Common Oral Diseases Flashcards
What are tori and exostoses?
Benign, reactive bony protuberances arising from the cortical plate
Which type of torus is more common: palatal or mandibular?
palatal
What are the characteristics of palatal tori?
- 25% of US population
- Females (2:1)
- Asians and Inuits (Eskimo)
- No treatment
What are the characteristics of mandibular tori?
- 10% of US population
- Most are bilateral
- Single or multiple nodules
- Slight male gender predominance
- Asians and Inuits
- No treatment
palatal torus
What are the characteristics of a mandibular torus?
- Less common than palatal tori
- 10% of US population
- Most are bilateral
- Single or multiple nodules
- Slight male gender predominance
- Asians and Inuits
- No treatment (unless necessary for partial/denture)
mandibular torus
buccal exostoses
mandibular tori
traumatic ulcer
traumatic ulcer
What is the most common “tumor” of the oral cavity?
traumatic (irritation) fibroma
What is traumatic (irritation) fibroma?
- Inflammatory fibrous hyperplasia
- Not a true neoplasm of fibroblasts - a reactive lesion rather than a true neoplasm
What is a giant cell fibroma?
- Distinct from irritation fibroma – may not be associated with an identifiable source of chronic irritation and occurs at younger age
- Often exhibits a papillary surface and may be clinically mistaken for papilloma
Differential diagnoses for this
giant cell fibroma
squamous papilloma
Differential diagnoses for this
giant cell fibroma
squamous papilloma
What are the characteristics of epulis fissuratum?
- Redundant fibrous tissue
- Associated with denture flange
epulis fissuratum
What is inflammatory papillary hyperplasia?
- Denture papillomatosis
- Poor oral hygiene combined with ill-fitting prosthesis
- Surgical excision and correct prosthesis
inflammatory papillary hyperplasia
With medication associated gingival enlargement the englargment begins in the interdental papillae and forms…
pseudopockets
Medication Associated Gingival Enlargement
What are the features of medication associated gingival enlargement?
- Non-specific clinical appearance
- Multiple drugs are synergistic
- Severity is related to patient susceptibility and local factors
What are the medications associated with gingival enlargement?
- Anticonvulsants
– Dilantin (phenytoin) – 50% - Calcium channel blockers
– Procardia (nifedipine) – 25% - Immunosupressants
– Sandimmune (cyclosporin) – 25%
How can you tell the difference between medication related gingival enlargement and giant cell fibroma?
medication related gingival enlargement is more diffuse throughout the mouth
What is the treatment strategy for medication related gingival enlargement?
- Control local factors - anti-plaque agents (chlorhexidine)
- Drug substitution
- Drug therapy - folic acid, metronidazole, azithromycin
- Surgical excision - gingivectomy
What is a pyogenic granuloma?
A reactive vascular lesion - essentially a capillary hemangioma
Who is more likely to get pyogenic granuloma?
Definite female predilection - vascular effects of hormones
Why is the name pyogenic granuloma stupid?
Name is a misnomer. It is unrelated to infection. It is not “pyogenic” and is not a true granuloma
What are the characteristics of a pyogenic granuloma?
- A reactive vascular lesion - essentially a capillary hemangioma
- May exhibit rapid growth
- Gingiva most common site, but not limited to gingiva. It occurs throughout the body on any skin or mucosal surface
pyogenic granuloma
What are the clinical variants of pyogenic granuloma?
- Pyogenic granuloma
- Granuloma gravidarum
- Pregnancy tumor
- Epulis granulomatosum
- Pulp polyp
What is a granuloma gravidarum?
- pregnancy tumor
- A clinical variant of pyogenic granuloma
- May involute without treatment post partum and undergo fibrous maturation
What is the differential diagnosis for this…
- peripheral ossifying fibroma
- pyogenic granuloma
What is a peripheral ossifying fibroma?
- Reactive lesion – not a neoplasm
- Fibrous hyperplasia with osseous metaplasia - may appear radio-opaque
Where does a peripheral ossifying fibroma form?
exclusively on the gingiva
What are the characteristics of peripheral ossifying fibroma?
- Reactive lesion – not a neoplasm
- Teenagers and young adults
- Occurs exclusively on the gingiva
- Fibrous hyperplasia with osseous metaplasia - may appear radio-opaque
- May recur
- May move teeth
What is a peripheral giant cell granuloma?
- Reactive lesion – not a neoplasm
Where does a peripheral giant cell granuloma form?
Occurs exclusively on gingiva and edentulous alveolar ridge
What are the characteristics of peripherl giant cell granuloma?
- Older adults
- Occurs exclusively on gingiva and edentulous alveolar ridge
- Contains hemosiderin - may be bluish-purple
- May recur
What are the differential diagnosis for a bump on the gums?
- traumatic fibroma
- giant cell fibroma
- epulis fissuratum
- inflammatory papillary hyperplasia
- pyogenic granuloma
- peripheral ossifying fibroma
- peripheral giant cell granuloma
What diseases are caused by human papilloma virus?
- Squamous papilloma
- Verruca vulgaris
- Condyloma acuminatum
What are the features of squamous papilloma?
- Solitary lesion in adult
- Pedunculated, exophytic papule
- Numerous surface projections
Differential diagnosis for this…
- giant cell fibroma
- squamou papilloma
- verruca vulgaris
What is verruca vulgaris?
- Skin of hands in children
- Multiple, clustered lesions common
- White, verrucoid surface
- Autoinoculation of oral mucosa
What is condyloma acuminatum?
- Venereal wart: sexually transmitted disease
- Multiple, clustered lesions common
- Sessile, pink exophytic mass, larger than squamous papilloma
- can be on yo penis or vulva (not showing pics of that)
When does primary herpetic gingivostomatitis happen?
- Initial exposure to virus in an individual without immunity
- Generally occurs at young age after physical contact with infected individual
What are the symptoms of primary herpetic gingivostomatitis?
- Flu-like illness with fever, malaise, arthralgia, headache
- Cervical lymphadenopathy
Recurrent herpes intraorally occurs on…
mastricatory/bound down tissue (hard palate or gingiva)
Recurrent aphthae is only on…
nonmasticatory/moveable tissue
Primary herpes intraorally occurs on…
masticatory and nonmasticatory tissue (any tissue type)
What are the clinical forms of recurrent aphthous stomatitis?
- minor
- major
- herpetiform
Aphthous-like Lesions may be
Associated with Systemic Disease such as…
- Behcet’s Syndrome
- Reiter’s Syndrome
- Inflammatory Bowel Disease
– Ulcerative colitis
– Crohn’s Disease - Malabsorption Syndromes
– Gluten Sensitive Enteropathy - Cyclic Neutropenia
- HIV / AIDS
What is important about minor aphthae?
- Recurrent disease
- Shallow, painful ulcerations on non-keratinized mucosa
- Solitary or multiple lesions
- Heal in two weeks
What is important about major aphthae?
- Larger (> 0.5cm)
- Deeper - may heal with scarring
- Heal slowly - weeks to months
What is important about herpetiform aphthae?
- Crops of small, shallow,
painful ulcers - Heal in two weeks
- Short remissions
How does someone typically get angular cheilitis?
drooling
What is the differential diagnosis for this…
hyperplastic candidiasis
leukoplakia
What are the features of hyperplastic candidiasis?
- does not wipe off
- been there for a long time
- isolate lesion
- leukoplakia
How do you know if something is candidiasis?
does it wipe off
- leaves behind a red background
What is one of the only diseases found on the midline of the dorsum of the tongue?
Central Papillary Atrophy/Median Rhomboid Glossitis
What is important to know about atrophic candidiasis/erythematous candidiasis?
be sure to treat the disease and the denture
What is the differential diagnosis for this…
mucocele
ranula
epidermoid cyst
What are the types of gingivitis?
- Plaque-associated gingivitis
- Necrotizing ulcerative gingivitis
– NUG - Medication-induced gingivitis
– Drug-related gingival hyperplasia - Allergic gingivitis
– Plasma cell gingivitis - Specific infection-related gingivitis
– Herpes Simplex Virus - Dermatosis-related gingivitis
– Desquamative gingiviti
gingivits
What are systemic diseases that can have periodontitis as a manifestation?
- Diabetes mellitus
- Human Immunodeficiency Virus infection
- Decreased numbers of leukocytes
– Neutropenia - Abnormal function of leukocytes
– Leukocyte dysfunction syndromes - Papillon-Lefevre Syndrome
What is pericoronitis?
inflammation associated with the soft tissue over the area where the third molars are located
pericoronitis
foliate papillae and lingual tonsils
(not pathology)
What is the differential diagnosis for this…
oral lymphoepithelial cyst
mucocele
lipoma
salivary stone (sialolithiasis)
What is hairy tongue?
- Elongated filliform papillae
- Exogenous pigmentation may impart a brown or black appearance
- Various associated factors
– Heavy smoking
– Antibiotic therapy
What are fordyce granules?
- Ectopic sebaceous glands
- Development stimulated at puberty
fordyce granules
fordyce granules
What is the differntial diagnosis for this…
squamous cell carcinoma
arepo leukoplakia
actinic cheilitis
What is actinic cheilitis?
- lips that have sun damage
- potentially premalignant condition
What is a leukoplakia?
A white patch or plaque that can’t be characterized clinically or pathologically as any other disease.
What IS NOT a leukoplakia (never ever)?
pseudomembranous candidiasis
leukoedema
smoker’s keratosis
What is the differential diagnosis for this?
hyperplastic candidiasis
squamous cell carcinoma
hyperkeratosis from trauma
leukoplakia
What is the best clinical diagnosis for this?
chronic mucosal chewing
Morsicatio Buccarum
What is a erythroplakia?
A red patch or plaque that can’t be characterized clinically or pathologically as any other disease
What is never a erythroplakia (NEVER EVER)?
medial rhomboid glossitis
What is the differential diagnosis for this…
epithelial dysplasia
squamous cell carcinoma
carcinoma in situ
What is a differential diagnosis for this…
Addison’s disease
smokers melanosis
pterts yager
What is an oral melanotic macule?
- Focal increase in melanin
- Normal number of melanocytes
- Lower lip vermillion most common
What are the clinical types of lichen planus?
- Reticular lichen planus
- Erosive lichen planus
What is reticular lichen planus?
- Bilateral asymptomatic white lesions of posterior buccal mucosa (Wickham striae)
- Also papules and plaques
erosive lichen planus
What are the other names of geographic tongue?
- Benign Migratory Glossitis
- Erythema Areata Migrans
- Stomatitis Areata Migrans
- Wandering Rash of the Tongue
What are the characteristics of geographic tongue?
- Cause unknown
– Hypersensitivity to environmental factor ? - Common at tip and lateral border
- Red
– Multiple erythematous zones
– Atrophy of filliform papillae - White
- Elevated, yellow-white, serpiginous border
geographic tongue
What is the histology of geographic tongue?
- Psoriasiform mucositis
– Resembles psoriasis - Exocytosis of neutrophils into epithelium
- Munro microabscesses
