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Dentistry Module 7 > Oral Pathology > Flashcards

Oral Pathology Flashcards

1
Q

What is incisional biopsy? And what does it allow for?

A

Where a small piece of a tissue is taken from a representative area of a lesion

It allows for diagnosis and future treatment planning.

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2
Q

After what type of biopsy is a specimen resection often carried out?

A

After incisional biopsy

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3
Q

In what two ways can a specimen be sent to pathology for investigation?

A

Fixed or fresh

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4
Q

In what way are most specimens sent to pathology for further investigation?

A

As fixed specimens

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5
Q

What is meant by a “fixed” specimen?

A

The specimen has been placed in a 10% neutral buffered formalin solution to stop the tissue from breaking down and to cross link the proteins to preserve the tissue histology.

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6
Q

What is meant by a “fresh” specimen? And in what situation is it likely used?

A

Where specimen comes as it is, patient may be in theatre and requires urgent diagnosis.

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7
Q

How are fixed specimens processed in the laboratory?

A

Tissue is placed within a cassette, which is placed into an automatic tissue processor, where further fixation then dehydration of tissue in ethanol takes place.

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8
Q

After processing of fixed specimen, what is the next step the pathology laboratory takes?

A

Embedding of tissue in hot paraffin wax to form tissue blocks

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9
Q

What instrument is used to precisely cut tissue blocks to a 4um thickness?

A

Microtome

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10
Q

What stains are most commonly used for tissue that is to be made into a slide and examined by pathologists?

A

Haematoxylin and Eosin stains (H&E stains)

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11
Q

Define, “the abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue.”

A

Hyperplasia

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12
Q

Define, “the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells.”

A

Hypertrophy

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13
Q

Define, “a decrease in cell size by loss of cell substance.”

A

Atrophy

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14
Q

Define, “a reversible change in which one adult cell type is replaced by another adult cell type.”

A

Metaplasia

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15
Q

Define, “a thickening of the stratum corneum”

A

Hyperkeratosis

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16
Q

What is the stratum corneum?

A

The outermost layer of the epidermis

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17
Q

Define, “the formation of an anuclear keratin layer, as in normal keratinised stratified squamous epithelium.”

A

Orthokeratosis

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18
Q

Define, “ the persistence of nuclei in the cells of a keratin layer”

A

Parakeratosis

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19
Q

Define, “premature keratinisation of epithelial cells that have not reached the keratinising surface layer.”

A

Dyskeratosis

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20
Q

Define, “ an increased thickness of the prickle cell layer”

A

Acanthosis

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21
Q

Define, “ the loss of intra cellular adhesion between keratinocytes.”

A

Acantholysis

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22
Q

Define, “alteration in differentiation, maturation and architecture of adult epithelial cells.”

A

Epithelial dysplasia

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23
Q

Define, “mucosal/skin defect with complete loss of surface epithelium”

A

Ulceration

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24
Q

Give an example of a developmental white lesion.

A

Fordyce granules

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25
Q

Give an example of a white lesion of normal variation.

A

Leukoedema

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26
Q

Give an example of a white lesion which is hereditary.

A

White sponge naevus

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27
Q

Give two examples of dermatological white lesions.

A
  1. Lichen planus
  2. Lupus erythematosus
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28
Q

Give an example of an infective white lesion.

A

Candidosis

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29
Q

Give an example of an idiopathic white lesion.

A

Leukoplakia

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30
Q

Give an example of a neoplastic white lesion.

A

Squamous cell carcinoma

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31
Q

What type of white lesion is described?:

-autosomal dominant
- may be apparent in infants or not until adolescence
- ill-defined
- shaggy surface
- often bilateral
- buccal mucosa most commonly affected
- mutations in keratins 4/13

A

White sponge naevus

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32
Q

What treatment is required for white sponge naevus?

A

None

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33
Q

What are the two most characteristic histopathalogical signs of white sponge naevus?

A
  1. Thickened epithelium with marked hyperparakeratosis
  2. Basket weave appearance of upper prickle cells and parakeratinised cells
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34
Q

What white lesion is due to EBV infection? And is strongly associated with HIV infection in many cases?

A

Oral hairy leukoplakia

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35
Q

What are the clinical features of oral hairy leukoplakia?

A
  • white, shaggy appearance on lateral tongue
  • asymptomatic
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36
Q

What is the treatment for oral hairy leukoplakia?

A

None

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37
Q

What is the pathogenesis of lichen planus?

A

T cell-mediated immunological damage to the basal cells of epithelium.

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38
Q

Which sites in the oral cavity are more commonly affected by lichen planus?

A
  • buccal mucosa
  • tongue
  • gingivae
  • lips
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39
Q

Which sites in the oral cavity are LEAST commonly affected by lichen planus?

A

FOM and palate

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40
Q

Where on the body is the most common site for lichen planus skin lesions?

A

Flexor surface of the wrist

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41
Q

What are the 6 presentations of lichen planus?

A
  1. Reticular
  2. Atrophic
  3. Plaque-like
  4. Papular
  5. erosive
  6. Bullous
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42
Q

What can lead to the formation of subepithelial bullae (blisters) in bullous lichen planus?

A

Lack of cohesion between epithelium and lamina propria as a result of basal cell degeneration and oedema

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43
Q

What are “civatte” bodies? When are they present?

A

Degenerating cells appearing as hyaline, shrunken bodies, they are present when basal cells are undergoing apoptosis. Often seen histopathologically in patients with lichen planus.

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44
Q

What is the common treatmnet for lichen planus?

A

Steroids

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45
Q

Name 3 oral potentially malignant disorders dentists should be very aware of?

A
  1. Oral lichen planus
  2. Leukoplakia
  3. Proliferative verrucous leukoplakia
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46
Q

Define, “ a clinical term used to describe a white plaque of questionable risk after having excluded other known diseases.”

A

Leukoplakia

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47
Q

Define, “ a clinico-pathological variant of oral leukoplakia that is multi-focal, persistent and regressive with a high rate of recurrence, and a high risk of progression to SCC.”

*WHO 2024

A

Proliferative Verrucous leukoplakia

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48
Q

What are 3 examples of infective red patches?

A
  1. Periodontal disease
  2. Median rhomboid glossitis
  3. HIV gingivitis
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49
Q

What type of lichen planus is classified as a red patch?

A

Erosive lichen planus

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50
Q

Give two examples of idiopathic red patches.

A
  1. Geographic tongue
  2. Erythroplakia
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51
Q

What is median rhomboid glossitis?

A

“Rhomboid red patch on midline of posterior aspect of anterior 2/3rds of dorsal tongue”

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52
Q

What oral infection if medium rhomboid glossitis associated with in most cases?

A

Candida infection

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53
Q

Is median rhomboid glossitis symptomatic or asymptomatic?

A

Asymptomatic

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54
Q

What are the 4 key histopathlogical signs of median rhomboid glossitis?

A
  1. Loss of lingual papillae
  2. Parakeratosis and acanthosis of the squamous epithelium
  3. Candidal hyphae in parakeratin and associated neutrophils
  4. Chronic inflammatory infiltrate in connective tissue
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55
Q

What is the treatment for median rhomboid glossitis if associated candida is involved?

A

Anti-fungal medication

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56
Q

Which type of stain will highlight Candida on histopathlogical examination?

A

PAS (periodic acid-Schiff) stain

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57
Q

Define, “ a red patch that cannot be characterised clinically or pathologically as another definable lesion.”

A

Erythroplakia

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58
Q

What are the typical clinical features of erythroplakia?

A

Red, “velvety” appearance
Smooth or nodular

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59
Q

On what three areas of the oral cavity is erythroplakia most frequently seen?

A

Palate, FOM and buccal mucosa

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60
Q

What two red patches are classified as oral potentially malignant disorders?

A
  1. Erythroplakia
  2. Erythroleukoplakia
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61
Q

What clinically characterises erythroleukoplakia?

A

It has both leukoplakia and erythroplakia components (both red and white).

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62
Q

Why might you worry if you spot an erythroplakia or erythroleukoplakia in the oral cavity?

A

They have a high likelihood of malignant transformation

(On biopsy, >90% are severe dysplasia or carcinoma)

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63
Q

What 5 exogenous factors can cause oral pigmentation?

A
  1. Superficial staining (e.g. foods/drinks, tobacco)
  2. Black hairy tongue
  3. Foreign bodies (e.g. amalgam tattoo)
  4. Heavy metal poisoning
  5. Drugs (e.g. NSAIDs, antimalarials, chlorohexidine)
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64
Q

Define, a condition characterised by papillary hyperplasia and overgrowth of pigment-producing bacteria.

A

Black hairy tongue

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65
Q

Define, a benign,well-defined small flat brown/black lesion that presents in the oral cavity due to an increased activity of melanocytes.

A

Melanotic Macule

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66
Q

What 2 histopathological changes would you expect to see in a Melanotic Macule?

A
  1. Increased melanin pigment in basal keratinocytes
  2. Melanin pigmentary incontinence in underlying connective tissue
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67
Q

Define, a malignant neoplasm of mucosal melanocytes which can vary in presentation from dark brown or black to non-pigmented or red. It is very invasive and metastasises early.

A

Mucosal melanoma

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68
Q

What is the treatment for mucosal melanoma?

A

Surgical resection, adjuvant radiotherapy and immunotherapy.

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69
Q

Describe the presentation of Melanotic neuroectodermal tumour of Infancy.

A
  • very rare, most <1years old
  • males> females
    -locally aggressive, rapidly grows
  • most frequently affects the anterior maxillary alveolus
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70
Q

What causes Melanotic neuroectodermal tumour of infancy?

A

Might be neural crest cell origin, however pathogenesis is unknown.

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71
Q

What two cell populations comprise a Melanotic neuroectodermal tumour of infancy?

A

Neuroblastic cells and pigmented epithelial cells

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72
Q

What is the treatment for Melanotic neuroectodermal tumour of Infancy?

A

Complete local excision

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73
Q

What is an ulcer?

A

“Localised surface defect with loss of epithelium exposing underlying inflamed connective tissue”

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74
Q

Give two examples of drugs/drug class that can often cause oral ulceration.

A
  1. Nicorandil
  2. NSAIDs
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75
Q

Define a vesicle.

A

Small blister

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76
Q

Define a bulla.

A

A blister >10mm

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77
Q

What is an immunobullous disorder?

A

“Autoimmune diseases in which autoantibodies against components of skin and mucosa produce blisters.”

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78
Q

How can disorders which result in vesicles/bullae be classified histologically?

A

Depending on the location of the bulla:
1. Intra epithelial
2. Subepithelial

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79
Q

What are the further classifications of intra epithelial vesicles/bullae?

A
  1. Non-acantholytic (death and rupture of cells)
  2. Acantholytic (desmosomal breakdown)
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80
Q

Give an example of intra-epithelial non-acantholytic vesicles/bullae?

A

Herpes simplex virus in primary herpetic stomatitis and herpes labialis

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81
Q

Describe in 4 steps, how herpes simplex viral infection leads to ulceration.

A
  1. Virus targets and replicates within epithelial cells
  2. Leads to cell lysis
  3. Groups of infected cells breakdown to form vesicles within the epithelium
  4. Infected cells infect nearby normal cells and an ulcer forms when the full thickness of the epithelium is involved and is destroyed.
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82
Q

Give an example of intra-epithelial acantholytic vesicles/bulla.

A

Pemphigus vulgaris

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83
Q

What sex and age group is most frequently affected by Pemphigus vulgaris?

A

Females, 40-60 years old.

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84
Q

What is the treatment for Pemphigus vulgaris?

A

Steroids

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85
Q

What are the 3 main histopathological features of Pemphigus vulgaris?

A
  1. Bullae just above basal cells forming base of lesion (tombstones)
  2. Acantholytic (Tzanck) cells lie free within bulla fluid
  3. Little inflammation until lesion ruptures
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86
Q

What type of specimen is mandatory for direct immunofluorescence studies?

A

Fresh specimen

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87
Q

What study is used in conjunction with routine histopathology to confirm diagnosis of vesiculobullous disorders?

A

Direct immunofluorescence (DIF) studies

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88
Q

Give 4 examples of subepithelial vesicles/bulla.

A
  1. Pemphigoid
  2. Erythema multiforme
  3. Dermatitis herpetiformis
  4. Epidermolysis bullosa acquisita
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89
Q

What sex and age range is mostly affected by the autoimmune condition, mucous membrane pemphigoid?

A

Females, 50-80 years old.

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90
Q

What clinical description is used for gingival lesions present in mucous membrane pemphigoid?

A

Desquamative gingivitis

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91
Q

What site is usually first affected by mucous membrane pemphigoid? And what other sites mat be involved?

A

Oral mucosa usually first affected.

Other sites:
1. Eyes
2. Nose
3. Larynx
4. Pharynx
5. Oesophagus
6. Genitalia

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92
Q

How does mucous membrane pemphigoid differ in bullae presentation to Pemphigus vulgaris?

A

Mucous membrane pemphigoid bullae tend to be relatively tough and involve full thickness of epithelium. Whereas, Pemphigus vulgaris bulla is much thinner.

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93
Q

What is the treatment for mucous membrane pemphigoid?

A

Steroids

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94
Q

What are the three histopathological features of mucous membrane pemphigoid?

A
  1. Separation of full thickness epithelium from connective tissue producing sub epithelial bulla with thick roof
  2. Infiltration of neutrophils and eosinophils around bulla
  3. Base of bulla comprised of inflamed connective tissue
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95
Q

Define, acquired autoimmune blistering dermatosis with subepithelial bullae.

A

Epidermolysis Bullosa Acquisita

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96
Q

What are the 3 variants of Epidermolysis bullosa?

A
  1. Simplex
  2. Junctional
  3. Dystrophic
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97
Q

Describe simplex Epidermolysis bullosa?

A

Intra-epithelial blistering, mutations in keratins 5/14.

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98
Q

Describe junctional Epidermolysis bullosa?

A

Subepithelial blistering, separation in lamina Lucinda, laminin mutations.

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99
Q

Describe dystrophic Epidermolysis bullosa?

A

Most severe form: Subepithelial blistering, separation beneath basal lamina, mutation in type VII collagen gene.

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100
Q

What is mean by angina bullosa Haemorrhagica?

A

Oral blood blistering , where blood-filled bullae burst to form ulcers and heal uneventfully.

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101
Q

Where does angina bullosa haemorrhagica most commonly occur in oral cavity?

A

On soft palate

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102
Q

Name a chronic, progressive, oral potentially malignant disorder associated with betel quid/areca nut chewing.

A

Oral submucous fibrosis

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103
Q

What are the clinical signs of oral submucous fibrosis?

A
  1. Clinically pale mucosa
  2. Firm to palpate
  3. Marked trismus
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104
Q

What are the three key histopathological features of oral submucous fibrosis?

A
  1. Dense collagenous tissue deposition in submucosa
  2. Loss of vascularity
  3. Marked epithelial atrophy
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105
Q

Define, atypical epithelial alterations limited to the surface squamous epithelium.

A

Epithelial dysplasia

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106
Q

What 4 sites in the mouth are associated with higher risk of malignant transformation if epithelial dysplasia is present?

A
  1. Lateral border of tongue
  2. Ventral tongue
  3. Retromolar area
  4. FOM
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107
Q

What grade of epithelial dysplasia is described:

Disorganisation, increased proliferation and atypia of basal cells.

A

Mild epithelial dysplasia

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108
Q

What grade of epithelial dysplasia is described:

More layers of disorganised basaloid cells, atypia, suprabasal mitoses.

A

Moderate epithelial dysplasia

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109
Q

What grade of epithelial dysplasia is described:

Very abnormal, affects full thickness of epithelium.

A

Severe epithelial dysplasia

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110
Q

According to WHO classifications, what are moderate and severe ED classified as?

A

High grade dysplastic lesions

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111
Q

What is the key histopathological difference between dysplasia and SCC?

A

In Dysplasia, atypical cells are confined to the surface epithelium.

In SCC, the atypical cells invade into the underlying connective tissue.

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112
Q

In the UK, what is the current incidence of mouth and oropharyngeal cancer?

A

8,500 cancers per year

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113
Q

Name the 11 variations in signs and symptoms for oral cancer.

A
  1. Lumps and bumps
  2. Ulcers
  3. White patches
  4. Red patched
  5. Speckled patches
  6. Non-healing socket
  7. Tooth mobility not associated with perio disease
  8. Induration/fixation of mucosa
  9. Dysphagia
  10. Pain/parasthesia
  11. Bleeding
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114
Q

Who should suspected oral cancer be referred to?

A

Oral and Maxillofacial surgery

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115
Q

When is a lesion/lump sent for referral as suspected oral cancer?

A

If it is persistent, unexplained and has been present for >3 weeks

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116
Q

What is the treatment for SCC?

A

Surgery, adjuvant therapy (chemotherapy or radiotherapy), monoclonal antibodies.

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117
Q

What is the importance of staging cancer?

A

Major determinant of appropriate treatment and prognosis

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118
Q

What staging is used for most cancers including external lip and oral cavity carcinomas?

A

TNM classification of malignant tumours staging

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119
Q

What do TNM staging components stand for?

A

T = extent of primary tumour
N = absence or presence and extent of regional lymph node metastasis
M = category described the absence or presence of distant metastasis

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120
Q

What would indicate a TNM staging suggests more extensive disease and poorer prognosis?

A

If the given numbers are high

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121
Q

Why is there usually no “M” stage in pathological staging using TNM classification?

A

Because we don’t receive tissue from distant sites so we cant test for distant metastases.

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122
Q

What are the 4 most significant prognostic factors for oral cancer?

A
  1. Tumour size
  2. Depth of invasion
  3. Nodal status
  4. Distant metastases
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123
Q

What is the most common cause of periradicular/periapical inflammation?

A

Due to bacterial infection following pulpal necrosis

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124
Q

What is the potential sequelae of acute periradicular periodontitis?

A

Acute abscess

Which can lead to:
Cellultis or chronic abscess

Periapical granuloma/radicular cyst

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125
Q

What is the potential sequelae of chronic periradicular periodontitis?

A

Periapical granuloma which can become:

A radicular cyst

An acute abscess, chronic abscess or lead to cellulitis.

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126
Q

What is a periapical granuloma?

A

Localised mass of inflamed granulation tissue at the apex of a non-vital tooth

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127
Q

A tooth has a history of trauma and pain, it is grossly carious into pulp/heavily restored, however not much is seen on the radiograph periapically. What is your diagnosis from these clinical features?

A

Acute periradicular periodontitis

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128
Q

What are the treatment options for acute periradicular periodontitis?

A
  • extraction
  • RCT
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129
Q

What are the clinical features of an acute periapical abscess?

A

Pain
Swelling/sinus

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130
Q

What are the treatment options for an acute periapical abscess?

A
  • drainage and extraction
  • RCT
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131
Q

A tooth has minimal symptoms, appears non-vital when tested but shows an apical radiolucency on radiograph. What is your diagnosis according to these clinical features?

A

Chronic periradicular periodontitis

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132
Q

What cells predominantly cause inflammation of granulation tissue?

A

Lymphocytes and plasma cells

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133
Q

What are the treatment options for chronic periradicular periodontitis?

A
  • extraction
  • RCT/endodontic re-treatment
  • periradicular surgery
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134
Q

Why is periapical granuloma not considered a “true” granuloma?

A

Because it does not contain granulomatous tissue (i.e. not a collection of macrophages)

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135
Q

What are the clinical features of periapical granuloma?

A

Similar to those of chronic periradicular periodontitis, initially usually asymptomatic.

If there’s inflammation patient can experience sensitivity/pain, swelling and sensitivity to percussive tests.

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136
Q

What histopathological feature of periapical granuloma may ultimately lead to inflammatory radicular cyst formation?

A

Proliferation of cell rests of Malassez

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137
Q

What are the histopathological features of periapical granuloma?

A
  1. Haemosiderin and cholesterol deposits from RBC/inflammatory cell breakdown
  2. Associated multinucleate foreign body giant cells
  3. Resorption of adjacent bone +/- tooth
  4. Inflamed granulation tissue
  5. Proliferation of cell rests of Malassez
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138
Q

What are the treatment options for periapical granuloma?

A
  • extraction
  • RCT/re-treatment RCT
  • periradicular suregry
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139
Q

Define pericoronitis?

A

Inflammation of soft tissues around a partially erupted tooth.

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140
Q

What are the 4 key clinical features of pericoronitis?

A
  1. Pain
  2. Swelling/tenderness of operculum
  3. Bad taste
  4. Trismus
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141
Q

What type of Odontogenic cyst might arise in chronic pericoronitis?

A

Paradental cyst

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142
Q

What are the treatment options for pericoronitis?

A
  • irrigation
  • extraction of opposing tooth
  • antibiotics (if systemically unwell)
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143
Q

What is a cyst?

A

A pathological cavity having fluid or semi-fluid content, lined wholly or in part by epithelium, not due to accumulation of pus.

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144
Q

Define this class of cyst:

Derived from epithelial residues of tooth-forming organ

A

Odontogenic cyst

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145
Q

Define this class of cyst:

Derived from sources other than toot-forming organ

A

Non-Odontogenic cyst

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146
Q

What two structures do teeth develop from?

A

Odontogenic epithelium and neural crest derived ectomesenchyme

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147
Q

What are the two subtypes of inflammatory odontogenic cysts?

A
  1. Radicular cyst
  2. Inflammatory collateral cysts
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148
Q

What is the most common type of jaw cyst, making up 55% of all odontogenic cysts?

A

Radicular cyst

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149
Q

How do radicular cysts arise?

A

From epithelial proliferation and cyst formation within some periapical granulomas

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150
Q

Where is the most frequent location of a radicular cyst in the oral cavity?

A

Anterior maxilla

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151
Q

What are the clinical features of a radicular cyst?

A
  • most common in anterior maxilla
  • Slow growing swelling
  • often no symptoms unless very large
  • associated with non-vital teeth
  • well circumscribed unilocular radiolucent lesion
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152
Q

What is the pathogenesis of a radicular cyst?

A

Proliferation of epithelium (cell rests of Malassez) in response to inflammation

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153
Q

What cysts do these histopathological features suggest could be present?

  • chronically inflamed fibrous capsule
  • wholly/partly lined by no-keratinised squamous epithelium
  • hyperplasia of epithelium common
  • mucous metaplasia and cilliated cells
  • hyaline/rushton bodies
  • cholesterol clefts and Haemosiderin
A
  1. Radicular cyst
  2. Paradental cyst
  3. Mandibular buccal bifurcation cyst
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154
Q

What are the three treatment options for a radicular cyst?

A
  1. Small cysts may resolve after RCT/extraction/periradicular surgery
  2. Enucleation
  3. Marsupialisation (very large lesions)
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155
Q

What is meant by ‘Enucleation’?

A

The removal of a cyst in such a way that it comes out whole, without rupture.

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156
Q

What is meant by Marsupialisation?

A

Cyst opened with a cut and fluid drained out, edges of skin stitched to create small pouch which allows further fluid drainage.

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157
Q

What is meant by a residual cyst?

A

A radicular cyst that persist after extraction of the associated non-vital tooth.

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158
Q

What are the 2 variants of inflammatory collateral cysts?

A
  1. Paradental cyst
  2. Mandibular buccal bifurcation cyst
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159
Q

What is the aetiology of inflammatory collateral cysts?

A
  1. Inflammation associated with pericoronitis
  2. Enamel spur on buccal aspect of involved tooth
  3. Proliferation of sulcular or junctional epithelium derived from reduced enamel epithelium
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160
Q

What exacerbates inflammatory collateral cysts?

A

Food impaction

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161
Q

Out of the two variants, which variant of inflammatory collateral cysts is more common (>60%)?

A

Paradental cyst

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162
Q

What are the clinical features of a Paradental cyst?

A
  • arise from chronic pericoronitis of lower 3rd molars
  • associated with vital tooth
  • well-demarcated radiolucency
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163
Q

What are the clinical features of a mandibular buccal bifurcation cyst?

A
  • often located at lower 1st or 2nd molars
  • painless swelling
  • associated tooth usually tilted buccaly with deep perio pocket
  • well-demarcated buccal radiolucency
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164
Q

What are the treatment options for inflammatory collateral cysts?

A
  1. Enucleation
  2. Removal of associated tooth and cyst
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165
Q

What are the 7 types of developmental odontogenic cysts?

A
  1. Odontogenic keratocyst
  2. Dentigerous cyst/eruption cyst
  3. Lateral periodontal cyst and botryoid odontogenic cyst
  4. Glandular odontogenic cyst
  5. Gingival cysts
  6. Calcifying odontogenic cyst
  7. Orthokeratinised odontogenic cyst
166
Q

What is the third most common cysts of the jaw?

A

Odontogenic keratocyst (OKC)

167
Q

What are the clinical features of an Odontogenic keratocyst?

A
  1. Majority arise in posterior mandible
  2. Symptomless unless infected or where there is cortical bony expansion
  3. Well-defined uni or multilocular radiolucent lesion
168
Q

In what direction to Odontogenic keratocysts tend to enlarge?

A

In an anterior-posterior direction

169
Q

How do odontogenic keratocysts arise?

A

From remnants of the dental lamina (glands of serres), they are associated with mutation or inactivation of PTCH1 gene.

170
Q

What syndrome is associated with multiple odontogenic keratocysts at a younger age than expected?

A

Naevoid basal cell carcinoma syndrome (Gorlin Syndrome)

171
Q

What cyst could be identified from these histopathological features?

  • keratinised stratified squamous epithelial lining
  • corrugated appearance of surface of parakeratin layer
  • well defined, palisaded basal cell layer
  • keratin debris in lumen
  • Thin fibrous cyst wall with no inflammation, unless secondary infection
  • may be daughter cysts in wall
A

Odontogenic keratocyst

172
Q

What is important to note if there is a suspected odontogenic keratocyst with secondary infection?

A

That the characteristic histopathological features will typically be lost

173
Q

Is an odontogenic keratocyst benign or malignant?

174
Q

Why do Odontogenic keratocysts have a high recurrence rate of incompletely removed?

A

Due to thin capsule/ daughter cysts in wall

175
Q

What are the 6 treatment options for an odontogenic keratocyst?

A
  1. Marsupialisation
  2. Enucleation
  3. Marsupialisation & Enucleation
  4. Enucleation + Carnoy’s solution
  5. Enucleation + cryotherapy
  6. Resection
176
Q

What is the purpose for carnoy’s solution in the treatment of odontogenic keratocysts?

A

Used as a complementary treatment. The application of this solution promotes superficial chemical necrosis and is intended to reduce recurrence rates by removing any daughter cells from walls.

177
Q

What is the 2nd most common odontogenic cyst?

A

Dentigerous cyst

178
Q

What cyst is suggested by these clinical features:

  • encloses all or part of crown of an unerupted tooth
  • attached to the ACJ
  • most commonly seen in unerupted 3’s,5’s,8’s.
  • more prevalent in the mandible compared to the maxilla
  • symptom free until significant swelling or if infected
  • well circumscribed unilocular radiolucency
  • ballooning expansion
A

Dentigerous cyst

179
Q

What cysts are suggested by these histopathological features?

  • thin non-keratinised stratified squamous epithelial lining
  • mucous metaplasia common
  • fibrous capsule
  • no inflammation, unless secondary infection
A
  1. Dentigerous cyst
  2. Eruption cyst
180
Q

What are the treatment options for Dentigerous cyst?

A
  1. Enucleation
  2. Exposure/transplantation/extraction of associated tooth
181
Q

What is an eruption cyst?

A

A Dentigerous cyst arising in an extra-alveolar location

182
Q

What cyst do these clinical features suggest?

  • typically seen in children
  • typically seen associated with deciduous and permanent molars
    -presents as bluish swelling
A

eruption cyst

183
Q

What are the treatment options for an eruption cyst?

A
  1. Do nothing, allow spontaneous eruption
  2. Exposure of erupting tooth
184
Q

What cyst do these clinical features suggest?

  • uncommon
  • arise adjacent to vital teeth
  • canine and premolar region of mandible most common
  • usually symptom free
  • well-circumscribed radiolucency in PDL
A

Lateral periodontal cyst

185
Q

What cyst is suggested by these histopathological features?

  • thin, non-keratinised squamous or cuboidal epithelium
  • focal thickening’s/ plaques
  • uninflamed fibrous wall
A

Lateral periodontal cyst

186
Q

What is the treatment for a lateral periodontal cyst?

A

Enucleation

187
Q

Name the cyst that is a very rare multi cystic variant of lateral periodontal cyst?

A

Botryoid odontogenic cyst

188
Q

What cyst is suggested by these clinical features?

  • very rare
  • anterior mandible most common site
  • multi-lobular radiolucency
  • strong tendency to recur
A

Glandular odontogenic cyst

189
Q

What is the treatment for glandular odontogenic cysts?

A

Enucleation (but high recurrence rate- up to 50%)

190
Q

What is a key histopathological feature of glandular Odontogenic cysts?

A

Cyst-like spaces in the epithelial lining

191
Q

What superficial keratin-filled cysts are often seen in infants, presenting as white nodules on the gingivae (Bohn’s nodules)?

A

Gingiva cysts

192
Q

What is the treatment for gingival cysts in a) infants and b) adults?

A

A) None, usually disappear in a few weeks
B) simple excision

193
Q

Gingival cysts are very rare in adults. If present where are the most likely found in the oral cavity?

A

In mandibular canine/premolar region

194
Q

What cyst is suggested by these clinical features?

  • rare
  • painless swelling of jaw
  • well-defined radiolucency
  • associated tooth displacement and resorption common
  • often anterior jaw
A

Calcifying odontogenic cyst (COC)

195
Q

Where does a calcifying Odontogenic cyst arise from?

A

Dental lamina

196
Q

What cyst is suggested by these histopathological features?

  • unicystic
  • lined by epithelium which is ameloblastoma like
  • palisaded basal layer with overlying Stellate reticulum like layer
  • focal ‘ ghost cells’ which may calcify
A

Calcifying odontogenic cyst (COC)

197
Q

What is the treatment for calcifying Odontogenic cyst?

A

Enucleation

198
Q

What cyst is suggested by these clinical features?

  • rare
  • male predilection
  • 90% in mandible
  • painless swelling of jaw
  • well-defined unilocular radiolucency
A

Orthokeratinised odontogenic cyst

199
Q

What cyst is suggested by these histopathological features?

  • uninflamed fibrous wall
  • lined by stratified squamous epithelium
  • prominent granular cell layer and Orthokeratinised
  • no basal palisading, no corrugated parakeratin
A

Orthokeratinised Odontogenic cyst

200
Q

What is the treatment for Orthokeratinised Odontogenic cyst? And recurrence rate?

A

Enucleation + recurrence rare

201
Q

What are the three main types of non-odontogenic cysts?

A
  1. Nasopalatine duct cyst
  2. Surgical ciliated cyst
  3. Nasolabial cyst
202
Q

What type of non-odontogenic cyst do these clinical features suggest?

  • uncommon
    -originates from epithelium of nasopalatine duct in incisive canal
  • slow growing
  • presents as swelling in midline of anterior palate
  • pt may complain of a salty taste
A

Nasopalatine duct cyst

203
Q

In what part of the nasopalatine canal does a nasopalatine duct cyst most frequently occur?

A

Palatal end of the canal

204
Q

How does a nasopalatine duct cyst tend to present on a radiograph?

A

As a rounded or heart-shaped radiolucency in midline of anterior hard palate

205
Q

What are three cysts now considered to represent different presentations of nasopalatine duct cysts?

A
  1. Median palatine cyst
  2. Incisive canal cyst
  3. Median alveolar cyst
206
Q

What type of non-odontogenic cyst do these clinical features suggest?

  • Rare
  • more prevalent in females
  • most found in posterior maxilla
  • may be asymptomatic or present with pain/swelling
  • develop after sinus/nasal mucosa implanted into jaw following trauma or surgery
A

Surgical ciliated cyst

207
Q

What type of non-odontogenic cyst do these clinical features suggest?

  • very rare
  • more prevalent in females
  • arise in upper lip below nose, lateral to midline
  • slowly growing, distorts nostril
  • painless unless infected
  • 10% are bilateral
A

Nasolabial cyst

208
Q

What is the treatment for a nasopalatine duct cyst?

A

Enucleation

209
Q

What is the treatment for a surgical ciliated cyst?

A

Enucleation

210
Q

What is the treatment for a Nasolabial cyst?

211
Q

What are the 5 types of soft tissue cysts?

A
  1. Salivary mucocoele
  2. Epidermoid cyst
  3. Dermoid cyst
  4. Lymphoepithelial cyst
  5. Thyroglossal duct cyst
212
Q

What type of soft tissue cyst is described by these clincial features?

  • painless swelling
  • often following trauma or surgery
  • more common on skin
A

Epidermoid cyst

213
Q

What cyst is described by these histopathological features?

  • cystic lesion with thin cyst wall
  • keratinising stratified squamous epithelium lining
  • abundant keratin debris in lumen
  • no skin appendages in cyst wall
A

Epidermoid cyst

214
Q

What is the treatment for an epidermoid cyst?

215
Q

What type of soft tissue cyst is described by these clinical features?

  • developmental lesion
  • various locations in head and neck
  • FOM is common oral site
  • presents as painless swelling in midline
A

Dermoid cyst

216
Q

What type of soft tissue cyst is suggested from these histopathological features?

  • keratinised stratified squamous lining
  • keratin debris within cyst lumen
  • must have skin appendages in cyst wall
A

Dermoid cyst

217
Q

What is the treatment for a Dermoid cyst?

218
Q

What type of soft tissue cyst is described by these clincial features?

  • developmental lesions
  • uncommon but do occur in oral cavity
  • FOM and tongue most commonly affected
  • painless small swelling
  • may be yellowish in colour
A

Lymphoepithelial cyst

219
Q

What type of soft tissue cyst is suggested from these histopathological features?
- thin keratinised stratified squamous epithelium lining
- keratin debris in cyst lumen
- lymphoid tissue in cyst wall

A

Lymphoepithelial cyst

220
Q

What is the treatment for a Lymphoepithelial cyst?

221
Q

What type of soft tissue cyst is described by these clincial features?

  • developmental cyst derived from embryonic Thyroglossal duct
  • intra-oral lesions rare
  • most arise near hyoid bone
  • presents as midline swelling
  • usually painless/ symptoms if infected
  • may have functioning thyroid issues
A

Thyroglossal duct cyst

222
Q

What type of soft tissue cyst is suggested from these histopathological features?

  • cystic lesion lined by stratified squamous/ciliated/nonciliated columnar epithelium
  • fibrous wall which typically contains thyroid tissue
  • can find incidental thyroid carcinoma
A

Thyroglossal duct cyst

223
Q

What is the treatment for Thyroglossal duct cyst?

A

Complete excision involving removal of mid third of hyoid bone (sistrunk procedure)

224
Q

What is the advantage of using a sistrunk procedure for treatment of a Thyroglossal duct cyst?

A

Lower chance of recurrence with this procedure

225
Q

What are the two types of non-epithelialised primary bone cysts?

A
  1. Simple/solitary bone cyst
  2. Aneurysmal bone cyst
226
Q

What type of cysts almost exclusively involves the mandible?

A

Non-epithelialised primary bone cysts

227
Q

Why are non-epithelialised primary bone cysts not considered to be true cysts?

A

They are not lined by epithelium

228
Q

What type of bone cyst is described by these clinical features?

  • peak incidence 2nd decade
  • premolar/molar regions of the mandible
  • may be asymptomatic swelling or often incidental finding
  • large radiolucency on radiograph
  • not a true cyst
A

Simple (solitary) bone cyst

229
Q

What type of bone cyst is suggested from these histopathological features?

  • bony cavity with no epithelial lining
  • may be thin fibrovascular tissue lining with haemosiderin, RBC’s or giant cells covering bony walls
  • usually no cyst contents
A

Simple (solitary) bone cyst

230
Q

What are the two treatment options for a simple (solitary) bone cyst?

A
  1. Resolve spontaneously
  2. Resolve after opening of cavity
231
Q

What type of bone cyst is described by these clinical features?

  • very rare in jaws
  • usually mandible
  • usually presents in young people
  • painless swelling
  • radiolucency on radiograph
A

Aneurysmal bone cyst

232
Q

What type of bone cyst is suggested from these histopathological features?

  • blood-filled spaces separated by cellular fibrous tissue
  • no lining of spaces
  • multi-nucleated giant cells in fibrous band
A

Aneurysmal bone cyst

233
Q

What is the treatment required for an Aneurysmal bone cyst?

234
Q

What is Stafne’s Defect/Stafne’s idiopathic bone cavity? What is its aetiology? And radiographic presentation?

A
  • A developmental anomaly
  • aetiology: due to part of the submandibular gland indenting the lingual part of the mandible.
  • presentation: appears cyst-like on radiograph and may be mistaken for a cyst
235
Q

Is Stafne’s defect a true lesion or not?

A

NOT a true lesion

236
Q

Name 4 benign mixed epithelial and mesenchymal odontogenic tumours?

A
  1. Odontoma
  2. Primordial Odontogenic tumour
  3. Ameloblastic fibroma
  4. Dentinogenic ghost cell tumour
237
Q

Name 4 benign mesechnymal odontogenic tumours

A
  1. Odontogenic fibroma
  2. Cementoblastoma
  3. Cement-ossifying fibroma
  4. Odontogenic myxoma
238
Q

What benign epithelial odontogenic tumour is described by these clinical features?

  • 2nd most common odontogenic tumour
  • usually located in the posterior mandible
  • swelling
  • radiolucent lesion on imaging
  • slow growing, locally aggressive
A

Ameloblastoma

239
Q

Describe the histopathology of ameloblastoma according to the two types of tumour cells present, and the two patterns of presentation.

A

Two types:
1. Well organised peripheral single layer of tall, columnar, pre-ameloblast like cells
2. Core of loosely arranged cells resembling Stellate reticulum

Two patterns:
- follicular (islands of epithelial cells) OR plexiform (long strands of epithelial cells)

240
Q

What is the treatment/management for ameloblastoma?

A

Complete excision with margin of uninvolved tissue + long term follow up

241
Q

What benign epithelial odontogenic tumour is described by these clinical features?

  • most in 2nd decade, 90% before 30 years old
  • greater prevalence in females compared to males
  • more common in maxilla
  • majority present in canine region
  • often associated with unerupted permanent tooth
  • unilocular radiolucency
  • most asymptomatic
A

Adenomatoid odontogenic tumour

242
Q

What cyst can an adenomatoid odontogenic tumour appear to mimic?

A

Dentigerous cyst

243
Q

What is the treatment for an adenomatoid odontogenic tumour?

A

Local excision

244
Q

What is an Odontoma?

A

Developmental malformation of dental tissue (contains enamel dentine and sometimes cementum)

245
Q

What is the most common odontogenic tumour?

A

Compound Odontoma

246
Q

Where is the most common place to find a compound Odontoma?

A

Anterior maxilla

247
Q

Where is the most common place to find a complex Odontoma?

A

Posterior mandible

248
Q

What is the treatment for an Odontoma?

A

Enucleation

249
Q

What benign mesenchymal odontogenic tumour is described by these clinical features?

  • formation of cementum-like tissue in connection with root of tooth
  • more common in mandible, especially associated with 6’s
  • painful swelling
  • tooth remains vital
  • well defined radiopaque or mixed density lesion
A

Cementoblastoma

250
Q

What is the treatment for Cementoblastoma?

A

Complete excision and removal of tooth

251
Q

Serum levels of what 3 substances is principal for biochemical investigations in the diagnosis of bone diseases?

A

Calcium, phosphorus and alkaline phosphotase

252
Q

Name 5 lesions/cysts that comprise giant cell lesions and bone cysts?

A
  1. Central giant cell granuloma
  2. Peripheral giant cell granuloma
  3. Cherubism
  4. Aneurysmal bone cyst
  5. Simple bone cyst
253
Q

What giant cell lesion is described by these clinical features?

  • localised benign lesion (can be aggressive)
  • more prevalent in mandible
  • more prevalent in females
  • often asymptomatic
  • if cortical plate perforates lesion can present as peripheral
A

Central giant cell granuloma

254
Q

What giant cell lesion disorder is described by these clinical features?

  • rare inherited autosomal dominant disorder
  • causes distension of jaws
  • more common in males
    -painless swelling usually bilateral
  • may regress by adulthood
  • may be associated dental anomalies
255
Q

What are fibro-osseous lesions histologically characterised by?

A

Replacement of normal bone by cellular fibrous tissue within which islands and trabeculae of meta plastic bone develop

256
Q

Name 4 key fibro-osseous lesions

A
  1. Cemento-osseous dysplasia
  2. Fibrous dysplasia
  3. Ossifying fibroma (3 types)
  4. Familial gigantiform cementoma
257
Q

What fibro-osseous lesion is described by these clinical features?

  • occurs in tooth-bearing areas of jaw
  • most common fibro-osseous lesion of jaw
  • often asymptomatic
  • involved teeth remain vital
  • characterised by replacement of normal bone by fibrous tissue and varying amounts of meta plastic bone and cementum like material
  • predilection for middle aged African-American females
A

Cemento-osseous dysplasia

258
Q

What are the 4 forms of cemento-osseous dysplasia?

A
  1. Periapical cemento-osseous dysplasia
  2. Focal cemento-osseous dysplasia
  3. Florid cemento-osseous dysplasia
  4. Familial florid cemento-osseous dysplasia
259
Q

What type of cemento-osseous dysplasia involves apical incisor region of the mandible, where several teeth are usually involved?

A

Periapical cemento-osseous dysplasia

260
Q

What type of cemento-osseous dysplasia is associated with a single tooth?

A

Focal cemento-osseous dysplasia

261
Q

What types of cemento-osseous dysplasia is multi focal/multiquadrant?

A

Florid cemento-osseous dysplasia and familial florid cemento-osseous dysplasia

262
Q

What is the treatment of cemento-osseous dysplasia?

A

Surgery but only if symptomatic

263
Q

What fibro-osseous lesion is described by these clinical features?

  • involves one bone
  • gives rise to painless bony swelling
  • usually starts in childhood and arrests in adulthood
  • jaws are the most frequent head and neck site
  • more common in maxilla
A

Monostotic fibrous dysplasia

264
Q

What is meant by Craniofacial fibrous dysplasia?

A

Monostotic fibrous dysplasia in the region of the maxilla, where lesions often involves adjacent bones.

265
Q

What fibro-osseous lesion is described by these clinical features?

  • rare
  • more common in females
  • affects several bones
  • skin pigmentation and endocrine abnormalities associated
  • head and neck involve in 50% of cases
A

Polyostotic fibrous dysplasia

266
Q

What syndrome comprises polyostotic fibrous dysplasia, skin pigmentation and sexual precocity?

A

Albright’s syndrome

267
Q

What is the treatmnet for fibrous dysplasia?

A

Aesthetic surgery

268
Q

What are the three types of ossifying fibroma?

A
  1. Cemento-ossifying fibroma
  2. Juvenile trabecular ossifying fibroma
  3. Psammomatoid ossifying fibroma
269
Q

What ossifying fibroma is described by these clinical features?

  • almost exclusively occurs in tooth bearing areas of jaw
    -slow, painless expansion of jaw
  • higher prevalence in females
  • more common in mandible
A

Cemento-ossifying fibroma

270
Q

What important histopathological features distinguishes cemento-ossifying fibroma from fibrous dysplasia?

A

Demarcated nature

271
Q

What are the treatment options for cemento-ossifying fibroma?

A
  1. Enucleation and curettage
  2. Resection
272
Q

What ossifying fibroma is described by these clinical features?

  • painless rapid expansion of jaw
  • occurs in children and adolescents
  • more common in females
  • more common in mandible
A

Juvenile trabecular ossifying fibroma

273
Q

What ossifying fibroma is described by these clinical features?

  • usually painless fast bone expansion
  • most arise in Craniofacial bones especially around paransal sinuses and orbit
    -more common in males
A

Psammomatoid ossifying fibroma

274
Q

What is a rare form of fibro-osseous lesion of the jaw which may be massive with facial deformity?

A

Familial gigantiform cementoma

275
Q

Name a rare development disorder, which is characterised by segmental maxillary and soft tissue enlargement with dental-osseous abnormalities.

A

Segmental odontomaxillary dysplasia

276
Q

What are the two main benign Maxillofacial bone and cartilage tumours to be aware of?

A
  1. Osteoma
  2. Osteochondroma
277
Q

Name a benign slow-growing Maxillofacial bone and cartilage tumour that consists of well-differentiated mature bone, is usually a solitary lesion unless in the case of Gardner syndrome where multiple lesions occur.

278
Q

What is Gardner syndrome and its key features?

A

A rare autosomal dominant disorder and features include multiple osteoma, polyposis coli (which show marked tendency to undergo malignant change) and multiple fibrous tumours and cysts of skin.

279
Q

What are the two types of osteoma histologically?

A
  1. Compact type
  2. Cancellous type
280
Q

What type of osteoma is described by these histological features?

Mass of dense lamellar bone with few marrow spaces

A

Compact type

281
Q

What type of osteoma is described by these histological features?

Interconnecting trabeculae enclosing fatty or fibrous marrow

A

Cancellous type

282
Q

What is the treatment or osteoma?

A

Lesions removed if symptomatic or causing probelms with fit of denture

283
Q

Name the benign Maxillofacial bone and cartilage Tumour which presents as a bony projection with a cap of cartilage and appears continuous with the underlying bone.

A

Osteochondroma

284
Q

What is the treatment for Osteochondroma?

A

Complete excision

285
Q

Define the benign Maxillofacial bone and cartilage tumour:

Benign but aggressive bone forming tumour

A

Osteoblastoma

286
Q

Define the benign Maxillofacial bone and cartilage tumour:

Benign tumour of bone composed of chondroblasts

A

Chondroblastoma

287
Q

Define the benign Maxillofacial bone and cartilage tumour:

Benign chondroid tumour

A

Chondromyxoid fibroma

288
Q

Define the benign Maxillofacial bone and cartilage tumour:

Benign chondroid tumour

A

Chondromyxoid fibroma

289
Q

Locally aggressive fibroblastic/myofibroblastic tumour

A

Desmoplastic fibroma of bone

290
Q

Define, a rare group of malignant bone neoplasms in which the cells produce immature bone.

A

Osteosarcoma of the jaw

291
Q

Define, a rare malignant bone neoplasm that produces cartilaginous matrix.

A

Chondrosarcoma

292
Q

Define, a rare high-grade, biphasic malignant cartilaginous neoplasm

A

Mesenchymal Chondrosarcoma

293
Q

Name 4 inherited disorders of bone.

A
  1. Osteogenesis imperfecta
  2. Osteopetrosis (marble bone disease)
  3. Cleidocranial dysplasia
  4. Achondroplasia
294
Q

Define the inherited bone disorder:

Characterised by impairment of collagen matrix. There are several different types, type 1 being most common and mild.

A

Osteogenesis imperfecta

295
Q

What are the clinical features of osteogenesis imperfecta?

A
  1. Easily fractured, osteoporotic bone
  2. Affected teeth appear as in Dentinogenesis imperfecta
  3. Malocclusion
296
Q

Define the inherited bone disorder:

Group of rare genetic diseases in which there is a marked increase in bone density due to failure of osteoclastic activity and absence of normal modelling resorption. Corticles are thickened and there is sclerosis of cancellous bone.

A

Osteopetrosis

297
Q

Why is anaemia often associated with Osteopetrosis?

A

Due to marrow space deficiency

298
Q

What recognised complication of Osteopetrosis makes prevention of dental infections of great importance?

A

Osteomyelitis

299
Q

Define the inherited bone disorder:

A rare genetic disorder characterised by abnormalities of many bones, but most notably there is defective formation of the clavicles, delayed closure of fontanelles and sometimes retrusion of the maxilla. Dental anomalies common.

A

Cleidocranial dysplasia

300
Q

What are the oral features of someone with Cleidocranial dysplasia?

A
  1. Delayed eruption of permanent dentition
  2. Supernumerary teeth
  3. Narrow, high arched palate
301
Q

Define the inherited bone disorder:

Associated with an abnormality in endochondral ossification, so limbs appear excessively short with head and trunk of body appearing normal.

A

Achondroplasia

302
Q

Why is severe malocclusion often associated with achondroplasia?

A

Defective growth of base of skull leads to a retrusive maxilla, often resulting in severe malocclusion

303
Q

What metabolic disorder results when bone loss is excessive or when apposition of bone is reduced, but bone composition is normal.

A

Osteoporosis

304
Q

What group of individuals is osteoporosis most commonly found?

A

Postmenopausal women

305
Q

How does osteoporotic bone appear on radiograph?

A
  1. Increased radiolucency of bone
  2. Cortex is thinned
  3. More marrow spaces in the cancellous bone associated with thin trabeculae
306
Q

What endocrine disorder is characterised by overproduction of parathormone (PTH)?

A

Hyperparathyroidism

307
Q

What is the result of overproduction of PTH in hyperparathyroidism?

A

Mobilises calcium and raises plasma calcium levels

308
Q

What is often the cause of primary hyperparathyroidism?

A

Either hyperplasia or adenoma of the parathyroids

309
Q

What is often the cause of Secondary hyperparathyroidism? And what disease is it usually associated with?

A

Develops when PTH produced in response to chronic low calcium levels.
Often seen in chronic renal disease

310
Q

What are the three key features of hyperparathyroidism?

A

‘Stones, bones and abdominal groans’

  1. Stones- renal calculi and other calcifications
  2. Bones - various bone lesions including ‘brown tumour’ of hyperparathyroidism
  3. Abdominal groans- tendency to develop duodenal ulcers
311
Q

How might hyperparathyroidism present in dental patients?

A

As a cyst-like swelling of the jaw which displays the histological features of a giant-cell lesion

312
Q

True or false?

It is histologically impossible to distinguish ‘brown tumour’ of hyperparathyroidism from other giant-cell lesions of bone.

A

True.

Clinical, radiological and biochemical investigations also required for diagnosis.

313
Q

What causes rickets/osteomalacia?

A

Deficiency of, or resistance to the action of, vitamin D.

314
Q

What oral findings can be associated with rickets/osteomalacia?

A
  1. Delay in tooth eruption
  2. Rare- hypocalcification of dentine and enamel hypoplasia
315
Q

What metabolic/endocrine disorder is caused by prolonged and excessive secretion of growth hormone?

A

Acromegaly

316
Q

What are the facial/oral features of acromegaly?

A
  1. Jaw enlarged
  2. Jaw protruded
  3. Increased spacing between teeth
  4. Thickening of facial soft tissues
317
Q

What inflammatory disease of the bone is characterised by a spectrum of inflammatory and reactive changes in bone and periosteum?

A

Osteomyelitis

318
Q

How does radiation affect the vascularity of bone?

A

By causing proliferation of the intima (innermost layer) of the blood vessels

319
Q

What is the action of bisphosphonates?

A

Inhibit osteoclasts, thus inhibiting bone resorption.

320
Q

What is Paget’s disease of bone?

A

Form of osteodystrophy characterised by disorganised formation and remodelling of bone unrelated to functional requirements.

321
Q

What 5 key dental considerations are there for patients with Paget’s disease of bone (osteitis deformans)?

A
  1. Maxilla more often affected than mandible
  2. More prone to pathological fracture due to thickened but weaker bone
  3. Progressive enlargement of skull and facial bones- dentures don’t fit.
  4. Malocclusion and spacing of teeth can occur
  5. Hypercementosis and ankylosis of teeth leading to extraction difficulties
322
Q

What is the characteristic radiograohic appearance of Paget’s disease of bone?

A

Cotton wool appearance

323
Q

What are the three progressive and overlapping phases of Paget’s disease of bone?

A
  1. Initial predominantly osteolytic phase
  2. Active stage of mixed osteolysis and osteogenesis
  3. Predominantly osteoblastic or sclerotic phase
324
Q

What are the main histopathological features of Paget’s disease of bone?

A
  1. Irregular pattern of reversal liens
  2. Many osteoblasts and osteoclasts
  3. Fibrosis of marrow spaces
  4. increased vascularity
325
Q

What is a mosaic appearance of bone histopathologically a sign of?

A

Paget’s disease of bone

326
Q

In terms of serum calcium, phosphorus and alkaline phosphotase levels, what would you expect to see in serum biochemistry tests of someone with Paget’s disease of bone?

A

Normal calcium and phosphorus levels
Increased alkaline phosphatase levels

327
Q

What are the two most common places in the oral cavity to find tori/exostoses?

A

Midline of palate or lingual surface of the mandible

328
Q

Name the 5 locations for primary tumours which are most likely to metastasise to bone (including bone in the jaw)?

A
  1. Breast
  2. Bronchus
  3. Prostate
  4. Thyroid
  5. Kidney
329
Q

What are jaw metastases indicative of?

A

Life-threatening disease

330
Q

What can jaw metastases look like radiographically?

A

Have a moth-eaten appearance, although some can appear radiopaque

331
Q

What are the three most common sites for metastases to the oral mucosa?

A
  1. Gingiva
  2. Alveolar mucosa
  3. Tongue
332
Q

What benign odontogenic tumour commonly presents at the angle of the mandible?

A

Ameloblastoma

333
Q

What developmental cysts is most commonly found at the angle of the mandible?

A

Odontogenic keratocyst

334
Q

On CT scan, what would buccal expansion of a radiolucency suggest?

A

Ameloblastoma

335
Q

On CT scan, what would anterior-posterior expansion of a radiolucency suggest?

A

Odontogenic keratocyst

336
Q

What is the presence of a soft tissue hyperplastic lesion usually a response to?

A

Chronic trauma/inflammation

337
Q

What is a soft tissue hyperplastic lesion located on the gingiva referred to as?

338
Q

From these clinical feature, name the localised soft tissue hyperplastic lesion:

  • pedunculated or sessile firm mass on gingiva, often between 2 teeth
  • pink in colour
A

Fibrous epulis

339
Q

What is the treatment required for fibrous epulis?

A

Excision and remove source of irritation

340
Q

From these clinical feature, name the localised soft tissue hyperplastic lesion:

  • soft red/purple swelling
  • often ulcerated
  • a form of this lesion tends to present in women who are pregnant
A

Pyogenic granuloma (pregnancy epulis)

341
Q

What is the treatment for pyogenic granuloma?

A

Local excision and remove source of irritation

342
Q

What is the treatment for pregnancy epulis?

A

Good OH and periodontal treatment, lesions typically regress post-partum

343
Q

From these clinical feature, name the localised soft tissue hyperplastic lesion:

  • soft purplish gingival swelling
  • mostly on gum of teeth anterior to molars
  • F>M
A

Giant cell epulis/peripheral giant-cell granuloma

344
Q

What causes giant cell epulis/ peripheral giant-cell granuloma?

A

Local irritation by dental calculus, plaque deposits, retained tooth roots or other chronic irritation

345
Q

From these histological features, name the localised soft tissue hyperplastic lesion:

Collections of lots of multinucleated osteoclast-like giant cells in rich vascular and cellular stroma

A

Peripheral giant cell granuloma

346
Q

What is the treatment for giant-cell epulis/peripheral giant cell granuloma?

A
  1. Excision of lesion and remove source of irritation
  2. Curettage of underlying bone to reduce chance of recurrence
347
Q

From these clinical feature, name the localised soft tissue hyperplastic lesion:

  • pink smooth mucosal polyp
  • very common
  • buccal mucosa, lip and tongue most commonly affected
A

Fibroepithelial polyp

348
Q

If a fibroepithelial polyp becomes flatten under denture what is it then referred to as?

A

Leaf fibroma

349
Q

What is the treatment for fibroepithelial polyp?

A

Excision of lesion

350
Q

What is the variant of fibroepithelial polyp called which is often seen on the gingivae and tongue?

A

Giant cell fibroma

351
Q

From these clinical feature, name the localised soft tissue hyperplastic lesion:

  • broad based, leaf-like folds of tissue related to periphery of badly fitting denture.
  • typically pale, fibrous swelling which may be ulcerated
A

Denture irritation hyperplasia

352
Q

From these clinical feature, name the localised soft tissue hyperplastic lesion:

  • numerous small tightly packed nodular lesions
  • involves all or part of denture bearing area of palate
  • typically older patients with ill-fitting dentures
  • can be seen in non-denture wearers
  • may be superadded candidia infection
A

Papillary hyperplasia

353
Q

What is the periodic acid schiff (PAS) special stain used for?

A

To highlight fungi

354
Q

What are the five categories of soft tissue neoplasms?

A
  • tumours of fibrous tissue
  • tumours of adipose tissue
  • tumours of vascular tissue
  • tumours of peripheral nerves
  • tumours of muscle
355
Q

Name the malignant tumour of fibrous tissue.

A

Fibrosarcoma

356
Q

Name the two tumours of adipose tissue and state which is benign and which is malignant.

A

Lipoma (benign)
Liposarcoma (malignant)

357
Q

What tumours does these clinical features suggest?

  • soft, smooth swelling
  • pedunculated or sessile
  • asymptomatic
  • can be yellowish or pink
  • buccal mucosa most common intra-oral site
  • patients typically adults 40+
358
Q

What is the treatment for lipoma?

359
Q

What is the treatment for liposarcoma?

A

Radical excision

360
Q

Name the 4 tumours of vascular tissue

A
  1. Haemangioma
  2. Lymphangioma
  3. Kaposi’s sarcoma
  4. Angiosarcoma
361
Q

What vascular tissue tumour does these clinical features suggest?

-benign
-common in children especially females
- dark red/purple swelling
- blanches on pressure
- usually solitary
- can be part of an angiomatous syndrome (sturge-Weber syndrome)

A

Haemangioma

362
Q

What is the difference between a capillary Haemangioma and a cavernous Haemangioma?

A

Capillary- lots os small blood vessels
Cavernous- large blood filled spaces

363
Q

What is the treatment for Haemangioma in adults?

A
  1. Do nothing as can regress
    OR
  2. Cryosurgery/therapy
364
Q

What vascular tissue tumour is suggested by these clinical features?

  • pale swelling
  • rare
  • often present in childhood
  • malformation of lymphatic vessels
  • can be localised or diffuse
  • may present in neck
A

Lymphangioma

365
Q

What is the treatment for Lymphangioma?

366
Q

What vascular tissue lesion is locally aggressive and associated with HHV-8 infection?

A

Kaposi’s sarcoma

367
Q

What are the 4 variants of kaposi sarcoma?

A
  1. Classic
  2. Endemic
  3. AIDS-associated
  4. Iatrogenic (immunosuppression associated)
368
Q

What vascular tissue lesion is suggested from these clinical findings?

  • palate and gingiva most commonly affected sites
  • purplish/red lesions
  • comes increasingly nodular
  • lesions frequently bleed
A

Kaposi’s sarcoma

369
Q

What is the treatment for kaposi’s sarcoma?

A

Antiretroviral therapy/chemotherapy

370
Q

What vascular tissue tumour is malignant, very rare in oral cavity, of poor prognosis and tends to present on the forehead and scalp of older male patients?

A

Angiosarcoma

371
Q

What is the treatment for Angiosarcoma?

A

Excision +/- radiotherapy

372
Q

Name 4 tumours of peripheral nerves.

A
  1. Neurofibroma
  2. Neurilemmoma
  3. Traumatic neuroma
  4. Malignant peripheral nerve sheath tumours (MPNST)
373
Q

What peripheral nerve tumour is suggested by these clinical features?

  • benign
  • rare
  • smooth painless swelling
  • solitary or multiple
  • associated with NF-1
A

Neurofibroma

374
Q

What is the concern if neurofibroma is NF-1 type?

A

Significant risk of malignant transformation

375
Q

What peripheral nerve tumour is suggested by these clinical features?

  • benign
  • Schwann cell origin
  • smooth painless swelling
  • slow growing
  • tongue most common site
A

Neurilemmoma (schwannoma)

376
Q

What peripheral nerve lesion is suggested by these clinical features?

  • reactive lesion after nerve damage, not a tumour
  • smooth nodule
  • tongue, lower lip, salivary gland
  • history of trauma/surgery
  • may be painful
A

Traumatic neuroma

377
Q

What peripheral nerve tumour is suggested by these clinical features?

  • 2-4% of head and neck sarcomas
  • may be associated with NF-1
  • painful quickly growing mass
  • requires radical excision +/- adjuvant therapy
A

Malignant peripheral nerve sheath tumour

378
Q

Name two tumours of muscle and describe if they are benign or malignant.

A
  1. Leiomyoma (benign)
  2. Leiomyosarcoma (malignant)
379
Q

Which muscle tumour is suggested by these clinical features?

  • rare in oral cavity
  • most arise from vascular smooth muscle
  • slow growing nodule
  • sometimes painful
380
Q

What is the treatment required for all tumours of peripheral nerves?

381
Q

What is Leiomyoma referred to if it involves multiple vessels with thickened walls?

A

Angioleiomyoma

382
Q

Name two tumours of skeletal muscle, stating which is benign or malignant.

A
  1. Rhabdomyoma (benign)
  2. Rhabdomyosarcoma (malignant)
383
Q

What are the two types of Rhabdomyoma?

A
  1. Foetal
  2. Adult
384
Q

How does foetal Rhabdomyoma tend to present?

A

Young males, swelling around face and ear region.

385
Q

What malignant tumour is described by these clinical features?

  • More frequently seen in young children
  • often painless rapidly growing mass
  • head and neck most common site
  • specific genetic alterations identified
A

Rhabdomyosarcoma

386
Q

What are the two tumours of uncertain histogenesis?

A
  1. Granular cell tumour
  2. Congenital epulis/congenital granular cell epulis
387
Q

Name the benign neuroectodermal tumour that has unknown aetiology, presents more commonly in females and is a sub mucosal smooth painless swelling.

A

Granular cell tumour

388
Q

What lesion is suggested by these clinical features?

  • uncommon
  • pink polyploid mass on alveolus of newborns
  • can be quite large
  • anterior maxilla most frequent site
  • females >males
A

Congenital epulis/ congenital granular cell epulis

389
Q

90% of major salivary gland tumours occur in which major salivary gland?

390
Q

Is malignancy more likely in the minor or major salivary glands?

A

Minor salivary glands

391
Q

Definitive Diagnosis of salivary gland tumours can be confirmed by various methods of obtaining tissue. Name these 4 methods.

A
  1. Fine needle aspiration (FNA)
  2. Core biopsy
  3. Open biopsy
  4. Excision
392
Q

Describe FNA.

A

A needle is used to aspirate cells from lesion and the cell features examined under microscope

393
Q

Describe core biopsy.

A

A larger hollow needle is used to remove a core of tissue

394
Q

Describe open biopsy.

A

A surgical incision is made then an incisional biopsy of the lesion taken

395
Q

What are the 4 categories of salivary gland tumours under the current WHO classification?

A
  1. Non-neoplastic epithelial lesions
  2. Benign epithelial tumours
  3. Malignant epithelial tumours
  4. Mesenchymal tumours specific to the salivary glands
396
Q

Name three key benign epithelial salivary tumours to be aware of.

A
  1. Pleomorphic adenoma
  2. Warthin tumour
  3. Canalicular adenoma
397
Q

What is the most common type of salivary gland tumour?

A

Pleomoprhic adenoma

398
Q

What gene rearrangements are most pleomorphic adenomas associated with?

A

PLAG1 and HMGA2

399
Q

What lesion is described by this histopathology?

  • well-circumscribed
  • incomplete fibrous capsule
  • may be cystic
  • complex intermingling of epithelial and myoepithelial components
A

Pleomorphic adenoma

400
Q

What is the treatment for pleomorphic adenoma?

A

Complete excision

401
Q

What is the risk of pleomorphic adenoma is not completely excised?

A

It has higher recurrence rate

402
Q

If pleomorphic adenoma becomes malignant, what is it referred to as?

A

Carcinoma ex pleomorphic adenoma

403
Q

What benign epithelial tumour is described?

  • almost exclusively in the parotid
  • bilateral lesions in 5-17% cases
  • painless swelling
  • strong link with cigarette smoking
  • radiation
A

Warthin tumour

404
Q

What type of benign epithelial tumour is described?

  • almost exclusively (80%) in the upper lip
  • can be multi focal
  • typically painless slow growing nodule
A

Canalicular adenoma

405
Q

Name three key malignant epithelial tumours to be aware of?

A
  1. Mucoepidermoid carcinoma
  2. Adenoid cystic carcinoma
  3. Acinic cell carcinoma
406
Q

What is the most common malignant primary epithelial salivary gland tumour?

A

Mucoepidermoid carcinoma

407
Q

What gland does mucoepidermoid carcinoma most frequently affect?

A

Parotid glands

408
Q

Mucoepidermoid carcinoma has varying proportions of 3 types of tumour cells. What are these cells?

A
  1. Mucous-secreting cells
  2. Epidermoid (squamous) cells
  3. Intermediate cells
409
Q

How do tumours with high mucous cell numbers compare to tumours with mainly Epidermoid cells?

A

High mucous cell number tumours = more cystic
Epidermoid cell tumours = more soluble and often more aggressive

410
Q

What malignant tumour has a predilection to infiltrate and spread along nerve sheaths?

A

Adenoid cystic carcinoma

411
Q

What is the characteristic histopathological feature of adenoid cystic carcinoma?

A

Numerous microscopic cyst-like spaces (produces cribiform, lace-like or “Swiss cheese” pattern)

Dentistry Module 7 (14 decks)

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