OM And OP Flashcards
What percentage of lesions were benign and what percentage were malignant?
Majority of lesions were benign
Less the 1% malignant
According to Jones and Franklin, what percentage of specimens from oral and max pathology were for children under 16?
10%
Which lesions predominate?
AOT
Ameoloblastic fibroma
Which lesions were rare?
Odontogenic tumours
What were the most frequently diagnosed mucosa lesions?
Mucous extravasion cyst 16%
How frequent were tooth pathology, salivary gland disease and mucosal path?
Tooth: 22%
Salivary gland: 19%
Mucosal: 12%
What percentage of Periapical path was seen and what type of lesions were they?nand how frequent were they?
Radicular cyst
Residual cyst
Chronic apical gran
13% of cases
Now can you classify lesions?
Newborn Infective/ulcerative Pigmented, vascular and red lesions Exophytic Gingival enlargement
Which newborn pathology is there?
Gingival cysts of infancy which include:
- Bohns nodules
- Gingival cyst of newborn
- Epstein pearl
Rare:
congenital epulis of newborn
Melanotic nueroectoderma, tumour of infancy
Other
Partial ankyloglossa
How do gingival cysts appear?
Small
White
Grey lesions on mucosa, alveolar ridge and hard palate
How common are gingival cysts of newborn?
75% of new borns
Why may parents not know their babies have gingival cysts?
Asymmptomic and rupture witching first three months of life
What is the name of the gingival cyst that occurs on the alveolar ridge?
Bohns nodules
Where do Bohns nodules arise from?
They arise from the remanants of the dental lamina
What is the dental lamina?
It is the earliest epithelium to grow into ectomesenchyme
What are the remnants of dental lamina called?
Epithelial cell rests of serres
Where are the epithelial cell rests of serres located?
In the CT between the developing tooth crowns and oral mucosa
What can happen to the Bohns nodules?
Can undergo cystic degen
What are the midline raphe cysts called?
Epstein pearls
How do Epstein pearls develop?
Small lesions located along the Palatal midline and they develop from trapped epithelium in the Palatal raphe which then undergo cystic change
What are Epstein pearls lined by?
Keratinising stratified squamous epithelium
Wheee do you find a congenital epulis?
Rare lesion seen in neonates
Usually in the anterior maxilla along the alveolar ridge
What is the clinical appearance of a congenital epulis?
Soft round exophytic swelling
In which gender a congenital epulis err common amongst?
Females
80% seen in females
What is inside congenital epulis?
Granular cells which are covered by epithelium
How do you manage congenital epulis?
Benign
Excise
When does a melanocytic tumour develop??
This develops withing the first few mths of life.
60% are found in those less than 6 months
Where are the majority of the MNT?
70% anterior maxilla
What is the composition of a MNE?
Epithelial cells containing melanin with a fibrous stroma
Neoplasm of neuroblsstic pigmented epithelial cells of neural crest origin
T/F MNE are rapidly growing?
T
How do you manage MNT?
Excision
What is partial ankyloglossa?
Lingual frenum has a short attachment to the FOM
May be seen in up newborn but may resolve with tongue use
Which infective lesions are there?
Infective
Bacterial: odontogenicninfection
Fungal: thrush
Viral: primary herpetic gingivostomatitis, hero angina, HFM, VZV,
What causes thrush?
Candida
What is the clinical appearance of thrush?
White plaques on labial,buccal and gingival mucosa and tongue
What happens when the white plaques are removed?
Raw, bleeding mucosa
How does an acute odontogenicn infection present?
Pyrexia
Red swollen face
Anxious child
How would you manage an acute odontogenic infection?
Antibiotics are indicted for oyredia and spreading infection
The cause of infection does also need to be eliminated
How does a chronic odontogenic infection present?
Sinus
Mobile tooth
Halitosis
Discoluree tooth
How would you manage a chronic infection?
Xla tooth
How does primary herpetic gingivostomatitis present?
This presents as inflamed gingiva Small vesicles throughout mouth oral mucosa, tongue, lips, and gingiva Vesicles can then coalesce forming a highly infectious exudate Painful Bleeding and crusting lips Lymphadenopathy Temperature Headache malaise
What. Age is primary herpetic usually seen in?
2-5
Maternal antibodies in young children protect young
What is the incubation period for primary herpetic gingival?
6-7 days
How long does it take for primary herpetic to go resolve?
14 days
What are rare complications of primary herpetic?
Aseptic meningitis and encephalitis
How do you manage primary herpetic?
Paracetamol for pyrexia 0.2% CHX Acilovir: 2+ 200mg 5 times a day , 5 days (half dose for less then 2 yrs and double dose for immunology risked) Fluids Bed rest Soft diet
Review in 7 days to check healing
How does herpangina present?
Small vesicles on soft palate and fauces
Febrile , irritatble, cervical lymphadenopathy , young children
NOT ON GINGIVAE
What causes herpangina?
Coxsackie
Usually A4 or A10 but can be 1-6,8,12,22
How does HFM present?
Vesicles on tongue and oral mucosa
Macula papillary rash on hand and feet
Hat causes HFM?
Coxsackie usually a16 but occasionally 5,7,9,10 or B9
How is HFM caused?
Faeco oral transmission
What causes herpes zoster?
VZV virus
How does Herpes zoster present in the mouth?
Vesicles on palate which rupture and produce ovoid ulcers with halos
What else is associated with intra oral ulceration in herpes zoster?
Skin lesions following dermatome
What causes EM?
It is a VB disorder with unknown aetiology but is predicated by infections, drugs and various other things
What intra oral lesions are seen in EM?
Subepithekual blisters
Crusting or the lips
Affects anterior region
What extra oral lesions are seen in EM?
Target lesions of squamous epithelium
What infective lesions can have similar appearances as primary herpetic?
Herpangina HFM herpes zoster EM Thrush
What ulcerative lesions are there?
Those caused by infection
Others: self induced post anaesthetic, Riga fede ulceration, RAS (seen in EM, SJS, Bechets, Epidermilysis bullosa, Lupus, neutropenia)
What is Riga fede ulceration?
Traumatic ulcer on ventral of tongue caused by rubbing of the tongue on newly erupted mandib teeth
How do you mange Riga fede ?
Smooth incisa edge
In which children is Riga fede more common amongst?
Indifference to pain
Familial dysautonomia
Cerebral palsy
What are examples of pigmented and vascular lesions?
Eruption cyst
Eruption heamatoma
Haemangioma
Petechia and purpura
What is an eruption cyst and how does this become a heamatoma?
Asymptomatic and resolve once tooth has erupted
Cyst: Fluctuations fluid filled cyst that may appear 2-3 weeks prior to tooth eruption
Heamatoma: as tooth emerges the cyst may become blood filled and appear bile or purple in colour
How do you manage eruption cysts?
Do not excise as risk of infection
What are haemaginomas?
This are typically present at birth and may grow with the infant and may then regress with time and even disappear
How do you manage haemajngiomas?
Monitor
Which syndrome can you see haemajngiomas in?
Sturge weber
What are the feature of Sturge weber?
Haemajngiomas of face and oral mucosa
Ipsilateral haemangiomas and calcification of the meninges
Contralateral focal epileptiform fits and transient or permanent paralysis
Mental retardation
Which exophytic lesions are there?
Congenital epulis of newborn Squamous papilloma Epulis Eruption cyst haemaoma Mucocele Ranula
What is a mucocele?
There are three types
- Retention
- Extravasion: arises due to damage of the salivary duct of a minor gland
- Superficial
What is a common cause of mucocele in children?
Cheek biting
What causes the mucosa to swell up in mucous extravasion cysts?
Mucous builds up in the connective tissue and appears as a blue swelling which may have a keratinised surface
What is the management for mucoceles?
Monitor
Some heal spontaneously
Others need surgical excision
What are the causes of gingival enlargements?
Drug induced : phenytoin, cyclosporin
Hereditary: gingivofibromatosis
Vascular: Sturge weber
Syndromes: gorlon goltz
What other pathology is seen in the young ?
Odontogenic tumours
What are the three common type of odontogenic tumours in children?
AOT
Ameloblastic fibroma
Odontoma
How common are Ameloblastic fibromas?
Rare
Which age group do Ameloblastic fibromas affect?
Patients below 20
Which site is most commonly affected by Ameloblastic fibromas?
Mandib molar premolars site
How do Ameloblastic fibromas appear radiographically?
Well defined
Usually unilocular radiolucency
T/F radiopacities are found in Ameloblastic fibromas?
F
They are seem in Ameloblastic fibro odontomas
Where do Ameloblastic fibromas develop from?
Mixed tumour: Odontogenic epithelium and mesenchymal tissue
What effect do Ameloblastic fibromas have in eruption?
May affect normal eruption of teeth in that area
What can an Ameloblastic fibroma be mistaken for occasionally?
Dentigerous
How do you manage Ameloblastic fibromas?
Excise or curettage
What is the microscopy of Ameloblastic fibromas?
Proliferating strands and cords of epithelium
Cellular fibroblastic stroma
May have inductive changes
How do adenomatoid odeontgenic tumours present?
Asymmptomatic slow growing associated with an unerupted tooth
More common in maxilla than mandible
How does an AOT appear radiographically?
Radiolucency with well defined margins
How do you mange AOT?
Enucleation
What is the microscopy behind AOt?
Whirls of epithelium
Duct like microsysts lined by columnar cells
Convoluted eosinophilia bands and sometimes calcification
What do complex odontomes appear as?
Disorganised mass of dentine, enamel and pulp
More commonly seen in posterior mandibl e
How do compound odontomes appear?
Denticles
Anterior maxilla
What is the effect of odontomes?
Prevent eruption of teeth
Which type of odontome is more common?
Compound 4x more common than complex
