Oral Path/Radiology Flashcards
Acantholysis, resulting from desmosome weakening by autoantibodies directed against the protein desmoglein, is the disease mechanism attributed to which of the following? A. Epidermolysis bullosa B. Mucous membrane pemphigoid C. Pemphigus vulgaris D. Herpes simplex infections E. Herpangina
C. In pemphigus vulgaris, autoantibodies attach to
antigens (desmoglein) found in desmosomes
that keep keratinocytes linked to each other.
Cells eventually separate from each other (acan-
tholysis), resulting in short-lived intraepithelial
vesicles/bullae.
Papillomavirus has been found in all of the following lesions except \_\_\_\_\_. A. Oral papillomas B. Verruca vulgaris of the oral mucosa C. Condyloma acuminatum D. Condyloma latum E. Focal epithelial hyperplasia
D. Condyloma latum is one of the lesions that may
be seen in secondary syphilis, which is caused by
Treponema pallidum. All the other lesions listed
may be associated with human papillomavirus.
Intranuclear viral inclusions are seen in tissue specimens of which of the following? A. Solar cheilitis B. Minor aphthous ulcers C. Geographic tongue D. Hairy leukoplakia E. White sponge nevus
D. Hairy leukoplakia is viral in origin and shows
intranuclear inclusions in infected epithelial
cells. Hairy leukoplakia is caused by Epstein–Barr
virus, a herpes virus. Intranuclear epithelial inclu-
sions are also seen other herpes virus infections
(e.g., herpes simplex virus infections).
The odontogenic neoplasm, which is composed
of loose, primitive-appearing connective tissue
that resembles dental pulp, microscopically is
known as _____.
A. Odontoma
B. Ameloblastoma
C. Ameloblastic fibroma
D. Ameloblastic fibro-odontoma
E. Odontogenic myxoma
E. Odontogenic myxomas are connective tissue
neoplasms that contain little collagen. This gives
them an embryonic look microscopically.
A biopsy of the lower lip salivary glands showed
replacement of parenchymal tissue by
lymphocytes. The patient also had xerostomia
and keratoconjunctivitis sicca. These findings
are indicative of which of the following?
A. Lymphoma
B. Crohn’s disease
C. Mumps
D. Sjögren’s syndrome
E. Mucous extravasation phenomenon
D. This triad of signs defines primary Sjögren’s syn-
drome. The patient has secondary Sjögren’s
syndrome if rheumatoid arthritis or other autoim-
mune disease is present.
A patient seeks help for recurrent palatal pain.
She presents with multiple punctate ulcers in the
hard palate that were preceded by tiny blisters.
Her lesions typically heal in about 2 weeks and
reappear during stressful times. She has _____.
A. Aphthous ulcers
B. Recurrent primary herpes
C. Recurrent secondary herpes
D. Erythema multiforme
E. Discoid lupus
C. Recurrent intraoral herpes simplex infections
occur only in the hard palate and hard gingiva,
with the exception of AIDS patients. Blister (vesi-
cle) history and recurrence are also supportive of
this diagnosis.
Conservative surgical excision would be appropriate treatment and probably curative for which of the following? A. Nodular fasciitis B. Fibromatosis C. Fibrosarcoma D. Rhabdomyosarcoma E. Adenoid cystic carcinoma
A. Nodular fasciitis is a rapidly developing reactive
lesion that typically does not recur following
excision. Fibromatosis is an aggressive nonen-
capsulated lesion that has significant recurrence
potential. The other lesions listed are malignan-
cies and require more than simple excision to
prevent recurrence.
On a routine radiographic exam, a well-defined
radiolucent lesion was seen in the body of the
mandible of a 17-year-old boy. At the time of
operation, it proved to be an empty cavity. This
is a(an) _____.
A. Osteoporotic bone marrow
B. Aneurysmal bone cyst
C. Odontogenic keratocyst
D. Static bone cyst
E. Traumatic bone cyst
E. Traumatic bone cysts characteristically occur in
the body of the mandible of teenagers. They are
pseudocysts in that they have no epithelial lining.
They are empty cavities.
- A 21-year-old woman went to her dentist because
of facial asymmetry. This had occurred
gradually over a period of 3 years. The patient
had no symptoms. A diffusely opaque lesion was
found in her right maxilla. All lab tests (CBC,
alkaline phosphatase, calcium) were within
normal limits. Biopsy was interpreted as a fibro-
osseous lesion. She most likely has _____.
A. Cementoblastoma B. Fibrous dysplasia C. Cherubism D. Osteosarcoma E. Chronic osteomyelitis
C. Cherubism is a fibro-osseous lesion that occurs
in teenagers. Characteristically, it presents with
ill-defined margins and a “ground glass” appear-
ance radiographically. The other features
described also support this diagnosis.
A cutaneous maculopapulary rash of the head
and neck preceded by small ulcers in the buccal
mucosa would suggest which of the following?
A. Primary herpes simplex infection
B. Rubeola
C. Varicella
D. Primary syphilis
E. Actinomycosis
B. The maculopapulary rash of rubeola (measles) is
preceded by the herald sign of Koplick’s spots
(punctate ulcers of the buccal mucosa).
The idiopathic condition in which destructive
inflammatory lesions featuring necrotizing
vasculitis are seen in the lung, kidney, and
upper respiratory tract is known as _____.
A. Epidermolysis bullosa
B. Stevens–Johnson syndrome
C. Sturge–Weber syndrome
D. Wegener’s granulomatosis
E. Secondary syphilis
D. Destructive inflammation in the three sites noted
is characteristic of Wegener’s granulomatosis.
The purpose of a high-voltage transformer in an
x-ray machine is to _____.
A. Decrease the tube current
B. Increase the wavelength of the x-rays
C. Improve timer accuracy
D. Increase the potential between the filament and
the cathode
E. Regulate the rate of release of photons from the
anode
F. Increase resistance in the filament
D. The high-voltage transformer increases the volt-
age from the line voltage to the high voltage
between the anode and cathode necessary to
impart sufficient energy to the electrons to con-
vert some of their energy into photons at the
target.
The mean energy of an x-ray beam is influenced by the \_\_\_\_\_. A. Kilovoltage B. Milliamperage C. Voltage in the filament circuit D. Quantity of electrons in the tube current E. Amount of filtration F. Two of the above G. None of the above
F. The mean energy (wavelength) of an x-ray
beam is influenced by the kilovoltage setting
on the machine and the amount of built-in filtra-
tion that preferentially absorbs low-energy
photons.
The function of the filament is to \_\_\_\_\_. A. Convert electrons into photons B. Convert photons into electrons C. Release photons D. Release electrons E. None of the above
D. When heated, the filament releases electrons
thermionic emission
The most radiosensitive of the following cells in terms of cell killing is the \_\_\_\_\_. A. Salivary gland acinar cell B. Basal epithelial cell C. Endothelial cell D. Neuron. E. Polymorphonuclear leukocyte.
B. Basal epithelial cells are the most mitotically
active of the cells on the list, and thus are the
most radiosensitive.
The long-term histopathologic consequences to
an irradiated organ depend on _____.
A. The presence of oxygen at the time of irradiation
B. The sensitivity of the parenchymal component
C. The damage to the stromal component
D. All of the above
E. None of the above
D. Numbers 1, 2, and 3 are correct.
The term ALARA refers to _____.
A. Reducing patient exposure to as low as is
reasonably achievable
B. As little as Roentgen allowed, an algorithm for
limiting patient exposure
C. A legal requirement to optimize occupational
exposure in dental radiology
D. Optimizing image quality
E. Reducing the costs of radiographic examinations
A. ALARA (As Low As Reasonably Achievable) is a
concept for minimizing patient and occupational
exposure.
X-ray film is composed of _____.
A. Silver halide crystals suspended in plastic and
coated on a gelatin base
B. Sodium thiosulphate crystals and suspended
within a plastic base
C. A plastic base coated with silver halide crystals
suspended in gelatin
D. Fluorescent particles that react to x-radiation
C. Silver halide is not fluorescent, and thus choices
1 and 2 are incorrect.
It is generally desirable that x-ray films be all of the following except \_\_\_\_\_. A. High speed B. Fine grain size C. Coated with emulsion on both sides D. Sensitive to visible light
D. Film is sensitive to visible light but this is not a
desired characteristic like the other choices.
You are unsure of the location of an opaque
mass seen over a molar root on a periapical
view. A second view of the same region, made
with the x-ray machine oriented more from the
mesial, reveals that the object has moved
mesially with respect to the molar roots on the
first view. The location of the object is _____.
A. Buccal to the roots
B. Lingual to the roots
C. In the same plane as the roots
D. Insufficient information to form an opinion
B. Use the rule of “SLOB”: Same Lingual, Opposite
Buccal.
Cone-cutting results from \_\_\_\_\_. A. Too great a target–film distance B. Not selecting the proper kVp C. Not enough time exposure D. The x-ray machine being improperly aimed
D. Cone-cutting results from misalignment of the x-
ray tube. Use a film-holding device with an exter-
nal guide.
If your radiographs start coming out too light, it may be that \_\_\_\_\_. A. Your exposure time is too long B. Your developer needs changing C. Your developer is too hot D. The fixer needs changing E. The films are not sufficiently washed
B. If proper processing procedures are followed, the
developer will become depleted with age and
need changing.
If an unwrapped, nonprocessed x-ray film is
exposed to normal light for just a second and
then processed, it _____.
A. May still be used but will be a little dark
B. May still be used but will be a little light
C. May still be used but will be brown
D. Will be completely black
E. Will be completely clear
D. Visible light will expose all the silver bromide
crystals and the film will be black after proces-
sing.
To ensure high radiographic image quality, it is
important to daily _____.
A. Check the temperature of the processing
solutions
B. Clean the processing equipment
C. Clean the intensifying screens
D. Calibrate the mA linearity
A. Daily check of the processing solution tempera-
ture, whether using automatic processing or
manual tanks, and comparison with the manu-
facturer’s recommended values will improve
image quality. The other procedures are useful
but can be performed less frequently.
Radiographs of the pregnant patient _____.
A. Should never be made
B. Cause fetal injury
C. Should only be made with triple leaded aprons on
the mother’s lap
D. Should be made when there is a specific need
D. Prudence suggests that radiographic examina-
tions of a pregnant patient should be kept to a
minimum consistent with the mother’s dental
needs.
Which of the following is a potential sequela of an acute periapical abscess? A. Central giant cell granuloma B. Peripheral giant cell granuloma C. Osteosarcoma D. Periapical granuloma E. Periapical cemento-osseous dysplasia
D. An acute exudate (pus) at the apex of a tooth will
follow the path of least resistance (e.g., into sur-
rounding bone, gingiva, or skin). If the offending
tooth is not treated and the abscess becomes
chronic, a periapical granuloma may result.
Which of the following odontogenic cysts
occurs as a result of stimulation and prolifera-
tion of the reduced enamel epithelium?
A. Dentigerous cyst B. Lateral root cyst C. Radicular cyst D. Odontogenic keratocyst E. Gingival cyst
A. Reduced enamel epithelium that overlies the crown
of an unerupted tooth may give rise to a cyst
occurring in the same position. This is, by definition,
a dentigerous cyst. The stimulus for cystic epithelial
proliferation is unknown.
Two cystic radiolucencies in the mandible of a
16-year-old boy were lined by thin, parake-
ratinized epithelium showing palisading of
basal cells. All teeth were vital and the patient had no symptoms. This patient most likely has which of the following? A. Odontogenic keratocysts B. Periapical granulomas C. Periapical cysts D. Traumatic bone cysts E. Ossifying fibromas
A. The key to this question is the description of the
cystic lining of thin, parakeratinized epithelium
with basal cell palisading—typical of odonto-
genic keratocyst. Tooth vitality, lack of symp-
toms, and more than one lesion are also
supportive.
When a diagnosis of odontogenic keratocyst is
made, the patient should be advised as to
_____.
A. The need for full-mouth extractions
B. The association with colonic polyps
C. The associated recurrence rate
D. The likelihood of malignant transformation
E. The need for additional laboratory studies
C. Odontogenic keratocysts are notable because of
their recurrence rate, their aggressive clinical
behavior, and their occasional multiplicity. When
multiple, they may be part of the nevoid basal cell
carcinoma syndrome.
A painless, well-circumscribed 1 ¥ 3-cm radiolu-
cent lesion with radiopaque focus was found
in the posterior mandible of an 11-year-old boy. Which of the following should be included in a differential diagnosis? A. Ameloblastic fibro-odontoma B. Paget’s disease C. Dentigerous cyst D. Ameloblastoma E. Langerhans cell disease
A. Ameloblastic fibro-odontoma is the only lesion
listed that is lucent with opaque foci. The
patient’s age is also characteristic for this lesion.
Paget’s disease may show a mixed opaque-
lucent pattern, but it occurs only over the age of
50 years.
Herpes simplex virus is the cause of which of the following? A. Minor aphthous ulcers B. Herpetiform aphthae C. Herpes whitlow D. Herpangina E. Herpes zoster
C. Herpes whitlow is a term used for secondary
herpes simplex infections that occur around the
nail bed. The cause of aphthous ulcers is
unknown, herpangina is caused by Coxsackie
virus, and herpes zoster is caused by varicella-
zoster virus.
A 12-year-old patient presents with premature
loss of primary teeth. On radiographic exam, a
sharply marginated lucency is seen in the area
of tooth loss. Biopsy shows a round cell infil-
trate with numerous eosinophils. This would
suggest which of the following? A. Cherubism B. Gardner’s syndrome C. Paget’s disease D. Fibrous dysplasia E. Langerhans cell disease
E. Premature tooth loss is seen in several conditions,
especially malignancies and Langerhans cell disease because of cellular invasion of the peri-
odontal ligament. Sharply marginated bone lesions
are characteristic of Langerhans cell disease (and
Paget’s disease of the elderly). The eosinophils in a
round cell infiltrate suggest Langerhans cell
disease (the round cells would be Langerhans
cells).
A 15-year-old patient has a numb lower lip and
pain in her right posterior mandible. A radi-
ogram shows uniform thickening of the periodon-
tal membrane space of tooth #30. The tooth
shows abnormally increased mobility. Which one
of the following should be seriously considered?
A. Periapical cyst
B. Periapical granuloma
C. Traumatic bone cyst
D. Ameloblastoma
E. Malignancy
E. Numb lip is malignancy of the jaw until proven
otherwise. About half of the patients with numb lip
have associated malignancies. The other half of the
patients have acute bone infections or neurologic
problems.
Which of the following signs or symptoms sug-
gest a chronic benign process?
A. Paresthesia B. Pain C. Vertical tooth mobility D Uniformly widened periodontal membrane space E. Sclerotic bony margins
E. Sclerotic bone margins indicate a long-term, low-
grade process, as it takes a considerable amount
of time for bone to become radiodense. The
signs and symptoms listed in A through D are
associated with malignancies.
Central and peripheral giant cell granulomas share which of the following features? A. Microscopic appearance B. Clinical behavior C. Recurrence rate D. Similar forms of treatment E. Radiographic appearance
A. Peripheral and central giant cell granulomas have
very different clinical presentations and behaviors,
but identical light microscopic features.
Diffuse soft swelling of the lips and neck fol-
lowing the ingestion of drugs, shellfish, or nuts
is known as \_\_\_\_\_. A. Fixed drug reaction B. Anaphylaxis C. Urticaria D. Acquired angioedema E. Contact allergy
D. Acquired angioedema is a rapidly developing
allergic reaction that results in characteristic non-
erythematous swelling of lips, face, and neck.
A 7-year-old patient presents with a quadrant
of teeth showing abnormal formation of both
enamel and dentin. All of his other teeth
appear clinically normal. Radiographically, the
affected teeth can be described as “ghost
teeth.” He has _____.
A. Regional odontodysplasia
B. Dens evaginatus
C. Dentin dysplasia
D. Ectodermal dysplasia
E. Cleidocranial dysplasia
A. Regional odontodysplasia is often called “ghost
teeth” because of the thin layers of dentin and
enamel produced. One quadrant of teeth is
affected, and the teeth are nonfunctional.
An adult patient presents with a 0.5 ¥ 0.5-cm
submucosal mass in the posterior lateral
tongue. Biopsy shows a neoplasm composed of
glandlike elements and connective tissue ele-
ments. It is covered by normal-appearing epithe-
lium. This could be which of the following?
A. Oral wart B. Pleomorphic adenoma (mixed tumor) C. Granular cell tumor D. Idiopathic leukoplakia E. Peripheral giant cell granuloma
B. Salivary gland tumors present as submucosal
masses. The combination of epithelial and con-
nective tissue elements is indicative of pleomor-
phic adenomas, also known as mixed tumors.
Oral warts and leukoplakias are surface or
epithelial lesions. Peripheral giant cell granulomas
are exclusively gingival lesions, and granular cell
tumors are composed exclusively of cells with
grainy or granular cytoplasm.
Oral squamous cell carcinomas present typi-
cally in which of the following ways?
A. Vesicular eruption B. Pigmented patch C. Inflamed pustule D. Submucosal swelling E. Indurated nonhealing ulcer
E. Oral cancers (squamous cell carcinomas) pres-
ent typically as indurated nonhealing ulcers. They
can also present as white patches, red patches,
or irregular masses.
A clinical differential diagnosis of an asympto-
matic submucosal lump or nodule in the tongue
would include all the following except \_\_\_\_\_. A. Traumatic fibroma B. Neurofibroma C. Granular cell tumor D. Salivary gland tumor E. Dermoid cyst
E. The dermoid cyst occurs in the midline floor of
mouth when above the mylohyoid and geniohyoid
muscles, and in the neck when below the
mylohyoid and geniohyoid muscles.
Ectopic lymphoid tissue would most likely be found in which of the following sites? A. Hard gingiva B. Soft gingiva C. Floor of mouth D. Dorsum of tongue E. Vermilion of the lip
C. Ectopic (normal tissue, abnormal site) lymphoid
tissue is commonly seen in floor of the mouth as
well as in posterior lateral tongue, soft palate,
and tonsilar pillar. It appears as one or more
small, dome-shaped yellow nodules.
The Schwann cell is the cell of origin for which of the following tumors? A. Odontogenic myxoma B. Rhabdomyoma C. Neurofibroma D. Mixed tumor E. Leiomyoma
C. The Schwann cell is of neural origin and gives rise
to one of several neoplasms, including neu-
rofibroma and Schwannoma.
A 43-year-old-male patient presents with an
asymptomatic anterior palatal swelling. A radi-
ograph shows a 1 × 1-cm lucency and diver-
gence of tooth roots #8 and #9. All teeth in the
area are vital. This is most likely a(an) \_\_\_\_\_. A. Periapical granuloma B. Aneurysmal bone cyst C. Nasopalatine duct cyst D. Globulomaxillary lesion E. Dermoid cyst
C. Nasopalatine duct cysts are anterior midmaxillary
lesions that occur in the nasopalatine canal. The
associated lucency is often heart-shaped because
of the superimposition of the nasal spine over the
lesion. They do not devitalize teeth.
The globulomaxillary lesion of bone _____.
A. Is associated with the crown of an unerupted
tooth
B. Occurs between maxillary lateral and canine
teeth
C. Typically causes pain
D. Typically presents as a mixed lucent-opaque
lesion with ill-defined margins
E. Is always associated with a nonvital tooth
B. Globulomaxillary lesion is a clinical term used to
designate any lucency that occurs between the
maxillary lateral incisor and canine.
A generalized red, atrophic tongue would sug-
gest all of the following except _____.
A. Vitamin B deficiency B. Pernicious anemia C. Chronic candidiasis D. Iron deficiency anemia E. Peripheral giant cell granuloma
E. Peripheral giant cell granuloma is the exception
here. Although it is red, it occurs only in the gin-
giva. Answers A through D are the differential
diagnoses for red atrophic tongue.
The nevoid basal cell carcinoma syndrome includes multiple basal cell carcinomas, bone abnormalities, and which of the following? A. Osteomas B. Café-au-lait macules C. Odontogenic keratocysts D. Hypoplastic teeth E. Lymphoma
C. Multiple odontogenic keratocysts are part of the
nevoid basal cell carcinoma syndrome.
All of the following characteristically present under the age of 20 except \_\_\_\_\_. A. Traumatic bone cyst B. Adenomatoid odontogenic tumor C. Ameloblastic fibroma D. Compound odontoma E. Ameloblastoma
E. The mean age for ameloblastoma is 40 years. All
other lesions listed occur in children and
teenagers.
Oral and genital lesions are seen in patients with which of the following diseases? A. Behçet’s syndrome B. Peutz–Jegher’s syndrome C. Herpangina D. Wegener’s granulomatosis E. Hairy leukoplakia
A. Behçet’s syndrome includes lesions in the
mouth, eye, and genitals. The other diseases do
not affect the genitalia.
A 32-year-old male patient presented with
a 1 ¥ 2-cm macular red-blue lesion in his hard
palate. The lesion was asymptomatic and had
been present for an unknown duration. He had
no dental abnormalities and no significant
periodontal disease. This could be all the
following except _____.
A. Vascular malformation
B. Nicotine stomatitis
C. Ecchymosis
D. Kaposi’s sarcoma
E. Erythroplasia
B. Nicotine stomatitis appears as opacification of
the palate, with red dots representing inflamed
salivary ducts.
Bremsstrahlung radiation results from _____.
A. X-rays interacting with electrons
B. Electrons interacting with electrons
C. Electrons interacting with nuclei
D. L shell electrons falling into the K shell
E. Photons interacting with nuclei
F. Photons converting into electrons
C. X-ray photons (Bremsstrahlung radiation) results
from the interaction of high-speed electrons with
tungsten nuclei in the target.
X-rays are produced in most conventional den-
tal x-ray machines _____.
A. Continuously during operation
B. When there is a large space charge
C. Half the time during operation
D. When the anode carries a negative charge
E. Only when the beam is collimated
F. Only during the first half of each second
C. X-rays are produced in most dental x-ray
machines half the time (i.e., in bursts at the rate
of 60 per second, each lasting 1/120th second)
due to the alternating current supplied to the
tube.
Deterministic effects are those that _____.
A. Show a severity of response proportional to
dose
B. Are seen only in the oral cavity
C. Are found following exposure to low levels of
radiation
D. Result from particulate radiation such as alpha
and beta particles, but not x-rays
E. None of the above
A. Deterministic effects are those with dose thresh-
olds, thus requiring at least moderate levels of
exposure, and where the severity of response is
proportional to dose.
In the radiolysis of water, _____.
A. Free radicals are formed which are nonreactive
B. The presence of dissolved O2 reduces the
number of free radicals
C. The formation of free radicals is the “direct
effect”
D. The resultant free radicals may alter biological
molecules
E. Two of the above
F. None of the above
E. “Direct effect” refers to production of free radi-
cals from the ionization of water (C). These free
radicals formed in the radiolysis of water are highly
reactive and may alter biological molecules (D).
The presence of oxygen increases the number of
free radicals.
The radiosensitivity of cells depends upon \_\_\_\_\_. A. Mitotic future B. Mitotic activity C. Degree of differentiation D. All of the above E. None of the above
D. Options A, B, and C are correct.
Rectangular collimation is recommended because it \_\_\_\_\_. A. Deflects scatter radiation B. Decreases patient dose C. Increases film density D. Increases film contrast
B. Using a rectangular collimator restricts the area
of the patient’s face exposed to the size of the
receptor, thus reducing more than half the
patient exposure.
- It is acceptable for the operator to hold the film
in a patient’s mouth _____.
A. If the patient is a child
B. If the patient or parent grants permission
C. If the patient has a handicap
D. If no film holder is available
E. Never
E. If someone must hold a film and the patient can-
not, then it should be a family member or friend of
the patient, not an x-ray operator in the dental
office.
A comparison of screen film/intensifying
screen combinations with direct-exposure films
reveals that screen film/intensifying screen
combinations _____.
A. Render less resolution
B. Require more exposure
C. Require special processing chemistry
D. Are preferred for intraoral radiography
A. The dispersion of visible light from the crystals in
the phosphor layer of the intensifying screen
reduces image resolution compared to direct-
exposure film.
It is important that the film base be \_\_\_\_\_. A. Opaque B. Very rigid C. Flexible D. Completely clear E. Sensitive to x-rays
C. The base needs to be flexible to go through auto-
matic processors and be put into film mounts.
Usually, the base is not completely clear and it is
the emulsion that is sensitive to x-rays.
Excessive vertical angulation causes \_\_\_\_\_. A. Overlapping B. Foreshortening C. Elongation D. Cone-cutting
B. The film should be parallel to the long axis of the
tooth and the central ray of the beam should be
perpendicular to both the film and the tooth.
Increasing the vertical angulation foreshortens
the image of the tooth.
To obtain the most geometrically accurate
image, which of the following is false?
A. The film should be parallel to the object.
B. The central ray should be parallel to the object.
C. The central ray should be perpendicular to the
film.
D. The object-to-film distance should be short.
E. The object-to-anode distance should be long.
B. The central ray should be perpendicular to the
object.
The size of the x-ray tube focal spot influences radiographic \_\_\_\_\_. A. Density B. Contrast C. Resolution D. Magnification E. Both C and D
C. The smaller the focal spot size, the greater the
resolution. Density, contrast, and magnification
are unchanged, other factors remaining equal.
The primary function of developer is to _____.
A. Reduce crystals of silver halide to solid silver
grains
B. Reduce solid silver grains to specks of silver halide
C. Remove unexposed silver halide crystals
D. Remove exposed silver halide crystals
A. Developer reduces silver bromide to solid silver
grains.
If an exposed radiograph is too dark after proper development, one should \_\_\_\_\_. A. Place it back in the fixer B. Place it back in the developer C. Decrease development time D. Increase milliamperage E. Decrease exposure time F. Decrease development temperature
E. Reduce exposure time. Do not change develop-
ment parameters if they are correct.
The radiolucent portions of the images on a
processed dental x-ray film are made up of _____.
A. Microscopic grains of silver halide
B. Microscopic grains of metallic silver
C. A gelatin on a cellulose acetate base
D. Unexposed silver bromide
B. Silver halide in the emulsion of an exposed film
is converted into grains of metallic silver in the
developer.
The purpose of the “penny test” is to check \_\_\_\_\_. A. Developer action B. Fixer action C. For proper development temperature D. For proper safelighting conditions
D. The “penny test” is a test of darkroom safelighting.
A penny is placed on an exposed film (after
removing the film from its cover) for 2 minutes and
then the film is processed. If the processed film
shows a lighter area on the film corresponding to
the penny, then the safelighting is too bright and is
fogging the film.
Proper radiographic infection control includes
all of the following except _____.
A. Wearing gloves while making radiographs
B. Disinfecting x-ray machine surface
C. Covering working surfaces with barriers
D. Sterilizing nondisposable instruments
E. Sterilizing film packets
E. Film packets need not be sterilized because the
goal is to prevent crosscontamination, not ensure
that everything that goes into a patient’s mouth is
sterile.
Occlusal radiographs are useful for all of the
following except _____.
A. For views of the TMJ
B. For displaying large segments of the mandibular
arch
C. When the patient has limited opening
D. When there are sialoliths in the floor of the
mouth
E. When there is buccal-lingual expansion of the
mandible
A. The TMJ is much too far from the occlusal plane
(the location of occlusal film) to be imaged with
this technique. The other choices are all proper
indications for using occlusal film.
Patient has bilateral white lines @ occlusal plane, what is primary microscopic finding?
Epithelial hyperkeratosis, frictional keratosis, linea alba.
Fordyce granules is what?
Ectopic sebaceous gland
Fordyce granule is what?
• salivary gland
• sebaceous gland
• sweat gland
• sebaceous gland
Varicosities in ventral tongue commonly seen in?
elderly
QUESTION: What causes varices on the tongue?
Hypertension
Pt with bilateral asymptomatic blue stuff under tongue?
a. hemangioma
b. varices
varices
Pano Radiograph of mandibular gland depression:
Stafne defect (also called salivary bone cyst (another name for stafne bone cyst) on PAN)
Very well-defined round radiolucency posterior mandible below inferior alveolar canal on a panoramic
à static bone cyst (stafne
defect)
QUESTION: X-ray of Stafne defect,
salivary inclusion defect
Attrition is
wearing away from natural dentition.
All of the following cause xerostomia except?
a. caries
b. candidiasis
c. dental attrition
c. dental attrition
Most attrition of enamel is against what?
a) Enamel
b) Amalgam
c) Hybrid resin
d) Microfill resin
porcelain first choice
d) Microfill resin?
All of the following reasons to restore erosion lesion except one, which one?
a. prevents future erosion
b. reduced sensitivity
c. esthetic
b. reduced sensitivity
What causes erosion?
Chemical, gastric reflux, & Bulimia
Which one is a chemical cause of tooth destruction?
Erosion
- Type of wear from gastric acids: erosion
Abfraction (flexure of tooth) à I
f it’s not too deep, don’t touch it. If deeper, fill with glass ionomer cement? Compomers
Mobile mass initially but is now sessile (fixed):
indicative of malignancy
Metastasis is most common to
posterior mandible.
Discrete, non-tender, soft tissue swelling, what is it – malignancy, benign tumor, bone cancer
benign tumor,
What is usually seen with affected hypertrophic filiform papillae?
Hairy tongue
Causes of Hairy tongue?
antibiotic, corticosteroid, hydrogen peroxide
- Mostly in heavy smokers, poor oral hygiene, general debilitation, hyposalivation, radiotherapy, fungal/bacterial overgrowth, certain
meds.
Which of the following is seen with hyperplastic (or was it associated with) foliate papilla: hairy tongue, Lingual tonsil hyperplasia,
median rhomboid glossitis, lymphadenopathy
Lingual tonsil hyperplasia,
Hyperplastic lingual tonsils may resemble which of the following?
a. Epulis fissuratum.
b. Lingual varicosities.
c. Squamous cell carcinoma
d. Median rhomboid glossitis.
e. Prominent fungiform papillae.
c. Squamous cell carcinoma
except not indurated and soft to palpation
biopsy if smoker
Loss of filliform papilla-
vitamin B deficiency
Bilateral swelling of parotid cannot be caused by:
Anorexia
- Bilateral usually caused by infections. Unilateral - sialoliths or obstruction.
why brush tongue?
to reduce odor. It removes biofilm, which can be associated with overgrowth of bacteria due to meds.
Transillumination of soft tissues is useful in detecting which of the following problems in a child? Sialolithiasis, Koplik’s spots, aortic
stenosis, sickle cell disease
Sialolithiasis
Baby with nodules on the palatal, what is it? • bone nodulus • Epstein pearls • congenital epulus • bohn nodule
• Epstein pearls
Epstein pearls are whitish-yellow cysts that form on the gums and roof
of the mouth in a newborn baby.
Neonate with numerous nodules on alveolar ridge. What is it?
• Eruption cyst
• Bohn’s nodule
• Congenital cyst of newborn
Bohn’s nodule (keratin-filled cysts of salivary gland origin, on junction
of hard/soft palate + buccal/lingual of dental ridges, away from
midline)
(Hutchinson triad):
congenital syphilis
interstitial keratitis, Hutchinson incisors, and 8th nerve deafness.
Indents on incisal edge with narrowing at mesial and distal?
Congenital syphilis (Hutchinson’s incisors and mullberry molars)
Stages of syphilis that is most infectious: primary and secondary, primary, secondary, tertiary, primary secondary and tertiary
- In secondary syphilis, the bacteria have spread in the bloodstream and have reached their highest numbers.
primary and secondary
secondary
In secondary syphilis, the bacteria have spread in the bloodstream and have reached their highest numbers.
oral lesions if lupus
palate, buccal mucosa, gingiva
Which syndrome has rash on cheeks, ulcers, kidney, etc?
Lupus
Which skin condition has endocarditis and glom-?
lupus
Cavernous sinus problem -
due to infection of upper lip/canine space, infxn from max ant teeth
Most likely to cause cavernous sinus thrombosis: valve infected by endocarditis, soft tissue abscess in upper lip
soft tissue abscess in upper lip (veins of face don’t
have valves)
Which of the following causes cavernous sinus thrombosis:
A) Subcutaneous abscess of upper lip
B) Subcutaneous abscess of lower anterior region
Subcutaneous abscess of upper lip
Infections in upper anterior teeth are within the “dangerous triangle” area, which is visualized by imagining a triangle with the top
point about at the bridge of the nose and the two lower points on either corner of the mouth.
Cavernous sinus infection would most likely come from, maxillary sinus, paranasal sinus, frontal sinus, anterior maxillary teeth
anterior maxillary teeth
Site of infection most likely to enter cavernous sinus? Anterior triangle of face, naso-labial cyst
Anterior triangle of face
Why are you afraid of having infection in anterior triangle (i.e. upper lip)?
Because there are valve-less veins that can send infection
back to the brain.
Danger zone of Cavernous Sinus thrombosis: What is the first signs/symptoms?
a. pre-orbital swelling (bulging eye)
b. loss vision
c. headache
headache
most common initial symptom of CST is a headache, which develops as a sharp pain located behind or around the eyes that steadily
gets worse over time.
- Symptoms often start w/ in 5- 10 days of developing an infection in the face or skull, such as sinusitis or a boil.
Which space is not involved/associated with Ludwig's angina? Sublingual Submandibular Retropharyngeal Submental
Retropharyngeal
Cellulitis most of the time is ____. Ludwig’s angina is _____& a complication is edema of ______.
Cellulitis most of the time is unilateral. Ludwig’s angina is bilateral & a complication is edema of GLOTTIS.
Patient has bilateral submandibular infection; tongue is elevated due infection -
Ludwig’s Angina
- Ludwig angina = bilateral cellulitis of submandibular & sublingual spaces.
What do you need to worry about the most with Ludwig’s Angina?
edema of glottis
What is the main danger in Ludwig’s angina?
closing of the airway
Mandibular 2nd molar infection spreads to what space?
Submandibular space
QUESTION: Infection on the mandibular buccal side of premolars is most likely to go where?
Submandibular space
Infxn of mnd 2nd pm goes into
submandibular space
You are extracting a mandibular 3rd molar and the distal root disappears into which space?
Submandibular space
Which muscle separates 2 potential infection spaces from a maxillary 2nd molar? Buccinator or Masseter
Buccinator
If you have an infection in the lateral pharyngeal space, what muscle is involved?
Medial pterygoid
Inferior Alveolar Nerve tract infection involves what space?
Pterygomandibular space
Strawberry tongue is seen in
scarlet fever (Also, Kawasaki disease & toxic shock syndrome)
where do aphthous ulcers happen
non-keratinized usually not over bone does not form vesicles no fever, no gingivitis usually painful
Patient has ulcer at mucolabial fold, it goes away and comes back, what could it be?
Aphthous
Pt has occasional sores on mucolabial fold on mandibular arch that healed without scarring after a week or so?
Minor Aphthous
ulcer. Ulcer healing with scar tissue: major
Ulcer on tongue that repeats every 4 months?
Apthous ulcer
A chancre due to Syphilis mostly resembles:
1) Cancer
2) Herpes
3) Herpangina
4) Apthous Ulcer
4) Apthous Ulcer
History of lesions that go away after 1 week –
recurrent aphthous ulcers
What don’t you treat aphthous ulcers with?
Acyclovir
- Acyclovir: Anti-viral used to tx herpes
Bechets syndrome produces what type of mouth lesion?
Apthous Ulcers
Apthous stomatitis
Recurrent, herpes
Apthous Ulcers
- Behçet disease/syndrome is a rare immune-mediated small-vessel systemic vasculitis that often presents with mucous membrane
ulceration & ocular problems. Triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis.
desquamative gingivitis
lichen planus, mucous membrane pemphigoid (95%), and pemphigus
lichen planus, mucous membrane pemphigoid (95%), and pemphigus
in relationship to epithelium
Lichen Planus and pemphigoid = sub epithelial, and pemphigus is suprabasilar vesicle.
acantholysis: pemphigus or pemphigoid
pemphigus
Tzanck cells
pemphigus
type of hypersensitivity in pemphigus
II
pemphigus ABs against
desmoglein
where are vesicles in pemphigus
suprabasilar, with acantholysis
vesicles in pemphigoid
subepithelial
acantholysis in pemphigoid?
no
ABs in pemphigoid against
hemidesmosomes
A patient has painful lesions on her buccal mucosa. A biopsy reveals acantholysis and a suprabasilar vesicle. Which of the following represents the MOST likely diagnosis? A. Pemphigus B. Psoriasis C. Erythema multiforme D. Bullous lichen planus E. Systemic lupus erythematosus
Pemphigus
Pemphigus: which was a vesicular disease & which layer it affects?
Lichen Planus and pemphigoid = sub epithelial, and pemphigus
is suprabasilar vesicular disease.
Immunofluorescence of antibodies: Pemphigus -
intraepithelial, desmosomes.
Pemphigoid and pemphigus: which one comes apart
from connective tissue?
Pemphigoid
Vesicular dz: If antibody is linear…
pemphigoid
Vesicular dz: If antibody is fishnet…
pemphigus
Immunofluorescence used for dx of: pemphigus or LP
pemphigus
White film w/ positive Nikolsky –
pemphigus, tx w/ incisional biopsy
Another name for chronic desquamative gingivitis?
Cicatricial pemphigoid
what’s targeted and destroyed in lichen planus
basal keratinocytes by T-cells
inflammation cells in pemphigus
mixed
inflammation cells in pemphigoid
eosinophils
histo pattern in lichen planus
saw tooth
loss of rete pegs
Histologically, the loss of the rete peg often is a sign of?
a. pemphigus
b. lichen planus
c. pemphigoid
d. syphilis
b. lichen planus
- Rete pegs are the epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes.
Development of a “saw-tooth” appearance of the rete pegs, which is much more common in non-oral forms of lichen planus.
Lichen planus most commonly found on
buccal mucosa
Lichen planus more common in .
women
Lichen planus, what do you treat with?
Topical corticosteroids or anti-histamines
Young child/infant exhibits ulcerations of mouth -
epidermolysis bullosa
pemphigus etc usually older
A child is most likely to have which of these: pemphigus, pemphigoid, erythema multiform,
epidermolysis bullosa
epidermolysis bullosa
Child formed blisters/ulcerations with minor lip irritation?
Epidermolysis bullosa
Which pemphigoid like-lesion most often in infants? Pemphigus vulgarius Pemphigoid Erythema multiform Epidermolysis bullosa
Epidermolysis bullosa
- small blisters that develop from mild provocation over areas of stress—ie elbows and knees
HIV patient with oropharyngeal candidiasis, what would you prescribe?
fluconazole
Which oral medication would you give to tx vaginal candidiasis? Nystatin, griseofulvin, Monistat, Diflucan
Diflucan (fluconazole)
If pt undergoes radiotherapy for cancer, the most common oral infection that necessitates drug tx in this stage is?
Candida albicans
Candidiasis in cancer patients due to- chemotherapy, radionecrosis
chemotherapy
Pt has multiple white patches that can be scraped off
candidiasis
Oral cytology smears are MOST appropriately used for the diagnosis of
Pseudomembranous candidiasis
What oral manifestation is often seen in children with HIV?
Candidiasis
Systemic medication for Candida:
amphotericin B
Which is associated w/ burning mouth?
Candida
Lesion in the middle of tongue also pt had it on palate before and pt is healthy? Kaposi, candidiasis, Syphilis
candidiasis
Symptoms of actinic cheilitis?
Loss of vermillion border
How do you treat actinic cheilitis?
- According to wiki, its 5-fluorouracil or imquimide – block DNA synthesis, but I’m not sure if those were even answer choices.
Actinic Chelitis:
lower lip shows epithelial atrophy and focal keratosis –> same as Actinic Keratosis
Which of the following lesions has the greatest malignant potential? A. Leukoedema B. Lichen planus C. Actinic cheilitis D. White sponge nevus
- Actinic chelitis can lead to SCC
What problem causes bilateral angular cheliits? high vertical dimension low interocclusal space high occlusal distance Low VDO
Low VDO
Angular chelitis for dentures, you need to
increase interocclusal space. It’s associated with overclosure.
Angular chelitis is caused by all of the following except:
a. Fungal infection
b. Decreased VDO
c. Increased VDO
d. Other options
c. Increased VDO (causes clicking of teeth)
decreased VDO causes it, b/c increase interocclusal distance; also cheek biting!!)
What problem causes bilateral angular cheliits? high vertical dimension, low interocclusal space, high occlusal distance, Low VDO
Low VDO
Median rhomboid glossitis —
smooth red area of tongue that lacks the lingual papillae
Healthy 36-year-old, red patch on palate, redness in middle of tongue:
- Kaposi sarcoma
- Syphilis
- Median rhomboid glossitis
- Gonorrhea
- Median rhomboid glossitis –> Candidiasis
tx for primary herpes
palliative
acyclovir for which herpes
1, 2, VZV, EBV
ganciclovir which herpes
IV, for CMV
alph herperviridae
HSV 1, 2, VZV
beta herpesviridae
CMV, 6, 7
gamma herpesviridae
EBV
how many ppl have herpes
- 65-90% worldwide; 80-85% USA
Kid with primary herpes infection. What is the age of infection? 2 y/o, 4 y/o, 8 y/o, 10 y/o
2 y/o
Young person w/ fever & oral vesicles:
Fever = PRIMARY herpes stomatitis
Ways to treat kid w/ herpetic gingivostomatitis EXCEPT:
a. antibiotics
b. gives numbing anesthetic before eating
c. has pt rest and drink lots of water
a. antibiotics
Herpes zoster (VZV) – _____ treats herpes labialis
Valacyclovir
Patient gets recurrent herpetic lesions very often with gingivostomatitis. What should be done? (herpetic gingivostomatitis) Acyclovir Palliative tx Systemic antibiotics Steroids
Palliative tx
- Treatment includes fluid intake, good oral hygiene and gentle debridement of the mouth. In healthy individuals, the lesions heal
spontaneously in 7–14 days without scarring.
Herpes can be diagnosed by
exfoliative cytology b/c a characteristic multinucleated cell appears in the smear of herpes infections.
Recurrent intraoral herpes occurs almost exclusively on
mucosa overlying bone. The hard palate is the most common site.
best med for herpes, CMV =
acyclovir
Valcyclovir (Valtrex):
Tx for herpes simplex/herpes zoster
where Secondary herpes?
lip, gingival, and palate
Herpetic whitlow -
Herpes on finger
- Herpetic whitlow is an intensely painful infection of the hand involving 1 or more fingers that typically affects the
terminal phalanx
Which most closely mimics dental pain: herpes zoster, CMV, herpangina
herpes zoster,
Patient comes with recurrent herpetic stomatitis on the lips and history shows no signs of primary herpetic gingivostomatitis. Why?
Most primary infections are subclinical.
Tx of herpetic gingivostomatitis
– within 3 days of onset: treat with Acyclovir 15mg/kg 5 times per day for 7 days
- More than 3 days, just do palliative care (plaque removal, systemic NSAIDS, and topical anesthetics). 3 days = borderline.
- Contagious when vesicles are present
recurrent herpes infection
Reactivation of the primary
QUESTION: Which disease is caused by the virus that causes acute herpetic gingivostomatitis?
Herpes simplex 1
Herpes lesion intraorally, how do you treat?
Palliative, acyclovir? Tx is supportive—topical before eating, analgesics, maintain
fluid/electrolyte balance, anti-viral agents. DO NOT GIVE CORTICOSTEROIDS.
How is Acyclovir selective toxicity mechanism of action?
only phosphorylated in infected cells and inhibits viral mRNA
- Acyclovir is selective and low in cytotoxicity as the cellular thymidine kinase of normal, uninfected cells does not use acyclovir effectively
as a substrate.
Post-herpetic neuralgia cause by: VZV, HSV 1, HSV 2, CMV
VZV
- Complication of long term shingles infection
What does histoplasmosis oral lesion look like?
Recurrent herpes
- Painful, ulcer with irregular borders, similar to cancer
Patient has upper denture, when he removes it, there is unilateral lesion on the palate. What could it be?
– Herpes
Pic with half the tongue (left side) that looks like herpes lesion and other nothing on it-
herpes zoster
Kaposi sarcoma by
herpes 8 & most likely on hard palate
A patient has a RPD and a firm, swelling under the buccal flange midway between incisors and molars. What is it?
Traumatic
neuroma
Mandibular Denture. Lump hurts & is anterior to posterior areas. What caused it?
Traumatic neuroma
pyogenic granuloma, peripheral giant cell granuloma, and peripheral ossifying fibroma – where in mouth?
pyogenic granuloma –
anywhere
peripheral giant cell granuloma, and peripheral ossifying fibroma only gingiva and alv mucosa
Picture said: “erythematous, bleeding swelling” mandibular swelling right next to premolars on right side?
pyogenic granuloma
Pink growth on palatal between canine and 1st PM? Papilloma, pyogenic granuloma, peripheral ossifying, irritation fibroma
pyogenic granuloma
Which lesion shows the most rapid change in size?
- fibroma
- pyogenic granuloma
pyogenic granuloma
Fastest growing tumor?
a. oncocytoma
b. pyogenic granuloma
c. pleomorphic adenoma
b. pyogenic granuloma
Fast growing Lesion on gingiva that blanches and bleeds easily when pressed?
pyogenic granuloma
who is giant cell granuloma common in
younger, female
where is giant cell granuloma
anterior mx and man
characteristics of giant cell granuloma
anterior max, man,
large lesion that expand the cortical plate & can resorb root + move teeth.
Where do you find giant cells? Hyperthyroidism, Hypothyroidism, Hyperparathyroidism, Hypoparathyroid
Hyperparathyroidism
Giant cell lesion found in bone, what test would you run to help with diagnosis? Bence Jones, calcium
levels, Complete blood count
Bence Jones (from multiple myeloma)
Giant cell lesion is most like histology of congenital epulis of the newborn. Y/N
NO! —Granular cell Myeloma
most common benign neoplasm of EPITHELIAL TISSUE ORIGIN.
Squamous cell papilloma
where Squamous cell papilloma
tongie (posterior), soft palate, gingiva, lips
Lesion on the palate that verrucous and pedunculated -
Papilloma
The causes of Verrucous xanthoma?
Human papilloma virus
- Xanthoma = fatty deposits under skin
Lesion in lip with cauliflower shape:
Papilloma
The most common between five choices? 1- Papilloma 2- Rhabdomyoma 3- Leiomyoma 4- Lymphangioma 5- Neurofibromatosis
Papilloma
Condyloma acuminatum (genital/venereal wart) is caused by which virus?
HPV
Which of the following does not have cauliflower-like, pebbly appearance? Verrucous carcinoma, fibroma, condyloma acuminatum,
papilloma.
fibroma
most common HPVs for genital warts
6 & 11 for condyloma acumintam
Which one resembles Epilus Fissuratum –
Fibroma (both share trauma as etiology)
Epulis fissuratum is most similar cellularly to: fibroma, granuloma cell tumor, etc
- Fibroma (and a question about how to treat a patient with old denture and epulis – usually make new denture or modify; don’t just
wear same denture)
another name for fibroma
Focal Fibrous Hyperplasia
QUESTION: Fibromas are a result of what dysfunction? Neoplasia, dysplasia, hyperplasia
hyperplasia
QUESTION: In most of the cases, localized fibromas are often: Dysplasia, metaplasia, anaplasia, hyperplasia
hyperplasia
QUESTION: Congenital epulis histological similar to: hemangioma, lymphangioma, granular cell myoblastoma
granular cell myoblastoma
Patient has congenital epulis. What is the histology most similar to?
Granular cell tumor
If you have leukoplakia for biopsy, do you incise or excise for biopsy?
Incision
- incise multiple areas w incisional biopsy
In smoker’s soft palate, there are red points. What could it be? Erythroplakia, initial stages of SCC, nicotinic stomatitis
Erythroplakia
not nicotinic stomatitis because that’s on hard palate
What presents with severe dysplasia? Erythroplakia, white sponge nevus
Erythroplakia
Lesion commonly with dysplasia and carcinoma in situ –
Erythroplakia
SCC racially
least in white, worst in black men
`Lesion that resembles SCC. 16 weeks and then disappears.
a. papilloma
b. keratoacanthoma
c. papillary hyperplasia
keratoacanthoma
- skin tumor that can occur on sun-exposed areas
Which of the following has the best survival rate?
a. squamous cell carcinoma
b. adenocarcinoma
c. osteosarcoma
b. adenocarcinoma
SCC on tongue, what you do?
Incisional
What is the #1 risk factor for oral cancer?
Tobacco
Most likely site for SCC? Least likely?
Ventrolateral tongue.
palate is least
Chewing Betel nut can lead to–> SCC, xerostomia, gingival recession
SCC
Pt has been a smoker (60 pack yr. history) & has ulcer in lower lip. Ulcer is non-indurated; what’s the most probable diagnosis?
SCC
Most common malignancy in the oral cavity?
a. metastatic ca
b. basal cell ca
c. epidermoid ca
d. mucoepidermoid ca
e. adenoid cystic ca
epidermoid ca
a. metastatic ca (most common malignancy found in bone)
b. basal cell ca (most common type of skin cancer)
c. epidermoid ca (aka SCC…I’m pretty sure this is the right answer…Xtina)
d. mucoepidermoid ca (most common salivary gland carcinoma)
e. adenoid cystic ca (second most common salivary gland carcinoma)
Most malignant cancer in oral cavity?
Epidermoid carcinoma (SCC)
Which is the most likely to become malignant?
low grade mucoepidermoid carcinoma
What race most likely to get oropharyngeal cancer?
black
What percentage gets oral cancer?
3% of new cancers among males & 1.6% of new cancer among females
How many people in the US get oral cancer:
30,000 SSC new cases annually
What population has the worst survival rate for SCC?
Black
Lowest 5-year oral cancer survival rate?
black people
Which one has the best prognosis? Verrucous carcinoma in vestibule verrucous carcinoma floor of mouth SCC floor of mouth SCC in other areas
Verrucous carcinoma in vestibule
Smokeless tobacco:
verrucous carcinoma
Verrucous leukoplakia -
HPV 16 and 18
Most common most pathogenic location for verrucous carcinoma:
buccal vestibule
Verrucous carcinoma presents with: • warty lesion • white ulcerated patch (that’s what it looks like on google images) • smooth pedunculated lesion • large warty mass
large warty mass- variant of SCC
Leukoedema –
blue/grey/white mucosa that blanches. It disappears when stretching. Mostly
bilateral. No treatment.
A patient presents with a bilateral, grayish-white lesion of the buccal mucosa. This lesion disappears
when the mucosa is stretched. Which of the following is the MOST likely condition?
A. Leukoedema
B. Leukoplakia
C. Lichen planus
D. White sponge nevus
Leukoedema
philadephia chromosome 22
translocation, chronic myelogenous leukemia
main pathologic finding in chronic lymphocytic leukemia
lymph node enlargements
may be complicated by autoimmune hemolytic anemia
20yo, bleeding gums, nruising easily
suspect what?
leukemia
Patient shows up with kid that has bleeding gums, problems healing & has discomfort –
leukemia
young person that is fatigued and has a jacked-up mouth, looks like multi pyrogenic granuloma, very inflamed
and red gums.
leukemia
Pt had erythematous and gingival enlargement over past 5 weeks. And increased report of bruising on body –
cause is acute
leukemia: Specifically, AML
6 years old patient has acute lymphatic leukemia (ALL). Her deciduous molar has a large carious lesion and furcation lucency. How will you treat this person? a. pulpotomy b. pulpectomy c. extraction d. nothing
extraction
where do most malignant salivary tumors start
parotid
Most common salivary gland benign major or minor:
Pleomorphic adenoma (benign mixed tumor)
Most common malignant major:
Mucoepidermoid carcinoma
Most common malignant minor:
Adenoid cystic carcinoma
Adenoid cystic carcinoma:
most common site
spreads how
micro pattern
palate
spreads through perineural spaces
swiss chesse micro
swiss cheese pattern on micro
adenoid cystic carcinoma
Picture of an ulcerated tumor on palate? SCC, salivary gland tumor, tori
salivary gland tumor
don’t exclude salivary sialometaplasia
Most common salivary gland tumor:
Pleomorphic adenoma
best prognosis of salivary malignancy
Adenoid cystic carcinoma
Most common gland in Pleomorphic adenoma:
MOST COMMON SITE = MINOR GLANDS OF PALATE
MOST COMMON TUMOR OF PAROTID GLAND
Which of the salivary tumor glands has the best prognosis: Mixed Tumor, Adenoid cystic carcinoma, Mucoepidormoid Carcinoma,
Mixed Tumor (plemomorphic adenoma),
- Malig Mixed tumor & adenomatoid = worst
which salivary tumor spreads perineurally
adenoid cystic carcinoma
QUESTION: Peri-neural invasion is seen in: adenoid cystic carcinoma, Pleomorphic adenoma, low grade mucoepidermoid carcinoma, OKC
- ACC (adenoid) tumor has a marked tendency to invade nerves. Perineural invasion is seen in about 80% of all specimens.
Which has swish cheese appearance?
Adenoid cystic carcinoma
which salivary tumor has lymphocytes with germinal centers
Warthin tumor (adenolymphoma) = benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers
Warthin tumor is most common in what gland?
Parotid (don’t get mixed up with Wharton’s duct)
most common epithelial odontogenic tumor
ameloblastoma
ameloblastoma frequency stats
most common, most aggressive epithelial odontogenic tumor
ameloblastoma mostly where
mandibular
ameloblastoma tx
excision
Ameloblastoma histology:
stellate reticulum
group of cells located in the center of the enamel organ of a developing tooth.
Which one can lead to ameloblastoma?
Dentigerous Cyst
What cyst is ameloblastoma most likely to stem from?
Dentigerous cyst
spread of ameloblastoma
local invasion
What is the most definite way to distinguish ameloblastoma from OKC?
a. smear cytology
b. reactive light microscopy
c. reflective microscopy
b. reactive light microscopy
Multiluncency in bone and ramus:
ameloblastoma
X-ray: A painless, well-circumscribed radiolucency and radioopacity in the posterior mandible of 11 yrs old boy. What is the
differential diagnosis?
Ameloblastic fibro – Odontoma
Which lesion can become ameloblastomic? dentigerous cyst, lymphedema, epidermoid
dentigerous cyst
QUESTION: Radiographic picture: upside down molar with lucency around crown, what is it?
Dentigerous cyst
STARTS AT CEJ
which tumor starts at CEJ
dentigerous cyst
Which cyst is most likely to become neoplastic?
a. dentigerous
b. residual
c. radicular
dentigerous
Complex Odontoma –
irregular calcified lesions w/ no distinct tooth components
Compound Odontoma –
identifiable tooth components
Syndrome associated with multiple odontoma-
Gardner’s syndrome
Picture of multiple small teeth within a radiolucency around the canine: compound odontoma, pindborg tumor, calcifying
odontogenic
compound odontoma,
- Tumor of mixed (epithelial and mesenchymal) origin is the odontoma. These calcified lesions take 1-2 general configurations. They may
appear as multiple miniature or rudimentary teeth (compound odontoma).
adenomatoid odontogenic tumor stats
2/3 tumor: adenomatoid odontogenic tumor: 2/3 in maxilla, 2/3 in female, 2/3 in anterior jaw
assoc w unerupted teeth
Radiolucent lesion Between maxillary canine-lateral with radiopacity inside:
adenomatoid tumor (AOT) - REMEMBER lesion goes to apex
Mixed density lesion in a young child:
AOT
16 y/o boy: x-ray showed maxillary anterior tooth with a radiolucency with “SPECKS” in it (yes that’s the word that was used) -
Adenomatoid Odontogenic Tumor
Amelogenesis imperfecta inheritance
autosomal dominant.
Pictures of teeth, premolars just erupted. Thick dentin, thin enamel, pulps not obliterated, and no
teeth contact
– Amelogenesis imperfecta
- Amelogenesis imperfecta in X-ray shows open contacts
Radiographic picture with large decay and radiolucency. In addition to periapical
radiolucency, what another thing do you see?
Amelogenesis imperfecta (tooth lacks enamel)
enamel in amelogenesis imperfecta
Hypoplastic pitting enamel
“Ghost cells” -
keratinized calcifying odontogenic cyst
When does enamel hypoplasia occur?
Altered matrix formation (BELL STAGE)
All of the following are congenital except…
a. dentinal dysplasia
b. amelogenesis imperfecta
c. regional odontodysplasia
d. ectodermal dysplasia
c. regional odontodysplasia aka odontogenesis imperfecta
Regional odontodysplasia:
ghost teeth. (enamel, dentin and pulp are all affected. Non hereditary, eruption is delayed or doesn’t
occur)
dentinogenesis imperfecta types
DI Type 1 is with osteogenic imperfecta. DI Type 2 is not with OI. DI Type 3 is the bradywine type,
which occurs in absence of OI, exhibits multiple periapical radiolucency, shell-like appearance, &
large pulp chambers/exposures.
X-ray with obliterated pulp chambers
dentinogenesis imperfecta
dentinal dysplasia types
DD Type 1 – radicular: shorter roots, obliterated pulp chamber.
- DD Type 2 – coronal: pulp enlarged, “thistle” tube appearance, primary dentition appears similar to DI type II.
What is seen with Osteogenesis Imperfecta?
Dentinogenesis Imperfecta
Osteogenesis imperfecta is usually associated with/seen with?
a. Dentinogenesis Imperfecta
b. Amelogenesis imperfecta
c. hypercementosis
d. cleidocranial dysplasia
a. Dentinogenesis Imperfecta (DI)
All of the following are differential diagnosis for Dentinogensis imperfecta except? ectodermal dysplasia amelogenesis imperfecta enamel dysplasia dentinal dysplasia enamel hypoplasia (AI)
ectodermal dysplasia
Which is not associated with dentogenesis imperfecta?
Ectodermal dysplasia because the enamel is the ectoderm, dentin is
mesoderm I think
Dentinogenesis Imperfecta =
poorly mineralized dentin, enamel frequently fractures from the teeth leading to rapid wear and
attrition of the teeth.
Which one is associated with dentinogenesis imperfecta?
• Blue sclera
• hypodontia
• Blue sclera (this is from osteogenesis imperfecta)
Other characteristics of this condition: opalescent teeth, affects both primary and permanent, teeth are bluish-brown and translucent,
enamel is lost early.
Blue sclera seen in?
Osteogenesis imperfecta
Radiographs of a patient’s teeth reveal that the crowns are bulbous; the pulps, obliterated; and the roots, shortened. These
findings are associated with which of the following?
Porphyria
Pierre Robin syndrome
Amelogenesis imperfecta
Osteogenesis imperfecta
Erythroblastosis fetalis
Osteogenesis imperfecta
What is the most common? Dentinal dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta, cleft lip
cleft lip (Cleft Lip/palate)
Dentin dysplasia looks like dentinogenesis imperfect WITH ONE DIFFERENCE?
Dysplasia has radiolucency.
12 y/o boy’s X-ray shows roots are short & open apex. Sister also has same condition. What condition is this?
Dentinogenesis imperfecta
Amelogenesis Imperfecta
Dentin dysplasia
Dentin dysplasia – autosomal dominant
DI - autosomal dominant
AI - autosomal recessive
A picture of dentin dysplasia –
Short rooted teeth with periapical lucencies
Some teeth appear to be clinically normal, but exhibit (1) globular dentin, (2) very early pulpal obliteration, (3) defective root
formation, (4) periapical granulomas and cysts, and (5) premature exfoliation. The condition is known as which of the following?
A. Shell teeth B. Dentin dysplasia C. Regional odontodysplasia D. Amelogenesis imperfect E. Dentinogenesis imperfecta
B. Dentin dysplasia
conical anterior teeth
ectodermal dysplasia
Ectodermal dysplasia expressed as?
anodontia or hypodontia, with or without a cleft lip and palate.
Congenitally missing teeth often seen in?
Ectodermal dysplasia
Ectodermal dysplasia inheritance:
It is X-linked, not autosomal dominant
Characteristic of Ectodermal Dysplasia is?
Oligodontia (some missing teeth, > 6 teeth, not all teeth) and hypohidrotic (reduced
sweating) or anhidrosis (lack of sweating)
Ectodermal dysplasia:
partial or complete anodontia
Hypohidrotic child
à ectodermal dysplasia
- Sweating dysfunction, abnormal reduced of sweating due to heat
Ectodermal dysplasia and hair –
sparse hair
Having hypodontia will prevent/undermine formation of what?
Alveolus (others were maxillary and mandibular arch but not
together)
Hypodontia- FEWER number of teeth
- max deficiency
- man deficiency
- mid-face deficiency
- cortical bone deficiency
- alveolar bone deficiency
- alveolar bone deficiency
- Less teeth à reduced alveolar ridge development so the vertical dimension of the lower face is reduced
Bilateral jaw expansion
Cherubism:
A kid presents for bilateral enlargement, painless, etc. , what is the Tx?
No Tx required
they imply cherubism
**Mccune-Albright Syndrome
— polyostotic fibrous dysplasia—areas radiolucent/radiopaque—potential for malignant transformation
Café au lait spots (coast of Maine)—bone and skin disorder—brown spots!
Fibrous Dysplasia on radiographs –
ground glass appearance, diffuse expansion of the
mandible (“orange peel”)
Panoramic with big radiopacity?
diffuse with vital tooth —
lucent with vital tooth –
- fibrous dysplasia: it is diffuse radiopacity-vital tooth
- osseous fibroma: radiolucent vital tooth
35 yo female, picture of a couple of radiolucency lateral to lateral incisors, asymptomatic:
fibrous dysplasia
- Monostotic fibrous dysplasia may be completely asymptomatic and is often an incidental finding on x-ray
Which of the following is frequently accompanied by melanin pigmentation (cafe-au- lait spots)? A. Osteomalacia B. Hyperparathyroidism C. Osteogenesis imperfecta D. Polyostotic fibrous dysplasia
D. Polyostotic fibrous dysplasia (Mccune-Albright Syndrome)
X-ray, what is the cause of radioopacity on the apex of the infected tooth -
condensing osteitis
what’s one non-lucent lesion
Condensing osteitis (radiopaque)
Picture said: “scalloped border, tooth is vital, patient is asymptomatic”
traumatic bone cyst
Traumatic bone cyst
(aka simple bone cyst) = nothing inside, not a true cyst b/c not epithelial lined so pseudocyst
that heals by itself. It scallops around the roots of the tooth.
Young patient with traumatic bone cyst, what tx?
None, spontaneous healing
Surgical exploration
curettage of the osseous socket and bony walls
intralesional steroid injections
None, spontaneous healing
cotton wool x ray
paget’s
also hypercementosis and loss of lamina dur
dentures and hats stop fitting
Paget’s
cancer risk with Paget’s
osterosarcomas
labs in Paget’s
increased alkaline phosphatase, normal P and Ca
Paget x ray
cotton wool
Which one most likely has potential (high incidence) for malignant transformation?
osteomas, Paget’s disease
Paget’s disease
Which of the following has the potential for undergoing spontaneous malignant transformation? A. Osteomalacia B. Albright's syndrome C. Paget's disease of bone D. Osteogenesis imperfecta E. von Recklinghausen disease of bone
C. Paget’s disease of bone
Paget’s disease can lead to (malignancy)
osteosarcoma
Radiographic picture: Floating tooth not in bone, opacities in lesion, what is it? • Whole jaw cyst • Ameloblastoma • Keratocyst • Dentigerous cyst • Langerhans X
• Langerhans X
Hand-Schuller-Christian triad:
Diabetes insipidus, exophthalmos, & lytic bone lesions (Langerhans dis).
nasolabial cyst origin
Not a bone cyst, occurs outside of bone & is a soft-tissue cyst
A patient has a swelling under the upper lip that is by her lateral incisor and raises the ala of the nose from the outside. What is it?
Nasolabial cyst
Radiolucency radiating from root of central incisor toward midline, could be all of the below except: lateral periodontal cyst,
nasopalatine cyst, some sort of fibrous dysplasia, nasolabial cyst
nasolabial cyst
nasolabial cyst on xray?
can’t see,not in bone
QUESTION: Lining of nasolabial cyst -
pseudostratified squamous (so like respiratory)
What is the rarest cyst?
Lateral Periodontal Cyst
The most common non-odontogenic cyst:
a. dermoid
b. thyroglossal
c. lymphoepithelial
d. nasopalatine duct cyst
d. nasopalatine duct cyst
heart shaped cyst near central incisors
nasopalatine
Nasopalatine cyst treatment?
Enucleation
Intraoral picture of nasopalatine cyst by incisive papilla on backside of #7 & 8. The foramen and nasopalatine canal is where the
incisive papilla is and if there’s a cyst there then what does it look like clinically?
Soft tissue is swelling and discolored.
LYMPHOEPITHELIAL CYST:
- Usually an enlargement of the parotid or lacrimal gland
Round yellow-white bump underneath tongue?
Oral lymphoepithelial cyst
Patient (young child) w/ nodules on right side of tongue that are fluid filled the rest of the mouth is WNL, no other systemic signs
a. Neurofibromatosis
b. Lymphangioma
c. Granular cell tumor
Lymphangioma
odontogenic keratocyst characteristics
benign but locally aggressive
usually spreads along md like a sausage
other name keratocystic odontogenuc tumor
high reoccurence rate
KOT associated with syndromes
Gorlin’s (aka basal cell nevus) , multiple OKCs
Which highest incidence of recurrence?
• Odontogenic keratocyst
• Dentigerous cyst
• Odontogenic keratocyst
- High recurrence, Intrabony, posterior mandible but anywhere; BCNS association
Initial treatment for OKC is enucleate or resect?
enucleate
- Conservative treatment generally includes simple enucleation, with or without curettage
Nevoid basal cell carcinoma
(Gorlin syndrome) = commonly see multiple OKCs and palmar pitting, plantar keratosis (odontogenic keratin cyst,
KCOT)
QUESTION: Pt has calcified falx cerebri, multiple OKCs, bifid ribs. What syndrome does the patient have?
Gorlin Goltz syndrome aka Basal cell
bifid rib syndrome.
What is most often seen with nevoid basal cell carcinoma?
Odontogenic keratocyst
What does multiple OKC tell you?
Gorlin-gotz syndrome (also called basal cell nevus syndrome)
Nevoid BCC and palmar melatonin indicative of:
OKC
Which syndrome includes multiple osteomas?
Gardner’s (Multiple facial
osteomas & skin nodules)
Gardner’s syndrome has
multiple osteoma, odontoma and intestinal polyps
What do Gardners and Peutz-Jeghers syndrome have in common?
GI polyps
- GI polps in Gardner’s, Peutz-Jegher, Crohn’s
In Gardner’s Syndrome, there may be cancerous transform of what?
polyps in intestine
Peutz Jeger syndrome on lips.
freckles (melanosis)
Peutz-Jeghers syndrome –
multiple melanotic macules and gastrointestinal polyposis
multiple melanotic macules and gastrointestinal polyposis
Peutz-Jeghers syndrome –
peak of bell’s palsy
2 days
unilateral eye and lip drooping, unable to close
bell’s palsy
most common cause
herpes simplex
which cranial nerve is bell’s palsy
7th (facial)
cause of erythema multiforme
unknown
which AB in erythema multiforme and where
IgM
deposition in microvasculature of skin and oral mucous membranes
usually after infx or drug exposure
Target lesions?
Erythema Multiforme (also has positive nikolsky sign) - Nikolsky sign - top layers of the skin slip away from the lower layers when slightly rubbed.
Blow cold air on mucosa causing a positive Nikosky sign a) erythema multiform b) herpes c) pemphigoid d) epidermolysis bullosa
a) erythema multiform
also pemphigus
nikolsky sign pemphigus and pemphigoid
pemphigus +, pemphigoid -!
Widening of PDL and loss of mandibular ramus:
Scleroderma
= limited SCLERODERMA
CREST Syndrome
usually only in lower arms & legs, sometimes face & throat
Description of geographic tongue:
burning sensation on the tongue, moves around
Migratory glossitis picture: red-white borders –
Erythema migrans
Guy with lesions on his tongue that seem to move locations?
Erythema migrans
Cause of geographic tongue:
unknown
Lesion hurts after eating spicy food, has white lesions with red borders that move:
Geographic tongue
round bluish lesion on side of lip
Oral path picture of Basal Cell carcinoma:
Painless ulcer, upper lip, it grew bigger after 2 weeks -
Basal cell carcinoma
Mucocele
= caused by ruptured salivary duct, commonly seen on the lower lip, & usually due to trauma.
- NEVER ON THE GINGIVA
Most common location for mucocele?
Lower lip
Patient had SSC removed and now has a mucocele looking lesion on the lower lip, what is it? mucocele, fibroma, SSC
mucocele
You get mucocele due to?
Rupture of salivary ducts (trauma related)
Texture/consistency of dermoid cyst vs ranula:
dermoid is doughy/rubbery consistency while ranula is more fluctuant, bluish
blue mass under tongue, blue nodule on the floor of mouth, fluctuant
ranula
Lady presents w/ blue swelling under tongue?
ranula
QUESTION: Ranula are due to? sialolith mucus plug trauma fibrous plug
trauma
Trauma to floor of mouth
• Mucocele
• Submandibular hemangioma
• Ranula
Ranula
How do you treat a ranula? excisional, incisional, aspiration
excise (all of it)/excisional
‘sausage link appearance’ on sialography
sialodochitis
Sialolithiasis (calcified salivary stone) is found where?
Submandibular Duct (Wharton’s)
Sialoliths are most common in what gland?
Submandibular gland & duct
what causes enlarged acini
sialolith in duct –> sialadenitis
How do you treat painful sialolith in Wharton’s duct initially? Moist heat Dilation of duct Surgically remove sublingual gland Surgically remove submand gland
Surgically remove submand gland (cannulate the duct and remove stone)
(massage or lemon drops not an option)
for smaller stone, moist heat is first option
Patients with sialadenitis (actini enlarge) caused by sialith in the duct. It is a large, painful sialoth near the orifice of Wharton’s duct. What procedure do you do for removal? a. transoral to unblock duct b. extraoral to remove gland c. cannulation & dilation
c. cannulation & dilation (Cannulate the duct (sialotomy) to remove stone)
mucocele vs antral pseudocyst
mucocele is destructive and requires surgery while the Antral Pseudocyst (mucous retention pseudocyst) does not require
intervention and will dissipate.
antral pseudocyst in max sinus?
Antral Y (they also called it an “inverted Y”)
- A radiographic anatomical landmark: The Y line of Ennis (Inverted Y). It is created by the superimposition of the floor of the nasal cavity
(straight radiopaque line) and the border of the maxillary sinus (curved radiopaque line).
What is the inverted Y made up of?
Maxillary sinus & floor of nasal cavity
What is the isthmus of Y (where nasal floor (straight radiopaque line) and maxillary sinus (curved radiopaque line) start and meet).
What are the two anatomical factors that border this?
Floor of nasal cavity & maxillary sinus
Photo of maxillary sinus with radiopacity in one of the sinus and you have to identify the
condition:
mucous retention cyst –> antral cyst
Ankylglossitis-
congenital oral anomaly that may decrease mobility of the tongue tip & is caused by an unusually short, thick
lingual frenulum from tongue to FOM.
Parulis
localized collection of pus in gingival soft tissue. Pus is produced as a result of necrosis of non-vital pulp
tissue or occlusion of a deep periodontal pocket.
Reason for parulis -
incomplete root canal
Oral signs of tuberculosis
cervical lymph nodes, larynx, and middle ear. TB oral lesions are uncommon - usually chronic painless ulcers.
Primary lesions usually enlarged lymph nodes.
- Secondary lesions on tongue, palate and lip. Rare is leukoplakic areas.
What does tuberculosis lesion in the oral cavity look like?
Large ulcer
- Painful nonhealing indurated often multiple ulcers
- Most frequently affected sites were the tongue base & gingiva. The oral lesions look like irregular ulceration or a discrete granular mass.
positive test for blanching
hemangiomas
Hemangioma excised from tongue. Which is it? Choristoma, hamartoma, teratoma
hamartoma
4 yr. old kid has hemangioma on his tongue from birth. It grew at the same rate he did. What is
it? chroistoma, hamartoma, teratoma
hamartoma
HAMARTOMA- Normal tissue overgrowth. It grows at the same rate as surrounding tissues.
CHORISTOMA- TISSUE overgrowth in wrong location
ecchymosis
Ecchymosis - a discoloration of the skin resulting from bleeding underneath, typically caused by
bruising.
goes away by itself
Allergic stomatitis of the mouth is commonly seen because of what flavors in a toothpaste?
Cinnamon
Causes of allergic gingivitis include:
a. flavoring in toothpaste
b. food coloring in foods
c. Fluoride in toothpaste
flavoring in toothpaste
Patient has red gums and is told she has “plasma cell gingivitis”. Common cause is?
cinnamon flavoring in the dentrifice
Child with granulomatous gingival hypertrophy and bleeding rectal-anus has what?
Crohn’s
- Crohn’s = chronic inflammatory bowel disease that affects the lining of the GI tract.
Oral granulomas, apthous ulcer, rectal bleeding is seen in:
a. Wegener’s granulomatosis
b. ulcerative colitis
c. Crohn’s disease
c. Crohn’s disease
Which would be located in the floor of the mouth and be “doughy”?
A Ranula
B. Dermoid cyst
C Lymphoepithelial cyst
- dermoid cyst
is a firm, dough-like, sac-like growth on or in the skin that is present at birth & range in
size.
inheritance pattern of white sponge nevus
autosomal dominant
White lesion on movable mucosa that you can’t wipe/stretch off?
leukoplakia or white sponge nevus
leukoplakia presents later in life, sponge nevus usually before puberty
Patient has bilateral white lines @ occlusal plane, what is primary microscopic finding?
White Sponge Nevus
Buccal cheek of 60 yrs man, not wipeable? Leukoplakia, candida, white spongy nevus
white spongy nevus
Leukoplakia (more on floor 50%, tongue 25%)
trigeminal neuralgia: age
Average age of pain onset in trigeminal neuralgia typically is 6th decade of life, but it may occur at any age. Symptomatic or secondary
trigeminal neuralgia tends to occur in younger patients > 35 years
pain in neuralgia
Pain is stabbing or electric shock like sensation and is typically quite severe. Pain is brief (few seconds to 1-2 minutes) and
paroxysmal, but it may occur in volleys of multiple attacks. Pain may occur several times a day; patients typically experience no pain
between episodes.
distribution of pain in trigeminal neuralgia
Pain is one-sided (unilateral, rarely bilateral). One or more branches of the trigeminal nerve (usually lower or
midface) are involved.
Patient feels pain on biting and feeling of fullness in maxillary posterior teeth. No decay noted, why? sinusitis, atypical trigeminal
neuralgia
atypical trigeminal
neuralgia
carbamazepine for pain?
Trigeminal Neuralgia,
do not use to treat constant, facial pain
tx for trigeminal neuralgia
carbamazepine
Maxillary sinusitis bacteria:
Strep pneumonia
Drug for max sinusitis:
Amox with clavulanic acid (for b-lactamase strep)
Which of the following is most likely to be interpreted as toothache by the patient?
Maxillary sinusitis
- can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache)
md anterior, vital teeth,
black 30-50yo female
cemento-osseous dysplasia
X-Ray: Black women, middle aged, anterior radiolucency (can be radio opaque), vital teeth:
cemento osseous dysplasia, periapical
cemental dysplasia
Most common place for periapical cemental
dysplasia:
Lower anteriors
25 has radiopaque lesion at apex. It has normal PDL, vital, tissues normal, no caries or existing restoration?
periapical cemento-
osseous dysplasia
Focal Cemento-Osseous Dysplasia
30-50 white female
• Posterior mand / asymptomatic solitary lesion
Peripheral Ossifying Fibroma
= gingival nodule composed of cellular fibroblastic connective tissue stroma, which is associated with the
formation of randomly dispersed mineralized products (bone, cementum-like tissue, or dystrophic calcification).
Which of the following reactive lesions of the gingival tissue reveals bone formation microscopically?
Peripheral ossifying fibroma
Clinical picture with nodules & café au lait spots:
neurofibromatosis
An adult patient presents with multiple, soft nodules and with macular pigmentation of
the skin. Which of the following BEST represents this condition?
a. lipomatosis
b. neurofibromatosis
c. metastatic malignant melanoma
d. polyostotic fibrous dysplasia
e. bifid rib-basal cell carcinoma syndrome
b. neurofibromatosis
Which of these conditions have supernumerary teeth & lisch nodule on iris?
neurofibromatosis
Neurofibromatosis clinical presentations:
Café au lait, lisch nodules of the iris
Auriculotemporal syndrome
(Frey syndrome) - symptom where you sweat near cheek area when eating. Often after parotid
surgery.
sweating near cheek when eating
frey’s syndrome (auriculotemporal)
Auriculotemporal nerve is severed, what are the symptoms?
gustatory sweating
- Ligation of auriotemporal nerve – disrupt gustory sweating
actoninomyces re: air
anaerobes
Actinomycosis of jaw presents how?
Lumpy Jaw
Actinomycosis has
abscess, draining fistula, & contains yellow sulfur granules. Tx is incision & drainage + antibiotics
Which disease is most likely to cause suppuration?
Actinomycosis
A patient presents with malocclusion and a unilateral, slowly progressing elongation of her face. This elongation has caused her chin
to deviate away from the affected side. The MOST probable diagnosis is which of the following?
A. Ankylosis
B. Osteoarthritis
C. Myofascial pain
D. Condylar hyperplasia
D. Condylar hyperplasia
Dens in dente are most commonly seen in
maxillary lateral incisor.
Talon cusp is for?
dens evagenatus, NOT invagenalis
Lesion looks like SCC?
Keratoacanthoma
Keratosis happen where in the mouth?
a. palate
b. buccal mucosa
c. floor of mouth
d. upper lip
d. upper lip
keratoacanthoma looks like
crater with crust inside
basal cell is more reddish and can be flat
Sjogren’s
– autoimmune destroy glands
Complications of Sjogren’s syndrome –
keratoconjunctivitis,
Sjogren’s Synd associated with all EXCEPT
Herpes
Keratoconjunctivitis
SLE
Herpes
What is most common with Sjogren’s syndrome? Lymphoma, pleomorphic adenoma,
increased sweating and osteoarthritis.
Lymphoma
Which articular disease most often accompanies Sjogren’s syndrome?
A. Suppurative arthritis. B. Rheumatoid arthritis. C. Degenerative arthrosis. D. Psoriatic arthritis. E. Lupus arthritis.
B. Rheumatoid arthritis.
Xerostomia is present in all of the following except?
Sjogren’s syndrome, Vit C. Deficiency, parotid problems
Vit C. Deficiency
- Xerostomia is rarely due to a vitamin deficiency
Sjogren syndrome laboratory test:
SS-A / SS-B (also ANA or Rheumatoid factor)
Secondary Sjogren Syndrome:
dry eye, dry mouth, rheumatoid arthritis
Which of these are used in lab test for sjogren?
ANA
- Typical Sjogren’s syndrome ANA patterns are SSA/Ro and SSB/La
Sarcoidosis:
abnormal collections of inflammatory cells (granulomas) that can form as nodules
Treatment of sarcoidosis? Corticosteroids, antibiotics
Corticosteroids
TB is similar to?
Sarcoidosis
Sarcoidosis commonly involved organ:
lungs
Sarcoidosis is mainly related to which organ?
predominately a pulmonary disease
character of sarcoidosis
granulomatous
osteosarcoma on x-ray
sunray appearance, symmetric widening of PDL
An 18-year-old male complains of tingling in his lower lip. An examination discloses a
painless, hard swelling of his mandibular premolar region. The patient first noticed this swelling 3
weeks ago. Radiograph indicate a loss of cortex and a diffuse radiating pattern of trabeculae in the
mass. Which of the following is the MOST likely diagnosis?
a. leukemia
b. dentigerous cyst
c. ossifying fibroma
d. osteosarcoma
e. hyperparathyroidism
osteosarcoma
Most common primary malignant tumor of young people?
Osteosarcoma
Osteosarcoma in x ray:
sun burst and symmetrical widening of PDL.
Enlarge PDL and radiolucency at mandibular angle?
Osteosarcoma sunburst
Widening of PDL is early sign of what?
Osteosarcoma
Uniform widening of PDL and there is resorption in the bone: osteosarcoma, fibrous dysplasia
osteosarcoma
Young patient has paresthesia and growth in mandible: is
going to be osteosarcoma (young patient)
Bence-Jones proteins in urine
multiple myeloma (light chains)
high protein in multiple myeloma
M protein
which cells in multiple myeloma
monoclonal B (plasma)
Multiple Myeloma radiographic appearance?
Punched out lesions
QUESTION: 1st sign of multiple myeloma:
bone pain (in limbs & thoracic region)
Usually in post. mandible, no symptoms, moves teeth, cortical
expansion and root displacement, always radiolucent and honeycombed pattern
odontogenic myxoma
Soap bubble lesion in x-ray, what is it? Giant cell, Odontogenic Myxoma
- Soap bubble lesion= odontogenic myxoma
often seen
with impacted tooth
ostomyelitis appearance
onion skin
Girl with caries into the pulp on tooth #3 – radiograph shows alternating RL/path at inferior border of mandible (a.k.a “onion skin”,
bacterial)
à Garre’s Osteomyelitis aka chronic osteomyelitis
onio skin appearance
Garre’s (proliferative periostitis) and Ewing sarcoma
When there is no barrier, how far does the dentist need to be for protection?
6 feet, 90-135 degrees
Most of the x-ray is converted to?
Heat
What is the oil in the x ray tube for? prevent rust, reduce radiation, dissipate heat to the target, lubricate
dissipate heat to the target
Why is there oil in x-ray tube?
cools off the anode
Thermionic emission where?
Cathode
- Thermionic emission = electron emission from a heated metal (cathode). The cathode has its filament circuit that supplies it with
necessary filament current to heat it up.
what is the best x-ray:
short wavelength, high energy
What is primary source of radiation to the operator when taking x-rays? radiation left in the air scatter from the patient scatter from the walls leakage from the x-ray head
scatter from the patient
In performing normal dental diagnostic procedures, the operator receives the greatest hazard from which type of radiation?
A. Direct primary-beam
B. Secondary and scatter
C. Gamma
B. Secondary and scatter
What characterizes secondary radiation?
coming off the matter
What is the max radiation dosage for a dental professional per year?
50msv/year or 5 rem/year
- per month = 4 msv, per week = 1 msv
what produces heat in x ray
filament
Digital image: which is digital detector?
Charge coupled device
MRI uses what electromagnetic wave?
RADIOWAVES
What does collimation do?
reduces x-ray beam size/diameter & volume of irradiated tissue, reduces area of exposure
- usually with circle diameter of 2.75 in
does collimator increase penetrability
no
Collimation in x-rays -
reduces low energy radiation
Collimation =
block (lead)
What the collimator does:
reduce the 1) volume of tissue being irradiated and 2) reduce the amount of scatter radiation by 60%
Collimation does everything except: reduce pt exposure, increase penetrability, reduce operator exposure, film fog, reduce average energy of x-rays
increase penetrability, reduce average energy of x-rays
(energy is unchanged)
- Scatter radiation decreases with change to rectangular collimator, film fog (scattered radiation that reaches the film, unwanted darkness
- -> decreased by collimation decreases and image quality increases.
Collimation controls
size & shape of x-ray beam
The greatest decrease in radiation to the patient/gonads can be achieved by:
a. change from D to F speed
b. thyroid collar
c. filtration
d. collimation
e. high doses low frequency
collimation
Which of the following safety techniques provides the GREATEST DECREASE in overall radiation-risk to patients?
A. Changing from Group D to Group E film
B. Switching from round to rectangular collimation
C. Using an automatic rather than manual processing switch
D. Adding a cervical collar to a leaded apron
B. Switching from round to rectangular collimation
By what % do you decrease radiation when you use a square collimator vs. rectangular?
80%
the use of intensifying screens
à reduce the radiation
X-rays filters are used for?
Reduced intensity of electron beam, selectively absorbs low energy photons
Which material is used as a filter in X-ray machines? Lead, aluminum, tungsten
aluminum
filter absorbs:
Long wavelength
X-ray tube target metal is made out of:
tungsten (target = tungsten/filter = aluminum)
Central X ray perpendicular to object but not film:
elongation
Central X-ray perpendicular to film but not object:
foreshortening
head too low on pan
maxillary anterior teeth will appear elongated & the mandibular anterior teeth will
appear foreshortened.
chin too high
(a lack of negative vertical angulation, the occlusal plane of the teeth will then appear horizontal or,
with a positive occlusal plane, as a “frown line.”) = reverse smile line
What happens when you don’t have proper vertical angulation when taking x-rays –
elongation of the object
Change in vertical angulation when taking a PA will cause what?
A. Distortion
B. Magnification
C. Elongation or foreshortening
C. Elongation or foreshortening
If you take a PA and the tooth is foreshortened, why did it happen?
Vertical angulation was too large
QUESTION: Foreshortening of roots caused by
excess vertical angulation
X-ray beam is perpendicular to the film, not to the tooth, =
foreshortening
Overlap on bitewings due to
horizontal angulation
X-ray with cone cut. What’s wrong?
MISALIGNED XRAY TUBE HEAD, incorrect
beam centering
Pano – max centrals look abnormally wide –
position of pt head is too far back
- If pt is positioned too far backward, the anterior teeth image will be so wide that the outline of the crowns cannot be discerned.
QUESTION: Reversed occlusal plane on pano –
chin raised too high, patient head/chin tilted too far upward
• Chin up = frown
• Chin down = steeper smile
Pano, with short upper roots?
Patient’s didn’t put tongue on the top of their mouth.
Penumbra =
blurring at edge of structure on radiograph
The area on the film that represents the image of a tooth is the umbra, or complete shadow.
- The area around the umbra is called the penumbra or partial shadow. It’s the zone of unsharpness along the edge of the image; the larger
it is, the less sharp the image will be.
Fuzziness on outside of radiograph due to:
• Umbra
• Penumbra
Penumbra
Penumbra is affected by all except: • Moving x-ray tube • Moving film • X-ray dimensions/field/scatter • Film-object distance (decrease) • Reduction of film target distance
Reduction of film target distance
How does penumbra affect the contrast of an x-ray?
Decrease in contrast
Penumbra – how to prevent this in x-rays:
decrease size of focal spot, increase source-object distance, and reducing object-film
distance (should be parallel), central ray must be perpendicular to tooth, object and film, no movement.
How to reduce penumbra? moving object, decrease object/source distance, decrease object/film distance
decrease object/film distance
How do you prevent penumbra?
o Should be produced from a point source to blurring of the edges of the image
o Strong beam to penetrate
o X-ray should be parallel
o X-ray should be parallel (reduce object-film distance)
PA distortion
14%
Pano distortion is:
25% but could range 10-30%
What does it look like on a pano when your patient moves during the pano?
vertical blur line
radioagraph position to evaluate orbital rim areas
Water’s view
kissing projection
If you have lesion of maxillary sinus, what kind of radiograph do you take?
Waters
Which is most important x-ray for diagnosis of maxillary sinus? occlusal, panoramic, MRI, Waters
Waters
Best to see siaolilith in Wharton's? Occlusal Water's PAN PA
Occlusal
Best imaging for sinusitis or sinus infection: CT, occlusal radiograph, PA radiograph, Panoramic.
CT
- Know that sinuses are best viewed with Waters technique, but this was not in answer choice neither was none of the above as a choice.
Answer will either be Waters or CT!
Best diagnostic image for pathology in max sinus: waters, CT, MRI, periapical, pan
waters
Which radiograph would you use to view a fracture of the mandibular symphisis?
Posterio-Anterior
also Mand occlusal works too. Lateral oblique for fractures in angle, body and ramus
Best view for zygomatic arches:
Panoramic
You have pano, what can’t you do without intraoral photos?
space analysis
Pano: arrow pointing b/w posterior wall of maxilla and posterior wall of
zygomatic process of maxilla:
pterygomaxillary fissure
- Tear drop shaped in max sinus - pterygomaxillary fissure ààà
external oblique ridge on radiograph
running down roots on
mandibular molars
genial tubercle on radiograph
radiopaque line under mandibular anteriors
QUESTION: Pano, what is the round opacity under #24 and #25: Genial tubercles, nutrient canal, zygomatic process of maxilla, normal anatomy
Genial tubercles
Nutrient canals seen radiographically are most common where?
Mandibular incisors
Vertical BWX are better than horizontal BWX because?
More alveolar bone
What cannot be seen with a PA? pterygoid hamulus, coronoid notch, mental foramen, mand. Canal
coronoid notch
What structure can you not see on a PA radiograph?
- Hamular process
- Mental Foramen
- Coronoid process
- Mandibular foramen
Mandibular foramen (too posterior & inferior)
Source/object distance for lateral ceph: 5 feet, 6 feet, 15 cm, 60 cm
5 feet,
X-ray taken from mesial of max 1st premolar, buccal root will be where? mesial, distal, occlusal
distal
What can you see on a radiograph? Lingual ridge height Root dehiscence Trabeculation pattern PDL
Trabeculation pattern
Kvp:
ability for the beam to penetrate tissues, energy
mA:
of x-ray in a beam à radiation quantity (not quality!), density & patient dose
for most penetration : kvp and mA?
YOU WANT TO HAVE HIGH KVP AND LOW mA for MOST penetration
Dark films
(overexposed/image too dense): due to incorrect mA (too high), exposure (too long), incorrect kVp (too high).
Light films
(underexposed/image not dense enough): due to incorrect mA (too low) or exposure (too short), incorrect focal-film distance, or
cone too far from the patient’s face, or film is placed backwards.
intensity and distance proportion
intensity = 1/ (distance squared)
inversely proportional
Deterministic effects:
has threshold, severity of effect is dose-related
Stochastic effects:
no threshold & no dose-related, probability of effect /likelihood that something will happen
- Stochastic effects are associated with long-term, low-level (chronic) exposure to radiation. Increased levels of exposure make these health
effects more likely to occur, but do not influence the type or severity of the effect.
Radiosensitive:
Bone marrow, reproductive cells, lymphoid cells, immature cells, intestine.
RadioRESISTANT:
muscle, nerves
Digital X-rays have _____ less exposure from d-films to digital films:
digital has 50% less radiation exposure
Going from a D speed film to digital film, What’s the speed difference?
Speed increases
By reducing film speed from D to E & still keeping film density the same. What would you need to change?
Decrease Exposure time
Latent period is
time between when you exposed patient & clinical reaction to x-ray.
In radiobiology, the “latent period” represents the period of time between
A. cell rest and cell mitosis.
B. the first and last dose in radiation therapy.
C. film exposure and image development.
D. radiation exposure and onset of symptoms
D. radiation exposure and onset of symptoms
Which electron shell has highest power?
(f/d… outermost shell)
Which electron level has the highest binding energy? N K L or M
- K is located closest to the nucleus –> highest energy
Radiographic Picture looks washed out/too light, no contrast, what was adjusted?
- Decrease kvp
- Increase kvp
- Increase time
- Less developing solution
• Increase kvp
What was the problem with x-ray that appears too white? incorrect distance from target to film distance, low mA, low density.
low mA,
If x-ray is too dark,
it was too long in developer solution.
- Dark films (overexposed/image too dense): due to incorrect milliamperage (too high), exposure (too long), incorrect kVp (too high)
You take an x-ray at a certain mA, KvP and exposure time is 8 seconds when the beam is 10 inches away. What if everything were
the same except the beam was 20 inches away?
quadruple the exposure time
You increase the distance of the tube by 2x the length, how much does the x-ray exposure decrease? intensity is
decreased by 4
If change from 8 mm cone to 16 mm, how much exposure time do you need to increase by? 2, 4, 6, 8
mA and exposure are increased.
4
- Remember that going from an 8 mm to 16 mm cone means the cone/target is LONGER. This is the PID (target to film distance). If the PID
is increased there is LESS magnification. If the PID is shorter there is MORE magnification. Also density (darker x-ray) increases when kA,
Increase PID distance from 8 to 16, exposure time change from 0.5sec to? 0.25, 1, 2, 3…… with paralleling technique.
2
The x-ray of an interproximal ________ the size of the actual crater
underestimates
QUESTION: How do you increase the average energy of the beam? Kvp versus mA
Kvp
Deterministic radiology effects:
increases effect with dosage-direct effect
The severity of response increases with the amount of X-ray exposure. This effect is called: Deterministic, Stochastic, Genetic
Deterministic
Radiation that is stochastic, with non-threshold effects would a clinician notice first – leukemia, skin burn, hair loss, bone marrow
effect
leukemia
Irradiation cause saliva to have lower -
sodium content
Know how x-rays interact with matter:
photoelectric effect
- photoelectric effect: electrons are emitted from matter (metals and non-metallic solids, liquids or gases) as a consequence of their
absorption of energy from electromagnetic radiation of very short wavelength and high frequency, such as UV radiation. Electrons
emitted in this manner may be referred to as photoelectrons.
QUESTION: Radiation injury from – free radical formation from indirect, free radical from direct
free radical formation from indirect
How do you minimize exposure radiation?
minimizing the amount of tissue being radiated
Which type of radiation is constantly in effect: Inhaled radon radiation, not terrestrial or cosmic
Inhaled radon radiation,
Most radiation from nature – inhaling radon, internal, terrestrial, cosmic
inhaling radon
Dentist is more exposed to what type of radiation besides machine?
Scatter tube
Scatter patient
Scatter wall
Scatter tube
How does x-rays primarily damage cells?
Hydrolysis of water molecules
Radiation induced mutation is the result of?
Hydrolysis of water molecules.
Radiation affects the body by:
LYSIS of H20
Which structure is most radio sensitive:
hemopoitic bone marrow
What is most radio-resistant cell:
Muscle
Which one of the following tissues is least sensitive to ionizing radiation: muscle, lymphocytes, squamous epithelium
muscle
What will cause xerostomia: chemo or radiation?
radiation
Radiation of 4(Gy) to the skin will cause?
Erythem
A higher kilovoltage produces x-rays with: Greater energy levels More penetrating ability Shorter wavelengths Increase in density
Increase in density
KVp inc –>
more penetrating, high energy
Increasing mA results in an increase in:
Temperature of the filament & Number of x-rays produced
Increasing ImA alone results in a film with:
High contrast
If you increase distance, then you need to increase
mA
How do you change from a low contrast (longer scale of contrast) to a high contrast (shorter scale) without changing
density: increase mA and kvp, decrease mA and kvp, increase kvp decrease mA, decrease kvp increase mA
decrease kvp increase mA
If something is a structure in mouth is thick –
it absorbs more radiation, appears more radio-opaque on x-ray
To get osteoradionecrosis, radiation dose must be:
Above 50 gys (above 60)
Which is greater risk for ORN? IV bis for a year, radiation 65 grays
radiation 65 grays
Bisphosphonates used for all except: multiple myeloma, osteomyelitis, metastasis to bones from breast cancer, metastasis to bones
from prostate cancer
osteomyelitis
Indication for bisphosphonates:
osteoporosis
Does bisphosphonate add calcium to bone
à No, it inhibits osteoclast via apoptosis
What is the mechanism of action of bisphosphonates?
Inhibit osteoclasts
oral bisphosphonates
alendronate (Fosamax)
Risendronate (Actonel)
Ibandronate (Boniva)
IV bisphosphonates
Ibandronate (Boniva)
Zolendronic acid (Reclast)
Pamidronate (Aredia)
ortho in pts on bisphosphonates
no
What is not true about a patient who takes Fosamax and will need an invasive procedure?
Discontinue Fosamax 1 week before
procedure (that stuff stays in the system longer than that)
Pt taking bisphosphonates for 1 yr. IV, highest risk during dental tx?
Osteonecrosis
QUESTION: Pt doesn’t like her bridge & didn’t like her smile. Can you do bone graph in a bisphosphonate pt and would it last?
NO BONE
GRAFTING
A scenario about a patient who is taking bisphosphonates and gets osteonecrosis of the jaw. Diagnosis is?
a. Osteonecrosis without radiation
b. Osteonecrosis with radiation
a. Osteonecrosis without radiation
QUESTION: Osteonecrosis of jaw -
more common in mandibular & has nothing to do with radiation
Osteoradionecrosis most associated w/ what?
Mandible
Osteoradionecrosis scenarios -
preextract questionable teeth, hyperbaric oxygen pre and post if doing invasive procedures
Pt has stage 1 osteonecrosis from bisphosphonate. What do you do?
debride area or rinse with chlorhexidine
- If STAGE 1 - rinse Chlorhexidine
- If STAGE 2 - Refer to OS or do under Hyperbaric O2
Pt has a history of osteonecrosis & IV bisphosphonates but extractions are needed, what do you do?
Do it under hyperbaric O2
Best tx for bisphosphate pt:
Section crown off & still do RCT
avoid extractions
pernicious anemia deficiency
B12; intrinsic factor in stomach
microcytic hypochromic anemia
Fe deficiency
most common
most common anemia
microcytic hypochromic (Fe deficiency)
Which hemoglobin is affected in sickle cell anemia?
S
Pt has sickle cell anemia & has a thrombolytic crisis, what could precipitate this?
a. Nitrous oxide / oxygen use
b. Cold
c. Trauma
d. Infection
Cold
Sickle cell anemia is seen exclusively in black patients. Periods of unusual stress or of O2 deficiency (hypoxia) can precipitate a sickle cell
crisis.
What disease is more predominate in males?
Mandibular dysostosis (Treacher Collins syndrome)
Hypothyroidism
Diabetes
Sickle cell anemia
Hemophilia
Hemophilia
Which one of the following effects males almost exclusively?
- hemophilia
- downs
- diabetes
hemophilia
Macrocytic anemia which vitamin deficient? A, B, C, D, E
B
