Differential diagnosis ( kumar's review and Neviel Book) Flashcards

Question

Café‐au‐lait pigmentation _ddx_ Kumar

Answer 1

* Polyostotic fibrous dysplasia * Neurofibromatosis of von Recklinghausen

Answer 2

* Langerhans cell disease * Papillon Lefevre

Answer 3

* Juvenile periodontitis * Langerhans cell disease * Papillon Lefevre * Cyclic neutropenia/Agranulocytosis * Burkitt’s lymphoma

Answer 4

* Sjogren (parotid) * Pleomorphic adenoma (parotid) * Warthin tumor (parotid) * Ameloblastoma (mandible) * Cherubism (bilateral) * Fibrous dysplasia (unilateral) * Mumps (bilateral usu.) * HIV (lymphoepithelial cysts) * Bulimia * Alcoholism

Answer 5

* Lateral periodontal cyst‐Gingival cyst * Dentigerous cyst‐Eruption cyst * Central giant cell granuloma‐Peripheral giant cell granuloma

Answer 6

* Melanoma * Lymphoma

Answer 7

**• Congenital epulis** **• Granular cell tumor**

Answer 8

**• Erosive lichen planus** **• Mucous membrane pemphigoid** **• Pemphigus vulgaris** **• Erythema multiforme**

Answer 9

**1) Iron deficiency anemia** **2) Pernicious anemia** **3) Folic acid and B12 deficiency** **4) Celiac sprue**

Answer 10

**• Aplastic anemia • Polycythemia • Leukemia • Thrombocytopenic purpura • Hemophilia**

Answer 11

**• Cyclosporine • Phenytoin • Nifedipine**

Answer 12

**• Leukemia • Drug induced**

Answer 13

**• Heart shape**‐Nasopalatine canal cyst • **Scalloping**‐traumatic bone cyst **• Ghost teeth**‐regional odontodysplasia **• Ghost cells**‐calcifying odontogenic cyst

Answer 14

**• X looks like a “t”**‐Turner **• Snow capped**‐amelogenesis imperfecta **• Pebbly**‐Verrucous carcinoma, lymphangioma **• Pearly doughnut with ulcer and telangiectactic blood vessels‐**basal cell carcinoma

Answer 15

* **Swiss cheese**‐adenoid cystic carcinoma * **Tennis raquet, step ladder**‐myxoma * **Bag of marbles**‐compound odontoma

Answer 16

* **Hair on end**‐thalassemia and sickle cell anemia * **Mosaic jigsaw‐**Paget histology * **Cobblestone**‐Crohn, papillary hyperplasia * **Sunray spiculated pattern**‐Osteosarcoma

Answer 17

**• Gardner syndrome**‐Malignant GI polyps * **Gorlin** – Basal cell carcinoma * **Multiple endocrine neoplasia** –Medullary thyroid carcinoma * **Neurofibromatosis of von Recklinghausen**‐Malignant transformation of neurofibromas

Answer 18

**• Amelogenesis imperfecta**‐ “crown preps” and taurodontism **• Dentinogenesis imperfecta‐**bulbous crown no root canal, shell teeth **• Dentin dysplasia type 1‐** “rootless teeth” **• Dentin dysplasia type 2‐** “thistle tube”

Answer 19

* **Gardner** (malignant) * **Peutz Jegher** (benign)

Answer 20

* **OpalescentTeeth**=Dentinogenesis imperfecta and osteogenesis imperfecta * **Opalescent Mucosa**=Leukoedema

Answer 21

## Footnote * **Ellis van Creveld‐**Chondroectodermal dysplasia * **Gorlin**‐Nevoid basal cell carcinoma • **Treacher Collin‐**Mandibulofacial dysostosis \

Answer 22

## Footnote * **Osler Rendu Parkes Weber** – Hereditary hemorrhagic telangiectasia * **Canon**‐White sponge nevus * **Pindborg tumor**‐Calcifying epithelial odontogenic tumor

Answer 23

* *•** **Neutrophil** – acute inflammation * *• B lymphocyte** – makes plasma cells (chronic) * *• Plasma cell** – makes antibodies (chronic)

Answer 24

**• Macrophage** – phagocytosis (both acute and chronic) **• Eosinophil and Langerhans cell** – Langerhans cell disease **• Eosinophil** ‐ allergy **• Mast cell** – allergy

Answer 25

**• Stafne bone cyst** – Static bone cyst=saliv.gland **• Traumatic bone cyst** –Simple bone cyst=empty **• White sponge nevu**s – Canon disease

Answer 26

**• Gorlin syndrom**e – Nevoid basal cell carcinoma syndrome **• Benign migratory glossitis** – Geographic tongue –Erythema migrans **• Wart** – Verruca vulgaris **• Canker sore** – Minor aphthous ulcer

Answer 27

**• Dens in dente** – Dens invaginatus ‐Tooth within a tooth * **Freckle**‐Ephelis‐ Melanotic macule (NOT MACULE ALONE) * **Birth mark**‐Nevus‐Melanocytic nevus * **Mole**‐Melanocytic nevus

Answer 28

* **Explosive onset** – Erythema multiforme * **Gets larger and smaller** – mucocele * **Attached mucosa** – Recurrent herpes

Answer 29

**• Movable mucosa** – Aphthous ulcers **• Urticaria** – superficial • **Angioedema** – deep

Answer 30

**• Female/max/canine?**‐Adenomatoid odontogenic tumor **• Compound odontoma**‐anterior max **• Complex odontoma**‐posterior md

Answer 31

**• Yellow with superficial blood vessels**‐lipoma **• Most common malignant soft tissue tumor of head and neck** childrenrhabdomyosarcoma • **Cluster of coalescing ulcers unilateral**‐recurrent intraoral herpes

Answer 32

**• Draining sinus at angle** –actinomycosis * **Loss of primary teeth**‐ hypophosphatasia * **Hole in palate**‐Gumma

Answer 33

* **Dysplasia**‐microscopic term * **Leukoplakia**‐clinical term * **Pericoronitis**‐clinical term not radiographic * **Varicella zoster virus**‐chicken pox/herpes zoster * **Oral hairy leukoplakia** CORRUGATED‐ EBV * **Mucocele** (granulation tissue lined) vs **mucous cyst** (epithelial lined)

Answer 34

* _**White coated tongue** May be scraped off slightly, with dif!culty_ * _**Pseudomembranous candidiasis** “Milk curd” or “cottage cheese” appearance; may leave red base when rubbed off_ * _**Morsicatio Surface** may appear to be peeling off_ * _**Toothpaste or mouthwash reaction** Filmy whiteness; leaves normal appearing mucosa when rubbed off_ * **Thermal burn** Example: pizza burn * **Sloughing traumatic lesion** Example: cotton roll “burn” * **Chemical burn** Example: aspirin burn secondary to direct application for toothache * **Secondary syphilis Mucous patch**; may be only partially scraped off * **Diphtheria** Gray-white pseudomembrane of oropharynx

Answer 35

* _**Linea alba** Buccal mucosa along occlusal plane_ * _**Leukoedema** Primarily in blacks; milky white alteration of buccal mucosa bilaterally; disappears when stretched_ * _**Leukoplakia** May show benign hyperkeratosis, epithelial dysplasia, or invasive carcinoma_ * _**Tobacco pouch keratosis** Usually in mandibular vestibule; associated with use of snuff or chewing tobacco_ * _**White coated tongue** Diffuse involvement of dorsal tongue_ * **Lichen planus** Wickham’s striae; typically bilateral on buccal mucosa * **Morsicatio** Most common on anterior buccal mucosa, labial mucosa, and lateral border of tongue; exhibits ragged surface * **Actinic cheilosis** Pale, gray-white, scaly alteration of lower lip; usually in older men with history of chronic sun exposure; precancerous * ***Nicotine stomatitis** Usually associated with pipe smoking; occurs on hard palate* * ***Hairy leukoplakia** Usually lateral border of tongue; rough surface with vertical !ssures; usually associated with HIV infection* * ***Hyperplastic candidiasis** Most commonly affects anterior buccal mucosa* * ***Lupus erythematosus** Most common on buccal mucosa; may mimic lichen planus or leukoplakia; associated skin lesions usually present* * ***Skin graft** History of previous surgery* * ***Submucous fibrosis** More common in South Asia; associated with betel quid chewing* * ***White sponge nevus** Hereditary; onset in childhood; generalized lesions, especially buccal mucosa* * ***Hereditary benign intraepithelial dyskeratosis** Hereditary; onset in childhood; generalized lesions, especially buccal mucosa; ocular involvement possible* * ***Pachyonychia congenita Hereditary**; onset in childhood; most common on dorsal tongue and areas of trauma; nail, palmar, and plantar changes also present* * ***Dyskeratosis congenita Hereditary**; onset in childhood; dystrophic nail changes* * ***Uremic stomatitis** Renal failur*

Answer 36

* _**Pharyngitis** Examples: strep throat, viral pharyngitis_ * _**Traumatic erythema** Caused by local irritation_ * _**Denture stomatitis** Denture-bearing palatal mucosa_ * _**Erythematous candidiasis** Example: central papillary atrophy (median rhomboid glossitis)_ * _**Erythema migrans Geographic tongue** (cases with absence of white borders); continually changing pattern; rarely involves other mucosal sites_ * _**Angular cheilitis** Erythema and cracking at labial commissures_ * **Thermal burns** Example: caused by hot liquids * **Erythroplakia** Usually shows epithelial dysplasia or carcinoma * ***Anemia** Atrophic, red tongue; can be due to pernicious anemia, ironde deficiency anemia, hypovitaminosis B* * ***Hemangioma** Develops in younger patients; may blanch; may show bluish hue* * ***Lupus erythematosus** Usually with associated skin lesions* * ***Scarlet fever** Secondary to B-hemolytic streptococcal infection; strawberry/ raspberry tongue* * ***Plasma cell gingivitis** Allergic reaction usually related to "avoring agents* * ***Radiation mucositis** Patient currently undergoing radiotherapy*

Answer 37

* _**Erythema migrans Geographic tongue**; continually changing pattern; rarely involves other oral mucosal sites_ * _**Candidiasis** White component may be rubbed off_ * **Lichen planus** Atrophic or erosive forms; Wickham’s striae; typically bilateral on buccal mucosa * **Burns** Examples: pizza burn, aspirin burn, other chemical burns; white component may be rubbed off * **Actinic cheilosis** Pale, gray-white and red alteration to lower lip; usually in older men with history of chronic sun exposure * **Erythroleukoplakia** Usually shows epithelial dysplasia or carcinoma * **Cinnamon reaction** Related to cinnamon "avored gum; typically on buccal mucosa and lateral tongue * ***Nicotine stomatitis** Usually associated with pipe smoking; occurs on hard palate* * ***Lupus erythematosus** Most common on buccal mucosa; may mimic lichen planus or leukoplakia; associated skin lesions usually present* * ***Scarlet fever** Secondary to B-hemolytic streptococcal infection; strawberry/ raspberry tongue* * ***Verruciform xanthoma** Most common on gingiva and hard palate; surface may be papillary*

Answer 38

* _**Fordyce granules** Sebaceous glands; usually multiple submucosal papules on buccal mucosa or upper lip vermilion_ * **Super facial abscess** Example: parulis from nonvital tooth * **Accessory lymphoid aggregate** Most common in oropharynx and "oor of mouth; may exhibit orange hue * **Lymphoepithelial cyst** Most common on lingual and palatine tonsils, and "oor of mouth; * may be yellow-white * **Lipoma** Most common on buccal mucosa; soft to palpation 488 * **Jaundice** Generalized discoloration, especially involving soft palate and " floor of mouth; sclera usually affected also * **Verruciform xanthoma** Most common on gingiva and hard palate; surface may be rough or papillary * **Pyostomatitis vegetans** “Snail-track” pustules; associated with in"ammatory bowel disease

Answer 39

* _**Varicosities** Especially after 45 years of age; most common on ventral tongue and lips_ * _**Submucosal hemorrhage** Petechial, Ecchymotic, and Telangiectatic Lesions_ * _**Amalgam tattoo** Most common on gingiva; blue-gray; radiopaque amalgam particles sometimes discovered on radiographs_ * _**Mucocele** Especially on lower labial mucosa; typically pale blue; cyclic swelling and rupturing often exhibited_ * **Eruption cyst** Overlying an erupting tooth * **Salivary duct cyst** Usually pale blue * **Hemangioma** Usually red-purple; may blanch under pressure; onset in younger patients * **Ranula** Pale blue, "uctuant swelling of lateral "oor of mouth * ***Kaposi sarcoma** Especially in AIDS patients; usually purple; most common on palate and maxillary gingiva* * ***Nasopalatine duct cyst** Midline of anterior palate* * ***Salivary gland tumors** Especially mucoepidermoid carcinoma and pleomorphic adenoma; usually pale blue; most common on posterior lateral palate* * ***Gingival cyst of the adult** Most common in mandibular bicuspid-cuspid region* * ***Blue nevus** Most common on hard palate*

Answer 40

* **Thyroid gland enlargement** Examples: goiter, thyroid tumor * **Thyroglossal duct cyst** May move up and down with tongue motion * **Dermoid cyst** Soft and fluctuant * **Plunging ranula** Soft and compressible

Answer 41

* _**Racial pigmentation** Most common on attached gingiva in darker complexioned patients_ * _**Amalgam tattoo** Most common on gingiva; usually slate-gray to black; opaque amalgam particles may be found on radiographs_ * _**Black/brown hairy tongue** Discoloration and elongation of filiform papillae_ * _**Melanotic macule** Brown; most common on lower lip_ * **Smoker’s melanosis** Most common on anterior facial gingiva * **Non-amalgam tattoo** Example: graphite from pencil * ***Melanocytic nevus** Most common on hard palate; can beflat or raised* * ***Melanoma** Most common on hard palate and maxillary gingiva; may show mixture of deep blue, brown, black, and other colors* * ***Oral melanoacanthoma** Rapidly enlarging pigmented lesion; usually occurs in blacks* * ***Drug ingestion** Examples: chloroquine, chlorpromazine, minocycline; especially on hard palate* * ***Peutz-Jeghers syndrome** Freckle-like lesions of vermilion and perioral skin; intestinal polyps; hereditary* * ***Addison disease** Chronic adrenal insuf!ciency; associated with bronzing of skin* * ***Neuro!bromatosis type I** Café au lait pigmentation; cutaneous neuro!bromas* * ***McCune-Albright syndrome** Café au lait pigmentation; polyostotic !brous dysplasia; endocrine disorders* * ***Heavy metal poisoning** Typically along marginal gingiva (e.g., lead, bismuth, silver)* * ***Melanotic neuroectodermal** tumor of infancy:Anterior maxilla; destroys underlying bone*

Answer 42

* _**Hairy tongue** Usually brown or black discoloration; hyperkeratotic elongation of !liform papillae on posterior dorsal tongue_ * _**Papilloma** Can be white or pink; most common on soft palate and tongue; usually pedunculated_ * _**Inflammatory papillary hyperplasia** Usually involves midportion of hard palate beneath denture_ * **Leukoplakia** (some variants) Examples: proliferative verrucous leukoplakia, granular or nodular leukoplakia * **Squamous cell carcinoma** Examples with papillary surface changes * **Giant cell fibroma** Usually in children and young adults; most common on gingiva * ***Verruca vulgaris** Common wart; especially in younger patients; most common on labial mucosa* * ***Hairy leukoplakia** Usually lateral border of tongue; rough surface with vertical fissures; usually associated with HIV infection* * ***Verruciform xanthoma** Most common on gingiva and hard palate* * ***Verrucous carcinoma** Especially in older patients with long history of snuff or chewing tobacco use; especially in mandibular vestibule and buccal mucosa; may be white or red* * ***Condyloma acuminatum** Venereal wart; broad-based lesions with blunted projections; frequently multiple* * ***Multifocal epithelial hyperplasia** Usually multiple, "at-topped papular lesions; usually in children; most common in Native Americans and Inuit; color may vary from normal to white* * ***Darier’s disease** Most commonly appears as pebbly appearance of hard palate; associated crusty, greasy skin lesions; hereditary* * ***Acanthosis nigricans (malignant type)** Most commonly appears as generalized pebbly alteration of upper lip; pigmented, pebbly skin changes*

Answer 43

* _**Nonspecific trauma** History of injury to lesional site_ * **Upper respiratory infections** Soft palate petechiae * ***Infectious mononucleosis** Soft palate petechiae; tonsillitis and/or pharyngitis may be present* * ***Idiopathic thrombocytopenic purpura** Areas of trauma; gingival bleeding possibly present* * ***Trauma from fellatio** Posterior palatal petechiae or ecchymosis* * ***Hemophilia Hereditary**; childhood onset; gingival bleeding may be present* * ***Leukemia** Caused by secondary thrombocytopenia; gingival bleeding may be present* * ***Hereditary hemorrhagic telangiectasia** Multiple, pinhead-sized telangiectasias; possible history of nosebleeds or gastrointestinal bleeding* * ***CREST syndrome Multiple**, pinhead-sized telangiectasias; Calcinosis cutis, Raynaud’s phenomenon, Esophageal motility defect, Sclerodactyly, Telangiectasias*

Answer 44

* _**Hyperplastic gingivitis** Examples: associated with puberty, pregnancy, diabetes_ * **Drug-related gingival hyperplasia** Examples: phenytoin, calcium-channel blockers, cyclosporine; may be fibrotic * ***Gingival fibromatosis** May be hereditary; onset in childhood* * ***Leukemic infiltrate** Usually boggy and hemorrhagic* * ***Wegener granulomatosis** “Strawberry” gingivitis; may have palatal ulceration and destruction; lung and kidney involvement* * ***Scurvy Vitamin C deficiency***

Answer 45

* _**Traumatic ulcer** Mild-to-moderate pain; history of local trauma_ * _**Aphthous stomatitis** Extremely painful; may be single or multiple; nonkeratinized movable mucosa; often recurs_ * _**Recurrent herpes labialis** Vermilion and labial skin; begins as multiple vesicles; often recurs_ * **Primary herpetic gingivostomatitis** Fever and malaise; children and young adults; multiple vesicles; gingiva consistently affect * **Necrotizing ulcerative gingivitis (NUG)** Painful destruction of gingival papillae; fetid odor; mostly in teenagers and young adults Mucosal burns Chemical or thermal * **Recurrent intraoral herpes simplex** Gingiva or hard palate (except in immunocompromised); focal cluster of vesicles and shallow ulcers * Allergic reactions Example: Caused by topical medications or dental materials; erythema and vesicles * **Erythema multiforme / Stevens-Johnson syndrome** Predominantly in children and young adults; multiple blisters and ulcers; often crusting, hemorrhagic lip lesions; may have associated “target” skin lesions or involvement of ocular and genital mucosa * **Herpangina** Especially in children; multiple small ulcers on soft palate and tonsillar pillars * ***Varicella** (chickenpox) Associated with skin eruption; few oral vesicles and ulcers; usually in children* * ***Herpes zoster** Unilateral involvement along nerve distribution; usually middle-aged and older adults; painful vesicles and ulcers* * ***Hand-foot-and-mouth disease** Especially in children; multiple vesicles and ulcers; associated vesicles on hands and feet* * ***Necrotizing sialometaplasia** Usually posterior lateral hard palate; prior swelling may be present; deep crater-like ulcer; may be only minimal pain* * ***Anesthetic necrosis** Usually at site of palatal injection* * ***Primary syphilis Chancre** at site of inoculation; usually painless with lean ulcer bed* * ***Behçet syndrome** Aphthous-like ulcers; genital ulcers and ocular in"ammation*

Answer 46

* _**Erosive lichen planus** Associated with white striae; usually in middle-aged and older adults; most common on buccal mucosa and gingiva_ * _(“desquamative gingivitis”)_ * **Traumatic granuloma** Solitary, non-healing ulcer * **Squamous cell carcinoma** Usually in middle-aged and older adults; usually indurated and may have rolled border; may be painless * **Mucous membrane pemphigoid** Most common in middle-aged and older women; most commonly presents as a “desquamative gingivitis”; may involve ocular and genital mucosa * **Lupus erythematosus** May have associated red and white change; usually with skin involvement * **Pemphigus vulgaris** Usually in middle-aged and older patients; multiple oral blisters and ulcers usually precede skin lesions * **Deep fungal infections** Examples: histoplasmosis, blastomycosis; may be painless * **Tuberculosis** Associated mass may be present; may be painless * **Sarcoidosis** May be associated with erythematous macules or plaques; may be painless * **Epidermolysis bullosa** Hereditary (except epidermolysis bullosa acquisita); onset in infancy and childhood; multiple skin and oral blisters or ulcers in areas of trauma; may result in extensive scarring * **Pyostomatitis vegetans** Yellowish “snail-track” pustules; associated with in"ammatory bowel disease * **Wegener granulomatosis** Usually palatal ulceration and destruction; associated lung and kidney involvement may be present; may show “strawberry gingivitis” * **Extranodal NK/T-cell lymphoma, nasal-type (midline lethal granuloma)** Palatal lymphoma with ulceration and destruction of underlying bone; may be painless * **Noma** Gangrenous necrosis secondary to necrotizing ulcerative gingivitis; usually in malnourished children or immunocompromised * individuals * **Tertiary syphilis Gumma**; associated mass may be present; may be painless; may perforate palate

Answer 47

* _**Palatal abscess** Associated with nonvital tooth_ * _**Leaf-like denture fibroma** Pedunculated hyperplastic growth beneath ill-fitting denture_ * **Salivary gland tumors** Especially pleomorphic adenoma, mucoepidermoid carcinoma, * **adenoid cystic carcinoma**, polymorphous low-gradeadenocarcinoma; may have bluish hue * **Nasopalatine duct cyst** Fluctuant swelling of anterior midline palate * ***Lymphoma** Often boggy and edematous; may have bluish hue; may be bilateral* * ***Kaposi sarcoma** Usually purple; may be multiple; usually associated with AIDS* * ***Other mesenchymal tumors** Examples: fibroma, hemangioma, neurofibroma* * ***Squamous cell carcinoma** Tumor with rough, granular, irregular surface; occasionally arises from maxillary sinus* * ***Mucocele/salivary duct cyst** Usually has bluish hue* * ***Melanocytic nevus/ melanoma** Usually pigmented* * ***Necrotizing sialometaplasia** Early stage lesion; often associated with pain or paresthesia* * ***Adenomatoid hyperplasia of minor salivary glands** Asymptomatic, painless mass*

Answer 48

* _**Fibroma** Usually normal in color; most common on margins of tongue_ * **Squamous cell carcinoma** Tumor with rough, granular, irregular surface; usually lateral or ventral border * **Mucocele** Usually anterior ventral surface; usually bluish or clear color * **Pyogenic granuloma** Usually red, ulcerated, easily bleeding * ***Granular cell tumor** Dome-shaped; usually on dorsum of tongue* * ***Other mesenchymal tumors** Examples: lymphangioma, hemangioma, neurofibroma, osseous choristoma* * ***Salivary gland tumors** Especially _mucoepidermoid carcinoma and adenoid cystic carcinoma_* * ***Lingual thyroid** Usually posterior midline of dorsal surface; usually in women*

Answer 49

* _**Ranula/mucocele** Typically a pale blue, "uctuant swelling_ * **Sialolith** Usually hard mass in submandibular duct; may be associated with tender swelling of affected gland; radiopaque mass * **Lymphoepithelial cyst** Small, yellow-white submucosal lesion * **Squamous cell carcinoma** Tumor with rough, granular, irregular surface * ***Epidermoid or dermoid cyst** Midline yellow-white submucosal lesion* * ***Salivary gland tumors** Especially mucoepidermoid carcinoma* * ***Mesenchymal tumors** Examples: lipoma, neuro!broma, hemangioma*

Answer 50

* _**Parulis** Fistula from nonvital tooth_ * _**Epulis fissuratum** Ill-fitting denture_ * _**Pyogenic granuloma** Usually red, ulcerated, easily bleeding; increased frequency in pregnant women_ * _**Peripheral ossifying fibroma** May be red or normal in color; may be ulcerated_ * _**Fibroma** Usually normal in color_ * **Peripheral giant cell granuloma** Reddish purple; frequently ulcerated * **Squamous cell carcinoma** Tumor with rough, granular, irregular surface * **Metastatic tumors** May be painful and destroy bone * **Gingival cyst of the adult** Most common in mandibular bicuspid-cuspid region; may be blue * **Traumatic neuroma** Edentulous mandible in mental foramen area; often painful to palpation * **Kaposi sarcoma** Especially in AIDS patients; usually purple * **Peripheral odontogenic tumors** Example: peripheral ameloblastoma * **Congenital epulis** Usually in females; especially anterior maxilla 50 * **Melanotic neuroectodermal tumor of infancy** Anterior maxilla; destroys underlying bone; may be pigmented * **Other mesenchymal tumors** Examples: hemangioma, neuro!broma

Answer 51

* _**Fibroma** Usually normal in color; along occlusal plane_ * **Lipoma** May be yellow; soft to palpation * **Mucocele** Typically pale blue; often exhibits cyclic swelling and rupturing * ***Hyperplastic lymph node** Usually buccinator node; movable submucosal mass* * ***Other mesenchymal tumors**, Examples: hemangioma, neuro!broma Chapter* * ***Squamous cell carcinoma** Tumor with rough, granular, irregular surface* * ***Salivary gland tumor** Pleomorphic adenoma and mucoepidermoid carcinoma most common*

Answer 52

* **Fibroma** Usually normal in color * **Minor gland sialolith** Small, hard submucosal mass: may be tender * **Salivary gland tumor** Usually canalicular adenoma (older than age 40) or pleomorphic adenoma (younger than age 40) * ***Salivary duct cyst** May be bluish* * ***Other mesenchymal tumors** Examples: hemangioma, neuro!broma, schwannoma* * ***Nasolabial cyst** Fluctuant swelling of lateral labial vestibule*

Answer 53

* **Reactive lymphadenopathy** Secondary to oral and maxillofacial infection; often tender to palpation * **Epidermoid cyst** Soft and movable * **Lipoma** Soft mass * **Metastatic carcinoma** Deposits from oral and pharyngeal carcinomas; usually indurated and painless; may be fixed * **Lymphoma** May be unilateral or bilateral; usually painless; Hodgkin and non-Hodgkin types * **Infectious mononucleosis** Fatigue; sore throat; tender lymph nodes * **Salivary gland tumors** Arising from submandibular gland or tail of parotid gland * **Submandibular sialadenitis** Example: secondary to sialolithiasis * **Branchial cleft cyst** Soft and "uctuant; most common in young adults * **Granulomatous diseases** Examples: tuberculosis, sarcoidosis * Cat-scratch disease History of exposure to cat * Cystic hygroma Infants; soft and "uctuant * Plunging ranula Soft and compressible * Other mesenchymal tumors Examples: neuro!broma, carotid body tumor

Answer 54

* **Mucocele** Typically pale blue; often exhibits cyclic swelling and rupturing; labial mucosa only * **Fibroma** Usually normal in color * **Pyogenic granuloma** Red, ulcerated, bleeds easily; usually on vermilion border * **Squamous cell carcinoma** Tumor with rough, granular, irregular surface; usually on vermilion border * ***Other mesenchymal tumors** Examples: hemangioma, neuro!broma, lipoma Chapter* * ***Salivary duct cyst** May be bluish; labial mucosa only* * ***Salivary gland tumor** Usually mucoepidermoid carcinoma Chapter* * ***Keratoacanthoma Volcano-**shaped mass with central keratin plug; rapid development; vermilion border only*

Answer 55

* _**Hyperplastic dental follicle** 5 mm in thickness_ * _**Eruption cyst** Bluish swelling overlying erupting tooth_ * **Odontogenic keratocyst** — * ***Orthokeratinized odontogenic cyst** —* * ***Ameloblastoma** Especially unicystic type* * ***Ameloblastic** fibroma Usually in younger patients* * ***Adenomatoid odontogenic tumor** Usually in anterior region of jaws; most often with maxillary canine; usually in teenagers* * ***Calcifying odontogenic cyst** Gorlin cyst* * ***Carcinoma** arising in dentigerous cyst Mostly in older adults* * ***Intraosseous mucoepidermoid carcinoma** Mostly in posterior mandible* * ***Other odontogenic lesions** Examples: calcifying epithelial odontogenic tumor, odontogenic myxoma, central odontogenic !broma*

Answer 56

* ***Developing tooth** bud Within alveolar bone —* * **Lateral radicular cyst** Nonvital tooth; lateral canal * **Nasopalatine duct cyst** Between and apical to maxillary central incisors; palatal swelling may occur * **Lateral periodontal cyst** Especially in mandibular bicuspid-cuspid region * **Residual (periapical) cyst** Edentulous area * **Odontogenic keratocyst** — * **Central giant cell granuloma** Especially in anterior mandible * *Stafne bone defect Angle of mandible below mandibular canal* * *Cemento-osseous dysplasia Early stage; usually in young adult and middle-aged black women; usually in mandible* * *Central ossifying !broma Early-stage lesion* * *Ameloblastoma Especially unicystic type* * *Buccal bifurcation cyst Buccal aspect of erupting mandibular !rst or second molar* * *Other odontogenic cysts and tumors Examples: ameloblastic !broma, central odontogenic fibroma, calcifying odontogenic cyst Chapter* * *Langerhans cell histiocytosis “Histiocytosis X”; usually in children or young adults* * *Melanotic neuroectodermal tumor of infancy Anterior maxilla; may be pigmented* * *Median palatal cyst Clinical midline swelling of hard palate* * *Schwannoma/ neurofibroma Usually associated with mandibular nerve*

Answer 57

* _**Odontogenic keratocyst** —_ * _**Ameloblastoma** Especially in posterior mandible; often associated with impacted tooth_ * **Central giant cell granuloma** Especially in anterior mandible * *Ameloblastic fibroma Especially in young patients* * *Odontogenic myxoma “Cobweb” trabeculation 679 \* Central odontogenic !broma —* * *Calcifying epithelial odontogenic tumor Often associated with impacted tooth* * *Orthokeratinized odontogenic cyst Often associated with impacted tooth* * *Lateral periodontal cyst (botryoid type) Especially in mandibular bicuspid-causpid region* * *Calcifying odontogenic cyst Especially in cases with minimal or no calcifications; often associated with impacted tooth* * *Central hemangioma/ arteriovenous malformation Especially in younger patients; may have honeycombed radiographic appearance; may pulsate* * *Aneurysmal bone cyst Especially in younger patients* * *Cherubism Hereditary; onset in childhood; multiple quadrants involved* * *Hyperparathyroidism (brown tumor) Usually elevated serum calcium levels* * *Intraosseous mucoepidermoid carcinoma Usually in posterior mandible* * *Fibrous dysplasia Very rarely on panoramic !lms of mandibular lesions*

Answer 58

* _**Periapical granuloma** Nonvital tooth_ * _**Periapical cyst** Nonvital tooth_ * **Periapical cementoosseous dysplasia (early)** Especially in black females; usually apical to mandibular anteriors; teeth are vital * ***Periapical scar** Usually endodontically treated tooth with destruction of cortical plate* * ***Dentin dysplasia type I** Multiple periapical granulomas or cysts; shortened, malformed roots*

Answer 59

* _**Periapical granuloma or cyst** Nonvital tooth_ * _**Focal osteoporotic marrow defect** Especially edentulous areas in posterior mandible; more common in females_ * **Osteomyelitis** Usually painful or tender * **Medication-related osteonecrosis of the jaw** Exposed necrotic bone; most often associated with bisphosphonate drugs * ***Simple bone cyst** Mandibular lesion that scallops up between roots of teeth; usually in younger patients* * ***Metastatic tumors** Painful; paresthesia; usually in older adults* * ***Osteoradionecrosis** History of radiation therapy; painful* * ***Multiple myeloma** May be painful; in older adults* * ***Primary intraosseous carcinomas** Odontogenic or salivary origin* * ***Osteosarcoma** Often painful; usually in young adults* * ***Chondrosarcoma** —* * ***Ewing sarcoma** Usually in children* * ***Other primary bone malignancies** Examples: !brosarcoma, lymphoma —* * ***Desmoplastic fibroma** of bone Especially in younger patients* * ***Massive osteolysis Phantom** (vanishing) bone disease*

Answer 60

* **Cemento-osseous dysplasia** Late stage lesions; especially in middle-aged and older black women; usually in mandible * **Medication-related osteonecrosis** of the jaw Sclerosis of alveolar crestal bone; exposed necrotic bone; most often associated with bisphosphonate drugs * **Condensing osteitis** Usually at apex of nonvital tooth * **Sclerosing osteomyelitis** May be painful * ***Fibrous dysplasia** “Ground glass” appearance; onset usually in younger patients* * ***Paget disease of bone** “Cotton wool” appearance; late-stage lesions; in older patients* * ***Proliferative periostitis** “Onion-skin” cortical change; in younger patients; often associated* * *with nonvital tooth* * ***Osteosarcoma** May have “sunburst” cortical change; frequently painful; usually in young adults* * ***Chondrosarcoma —***

Answer 61

* **Florid cemento-osseous dysplasia** Late-stage lesions; especially in middle-aged and older black women; usually in mandible * **Medication-related osteonecrosis of the jaw** Multifocal sites of involvement; sclerosis of alveolar crestal bone; exposed necrotic bone; most often associated with bisphosphonate drugs * ***Idiopathic osteosclerosis** Occasionally may be multifocal* * *Paget disease of bone “Cotton wool” appearance; late-stage lesions; in older patients; more common in maxilla* * ***Gardner syndrome** Multiple osteomas; epidermoid cysts; gastrointestinal polyps with high tendency toward malignant transformation; hereditary* * ***Polyostotic fibrous dysplasia** “Ground glass” appearance; onset usually in younger patients; may be associated with café au lait skin pigmentation and endocrine abnormalities (McCune-Albright syndrome)* * ***Osteopetrosis Hereditary**; recessive form may be associated with secondary osteomyelitis, visual and hearing impairment*

Answer 62

* _**Developing tooth** —_ * _**Cemento-osseous dysplasia** Intermediate-stage lesions; especially in middle-aged black women; usually in mandible_ * **Odontoma** Compound or complex type; in younger patients; may prevent eruption of teeth * ***Central ossifying fibroma** —* * ***Ameloblastic fibroodontoma** Usually in children* * ***Adenomatoid odontogenic tumor** Usually in anterior region of jaws; most often with maxillary canine; usually in teenagers* * ***Calcifying epithelial odontogenic tumor** Pindborg tumor; often associated with impacted tooth; may show “driven snow” opacities* * ***Calcifying odontogenic cyst** Gorlin cyst; may be associated with odontoma* * ***Osteoblastoma/osteoid osteoma** Intermediate-stage lesion; usually in younger patients; often painful* * ***Cementoblastoma** Intermediate-stage lesion; attached to tooth root*

Answer 63

* **Medication-related osteonecrosis of the jaw** Exposed necrotic bone; most often associated with bisphosphonate drugs * **Osteomyelitis** With sequestrum formation or with sclerosing type; often painful * ***Metastatic carcinoma** Especially prostate and breast carcinomas; may be painful* * ***Osteosarcoma/ chondrosarcom**a May be painful*

Answer 64

* **Florid cemento-osseous dysplasia** Intermediate-stage lesions; especially in middle-aged black women; usually in mandible * **Medication-related osteonecrosis of the jaw** Exposed necrotic bone; most often associated with bisphosphonate drugs * ***Paget disease of bone** In older patients; more common in maxilla*

Answer 65

* **Fibrous dysplasia** Onset usually in younger patients * **Hyperparathyroidism** May cause loss of lamina dura

Answer 66

* **Cemento-osseous dysplasia** Especially in middle-aged black women; usually in mandible * ***Paget disease** of bone In older patients; more common in maxilla* * ***Gardner syndrome** Multiple osteomas; epidermoid cysts; gastrointestinal polyps with high tendency toward malignant transformation; hereditary* * ***Gigantiform cementoma** Hereditary; facial enlargement may be present*

Answer 67

* ***Osteosarcom**a Often painful; usually in young adults* * ***Intraosseous hemangioma** Especially in younger patients*

Answer 68

* ***Proliferative periostitis** In younger patients; often associated with nonvital tooth; best seen with occlusal radiograph* * ***Ewing sarcoma** In young children* * ***Langerhans cell histiocytosis** “Histiocytosis X”; usually in children or young adults*

Answer 69

* _**Amalgam tattoo** Markedly radiopaque; associated with surface discoloration_ * **Other foreign bodies** Examples: bullet fragments, shotgun pellets — * **Sialolith** Glandular pain may be present while patient is eating * **Tonsilloliths** Superimposed on mandibular ramus * ***Phlebolith** May occur in varicosities or hemangiomas* * ***Calcified lymph nodes** Example: tuberculosis* * ***Osseous** **and cartilaginous choristomas** Most common on tongue* * ***Calcinosis cutis** May be seen with systemic sclerosis (especially CREST syndrome)* * ***Myositis ossificans** Reactive calcification in muscle*

Answer 70

* _**Idiopathic supernumerary teeth** Mesiodens, paramolar, distomolar_ * **Cleft lip and palate** Extra lateral incisor or canine 1 * ***Gardner syndrome** Osteomas and gastrointestinal polyps* * ***Cleidocranial dysplasia** Hypoplastic or missing clavicles; failure of tooth eruption*

Answer 71

* **Fusion** Joining of two tooth germs * **Gemination** Incomplete splitting of a tooth germ * ***Idiopathic macrodontia** —* * ***Facial hemihyperplasia**\* Affected side only; nondental tissues also enlarged* * ***Gigantism** Abnormally tall stature*

Answer 72

* _**Supernumerary teeth** Mesiodens; fourth molars_ * _**Peg-shaped lateral incisors** Cone-shaped teeth_ * **Dens invaginatus** Cone-shaped teeth; tendency for pulpal death and periapical pathosis * ***Idiopathic microdontia** Usually generalized* * ***Hereditary hypohidrotic** ectodermal dysplasia* * ***Cone-shaped teeth;** sparse, blond hair; diminished sweating* * ***Radiotherapy during childhood** Stunted tooth development* * ***Congenital syphilis** Hutchinson’s incisors* * ***Hypopituitarism** Associated dwarfism*

Answer 73

* _**Mesiodens and other supernumeraries** Cone-shaped teeth or microdont_ * **Environmental enamel hypoplasia** Example: high fever during tooth development * **Peg-shaped lateral incisors** Cone-shaped teeth * **Dens invaginatus** Cone-shaped teeth; tendency toward pulpal death and periapical pathosis * **Turner tooth** Infection or trauma to associated primary tooth * **Fusion or gemination** “Double” tooth * **Talon cusp** Extra cusp on lingual of anterior tooth * **Dens evaginatus** Extra cusp on occlusal of premolar tooth * **Amelogenesis imperfecta** Hereditary defect in enamel formation * **Dentinogenesis imperfecta** Fracturing away of enamel due to hereditary defect in dentin formation; gray-yellow opalescent teeth; calcified pulp chambers * **Regional odontodysplasia** Poor tooth formation in a focal area; “ghost teeth” * **Congenital syphilis** Hutchinson’s incisors; mulberry molars * **Vitamin D–resistant rickets** Hereditary condition; high pulp horns * **Renal osteodystrophy** Abnormal calcium and phosphate metabolism * **Hypoparathyroidism** Possible associated endocrine-candidiasis syndrome * Pseudohypoparathyroidism — * **Epidermolysis bullosa** Hereditary blistering skin disease * **Radiotherapy during childhood** Stunted tooth development * **Globodontia** Associated with otodental syndrome * **Lobodontia** Cusp anatomy resembles teeth of carnivores

Answer 74

F. Enamel Loss After Tooth Formation \*\*\* Caries — — \*\*\* Trauma Fractured tooth — \*\*\* Attrition Physiologic loss of tooth structure 55 \*\*\* Abrasion Pathologic loss of tooth structure 56 \*\* Erosion Chemical loss of tooth structure 56 \* Dentinogenesis imperfecta Hereditary defect in dentin formation; poor junction between enamel and dentin 98 \* Amelogenesis imperfecta Hereditary defect in enamel formation; especially hypocalcified types 92

Answer 75

* _**Tobacco** Black or brown_ * _**Coffee, tea, and cola** **drinks** Brown or black_ * **Chromogenic bacteria** Brown, black, green, or orange 63 * **Chlorhexidine** Yellow-brown 63

Answer 76

* _**Aging** Yellow-brown; less translucency —_ * _**Death of pulp** Gray-black; less translucency_ * **Fluorosis** White; yellow-brown; brown; mottled * **Tetracycline** Yellow-brown; yellow fluorescence * **Internal resorption** “Pink tooth of Mummery”