Oral Path- ABGD Flashcards
What is “ cobweb trabeculation” imaging descriptors suggestive of?
odontogenic myxoma
What is “ beaten copper/beaten metal” imaging descriptors suggestive of?
Crouzon and Apert Syndromes
Hypophosphatasia
What is “ Cotton ball opacification” imaging descriptors suggestive of?
chondrosarcom
What is “cotton wool opacification” imaging descriptors suggestive of?
pagets disease
What is “floating in air” imaging descriptors suggestive of?
langerhans cell histiocytosis
What is “garrington sign (symmetric PDL widening)” imaging descriptors suggestive of?
osteosarcoma, chondrosarcoma
What is “ground/etched glass, orange peal” imaging descriptors suggestive of?
fibrous dysplasia
What is “hair on end pattern” imaging descriptors suggestive of?
sickle cell anemia
thalassemia
What is “honeycomb pattern” imaging descriptors suggestive of?
hemangioma/av malformation
What is “moth eaten radiolucency” imaging descriptors suggestive of?
osteomyelitis
ewing sarcoma
What is “onion skin opacification” imaging descriptors suggestive of?
osteomyelitis with proliferative periostitis
ewing sarcoma
What is “Punched out lesion” imaging descriptors suggestive of?
myeloma (adults)
LCH (children)
(Langerhan Cell Histiocytosis)
What is “snow driven, snow plow calcification” imaging descriptors suggestive of?
CEOT Calcifying epithelial odontogenic tumor (Pindborg tumor)
What is “snow flake calcification” imaging descriptors suggestive of?
AOT
What is soap ubble trabeculation” imaging descriptors suggestive of?
ameloblastoma
what is “Stepladder trabeculation” imaging descriptors suggestive of?
sickle cell disease
what is “sunburst/sunray opacification” imaging descriptors suggestive of?
osteo sarcoma
chondrosarcoma
hemangioma
What is “Tower skull “ imaging descriptors suggestive of?
apert syndrome
What is “tramline calcification (skull film) “ imaging descriptors suggestive of?
sturge weber angiomatosis
What is “wormian (sutural) bones (skull film)” imaging descriptors suggestive of?
cleidocrandial dysplasia
osteogenesis imperfecta
When to use an incisional biopsy? What solution do you put it in
for high risk lesions and for ulcerative/fermatologic disease
10% formalin
Michel’s solution (immunofluorescence)
Fresh (frozen, oncology protocol)
When do you use an excisional biopsy?
for small nodule on the buccal mucosa or gingiva, a small mucocele.
What might be your diff dx for a gingival nodule? What is the recurrent rate?
Pyogenic granuloma
Peripheral ossifying fibroma
peripheral odotogenic fibroma
peripheral giant cell granuloma
fibroma
*3-16% recurrence
What are common causes for generalized gingival overgrowth?
local factors
immunologic/immunodeficient/immunosenescent
hormonal (pregnancy)
medications (dilantin, CCBs, cyclosporine)
genetic/developmental/syndromic
neoplastic (leukemia/lymphona or metastatic)
What re diff dx for papillary/verrucous nodules
squamous papilloma (HPY, low risk)
condyloma acuminatum (HPV, sex transmit)
fibroma
verruciform xanthoma
Verrucous hyperplasia, proliferative verrucous leukoplakia, carcinoma may also be considered
What are the diff dx for soft tissue/multiple nodules?
Granular cell tumors
neuromas and neurofibromas (like in MEN and neurofibromatosis)
If youre concerned about multiple nodules what else should you look for?
cafe au lait spots, endocrinopathies
What is the differential for a single lower lip dark macule that is unchanged?
melanotic macule
melanocytic nevus
ephelis (freckle)
What are potential sources of pigmentation of the oral tissues?
physiologic
melanin deposition
melanocyte activity
medications
foreign bodies
vascular
syndromic (addisons, Sturge-Weber, ORWD, Peutz-Jeghers)
What are the clinical findingsthat may make you concerned for melanoma?
A: asymmetry
B: border irregularity
C: color variation
D: diameter >5-6mm
E: Evolution (change over time
What are the three most common skin cancers?
- basal cell carcinoma
- squamous cell carcinoma
- melanoma
How would you prescribe valacyclovir for a viral stomatitis?
2g STAT, then 2g 12 hrs later (+/- Q12 hr for 2-5 days)
What is an oral manifestation of crohn’s disease called?
pyostomatitis vegetans
What infectious diseases are associated with oral ulcers and granulomatous ulcers?
herpes (HSV1, HSV2, VZV, EBV, CMV, HHV6, HHV7, HHV8/KSV)
enteroviruses- usually towards the oropharynx
actinomycetes
treponema- syphilis
histoplasmosis, coccidiodiomycosis, blastomycosis (fungi)
What treatment options do you have for aphthous stomatitis?
- none
- rx: fluocinonide (lidex) 0.05% gel, 30 gram tube, apply 2-3x per day, with 1 refill
- rx: clobetasol (temovate) 0.05% gel, 30 gm tube, apply 2-4x/day
whats the fancy name for frictional irritation like chronic cheek biting?
morsicatio
What are some considerations for clinical licehnoid mucositis?what might cause it?
licehn planus
rxn to materials- amalgam, mouth rinse, toothpaste etc
dietary: cinnamon rxn
lichenoid rxn ot meds
oral GVHD
systemic lupus erythematosus or other autoimmunue disease
With lichen planus, what are you looking for?
striations, examine skinfor other dematologic dz
what do you look for with pemphigus?
spontaneous ulceration, hx of reveal systemic dz or neoplasm
What to look for with pemphigoid?
bullae (blisters), examine skin, eyes, nasal mucosa
What to look for with erythema multiform
desquamation, crusting lesions, burn like lesions, target lesions
For lichenoid mucositis, how might you treat?
- Lidex
- temovate
- if non responsedoxy 20mg 1 tab Q6 hr, 60 tabs
What are the high risk strains for HPV with regards to oral cancer?
high risk HPV (16, 18, 31, 33, 51, 52)
What is gardisil and when should it be used?
HPV vaccine:
routine vaccination 11-12 yo females (started at age 9)
13-26 yo high risk groups
to 26 yo
Where are you most likely to find HPV related cancer?
base of tongue
tonsils, oropharynx, nasopharynx
cysts in the sinus on a pano? what might that be?
Antral pseudocyst
refer if symptomatic or concerns regarding tx.
If you see what appears to be an antral pseudocyst on a pano what things would you want to clarify with the examiner/test on the patient?
restorationsvs no restorations
pulp vitality, apical tissue status (periodontal probing, transillumination)
surgical/traumahistory
symptomatic vs asymptomatic
If an antral pseudocyst is symptomatic, what meds might you give?
antihistamine
decongestant
antibiotic (if systemic symptoms)
What are some OTC antihistamines?
oxymetazoline (Afrin) – vasoconstrictor
phenylephrine (Sudafed PE)* – vasoconstrictor
pseudoephedrine (Sudafed )* –vasoconstrictor
What cautionary concerns should you have with antihistamines?
sympathomimetic effects, MAOI interactions, mydriasis (dilation), abuse potential
What are some OTC antihistamines?
cetirizine (Zyrtec
fexofenadine (Allegra
loratidine (Claritin
diphenhydramine (Benadryl)
be careful of sedating effects
What things could you prescribe antihistamine/decongestant/steriod for antral pseudocyst?
Entex LA (guaifenesin, phenylephrine) - decongestant/mucolytic
Astelin (azelastine) - antihistamine
Dymista® (azelastine/fluticasone) -antihistamine/steroid
Flonase® (fluticasone) steroid (OTC or RX)
What are common inflammatory odontogenic cysts?
periapical cyst / periradicular cyst ** MOST COMMON
buccal bifurcation cyst / paradental cyst
residual cyst (remaining cyst after treatment)
What are the most common developmental odotogenic cysts?
dentigerous / follicular cyst (MOST COMMON DEVELOPMENTAL)
odontogenic keratocyst
primordial (no tooth develops; often histologically odontogenic keratocysts)
orthokeratinizing odontogenic cyst
glandular odontogenic cyst
What are common odotogenic tumors
ameloblastoma (MOST COMMON TUMOR)
adenomatoid odontogenic tumor
ameloblasticfibroma ameloblastic
fibro odontoma/fibro dentinoma
odontoma (hamartomas (normal tissue, but malformed or)
What are two other odotogenic cyst/tumors that are not as common
calcifying odontogenic cyst (Gorlin cyst); often included as a tumor
calcifying epithelial odontogenic tumor (Pindborg tumor)
What is what are the characteristics of nevoid basal cell carcinoma syndrome also known as?
(Gorlin Syndrome)
What are the common characteristics of Gorlin syndrome?
Basal Cell Carcinomas (<20yo)
OKC (<20yo)
Palmer/planter pitting
family member with Gorlin Syndrome
Whats the recurrence rate on ameloblastomas? Will this often require adjunctive treatments or resective surgeries?
30-90%
yes
What is the recurrence rate on OKC? Will this often require adjunctive treatments or resective surgeries?
5-60%
yes
What is the recurrent rate on ameloblastic
fibroma? Will this often require adjunctive treatments or resective surgeries?
0-18%
yes
What is the recurrent rate on adenomatoid
odontogenic tumor? Will this often require adjunctive treatments or resective surgeries?
RARE
no
What are the signs and symptoms of Gardner syndrome? Who should you refer to?
osteomas, odontomas, supernumeraries
adenomatous polyposis
premalignant / malignant polyps of colon
extracolonic tumors
thyroid
desmoids (intestinal fibromas), liver, kidney
gastroenterology
What are the signs and symptoms of eagle syndrome and who should you refer to?
pain in neck
dysphagia
dysgeusia (altered taste)
dystonia
tinnitus
vertigo
visual disturbances
TIA (vascular Eagle Syndrome)
intracranial pressure increase
Neurology
Whats another name for dense bone island?
idiopathic osteosclerosis (NOT CONDENSING OSTEITIS = CHRONIC INFECTION)
describe what cemento-osseous dysplasia looks like clinically?
non-expansile (normally)
not attached to roots with PDL intact
RL rim with opacify from center out
How can you tell the difference between cemtno-osseous dysplasia and cementoblastoma
cementoblastoma does not have a PDL intact- its attached to the roots
If something looks like a cementoblastoma is associated with pain and responds to NSAIDs what might you consider?
osteoid osteoma
describe an ossifyng fibroma
expansile
not attached to tooth
mixed radiodensity
describe fibrous dysplasia
expansile, often ground glass appearance, ill defined radiographically, may be associated with endocrinopathy (McCune Albright Syndrome)
overlaps with fibro-osseous, giant cell, and bone metabolic disorders
What things should you consider when encountering giant cell lesions?
cherubism
primary and secondary hyperparathyroidism
CKD
chronic gastrointestinal dz/malabsorption
What is the most common bone malignancy other than myeloma?
osteosarcoma
What is a normal EF?
50-70%
What tools can you use to help identify oral cancer?
Velscope Vx- blue exitation light
What scale is MET’s and what does it mean?
Metabolic equivalents
1-10. 1= self care, 10= stenuous sports
4= flight of stairs or short run
Common soft tissue masses of the upper lip
Fibroma
Minor gland sialolith
Salivary gland tumor
Salivary duct cyst
Other mesenchymal tumors
Nasolabial cyst
Common soft tissue masses of the buccal mucosa?
Fibroma
Lipoma
Mucocele
Hyperplastic lymph node
Other mesenchymal tumors
SCC
Salivary gland tumor
What are common masses of the floor of mouth
Ranula/mucocele
Sialolith
Lymph-epithelial cyst
SCC
Epidermoid or dermoid cyst
Salivary gland tumors
Mesenchymal tumors
When there is a RL above the impacted 3rd that is <5mm thickness?
hyperplastic dental follicle
What do you call it when the perm tooth is damaged due to periapical inflammation on the primary tooth?
Turner tooth
What are the fixatives/media used for biopsy specimens?
10% buffered formalin
Michel’s solution
- preservative, potassium citrate, buffered
used for immunofluorescence
Describe: white and pink papillary lesions approx 3-4mm located on th epapilla adjacent to the FGM of #29
Diffdx: squamous papilloma, verruciform xantoma, giant cell fibroma
squamous papilloma
-papillary bumpy, usually white to pink
-association HPV 6, 11
Verruciform xanthoma
-papillary (bumpy), white to white-yellow to pink
-association: none specific
Giant cell fibroma
-papillary (bumpy), usually pink
-assocation: none specific
antral pseudocyst aka mucous retention cyst
inflammatory
2/2 sinus inflammation (sinusitis)
2/2 dental inflammatory
relative radiopacity in sinus
consider: vitality of teeth, perio eval
What are the 2 most common sites for salivary gland tumors?
Parotid: 80%
Minor Glands: 20%
Which salivary glands have the highest frequency of malignancy? Which is the lowest?
80-50-20 rule
80% benign Parotid
50% benign- submandibular/minor
20% benign sublingual
Which is the most common benign salivary gland tumor?
Pleomorphic adenoma (mixed tumor)
Which is the most common MALIGNANT salivary gland tumor?
Mucoepidermoid carcinoma
What are the diagnostic findings for sjogrens syndrome?
Blood work determines SS–> Anti-Ro (SS-A), Anti-La (SS-B)
1.: ocular >3month of dry eyes
2: dry mouth >3 months
and more
and described the lesion
Ill defined lesion on the R mandibule.
DDx: Fibrous Dysplasia (ground glass)
Paget’s disease (Cotton wool)
Often displaces teeth as lesion expands
may be symptomatic if it impinges on nerves
not age specific
warrants a full body exam for polyostotic disease or endocrine disturbance
Thyroid–> Calcitonin= activates osteoblasts, therefore decrease blood calcium levels by decreasing bone breakdown by inhibiting osteoclast. Whereas, PTH(antagonist with calcitonin) activates osteoclast and thereby increases blood calcium.
lichenoid mucositis
linea alba
Herpes zoster
What would you find from the biopsy of a traumatic bone cyst
Uncomplicated non-epithelial lined cavity within the jaw.
No known cause, however trauma is suspected.
Inside the cyst = nothing
What are sialoliths, and how do you manage them in the parotid duct and sublingual duct?
salivary gland stones, painful swelling
tx: sour foods to stimulate flow
increase fluid intake
OTC pain meds
if too bad, need sx
DDX for a multilocular radiolucent lesion of the mandible
MACHO
Myxoma
Ameloblastoma
Centra Giant Cell Granuloma
Hemangioma
OKC
Alveolar osteitis- what is it and how do you treat it?
dry socket- loss of blood clot frmo a healing ext socket
Increases risk: smoking, BC, hx of infection, traumatic extraction, inadeuqate irrigation
Decrease risk: CHX pre-rinse, Good OH
Tx: pallative, numb, irrigate, dry socket dressing (eugenol on gel foam)
daily f/u
What is the retromolar pad? What is it?
Contains mucous glands, temporalis tendon, buccinator tendon
occlusal plane reference for denture teeth setup
What types of tissues are apthous ulcers located on?
Non-keratinized
What type of treatment would you prescribe for aphthous ulcers?
CHX
viscous lidocaine
Lidex-TID (Fluocinonide Ointment 0.05%)
Lichenoid Reaction: How do you manage, What would you prescribe?
Discontinue and med causing allergy Ie: cinnamon, new meds, toothpaste, mouthwashes
Ensure ot rule out pemphigus, pemphigoid and desquamative gingicitis
Lidex- TID (Fluocinonide 0.05%)
Doxycycline 20mg BID
Pseudomembranous candidiasis…why would someone have this?
taking ABX
denture
RPD
dry mouth
inhaler
smoker
immunocompromised
What do you prescribe for pseudomembranous candidiasis
Nystatin Solution (soak denture)
Clotrimazole Troche
What contributes to gingival overgrowth
meds:
Antiseizure (Dilantin)
Chemotheraputic (cyclosporine)
CC Blocker(enalapril)
Necrotizing gingivitis
leukemic overgrowth- soft boggy
Pregnancy
What is the tx for gingival overgrowth
plasty
stop meds
oral hyg
Hypoparathyroidism- discuss it
Parathyroid- affects calcium and phosphorous metabolism –> bones and teeth
Types:
Primary: increased PTH from tumor
2ndary: increased PTH due to abnormality low Ca or Vit D
Tertiary: long standing 2ndary hyperparathyroid
Findings:
Osteoporosis
vauge jaw pin, pulp stone, altered eruption, perio issues
Brown tumor- often in the jaw- mostly RL little mix.
Bump on the side of the tongue- Diff Dx
fibroma
Neuroma
Lipoma
Neurofibroma
papilloma
Squamous cellCarcinoma
What is it?
melanotic macule
physiologic pigmentation
melanocytic nevus
tattoo
melanoma
ABCDEs of melanoma
A: asymmetry
B: irregular boarder
C: color reddish
D: diameter >6mm
E: evolution raised, changed?
What are syndromes associated with neurofibromas?
Neurofibromatosis
Cowden
Peutz-Jeuger’s syndrom
If there appeared to be an enlarged
cyst around a canine…could you still
extrude it?
Give DDX
No
Dentigerous cyst
Eruption cyst
OKC
AOT
Ameloblastoma
Supernumerary tooth in the maxilla with a white lesion around the tooth — what is it?
Odontogenic lesions with calcifications
Odontoma
COC: Gorlin cyst (Calcifying odontogenic cyst )
CEOT (Calcifying epithelial odontogenic tumor) Pindborg
AOT (adenomatoid odontogenic tumor)
What are the DiffDx for a radiopacity lesion at the apex of the tooth?
Condensing osteitis (non-vital)
Idiopathic osteosclerosis (vital)
Odontoma
Fibro-osseous lesion
cementoblastoma
osteoblastoma
What are the diffDx for white lesions intraorally?
leukedema
white sponge nevus
hyperkeratosis acanthuses
Epithelial dysplasia
SCC
lichen planus
cadidiasis
traumatic fibroma
Gum bumps- “Ps”
4 P’s
Pyogenic granuloma
peripheral giant cell granuloma
peripheral ossifying fibroma
“Plain” fibroma
What are Wickham’s Striae?
Fine white or gray lines (dots) seen on top of oral mucosa lesions associated with lichen planus.
Steven’s Johnson
erythema Multiform
*Pemphigoid: -Ophthamlic concerns, Nikolsku sign +/-
Pemphigus- dem concerns, nikolsky sign +
Biopsy x 2: 1 with formalin, one with Miche’;s
Tx: topical or systemic steriods, F/u
