Oral Pathology Flashcards
Osteogenesis Imperfecta “Brittle Bones”
genetic defect, affects production of COLLAGEN
- weak bones that break easily
- blue sclera, deaf, loose joints, low muscle tone, triangle face, curved spine
- dentally: bulbous crowns with cervical constriction, obliterated pulps, narrow and short roots, dentin malformation (dentinogenesis type I)
tx: no cure
Hypophosphatasia
resembles Osteogensis Imperfecta
- inherited
- LOW levels of ALKALINE PHOSPHATASE (important for calcifying bone)
- characteristics: looseness, hypocalcification, premature loss of deciduous teeth, large pulp chambers, bone loss
- Perinatal - fails to form skeleton, stillborn
- Infantile - severe rickets, hypercalcemia, bone abnormalities, most cases lethal
- Childhood - premature exfoliation of teeth, more infxn, skeletal anormalities, DWARFS
- Adult - spontaneous fractures, hx of ricks, osseous radiolucencies
Paget’s Disease (Osteitis Deforman)
chornic, non-metabolic disease
- INCREASE in serum ALKALINE PHOSPHATASE
- bones big, deformed, dnse but fragile, has potential to undergo malignant transformation
- affects middle aged and old ppl
- pts predisposed to OSTEOSARCOMAS
clinical features - hx of increasing size of hats or new denture made (bony changes), bones warm
lab tests - high serum alkaline phosphatase, urinary calcium and hydroxyproline
xray - COTTON WOOL, hypercementosis, loss of lamina dura
tx: antimetabolites or CALCITONIN, or tx with high protein and calcium
Osteomalacia
SOFTENING of bones in adults (adult form of Rickets)
-lack of VIT D
-STEATORRHEA one of the common causes due to fat malabsorption
signs and symptoms - pain in bones of arm, leg, spine, pelvis
Rickets
osteomalacia in kids, accompanied by listelessness, irritable, muscle weakness
- bowlegs, pigeon breast, protruding stomach
- dentally: delayed eruption, malocclusion, dentin and enamel abnormality, higher caries rate
Dwarfism (pituitary dwarfs)
arrested growth from undersecretion of growth hormone
oral manifestation - delayed eruption and exfoliation, smaller crowns and roots, small dental arch, malocclusion, underdeveloped mandible
ACHONDROPLASIA is most common type of dwarfism - kid is short, stubby fingers, bowed legs, bulging forehead
Cerebral Palsy
body movement and muscle coordination, damage to motor control centers
-spastic paralysis, impairment of coordination over voluntary muscles, accompanied by MR, seizures, vision and communication disorders
-NO oral manifestations unique to them but more commmon for: perio disease, caries, bruxism, malocclusion, gingival hyperplasia (if Dilantin for seizures), trauma
Down Syndrome
oral manifestations - mandibular prognathism, incr. perio disease, thick tongue, delayed tooth eruption, more missing teeth, malocclusion, enamel dysplasia
Muscular Dystrophy
weakness and degeneration of skeletal or voluntary muscles that control movement
oral manifestations - incr. in dental disease if OH neglected, weak in muscles of mastication, mouth breathing, open bite
Fibrous Dysplasia
GROUND GLASS appearance of bone
- Monostotic - 1 bone
- Polyostotic - 1+ bone
- Polyostotic with ENDOCRINE disturbances (Albright’s Syndrome -> pathologic fractures
swelling mass of bone
tx - surgery
Ectodermal Dysplasia
HEREDITARY, abnormal development of skin and hair, nails, teeth, sweat glands
Clinical signs - hypothrichosis, anhidrosis (no sweat or sebaceous glands, heat intolerance), anodontia, oligodontia, lack of salivary glands, kid looks old
no tx
Cleidocranial Dysostosis
INHERITED, absent or incomplete collar bones, supernumerary teeth, unerupted teeth
Pierre-Robin Syndrome
INHERITED, following findings in the neonate:
micrognathia, glossoptosis, breathing problems, cleft palate
Lateral clefting of lip
failure of MAXILLARY and FRONTAL NASAL PROCESSES to merge
in 5th-6th week of life
more common in males; more common left side
Cleft palate
6th-8th week of life, more common in females
- fissure in midline of palate
- speech and swallowing
Exostosis
slow growing, benign knots on hard palate, tori
Cherubism
BENIGN INHERITED autosomal dominant disease, in kids by 5 yrs., 2x affects males, mostly MANDIBLE
BILATERAL expansion of jaw gives kid a round face
histo - looks like central giant cell granulomas
xrays - multiple, well defined, multi-locular radiolucencies
- perivascular collagen cuffing is pathognomonic
- no systemic manifestations
- may have early exfoliation, delayed eruption
- tends to regress in adulthood so don’t radiate!
Acromegaly
hormonal disorder, when pituitary gland produces excess growth hormone due to a BENIGN tumor after adolescence (fusion of epiphyses)
-in > 90% it’s from ADENOMA
clinical signs - soft tissue swelling of hands and feet, change in ring or shoe size, brow and lower jaw protrude, nasal bone enlarges, teeth spacing increases
oral manifestation - enlarged tongue, mand prognathism, teeth tipped to side, long roots
gigantism - caused by benign tumor BEFORE adolescence
Cystic fibrosis
congenital/heredity metabolic disorder involving EXOCRINE glands, affect GI and respiratory systems
- thick secretions
- most common inherited disease causing death in white ppl in US
characterized by COPD, exocrine pancreatic insufficiency, high sweat electrolytes
oral manifestations - staining of teeth (dark), reduced caries rate
signs and symp - poor growth, malabsorption, steatorrhea, COPD, clubbed fingers/toes, barrel chest
Osteomyelitis
inflammation of bone marrow and adj. bone, caused by Staphylococci due to trauma/surgery
signs - pain, red, swelling, malaise
xray - poorly circumscribed radiolucency with central sclerotic nidus
Condensing osteitis (chronic focal sclerosing osteomyelitis)
bone rxn to infxn, mandibular 1st molar most involved
xray - well circumscribed radiopaque sclerotic bone surruound and extending below apex of root (entire root visible! distinguishes from benign cementoblastoma)
tx - RCT, EXT (sclerosing bone will remain)
Periapical Abscess
from pulpal infxn of tooth, follows caries
Acute - painful to percussion, mobile
Chronic - presents as granuloma or cyst (radiolucent at apex), asymptomatic
tx - DRAIN or ext
Osteoporosis
rdxn of total skeletal mass due to increased bone resorption
- predisposed to fractures caused by clacium or estrogen hormone deficiences
- thin, old, white women
tx - estrogen therapy, calcium, vit D
Osteopetrosis “Albers-Schonberg Disease” or “Marble Bone Disease”
HEREDITARY/congenital, manifests in infancy
- overgrowth and denseness of bones from defect in osteoclasts
- long bones dense and hard so bone marrow is obliterated
signs - abnormal bone and dental development, fragile bones, stunted growth anemia, spleen and liver enlargement, blind, deaf
Von Recklinghausen’s Disease (Neurofibromatosis)
multiple tumors of nerve tissue origin, inherited autosomal dominant trait by multiple neurofibromas, cutaneous cafe-au-lait macules, bone abnormalitis, CNS changes
signs - 6 or more cafe-au-lait macules > 1.5 cm in diameter
tx - no good ones, run high risk of transforming into malignancy
Scleroderma
rare autoimmune disease affecting blood vessels and CT
- hard and rigid skin/subcutaneous tissue
- deposition of collagen in major organs
- middle age females (4:1)
x-rays - wide PDL (also a finding in osteosarcomas)
tx - none really
Oral Traumatic Neuroma
lesion caused by trauma to nerve, small nodule of mucosa by the MENTAL FORAMEN, but also wherever a tooth was ext
-painful on palpation, “electric shock”
tx - excise
multiple neuromas on lips, tongue, palate can indicate pt has
MEN III (multiple endocrine neoplasia syndrome)
Neurilemoma (Schwannoma)
benign soft tissue tumor of Schwann cells around nerve, usually on tongue
tx - excise
can be derived from Schwann cell or perineural fibroblast
- Solitary - asymptomatic nodule -> excise
- Multiple - part of Neurofibromatosis syndrome -> can transform to malignant!!
Fibroma (Irritation or Traumatic)
most common intra-oral benign neoplasm of CT
-most common on buccal mucosa, lateral tongue, lower lip
clinical - pink, smooth, sessile
microscopic - bundles of collagen interspersed with fibroblasts and small blood vessels
histogenesis - fibrous CT
comparable to hyperplasias from denture irritation (epulis fissuratum)
Peripheral Fibroma
hyperplastic tissue with sessile or pedunculated base, may be ulcerated, rare recurrence
- peripheral ossifying - calcified islands of bone, ulcerated surface, young adult females, this may recur
- peripheral odontogenic fibroma - well vascularized, non-encapsulated fibrous CT
- giant cell fibroma - fibrous hyperplasia of multi-nucleated CT cells
Giant cell tumor
multinucleated giant cells, resemble osteoclasts scattered in matrix of spindle cells
-myelomas can be benign or malignant, can cause pain, sometimes bone fracture
Papillary fibroma
benign CT neoplasm
Lipoma
benign soft tissue tumor from ADIPOSE tissue
- yellowish mass, soft, smooth
- FLOAT in FORMALIN
Rhabdomyoma
rare benign tumor of SKELETAL MUSCLE
tongue most common place
sessile, non painful
Leiomyoma
benign tumor of smooth muscle, not painful
Lymphangioma
benign, yellow-tan tumor made of DILATED LYMPH VESSELS
-most common is TONGUE
microscopic characteristics - simple, circumscriptum, cystic
Benign tumors of Epithelium
- Papilloma - viral, caulfiflower-like, white, verrucous, pedunculated, must do surgery
- Verruca (warts) - not pedunculated, VIRAL, excise
- Keratocanthoma - VIRAL, crater lesion growing in skin that looks like SCC or BCC, can heal by itself
Multiple Endocrine Neoplasia Syndromes (MEN)
endocrine glands
-MEDULLARY CARCINOMA of THYROID
- Men I - tumors/hyperplasias of pituitary, parathyroids, adrenal cortex, pancreatic islets
- Men II (Sipple’s) - parathyroid hyperplasia or adenoma, NO tumor of pancreas, have PHEOCHROMOCYTOMAS of adrenal medulla and medullary carcinoma of thyroid!!
- MEN III - mucocutaneous neuromas, pheochromocytomas of adrenal medulla, medullary carcinoma of thyroid gland, presence of neuromas in oral cavity!!
Epulis granulomatosum
caused by retained foregin material due to iatrogenic error
Congenital Epulis of Newborns (Gingival Granular Cell Tumor)
cells identical to cell of a granular cell myoblastoma (granular cell tumor)
anterior gingiva of newborns, non-inflamed, pedunculated or broad based mass
Granular cell myoblastoma
unknown eitiology, uninflamed asymptomatic mass
-most common on TONGUE
*congenital epulis and granular cell myoblastoma are histologically identical BUT congenital epulis does not have pseudoepitheliomatous hyperplasia of overlaying epithelium
Pyogenic granuloma (pregnancy tumor)
bleeds easily, more common in females
microscopic - GT
Pregnancy tumor
pyogenic granuloma, maybe secondary to hormone changes, during FIRST trimester
remove AFTER pregnanc
Autograph (autologous graph)
tissue/organ transferred to new position in SAME body
Biopsy
fixative?
formalin 10%
only way to distinguish btw a granuloma and cyst
choristoma
hamartoma
overgrowth of tissues abnormal to organ from which it arises
overgrowth of tissues NORMAL to organ from which it arises
anaplasia
dysplasia
hyperplasia
metaplasia
feature of malignancy, absence of cell differentiation
non-malignant, structureless, disorganized, atypical cells without invasion, epithelium exhibits acanthosis
increase in size of tissue from incr. in # of cells
cell changes to another type in response to stress, NOT a feature of malignancy
hypertrophy
incr. in size of tissue from SIZE of cells
nosocomial
infxn from hospital
teratoma
benign or malignant made of multiple tissues foreign to organ from which it arises
carcinoma vs. sarcoma
carcinoma - malignant EPITHELIAL neoplasm
sarcoma - malignant MESENCHYMAL (C.T.) neoplasm
Lymphoepithelioma
poorly differentiated SCC involving lymphoid tissue in tonsils and nasopharynx regions
swelling of lymph nodes, sore throat, nasal obstruction
METASTASIS at early stage to cervical lymph nodes
tx - radiation, POOR PROGNOSIS (30% 5 yr survival)
Metastatic Carcinoma
most common malignancy of SKELETAL bones
clinical features - paresthesia or anesthesia of lip/chin
metastases to jaws originate from primary cancers of:
Breast Lung Thyroid Kidney Prostate Colon
most common osseous malignancies are
OSTEOSARCOMAS
then chondrosarcomas, fibrosarcomas, Ewing’s sarcom
Osteosarcoma (osteogenic sarcoma)
malignant bone tumor, in LONG BONES, peak before epiphyseal fusion (10-25 yr.s)
early xray feature is SYMMETRIC WIDENED PDL SPACE, sclerotic SUN-RAY appearance, lytic, mixed
diff dx for osteosarcoma of jaw include
chondrosarcoma, metastic carcinoma, pindborg tumor
ossifying subperiosteal hemangioma, peirpheral odontogenic fibroma
scleroderma, chronic osteomyeleitis
symp - tumor, mass swelling, pain, loose teeth, paresthesia, bleeing
histo classification of osteosarcoma based on dominant type of tissue cell
- osteoblastic - produces osteoid
- chrondroblastic - makes cartilage
- fibroblastic - makes fibrous tissue
osteosarcomas classified by site of origin
- conventional - medullary cavity
- juxtacortical - periosteal surface
- extraskeletal osteosarcomas - soft tissue
Ewing’s Sarcoma
malignant tumor from bone marrow, long bones or pelvis of young boys, HIGHLY LETHAL
sites - pelvis, thigh, body trunk
cells contain GLYCOGEN
when jaw is involved, predilection for RAMUS of mandible
xray MOTH EATEN radiolucency of medulla with erosion of cortex, periosteal ONION-SKIN rxn
Multiple Myeloma (Plasma Cell Myeloma)
bone marrow and plasma cells, MOST LIKELY FATAL
- elevated blood levels of BENCE JONES PROTEIN
- plasma cells that destroy osseous tissues
- older males
- mostly involves vertebrae, ribs, skull
- jaws rarely a primary site but become involved 70% of the time -> molar-ramus area
xray features of Multiple Myeloma
lab findings?
tx?
PUNCHED OUT radiolucencies
take a lateral ceph
lab - hypergammaglobulinemia (IgG), BENCE JONES proteinuria
tx by chemo, radiation. POOR PROGNOSIS, survival 2-3 yrs
Odontogenic Myxoma
rare slow growing, asymptomatic jaw tumor in mandible
-localized expansion of jaw
tx - curettage
TNM - stage, assess prognosis and therapy of malignant neoplasma (tumors)
T = SIZE of tumor N = presence of regional lymph node involvement M = presence of distant metasasis
melanoma exhibits 2 growth phases in skin
- Radial (horizontal) - INITIAL phase, just above and below dermo-epidermal jxn in horizontal plane
- Vertical - neoplastic cells populate the underlying dermis. METASTASIS is possible
Malignant Melanoma
MOST SEVERE and serious type of SKIN CANCER
- from excessive exposure to UV radiation
- often develops from a MOLE (nevus)
- uncommon in oral mucosa but has predilection for palate and maxillary gingiva/alveolar ridge
- 5 yr. survival is 7%
what cancer is the most common malignancy in the US. 1 in 100 will develop it
SKIN CANCER
most common intra-oral site for melanoma is
hard palate
4 clinical types of Melanoma
- Superficial Spreading - most COMMON, tan, brown, sun-exposed skin, radial growth, clinically macular or slightly elevated
- Nodular - no radial growth
- Lentigo Maligna - elderly, radial before vertical
- Acrolentiginous - hands and feet
Nevus
mole
atypical (dysplastic) - bigger, can mark a greater risk of malignant melanoma
Basal cell carcinoma
malignant epithelial cell tumor
- central crater that erodes, crusts, bleeds
- ONLY skin (never mouth)
- caused by sun exposure
tx by electrodessication or cryotherapy
Squamous Cell Carcinoma (Epidermoid Carcinoma)
sites?
most common malignancy in oral cavity (90%)
-malignant epithelial tumor, more in males
- more on lower lip than intra-orally
- intra-orally on LATERAL and VENTRAL tongue -> cervical lymph nodes
- FOM is 2nd most common site with worst prognosis
-can be red, irregular, non-painful, or white
risk factors for SCC
tx?
smoking, smokeless tobacco, alcohol, painful and ill fitting dentures, chronic inflammation
tx by surgery and radiation
most reliable histologic criterion for dx of oral SCC
INVASION
SCC H&N locations (9)
- nasopharynx
- palate
- oropharynx
- maxillary sinus
- tongue** lateral and ventral surface
- lips** lower lip (most easily managed when it’s here)
- FOM
- buccal mucosa
- gingiva and alveolar mucosa
3 types of SCC
- Verrucous Carcinoma
- Carcinoma IN SITU
- Carcinoma Invasive
Verrucous Carcinoma
rare form of SCC, does NOT metastasize
- from tobacco, smoking, snuff
- old men
- UPPER ALVEOLAR RIDGE
- white, cauliflower/coral like papillary appearance
- can transform into invasive kind of carcinoma
Carcinoma IN SITU
only intraepithelial, atypical mitosis, hyperchromatism, but DOES NOT INVADE C.T.
-can’t metastasize cause lack of blood in epithelium
ex. old alcoholic female with red FLAT area in FOM
Carcinoma Invasive
ex. old alcoholic female with red area in FOM, med hx non-contributory
Erythroplasia
red, or speckled, non-ulcerated
-early carcinoma often begins as erythroplasia
characteristics of lesions that may be malignant include
erythroplasia rapid growth ulceration bleeding induration (firm to touch) fixation
abrasion
attrition
erosion
- abnormal pathologic wearing away ex. toothbrush (V-shaped wedges); occlusal (flat cusps)
- physiologic wearing of enamel and dentin from NORMAL FUNCTION, or bruxism
- chemical loss from non-mechanical means, ex. acid
internal resorption
begins in root canal (looks like balloon)
-first evidence may be pink-hued area on crown
intrinsic staining of teeth can be caused by the following
dentinogenesis imperfecta erythroblastosis fetalis porphyria fluorosis pulpal injury internal resorption tetracyclines
NOT DIABETES
ankylosis
fusion of alveolar bone to tooth
gemination (twinning)
division of single tooth germ by invagination causing incomplete formation of 2 teeth
gomphosis
fibrous joint where conical process is inserted into socket-like portion
taurodontism
enlarged pulp, shortened roots, usually molars
hypercementosis
excess cementum around/on root after tooth eruption
- seen in ACROMEGALY
- affects VITAL teeth
- usually premolars
enamel hypoplasia
incomplete formation of matrix
- enamel hard, but thin and deficient
- genetic forms are types of amelogenesis
clinically - lack of contact, rapid breakdown of occlusal, yellow-brown stain that appears from exposed dentin
enamel hypocalcification
hereditary defect, enamel is soft and undercalcified
- normal in quantitiy due to defective maturation of ameloblasts
- defect in mineralization of formed matrix
amelogenesis imperfecta
hereditary ectodermal condition
- enamel is soft, thin, yellow
- dentin, pulp, cementum NOT affected
3 types of amelogenesis imperfecta
Type 1 Hypoplastic AI: enamel not formed to full thickness or might be absent on newly erupted teeth due to defective FORMATION of enamel matrix
Type 2 Hypomaturation AI: enamel can be pierced and chipped away, has IMMATURE CRYSTALLITES
Type 3 Hypocalcified AI: quantity of enamel is normal but so soft it can be removed during prophy due to defective MINERALIZATION
Dentinogenesis Imperfecta (Hereditary Opalescent Dentin)
features?
sometimes assoc. with what condition?
RARE, only 1:7,000 kids. Hereditary MESODERMAL defect.
clinical features - amber, gray, purple teeth, pulp chambers obliterated, short and bulbous crowns, narrow roots, constriction at enamel-cementum junction
-sometimes linked to osetogenesis imperfecta, blue sclera common
3 types of dentinogenesis imperfecta
Type 1 - in pts with osteogenesis imperfecta, blue sclera, hx bone fractures
Type 2 - most common, only dentin is weird
Type 3 (Brandywine) - only dentin abnormal, but variations incl. multiple pulp exposures
dentin dysplasia (rootless teeth)
hereditary disease, autosomal dominant
clinical features - normal enamel, atypical dentin, pulp obliteration, defective roots, radiolucencies, early exfoliation
Type 1 (Radicular) - more common, mobile teeth, premature exfoliation, short roots, obliterated pulp, CRESCENT shaped pulpal remnant, radiolucencies, “CHEVRON” shaped pulp chambers
Type 2 (Coronal) - blue gray, obliterated pulp, amorphous and atubular dentin, THISTLE tube pulp and stones, true denticles, pulp stones
Oral Candidiasis (Thurs or Moniliasis)
symptoms?
predisposing factors?
tx?
fungal infxn caused by Candida
- diffuse, curly, velvety white mucosal plaque
- CAN BE WIPED OFF -> red, raw, bleeding surface
- symptoms = discomfort, burning, altered taste
-factors that stimulate growth = abx, steroids, diabetes, pregnancy, vit deficiency (iron, folate, b12, zn)
tx - lozenges (trouches) and Nystatin rinse
Angular Cheilitis (Perleche)
predisposing factors?
tx?
inflammatory lesion at corners of mouth
predisposing factors - candida infxn, loss of vertical dimension, trauma, vit deficiency (riboflavin, thiamine)
tx - NYSTATIN
Actinic Cheilitis (Solar Cheilitis)
premalignant, caused by sun
- counterpart of actinic keratosis
- can develop into SCC
-thick, white discoloration of lip at border and sharp demarcation btw red of lip and normal skin
White sponge nevus (familial white folded dysplasia)
buccal mucosa abnormality often mistaken for leukoplakia
-soft, thick, corrugated folds
NO TX
Leukoplakia
PREMALIGNANT, white patch or plaque, WON’T RUB OFF, DOESN’T DISAPPEAR WHEN STRETCHED
-etiologic factors = tobacco, alcohol, oral sepsis, chronic irritation
tx = biopsy! all leukoplakias must be biopsied and completely excised
carcinoma in situ
mucosal lesions that resemble leukoplakia except that dysplasia is prnounced and involves almost all epithelial layers, shows no tendency to metastasize or invade
-exhibits all histo characteristics of malignancy but DOES NOT show invasiveness or extension
diff dx of white patch includes
leukoplakia lupus erythematosus leukoedema white sponge nevus chemical burn candidiasis lichen planus migratory glossitis
Stomatitis Nicotina (Pipe Smoker’s Palate, Nicotinic Stomatitis)
related to pipe smoking, ONLY ON PALATE, mostly males
- palate red, inflamed, then diffuse gray-white multi-nodular appearance with small red “spot” in center of each nodule
- leathery white hyperkeratosis (inflamed minor salivary glands)
- the only lesion produced by tobacco that is not cancerous
tx = stop smoking
PREMALIGNANT
Leukoedema
mimics leukoplakia, along occlusal line, DISAPPEARS on STRETCHING
tx = none
histo - epithelium is parakeratotic and acanthotic, marked with edema
diff dix = leukoplakia, white sponge nevus, herditary benign intraepithelial dyskeratosis
Lichen Planus
oral lesion on buccal mucosa, appears as white or gray-white STRIAE in a lace-like pattern “WICKMAN’S STRIAE”’
-may be autoimmune
microscopic features = hyperparakeratosis, thickened granular layer, saw-tooth appearance of rete pegs, degeneration of basal cell layer, infiltration of inflammatory cells
-more common in women
tx - topical STEROIDS
2 forms
- Bullous lichen planus - fluid filled vesicles
- Erosive lichen planus - RED, when involves gingiva looks like desquamative gingivitis
Hairy Tongue
hypertrophy of FILIFORM PAPILLAE
- BENIGN condition
- discolaration of dorsum tongue
- can be white, green, brown (stained from debris)
etiology - overgrowth of fungal microorganisms from smoking or poor OH
4 types of Papillae on Tongue
taste buds are on which ones?
- Filiform - most numerous, V-shaped rows, NO taste buds
- Fungiform - scattered along filiform, flat, mushroom shaped at tip and lateral margins
- Circumvallate - largest but least numerous, circular in V-shaped row at back of tongue, assoc. with ducts of von Ebner
- Foliate - lateral margins as 3-4 vertical folds
Taste buds are on fungiform, circumvallate, foliate
Benign Migratory Glossitis “Geographic Tongue” or “Erythema Migrans”
harmless, desquamation of filiform papillae
- slight burning of tongue
- often occurs with fissured tongue
Fissured tongue “Scrotal Tongue”
found in what Syndrome?
deep, asymptomatic MEDIAN FISSURE with laterally radiating grooves, arranged across dorsum of tongue
found in Melkersson-Rosenthal Syndrome (along with Cheilitis Granulomatosum and Facial Nerve paralysis)
Fordyce’s Granules
ectopic sebaceous glands in oral mucosa, in > 75% adults
-yellow clusters, NORMAL
Purpura
hemorrhages, looks like purple spots or patches
-extractions are contraindicated due to potential excess bleeding
2 types
- Thrombocytopenic Purpura (Werlhof’s Disease) - deficiency in # of platelets, can be caused by heparin
- Thrombotic Thrombocytopenic Purpura (TTP) - fatal form, low platelets and thrombosis in terminal arterioles and capillaries
Agranulocytosis
rdxn in # of neutrophils
- LEUKOPENIA with rdxn in # of PMNs
- toxic effect of certain ANTITHYROID DRUGS (propylthiouracil, methimazole, carbimazole)
WBC < 2000, almost no nutrophils
- high fever, chills, sore throat, infection in oral cavity
- oral lesions - necrotizing ulcerations, ragged ulcers covered by gray membrane
tx - figure out what drug and stop it, give abx
Cyclic Neutropenia
form of agranulocytosis where pts exhibit severe gingivitis, usually no ulcerations
Sickle Cell Anemia (Sickle Cell Disease)
inherited anemia, crescent shaped RBCs, characterized by fever, leg ulcers, jaundice, pain in joints
- production of abnormal hemoglobin (hemoglobin S)
- usually blacks, females
- signs of anemia (weak short breath, joint pain)
dental xrays are diagnostic -> marrow spaces are enlarged, trabeculae are prominent, osteosclerotic areas noted in midst of large radiolucent marrow spaces
Leukemia
what agents are assoc. with its development?
cancer, uncontrolled proliferation of leukocytes -> replacement of red bone marrow with leukemic cells
-unknown etiology
agents assoc. with its development
- ionizing radiation
- viruses - herpes like viral particles, and they have high titer to Epstein Barr
- genetic mutations - Philadelphia chromosome in 90% pts with CML; in Down’s
- Other - benzol, aniline dyes
3 types of Leukemia
- Myelogenous - granulocytes and megakaryocytes
- CML is 4 yrs. with death from hemorrhage or infxn
- Philadelphia chromosome and low levels of leukocyte alkaline phosphatease
- massive splenomegaly - Lymphocytic Leukemia - lymphocytes
- CLL variable course
- lymph node enlargement main finding - Monocytic Leukemia - monocytes
- oral lesions (gingivitis, gingival hemorrhage, gingival hyperplasia, petechiae, ecchymoses, ulcerations)
- RARE
clinical features of chronic leukemia
- insidious (slow) onset with weakness and weight loss
- organ involvement similar to acute leukemia: skin involved, manifest as petechiae or ecchymoses, recurrent hemorrhages, bacterial infxns
- lab findings: leukocytosis > 100K with mature forms (granulocytes and lymphocytes) predominating
Chronic Myelogenous Leukemia (CML)
myeloproliferative disorder
- the least malignant leukemia
- affects middle age
clinical signs - spongy bleeding gums, fatigue, fever, weight loss, moderate splenomegaly, joint pain
PHILADELPHIA CHROMOSOME - translocation btw chromosomes 9 and 22
survival time = 4 years with death due to hemorrhage or infxn
Polycythemia Vera (Primary Erythemia)
chronic myeloproliferative disorder of TOO MANY RBCs
- blood is too thick to pass through small vessels -> clot formation and blockage -> CVA
- splenomegaly in 75% pts
clinical features - headache, weak, weight loss, pruritis, hemorrhage, thrombosis
oral manifestations - gingiva and tongue deep purple-red, gingiva swollen and bleeds, submucosal petechiae, hematomas
Secondary Polycythemia - incr. in total # of RBCs due to another condition
Acute Myeloid/Myelogenous Leukemia (AML)
malignant disease of bone marrow, hematopoietic precursors arrested in early development
- has > 30% myeloblasts in blood, which contain AUER RODS
- MOST MALIGNANT leukemia
Acute Leukemia
abrupt onset of few months
-pt dies within 6 due to brain hemorrhage or bacterial infxn
clinical features - anemia, hemorrhages, enlargement of lymph nodes or spleen, petechiae
primary organs involves = bone marrow, spleen, liver
lab findings - leukocytosis with immature forms predominating (myeloblasts, lymphoblatss); anemia, thrombocytopenia, prolonged bleeding and coagulation times, tournique test +
acute myelogenous leukemia more common in kids or adults?
adults
Acute Lymphocyt (Lymphoblastic) Leukemia more common in kids or adults?
CHILDREN
- most common leukemia in children
- lymph node enlargement
- lymphocytes are not B or T cells but “null” cells
Aleukemic Leukemia
-leukemic cells in bone marrow, but circulating WBC are neither immature nor increased in number
Leukemoid Reaction
increase in # circulating granulocytes (neutrophils)
Stem Cell Leukemia
abnormal cells are the precursors of lymphoblasts, myeloblasts, monoblasts
Subleukemic Leukemia
leukemic cells appear in blood but no significant increase in # of circulating WBC
Plummer Vinson Syndrome
severe and chronic IRON DEFICIENCY anemia, mainly mid aged women
-predisposition to carcinoma in oral mucous membranes
systemic symp - weak, pallor, dysphagia, dyspnea
oral symp - angular stomatitis, smooth, red painful tongue with atrophy of papillae
Aplastic Anemia
2 types?
capacity of bone marrow to produce RBCs is defectie
-most serious and life threatening blood dyscrasia assoc. with drug toxicity
- Primary - unknown cause, affects young adults, usually fatal. oral symp = bleeding, petechiae, gingival infxns
- Secondary - exposure to toxic agents, any age, good prognosis
Pernicious Anemia
deficiency in what?
what are the symptoms?
inability to absorb Vit B12 from digestive tract
-megaloblastic anemia caused by lack of INTRINSIC FACTOR
triad of symptoms = weak, sore painful tongue, tingling of extremities
Thalassemia Major and Minor
hemolytic anemias caused by genetic defect
-low level of erythrocytes and abnormal hemoglobin
oral manifestations - oral mucosa shows anemic pallor, flaring of max anteriors
Erythroblastosis Fetalis (hemolytic disease of newborn)
production of maternal antibodies for fetal RBC
- involves RH FACTOR INCOMPATIBILITY
- destruction of RBCs
- only occurs when MOM is RH(-) and KID is RH(+)
oral manifestations - teeth green blue, brown, enamel hypoplasia
Erythrocyte Sedimentation Rate (ESR)
non-specific test that monitors progression of disease
- rate at which RBC settle out in a tube of unclotted blood
- elevated sedimentation rates indicates presence of inflammation (makes blood proteins heavier)
ESR rises in inflammation, tissue degen., suppuration, necrosis, pregnancy
Wiskott-Aldrich Syndrome
only boys, causes eczema, low platelets, deficiency of B and T cells
-if they survive past 10 -> lymphoma and leukemia
Trigeminal neuralgia
stab-like pains, provoked by a trigger zone near nose or mouth, caused by degen. of trigem nerve or pressure
tx - CARBAMAZEPINE (tegretol), an analgesic/anticonvulsant
Multiple Sclerosis
chronic, attacks CNS (brain, spinal cord) due to AI response, facial and jaw weakness
-predisposed to Bell’s Palsy, Trigem. Neuralgia
Glossopharyngeal Neuralgia
sharp, sudden, shooting, UNILATERAL
Postherpetic Neuralgia
burning, aching, itching, hyperesthesia along a cutaneous nerve after attack by HERPES ZOSTER
-facial nerve CN VII and geniculate ganglion -> Ramsey Hunt Syndrome
Myasthenia Gravis
extreme muscle weakness due to AI dosrder, antibodies against Ach receptors in NMJs.
- xerostomia, caries
- more in women
- droopy eyelids, double vision, fatigue
tx - pyridostigmine, neostigmine
Eaton-Lambert Syndrome
like myasthenia gravis, AI disease
-caused by inadequate release of Ach
Muscle spasm
prime factor that initiates Myofascial Pain-Dysfunction Syndrome (MPD). Mostly in women, unilateral.
Usually LATERAL PTERYGOID
tx - self limiting but can use NSAIDS and diazepam (valium)
4 cardinal signs and symp of MPD
pain, muscle tenderness, clicking/popping, limited jaw movement
Frey’s Syndrome (Auriculotemporal)
damage of auriculotemporal nerve and innervation of sweat glands
Bell’s Palsy
facial paralysis from damge to facial nerve
signs - unilateral paralysis with loss of wrinkles, drooping eyebrows, etc.
if you do IA block into parotid gland can get Bell’s Palsy
Congenital Cysts
- Branchiogenic - anterior border of sternocleidomastoid
- Dermoid - contains hair, sebaceous and sweat glands, tooth structures, in FOM
- Thyroglossal Duct Cyst - midline, dark, vascular, hemorrhage into mouth
Developmental Cysts (Fissural)
- Nasopalatine Duct Cyst (Incisive) - heart shaped, non-odontogenic, teeth are VITAL; soft tissue counterpart is Palatine Papilla Cyst
- Nasolabial Cyst - swelling by nostril, NOT in bone, fibrous CTs
- Globulomaxillary Cyst - pear shaped btw roots of max. lateral and canine, IN BONE, epithelial remnants at line btw globular and mx processes
- Median Palatal Cyst
5 Median Alveolar Cyst - btw central incisors, adjacent teeth are vital
Fibrous Dysplasia (3 types)
- Monostotic Fibrous Dysplasia - most common, GROUND GLASS xray. Craniofacial Fibrous Dysplasia (of the jaw) causes EXPANSION and deformity, see a thickening at skull base
- Polyostotic Fibrous Dysplasia - during childhood, long bones, face, clavicles
- McCune-Albright Syndrome - bones, pigmentation, premature puberty (endocrine), hallmark is FEMALE PREMATURE PUBERTY
- triad of symp - polyostotic fibrous dysplasia, Cafe au lait spots, endocrine abnormalities
- malignant transformation potential into osteosarcomas
- tx is nonspecific but can use something that inhibits estrogen production
Gardner’s Syndrome
POLYPOSIS -> usually malignant transformation -> colon cancer
- impacted, supernumerary teeth
- COTTON WOOL appearance
- fibromatosis, epidermoid skin cysts
Central Giant Cell Granuloma
within jawbones caused by trauma, more in kids
-anterior jaw
Condylar Hyperplasia
unilateral enlargment, unknown cause, deviate chin away from affected side
Central Ossifying Fibroma
slow-growing, painless, asymptomatic
Histiocytosis X
abnormal scavenger cells (histiocytes/macros), eosinophils proliferate -> scars
-defects in reticuloendothelial system, proliferation of macros of loose CT
- Eosinophilic Granuloma - most benign
- Letterer-Siwe Disease - before 3, usually fatal, pneumothorax
- Hand-Schuller-Cristian - exophthalmos, diabetes insipidus
can treat with corticosteroids and cyto-toxic drugs, should radiate bone
death from respiratory or heart failure
Eosinophilic Granuloma
benign form of Histio X, affects bones and lungs as a result of metabolic defects in the reticuloendothelial system
-pneumothorax a complication
Verruciform Xanthoma (Histocytosis Y)
benign, soft tissue tumor, large FOAM cells in CT papilla
Nevoid Basal Cell Carcinoma (Basal Cell Nevus - Bifid Rib Syndrome/Gorlin & Goltz Syndrome)
- multiple basal cell carcinomas
- multiple OKCs, bifid ribs
- blindness
- MR, dural calcification, hydrocephalus
- sexual anomalies - hypogonadism, ovarian tumors
Dentigerosu Cyst (Follicular)
assoc. with crown of unerupted tooth or dental anomaly, usually by 3rd molar
AMELOBLASTOMA most likely to develop in wall
Eruption Cyst
swelling of alveolar ridge over crown, can be mistaken for hemangioma or hematoma
Primordial Cyst (Follicular)
no calcified structures, found in place of a tooth
Odontogenic Keratocyst
follicular and dentigerous cysts that contain keratinizing material
- tendency to RECUR (over 30%)
- grow cause of epithelial cell multiplication
Traumatic Bone Cyst
- usually btw mand canine and ramus
- teeth are vital
- case: radiolucency apical to PM and molars
Lateral Periodontal Cyst
inflammatory, a RADICULAR cyst
- most in mandibular canine-premolar area
- apposition with root of vital tooth, asymptomatic
Dental Granuloma
- sequelae of pulpitis, can only be distinguished by histo
- asymptomatic, tooth NON-VITAL
- histo - fibrous CT with macros, lymphocytes
tx -> RCT or EXT
Radicular Cyst (Apical Periodontal Cyst or Periapical Cyst)
most common odontogenic cyst, develops within a pre-existing dental granuloma, incr. osmotic pressure in cyst lumen
-histo: lumen (true cyst)
tx -> RCT with apico or ext
Residual Cyst
tooth with a radicular (periapical) cyst is ext, but the radicular cyst persists, asymptomatic -> curette
Gingival Cyst
canine and premolar areas of mandible
MOST COMMON EPITHELIAL (ECTODERMAL) odontogenic tumor
Ameloblastoma
Ameloblastoma
- odontogenic epithelium that shows differentiation of histologic layers of enamel organ
- slow growing, invasive, usually BENIGN
- Multicystic (Solid) - most cases, more aggressive, do marginal resection
- Unicystic - usually younger, most in mandible, tx by ENUCLEATION
- Peripheral (Extraosseous) = uncommon, from rests of dental lamina
radiographic appearance of ameloblastoma
microscopic feature?
recurrence?
lesion on VITAL teeth with SOAP bubble (if big) or HONEYCOMB (if small)
-irregular scalloped borders, looks like a central giant cell granuloma
-nonencapsulated
recurs 50-90% if not treated well
Adenomatoid Odontogenic Tumor (Adenoameloblastoma)
ectodermal origin, younger ppl, in ANTERIOR MAXILLA, females, asymptomatic
-looks like gingival fibrous lesion
histo - well defined, surounded by thick fibrous capsule, enamel organ, lining of dentigerous cyst, reduced enamel epithelium, rests of malassez
SPINDLE SHAPED epithelial cells -> form sheets, strands, whorls
BENIGN -> enucleate
rare recurrence, not aggressive
Calcifying Epithelial Odontogenic Tumor “Pindborg Tumor”
derived from ectoderm (epithelial), amyloid production
xray - scalloped margin, assoc. with impacted tooth (3rd molar)
histo - islands of epithelial cells
Squamous Odontogenic TUmor
BENIGN, ectodermal (epithelial), asymptomatic
xray - radiolucency lateral to roots
histo - rests of malassez
Cementoma (Periapical Cemental Dysplasia)
mandible (incisor region), VITAL teeth, black women
Benign Cementoblastoma (True Cementoma)
young males, md premolars/molars, vital tooth
Gigantiform Cementoma (Familial Multiple Cementomas)
middle aged black women, can cause jaw expansion, multiple (often symmetrical)
tx -> excise
Cementifying Fibroma
well defined radiolucency with scattered radiopaque foci, mandible
Complex Odontoma
may prevent eruption, posterior, from ectodermal and mesenchymal, in md premolar/molar area, asymptomatic, unorganized mass of dental tissues (enamel, dentin, cementum)
tx -> enucleation
Compound Odontoma
from ecto and mesenchymal parts of tooth germ, more common in max incisor-canine rea, can cause delayed eruption
xray - small tooth-like structures
microscopic features - small, malformed teeth
Odontogenic Myxoma
aggressive tumor from papilla, dental sac, or PDL
xray - poorly defined, multilocular, assoc. with unerupted or displaced teeth
tx -> curette, cauterize
Odontogenic Fibroma
from dental papilla, dental sac, PDL. painless swelling in mandible of young ppl
tx -> enucleation
Odontogenic Tumors of MIXED origin (Eco-Mesodermal components)
- Ameloblastic Fibroma - often mistaken for ameloblastoma, young ppl, in md premolar-molar area, painless swelling, assoc. with unerupted tooth, see nests and strands of odontogenic epithelium, young cellular fibrosis
- tx by excision - ameloblastic fibro-odontoma - kids under 20, may have foci of calcification with dentin and enamel (induction effect)
- tx by excision - Ameloblastic Odontoma - painless swelling, looks like ameloblastoma with combo of composite odontoma
Peutz-Jeghers Syndrome (Hereditary Intestinal Polyposis Syndrome)
inherited, AD, intestinal polyps (tendency to go malignant), intraoral pigmentations,
Dilantin
anticonvulsant to control epileptic seizures, causes fibrous hyperplasia
Acquired nevi (5 kinds)
intramucosal nevus - most common in mouth, in CT or lamina propria
blue nevus - congenital, painless
compound nevus - rare, at epithelium-lamina propria interface, raised and solid
jxn nevus - rare, btw epithelium and lamina propria, flat, can undergo transformation into malignant melanoma
intradermal nevus (common mole)
BK Mole Syndrome and Dysplastic Nevus Syndrome
numerous large pigmented atypical nevi with high risk for developing malignant melanoma
Focal Melanosis (2)
mostly LOWER LIP
- labial melanotic macule - lower lip, midline, < 5 mm
- oral melanotic macule - intra-orally, < 1 cm
tx -> excise to rule out malignant melanoma
3 conditions with PIGMENTATION of intra-oral mucosa
- Addison’s - adrenocortical insufficiency, hypocorticolism, lab shows low blood conc. of Na and glucose and incr. K+
- Albright’s - polyostotic fibrous dysplasia, cafe au lait spots, endocrine dysfunction, incr. incidence of osteosarcoma
- Petuz-Jegher’s - intestinal polyps, intraoral pigmentations
- Peutz-Jegher’s
Aneurysmal Bone Cyst
benign lesion of bone, expansile, proliferaiton of vacular tissue that forms a lining around blood-filled cysts, in humerus/femur/tibia/pelvis
xray - honeycomb or soap bubble
Median Rhomboid Glossitis
chronic candida albicans infection
- smooth, denuded, beefy, red lesion devoid of filiform papillae
- located in midline of dorsum of tongue anterior to circumvallate papillae
no tx
Pyogenic Granuloma
interdental gingiva, from trauma, pregnant pts
-soft, pedunculated, smooth red surface, hyperplastic granulation
tx -> excision
Erythroplakia
red patch, most common in md mucobuccal fold, oropharynx and FOM, especially old ppl
Rendu-Osler-Weber Disease (Hereditary Hemorrhagic Telangiectasia)
congenital hereditary form of hemangioma, SPIDER-LIKE telangiectases
-epistaxis (nosebleeds)
Encephalotrigeminal Angiomatosis (Sturge-Weber Disease)
unilateral facial lesion (PORT WINE STAIN) over trigem nerve
Juvenile Nasopharyngeal Angiofibroma
adolescent males, benign, produces a nasopharynx mass
tx - surgery
Burning Tongue Syndrome
no detectable lesions, usually mid-aged females
etiologic factors - anemias, diabetes mellitus, gastric disturbances, psychogenic factors, trigem neuralgia, bacteria, xerostomia, vit B deficiency
Peripheral Giant Cell Granuloma
pedunculated broad absed with smooth surface, on gingiva btw 1st perm molar and incisors or alveolar process
-histo is diagnostic - non-encapsulated with multi nucleated giant cells
Hemangioma
benign, proliferation of blood vessels, more in females
etiology - endothelial cells, C. T. origin
microscopic features - capillary, cavernous, hemangioendothelioma
tx - laser or surgery
Benign Salivary Gland Tumors (2)
- Pleomorphic Adenoma (Mixed) - most common benign one
- Monomorphic - basal cell, etc.
common site for MINOR = palate
for MAJOR = parotid
Necrotizing Sialometaplasia
of MINOR salivary glands, necrosis of glandular parenchyma with assoc. squamous metaplasia and hyperplasia of ductal epithelium
hard palate most common
Mumps
most common viral disease of salivary glands caused by RNA-Paramyxovirus
- salivary gland swelling without purulent discharge
- PAROTID GLAND involved
complications - orchitis, epididymitis, can cause sterility, meningitis, encephalitis
serum AMYLASE may be elevated
RNA paramyxoviruses cause what 2 diseases
- Rubeola - KOPLIK SPOTS (small blue white lesions surrounded by red ring), can’t be wiped off
- Mumps - enlarged parotid glands, can cause deafness and orchitis
Mucocele
usually lower lip, minor salivary glands and ducts
Ranula (True Retention Cyst)
fluctuant, painless, occurs UNILATERALLY, assoc. with SUBMANDIBULAR or SUBLINGUAL glands
hx - incr. before meal and decr. in size btw meals
tx -> excise
Mikulicz’s Disease (Benign Lymphoepithelial Lesion)
related to Sjogren’s, asymptomatic enlargement of PAROTID and SUBMANDIBULAR glands, unilateral, middle aged women
histo - scattered epimyoepithelial islands
-most are benign but malignant transformation of island can happen
Malignant Salivary Gland TUmors
- Adenocarcinoma (NOS) - major and minor glands, asymptomatic mass
- Adenoid Cystic Carcinoma - minor glands of palate, pain, facial paralysis, weakness
- Acinic Cell Carcinoma - parotid gland, pain, facial weakness or paralysis
- Mucoepidermoid Carcinoma - in parotid gland, asymptomatic, facial weakness or parlysis
Metabolic Conditions assoc. with Chronic Salivary Gland Enlargement
diabetes, alcoholism, malnutrition, obesity, HTN, hyperlipidema, not hypothyroidism, PAROTID GLAND
Conditions assoc. with parotid gland enlargement
- Sjogren’s and Sarcoidosis
- Warthin’s tumor (papillary cystadenoma lymphomatosum)
- Infxn - mumps, actinomycosis, TB
- benign lymphoepithelial lesion (Mikulicz’s disease)
- Acute epidermic parotitis
- Malnutrition
Sjogren’s Syndrome
autoimune, inflammation of sliavary and lacrimal glands, progresses to fibrosis and atroph, post menopausal women
symp - rheumatoid arthritis, xerostomia, keratoconjunctiva sicca
-some pts get malignant lymphomas and pseudolymphomas
Sialoliths
more common in submandibular gland and duct > parotid or sublingual
use occlusal xray to detect it in Wharton’s duct (submand)
Oncocytomas (Oxyphilic/Acidophilic Adenoma)
benign, made of large cells with granular and eosinophilic cytoplasm, related to aging
- seen in parotid glands
- histo - bright pink cytoplasm, small round nuclei
Sialoscintigraphy
separate Warthin’s tumor and oncocytoma from malignant tumors
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
in parotid gland
- old males
- over angle or ramus of mandible
histo - eosinophilic coagulum
Stevens Johnson Syndrome
severe bullous form of Eythema Multiforme
clinically - BULLS EYE shaped lesions
triad - eye lesion, genital lesion, stomatitis
tx - steroids, abx
Erythema Multiforme
allergic hypersensitivity
TARGET or BULLS EYE shaped SKIN lesion
oral lesions - red macules, papules, vesicles
Granulomas
nodules of epithelioid cells that are modified macrophages with eosinophilic tyoplasm
Granulomatous infxns include
mycobacterial diseases fungal parasitic syphilis silicosis and berylliosis sarcoidosis
acute/chronic inflammation is involved with pneumonia?
acute, where there is purulent exudates in response to a bacterial infxn
Actinomycosis
gram + filamentous, can cause abscesses and sinus tracts -> CHRONIC SUPPRATIVE LESION
Cervicofacial Actinomycosis “lumpy jaw”
most common manifestation of actinomycosis
Histoplasmosis
caused by fungus Histoplasma Capsulatum
-affects lungs
oral manifestations - nodular, ulcerative, vegetative lesions, covered by gray membrane, indurated
Mucormycosis “Phycomycosis/Zygomycosis”
caused by water mold fungus Mucorales
Rhinocerebral Mucormycosis - in nose and brain, usually fatal, in pts with diabetes or chronic diseases
-symp - orbital cellulitis, bulging eye
tx - Amphotericin B
Syphilis
by spirochete Treponema Pallidum, tx with penicillin
- Primary - CHANCRE< non painful ulcer
- Secondary - rash, brown sores
- Tertiary - GUMMA (focal mass), on palate and tongue
CONGENITAL Syphilis
Sequela - Hutchinson’s teeth, mulberry molars, NO chancre
HSV 1
oral herpes, transmitted by direct contact
-NO CORTICOSTEROID tx
- Primary Herpetic Gingivostomatitis (Acute Herpetic) - young kids, flue like symp, on free and attached mucosa
- stays inactive in CN V Trigeminal Ganglion then later appears as RECURRENT HERPES LABIALIS (cold sore) - Secondary (Recurrent) Herpetic Stomatitis - adults, cold sores, localized, dormant in CN V ganglion
- Herpes Labialis (Fever Blisters or Cold Sores) - BALLOONING degeneration of epithelial cells with loss of cohesion to adjacent cells, intra-nuclear inclusions called LIPSCHULTZ BODIES
HSV 2
GENITAL, via sexual contact
HSV 3
by herpes varicella zoster, does NOT cross midline, causes recurrent herpes and chickenpox, lesion follows path of trigeminal nerve
Varicella Virus
can cause Herpes Zoster lesions
- chickenpox - pruritic vesicular lesions, contagious
- shingles - reactivate latent varicella zoster, reaches sensory ganglia of spinal and cranial nerves, does NOT CROSS midline
HSV 4
caused by Epstein Barr Virus
- Hairy Leukoplakia - in HIV pts, white furry lingual lesions on latearl border, can coexist with recurrent herpes
- Infectious Mononucleosis - no oral manifestations, neck swellings
- Burkitt’s Lymphoma - high grade Non-Hodgkin’s with viral etiology, looks MOTH EATEN
HSV 5
cytomegalovirus affects salivary glands
HSV 8
assoc. with Kaposi’s sarcoma - AIDS/HIV, lesions on palate, negative to pressure test
Kaposi’s Sarcoma
common with AIDS, MALIGNANT neoplasm, usually hard palate
Tests to dx Herpes
- Tzanck smear - exam of fluid from unopened vesicle, look for epithelial cells with intranuclear inclusions called LIPSHULTZ BODIES
- Fluorescent stasining - use HSV immune serum and globulin, to distinguish btw herpes zoster and herpes simplex
- Isolation in tissue culture
- Antibody titiers (Anti HSV Ab)
- Biopsy
Herpangina
acute disease, affects young kids by GROUP A COXSACKIE virus
-stomatitis, papules/vesicles form in pharynx -> ulcers
heals on its own
Hand, Foot, and Mouth Disease
VIRAL infx, makes red lesions
-self healing
Benign Mucous Membrane Pemphigoid (BMMP)
autoimmune, vesiculobullous disease, act against basement membrane (SUBEPITHELIAL)
-oral lesions look like desquamative gingivitis
tx - biopsy and steroids!
Pemphigus Vulgaris
chornic, rare, vesicles and bullae made by dyhesion (ACANTHOLYSIS) of epidermal cells, autoimmune
oral lesions - NIKOLSKY’S SIGN (also in BMMP)
histo - suprabasilar vesicles, intercellular edema, loss of intercellular bridges, clumps of cells floating around called TZANCK CELLS
Rubella
German measles - rash, flat pink spots on face, swollen tonsils, red macules
Hep A
caused by RNA enterovirus, transmitted by fecal-oral route, disease of LIVER, shellfish is a source too
-damage to liver causes incr. serum levels of TRANSAMINASES
self-limiting
Hep B
LIVER disease caused by DNA virus
-transmission is contaminated blood or serum, sexually
signs - longer incubation of mounths
carrier state - presence of surface antigen (a or b) indicated pt might be infected
VERY heat resistant
Verruca Vulgaris (Squamous Papilloma)
common wart of viral etiology (caused by papilloma)
-sessile, soft, cauliflower like
microscope - shows alternating hyperkeratosis, parakeratosis, long epithelial ridges
Papilloma
most common benign neoplasm of epithelial tissue origin, pedunculated, sessile
microscope - projections of stratified sq. epithelium, cores of vascular fibrous CT
tx - excise
Inflammatory Fibrous Hyperplasia (Epulis FIssuratum)
area of denture borders, more in max
clinically - rolls of tissue in muco labial fold
tx - excise; re-evaluate prosthesis or remake
Inflammatory Papillary Hyperplasia (Palatal Papillomatosis)
hard palate, caused by bad OH and ill fitting dentures
clinically - numerous red papillary projections
tx - excise; correct prosthesis
