Final Exam Flashcards
When does central face development occur?
Begins at 4 weeks
When does upper lip formation occur?
Between weeks 6-7
What structures fuse to forms the upper lip?
Medial nasal processes merge with each other as well as the maxillary processes of the 1st branchial arch
What structures fuse to from the primary palate?
The medial nasal processes
What structures fuse to form the secondary palate?
The maxillary processes – makes up 90% of the hard and soft palate
What is cleft lip?
A failure of fusion of the medial nasal process with the maxillary process
Is cleft lip more commonly unilateral or bilateral?
80% are unilateral
When can cleft lip be treated?
Rule of 10 – 10 weeks, 10 pounds, 10% hemoglobin
What is cleft palate?
Failure of the palatal shelves to fuse
What is the minimal manifestation of a cleft palate?
A bifid uvula
Is cleft palate more common to present alone or with cleft lip?
45% of developmental cases are cleft lip and cleft palate. This is more common in males!
50% of patients with syndromic cleft palate have only cleft palate. This is more common in females!
What syndrome is associated with cleft palate and what are its characteristics?
Pierre Robin Sequence
Cleft palate, mandibular micrognathia, glossoptosis
What are nonsyndromic factors that are associated with orofacial clefts?
Maternal alcohol or cigarette use, folic acid deficiency, anticonvulsant therapy
In what racial groups are orofacial clefts most common?
Native Americans = 1 in 250
Asians = 1 in 300
Caucasians = 1 in 700
African Americans = 1 in 1500
What term describes when the surface of a palatal cleft is still intact?
Submucous palatal cleft
What term describes mucosal invaginations that occur at the corners of the mouth on the vermillion border?
Commissural lip pits – NOT associated with facial or palatal clefts
What term describes mucosal invaginations of the lower lip and are usually bilateral?
Paramedian lip pits – evaluate for syndrome
What syndrome is associated with paramedian lip pits and what are its characteristics?
Van der Woude syndrome
Autosomal Dominant, Cleft lip and Cleft palate, Paramedian lip pits
*This is also the most common form of syndromic clefting CL+CP
What term describes a redundant fold of tissue on the mucosal side of the lip?
Double lip
What syndrome is associated with double lip and what are its characteristics?
Ascher syndrome
Double lip (usually acquired from fluid retention), blepharochalasis, nontoxic thyroid enlargement
What term describes “ectopic” sebaceous glands?
Fordyce Granules (these are a variation of normal)
When do Fordyce Granules appear and where do they usually occur?
Appear around puberty, and occur on the buccal mucosa and lateralportionof the vermillion upper lip
What term describes a diffuse, gray-white lesions found bilaterally on the buccal mucosa that do not wipe off and disappear when the tissue is stretched?
Leukoedema (this is a variation of normal)
In what population is leukoedema most common?
African American adults (90%) and children (50%)
True or False: Microglossia is usually syndromic,
True, the syndromes usally have asscoiated limb features such as hypodactlyly or hypomelia
What 3 things frequently cause macroglossia?
Vascular malformations, muscular hypertrophy (down’s syndrome), tumors
What syndrome is associated with macroglossia due to tumors?
Beckwith-Wiedmann syndrome
Patients have increased risk for several childhood tumors (macroglossia, and hemihyperplasia)
What term describes a developmental tongue abnormality characterized by a short, thick lingual frenum resulting in limitation of tongue movement?
Ankyloglossia
Where does a lingual thryoid occur? (Between what structures)
Between the foramen cecum and the epiglottis
Are males or females more likely to have lingual thryoids?
Females
What are some symptoms of lingual thyroid and when do they occur?
Dysphagia, dystonia, dyspnea and they arise during puberty
ALso hypothyroidisn because it is usually the patients only functioning thryoid tissue
How can the presence of lingual thyroid be confirmed/dx?
Through a thryoid scan using iodine isotopes or technitium-99m, CT or MRI
Why should biopsy be avoided in patients with lingual thryoid?
Because of risk of hemorrhage and it may be the patients only functioning thyroid tissue
What syndrome is associated with fissured tongue?
Melkersson-Rosenthal syndrome
Also has cheilitis granulomatosa, and facial paralysis
What other condition is fissured tongue strongly associated with?
Geographic tongue
What are two other names for geopgraphic tongue?
Benign migratory glossitis and erythema migrans
What is geographic tongue and who does it usually affect?
A common inflammatory condition that affects females more often than males
What term describes a marked accumulation of keratin of the filiform papilla of the tongue?
Hairy tongue
What might be associated with causing hairy tongue?
heavy smoking, poor oral hygiene, abx, radiation therapy
What term describes superficial dilated veins and where do they commonly occur?
Varicosities (or varices), they occur on the ventral and lateral tongue
What term describes a calcification within a varix?
phlebolith
It will feel like a bb
What term describes a large superficial artery and where do they commonly occur?
Caliber persistent artery, they almost exclusively occur on the lip mucosa
Can feel a pulsation
What way will the mandible deviate in coronoid hyperplasia?
Toward the affected side, and will see on opening
What way will the mandible deviate in condylar hyperplasia?
Toward the opposite side, and should see when closed (and opened)
Name the 5 types of localized bony protuberances
Torus palatinus, torus mandibularis, buccal exostoses, palatal exostoses, solitary exostoses
What are the two different terms that describes a focal concavity of the cortical bone in the lingual surface of the mandible?
Stafne defect aka lingual mandibular salivary gland depression
What are the 3 different terms that describe calcification of the stylohyoid ligament?
Eagle’s syndrome, Stylohyoid syndrome, carotid artery syndrome
What are some symptoms of Eagle’s syndrome and when do they “classically occur”?
Vague facial pain while swallowing, turning the head, or opening the mouth, dysphagia, dysphonia, headache, dizziness
They occur after a tonsillectomy
What are the 2 cysts of the newborn, what are they likely from and where do they occur?
Epstein’s pearls – median palatal raphe
Bohn’s nodules – usually near junction of hard and soft palate
Remnants of epithelium
What term describes a swelling of the upper lip that results in elevation of the ala of the nose, who is most commonly affected by this, and what is the treatment ?
Nasolabial cyst, females between 30-50, requires surgical removal
What two different terms describe the most common non-odontogenic cyst of the oral cavity and when should it be removed?
Nasopalatine duct cyst aka incisive canal cyst
Biopsy is mandatory b/c it cannot be dx radiogrpahically
IF greater than 6 mm or there is pain, swelling or drainage
What term describes the soft tissue counterpart of the nasopalatine duct cyst?
Cyst of the incisive papilla
How are epidermoid and dermod cysts different?
Dermoid cysts contain dermal adnexal structures in the cyst wall and occur in the FOM, epidermoid cysts are like large pimples that occur in acne prone areas like the back, head and neck
What term describes a cyst that develops from remnants of the thyroglossal tract and where does it usually occur?
Thyroglossal duct cyst
Swelling near midline, usually inferior to hyiod bone
What term describes a cyst that develops within oral lymphoid tissue and where does it usually occur?
Lymphoepithelial cyst
FOM is most common, but can be ventral tongue or soft palate
What are two different names for a cyst that occurs in the upper lateral neck along the anterior border of the SCM?
Branchial cleft cyst aka cervival lymphoepithelial cyst
What term describes assymetric overgrowth of one or more body parts?
Hemihyperplasia
beckwith-wiedemann syndrome
What term describes atrophy affecting one side of the face and what might be the cause?
Progressive hemifacial atrophy, and borelia infection (lyme diseas) might be the cause
What term describes painless, unilateral enlargement of the maxillary bone?
Segmental odonotmaxillary dysplasia
What is Crouzon syndrome?
It is a type of craniofacial dysostosis, characterized by cranisynostosis –> abnormal shaped heads, ocular proptosis, underdeveloped maxilla, and a beaten metal pattern in the skull in radiographs
What is Apert syndrome?
Ocular proptosis, hypertelorism, downward slant of lateral palpebral fissures, syndactyly and mental retardation
What is treacher-collins syndrome?
Defects of structures derived from the 1st and 2nd branchial arches
Characteristics are hypoplastic zygoma, coloboma and underdeveloped mandible
What factors can result in defects in enamel?
Birth related trauma, chemicals, radiation therapy, infections, malnutrition, and metabolic and neurologic disorders
What term describes enamel defects in permanent teeth caused by periapical inflammation of the overlying deciduous tooth? What tooth is most commonly affected?
Turner’s hypoplasia (turner’s tooth)
Commonly seen in permanent bicuspids because of overlying deciduous molars
What is dental fluorosis caused by?
excess amounts of fluoride, just aesthetic concerns
What are Hutchinson’s incisors and mulberry molars and what are they caused by?
Anterior teeth that look like straight edged screwdrivers
Berry looking molars
Caused by congenital syphillis
What is attrition?
loss of tooth structures caused by tooth-tooth contact
What is abrasion?
pathologic wearing away of tooth structure (like tooth brushing)
What is demastication?
loss of tooth structure exhibiting features of both attrition and abrasion
What is erosion/corrosion?
loss of tooth structure caused by nonbacterial chemical processes
What is perimolysis?
Erosion from dental exposure to gastric secretions
What is abfraction?
Loss of tooth structure from occlusal stresses that create repeated tooth flexure
What is oligodontia?
Lack of 6 or more teeth
What teeth are most likely congenitally missing?
3rd molars, then 2nd premolars and lateral incisors
What is the most common site of a supernumerary tooth?
Maxillary incisor region (mesiodens)
What is gemination?
single enlarged tooth
Count is normal when abnormal tooth is counted as one
What is fusion?
single enlarged tooth
Count reveals a missing tooth when the abnormal tooth is counted as one
What is concrescence?
Union of two adjacent teeth by cementum alone wihhout dentin
What tooth does dens evaginatus typically occur on and who does it commonly affect?
Premolar teeth in the mandible, usually bilateral
Native Americans, Inuit, Asians
What tooth are most commonly affected by dens-in-dente/dens invaginatus?
Permanent maxillary lateral incisors
What term describes ectopic enamel?
Enamel pearl
What term describes an enlargement of the pulp chamber of a multirooted tooth and what 3 things is this associated with?
Taurodontism
Kleinfelter’s syndrome
Amelogenesis imperfecta
Tricho-dento-osseous syndrome
What is tricho-dento-osseous syndrome?
Taurodontism, kinky hair, osteosclerosis, brittle nails
What is disease is strongly associated with generalized hypercementosis?
Paget’s disease of bone
What is amelogenesis imperfecta?
developmental alteration in the structure of enamel (both permanent and deciduous) in the absence of systemic disorder
What are the types of amelogenesis imperfecta?
Hypoplastic - inadequate depostion of enamel matrix = pinpoint
Hypocalcified – enamel does not mineralize properly = soft enamel is lost so see dentin and its brown
Hypomaturation – enamel doesn’t mature properly = brown or snowcapped crowns
What is dentinogenesis imperfecta and what is it caused by?
Hereditary developmental disturbance of dentin in the absence of any systemic disorder
Caused by a mutation in dentin sialophosphoprotein (DSPP) gene
What term describes dentinogenesis imperfecta in the presence of osteogenesis imperfecta? What is the defect in osteogenesis imperfecta?
Osteogenesis imperfecta with opalescent teeth
Also have blue sclera
Mutation of COL1A1 or COL1A2
Defect in Type 1 collagen maturation
What is the clinical and radiographic presentation of dentinogenesis imperfecta?
Blue-to-brown discoloration and translucency
Bulbous crowns, cervical constriction, thin roots, obliteration of root canals and pulp chambers!
Shell teeth in deciduous teeth
What are the two major patterns of dentin dysplasia?
Type I: clinically normal, but rootless teeth
Type II: blue to brown translucency, Bulbous crowns, cervical constriction, thin roots, obliteration of root canals and pulp chambers, “hot dog on a stick pulp”
How is Type II dentin dysplasia and dentinogenesis dysplasi differentiated?
Can’t distinguish clincally, need genetic testing to differentiate
What term describes a localized, non-hereditary developmental abnormality in the formation of teeth?
Regional Odontodysplasia
“ghost teeth”
What are the 4 differential diagnoses for a periapical radiolucency ?
periapical cyst, periapical granuloma, periapical abscess, periapical scar
What are some sequelae of periapical pathology?
Sinus tract, osteomyelitis, cellulits, condensing osteitis
What is the most common peripapical pathosis?
Periapical granuloma
Consists of chronic inflammatory cells (few neutrophils)
What is a phoenix abscess?
Secondary acute inflammatory changes within within a periapical granuloma
What are two other names for a periapical cyst?
Apical peridontal cyst, or radicular cyst
What inflammatory cells are present in a periapical abscess?
Neutrophils
When does a periapical scar usually form?
Following surgical endodontic therapy, when both the facial and lingual cortical plates have been lost
What is a sinus tract?
From a periapical abscess with pus formation! IT follows the path of lest resistant through bone and soft tissue
If drainage occurs intraoral –> parulis or fistula
If draining occurs in skin (which is most common in mandibular teeth) –> cutaneous sinus tract
What is osteomyelitis, what does it result in and where is it most common?
Acute or chronic inflammation in bone, usually due to bacterial infection resulting in expanding lytic destruction, suppuration and sequestra formation.
Most common in mandible
What is an involucrum?
During osteomyleitis, fragments of necrotic bone may become surrounded by new, vital bone
Why does cellulitis occur?
Purulence is unable to establish a draingage point so it spreads diffusely through the overlying soft tissue
What are the 2 dangerous types of cellulitis associated with dental infections?
Ludwigs’ angina, canvernous sinus thrombosis
What are the signs of Ludwig’s angina and what tooth usually causes it? How is it treated?
Rapid swelling of sublingual, submandibular and submental spaces (“bull neck”), elevation of the tongue, drooling, pain, dysphagia, dysphonia, fever, restricted neck movement
Mandibular molar with periapical abscess
- Maintain airway
- incision and drainage
- ABX therapy
- elimination of original focus of infection
What are the signs of cavernous sinus thrombosis and what tooth is usually the cause? How is it treated?
Edematous periorbital enlargement +lateral border of nose
Maxillary canine
Surgical drainage and ABX
What are some possible sequelae of cavernous sinus thrombosis?
Protrusion and fixation of the eyeball, pupil dialtion, excessive lacrimation, loss of sight, meningitis, bran abscesses
What is another name for condensing osteitis and how can it be distinguished from cemento-osseous deysplasia and idiopathic osteosclerosis?
Focal sclerosing osteomyelitis
No RL border (–> cemento-osseous dysplasia)
Associated with root apex (–> idiopathic osterosclerosis)
What is epulis granulomatosa?
A mass growing out of a extraction site which can be indicative metastatic cancer
What two different terms describe a hypersensitivity reaction that causes gingival inflammation and erythema? What is it usually related to?
Plasma cell gingivitis aka allergic gingivostomatitis
It is an acute onset from cinnamaldehyde
What term describes a idiopathic, small bright red papillary alteration of the maxillary anterior facial gingiva that bleeds easily upon manipulation? What is it though it be?
Localized Juvenile Spongiotic Gingival Hyperplasia
Exteriorized junctional or sulcular epithelium
What term is used to describe gingival epithelium that spontaneous sloughs off or can be removed with the mirror? What are the 5 differential diagnoses for this?
Desquamative gingivitis
THIS IS A CLINICAL description
- Lichen planus
- Mucous membrane pemphigoid
- pemphigus vulgaris
- systemic lupus erythematosis
- Hypersensitivity
What drugs can cause drug induced gingival hyperplasia?
Cyclosporin
Phenytoin
Nifedipine
What term describes a slowly progressive gingival enlargement caused by a collagenous overgrowth of the gingival fibrous CT that can be familial or idiopathic?
GIngival Fibromatosis
What term describes a inflammatory process that arises with the operculum? What tooth is most commonly affected?
Pericoronitis
Mandibular 3rd molars
What syndrome is associated with accelerated periodontitis and what are its characteristics?
Papillon-Lefevre Syndrome
Mutation of Cathepsin C gene on chromosome 11 –> defect in neutrophils leading to accelerated periodontitis due to A.a. in young individuals , and palmar plantar keratosis
What characteristics are associated with necrotizing ulcerative gingivitis?
Foul odor
Blunted papilla
Gray pseudomembrane
Frequently occurs with physiological stress
What causes impetigo?
Streptococcus pyogenes and staphylcoccus aureus
What commonly causes tonsillitis and pharyngitis?
Group A hemolytic strep, influenza, EBV – majority are caused by viruses
What are some sequelae of streptococcal pharyngitis and tonsillitis?
Scarlet fever, rheumatic fever, rheumatic heart disease, acute glomerulonephritis
What are the signs of scarlet fever?
First 2 days: White Strawberry tongue - white coating with only visible fungiform papillae
4-5 days: red strawberry tongue - erythematous dorsal surface with hyperplastic fungiform papillae
1 week: dermatological features = skin erythema and desquamation
Pastia’s lines - red streaky rash in areas of pressure and skin folds
What are some sequelae of scarlet fever?
Acute rheumatic fever, glomerulonephritis, hepatitis, abscess, pneumonia
What term describes concretions in pharyngeal tonsillar crypts and what bacteria can secondarily colonize these?
Tonsillolithiasis/tonsillar concretions
Actinomyces spp
What microorganism causes diphtheria and what organism is the reservoir for diphtheria?
Cornebacterium diphtheriae
Humans are the sole reservoir
What microorganism causes syphilis and how is it spread?
Treponema pallidum
Spread through sexual contact and from mother to fetus
What is primary syphilis characterized by?
Characterized by the chancre that develops at the site of inoculation (3-90 days after inoculation) – it is a painless ulceration
What is secondary syphilis characterized by?
Disseminated syphilis = always a diffuse, painless, cutaneous rash and may have painless lymphadenopathy, or a mucus patch in the oral cavity
What is tertiary syphilis characterized by?
Latent syphilis (1-30 years) with cardiac complications, ocular lesions, tongue lesions (gumma)
What are some things that can cause granulomatous inflammation affecting the palate or tongue?
TB (disseminated TB), Cocaine, NK T cell lymphoma, deep fungal infection
What is congenital syphilis characterized by?
Hutchinson’s triad =
Hutchinson’s incisors (and mulberry molars0, ocular interstitial keratitis, 8th nerve deafness
What microorganism causes gonorrhea?
Neisseria gonnorhoeae
Most common reportable infectious disease in the US
What microorganism causes tuberculosis?
Mycobacterium tuberculosis
What term describes a TB infection of the skin?
Lupus vulgaris
What term describes a mycobacterial infection caused by drinking contaminated milk (bovine TB)?
Scrofula
What microorganism causes leprosy and what is the host of the microorganism?
Mycobacterium leprae
Nine-banded armadillo
What term describes a rapidly progressive, opportunistic, polymicrobial infection that causes necrosis through anatomic barriers?
Noma
Measles usually precedes infection
What microorganism causes actinomycosis and what is a characteristic feature of actinomycoses infections?
Actinomyces israelii
Suppurative infection that discharges yellow material that are colonies of bacteria and termed sulfur granules
What microorganism causes cat scratch disease?
Bartonella henselae
Most common cause of chronic regional lymphadenopathy in children
What term describes cat scratch disease resulting in a conjuctival granuloma with pre-auricular lymphadenopathy?
Oculoglandular syndrome of Parinaud
What is the cause of sinusitis?
Blockage of the ostiomeatal complex disrupting drainage of sinuses
What term describes a calcification in the sinus in chronic sinusitis?
Antrolith
What microorganism causes candidiasis and which from is the invasive form?
Candida albicans
The hyphae form is the invasive form
(in all other yeast infections, the yeast form is the infectious form)
Who does candidiasis commonly affect?
It is mostly an opportunistic infection
What are the 4 clinical patterns of candidiasis and which form is the most common?
Psuedomembranous, erythematous, chronic hyperplastic, mucocutaneous
Erythematous is the msot common
What are the 5 clinical presentations of erythematous candidiasis?
Median rhomboid glossitis, chronic multifocal candidiasis, angular cheilitis, denture stomatitis, acute atrophic candidiasis
What is chronic multifocal candidiasis?
Median rhomboid glossitis and signs of infection at other sites (like the palate or angular cheilitis)
Why does denture stomatitis occur?
The patient wears the denture continuously, so remember to treat the soft tissues and the denture!
What is another name for chronic hyperplastic candidiasis and what are the characteristics of it?
Candidal leukoplakia
It is a white patch that cannot be removed
What is mucocutaneous candidiasis?
A rare group of immunological disorders where patients develop endocrine candidiasis syndrome, autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome, and iron deficiency anemia
Also, oral lesions do not rub off
What microorganism causes histoplasmosis and where is it found?
Histoplasma capsulatum
Found in humid areas with soil enriched areas by bird or bat excrement
Ohio and MIssissippi RIver Valley
What microorganism causes blastomycosis and where is it found?
Blastomyces dermatitidis
Found in eastern areas of the US and into Canada
What does blastomycosis cause?
It resembles pneumonia or tuberculosis, and induces pseudoepitheliomatous hyperplasia
What causes paracoccidiodomycosis and what harbors the microorganism?
Paracoccidioides brasiliensis
Nine banded armadillo
What microorganism causes coccidiodomycosis/San Joaquin Valley Fever and where is it found? What can is cause?
Coccidiodes immitis
Lives on dead/decaying organic matter
Can cause erythema nodosum which affects the legs
What microorganism causes cryptococcosis and where is it found?
Cryptococcus neoformans, and it is found in pigeon excrement
Where is zygomycosis found?What patient is at risk for zygomycosis/mucomycosis?
Decaying organic matter
Uncontrolled diabetic can have rhinocerebral zygomycosis
What microorganisms cause aspergillosis adn what is a large mass of the fungal hyphae called?
Aspergillosis fumigatus, Aspergillosis flavus
Aspergilloma –> can calcify in sinus and become an antrolith
What condition has been the only condition to induce lesions of HSV 1?
UV light
What terms describe primary infections of HSV 1?
Primary herpetic gingivostomatitis is young patient
Primary herpetic pharyngotonsillitis if older than 18
What is the most common site of recurence/recrudescent infection of HSV 1 and what is this called?
Vermillion border and adjacent skin of the lips aka Herpes labialis, “cold sore”, “fever blister”
What is the prodrome of herpes labialis?
Pain, burning, itching, tingling 6-24 hours before the lesion develops
What is the progression of herpes labialis?
Start as multiple, small, erythematous papules/vesicles that rupture and crust withing 2 days, then heals without scarring in 7-10 days
When is active viral replication complete in herpes labialis?
Within 2 days, so mechanical rupture of the intact vesicles releases the virus and can result in spreading of infection
Where do intraoral recurrent herpes simplex lesions occur?
Almost always on keratinized, bound mucosa (so the palate and attached gingiva)
Have a central, yellowish area of ulceration
What virus causes chicken pox?
Varicella Zoster Virus (or HHV 3)
Where does VZV establish latency? And what disease/characteristics occur with reactivation?
Dorsal root ganglia Herpes zoster (Shingles)
What should you be concerned about if the tip of nose is involved in VZV infections?
Ocular involvement leading to permanent blindness
What syndrome is associated with VZV infections?
Ramsay Hunt Syndrome
Cutaneous lesions of the external auditory canal, involvement of ipsilateral face and auditory nerves, facial paralysis, heraing deficits, vertigo
What virus causes infectious mononucleosis? How is it diagnosed?
Esptein Barr Virus
Presence of Paul-Bunnel heterophil antibodies
What are other lesions that are associated with EBV?
Oral hairy leukoplakia, Lymphomas (BUrkitt’s Lymphoma), Nasopharyngmeal carcinoma
What are characteristics of CMV infections and in the histology?
Usually in AIDS patients, usually asymptomatic but can have fever, joint and muscle pain, etc
Owl eye cell in histology
What are the classifications of enteroviruses? And what classification is most important to oral health care professionals and why?
Echoviruses
Caxsackievirus
Poliovirus
Coxsackie produces herpangina, hand-foot-mouth disease, acute lymphonodular pharyngitis
What are the characteristics of herpangina?
Skin rash, small 2-6 oral lesions in the posterior mouth (red –> vesicles –> ulcers), with sore throat, fever, dysphagia
What are characteristics of Hand-Foot-and-mouth disease?
Skin rash on hands and feet, and large oral lesions with flu like symptoms
What are 2 other names for Measles, what is the cause of measles and what are the stages of measles?
Rubeola/9 day measles
Paramyxovirus
1st stage = 3 Cs+Fever+Koplik’s spots
2nd stage = Skin rash on trunk and extremities + fever
3rd stage = rash gets brown pigment staining
What are 2 other names for German Measles, what is it caused by, what are the signs?
Rubella/3 day measles
Togavirus
Arthritis, Forcheimer’s sign (dark red papules on the palate)
What is congenital rubella syndrome? What can prevent it?
Deafness, Heart disease, Cataracts
The MMR vaccine
What is another name for mumps, what causes it and what are some characteristics of it?
Epidemic parotitis
Paramyxovirus
Incubation of 2-4 weeks, contagious 1 day before till 2 weeks after resolution of symptoms
Causes discomfort and swelling in exocrine glands
What are the most frequent routes of transmission of HIV?
Sexual contact, Parenteral exposure to blood, transmission from mother to fetus
What cell is targeted by HIV?
CD4+ T helper lymphocyte
What are the 3 stages of AIDS?
Acute self limited viral syndrome
Asymptomatic/Latenet syndrome
Final symptomatic syndrome
What are the oral manifestations most strongly associated with HIV infection?
Candidiasis (psuedomembranous), oral hairy leukoplakia, Kaposi’s sarcoma, non-hodgkin’s lymphoma, periodontal diseases
What is the clinical presentation of oral hairy leukoplakia?
BILATERAL white mucosal plaque that does not rub off
Usually on the lateral border of the tongue
What is the clinical presenation of Kaposi’s sarcoma?
Multifocal neoplasm of vascular endothelial cell origin
What are the 3 atypical patterns of periodontal disease in HIV/AIDS patients?
Linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontisis
What are the characteristics of linea alba?
Typically bilateral, from pressure, irritation, or sucking trauma and located on the buccal mucosa at the level of the occlusal plan
What are the characteristics of morsicatio buccarum?
Due to chronic cheek chewing, just the epithelium is involved
What are the characteristics of a traumatic ulceration?
From acute or chronic trauma, appears as areas of erythema surrounding a central removable, yellow fibrinopurulent membrane with a rolled white border of hyperkeratosis
What term describes a unique from of chronic traumatic ulceration and where is it usually found?
Traumatic ulcerative granuloma with stromal eosinophilia, occurs on the tongue because of the skeletal muscle
muscle damage –> eotactin –> eosinophils = non healing ulcers that last for months
What term describes chronic ulceration found under the tongue in infants?
Riga-Fede disease
When is biopsy warranted in cases of traumatic ulcerations and morsicatio buccarum?
Cases that do no resolve after 2 weeks
What are the characteristics of electrical burns?
Appear as painless, charred, yellow area that doesn’t bleed, then a few days later will become necrotic and begins to slough
What is the yellow center due to in thermal burns and traumatic ulcerations?
Yellow center is due to fibrin
What are the predominant problems associated with anticancer therapy?
Mucositis, hemorrhage (oral pethechiae, etc from bone marrow suppression), xerostomia, altered taste, osteoradionecrosis, trismus
What is the difference between 1st and 2nd generation bisphosphonates?
1st gen have low potency and are readily metabolized
2nd gen are more potent and termed aminobisphosphonates due to the addition of a nitrogen side chain, and have a half life of 10 years
Why is there a strong association of gnathic osteonecrosis and aminobisphosphonates?
The incorporation of medication is highest in areas of active remodeling, such as the jaws
What is the prevalence of osteonecrosis in patients taking IV and oral bisphosphonates?
IV is up to 6-8%
Oral is 1:100,000
What are the treatment protocols for people taking IV and oral bisphosphonates?
60% of BRONJ occurs after a dental procedure
Oral: informed consent before bone manipulation
IV: manipulation of bone should be avoided
What are the signs of methamphetamine use?
Delusions of parasitosis, rampant caries (due to xerostomia and consumption of acidic drinks/foods)
What is a concern with meth use and sympathomimetic amines?
Use of LA and epinephrine can lead to hypertensive crisis, cerebral vascular accident, myocardial infarction
What is exfoliative cheilitis?
Persistent scaling and flaking of the vermillion border usually due to habits like lip licking
What are some causes of submucosal hemorrhage?
Repeated coughing or vomiting, convulsions, trauma, anticoagulant therapy, thrombocytopenia, disseminated intravascular coagulation, viral infections
How is the diagnosis of amalgam tattoo confirmed?
Take a radiograph of the affected areas, and biopsy must be done if it can’t be see on the radiograph in order to rule out melanoma
What is smoker’s melanosis?
Nicotine stimulates melanin production, most commonly seen on the anterior facial gingiva, cessation of smoking results in gradual disappearance
What is an antral pseudocyst?
A dome shaped, slight radiopaque lesion arising from the intact floor of the maxillary sinus
Under the sinus mucosa! (schniederian membrane)
What is cervicofacial emphysema and when can it occur?
It is the introduction of air into subcutaneous or fascial spaces of the face and neck
May occur after use of compressed air, after difficult/prolonged extractions, or as a result of increased intraoral pressure after an oral surgery
*do not use air driven handpieces during oral surgery
What term describes a clinical alteration involving the fungiform papilla, likely due to an allergy and what are the 3 types?
Transient lingual papillitis
Localized
Generalized
Diffuse, papulokeratotic variant
What are two terms for a “canker sore” and where do they occu?
Recurrent aphthous ulcer aka recurrent apthous stomatitis
Occur exclusively on movable mucosa
What are the 3 clinical variations of recurrent aphthous ulcers?
Minor = 3-10 mm, 7-14 days to heal, no scarring, 1-5 lesions/episode, Fewst recurrences
Major= 1-3 cm, 2-6 weeks of healing time, possible scarring, 1-10 lesion/episode
Herpetiform = 1-3 mm, 7-10 days to heal, no scarring, up to 100, most
What syndrome is associated with chronic, recurrent aphthous like ulcerations? What are the other characteristics of this syndrome?
Behcet’s syndrome
Oral aphthous like ulcerations, ocular inflammation, genital ulcers and skin lesions,
joint pain
What term describes a multisystem granulomatous disorder of unknown cause and who does it affect?
Sarcoidosis
African Americans»_space;»> Caucasians
What are 2 different syndromes associated with Sarcoidosis and what are their characteristics?
Lofgren’s syndrome = erythema nodosum, bilateral hilar lymphadenopathy, arthralgia
Heerfordt’s syndrome (uveoparotid fever) = Parotid enlargement, inflammation of the eye, facial paralysis and fever
What are the
skin lesions and histological features of sarcoidosis?
Lupus pernio, erythema nodosum
Granulomatous inflammation, schaumann bodies, asteroid bodies, hamazaki-Wesenberg bodies
What is the diagnostic test for sarcoidosis?
Elevated serum angiotensin converting enzyme levels and chest x ray
What is Wegener’s granulomatosis, what are the oral lesions associated with is and what is the diagnostic test?
Class Wegener’s granulomatosis = necrotizing granulomatous lesions of respiratory tract, necrotizing glomerulonephritis, and systemic vasculitis of small arteries and veins
Strawberry gingivitis
Diagnostic: indirect immunofluorescence detects the presence of antineutrophil cytoplasma antibodies (either perinuclear or cytoplasmic)
What term describes a hypersensitivty reaction to cinnamon?
Contact stomatitis from cinnamon
What two terms describe diffuse edematous swelling of the soft tissues most commonly caused by mast cell degranulation (IgE mediated histamine release)?
Angioedema
Treatment for allergic angioedema is oral antihistamines
What can cause diffuse involvement of the head and neck in angioedema and what is the treatment?
Angiotensin converting ezyme inhibitors (-prils)
Do not respond to antihistamines, some respond to C1-INH concentrate, avoid all medications in this class (ACE inhibitors)
What term describes a benign proliferation of stratified squamous epithelium, and what types of HPV specifically cause it?
Squamous papilloma
HPV types 6 and 11
What type of virus is HPV and types of HPV specifically cause verruca vulgaris?
HPV is a DNA virus of the papovavirus subgroup
Types 2, 4, 6, and 40
What is another name for condyloma acuminatum and what types of HPV cause condyloma acuminatum?
Venereal wart (an STD) 2, 6, 11, 16, 18, 31, 53, 54
6 and 11 is most common
16 and 18 are high risk for malignant transformation to squamous cell carcinoma in the anogenital area
What are the 3 differential diagnoses for squamous papilloma?
Verruca vulgaris, condyloman acuminatum, verruciform xanthoma
What two terms describe an epithelial disease that appears in childhood with painless, multiple lesions in clusters that are flattered or rounded and mucosal colored? What causes it?
Multifocal epithelial hyperplasia aka Heck’s disease
HPV types 13 adn 32
What term describes a virally induced epithelial hyperplasia that is typically seen in children, is painless and caused by DNA poxvirus?
Molluscum contagiosum
Contains molluscum bodies aka Henderson-Paterson bodies
What is a characteristic of verruciform xanthoma?
Lipid laden histiocytes in the epithelium
What is an extremely common skin lesion of older people that is a proliferation of basal cells?
Seborrheic keratosis
What term describes an inherited condition where multiple small black papules are found scattered around the zygomatic and peri-orbital region?
Dermatosis papulosa nigra
What is Leser- Trelat sign?
A sudden appearance of numerous seborrheic keratoses with pruritus that has been associated with internal malignancy
What is the medical term for a freckle, and how is the diagnosis confirmed?
Ephelis
Become more prominent with sun exposure
What term describes a benign brown macule resulting from UV light damage to the skin, and how is the diagnosis confirmed?
Actinic lentigo
Does not change in color intensity with UV light exposure
What term describes a benign cutaneous melanocytic hyperplasia that occurs on skin not exposed to sublight?
Lentigo simplex
An actual increase in number of melanocytes
What term describes an acquired, symmetrical, hormonally driven hyperpigmentation of the sun exposed skin of the face, and what is it associated with?
Melasma
Associated with pregnancy
- melanocytes stimulated by MSH which is released by the pituitary gland along with other hormones
What term describes a freckle in the mouth, and what is the most common site?
Oral melanotic macule
BUT most common site s the vermillion zone of the lower lup so it is called a labial melanotic macule
What term describes an acquired pigmentation of the oral mucosa that appears to be a reactive process due to trauma?
Oral melanoacanthoma
What is the most commonly recognized nevus and what is it from? Is there a risk of malignant transformation?
Acquired melanocytic nevus and it is a proliferation of cells from the neural crest (theques are islands of melanocytes)
Most common of all adult tumors , and yws 1 in a million can transform into melanoma
What are some names for larger congenital melanocytic nevi and what is important about them?
Bathing trunk nevus or garment nevus
15% may undergo malignant transformation into melanoma
What term describes a melanocytic nevus with surrounding pale hypopigmented border thought to be cell destruction by the immune system?
Halo nevus
What term describes a nevus that occurs in childhood, but looks histopathologically the same as melonoma?
Spitz nevus
What is the 2nd most frequent melanocytic nevus encountered in the oral cavity?
Blue nevus
(Tyndall effect – light with long wavelengths are absorbed, blue is reflected back)
Malignant transformation can occur
What term decribes an intraoral white plaque that does not rub off and cannot be identified as any other entity?
Leukoplakia
What is leukoplakia considered?
A pre-malignant lesion (so a biopsy needs to be done)
80% are “benign” but 20% are starting cancers
What are some causative factors for leukoplakia?
Tobacco, Alcohol, Sanguinaria, UV radioation, microorganisms (Treponema pallidum, candida albicans)
Predilection for men
What sites are high risk sites for dysplasia or carcinoma in leukoplakia?
Lip vermillion, lateral/ventral tongue, floor of mouth
What term describes an leukoplaki with scatterered patches?
Erythroplakia
What term describes a high risk form of leukoplakia, and who does it affect?
Proliferative verrucous leukoplakia (mulitple, rough, white plaques)
Predilection for women, and no association with tobacco use
Will eventually turn into cancer
What is the difference between hyperkeratosis, hyperparakeratosis, and hyperorthokeratosis?
Hyperkeratosis = thickened keratin layer
Hyperparakeratosis - no granular cell layer (nuclei retained)
Hyperorthokeratosis = nuclei lost
What are the classifications of “involvement” for leukoplakia biopsies?
Mild dysplasia = limited to lower 1/3
Moderate dysplasia = limited to lower 1/2
Severe dysplasia = present above lower 1/2
Carcinoma in situ = present throughout epithelium
What carcinoma do leukoplakias become?
Squamous cell carcinomas (5% in 2-4 years)
What term descrubes a ale, corrugated appearing lesion from smokeless tobacco?
Tobacco pouch keratosis
What term describes a chronic, progressive scarring, high risk, precancerous condition of the oral mucosa and what is it linked to? Why is it high risk considered high risk?
Oral submucous fibrosis
Linked to betwl quid or paan
- areca nut, slaked lime, betel leaf, with or without tobacco or sweeteners
10% undergo malignant transformation
What term describes a white keratotic change on the palate due to heat, usually from smoking? What is a variation that can be premalignant?
Nicotine stomatitis
Reverse smoker’s palate
What term describes a lesion caused by cumulative UV radiation, and is a scaly irregular plaque? Why is it high risk?
Actinic keratosis
About 10% will progress to squamous cell carcinoma in 2 years
What term describes a common premalignant alteration of the lower lip vermillion? When should a biopsy be done?
Actinic cheilosis
If there is induration, scaly areas, leukoplakia, ulcers
same as actinic keratosis where 10% will develop squamous cell carcinoma
What term describes a firm, well demarcated, painless, sessile, dome shaped nodule with a central plug of keratin?
Keratoacanthoma
What kinds of smoking has a greater oral cancer risk ?
Pipe and cigar smoking, but reverse smoking presents the greatest risk
Risk of squamous cell carcinoma increases the longer the person smokes
What is the role of alcohol in the development of squamous cell carcinoma?
Uncertain if alcohol alone can initiate, but it is a significant risk factor
What are some other things that can cause squamous cell carcinoma?
Phenolic agents, radiation, iron deficiency, Vitamin A deficiency, syphilis, oncogenic viruses, immunosuppression, oncogenes
What are the most common sites of squamous cell carcinoma in the oral cavity?
Posterio lateral/ventral tongue, then floor of mouth, soft palate, gingiva
Where does squamous cell carcinoma tend to spread?
Ipsilateral cervical lymph nodes, then distantly to the lungs,liver, or bones
What is true about the histologic grading and clinical staging with squamous cell carcinoma?
Clinical staging is a better prognostic indicator than histologic grading when it comes to squamous cell carcinoma
What two terms describe a low grade variant of oral squamous cell carcinoma, that can be caused by smokeless tabacco and can look like cauliflower?
Verrucous carcinoma aka Snuff Dipper’s cancer
What term refers to a group a malignancies that arise fromthe lining epithelium of the nasopharynx and is most prevalent in Chinese men? What are some strong contributory factors?
Nasopharyngeal carcinoma
EBV infection
Vitamin C deficiency
Consumption of salt fish with N-nitrosamines
Tobacco
What is the most common of all cancers?
Basal cell carcinoma
What is the cause of basal cell carcinoma?
Results from UV radiation
Frequent sunburns
What is the most common form of basal cell carcinoma and what are its characteristics?
Nodular
Firm, painless papule that slowly enlarges to develop a central depression and umbilicated appearance
Has one or more telangiectatic blood vessels
Rolled borders are usually present
What is the risk of metastasis in basal cell carcinoma?
Metastasis is extremely rare
What is a type of treatment for basal cell carcinoma?
Mohs micrographic surgery – uses frozen sections to evaluate margins during surgery
What does melanoma arise form and what is a major causative factor?
Melanocytic origin
UV radiation (Acute sun exposure) -other risk factors are fair complexion, light hair, painful blistering sunburns, dysplastic or congenital nevi
What is important about melanoma?
It is very aggressive! Even though it is the 3rd most common skin cancer, it accounts for the most deaths and patient usually die from distant metastasis
What are the ABCDE’s of melanoma? and what are they used for?
Used to distinguish melanoma from a melanocytic nevus
Asymmetry Border irregularity Color Variation Diameter greater than 6 mm Evolving/Changing lesion
What are the 2 patterns of growth in melanoma and what determines the prognosis?
Radical (horizontal spread), Vertical (invade underlying CT)
Depth of invasion correlates with prognosis – any invasion more then .5 mm in oral mucosal melanoma has poor prognosis
What are some areas with worse prognosis in melanoma?
BANS Interscapular area of the back Posterior Upper arm Posterior and Lateral Neck Scalp
What are the most common locations of a mucocele?
Lower lip, FOM, anterior ventral tongue, then buccal mucosa
What term describes a mucocele in the floor of the mouth that can get large enough to even block off the airways?
Ranula (plunging ranula)
What term describes a n epithelium lined cavity that arises from salivary gland tissue?
Salivary duct cyst
What term describes a calcification developed in a salivary gland? What salivary gland is most likely to be affected?
Sialolith
The submandibular gland (long and tortuous duct with thick secretion)
What term describes inflammation of the salivary glands?
Sialadenitis
What are some infectious and non infectious causes of sialadenitis?
Mumps, Bacteria, Sjogren syndrome, sarcoidosis, radiation, recent surgery (anesthesia mumps), allergic reaction, obstruction of the salivary gland
What term describes a non-inflammatory asymptomatic salivary gland enlargement and what causes it?
Sialadenosis
DM, hypothyroidismm pregnancy, general malnutrition, alcoholism, anorexia nervosa, bulimia, anti-hypertensive drugs, psychotropic drugs
What term describes a localized, sessile, painless mass that mimics a neoplasm on the hard palate?
Adenomatoid hyperplasia of the minor salivary glands
What term describes a locally destructive inflammatory condition of the salivary glands, believed to be due to ischemia?
Necrotizing sialometaplasia
What term describes a swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands?
Cheilitis glandularis
What can cause sialorrhea?
Local irritations, GERD, rabies, heavy metal posioning, medication, neurological disorder
What are some complications of xerostomia?
Candidiasis, root and cervical caries, alteration of taste (and fissured tongue)
What are some things that should be eliminated to help manage xerostomia?
Alcohol, smoking, caffeine consumption
What term describes an autoimmune disease tha tminaly affects salivary and lacrimal glands?
Sjogren syndrome
What is the difference between primary and secondary sjogrens syndrome?
No other autoimmune disease, or associated with other autoimmune disease (like rheumatoid arthritis, or SLE)
What are the diagnostic criteria for Sjogren’s syndrome?
Positive serum anti-SSA/SSB, ocular staining score > or + 3, Presence of focal lymphocytic sialadenitis with a focus score > or + 1/4 mm2 is labial salivary gland biopsy samples
What are individuals with sjogren’s syndrome at an increased risk for?
Lymphoma (MALT lymphoma)
What is the most common site of a salivary gland neoplasm out of all sites?
Parotid gland > minor glands > submandibular and sublingual
What are the % of benign and malignant salivary gland neoplasms in major salivary glands?
All major sites= 66B - 34M
Parotid= 70B - 30M
Submd= 60B - 40M
Sublg= 30B - 70M
What are the % of benign and malignant salivary gland neoplasms in minor salivary glands?
Retromolar= 90M - 10B Tongue= 85M - 15B Lower lip= 60M - 40M Cheek/Palate/All minor= 50M - 50B Upper lip= 2020M - 80B
What is the most common salivary gland neoplasm?
Pleomorphic adenoma is the most common salivary gland neoplasm
What is the most common malignant salivary neoplasm?
Mucoepidermoid carcinoma
*in both adults and children!!
What are the 4 common benign salivary gland neoplasms?
Canalicular adenoma
Pleomorphic adenoma
Warthin tumor
Oncocytoma
Where does canalicular adenoma occur and who is commonly affected?
In the upper lip exclusively in minor glands
>60 = canalicular adenoma <50 = pleomorphic adenoma
What is unique about the cells in a oncocytoma?
Large epithelial cells known as oncocytes, and they have an excessive amount of mitochondira
What is the another name for Warthin’s tumor, where does it occur and who does it
commonly affect?
Papillary Cystadenoma Lymphomatosum
Almost exclusively in the parotid gland
And 60 year old males who are smokers have the greatest risk
What are the 5 common malignant salivary gland neoplasms?
Mucoepidermoid carcinoma Acinic cell adenocarcinoma Adenoid cystic carcinoma Polymorphous low grade adenocarcinoma Malignant mixed tumor
What is the most common locations of mucoepidermoid carcionoma?
Parotid, then minor glands, specifically the palate.
Although, the submandibular gland has a poorer prognosis that the parotid gland
What is the 2nd most common malignant salivary gland neoplasm what where does it occur?
Acinic cell adenocarcinoma
Partoid, then minor glands, then submandibular
What is the most common salivary gland neoplasm of the submandibular gland? What can it cause?
Adenoid cystic carcinoma
(although this is more common in minor glands)
It can cause pain and facial nerve paralysis because it has a tendency for perineural spread
Where does polymorphous low grade adenocarcinoma occur?
Almost exclusively in the minor glands
What is the most common tumor of the oral cavity? Why is it not an actual tumor?
Fibroma
Reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma
What term describes a fibrous tumor not associated with irritation and typically occurs lingual to the cuspid papilla?
Giant Cell Fibroma
What term describes a tumor-like hyperplasia of fibrous connective tissue usually in association with a ill fitting denture?
Inflammatory fibrous hyperplasia
Epulis fissuratum
What term describes a tumor-like growth that has a pebbly or papillary surface? What is this condition related to?
Inflammatory papillary hyperplasia Related to: Ill fitting denture Poor denture hygiene Wearing a denture 24/7
What term describes a counterpart of a cutaneous lesion, that rarely occurs in the mouth but is a result from overproduction of hyaluronic acid by fibroblasts?
Oral focal mucinosis
another thing that looks like a bump on the gums
What are the 3 P’s for a bump on the gums?
Pyogenic granuloma
Peripheral giant cell granuloma
Peripheral ossifiying fibroma
Why is a pyogenic granuloma not a true granuloma? What do they look like? What are 2 other names for it?
Reactive lesion to local irritation or trauma
Ulcerated and bleeds easily (blood vessels)
Pregnancy tumor, granuloma gravidarum
How is a peripheral giant cell granuloma different than the other P’s?
Often more blue or purple, and may produce a cupping resorption to the underlying bone
How is a peripheral ossifying fibroma different than the other P’s?
About half of cases occur in the incisor-cuspid region, can appear more pale and have bone formation within the mass
What term describes a benign tumor of fat and what diagnostic test can be done to confirm the diagnosis?
Lipoma
Float in formalin
What term describes a benign tumor of nerve origin? What causes them and where do they usually occur in the oral cavity?
Neuroma (traumatic neuroma)
Most common in mental foramen area, and are painful!!
What two different terms describe a benign neural neoplasm of Schwann cell origin, and where do they typically occur?
Schwannoma aka Neurilemoma
Tongue
What are the histopathologic features of a Schwannoma?
Antoni A: Verocay bodies – organization/spindle like
Antoni B: Everything that is not A
What is the most common type of peripheral nerve neoplasm and what conditions are associated with it?
Neurofibroma
Neurofibromatosis
What is another name for Neurofibromatosis Type I? What are the diagnostic criteria?
Aka von Recklinghausen’s disease of the skin
Plexiform variant is pathognomonic
2 or more: 6+ cafe au lait macules with coasts of california 2+ NF or 1 plexiform NF Crowe's sign Optic glioma 2+ iris hamartomas (lisch nodules) osseous lesion (like sphenoid dysplasia) 1st degree relative with NF1
What are the oral manifestations of neurofibromatosis type 1?
enlargement of the fungiform papilla, intraoral neurofibromas, enlargement of the mandibular foramen or canal
What are the characteristics of Multiple endocrin neoplasia, Type 2b? What is usually the first sign of the condition
Parathyroid, Pituitary tumors, Pancreatic tumors, Adrenal gland tumors (Pheochromocytoma), Thyroid tumors (Medullary carcinoma), Mucosal neuromas wiht a predilection for the oral cavity
Bilateral neuromas of the commissural mucosa (or oral neuromas)
What is characteristic about the build of patients with multiple endocrine neoplasia type 2b?
Patients have a marfanoid build with thin, elongated limbs, narrow face, protuberant lips
What term describes a rare pigmented tumor in the mouth of infants? Where in the mouth does it occur? What is a diagnostic test for this?
Melanotic neuroectodermal tumor of infancy
Anterior maxilla
High urinary levels of vanillylmandelic acid
What term describes a benign neoplasm in the oral cavity that is yellow and commonly occurs on the dorsal tongue? What is a diagnostic test for this?
Granular cell tumor
Exhibit significant pseudoepitheliomatous hyperplasia (looks like squamous cell caricinoma)
s-100 positive
What term describes a mass that occurs almost exclusively on the maxillary, alveolar ridge of newborns? What is a diagnostic test for this?
Congenital epulis
No pseudoepitheliomatous hyperplasia and s-100 negative
What is the most common tumor of infancy? What are the 2 types? What test can be done to confirm diagnosis?
Hemangioma
Capillary – may not blanch
Cavernous – blanches on diascopy and looks darker red
What term describes a non hereditary condition caused by the persistence of a vascular plexus around the cephalic portion of the neural tube? What are the lesions called?
Sturge Weber angiomatosis
Port wine stain or nevus flammeus
What are the characteristics of Sturge-Weber angiomatosis?
In addition to nevus flammeus, patients have leptomeningeal angiomas that overlie the ipsilateral cerebral cortex. Typically associated with a convulsive disorder. May result in mental retardation or contralateral hemiplagia
What term describes a benign tumor of lymphatic vessels? What type commonly occur in the mouth and where?
Lymphangioma
Cavernous lymphangiomas, most frequently on the tongue
“frog eggs or tapioca pudding”
What term describes a benign tumor of smooth muscle?
Leiomyoma
can be the smooth muscle around a blood vessel
What term describes a benign neoplasm of skeletal muscle and where do they usually occur?
Rhabdomyoma
Heart, but if outside the heart then the Head and Neck
What is Kaposi’s sarcoma caused by adn what are the 4 types?
Caused by HHV-8
- Classic: Older men of Italian, Jweish, Slavic descent; on legs
- Endemic: African, poor prognosis
- Iatrogenic: organ transplant recipients
- AIDS related
What term describes a malignancy of skeletal muscle? Who is usally affected by this?
Rhabdomyosarcoma
Children (60% of soft tissue sarcomas of childhood)
Like rhabdomyomas and occur in face and orbit
What is one possible explanation of Head and Neck metastasis in the absence of lung mets?
Batson’s plexus - a valveless vertebral venous plexus
What is the most common site of metastases to the oral tissues?
The gingiva
What are the oral symptoms related to anemia?
Erythematous, bald tongue, glosspyrosis, glossodynia
Mucosa may show pallor, Petechiae, spontaneous gingival hemorrhage
What is thrombocytopenia and what can causes it?
Decreased number of circulating platelets
Reduced production (malignancy in bone marrow), Increased destruction (autoimmune), Sequestration in the spleen (conditions causing splenomegaly)
What is normal platelet count? When is clinical evidence of thrombocytopenia usually seen? When can thrombocytopenia be fatal?
200,000-400,000 mm3
Below 100,000 mm#
Fatal if less than 10,000 mm3
What is the difference in lymphoid hyperplasia on lymph nodes/tonsils in chronic and acute infections?
Chronic: enlarged, non tender, firm, freely movable nodules
Acute: enlarged, tender, soft, freely moveable
What is neutropenia? What is this often associated with?
Decrease in the number of circulating neutrophils
Bacterial, viral, fungal infections becuase neutrophils are the first line of defense
What is lymphopenia?
Decrease in lymphocytes
What term describes several types of malignancies of hematopoietic stem cell derivation?
Leukemia
What leukemia shows specific chromosomal abnormalities?
Chronic myeloid luekemia
Translocation of 9 and 22
What is the most common childhood leukemia? What is the most common leukemia of adulthood?
Childhood: Acute lymphoblastic leukemia
Adulthood: Chronic lymphoblastic leukemia
What may be an oral sign of leukemia?
Infiltrate of leukemic cells may infiltrate = boggy, non tender swelling called granulocytic sarcoma
What term describes a condition with pain and tenderness, with sharply demarcated radiolucencies and teeth floating in air? What are the different spectrums in this condition and how is diagnosis confirmed?
Langerhans Cell Histiocytosis
Eosinophilic granuloma of bone - no visceral involvement
Acute disseminated histiocytosis - mostly in infants (letterer-siwe disease)
Crhonich disseminated histocytosis (hand-Schuller Christian Disease)
Need id of lesional langheran cell to confirm dx – birbeck granules to distinguish them (done by electron microscopy)
What is the most common lymphoma? And what cell are characteristic with this condition? What virus is associated with this?
Hodgkin’s Lymphoma
Reed-Sternberg cells
Epstein Barr Virus
What cell is commonly affected in non-hodgkin’s lymphoma? What is the most common non-Hodgkin’s lymphoma of the oral cavity? What are some characteristics of it?
B-cell origin
Diffuse large B cell lymphoma
Non tender masses, fixed nodes, patietns may complain that their denture has become too tight
What is the most common cutaneous lymphoma? What term describes an aggressive expression of this condition? And what are some histopathological features of this condition?
Mycosis Fungoides
Sezary syndrome
Epidermotropism (atypical lymphocytes invade the epithelium) – termed Sezary cells and they form small intraepithelial aggregates termed Pautrier’s microabscesses
What terms describe a malignancy of B cell origin? What virus has been associated with it?? What is the histopathology associated with this malignancy?
Burkitt’s Lymphoma or African Burkitt’s lymphoma or B cell lymphoma
EBV
Starry sky pattern – solid sheet of B cells and occasional macrophages
What lymphoma cause an aggressive, nonrelenting destruction of the midline structures of the palate and nasal process?
NK/T-cell lymphoma aka angiocentric T cell lymphoma
What term describes a malignancy of plasma cell origin and is the most common hematologic malignancy of African Americans? What are the characteristics of this condition? Why does renal failure occur in these patients?
Multiple myeloma
Multiple well defined punched out RL especially in the skull
Kidneys become overburdened with Bence Jones proteins
What term describes a unifocal, monoclonal neoplastic proliferation of plasma cells and what does it probably give rise to?
Plasmacytoma
Probably gives rise to multiple myeloma
What is the cause of osteopetrosis? What are some other characteristics of osteopetrosis?
Failure of normal osteoclast function = widespread increase in skeletal density
Cranial nerve compression, delayed tooth eruption, osteomyelitis after extraction
What term describes a syndrome complex characterized by dental and clavicle abnormalities? What are the other characteristics?
Cleidocranial dysplasia
Short stature, big head, pronounced frontal bossing, ocular hypertelorism, broad base of nose, prolonged retention of deciduous teeth, delay or failure of eruption of permanent teeth, numerous unerupted permanent and supernumerary teeth
What term describes an isolated lesion in bone that looks like osteoporosis or a neoplasm?
Focal Osteoporotic Marrow Defect
What term describes a focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else?
Idiopathic Osteosclerosis
What term describes an abnormal resorption and deposition of bone? What are some characteristics of this condition? What is diagnostic of this condition?
Paget’s disease of bone
Maxillary disease is much more common, enlargement of the middle 1/3 of the face called leontiasis ossea, symmetrical and enlarged alveolar ridge (dentures no longer fit)
Cotton wool or cotton roll appearance in radiograph
High elevations in serum alkaline phosphatase levels with normal calcium and phosphorous levels
What must patients be evaluated for if they have a central giant cell granuloma?
Brown tumor of hyperparathyroidism and lesions of cherubism
What are the characteristics of cherubism?
Developmental jaw condition that occurs between 2-5 years old
Bilateral involvement of the posterior mandible, infraorbital rim and orbital floor involvement = eyes turned up to heaven
What are the characteristics of traumatic one cyst?
Benign, empty cavity
Cyst is a misnomer - no epithelial lining
Trauma hemorrhage theory
Scalloping between roots, teeth or vital
What are the characteristics of a aneurysmal bone cyst?
“blood soaked sponge”
Not a true cyst
Blow out/Ballooning distension of the bone
What term describes a sporadic condition resulting from a postzygotic mutation? What are the characteristics of the lesions?
What syndromes are associated with this condition?
Fibrous dysplasia
Ground glass appearance
Jaffe-Lichtenstein syndrome: Polyostotic fibrous dysplasia and Cafe au lait spots (coasts of maine)
McCune-Albright syndrome: Polyostotic fibrous dysplasia, cafe au laits spots (coasts of Maine), sexual precocity, pituitary adenoma, hyperthyroidism
Mazabraud syndrome: has intramuscular myxomas
What are the 3 types of cemento-osseous dysplasia? Who is most commonly affected by cemento-osseous dysplasia? Why is it important to not biopsy these conditions?
Focal: single sight of involvement in the posterior mandible
Periapical: involves the anterior mandible
Florid: multiple focal involvement not limited to the anterior mandible
Female, African Americans
Might lead to inflammation –> necrosis due to hypovascularity
What term describes a true neoplasm with composed of a variable mixture of bone and cementum, and cause a downward bowing of the inferior cortex of the mandible?
Ossifying fibroma
How is juvenile ossifying fibroma different from an ossifying fibroma?
It occurs in adolescent males, usually in the maxilla, and is more aggressive
What is a benign tumor of mature bone? What is the most common location? What are some signs of an osteoma?
Osteoma
Paranasal sinus lesions are more common than gnathic lesions
Can have pain, swelling, sinusitis and nasal discharge
What are the characteristics of Gardner Syndrome?
Colonic polyps that turn into adenocarcinoma, dental abnormalities (supernumerary teeth and odontomas), skeletal abnormalities (osteomas), epidermoid cysts, dermoid tumors, thyroid carcinoma, pigmented lesions of the ocular fundus
What is the difference between osteoblastoma and osteoid osteoma?
Produce prostaglandins, arise from osteoblasts, target like appearance
Osteoid osteoma = smaller than 2 cm, pain is relieved by aspirin
Osteoblastomas = larger and cannot be relieved by aspirin
What term describes an odontogenic neoplasm of cementoblasts? How can you distinguish this growth from other periapical radiodensities?
Cementoblastomas
The PDL is obscured – mass is fused to tooth
Needs extraction
What term describes a condition where swelling, pain and crepitus occur in the TMJ and loose bodies are seen on radiograph?
Synovial Chondromatosis
What is the most common type of malignancy to originate within bone? What are the radiographic features?
Osteosarcoma
Root resorption –> spiking resorption
Widening of the PDL
Sunburst appearance (bony projections)
Codman’s triangle
What term describes a sarcoma in a bone that has been previously subjected to radiation therapy?
Postirradiation bone sarcoma
What term describes a malignant tumor of cartilage?
Chondrosarcoma
What is the 3rd most common osseous neoplasm and occurs in young patients?
Ewing Sarcoma
What is the most common form of cancer involving bone? Where does it originate from
Metastatic tumors to the jaws
Breast, Lung, Thyroid, Prostate, Kidney
What are the characteristics of metastastic tumors to the jaws?
Pain, swelling, loosening of teeth, paresthesia (numb chin syndrome), widening of the PDL
