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

Question 1

Q

Solitary pigmented
lesion

DDx

Kumar lecture

Answer

A

Amalgam tattoo
Melanocytic nevus
Melanotic macule
Post‐inflammatory melanosis
Melanoma

Question 2

Q

Nodule on gingiva
(3P’s)

DDx

Kumar lecture

Answer

A

Pyogenic granuloma
Peripheral ossifying fibroma
Peripheral giant cell granuloma
Fibroma
Parulis (not interproximal though)
Gingival cyst (not interproximal though)

Question 3

Q

White Patch‐
Leukoplakia
(Oral Potentially
Malignant Disorder)

Answer

A

• Epithelial hyperplasia
• Epithelial hyperkeratosis
• Epithelial dysplasia
• Carcinoma‐in‐situ
• Squamous cell carcinoma
*Other white patches with an explanation (NOT OPMD)
• Hyperplastic candidiasis
• Frictional keratosis
• Oral hairy leukoplakia

Question 4

Q

Solitary non‐healing
ulcer

DDx

Kumar lecture

Answer

A

Squamous cell carcinoma
Traumatic ulcer
Fungal ulcer
Tuberculosis ulcer
Major aphthous ulcer (immune related)
Syphilitic chancre

Question 5

Q

Multilocular lesion

DDx

Kumar lecture

Answer

A

MACHO

M‐myxoma
A‐ameloblastoma
C‐central giant cell granuloma
H‐hemangioma
O‐odontogenic keratocyst
Cherubism (bilaterally)
Intra‐osseous mucoepidermoid carcinoma

Question 6

Q

Radiolucency at
apex of decayed
tooth

DDx

Kumar lecture

Answer

A

Periapical/radicular cyst
Periapical/radicular granuloma
Periapical/radicular abscess
Periapical/radicular scar

Question 7

Q

Well‐defined
radiolucency
around crown
impacted molar
post. md

DDx

Kumar lecture

Answer

A

D‐Dentigerous cyst
O‐Odontogenic keratocyst
A‐Ameloblastoma

Question 8

Q

Non‐ulcerated soft
tissue swelling in
tongue (or
submucosal)

DDx

Kumar lecture

Answer

A

Granular cell tumor
Neurofibroma
Neuroma
Schwannoma
Deep hemangioma
Fibroma
Deep lipoma
Include salivary gland neoplasm

Question 9

Q

Petechiae on palate

Answer

A

• Scarlet fever
• Infectious mononucleosis
• Trauma

• NOT nicotine stomatitis

Question 10

Q

Swollen tonsils

DDx

Kumar lecture

Answer

A

Infectious mononucleosis
Streptococcal tonsillitis

Question 11

Q

Palatal lesions

DDx

Kumar lecture

Answer

A

Necrotizing sialometaplasia
Nicotine stomatitis
Papillary hyperplasia of the palate
Denture stomatitis
Gumma
Median palatine cyst
Salivary gland tumor
Cocaine abuse
Leprosy

Question 12

Q

Swelling of palate
midline

DDx

Kumar Lecture

Answer

A

 Torus
 Median Palatal Cyst

Question 13

Q

Swelling of palate

DDx

Kumar Lecture

(not midline)

Answer

A

Pleomorphic adenoma
Adenoid cystic carcinoma (pain)
Mucoepidermoid carcinoma (blue hue)
Odontogenic tumor
Abscess

Question 14

Q

Skull film

DDx

Kumar Lecture

Answer

A

• Paget
• Sickle cell anemia
• Thalassemia
• Multiple myeloma
• Hand Schuller

Question 15

Q

Perioral crusts

DDx

Kumar Lecture

Answer

A

Impetigo (amber/cornflakes stuck on skin)
Recurrent herpes

Question 16

Q

Crops of coalescing
ulcers

Answer

A

Recurrent herpes on palate/gingiva ( infectious category)
Herpetiform aphthous (inflmatory category)

Question 17

Q

Conical teeth

DDx

Kumar Lecture

Answer

A

Ellis van Creveld (chondroectodermal dysplasia)
Hypohidrotic ectodermal dysplasia

Question 18

Q

Low Risk HPV
Tumors

Answer

A

Verruca vulgaris (common wart)
Squamous papilloma
Condyloma acuminatum

Question 19

Q

High risk HPV

DDx

Kumar Lecture

Answer

A

Oropharyngeal squamous cell carcinoma
Cervical cancer

Question 20

Q

Angular cheilitis
cause

Answer

A

Candida
Iron deficiency
B12 deficiency
Pernicious anemia
Folic acid deficiency

Question 21

Q

Multiple melanotic
macules

DDx

Kumar

Answer

A

Peutz Jeghers
Addison disease

Question 22

Q

Benign fibroosseous
lesions

DDx

Kumar

Answer

A

Central cemento‐ossifying fibroma (neoplasm)
Periapical cemento‐osseous dysplasia
Florid cemento‐osseous dysplasia
Focal cemento‐osseous dysplasia
Fibrous dysplasia
All have same histopathology therefore need an xray

Question 23

Q

Sun exposure

DDx

Kumar

Answer

A

Basal cell carcinoma
Actinic cheilitis

Question 24

Q

Recessive

DDx

Kumar

Answer

A

Papillon Lefevre (autosomal)
Chondroectodermal dysplasia (autosomal)
Hypophosphatasia (autosomal)
Hypohidrotic ectodermal dysplasia (X‐linked)

Question 25

Q

Café‐au‐lait
pigmentation

ddx

Kumar

Answer

A

Polyostotic fibrous dysplasia
Neurofibromatosis of von Recklinghausen

Question 26

Q

Looks like
periodontitis

DDx

Kumar

Answer

A

Langerhans cell disease
Papillon Lefevre

Question 27

Q

Teeth “floating in
air” in childrenalveolar
bone loss

DDx

Answer

A

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

Question 28

Q

Face/Angle swelling

List of dx

Answer

A

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

Question 29

Q

These are Intra osseous pathologies, what are the their Extra Osseous counterpart ?

• Lateral periodontal cyst
• Dentigerous cyst
• Central giant cell granuloma

Answer

A

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

Question 30

Q

Tumors that sound
benign but are
malignant

Answer

A

Melanoma
Lymphoma

Question 31

Q

Same under
microscope

ddx

Answer

A

• Congenital epulis

• Granular cell tumor

Question 32

Q

Desquamative
gingivitis

ddx

Answer

A

• Erosive lichen planus

• Mucous membrane pemphigoid

• Pemphigus vulgaris

• Erythema multiforme

Question 33

Q

What are the Differential for the following:
• Glossitis
• Angular cheilitis
• Atrophy of papillae on tongue
• Pallor

Answer

A

1) Iron deficiency anemia

2) Pernicious anemia

3) Folic acid and B12 deficiency

4) Celiac sprue

Question 34

Q

What are the Differential for
gingival bleeding?

Answer

A

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

Question 35

Q

Drugs that cause
gingival
enlargement
(gingival hyperplasia)

Answer

A

• Cyclosporine
• Phenytoin
• Nifedipine

Question 36

Q

Gingival
enlargement

Answer

A

• Leukemia
• Drug induced

Question 37

Q

Associations
With what the following are assoiciated?
• Heart shape
• Scalloping
• Ghost teeth
• Ghost cells

Answer

A

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

Question 38

Q

Associations
With what the following are assoiciated?

• X looks like a “t”
• Snow capped
• Pebbly
• Pearly doughnut with ulcer and telangiectactic blood vessels•

Answer

A

• 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

Question 39

Q

Associations
With what the following are assoiciated?
• Swiss cheese
• Tennis raquet, step ladder
• Bag of marbles

Answer

A

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

Question 40

Q

Associations
With what the following are assoiciated?

• Hair on end
• Mosaic jigsaw
• Cobblestone
• Sunray spiculated pattern

Answer

A

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

Question 41

Q

Malignancy
Association
With what the following are assoiciated?
• Gardner syndrome
• Gorlin
• Multiple endocrine neoplasia
• Neurofibromatosis of von Recklinghausen

Answer

A

• Gardner syndrome‐Malignant GI polyps

Gorlin – Basal cell carcinoma
Multiple endocrine neoplasia –Medullary thyroid carcinoma
Neurofibromatosis of von Recklinghausen‐Malignant transformation of neurofibromas

Question 42

Q

What we can find in the xray of the following?
• Amelogenesis imperfecta‐
• Dentinogenesis imperfecta‐
• Dentin dysplasia type 1
• Dentin dysplasia type 2

Answer

A

• 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”

Question 43

Q

Polyps‐benign or
malignant?

• Gardner
• Peutz Jegher‐

Answer

A

Gardner (malignant)
Peutz Jegher (benign)

Question 44

Q

What syndrom has Opalescent

• Teeth =
• Mucosa=

Answer

A

OpalescentTeeth=Dentinogenesis imperfecta and osteogenesis imperfecta
Opalescent Mucosa=Leukoedema

Question 45

Q

What are other names for the followings?

**• Ellis van Creveld
• Gorlin
• Treacher Collin
**

Answer

A

Ellis van Creveld‐Chondroectodermal dysplasia
Gorlin‐Nevoid basal cell carcinoma

• Treacher Collin‐Mandibulofacial dysostosis
\

Question 46

Q

What are other names for the followings?

• Osler Rendu Parkes Weber
• Canon
• Pindborg

Answer

A

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

Question 47

Q

The following cells are found when:

• Neutrophil –
• B lymphocyte –
• Plasma cell –

Answer

A

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

Question 48

Q

The following cells are found when:

• Macrophage –
• Eosinophil and Langerhan cell –
• Eosinophil‐
• Mast cell –

Answer

A

• Macrophage – phagocytosis (both acute and chronic)

• Eosinophil and Langerhans cell – Langerhans cell disease

• Eosinophil ‐ allergy

• Mast cell – allergy

Question 49

Q

What are the synonymous names of the following

• Stafne bone cyst
• Traumatic bone cyst
• White sponge nevus

Answer

A

• Stafne bone cyst – Static bone cyst=saliv.gland

• Traumatic bone cyst –Simple bone cyst=empty

• White sponge nevus – Canon disease

Question 50

Q

What are the synonymous names of the following:

• Gorlin syndrome
• Benign migratory glossitis
• Wart
• Canker sore
\

Answer

A

• Gorlin syndrome – Nevoid basal cell carcinoma syndrome

• Benign migratory glossitis – Geographic tongue –Erythema migrans

• Wart – Verruca vulgaris

• Canker sore – Minor aphthous ulcer

Question 51

Q

What are the synonymous names of the following:

Dens in dente
Freckle
Birth mark
Mole

Answer

A

• Dens in dente – Dens invaginatus ‐Tooth within a tooth

Freckle‐Ephelis‐ Melanotic macule (NOT MACULE ALONE)
Birth mark‐Nevus‐Melanocytic nevus
Mole‐Melanocytic nevus

Question 52

Q

What are Descriptive associations of the following:
• Explosive onset
• Gets larger and smaller
• Attached mucosa

Answer

A

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

Question 53

Q

What are Descriptive associations of the following:

Movable mucosa
Urticaria
Angioedema

Answer

A

• Movable mucosa – Aphthous ulcers

• Urticaria – superficial

• Angioedema – deep

Question 54

Q

What are Descriptive associations of the following:

Female/max/canine?
Compound odontoma
Complex odontoma

Answer

A

• Female/max/canine?‐Adenomatoid odontogenic tumor

• Compound odontoma‐anterior max

• Complex odontoma‐posterior md

Question 55

Q

What are Descriptive associations of the following:

Yellow with superficial blood vessels
Most common malignant soft tissue tumor of head and neck children
Cluster of coalescing ulcers unilateral

Answer

A

• 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

Question 56

Q

What are the following classic pics related to?
• Draining sinus at angle
• Loss of primary teeth
• Hole in palate

Answer

A

• Draining sinus at angle –actinomycosis

Loss of primary teeth‐ hypophosphatasia
Hole in palate‐Gumma

Question 57

Q

Common Errors

Answer

A

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)

Question 58

Q

White Lesions: Can Be Scraped Off

DDx

Bold and underlines most likely

Bold second most likely

italic least likely

Neivel book

Answer

A

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

Question 59

Q

White Lesions: Cannot Be Scraped Off

DDx

(long list just know what’s relevant to us)

Bold and underlines most likely

Bold second most likely

italic least likely

Answer

A

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

Question 60

Q

Red Lesions

Bold and underlines most likely

Bold second most likely

italic least likely

Answer

A

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

Question 61

Q

White and Red Lesions

DDx

Bold and underlines most likely

Bold second most likely

italic least likely

Answer

A

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

Question 62

Q

Yellow Lesions

ddx

Answer

A

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

Question 63

Q

Blue and/or Purple Lesions

Answer

A

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

Question 64

Q

Soft Tissue Masses (Lumps and Bumps): Midline Neck Lesions

DDX

Answer

A

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 65

A

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 66

A

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 67

A

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 68

A

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 69

A

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 70

A

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 71

A

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 72

A

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 73

A

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 74

A

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 75

A

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 76

A

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 77

A

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 78

A

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 79

A

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 80

A

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 81

A

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 82

A

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 83

A

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 84

A

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 85

A

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 86

A

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 87

A

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/ chondrosarcoma May be painful

Answer 88

A

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 89

A

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

Answer 90

A

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 91

A

Osteosarcoma Often painful; usually in young adults
Intraosseous hemangioma Especially in younger patients

Answer 92

A

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 93

A

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 94

A

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 95

A

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 96

A

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 97

A

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 98

A

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 99

A

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 100

A

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”