ORAL PATH: COMPLETE SET Flashcards
1
Q
Linea Alba
A
White Line on Buccal Mucosa
* Plane of occlusion
Focal Hyperkeratosis
* due to chronic friction on mucosa
2
Q
Traumatic Ulcer
A
Very Common
* Erosion: Incomplete break of epithelium
* Ulcer: Complete break through epithelium (much more painful)
3
Q
Erosion vs Ulcer
A
Erosion: Incomplete break of epithelium
* only mucosa layer
Ulcer: Complete break through epithleium
* goes into submucosal layer
4
Q
Chemical Burn
A
White Sloughing Mucosa
Due to:
* Aspirin (topical application)
* Hydrogen Peroxide
* Silver Nitrate
* Phenol
5
Q
Nicotinic Stomatitis
A
Red Dots= inflammed minor salivary duct openings on hard palate
Only premalignant if “reverse smoking” (lit end in mouth)
6
Q
Amalgam Tattoo
A
Traumatic implantation of amalgam particles into mucosa
* See clinically & radiographically
Don’t need to biopsy to treat
7
Q
Smoking-Associated Melanosis
A
Tobaccoo chemicals stimulate melanocytes to make more melanin
* Brown, diffuse, irregular macules
* anterior gingiva
Tx: reversible if stop smoking
8
Q
Melanotic Macule
A
Benign
* hyperpigmentation in mucous membrane (Basically a freckle)
9
Q
Peutz-Jeghers Syndrome
A
Melanotic Macule=Freckles (Lips and mouth)
+ Intestinal polyps
10
Q
Hairy Tongue
A
Elongated Filiform Papillae
11
Q
Dentifrice-Associated Sloughing
A
Related to SLS (Sodium-Lauryl Sulfate)
* Suggest SLS free toothpaste
12
Q
Submucosal Hemorrhage
A
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
13
Q
Herpes Simplex Virus
A
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)
14
Q
Varicella Zoster Virus (VZV)
A
Primary Infection: Varicella (aka chickenpox)
* self limiting
* Childhood
* Latent in trigeminal ganglion
Recurrent Infection: Herpes Zoster (Aka Shingles)
tx: Acyclovir
15
Q
Ramsay Hunt Syndrome
A
Herpes Zoster reactivation –>geniculate ganglion–>affects CN 7 & 8–>Facial paralysis + vertigo +deafness
16
Q
Coxsackie Virus
A
Hand-Foot-and-Mouth Disease
* Herpangina: Posterior oral cavity (soft palate, throat, & tonsils)
17
Q
Measles
A
aka Rubeola
Koplik’s Spots:
* red dots/ulcers on buccal mucosa
* before skin rash
Primary infection:
* self-limiting
* Kids
18
Q
HPV Papilloma
A
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):
19
Q
Verruca Vulgaris
A
HPV Papilloma type:
* Cause: HPV Strains
Common Skin Wart
20
Q
Condyloma Acuminatum
A
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
21
Q
Focal Epithelial Hyperplasia
A
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
22
Q
Oral Hairy Leukoplakia
A
Cause: EBV (Epstein-Barr Virus)
White patch on lateral tongue
* DOES NOT wipe off
Opportunistic infection
associated with:
* HIV
* Burkitt’s Lymphoma
23
Q
Syphillis
A
Cause: Treponema Pallidum (Spirochette bacteria)
Primary Lesion: chancre
Secondary Lesion
* Oral mucous patch
* condyloma latum
* Maculopapular rash
Tertiary Lesion:
* gumma
* CNS & CV involvement
24
Q
Congenital Syphillis
A
Hutchinsons Triad:
* Notched Incisors
* Mulberry molars
* Deafness
* Ocular Keratitis
25
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)
26
Gonorrhea
Cause: **Neisseria gonorrhoeae**
Oral manifestations=rare
27
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
28
Scarlet Fever
Cause: Group A Strep (Streptococcus pyrogenes)
* Strep throat becomes systemic
**Strawberry tongue**:
* White coated tongue w/red **fungiform** papillae
Tx: Penicillin
29
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)
30
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
31
What area of the mouth are nonkeratinized
Labial/buccal/alveolar mucosa
Floor Of Mouth
Soft palate
Ventral Surface of Tongue (Bottomside)
32
Behcet's Syndrome
Multisystem vasculitis:
* Oral and genital Aphthous ulcers
* Eye inflammation
Tx: Corticosteroids
33
Erythema Multiforme
Usually on lips
2 Forms:
Minor:
* Herpses simplex hypersensitivity
Major:
* Drug sensitivity
* aka Steven-Johnson Syndrome
34
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
35
Wegener's Granulomatosis
Allergic reaction to inhaled antigen
**Strawberry Gingivitis**
Tx: Corticosteroids (prednisone) & cyclophosphamide
36
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
37
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
38
Scleroderma
Hardened Skin and Connective Tissue
Restrict mouth opening
Uniform widened PDL space
39
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
40
Pemphigoid
**O, Old, Opthamlogist**
* Subasilar
* Autoantibodies against **Hemidesmosomes**
Pemphigus= U-bove
Pemphigoid=Below
41
Leukoplakia
Clinical Description, NOT a Diagnosis
White patch that does NOT rub off
* No obvious Clinical Dx
Tx: Mandatory biopsy
42
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
43
Erythroplakia
Clinical Description, NOT diagnosis
Red Patch
* higher risk of becoming malignant than leukoplakia (Erythroleukoplakis=highest risk)
Tx: Mandatory Biopsy
44
Erythroleukoplakia
Clinical Description, Not Dx
*Red and white patch
Highest risk for malignant transformation
Tx: Manditory biopsy
45
Actinic Cheilitis
Actinic=Solar
Cheilitis= lip inflammation
cause: sun damage (UV-B especially)
(UV-Bad)
46
Smokeless Tobacco-Associated Lesion
Wrinkly white appearance in vestibule
cause: smokeless tobaccco and additives
47
What are the high risk sites for oral cancer?
1. Floor of Mouth
2. Posterior Lateral Tongue
48
What are the different types of cancer and origin?
Carcinoma: Epithelial origin
Sarcoma: mesenchymal (aka CT) origin
Leukemia: Blood
Lymphoma: Lymphatics
49
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
50
Verrucous Carcinoma
aka Snuff Dippers Carcinoma
cause:
* **HPV 16 & 18**
* tobacco
Slow growing malignancy
Tx: Excisision
51
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
52
Plummer-Vinson Syndrome
=Mucosal Atrophy
+ Dysphagia (Trouble Swallowing)
+ Iron Deficiency anemia
+ Increased oral cancer risk
53
Basal Cell Carcinoma
Cause: Sun Damage
Rarely Metastasizes
least dangerous cancer
Tx: Surgical excision
54
Oral Melanoma
Malignancy of Melanocytes
* Purple/black lesion
High risk areas:
* Palate
* gingiva
5 year survial rate:
* Skin=65%
* Oral= <20%
55
Deep Fungal Infections
Fungi found in soils
Blastomycosis:
* Northeast US
* inhale spores
Caccidiomucosis:
* Southwest US
* Valley fever
Cryptococcosis:
* West US
Histoplasmosis:
* Midwest US
56
c
57
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
58
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
59
Lip Pits
Invagination at commissures or midline
Commisural Lip Pits: at corner of mouth
Paramedian Lip Pits: Bilateral midline lips
60
Van der Woude Syndrome
Most common genetic syndrome associated w/Cleft Lip & Palate
Cleft (Lip, palate, or both) + (Paramedial) Lip Pits
61
Fordyce Granules
Ectopic Sebacceous glands
Buccal Mucosa
Benign
62
Leukoedema
White/grey edematous (Fluid Filled) lesion
* on buccal mucossa (Very common)
Goes away when cheek is stretched
63
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**
64
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
65
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
66
Fissured Tongue
Folds & Furrows of dorsum tongue (Surface)
67
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
68
Angioma
Tumors composed of blood vessels or lymph vessels
69
Cherry Angioma
Red Mole
* very common
* Benign
* small tumor of capillarioes
70
Hemangioma
Congenital Focal Proliferation of capillaries
Most undergo involution as a child, but persistent lesions are excised
71
Lymphangioma
Congenital Focal Proliferation of Lymph Vessels
Oral Lymphangiomas:
* very rare
* purple spots on tongue
On neck=Cystic Hygroma
72
Sturge-Weber Syndrome
=Angiomas of leptomeninges (Arachnoid & pia Mater) + Skin w/CN V distribution
73
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
74
Branchial Cyst
**Lateral** neck swelling
Epithelial Cyst w/in *lymph node of neck*
75
Cysts
Have an epithelial lining
76
Oral Lymphoepithelial Cyst
Epithelial cyst w/in *Lymph nodes of oral mucosa*
Common: Palatal or Lingual Tonsils
77
Stafne Bone Defect
posterior mandible Radiolucency
* below mandibular/IAN canal
Normal Anatomic Variation: Very severe lingual concavity
78
Nasopalatine Duct Cyst
Heart shaped radiolucency in nasopalatine canal
caused by cystification of canal remnants
Tx: Surgical Excision
79
Globulomaxillary Lesion
Clinical Term (not a Dx)
* any radiolucency b/w maxillary canine and maxillary lateral incisor
80
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
81
Leukoplakia
Clinical Description, NOT a Diagnosis
White patch that does NOT rub off
* unknown etiology
Tx: Mandatory biopsy
82
Proliferative Verrucous Leukoplakia
Recurrent & warty
associated with: **HPV 16 & 18**
High risk of malignant transformation to SCC or verrucous carcinoma
83
Erythroplakia
Clinical Description, NOT a diagnosis
Red Patch
* higher risk of malignant transformation than leukplakia
Tx: Mandatory Biopsy
84
Actinic Cheilitis
Actinic=Solar
Due to sun damage (UVB especially)
85
Smokeless Tobacco-Associated Lesion
Wrinkly white appearance in vestibule
due to: smokeless tobaccco and additives
86
What are the high risk sites for oral cancer?
1. Floor of Mouth
2. Posterior Lateral Tongue
87
What are the different types of cancer?
originates from:
Carcinoma: Epithelial Tissue
Sarcoma: mesenchymal (aka CT)
Leukemia: Blood
Lymphoma: Lymphatics
88
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
89
Verrucous Carcinoma
cause:
* **HPV 16 & 18**
* tobacco
Slow growing malignancy
Tx: Excisision
90
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
91
Oropharyngeal SCC
HPV 16 & 18
92
Plummer-Vinson Syndrome
=Mucosal Atrophy + Dysphagia (Trouble Swallowing) + Iron Deficiency anemia + Increased risk of oral cancer
93
Basal Cell Carcinoma
Cause: Sun Damage
Rarely Metastasizes
Tx: Surgical excision
94
Oral Melanoma
Malignancy of Melanocytes
High risk areas: Palate & gingiva
5 year survial rate:
* Skin=65%
* Oral=20%
95
Fibroma
aka Traumatic Fibroma, Irritation Fibroma, Hyperplastic scar
Fibrous hyperplasia of oral mucosa
* Cause: Chronic Trauma or irritation
96
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
97
Dentur-Induced Fibrous Hyperplasia
Epulus Fissuratum:
* Base of vestibule
* Cause: Overextended flange of denture
Papillary Hyperplasia:
* hard palate
* cause: Poor denture hygiene
(Angular Cheilitis)
98
Traumatic Neuroma
Entangled submucosal mass of:
* neural tissue
* scar
Cause: Nerve Injury
* most common=mental foramen (Mental N.)
99
Multiple Endocrine Neoplasia
aka MEN 2B
=Multiple Neuromas (not traumatic)
+ medullary thyroid Cancer
+ Pheochromocytoma of adrenal gland
100
Pyogenic Granuloma
Hyperplasia of **capillaries**=RED color
Cause:
* Chronic trauma or irritation
Gingiva=most commn
101
Nodular Fasciitis
Neoplasm of **Fibroblasts**
easy to eradicate (Opposite of Fibromatosis)
* Rare recurrence
Tx: Excision
102
Fibromatosis
Neoplasm of **fibroblasts**
Difficult to eradicate (opposite of nodular fasciitis)
* high Recurrence
103
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
104
Schwannoma
aka Neurilemmoma
Neoplasm of **Schwann Cells**
**Acellular Verocay bodies in Antoni A Tissue**
* Forms a line of scrimmage
105
Neurofibroma
Neoplasm of **Schwann Cells** and **Fibroblasts**
106
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**
107
Leiomyoma
Neoplasm of **smooth muscle cells**
108
Rhabdomyoma
Neoplasm of **skeletal muscle cells**
109
Lipoma
Neoplasm of **fat cells**
buccal mucosa=most common
110
Fibrosarcoma
Malignant Proliferation of **fibroblasts**
111
Neurofibrosarcoma
aka Peripheral Malignant nerve sheath tumor
Malignant proliferation of **Schwann Cells**
112
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**
113
Leiomyosarcoma
Malignant proliferation of **smooth muscle cells**
114
Rhabdomyosarcoma
Malignant prolifeation of **Skeletal Muscle cells**
115
Liposarcoma
Malignant proliferation of **Fat cells**
116
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
117
Mucous Retention Cyst
Cause: Sialolith blocks salivary duct
* True Cyst
118
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
119
Sinus Retention Cyst
Aka Antal Pseudocyst
Cause: Salivary Glands blocked in sinus mucosa
Tx: None
120
Sarcoidosis
**Hyperimmune**
* involves granulomas
Triggers:
* Mycobacteria (same as TB)
Primarily a pulmonary disease
* Causes **XEROSTOMIA**
Tx: Corticosteroids
121
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
122
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
123
Monomorphic Adenoma
Benign Salivary Gland tumor
Composed of: **1 type of cell**
Includes:
* basal cell adenoma
* canalicular adenoma
* myoepithelioma
* oncocytic tumor
tx: Surgical excision
124
Warthin's Tumor
Benign Salivary Gland Tumor
Composed of:
* **Oncocytes**(Cells w/XS Mitochondria)
* **Lymphoid cells**
Most common: Parotid Gland of Older Men
125
Mucoepidermoid Carcinoma
Most common Salivary Gland Malignancy
composed of:
* **Mucous**
* **epithelial cells**
126
Polymorphous Low-Grade Adenocarcinoma (PLGA)
2nd most common Salivary Gland malignancy for minor glands
Adeno=gland
127
Adenoid Cystic Carcinoma
Malignant Salivary Gland Tumor
**Cribiform or Swiss cheese microscopic pattern**
5 year survival=70%
15 year=10% **Very Lethal**
128
Cysts
Cavities lined by epithelium
129
Odontogenic Cysts
derived from cells associated w/tooth formation
130
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
131
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
132
Lateral Periodontal Cyst
**Most common=mandibular premolar region**
* **Always vital tooth**
* not centered around apex
133
Gingival Cyst of Adult
**Soft tissue part of Lateral Periodontal Cyst**
**NO Radiolucency** bc not in bone
134
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
135
Primordial Cyst
Develops **where a tooth would have formed, but didn't**
Most common area=Mandibular 3rd molar
Tx: Complete removal
136
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
137
Gorlin Syndrome
=Multiple KCOTs (Keratocystic odontogenic tumor)
+ Multiple BCCs (Basal Cell Carcinomas)
+ Calcified Falx Cerebri
+ Fatal Disease
Aka Nevoid Basal Cell Carcinoma
138
Calcifying Odontogenic Cyst
aka Gorlin Cyst
**Rare & Unpredictable**
Involves: Ghost Cells
* empty space and filled w/keratin--> Calcify
* Little radiodencities on x-ray
139
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**
140
Classic Differential Diagnosis for Multilocular Radiolucency in posterior mandible?
Ameloblastoma
KCOT (Keratocystic Odontogenic Tumor)
CGCG (Central Giant Cell Granuloma)
COF (Central Odontogenic Fibroma)
141
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
142
Adenomatoid Odontogenic Tumor (AOT)
**anterior maxilla over impacted canine** (most common)
Contains:
* epithelial duct-like spaces
* enameloid material
143
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
144
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)
145
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
146
Ameloblastic Fibroma
**Children & Teens**
Posterior mandible
* contain: Myxomatous CT
Tx: Surgical Excision
147
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
148
Gardner Syndrome
=Multiple Odontomas
+ Intestinal Polyps
149
Hodgkin's Lymphoma
**Oral cavity=rare**
**Reed-Sternberg cells**= **Malignant B cells**
Tx: Chemo +/- radiation
150
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
151
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
152
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**
153
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
154
Aneurysmal Bone Cyst
**Pseudocyst w/ blood-filled spaces**
Posterior Mandible
* **Multilocular Radiolucency**:
* **Expansile**
Tx: Fine Needle Aspiration 1st (Blood=Confirms Dx)
* Excision
155
Hyperparathyroidism
**Multiple bone lesions that look like CGCG's**
* due to Excessive PTH Levels
**Brown Tumor**:
* Excess osteoclast activity--> **Elevated Alkaline Phosphate**
156
Cherubism
Clinical: **Symmetrical Bilateral Swelling**
Radiographically:
* **expansile bilateral multilocular RL**
Stops growing after puberty
157
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**
158
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
159
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
160
Fibrous Dysplasia
**Ground Glass Appearance**
* Fiberglass--> Fibrous Glass
Stops growing after puberty
Tx: Surgical recontouring for cosmetics (after puberty)
161
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
162
Osteoblastoma
Circumscribed opaque mass of bone & Osteoblasts
163
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
164
Cardinal Signs of Systemic Infection
FML!
Fever
Malaise
Lymphadenopathy
165
Chronic Osteomyelitis
**Diffuse Mottled Radiolucency**
**Garre's Osteomyelitis**:
* Chronic Osteomyelitis w/proliferative periosteitis (onion skin)
Tx: ANtibiotics & debridement of infected area
166
Focal Sclerosing Osteomyelitis
Aka Condensing Osteitis
Bone sclerosis
*resulting from low-grade inflammation (like chronic pulpitis)
Tx: None, address cause of inflammation
167
Diffuse Sclerosing Osteomyelitis
Same as Focal, BUT wider scale
* may lead to **Jaw fracture**
Bone Sclerosis:
* resulting from low-grade inflammation (like chronic pulpitis)
168
What are the most common symptoms associated with Malignant bone lesions?
**Nump lip/paresthesia**
169
Osteosarcoma
Sarcoma of the jaw
* **new bone is produced by tumor cells**
**Sunburst Pattern of radiopacity**
Tx: Resection & Chemo
170
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
171
Chondrosarcoma
Sarcoma of the jaws
* **New CARTILAGE is produced by tumor cells**
* Same presentation & Tx as osteosarcoma
**COndyle**
*. Due to cartilage origin
172
Ewing's Sarcoma
Sarcoma of **Long bones involving "Round cells"**
Children
* rarely affects the jaw
* swelling
Moth Eaten or Onion skinning
173
Metastatic Carcinoma
**Breast > Lung > Kidney > Kidney > Prostate**
174
White Sponge Nevus
Asymptomatic spongy white lesion on buccal mucosa
* **Doesn't wipe off**
* Autosomal Dominant
175
Epidermolysis Bullosa
**Skin & mucosa is fragile & Blisters easily**
* Widespread blisteriing
176
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
177
Cleidocranial Dysplasia
Autosomal Dominant
Common Sign:
* **Missing/poorly developed clavicles--shoulders appear hunched in towards midline**
* **Supernumery teeth**
Tx: Alot of Extractoins & Dentures
178
Ectodermal Dysplasia
X-Linked Recessive
Common Signs:
* **Missing Teeth**
* **Hypoplastic hair or nails**
179
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
180
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
181
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
182
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
183
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
