Oral pathology Flashcards
What is the difference between fusion and gemination?
Fusion = 2 into 1 (different root) Gemination = 1 into 2 (but shares the same root)
What is concrescence?
How is it caused?
- Tooth joined by cementum
- Related to trauma or overcrowding
What is Dilaceration?
How is it caused?
- Bent root
- Trauma or developmental anomaly
What is taurodontism?
- Elongated crowns and apically displaced furcations
What is a periapical granulmona/scar?
What can it turn into?
- PA granuloma refers to granulation tissue (NOT a granuloma found in TB)
- It can turn into a PA cyst
True or false: An acute periapical abscess can be seen as a PA radiolucency.
False, though it can be seen as widening of PDL space.
What are FOUR reasons why pulpal tissue inflammation has a worse prognosis than the inflammation you get from a simple skin infection?
- Limited capacity for drainage
- Limited access for repair
- Limited space for swelling
- Concentrated stimulus
True or false: A PA abscess won’t form a radiolucent lesion but a PA granuloma will.
True, if the abscess is there for long enough, it will develop into a granuloma and bone resorption will occur, forming a radiolucency.
What are TWO signs of primary syphilis?
- Chancre (painless ulcer at site of infection)
- Regional lymphadenopathy (swollen nodes around site of infection)
What are FOUR signs of secondary syphilis?
- Condyloma Latum (painless bulbous lump instead of chancre)
- Maculopapular rash on palms/soles
- Fever
- Generalised lymphadenopathy
What are TWO dental signs of congenital syphilis?
- Notched permanent incisors “hutchinson’s incisors” (congenital)
- Mulberry or moon-shaped molars (congenital)
What stages is someone with syphilis contagious?
Primary and secondary stages are contagious. Tertiary stage is not.
What is the most distinctive sign of tertiary syphilis?
Gumma (granulomatous growth that can affect any organ of the body)
- In the palate it can cause perforations
- Is similar to TB granulomas
What is syphilis caused by?
Treponema Pallidum (spirochaete bacteria)
What is TB caused by?
Mycobacterium Tuberculosis
What is Gonorrhoea caused by?
Neisseria gonorrhoeae (bacteria)
What is Leprosy caused by?
Mycobacterium laprae
What is one way to provide fast pain relief to a patient with NUG?
Betadine mouthwash
What can NUG progress into if patient is susceptible?
Cancrum oris (aka. Noma) - Surrounding soft tissue and bone also become necrotised.
What is osteomyelitis?
Bone infection
What are THREE oral factors that might lead to fungal infection?
- Poor denture hygiene
- Reduced vertical dimension (creasing of the mouth -> angular chelitis)
- Reduced salivary flow
What are the TWO main types of acute and chronic oral candida infections?
What is there appearance?
- Atrophic (red patches = epithelium getting thinner)
- Hyperplastic (white patches = epithelium getting thicker)
True or false: chronic atrophic candidiasis lesions are more solid red than acute atrophic candidiasis.
True
What are THREE main differences between primary and secondary disease in herpes simplex virus (HSV) infection?
Primary disease:
- Widespread vesicular eruption (skin, attached mucosa, mucosa) vs. perioral
- Systemic Sx (fever, arthralgia, cervical lymphadenopathy)
- Seen in young people who have never come into contact with the virus
Vesicular eruption on gingivae in primary HSV infection can look like NUG. What is ONE way to differentiate?
- NUG normally affects adults with other risk factors (e.g. smoking)
- Primary herpes affects young people not yet exposed to virus
Secondary HSV disease can mimic apthous ulcers. What is ONE way to differentiate?
Apthous ulcers dont appear on the attached gingiva.
How long does it usually take for cold sores to heal once they ‘pop’?
1-2 weeks
What is the similarity between herpes simplex virus (HSV) and varicella zoster virus (VZV)?
Both are part of the Human Herpes Virus (HHV) family.
- HSV (HHV-1/2) causes cold sores
- VZV (HHV-3) causes chicken pox/shingles
What pattern might shingles appear as on the gingiva and why?
It may appear on one side not crossing the midline
- It is following the sensory dermatome
Where does the varicella-zoster virus lay dormant in the body?
Sensory ganglia
What TWO things cause oral hairy leukoplakia?
What is its appearance?
- Epstein Barr virus associated with HIV infection
- Appears as white patches on the lateral aspect of tongue
What is the usual appearance of cytomegalovirus in immunocompetent vs. HIV infected patients?
Immunocompetent:
- Usually assymptopmatic, can present as CMV mononucleosis
HIV infected:
- Eye infections and oral ulceration
What is the main risk of mouth ulceration and in what age group?
Dehydration in young children due to oral pain from drinking fluid.
What causes hand-foot-and-mouth disease?
What is the appearance and prognosis?
- Coxsackie virus
- Mouth ulceration with vesiclular rash on hands/feet
- Self-limiting infection resolving in 1-2 weeks
What causes herpangina?
What is the appearance and prognosis?
- Coxsackie virus
- Vesicular lesions on soft palate and fauces
- Resolves within 1 week
What is the appearance and cause of squamous papilloma?
- Cauliflower appearance
- Caused by Human Papilloma Virus (HPV)
What is acanthosis?
Thickening of the epithelium (via thickening of prickle cell layer)
What is the difference in appearance between condyloma accuminatum and squamous papilloma?
Condyloma accuminatum:
- Still exophytic, but more pink nodules rather than white cauliflower appearance
- Both caused by HPV but different types
Lesions infected with what might cause oropharyngeal carcinomas?
(be specific)
Where are these lesions commonly found?
- HPV type 16 and 18
- Tonsillar area
What is median rhomboid glossitis?
It is an area of redness situated in the midline of the tongue dorsum just in-front of the CV papillae.
- Caused by chronic fungal infection (e.g. candida)
- Redness caused by atrophy of papillae
- Can also present on a corresponding area on the hard palate
What are FIVE viral infections with oral manifestations that are associated with HIV?
- Epstein barr virus
- HSV
- HPV
- Varicella Zoster virus
- Cytomegalovirus
What oral manifestation can be considered a good indicator for HIV disease progression?
What is the associated pathogen?
What is the appearance?
Oral hairy leukoplakia
- associated Epstein Barr Virus
- white patch (corrugated), often bilateral, (can spread to ventral surface of tongue -> it will then appear smooth)
If someone presents with a white patch/lesion on the lateral surface of the tongue, what are FOUR differential diagnoses?
- Trauma (most common)
- Oral hairy leukoplakia (in HIV positive pts)
- Lichen planus
- Neoplasm
What do koilocyte-like cells look like on a light microscope?
Cells with large white portions
True or false: Oral hairy leukoplakia is not pre-malignant.
True, no dysplasia is present.
What is another name for squamous papilloma?
More accurately, one type of oral squamous papilloma that Logan referred to
Verruca vulgaris
What is the appearance of linear gingival erythema?
Red band along gingival margin (present in someone with good OH)
What is the difference between ANUG and NUG?
NUG is associated with HIV infection
ANUG is associated with stress, smoking
Why is there minimal pocketing in nectrotising ulcerative stomatitis?
Is this destruction generalised or localised?
The soft tissues are being eaten away, so no pocket formation occurs
- damage is localised
What is the appearance and location of karposi’s sarcoma?
What pathogen is it associated with?
Vascular tumour (purplish, bleeds easily)
- Palate most frequently affected
- Associated with Human Herpes virus 8 (HHV-8)
True or false: HIV is associated with salivary gland disease (ie. dry mouth)
True
What are TWO causes of non-idiopathic mucosal pigmentation?
- Addison’s disease (adrenal insufficiency)
- Medications (Azidothymidine [AZT] aka. Zidovudine - HIV antiretroviral drug)
Leukoedema:
- Clinical appearance
- Diagnostic test
- Cause
- White/grey translucent patches
- When you stretch the buccal mucosa, the white lesion disappears.
- Genetics
What is a White Sponge Naevus?
Lesion that looks like leukoedema (only more solid white), also with genetic origin (ie. present from young age, no treatment reqd)
What are FIVE common causes of white intraoral lesions?
- Leukoedema
- Trauma (cheek biting, frictional keratosis)
- Fordyce granules
- Tobacco-induced keratosis
- Acute hyperplastic candidiasis
What are THREE uncommon causes of white intraoral lesions?
- Chemical trauma (eg. dissolvable aspirin)
- White sponge naevus
- Oral hairy leukoplakia
What are TWO kinds of CT lesions? (not a good q)
- Gingival fibromatosis
- Endothelial cell proliferation (haemangioma, lymphangioma, calibre-persistent labial artery)
What are THREE examples of ectopic intraoral tissues?
- Fordyce spots
- Lingual thyroid
- Lingual tonsils
What is Benign Migratory Glossitis?
- aka. geographic tongue, erythema migrans
- Area of loss of filiform papillae +/- white thickened border
- Quite common, aetiology unknown
What is another name for an intraoral “freckle”?
Oral melanotic macule
What is a hamartoma?
Tumour-like growth, but it grows at the same speed as surrounding tissue, only in a more disorganised fashion.
What is a naevi and what are the FOUR types?
- Small (5-8mm), painless, pigmented lesion (aka. mole)
- Types: junctional, intramucosal, compound, blue.
- Treat just like a mole
What is an amalgam tattoo?
Grey/blue/black area on intraoral mucosa due to entry of amalgam into soft tissues.
What is ONE oral manifestation of TB and how does it occur?
Abnormal looking ulcers, caused by haematogenous/lymphatic/direct spread of mycobacterium (progressive TB).
What are TWO oral manifestations of gonorrhoeae?
Sx are non-specific.
- Pharyngitis
- Oral ulceration
