Hertz Oral Cavity Path

Question 1

Dental caries is caused by

Answer 1

focal demineralization of tooth structure (enamel and dentin) by acidic metabolites of fermenting sugars that are produced by bacteria.

Question 2

gingivitis

Answer 2

is inflammation of the oral mucosa surrounding the teeth. It is the result of a poor oral hygiene and leads to the accumulation of dental plaque and calculus

Question 3

Dental plaque

Answer 3

is a sticky, colorless, biofilm that collects between and on the surface of the teeth. It contains a mixtures of bacteria, salivary proteins, and desquamated epithelial cells.

Question 4

Periodontitis

Answer 4

inflammatory process that affects the supporting structures of hte teeth (periodontal ligaments), alveolar bone, and cementum

Question 5

canker sores

Answer 5

aphthous ulcers.

common, often recurrent, exceedingly painful, superficial oral mucosal ulscerations of unknown etiology

In mouth, usually gram positive

Question 6

pyogenic granuloma

Answer 6

inflammatory lesion typically found on the gingiva of children, young adults and pregnant women (pregnancy granuloma)

(not really a granuloma)

Question 7

Peripheral giant cell granuloma

Answer 7

outside the jaw bone

put it inside and it’s the central giant cell granuloma

Question 8

herpes simplex– how to diagnose?

Answer 8

Wright stain- Tzanck smear

now we actually use immunocytochemistry

Question 9

candidiasis (thrush)

Answer 9

Candida albicans is a normal component of the oral flora in approximately 50% of the population and is the most common fungal infection of the oral cavity.

Scrape off and use PAS stain

Question 10

deep fungal infection seen in HIV

Answer 10

45 degree septate, fruiting head: aspergillus

Question 11

oral manifestations of systemic disease

Answer 11

it is not uncommon for oral lesions to be the first sign of some underlying systemic condition

Question 12

what does phenytoin (dilantin) do?

Answer 12

causes gingival hyperplasia

“striking fibrous enlargement of the gingivae”

Question 13

monocytic leukemia can cause

Answer 13

leukemic infiltration and enlargement of the gingivae, often with accompanying periodontitis

Question 14

Rendu-Osler-Weber syndrome

Answer 14

autosomal dominant disorder with multiple congenital aneurysmal telangiectasias beneath mucosal surfaces of the oral cavity and lips

Question 15

Hairy Leukoplakia

Answer 15

Hairy leukoplakia is a distinctive oral lesion on the *lateral border of the tongue that is usually seen in immunocompromised patients and is caused by Epstein-Barr virus (EBV)

Question 16

speckled leukoplakia is a precursor to

Answer 16

squamous cell carcinoma

Question 17

firm mass in the mouth

Answer 17

must be biopsied before it can be confirmed as squamous cell carcinoma

Question 18

Leukoplakia and Erythroplakia

Answer 18

Leukoplakia is defined by the World Health Organization as “a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease.”

Thus, until proven otherwise by means of histologic evaluation, all leukoplakias must be considered precancerous.

red ones are more likely to be cancerous (blood vessels)

Question 19

Squamous Cell Carcinoma- likelihood and risk factors

Answer 19

Approximately 95% of cancers of the head and neck are squamous cell carcinomas (SCCs), with the remainder largely consisting of adenocarcinomas of salivary gland origin

Within North America and Europe, oral cavity SCC has classically been a disease of middle-aged individuals who have been chronic abusers of smoked tobacco and alcohol.
In India and Asia, the chewing of betel quid and paan is a major regional predisposing influence. This con­coction, considered a delicacy by some, contains ingredients such as areca nut, slaked lime, and tobacco, wrapped in a betel leaf; many of the ingredients of paan could give rise to potential carcinogens.
Actinic radiation (sunlight) and, particularly, pipe smoking are known predisposing influences for cancer of the lower lip.
The incidence of oral cavity SCC (particularly the tongue) in individuals younger than age 40, who have no known risk factors, has been on the rise. The pathogenesis in this group of patients, who are nonsmokers and not infected with human papillomavirus (HPV), is unknown!

Question 20

What do squamous cell carcinomas harbor?

Answer 20

In the oropharynx, as many as 70% of SCCs, particularly those involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of HPV, particularly HPV-16*

Question 21

Molecular Biology of Squamous Cell Carcinoma

Answer 21

The development of SCC is driven by the accumulation of mutations and epigenetic changes that alter the expression and function of oncogenes and tumor suppressor genes, leading to acquisition of cancer hallmarks, such as resistance to cell death, increased proliferation, induction of angiogenesis, and the ability to invade and metastasize

Question 22

Odontogenic Cysts and Tumors

Answer 22

The overwhelming majority of odontogenic cysts are derived from remnants of odontogenic epithelium present within the jaws

Question 23

cyst associated with unerupted tooth

Answer 23

dentigerous cyst (crown)

Question 24

periapical cyst

Answer 24

roots

Question 25

odontogenic keratocyst

Answer 25

large cyst, squamous epithelium, need to biopsy, recurs a lot

Question 26

aphthous ulcers

Answer 26

painful superficial ulcers of unknown etiology