden onset

356
Q

types of apthous ulcers

A

minor, major, herpetiform

357
Q

treatment of apthous ulcers

A

coating agents, topical anesthetics, steroids, other

358
Q

apthous ulcers associated with systemic disease

A

behcet disease, celiac disease, chron’s disease
periodic fevers, apthous stomatitis, pharyngitis and adenititis (PFAPA)
neutropenia
immunodeficiency syndrome
GERD

359
Q

cause of angular chelitis

A

Candida albicans, S aureus, nutritional deficiency, anemia, Chron disease

360
Q

description of angular chelitis

A

site: corners of the mouth
erosions, scaly crust, ulcerated fissures, papules, may bleed, tender
may recur

361
Q

treatment for angular chelitis

A

depends on cause, antifungal ointment with or without short-term, low potency topical steroids

362
Q

cause of recurrent herpes simplex infection

A

cause: reactivation of the HSV-1

363
Q

prevalence of recurrent herpes simplex infection

A

20-35%

364
Q

types of recurrent herpes simplex infection

A

herpes labialias, facialis, intraoral HSV

365
Q

description of recurrent herpes simplex infection 9site, duration, complications)

A

site: perioral skin, vermillion, gingiva, hard palate
duration 7-10 days
Recurrent, tender lesions, sudden onset, prodrome, clustered vesicles that ulcerate
complications: scars, erythema multiforme
Herpetic whitlow (herpetic paronychia on the finger)

366
Q

treatment of recurrent herpes simplex infection

A

topical anesthetics, topical and systemic antiviral agents

367
Q

cause of Acute herpetic gingivostomatitis

A

infectious disease, primarily caused by herpes simplex virus type 1 (HSV-1)

368
Q

description of Acute herpetic gingivostomatitis (duration, who it affects, signs/symptoms)

A

most common under age 5
disease duration 5-14 days
fever, lymphadenopathy, headache, malaise, intense gingival erythema, and oral vesicles throughout the mouth
vesicles rupture leaving painful ulcers
widespread ulcers occur on any oral mucosa site and lip vermillion
self-inoculation of fingers, eyes, genital area

369
Q

treatment of Acute herpetic gingivostomatitis

A

systemic acyclovir, valavyclovir may be warranted

palliative and supportive care

370
Q

cause of herpangina

A

enterovirus, usually coxsackie virus

371
Q

description of herpangina

A

most common in young children during summer months
multiple small vesicular lesions involving tonsillar pillars, uvula, and soft palate
vesicles rupture leaving ulcers with erythematous borders
malaise, fever, sore throat, cough rhinorrhea, diarrhea

372
Q

treatment of herpangina

A

supportive and palliative care

373
Q

cause of hand, foot and mouth disease

A

enterovirus, usually coxsackie virus

374
Q

hand, foot and mouth disease population

A

common age is infants to age 4

375
Q

hand, foot and mouth disease signs and symptoms

A

fever, malaise, lymphadenopathy, flu-like symptoms
vesicles and ulcers on buccal, labial mucosa, tongue
skin lesions on hands, arms, feet and legs, diaper rash

376
Q

aggressive form of hand, foot and mouth disease can lead to

A

aggressive form associated with neurologic complications

377
Q

treatment of hand, foot and mouth disease

A

palliative and supportive, usually resolves in 7-10 days

378
Q

impetigo cause

A

most commonly caused by Staphylococcus aureus or in combination with Group A or B hemolytic streptococcus

379
Q

impetigo lesions

A

lesions are often on the face, bacteria is harbored in the nose,
scaly and thick amber crusts that are pruritic and localized
usually seen in young children

380
Q

impetigo treatment

A

localized disease treated with topical antibiotics

widespread disease treated with systemic antibiotics

381
Q

necrotizing ulcerative gingivitis cause

A

fusiform bacteria, spirochetes, HHVs

382
Q

necrotizing ulcerative gingivitis lesions and population of patients

A

painful lesions, necrosis, ulceration, punched out papillae, halitosis
rare in young children

383
Q

predisposing factors for necrotizing ulcerative gingivitis

A

vitamin deficiency, compromised immune function, poor oral hygiene, cigarette smoking, viral infections (HIV, EBV, measles)

384
Q

treatment for necrotizing ulcerative gingivitis

A

debridement, oral hygiene, antimicrobial oral rinse, +/- systemic antibiotics

385
Q

triggers for erythema multiforme

A

triggers: drugs, HSV, mycoplasma pneumonia, other infections, tattooing,
50% unknown case

386
Q

site for erythema multiforme

A

extremities, palmar and plantar surfaces, neck, face, eyes, lips, oral mucosa

387
Q

disease description for erythema multiforme

A

immunologically mediated disease
acute onset, fever, sore throat, blood crusted lips, irregular ulcers, erythema
target lesions on skin
may have ocular and genital involvement (Steven’s Johnsons’ syndrome)

388
Q

treatment of erythema multiforme

A

identify cause, palliative care

389
Q

cause of varicella (chickenpox)

A

varicella-zoster virus

390
Q

signs and symptoms for varicella (chickenpox)

A

crops of pruritic vesicles onskin and mucous membrane
vesicles may precede fever
begins on trunk, spreads to limbs and face
infectious 24 hours before to 6-7 days after vesicles appear
resolves in 7-10 days

391
Q

treatment of varicella

A

palliative and supportive, systemic antiviral drugs in severe cases or immunocompromised children

392
Q

preventive of varicella

A

vaccine, rare disease because of vaccine

393
Q

ulcerations fro chemotherapy

A

drug-induced mucositis
widespread involvement
pain, bleeding, sloughing, erythema, irregular ulcerations
tx: supportive and palliative care

394
Q

what is epidermolysis bullosa

A

hereditary vesiculobullous disease of skin and mucous membranes –multiple types

395
Q

types of epidermolysis bullosa

A

EB simplex – most common; autosomal dominant

junctional EB: severe form; autosomal recessive

396
Q

manifestations of epidermolysis bullosa (oral and systemic)

A

blistering of hands, feet, mouth, in particular
scarring is common
oral problems: enamel hypoplasia, microstomia, ankyloglossia, caries, gingivostomatitis
severe forms can be life-threatening

397
Q

treatment of epidermolysis bullosa

A

no satisfactory treatment caries prevention, minimize trauma

398
Q

what is Systemic lupus erythematosus disorder

A

chronic multisystem progressive disorder

autoimmune disease

399
Q

manifestations of Systemic lupus erythematosus

A

oral ulcerations, erosions and white striations, mimics lichen planus, secondary candidiasis
skin lesions, arthralgia, hematologic disorders are common, butterfly rash on face

400
Q

treatment for Systemic lupus erythematosus

A

steroids, other immunosuppressive agents, antifungal agents

401
Q

graft versus host disease description

A

acute and chronic types
associated with hematopoietic stem cell transplant
multiorgan disease including oral mucosa and skin
rare development of oral cancer

402
Q

oral manifestations of graft versus host disease

A

mucosal atrophy and ulcers, xerostomia, lichenoid reaction, systemic sclerosis

403
Q

congenital indifference to pain

A

autosomal recessive
frequent scarring of face with mutilation of lips, arms and legs, as well as phalangeal amputation due to self-mutilation
tongue and lips especially subject to injury
extensive decay not associated with pain

404
Q

lesch-nyhan syndrome

A

X-linked condition
intellectual disability, may have cerebral palsy, choreoathetosis
bizarre, self-mutilating behavior (including lip destruction with teeth)
absence of hypoxanthine-guanine
phosphoribosyltransferase (enzyme involved in purine metabolism)

405
Q

traumatic granuloma

A

traumatic ulcerative grnuloma with stromal eosinophilia, deep injury to the oral tissues, especially the tongue
solitary, painful, deep, persistent ulcer
takes weeks to months to heal
may mimic mycotic infection or malignancy

406
Q

treatment of traumatic granuloma

A

eliminate cause, topical or intralesional steroids, incisional biopsy if persistent

407
Q

Common reasons for soft tissue neck swelling

A

reactive lymphadenopathy – secondary to odontogenic infections
lymphadenopathy secondary to viral infections

408
Q

findings associated by infectious mononucleosis (and name of virus)

A

caused by Epstein Barr Virus

fever, palatal petechiae, NUG, pharyngitis, cervical lymphadenopathy

409
Q

what is cat-scratch fever?

A

caused by bartonella henselae
usually due to scratch or bite from a cat
scratches on the face can result in submandibular lymphadenopathy or enlarged parotid lymph nodes

410
Q

treatment for cat scratch fever?

A

usually resolves within 4 months, antibiotics may be necessary

411
Q

findings associated with HIV-associated salivary gland disease

A

enlarged parotid gland, often with concurrent cervical lymphadenopathy
xerostomia
associated with improved prognosis

412
Q

findings associated with Hodgkin’s lymphoma

A

malignant lymphoproliferative disease
usually unilateral, painless enlarging mass
unilateral presentation
most common nodes are cervical and supraclavicular nodes
may be associated with fever, weight loss, night sweats, pruritus

413
Q

treatment of Hodgkin’s lymphoma

A

tx: radiation and chemotherapy

414
Q

swellings associated with leukemia

A

enlarged lymph nodes due to infection and leukemic infiltrates

415
Q

findings associated with thyroglossal duct cyst

A

remnant of thyroglossal duct
occurs midline anywhere along the path of thyroglossal duct
usually below hyoid
may move up and down with tongue movement

416
Q

findings (and swellings) associated with Mumps

A

usually inovlves the parotid
paramyxovirus (cytomegalic virus or staph in immunocompromised patients)
incubation 2-3 weeks
pain, fever, malaise, headache, vomiting may precede swelling
xerostomia
tx: symptomatic

417
Q

findings associated with Kawasaki disease

A

Mucocutaneous lymph node syndrome
bilateral conjunctivitis
fissured lips, infected pharynx, strawberry tongue, erythema of palms and soles, rash, cervical adenopathy

418
Q

organism that causes tuberculosis

A

mycobacterium tuberculosis

419
Q

findings associated with tuberculosis

A

infectious disease that affects the lungs
clinical findings: weight loss, fever, night sweats, productive cough
most common extrapulmonary sites in head and neck region are cervical lymph nodes

420
Q

treatment for tuberculosis

A

multiagent antibiotic therapy

421
Q

most common benign salivary gland tumor

A

pleomorphic adenoma most common benign lesion

422
Q

most common salivary gland tummor site

A

Parotid gland most common site

423
Q

most common malignant salivary gland tumor

A

mucoepidermoid carcinoma is the most common malignant lesion

424
Q

what is a branchial cleft cyst

A

area of the anterior border of the sternocleidomastoid muscle
soft, movable, poorly delineated mass

425
Q

theories of origin of banchial cleft cyst

A

origin from remnant of banchial clefts

remnant of salivary gland

426
Q

what is a cystic hygroma

A

lymphatic malformation
may be present at birth
slowly enlarges, may cause respiratory distress

427
Q

radiographic appearance of a developing tooth bud

A

normal development of a tooth, including supernumerary tooth
ectopic position in infant may cause alveolar swelling
radiograph; distinct circular radiolucency with corticated margin; usually bilateral and symmetrical

428
Q

findings associated with periapical abscess (acute apical periodontitis)

A

acute infection at root apex or furcation
flare-up of sudden onset
associated with deep carious lesion, trauma, and nonvital pulp
tender to painful, tooth mobility, tooth extrusion
soft swelling, erythema, purulence, parulis, cellulitis may be present

429
Q

radiographic appearance of periapical abscess (acute apical periodontitis)

A

radiograph: periapical or furcal radiolucency with indistinct borders, widened periodontal ligament space
internal and/or external resorption

430
Q

treatment for periapical abscess (acute apical periodontitis)

A

root canal treatment or extraction, currette tissue if extract tooth; antibiotics if prominent cellulitis and systemic manifestation

431
Q

clinical findings for periapical granuloma (chronic apical periodontitis)

A

chronic or subacute infection at the root apex or furcation
periodic flare-ups; asymptomatic to tender
associated with deep carious lesion, trauma and non-vital pulp

432
Q

radiographic appearance of periapical granuloma (chronic apical periodontitis)

A

radiolucency with indistinct or distinct borders; apical and furcal loss of lamina dura, root resorption

433
Q

treatment of periapical granuloma (chronic apical periodontitis)

A

extract primary tooth, root canal treatment or extraction for permanent, curette tissue if extracting the tooth

434
Q

periapical cyst (radicular cyst) description

A

chronically inflammed cyst at root apex or furcation
asymptomatic to tender, tooth mobility, may cause bony expansion
associated with deep carious lesion, trauma, and non-vital pulp

435
Q

periapical cyst (radicular cyst) radiographic findings

A

unilocular radiolucency with indistinct or distinct borders; may have cortiated margin, apical and furcal loss of lamina dura, root resorption, may displace teeth

436
Q

treatment for periapical cyst (radicular cyst) radiographic findings

A

extraction of a primary tooth, enucleate cyst, root canal treatment or extraction of a permanent tooth

437
Q

periapical cyst (radicular cyst) may stimulate…

A

stimulates a dentigerous cyst wen the primary molar is affected

438
Q

multiple periapical cysts (radicular cysts) may sometimes be associated with

A

multiple periapical granulomas and cysts can be associated with dentin dysplasia (type I), and vitamin D-resistant rickets

439
Q

nasopalatine duct cyst origin

A

develops from the remnants of nasopalatine duct

440
Q

clinical findings of nasopalatine duct cyst

A

may cause fluctuant swelling of the palate
teeth are vital
may cause divergence of roots
soft-tissue conterpart: cyst of incisive papilla

441
Q

radiographic findings for nasopalatine duct cyst

A

ovoid to heart-shaped raidolucency between maxillary incisors

442
Q

treatment for nasopalatine duct cyst

A

enucleation of cyst

443
Q

description of simple bone cyst (traumatic bone cyst)

A

usually in the mandible, usually asymptomatic without expanision
teeth are vital
may cross midline

444
Q

radiographic findings simple bone cyst

A

usually unilocular with scalloping between roots of vital teeth

445
Q

treatment of simple bone cyst

A

surgical exploration

446
Q

stafne defect (static bone cyst) description

A

developmental cortical defect of the lingual mandible containing salivary gland
usually seen in adolescent males when it occurs in children
represents submandibular fossa

447
Q

stafne defect (static bone cyst) radiographic findings

A

well-defined unilocular radiolucency of posterior mandible below mandibular canal; occasionally seen in anterior mandible

448
Q

treatment for stafne defect (static bone cyst)

A

no treatment

449
Q

median palatal cyst description

A

fissural cyst developes along line of fesion of the lateral palatal shelves
fluctuant swelling of midline palate posterior to incisive papilla
not intimately associated with non-vital teeth

450
Q

radiographic findings median palatal cyst

A

ovoid to circular radiolucency in midline of palate

451
Q

common pericoronal pathology

A

normal follicular space and dentigerous cyst

452
Q

normal vs hyperplastic follicular space appearance

A

may be enlarged or hyperplastic
follicular space should be less than 5mm
if hyperplastic, may delay tooth eruption
if hyperplastic, canine are primarily involved

453
Q

dentigerous cyst findings

A

forms around crown of impacted tooth

may be expansile, painless, tooth eruption failure

454
Q

common sites for dentigerous cyst

A

common sites: mandibular molar, maxillary canine

455
Q

radiographic appearance of dentigerous cyst

A

pericoronal, unilocular radiolucency

456
Q

treatment of dentigerous cyst

A

enucleation of cyst with or without tooth extraction, recurrence is rare

457
Q

buccal bifurcation cyst (inflammatory paradental cyst) description and location

A

occurs in children
usually involves mandibular first molar, 1/3 are bilateral
large periodontal defect on buccal with probing
buccal swelling tenderness, partially or fully erupted tooth; history of pericoronitis

458
Q

radiographic appearance of buccal bifurcation cyst (inflammatory paradental cyst)

A

buccal pericoronal and furcal, unilocular radiolucency; proliferative periosteitis

459
Q

treatment for buccal bifurcation cyst (inflammatory paradental cyst)

A

curettage and enucleation of cyst

460
Q

unicystic ameloblastoma description

A

usually seen in younger age group than conventional ameloblastoma
site: 80% in molar/ramus region of the mandible
may show painless expansion
associated with unerupted tooth

461
Q

radiographic findings for unicystic ameloblastoma

A

unilocular radiolucency with well-defined margins; may be scalloped

462
Q

treatment of unicystic ameloblastoma

A

enucleation with long term follow up; 10-30% recurrence rate

463
Q

Adenomatoid odontogenic tumor description

A

anterior region maxilla > mandible

painless expansion; usually associated with crown of unerupted tooth, especially canine

464
Q

radiographic findings for Adenomatoid odontogenic tumor

A

usually pericoronal radiolucency with well-defined borders; may exhibit flecks of opacities

465
Q

melanotic neuroectodermal tumor of infancy appearance/origin/population

A 
tumor of neural crest origin
usually occurs in the first year of life
anterior maxilla is the most common site
rapidly expanding mass of alveolus
frequently pigmented--blue or black
displacement of teeth
466
Q

lab findings associated with melanotic neuroectodermal tumor of infancy

A

elevated urinary levels of vanillylmandelic acid

467
Q

radiographic findings associated with melanotic neuroectodermal tumor of infancy

A

poorly circumscribed radiolucency with floating teeth; may have sun-ray pattern

468
Q

treatment of melanotic neuroectodermal tumor of infancy

A

prognosis-excision with margins; 20% recur

469
Q

acute suppurative osteomyelitis appearance/causes/site

A

causes odontogenic infection, trauma, idiopathic
necrosis of the bone with pain, fever, trismus, lymphadenopathy
site: usually posterior mandible; maxilla in infants

470
Q

radiographic appearance acute suppurative osteomyelitis

A

ill-defined radiolucency, may have periosteal new bone formation

471
Q

treatment of acute suppurative osteomyelitis

A

antibiotics and drainage

472
Q

what is langerhans cell histiocytosis

A

neoplastic disease of myeloid cells

disseminated and localized forms

473
Q

appearance (skin and oral)/population/site of disseminated langerhans cell histiocystosis

A

multiorgan involvement
young children and infants
site: any bone; skull and mandible are common, jaw involved in 20%
skin lesions: red rash, red-purple nodules
oral findings: ulcers, gingival masses, lymphadenopathy, premature exfoliation of teeth

474
Q

radiographic appearance of disseminated langerhans cell histiocystosis

A

multiple periapical radiolucencies

floating teeth appearance

475
Q

treatment of disseminated langerhans cell histiocystosis

A

curettage and chemotherapy

476
Q

description of localized langerhans cell histiocystosis (eosinophilic granuloma)

A

usually localized to the bone
may have soft tissue involvement
rapid alveolar bone loss and tooth mobility
mimics aggressive periodontitis, periapical inflammatory lesions

477
Q

radiographic appearance of localized langerhans cell histiocystosis (eosinophilic granuloma)

A

multiple periapical radiolucencies; floating tooth appearance

478
Q

treatment of localized langerhans cell histiocystosis (eosinophilic granuloma)

A

curettage when jaw is involved

479
Q

systemic and oral associated with leukemia

A

hematologic malignancy
widespread involvement with fever and fatigue
oral and cutaneous purpura
gingival enlargement with bleeding due to leukemia infiltrates (AML)
oral candidiasis, oral ulcers, atypical gingivitis and tooth mobility

480
Q

radiographic findings associated with leukemia

A

radiographic: diffuse, multifocal, poorly defined radiolucency; loss of lamina dura and dental crypt; floating tooth appearance

481
Q

treatment of leukemia

A

chemotherapy

482
Q

Burkitt lymphoma description and oral findings

A

aggressive malignancy of B-cells
strong association with Epstein Barr Virus
Jaw involvement common initial finding
rapid multifocal expansion of jaws with loosening of teeth

483
Q

radiographic appearnce of Burkitt lymphoma

A

early loss of lamina dura and dental crypt, may have enlargement of follicular spaces, ill-defined radiolucencies, floating tooth appearance

484
Q

treatment for Burkitt Lymphoma

A

chemotherapy

485
Q

Ewing sarcoma description and origin

A

malignancy of mesenchymal stem cells of bone
second most common primary malignant bone tumor in pediatrics
usually in long bones, pelvis, jaw involvement is rare
rapid swelling, pain, ulceration, fever, leukocytosis
metastasis to lungs and bone are common

486
Q

ewing sarcoma radiographic appearance

A

ill-defined radiolucency but mixed radiolucent-radiopaque pattern may be present
infrequently cortical infiltration may produce onion-skin appearance in jaw bone

487
Q

treatment of Ewing sarcoma

A

chemotherapy and surgery with or without radiotherapy

488
Q

signs of metastatic lesions

A

history of malignancy is important
pain, swelling, tooth mobility, paresthesia
site: posterior mandible usually, may be multifocal
soft tissue extension is common
radiographically: poorly delineated radiolucency

489
Q

odontogenic keratocyst (keratocystic odontogenic tumor) description (and clinical findings)

A

agressive odontogenic cyst
pericoronal, periapical, central location
most common in posterior mandible–ascending ramus area
may be locally aggressive with expansion of bone and root resorption; often painful; drainage
25-40% associated with unerupted tooth

490
Q

odontogenic keratocyst (keratocystic odontogenic tumor) radiographic findings

A

radiograph: minimally expansile unilocular or multilocular with thin sclerotic border

491
Q

odontogenic keratocyst (keratocystic odontogenic tumor) is sometimes associated with what syndrome

A

associated with nevoid basal cell carcinoma syndrome

492
Q

odontogenic keratocyst (keratocystic odontogenic tumor) treatment and recurrence rate

A

surgical excision with or without ostectomy

high recurrence rate of 30%

493
Q

nevoid basal cell carcinoma syndrome systemic findings

A 
enlarged occipitofrontal circumference
mild ocular hypertelorism
multiple basal cell carcnimoas
multiple odontogenic keratocysts of the jaws
epidermoid cysts of the skin
palmar and plantar pits
calcified falx cerebri
rib anomalies
spina bifida occulta
hyperpneumatization of paranasal sinuses
494
Q

ameloblastoma clinical findings and affected population

A

may occur at any age, although most common between 20-40 years old, uncommon under the age of 19
commonly involves the posterior mandible
arises from remnants of odontogenic epithelium
clinical findings: usually painless expansion

495
Q

radiographic findings of ameloblastoma

A

multilocular radiolucency, may cause root resorption; often associated with unerupted third molar

496
Q

treatment of ameloblastoma

A

tx: surgical excision with marginal block resection; recurrence rate of 15% with this treatment

497
Q

ameloblastic fibroma location and description

A

mixed odontogenic tumor
commonly found in posterior mandible (70%) often associated with unerupted tooth (75%)
painless expansion

498
Q

patient population affected by ameloblastic fibroma

A

generally seen in patients under 20 years

499
Q

radiographic findings ameloblastic fibroma

A

radiographic: usually pericoronal, multilocular radiolucency, unilocular when small

500
Q

treatment for ameloblastic fibroma

A

surgical excision but may recur

501
Q

central giant cell granuloma description and location

A

reactive versus neoplastic of jaw
aggressive and non-aggressive variants
commonly involves mandible (70%), especially anterior region, posterior lesion may cross midline

502
Q

signs of aggressive central giant cell granuloma

A

aggressive lesions associated with pain, rapid growth, cortical perforation, root resorption, tooth displacement, paresthesia

503
Q

radiographic findings central giant cell granuloma

A

multilocular with well-delineated or ill-defined borders; unilocular when small

504
Q

Treatment and recurrence rate of central giant cell granuloma

A

tx: surgical excision

15-20% recurrence rate

505
Q

jaw lesions with giant cell histopathology seen in children

A

hyperparathyroidism, giant cell tumor, aneurysmal bone cyst, central odontogenic fibroma

506
Q

if multifocal pattern (of giant cell histopathology) include the following syndromes

A 
cherubism
noonan-like syndrome
ramon syndrome
jaffe-campanacci syndrome
neurofibromatosis type I
507
Q

odontogenic myxoma description and etiology

A

arises from mesenchyme of tooth germ
more commonly involves posterior portion of jaws
slow progressive swellings, may cause facial deformity
may displace unerupted teeth, most commonly associated with missing or unerupted tooth; may resortb teeth

508
Q

radiographic findings odontogenic myxoma

A

unilocular or multilocular radiolucency with faint radiopaque striations (stepladder or cobweb appearnce); margins well-defined

509
Q

treatment and recurrence rate of odontogenic myxoma

A

surgical excision

recurrence rate of 25%

510
Q

aneurysmal bone cyst types, age group, description/symptoms

A

reactive versus benign neoplasm
under 20 years is the peak incidence
tender, painful in 50%
usually occurs in the mandible, including body and ascending ramus
cortical expansion with buccal eccentric ballooning of involved area

511
Q

radiographic findings for aneurysmal bone cyst

A

radiograph: expansile, cystic, honeycombed, or soap bubble radiolucency. unilocular when small

512
Q

treatment and recurrence rate for aneurysmal bone cyst

A

currettage or enucleation; en bloc resection for large or recurrent lesion
13% recurrence rate

513
Q

central vascular malformation description

A

may have soft tissue vascular lesions
listen for bruit, palpate for thrill
more common in the mandible
gingival bleeding, tooth mobility, bony expansion; facial asymmetry
may be life threatening if high flow lesion

514
Q

treatment of central vascular malformation

A

advanced imaging, embolization, resection

515
Q

what is cherubism?

A

autosomal dominant disorder
bilateral fullness of cheeks and angles of the mandible, hypertelorism and unpslanting eyes
malocclusion with displaced teeth

516
Q

radiographic findings for cherubism

A

expansile multilocular radiolucencies in all four quadrants; displaced toothbuds

517
Q

treatment of cherubism

A

tends to burn out over time; cosmetic recontouring

518
Q

What is periapical cemento-osseous dysplasia (cementoma)

A 
rarely seen under the age of 20
teeth vital
lesion occurs near and in periodontal ligament
lesion usually multiple
no treatment necessary
519
Q

radiographic findings for periapical cemento-osseous dysplasia

A

radiolucent, mixed, to radiopaque lesions; surrounded by thin radiolucent rim, PDL is intact.

520
Q

what is a calcifying odontogenic cyst? (Gorlin cyst)

A

affects both maxilla and mandible 65% in the anterior region
33% associated with unerupted tooth; most are centrally located in bone
25% associated with odontomas, especially in children
may appear peripherally as gingival lesion
there are aggressive and non-aggressive variants

521
Q

radiographic findings for calcifying odontogenic cyst (Gorlin cyst)

A

well-cicumscribed radiolucency with radioopaque flecks or tooth-like structures

522
Q

treatment for calcifying odontogenic cyst (Gorlin cyst)

A

surgical excision

523
Q

what is ameloblastic fibro-odontoma?

A

mixed odontogenic tumor
site: posterior mandible is the most common
usually asymptomatic; involved with unerupted tooth

524
Q

ameloblastic fibro-odontoma radiographic findings

A

usually unilocular radiolucency with variable amounts of calcifications that resemble odontomas

525
Q

treatment for ameloblastic fibro-odontoma

A

curettage, does not recur

526
Q

what is a calcifying epithelial odontogenic tumor? (pindborg tumor)

A

mandible premolar-molar region most commonly involved
painless swelling of the jaw
often associated with unerupted tooth
may have a central location

527
Q

radiographic findings for calcifying epithelial odontogenic tumor (pindborg tumor)

A

well-circumscribed radiolucency containing varying sized radiopacities, some totally radiolucent

528
Q

treatment for a calcifying epithelial odontogenic tumor? (pindborg tumor) and recurrence rate

A

treatment: local resection

15% recurrence

529
Q

what is cementoblastoma? (and common site)

A

odontogenic tumor of cementoblasts
site: posterior mandible; molar-premolar region; 50% involve first molars, rarely in the primary molar
pain, bony expansion, displaced teeth

530
Q

radiographic findings for cementoblastoma

A

radiograph: localized radiolucent, mixed, radiopaque with radiolucent rim fused to roots, may resorb roots
progresses from radiolucent to radiopaque

531
Q

treatment of cementoblastoma, and recurrence

A

extraction of tooth, excisional biopsy; 22% recur

532
Q

what is central ossifying fibroma?

A

neoplastic lesion with wide age range
either jaw; mandible greater than maxilla
posterior region
slow growing, expansile lesion with bowing of inferior cortex of the mandible

533
Q

radiographic appearance of central ossifying fibroma

A

mixed radiolucent and radiopaque mass with sclerotic border

displacement of teeth, root divergence, root resorption

534
Q

treatment for central ossifying fibroma

A

excision

535
Q

what is juvenile ossifying fibroma

A

rapidly growing neoplasm of the bone
site: occurs in maxilla more than the mandible
aggressive expansile lesion
may see nasal obstruction, involvement of the maxillary sinus, exophthalmia, intracranial extension
displacement of teeth, root divergence, root resorption

536
Q

treatment and recurrence for juvenile ossifying fibroma

A

excision, wide resection, high recurrence rate

537
Q

radiographic appearance for juvenile ossifying fibroma

A

circumscribed radiolucency with calcification; may have “ground glass” appearance
displacement of teeth, root divergence, root resorption

538
Q

what is craniofacial fibrous dysplasia?

A

diffuse and poorly demarcated lesion
developmental disorder
facial asymmetry
painless unilateral enlargement of maxillary bone; mandible may be affected
dental abnormalities: missing premolars; delayed eruption of teeth
segmental odontomaxillary dysplasia should be included in the differential diagnosis

539
Q

radiographic findings craniofacial fibrous dysplasia

A

diffuse ground glass appeearance; poorly defined margins; progresses from radiolucent to radiopaque

540
Q

treatment for craniofacial dysplasia

A

cosmetic recontouring may be necessary; stabilizes after puberty

541
Q

What is Albright syndrome? (polyostotic fibrous dysplasia)

A

abnormal skin pigmentation-large cafe au lait macules
endocrine dysfunction
multiple bones are affected
precocious puberty in females

542
Q

radiographic findings from Albright syndrome

A

poorly defined margins; ground-glass appearance, progresses from radiolucent to radioopaque

543
Q

what is chronic diffuse sclerosing osteomyelitis?

A

cause is uncrtain; lack of an obvious odontogenic infection
recurrent episodes of pain, swelling, induration, restricted mouth opening
absence of fever, purulence or sequestration
may result in ankylosis of the joint
site: posterior mandible and ramus

544
Q

radiographic findings for chronic diffuse sclerosing osteomyelitis

A

radiographs: poorly defined margins, moth-eaten to mottled sclerotic bone pattern

545
Q

treatment for chronic diffuse sclerosing osteomyelitis

A

refractory to treatment, bisphosphonates may be useful

546
Q

What is chronic osteomyelitis with proliferative periostitis

A

due to chronic dental infection
tender, diffusely expansile jaw enlargement
site: posterior mandible

547
Q

radiographic findings from chronic osteomyelitis with proliferative periostitis

A

poorly defined margins, mottled bone pattern with ONION SKIN pattern of periosteum

548
Q

treatment of chronic osteomyelitis with proliferative periostitis

A

treatment: treat the source of infection; bone remodel happens over time (6-12 months)

549
Q

What is osteosarcoma?

A

malignancy of the mesenchymal cells that produce osteoid and bone
most common primary malignant bone tumor
occurs in long bones; uncommon in jaws
most common initial symptom is jaw enlargement especially in the posterior mandible, paresthesia

550
Q

radiographic findings for osteosarcoma

A

poorly delineated radiolucency; mixed or radiopaque lesion; may cause root resorption with widening of periodontal ligament space; spiky root resorption may occur; sunburst pattern is uncommon

551
Q

treatment for osteosarcoma

A

surgical resection, chemotherapy and radiotherapy

552
Q

description of eruption sequestrum

A

dysplastic cementum in the dental follicle
occurs in the molar region
radiographically: small opacity in soft tissue overlying erupted molar
most spontaneously exfoliate

553
Q

description of retained root tip

A

usually lower primary molar

radiograph: well defined oval radiopacity; often can trace a portion of the PDL

554
Q

treatment options for retained root tip

A

extract or periodic evaluation, may partially erupt over time.

555
Q

idiopathic osteosclerosis description

A

cause is unknown; incidental finding
site: mandibular, molar-premolar region
radiograph: well defined oval to irregular radiopacity; usually uniformly opaque
may be adjacent to root apex but normal periodontal ligament space.

556
Q

treatment for idiopathic osteosclerosis

A

none, periodic evaluation, tends to stabilize with time

557
Q

focal sclerosing osteomyelitis (condensing osteitis)

A

commonly involves mandibular first molar
reactive process of bone at apex in association with carious lesion
symptoms related to pulpal status; non-expansile lesion
xray: well defined, oval to irregular radioopacity, uniform density in the periapical region
tx: treat tooth, lesion stabilizes or resolves

558
Q

odontoma description

A

common odontogenic lesion
delayed tooth eruption is a common sign
occurs in maxilla more than the mandible
often pericoronal but may be periapical or intraradicular
may be associated with calcifying odontogenic cyst, ameloblastic fibro-odontoma, odontoameloblastoma

559
Q

odontoma radiographic findings

A

compound: resembles tooth-like structures
complex: amorphous mass
both have radiolucent border

560
Q

treatment of odontoma

A

excisional biopsy

561
Q

antral pseudocyst description

A

inflammatory lesion of the sinus
located in the floor of the maxillary sinus
asymptomatic unless sinusitis or allergies present

562
Q

radiographic findings for antral pseudocyst

A

dome-shaped, radioopacity of the maxillary sinus

563
Q

treatment for antral pesudocyst

A

no treatment, rule out an odontogenic infection if symptomatic

564
Q

description of torus/exostoses, prevalence in children

A

most represent developmental lesions
uncommon in children, but common in adults
slow growing asymptomatic enlargement unless alveolar mucosa is ulcerated
radiographically: well demarcated, oval to elliptical radiopacity, usually overlying roots of teeth, “headlights” appearance
no treatment necessary

565
Q

types of exostoses

A

exostosis: single or multiple enlargements on the buccal or palatal alveolar ridges
torus palatinus: midline hard palate
torus mandibularis: lingual mandible premolar region

566
Q

where is a sialolith seen radiographically?

A

pain when eating, radiopacity in floor of the mouth

567
Q

where is a tonsillolith seen radiographically?

A

non-tender radiopacities overlying the ramus

568
Q

what children experience phleboliths?

A

in child associated with vascular lesions; usually multiple radiopacities

569
Q

where are calcified lymph nodes seen radiographically?

A

usually history of chronic infection such as TB, discrete radiopacities

570
Q

description of an osteoma

A

benign tumor or hamartomatous lesion of mature bone
almost exclusively in the craniofacial region
peripheral and central locations
may cause facial asymmetry
mandible>maxilla
seen at lower mandibular border angle, ramus, condyle

571
Q

radiographic findings of osteoma

A

well-demarcated, round to oval radiopacity; may cause cortical expansion

572
Q

description of gardner syndrome

A

autosomal dominant
multiple osteomas, epidermoid and dermoid cysts
multiple polyposis of large intestines with high malignant potential
dental findings: supernumerary teeth or delayed eruption

573
Q

segmental odontomaxillary dysplasia description

A

developmental disorder of the jaw, painless unilateral enlargement of the maxilla
mild facial asymmetry, gingival hyperplasia, hypoplastic or missing teeth
radiograph: poorly-demarcated, thickened radiopaque trabeculae; vertically oriented and granular to streaky appereance
tx: restoration of involved teeth, gingival and bone recontouring as needed.

Pediatric Dentistry Handbook (9 decks)

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