Chapter 3: Oral Pathology and Associated Syndromes Flashcards
where are epstein pearls located?
the palatal midline
where are Bohn nodules found?
on the junction of hard and soft palate, remnant of minor salivary glands
where are dental lamina cysts found?
occurs on alveolar mucosa, remnants of dental lamina
How common are palatal cysts of the newborn?
55-85%
Gingival (alveolar) cyst of the newborn occurs in what % of newborns
50%
Sucking pads and calluses
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
Concurrent conditions with sucking pads and calluses
Leukoedema, labial vesicles, bullae, erythema of nasiolabial folds and lips
Treatment of sucking pads and calluses
resolves, feeding position, lip emollient, such as lanolin
What organism causes pseudomembranous candidiasis
Candida albicans
Contributing factors toward pseudomembranous candidiasis
Maternal vaginal or breast infection, prematurity, immunosuppression, antibiotics
Appearance of pseudomembranous candidiasis
white nonadherent papules and plaques with a curdled milk appearance
Treatment of pseudomembranous candidiasis
nystatin, fluconazole
What conditions mimic pseudomembranous candidiasis
Coated tongue, materia alba, oral cyst of the newborn, mucosal sloughing, breastfeeding keratosis
what can cause riga-fede disease
chronic trauma from the primary incisors
what does Riga-Fede disease appear as?
represents a traumatic granuloma, ulcerated lesion or mass on the anterior ventral tongue
Treatment of Riga-Fede disease
Identify the cause, modify feeding position and bottle used, smooth incisal edges, apply Chlorhexidine rinse to ulcer for secondary infection, evaluation of ankyloglossia
What does Riga-Fede disease mimic
neuropathologic chewing, factitial injury, trauma from child abuse
Tongue trauma in infants may occur from
neuropathologic chewing, seizure disorder, incorrect usage of pacifier, bottle, teething rings
Conditions with neuropathologic ulcers
familial dysautonomia
- Lesch-Nyhan syndrome
- Gaucher disease
- Cerebral palsy
- Tourette syndrome
- Rhett syndrome
- Autism
- Cornelia de Lange syndrome
- Traumatic brain injury
Types of vascular tumors
Infantile hemangioma, congenital hemangioma, pyogenic granuloma (lobular capillary hemangioma)
Types of vascular malformations
capillary malformation, venous malformation, lymphatic malformation, arteriovenous malformation, combined malformation
when do vascular malformations appear
at birth, and is persistent, occurs in 0.3% of infants
do vascular malformations grow
tends to grow with the child
where do vascular malformations appear
occurs in the head and neck region, including facial skin
what are vascular malformations associated with
skeletal changes, may be intrabony
what do vascular malformations look like
red, purple, blue macule, nodule or diffuse swelling
what is the difference between low-flow and high-flow vascular malformations
low-flow is a venous malformation
high-flow: arteriovenous malformation with bleeding, pain warmth, palpable thrill or bruit
Name the syndrome associated with vascular lesion of face and brain, port-wine nevus, risk for seizure disorder
Sturge-Weber syndrome
Treatment of vascular malformations
surgery, embolization, laser treatment for port wine nevus
what do vascular malformations mimic
hemangioma, varix, eruption cyst/hematoma, blue nevus, ecchymosis
types of hemangioma
infantile and congenital
how common are hemangiomas
neoplasm of vascular origin affecting 5% of infants
what percent occur of hemangiomas occur in the head and neck region
60%
what major salivary gland might hemangiomas be associated with?
parotid
common oral sites for hemangiomas
lip and tongue
appearance of hemangiomas
normal or reddish-blue skin coloration with swelling
rubbery to palpation and may not blanch
treatment of hemangiomas
observe, propranolol, steroids
hemangiomas may mimic
vascular malformation, pyogenic granuloma, hematoma, mucocele
lympathic malformation represent what type of growth
hamartomatous growth of lymphatic vessels
what percent of lympathic malformations occur in the head and neck
50-75%
what age do most lympathic malformations appear
90% develop by the age of 2
appearance of lympathic malformations
superficial lesions are pink, red, or purple with pebbly vesicular surfaces
appearance of cystic hygroma
diffuse swelling of cervical region of neck, parotid gland, tongue
lympathic malformation may cause
compromised airway, and rarely regress
treatment of lympathic malformation
surgery, sclerotherapy, drugs
lympathic malformations may mimic
venous malformation, squamous papilloma, mucocele
when does neonatal alveolar lymphangioma appear
present at birth
what demographic is usually affected by neonatal alveolar lymphangiomas
African American Males
appearance of neonatal alveolar lymphangioma seen intraorally
alveolar ridge, mandible>maxilla
translucent pink to blue, fluctuant swelling
treatment for neonatal alveolar lymphangioma
none, resolves spontaneously
neonatal alveolar lymphangioma may mimic
gingival cyst of the newborn, eruption cyst
what is congenital epulis
soft tissue tumor of unknown origin
firm, pink to red mass arising from alveolar mucosa at birth
congenital epulis is seen more in which gender
occurs in females 90%
which arch is congenital epulis most commonly found
maxilla>mandible
most common site intraorally for congenital epulis
maxillary lateral and canine region
what does congenital epulis mimic
eruption cyst, gingival hamartoma, pyogenic granuloma, fibrous epulis
what is congenital hamartoma
overgrowth of normal tissue that belongs at that site
what is congenital choristoma
overgrowth of normal tissue that does not belong to that site
most common location of congenital hamartoma/choristoma
tongue and alveolar mucosa
what do congenital hamartoma/choristomas appear as
firm, pink nodules, single or multiple; non-tender
soft-tissue tumor-like enlargement
treatment of congenital hamartoma/choristoma
excisional biopsy, exclude syndromes such as orofacial digital syndrome
congenital hamartoma/choristomas may mimic
irritation fibromas, congenital epulis, lipoma, peripheral ossifying fibroma
melanotic neuroectodermal tumor of infancy originates from what structure
neural crest origin
at what age does a melanotic neuroectodermal tumor of infancy usually occur
usually occurs in the first year of life
where is a melanotic neuroectodermal tumor of infancy usually found?
anterior maxilla is the most common site
appearance of melanotic neuroectodermal tumor of infancy
rapidly expanding mass of alveolus, displacement of teeth
frequently pigmented blue or black
lab signs of melanotic neuroectodermal tumor of infancy
elevated urinary levels of vanillylmandelic acid
radiographic signs of melanotic neuroectodermal tumor of infancy
poorly circumscribed radiolucency with floating teeth, may have sun ray pattern
treatment of melanotic neuroectodermal tumor of infancy
prognosis, excision with margins, 20% recur
melanotic neuroectodermal tumor of infancy may mimic
congenital epulis, intrabony vascular malformation, malignancy
hemifacial hyperplasia signs and symptoms
unilateral oral and facial enlargement, usually evident at birth
involves soft tissues, bone, tongue, palate teeth
teeth may exfoliate and erupt prematurely
hemifacial hyperplasia is often seen on which side of the face
right side> left side
hemifacial hyperplasia may be associated with other findings like
increased incidence of abdominal tumors (Wilms tumor, hepatoblastoma, cortical carcinoma)
Intellectual disability in 20%
treatment for hemifacial hyperplasia
evaluate for syndrome, cosmetic surgery, orthodontics
syndromes associated with hemifacial hyperplasia
neurofibromatosis, Beck-with-Wiedemann, McCune-Albright, others
hemifacial hyperplasia may mimic
segmental odontomaxillary dysplasia
Which brachial arches are associated with hemifacial microsomia
anomalies of the first and second brachial arches
inheritance pattern of hemifacial microsomia
unilateral microtia, microstomia and failure of formation of mandibular ramus and condyle
other systems affected by hemifacial microsomia
frequent eye and skeletal involvement
50% have cardiac pathology (VSD, PDA)
cause of hemifacial microsomia
unknown etiology
treatment of hemifacial microsomia
orthognathic surgery, distraction osteogenesis
syndrome of hemifacial microsomia
goldenhar syndrome
hemifacial microsomia may mimic
localized scleroderma, unilateral TMJ ankylosis, fracture
white wipable lesions
coated tongue pseudomembranous candidiasis morsicatio (cheek or lip chewing) chemical burn toothpaste or mouthwash reaction
white non-wipable, bilateral lesions
bilateral/symmetrical: linea alba, leukoedema, reticular lichen planus, white sponge nevus
white non-wipable, unilateral lesions
smokeless tobacco keratosis, pachyonychia congenita, dyskeratosis congenita, hereditary benign intraepithelial dyskeratosis
What causes pseudomembranous candidiasis
caused by candida species, especially Candida albicans, which usually does not cause infection unless host is immunocompromised
how may a newborn acquire pseudomembranous candidiasis
a newborn’s mother may have untreated vulvovaginitis
what increases susceptibility of pseudomembranous candidiasis
long term antibiotics, corticosteroids, drugs that cause xerostomia, oral appliances
intraoral presentation of pseudomembranous candidiasis
multifocal white papules and plaques that wipe off and red patches that may burn
It is white and wipes off
treatment of pseudomembranous candidiasis
tx: nystatin, clotrimazole, fluconazole, itraconazole
what is coated tongue made up of and where is it located?
collection of bacterial and sloughed epithelial cells on the dorsal tongue
contributes to halitosis
may be diffuse or localized to the posterior tongue
contributing factors of coated tongue
xerostomia, mouth-breathing, sinusitis, poor OH, febrile conditions, dehydration
treatment of coated tongue
improve hydration, gently debride dorsal tongue, improve OH
what is leukoedema? where is it located?
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
who does leukoedema often effect?
most commonly observed in blacks, occurring in 50% of children
treatment for leukoedema
none indicated
what causes frictional keratosis (morsicatio) lesions?
caused by low-grade chronic irritation that is usually obvious, especially chronic nibbling of the mucosa
where is frictional keratosis (morsicatio) lesions usually seen?
gingiva, buccal mucosa, and lateral tongue
what does frictional keratosis (morsicatio) lesions look like?
white, smooth to shaggy non-tender, adherent patches
may observe a prominent linea alba on buccal mucosa
treatment for frictional keratosis (morsicatio) lesions
none, habit modification
where are mucosal burns (thermal) observed and what are their typical causes?
thermal burn is common due to pizza, soup, and hot beverages
usually seen on the palate and tongue
where are mucosal burns (chemical) observed and what are their typical causes?
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
what do mucosal burns look like?
irregular, white necrotic patch that wipes off or red erosion, tender
treatment of mucosa burns
palliative treatment only
what causes mucosal sloughing (toothpaste/mouthwash reaction)
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
site of (toothpaste/mouthwash reaction)
usually the buccal and labial mucosa and floor of the mouth
treatment of (toothpaste/mouthwash reaction)
discontinue causative agents, palliative treatment if needed, most resolve in several days
signs and symptoms of (toothpaste/mouthwash reaction)
burning sensation, peeling of filmy white material, may be associated with erythema, ulcers and vesicles.
other names for benign migratory glossitis
geographic tongue, erythema migrans
cause of benign migratory glossitis
unknown, association with atopy
what does benign migratory glossitis look like and where does it appear?
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
treatment for benign migratory glossitis
palliative treatment as needed, persistent condition
what are fordyce granules and where/when do they appear?
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
treatment for fordyce granules
none
causes of smokeless tobacco keratosis
chewing tobacco, snuff, snus
location/appearance of smokeless tobacco keratosis
occurs in vestibular mucosa
white, wrinkled, adherent plaque, gingival recession, stained, sensitive teeth, root caries, halitosis
treatment of smokeless tobacco keratosis
discontinue the habit, biopsy persistent lesions
chances of malignancy with smokeless tobacco keratosis
rare malignant transformation
white hairy tongue appearance/location
accumulation of keratin filiform papillae
occurs on dorsal tongue
multiple cream-colored to brown, slender surface projections; may not have a thick-matted appearance
cause of white hairy tongue
cause is unknown,
xerostomia, poor OH, tobacco smoking in adolescence
treatment of white hairy tongue
improve hydration, brush tongue, discontinue cigarette smoking
what is lichen planus
chronic mucocutaneous disease, rare in children
cause of lichen planus
t-cell mediated autoimmune disease, some cases represent a contact allergy (lichenoid reaction)
intraoral appearance of lichen planus
white lacy lines with red background, bilateral and symmetrical, burns, WAXES and WANES
sites, and oral sites of lichen planus
oral sites include buccal mucosa, gingiva and tongue
affects both skin, especially extremities, and oral mucosa
may have a secondary candidal infection
treatment of lichen planus
incisional biopsy, topical steroids, and antifungal agents
What disease is Chronic hyperplastic candidiasis associated with
a chronic mucocutaneous disease that are sometimes associated with endocrine disease and autoimmune disorders
location of Chronic hyperplastic candidiasis
site: anterior buccal mucosa and tongue, may have nail involvement
appearance of Chronic hyperplastic candidiasis
white, wrinkled adherent plaques that are adherent, may be tender
treatment of chronic hyperplastic candidiasis
incisional biopsy, antifungal agents
contributing factors/cause of hairy leukoplakia
cause by latent infection of Epstein Barr Virus
contributing factors: immunosuppression, especially HIV
site and appearance of hairy leukoplakia
site: ventrolateral tongue
white, shaggy plaques that are adherent, may be tender
superimposed candidal infection
treatment of hairy leukoplakia
incisional biopsy if cause is not evident, antiviral and antifungal agents if problematic
what is white sponge nevus and what does it look like?
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
treatment of white sponge nevus
none, persistent condition
what is hereditary benign intraepitherlial dyskeratosis (HBID)
autosomal dominant mucocutaneous disease
appears similar to white sponge nevus but affects eyes, may cause visual impairment
who does hereditary benign intraepitherlial dyskeratosis (HBID) effect?
affects individuals of mixed white, American Indian, and black ancestry living in North Carolina.
What are Koplik spots, and where do they appear?
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)
treatment of Koplik spots
referral to the pediatrician
types of red lesions
vascular-diascopy positive (blanch with pressure)
vascular-diascopy negative (does not blanch with pressure)
non-vascular
acute gingivitis cause
plaque induced inflammatory lesion
description of acute gingivitis
lesions may blanch with pressure to due vascular dilation
non-tender, red, swollen lesions that may bleed with toothbrushing
treatment of acute gingivitis
improve OH, reversible lesion
description of submucosal hemorrhage
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
most common cause for submucosal hemorrhage
trauma
some may be associated with child abuse
non-traumatic causes of submucosal hemorrhage (rare)
blood dyscrasia, viral infection (infectious mononucleosis, measles), anticoagulants
treatment of submucosal hemorrhage
resolves in 1-2 weeks, if recurrent, identify cause
description of traumatic erythema
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
tx of traumatic erythema
palliative treatment, if tender, resolves in less than 1 week
other causes of erythema
vascular malformations and thermal burns (more commonly leukoplakic)
description of glossitis
redness due to thinning of the oral mucosa
generalized erythema and depilation of dorsal tongue, may appear normal
burning sensation
causes of glossitis
anemia, candidiasis, vitamin B deficiency, factitial injury, xerostomia, allergies, diabetes, hypothyroidism
treatment of glossitis
treat underlying cause
what is hereditary hemorrhagic telangiectasia
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
prominent signs of hereditary hemorrhagic telangiectasia
epistaxis and oral bleeding
what is sturge-weber angiomatosis
congenital port wine stains of upper face that includes forehead
leptomeningeal angiomas
ipsilateral facial angiomatosis usually
ipsilateral gyriform calcifications of cerebral cortex
sturge-weber angiomatosis may be affected with (systemically)
intellectual disability, seizures, strokes, ocular defects
oral findings for sturge-weber angiomatosis
oral bleeding, pyogenic granulomas, gingival hyperplasia, alveolar bone loss, diffuse vascular lesions
treatment for sturge-weber angiomatosis may include
aspirin for stroke prevention
other rare causes of oral erythema
acquired coagulation disturbance, plasminogen deficiency, thrombocytopenia, hemophilia
types of hemophilia associated with oral erythema
Factor VIII, FACTOR IX, von Willebrand disease, vitamin K deficiency, hepatobiliary disease
most common types of red and white lesions
geographic tongue and candidiasis
geographic tongue (benign migratory glossitis) description/location
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
what percent of the population does geographic tongue (benign migratory glossitis) affect
affects 2% of the population
cause and treatment of geographic tongue (benign migratory glossitis)
unknown cause
palliative treatment
cinnamon contact mucositis cause
cause-flavoring agent in oral hygiene products, candy, gum
cinnamon contact mucositis location and appearance
occurs on buccal mucosa and lateral tongue
white, shaggy, adherent patches with erythema, tender
treatment of cinnamon contact mucositis
identify cause and discontinue offending agent
lichen planus description and location
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
lichen planus cause
t-cell mediated autoimmune disease, some cases represent a contact allergy (lichenoid reaction)
treatment of lichen planus
incisional biopsy, topical steroids, antifungal agents (may have secondary candidal infection)
syndromes associated with diffuse brown/black/grey lesions
Peutz-Jegher’s
Addison’s disease
why would a submucosal hemorrhage (petechiae, purpura, ecchymoses) may be blue-gray in color
hemosiderin deposition
suspect repeated trauma or chronic condition if multiple colors of bruising are present
late or resolving traumatic lesion
site and description of a melanotic macule
common lesion due to focal increase in melanin
Site: lip, buccal mucosa, gingiva, palate
solitary, round to oval macule, brown, grey, black in color
treatment of melanotic macule
none required, no malignant potential
excise if sudden onset and large
description of an ephelis (freckle)
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
treatment of an ephelis (freckle)
none required, sunscreen to prevent more lesions and darkening of lesions
site and description of amalgam/graphite tattoo
grey or blue macule on gingiva and palate
entrapped foreign body, history supports lesion
large particles may be seen on radiographs
treatment for amalgam/graphite tattoo
none required
description of melanocytic nevus
benign proliferation of nevus cells
may be congenital
common in skin and uncommon in mouth
oral site/description of melanocytic nevus
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
treatment of melanocytic nevus
excisional biopsy, rare malignant potential
where is a melanoma usually found intraorally
on the palate and gingiva
who does oral melanoacanthoma usually affect
rapidly enlarging lesion that occurs in blacks
what is melanotic neuroectodermal tumor of infancy
expansile destructive tumor of the anterior maxilla
where is physiologic (racial) pigmentation usually found?
most prominent on the attached gingiva
description of brown hairy tongue
exogenous staining of elongated filiform papillae
what is post-inflammatory pigmentation
hyperpigmentation in response to chronic mucosal trauma
what is acanthosis nigricans and what systemic conditions is it associated with in children
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
what is smoker’s melanosis
brown patch on the anterior gingiva and labial mucosa
usually in females, may be localized
what is melasma
symmetrical pigmentation of face and neck associated with pregnancy and oral contraceptives
describe the generalized pigmentation seen in patient’s with Addison disease
oral: diffuse gray patches
what is addision’s disease and common signs/symptoms
adrenal insufficiency
weakness, nausea, vomiting, low blood pressure, oral and cutaneous pigmentation
describe Peutz-Jegher’s syndrome and the generalized pigmentation seen in these patients
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
medications associated with generalized pigmentation and location of pigmentation (usually)
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
heavy metal toxicity from Bismuth may cause
gingivostomatitis similar to necrotizing ulcerative gingivitis
blue-black pigmentation of interdental papillae
heavy metal toxicity from Lead may cause
salivary gland swelling and dysphagia
grey pigmentation of marginal gingiva
heavy metal toxicity from Mercury may cause
ropy, viscous saliva,
faint grey alveolar gingival pigmentation
gingivostomatitis similar to necrotizing ulcerative gingivitis
heavy metal toxicity from Silver may cause
skin is slate gray
diffuse pigmentation
heavy metal toxicity from copper may cause
blue-green gingiva and teeth
heavy metal toxicity from Zinc may cause
blue-grey line on gingiva
periodontal involvement
Hemochromatosis may cause what type of pigmentation
iron storage disease
bronzing of skin and gray pigmentation of palate
Neurofibromatosis may cause what type of pigmentation
multiple cafe au lait macules and pigmented neurofibromas
McCune-albright syndrome may cause
Large cafe au lait macules, endocrine disease, polyostotic fibrous dysplasia
description of a parulis (color, cause, feel)
odontogenic or gingival infection, or entrapped foreign body
red or pinkish white nodule with purulence, fluctuates in size
soft and tender to palpation
treatment of a parulis
treat source of infection, currette lesions, antibiotics may be indicated
description and site of a pyogenic granuloma
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
treatment of pyogenic granuloma
surgical excision, removal of irritant
origin of localized juvenile spongiotic gingival hyperplasia
sulcular, junctional epithelial
what is localized juvenile spongiotic gingival hyperplasia
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
localized juvenile spongiotic gingival hyperplasia treatment
does not respond to local plaque control
tx: surgical excision, may resolve spontaneously
cause, description, and location of irritation fibroma
reactive hyperplasia due to chronic trauma
occurs on buccal and labial mucosa, gingiva and tongue
pink, smooth nodule, non-tender
treatment of irritation fibroma
surgical excision
description of peripheral ossifying fibroma
reactive lesion
occurs ONLY on the gingiva
firm, pink, or red nodule that begins in interdental papilla, usually ulcerated
may displace of loosen teeth
radiographic findings of peripheral ossifying fibroma
may show foci of dystrophic calcification
may displace teeth
treatment of peripheral ossifying fibroma
surgical excision down to periosteum
recurrence rate of peripheral ossifying fibroma
up to 16%
description of eruption cyst/hematoma
soft tissue dentigerous cyst, associated with eruption of permanent and primary teeth
red, purple swelling of alveolar mucosa
radiographic findings for eruption cyst/hematoma
may show an enlarged follicular space that extends to alveolar mucosa
treatment for eruption cyst/hematoma
none, unless delayed eruption, or symptomatic
squamous papilloma cause
caused by human papillomavirus
occurs on soft palate tongue and labial mucosa, uncommon on gingiva
squamous papilloma location
occurs on soft palate tongue and labial mucosa, uncommon on gingiva
squamous papilloma description
pink, or white papillary, pedunculated nodule
treatment of squamous papilloma
excisional biopsy
if multiple lesions, rule out verruca vulgaris and condyloma acuminatum
giant cell fibroma description and cause
fibrous hyperplasia of unknown cause
pink, smooth to stippled nodule, non-tender
giant cell fibroma location
occurs on gingiva, hard palate, and tongue
treatment of giant cell fibroma
surgical excision
peripheral giant cell granuloma cause
reactive lesion caused by local irritation
peripheral giant cell granuloma description and location
occurs on gingiva and alveolar mucosa only
red or purple nodule that may bleed
may cause superficial bone resorption
treatment of peripheral giant cell granuloma
surgical excision and remove local irritation
rare cases represent central bony lesion with soft tissue extension
recurrence rate of peripheral giant cell granuloma
10%
examples of neoplastic lesions that cause localized gingival enlargement
benign neoplastic lesions langerhans cell histiocytosis aggressive fibromatosis malignant disease, like lymphoma metastatic disease
3 most Common types of generalized gingival enlargements (types of gingivitis)
chronic hyperplastic gingivitis (plaque induced)
mouth-breathing gingivitis
puberty (hormonal induced) gingivitis
gingival fibromatosis
giant cell fibroma
leukemic infiltrates (AML, or CML)
ganulomatous gingivitis
types of medications which cause drug induced gingival hyperplasia and the prevalence
phenytoin (prevalence 50%)
cyclosporine (prevalence 25%)
calcium channel blockers (prevalence 25%)
linear gingival erythema cause/assocation
appears to be associated with candidal infection
HIV related or immunosuppressed children
key findings and description of linear gingival erythema
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
treatment of linear gingival erythema
tx: local debridement, chlorhexidine rinse, with or without antifungal agents
cause of plasma cell gingivitis
allergic reaction to multiple allergens including those found in toothpaste, candy, chewing gum, and mouthwash
appearance and location of plasma cell gingivitis
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
diagnosis and treatment of plasma cell gingivitis
dx: incisional biopsy, dietary history, allergy testing if persistent
tx: identify and eliminate the allergen, topical steroids
inheritance pattern of gingival fibromatosis
may be familial or idiopathic
autosomal dominant if familial
what is gingival fibromatosis
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
gingival fibromatosis may have what impact on eruption
may delay eruption and cause malocclusion
treatment and recurrence of gingival fibromatosis
routine dental prophylaxis if mild, surgical excision (gingival recontouring if severe)
recurrence is common
cause of gingivitis secondary to leukemia
gingivitis secondary to neutropenia
gingival enlargement due to leukemic infiltrates especially in myelomonocytic types
other oral signs of leukemia
other signs include spontaneous gingival bleeding, mucosal petechiae and ecchymosis, ulcerations, tumor-like growths, mobility of teeth
radiographic findings associated with leukemia
multifocal alveolar bone loss, loss of lamina dura
oral treatment of leukemia
oral hygiene measures tolerated by lab studies
systemic factors associated with gingivitis (syndromes, diet, etc)
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
granulomatous gingivitis may be associated with
foreign body gingivitis orofacial granulomatosis Crohn disease Sarcoidosis Granulomatosis with polyangiitis (Wegener granulomatosis)
where are mucoceles usually located
lower lip
where is squamous papilloma usually located
soft palate, tongue
where are fibromas usually located
buccal mucosa, lower lip, tongue
where are ranulas found
floor of the mouth
where are lymphoepithelial cyst usually located
floor of the mouth
cause of mucocele
due to severance of duct and spillage of mucin into tissues
location of mucocele
most frequent on the lower lip, but may occur on the palate or tongue, floor od the mouth, buccal mucosa
appearance of mucocele
fluid-filled, translucent blue nodule, fluctuates in size, may be tender
treatment of mucocele
tx: excisional bipsy; ay spontaneously resolve
soft tissue abscess location and cause
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
treatment of soft tissue abscess
treat cause, may require incision and drainage
cause of verruca vulgaris
caused by HPV 2 and others
oral and other site of verruca vulgaris (common wart)
common on skin but uncommon in mouth
occurs on skin, especially hands, face
oral site include lip vermillion, labial mucosa, anterior tongue
appearance of verruca vulgaris
pink or white stippled to papillary nodules; usually multiple
treatment of verruca vulgaris
exisional biopsy in mouth, refer skin lesions to prevent spread
description of lipoma
well circumscribed submucosal mass less
soft, freely movable
yellow in color
location of lipoma
common on buccal mucosa, tongue, floor of mouth
treatment of lipoma
surgical excision
what is a traumatic neuroma
reactive lesion that may be tender
focal reactive lesion due to a local injury
clinically resembles a fibroma
may be tender to palpation
treatment of traumatic neuroma
excisional biopsy
types of vascular lesions
hemangioma, vascular malformation, lymphatic malformation
what is multifocal epithelial hyperplasia (Heck disease) caused by
caused by HPV 13, 31
risk factors for multifocal epithelial hyperplasia (Heck disease)
risk factors include genetics, ethnicity, poverty, malnutrition, poor hygiene, HIV, infection
occurs usually in children
appearance of multifocal epithelial hyperplasia (Heck disease)
numerous pink nodular lesions with a stippled, flat-topped to papillary surface
may be mistaken for condylomas
sites of multifocal epithelial hyperplasia (Heck disease)
labial and buccal mucosa, tongue are common sites
angioedema cause
allergic and hereditary forms
multiple allergens and physical stimuli can trigger reaction
what happens when agioedema occurs
acute onset of swelling and itching
swelling of face, kips, tongue, pharynx, extremities
may be life threatening with laryngeal involvement
treatment of angioedema (both hereditary and allergic form)
allergic form– antihistmines, steroids, epinephrine,
hereditary form-androgens and esterase-inhibiting drugs
orofacial granulomatosis cause/trigger
granulomatous disease due to abnormal immune reaction
ford allergens are trigger for children
may have GI problems
site of orofacial granulomatosis
lip, buccal mucosa, gingiva and tongue
appearance of orofacial granulomatosis
persistent swelling, erythema, ulvers, cobblestone pattern, fissured tongue
treatment of orofacial granulomatosis
incisional biopsy, identify the allergen, steroids, other
rule out Chron’s disease
multiple endocrine neoplasia, type 2B inheritance pattern
autosomal dominant
appearance of multiple endocrine neoplasia, type 2B
Marfanoid body, narrow facies, full lips,
mucosal neuromas of lips, tongue, buccal mucosa, and gingiva
multiple endocrine neoplasia, type 2B may cause
medullary carcinoma of the thyroid
pheochromocytoma
treatment of multiple endocrine neoplasia, type 2B
biopsy to confirm diagnosis, early evaluation of thyroid is important
types of benign mesenchymal neoplasms
neurilemmoma, neurofibroma
benign and malignant salivary gland tumors
canalicular adenoma found on upper lip
malignant salivary gland tumors of the posterior buccal mucosa
most common reason for tongue swelling
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
another common reason for tongue swelling
hyperplastic foliate papilla
benign lymphoid hyperplasia of lingual tonsil
enlargement triggered by infection or trauma to the area
site and appearance of hyperplastic foliate papilla swelling
site: posterior lateral tongue, often bilateral
yellow-pink to red enlargement with irregular surface, may be tender
important oral cancer site
treatment of hyperplastic foliate papilla
tx: none except treat the source of irritation if present, may spontaneously resolve
other less common reasons for tongue swelling
irritation fibroma, pyogenic granuloma, mucocele of Blandin-Nuhn, entrapped foreign body, tongue piercing, giant cell fibroma
rare reasons for tongue swelling
vascular malformation, hemangioma, lymphatic malformation
granular cell tumor
what is a granular cell tumor and where is it found
granular cell tumor: benign neoplasm of Schwann cells, dorsal tongue most common oral site, pale/smooth or slightly stippled nodule
treatment for granular cell tumor
excisional biopsy
micro findings for granular cell tumor
pseudoepitheliomatous hyperplasia of surface epithelium and sheets of granular cells
hamartoma and choristoma location
tongue is the most common site
hamartoma and choristoma may be associated with what syndrome
may be associated with syndromes such as oral-facial-digital syndrome
treatment of hamartoma and choristoma
surgical excision
lingual thyroid origin, location, and appearance
developmental lesion
ectopic thyroid tissue in the tongue
located midline base of the tongue
what percentage of lingual thyroid is associated with hypothyroidism
33%
treatment for lingual thyroid
thyroid replacement therapy; may require surgery
what is cretinism
congenital hypothyroidism (myxedema in adults)
what does cretinism cause
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
treatment for cretinism
thyroid replacement therapy
syndromes associated with macroglossia
down syndrome neurofibromatosis type 1 mucopolysaccharidosis (multiple types) Multiple endocrine neoplasia type 2B Beckwith-Weidemann syndrome Duchenne muscular dystrophy (hypotonicity of tongue)
most common reason for submucosal swelling
enlarged varices
description of a ranula
mucous retention in oral floor
dome shaped, painless, soft swelling of normal or blue color
unilateral; fluctuates in size
arises from the sublingual gland
treatment for a ranula
excisional biopsy, marsupialization of small lesions
causes of sialolithiasis (salivary stone)
calcium slats around focal debris in duct
symptoms associated with sialolithiasis (salivary stone)
episodic pain and swelling when eating
appearance of sialolithiasis (salivary stone)
xray may aid in detection
yellow-white mass may be seen close to ductal orifice
usually sialolithiasis (salivary stone) involves what duct
usually involves Wharton’s duct
treatment of sialolithiasis (salivary stone)
tx: gentle massage, salivary stimulation, surgery
what is oral lymphoepithelial cyst
entrapped epithelium within lymphoid tissue
undergoes cystic degeneration
persistent yellow-white nodule
where are oral lymphoepithelial cysts found
occurs in oral floor, soft palate, tonsillar region and lateral tongue
treatment for oral lymphoepithelial cysts
observe or excisional biopsy
location of epidermoid/dermoid cyst
midline floor of the mouth
rare sublingual swelling
salivary gland tumors causing sublingual swelling are usually benign or malignant
most likely malignant
What is Ludwig’s angina
life-threatening infection, may cause sublingual swelling
usually of odontogenic origin
Common causes of palatal swelling
benign lymphoid hyperplasia
palatal abscess
torus palatinus
squamous papilloma
benign lymphoid hyperplasia appearance and origin
oral tonsil tissue
yellow pink to red nodules
may be tender
treatment for benign lymphoid hyperplasia
none
palatal abscess origin
odontogenic and gingival in origin
torus palatinus description, and treatment
bony exostosis that occurs in the midline of the hard palate
nodular to lobular in appearance
no treatment required
HPV strains which cause squamous papilloma
caused by HPV 6 and 11
location of squamous papilloma
occurs on tongue, labial mucosa and soft palate
most common mass of the soft palate
description of squamous papilloma
solitary pink or white nodule with multiple fingerlike projections
treatment for squamous papilloma
tx: excisional biopsy
what is a nasopalatine duct cyst
arises from remnants of nasopalatine duct
located in midline between roots of maxillary incisors
effects of nasopalatine duct cyst
may cause root divergence
may cause fluctuant swelling
radiographic appearance of nasopalatine duct cyst
oval to heart shaped radiolucency
treatment of nasopalatine duct cyst
surgical excision/curretage
causes of inflammatory papillary hyperplasia
reactive hyperplasia of the hard palatal mucosa
inflammatory papillary hyperplasia may be associated with
associated with dentures, palatal coverage appliances, high palatal vault, mouth-breathing
may associated with candidal infection, alongside trauma from appliance
appearance of inflammatory papillary hyperplasia
red or pink sheets of papules, non-tender
treatment of inflammatory papillary hyperplasia
antifungal agent, disinfect appliance, may need to decrease the wearing of the appliance, surgical excision
oral lymphoepithelial cyst is common seen sublingually or in this location
the soft palate
condyloma acuminatum is associated by which strains of what virus
caused by HPV 6, 11, 16, 18
how is condyloma acuminatum acquired
sexually transmitted disease
may be infected at birth
location and description of condyloma acuminatum
oral sites: palate, tongue, oral floor, labial mucosa
multiple coalescing, pink nodules, cauliflower like surface
treatment of condyloma acuminatum
excisional biopsy
salivary gland tumors intraoral site
both benign and malignant
most common intraoral site is posterior hard palate
cause of necrotizing sialometaplasia
cause: trauma, dental injections, upper respiratory infection
reactive lesion of minor salivary glands due to ischemia and infarction
description of necrotizing sialometaplasia
may start as a swelling that progresses to a cratered, irregular ulcer
usually unilateral but may be bilateral
ranges from non-tender to painful
treatment of necrotizing sialometaplasia
incisional biopsy to confirm diagnosis, resolves in 6 weeks.
types of single ulcerations
apthous ulcers, traumatic ulcer (riga-fede, iatrogenic, self-induced), recurrent herpes labialis, angular chelitis, behcet syndrome, chron’s disease
types of acute, multiple ulcerations
primary herpetic gingivostomatitis, coxsackie virus (herpangina, hand/foot/mouth disease), intraoral recurrent herpes simplex, erythema multiforme, necrotizing ulcerative gingivitis, varicella
types of chronic single ulceration
chronic traumatic ulcer, infections (deep fungal or tuberculosis), squamous cell carcinoma
types of chronic multiple ulcerations
erosive/ulcerative lichen planus, systemic lupus erythematous, chronic graft vs host disease
prevalence of apthous ulcers
20-30% of US children
what are apthous ulcers (description, etiology/cause)
t-cell mediated immunologic reaction
familial tendency
site-non-keratinized mucosa
signs and symptoms of apthous ulcers
single or multiple, painful ulcers, recurrent lesions of sudden onset
types of apthous ulcers
minor, major, herpetiform
treatment of apthous ulcers
coating agents, topical anesthetics, steroids, other
apthous ulcers associated with systemic disease
behcet disease, celiac disease, chron’s disease
periodic fevers, apthous stomatitis, pharyngitis and adenititis (PFAPA)
neutropenia
immunodeficiency syndrome
GERD
cause of angular chelitis
Candida albicans, S aureus, nutritional deficiency, anemia, Chron disease
description of angular chelitis
site: corners of the mouth
erosions, scaly crust, ulcerated fissures, papules, may bleed, tender
may recur
treatment for angular chelitis
depends on cause, antifungal ointment with or without short-term, low potency topical steroids
cause of recurrent herpes simplex infection
cause: reactivation of the HSV-1
prevalence of recurrent herpes simplex infection
20-35%
types of recurrent herpes simplex infection
herpes labialias, facialis, intraoral HSV
description of recurrent herpes simplex infection 9site, duration, complications)
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)
treatment of recurrent herpes simplex infection
topical anesthetics, topical and systemic antiviral agents
cause of Acute herpetic gingivostomatitis
infectious disease, primarily caused by herpes simplex virus type 1 (HSV-1)
description of Acute herpetic gingivostomatitis (duration, who it affects, signs/symptoms)
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
treatment of Acute herpetic gingivostomatitis
systemic acyclovir, valavyclovir may be warranted
palliative and supportive care
cause of herpangina
enterovirus, usually coxsackie virus
description of herpangina
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
treatment of herpangina
supportive and palliative care
cause of hand, foot and mouth disease
enterovirus, usually coxsackie virus
hand, foot and mouth disease population
common age is infants to age 4
hand, foot and mouth disease signs and symptoms
fever, malaise, lymphadenopathy, flu-like symptoms
vesicles and ulcers on buccal, labial mucosa, tongue
skin lesions on hands, arms, feet and legs, diaper rash
aggressive form of hand, foot and mouth disease can lead to
aggressive form associated with neurologic complications
treatment of hand, foot and mouth disease
palliative and supportive, usually resolves in 7-10 days
impetigo cause
most commonly caused by Staphylococcus aureus or in combination with Group A or B hemolytic streptococcus
impetigo lesions
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
impetigo treatment
localized disease treated with topical antibiotics
widespread disease treated with systemic antibiotics
necrotizing ulcerative gingivitis cause
fusiform bacteria, spirochetes, HHVs
necrotizing ulcerative gingivitis lesions and population of patients
painful lesions, necrosis, ulceration, punched out papillae, halitosis
rare in young children
predisposing factors for necrotizing ulcerative gingivitis
vitamin deficiency, compromised immune function, poor oral hygiene, cigarette smoking, viral infections (HIV, EBV, measles)
treatment for necrotizing ulcerative gingivitis
debridement, oral hygiene, antimicrobial oral rinse, +/- systemic antibiotics
triggers for erythema multiforme
triggers: drugs, HSV, mycoplasma pneumonia, other infections, tattooing,
50% unknown case
site for erythema multiforme
extremities, palmar and plantar surfaces, neck, face, eyes, lips, oral mucosa
disease description for erythema multiforme
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)
treatment of erythema multiforme
identify cause, palliative care
cause of varicella (chickenpox)
varicella-zoster virus
signs and symptoms for varicella (chickenpox)
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
treatment of varicella
palliative and supportive, systemic antiviral drugs in severe cases or immunocompromised children
preventive of varicella
vaccine, rare disease because of vaccine
ulcerations fro chemotherapy
drug-induced mucositis
widespread involvement
pain, bleeding, sloughing, erythema, irregular ulcerations
tx: supportive and palliative care
what is epidermolysis bullosa
hereditary vesiculobullous disease of skin and mucous membranes –multiple types
types of epidermolysis bullosa
EB simplex – most common; autosomal dominant
junctional EB: severe form; autosomal recessive
manifestations of epidermolysis bullosa (oral and systemic)
blistering of hands, feet, mouth, in particular
scarring is common
oral problems: enamel hypoplasia, microstomia, ankyloglossia, caries, gingivostomatitis
severe forms can be life-threatening
treatment of epidermolysis bullosa
no satisfactory treatment caries prevention, minimize trauma
what is Systemic lupus erythematosus disorder
chronic multisystem progressive disorder
autoimmune disease
manifestations of Systemic lupus erythematosus
oral ulcerations, erosions and white striations, mimics lichen planus, secondary candidiasis
skin lesions, arthralgia, hematologic disorders are common, butterfly rash on face
treatment for Systemic lupus erythematosus
steroids, other immunosuppressive agents, antifungal agents
graft versus host disease description
acute and chronic types
associated with hematopoietic stem cell transplant
multiorgan disease including oral mucosa and skin
rare development of oral cancer
oral manifestations of graft versus host disease
mucosal atrophy and ulcers, xerostomia, lichenoid reaction, systemic sclerosis
congenital indifference to pain
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
lesch-nyhan syndrome
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)
traumatic granuloma
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
treatment of traumatic granuloma
eliminate cause, topical or intralesional steroids, incisional biopsy if persistent
Common reasons for soft tissue neck swelling
reactive lymphadenopathy – secondary to odontogenic infections
lymphadenopathy secondary to viral infections
findings associated by infectious mononucleosis (and name of virus)
caused by Epstein Barr Virus
fever, palatal petechiae, NUG, pharyngitis, cervical lymphadenopathy
what is cat-scratch fever?
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
treatment for cat scratch fever?
usually resolves within 4 months, antibiotics may be necessary
findings associated with HIV-associated salivary gland disease
enlarged parotid gland, often with concurrent cervical lymphadenopathy
xerostomia
associated with improved prognosis
findings associated with Hodgkin’s lymphoma
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
treatment of Hodgkin’s lymphoma
tx: radiation and chemotherapy
swellings associated with leukemia
enlarged lymph nodes due to infection and leukemic infiltrates
findings associated with thyroglossal duct cyst
remnant of thyroglossal duct
occurs midline anywhere along the path of thyroglossal duct
usually below hyoid
may move up and down with tongue movement
findings (and swellings) associated with Mumps
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
findings associated with Kawasaki disease
Mucocutaneous lymph node syndrome
bilateral conjunctivitis
fissured lips, infected pharynx, strawberry tongue, erythema of palms and soles, rash, cervical adenopathy
organism that causes tuberculosis
mycobacterium tuberculosis
findings associated with tuberculosis
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
treatment for tuberculosis
multiagent antibiotic therapy
most common benign salivary gland tumor
pleomorphic adenoma most common benign lesion
most common salivary gland tummor site
Parotid gland most common site
most common malignant salivary gland tumor
mucoepidermoid carcinoma is the most common malignant lesion
what is a branchial cleft cyst
area of the anterior border of the sternocleidomastoid muscle
soft, movable, poorly delineated mass
theories of origin of banchial cleft cyst
origin from remnant of banchial clefts
remnant of salivary gland
what is a cystic hygroma
lymphatic malformation
may be present at birth
slowly enlarges, may cause respiratory distress
radiographic appearance of a developing tooth bud
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
findings associated with periapical abscess (acute apical periodontitis)
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
radiographic appearance of periapical abscess (acute apical periodontitis)
radiograph: periapical or furcal radiolucency with indistinct borders, widened periodontal ligament space
internal and/or external resorption
treatment for periapical abscess (acute apical periodontitis)
root canal treatment or extraction, currette tissue if extract tooth; antibiotics if prominent cellulitis and systemic manifestation
clinical findings for periapical granuloma (chronic apical periodontitis)
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
radiographic appearance of periapical granuloma (chronic apical periodontitis)
radiolucency with indistinct or distinct borders; apical and furcal loss of lamina dura, root resorption
treatment of periapical granuloma (chronic apical periodontitis)
extract primary tooth, root canal treatment or extraction for permanent, curette tissue if extracting the tooth
periapical cyst (radicular cyst) description
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
periapical cyst (radicular cyst) radiographic findings
unilocular radiolucency with indistinct or distinct borders; may have cortiated margin, apical and furcal loss of lamina dura, root resorption, may displace teeth
treatment for periapical cyst (radicular cyst) radiographic findings
extraction of a primary tooth, enucleate cyst, root canal treatment or extraction of a permanent tooth
periapical cyst (radicular cyst) may stimulate…
stimulates a dentigerous cyst wen the primary molar is affected
multiple periapical cysts (radicular cysts) may sometimes be associated with
multiple periapical granulomas and cysts can be associated with dentin dysplasia (type I), and vitamin D-resistant rickets
nasopalatine duct cyst origin
develops from the remnants of nasopalatine duct
clinical findings of nasopalatine duct cyst
may cause fluctuant swelling of the palate
teeth are vital
may cause divergence of roots
soft-tissue conterpart: cyst of incisive papilla
radiographic findings for nasopalatine duct cyst
ovoid to heart-shaped raidolucency between maxillary incisors
treatment for nasopalatine duct cyst
enucleation of cyst
description of simple bone cyst (traumatic bone cyst)
usually in the mandible, usually asymptomatic without expanision
teeth are vital
may cross midline
radiographic findings simple bone cyst
usually unilocular with scalloping between roots of vital teeth
treatment of simple bone cyst
surgical exploration
stafne defect (static bone cyst) description
developmental cortical defect of the lingual mandible containing salivary gland
usually seen in adolescent males when it occurs in children
represents submandibular fossa
stafne defect (static bone cyst) radiographic findings
well-defined unilocular radiolucency of posterior mandible below mandibular canal; occasionally seen in anterior mandible
treatment for stafne defect (static bone cyst)
no treatment
median palatal cyst description
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
radiographic findings median palatal cyst
ovoid to circular radiolucency in midline of palate
common pericoronal pathology
normal follicular space and dentigerous cyst
normal vs hyperplastic follicular space appearance
may be enlarged or hyperplastic
follicular space should be less than 5mm
if hyperplastic, may delay tooth eruption
if hyperplastic, canine are primarily involved
dentigerous cyst findings
forms around crown of impacted tooth
may be expansile, painless, tooth eruption failure
common sites for dentigerous cyst
common sites: mandibular molar, maxillary canine
radiographic appearance of dentigerous cyst
pericoronal, unilocular radiolucency
treatment of dentigerous cyst
enucleation of cyst with or without tooth extraction, recurrence is rare
buccal bifurcation cyst (inflammatory paradental cyst) description and location
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
radiographic appearance of buccal bifurcation cyst (inflammatory paradental cyst)
buccal pericoronal and furcal, unilocular radiolucency; proliferative periosteitis
treatment for buccal bifurcation cyst (inflammatory paradental cyst)
curettage and enucleation of cyst
unicystic ameloblastoma description
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
radiographic findings for unicystic ameloblastoma
unilocular radiolucency with well-defined margins; may be scalloped
treatment of unicystic ameloblastoma
enucleation with long term follow up; 10-30% recurrence rate
Adenomatoid odontogenic tumor description
anterior region maxilla > mandible
painless expansion; usually associated with crown of unerupted tooth, especially canine
radiographic findings for Adenomatoid odontogenic tumor
usually pericoronal radiolucency with well-defined borders; may exhibit flecks of opacities
melanotic neuroectodermal tumor of infancy appearance/origin/population
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
lab findings associated with melanotic neuroectodermal tumor of infancy
elevated urinary levels of vanillylmandelic acid
radiographic findings associated with melanotic neuroectodermal tumor of infancy
poorly circumscribed radiolucency with floating teeth; may have sun-ray pattern
treatment of melanotic neuroectodermal tumor of infancy
prognosis-excision with margins; 20% recur
acute suppurative osteomyelitis appearance/causes/site
causes odontogenic infection, trauma, idiopathic
necrosis of the bone with pain, fever, trismus, lymphadenopathy
site: usually posterior mandible; maxilla in infants
radiographic appearance acute suppurative osteomyelitis
ill-defined radiolucency, may have periosteal new bone formation
treatment of acute suppurative osteomyelitis
antibiotics and drainage
what is langerhans cell histiocytosis
neoplastic disease of myeloid cells
disseminated and localized forms
appearance (skin and oral)/population/site of disseminated langerhans cell histiocystosis
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
radiographic appearance of disseminated langerhans cell histiocystosis
multiple periapical radiolucencies
floating teeth appearance
treatment of disseminated langerhans cell histiocystosis
curettage and chemotherapy
description of localized langerhans cell histiocystosis (eosinophilic granuloma)
usually localized to the bone
may have soft tissue involvement
rapid alveolar bone loss and tooth mobility
mimics aggressive periodontitis, periapical inflammatory lesions
radiographic appearance of localized langerhans cell histiocystosis (eosinophilic granuloma)
multiple periapical radiolucencies; floating tooth appearance
treatment of localized langerhans cell histiocystosis (eosinophilic granuloma)
curettage when jaw is involved
systemic and oral associated with leukemia
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
radiographic findings associated with leukemia
radiographic: diffuse, multifocal, poorly defined radiolucency; loss of lamina dura and dental crypt; floating tooth appearance
treatment of leukemia
chemotherapy
Burkitt lymphoma description and oral findings
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
radiographic appearnce of Burkitt lymphoma
early loss of lamina dura and dental crypt, may have enlargement of follicular spaces, ill-defined radiolucencies, floating tooth appearance
treatment for Burkitt Lymphoma
chemotherapy
Ewing sarcoma description and origin
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
ewing sarcoma radiographic appearance
ill-defined radiolucency but mixed radiolucent-radiopaque pattern may be present
infrequently cortical infiltration may produce onion-skin appearance in jaw bone
treatment of Ewing sarcoma
chemotherapy and surgery with or without radiotherapy
signs of metastatic lesions
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
odontogenic keratocyst (keratocystic odontogenic tumor) description (and clinical findings)
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
odontogenic keratocyst (keratocystic odontogenic tumor) radiographic findings
radiograph: minimally expansile unilocular or multilocular with thin sclerotic border
odontogenic keratocyst (keratocystic odontogenic tumor) is sometimes associated with what syndrome
associated with nevoid basal cell carcinoma syndrome
odontogenic keratocyst (keratocystic odontogenic tumor) treatment and recurrence rate
surgical excision with or without ostectomy
high recurrence rate of 30%
nevoid basal cell carcinoma syndrome systemic findings
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
ameloblastoma clinical findings and affected population
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
radiographic findings of ameloblastoma
multilocular radiolucency, may cause root resorption; often associated with unerupted third molar
treatment of ameloblastoma
tx: surgical excision with marginal block resection; recurrence rate of 15% with this treatment
ameloblastic fibroma location and description
mixed odontogenic tumor
commonly found in posterior mandible (70%) often associated with unerupted tooth (75%)
painless expansion
patient population affected by ameloblastic fibroma
generally seen in patients under 20 years
radiographic findings ameloblastic fibroma
radiographic: usually pericoronal, multilocular radiolucency, unilocular when small
treatment for ameloblastic fibroma
surgical excision but may recur
central giant cell granuloma description and location
reactive versus neoplastic of jaw
aggressive and non-aggressive variants
commonly involves mandible (70%), especially anterior region, posterior lesion may cross midline
signs of aggressive central giant cell granuloma
aggressive lesions associated with pain, rapid growth, cortical perforation, root resorption, tooth displacement, paresthesia
radiographic findings central giant cell granuloma
multilocular with well-delineated or ill-defined borders; unilocular when small
Treatment and recurrence rate of central giant cell granuloma
tx: surgical excision
15-20% recurrence rate
jaw lesions with giant cell histopathology seen in children
hyperparathyroidism, giant cell tumor, aneurysmal bone cyst, central odontogenic fibroma
if multifocal pattern (of giant cell histopathology) include the following syndromes
cherubism noonan-like syndrome ramon syndrome jaffe-campanacci syndrome neurofibromatosis type I
odontogenic myxoma description and etiology
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
radiographic findings odontogenic myxoma
unilocular or multilocular radiolucency with faint radiopaque striations (stepladder or cobweb appearnce); margins well-defined
treatment and recurrence rate of odontogenic myxoma
surgical excision
recurrence rate of 25%
aneurysmal bone cyst types, age group, description/symptoms
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
radiographic findings for aneurysmal bone cyst
radiograph: expansile, cystic, honeycombed, or soap bubble radiolucency. unilocular when small
treatment and recurrence rate for aneurysmal bone cyst
currettage or enucleation; en bloc resection for large or recurrent lesion
13% recurrence rate
central vascular malformation description
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
treatment of central vascular malformation
advanced imaging, embolization, resection
what is cherubism?
autosomal dominant disorder
bilateral fullness of cheeks and angles of the mandible, hypertelorism and unpslanting eyes
malocclusion with displaced teeth
radiographic findings for cherubism
expansile multilocular radiolucencies in all four quadrants; displaced toothbuds
treatment of cherubism
tends to burn out over time; cosmetic recontouring
What is periapical cemento-osseous dysplasia (cementoma)
rarely seen under the age of 20 teeth vital lesion occurs near and in periodontal ligament lesion usually multiple no treatment necessary
radiographic findings for periapical cemento-osseous dysplasia
radiolucent, mixed, to radiopaque lesions; surrounded by thin radiolucent rim, PDL is intact.
what is a calcifying odontogenic cyst? (Gorlin cyst)
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
radiographic findings for calcifying odontogenic cyst (Gorlin cyst)
well-cicumscribed radiolucency with radioopaque flecks or tooth-like structures
treatment for calcifying odontogenic cyst (Gorlin cyst)
surgical excision
what is ameloblastic fibro-odontoma?
mixed odontogenic tumor
site: posterior mandible is the most common
usually asymptomatic; involved with unerupted tooth
ameloblastic fibro-odontoma radiographic findings
usually unilocular radiolucency with variable amounts of calcifications that resemble odontomas
treatment for ameloblastic fibro-odontoma
curettage, does not recur
what is a calcifying epithelial odontogenic tumor? (pindborg tumor)
mandible premolar-molar region most commonly involved
painless swelling of the jaw
often associated with unerupted tooth
may have a central location
radiographic findings for calcifying epithelial odontogenic tumor (pindborg tumor)
well-circumscribed radiolucency containing varying sized radiopacities, some totally radiolucent
treatment for a calcifying epithelial odontogenic tumor? (pindborg tumor) and recurrence rate
treatment: local resection
15% recurrence
what is cementoblastoma? (and common site)
odontogenic tumor of cementoblasts
site: posterior mandible; molar-premolar region; 50% involve first molars, rarely in the primary molar
pain, bony expansion, displaced teeth
radiographic findings for cementoblastoma
radiograph: localized radiolucent, mixed, radiopaque with radiolucent rim fused to roots, may resorb roots
progresses from radiolucent to radiopaque
treatment of cementoblastoma, and recurrence
extraction of tooth, excisional biopsy; 22% recur
what is central ossifying fibroma?
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
radiographic appearance of central ossifying fibroma
mixed radiolucent and radiopaque mass with sclerotic border
displacement of teeth, root divergence, root resorption
treatment for central ossifying fibroma
excision
what is juvenile ossifying fibroma
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
treatment and recurrence for juvenile ossifying fibroma
excision, wide resection, high recurrence rate
radiographic appearance for juvenile ossifying fibroma
circumscribed radiolucency with calcification; may have “ground glass” appearance
displacement of teeth, root divergence, root resorption
what is craniofacial fibrous dysplasia?
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
radiographic findings craniofacial fibrous dysplasia
diffuse ground glass appeearance; poorly defined margins; progresses from radiolucent to radiopaque
treatment for craniofacial dysplasia
cosmetic recontouring may be necessary; stabilizes after puberty
What is Albright syndrome? (polyostotic fibrous dysplasia)
abnormal skin pigmentation-large cafe au lait macules
endocrine dysfunction
multiple bones are affected
precocious puberty in females
radiographic findings from Albright syndrome
poorly defined margins; ground-glass appearance, progresses from radiolucent to radioopaque
what is chronic diffuse sclerosing osteomyelitis?
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
radiographic findings for chronic diffuse sclerosing osteomyelitis
radiographs: poorly defined margins, moth-eaten to mottled sclerotic bone pattern
treatment for chronic diffuse sclerosing osteomyelitis
refractory to treatment, bisphosphonates may be useful
What is chronic osteomyelitis with proliferative periostitis
due to chronic dental infection
tender, diffusely expansile jaw enlargement
site: posterior mandible
radiographic findings from chronic osteomyelitis with proliferative periostitis
poorly defined margins, mottled bone pattern with ONION SKIN pattern of periosteum
treatment of chronic osteomyelitis with proliferative periostitis
treatment: treat the source of infection; bone remodel happens over time (6-12 months)
What is osteosarcoma?
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
radiographic findings for osteosarcoma
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
treatment for osteosarcoma
surgical resection, chemotherapy and radiotherapy
description of eruption sequestrum
dysplastic cementum in the dental follicle
occurs in the molar region
radiographically: small opacity in soft tissue overlying erupted molar
most spontaneously exfoliate
description of retained root tip
usually lower primary molar
radiograph: well defined oval radiopacity; often can trace a portion of the PDL
treatment options for retained root tip
extract or periodic evaluation, may partially erupt over time.
idiopathic osteosclerosis description
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.
treatment for idiopathic osteosclerosis
none, periodic evaluation, tends to stabilize with time
focal sclerosing osteomyelitis (condensing osteitis)
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
odontoma description
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
odontoma radiographic findings
compound: resembles tooth-like structures
complex: amorphous mass
both have radiolucent border
treatment of odontoma
excisional biopsy
antral pseudocyst description
inflammatory lesion of the sinus
located in the floor of the maxillary sinus
asymptomatic unless sinusitis or allergies present
radiographic findings for antral pseudocyst
dome-shaped, radioopacity of the maxillary sinus
treatment for antral pesudocyst
no treatment, rule out an odontogenic infection if symptomatic
description of torus/exostoses, prevalence in children
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
types of exostoses
exostosis: single or multiple enlargements on the buccal or palatal alveolar ridges
torus palatinus: midline hard palate
torus mandibularis: lingual mandible premolar region
where is a sialolith seen radiographically?
pain when eating, radiopacity in floor of the mouth
where is a tonsillolith seen radiographically?
non-tender radiopacities overlying the ramus
what children experience phleboliths?
in child associated with vascular lesions; usually multiple radiopacities
where are calcified lymph nodes seen radiographically?
usually history of chronic infection such as TB, discrete radiopacities
description of an osteoma
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
radiographic findings of osteoma
well-demarcated, round to oval radiopacity; may cause cortical expansion
description of gardner syndrome
autosomal dominant
multiple osteomas, epidermoid and dermoid cysts
multiple polyposis of large intestines with high malignant potential
dental findings: supernumerary teeth or delayed eruption
segmental odontomaxillary dysplasia description
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.
