Final Exam Flashcards
Clinical Description
Multiple white plaques that are mildly corrugated on the anterior floor of the mouth. The plaques have well-demarcated margins that are separated by deep fissures with focal areas of erythema
Differential Diagnosis
Leukoplakia
Squamous cell carcinoma
Proliferative verrucous Leukoplakia
Candidiasis (hyperplastic)
Confirmatory Test
Excisional Biopsy
Histopathological examination of every part of tissue
Management
Tobacco cessation
Low grade dysplasia: Frequent follow-up
High grade dysplasia: assess margins and wider excision if margins transected with frequent follow-up
Clinical Description
Multiple areas of curd-like white plaques on the anterior labial mucosa with coalesced areas.
Differential Diagnosis
Pseudomembranous Candidiasis (Thrush)
Leukoplakia
Verrucous Carcinoma
Confirmatory Test
Clinical findings (oral mucosa in susceptible individual for thrush)
Cytosmear stained with KOH to identify hyphae and spores
Swabs on sabourauds agar medium to grow white, curd-like colonies
Management
Manage drug-induced xerostomia
Better control of diabetes
Nystatin oral rinse
Clotrimazole oral troches
Clinical Description
White plaque on lower buccal mucosa/vestibule that has well-demarcated borders. The plaque is adjacent to a tooth with a cavity. There are areas that appear lifted or peeling (pseudomembrane)
Differential Diagnosis
Chemical burn
Tobacco pouch keratosis
Confirmatory test
Diagnosed clinically (acute onset, pseudomembrane, pain) and history of aspirin in that location
No biopsy required
Management
Do not remove pseudomembrane
Treat tooth
Viscous xylocaine mouth rinse to alleviate pain/burning of chemical burn
Lesions heal spontaneously over 7-10 days with reepithelization
Clinical Description
White lesion enclosing mild erythema on the lower left posterior buccal mucosa adjacent to a metal crown. Lesion exhibits fine radiating white striae
Differential Diagnosis
Lichenoid contact metal reaction
Lichen planus
Lupus erythematosus
Drug-induced lichenoid mucositis
Confirmatory test
Clinical presentation (localized nature of lesion, adjacent to metal restoration)
Skin sensitivity patch test by rheumatologist/dermatologist if patient desires
Management
Asymptomatic do not need treatment
Mild soreness due to superimposed candidiasis (antifungal medications) or excessive inflammatory response (topical steroid)
Replace crown if desired
Clinical Description
White plaque on the right lateral tongue with multiple coalescing areas varying in size. Granular corrugated surface with indistinct margins
Differential Diagnosis
Hairy Leukoplakia
Leukoplakia
Tongue chewing (morsicatio)
Cinnamon reaction
Confirmatory Test
RT-PCR for HIV RNA (viral load)
CD4 T-lymphocyte counts (less than 200 cells/ul of blood)
Lesion biopsy (koilocytes in spinous layer, demonstration of Epstein Barr virus in koilocytes)
Management
Benign condition requires no treatment
Clinical indicator of low CD4 T-lymphocyte count (less than 200 cells/ul of blood) - transition point of HIV to AIDS
Indicator to initiate highly active antiretroviral therapy
Clinical Description
Irregular red patch with intermittent white areas on the left posterior soft palate
Differential Diagnosis
Erythroplakia (speckled leukoplakia)
Candidiasis
Thermal Burn
Autoimmune mucositis
Confirmatory Test
Excisional Biopsy
Histopathological examination of tissue
Management
Tobacco cessation
90% high-grade dysplasia or invasive carcinoma
Wide excision with assessment of margins for high-grade dysplasia or carcinoma (wider excision is margins are involved)
Clinical Description
Generalized erythema of denture bearing area on the maxilla. Focal areas on alveolar ridge show light frictional keratosis
Differential Diagnosis
Chronic Atrophic Candidiasis (denture sore mouth)
Confirmatory Test
Clinical findings (most cases with poor denture hygiene)
Cytosmear stained with KOH to identify hyphae and spores
Swabs on Sabourauds agar medium to grow white, curd-like colonies
Management
Teach patient hygiene
Brush/rinse denture
Soak denture in Nystatin rinse solution overnight (for 7-10 nights)
Nystatin oral suspension (100,000 units/ml, DISP 240 ml: use 10 ml to rinse 5 times daily)
Clinical Description
Large erythematous mass extending from the alveolar ridge to the lingual area with involvement in the vestibule and left posterior floor of the mouth
Differential Diagnosis
Squamous cell carcinoma
Histoplasmosis
Confirmatory test
Incisional biopsy
Histopathological examination of tissue
Management
Depends on stage
Determine the stage
Wide surgical excision and/or radiation therapy
Neck node dissection
Chemotherapy
Clinical Description
Multiple areas of depapillation on the dorsal tongue extending to the lateral surface. Red areas partially surrounded by a yellow-white line
Differential Diagnosis
Migratory Glossitis (Geographic tongue)
Migratory stomatitis
Anemia
(iron deficiency, megaloblastic vitamin B12 deficiency)
Confirmatory Test
Clinical presentation for migratory glossitis (lesions heal spontaneously and reappear in another area, Sometimes associated with fissured tongue)
Migratory - other areas affected
Management
No treatment necessary
Rarely symptomatic cases have superimposed candida infection
Clotrimazole oral torches 10 mg, DISP 50, dissolve one in mouth 5X/day for 10 days
Clinical Description
Palatal soft tissue nodule that appears pushed against the palate. Areas of red and white that likely arise from the palatal gingiva around the maxillary right premolar/molar area
Differential Diagnosis
Pyogenic Granuloma
Peripheral Giant Cell Granuloma
Neurofibroma
Confirmatory Test
Evaluate to determine origin
Fairly rapid growth, current history of pregnancy all favor a working clinical diagnosis of pyogenic granuloma
Biopsy: Surgical removal scheduled 2 weeks after delivery
Management
Biopsy: Surgical removal scheduled 2 weeks after baby delivery
Through removal of local factors
15% recurrence
Clinical Description
Solitary dome-shaped, exophytic, popular sessile nodule on the right dorsum of the tongue. It is presented in the submucosa and non-ulcerated with no change in color
Differential Diagnosis
Granular Cell Tumor
Fibroma
Schwannoma
Neurofibroma
Confirmatory Test
Biopsy (size <1 cm in size excisional biopsy can be done)
Deeper extent of lesion harder to predict
Histopathological exam of biopsied tissue
Management
Even incisional biopsy is curative
No Recurrence has been reported
Clinical Description
Exophytic sessile nodule on the right commissure that is less than 5 mm. It has a smooth dome-shaped surface that is pink to pale pink in color
Differential Diagnosis
Fibroma
Neurofibroma
Schwannoma
Lipoma
Confirmatory Test
Excisional Biopsy
Histopathological examination
Management
Excisional Biopsy
No recurrence
Clinical Description
Smooth dome-shaped sessile exophytic nodule on the right posterior palate.
Differential Diagnosis
Pleomorphic Adenoma
Malignant salivary gland tumor
(mucoepidermoid carcinoma, Polymorphous adenocarcinoma)
Confirmatory Test
Excisional Biopsy
Histopathological examination of excised tissue
management
Excisional biopsy is curative
Long-term followup
Clinical Description
Smooth pink dome-shaped sessile exophytic nodule on the anterior left mandibular ridge
Differential Diagnosis
Peripheral ossifying fibroma
Pyogenic granuloma
Peripheral giant cell granuloma
Peripheral odontogenic tumor
Confirmatory Test
Excisional Biopsy
Histopathological examination of excised tissue
Management
Excisional Biopsy
At this size, may require removal of teeth in the vicinity of the lesion
15% rate of recurrence
Clinical Description
Smooth dome-shaped yellow-red submucosal sessile nodule in the area of the left pharyngeal tonsils
Differential Diagnosis
Oral Lymphoepithelial Cyst
Tonsillar Stone
Confirmatory Test
Excisional Biopsy
Histopathological examination of excised tissue
Management
Excisional Biopsy is curative
Low recurrence potential
Clinical Description
Gray submucosal macule in the area of the edentulous ridge at a healing extraction site
Differential Diagnosis
Amalgam Tattoo
Drug-induced pigmentation
Melanotic macule
Confirmatory Test
X-ray (may or may not show radiopaque material)
Excisional biopsy (lesion is small and readily accessible)
Send biopsied tissue for histopathological exam
Management
Nothing needs to be done for amalgam tattoo once confirmed
Inform patient, explain inert nature of the material
Follow-up to complete healing of biopsy site
Clinical Description
Generalized brown/black macular homogenous pigmentation on the attached gingiva of the maxilla and mandible
Differential Diagnosis
Physiological/Ethnic Pigmentation
Intentional Social Tattooing
Drug-induced pigmentation
Melanoma
Confirmatory Test
No compelling reason to test (biopsy)
Management
Reexamine at each follow-up visit
(there should be no significant change)
Clinical Description
Diffuse macular gray/black variable density pigmentation of the palatal mucosa. Mucosa is smooth and uninterrupted
Differential Diagnosis
Drug-induced Pigmentation
Ethnic/physiologic pigmentation
Addison disease Melanoma
Confirmatory Test
Due to patient use of Imatinib mesylate for leukemia no further testing is necessary
Clinical Features (lack of mass or ulceration) and lack of other history (hypotension/Salt craving) others are excluded
Management
No specific management required for pigmentation
Patient counselled that the pigmentation is due to the medication
Will fade over months following cessation of medication
Clinical Description
left lower lip brown-black solitary well-defined smooth macule
Differential Diagnosis
Melanotic Macule
Drug-induced pigmentation
Melanocytic Nevus
Melanoma
Confirmatory Test
Unless patient is concerned or wants to have lesion removed for esthetic purpose, no biopsy is required
Management
If the patient concerned or desires removal, an excisional biopsy may be performed
In the absence of above, do nothing other than reexamine at follow-up visits
Clinical Description
Large area of variable ill-defined pigmentation changes from black, brown to tan that is affecting the maxillary attached gingiva from the incisors to the molar region
Differential Diagnosis
Melanoma
Confirmatory Test
Immediate Biopsy and histopathological examination
Management
Immediate referral to an oncologist
Surgical resection with 1.5 cm margins, neck nodes dissection for occult metastasis.
Oral tumors present with early distant metastasis
5 year survival rate 15% with median survival of 25 months
Nodal involvement reduces survival to 18 months
Clinical Description
Diffuse Erythematous areas on the marginal and attached gingiva of the maxilla and mandible. Fine white striae at some margins of red areas. Edema and swelling are not prominent.
Differential Diagnosis
Erosive Lichen Planus
Pemphigus vulgaris
Cicatricial (mucous membrane)
Pemphigoid
Confirmatory Test
Incisional biopsy (lichenoid mucositis: saw-tooth rete ridges)
Direct immunofluorescence study (shaggy band of fibrinogen at basement membrane)
Management
Strong topical corticosteroids
Fluocinonide (gel)
Clobetasol (gel)
Clinical Description
Erythematous gingiva with several areas of ulceration with fibrin on the maxillary anterior attached gingiva. At least one intact fluid-filled blister on the right anterior with no significant local factors or gingival swelling throughout
Differential Diagnosis
Mucous membrane (cicatricial) Pemphigoid
Erosive lichen planus
Pemphigus vulgaris
Confirmatory Test
Biopsy unaffected perilesional tissue
Half specimen in routine formalin (H&E stain) and half into Michel’s solution for DIF (to show immunoreactants)
Management
Tetracycline and niacinamide
Dapsone
Topical Steroids
Systemic steroids if there is ocular disease
Clinical Description
Solitary well-circumscribed round superficial ulcer less than 1 cm in diameter with an erythema halo in the maxillary right vestibule
Differential diagnosis
Aphthous Ulcer Minor
Herpetic ulcer
Behcet’s Syndrome
Traumatic Ulcer
Confirmatory Test
Clinical presentation including previous episodes, self-healding are all highly diagnostic for aphthous ulceration
Biopsy is not indicated because histopathology is non-specific
Management
Self-healing
For prodromal symptoms, you can prescribe topical strong cortical steroids: Fluocinonide gel, Clobetasol gel
Clinical Description
Multiple superficial ulcers in the hard palate gingiva with some coalesced and an erythematous bed. Areas of gingival recession and necrosis
Differential Diagnosis
Recurrent Intraoral Herpes Simplex
Intraoral Herpes Zoster (shingles)
Primary herpetic gingivostomatitis
Herpangina
Confirmatory Test
Clinical presentation is diagnostic
Lesions resolve within 7-10 days
No other tests are necessary
Management
Often mild and unnoticed
Self resolving (no treatment)
Precaution for spread by contact since contagious
Xylocaine mouthwash prior to mealtime
Popsicles for irritation
Clinical Description
Irregular, deep ulcer with raised margins on the left lateral tongue that is surrounded by erythema and swelling
Differential Diagnosis
Traumatic Ulcer
Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)
Squamous Cell Carcinoma
Tuberculosis
Deep fungal infections
Confirmatory Test
Incisional Biopsy with histological exam including special stain (GMS: fungus, acid-fast: TB) MUST BE DONE due to the high-risk area and especially if it has been present for a long period of time
Clinical characteristic, likely trauma may have been preexisting asymptomatic condition (such as carcinoma/TB/histoplasmosis)
Management
Incisional Biopsy curative resulting in healing
Zilactin gel over lesion to reduce friction
TOpical steroids not recommended because they suppress healing
Clinical Description
Multiple papillary/warty pink coalescing lesions on the right buccal mucosa that vary in size
Differential Diagnosis
Condyloma Acuminatum (venereal warts)
Verruca vulgaris
Squamous papilloma
Confirmatory Test
Test for HIV infection (ELISA screening, Western Blot)
Biopsy one or two lesions (koilocytes, in-situ PCR staining for HPV 6, 11, 16, 18)
Management
Scalpel excision or cryotherapy
Avoid laser/electrocautery due to aerosolization of virus
Highly contagious, new lesions develop by direct contact or inoculation (recurrence >30%)
Clinical Description
Multiple papillary wart-like growths on the right vermillion commissure. These papillary growths vary in size from 1-2 mm and in their phase of growth
Differential Diagnosis
Verruca Vulgaris
Squamous papilloma
Multifocal epithelial hyperplasia
Condyloma acuminatum
Confirmatory Test
Clinical is characteristic
Single lesion may be biopsied for histopathological confirmation
(papillary surface architecture, epithelial hyperplasia with alternating hyperpara and hyperortho keratosis, Koilocytes)
Management
Skin lesions: Topical salicylic acid, cryotherapy, intralesional bleomycin
Intraoral Lesions: Surgical excision, laser ablation, cryotherapy
Clinical Description
Single mucus-filled vesicle on the lower left lip.
Incidental findings: skin of left chin nevus
Differential Diagnosis
Mucus extravasation phenomenon (mucocele)
Salivary gland tumor
Confirmatory Test
Clinical presentation is diagnostic but an excisional biopsy is required for management
Histopathological exam of tissue confirms diagnosis and excludes tumor
Management
Excisional biopsy including deep wedge to remove the involved minor mucus gland lobules to mitigate recurrence
Clinical Description
Left anterior floor of the mouth solitary submucosal nodule that is pale pink to yellow near the Wharton’s duct
Differential Diagnosis
Sialolith
Oral lymphoepithelial cyst
Lipoma
Salivary gland tumor
Confirmatory Test
Palpation (bi-manual palpation will reveal firm mass)
Occlusal x-ray (shows an oval-shaped radiopaque mass)
Biopsy - excisional (results in removal of hard mass)
Management
Excisional biopsy
if pain persists upon removal of stone - chronic sialadenitis of left submandibular gland is suspected - gland may require removal
Clinical Description
Irregular lobulated deep-seated swelling on the right retromolar to pterygomandibular area. Extent is not defined. Surface telangiectasia.
Differential Diagnosis
Mucoepidermoid Carcinoma
Until proven otherwise
Confirmatory Test
CT exam for extent of lesion and possible bone involvement
Incisional biopsy and histopathological exam of tissue
Management
Surgical excision with wide margins
Bone involvement requires segmental resection
Intermediate/high-grade tumors require neck dissection for lymph node involvement
High-grade may be treated with proton beam therapy
