Oral Path Info Flashcards
Dentigerous Cyst (and hyperplastic dental follicle) Cause Commonality Most often which teeth Treatment
Cyst originating by separation of follicle. Fluid between reduced enamel epithelium and tooth crown Most common developmental cyst Mandibular 3rd molars Treatment: enucleation of cyst
Peripheral Ossifying Fibroma Originates from what Age and predilection Common region, exclusively on what Treatment
Originates from interdental papilla Age 15, 2/3 are female 50% in incisor/canine region Exclusively on gingiva Treatment: excision down to periosteum and scale adjacent teeth/ 15% RECUR from improper treatment
Mucous Membrane Pemphigoid Etiology Pathognomonic characteristic Most significant complication Treatment
Mucocutaneous autoimmune disease - Antibodies directed against Basement membrane Intraoral blister is pathognomonic Ocular involvement is most significant complication - can lead to blindness Treatment - possible referral to ophthalmologist Topical corticosteroids
Central Giant Cell Granuloma Neoplastic lesion? More common in which area Appearance is similar to what condition Treatment
Non-neoplastic More common in anterior jaw, midline Similar to Cherubism Treatment: Curettage with a 20% recurrence rate
Racial pigmentation Location Treatment
Most common on attached gingiva in darker complexioned patients Do nothing
Lichen Planus Def Identifiable characteristic 2 forms If confined to gingiva, called what Treatment Contraindications/risks of treatment
Chronic dermatologic disease Wickham striae Erosive and Reticular Gingiva - Desquamative gingivitis Treatment - Oral topical corticosteroids only when ulcerated - too much corticosteroids lead to candida, pain, burning Diabetics - steroids increase glucose
Fordyce Granules What is it Percent of population Where
Ectopic sebaceous glands 80% of population Buccal mucosa and lateral portion of vermillion of upper lip
Odontoma Commonality Types symptoms/discovered when Age Considered to be (what type of clinical description) Treatment
Most common odontogenic tumor Complex: Mass of enamel and dentin Compound: tooth like structures Asymptomatic, discovered on radiograph for failure of tooth eruption Age 15 considered to be a hamartoma Treatment: local excision, doesn’t recur
Torus/Exostoses Etiology Best known ones Other types Treatment
Localized bony protuberance arising form cortical plate Best known: Torus palatinus, torus Mandibularis Others: buccal exostoses, palatal exostoses, solitary exostoses Treatment: no treatment except removal if trauma is an issue (dentures)
Epulis Fissuratum Cause Appearance Location Associated with what condition (bump on the gums) Treatment
Hyperplasia of fibrous connective tissue in association with flange of ill-fitting denture Appearance: single or multiple folds of hyperplastic tissue in alveolar vestibule. Firm and fibrous, can be ulcerated and erythematous Facial aspect of alveolar ridge Also called Inflammatory Fibrous Hyperplasia Treatment: surgical removal, remake or reline denture
Mucocele Caused by Filled with what Most common location Treatment
Caused by trauma, rupture of salivary gland duct Mucin-filled Lower lip most common location Treatment: surgical excision with duct of minor salivary gland
Pemphigus Vulgaris Etiology Histo - 2 Treatment
Autoimmune disease - antibodies directed against desmosomes Histo: Acantholysis, Tzanck cells Treatment: Referral to dermatologist Corticosteroids
Adenomatoid Odontogenic Tumor (AOT) Radiographic term age Region of mouth, male female Origin Treatment
Snowflake Calcifications Age 10-20 (uncommon over 30) Mx>Md, F>M Tumor of odontogenic epithelium Treatment: enucleation
Lichen Planus Histo features - 4 (specific name of one feature) Treatment/Biopsy
Histo: 1. Pointed, saw tooth rete ridges 2. Band-like infiltrate of lymphocytes 3. Degenerating keratinocytes - Civatte bodies 4. Destruction of basal layer Bilateral and asymptomatic - no biopsy or treatment Asymmetric or symptomatic - biopsy and topical corticosteroids
Mucocele Most common locations Caused by Treatment Locations vs more serious conditions
Lower lip (most common), floor of mouth, anterior/ventral tongue, buccal mucosa Spillage of mucin into soft tissue, usually from trauma rupturing salivary gland duct Surgical excision with adjacent salivary duct Lower lip - benign mucoceles Upper lip - more likely to be salivary gland tumor Retromolar - tend to be mucoepidermoid carcinoma
Squamous Papilloma Cause Clinical Appearance - form, color, size Location Treatment
HPV types 6 and 11 Pedunculated, Exophytic, white red mucosal colored, enlarges to 5mm Tongue, lips, soft palate Treatment: Conservative surgical excision
Antral Pseudocyst How common Symptoms Increased prevalence during when Develops due to what
2-15% of population Asymptomatic Increase during winter months Due to accumulation of serum exudate (not mucous) beneath maxillary sinus mucosa
Odontogenic Keratocyst Etiology Recurrence Uni or multilocular Age Evaluate for what other condition Histo Treatment
Arises from cell rests of dental lamina 30% recurrence rate - up to 10 yrs after Both uni and multi-locular Young pts, less than 20 Evaluate for Gorlin Syndrome Histo: Palisading basement membrane Treatment: enucleate and curettage
Erythroleukoplakia Caused by Treatment Biopsy reveals what
Tobacco, Alcohol, Sanguinaria, UV, Microorganisms (syphilis, candida) Biopsy reveals advanced dysplasia Premalignant lesion
Angular Cheilitits Def Caused by what Treatment
Accentuated folds at corners of mouth C. Albicans or Staph Aureus Treatment: Antifungal
Lichen Planus Etiology 4 Ps of skin lesions Characteristic manifestation What two forms - which is more common
Common, chronic, immunologically mediated dermatologic disease Ps - Purple, Pruritic, Polygonal, Papules Wickham’s Striae - Lace-like network of white lines Two forms: Reticular (more common) Erosive
White Coated Tongue Scraped? Etiology - accumulation of what Causes Treatment
Can be Scraped Accumulation of bacteria and desquamated epithelial cells Lack of oral hygiene, High carb diet Periodic scraping/brushing
Peripheral Giant Cell Granuloma Cause age and predilection Distinct clinical/radiograph characteristic Similar to but different how, from what condition Treatment
Reactive lesion caused by irritation/trauma 35 yrs, 60% female Cupping resorption of alveolar bone Looks like Pyogenic granuloma, but more blue or purple Treatment: surgical excision down to bone, scale adjacent teeth 10% RECUR
Sialolith Cause Risk factors Most common location, why Symptoms Diagnose with what Treatment - 5
Calcifications developed in salivary duct Risk: mucous plug, bacteria, chronic blockage, xerostomia Location: Submandibular gland - long and tortuous duct with thick secretions Symptoms: Pain or swelling at meal time Dx: Radiograph, ultrasound, CT Treatment: Gentle massage, increased fluid intake, moist heat, sialogogue, surgery
Melanotic Macule types Oral counterpart to what Etiology Treatment
Oral counterpart to ephelis Etiology: brown asymptomatic macule produced by a focal increase in melanin production Treatment: can’t be distinguished clinically from early melanoma, biopsy required
Periapical cemento-osseous dysplasia Mostly in which gender Ethnicity Region in mouth Appearance of PDL Treatment
90% female 70% African American Periapical region of anterior mandible PDL will be intact, lesion not fused to roots Treatment: diagnosis definitive from clinical and radiograph exam, no biopsy required (same for florid)
Denture Stomatitis A type of what condition Caused by what Treatment
Type of Erythematous Candidiasis Caused by candida, not removing denture Treatment: Treat both denture and soft tissues Antifungal mouth rinse, soak denture in Nystatin
Ameloblastic Fibro-Odontoma (AFO) Age Location in mouth Origin Treatment
Age 10 Posterior jaw MIxed odontogenic tumor (odontogenic epithelium and odontogenic ectomesenchyme) Treatment: Conservative curettage
Geographic tongue also called what if not on tongue Kind of condition Symptoms Common in patients with what
Benign migratory glossitis Erythema migrans Inflammatory condition Burning / Pain Patients with fissured tongue
Focal Cemento-Osseous dysplasia Mostly in which gender Age Ethnicity Treatment
90% in females Average age 40 More common in caucasians Treatment: require biopsy, features are less specific
When to treat cemento-osseous dysplasia
When radiolucent, lesions don’t cause problems When radiopaque, lesions can be hypovascular and prone to necrosis and secondary infection frequent recall
Lateral Periodontal cyst Arises from what type of cyst Intrabony counterpart to what Common region Treatment
Arises from rests of dental lamina Developmental odontogenic cyst Counterpart to gingival cyst of the adult Mandibular/Premolar/Canine/Lateral incisor area Treatment: Conservative enucleation
Nasopalatine duct cyst Etiology Commonality Treatment
Two passageways persist in midline between primary and secondary palates Most common non-odontogenic cyst Treatment: NEVER sit and watch Biopsy is mandatory surgical enucleation
Recurrent Herpes Location Caused by Virus lies latent where Prodrome occurs when Always on what tissue Treatment/Healing
Indurated lesions on lip and keratinized bound mucosa HSV type 1 Trigeminal nerve Prodrome 6-24 hours before outbreak Intraoral lesions always on keratinized bound tissue Treatment: heals in 7 - 10 days Acyclovir for severe cases (shorten outbreak duration and lessen severity)
Traumatic Ulcer Acute or Chronic trauma? Injuring usually from what Appearance Location Treatment When to biopsy Traumatic ulcer of tongue
Both acute or chronic Injury from dentition Erythema surrounding central removable, yellow fibrinopurulent membrane -Lips, tongue, buccal mucosa -remove source of trauma, topical analgesics Biopsy if not gone in 2-4 weeks TUGSE - traumatic ulcer on tongue
Leukoplakia Def Causes Treatment Severities 80% of time it is what condition
Intraoral white plaque that does not rub off and cannot be identified as any well known entity Tabacco (80% are smokers), Alcohol, Sanguinaria, UV radiation, Microorganisms (treponema pallidum), Trauma Biopsy Mild dysplasia (lower 1/3 altered), Moderate dysplasia (lower 1/2), Severe dysplasia (aboe 1/2) This condition is precancerous 80% is hyperkeratotis PVL is highest risk of cancer
Fibroma Cause Commonality Most common location Treatment
Caused by reactive hyperplasia of fibrous connective tissue from local irritation or trauma Most common tumor of oral cavity Buccal mucosa along bite line Treatment: conservative surgical excision MUST submit excised tissue for microscopic examination
Parulis What Inflamed what kind of tissue Other names Treatment
Periapical abscess forms pus, follows least resistance, point of exit Subacutely inflamed granulation tissue Also called bum boil or intraoral sinus tract Treatment: Drainage, Gutta percha to find source of infection, extraction or endo treatment resolves infection
Periapical Cyst Cause originate from what Symptoms Radiograph Growth speed Relation to removal of tooth Location Treatment
Inflammatory stimulation of epithelium in area From Rests of Malassez Asymptomatic with no pulpal response Radiographically identical to periapical granuloma Slow growth or static Can be residual upon affected tooth removal Can be found on side of root: lateral apical periodontal cyst RCT or extraction
Pseudomembranous Candidiasis Known as what Resembles what Most common locations Scraped? Causes - 3
Thrush Resembles cottage cheese Buccal mucosa, palate, dorsal tongue Can scrape off - Broad spectrum antibiotics, impaired immune system (Leukemia, HIV, Infants), Asthma inhalers
Black/Brown Hairy tongue Accumulation of what, which papilla Associated with what possible causes Symptoms/signs Treatment
Accumulation of keratin on filiform papilla Associated with Smoking, poor hygiene, antibiotics, radiation - Gagging, bad taste, halitosis, esthetics - Tongue Brushing/scraping with oral hygiene instruction
Inflammatory Papillary Hyperplasia Cause clinical appearance symptoms Treatment
Caused by Ill fitting denture, Poor denture hygiene, Wearing it 24 hrs appearance: erythematous tissue, pebbly or papillary surface Asymptomatic Treatment: Removal of denture, Antifungal may help, surgical removal if lesions are advanced
Leukoedema Location - Uni or bilateral Cause Treatment Test Ethnic Relation
Bilateral buccal mucosa, doesn’t rub off Caused by - variation of normal edematous swelling No treatment Stretch cheek, disappears up to 90% of African Americans - melanin
Bump on the gums differential
Pyogenic Granuloma Peripheral Ossifying Fibroma Peripheral Giant Cell Granuloma Inflammatory Fibrous Hyperplasia
Tonsilloliths Location Made of what Where on radiograph Secondary results, can promote what negative condition Symptoms Treatment
Pharyngeal tonsillar crypts Desquamated keratin and foreign material Midportion of ascending ramus on radiograph Secondarily colonized with bacteria, calcify, smell, promote recurrent tonsillar infections Asymptomatic Treatment: Gargle warm salt water, water jet, enucleation, excision
Residual cyst Etiology Arises from what, why As cyst ages, what happens Treatment
Cyst that persists at site of previous tooth extraction Arises from rests of malassez stimulated by inflammation and infection Aging causes cellular components to degenerate, can lead to dystrophic calcification and central luminal radiolucency Treatment: surgical excision
Traumatic Bone cyst Filled with what X-ray term True cyst? Etiology Treatment
Filled with fluid Scalloping Not a true cyst Trauma-hemorrhage theory most accepted - trauma doesn’t fracture, intraosseous hematoma, doesn’t repair correctly, liquifies Treatment: surgical exploration and curettage
Primary Herpetic Gingivostomatitis Relation to HSV 1 Age Tissue type Risks to self Relation to eyes Treatment
Most common symptom of primary HSV 1 infection Majority occur before age 5 Both movable and non-movable mucosa Can self inoculate Leading infectious cause of blindness Treatment: Acyclovir - early treatment is more effective and shortens episode lengths
Morsicatio Buccarum Other kinds Uni or Bilateral Length of time to wait/test
Labiorum, Linguarum Bilateral 2 weeks
Eruption cyst analog to what etiology age treatment
Soft tissue analogue of dentigerous cyst Etiology - separation of dental follicle form around the crown of erupting tooth Usually under 10 yrs Treatment: Cysts usually rupture spontaneously, if not, excision of roof of cyst to permit eruption of tooth
Varicosities Detected by what Treatment
Detected by blanching No treatment unless on lips or buccal mucosa - for thrombus or esthetics
Idiopathic Osteosclerosis What Treatment
Focal area of increased radiodensity of unknown cause Treatment: no treatment. Biopsy if symptoms exist or if cortical expansion
Lymphoepithelial Cyst What is it Colors Symptoms Size Location Treatment
Lesion within oral lymphoid tissue, submucosal mass White or yellow Asymptomatic Less than 1 cm in diameter Most common on lingual and palatine tonsils and FOM Waldeyer’s ring (palatine tonsils, lingual tonsils, pharyngeal adenoids), ventral tongue, soft palate Treatment: surgical excision (biopsy) or clinical diagnosis
Stafne Defect Cause Def Location
Caused by portion of submandibular salivary gland Focal concavity of cortical bone Lingual surface of mandible, below mandibular canal
Condensing Osteitis Distinguishing factor PDL appearance Distinguished from cemento-osseous dysplasia how Treatment
Associated with infection/Large restoration Thickened PDL No RL border, not cemento-osseous dysplasia Treatment: 85% regress after infection is eliminated
Tobacco Pouch Keratosis Appearance of teeth Does not include Treatment - effective for how many, time period When to take biopsy
brown/black stain on teeth is common, localized No Induration, ulceration, or pain Habit cessation or switch sides of tobacco 2 weeks Biopsy if persists for 6 weeks
Calcifying Odontogenic Cyst (COC) AKA Age Origin Cause Treatment
AKA Gorlin cyst age 35 Rests of Series and Malassez Unknown cause Simple enucleation or surgical excision
Calcifying Epithelial Odontogenic tumor (CEOT) AKA Radiograph key term Age Location in mouth Histo and lab test Origin Treatment
AKA Pindborg tumor Driven snow pattern Avg. age is 40 Md>Mx, Post>Ant, F=M Liesegang rings (amyloid-like areas), Positive Congo Red test Tumor of Odontogenic Epithelium Treatment: conservative local resection with a narrow rim of bone or curettage
Smoker’s Melanosis Etiology Treatment
Melanin production stimulated by nicotine - Cessation of smoking with biopsy if found in unexpected location or clinical changes
Differential for midline radiograph lesions
Central Giant Cell Granuloma Ameloblastoma OKC GOC
Linea Alba Location Causes How common
buccal mucosa, occlusal plane Pressure, irritation, sucking 10% of population
Ameloblastoma Commonality Mostly occur in which region (except for which form) Uni or multilocular Bone formation Histo Treatment - most common procedure and size of cut
Most common clinically significant odontogenic tumor 85% occur in mandible molar ascending ramus region - except desmoplastic which occurs in anterior maxilla Multilocular RL Buccal-Lingual coritcal expansion Histo: Palisading basal layer Treatment: Varies, most common is marginal resection 1.5 cm beyond radiographic lesion
Hypersensitivity type of reaction Two types - diffuse, localized, triggers
Allergic reaction -Contact stomatitis from cinnamon Toothpaste - diffuse Gum/candy - localized Plasma cell gingivitis - most cases related to hypersensitivity (Big red gum) Allergic reaction to cinnamaldehyde
Desquamative Gingivitis Describes what Differential Biopsy?
Describes gingival epithelium that spontaneously sloughs or can be removed with minor manipulation Lichen Planus Pemphigoid Pemphigus Hypersensitivity reaction Biopsy required
Drug related gingival hyperplasia Most common medications, used for what Treatment
Phenytoin (50%) - anticonvulsant, common in young pts Nifedipine (25%) - Calcium channel blocker Cyclosporine (25%) - Transplant therapy Brushing and flossing can help Change medication if possible
Lymphoid hyperplasia other names what is it Typical cause Appearance Tenderness Location When to biopsy
Lingual Tonsil, Accessory Lymphoid Aggregates Enlargement of lymphoid tissue Typically from infection Discrete, submucosal swellings, yellow or normal color Non-tender Most common in oropharynx - Base of tongue Lateral tongue, lymph nodes, Soft palate, WALDEYER’S RING Biopsy when unilateral
Amalgam Tatto Locations Treatment Other causes of tattooing
Gingiva, alveolar and buccal mucosa Treatment - biopsy only if radiograph is negative to rule out melanoma Other: pencil graphite, coal dust, metal dust, broken carborundum disks, burs, intentional tattooing
Florid cemento-osseous dysplasia More common in which gender Ethnicity Uni or bi lateral Treatment
90% female 90% African American Tendency to be bilateral and symmetrical Treatment: diagnosis definitive from clinical and radiograph exam, no biopsy required (same for Periapical)
Abcess Etiology - accumulation of what where Treatment
Accumulation of acute inflammatory cells (neutrophils) at apex Treatment: Root canal therapy
Lipoma What Commonality Location Treatment
Benign tumor of fat Most common mesenchymal neoplasm 50% occur in buccal mucosa Surgical excision
Periapical Granuloma How often is pulp involved in periapical lesion Pulpal irritants Commonality Symptoms Type of inflammation Cell types Radiographic features Treatment
95% pulpal involvement Bacteria, Mechanical, Thermal Most common periapical pathosis Most are asymptomatic with no pulpal response Chronic inflammation Plasma cells and lymphocytes Loss of lamina dura at root tip, root resorption possible Treat with RCT or extraction
Aphthous Stomatitis AKA Caused by Occurs where Types Age Treatment
AKA - Recurrent Aphthous Ulcer or Canker Sore No universal etiology - may be allergy or immune dysfunction -Exclusively on movable mucosa Minor (85%), Major (10%), Herpetiform (5%) Usually in younger patients Treatment: no treatment or OTC meds Magic Mouthwash or prescribed corticosteroids
Pyogenic Granuloma True Granuloma? Cause AKA Predilection for who, when Clinical features Age of lesion and color Treatment
Not a true granuloma Reactive lesion to local irritation or trauma, poor oral hygiene AKA Pregnancy tumor Female predilection, Pregnancy 1st trimester Clinical: proliferating capillaries, bleeds easily Young lesions: Red, Old: Pink Treatment: Surgical Excision, extending to periosteum Pregnancy - defer treatment unless esthetic problem
