ORAL PATH: COMPLETE SET Flashcards
Linea Alba
White Line on Buccal Mucosa
* Plane of occlusion
Focal Hyperkeratosis
* due to chronic friction on mucosa
Traumatic Ulcer
Very Common
* Erosion: Incomplete break of epithelium
* Ulcer: Complete break through epithelium (much more painful)
Erosion vs Ulcer
Erosion: Incomplete break of epithelium
* only mucosa layer
Ulcer: Complete break through epithleium
* goes into submucosal layer
Chemical Burn
White Sloughing Mucosa
Due to:
* Aspirin (topical application)
* Hydrogen Peroxide
* Silver Nitrate
* Phenol
Nicotinic Stomatitis
Red Dots= inflammed minor salivary duct openings on hard palate
Only premalignant if “reverse smoking” (lit end in mouth)
Amalgam Tattoo
Traumatic implantation of amalgam particles into mucosa
* See clinically & radiographically
Don’t need to biopsy to treat
Smoking-Associated Melanosis
Tobaccoo chemicals stimulate melanocytes to make more melanin
* Brown, diffuse, irregular macules
* anterior gingiva
Tx: reversible if stop smoking
Melanotic Macule
Benign
* hyperpigmentation in mucous membrane (Basically a freckle)
Peutz-Jeghers Syndrome
Melanotic Macule=Freckles (Lips and mouth)
+ Intestinal polyps
Hairy Tongue
Elongated Filiform Papillae
Dentifrice-Associated Sloughing
Related to SLS (Sodium-Lauryl Sulfate)
* Suggest SLS free toothpaste
Submucosal Hemorrhage
Extravascular lesions that DO NOT BLANCH
* Vascular lesions (Hemangiomas, telangiectasias) do blanch
Petechiae: 1mm Hemorrhages
Purpura: Slightly larger than petechiae
Ecchymosis: 1 cm or bigger bruise
Hematoma: Mass of blood w/in tissue, caused by trauma to oral mucosa
Tx: Eliminate the cause
Herpes Simplex Virus
Primary Infection:
* Pan-oral (Anywhere in mouth)
* self-limiting
* typically in children
* tx: palliative (symptomatic relief)
* Remains latent in trigeminal ganglion
Recurrent: Keratinized tissue only
1.Herpes labialis: (Cold sore, fever blister)
* vermillion border
2.Recurrent Intraoral Herpes:
* attached gingiva, hard palate
Reactivation is triggered by: Sunlight, stress, or immunosuppresion*
Herpetic Whitlow: Finger Lesions
Herpes Gladiatorum: Head (typically in wrestlers)
Tx: Acyclovir in prodormal period (before it activates)
Varicella Zoster Virus (VZV)
Primary Infection: Varicella (aka chickenpox)
* self limiting
* Childhood
* Latent in trigeminal ganglion
Recurrent Infection: Herpes Zoster (Aka Shingles)
tx: Acyclovir
Ramsay Hunt Syndrome
Herpes Zoster reactivation –>geniculate ganglion–>affects CN 7 & 8–>Facial paralysis + vertigo +deafness
Coxsackie Virus
Hand-Foot-and-Mouth Disease
* Herpangina: Posterior oral cavity (soft palate, throat, & tonsils)
Measles
aka Rubeola
Koplik’s Spots:
* red dots/ulcers on buccal mucosa
* before skin rash
Primary infection:
* self-limiting
* Kids
HPV Papilloma
aka Wart
* Cause: HPV Strains
* Benign epithelial proliferation of skin or mucosa (Pedunculated or sessile)
Verucca Vulgaris:
Condyloma Acuminatum:
Focal Epithelial Hyperplasia (Heck’s Disease):
Verruca Vulgaris
HPV Papilloma type:
* Cause: HPV Strains
Common Skin Wart
Condyloma Acuminatum
HPV Papilloma (Wart) Type:
* Cause: HPV 6 and 11
Genital wart, or from oral sex w/someone w/genital warts
Tx: Excise w/high recurrence
Focal Epithelial Hyperplasia
Aka Heck’s Disease
HPV Papilloma Type (wart):
* Cause; HPV 13 and 32
Multiple small dome-shaped warts on oral mucosa
“Whole mouth goes to heck”
Tx: Excise w/excellent prognosis
Oral Hairy Leukoplakia
Cause: EBV (Epstein-Barr Virus)
White patch on lateral tongue
* DOES NOT wipe off
Opportunistic infection
associated with:
* HIV
* Burkitt’s Lymphoma
Syphillis
Cause: Treponema Pallidum (Spirochette bacteria)
Primary Lesion: chancre
Secondary Lesion
* Oral mucous patch
* condyloma latum
* Maculopapular rash
Tertiary Lesion:
* gumma
* CNS & CV involvement
Congenital Syphillis
Hutchinsons Triad:
* Notched Incisors
* Mulberry molars
* Deafness
* Ocular Keratitis
Tuberculosis
Cause: Inhale Mycobacterium Tuberculosis
* Lung infection then nonhealing chronic oral ulcers
Primary Infection: Ghon Complex
Secondary Infection:: more wide spread lung infection w/cavitation
Miliary Infection: systemic spread
HIV Pts=Higher risk of progressive disease
Tx: Multidrug therapy
* Isoniazid, rifampin, ethambutol)
Gonorrhea
Cause: Neisseria gonorrhoeae
Oral manifestations=rare
Actinomycosis
Cause: Actinomyces israelii (Filamentous bacteria)
* NOT FUNGAL)
sulfur granules In puss*
types:
* Periapical: Jaw infections
* Cervicofacial: Head and neck infections
Tx: Long term high does Penicillin
Scarlet Fever
Cause: Group A Strep (Streptococcus pyrogenes)
* Strep throat becomes systemic
Strawberry tongue:
* White coated tongue w/red fungiform papillae
Tx: Penicillin
Candidiasis
aka Thrush
Types:
Pseudomembranous:
* White plaque that rubs off
Atrophic:
* Red
Median Rhomboid Glossitis:
* Loss of lingual papillae (pictured)
Angular Cheilitis:
* Corner of mouth
Tx: Antifunal (Azole or statin)
Aphthous Ulcer
Aka Canker Sore
Affeects Nonkeratinized tissue
* Herpes ulcers only on keratinized tissue
2 Forms:
Minor:
* Heal w/o scarring
* Tx: Salt rinse
Major: Aka sutton disease
* Heal w/scarring
What area of the mouth are nonkeratinized
Labial/buccal/alveolar mucosa
Floor Of Mouth
Soft palate
Ventral Surface of Tongue (Bottomside)
Behcet’s Syndrome
Multisystem vasculitis:
* Oral and genital Aphthous ulcers
* Eye inflammation
Tx: Corticosteroids
Erythema Multiforme
Usually on lips
2 Forms:
Minor:
* Herpses simplex hypersensitivity
Major:
* Drug sensitivity
* aka Steven-Johnson Syndrome
Angioedema
Allergic reaction to drug or food contact
Diffuse swelling of lips
* (and/or neck & face)
Mediated by IgE & histamines released by mast cells
Tx: Antihistamines
Wegener’s Granulomatosis
Allergic reaction to inhaled antigen
Strawberry Gingivitis
Tx: Corticosteroids (prednisone) & cyclophosphamide
Lichen Planus
T lymphocytes target & destroy basal keratinocytes
* secondary affect: Sawtooth rete pegs
Forms:
Reticular:
* Wickham striae
* White-lacy; net-like
* more common
Erosive:
* Wickham striae w/red ulceration
Tx: Corticosteroids
Lupus Erythematosus
Aka Lupus
Types:
Discoid Chronic:
* Disc-like lesion on fascial skin
* Oral lesions mimic erosive lichen planus
Systemic Acute:
* involves multiple organs
* butterfly rash over bridge of nose
* involves autoantibodies (ANA Test)
Tx: Corticosteroids
Scleroderma
Hardened Skin and Connective Tissue
Restrict mouth opening
Uniform widened PDL space
Pemphigus Vulgaris
Suprabasilar clefting
Autoantibodies against desmosomes
Bullae –> multiple painful ulcers
* bullae-big fluid filled blister that pops
Positive Nikolsky’s Sign: sloughing of outer skin layer
Tx: Corticosteroids
Pemphigoid
O, Old, Opthamlogist
* Subasilar
* Autoantibodies against Hemidesmosomes
Pemphigus= U-bove
Pemphigoid=Below
Leukoplakia
Clinical Description, NOT a Diagnosis
White patch that does NOT rub off
* No obvious Clinical Dx
Tx: Mandatory biopsy
Proliferative Verrucous Leukoplakia
Clinical Description
* Recurrent & warty
* associated with: HPV 16 & 18 (develop cervical cancer)
High risk of malignant transformation to:
* SCC or
* verrucous carcinoma
Erythroplakia
Clinical Description, NOT diagnosis
Red Patch
* higher risk of becoming malignant than leukoplakia (Erythroleukoplakis=highest risk)
Tx: Mandatory Biopsy
Erythroleukoplakia
Clinical Description, Not Dx
*Red and white patch
Highest risk for malignant transformation
Tx: Manditory biopsy
Actinic Cheilitis
Actinic=Solar
Cheilitis= lip inflammation
cause: sun damage (UV-B especially)
(UV-Bad)
Smokeless Tobacco-Associated Lesion
Wrinkly white appearance in vestibule
cause: smokeless tobaccco and additives
What are the high risk sites for oral cancer?
- Floor of Mouth
- Posterior Lateral Tongue
What are the different types of cancer and origin?
Carcinoma: Epithelial origin
Sarcoma: mesenchymal (aka CT) origin
Leukemia: Blood
Lymphoma: Lymphatics
Cancer Stages
Dysplasia: Pre-cancer
Carcinoma in situa: affects all epithelium layers
Manlignant Neoplasm: Aka Cancer
* invades past the basement membrane
* Local Invasion: Connective Tissue
* Metastasis: Access blood or lymph–>rest of body
Verrucous Carcinoma
aka Snuff Dippers Carcinoma
cause:
* HPV 16 & 18
* tobacco
Slow growing malignancy
Tx: Excisision
Squamous Cell Carcinoma
Aka Oral cancer, oral SCC
cause: oncogene activation or inactivation of tumor suppressor genes
Increased incidence of oropharyngeal SCC associated w/HPV 16 & 18
5 year survival rate: 50%
Tx: excision or radiation
Plummer-Vinson Syndrome
=Mucosal Atrophy
+ Dysphagia (Trouble Swallowing)
+ Iron Deficiency anemia
+ Increased oral cancer risk
Basal Cell Carcinoma
Cause: Sun Damage
Rarely Metastasizes
least dangerous cancer
Tx: Surgical excision
Oral Melanoma
Malignancy of Melanocytes
* Purple/black lesion
High risk areas:
* Palate
* gingiva
5 year survial rate:
* Skin=65%
* Oral= <20%
Deep Fungal Infections
Fungi found in soils
Blastomycosis:
* Northeast US
* inhale spores
Caccidiomucosis:
* Southwest US
* Valley fever
Cryptococcosis:
* West US
Histoplasmosis:
* Midwest US
c
Cleft Lip
4-6 weeks in utero
No fusion b/w medial nasal process and maxillary process anteriorly
Usually offset, Unilteral
More common in Males
Tx: Surgically repaired at 3-5 months old
Cleft Palate
6-8 weeks in utero
No fusion b/w palatal shelves/Medial Nasal Process and Maxillay process posteriorly
Primary Palate: carries lateral incisor to lateral incisor. Why lateral incisors are missing
Complete CP: No fusion of Both Primary & Secondary palates
More common in Females
Surgical Repair: 6-12 months old
Lip Pits
Invagination at commissures or midline
Commisural Lip Pits: at corner of mouth
Paramedian Lip Pits: Bilateral midline lips
Van der Woude Syndrome
Most common genetic syndrome associated w/Cleft Lip & Palate
Cleft (Lip, palate, or both) + (Paramedial) Lip Pits
Fordyce Granules
Ectopic Sebacceous glands
Buccal Mucosa
Benign
Leukoedema
White/grey edematous (Fluid Filled) lesion
- on buccal mucossa (Very common)
Goes away when cheek is stretched
Lingual Thyroid
Thyroid TIssue mass at midline base of tongue
*This is where the thyroid tissue orignates during development
* it normally migrates down the neck/trachea to form thyroid gland
located along embryonic path of thyroid descent
Thyroglossal Duct Cyst
Midline Neck Swelling
located along embryonic path of thyroid descent
Similar to lingual thyroid, but did not migrate all the way down
Geographic Tongue
Aka Benign Migratory Glossitis, Erythema Migrans
White Ring surround central red islands
* migrate
May be associated w/certain foods
occasionally hurt & burn
Tx: None
Fissured Tongue
Folds & Furrows of dorsum tongue (Surface)
Melkerson-Rosenthal Syndrome
=Fissured Tongue + Granulomatous Cheilitis + Facial Paralysis
Think of it as MELS BELLS
* Bells Palsy=another type of facial paralysis w/facial nerve
Rosy Red
* red affecting lips-cheilitis
Angioma
Tumors composed of blood vessels or lymph vessels
Cherry Angioma
Red Mole
- very common
- Benign
- small tumor of capillarioes
Hemangioma
Congenital Focal Proliferation of capillaries
Most undergo involution as a child, but persistent lesions are excised
Lymphangioma
Congenital Focal Proliferation of Lymph Vessels
Oral Lymphangiomas:
* very rare
* purple spots on tongue
On neck=Cystic Hygroma
Sturge-Weber Syndrome
=Angiomas of leptomeninges (Arachnoid & pia Mater) + Skin w/CN V distribution
Dermoid Cyst
If Above Mylohyoid
* midline floor of mouth mass (Intraoral)
If Below mylohyoid:
* upper neck mass (extraoral)
Contains Adnexal Structures (hair, sebaceous glands)
Doughy Consistency: Main distinguishing feature vs a ranula
Branchial Cyst
Lateral neck swelling
Epithelial Cyst w/in lymph node of neck
Cysts
Have an epithelial lining
Oral Lymphoepithelial Cyst
Epithelial cyst w/in Lymph nodes of oral mucosa
Common: Palatal or Lingual Tonsils
Stafne Bone Defect
posterior mandible Radiolucency
* below mandibular/IAN canal
Normal Anatomic Variation: Very severe lingual concavity
Nasopalatine Duct Cyst
Heart shaped radiolucency in nasopalatine canal
caused by cystification of canal remnants
Tx: Surgical Excision
Globulomaxillary Lesion
Clinical Term (not a Dx)
* any radiolucency b/w maxillary canine and maxillary lateral incisor
Traumatic Bone Cyst
Aka Simple Bone Cyst, Idiopathic Bone Cavity
Large radiolucency that scallops around tooth roots
No Epithelial lining (like a Pseudocyst)
Mostly in mandible of teenages
* associated w/jaw trauma
Tx: Aspirate to diagnose (Blood in it), Just monitor
Leukoplakia
Clinical Description, NOT a Diagnosis
White patch that does NOT rub off
* unknown etiology
Tx: Mandatory biopsy
Proliferative Verrucous Leukoplakia
Recurrent & warty
associated with: HPV 16 & 18
High risk of malignant transformation to SCC or verrucous carcinoma
Erythroplakia
Clinical Description, NOT a diagnosis
Red Patch
* higher risk of malignant transformation than leukplakia
Tx: Mandatory Biopsy
Actinic Cheilitis
Actinic=Solar
Due to sun damage (UVB especially)
Smokeless Tobacco-Associated Lesion
Wrinkly white appearance in vestibule
due to: smokeless tobaccco and additives
What are the high risk sites for oral cancer?
- Floor of Mouth
- Posterior Lateral Tongue
What are the different types of cancer?
originates from:
Carcinoma: Epithelial Tissue
Sarcoma: mesenchymal (aka CT)
Leukemia: Blood
Lymphoma: Lymphatics
Cancer Stages
Dysplasia: Pre-cancer
Carcinoma in situa: affects all epithelium
Manlignant Neoplasm: Aka Cancer
* invades past the basement membrane
* Local Invasion: Connective Tissue
* Metastasis: Access to blood or lymph to travel around the body
Verrucous Carcinoma
cause:
* HPV 16 & 18
* tobacco
Slow growing malignancy
Tx: Excisision
Squamous Cell Carcinoma
Aka Oral cancer, oral SCC
cause:
* oncogenes
* inactivation of tumor suppressor genes
Increased incidence of oropharyngeal SCC
5 year survival rate: 50%
Tx: excision or radiation
Oropharyngeal SCC
HPV 16 & 18
Plummer-Vinson Syndrome
=Mucosal Atrophy + Dysphagia (Trouble Swallowing) + Iron Deficiency anemia + Increased risk of oral cancer
Basal Cell Carcinoma
Cause: Sun Damage
Rarely Metastasizes
Tx: Surgical excision
Oral Melanoma
Malignancy of Melanocytes
High risk areas: Palate & gingiva
5 year survial rate:
* Skin=65%
* Oral=20%
Fibroma
aka Traumatic Fibroma, Irritation Fibroma, Hyperplastic scar
Fibrous hyperplasia of oral mucosa
* Cause: Chronic Trauma or irritation
Gingival Hyperplasia
aka Gingival Enlargement
CDC concerned about Gingival Hyperplasia
Calcium Channel Blockers:
* Nifedipine
* Amlodipine
* Verapamil
Dilantin: Anticonvulsant/epileptic
Cyclosporine: Immunosuppressant
Tx: Gingivectomy and discontinue drug if possible
Dentur-Induced Fibrous Hyperplasia
Epulus Fissuratum:
* Base of vestibule
* Cause: Overextended flange of denture
Papillary Hyperplasia:
* hard palate
* cause: Poor denture hygiene
(Angular Cheilitis)
Traumatic Neuroma
Entangled submucosal mass of:
* neural tissue
* scar
Cause: Nerve Injury
* most common=mental foramen (Mental N.)
Multiple Endocrine Neoplasia
aka MEN 2B
=Multiple Neuromas (not traumatic)
+ medullary thyroid Cancer
+ Pheochromocytoma of adrenal gland
Pyogenic Granuloma
Hyperplasia of capillaries=RED color
Cause:
* Chronic trauma or irritation
Gingiva=most commn
Nodular Fasciitis
Neoplasm of Fibroblasts
easy to eradicate (Opposite of Fibromatosis)
* Rare recurrence
Tx: Excision
Fibromatosis
Neoplasm of fibroblasts
Difficult to eradicate (opposite of nodular fasciitis)
* high Recurrence
Granular Cell Tumor
Neoplasm of Schwann Cells
Contain:
* granular cytoplasm
* Pseduoepitheliomatosu Hyperplasia (PEH)-mimics SCC histologically
Dorsal/Anterior tongue=Most common
Congenital Epulis of Newborn
* variant
* on gingiva
* no PEH
Schwannoma
aka Neurilemmoma
Neoplasm of Schwann Cells
Acellular Verocay bodies in Antoni A Tissue
* Forms a line of scrimmage
Neurofibroma
Neoplasm of Schwann Cells and Fibroblasts
Neurofibromatosis type I
Aka Von Recklinghausens Disease (Von FRECKLINGhuasen Disease)
=Multiple Neurofibromas
+ Multiple skin freckles (Cafe au lait spots)
+ Axillary Freckles (Crowe’s sign)
+ Iris freckles (Lisch spots)
neurofibromas can transform to neurofibrosarcomas
Leiomyoma
Neoplasm of smooth muscle cells
Rhabdomyoma
Neoplasm of skeletal muscle cells
Lipoma
Neoplasm of fat cells
buccal mucosa=most common
Fibrosarcoma
Malignant Proliferation of fibroblasts
Neurofibrosarcoma
aka Peripheral Malignant nerve sheath tumor
Malignant proliferation of Schwann Cells
Kaposi’s Sarcoma
Malignant proliferation of endothelial cells
cause: HHV8 (Human Herpes Virus 8)
* Hard Palate
* most commonly seen as complication in AIDs pt
Purple Lesion
Leiomyosarcoma
Malignant proliferation of smooth muscle cells
Rhabdomyosarcoma
Malignant prolifeation of Skeletal Muscle cells
Liposarcoma
Malignant proliferation of Fat cells
Mucous Extravasation Phenomenon
Cause: Salivary Duct Trauma
* not a true cyst
Mucocele:
* Lower Lip
* Salivary Duct blocked due to trauma
Ranula:
* Floor of mouth
tx: COMPLETE excision of minor gland
* Ranula=Sublingual Gland
Mucous Retention Cyst
Cause: Sialolith blocks salivary duct
* True Cyst
Necrotizing Sialometaplasia
Rapidly expanding ulcerative lesion
Cause: ischemic necrosis of minor salivary glands
* due to trauma or local anesthesia
Tx: Palliative
* heals on its own in 6-10 wks
Sinus Retention Cyst
Aka Antal Pseudocyst
Cause: Salivary Glands blocked in sinus mucosa
Tx: None
Sarcoidosis
Hyperimmune
* involves granulomas
Triggers:
* Mycobacteria (same as TB)
Primarily a pulmonary disease
* Causes XEROSTOMIA
Tx: Corticosteroids
Sjogren’s Syndrome
Autoimmune & lymphocyte mediated
* Affects salivary & tear glands
Types:
Primary:
* Keratoconjunctivitis sicca (Dry eyes)
* + Xereostomia
Seconary:
* Primary + another autoimmune disease (Rheumatoid arthritis)
Tx: Symptomatic
Pleomorphic Adenoma
Most common Benign Salivary gland tumor
comoppsed of:
* mixture of cell types: epithelial & CT
* why its AKA Mixed tumor
Firm rubbery swelling:
Water chest-nut Appearance
Most common site:
* minor salivary gland=palate
* parotid gland=ear
Monomorphic Adenoma
Benign Salivary Gland tumor
Composed of: 1 type of cell
Includes:
* basal cell adenoma
* canalicular adenoma
* myoepithelioma
* oncocytic tumor
tx: Surgical excision
Warthin’s Tumor
Benign Salivary Gland Tumor
Composed of:
* Oncocytes(Cells w/XS Mitochondria)
* Lymphoid cells
Most common: Parotid Gland of Older Men
Mucoepidermoid Carcinoma
Most common Salivary Gland Malignancy
composed of:
* Mucous
* epithelial cells
Polymorphous Low-Grade Adenocarcinoma (PLGA)
2nd most common Salivary Gland malignancy for minor glands
Adeno=gland
Adenoid Cystic Carcinoma
Malignant Salivary Gland Tumor
Cribiform or Swiss cheese microscopic pattern
5 year survival=70%
15 year=10% Very Lethal
Cysts
Cavities lined by epithelium
Odontogenic Cysts
derived from cells associated w/tooth formation
Radicular Cyst
Aka Periapical Cyst
Most common odontogenic cyst
Radiolucency at apex
* Always Nonvital tooth
Necrotic pulp –> periapical inflammation
* Acute=Abscess
* Chronic=Granuloma
Epithelial Rests of Malassez (ERM)
* from Hertwig’s Epithelial Root Sheath (HERS)
* encapsulate lesion=forms cyst
Tx: RCT, apicoectomy, or EXt w/curretage
Dentigerous Cyst
Aka Eruption Cyst
Accumulation of fluid b/w crown & Reduced Enamel Epithelium
Radiolucency attached to CEJ of impacted teeth
Most common: K9s & 3rd molars
Tx: Excision, but might be source of future odontogenic tumor
Lateral Periodontal Cyst
Most common=mandibular premolar region
* Always vital tooth
* not centered around apex
Gingival Cyst of Adult
Soft tissue part of Lateral Periodontal Cyst
NO Radiolucency bc not in bone
Gingival cyst of Newborn
Rests of dental lamina epithelialize the small lesions
Bohn’s Nodules=Lateral Palate
Epstein’s Pearls=midline palate
Tx: None,
* will go away as children get older
Primordial Cyst
Develops where a tooth would have formed, but didn’t
Most common area=Mandibular 3rd molar
Tx: Complete removal
Keratocystic Odontogenic Tumor (KCOT)
Aggressive & recurrent
Posterior Ascending Ramus of Mandible:
* Fusiform, M-D expansion (Not B-L)
* minimal displacement of teeth or resorption
Tx: Aggressive enucleation
Gorlin Syndrome
=Multiple KCOTs (Keratocystic odontogenic tumor)
+ Multiple BCCs (Basal Cell Carcinomas)
+ Calcified Falx Cerebri
+ Fatal Disease
Aka Nevoid Basal Cell Carcinoma
Calcifying Odontogenic Cyst
aka Gorlin Cyst
Rare & Unpredictable
Involves: Ghost Cells
* empty space and filled w/keratin–> Calcify
* Little radiodencities on x-ray
Ameloblastoma
Benign BUT very AGGRESSIVE
Posterior Mandible
* Multilocular expansive lesion (Beach Ball B-L Expansion) w/erosion and displacement of roots & cortical bone
Tx: Wide excision or resection
* if too conservative=high recurrence
Classic Differential Diagnosis for Multilocular Radiolucency in posterior mandible?
Ameloblastoma
KCOT (Keratocystic Odontogenic Tumor)
CGCG (Central Giant Cell Granuloma)
COF (Central Odontogenic Fibroma)
Calcifying epithelial Odontogenic Tumor (CEOT)
Aka Pindborg Tumor
Radiolucency with driven snow calcifications (White flecks)
Liesegang rings: amorphous pink amyloid w/concentric calcifications
Tx: Surgical Excision, good prognosis
Adenomatoid Odontogenic Tumor (AOT)
anterior maxilla over impacted canine (most common)
Contains:
* epithelial duct-like spaces
* enameloid material
Odontogenic Myxoma
aka Myxofibroma
Myxomatous CT=Slimy stroma
* Pulp-like material w/minimal collagen
Messy radiolucency with:
* unclear borders
* honeycomb/tennis racket pattern
Tx: Surgical Excision, moderate recurrence
Central Odontogenic Fibroma (COF)
Dense collagen w/strands of epithelium woven w/in it
Types:
Central:
* Bone
* well defined multilocular radiolucency
Peripheral:
* Gingiva
* No RL (not seen on x-ray)
Cementoblastoma
Well-circumscribed radiopaque mass
* ball of cementum + cementoblasts= replace root of tooth
Connected to the root (Surrounded by a PDL Space)
tx: Surgical excision and extraction
Ameloblastic Fibroma
Children & Teens
Posterior mandible
* contain: Myxomatous CT
Tx: Surgical Excision
Odontoma
Opaque lesion
* composed of dental hard tissues
* block eruption of teeth
2 types:
Compound:
* anterior
* “bag of teeth”
Complex:
* posteiror
* conglomerate mass of dental tissue
Gardner Syndrome
=Multiple Odontomas
+ Intestinal Polyps
Hodgkin’s Lymphoma
Oral cavity=rare
Reed-Sternberg cells= Malignant B cells
Tx: Chemo +/- radiation
Non-Hodgkin’s Lymphoma
Neoplasm of B or T cells
Burkett’s Lymphoma= Type of B cell NHL
Involves:
* bone marrow
* swelling
* pain
* tooth mobility
* Lip paresthesia (Pins & needs)
* Halted tooth development
Tx: Chemo +/- chemo
Multiple Myeloma
Aka Plasma Cell Myeloma
Neoplasm of Plasma Cells
* Antibody-secreting B cells
multiple punched out radiolucencies in skull
Amyloidosis
* Accumulation of amyloid proteins-from antibody light chains
Tx: Chemotherapy- Poor prognosis
Leukemia
Neoplasm of Bone Marrow cells:
* Lymphocytes
* NK Cells
* Granulocytes
* Megakaryocytes
Classification based on cell lineage (Myeloid or lymphoid) & Acute vs chronic:
* ALL -> CML -> AML -> CLL (Youngest to oldest)
* ALL Children Are Chill
Clinical Signs:
* Bleeding (Platelets)
* Fatigue (RBC)
* Infection (WBC)
Even though we are seeing increased production of bone marrow cells, they are immature & have less fxn
Central Giant Cell Granuloma (CGCG)
Anterior Mandible mostly
Composed of:
* Fibroblasts
* Multinucleated Giant cells
Types:
Central (CGCG):
* Bone
* RL w/thin wipsy septations
Peripheral:
* Soft tissue
* Red-purple gingival Mass
Tx: Excision
Aneurysmal Bone Cyst
Pseudocyst w/ blood-filled spaces
Posterior Mandible
* Multilocular Radiolucency:
* Expansile
Tx: Fine Needle Aspiration 1st (Blood=Confirms Dx)
* Excision
Hyperparathyroidism
Multiple bone lesions that look like CGCG’s
* due to Excessive PTH Levels
Brown Tumor:
* Excess osteoclast activity–> Elevated Alkaline Phosphate
Cherubism
Clinical: Symmetrical Bilateral Swelling
Radiographically:
* expansile bilateral multilocular RL
Stops growing after puberty
Langerhans Cell Disease
Aka Idiopathic Histiocytosis
Rare Cancer
Langerhan cells (Histiocytes):
* normally found in skin as antigen-presenting cells
* Cause damage if buildup in body
Punched out “Ice cream scoop” radiolucencies
* lead to floating teeth
Paget’s Disease
Progressive Metabolic Disturbance of many bones (Spine, femur, skull, jaws)
* Causes symmetric enlargement
Cotton Wool Appearance
Adults > 50
* Increased Bone Breakdown=Elevated alkaline phosphate
* Denture & hats become too tight
Associated with: hypercementosis
Tx: Bisphosphonates & Calcitonin
Central Ossifying Fibroma
Fibroblastic Stroma: form foci of mineralized products
* Similar in appearance & Behaviour to cementifying fibroma (Odontogenic tumor)
3 types:
Central:
* Bone
* Well circumscribed RL w/ossificaotin product in center
Peripheral:
* Soft tissue
* no RL
Juvenile:
* Aggressive variant
* rapid growth
* younger pts
Fibrous Dysplasia
Ground Glass Appearance
* Fiberglass–> Fibrous Glass
Stops growing after puberty
Tx: Surgical recontouring for cosmetics (after puberty)
Periapical Cemento-Osseous Dysplasia (PCOD)
Reactive Process
* Unknown Origin
Most common:
* apices of mandibular anteriors
* Middled aged black females
* Vital Teeth
Starts RL–>progress to RO (w/RL halo) as it matures
Osteoblastoma
Circumscribed opaque mass of bone & Osteoblasts
Acute Osteomyelitis
Cause:
* Odontogenic Infection
* Trauma
Infection/inflammation:
* Starts in the medullary space involving cancellous bone
* spreads to cortical bone, periosteum, soft tissues
Symptoms:
* Deep intense pain
* high or intermittent fever
* Paresthesia or anesthesia of IAN
* Tooth is not loose (This is caused by periodontitis)
Tx: Antibiotics
Cardinal Signs of Systemic Infection
FML!
Fever
Malaise
Lymphadenopathy
Chronic Osteomyelitis
Diffuse Mottled Radiolucency
Garre’s Osteomyelitis:
* Chronic Osteomyelitis w/proliferative periosteitis (onion skin)
Tx: ANtibiotics & debridement of infected area
Focal Sclerosing Osteomyelitis
Aka Condensing Osteitis
Bone sclerosis
*resulting from low-grade inflammation (like chronic pulpitis)
Tx: None, address cause of inflammation
Diffuse Sclerosing Osteomyelitis
Same as Focal, BUT wider scale
* may lead to Jaw fracture
Bone Sclerosis:
* resulting from low-grade inflammation (like chronic pulpitis)
What are the most common symptoms associated with Malignant bone lesions?
Nump lip/paresthesia
Osteosarcoma
Sarcoma of the jaw
* new bone is produced by tumor cells
Sunburst Pattern of radiopacity
Tx: Resection & Chemo
Bisphosphonate Related Osteonecrosis of the Jaws (BRONJ)
Greater risk w/IV Bisphosphonates than oral
5 yr survival rate: 25-40% (Pretty deadly)
Jaw Pain
* exposed necrotic bone
Tx: CHX rinse, antibiotics, conservative sx
Chondrosarcoma
Sarcoma of the jaws
* New CARTILAGE is produced by tumor cells
* Same presentation & Tx as osteosarcoma
COndyle
*. Due to cartilage origin
Ewing’s Sarcoma
Sarcoma of Long bones involving “Round cells”
Children
* rarely affects the jaw
* swelling
Moth Eaten or Onion skinning
Metastatic Carcinoma
Breast > Lung > Kidney > Kidney > Prostate
White Sponge Nevus
Asymptomatic spongy white lesion on buccal mucosa
* Doesn’t wipe off
* Autosomal Dominant
Epidermolysis Bullosa
Skin & mucosa is fragile & Blisters easily
* Widespread blisteriing
Hereditary Hemorrhagic Telangiectasia (HHT)
AkA Olser-Weber-Rendu Syndrome
Abnormal Capillary Formation on skin, mucosa, and viscera
associated with:
* iron deficiency anemia
* Espistaxis (Nose bleeds)=frequent sign
Telangiectasia=red macule or papule from diluted or broken capillaries
Cleidocranial Dysplasia
Autosomal Dominant
Common Sign:
* Missing/poorly developed clavicles–shoulders appear hunched in towards midline
* Supernumery teeth
Tx: Alot of Extractoins & Dentures
Ectodermal Dysplasia
X-Linked Recessive
Common Signs:
* Missing Teeth
* Hypoplastic hair or nails
Amelogenesis Imperfecta
Intrinsic alteration of the ENAMEL in primary and permanent teeth
* Normal Dentin and Pulp
Autosomal Dominant, Recessive, or X-linked
Tx: Full coverage crowns for cosmetics
Dentinogenesis Imperfecta
Intrinsic alteration of DENTIN in primary & permanent teeth
Autosomal Dominant
Characteristics:
* SHOrt roots, bell shaped crowns, & obliterated pulps
* Bulbous crowns in radiographs (Bc constricted DEJ)
* Blue sclera
Tx: Full Coverage crowns
Regional Odontodysplasia
Quadrant of teeth exhibiting:
* short roots
* open apices
* enlarged pulp chambers
Radiographic:
* Ghost teeth: pulps are so huge they make the teeth look almost completely RL
Tx: Ext affected teeth
Dentin Dysplasia
Intrinsic alteration of dentin in permanent & primary teeth
Autosomal Dominant
2 types:
* Type 1: Chevron Pulp w/short roots
* Type 2: Thistle shaped Pulp w/normal roots; Primary teeth=blue or amber color
Tx: Not good candidates for restorations
Fusion & Gemination
Fusion:
* 2 tooth buds merging into 1 tooth
* Tooth count=1 less than normal
Gemination:
* 1 root buds into 2 crowns
* tooth count=normal
