OMFP Flashcards
Stochastic effect of radiation?
Leukemia
Strawberry tongue
Scarlett fever
Caused by Group A, β-hemolytic Streptococci- attack blood vessels and produce skin rash
Fungiform papillae become erythematous- “White strawberry tongue” first two days “Red strawberry tongue” fourth to fifth day
tx: Antibiotics (Penicillin V or Amoxicillin)
Fodyce Granules what gland is affected?
Sebbaceous gland
Port wine stain
Sterg- Webber
port wine = nevus flammeus
congenital skin/nerve dz ; can have seizures
Condyloma accuminatum is ass with ?
HPV 6, 11
Heck’s Diseases?
HPV 13, 32
ghost teeth
regional odotodysplasia
all the ghost in this region have teeth
Most common benign salivary tumor
Pleomorphic adenoma
Nickolski’s sign
Pemphigus
Best imaging for the maxillary sinus
A water’s View aka occipitomental view
** comes up alot**
Waters’ view (also known as the Occipitomental view) is a radiographic view, where an X-ray beam is angled at 45° to the orbitomeatal line. The rays pass from behind the head and are perpendicular to the radiographic plate. It is commonly used to get a better view of the maxillary sinuses. Another variation of the waters according to Merrill’s Atlas of Radiographic Positioning and Procedures places the orbitomeatal line at a 37° angle to the image receptor.
Best imaging for the facial fx
CBCT
Blue sclera
Dentinogenisis Imperfecta
HPV 13, 32
Heck’s Dz
Mucus plug on floor of mouth and can be blue/purple
Ranula
Cafe au late spots + Neurfibromatosis
Von reckenhousin’s dz
lich nodules on iris
supernumery teeth
Ground glass
Fibrous dysplasia
“You have to grind the glass to make the fibrer of the display windows”
What would you see Gardner’s
Intestinal polyps and
multp osteomas
Cotton wool
Pagets Dz = inc in alkaline phosphate but norm Ph/Ca ; bones become dense but fragile ; inc incidence for malignancy - can lead to osteosarcoma
AKA OSTEITIS DEFORMANS
seen in older pts ( denture stops fitting)
Paget wears cotton and wool barets
Punched Out
Multiple Myeloma
Sunburst
Osteosarcoma
most common primary malignant tumor of young ppl
Teens with bone ca use clerasil sunburst face wash
Honeycomb or soap bubble + giant cell
Odontogenic myxoma
tx: sx xcisn b/w inner materiel jelly
Myx the soap with water to get bubbles and eat honey in the bath.
Most common malignant major salivary gland tumor
Mucoepidermoid carcinoma
Kpolick Spots
Rubeolla
Measles
Hunter syndrome and Hurler’s Synd is when?
glycoaminoglycans (GAGs) build up and
mucoployscaarides ?????
Verrucous carcinoma has which HPVs
HPV 16, 18
most common primary malignant tumor of young ppl
Osteosarcoma
sunburst
Most common epithelial odontogenic tumor
Ameloblastoma
local invasion?
Doughy consistency
Dermoid cyst
obliterated pulp and short roots
Dentin dysplasia
Bilateral jaw expansion
Cherbusim
no tx
HPV 6, 11
HPV 16, 18
HPV 13, 32
condoloma accumlatum
Verroucous
Heck’s
Pleomorphic Adenoma
Most common benign salivary tumor
Cleft lip is the lack of fusion b/w?
Medial Nasal process and maxillary proces
congenital focal proliferation of capillaries
Hemangioma
most involute but persistn = xcised
Cleft palate is the lack of
fusion b/w palatal shelves
components of Melkerson-Rosenthal syn
- fissured tounge
- granulomatous chelitis
- facial paralysis
Mel fell face first in ROse bush and busted her lip and split her toungue
Occurrence of cleft lip/cleft palate
1/700 ; boys > girls 3:2
CL/CP =boys ; CP only = girls
In whites CL 1:1000 ; CP 1:2000
congenital focal proliferation of lymph vsl
lymphangioma
oral lymphangiomas are very rare - purple spots on tongue
cystic hygroma = neck
angiomas of _____1____ and skin along the dirstrubtion of the trigeminal nerve is part of _______2___ condition?
- leptomeninges (arachoniod and pia )
2. STURGE- webber
Mass in the midline floor of the mouth of doughy consistncy
Dermoid cyst
if above mylohyoid - floor of mouth
if below = neck
can contain adexnal stx ( hair/sebecaous glands)
- Raunla will NOT be midline - dermoid cyst = MIDLINE*
Radioluceny in posterior mandible below mandibular canal
Stafne Bone Defect
due to lingual concavity of the jaw - anatomy variation 10-30mm
- is not pathologic
-pseudocyst b/c no fluid / epithelial lining.
Lateral to midline purlple Mucocele tx with marsupulization
Ranula
Marsupialization(exterirorization) entails removal of the roof of the intraoral lesion, potentially allowing the sublingual gland ducts to reestablish communication with the oral cavity. However, this procedure is often unsuccessful, and most authors emphasize that removal of the offending gland is the most important consideration in preventing a recurrence of the ranula. If the gland is removed, meticulous dissection of the lining of the lesion may not be necessary for the lesion tends to resolve, even for the plunging ranula.
__% of ppl ahve herpes in uS
80-85%
60-90% ww
Red, ulcerated, bleeds easily lesion; usually on vermilion
Pyogenic granuloma - inc freq in preg
reactive proliferation of capillary blood vessels. It presents as a shiny red lump with a raspberry-like or minced meat-like surface. Although they are benign, pyogenic granulomas can cause discomfort and profuse bleeding.
Fistula from nonvital tooth
Parulis:
Most common in mandibular bicuspid-cuspid region; may be blue
Gingival cyst of the adult
Shingles + Bells aplsy
Rasmy- hunts
Tx of SV = acyclovir
Herpes in kids
Acute herpetic gingivostomatits
s/s fever w/ vesicles
[1-5 yrs google]
The best tx: inc liquid intake, gentle debridement of the mouth, and sustained good oral hygiene. self limit (10-14d)
HSV1 = HSV 2 = HSV 3 = HSV 4 = HSV 5 = HSV 8 =
1 oral ( fever, HA, malise, gingivits-no necrosis)
2 genital
3 Chicken pox VZV shingles
4 EBV ( infec mono ;kiss; lymphaden; NUG peticha on pal)
5 Cytomeglavirus
8 = kaposi sarcoma
Drug to treat HSVs
1,2,3,4 = Acyclovir ( 1 also palliative)
5 CMV = ganciclovir or valancyclovir
recurrent hsv infx = docosanol ( abreva) OR acyclovir
Vlatrex
Edentulous mandible in mental foramen area; often painful to palpation firm
Traumatic neuroma
Denture can be cause
white or pink cauliflower peduculated lesion on palate
Papilloma
HPV
Can be white or pink; most common on soft palate and tongue; usually pedunculated
Globulomaxillary Lesion is ___-
any readioluceny b/w max canine and lateral incisor
( clinical description)
tx: enucleaation
heart shaped radiolucency in nasopal canal
Nasopalatine duct cycts
Syphlis chancre ressembles
herpes lesion
scallops around roots lesion typically casued by trauma
Simple bone cyst
- benign, no epithelial lingin ( not true cyst) ; in mandible of teens
tx; aspirate to dx, monitor
Hyperplasia of filliform papilla
Hairy [black] tongue
nerves affected in CST
CN 3,4,5, 6,
first sign of canverous sinuts thrmobosis (CST)
Headache
blurred vision
CST mostly comes from
ant max, upper lip, canine infx
staph aureus, streptococcus
s/s: ptosis, dec vision, paralysis of CN, exopthalmus
This type of cellulits, _____, is bliateral and spreads to what spaces ?
Ludwigs Angina
Subling
Sub mand
sub mental
ALL EXCEPT retropharyngeral
Reg cellulits = unilateral Ludwigs = bilateral
complication of Ludwigs angina
epiglotis edema
Airway obstruction
s/s of ludwigs
raising of tongue, pain, swelling of tongue /neck/tissues in spaces, maliase fever, SEV = stridor/DOB
infx of mand pm/moalr goes to
submand space
PT has an infxn of Max 2M what muscel will sstop the spread of th infextion to multiple spaces?
Buccinator
Infxn of lateral pharyngeal space involves what muscle?
Medial pterygoid
EXT 2nd mand molar root can be lost in what space?
submandbib
Ext MAX 3rd , root can be lost whree?
max sinus
Treacher collins aka
Mandibulofacila dystosis
Turner tooth is assoc with?
Trauma or local infxn
Enamel hyposplasia ( usualy d/t traum when young effects 2nry tooth)
transient Ulcer that heals without scaring
minor apthous ulcer
Apthous ulcer typically effect what kind of tissue
non-keratinized
HSV - keratinzed only
pt presents in dental chair with c/o having big fluid filled vessicles that turned into multiple painful uclers after .
Pempigus vulgaris
- ashkenazi jews *
- ROunded Tzanack cells*
tx: corticosteroids ; azothioprine ; ig therapy
how does acyclovir selective toxity mech of action
Phosphyrlated infected cells Inhibits viral mRNA so it cant make DNA ; DSNT work on DNA
What does histoplasmosis oral look like/resemble?
carcinoma
Oral lesions present as a painful solitary ulceration of tongue, palate
Most common systemic fungal infection in United States
Seen in the Ohio-Mississippi River Valley; Spores inhaled from bird or bat droppings
kaposis sarcoma most likely to appear on
hard pallate
Post herpetic neuralgia is caused by?
VSV - herpes zoster
Mutation of the 5q32 gene
mandibulofacial dystosis
malformed ears, mand hypolasia, midfacial dvlpmntl def
Pathologist sees pt with dz where autoantibodies attacked pt’s desmisomes*; smear show a positive Nickolsy’s sign
Pemphigus vulgaris
tx: corticosteriods
nicks - blow air on tissue and it peels off
Nick gets vulgur when he hangs out with pem and desi
S/s of mandibulofacial dystosis
- Mand hypoplasia
- zygoma hypolasia
- malformed ear*
- malformed eyelids - downwars slanting eyes
BEchet’s dz =
multisystem vasculitis that causes apthous-type of ulcers of gential and oral and inflammation of the eye
Sutton’s aka
Major apthous ulcer ( scarring)
transient Ulcer that heals with scaring
Major apthous ulcer aka Suttons
pt presents with is a hereditary skeletal condition- having partly missing or missing clavicles. and unerupted and supernumerary teeth of permanent dentition.
Cleidocranial Dysplasia
Individuals with this condition will also have an abnormally increased distance between the eyes as well as bulging foreheads. However, the hypoplastic or aplastic clavicles are usually the main sign of a person having cleidocranial dysplasia and it will make the neck and shoulders look longer and narrower than it really does
PT presents with malformed ears, downward slanting eyes mandibular hypoplasia
mandibulofacial dystosis aka treacher collins
______is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid.
Graves’ disease
With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than the body needs.
PT present wiht Erythematous mucosal patches Hemorrhagic crusts of lips all of a sudden, dx?
erythema multiforme
Entire perimeter of tongue may be affected
Targetoid ( bull’s eye) * cutaneous lesions
Males, 20-40 , most cases secondary to HSV or mycoplasma pnuemonia
Tx: steriods ( sys/top)
Burkitts lymphoma assoc with what virus?
EBV virus
yellow spots on buccal mucosa?
Fordyce granulers
ectopic sebaceous glands*
ulcers of genital and oral
inflammation of the eye
Bechets
tx: corticosteroids
Allergic rxn to inhaled antigen
Wegner;’s granulomatosis
Strwberry gingiva
tx: prednisone + cyclophosamaine
Angioedema allergic rxn?
IgE and histamine relase by mast cells d/t allergic rxn to food or drug
edema of lips neck or face
antihistmines
Dz where T lymphocyte target and destroy basal keratinocytes ; vacuolized basal zone
Lichen planus
EM look alike involves head and trunk drug induced
Steven’s Johnsons syndrome
Drug induced ( major)
Can effect genitals ( johnsons) eyes **
tx: steroids or palliatve
Sawtooth rete pegs
Lichen planus
tx: corticosteroids
disc like lesions on the face where oral lesions can look like whicam striae w/ red ulcerations
LUPUS discoid form
Candida forms (6)
- Psuedomebranous
- Eyrthematous
- Angulr Chelitis
- Hyperplastic (candial leukoplakia)
- Central papilary atrophy (median rhombiod glossitis)
- Denture stomatitis
burning mouth assoc w/ pseudo + erythem
Crowns are short & bulbous, narrow roots, obliterated pulp
Dentiogenesis Imperfecta
- DI Type 1 is with osteogenic imperfecta. DI Type 2 is not with OI. DI Type 3 is the bradywine type, which occurs in absence of OI, exhibits multiple periapical radiolucency, shell-like appearance, & large pulp chambers/exposures.
Dentin dysplasia looks like dentinogenesis imperfect WITH ONE DIFFERENCE?
Dysplasia has radiolucency.
Condyloma acuminatum -
Genital warts
HPV 6,11
Pemphigoid like dz in kids
Epidermolysis BUllosa
Or Bullous pemphigoid
Pathologist sees pt with dz where autoantibodies attacked pt’s basement membrane*; smear show a positive Nickolsy’s sign and pt c/o trichiasis
Pemphigoid (benign mucous membrane pemphigoid)
Twice as common as -gus
Cicatricial type - scarring from ulcer oustide oral - no scaring w/i oral
direct immofluoresence (michels soln) shows contin liner band of IgG and C3 along bm
Nick eats subs all day and still lives in mothers basement
```
1
CA pt get candida d/t?
Chemotherapy
or radiotherapy
HIV pt wiht oropharyngeal candid tx?
Fluconazole ( aslo for vag candida) and amph B
occurs with low CD4 counts mostly- mostly pseudo/eryth/chlit forms ( immunsup)
nystatin (topical), clotrimazole (topical), ketoconazole (systemic), fluconazole (systemic), and itraconazole (systemic) AMPHOTERICIN B*
Fibromas are a result of what ?
hyperplasia
Focal Fibrous hyperplasia
usually normal in color ; can be along occlusal line
pt presents wiht TB like symptoms but theres no calcification of the lungs, dx?
BLASTOMYCOSIS
Oral lesions resemble squamous cell carcinoma-
white spidery/lacy straie on mucosa
lichen planus - reticular form ( most common)
Deep fungal infection seen in South or Central America, also known as South American blastomycosis ; Oral lesions have “mulberry ulcerations” of alveolar mucosa, gingiva, palate
PARACOCCIDIOMYCOSIS
Organisms resemble “Mickey Mouse ears” or a “ship’s steering wheel”
1
1
Whicken striae with ulceration
lichen planus - erosive form
Multiple organ involvement w/ butterfly rash
SLE - Systemic acute type
Dx w/ ANA( autoantibodies) test
tx: corticosteroids
Blue purple lesion on ant mandible dentist runs labs from calcium lvls and to rule out hyperparathyroidsm, dx?
Giant cell granuloma
70% in mand, ant
R/o hyperparathyroid
Tx: corticosteriods, calcitonin, intereron2a
pt presents in dental chair with restricted mouth opening and hard skin ; xrays show uniform widened PDL space, loss of ramus of mandible, Dx?
Scleroderma
Depostition of collagen in organs causes organ failure
tx: tx sysmtoms
Getting pain relief through nonsteroidal, anti-inflammatory medications or corticosteroids. Immunosuppressive drug, Calcium channel blocker, Steroid, and Proton-pump inhibitor
Mom comes in with neborn baby girl c/o pink-red, smooth-surfaced mass on the gums lateral of the baby’s midline maxilla
congenital epulis of newborn
rare soft tissue polypoid tumor occurring on alveolar ridge of newborn ; resembles granular cell tumor (myobalstoma)
Usually in females; especially anterior maxilla
Mulberry molars (Moon’s molars or Fournier)
congenital syphylis
S/s: Hutchinson’s Triad
1. Hutchinson teeth [ incisors, mulberry molars] , 2. Ocular interstitial keratitis 3. Eighth nerve deafness
Indurated (wooden) area of fibrosis; “Sulfur granules”-yellow flecks of bacterial colonies found in pus or tracts
Caused by anaerobic, gram-positive branching organism, Actinomyces israeli
CERVICOFACIAL ACTINOMYCOSIS
Found in uncontrolled insulin-dependent diabetics with ketoacidosis, bone marrow ; Branching at right angles
MUCORMYCOSIS
Organisms are found in bread molds or decaying fruits or vegetables
Perineural invasion is seen in:
adenoid cystic carcinoma
neurotrophic factor and perineral invasion
Fungal infection commonly seen in Southwestern United States and Mexico ; akak vally fever
COCCIDIOIDOMYCOSIS
“swiss cheese ” microscopic pattern
adenoid cystic carcinoma
High grade salivary malignancy; Palate most common;Most common malignant; spreads through perinueral spaces*****
Most common EPITHELIAL ODONTOGENIC TUMOR…mand molar area
Ameloblastoma
Ameloblastoma histology :
Stellate Reticulum in bell stage, epithelium in net flex
_______ = bone disorder where scar-like tissue develops in place of normal bone. This can weaken the affected bone & cause it to deform or fracture.
Fibrous dysplasia
________ = rare disease w/ clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes.
Langerhans cell histiocytosis (LCH)
T/F. Nasolabial cyst is a bone cyst.
FALSE : Not a bone cyst b/c it occurs outside of bone & is a soft-tissue cyst
Radiolucency radiating from root of central incisor toward midline, could be all of the below EXCEPT: lateral periodontal cyst, nasopalatine cyst, some sort of fibrous dysplasia, nasolabial cyst
nasolabial cyst
-Because this cyst is extra osseous [SOFT TISSUE}, it is not likely to be seen on a radiograph.
1
1
_________ disease is associated with multifocal Langerhans cell histiocytosis.
Hand–Schüller–Christian
- Oral signs: bad breath, sore mouth, loose teeth. Lesion are sharply punched out radiolucency & teeth
Etiology of Squamous Cell Carcinoma,
external factors and stress.
etoh, tobacco, UV radiation, certain HPV types, vitamin deficiency, immunocompromised, iron deficiency anemia – plummer Vinson syndrome..
T/F. Xerostomia increases risk of SCC
TRUE
HPV ___ identified in 90% of HPV+ oropharyngeal cancers
16
Persistent infection with HPV 16 inc risk of ascc
Five year survival if HPV + = 54-89 ; - = 33-65
Lesion that resembles SCC…16wks and then disappears
keratoacanthoma
keratoacanthoma has a bump with a crusty crater in the middle, but BCC can be pink, waxy/pearly, or skin colored or brownish. BCC is more reddish/can be flat while keratoacanthoma has a crust and looks really gross
Most likely site for SCC?
Ventrolateral tongue
pt fresh from tiwan has an angry ulcerated lesion on his ventrolateral tongue he eats alot of betel dx?
SCC
Betel quid nut - black inc risk of SCC
Most common malignancy in the oral cavity?
SCC aka Epidermoid Carinoma
Philadelphia chromosome mutation ; lymoh node enlargemtn
(chromosomal translocation)**Chronic myelogenous leukemia
Which of the salivary tumor glands has the best prognosis:
Mixed Tumor ( 1st
Acinar Cell Carcinoma 2nd if mixd not there
Most common malignant major salivary gland tumor:
Mucoepidermoid carcinoma
Most common malignant minor salivary gland tumor:
Adenoid cystic carcinoma
Most common salivary gland benign major or minor :
Pleomorphic adenoma
MOST COMMON SITE = MINOR GLANDS OF PALATE
MOST COMMON TUMOR OF PAROTID GLAND
Of verrucus ca which has the best prognosis
in the vestibule
Max canine surrounded by lesion:
AOT Adenomatoid Odontogenic Tumor (AOT)
mixed density young child; GOES TO APEX
kid c/o fatigue, easily bleeding gums
luekmia
get cbc to r/o
What cyst is ameloblastoma most likely to stem from?
Dentigerous cyst
Teeth show: globular dentin, early pulpal obileration, defective root formation, PARL, premature exfoliation, Dx?
Dentin Dysplasia
________ = X-linked conditions in which there are abnormalities of 2 or more ectodermal structures
Ectodermal dysplasia
(ex. hair, teeth, nails, sweat glands, salivary glands, cranial-facial structure, digits). During tooth bud development, it frequently results in congenitally absent teeth (in many cases, a lack of a permanent set) and/or in the growth of teeth that are peg-shaped or pointed.
MOST COMMON epithelial odontogenic tumor.
Ameloblastoma
_______ tumor consists entirely of odontogenic epithelium. MOST AGGRESSIVE odontogenic tumor.
Ameloblastoma
sx excision
____ compared to ameloblastoma - younger age, slower growth, does not infiltrate
A painless, well-circumscribed radiolucency and radioopacity in the posterior mandible of
Ameloblastic Fibroma
Mixed density lesion in a young child
ADENOMATOID ODONTOGENIC TUMOR (AOT):
What is the most definite way to distinguish ameloblastoma from OK?
reactive light microscopy
______ = benign tumor of odontogenic origin, commonly in mandible. It starts off lucent but develops small calcifications to be radiodense lesion, can give rise to dentigerous cyst, divided into 2 categories:
Odontoma
compound odontoma- looks like a tooth more defined;
complex odontoma – giant mass that is radiopaque but doesn’t look like a tooth
This tumor arises from the enamel organ or dental lamina. It’s mostly young females, maxillary, & usually associated w/ unerupted permanent tooth.
Adenomatoid odontogenic aka 2/3 tumor:
- 2/3 in maxilla, 2/3 in female, 2/3 in anterior jaw
- REMEMBER lesion goes to apex*
___________ has identifiable tooth components while __________ has irregular calcified lesions w/ no distinct tooth components
- Compound Odontoma –
Complex Odontoma –
16 y/o boy: x-ray showed maxillary anterior tooth with a radiolucency with “SPECKS” in it
Adenomatoid Odontogenic Tumor
___________ = malfunction of the proteins in the enamel: ameloblastin, enamelin, tuftelin and amelogenin.
Amelogenesis imperfecta
People afflicted with amelogenesis imperfecta have teeth with abnormal color (yellow, brown or grey) and have rapid attrition, excessive calculus deposition, and gingival hyperplasia.
Amelogenesis imperfecta is ________ gene
autosomal dominant.
Congenitally missing teeth often seen in?
Ectodermal dysplasia
Ectodermal dysplasia is __________ gene
It is X-linked, not autosomal dominant
Characteristics of Ectodermal Dysplasia ?
Oligodontia (some missing teeth, > 6 teeth, not all teeth) Hypohidrotic , sparse hair, dec alvelar ridge= dec VDO, Conical shape ant teeth , lips = prominent ; OLD AGE FACE (lack of sweat glands)
Having hypodontia will prevent/undermine formation of what?
Alveolus
- Less teeth = reduced alveolar ridge development so the vertical dimension of the lower face is reduced
IN Polycystotic fibrous dysplasia aka _______ you see areas of radiolucent/radiopaque—potential for malignant transformation
**Mccune-Albright Syndrome
Café au lait spots (coast of Maine)—bone and skin disorder—brown spots!
Diffuse expansion of the mandible, (“orange peel”) appearance
FIbrous Dysplaisa
difuse radiopacity w/ teeth will be vital
- Monostotic fibrous dysplasia may be completely asymptomatic and is often an incidental finding on x-ray
** osseous fibroma: radiolucent vital tooth**
________ = periapical inflammatory disease that results from a reaction to a dental infection. It causes more bone production rather than bone destruction in the area (most common site is near the root apices of premolars and molars).
Condensing osteitis
- appears as a radiopacity in the periapical area due to the sclerotic reaction.
Picture said: “scalloped border, tooth is vital, patient is asymptomatic”
traumatic bone cyst
No tx, spontaneous healing
Football player with mouthguard, crepitation of left TMJ, trigger zone / tenderness at L temporalis, stiffness upon wakening. dx?
Myofacial pain syndrome
Dentin Dysplasia vs Dentiongenesis Imperfecta?
DI: Crowns are short & BULBOUS, NARROW roots,
obliterated pulp
DD: SHORT roots (sometimes rootless), obliterated pulp, sometimes PARL, MOBILE teeth
“Ghost cells” =
keratinized calcifying odontogenic cyst aka
Calcifying Odontogenic cysts (COC) aka
Gorlin Cyst
eosinophils - lost nuclei = gost cells
GORLIN married casper; she get GHOST COC ; and they had a MIXED baby
All of the following are congenital except…:
a. dentin dysplasia
b. AI
c. Regional odontodysplasia
d. ectodermal dysplasia
c. regional odontodysplasia
Hypoplastic pitting enamel
Amelogenesis Imperfecta
does not contain the proteins ameloblastin, enamelin, tuftelin, and amelogenin.
Pictures of teeth, premolars just erupted. Thick dentin, thin enamel, pulps not obliterated, and no teeth contact
Amelogenesis imperfecta
AI in X-ray shows open contacts
When does enamel hypoplasia occur?
Altered matrix formation (BELL STAGE)
ghost teeth.
Regional odontodysplasia (enamel, dentin and pulp are all affected. Non hereditary, eruption is delayed or doesn’t
Dentin Dysplasia is _______ gene
autosomal dominant
short roots ; PARL***
Hand-Schuller-Christian triad:
Diabetes insipidus
exophthalmos
lytic bone lesions (Langerhans dis).
________ = rare non-odontogenic, soft-tissue, developmental cyst occurring inferior to the nasal alar region.
- Patient usually presents with a slowly enlarging asymptomatic swelling.
Nasolabial cyst (nasoalveolar cyst, Klestadt`s cyst)
Derived from epithelial cells retained in the mesenchyme after fusion of the medial & lateral nasal processes + maxillary prominence or due to the persistence of epithelial remnants from the nasolacrimal duct
extending between the lateral nasal process and the maxillary prominence.
Round yellow-white bump underneath tongue?
Oral lymphoepithelial cyst
- Usually an enlargement of the parotid or lacrimal gland
X-ray shows heart shaped near central incisors
Nasopalatine cyst
tx = Enucleation
What is the rarest cyst?
Lateral Periodontal Cyst
The most common non-odontogenic cyst:
nasopalatine duct cyst
pt shows w/ bad breath, sore mouth, loose teeth. Lesion are sharply punched out radiolucency & teeth appear as FLOATING IN AIR
LANGERHANS CELL HISTOCYTOSIS
- Hand–Schüller–Christian disease is associated with multifocal Langerhans cell histiocytosis.
Lining of nasolabial cyst =
pseudostratified squamous
_______ Originates from epithelial cell rests (stratified squamous keratinizing epithelium) ; along mandible, presents with swelling & pain, & has a high reoccurrence rate.
Odontogenic keratocyst
Freckles on lips + intestinal polyps =
Peutz–Jeghers syndrome
Basal cell nevus syndrome a.k.a. :
Gorlin’s syndrome, multiple OKC’s seen)
What causes bell’s palsy?
idiopathic
One theory of its cause is that the facial nerve becomes inflamed within the temporal bone, possibly with a viral etiology.
Man comes in after years of tmjd with reduction and is now only able to open 25mm and that’s it with muscle pain. Whats his disorder?
Myofacial pain syndrome.
_______ = destruction of salivary and tear ducts causes dry mouth
Sjogren’s syndrome:
Fetal alcohol syndrome causes:
Midfacial deficiency
Cleft lip (if midfacial def not an opt)
TMJ pain are mostly related to what nerve?
V3
_______ = commonly see multiple OKCs and palmar pitting, plantar keratosis (odontogenic keratin cyst, KCOT)
Nevoid basal cell carcinoma (Gorlin syndrome)
Which cranial nerve affected bell’s palsy?
Facial nerve ( CN 7)
Initial treatment for OKC is:
- Conservative treatment generally includes simple enucleation, with or without curettage
Most immediate sign after delivering a FP with a high occlusion?
Myofacial pain
TMJ ligaments purpose –
limit the movement of mandible
What branch off facial nerve gets damaged the most during TMJ surgey?
CN 7 (facial) - Temporal branch
__________ = rare benign but locally aggressive developmental cystic neoplasm. It often affects the posterior mandible but can extend to maxillary. Usually, a lucent uniloclar lesions extending along mandible, presents with swelling and; pain, and; has a high reoccurrence rate.
Keratocystic odontogenic tumor (OKC)
- High recurrence rate
- “Picket fence -Palisaded columnar basal cell layer
- Derived from rests of the dental lamina (Rests of Serre)
- Thin layer of parakeratotic stratified squamous epithelium
- Epithelial surface is corrugated (wavy)
OKC players bought houses with pickett fence wavy pools parakeets AND satalite tv
Depostition of collagen in organs causes organ failure
Scleroderma
immunofluorescence of antibodies shows linear pattern
pemphigoid
Which muscle mainly responsible for positioning and translating condyles?
Lateral pterygoids
Pt has calcified falx cerebri, multiple OKCs, bifid ribs. What syndrome does the patient have?
Gorlin Goltz syndrome aka Basal cell bifid rib syndrome.
CREST syndrome aka ?
sclerodoma
CT disease of skin, blood vessels, muscles, and internal organs. autoimmune disorder. Blue fingers, Hair loss Skin hardness Skin that is abnormally dark or light
Geographic tongue aka
erythema migrans aka Migratory glossitis
can move locations ; burning tongue ; red w/ white borders ; cause unknown = loss of papillae
aspirin burn is due to:
coagulation necrosis.
biopsy reveals acantholysis and a suprabasilar vesicle. Which of the following represents the MOST likely diagnosis?
Pemphigus
acantholysis
______ = Caused by ruptured salivary duct, Usually due to trauma, Seen on the lower lip
Mucocele
NEVER ON GINGIVA
Complications of Sjogren’s syndrome
keratoconjunctivitis, it involves the genitalia too.
Sjogrens ass w/ SLE ( NVR herpes)
immunofluorescence of antibodies shows fishnet pattern
Pemphigus
______ = unilateral facial paralysis with no known cause, except that there is a loss of excitability of the involved facial nerve. The paralysis onset is abrupt & most symptoms reach their peak in 2 days.
Bell’s palsy
Nevoid BCC and palmar melatonin indicative of:
OKC
What is most common with Sjogren’s syndrome?
Lymphoma (or maybe lipoma or some other growth),
- Xerostomia is rarely due to :
a vitamin deficiency
Ex: Sjogren’s syndrome, (Other parotid problems)
Sialoliths most commonly associated with
submandibular gland
/ submand duct (wharton’s)
suasuage –sialolith–stenson-parotod
Which articular disease most often accompanies Sjogren’s syndrome?
B. Rheumatoid arthritis.
Sjogren syndrome laboratory test:
SS-A / SS-B (also ANA or Rheumatoid factor)
ranula due to –
mucus plug
Ranula tx = excisional
Gorlin-gotz syndrome aka
basal cell nevus syndrome
Nevoid basal cell carcinoma causes cyst in the jaws
-Caused by mutation in PTCH suppressor gene on chromosome 9
Most common location for mucocele?
Lower lip
nv on gingiva
due to- rupture of salivary ducts (trauma related)
AKA mucus extravasation phenomenon/ mucus retention cyst.
What else most often seen with nevoid basal cell carcinoma?
Odontogenic keratocyst ( OKC)
QUESTION: What does multiple OKC tell you?
Gorlin-gotz syndrome (also called basal cell nevus syndrome)
______ = TISSUE overgrowth in Wrong location
CHORISTOMA-
Gardner’s syn is _______ gene.
Autosomal Dominant
Which artery supplies the TMJ?
MADS:
Middle meningeal from maxillary, Ascending pharyngeal, Deep auricular, Superficial temporal
Secondary Sjogren Syndrome causes:
dry eye, dry mouth, rheumatoid arthritis
What do Gardners and Peutz-Jeghers syndrome have in common?
GI polyps
Crohns also has polyps
Part of the TMJ that purely rotates :
Articular eminence w/ condyle
______ = a variant of familial adenomatous polyposis (FAP), is an autosomal dominant disease characterized by GI polyps, multiple osteomas, and skin/soft tissue tumors.
Gardner syndrome
Cutaneous findings of Gardner syndrome include epidermoid cysts, desmoid tumors, and other benign tumors. (mult facial osteomas & skin nodules)
Polyps can become cancerous
_______= autosomal dominant disorder characterized by the development of benign hamartomatous polyps in the GI tract & hyp agonists for the insulin receptor, pigmented macules on the lips and oral mucosa (melanosis)
Peutz–Jeghers syndrome
HISTO = “SAUSAGE links “ dx?
Sialodochitis
Parotid gland – chronic sialodochitosis
_____ = unilateral facial paralysis with no known cause, except that there is a loss of excitability of the nerve
Bell’s palsy
Which anatomical components are responsible for rotation of the mandible?
Condyle and articulating disk
How do u tx painful Sialolith in whartons duct initially?
Moist heat ; massage or lemon drops to stimlate unblocking -> Dilation of duct –> Sx remove (cannulation & dilation)
wartons = submand
Antral Pseudocyst aka
mucous retention pseudocyst
Lower compartment of TMJ is for? ,
upper compartment ?
Lower = ROT UPPER = TRANS
Huge PA radioopacity in maxillary sinus
– mucus retention cyst
Ankylglossitis aka
tongue tied
what causes tmj ankylosis?
Trauma
Which cyst is most likely to become neoplastic?
dentigerous cyst
When TMJ is in rotational movement, rotation is in:
lower compartment
Varicosities in ventral tongue are mostly seen in
– elderly
Reason for parulis = ?
incomplete root canal (redue root canal)
What does tuberculosis lesion in the oral cavity look like?
large ulcer
The most frequently affected sites = tongue base and gingiva ( irregular ucler or discrete granular mass)
Allergic gingivitis caused most by-
toothpaste flavor(cinnamon)
Target lesions ass w/?
Erythema Multiforme (also has positive nikolsky sign)
_______ = Normal tissue overgrowth
HAMARTOMA-
What does tuberculosis lesion in the oral cavity look like?
large ulcer (Painful nonhealing indurated often multiple ulcers)
Cemento-osseous dysplasia aka :
CEMENTOMA
• Usually 30-50 years old, African-American Female
• Mandibular anterior VITAL teeth
• Asymptomatic periapical radiolucencies, which transform to radiopacities
Most common place for periapical cemental dysplasia:
Lower anteriors
- Most common clinical forms of actinomycosis are:
cervicofacial (lumpy jaw), thoracic, and abdominal.
Actinomycosis has abscess, draining fistula, & contains yellow sulfur granules. Tx is
incision & drainage + antibiotics
_______ = relatively common low-grade tumor that originates in the pilosebaceous glands & closely resembles squamous cell carcinoma (SCC).
Keratoacanthoma (KA)
Focal White females vital edentulous one lesion:
Focal Cemento-Osseous Dysplasia
___________= gingival nodule composed of cellular fibroblastic connective tissue stroma, which is associated with the formation of randomly dispersed mineralized products (bone, cementum-like tissue, or dystrophic calcification).
Peripheral Ossifying Fibroma
Talon cusp is for?
dent evagenatus, NOT invagenalis
Asymptomatic periapical radiolucencies, which transform to radiopacities
(Periapical) Cemento-osseous dysplasia aka CEMENTOMA:
Child with granulomatous gingiva and bleeding rectal-anus has what?
Crohn’s
s/s: granulomatous gingival hypertrophy- swollen gums + mouth ulcers
_______ is characteristic of adrenal over production
Multiple Endocrine Neoplasia Syndrome
Patient has red gums and is told she has “plasma cell gingivitis”. Common cause is?
cinnamon
4 yr old kid has hemangioma on his tongue from when he grew. It grew at the same rate he did, dx?
hamartoma
most common nonodontogenic cyst
nasopalatine duct cyst
Pt c/o symptom where they sweat near cheek area when eating.
Auriculotemporal syndrome (Frey syndrome) - Damage Often after parotid sx
Which reactive lesion of the gingival tissue reveals bone formation microscopically?
Peripheral ossifying fibroma
Maxillary sinusitis bacteria:
Strep pneumonia
Most likely interp as toothache - can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache)
Tx: Amox with clavulanic acid (for b-lactamase strep)
Site almost nvr affect with white spngy nevus
The gingival margin and dorsum of the tongue are almost never affected.
AUTOSOMAL DOM
________ is used for Trigeminal Neuralgia,
Carbamazepine ( tegretol - anticonvulsant)
do not use to treat constant, fascial pain. Use NSAIDS
Patient feels pain on biting and feeling of fullness in maxillary posterior teeth, why?
sinusitis/ atypical trigeminal neuralgia,
GUm boil aka?
Parulis
Auriculotemporal nerve is severed, what are the symptoms?
gustatory sweating
TX: Ligation of auriotemporal nerve – disrupt gustory sweating
leukoplakia that you can’t wipe off; Thick bilateral white plaque wiht spongy texture
white sponge nevus
usually on the buccal mucosa, but sometimes on the labial mucosa, alveolar ridge or floor of the mouth
AURICULOTEMPRAL SYNDROME AKA ?
FREY’S SYNDROME:
_______ = infectious subacute-to-chronic bacterial disease caused by filamentous, gram- (+) anaerobic bacteria (Actinomyces species).
Actinomycosis
IT is characterized by contiguous spread, suppurative and granulomatous inflammation, and formation of multiple abscesses and sinus tracts that may discharge sulfur granules.
Keratosis happen where in the mouth?
Upper lip
______: abnormal collections of inflammatory cells (granulomas) that can form as nodules
Sarcoidosis
1st sign of multiple myeloma:
bone pain (in limbs & thoracic region)
Bone infection = “onion skin” appearance
OSTEOMYELITIS
Garre’s (proliferative periostitis) and Ewing sarcoma are both onion skin
Girl with caries into the pulp on tooth #3 – radiograph shows alternating RL/path at inferior border of mandible (a.k.a “onion skin”, bacterial)
Garre’s Osteomyelitis aka chronic osteomyelitis
= plasma cell cancer, a type of WBC normally responsible for producing antibodies.
Multiple myeloma (plasma cell myeloma)
Initially, there are often no symptoms. When advanced bone pain, bleeding, frequent infections, and anemia may occur. Complications may include amyloidosis(buildup of amyloid proteins).
- Symmetric widening of the periodontal ligament space is an early radiographic sign of ?
osteosarcoma
SYMMETRICALLY WIDENED PDL SPACE, SUN-RAY/ S unburst APPEARANCE
Garre’s Osteomyelitis aka
chronic osteomyelitis
ONION SKIN
TB is similar to?
Sarcoidosis
Involves granulomas in th elungs
bence jones protein in urine (light chains)
Multiple myeloma/plasma cell myeloma
- Bence jone proteins
- high M protein in serum
- multiple punched out bone lucencies
- monoclonal neoplastic expansion of immunoglobulin secreting B cells
most significant oral finding in cleiocrainal dysplasia
supernumerary teeth
Also retained primary teeth
when due fontanelles close?
Ant = 12-18mo
Post = 3-4 mo
skull closed by 2
Most common developmental odontogenic cyst
DENTIGEROUS CYST aka (FOLLICULAR CYST)
S?S of cleiodcranila dysplasia
Supernumery teeth retained priamry teeth high palate no or hyposplastic clavicles cranial bossing- fontanelles failed to close
autosmal DOM
Calcifying Odontogenic Cysts aka
(CALCIFYING CYSTIC ODONTOGENIC TUMOR/GORLIN CYST/COC)
Unilateral slow growing elongation of face - this caused chin devation + malocclusion,
Condylar hyperplasia
Epulis fissuratum is most like
fibroma ( both form trauma)
s/s of painless ulcer on hard palaet then went away; heals w/o scarring
necrotizing sialometaplasia
Necrotizing sialometaplasia is an infectious condition of the salivary glands.
It is the most common variety of salivary gland tumor and also the most common tumor of the parotid gland.
Pleomorphic adenoma
______ is a health condition manifested with spontaneous mucous membrane ulcerations in the mouth, vagina, or rectum.
Agranulocytosis
Agranulocytosis occurs when the body fails to create mature and normal white blood cells, making the body more susceptible to bacterial infection. (s/s: sore throat rigor fever chills)
what conditions typically results in crossbite malocclusion, facial asymmetry, and shifting of the midpoint of the chin to the unaffected side?
condylar hyperplasia
______is the most common site of an intraoral malignant melanoma?
Hard palate and maxillary gingiva
Stones in the Wharton duct are made visible in ?
cross-sectional occlusal radiographs
Occlusal radiographs are important when attempting to discern the location of submandibular sialoliths.
______ has a common etiology of infection, loss of interocclusal/intermaxillary space, or vitamin B deficiency.
Angular cheilitis
Angular cheilitis is also known as angular cheilosis, commissural cheilitis, angular stomatitis, and perlèche.
The floor of the mouth and lateral border of the tongue are the most common locations for the development of
squamous cell carcinoma inside the mouth.
The most common mucocele locations are :
the lower lip, the inner side of the cheek, on the anterior ventral tongue, and the floor of the mouth.
Definitive diagnosis of candidosis requires specialized tests, such as
a cytologic smear.
______ is a neoplasm that commonly arises along the posterior aspect of the mandible during the fourth to fifth decades of life. It is a benign tumor that is thought to have originated from the epithelial remnants of the stratum intermedium of the enamel organ. It is a slowly progressing, painless swelling that is often associated with impacted teeth and occurs most frequently in the molar area but may also appear near premolars.
Calcifying epithelial odontogenic tumor (Pindborg tumor)
Which of the following conditions is associated with hypodontia?
A- Ectodermal dysplasia
B- Cleidocranial dysplasia
C- Apert Syndrome
D- Gardner syndrome
A
