Oral Anatomy & Histology (Review: Outcome 13) Flashcards
Oral pathology
The study of diseases in the oral cavity
- Many systemic diseases as well as infectious diseases have oral signs/symptoms
- Only a dentist or physician may diagnose pathological (disease) conditions
The Making of a Diagnosis
- Historical
- Clinical
- Radiographic
- Microscopic
- Laboratory
- Therapeutic
- Surgical
- Differential
Oral Lesions
Lesions is a broad term for abnormal tissues in the oral cavity
- can be a wound, a sore, or any other tissue damage caused by injury or disease
- Classified as to whether they are:
i. extend below or extend above the mucosal surface
ii. lie flat or even with the mucosal surface
Lesions extending below mucosal surface
1) Ulcer
- a defect or break in continuity of the mucosa that results in a punched-out area similar to a crater
2) Erosion of the soft tissue
- a shallow defect in the mucosa caused by mechanical trauma
3) Abcess
- a localized collection of pus in a circumscribed area
4) Cyst
- a closed sac or pouch that is lined with epithelium and contains fluid or semisolid material
Lesions extending above mucosal surface
1) Blisters
- also known as vesicles; filled with a watery fluid
- Bulla (blister greater than an inch)
2) Pustule
- similar in appearance to a blister but containing pus
3) Hematoma
- Also similar to a blister but containing blood
4) Plaque
- any patch or flat area that is slightly raised from the surface
Lesions even with mucosal surface
Lie flat or even with the surface of the oral mucosa and are well-defined areas of discoloration
1) Purpura
- red or purple spots that occur on the skin or mucosa caused by localized bleeding
- pinpoint size called petechiae
2) Ecchymosis
- medical term for bruising
3) Macule
- flat pigmented spot on the skin, lips or inside mucosa (mole/freckle)
4) Patch
- an area on the skin that is a different colour
Raised or flat lesions
- Nodules, which may appear below the surface or may be slightly elevated, are small, round, solid lesions
(when palpated, a nodule feels like a pea beneath the surface) - Granuloma = often used to describe a nodule that contains granulation tissue
- Tumors, also known as neoplasms (benign or malignant)
Causes and Mechanisms
- Intrinsic (Nature)
- Extrinsic (Nurture)
Acute and Chronic Inflammation
Inflammation = body’s protective response to irritation or injury
- Acute inflammation occurs if injury to tissue is minimal and short-lasting and the tissue begins to repair quickly
- Chronic inflammation occurs when injury or irritation to tissue continues
Common symptoms of inflammation
- Redness (erythema)
- Heat
- Pain
- Swelling
Cellulitis
- Inflammation spreads through the soft tissue or organ
- Swelling develops rapidly, accompanied by a high fever
- Skin becomes very red, severe throbbing pain as the inflammation localizes
- Cellulitis associated with oral infections is potentially dangerous because it can travel quickly to sensitive tissues such as the eye or brain
Cellulitis
- Inflammation spreads through the soft tissue or organ
- Swelling develops rapidly, accompanied by a high fever
- Skin becomes very red, severe throbbing pain as the inflammation localizes
- Cellulitis associated with oral infections is potentially dangerous because it can travel quickly to sensitive tissues such as the eye or brain
Leukoplakia
- Means white patch
- Lesions vary in appearance and texture from a fine white transparency to a heavy, thick, warty plaque
- Cause is unknown, but is commonly linked to chronic irritation or trauma
- Very often precedes the development of a malignant tumor
Sialolith
- Salivary stones of calcium deposits
- May cause obstruction of involved gland
- Extra oral swellings
- Painful (antibiotics/surgery)
Mucocele
- Blocked/broken minor salivary duct
- Swelling of lower lip
- Kids, biting lips
- Surgery or regress on own
Amalgam Tattoo
- Amalgam particles become trapped in the tissue
- Gingival tissue in the area appears blue-gray (looks like a tattoo)
Ranula
- Usually caused by a sialolith or local trauma to the duct
- Saliva escapes into the connective tissue of the floor of the mouth
Tonsil tissue
- Lymphoid tissue
- Enlarge in infections
- Mistaken for tumors
Linea Alba
- Raised, wavy line
- Level of collusion on buccal mucosa
- Hyperkeratotic
- Cheek biting
Aspirin Burn
- Aspirin is placed in the area of a toothache
- Acid in the aspirin causes a tissue burn
- Necrotic white tissue that may slough off resulting in a large painful ulceration
- Should heal within 7-14 days after aspiring use is discontinued
Glossitis
- General term used to describe inflammation and changes in the topography of the tongue
- There is atrophy of the papilla to creating a smooth erythematous tongue
- Causes:
i. allergic reactions
ii. irritations from foods
iii. nutritional deficiencies
Black Hairy Tongue
- The filiform papillae are so greatly elongated that they resemble hairs
- These elongated papillae become stained by food tobacco and chromogenic bacteria, hence the name
- May be caused by an imbalance of oral flora after the administration of antibiotics or the use of mouthrinses
Fissured Tongue
- A variant of normal; its cause is unknown
- Theories about its cause include vitamin deficiency and chronic trauma over a long period
- Dorsal surface (top) of the tongue is marked by having deep fissures or grooves, which become irritated if food debris collects in them
- Patient with a fissured tongue is advised to brush the tongue gently with a soft toothbrush to keep the fissures clean of debris and irritants
Bifid Tongue
- Rare
- Partial fusion of the tongue during development
- No treatment required
Ankyloglossia
- Tongue tie
- Lingual frenum is attached near the tip of the tongue
- Short lingual frenum can also attached the top of the tongue to the floor of the mouth
- Limits movement of tongue (speech disruption)
- Treatment: frenectomy (surgical removal of part of the lingual frenum)
Clinical Considerations of numerous diseases that manifest themselves by causing alterations in the oral tissues
- Oral mucosa is a good indicator of health or disease
- Many disease or conditions manifest in some way on oral tissue
- Dental team plays an important role in early detection of these diseases
DA’s role in clinical consideration
- Describe what you see
- Identify possibilities
- Understand causes
- Consider clinical implications: patient comfort, IPC, treatment options
Pernicious Anemia
- A condition in which the body does not absorb vitamin B12
- People with this condition show signs of anemia, weakness, pallor, and fatigue on exertion
- Other signs: nausea, diarrhea, abdominal pain and loss of appetite
- Oral manifestations: angular cheilitis (ulceration and redness at the corners of the lips), mucosal ulceration, loss of papillae on the tongue, and painful burning sensation of tongue
HIV and AIDS
- Oral lesions are prominent features
- Oral lesion develop because of the breakdown of immune system that occurs when T-helper cells become depleted as a result of the disease
AIDS
- Because the patient’s immune system is severely damaged, death is usually caused by an opportunistic infection
- Opportunistic infection: one that normally would be controlled by the immune system but cannot be controlled because the immune system is not functioning properly
- Some lesions that look like HIV and AIDS related infection may also be caused by other disorders
HIV Gingivitis
- Often a bright red line along the border of the free gingival margin
- Also known as atypical gingivitis (ATYP)
- Some cases, may be progression of the bright red line from the free gingival margin over the attached gingival and alveolar mucosa
HIV Periodontitis
- Resembles acute necrotizing ulcerative gingivitis superimposed on rapidly progressive periodontitis
- Other symptoms include:
- interproximal necrosis and cratering
- marked swelling
- intense erythema over the free and attached gingiva
- intense pain
- spontaneous bleeding and bad breath
Candidiasis
- Often the initial oral sign of progression from HIV-positive status to AIDS
- Patient with compromised immune system, candidiasis can be very debilitating and serious disorder
Cervical Lymphadenopathy
- Enlargement of the cervical (neck) nodes
- Frequently seen in association with AIDS
Lymphoma
- General term used to describe malignant disorders of the lymphoid tissue
- In immunocompromised individual, may occur as a solitary lump or nodule, a swelling, or non-healing ulcer that occurs anywhere in the oral cavity
- Swelling may be ulcerated or may be covered with intact, normal-appearing mucosa
- usually painful, lesion grows rapidly and may be first evidence of lymphoma
Hairy Leukoplakia
- Can be important early manifestation of AIDS status
- Filamentous white plaque usually found unilaterally or bilaterally on the lateral borders (sides) on the anterior portion of the tongue
- may spread to cover the entire dorsal surface of the tongue
- Can also appear on the buccal mucosa, where it generally has a flat appearance
Kaposi Sarcoma
- One of the opportunistic infections that occurs in patients with HIV infection
- Lesions may appear as multiple bluish, blackish, or reddish blotches that are usually flat in the early stages
- One of the intraoral lesions that is used to diagnose AIDS
Herpes Simplex
- Lesions usually occur on the lip
- In immunocompromised patients, lesions may occur throughout the mouth
- An ulcer caused by the herpes virus that persists for longer than 1 month may be an indicator of AIDS
- Patients who do not have HIV or AIDS may also suffer from herpes
Human Papillomavirus
- Appears most commonly in immunocompromised individuals
- Diagnosis is made on the basis of history, clinical appearance, and biopsy findings
- Lesions are a common finding in patients with early HIV infection
- These warts appear spiky and some have a raised cauliflower-like appearance
