Midterm Review Flashcards
What is a differential diagnosis?
A list of all the possibilities arranged from the most common to the least common
What is the #1 most common lesion of the oral cavity?
Leukoplakia
What is a leukoplakia?
A pre-malginant, intraoral, white plaque that does not rub off and can not be identified as any known entity
What are 5 other white lesion that can be scraped off?
- Materia alba
- White coated tongue
- Burn (thermal, chemical or cotton roll)
- Pseudomembranous candidiasis
- Allergy (toothpaste or mouthwash)
What is the treatment for white coated tongue?
Treatment is tongue scraping – best is a flat, stainless steel bar in a horse shoe shape
What are 6 other white plaques that do not rub off?
- Linea alba
- Leukoedema
- Nicotine stomatitis
- Oral hairy leukoplakia
- Tobacco pouch keratosis
- Lichen planus
What is the treatment for linea alba?
No treatment necessary
In what population is leukoedema most common? What is the treatment?
In 70-90% African people (bilateral lesion)
No treatment necessary
What is the cause of nicotine stomatitis? What is another name for nicotine stomatitis? What is the treatment?
It is a callous from heat
Smoker’s keratosis
Stop smoking to see if lesion goes away within 2 weeks
What population is at risk for oral hairy leukoplakia? What virus is associated with this condition?
AIDS patients (*remember this is bilateral)
Epstein Barr Virus
What is the treatment for tobacco pouch keratosis?
Move the tobacco to see if the lesion disappears within 2 weeks
What is a pathognomonic sign of lichen planus? What is the cause of lichen planus? What is the treatment?
Wickham Striae
Autoimmune condition involving CD4+ T cells –> saw tooth rete ridges and a band of luekocytes
Biopsy and tx with a topical steroid
What are the different results possible for leukoplakia?
Hyperkeratosis
Dysplasia (mild, moderate, severe)
Carcinoma in situ
What does carcinoma in situ mean?
Cancerous cells that are getting ready to invade
What are the high risk sites for leukoplakia?
Floor of mouth, tongue and lip
*if there is a leukoplakia in these areas do not wait to do a biopsy
What is the best guide for the potential progression to cancer from luekoplakias?
Degree of dysplasia
Severe = 16% transformation (take it out) Moderate = 3-15% transformation (take it out) Mild = <5% (watch it, and biopsy again if it changes)
What was the mean transformation time of leukoplakias into cancer? What does this mean for patients?
About 4.3 years
This means that leukoplakias need really good follow up! Even if they have been removed, they need to be continually evaluated for reappearance and change
What is the 2nd most common lesion of the oral cavity?
Tori (palatinus and mandibularis)
When should tori be removed?
If they cause the patient pain (usually from frequent trauma), if it bothers the patient, or if they need dentures
Which type of tori are most common in men?
Mandibular tori
What are the common different types of inflammation or irritiation in the oral cavity?
Traumatic ulcer
Pericoronitis
Periodontal abscess
ANUG
What is the name for persisting ulcers involving skeletal muscles?
Traumatic ulcerative granuloma with stromal eosinophilia
What is the treatment for traumatic ulcers/TUGSE)
Excise the inflamed tissue or/and inject a steroid
a topical steroid will not penetrate enough since TUGSE is a deep ulcer
What steroid is used and what dose of steroid is used for TUGSE?
Kenalog 10 or 40 – need 10 mg of steroid for every 1 cm of ulcered tissue
10 = 10 mg/ml --> 1 ml/cm 40 = 40 mg/ml --> .25 ml/cm
What is the tissue called that overlies the occlusal table?
Operculum (can become inflammed in pericoronitis)
What is the most common neoplasm in the oral cavity? Where do they commonly occur?
Firboma – however, this is a misnomer
Buccal mucosa > labial mucosa > tongue ? gingiva
What is the treatment for a fibroma?
Excision and submit to pathologist
What term describes ectopic sebaceous glands?
Fordyce’s Granules
How common are Fordyce’s granules? Where do they occur and what is the treatment?
Occur in 80% of the population (yellowish white papules)
Buccal mucosa>lips
No treatment necessary
What term describes a benign proliferation of blood vessels?
Hemangioma
In what population are hemangiomas most common? How can a hemangioma dx be confirmed? What is the treatment?
In 10-12& of children
Clinically blanches under pressure = dioscopy
Treatment is surgery, laser tx, or embolization
Where do recurrent aphthous ulcers occur? What is a characteristic feature of a RAU?
On non-keratinized, movable mucosa
Yellow. fibrin membrane and red borders
How common are RAU? What is the treatment?
Occur in 20-25% of the population
Treat with topical steroids
What are the differences between minor, major, and herpetiform RAU?
Minor: 3-10 mm in size, 1-2 weeks healing time, 1-5 lesions, fewest recurrences
Major: 1-3 cm in size, 2-6 weeks healing with possible scarring, 1-10 lesions
Herpetiform: 1-3 mm in size, 7-10 days healing, up to 100 lesions, most recurences
What term describes a benign proliferation of squamous epithelium? What is a characteristic of these lesions?
Papilloma
Pedunculated with “finger like” projections
What are the most common locations of papillomas and what is the treatment?
Tongue > soft palate
Treatment is surgical excision
What are the different variations of papillomas and what are they caused by?
Squamous papillomas = HPV 6, 11
Verruca Vulgaris (common wart) = HPV 2, 4, 60, 40
Condyloma Accuminatum = HPV 16, 18
Focal Epithelial Hyperplasia (Heck’s disease) = HPV 13, 32
Sinomasal papillomas
What is caused by an ill-fitting denture? What is the treatment?
Epulis fissuratum
Excise the extra tissue and reline the denture
What is the histopathologic dx for epulis fissuratum?
Focal inflammatory fibrous hyperplasia
What term describes superficial veins on the tongue?
Lingual varices
What term describes numerous grooves or fissures on the dorsal tongue? What is often associated with this condition?
Fissured tongue
Often associated with geographic tongue
What should be done if the patient experiences mild burning or soreness with fissured tongue?
Brush the tongue! The fissures need to be cleaned out
What are the other names for geographic tongue?
Erythema areata migrans, benign migratory glossitis
What term describes something that looks like geographic tongue but is in the vestibule, and is associated with celiac patients?
Pysostomatitis vegetans
What term describes a pebbly mucosa of patients who wear their dentures all day? How is it treated? What if it is erythematous?
Inflammatory papillary hyperplasia
Surgical excision and reline the denture
Red indicates a yeast infection, so use an antifungal on the mouth and the denture
Where do recurrent herpes simplex lesions occur?
Almost always on bound, keratinized mucosa
What terms describe the initial exoposure of herpes virus and is based on age?
Young children = acute herpetic gingivostomatitis
18 and older = pharyngotonsillitis
What term describes an intraoral vesicle filled with clear fluid? What if it is blood filled?
Mucocele
Blood filled in indicative of an autoimmune disease like mucous membrane pemphigoid
What is the most common location for a mucocele? What causes them? What is the treatment?
The lower lip
Trauma to salivary duct
Excise the feeding gland
Why is it important to ask the history of the present lesion?
Because it may be scar tissue from trauma or surgery and does not require treatment
What term describes a yeast infection at the corners of the mouth? What is the treatment?
Anguar cheilitis
Treat with an antifungal and increase the vertical dimension to prevent pooling of saliva and folding of skin
What term describes lymphoid hyperplasia on the posterior lateral tongue? What is the treatment?
Lingual tonsil
No treatment
What term describes an accumulation of blood within the tissues secondary to trauma? What is the treatment?
Hematoma
No treatment
What might tobacco pouch keratosis progress to if tobacco use continues?
Verrucous carcinoma
What are the terms that describe chronic biting of the cheeks, lips, or tongue? What is the treatment?
Morsicatio buccarum
Morsicatio labiorum
Morsicatio linguarum
No treatment or bite guard
What must lichen planus be differentiated from?
Lichenoid drug reactions (lichenoid mucositis)
What are the two froms of lichen planus?
Reticular and Erosive
What do cutaneous lichen planus lesiosn look like?
Purple, pruritic, polygonal papules
What term describes bony protuberances on the buccal of the mandible/maxilla? What is the treatment?
Buccal exostoses
Remocal if repeated trauma, aesthetic concerns, or if the patien is in need of dentures
What term describes an oral freckle?
Oral melanotic macule
What term describes a central papillary atrophy of the tongue due to a yeast infection? What is the treatment?
Median rhomboid glossitis
Treat with an antifungal and encourage brushing of the tongue
What can occur with hairy tongue?
Gagging, bad taste, halitosis, esthetic concerns
What can cause a smooth red tongue (bald tongue)? What symptoms accompany this?
Pernicious anemia, medications, vitamin deficiencies
Burning and pain
What term describes a slow growing, painless, skin cyst associated with inflammation of a hair follicle? What is the treatment?
Epidermoid cyst
Surgical removal
What term describes a benign tumor of fat? Where do they usually occur in the mouth? What is the treatment?
Lipoma
Buccal mucosa, tongue, FOM, lips
Surgical excision
What is the definition of an odontogenic cyst? What do they arise from?
Pathologic cavity lined by odontogenic epithelium and filled with fluid of semisolid material
Arise from the rests of the dental lamina
What are the top 4 odontogenic cysts?
Dentigerous cyst
Odontogenic keratocyst
Orthokeratinized odontogenic cyst
Calcifying odontogenic cyst
What are the top odontogenic tumors of epithelial and mixed origin?
Epithelial origin: Adenomatoid odontogenic tumor, Calcifying epithelial odontogenic tumor
Mixed origin: Ameloblastic fibroma, Ameloblastic fibro-odontoma, odontoma
What is the most common developmental cyst? What does it originate from?
Dentigerous cyst
Originates from the separation of the follicle from around the crown of an unerupted tooth
Where are dentigerous cysts attached at on the unerupted tooth?
The CEJ
What teeth are most commonly involved in a dentigerous cyst?
The mandibular 3rd molars, followed by the MX 3rds, then MX canines
Almost never occur in deciduous teeth
What term describes a cyst filled with keratin debris?
Odontogenic keratocyst
What are the 2 most important things to remember about odontogenic keratocysts?
30% recurrence rate and associated with Gorlin’s syndrome
What is another name for Gorlin’s syndrome? What are the characteristics of Gorlin’s syndrom? What causes it?
Nevoid basal cell carcinoma syndrome
Characterized by multiple basal cell carcinomas, OKCs, calcification of the falx cerebri and rib anomalies
Caused by a mutation in PTCH gene on chromosome 9
Why do so many Odontogenic keratocysts recur?
OKCs have thin, friable walls so complete removal is often difficult
What are the histopathologic features of odontogenic keratocysts?
- Thin, friable wall
- Wavy, parakeratinized epithelial lining that is a uniform 6-8 layers thick
- Palisading, hyperchromatic basal cell layer
- Daughter cysts
What do odontogenic keratocysts radiographically appear as?
Radiolucent lesions with corticated rims
Large lesions can be multilocular
1/3 are associated with an unerupted tooth
What makes orthokeratinized odontogenic cysts different than odontogenic keratocysts?
Orthokeratinized odontogenic cysts have an orthokeratinized lining and no basal palisading
Why is the term traumatic bone cysts a misnomer? What is another name for traumatic bone cyst? Are teeth vital?
Because the lesion does not have an epithelial lining and is often empty
Simple bone cyst
Yes, teeth are vital
What is the current theory of etiology of traumatic bone cysts?
Trauma-hemorrhage theory = trauma to the bone which causes a hematoma, but the hemotoma does not undergo organization and repair, resulting in a defect
In what age group are traumatic bone cysts of the jaws most common found? Where are they specifically found?
In patients between 10-20 and they exclusively occur in the mandible
What term describes a unilocular, well defined RL with RO structures usually found in the incisor canine area? What age are most patients with this lesion?
Calcifying odontogenic cyst
35
What is another name for calcifying odontogenic cyst?
Gorlin cyst
What term describes a unilocular, well defined RL lesion in the anterior maxilla with snowflake calcifications? What age are most patients with this lesion?
Adenomatoid odontogenic tumor
Between the ages of 10-20, more often female (younger than COC)
What term describes a uni/multilocular RL, with well defined scalloped margins and calcifications in a driven snow pattern?
Calcifying epithelial odontogenic tumor
What is another name for calcifying epithelial odontogenic tumor?
Pindborg tumor
What are the histopathologic characteristics of calcifying epithelial odontogenic tumors?
- Nuclear pleomorphism and atypia
- Amyloid like ECM –> positive for congo red and exhibit apple green birefringence when viewed under polarized light
- Calcifications with concentric rings in amyloid areas (liesegang rings)
What is the most common odontogenic tumor? Is it a true neoplasm?
Odontoma
Not a true neoplasm, considered a hamartoma
What are the 2 types of odontomas and what are the diffences between these types?
Compound and Complex
Compound = composed of multiple, small tooth like structures, more common in anterior
Complex = conglomerate mass of enamel and dentin, more common in molar regions
What is the average age of patients with odontomas? What are they associated with?
15
Associated with an unerupted tooth
What term descirbes a true mixed tumor with islands of dental papilla like tissues and ameloblasts? Where do they occur?
Ameloblastic fibroma
Usually located in the posterior mandible
What term describes a lesion that is a true mixed tumor and has enamel and dentin? Where do they occur?
Ameloblastic fibro-odontoma
Occurs in the posterior jaws
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
What are the 3 different types of ameloblastomas?
Conventional solid/multicystic
Unicystic
Peripheral
What is the clinical presentation of ameloblastomas?
Painless swelling in posterior mandible – buccal and lingual cortical expansion is frequently present
(except desmoplastic which is anterior maxilla)
What is the radiographic presentation of ameloblastomas?
Multilocular RL that is either soap bubble or honeycomb in appearance
What are the histopathologic features of ameloblastomas?
- Palisading, hyperchromatic basal layer
- Reverse polarity
- Apical vacuolization
What is the difference between malignant and metastatic ameloblastoma?
Malignant is cancer, metastatic is benign, but is somewhere unusual – once the patient gets the metastatic removed they will be fine and have no worries
What characteristics typically indicate a benign bony neoplasms?
Asymptomatic
Grows slowly – displaces teeth and expands cortex
Symmetrical
Does not metastasize
What characteristics typically indicate a malignant bony neoplasm?
Symptomatic Grows rapidly Invades and destroys adjacent structures Asymmetrical Poorly defined margins Laying down bone outside the cortex Capable of metastasis
What term describes an isolated RL usually with ill defined borders and fine central trabeculations? What is the treatment?
Focal Osteoporotic Marrow Defect (hematopoietic marrow that produces a RL)
No treatment necessary – need incisional biopsy to dx
What term describes a focal area of increased RO that is of unknown causes and can not be attributed to anything else? What is the treamtent?
Idiopathic osteosclerosis
No treatment necessary – dx can be made based on history, clinical features, radiographic findings
What terms describes a localized area of bone sclerosis that is associated with apices of teeth with pulpitis?
Condensing osteitis aka focal sclerosing osteomyelitis
What term describes a metabolic lesion, that occurs in the anterior jaws and frequently crosses the midline?
Central giant cell granuloma
In what age group are central giant cells more common? What is the treatment and recurrence?
Usually occur in younger patients
Treatment is curettage
Recurrence is 20% (prognosis is good – not neoplastic)
What is a radiographic feature that is highly suggestive of a traumatic bone cyst?
What is the treatment for traumatic bone cysts?
Surgical exploration is necessary for dx, b/c need curettage of walls to rule out thin walled lesions
surgical exploration is curative
What term describes an intraosseous accumulation of blood filed spaces surround by connective tissues?
Aneurysmal bone cyst
What are fibro-osseous lesions? What are 3 benign fibro-osseous lesions?
A group of lesions characterized by replacement of normal bone with fibrous tissue containing materialized product
- Fibrous dysplais
- Cemento-osseous dysplasia
- Ossifying fibroma
What are the differences in the 3 types of cemento-osseous dysplasia?
Focal cemento-osseous dysplasia = single site in posterior mandible
Peripapical cemento-osseous dysplasia = PA region of anterior mandible, teeth are vital
Florid cemento-osseous dysplasia = multiple foci not limited to anterior mandible, bilateral, symmetrical
What is the treatment for cemento-osseous lesions?
Do NOT biopsy florid or periapical –> might lead to inflammation and necrosis
Encourage oral hygiene
What term describes a true neoplastic fibro-osseous lesion composed of fibrous tissue that containes bone and cementum? What might large lesions demonstrate in the mandible? What is the treatment?
Ossifying fibroma
Downward bowing of the inferior cortex of the mandible
Tx: resection of bone
What term describes an odontogenic neoplasm of cementoblasts? What is common with these lesions? What do they look like radiographically? What is the treatment?
Cementoblastoma
Usually cause pain and swelling
RO mass fused to one of more tooth roots – cannot see outline of root and surrounded by a thin RL rim
Tx: surgical extraction with the calcified mass
What term describes a mesenchymal malignancy, and is the most common type of malignancy to originate within bone? What are the characteristics of this lesion?
Osteosarcoma
Spiking resorption of roots, sunburst appearance, triangular elevation of periosteum (codmans triganle), symmetrical widening of PDL space
What is the most common malignancy of bone?
Metastatic tumors!! From lung, breast/prostate
Where do many metastatic tumors of bone occur in the skull? What are some symptoms?
80% of mets in skull in mandible
Pain, swelling, loosening of teeth, paresthesia (numb chin syndrome)
What is the prognosis of metastatic tumors to the jaws?
Poor – 5 year survival is rare
How is juvenile ossifying fibroma distinguished from ossifying fibroma?
Most commonly in adolescents, is in the maxilla, and is more aggressive
What is the histopathology of central giant cell identical to?
Brown tumor of hyperparathyroidism
Lesions of cherubism
