Oral Pathology Flashcards
What are the types of epithelial cysts
-Odontogenic
-Non-odontogenic
What are the types of odontogenic cysts
-Inflammatory
-Developmental
What are the types of inflammatory cysts
-Radicular
-Residual
What are the types of developmental cysts
-Odontogenic keratocyst
-Dentigerous cyst
What are the phases of cyst formation
-Source of epithelium
-Mechanism for epithelial proliferation
-Mechanism for continued growth
What are the sources of epithelium and which cysts use which source
-Hertwig’s root sheath (radicular and residual cysts)
-Reduced enamel epithelium (dentigerous cyst)
-Remnants of dental lamina (odontogenic keratocyst)
What are the mechanisms of continued cyst growth
-Internal hydraulic pressure (radicular, residual and developmental cysts)
-Bone resorption by cytokines (odontogenic keratocyst)
-Epithelial cell proliferation
What are the general clinical features of a cyst
-Swelling
-Pain if infection
-Displacement or loosening of teeth
-Eggshell crackling
-Signs of fluctuant
What are the features and treatment of a radicular cyst
-Associated with apex of non-vital tooth
-Unilocular, well defined, well corticated
-No resorption
-Treated with endo or surgical extraction
What are the features of a residual cyst
-Forms in an edentulous area
-Well-defined, oval radiolucency
What are the features and treatment of a dentigerous cyst
-Also called eruption cyst
-Found at the CEJ of unerupted teeth (8s and 3s)
-Unilocular, well corticated
-Treated with surgical excision or uncover tooth
What are the features and treatment of an odontogenic keratocyst?
-Found at the angle of the mandible
-Multilocular
-Associated with unerupted tooth
What is gorlin goltz syndrome
-Genetic disorder characterised by basal cell carcinoma
-Odontogenic keratocyst
-Pitting of palms, defects in spine and rib
What is a lateral periodontal cyst
-Associated with lateral roots of vital teeth
-Very small, round, well corticated
-Unilocular
What is a solitary bone cyst
-Associated with children and adolescents
-Occurs in the body of the mandible
-Monolocular, irregular outline
List non-neoplastic bone lesions
-Tori
-Bony exostosis
Describe tori
-Found in midline of hard palate or mandible
-Bony outgrowth
-Clear radiopacity on radiograph
List benign bone neoplasms
-Osteoma
-Gardener’s syndrome
-Chondroma
-Haemangioma (intraosseous)
List malignant bone neoplasms
-Myeloma (increased Bence-Jones protein)
-Lymphoma
-Metastases (from breast or lung)
Describe osteoma and gardener’s syndrome
-Osteoma is a slow growing benign tumour
-Common in mandible
-Gardener’s syndrome is when there are several osteomas of the jaw
-Gardener’s syndrome is genetic
What is a chondroma
-Benign neoplasm of cartilage
-Affects maxilla, mandible, palate
What is an intraosseous haemangioma
-Benign lesion of blood vessels
-More common in mandible than maxilla
-Causes mobility of teeth
What is a chondrosarcoma
-Formation of malignant cartilage
-Causes exfoliation of teeth
-Evidence of calcification representing cartilage formation
-Irregular bone destruction
What is an osteosarcoma
-Malignant tumour of the bone
-More common in mandible
-Rapid growth
-Parasthesia
-Loosening of teeth
What is a myeloma
-Most common malignant tumour
-Increased bence-jones protein in blood and urine
-Pain, anaemia, infection
-Punched out defects with radiolucent lesions
What is a lymphoma
-Pain and pathological fractures
-Malignant neoplasm
What is alveolar osteitis
-Inflammation of the bone following failure of blood clot to form or premature loss of blood clot
What are the predisposing factors for alveolar osteitis
-Mandibular extractions
-Traumatic extractions
-Females
-Oral contraceptive pills
-Periodontitis
-Smoking
-Poor OH
-Previous history of dry socket
Clinical affects of alveolar osteitis
-Pain
-Halitosis
-Granulation tissue forming from adjacent vital bone
Management of alveolar osteitis
-Irrigate socket with saline
-Pack with Alvogyl
-Analgesics
-Review
-Consider radiograph if concern of remaining tooth fragments in socket
How does alvogyl work
-Oxidised celloluse
-Non-irritant antiseptic
-Prevents bacterial and fungal infections
-Contains medicament for pain-relief
What is osteomyelitis
-Infection of the medullary spaces
-Can be due to bacterial infection of dental origin or extraction sites
What are the local predisposing factors for osteomyelitis
-Radiation to the jaw
-Reduced blood flow and reduced healing
-Paget’s disease
-Osteoporosis
-Bisphosphonate medication
What are the systemic predisposing factors for osteomyelitis
-Immunosuppression
-Diabetes
-Leukaemia
-Elderly
-Corticosteroids
-Chemotherapy
Symptoms of osteomyelitis
-Pain
-Fever, malaise
-Trismus (oedema of muscles of mastication)
-Parasthesia
-Pus
Complications of osteomyelitis
-Bacterial sepsis
-Pathological fractures
Management of osteomyelitis
-Antibiotics
-Pus sample to identify bacteria present
-Surgery to remove necrotic bone
What is osteoradionecrosis
-Exposed radiated bone
-More than 3 months
-Without evidence of recurring tumour
How does radiation cause non-vital bone
-Thrombosis of the blood vessels suppling the bone
-Causes loss of vitality
-Aseptic necrosis
What are the symptoms of osteoradionecrosis
-Painful necrosis of the bone
-If becomes infected, then spreads quickly
-Sloughing of the soft tissues
What is the management of osteoradionecrosis
-Antibiotics (tocopherol or pentoxifylline)
-Hyperbaric oxygen therapy
-Surgical removal of the bone and reconstruction
What is MRONJ
-Medication related osteonecrosis of the jaw
-Exposed bone for more than 8 weeks, probable through a fistula
-Absence of radiation
-Use of anti-resorptive or anti-angiogenic drugs
-No metastases
Symptoms of MRONJ
-Pain
-Discharge
-Swelling
Aims of treatment in MRONJ
-Relieve pain
-Control infection of bone and soft tissue
-Minimise progression of bone necrosis
What is fibrous dysplasia
-Replacement of normal bone with poorly organised, immature bone and fibrous tissue
Clinical presentation of fibrous dysplasia
-Facial asymmetry
-Associated with McCune Albright syndrome
What is paget’s disease
-Abnormal bone remodelling
-Caused by genetic and environmental factors
Dental relevance of Paget’s disease
-Wider alveolar ridge
-Poor fitting dentures
-Derangement of the occlusion
-Late stages can cause decreased vascularity and increased risk of osteomyelitis
What is cherubism
-Benign genetic condition affecting children
-Bilateral enlargement of the maxilla and mandible
What is the treatment for cherubism
-Good OH
-Extraction of unerupted teeth
-Wait for growth cessation before surgical correction of facial deformities
What is ameloblastoma
-Benign neoplasm
-Common in the mandible
-Resorption of the soft tissues, painless, egg shell cracking
What is the treatment of ameloblastoma
Surgical excision with a high reoccurrence rate
What is the radiological appearance of ameloblastoma
-Soap bubble appearance
-Borders are well defined and well corticated
-Multilocular
What is the high risk area for oral SSC
-Floor of the mouth
-Retromolar pad
-Ventral surface of the tongue
-Mandibular alveolus
How do oral cancers present
-Sore mouth ulcers non-healing
-Indurated (firm)
-Necrotic centre
-Rolled borders
-Red/white speckled
-Non-homogenous
-Bleeding/numbness in the mouth
Systemic manifestations of cancer
-Unexplained weight loss
-Shortness of breath
-Coughing up blood
Treatment options for oral cancers
-Surgery +/- radiotherapy
-Chemoradiotherapy
-Palliative care
List the major salivary glands and their salivary composition
Parotid - serous
Submandibular - serous and mucous
Sublingual - mucous
What is bacterial siladenitis
-Acute or chronic infection of salivary gland
-Predisposing factor is reduced salivary flow
-Staph. aureus infection
What are the risk factors for bacterial siladenitis
-Salivary gland stones/calculi
-Diabetes
-Sjorgrens syndrome
-Hypothyroidism
-Chronic renal failure
-Medications
What are the clinical features of bacterial siladenitis
-Pus
-Erythema and redness of the overlying soft tissue
-Fever, malaise
-Lymphadenopathy
-Trismus
What is the management of bacterial siladenitis
-Antimicrobial therapy
-Reverse predisposing factors
-Good hydration
-Good OH
What imaging options are used for bacterial siladenitis
-US
-Sialography
-MRI
-CT Scan
What are the causes of viral siladenitis
-Mumps (paramyxovirus)
-HIV
-Cytomegalovirus
What is the clinical appearance of necrotising silometaplasia
-Occurs in hard palate
-Crater-like ulceration
-Indurated swelling
-Surrounding erythema
