Details for Final Flashcards
1
Q
How do you treat black hairy tongue?
A
Brush, scrape with oral hygiene instructions
2
Q
What is the main cause of a squamous papilloma?
A
HPV, types 6 and 11
3
Q
What percentage of condensing osteitis cases regress after the odontogenic infection is eliminated?
A
85%
4
Q
Of the four mixed RO/RL lesions, which two occur in younger patients, average ages of 10?
A
The two that start with A. Adenomatoid Odontogenic Tumor and Ameloblastic Fibro-Odontoma.
5
Q
Central Giant Cell Granulomas are of a neoplastic nature. True or False?
A
False. They are non-neoplastic.
6
Q
A
Periapical Granuloma
7
Q
How do you treat a nasopalatine duct cyst?
A
Never just sit and watch. Biopsy is mandatory (cannot diagnose radiographically). Then do surgical enucleation.
8
Q
What accumulates on the black hairy tongue and where specifically on the tongue?
A
Keratin on the filiform papilla of dorsal tongue
9
Q
What does an odontogenic keratocyst arise from?
A
The cell rests of the dental lamina
10
Q
Leukoplakia
A
- Clinical description: an intraoral white plaque that does not rub off and cannot be identified as any well known entity
- Cause: Tobacco (80% are smokers), Alcohol (synergistic with tobacco), Sanguinaria, UV radiation, Microorganisms (treponema Pallidum), Trauma
- Treatment: Biopsy. Mild dysplasia (alterations limited to lower ⅓), Moderate dysplasia (alterations limited to lower ½), severe dysplasia (alterations above ½)
- Other Relevant Information: Precancerous (always keep monitoring), white because something is blocking redness of mucosa (80% of the time it is hyperkeratosis). PVL is highest risk of cancer.
11
Q
What are the names of the two pathways that compose the nasopalatine?
A
Foramen of Scarfa and Forament of Stenson
12
Q
How do you treat a calcifying odontogenic cyst?
A
Simple enucleation or simple surgical excision
13
Q
Where does a calcifying odontogenic cyst come form?
A
Rests of serres and rests of malassez
14
Q
What is the treatment for periapical cemento-osseous dysplasia?
A
No biospy required. No treatment.
15
Q
Odontoma
A
- ➢Most common odontogenic tumor, but once removed it won’t come back.
- ○Complex; Conglomerate mass of enamel and dentin that bears no resemblance to a tooth.
- ○Compound; Composed of multiple tooth like structures.
- ➢Asymptomatic, usually discovered on radiograph taken to diagnose failure of a tooth to erupt.
- ➢Average age is 15.
- ➢Considered developmental anomalies (hamartomas) not true neoplasms.
- ➢Tx is simple local excision; once removed it won’t come back.
16
Q
Fibroma
A
- Not a true neoplasm
- -Cause:
- -Reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma
- -Clinical Appearance:
- -Sessile, asymptomatic, smooth-surfaced nodule
- -Most common tumor of the oral cavity
- -Most common location is the buccal mucosa along the bite line
- -Treatment:
- -Conservative surgical excision
- -MUST submit the excised tissue for microscopic examination
17
Q
Which type of patients with OKCs and what syndrome should they be evaluated for?
A
Young patients for Gorlin syndrome
18
Q
Amalgam Tattoo
A
- Clinical Description: Blue, black or grey lesion found in the oral mucosa often in the gingiva and alveolar mucosa or buccal mucosa.
- Etiology: Iatrogenic infiltration of amalgam or other foreign matter into the oral mucosa
- Treatment: Radiograph to confirm pieces of amalgam, biopsy indicated if radiograph is negative (to rule out melanoma).
- Other information: Can also be caused by pencil graphite, coal dust, metal dust, broken carborundum disks, burs, or intentional tattooing.
19
Q
Aphthous Stomatitis
A
- AKA Recurrent Aphthous Ulcer or Canker Sore
- No universal etiology - may be an allergy/immune dysfunction
- Appear as white lesions
- Occurs exclusively on movable mucosa
- Three major forms:
- Minor (85%)
- Major (10%)
- Herpetiform (5%)
- Usually occurs in younger patients
- Treatment
- If minor case, no treatment or OTC medications
- “Magic mouthwash” or prescribed corticosteroids (Magic mouthwash - Lidocaine, Mallox, Benadryl)
20
Q
Leukoplakia is not precancerous. True or False?
A
False, it is. Always keep monitoring.
21
Q
Where does recurrent herpes usually take place?
A
On the lip and attached keratinized mucosa of the mouth
22
Q
Black Hairy Tongue
A
- Accumulation of keratin on the filiform papilla of dorsal tongue
- Unknown etiology, but many are heavy smokers
- Also poor oral hygiene, antibiotics, or radiation therapy
- Patients occasionally complain of:
- Gagging sensation, bad taste, halitosis, and esthetics
- Treatment:
- Tongue brushing/ scraping with oral hygiene instruction
23
Q
White Coated Tongue
A
- Clinical Description: White coating on the dorsal surface of the tongue. Can be scraped off.
- Etiology: Accumulation of bacteria and desquamated epithelial cells (Oral hygiene, high carb diet)
- Tx: No tx needed. Periodic scraping/brushing with a tongue scraper or toothbrush.
24
Q
What causes recurrent herpes?
A
HSV-1
25
Where does epulis fissuratum usually develop?
On the facial aspect of the alveolar ridge
26
Squamous Papilloma
* -Cause:
* -HPV- types 6,11
* -Clinical Appearance:
* -Pedunculated (cauliflower stalked)
* -Exophytic
* -White, red, mucosal colored
* -Enlarges to 5mm
* -Tongue, lips, and soft palate
* -Treatment:
* -Conservative surgical excision
27
The lymphoepithelial cyst is painful. True or False?
False. it is asymptomatic.
28
Linea Alba
* Clinical Description: white line located on buccal mucosa at the level of the occlusal plane
* Cause: Pressure, irritation, or sucking trauma.
* Treatment: No treatment Necessary
* Other relevant information:10% of population.
29
How do you treat racial pigmentation?
Do nothing
30
What type of people are prone to florid cemento-osseous dysplasia?
90% female and 90% african american.
31
What do you call Herpes on the hands?
Herpetic Whitlow
32
Where do 50% of peripheral ossifying fibromas occur?
In the incisor/canine region, and they occur EXCLUSIVELY on the gingiva, and are more pink in color than the others.
33
How do you treat a CEOT?
Conservative local resection with a narrow rin of bone or curettage
34
Nasoplatine Duct Cyst
* ETIOLOGY
* -Two passageways persist in midline between the primary and secondary palates
* IMPORTANT INFO
* -MOST COMMON NON-ODONTOGENIC cyst
* -Radiolucency in/near anterior maxilla between apical central incisors (NO RESORPTION)
* TX
* -NEVER sit and watch
* -Biopsy is mandatory (cannot diagnose radiographically)
* -Surgical enucleation
* 2 passageways that compose nasopalatine, \*foramen of scarfa, foramen of stenson
35
What causes a stafne defect?
Focal concavity of the cortical bone on the lingual surface of the mandible caused by a portion of the submandibular salivary gland
36
What are the two other names for aphthous stomatitis?
Recurrent aphthous ulcer or Canker sore
37
What causes smoker's melanosis?
Melanin production stimulated by nicotine
38
What is the most widely accepted theory regarding tramautic bone cyst etiology?
Trauma-Hemorrhage theory. Traumat to the bone which is insuficcient to cause a fracture results in intraosseous hematoma. If hematoma does not undergo organization and repair, may liquify and result in defect.
39
When something is white because something is blocking redness of mucosa, what is it 80% of time?
Hyperkeratosis
40
How do you treat an amalgam tattoo?
Radiograph to confirm pieces of amalgam and biopsy if radiograph is negative (to rule out melanoma)
41
Where does the herpes virus stay latent?
In the trigeminal nerve
42
Leukoedema
* Clinical description: diffuse, gray-white, milky, opalescent lesions found bilaterally on buccal mucosa that does not rub off.
* Cause: Variation of normal edematous swelling
* Treatment: None needed
* Other Relevant Information: White appearance disappears when cheek is stretched and comes back when released. up to 90% of African Americans (racial pigmentation) and 50% of children
43
How do you treat pyogenic granulomas?
Surgical excision, extending down to the periosteum and adjacent teeth are scaled. If pregnant, defer treatment unless esthetic problem.
44
If a mucocele is found on the gingiva, what is it most likely?
A gingival cyst
45
What usually causes pseudomembranous candidiasis?
Broad spectrum antibiotics, impaired immune system (leukemia, HIV, infants), and asthma inhalers
46
Pyogenic Granuloma is not a true granuloma. True or False?
True
47
Where does the peripheral giant cell granuloma EXCLUSIVELY occur?
On the gingiva
48
What is the name of the cells associated with pemphigus vulgaris?
Tzanck cells
49
What is another name for epulis fissuratum?
IFH (inflammatory Fibrous Hyperplasia)
50
Which type of leukoplakia has the highest risk of cancer?
Proliferative Verrucous Leukoplakia
51
What is the most common periapical pathosis?
Periapical Granuloma
52
What is the most recognized form of candidiasis?
Pseudomembranous
53
What is the most common site of a mucocele?
Lower lip
54
What is the most common location of a sialolith?
Submandibular gland - which is a long and tortuous duct with thick secretions
55
How do you treat varicosities?
No treatment unless on lips or bucal mucosa because of thrombus formation or esthetics.
56
How do you treat smoker's melanosis?
Cessation of smoking with biopsy if found in unexpected location or exhibits clinical changes. To confirm that it isn't just pigmentation, do a biopsy, especially if is different colors.
57
What is the most common location of a lateral periodontal cyst?
Mandibular premolar/canine/lateral incisor area
58
How do you treat an antral pseudocyst?
No treatment is necessary
59
What are the percentages of the three major forms of aphthous stomatitis?
Minor 85%
Major 10%
Herpetiform 5%
60
What causes a periapical cyst?
Inflammatory stimulation of epithelium in the area, caused by rests of malassez
61
Where does aphthous stomatitis EXCLUSIVELY occur?
On movable mucosa
62
What type of cells are involved with a periapical granuloma?
Chronic inflammation so plasma cells and lymphocytes
63
Racial Pigmentation
* Etiology: Most common on attached gingiva in darker complexioned patients
* Treatment: Do nothing
64
Recurrent Herpes
* Clinical Description: Indurated lesions on the lip and keratinized bound mucosa of the mouth
* Etiology:
* Caused by HSV type I
* Virus lies latent in the trigeminal nerve and flares up periodically
* Prodrome occurs 6-24 hours before outbreak
* Intraoral episodes always occur on keratinized, bound tissue
* Treatment:
* Heals naturally between 7-10 days
* In severe cases acyclovir can be prescribed to shorten outbreak duration and lessen severity
65
What is the recurrence rate of an OKC?
30% up to 10 years afte surgery
66
Tonsillolith
* ➢Pharyngeal tonsillar crypts which are filled with desquamated keratin and foreign material.
* ➢Usually discovered as ROs in the midportion of the ascending ramus.
* ➢Secondarily become colonized with bacteria, calcify and develop foul smell.
* ➢Can promote recurrent tonsillar infections.
* ➢Usually asymptomatic.
* ➢Tx:
* ○At home: Gargle warm salt water and/or use water jet. Bathroom surgery.
* ○In office: Enucleation, local excision, or tonsillectomy is definitive.
* what happens if its near the angle close to cervical spine? closer to carotid : phlebolith
* differential:
* sialolith
* tonsilotlith
* antrolith - in sinus
* phlebolith
* calcified lymph node
67
Stafne Defect
* Also called Lingual Mandibular Salivary Gland Depression
* Etiology
* Focal concavity of the cortical bone on the lingual surface of the mandible caused by a portion of the submandibular salivary gland
* Treatment
* None
68
How do you treat epulis fissuratum?
Surgical removal, and reline denture
69
What does a tramautic ulcer look like?
Area of erythema surrounding a central removable, yellow fibrinopurulent membrane
70
In what age group does aphthous stomatitis usually occur?
In younger patients
71
What are the four things for a bump on the gums?
1. Pyogenic Granuloma
2. Peripheral Ossifying Fibroma
3. Peripheral Giant Cell Granuloma
4. Inflammatory Fibrous Hyperplasia
72
What are the other two names for lymphoid hyperplasia?
Lingual tonsil and Acessory Lymphoid Aggregates
73
How do you treat angular cheilitis?
With antifungals
74
What is the most common location of an AOT?
Maxillary Canine
75
How do you treat tori/exostoses?
No treatment except removal if trauma is an issue
76
What is the average age for a peripheral ossifying fibroma?
15, 2/3rds are female
77
When people have what other tongue pathosis are they prone to geographic tongue?
Fissured tongue
78
What are the two main histo features of ameloblastomas?
Palisading basal layer and reversed polarity
79
How do you treat Leukoplakia?
Biopsy! Mild dysplasia is when limited to lower 1/3, moderate is limited to lower 1/2, and severe is above 1/3.
80
Geographic tongue involves no inflammation. True or False?
False, it is a common inflammatory condition
81
Is an odontoma a true neoplasm?
No, it is a developmental anomaly (HAMARTOMA)
82
Drug-Related Gingival Hyperplasia
* -Cause:
* -Gingival overgrowth secondary to systemic medication use
* -Most common medications:
* **-Phenytoin (50%): Anticonvulsant, common in young patients**
* **-Nifedipine (25%): Calcium channel blocker**
* **-Cyclosporine (25%): Transplant therapy**
* -Treatment:
* -Brushing and flossing can help
* Change medication if possible
83
How do you treat a Mucocele?
Surgical excision and pathology submission, including removal of adjacent minor salivary glands (feeders).
84
How do you treat a melanotic macule?
Can't be distinguished clinically from early melanoma so a biopsy is mandatory
85
What tooth does the dentigeorus cyst most often involve?
Mandibular 3rd molars
86
Where are tori locate?
Palatal they are midline to hard palate and lingual to mandibular alveolar bone
87
What type of tissue is a periapical granuloma made of?
Granulation tissue that is inflamed
88
For pyogenic granulomas, what is the color of young and old lesions?
Young are red and old are pink.
89
What are the five differentials for a tonsillolith?
1. Tonsillolith
2. Sialolith
3. Phlebolith
4. Antrolith (in sinus)
5. Calcified lymph node
90
Where do tori/exostoses arise from?
The cortical plate
91
How do you treat mucous membrane pemphigoid?
Referral to opthalmologist and topical corticosteroids
92
Tori/Exostoses
* Etiology: localized bony protuberance arising from cortical plate
* - Best Known: Torus Palatinus, Torus Mandibularis
* - Other Types: Buccal Exostoses, Palatal Exostoses, Solitary Exostoses
* Tx: No tx except removal if trauma is an issue
* 2 times to deal with exostoses//tori : trauma or denture
* exotosing : broad category of bony masses on bone
* tori is differentiated 2x : palatal (midline to hard palate) and lingual (lingual to mandibular alveolar bone)
93
Pemphigus vulgaris never has cutaneous lesions. True or False?
False. They do.
94
What is the CEOT?
A tumor of odontogenic epithelium
95
What is wickhan's striae associated with?
Lichen Planus
96
What percentage of the population does Linea Alba occur in?
10%
97
Pemphigus Vulgaris
* Autoimmune disease - autoantibodies are directed against the desmosomes (intraepithelial split)
* Oral and cutaneous lesions
* Histology:
* Acantholysis = cells “fall apart”
* Tzanck cells
* **Desmosomes stay with lower layer near dermis**
* Treatment:
* Referral to dermatologist
* Corticosteroids
98
Besides amalgam, what else can cause an amalgam tattoo?
Pencil graphite, coal dust, metal dust, broken carborundum disks, burs, or intentional tattooing.
99
What is the treatment for drug-related gingival hyperplasia?
Brushing and flossing can help, and change the medication if possible
100
In addition to multiple OKC's, what also helps give away gorlin syndrome?
(Nevoid Basal Cell Syndrome) Basal cell carcinoma
101
What is an odontoma made of?
Mass of enamel and dentin, and once removed, won't come back.
102
How does an eruption cyst form?
It results form the separation of the dental follicle from around the crown of an erupting tooth
103
What is the most common location of the fibroma?
Buccal mucosa along the bite line
104
What is the name for the degenerating keratinocytes associated with lichen planus?
Civatte bodies
105
What are the other two names for a pyogenic granuloma?
Pregnancy tumor or granuloma gravidarum
106
What type of tissue is a fibroma composed of, and what causes them?
Reactive hyperplasia of fibrous connective tissue in response to local irritaiton or trauma
107
What is the other name for a calcifying epithelial odontogenic tumor?
Pindborg tumor
108
Tobacco Pouch Keratosis
* A brown-black extrinsic tobacco stain on the teeth is common (Typically localized, not generalized)
* Appears fissured or rippled
* NO: Induration, ulceration, pain
* Treatment is alternating the site of tobacco placement
* Habit cessation leads to normal mucosal appearance in 98% of users, usually in 2 weeks
* A lesion remaining 6 weeks after habit req biopsy. (tobacco pouch keratosis)
109
Fordyce Granules
* What:
* “Ectopic” sebaceous glands in 80% of the population
* appear as yellow or yellow-white papular lesions
* Where:
* Buccal mucosa & lateral portion of vermilion of upper lip
* Treatment:
* sprinkle some magic moody dust on them (AKA no treatment required)
110
How do you treat an ameloblastic fibro-odontoma?
Conservative curettage
111
What is the name for the unique form of tramautic ulcerations?
TUGSE - Tramautic Ulcerative Granuloma with Stromal Eosinophilia.
## Footnote
Exhibits a deep pseudoinvasive inflammatory process and is slow to resolve – Looks just like oral cancer on the lips or even the tongue, ask them about it’s history, and see if rest of lips have been sunburned, etc.
Incisional bx (biopsy) is usually curative
112
There is no loss of lamina dura at the root tip in the area of radiolucency with a periapical granuloma. True or False?
False, there usually is.
113
What are the percentages for gender and race for periapical cemento-osseous dysplasia?
90% female and 70% african american
114
What is the term used with pemphigus vulgaris referring to the cells "falling apart?"
Acantholysis
115
What is the oral counterpart to the ephelis?
Melanotic Macule
116
What is the most common tumor of the oral cavity?
Fibroma
117
Where do 50% of lipomas occur?
In the buccal mucosa
118
What is "magic mouthwash" composed of?
Lidocaine, Maalox, Benadryl
119
Erythroleukoplakia
* Clinical Description: Red and white intermixed lesion that cannot be identified as anything else or rubbed off.
* Etiology: Tobacco, Alcohol, Sanguinaria, UV radiation, Microogranisms (Syphillis, Candida Albicans)
* Treatment: Biopsy, surgical excision, frequent monitoring.
* Other information: Biopsy reveals advanced dysplasia. Premalignant lesion.
120
How do you treat tobacco pouch keratosis?
Alternate the site of tobacco placement. Habit cessation leads to normal mucosal appearance in 98% of users, usually in two weeks. A lesion remaining 6 weeks after habit requires a biopsy.
121
What is the name for a tonsillolith near the angle close to the cervical spine?
Phlebolith
122
What happens to a residual cyst as it ages?
Cellular components degenerate and can lead to dystrophic calcification and central luminal radiolucency.
123
Where do 85% of ameloblastomas occur?
Molar-ascending ramus region
124
What two things can a parulis turn into?
Cavernous sinus thrombosis or ludwig's angina
125
Periapical Cemento-Osseous Dysplasia will fuse to the roots of the teeth. True or False?
False. The PDL will be intact. If fused to root surface, most likely cementoblastoma.
126
What is Lichen Planus?
A common, chronic, immunologically mediated dermatologic disease that often affects the oral mucosa.
127
Inflammatory Papillary Hyperplasia
* -Cause:
* -Ill-fitting denture
* -Poor denture hygiene
* -Wearing denture 24 hr/day
* -Clinical Appearance:
* -Asymptomatic, erythematous tissue with a pebbly or papillary surface
* -Hard palate
* -Treatment:
* -Removal of denture for early lesions
* -Antifungal therapy may show improvement
* -Advanced lesions require surgical removal
128
Root resorption can be seen with periapical granulomas. True or False?
True
129
Residual Cyst
* ETIOLOGY
* -Cyst that persist at the site of a previous tooth extraction.
* -inflammation and infection that stimulate rests of malassez
* IMPORTANT INFO
* -**As the cyst ages, cellular components degenerate and can lead to dystrophic calcification and central luminal radiolucency**
* TX
* -Surgical Excision
* etiology: inflammation and infection that stimulate rest of malazzez, etiology is infection that stimulates rest of malassez,
130
How do you treat morsication buccarum?
No treatment needed, but do a 2 week test to confirm
131
What is the average age and is the peripheral giant cell granuloma more common in males or females?
35 year old, 60% females
132
Where is focal cemento-osseous dysplasia ONLY found?
In tooth-bearing areas
133
Lymphoid Hyperplasia
* Also called **Lingual Tonsil or Acessory Lymphoid Aggregates**
* What:
* enlargement of lymphoid tissue, typically from infection
* intraoral lesions are discrete, nontender, submucosal swellings
* yellow or normal in color
* Where:
* lymph nodes, Waldeyer’s ring
* aggregates of lymphoid tissue are most commonly seen:
* oropharynx
* soft palate
* lateral tongue
* floor of mouth
* Treatment:
* biopsy to diagnose. Then no treatment required.
* usually bilaterel and symmetric, which helps to distinguish the condition from a malginancy
* More NORMAL in color
* Assymetrical - biopsy.
* One side has a large node and the other side doesn’t
134
What are the four radiolucency differentials that cross the midline?
1. OKC
2. Ameloblastoma
3. Glandular Odontogenic Cyst
4. Central Giant Cell Granuloma
135
The odontoma is asymptomatic. True or False?
True
136
What are the main causes of erythroleukoplakia?
Tobacco, alcohol, sanguinaria, UV radiation, microorganisms (syphillis, candida albicans)
137
Odontogenic Keratocyst
* ETIOLOGY
* -Arises from cell rests of the dental lamina
* IMPORTANT INFO
* -30% recurrence rate (up to 10 yrs after surgery)
* -Unilocular (smaller lesions)/Multilocular (larger lesions)
* -CAN CROSS MIDLINE
* -Young patients (\<20 yrs) with OKC, should be evaluated/questioned for GORLIN SYNDROME
* -HISTO!!!
* -Basal cell layer shows palisading and is hyperchromatic
* -Epithelial surface is 6-8 layer thick and is corrugated
* TX
* -Enucleate and curettage
* Know Histology
* differential that cross midline:
* OKC
* Ameloblastoma
* GOC
* central giant cell
* Basal cell carcinoma, multiple odontogenic keratocysts helps with identifying gorlin syndrome
* Histology:
* ●Pallisading
* ●Parakeratin
* ●Thin and Friable (6-8 cells thick)
* ●Daughter Cysts
* ●Hyperchromatic
138
Florid Cemento-Osseous Dysplasia
* Etiology
* 90% Female
* 90% African American
* Tendency to be bilateral and symmetrical
* For Florid and Periapical, diagnosis can be made from distinctive clinical and radiographic features
* No biopsy required
* Focal may require surgical investigation because features are less specific
* When lesions are in RL phase they usually don’t cause any problems
* Once in the RO phase lesions are hypovascular and prone to necrosis and secondary infection
* frequent recall
* Don't want to end up extracting in the RO phase
139
Idiopathic Osteosclerosis
* Etiology: Focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else
* Hence: idiopathic
* Tx: No treatment indicated. Only biopsy if there are symptoms, continued growth, or cortical expansion
* follows the PDL!
140
Denture Stomatitis
* Clinical Description: Erythematous lesion beneath an RPD or denture. No plaque to rub off, bright red patch.
* Etiology: A type of ERYTHEMATOUS CANDIDIASIS. Do not remove denture - creates a moist environment.
* Treatment: Treat both denture and soft tissues! Antifungal mouthrinse and soak denture in Nyastatin (anti-fungal medication)
* Other information: Advise patient to remove denture at night to allow tissues to “breath”
141
Condensing osteitis often exhibits a clinical expansino of bone. True or False?
False
142
What are the six main causes of leukoplakia?
Alcohol, tobacco, sanguinaria, UV radiation, microorganisms (trep pallidum), trauma
143
Periapical Cyst
144
How do you treat squamous papilloma?
Conservative surgical excision
145
What are the pharyngeal tonsillar cryps filled with with Tonsilloliths?
Desquamated keratin and foreign material. Secondarily become colonized with bacteria, calcify, and develop a foul smell.
146
What causes a nasopalatine duct cyst?
Two passageways persist in the midline between the primary and secondary palates.
147
On which type of mucosa does primary herpetic gingivostomatitis occur on?
Both movable and non-movable
148
What causes a melanotic macule?
A focal increase in melanin production
149
Tramautic Bone Cyst
* Description: Benign, empty or fluid filled cavity within bone
* -"Scalloping." Not true "cyst" - no epithelial lining.
* Etiology: Trauma-Hemorrhage Theory is most widely accepted theory.
* Trauma to the bone which is insufficient to cause a fracture results in intraosseous hematoma
* If the hematoma does not undergo organization & repair, it may liquify and result in a defect
* Tx: surgical exploration and curettage
150
How does a peripheral giant cell granuloma mainly differ from a pyogenic granuloma?
It is more blue and purple
151
Pyogenic granulomas often exhibit slow growth. True or False?
False, rapid growth with proliferating capillaries
152
What are the four P's to the skin lesions of lichen planus?
1. Purple
2. Pruritic
3. Polygonal
4. Papules
153
What is the most common form of lichen planus? And where does it occur?
Reticular. Bilateral and posterior buccal mucosa.
154
What are the three main causes for an inflammatory papillary hyperplasia?
1. Ill-fitting denture
2. Poor denture hygiene
3. Wearing for 24 hours a day
155
How do you treat an OKC?
Enucleation and curettage
156
Lichen Planus Histo features
Pointed, saw tooth rete ridges
Band like infiltrate of lymphocytes
Degenerating keratinocytes = civatte bodies
Destruction of basal layer
157
What percentage of african americans and what percentage of children have leukoedema?
90% and 50%
158
Tramautic Ulcer
* What:
* acute or chronic trauma causing surface ulcerations.
* injured from dentition
* areas of erythema surrounding a central removable, yellow fibrinopurulent membrane
* Where:
* lips, tongue, buccal mucosa
* treatment:
* remove source of injury
* topical analgesics
* biopsy warranted if not resolved in 2-4 weeks.
* Unique form of chronic traumatic ulceration is termed eosinophilic ulceration or **TUGSE**
* **Traumatic Ulcerative Granuloma with Stromal Eosinophilia**
* Exhibits a deep pseudoinvasive inflammatory process and is slow to resolve – Looks just like oral cancer on the lips or even the tongue, ask them about it’s history, and see if rest of lips have been sunburned, etc.
* Incisional bx (biopsy) is usually curative
159
Tobacco pouch keratosis usually exhibits induration, ulceration, and pain. True or False?
False, none of the above
160
Peripheral Ossifying Fibroma
* -Cause:
* -Usually originates from interdental papilla
* -Age 15, ⅔ Female
* -Clinical Appearance:
* -50% occur in incisor - canine region
* -Nodular mass EXCLUSIVELY on gingiva
* -More PINK in color
* -Treatment:
* -Excision down to periosteum & scale adjacent teeth. 15% recur b/c it wasn’t completely removed.
* \*\*Bump on the gums Dx: 3 P’s & IFH\*\*
161
What causes a mucocele?
Spillage of mucin into soft tissues due to traumatic rupture of salivary gland duct
162
Which gingival pathosis may exhibit cupping resorption of alveolar bone?
Peripheral Giant Cell Granuloma
163
Mixed RL/RO Four Differentials
* **CEOT, COC, AOT, AFO**
* DDx: Mixed RL/RO
* **CEOT - Calcifying Epithelial Odontogenic Tumor**
* -Description:
* -AKA Pindborg Tumor
* -“Driven-Snow Pattern”
* -Avg age 40
* -Md\>Mx, F = M, Post \> Ant
* -Liesegang rings (amyloid-like areas), Positive for Congo Red Test
* -Etiology: Tumor of Odontogenic Epithelium
* -Tx: Conservative local resection with a narrow rim of bone or curettage
* **COC - Calcifying Odontogenic Cyst**
* -Description:
* -AKA Gorlin Cyst
* -Avg Age 35
* -Etiology: Book - Unknown (Classified by WHO as odontogenic tumor but listed under developmental odontogenic cyst in book). Notes - “Rests of Series & Rest of Malassaze”
* -Tx: Simple enucleation or simple surgical excision
* **AOT - Adenomatoid Odontogenic Tumor**
* -Description:
* -“Snowflake Calcifications”
* -Avg age 10 - 20 (uncommon over 30)
* -Mx\>Md, F\>M (2:1)
* -Etiology: Tumor of odontogenic epithelium
* -Tx: Enucleation
* **AFO - Ameloblastic Fibro-Odontoma**
* -Description:
* -Avg age 10
* -Post Jaw
* -Etiology: Mixed Odontogenic Tumor (odontogenic epithelium + odontogenic ectomesenchyme)
* -Tx: Conservative Curettage
* CEOT- older peeps
* COC- Gorlin cyst
* AOT - Younger peeps (Mx canine)
* AFO - avg age 10
* one radiograph mixed rl with small impacted canine - aot
* impacted 3rd molar - ceot (snow drift)
164
What has the "driven-snow" pattern?
Calcifying Epithelial Odontogenic Tumor
165
How do you treat an adenomatoid odontogenic tumor?
Enucleation
166
Eruption Cyst
* Soft tissue analogue of the dentigerous cyst
* Etiology: Result of the separation of the dental follicle from around the crown of an erupting tooth
* Usually in children under 10
* Treatment:
* Cysts usually rupture spontaneously
* If it does not, excision of the roof of the cyst permits eruption of the tooth
167
What causes a pyogenic granuloma?
Reactive lesion to local irritation or trauma (or poor oral hygiene)
168
How do you treat primary herpetic gingivostomatitis?
Acyclovir, early treatment is more effective and shortens episode lengths
169
Where does desmoplastic ameloblastoma usually occur?
Anterior maxilla
170
Pseudomembranous Candidiasis
Also called "thrush"
Clinical Description:
* Best recognized/classic form of Candidiasis
* Adherent white plaques that resemble “cottage cheese”
* Buccal mucosa, palate, dorsal tongue
* Can wipe off
Etiology:
* Broad Spectrum Abx (disrupts balance)
* Impaired immune system (i.e. Leukemia, HIV, Infants)
* Asthma inhalers
Tx: Antifungal (Nystatin)
171
Is pemphigus vulgaris an intra- or interepithelial split?
It is an INTRA. Mucous membrane Pemphigoid is an INTERepithelial split, that is why the desmosomes stay with the upper epithelial layer.
172
Upper lip mucoceles are usually normal. True or False?
False. Lower lip mucoceles tend to be benign, upper lip are more likely to be a salivary gland tumor, retromolar (rare) tend to be mucoepidermoid carcinoma.
173
Teeth are non-vital with tramautic bone cyst. True or False?
False, they are vital
174
Traumatuic bone cyst is not a true cyst. True or False?
True, because no epithelial lining.
175
How do you treat focal cemento-osseous dysplasia?
May require surgical investigation because features are less specific. Don't want to end up extracting in the RO phase.
176
How do you treat a fibroma?
Conservative surgical excision. Must submit the excised tissue to make sure it is not something else.
177
During what months are antral pseudocysts most prevalent?
Winter months
178
What percentage of the population has antral pseudocysts?
2-15%. They are mostly asymptomatic.
179
What is the term for lichen planus that is confined to the gingiva?
Desquamative Gingivitis
180
How do you treat a central giant cell granuloma?
Treatment is curettage
181
How does a hyperplastic dental follicle and dentigerous cyst develop?
Accumulation of fluid between the REE and the tooth crown.
182
How do you distinguish condensing osteitis form cemento-osseous dysplasia?
No RL border with condensing osteitis
183
Periapical Cyst
184
How do you treat erythroleukoplakia?
Biopsy, surgical excision, and frequent monitoring. Biopsy would reveal advanced dysplasia. Premalignant lesion.
185
What are the five white lesions that CAN be scraped off?
o Materia Alba
o White coated tongue
o Burn (thermal, chemical, cotton roll, etc.)
o Pseudomembranous candidiasis
o Sloughing from toothpaste
186
What are the three most common medications associated with drug-related gingival hyperplasia and what are they used for?
1. Phenytoin (50%): is an anticonvulsant, common in young patients
2. Nifedipine (25%): is a calcium channel blocker
3. Cyclosporine (25%): is for transplant therapy
187
What is the most common location for periapical cemento-osseous dysplasia?
Anterior mandible
188
How do you treat an odontoma?
Simple local exicsion, once removed, won't come back
189
What is another name for pseudomembranous candidiasis?
Thrush
190
Mucocele
Also called Mucus Extravasation Phenomenon
* Clinical Description: Small clear papule found on the lower lip (most common), floor of the mouth, anterior ventral tongue, or buccal mucosa
* Etiology: Spillage of mucin into soft tissues due to traumatic rupture of salivary gland duct
* Treatment: Surgical excision and pathology submission, including removal of adjacent minor salivary gland.
* Other information: Lower lip mucoceles tend to be benign, upper lip are more likely to be a salivary gland tumor, retromolar (rare) tend to be mucoepidermoid carcinoma.
* -Cause:
* -Trauma
* -Rupture of salivary gland duct
* -Clinical Appearance:
* -Dome-shaped mucosal swelling
* -Mucin-filled
* -Most common on lower lip
* -Treatment:
* -Surgical excision of duct and minor salivary gland
* If found on gingiva, most likely gingival cyst
191
What type of disease is mucous membrane pemphigoid?
Chronic, blistering, mucocutaneous autoimmune disease. Antibodies are directed against the basement membrane (INTERepithelial split). Desmosomes stay with upper epithelial layer.
192
What is "snowflake calcifications" associated with?
Adenomatoid Odontogenic Tumor
193
Hypersensitivity
* Allergic reaction
* Contact stomatitis from cinnamon
* Toothpaste = diffuse
* Gum/candy = localized
* Plasma cell gingivitis
* Most cases related to hypersensitivity (Big Red chewing gum)
* Allergic reaction to cinnamaldehyde
* Treatment:
* Discontinue use of cinnamon product
194
How can you detect a varicosity?
Blanch with a glass slide
195
What is the most common symptom of primary HSV-I infection?
Primary herpetic gingivostomatitis
196
Idiopathic Osteosclerosis doesn't involve inflammation. True or False?
True. Whereas condensing osteitis does.
197
Yellow Lesions Summary (4 of them)
* Fordyce Granules
* yellow or yellow-white. Multiple submucosal papules on buccal mucosa/upper lip vermillion
* Accessory lymphoid aggregate (lingual tonsil)
* most common in orophaynx(base of tongue) may exhibit orange hue
* Lymphoepithelial cyst
* most common on lingual and palatine tonsils and FOM, may be yellowish-white
* Lipoma
* most common on buccal mucosa, soft to palpation
198
Focal Cemento-Osseous Dysplasia
* Etiology
* 90% females
* Average age = 40
* More common in Caucasians
* Found only in tooth-bearing areas
* For Florid and Periapical, diagnosis can be made from distinctive clinical and radiographic features
* No biopsy required
* Focal may require surgical investigation because features are less specific
* When lesions are in RL phase they usually don’t cause any problems
* Once in the RO phase lesions are hypovascular and prone to necrosis and secondary infection
* frequent recall
* Don't want to end up extracting in the RO phase
199
If you have a mixed RO/RL lesion around an impacted 3rd molar, what is it most likely?
CEOT
200
Periapical Granuloma
* -Cause:
* -95% of all lesions found at the periapical region are pulpal in etiology
* -Pulpal irritants include bacteria, mechanical, thermal, etc.
* -Clinical Appearance:
* -The most common periapical pathosis!
* -Most are asymptomatic, insensitive to percussion, no response to thermal or electric pulp test
* -Mass of inflamed granulation tissue at the apex of a nonvital tooth
* -Chronic inflammation (plasma cells and lymphocytes)
* -Radiolucent lesion, variable size, symmetrical, well defined, punched out border
* -Loss of lamina dura at the root tip in the area of the radiolucency, root resorption can be seen
* Treatment: RCT or extraction
201
What is the average age for an odontoma?
15
202
Sialolith
* -Cause:
* -Calcifications developed in the salivary duct
* -Risk factors: mucous plug, bacteria, chronic duct blockage, xerostomia
* -Clinical Appearance:
* -Most common location: Submandibular gland - Long and tortuous duct with thick secretions
* -Symptoms: Pain or swelling at meal time
* -Dx: Radiograph, ultrasound, CT
* -Treatment:
* -Gentle massage
* -Increased fluid intake
* -Moist heat
* -Sialogogue
* -Surgery
203
Periapical Cyst
* -Cause:
* -Inflammatory stimulation of epithelium in the area
* -Rests of Malassez
* -Clinical Appearance:
* -Most are asymptomatic, insensitive to percussion, no response to thermal or electric pulp test
* -Radiographic pattern is identical to that of a periapical granuloma
* -May show very slow growth or be static
* -Can be residual upon affected tooth removal
* -Can be found on side of root: lateral apical periodontal cyst
* -Treatment:
* -Treated by RCT or extraction
* **Spider Web appearance on Histo**
204
What is the most common non-odontogenic cyst?
Nasopalatine Duct Cyst
205
What is a sialolith?
Calcification developed in the salivary duct
206
Primary Herpetic Gingivostomatitis
* Etiology:
* Most common symptom of primary HSV I infection
* Majority of cases occur before age 5
* **Both movable and non-movable mucosa can be affected**
* Can be self-inoculate
* **Leading infectious cause of blindness**
* Treatment:
* Acyclovir - early treatment is more effective and shortens episode lengths
* Herpetic Whitlow - Herpes on the Hands
207
How do you treat a residual cyst?
Surgical excision
208
What disease can be self-inoculating?
Primary herpetic gingivostomatitis
209
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
210
Pyogenic Granuloma
* -Cause:
* -Not true granuloma- reactive lesion to local irritation or trauma (poor oral hygiene)
* -aka “Pregnancy tumor” or Granuloma Gravidarum
* -Female predilection, pregnancy in 1st trimester
* -Clinical Appearance:
* -Often rapid growth with proliferating capillaries
* -Gingival (75%) smooth or lobulated mass, often pedunculated
* -Surface is ulcerated and bleeds easily
* -Young lesions: RED. Older lesions: PINK
* -Treatment:
* -Surgical Excision, extending down to periosteum & adjacent teeth scaled
* -Pregnancy: defer tx unless esthetic problem
* \*\*Bump on the gums Dx: 3 P’s & IFH\*\*
211
What percent of all lesoins found at the periapical region are pulpal in etiology?
95%
212
What is the soft tissue analog of the dentigerous cyst?
Eruption cyst
213
What is the intrabony counterpart of the gingival cyst of the adult?
Lateral Periodontal Cyst
214
How do you treat lichen planus?
If bilateral and asymptomatic, no biopsy and no treatment. If asymmetric and symptomatic, biopsy and use topical corticosteroids when ulcerated. Steroids make clucose shoot up so check diabetes.
215
What are the four differentials for desquamative gingivitis?
1. Lichen Planus
2. Pemphigoid
3. Pemphigus
4. Hypersensitivity
216
Hyperplastic Dental Follicle vs Dentigerous Cyst
* HDF \<5mm vs DC \>5mm
* -Cause:
* Cyst that originates by separation of the follicle from around the crown of an unerupted tooth -Apparently develops by accumulation of fluid between the reduced enamel epithelium
* (REE) and the tooth crown
* -Clinical Appearance:
* -Most common developmental cyst
* - Most often involves mandibular 3rd molars
* -Unilocular radiolucency associated with crown of unerupted tooth
* -Radiolucency usually has a well-defined and often corticated border
* -Treatment:
* -Treatment is enucleation of the cyst together with unerupted tooth
* DC 3mm
* normal dental follicle means no tx 1-3mm
* 3-5mm could start to be a dentigeours cyst
* 5 or above mm its a dentigerous cyst
* hyperplastic means when biopsy there is no cyst
217
What does a lateral periodontal cyst arise from?
Rests of the dental lamina
218
How do you treat Inflammatory Papillary Hyperplasia?
Removal of denture, antifungal therapy can help, but advance lesions may require surgical removal
219
What is the treatment for aphthous stomatitis?
If minor, no treatment or OTC medications. But you can make "magic mouthwash" for them or prescribe corticosteroids.
220
In what patient population does a pyogenic granuloma commonly occur?
In pregnant patients in 1st trimester
221
How do you treat a lymphoepithelial cyst?
Surgical excision (biopsy) or clinical diagnosis
222
What type of disease is pemphigus vulgaris?
An autoimmune disease, antibodies are directed against the desmosomes (intraepithelial split)
223
Periapical Cemento-Osseous Dysplasia
* Etiology
* 90% female
* 70% African American
* Periapical region of anterior mandible
* PDL will be intact, lesion will not fuse to roots
* if fused to root surface most likely cementoblastoma
* For Florid and Periapical, diagnosis can be made from distinctive clinical and radiographic features
* No biopsy required
* Focal may require surgical investigation because features are less specific
* When lesions are in RL phase they usually don’t cause any problems
* Once in the RO phase lesions are hypovascular and prone to necrosis and secondary infection
* frequent recall
* Don't want to end up extracting in the RO phase
224
Lipoma
* benign tumor of fat
* most common mesenchymal neoplasm
* soft, smooth-surface nodular mass
* yellow or mucosal colored.
* Where:
* 50% occur in buccal mucosa
* Treatment:
* surgical excision
225
What is the other name for a mucocele?
Mucus extravasation phenomenon
226
Where does a peripheral ossifying fibroma usually originate from?
The interdental papilla
227
What is in the cavity with a tramautic bone cyst?
It is a benign, empty, or fluid filled cavity within bone.
228
What are the main risk factors for a sialolith?
Mucous plug, bacteria, chronic duct blockage, xerostomia
229
Condensing osteitis involves sclerotic bone. True or False?
True
230
A fibroma is not a true neoplasm, True or False?
True
231
What happens to leukoedema when the cheek is stretched?
The white disappears, then comes back.
232
Leukodema does not rub off and is usually found bilaterally. True or False?
True
233
How do you treat idiopathic osteosclerosis?
No treatment. Only biopsy if there are symptoms, continued growth, or cortical expansion. It follows the PDL!
234
What is the antral pseudocyst an accumulation of?
Serum exudate (not mucous), and it happens beneath the maxillary sinus mucosa, causing sessile elevation.
235
What is the other name for condensing osteitis?
Focal sclerosing osteomyelitis
236
How do you treat a lateral periodontal cyst?
Conservative enucleation
237
What category does denture stomatitis fall under?
It is a type of erythematous candidiasis.
238
How do you treat desquamative gingivitis?
Biopsy is required
239
Lateral Periodontal Cyst
* ETIOLOGY
* -Arises from rests of the dental lamina
* -Developmental odontogenic cyst along lateral root surface
* IMPORTANT INFO
* -Intrabony counterpart of the gingival cyst of an adult
* -MANDIBULAR PREMOLAR-CANINE-LATERAL INCISOR area
* TX
* -Conservative enucleation
240
What is the most common mesenchyal neoplasm?
Lipoma
241
How do you treat a peripheral ossifying fibroma?
Excision down to the periosteum and scale adjacent teeth.
242
What are the symptoms of a sialolith?
Pain or swelling at meal time
243
How do you treat ameloblastomas?
Varies from enucleation and curettage to end block resection. But marginal resection is the most widely used treatment. You do it 1.5 cm beyond what is visible radiographically.
244
What is the treatment for leukoedema?
None needed
245
What is the treatment for pemphigus vulgaris?
Referral to dermatologist and use corticosteroids.
246
Condensing Osteitis
* Also called Focal Sclerosing Osteomyelitis
* Localized area of bone sclerosis associated with apices of teeth with pulpitis.
* Association with inflammation distinguishes it from idiopathic osteosclerosis diagnosis.
* Increased RO adjacent to tooth apex that has a thickened PDL.
* No RL border distinguishes it from cemento-osseous dysplasia.
* No clinical expansion of bone.
* 85% regress after odontogenic infection is eliminated.
* Associated with teeth that have had extensive treatment i.e. using condenser.
247
Desquamative Gingivitis
* Clinical diagnosis
* Used to describe gingival epithelium that spontaneously sloughs or can be removed with minor manipulation
* Differential:
* Lichen planus
* Pemphigoid
* Pemphigus
* Hypersensitivity
* Biopsy required
248
What is the other name for a stafne defect?
Lingual mandibular salivary gland depression
249
How do you treat a tramautic bone cyst?
Surgical exploration and curettage
250
What is spider web epithelium associated with?
The histo for a periapical cyst
251
OKC, hence the basal cell layer showing palisading and hyperchromaticity. The epithelial surface is 6-8 layers thick and the parakeratin is corrugated at the surface
252
How do you treat denture stomatitis?
Treat both the denture and soft tissue, use an antifungal mouthrinse and soak the denture in nystatin.
253
Antral Pseudocyst
* ➢Common finding on panoramic radiographs on 2-15% of population.
* ➢Mostly asymptomatic.
* ➢Increased prevalence during winter months.
* ➢Appears as dome-shaped, faintly radiopaque lesion arising from floor of maxillary sinus.
* ➢Develops due to accumulation of serum exudate (not mucous) beneath maxillary sinus mucosa, causing sessile elevation.
* ➢No treatment necessary
254
What is the most common location of a central giant cell granuloma?
Anterior jaw, frequently cross the midline
255
What percentage of peripheral ossifying fibromas will occur because they weren't properly removed?
15%
256
How do you treat eruption cysts?
They usually rupture spontaneously, and if it does not, excision of the roof of the cyst permits eruption of the tooth
257
What stimulates the rests of malassez in a residual cyst?
Inflammation and infection
258
The OKC can cross the midline. True or False?
True
259
Mucous Membrane Pemphigoid
* Chronic, blistering, mucocutaneous autoimmune disease
* Antibodies are directed against the _basement membrane_ (interepithelial split)
* **Desmosomes stay with upper epithelial layer**
* Intraoral blood blister is pathognomonic
* **Ocular involvement is most significant complication**
* Can result in blindness
* Treatment:
* Referral to ophthalmologist
* Topical corticosteroids
260
What is the most significant complication of mucous membrane pemphigoid?
Ocular involvement
261
How do you treat lymphoid hyperplasia?
Biopsy to diagnose and then no treatment is required. Usually ilateral and symmetric, and normal in color. If assymetric, make sure you biopsy
262
What are the two common bacteria that cause angular cheilitis?
C. Albicans and S. Aureus
263
What is pathognomonic for mucous membrane pemphigoid?
Intraoral blood blister
264
What are the main causes of black hairy tongue?
Smokers, poor oral hygiene, antibiotics, radiation.
265
How do you treat pseudomembranous candidiasis?
Antifungals (nystatin)
266
Parulis
* -Cause:
* -When a periapical abscess forms pus, it will follow the path of least resistance, find a point of exit, and drain the purulent material
* -Clinical Appearance:
* -The parulis marks the exit point of the sinus tract on the oral mucosa
* -Subacutely inflamed granulation tissue
* -Also called “gum boil” or “intraoral sinus tract”
* -Treatment:
* -Drainage and elimination of the focus of the infection
* -Gutta Percha is often placed in the parulis in order to enter the fistula to find the source of the infection radiographically
* -The sinus tract usually resolves spontaneously after the offending tooth is extracted or endodontically treated
* Can turn into cavernous sinus thrombosis or Ludwig's Angina
267
Fibromas are usually symptomatic. True or False?
False, they are sessile, asymptomatic, and smooth-surfaced nodules
268
What is the most common developmental cyst?
Dentigerous cyst
269
How do you treat a sialolith?
Gentle massage, increased fluid intake, moist heat, sialogogue, surgery
270
How do you treat Linea Alba?
No treatment necessary
271
Central Giant Cell Granuloma
* Etiology
* Non-neoplastic lesion
* \*\*More common in the anterior jaw; frequently cross the midline\*\*
* Cherubism
* Treatment
* Treatment is curettage with a recurrence of 20%
272
What percentage of peripheral giant cell granulomas still recur after surgical excision down to bone and scaling adjacent teeth?
10%
273
How do you treat a gum hypersensitivity problem?
Discontinue use of whatever it is, cinnamon, whatever, just do it, don't ask.
274
What is the other name for a Calcifying Odontogenic Cyst?
Gorlin cyst
275
Melanotic Macule
* •Oral counterpart to the ephelis
* •Etiology: Brown asymptomatic macule produced by a focal increase in melanin production
* •Treatment: Can’t be distinguished clinically from early melanoma, so biopsy is mandatory.
* Remember there is a difference between a labial and an oral melanotic macule.
276
What is the most common odontogenic tumor?
Odontoma
277
What is the histopathology of a central giant cell granuloma identical to?
Cherubism and brown tumor of hyperparathyroidism
278
Angular Cheilitis
* Clinical Description
* Accentuated folds at the corners of the mouth
* Etiology:
* C. Albicans or Staph Aureus
* Treatment
* Antifungal
279
What is Waldeyer's ring?
Waldeyer's ring circumscribes the naso- and oropharynx, with some of its tonsillar tissue located above and some below the soft palate (and to the back of the oral cavity). Associated with Lymphoid Hyperplasia and lymphoepithelial cyst. Waldeyer's ring (palatine tonsils, lingual tonsils, pharyngeal adenoids).
280
In what gender is focal cemento-osseous dysplasia most commonly found, and what is the average age?
90% females, average age is 40. More common in caucasians.
281
What is an ameloblastic fibro-odontoma made up of?
It is a mixed odontogenic tumor. Made up of odontogenic epithelium and odontogenic ectomesenchyme.
282
Lymphoepithelial Cyst
* What:
* lesion of the mouth that develops within oral lymphoid tissue.
* white or yellow
* asymptomatic
* submucosal mass less than 1 cm in diameter
* Where:
* Waldeyer's ring (palatine tonsils, lingual tonsils, pharyngeal adenoids)
* also found on the floor of mouth, ventral tongue, soft palate
* Treatment:
* surgical excision (biopsy) or clinical diagnosis
283
How do you treat tonsilloliths?
At home, gargle salt water or water jet. In office, enucleation, local excision, or tonsillectomy is definitive.
284
What is the leading infectious cause of blindness?
Primary herpetic gingivostomatitis
285
Abscess
* Etiology: Accumulation of acute inflammatory cells (neutrophils) at apex
* Treatment: Root Canal Therapy
286
What are the two other names for geographic tongue?
Benign Migratory Glossitis and Erythemia Migrans (when not on tongue)
287
What is the name for the Big Red gum hypersensitivity? What is it an allergic reaciton to?
Plasma Cell gingivitis. Cinnamaldehyde.
288
Peripheral Giant Cell Granuloma
* -Cause:
* -Reactive lesion caused by irritation/ trauma
* -35yr, 60% female
* -Clinical Features:
* -EXCLUSIVELY on gingiva, may have “cupping” resorption of alveolar bone
* -Erythematous mass, looks like PG but more BLUE or PURPLE
* -Treatment:
* -Surgical excision down to bone, scale adjacent teeth
* -10% recur
* \*\*Bump on the gums Dx: 3 P’s & IFH\*\*
289
Morsicatio Buccarum
Clinical Description:
* Found bilaterally on the anterior buccal mucosa
* Thickened, shredded white areas
* Etiology: Chronic cheek chewing (parafunctional habit)
Tx:
* No tx needed
* 2 wk test to confirm
290
What are Liesegang rings, what are they associated with, and what does this pathosis test positive for?
They are amyloid-like areas, the CEOT, and tests positive for Congo Red test.
291
What are the two other names for a parulis?
Gum boil or intraoral sinus tract
292
What causes a peripheral giant cell granuloma?
It is a reactive lesion caused by irritation or trauma
293
Which radiolucency that crosses the midline is known for having daughter cysts?
Odontogenic Keratocyst
294
What is the size range of a lymphoepithelial cyst?
Submucosal mass less than 1 cm in diameter
295
How long before an outbreak does prodrome occur?
6-24 hours
296
What causes leukoedema?
Just variation of normal edematous swelling
297
How do you treat a tramautic ulcer?
Remove soure of injury, topical analgesics, and a biopsy is warranted if not resolved in 2-4 weeks
298
Lichen Planus
* Common, chronic, immunologically mediated dermatologic disease that often affects the oral mucosa
* Skin lesions = 4 P’s **(purple, pruritic, polygonal, papules)**
* Wickham’s striae = lace-like network of while lines
* Two forms:
* Reticular (most common)
* Erosive
* **Reticular -- bilateral and posterior buccal mucosa most commonly**
* Histological features:
* Pointed, saw tooth rete ridges
* Band-like infiltrate of lymphocytes
* Degenerating keratinocytes = civatte bodies
* Destruction of basal layer
* Treatment:
* Bilateral and asymptomatic = no biopsy and no treatment
* Asymmetric or symptomatic = biopsy and topical corticosteroids
* **Don't need to treat reticular if bilateral and asymptomatic**
* Common, chronic dermatologic disease that can affect the oral mucosa
* Identifiable Wickham striae
* 2 forms of oral lesions:
* Erosive and Reticular
* If confined to the gingiva it is Desquamative gingivitis
* Tx:
* Oral topical corticosteroids are used for treatment just when ulcerated..but too much corticosteroid lead to candida..feeling pain..burning lesion.. yeast.
* Steroids make glucose shoot up so know if patient is diabetic
*
299
How could you describe clinically a squamous papilloma?
* Pedunculated
* Exophytic
* White, red or mucosal colored
* Around 5 mm or less
* Tongue lips or soft palate
300
How do you treat recurrent herpes?
Heals naturally betweeen 7-10 days. In severe cases, acyclovir can be prescribed to lessen severity.
301
What is a parulis composed of?
Subacutely inflamed granulation tissue
302
How do you treat a stafne defect?
You don't
303
How do you treat a lipoma?
Surgical excision
304
What type of tissue makes up epulis fissuratum?
It is a tumorlike hyperplasia of fibrous connective tissue
305
Varicosities
* Clinical description
* Superficial dilated veins detected by blanching with glass slide.
* Treatment
* No treatment unless on lips or buccal mucosa because of thrombus formation or esthetics
306
Epulis Fissuratum
* -Cause:
* -Tumorlike hyperplasia of fibrous connective tissue that develops in association with the flange of an ill-fitting complete or partial denture
* -Clinical Appearance:
* -Single or multiple folds of hyperplastic tissue in the alveolar vestibule
* -Usually firm and fibrous, but can be ulcerated and erythematous
* -Usually develops on the facial aspect of the alveolar ridge
* -Also called Inflammatory Fibrous Hyperplasia (IFH)
* -Treatment:
* -Surgical removal
* -Ill-fitting denture should be remade or relined to prevent a recurrence of the lesion
* \*\*Bump on the gums Dx: 3 P’s & IFH\*\*
307
Smoker's Melanosis
* •Etiology: Melanin production stimulated by nicotine
* •Treatment: Cessation of smoking with biopsy if found in unexpected location or clinical changes
* To confirm that it isn’t just pigmentation - do a biopsy
* Different colors -- will want to biopsy
* Uniform colors throughout with clinical description -- don’t have to biopsy
308
Periapical Abscess
309
Condensing Osteitis exhibits a thickened PDL around the tooth. True or False?
True
310
Geographic Tongue
a.k.a. benign migratory glossitis, erythema migrans (when not on the tongue)
## Footnote
· Common inflammatory condition
· Dorsal and/or lateral tongue
· Asymptomatic (may burn or hurt)
· Often patients with fissured tongue are affected
311
What is the recurrence rate of a central giant cell granuloma after curettage?
20%
312
At what age do a majority of cases of primary herpetic gingivostomatitis occur before?
Before age of 5
313
How do you treat florid cemento-osseous dysplasia?
No biospy required, diagnosis can be made clinically.
314
How do you treat a dentigerous cyst?
Enucleation of the cyst together with the unerupted tooth
315
How do you treat a peripheral giant cell granuloma?
Surgical excision down to bone, scale adjacent teeth.
316
Ameloblastoma
* Most common clinically significant odontogenic tumor
* 85% occur in mandible molar-ascending ramus region (except desmoplastic which occurs in anterior maxilla)
* Multilocular RL.
* Buccal-Lingual cortical expansion
* Histopathologic features
* Palisading basal layer
* Reverse polarity
* Treatment:
* Varies from enucleation and curettage to en bloc resection
* Marginal resection is the most widely used treatment
* 1.5 cm beyond what is visible radiographically
