Oral Path Exam 1 sweep 1 Flashcards
- Fluctuant –
wavelike on palpation due to fluid content
hardened
- Indurated –
lines forming a skin pattern
Dermatoglyphics –
scalloped
- Crenated –
flakes of retained surface keratin
- Scale –
dried blood, serum or purulent exudate on the skin surface
- Crust –
Amelogenesis Imperfecta 3 divisions
Hypoplastic
Hypomaturation
Hypocalcified
inadequate deposition of
enamel matrix
Hypoplastic AI
incomplete mineralization
Hypomaturation AI
no significant degree of mineralization
Hypocalcified AI
Dentin Dysplasia
—— inheritance, 2 types:
Autosomal dominant
Type I: Radicular Dentin Dysplasia
Type II: Coronal Dentin Dysplasia
Dentin Dysplasia
Type II:
Coronal Dentin Dysplasia
Thought to be related to dentinogenesis
imperfecta
Enlarged pulps with “thistle tube” appearance, pulp stones
Dentin Dysplasia
Type I:
Radicular Dentin Dysplasia
Radicular roots are very short “rootless teeth”, obliteration of pulp (crescent-shaped remnant in crown), periapical radiolucencies
Syphilis - Primary
Relatively painless ulceration – “chancre” Develops —- days after exposure
Most affect genital region; ~4% are oral
Lip, buccal mucosa, tongue
Resolves spontaneously in —-weeks
3-90
3-8
Syphilis - Secondary
Develops —- weeks after initial infection
Generalized ——
—– cutaneous eruption
Mucous patches & —– of oral mucosa
Split —- at angles of mouth
4-10
lymphadenopathy
Erythematous maculopapular
condylomata lata
papules
Syphilis - Tertiary
Develops after a latency period of —- years
Approximately 30% of patients affected
May affect any tissue; vascular, CNS, skin, bones, soft tissues
—- formation
Oral involvement may produce palatal perforation
1-30
Gumma
Hutchinson’s triad:
Malformed incisors (“Hutchinson’s incisors”) and molars (“mulberry molars”) Ocular interstitial keratitis Eighth nerve deafness
Syphilis - Histopathology
Primary and secondary lesions show intense ——- infiltrate
Tertiary (gumma) is characterized by ——- inflammation
Spirochetes can be identified using the ——- stain
plasmacytic
granulomatous
Warthin-Starry
Often associated with local trauma
actinomycosis
May follow dental extraction or untreated dental disease
Diffuse swelling and erythema
Draining sinus tracts
“Sulfur granules” – colonies of organisms in purulent exudate
cervicofacial actinomycosis
Histopathology
Filamentous bacteria that form colonies
Bacterial colonies surrounded by neutrophils
Adjacent tissue may show granulomatous inflammation or granulation tissue
Actino
Actino - Treatment
Removal of offending tooth
High-dose antibiotics, usually IV PCN for 2
weeks, then oral PCN for 2 weeks
Periapical actinomycosis usually responds to less aggressive treatment
Good prognosis with appropriate therapy
Histopathology: fluid accumulation within the epithelial cells of the spinous layer
leukoedema
Upper lip, lateral to midline; along nasolabial groove; 10% bilateral
nasolabial cyst
aka- “follicular cyst of the skin
epidermoid cyst
(Milia are simply very
small epidermoid cysts)
Uncommon
Lined by epidermis-like epithelium
Cyst wall contains adnexal skin structures hair follicles, sebaceous glands, sweat glands
May be classified as “benign cystic form of teratoma” (composed of tissue derived from multiple germ layers)
dermoid cyst
Sistrunk procedure for
thyroglossal duct cyst
Cervical variant of lymphoepithelial cyst
Presumably arises from remnants of the
branchial arches; usually 2nd arch
Fluctuant swelling of upper lateral neck
Usually anterior to the sternocleidomastoid
May develop fistula tract (1/3 of cases)
branchail cleft cyst
Lined by stratified squamous epithelium with lymphoid tissue in cyst wall.
branchial cleft cyst
Oral counterpart to branchial cleft cyst
Arises from epithelial rests trapped in oral
lymphoid tissue (Waldeyer’s ring or accessory lymphoid aggregates)
Oral Lymphoepithelial Cyst
Soft to firm, yellowish-white nodule
Usually <1 cm and asymptomatic
Treatment: Surgical excision is curative
Histopathology: Lined by stratified squamous epithelium with lymphoid tissue in cyst wall.
oral lymphoepithelial cyst
Patient management: Incisional biopsy is necessary for definitive diagnosis. with
desquamative gingivitis
Slowly progressive collagenous overgrowth
of the gingiva
gingival fibromatosis
Can Brutus Describe the Easy Lesion?
Color – Borders – Diameter (size) – Elevation (character) - Location
vareigated
(uneven color
An area of color change with NO elevation or
depression of the surface
May be any shape or color
macule
A macule over 2 cm in diameter
PATCH
Solid, elevated lesion
0.5 cm or less in diameter
papule
Solid, elevated lesion
Larger than 0.5 cm in diameter Sessile or pedunculated
nodule
A slightly-elevated lesion Can be of any surface area
Plaque
A fluid-filled elevation
0.5 cm or less in diameter
Vesicle
A fluid-filled elevation
Larger than 0.5 cm in diameter
Bulla
A slightly-raised lesion
Caused by increased production and retention of keratin
Keratosis
- Flat, pinpoint areas of hemorrhage
Petechiae
area of hemorrhage that is larger than
petechiae but not larger than 1 cm in diameter
Purpura
– area of hemorrhage that is larger than 1 cm in diameter
Ecchymosis
diffuse atrophy of dorsal tongue papillae, particularly after broad-spectrum antibiotics
acute onset
typically associated with “burning” sensation
acute atrophic candida
Probably referred to as “median rhomboid glossitis” in the past
Most are due to chronic candidiasis
Well-defined area of redness, mid-posterior
dorsal tongue
Usually asymptomatic
central papillary atrophy
Often associated with lip-licking or chronic use of petrolatum-based materials
Usually related to candidiasis, but may have other cutaneous bacterial microflora admixed
Redness, cracking of cutaneous surface
Typically responds well to topical antifungal therapy
perioral candida
Patient will have angular cheilitis, central papillary atrophy and a “kissing lesion” of the posterior hard palate
chronic multifocal candida
Also known as “candidal leukoplakia”
White patch that cannot be rubbed off
Uncommon; generally anterior buccal mucosa
May be problematic because a true leukoplakia may have candidiasis superimposed on it
Should resolve with antifungal therapy
hyperplastic candida
associated with specific immunologic defects related to how the body interacts with Candida albicans
Chronic Mucocutaneous Candidiasis –
– seen in situations of severe uncontrolled diabetes mellitus or immune suppression
Invasive Candidiasis
Imidazole antifungal agent
No significant systemic absorption or side
effects
Pleasant-tasting lozenges (troches)
Disadvantage – dosing schedule (should be dissolved in mouth 5 times per day)
Clotrimazole (Mycelex)
Triazole antifungal agent
Readily absorbed systemically- no significant
degree of side effects (potential drug interactions) Daily dosing is convenient
Relatively expensive
Fluconazole (Diflucan)
- combination of nystatin and triamcinolone
Mycolog II Cream
- combination of iodoquinol and hydrocortisone
Vytone Cream
Most cases are asymptomatic – calcified hilar lymph nodes seen coincidentally
Acute – may have flu-like illness
Chronic – cavitary pulmonary lesions
Disseminated – elderly, debilitated, or immunocompromised
histo
Granulomatous inflammation, with or without necrosis
1-2 micron yeasts, usually within macrophages Best visualized by silver stain (GMS) or PAS
histo
Acute – no treatment is usually necessary
Chronic or disseminated histoplasmosis – may
require amphotericin B
Ketoconazole or itraconazole for mild cases or as maintenance therapy
histo
Endemic to desert Southwest U.S.
100,000 people infected annually in U.S.
“Valley fever” represents a hypersensitivity reaction
coccidiomycosis
Inhalation of spores
Flu-like illness in 40% of infected patients Dissemination in <1%
Skin of central face may be affected; oral lesions are rarely described
coccidiomycosis
Histopathologically shows large (20-60 micron) spherules that contain endospores
Variable host response, ranging from acute to granulomatous inflammation
Diagnosis can be made by culture or biopsy
coccidiomycosis
Amphotericin B for disseminated cases
Fluconazole or itraconazole for milder cases May be more aggressive in persons of color
Generally good prognosis if patient is not immunocompromised
tx coccidiomycosis
Organism lives in pigeon droppings Transmitted by air-borne spores
Affects immunosuppressed patients almost exclusively
cryptococcosis
Histopathologically, 4-6 micron yeasts with a clear halo (representing a mucopolysaccharide capsule)
Organisms may be visualized with mucicarmine, PAS, or silver stain (GMS)
Diagnosis based on culture or identification of organisms in tissue sections
cryptococcosis
Severe cases treated with amphotericin B and flucytosine
Fluconazole for less severe cases and for maintenance
Poor prognosis because most patients are immunocompromised
tx crypto
Diagnosis is usually based on histopathologic findings because culture is too slow
Large, branching, nonseptate hyphae with extensive tissue necrosis
Hyphae are often seen plugging small blood vessels
Zygomycosis
Common; second in frequency to Candidiasis
Spectrum of disease that includes allergy, localized infection or invasive ———-
Spores in soil, water, decaying organic debris
May be “nosocomial” infection
Aspergillus
Features vary, depending on immune status and extent of tissue invasion
Allergy- Allergic fungal sinusitis (may trigger asthma)
“——-” – maxillary sinus fungus ball
Tissue damage - locally invasive
Immunocompromised patient - disseminated
aspergillus
Aspergilloma
Non-invasive disease: debridement
Invasive disease:
Voriconazole or itraconazole, with or without
debridement
Good prognosis if normal immune status
Poor prognosis if patient is immunocompromised
tx aspergillus
First oral antifungal agent that could be absorbed systemically- imidazole
Requires acidic stomach environment
Single daily dose is convenient
Problems with drug interactions and idiosyncratic hepatotoxicity (1 in 12,000)
ketoconazole
)
Approved for treating histoplasmosis Well-absorbed; daily dosing
Minimal side effects
Quite expensive
Itraconazole (Sporanox
Triazole compound; IV or oral
Approved for treating Candida, Aspergillus and
several other species
Side effects include photosensitivity
1st line therapy - invasive aspergillosis
Quite expensive ($460)
Voriconazole
