Oral Path Flashcards
The most commonly affected branches of trigeminal nerve in Trigeminal neuralgia are __ and __, but pain can be about in any location on the head and even the index finger.
V2 and V3
Anterior disc displacement [with/without] reduction occurs when the articular disc is located anterior to the condyle during opening of the jaw Reich results in a limited mouth opening without any clicking or popping sounds.
Without
Anterior disc displacement [with/without] reduction is observed in patients who experience pain and popping or clicking sound upon opening and closing their mouth.
With
Popping sounds indicate that…
The condyle head is moving back against the disc, and as the mouth closes, the condyle head slides off to the posterior aspect of the disc creating another clicking sound
True or false… most patients suffering from TMD typically exhibit no obvious TMJ pathology on Panos
True
___ imaging is the preferred method for visualizing the TMJ followed by ___
MRI
Cone bean tomography
___ is the term to describe the mandibular hinge position which further opening of the mandible would produce forward translators movement rather than hinge movement.
Terminal hinge position (transverse horizontal axis)
___ is the prime muscle that pulls the condyle head anterio-medially out of the glenoid fossa.
Lateral pterygoid
____ most commonly cause intracapsular restraint of mandibular movement in adults
Disc interference disorders (AKA internal derangement disorders)
Disc interference disorders are commonly associated with anterior and medial displacement or dislocation of the anterior disc.
What are signs and symptoms of internal derangements?
Clicking sounds
catching or locking during jaw movements
May or may not be associated with pain
An occlusal splint should be fabricated in __ since it is the most stable, most reliable, reproducible joint position. Define this position.
CR (centric relation)
CR describes the maxillomandibular relationship when the condyles articulate with the thinnest, avascular portion of the articular disc so that the condyle is in its most anterior-superior position against the condylar eminence
What TMJ disorder is most responsive to treatment with an occlusal separator?
Muscle spasm
Occlusal separators separate upper and lower teeth from each other and allow the TMJ to rest and recover.
They also serve to help the muscles of mastication relax.
____ 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 originates from ___. It is a [quickly/slowly] progressing [painful/painless] swelling that is often associated with impacted teeth and occurs most frequently in the ___ area, but may also occur in the ___ area.
CEOT (calcifying epithelial odontogenic tumor) (pindborg tumor)
The epithelial remnants of the stratum intermedium of the enamel organ.
Slowly
Painless
Molar
Premolar
CEOTs have a presence of ___ deposits appear microscopically and a “____” appearance is observed radiographically.
Amyloid-like
Driven-snow
Incisional biopsy is indicated in cases where the lesion is large and it >___mm
10
What area has the worst prognosis for squamous cell carcinoma? Why?
Floor of the mouth
Its rich blood supply.
Angular cheilitis is associated with what three things?
Nutritional deficiency (vitamin B)
Loss of vertical dimension
Candida albicans infection
What are some characteristics of angular chelitis?
Erythema Moist maceration Soreness Pain Burning Pruritis Ulceration And crusting at the corners of the mouth
(AKA angular cheilosis, commissars chelitis, angular stomatitis, and perleche)
What is necrotizing sialometaplasia and what causes it?
Rapidly expanding ulcerative lesion that mostly occurs on the posterior area of the hard palate
Usually engine, often painless, self-limiting, and resolves in about 6-10 weeks
Trauma to the minor salivary glands in the hard palate causes this condition
What condition presents with a radiographic “___” appearance lesion. It can cause paresthesia, loosening and displacement of teeth, along with a localized swelling in the posterior mandible.
Sunburst
Osteosarcoma
Osteosarcoma is classified as a form of bone cancer that predominantly occurs in __ and ___. Osteosarcomas usually manifest as a ___ ___ swelling that can be distinguished in radiographs as appearing ___ or having a __ apperance. The ___ appearance is due to the calcified tumor spicules that radiate outward of the bone.
Children and teenagers
Solid, indurated
Moth-eaten or having a sunburst apperance
Sunburst
____ is a condition that manifests on the hard palate as a white surface lesion associated with pipe and cigar smoking and is not considered to be premalignant
Nicotinic stomatitis
Nicotinic stomatitis is induced by…
It is found most commonly in [men/women] over the age of __
The palate being exposed to very hot conditions, is also associated with the chronic ingestion of hot beverages
Men. 45
True or false… cancer risk is significantly increased with nicotinic stomatitis
False
Nicotinic stomatitis should completely resolve on its own after __-___ upon smoking cessation. If the lesion persists, a biopsy may be necessary to confirm the diagnosis
1-2 weeks
What muscle of mastication/facial expression is the most susceptible to myositis?
Myositis - inflammation of the muscles
The masseter
Myositis is a documented side effect of ___ drugs like ___ and ___
Lipid-lowering
Statins and fibrates
___ is a rapidly expanding ulcerative lesion that mostly occurs on the posterior area of the hard palate. It is usually benign and is often painless. It is usually self-limiting and resolves in about __-___ weeks.
Necrotizing sialometaplasia
6-10
List some etiologies for necrotizing stomatitis
Trauma
Local anesthetic injection
Smoking
Alcohol
Diabetes
Vascular disease (arteriosclerosis)
Pressure from a dental prosthesis
Allergy
Carcinoma in situ is most associated with [erythroplakia, leukoplakia, white sponge nevus]
Erythroplakia
Erythroplakia is most commonly found in what three locations?
Floor of the mouth
Tongue
Soft palate
Why does erythroplakia appear red in some areas?
Absence of keratin production
Reduced number of epithelial cells
Increased vascularity due to inflammation
Thin and neoplastic epithelium
Metastatic squamous cell carcinoma of the tongue will likely migrate to the __ first. If it progresses there it typically results in a [poor/questionable] prognosis. ___ is typically used to treat this type of cancer.
Cervical nodes.
Poor
Surgical neck dissection
True or false… leukoedema should be biopsied because it is considered premalignant.
False. It is diagnosed clinically by stretching. It is benign, and NOT premalignant.
______ presents as a rubbery, firm, asymptomatic nodule within the main body of the parotid gland. It accounts for 90% of the benign tumors occurring in the gland. It occurs as a preexisting lesion of long duration
Benign mixed tumor or pleiomorphic adenoma
Describe the presentation of post-herpetic neuralgia
Possible paresthesia and itching
Discomfort to severe pain which can be described as burning or stabbing
Persistence of pain for 3+ months
Cutaneous scarring may be present
____ is a condition characterized by the presence of multiple ensign tumors of ectodermal origin, along with multiple pigmented macules on the skin. It is a genetic condition that manifests as cafe au lait spots and multiple soft nodules which may occur anywhere in the body.
Neurofibromatosis
Neurofibromatosis occurs with many varieties. The most commonly occurring form is ____
NF1
Von Recklinghausen’s disease
Adenomatoid odontogenic tumors are most likely to manifest in which location? They are benign ___ tumor of bone that may or may not mineralize. They are most commonly found in [males/females] [over/under] the age of 20.
Anterior maxilla (associated with an unerupted tooth)
Epithelial
Females under the age of 20
True or false… peripheral ossifying fibroma shows histological evidence of calcification.
True
The formation of apthae involve a ___ mediated immune response triggered by a variety of factors, including ___, ___, ___, ___, ___, and ___
T-cell
Nutritional deficiencies Local trauma Stress Hormonal influences Allergies Genetic predisposition
Where is the most common site of intraoral malignant melanoma?
Hard palate and maxillary gingiva
Describe the features of carcinoma in situ.
Invasion has NOT yet breached the basement membrane and there is no invasion of surrounding tissues.
Abnormal mitosis
Los of cellular polarity
Pleomorphism
What are some risk factors of median rhomboid glossitis?
Smoking
Wearking dentures
Corticosteroid sprays/inhalers
HIV
Tender swelling localized within the submandibular triangle is indicative of ___
Lymphadenopathy - condition in which the lymph nodes become swollen, tender, and enlarged. Lymphadenopathy could be an indication of infection, malignancy, or an auto-immune disease.
Ranulas typically exhibit a recurrence rate of up to ___% after complete excision of the ranula and up to ___% of cases of complete excision of the ranula with sublingual gland.
20%
2%
___ is indicated for a ranula occurring the first time. ___ is indicated for a recurring ranula.
Marsupialization
Complete lingual gland excision
Premalignant squamous epithelial lesions typically manifest where?
Floor of the mouth and lateral border of the tongue
True or false… an ulcer at the floor of the mouth heals quickly because of the increased blood flow to the area.
False. Although there is increased blood flow to this area, the healing occurs slower because of the high degree of mobility of the tongue and floor of the mouth. The rich blood supply actually serves as an explanation for the high potential for premalignant lesions because rapidly dividing malignant cells require more nutrition than normal cells.
What are 5 prodromal symptoms of acute herpetic gingivostomatitis?
Fever
Anorexia
Malasie
Headache
____ are the most active during a histamine/allergic immune reaction. ____ contain histamine and heparin, that they are able to secrete to affect the activity of the body in an immune reaction and are known for allergy and anaphylaxis.
Mast cells
_____ is a common benign salivary gland neoplasm of glandular cells along with myoepithelial components, that can potentially become malignant. It is the most common variety of salivary gland tumor and also the most common tumor of the parotid gland.
Pleomorphic adenoma
What is the most common tumor of the parotid gland?
Pleomorphic adenoma
The presence of “sulfur granules” is pathognomonic of which condition?
Actinomycosis
Name four characteristics of actinomycosis (caused by actinomyces israeli)
A non-painful hard lump in the jaw
Painful skin abscesses which initiate as red bruises
Muscle spasms in the jaw leading to locked jaw
Presence of sulfur granules
Where is the most common location of mucoceles?
Lower lip
Mucoceles present a bluish translucent color and are most commonly found in children and young adults.
What are mucus retention cysts?
True cysts that are lined by epithelium and are more rare than mucus extravasion phenomena. Mucus retention cysts usually present as asymptomatic swelling of the palate, cheek, FOM, or maxillary sinus. The lesions range from 3mm to 1cm and demonstrate non-tender mobility and a normal surface color
Which site in the oral cavity is kaposi’s sarcoma most likely to appear? The mouth is involved in ___% of cases and is the initial site in 15% of ___-related kaposi’s sarcoma.
Palate
30%
AIDS
_____are a collection of mucous deposits within the paranasal singuses. They appear radiopaque because the air that surrounds the psuedocyst is radiolucent, making the mucus appear more radiopaque.
Mucus retention pseudocysts
What is the best treatment of generalized acute herpetic gingivostomatitis?
Increase fluid intake, gentle debridement of the mouth, and good oral hygiene.
How long does generalized acute herpetic gingivostomatitis typically last? What are some palliative treatments? What should be used in extreme cases?
10-14 days
Topical xylophone, Benadryl, kaopectate to coat the mouth, and a balanced diet, magic mouthwash
Acyclovir
True of false… mucous retention pseudocysts are lined with respiratory epithelium
True
What type of TMJ disorder is most likely to elicit an audible “click” or “pop” when opening the jaw?
Anterior disc displacement with reduction
Pain and tenderness upon palpation of the TMJ is usually associated with deviation of the jaw to the [painful/nonpainful] side upon opening of the mouth.
Painful
This is because the jaw is limiting itself from excessive movements that may cause further pain and damage to the joint
Degeneration of the basal cell layer, a mononuclear inflammatory cell infiltrate in the subepithelial connective tissue, and “saw-tooth” rete pegs are indicative of ____. It typically affects the ___, ___, and ____
Lichen planus
Skin
Tongue
Oral mucosa
Lichen planus is sometimes associated with oxidative stress, certain medications, and diseases. ____ lichen planus is the most common and manifests as white lacy streaks on the mucosa (known as ____) or as smaller papules. The lesions tend to be bilateral and asymptomatic. ___ lichen planus presents as fluid-filled vesicles which project from the surfaces. ___ lichen planus presents with painful erythematous ulcerated lesions which may occur in many areas in the mouth but mostly on the posterior buccal mucosa, and may resemble desquamative gingivitis.
Reticular
Wicham’s Striae
Bullous
Erosive
____ exhibits globular dentin, early pulpal obliteration, defective root formation, periapical granulomas/cysts, premature exfoliation, and appear to be normal clinically.
Dentin dysplasia
____ is a hereditary disease characterized by a disturbance in normal dentin formation causing pulpal chamber obliteration, alteration or absence of root formation, and premature tooth exfoliation.
Dentin dysplasia
True or false… amelogenesis imperfecta ONLY affects the formation of enamel and not dentin
True
What is the classic clinical sign/symptom of an anteriorly displaced disk with reduction?
Reciprocal click
In ____, the disk stays anterior to the condylar head upon opening so the mouth opening is limited and there is no pop or click sound upon opening.
Disk displacement without reduction
True or false… lateral periodontal cysts are identifiable radiographically
True
What is the most common cause of intracapsular restraint of mandibular movement?
Disk interference disorders (AKA internal derangement disorders)
Disc interference disorders are commonly associated with ___ and ___ displacement or dislocation of the articular disc.
Anterior
Medial
People most prone to TMJ possess a ___. Other factors that cause TMD include…
Malocclusion
Bruxism
Overbite
Rheumatoid arthritis
Depression psychosis
Stress
Ameloblastomas are rare, benign ___ tumors derived from ___ that occurs more common in the __ than the ___ and is often associated with ___ teeth. They are rarely malignant or metastatic. They exhibit a tendency to…
Odontogenic
Epithelium
Mandible
Maxilla
Unerupted
Expand the body cortices at a slow growth rate that allows time for the periosteum to develop a thin shell of bone that cracks when palpated (egg shell cracking).
Ameloblastomas often appear with a ___ appearance. And roots may….
Other symptoms include…
Multilocultated “soap bubble”
Resorbed in involved teeth
Painless swelling
Facial deformity
Loose teeth
Ulceration
Periodontal disease
What are the most common locations for the development of squamous cell carcinoma inside the mouth?
Floor of the mouth
Lateral border of the tongue
___ radiographs are important when attempting to discern the location of submandibular sialoliths
Cross-sectional occlusal
_____ is a benign odontogenic tumor arising from epithelial and ectomesenchymal tissues and produces no mineralized product. It is more common in patients 10-20 years old with unerupted teeth in 50%of cases. It appears radiographically as a sharply demarcated radiolucent lesion.
Ameloblastic fibroma
Suprabasilar acantholysis is pathognomonic of what condition?
Pemphigus vulgaris
Pemphigus vulgaris is most commonly associated with painful lesions on the ____. Biopsy reveals __ and ___. It is an ___ disorder characterized by the production of antibodies against specific proteins in the ___ resulting in formation of skin blisters.
Buccal mucosa
Suprabasilar vesicle
Acantholysis
Autoimmune
Skin and mucus membranes
True or false… central giant cell granulomas are characterized by a large radiolucent multilocular lesion that expands the cortical plate and can often resorb roots and move teeth. This causes them to often be confused with ameloblastomas
True
Inflammatory papillary hyperplasia is found in ___% of patients that wear their dentures 24 hours a day
20%
In which location is inflammatory papillary hyperplasia most likely to be found?
Hard palate
Paget’s disease of bone is diagnosed by the presence of an elevated level of ____ and normal __, ___, and ___ levels in the blood. The pathognomonic sign for Paget’s disease is a radiopaque ___ appearance. Other signs include… (4 things)
Alkaline phosphatase
Calcium, phosphate, aminotransferase
Cotton wool
Enlarged skull and facial bones
Enlarged maxilla and alveolar ridges
Displaced teeth
Hypercementosis
____ is a health condition manifested with spontaneous mucous membrane ulcerations in the mouth, vagina, or rectum. Other manifestations include sore throat, rigor, chills, fever
Agranulocytosis
True or false.. the clinical appearance of pseudomembranous candidiasis alone is sufficient for the diagnosis of candidiasis
True
What is the most common cause of intraoral verruca vulgaris?
Autoincoulation
With complete surgical removal of verrucous carcinoma, patients become disease-free over a 5-year period approximately __% of the time
90
Cleft lip occurs approximately 1 in ___ births. Cleft lip is unilateral in ___% of cases and bilateral in ___% of cases. It results in lack of fusion between which two processes?
1000
80%
20%
Medial nasal process and maxillary process
Cleft palate occurs in approximately 1 in ___ births. It results in lack of fusion between ___
2000
Palatal shelves
Which syndrome is associated with lip pits near the midline and clefting?
Van der Woude syndrome
Lingual thyroid is located ____
At the midline base of the tongue.
It is located along the embryonic path of thyroid descent
The thyroglossal duct cyst is a neck swelling located at the ____ and located along the ____
Midline
Embryonic path of thyroid descent
_____ syndrome is fissured tongue + granulomatous cheilitis + facial paralysis
Melkersson-Rosenthal
What is cystic hygroma?
Lymphangioma of the neck
What is sturge-Weber syndrome?
Angiomas of leptomeninges (arachnoid and pia mater) + angiomas skin along the distribution of the trigeminal nerve
Where are dermoid cysts found?
Midline floor of mouth if above mylohyoid
Mass in upper neck if below mylohyoid
Dermoid cysts may contain __ structures like ___. They often have a __ consistency
Adnexal structures like hair and sebaceous glands
Doughy
Bronchial cysts are swelling found in ____. They are due to ___
The lateral neck
Epithelial cyst within the lymph node of the neck
Where are common regions where oral lymphoepithelial cysts are found?
Palatine and lingual tonsils
They are epithelial cysts within lymphoid tissue of oral mucosa
_____ are heart-shaped radiolucencies in the nasopalatine canal. They are caused by cystificaiton of canal remnants. What is the treatment of choice?
Nasopalatine duct cysts
Excision
What is a globulomaxillary lesion?
Clinical term denoting any radiolucency between maxillary canine and lateral incisor
A ____ is also called a simple bone cyst and idiopathic bone cavity. It is a large radiolucency which scallops around roots. It has no epithelial lining (dead space) in mandible of teenagers. Usually associated with jaw trauma. What is the treatment of choice?
Traumatic bone cyst
Aspirate to diagnose, just monitor once confirmed its a traumatic bone cyst
What is the difference between an erosion and an ulcer?
Erosion = incomplete break through epithelium
Ulcer = complete break through epithelium
What is nicotine stomatitis?
Red dots that are inflamed salivary duct openings
Nicotine stomatitis is only premalignant if related to ____
“Reverse smoking” (lighted end in mouth)
True or false… smoking-associated melanosis is reversible is smoking is discontinued
True
_____ is a syndrome in which oral melanotic macules (and around lips) are assocaited with intestinal polyps
Peutz-jeghers syndrome
Dentrifice-assocaited sloughing is related to what ingredient in tooth paste?
Surfactant ingredient sodium laurel sulfate
What brands of toothpaste should you recommend to a patient who has dentrifice associated sloughing?
Toms of Maine or Rembrandt toothpaste
True or false… subucosal hemorrhages do not Blanche
True
Varicella zoster virus is associated with ___ syndrome which is herpes zoster deactivation in geniculate ganglion affecting cranial nerves VII and VIII resulting in facial paralysis, vertigo, deafness
Ramsay Hunt Syndrome
The ___ virus is assocaited with hand-foot-and-mouth disease. As well ass herpangia, which is affects the…
Coxsackie
Posterior oral cavity (soft palate, throat, and tonsils)
___(___) is associated with Koplik’s spots (buccal mucosa dot ulcers) which precede a skin rash. It is self-limiting and mostly occurs in childhood
Measles (rubeola)
Condylomata acuminatum is caused by ___ and ___. They are often found on ___ but can occur orally if…
What is the treatment of choice?
HPV 6 and 11
Genitals
Oral sex with someone with genital warts
Excision (high recurrence)
Focal epithelial hyperplasia (AKA ___ disease) is caused by __ and ___. It appears as ____.
What is the treatment of choice?
Heck’s disease
HPV 13 and 32
Multiple small dome-shaped warts on oral mucosa
Excision with excellent prognosis
Oral hair leukoplakia is caused by ___. It appears as ____. It is an opportunistic infection often associated with ___. It is also assocaited with ___.
EBV
White patch on lateral tongue that does not wipe off
HIV
Burkitt’s lymphoma
What oral lesion is often associated with burkitt’s lymphoma?
Oral hairy leukoplakia
Syphilis is caused by contact with what spirochete bacteria/
Treponema pallidum
What is the primary lesion of syphilis?
Secondary?
Tertiary?
Primary = chancre
Secondary = oral mucous patch, condyloma Latum, maculopapular rash
Tertiary = gumma, CNS involvement, CV involvement
Congenital syphilis causes Hutchinson’s triad, which is…
Notched incisors and mulberry molars
Deafness
Ocular keratitis
Tuberculosis is caused by inhalation of what bacteria?
Mycobacterium tuberculosis
What is the oral manifestation of tuberculosis?
Oral nonhealing chronic ulcers following lung infection
What is the appearance of primary tuberculosis?
Ghon complex (inhaled bacteria surrounded in a granuloma that undergoes caseating necrosis + infected hilar lymph node draining the first lesion)
What is the appearance of secondary TB?
More widespread lung infection with cavitation
What is the apperance of miliary TB?
Systemic spread
True or false… HIV patients are at high risk of getting progressive disease of TB
True
Actinomycosis is caused by ___
Actinomyces israelii (filamentous, yet not fungal)
What are the two main types of actinomycosis?
Periapical - jaw infections
Cervicofacial - head and neck infections
Which disease is associated with sulfur granules in purulent exudate?
Actinomycosis
What is the treatment for actinomycosis?
Long—term high-dose penicillin
Scarlet fever is caused by ____. This is when strep throat becomes a systemic infection. What happens in the oral cavity?
Group A strep (streptococcus pyogenes)
Strawberry tongue = white coated tongue with red inflamed FUNGIFORM papillae
What is the treatment for scarlet fever?
Penicillin
What type of papillae are affected in strawberry tongue of scarlet fever?
Fungiform papillae
Name 4 different types of candidiasis and describe them
Pseudomembranous = white plaque that rubs off
Atrophic = red
Median rhomboid glossitis = loss of lingual papillae
Angular chelitis = corner of mouth
Where is blastomycosis found?
Coccidodomycosis?
Cryptococcusis?
Histoplasmosis?
Blastomycosis - US northeast, spores
Coccidiodomycosis - US southwest, valley fever
Cryptococcosis - US west
Histoplasmosis - US Midwest
Apthous ulcers affect [keratinized/nonkeratinized] tissue
Nonkeratinized
True or false… both minor and major apthous ulcers heal without scarring
False. Minor heals without scarring
Major heals with scarring
What is Sutton disease?
Another name of major form of apthous ulcers
____ syndrome is a multisystem vasculitis that causes apthous-type ulcers of oral and genital, and inflammation of eye
Bechet’s syndrome
What is the treatment for Behcet’s syndrome?
Corticosteroids
Erythema multiforme often appears on the lips but can occur anywhere on the skin and mucosa. The minor form is associated with ___. The major form (AKA ____) is associated with ____
Herpes simplex hypersensitivity
Stevens-Johnson syndrome
Drug sensitivity
____ is an allergic reaction to drug or food contact and is diffuse swelling of lips, neck, or face. It is mediated by ___ release of ___ and ___. What is the treatment?
Angioedema
Mast cell
IgE and histamines
Antihistamines
____ is an allergic reaction to an inhaled antigen. It results in “strawberry gingivitis”. What is the treatment?
Wegener’s granulomatosis
Corticosteroids (prednisone) and cyclophosphamide
Lichen planus involves ___ which target and destroy ___. Basal zone vacuolization and ___ rete pegs secondary to this destruction is observed histologically
T lymphocytes
Basal keratinocytes
Sawtooth
What are the two types of lichen planus? Which is the most common?
Reticular (most common) - wickham striae
Erosive (red ulceration)
What is the treatment for lichen planus?
Corticosteroids
Lupus erythematosus has two different types. What are they?
Discoid chronic type - disc-like lesions on facial skin. Oral lesions mimic erosive lichen planus
Systemic acute type - multiple organ involvement. BUTTERFLY RASH over bridge of nose. Autoantibodies (ANA test is run)
Treatment is corticosteroids
What is scleroderma? What are the oral applications?
Hardening of skin and connective tissue
Restricted opening of mouth and uniform widening of PDL space is observed
Pemphigus vulgaris is observed ____. Autoantibodies are against ___. It is characterized by multiple painful ulcers preceded by bullae. A diagnostic indication is a positive ___.
Suprabasilar
Desmosomes
Nikolsky’s sign (sloughing of superficial epithelial layer)
Treated with corticosteroids
Mucous membrane pemphigoid is located ____. It has autoantibodies against the ___. Otherwise, it is the same as pemphigus
subbasilar
Basement membrane
