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Oral Medicine - My deck > Midterm Review > Flashcards

Midterm Review Flashcards

1
Q

What is a differential diagnosis?

A

A list of all the possibilities arranged from the most common to the least common

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2
Q

What is the #1 most common lesion of the oral cavity?

A

Leukoplakia

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3
Q

What is a leukoplakia?

A

A pre-malginant, intraoral, white plaque that does not rub off and can not be identified as any known entity

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4
Q

What are 5 other white lesion that can be scraped off?

A
  1. Materia alba
  2. White coated tongue
  3. Burn (thermal, chemical or cotton roll)
  4. Pseudomembranous candidiasis
  5. Allergy (toothpaste or mouthwash)
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5
Q

What is the treatment for white coated tongue?

A

Treatment is tongue scraping – best is a flat, stainless steel bar in a horse shoe shape

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6
Q

What are 6 other white plaques that do not rub off?

A
  1. Linea alba
  2. Leukoedema
  3. Nicotine stomatitis
  4. Oral hairy leukoplakia
  5. Tobacco pouch keratosis
  6. Lichen planus
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7
Q

What is the treatment for linea alba?

A

No treatment necessary

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8
Q

In what population is leukoedema most common? What is the treatment?

A

In 70-90% African people (bilateral lesion)

No treatment necessary

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9
Q

What is the cause of nicotine stomatitis? What is another name for nicotine stomatitis? What is the treatment?

A

It is a callous from heat

Smoker’s keratosis

Stop smoking to see if lesion goes away within 2 weeks

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10
Q

What population is at risk for oral hairy leukoplakia? What virus is associated with this condition?

A

AIDS patients (*remember this is bilateral)

Epstein Barr Virus

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11
Q

What is the treatment for tobacco pouch keratosis?

A

Move the tobacco to see if the lesion disappears within 2 weeks

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12
Q

What is a pathognomonic sign of lichen planus? What is the cause of lichen planus? What is the treatment?

A

Wickham Striae

Autoimmune condition involving CD4+ T cells –> saw tooth rete ridges and a band of luekocytes

Biopsy and tx with a topical steroid

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13
Q

What are the different results possible for leukoplakia?

A

Hyperkeratosis
Dysplasia (mild, moderate, severe)
Carcinoma in situ

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14
Q

What does carcinoma in situ mean?

A

Cancerous cells that are getting ready to invade

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15
Q

What are the high risk sites for leukoplakia?

A

Floor of mouth, tongue and lip

*if there is a leukoplakia in these areas do not wait to do a biopsy

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16
Q

What is the best guide for the potential progression to cancer from luekoplakias?

A

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)
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17
Q

What was the mean transformation time of leukoplakias into cancer? What does this mean for patients?

A

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

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18
Q

What is the 2nd most common lesion of the oral cavity?

A

Tori (palatinus and mandibularis)

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19
Q

When should tori be removed?

A

If they cause the patient pain (usually from frequent trauma), if it bothers the patient, or if they need dentures

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20
Q

Which type of tori are most common in men?

A

Mandibular tori

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21
Q

What are the common different types of inflammation or irritiation in the oral cavity?

A

Traumatic ulcer
Pericoronitis
Periodontal abscess
ANUG

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22
Q

What is the name for persisting ulcers involving skeletal muscles?

A

Traumatic ulcerative granuloma with stromal eosinophilia

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23
Q

What is the treatment for traumatic ulcers/TUGSE)

A

Excise the inflamed tissue or/and inject a steroid

a topical steroid will not penetrate enough since TUGSE is a deep ulcer

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24
Q

What steroid is used and what dose of steroid is used for TUGSE?

A

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
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25
Q

What is the tissue called that overlies the occlusal table?

A

Operculum (can become inflammed in pericoronitis)

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26
Q

What is the most common neoplasm in the oral cavity? Where do they commonly occur?

A

Firboma – however, this is a misnomer

Buccal mucosa > labial mucosa > tongue ? gingiva

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27
Q

What is the treatment for a fibroma?

A

Excision and submit to pathologist

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28
Q

What term describes ectopic sebaceous glands?

A

Fordyce’s Granules

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29
Q

How common are Fordyce’s granules? Where do they occur and what is the treatment?

A

Occur in 80% of the population (yellowish white papules)

Buccal mucosa>lips

No treatment necessary

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30
Q

What term describes a benign proliferation of blood vessels?

A

Hemangioma

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31
Q

In what population are hemangiomas most common? How can a hemangioma dx be confirmed? What is the treatment?

A

In 10-12& of children

Clinically blanches under pressure = dioscopy

Treatment is surgery, laser tx, or embolization

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32
Q

Where do recurrent aphthous ulcers occur? What is a characteristic feature of a RAU?

A

On non-keratinized, movable mucosa

Yellow. fibrin membrane and red borders

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33
Q

How common are RAU? What is the treatment?

A

Occur in 20-25% of the population

Treat with topical steroids

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34
Q

What are the differences between minor, major, and herpetiform RAU?

A

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

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35
Q

What term describes a benign proliferation of squamous epithelium? What is a characteristic of these lesions?

A

Papilloma

Pedunculated with “finger like” projections

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36
Q

What are the most common locations of papillomas and what is the treatment?

A

Tongue > soft palate

Treatment is surgical excision

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37
Q

What are the different variations of papillomas and what are they caused by?

A

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

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38
Q

What is caused by an ill-fitting denture? What is the treatment?

A

Epulis fissuratum

Excise the extra tissue and reline the denture

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39
Q

What is the histopathologic dx for epulis fissuratum?

A

Focal inflammatory fibrous hyperplasia

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40
Q

What term describes superficial veins on the tongue?

A

Lingual varices

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41
Q

What term describes numerous grooves or fissures on the dorsal tongue? What is often associated with this condition?

A

Fissured tongue

Often associated with geographic tongue

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42
Q

What should be done if the patient experiences mild burning or soreness with fissured tongue?

A

Brush the tongue! The fissures need to be cleaned out

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43
Q

What are the other names for geographic tongue?

A

Erythema areata migrans, benign migratory glossitis

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44
Q

What term describes something that looks like geographic tongue but is in the vestibule, and is associated with celiac patients?

A

Pysostomatitis vegetans

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45
Q

What term describes a pebbly mucosa of patients who wear their dentures all day? How is it treated? What if it is erythematous?

A

Inflammatory papillary hyperplasia

Surgical excision and reline the denture

Red indicates a yeast infection, so use an antifungal on the mouth and the denture

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46
Q

Where do recurrent herpes simplex lesions occur?

A

Almost always on bound, keratinized mucosa

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47
Q

What terms describe the initial exoposure of herpes virus and is based on age?

A

Young children = acute herpetic gingivostomatitis

18 and older = pharyngotonsillitis

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48
Q

What term describes an intraoral vesicle filled with clear fluid? What if it is blood filled?

A

Mucocele

Blood filled in indicative of an autoimmune disease like mucous membrane pemphigoid

49
Q

What is the most common location for a mucocele? What causes them? What is the treatment?

A

The lower lip

Trauma to salivary duct

Excise the feeding gland

50
Q

Why is it important to ask the history of the present lesion?

A

Because it may be scar tissue from trauma or surgery and does not require treatment

51
Q

What term describes a yeast infection at the corners of the mouth? What is the treatment?

A

Anguar cheilitis

Treat with an antifungal and increase the vertical dimension to prevent pooling of saliva and folding of skin

52
Q

What term describes lymphoid hyperplasia on the posterior lateral tongue? What is the treatment?

A

Lingual tonsil

No treatment

53
Q

What term describes an accumulation of blood within the tissues secondary to trauma? What is the treatment?

A

Hematoma

No treatment

54
Q

What might tobacco pouch keratosis progress to if tobacco use continues?

A

Verrucous carcinoma

55
Q

What are the terms that describe chronic biting of the cheeks, lips, or tongue? What is the treatment?

A

Morsicatio buccarum
Morsicatio labiorum
Morsicatio linguarum

No treatment or bite guard

56
Q

What must lichen planus be differentiated from?

A

Lichenoid drug reactions (lichenoid mucositis)

57
Q

What are the two froms of lichen planus?

A

Reticular and Erosive

58
Q

What do cutaneous lichen planus lesiosn look like?

A

Purple, pruritic, polygonal papules

59
Q

What term describes bony protuberances on the buccal of the mandible/maxilla? What is the treatment?

A

Buccal exostoses

Remocal if repeated trauma, aesthetic concerns, or if the patien is in need of dentures

60
Q

What term describes an oral freckle?

A

Oral melanotic macule

61
Q

What term describes a central papillary atrophy of the tongue due to a yeast infection? What is the treatment?

A

Median rhomboid glossitis

Treat with an antifungal and encourage brushing of the tongue

62
Q

What can occur with hairy tongue?

A

Gagging, bad taste, halitosis, esthetic concerns

63
Q

What can cause a smooth red tongue (bald tongue)? What symptoms accompany this?

A

Pernicious anemia, medications, vitamin deficiencies

Burning and pain

64
Q

What term describes a slow growing, painless, skin cyst associated with inflammation of a hair follicle? What is the treatment?

A

Epidermoid cyst

Surgical removal

65
Q

What term describes a benign tumor of fat? Where do they usually occur in the mouth? What is the treatment?

A

Lipoma

Buccal mucosa, tongue, FOM, lips

Surgical excision

66
Q

What is the definition of an odontogenic cyst? What do they arise from?

A

Pathologic cavity lined by odontogenic epithelium and filled with fluid of semisolid material

Arise from the rests of the dental lamina

67
Q

What are the top 4 odontogenic cysts?

A

Dentigerous cyst
Odontogenic keratocyst
Orthokeratinized odontogenic cyst
Calcifying odontogenic cyst

68
Q

What are the top odontogenic tumors of epithelial and mixed origin?

A

Epithelial origin: Adenomatoid odontogenic tumor, Calcifying epithelial odontogenic tumor

Mixed origin: Ameloblastic fibroma, Ameloblastic fibro-odontoma, odontoma

69
Q

What is the most common developmental cyst? What does it originate from?

A

Dentigerous cyst

Originates from the separation of the follicle from around the crown of an unerupted tooth

70
Q

Where are dentigerous cysts attached at on the unerupted tooth?

A

The CEJ

71
Q

What teeth are most commonly involved in a dentigerous cyst?

A

The mandibular 3rd molars, followed by the MX 3rds, then MX canines

Almost never occur in deciduous teeth

72
Q

What term describes a cyst filled with keratin debris?

A

Odontogenic keratocyst

73
Q

What are the 2 most important things to remember about odontogenic keratocysts?

A

30% recurrence rate and associated with Gorlin’s syndrome

74
Q

What is another name for Gorlin’s syndrome? What are the characteristics of Gorlin’s syndrom? What causes it?

A

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

75
Q

Why do so many Odontogenic keratocysts recur?

A

OKCs have thin, friable walls so complete removal is often difficult

76
Q

What are the histopathologic features of odontogenic keratocysts?

A
  • Thin, friable wall
  • Wavy, parakeratinized epithelial lining that is a uniform 6-8 layers thick
  • Palisading, hyperchromatic basal cell layer
  • Daughter cysts
77
Q

What do odontogenic keratocysts radiographically appear as?

A

Radiolucent lesions with corticated rims

Large lesions can be multilocular

1/3 are associated with an unerupted tooth

78
Q

What makes orthokeratinized odontogenic cysts different than odontogenic keratocysts?

A

Orthokeratinized odontogenic cysts have an orthokeratinized lining and no basal palisading

79
Q

Why is the term traumatic bone cysts a misnomer? What is another name for traumatic bone cyst? Are teeth vital?

A

Because the lesion does not have an epithelial lining and is often empty

Simple bone cyst

Yes, teeth are vital

80
Q

What is the current theory of etiology of traumatic bone cysts?

A

Trauma-hemorrhage theory = trauma to the bone which causes a hematoma, but the hemotoma does not undergo organization and repair, resulting in a defect

81
Q

In what age group are traumatic bone cysts of the jaws most common found? Where are they specifically found?

A

In patients between 10-20 and they exclusively occur in the mandible

82
Q

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?

A

Calcifying odontogenic cyst

35

83
Q

What is another name for calcifying odontogenic cyst?

A

Gorlin cyst

84
Q

What term describes a unilocular, well defined RL lesion in the anterior maxilla with snowflake calcifications? What age are most patients with this lesion?

A

Adenomatoid odontogenic tumor

Between the ages of 10-20, more often female (younger than COC)

85
Q

What term describes a uni/multilocular RL, with well defined scalloped margins and calcifications in a driven snow pattern?

A

Calcifying epithelial odontogenic tumor

86
Q

What is another name for calcifying epithelial odontogenic tumor?

A

Pindborg tumor

87
Q

What are the histopathologic characteristics of calcifying epithelial odontogenic tumors?

A
  • 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)
88
Q

What is the most common odontogenic tumor? Is it a true neoplasm?

A

Odontoma

Not a true neoplasm, considered a hamartoma

89
Q

What are the 2 types of odontomas and what are the diffences between these types?

A

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

90
Q

What is the average age of patients with odontomas? What are they associated with?

A

15

Associated with an unerupted tooth

91
Q

What term descirbes a true mixed tumor with islands of dental papilla like tissues and ameloblasts? Where do they occur?

A

Ameloblastic fibroma

Usually located in the posterior mandible

92
Q

What term describes a lesion that is a true mixed tumor and has enamel and dentin? Where do they occur?

A

Ameloblastic fibro-odontoma

Occurs in the posterior jaws

93
Q

What is the most common clinically significant odontogenic tumor?

A

Ameloblastoma

94
Q

What are the 3 different types of ameloblastomas?

A

Conventional solid/multicystic
Unicystic
Peripheral

95
Q

What is the clinical presentation of ameloblastomas?

A

Painless swelling in posterior mandible – buccal and lingual cortical expansion is frequently present

(except desmoplastic which is anterior maxilla)

96
Q

What is the radiographic presentation of ameloblastomas?

A

Multilocular RL that is either soap bubble or honeycomb in appearance

97
Q

What are the histopathologic features of ameloblastomas?

A
  • Palisading, hyperchromatic basal layer
  • Reverse polarity
  • Apical vacuolization
98
Q

What is the difference between malignant and metastatic ameloblastoma?

A

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

99
Q

What characteristics typically indicate a benign bony neoplasms?

A

Asymptomatic
Grows slowly – displaces teeth and expands cortex
Symmetrical
Does not metastasize

100
Q

What characteristics typically indicate a malignant bony neoplasm?

A 
Symptomatic
Grows rapidly
Invades and destroys adjacent structures
Asymmetrical
Poorly defined margins
Laying down bone outside the cortex
Capable of metastasis
101
Q

What term describes an isolated RL usually with ill defined borders and fine central trabeculations? What is the treatment?

A

Focal Osteoporotic Marrow Defect (hematopoietic marrow that produces a RL)

No treatment necessary – need incisional biopsy to dx

102
Q

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?

A

Idiopathic osteosclerosis

No treatment necessary – dx can be made based on history, clinical features, radiographic findings

103
Q

What terms describes a localized area of bone sclerosis that is associated with apices of teeth with pulpitis?

A

Condensing osteitis aka focal sclerosing osteomyelitis

104
Q

What term describes a metabolic lesion, that occurs in the anterior jaws and frequently crosses the midline?

A

Central giant cell granuloma

105
Q

In what age group are central giant cells more common? What is the treatment and recurrence?

A

Usually occur in younger patients

Treatment is curettage
Recurrence is 20% (prognosis is good – not neoplastic)

106
Q

What is a radiographic feature that is highly suggestive of a traumatic bone cyst?
What is the treatment for traumatic bone cysts?

A

Surgical exploration is necessary for dx, b/c need curettage of walls to rule out thin walled lesions

surgical exploration is curative

107
Q

What term describes an intraosseous accumulation of blood filed spaces surround by connective tissues?

A

Aneurysmal bone cyst

108
Q

What are fibro-osseous lesions? What are 3 benign fibro-osseous lesions?

A

A group of lesions characterized by replacement of normal bone with fibrous tissue containing materialized product

  • Fibrous dysplais
  • Cemento-osseous dysplasia
  • Ossifying fibroma
109
Q

What are the differences in the 3 types of cemento-osseous dysplasia?

A

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

110
Q

What is the treatment for cemento-osseous lesions?

A

Do NOT biopsy florid or periapical –> might lead to inflammation and necrosis

Encourage oral hygiene

111
Q

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?

A

Ossifying fibroma

Downward bowing of the inferior cortex of the mandible

Tx: resection of bone

112
Q

What term describes an odontogenic neoplasm of cementoblasts? What is common with these lesions? What do they look like radiographically? What is the treatment?

A

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

113
Q

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?

A

Osteosarcoma

Spiking resorption of roots, sunburst appearance, triangular elevation of periosteum (codmans triganle), symmetrical widening of PDL space

114
Q

What is the most common malignancy of bone?

A

Metastatic tumors!! From lung, breast/prostate

115
Q

Where do many metastatic tumors of bone occur in the skull? What are some symptoms?

A

80% of mets in skull in mandible

Pain, swelling, loosening of teeth, paresthesia (numb chin syndrome)

116
Q

What is the prognosis of metastatic tumors to the jaws?

A

Poor – 5 year survival is rare

117
Q

How is juvenile ossifying fibroma distinguished from ossifying fibroma?

A

Most commonly in adolescents, is in the maxilla, and is more aggressive

118
Q

What is the histopathology of central giant cell identical to?

A

Brown tumor of hyperparathyroidism

Lesions of cherubism

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