Oral Pathology Flashcards
1
Q
When does Secondary Syphilis occur?
A
A mucous patch developing 6-8 weeks after the primary stage
2
Q
Congenital Syphilis results in what dental abnormalities?
A
Hypoplastic 1st Molars (Mulberry Molars)
Notched Permanent Incisors (Hutchinson’s Incisors)
3
Q
What type of bacteria is Syphilis?
A
Treponema Pallidum (Spirochete)
4
Q
What sort of necrosis is Gumma (Tertiary Syphilis)?
A
Coagulation Necrosis
5
Q
How is Syphilis treated?
A
Antibiotic treatment with Penicillin
6
Q
Candidosis is caused by what fungus?
A
Candida Albicans
7
Q
What are risk factors that can cause Cancrum Oris (Noma)
A
Malnutrition, contaminated drinking water, proximity to cattle, lowered immunity (AIDS, Measles)
8
Q
What are 3 local causes of Oral Candidosis?
A
Poor Denture Hygiene
Reduced Vertical Dimension
Xerostomia
9
Q
What are 8 systemic causes of Oral Candidosis?
A
Extremes of Age Endocrine Disturbances Malnutrition Blood Dycrasias Antibiotic Therapy Advanced Malignancies Postoperative Stress Immunosuppression - Drug induced, HIV, Transplant
10
Q
Mucocutaneous Oral Candidosis is caused by what?
A
Usually T-Cell Deficiency
11
Q
What are the 3 classifications of Oral Candidosis?
A
Acute, Chronic and Mucocutaneous
12
Q
Acute Hypertrophic Candidiasis is also known as what?
A
Thrush
13
Q
With Acute Hypertrophic Candidiasis, the patient has a white/yellow plaque that can be removed off the mucosa. What is the significance of this plaque?
A
Plaque is inflammatory exudate - dead cells and fungal colonies
14
Q
How is a simple thrush case treated?
A
Use a topical anti-fungal agent and advise patient on good oral hygiene
15
Q
A Chancre occurs in what stage of Syphilis?
A
Primary Disease after exposure of T. Pallidum
16
Q
T/F: Hyperplastic Candidosis is typically associated with red lesions?
A
False: White patches
17
Q
What might be one very severe manifestation of Tertiary Syphilis?
A
Gumma lesion leading to coagulative necrosis and perforation of the palate
18
Q
T/F: Chancre is the characteristic lesion of Tertiary Syphilis?
A
False, it is the characteristic painless, ulcerated and localised lesion found in Primary Syphilis
19
Q
Histologically, what can be seen in a Tertiary Syphilis gumma?
A
Coagulative necrosis and high numbers of macrophages. It has a similar histologically appearance to TB
20
Q
How would you test for arrested TB?
A
Positive skin test
21
Q
When treating a patient with TB, what would be transmission precautions you would need to take?
A
- Reappoint where possible
- Negative Pressure Surgery
- Special Ventilation
- Treat patient last in the day
22
Q
In western countries what demographic are most likely to contract TB?
A
Immunocompromised - elderly, HIV, patients using Immunosuppressants
23
Q
How would Gonorrhoea manifest symptoms in the head and neck?
A
Symptoms non-specific
Infection of pharyngeal mucosa
Pharyngitis, oral ulceration, mucosal erythema
Swollen cervical lymph nodes
24
Q
What is the radiographic appearance of Chronic Osteomyelitis?
A
Moth Eaten radiolucency
More commonly affecting the mandible
Areas of Focal Sclerosis
25
What is the main cause of Acute Atrophic Candidiasis
Poor oral and denture hygiene
26
What are some possible clinical presentations of Chronic Atrophic Candidiasis?
```
Non-specific red areas in the mouth
Chronic Denture Stomatitis - very clearly follows the location of the denture
Median Rhomboid Glossitis
Papillary Hyperplasia of the palate
Angular Cheilitis
```
27
A patient has a form of candidiasis that presents with a mild burning sensation and a non-specific red patch in the mouth. What could this be?
Chronic Atrophic Candidiasis
28
A patient has a form of candidiasis that presents with a fixed white patch in multiple area. What could this be?
Chronic Hyperplastic Candidiasis
29
What microorganisms are responsible for ANUG?
Gram Negative Bacteria
30
What are other risk factors for ANUG?
```
Stress
Smoking
Fatigue
Poor OH
Decreased Host Immune Response
```
31
A firm swelling on the submandible region with numerous small yellow granules that suppurate is probably a sign of what infection?
Actinomyces
32
What bacteria is primarily responsible for acute osteomyelitis?
Staph Aureus
33
What sort of infection is mot likely to occur in the mouth in Australia: bacterial, fungal or viral?
Fungal
34
What is the main high risk group for Syphilis in Australia?
Indigenous communities
35
What are 3 triggers for recurrent herpes simplex
Sunlight
Stress
Immunosuppression
36
T/F: Shingles can cross the midline based if Herpes Zoster is reactivated from the Trigeminal Ganglion?
False: Herpes Zoster resides within the neural ganglion of CN V so activation will not cross the midline
37
What are the main risk factors for Shingles?
Being elderly
| Immunocompromised
38
Give 3 examples of localised microdontia
Peg Lateral Incisors
Maxillary 3rd Molars
Supernumerary Teeth
39
What type of disorder is Ectodermal Dysplasia?
X-Linked Recessive
40
What are the symptoms of Ectodermal Dysplasia?
- Hypodontia
- Atypical cone-shaped teeth
- Lack of alveolar bone development
- Hypotrichosis: Malformed hair + cutaneous appendages (Nails)
- Anhidrosis (No Sweat Glands)
41
When might a patient have pseudonodontia?
If they have had teeth extracted
42
How many teeth need to be missing to qualify as Oligodontia?
6 or more teeth missing from development
43
What is a Compound Odontome?
A mass of tooth tissue, lots of little teeth inside
44
What is a Complex Odontome?
A tooth with a complex mixture of enamel, dentine and pulp
45
How would the tooth count change if a patient was affected by a single instance of dental fusion
1 less tooth - Fusion is the union between dentine/enamel between 2 or more teeth
46
What is Gemination?
Partial development of two teeth from a single tooth bud following incomplete division. Clinically you would see 2 Crowns sharing same root.
47
What is the likely cause of concrescence?
Trauma or Overcrowding
48
How would dilaceration appear clinically?
A traumatised tooth with angulated roots appearing on a radiograph
49
What is concrescence?
Roots of one or more teeth united by cementum after crown formation
50
Which teeth are often affected by Dens in Dente?
Maxillary Lateral Incisors
51
Would a tooth with Taurodontism be more likely to be affected by furcation involvement?
No, due to an elongated crown, the furcation is hence apically displaced
52
When is pulpitis radiographically viable?
When it has progressed to a periapical granuloma or cyst
53
Which has more severe pain symptoms: Acute or Chronic irreversible pulpitis?
Acute Irreversible Pulpitis
54
What sensitivity test will be positive to reversible pulpitis?
Sensitivity to cold
55
What immune cells are primarily involved with acute irreversible pulpitis?
Mostly neutrophils
56
What is the likely cause chronic pulpitis?
Inflammation resulting from long-term/low-grade injury
57
What immune cells are primarily involved with chronic irreversible pulpitis?
Plasma Cells + Lymphocytes. Very few PMNs
58
Why is pulpal necrosis the likely end point for pulpitis?
1. Limited Capacity for drainage: anatomy
2. Limited Access for Repair
3. Limited space for swelling
4. Concentrated Stimulus
5. Limitations of Materials to treat
59
A periapical abscess that drains extra-orally is known as?
A Fistula
60
A periapical abscess that drains intral-orally is known as?
Sinus Tract
61
What can be found in the contents of a periapical granuloma formation
1. Granulation Tissue
2. Fibrous Tissue
3. Inflammatory Cells - Macrophages, Lymphocytes, Plasma Cells, PMNs
62
Where does Herpes Simplex 1 (HSV1) tend to reside?
The Trigeminal Ganglia
63
Where does Herpes Simplex 2 (HSV2) tend to reside?
The Sacral Ganglia
64
Is it possible to have HSV2 manifest symptoms in the mouth?
Yes, if HSV-2 is contract through contact with oral sex with an individual with an active outbreak/sore
65
T/F: You would manage a recurrent bout of
| HSV-1 with a topical Acyclovir (Zovirax): antiviral. creme
No, topical are for a sores for recurrent infections. A buccal tablet or oral liquid of Acyclovir can be taken for primary HSV-1 infections
66
What is the most common viral infection in the mouth?
Core Sores from Herpes Simplex Virus 1
67
What are the main clinical signs of a primary HSV-1 infection?
- Difficulty eating/drinking
- Vesicular lesions on attached epithelium such as hard palate or dorsum of tongue
- Primary Gingivostomatitis
- Swollen Lymph Glands in the submandibular region
- Fever and Pain
68
What is the management for a primary HSV-1 infection?
- Analgesics for pain control
- Ensure hydration
- Soft Diet
- Metronidazole Antibiotic Coverage
- Chlorhexidine mouthwash and gel: helps to maintain OH
Acyclovir (Zovirax): antiviral. Taken orally as buccal tablet or oral liquid
69
What are the clinical symptoms of a secondary HSV-1 infection
Tingling/Buring sensation
Development of blister
Crusting and healing within 10-14 days
70
How is a secondary HSV-1 lesion treatment
Early topical acyclovir (zovirax) applied in prodromal period may reduce severity of pain
71
Histologically, what can be seen in a HSV-1 infection?
- Virally infected multinucleated giant cells
- Formation of very shallow intraepithelial vesicles
- Inflammation at site
- Acantholysis: loss of desmosomes resulting in loss of layering of the epithelium. This is what makes the vesicles prone to rupture
72
Why is varicella-zoster less commonly seen?
Due to effective immunisation program for chicken pox
73
How is varicella-zoster transmitted?
1. Inhalation of droplets
| 2. Direct Contact
74
What is the incubation period for varicella-zoster virus?
2 weeks
75
Where does the Varicella-Zoster Virus remain dormant?
Sensory Ganglion
76
What are the triggers for Shingles?
Reactivation of Varicella-Zoster Virus due to age / lowered immune function
77
What is Ramsay-Hunt Syndrome?
Reactivation of Varicella-Zoster Virus in the facial and auditory nerve - leading to hearing loss or facial paralysis
78
What are treatments to minimise severity of shingles?
Application of topical acyclovir (Zovirax) within 72 hours of the vesciular rash appearing
79
Presence of a Oral Hairy Leukoplakia from Epstein-Barr virus is a possible indication of what?
Progression of HIV to AIDS
80
Where is Oral Hairy Leukoplakia most likely found?
Fixed white lesion on the lateral border of the tongue
81
Who are the most at risk for Epstein-Barr Virus?
HIV
| Organ Transplants, Bone Marrow Transplant, Stem Cell Transplant (Immunosuppressed)
82
How does Kaposi’s sarcoma (Human Herpes 8) present clinically?
Very dark, deep red lesion in sulcus areas
83
What are 3 main groups affected by Kaposi's sarcoma
Mediterranean older men
African origin
Immunosuppressed Patients
84
What are the typical symptoms of Cytomegalovirus (CMV) in a healthy individual?
Flu-like illness that lasts a few days
85
In which group would you likely see oral manifestations of Cytomegalovirus (CMV)
Oral ulceration in HIV and immunosuppressed individuals
86
Type 2 and 4 Human Papillomavirus are commonly associated with what?
Veruca Vulgaris (Common Warts)
87
A slow growing cauliflower-like lesion on the hard/soft palate is a possible sign of what?
Squamous Papilloma (Oral Wart) from Oral HPV infection
88
Focal Epithelial Hyperplasia is caused by what and where can it be found?
Oral HPV Infection: numerous lesions involving buccal/labial mucosa and the tongue
89
What is the high risk group for Coxsackie Viruses?
Young children due to poor hygiene and transmission through saliva and faecal-oral spread
90
How does Hand-Foot-And-Mouth disease manifest orally?
Mild mouth ulceration, difficulty eating and drinking
91
Where is Herpangina more likely to present orally?
Vesicular lesions that are posteriorly towards the Fauces and Soft Palate
92
Why would metronidazole be given to a a HSV-1 primary infection?
To prevent secondary bacterial infection
93
How would Chicken Pox manifest orally?
Oral lesions present as 2-4mm ulcers with erythematous halo (red) with multiple crops developing over 1-2 weeks
94
Oropharyngeal carcinoma can develop from what viral infection?
HPV Types 16/18
95
What are the high risk groups of Conduloma Accuminaturm?
Immunocompromised patients (eg HIV)
96
What immune cell count reduces with the onset of HIV/AIDs?
CD4
97
What are the 3 main oral manifestations of HIV infections
1. Opportunistic Infections
2. Atypical presentations of common oral conditions
3. Side Effects of Combination therapy for HIV
98
You see a young male patient with angular cheilitis. Is this normal and what could it be?
It is atypical, could be a marker for HIV infection or immunosupression
99
Presence of Oral Hairy Leukoplakia is an indicator of what?
Prognostic of viral load for HIV
100
Where can Oral Hairy Leukoplakia be found?
1. Bilaterally on lateral surface of tongue
| 2. Ventral surface tongue
101
What are differential diagnosis for Oral Hairy Leukoplakia
1. Trauma (most common)
2. Lichen Planus
3. Neoplasms
102
What are the atypical presentations of Herpes-Simplex virus in a HIV patient?
I/O presentation rather than general E/O cold sores
103
What are the atypical presentations of Varicella Zoster Virus in a HIV patient?
Onset of shingles in a young patient
104
What are the clinical signs of Necrotising Ulcerative Gingivitis in a HIV patient
```
Similar to ANUG
Sudden onset
Severely inflamed, ulcerated gingiva
Spontaneous bleeding
Necrosis - particularly around Interdental papillae
Halitosis - is from the necrotic tissue
Plaque - poor OH due to pain
Pain
```
105
What is a good immediate treatment for ANUG?
Irrigate gums with monojet gun with betadine
106
Who are contraindicated for Betadine irrigation?
People with iodine allergies
107
What are the high risk groups for Kaposi's Sarcoma
HIV positive homosexual men - thought to be sexually transmitted
108
What are treatment options for Kaposi's Sarcoma?
Radiotherapy
Chemotherapy
Local, intralesional chemotherapy treatment
109
What might be seen intraorally with AZT treatment for HIV?
Mucosal pigmentation
110
What group is more pre-disposed to Leukoedema?
Dark skinned populations
111
What sort of inheritance pattern occurs with White Spongy Naevus?
Autosomal Dominant with variable expression
112
What are signs and symptoms of Leukoedema?
1. Lesion is asymptomatic
2. Bilateral expression
3. White/Grey translucency
4. Thickening of mucosa
5. Poorly defined margins
6. Lesion disappears when buccal mucosa is stretched
113
What are signs and symptoms of White Spongy Naevus?
Raised and Flappy White thickening of buccal mucosa
114
Histologically what is happening with Leukoedema?
- Intracellular Oedema of superficial half of the epithelium
- Large Vacuolated Cells
- Pyknotic (Condensed Chromatin) Nuclei
- Epithelial Hyperplasia
- Broad Elongated Rete Pegs
115
T/F: Sulcular and Junctional Epithelium normally express rete pegs?
False, in the mouth attached gingival exhibits rete pegs (The infolds of Epithelium into the adjacent CT layers)
116
What is the aetiology of Leukoedema?
Normal / Developmental. Heightened by local irritation, particularly for smokers
117
What is the aetiology of White Sponge Naevus?
Genetic inheritance
118
What is the aetiology of Frictional Keratosis?
Physical Trauma
119
What is the aetiology of Fordyce Granules?
Developmental
120
What is the aetiology of Tobacco-Induced Keratosis?
Chemical/Thermal trauma from smoking
121
What is the aetiology of
| Acute Hyperplastic Candidiasis?
Candida Infection
122
What is the aetiology of
| Oral Hairy Leukoplakia?
EBV Infection
123
What is the aetiology of
| Verruciform Xanthoma?
Unknown
124
What are the common epithelial oral lesions?
```
Leukoedema
Cheek Biting
Frictional Keratosis
Fordyce Granules
Tobacco-Induced Keratosis
Acute Hyperplastic Candidiasis
```
125
What are some uncommon epithelial oral lesions?
Chemical Burns
White Sponge Nevus
Oral Hairy Leukoplakia
Verruciform Xanthoma
126
A patient presents with an asymptomatic enlargement of the gingiva, so much so it covers over the teeth.
There is no bleeding or exudate. What could this be?
Gingival Fibromatosis
127
What are the 2 known types of Gingival Fibromatosis?
1. Hereditary
| 2. Idiopathic
128
Histologically, what occurs during Gingival Fibromatosis?
1. Epithelial Rete Pegs
2. Mild chronic inflammatory cell infiltrate
3. Growth of avascular dense fibrous CT
129
What are some differential diagnosis to Gingival Fibromatosis?
1. Drug Induced Gingival Hyperplasia
2. Neoplastic Disease
3. Granulomatous Disease (Foreign Body, Sarcoidosis, Crohn's)
130
What are some differential diagnosis to Leukoedema?
Frictional keratosis, tobacco-related keratosis, white sponge nevus
131
What syndromes are Haemangioma's commonly associated with?
1. Sturge-Weber Syndrome
| 2. Hereditary Hemorrhagic Telangiectasia
132
What is a Haemangioma?
A vascular proliferation of endothelial cells that either occurs shortly after birth or later in life (approx 30 years)
133
What is the distribution of Haemangioma when associated with Sturge-Weber Syndrome?
Intra-orally with skin lesions corresponding to the distribution of the trigeminal nerve
134
What is a Lymphangioma?
A malformation of the lymphatic system with thin-walled cystic lesions
135
What is Cystic Hygroma?
A life threatening, rare congenital lesions that involves a large Lymphangioma of the lateral net that can disfigure and cause respiratory distress
136
Which nerve is congenitally extending all the way to the lower lip in Calibre-Persistent Labial Artery?
The IAN maintaining it's size after the mental foramen and becoming superficial to the lower lip.
137
What is an ectopic lesion?
Normal tissues that are found in abnormal sites
138
What is a fordyce spot?
A sebaceous gland (sweat) located in the oral cavity
139
What does a fordyce spot look like and how does it present clinically?
1. Yellow Nodule
2. More likely to present in older patients
3. Affects upper lip and buccal mucosa, retromolar pads and palatoglossal areas
140
T/F: Lingual Thyroid Tissue are a result of hyperplasia of thyroid tissue
False, It is actually is the thyroid gland, but has embryologically failed to descend along the thyroglossal duct to the neck
141
Where is Lingual Thyroid Tissue likely to be found?
1. More common in females
| 2. Base of the tongue in the foramen caecum area
142
What is the aetiology of a lingual tonsil?
Lymphoid Hyperplasia or
| Lymphoepithelial Cyst Formation
143
What are lingual tonsils?
Possible variation to anatomy, they are benign lymphoid aggregates found in:
1. Posterior Lateral Tongue
2. Soft Palate
3. Floor of the mouth
144
What is a hamartoma?
A Non-Neoplastic growth that looks like a tumour
145
What is a hematoma?
A Blood Blister
146
T/F: Geographic tongue is a loss of fungiform papillae on the tongue?
False - filliform papillae
147
What symptom can accompany geographic tongue?
Burning mouth syndrome
148
Histologically what can be seen with Benign Migratory Glossitis (Geographic Tongue)
Microabscesses on surface of epithelium with inflammation - neutrophils and lymphocytes
149
Benign Migratory Glossitis is also known as what?
Geographic tongue
150
What is the aetiology of Geographic Tongue?
Unknown
151
What are two pigmented lesions that can be found in the mouth
Oral Melanotic Macula
Naevi
Amalgam Tattoo
152
What is the aetiology of an Oral Melanotic Macule?
```
1. Syndromic: Addisons Disease, McCune-Albright Syndrome,
Peutz-Jegher’s Syndrome
2. Racial / Physiological Pigmentation
3. Smoker’s Melanosis
4. Lung Carcinoma
5. Medications
```
153
What are the signs and symptoms of a oral melanotic macule?
1. Well demarcated
2. Uniform color
3. Asymptomatic
4. Same consistency as surrounding mucosa
154
Histologically, what is happening with an oral melanotic macule?
Normal Stratified Squamous Epithelium
Increased melanocytes in basal layer => Increased melanin deposition
Melanic Incontinence (pigmentation “leaks” into CT)
Melanin deposition causes chemotaxis gradient
Attracts macrophages deemed “Melanophages”
`
155
What is a Mucosal Melanocytic Naevus?
Benign proliferation of naevus cells (similar to meoanocytes), resulting in a painless, small black/brown/blue pigmented lesion that grows at the same rate as neighbouring tissue
156
What is usually the cause of epithelial hyperplasia?
Low grade chronic trauma
157
What is usually the cause of cellular hypertrophy
Response to a stimulus for increased activity
158
What is a polyp?
Any small growth projection in a cavity
159
What are the implications of surgically removing a sessile vs a pedunculated lesion?
Pedunculated will have a thinner diameter - therefore will result in a smaller hole and less likely to require a suture
160
What defines a papillary lesion?
Any small growth projecting into a cavity
161
What defines a verrucous lesion?
A warty surface appearance
162
What defines a epulis?
A non-neoplastic lump on the gum
163
What is the cause of linea alba?
Lesion from low grade mechanical trauma from cheek biting
164
What is the management of linea alba?
Nothing required
165
Histologically what is the cause of linea alba?
Hyperkeratosis
| Acanthosis: thickening of prickle cell layer
166
How does linea alba differ from cheek biting?
Cheek biting is higher grade trauma resulting in an inflammation response
167
Describe the appearance of cheek biting
- Unilateral or bilateral white patch on the buccal mucosa
- Roughened white mucosa similar to linea alba
- May be surrounded by red patches of localised inflammation
168
What is the aetiology of smoker's keratosis?
- Tobacco smoking (heat? Combustion products?)
| - Seen more in people who smoke from a pipe and reverse smoking
169
What is the clinical symptoms of smoker's keratosis
- Diffuse, white, moderately thickened palate
- Sometimes roughened
- Involves entire palate
- Characterised by presence of 1-2 mm diameter red “Dots”
170
Generally white lesions will involve what 2 histological changes?
Hyperkeratosis and acanthosis (thickening of prickle cell layer)
171
What are the histological changes involved to smoker's keratosis?
Hyperkeratosis
Thickening of the prickle cell layer (acanthosis)
Subepithelial chronic inflammation
Periodontal inflammation in the minor salivary glands
172
T/F: Smoker's keratosis is a premalignant change to the oral mucosa
False, it's a non-malignant chronic injury marker, but good education tool to show patients the changes smoking can causes
173
Chronic Hyperplastic Candidiasis is caused by what?
Microbial imbalance caused by antibiotic use. Candida fungi infection results in changes in epithelial laer
174
Fibroepithelial Hyperplasia is commonly called what?
Denture Hyperplasia
175
What occurs during Fibroepithelial Hyperplasia?
Cellular proliferation growth in response to chronic physical trauma and inflammation - usually from ill-fitting dentures
176
What are the clinical signs of papillary hyperplasia of the palta?
Nodular overgrowth from ill-fitting dentures that causes on/off suction against the palate
177
T/F: A Fibroepithelial polyp (Fibroma) is neo-plastic in nature
False - it is a hyperplastic lesion of the fibrous tissue
178
What is the cause of a Fibroepithelial polyp?
Chronic physical trauma and inflammation - look to sites prone to trauma
179
Where can Pyogenic granuloma typically occur in the mouth and why?
Occur on the gum margins around where there is subgingival calculus or ill-fitting crowns
180
When are Pyogenic granuloma more likely to be clinically evident?
Hormonal factors during pregnancy + puberty in females
181
What are the clinical signs of a Pyogenic granuloma
Sudden onset
Rapid growth
Bright red ulcerative surface that bleeds easily
Located on the gum margins - around subgingival calculus or poor crow margins
182
What would you expect to see histologically on a pyogenic granuloma
High vascular lesion
Lots of granulation tissue
Thin/Non-existant epithelial layer (as lesion is ulcerated)
Surface area of fibrin
Inflammatory cells
Bacterial colonies
Epithelial hyperplasia in non-ulcerated areas (areas of healing)
183
What is the treatment for a pyogenic granuloma?
Excision - incomplete excision results in reoccuring lesion
184
Where are you more likely to see a Peripheral giant cell granuloma?
Around the gingiva in the anteriors
185
What is the main differentating factor between pygoenic granuloma and peripheral giant cell granuloma?
Multinucleated giant cells
186
T/F: A Calcifying Fibroblastic Granuloma will exhibit extensive inflammation
False - it is generally painless and lacks inflammation unless ulcerated. It exhibits more like scar tissue.
187
What are the causes of generalised gingival hyperplastic lesions?
```
Local factors: plaque, calculus
Hormonal imbalance
Drugs: dilantin, cyclosporine, nifedipine (Ca channel blocker)
Leukaemia
Genetic factors
```
188
What are 2 causes of a traumatic neuroma?
1) Injuries to trigeminal nerve during deep oral surgery
| 2) Most commonly from hard impact of dentures onto the mental nerve
189
What are the signs of Verruciform Xanthoma?
Flat, velvety pebbly lesion of the mucosa
Often occurs on the gingiva
Can also be seen on tongue
White / Orange appearance
190
What can be seen histologically in Verruciform Xanthoma?
- Epithelial hyperplasia
- Parakeratin plugging of rete pegs
- Large pale foam cells filling CT papillae that are full of Macrophages that produce lots of cholesterol giving foamy appearance
191
What is the cause of Benign Lymphoid hyperplasia?
Irritation of existing lymphoid tissue
192
What is the histology of Giant cell fibroma?
Large stellate like cells and multinucleated fibroblasts
193
You have a histology slide that shows a thick epithelial layer that is highly mitotic. What is the likely clinical presentation of this oral pathology?
White Patch
194
You have a histology slide that shows a thin epithelial layer. What is the likely clinical presentation of this oral pathology?
Red Patch
195
You have a histology slide that shows no epithelium. What is the likely clinical presentation of this oral pathology?
Ulcer
196
What are the 4 main causes of traumatic ulcers?
Mechanical
Chemical
Thermal
Radiation
197
What are the clinical presentation of acute traumatic lesion?
- Acute Inflammation
- Surface has yellow fibrinous exudate
- Erythematous border or halo
198
What are the clinical presentation of chronic traumatic lesion?
- Minimal Pain
- Elevated margins, fibroepithelial hyperplasia, epithelial hyperkeratosis
- Induration (More fibrous tissue)
199
What are the 8 possible causes of Aphthous ulcers?
1. Genetic
2. Exaggerated response to trauma
3. Gastrointestinal Disorder
4. Immunological Abnormality
5. Infections
6. Anaemia
7. Hormonal Disturbances
8. Stress
200
What are 4 different Haematological Disorders associated with oral lesions
Anaemia
Iron Deficiency
Folate Deficiency
B12 Deficiency
201
What are some possible dental implications of haematological disorders?
For severe anaemia:
- Glossitis
- Bacterial Infection: Angular Cheilitis
- Aphthous ulceration
202
Behcet's Disease can manifest in what type of ulcerative lesion?
Aphthous ulcer
203
What group are more likely to suffer from aphthous ulcers and behcet's disease?
Mediterranean males below 40
204
What are the clinical signs of Orofacial granulomatosis?
Lip or gingival swelling
205
What can Orofacial granulomatosis potentially progress into?
Crohn's disease
| Sarcoidosis
206
What is the main histological feature that can be seen in Orofacial granulomatosis?
Giant Cells
207
What are some general systemic signs of Crohn's disease?
Inflammatory Bowel Disease
Abdominal Pain
Constipation/Diarrhoea
208
What are some oral mucosal symptoms of Crohn's disease?
- Diffuse lip swelling
- “Cobble stone” thickening of mucosa
- Gingival erythema and swelling
- Ulcers
- Hyperplastic Mucosal tags
- Glossitis
209
What are factors for a patient would potentially increase risk for a potentially malignant lesion?
1. Tobacco Use
2. Alcohol Intake
3. UV Light Exposure - particularly for lip
4. Age
5. Gender - older males
6. Location and Presentation of lesion
210
What would be some architecture changes in epithelial atypia?
```
Drop Shaped Rete Pegs
Irregular Epithelial Stratification
Loss of polarity of basal cells
Increased number of mitotic figures
Superficial Mitoses
Single Cell Keratinisation (Dyskeratosis)
```
211
What would be some cytological changes in epithelial atypia?
Nuclear Pleomorphism: Abnormal variation of either nuclear size/shape
Cellular Pleomorphism: Abnormal variation of either cell size/shape
Increased Nuclear/Cytoplasmic Ratio
Increased Nuclear Size
Atypical Mitotic Figures
Increased number + size of nucleoli
Hyperchromasia
212
What are the 4 forms of dysplasia?
1. Mild Dysplasia
2. Moderate Dysplasia
3. Severe Dysplasia / Carcinoma In Situ
213
How would you expect the rete pegs to appear in hard palate tissue?
Finger shaped like projections to provide strength against sheer forces
214
What would atypical mitotic figures look like?
1 cell trying to divide into 3 or 4 rather than just 2.
215
T/F: Dysplasia can involve cellular changes in the epithelium and connective tissue around it
False, Dysplasia is limited to cellular and architectural changes in the epithelium only
216
If Dysplasia involves the full thickness of the epithelium what is this caused?
Severe Dysplasia / Carcinoma in Situ
217
What is Leukoplakia?
Clinical term to describe a fixed white lesion in the oral mucosa. Once biopsied a more definitive diagnosis can be given
218
What are the 2 types of leukoplakia?
Homogenous Leukoplakia
| Speckled Leukoplakia
219
Which type of leukoplakia is clinically of more concern?
Speckled Leukoplakia - biopsy this straight away
220
What is an easy way to identify lichen planus?
Often displays bilateral Symmetrical Lesion on tongue / buccal mucosa
221
If a mass is Pleomorphic what does it look like histologically and what could it represent?
Histologically there is a mass of cells with variable cell size, shape or staining. It is indicative of dysplastic or malignant neoplastic cell growth
222
What are architectural changes seen in dysplasia?
1. Drop Shaped Rete Pegs -
2. Irregular Epithelial Stratification
3. Loss of polarity of basal cells
4. Increased number of mitotic figures
5. Superficial Mitoses
6. Single Cell Keratinisation (Dyskeratosis)
223
What are cytological changes in dysplasia?
1. Nuclear Pleomorphism: Abnormal variation of either nuclear size/shape
2. Cellular Pleomorphism: Abnormal variation of either cell size/shape
3. Increased Nuclear/Cytoplasmic Ratio
4. Increased Nuclear Size
5. Atypical Mitotic Figures
6. Increased number + size of nucleoli
7. Hyperchromasia: very dark staining slide due to lots of nuclear material
224
What are some potentially malignant lesions
```
Dysplastic Leukoplakia
Erythroplakia
Speckled Leukoplakia
Tertiary Syphilis
Oral Submucous Fibrosis
Chronic Candidiasis
Lichen Planus
Discoid Lupus Erythematosus
```
225
What are the 3 grades of epithelial dysplasia?
Mild
Moderate
Severe / Carcinoma In Situ
226
When is the term leukoplakia used?
It is a clinical term used when a fixed white page that can not be characterised clinically as another disease. Once biopsied a more definitive diagnosis can be given
227
What is panleukoplakia?
When multiple leukoplakia lesions exist
228
Describe the clinical appearance of Homogenous Leukoplakia
Solid white lesion
Usually well delineated
Slightly Raised
Surface variable: smooth, fissured, corrugated, warty
229
Describe the clinical appearance of Speckled (Nodular) Leukoplakia
Raised
Rough Nodular appearance
Intermingled Red + White areas
Higher proportion histologically will exhibit dysplasia: biopsy straight away!
230
What elevates the risk of transformation of leukoplakia to SCC?
Higher risk based on geographic + tobacco/betel nut use
231
Describe the clinical appearance of Sublingual Keratosis
White lesions on floor of mouth + tongue
232
T/F: Erythroplakia has a low risk of malignant transformation
False - it has a high risk
233
Describe the clinical appearance of Erythroplakia
```
Red Patches
Velvety Surface
Variable defined margin
Flat, depressed lesions
Rarely “Plaque-Like”
```
234
Describe the clinical appearance of Chronic Hyperplastic Candidosis
Fixed White Plaque
| Locations: Dorsum Tongue, Buccal Mucosa, Commissure
235
What is the aetiology of Oral Submucous Fibrosis
Associated with betel quid use
236
What are the signs and symptoms of Oral Submucous Fibrosis?
Increased fibrosis of oral mucosa
| Increased immobility and contraction
237
What is the disease mechanism of lichen planus?
1. Initiating Factor / Event
2. Focal release of regulatory cytokines
3. Upregulation of vascular adhesion molecules
4. Recruitment + Retention of T-Lymphocytes
5. Cytotoxicity of basal keratinocytes
238
What are some histological markers of Lichen Planus?
1) Predominantly T-Lymphocyte Infiltrate: CD4 / CD8
| 2) Presence of Macrophages, Langerhans Cells, Mast Cells
239
T/F: Lichen Planus commonly presents with bilaterally symmetrical lesions
True
240
What is the treatment for Lichen Planus
Corticosteroids: Modulate Inflammation + Immune Response
Antifungal Therapy: Treats secondary infection
Topical Retinoids
Topical Vitamin E
Chlorhexidine: controls symptoms
241
What is the aetiology of Lichen Planus?
Idiopathic /
| Immune Related
242
What are the 3 types of lesions that present in lichen planus
1. Striated
2. Atrophic
3. Erosive
243
What is the histology of a striated lichen planus lesion?
Hyperkeratosis
Hyperparakeratosis
Saw-tooth appearance of rete pegs
Basal Cell Layer degeneration - formation of civatte bodies
Band-like lymphocytic infiltrate subadjacent to basement membrane
244
What is aetiology of a Traumatic Eosinophilic Ulcer?
Typically history of deep mucosa trauma
245
What are the signs/symptoms of a Traumatic Eosinophilic Ulcer?
Usually on the tongue
Large cratered ulcer 1-2cms
Edge of ulcer has raised margins and increased mitotic activity to try to cover the ulcer
246
What is the histology of a Traumatic Eosinophilic Ulcer?
- Lack of epithelium
- Inflammatory infiltrate full of eosinophils
- Pale plump grey fibroblasts producing collagen (healing)
- HEVS
- High mitotic activity at edge of margins (healing)
247
What is the main cause of Mucositis?
Side effect of cancer treatment: cells stop dividing in the mucosa, breaking down and ulcerating
248
What are management steps for mucositis?
1. Palliation of side effects of cancer treatment: maintain oral hygiene, control pain, control infections
2. Palifermin (epithelial keratinocyte growth factor): encourages epithelial growth but has many side effects
249
What is the cause for minor aphthous ulcers?
Unknown, but has systemic triggers and more common in patients with history of ulcers
250
What is the cause for major aphthous ulcers?
HIV
251
What is the cause for minor herpetiform ulcers?
Unknown
252
What tissues are involved with aphthous ulcers?
Non-keratinised mucosa
253
What does a minor aphthous ulcer look present clinically
- Circular lesion typically affecting non-keratinised mucosa
- Shallow crater approx 5-7mm across
- Red margin, yellowish floor (dead fibrin tissue)
- May see red dots on surface
254
How do minor aphthous ulcers resolve?
Typically resolves within 7-10 days without scarring
255
What are treatment steps for minor aphthous ulcers?
- Typically nothing
- Steroids for persistent ulcers
- Diffam oral gel (anti-inflammatory)
256
What does Crohn's disease look like histologically in the gut?
Inflammation
Granulomatous tissue
Giant cells
257
Crohn's disease is associated with what sort of mouth ulcer?
Aphthous ulcers
258
What are the 3 biggest risk factors for pre-malignant lesions?
Tobacco Use
Alcohol Intake
UV Light Exposure
259
What are the layers of normal epithelium?
```
Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale
```
260
What are the Architectural Changes seen in epithelial dysplasia?
```
Drop shaped rete pegs
Irregular Epithelial Stratification
Loss of polarity of basal cells
Increased mitotic figures
Superficial Mitosis
Single Cell Keratinisation (Dyskeratosis)
```
261
What are the cytological changes seen in epithelial dysplasia?
Nuclear Pleomorphism: Abnormal variation of either nuclear size/shape
Cellular Pleomorphism: Abnormal variation of either cell size/shape
Increased Nuclear/Cytoplasmic Ratio
Increased Nuclear Size
Atypical Mitotic Figures
Increased number + size of nucleoli
Hyperchromasia: very dark staining slide due to lots of nuclear material
262
What is Carcinoma-in-situ?
When there is epithelial dysplasia that involves the full thickness of the epithelium without crossing the basement membrane
263
What are the 3 grades of dysplasia?
Mild Dysplasia
Moderate Dysplasia
Severe Dysplasia / Carcinoma-in-situ
264
Which dysplastic lesions have a high risk of becoming cancerous?
Erythroplakia
Tertiary Syphilis
Oral Submucous Fibrosis
265
What is leukoplakia?
A fixed oral white patch that cannot be characterised clinically or pathologically by any other disease. Once biopsied a more definitive diagnosis can be given
266
What are the different presentations of Leukoplakia?
Homogenous Leukoplakia: solid white lesion
Speckled (Nodular) Leukoplakia: rough nodular appearance
Sublingual Keratosis: Leukoplakia on the floor of the mouth
267
What are risk factors for Leukoplakia?
Trauma, alcohol, infection, smoking, betel nuts, chewing tobacco
268
Sublingual Keratosis is a manifestation of what other oral lesion?
It is Leukoplakia on the floor of mouth + tongue
269
Oral Submucous Fibrosis is associated with what sort of habit?
Betel Quid / Tobacco chewing
270
What is the difference between Lichen Planus and Lichenoid Reactions?
They both share clinical and histopathological similarities,
Difference is from aetiologic cause:
Lichen Planus: unknown but liked to T-cell autoimmunity reaction
Lichenoid Reactions: contact sensitivity, drug interaction, systemic causes
271
What are 3 types of Lichenoid Reactions?
Contact Lesions
Lichenoid Drug Reactions
Graft vs Host Disease
272
What is the aetiology of Lichen Planus?
Unknown but proposed that it is a T Cell Autoimmune reaction against the basal keratinocytes in the epithelium
273
What are the 6 different types of lichen planus lesions?
```
Atrophic
Erosive
Plaque (appear similar to leukoplakia)
Striated (spider's web Wickham's Striae)
Bullous
Papular
```
274
Where are lichen planus lesions typically found?
```
Buccal Mucosa (Most likely)
Dorsal Surface of Tongue
Gingiva - striated lesions on the interdental regions
```
Expression is typically bi-laterally
275
What is the management for lichen planus?
Corticosteroids - modulates immune response
Antifungal Therapy - Treats secondary infection
Topical Vitamin A + E - promotes mucosal repair
Chlorhexidine - Control of symptoms
276
Is Lichen Planus a risk of Malignant Transformation?
No - it is actually low risk (0.5%), however many other white lesions are misdiagnosed as Lichen Planus (eg Dysplastic Epithelium, Subepithelial Lichenoid Infiltration).
Treatment needs to address reducing risk factors for SCC and long term monitoring
277
What are the 3 main categories of malignancies in the oral cavity?
Epithelial
Mesenchymal
Hematolymphoid
278
Who are at most risk for Oral Squamous Cell Carcinoma?
Males in 50-60 years who have combined smoking and alcohol use
279
What are risk factors for Oral Squamous Cell Carcinoma?
Smoking
Alcohol
HPV Infection
280
Where are Oral Squamous Cell Carcinomas most commonly found?
Most common site: Lower Lip (UV exposure)
Other SItes: Floor of Mouth, Lateral Border of Tongue, Retromolar area.
Areas of habit - tobacco/betel quid usage
281
Where is the clinical presentation of Oral Squamous Cell Carcinomas?
Variable presentation: Red, speckled or white patches
Raised nodule, nonhealing ulcer, "rolled" borders
282
What are the routes of metastasis for SCC?
Direct extension into adjacent tissue
Perineural infiltration
Vascular invasion
Lymphatics
283
Why might there be an inflammatory reaction in SCC?
1. Ulceration
| 2. Very fast tumour growth causes necrosis (insufficient vascularisation)
284
What are the treatment modalities for SCC?
1. Surgery Alone (Gold Standard)
2. Surgery + Postop Radiotherapy
3. Radiotherapy Alone
4. Chemotherapy
285
What is the dentist's role in the management of malignancies?
1. Accurate diagnosis - be suspicious, biopsy and refer
2. Follow up
3. Maintenance before and after therapy
4. Role in treatment planning with head/neck cancer team
286
What are some side effects of radiotherapy for SCC?
Skin Inflammation
Mucositis: ulceration caused by cells that stop dividing
Xerostomia: candida infections, caries
Osteoradionecrosis
287
How can radiation caries be prevented?
1. Pre Operative: extraction of teeth with poor prognosis
2. Oral Compliance
3. Post Operative: fluoride, saliva substitutes, regular exams
288
What are implications of surgical removal of SCC?
Aesthetics: loss of teeth, soft tissue
Loss of Function: speech, swallowing, mastication
289
What are some side effects of chemotherapy for SCC?
Mucositis: ulceration caused by cells that stop dividing
Xerostomia: affect salivary glands
Impact Taste
Opportunistic infections: Candidiasis, Herpes Simplex, Rare Opportunistic Bacterial Infections (Klebsiella, Pseudomonas)
290
What dental care should be taken for patients under pallative treatment with terminal cancer?
1. Focus on quality of life
2. Minimum treatment
3. Pain control (non morphine based analgesics)
4. Antibacterial mouthwashes and gels
291
HPV 16 and 18 are implicated in what sort of oral malignancy?
Heighten risk of oropharyngeal cancers
292
What are the 5 histological gradings for tumours?
Carcinoma In Situ: Pre-invasive dysplasia
Grade 1: Well differentiated
Grade 2: Moderately differentiated
Grade 3: Poorly differentiated
Grade 4: Anaplastic: lack/poor differentiation of tumour cells
293
In TNM scoring, what is the T and give a description of the different scores
T: Tumour Size (1-4), the extent of primary tumour
T1: Primary Tumour < 2cm diameter
T2: 2-4cm diameter
T3: > 4cm diameter
T4: > 4cm diameter + invading local structures
294
In TNM scoring, what is the N and give a description of the different scores
N: Lymph Nodal Involvement (0-3)
Condition of regional lymph nodes
N0: No nodes clinically
N1: Ipsilateral palpable nodes
N2: Contralateral palpable nodes
N3: Fixed Palpable Nodes
295
In TNM scoring, what is the M and give a description of the different scores
M: Metastasis (0,1)
Presence/absence of distant metastases
M0: No metastasis
M1: Evidence of distant metastasis (clinical or radiographic)
296
What defines a stage 4 prognosis using the TNM scale?
Tumour with significant lymphatic spread or metastasis to secondary tumour(s)
Tx with N2/N3 OR
Anything with M1 (Metastasis occurred)
297
What defines a stage 3 prognosis using the TNM scale?
Large localised tumour or any tumour that has ipsilateral lymph node spread
T3 N0 M0 or
Tx with N1 (Ipsilateral Lymph Node Involvement)
298
What defines a stage 2 prognosis using the TNM scale?
Larger localised tumour confined to parent tissue
299
What defines a stage 1 prognosis using the TNM scale?
Localised tumour confined to parent tissue
T1 N0 M0
300
What is the nomenclature typically given to malignant tumours of a mesenchymal origin?
-sarcoma
301
What is a Mesenchymal tumour?
Grouping of all soft connective tissue (non-epithelial) cancers that derive from mesenchymal tissue.
Mesenchymal Tissue typically in Ground Substance of CT.
Tumours are grouped into the tissue they most resemble
Fibrous, Fat, Nervous, Bone, Muscle tissue
302
What is the main diagnostic way to differentiate between non-hodgkin and hodgkin lymphoma?
Hodgkin Lymphoma = lymph node histology has the presence of a large malignant B Cell called a Reed-Sternberg Cell
303
Hodgkin Lymphoma typically has the malignant transformation of which cells?
B Cells predominantly
| T Cells
304
What the clinical signs and of Hodgkin /Non-Hodgkin Lymphoma?
- Painless Lymphadenopathy (swollen Lymph Nodes).
- Swollen waldeyer tonsillar ring, particularly palatine tonsil
- Fever, itchy skin, weight loss, night sweats
305
A fixed brown patch appears in the mouth. It is asymmetrical with an irregular border and variable colour. If Nevus and Amalgam Tattoo have been discounted, what could this lesion be?
Malignant Melanoma
306
What is the cause of Non-Hodgkin Lymphoma?
Currently unknown, but associated with EBV and immunodeficiency
307
Granular Cell (Congenital) Epulis are found in newborns. Where are they found and why might they be an issue?
Come out from the alveolar ridge, mostly in the maxilla.
They are vascular, from an odontogenic epithelial source and can interfer with breastfeeding
308
Where can a Granular Cell Tumour be found?
Benign painless smooth swelling found on the tongue
309
What is the histology of Peripheral Nerve Sheath Tumour?
Spindle Cell Lesion
Increased/Abnormal Mitoses
Atypical Cells: Nuclear Pleomorphism (variability in size/shape)
Immunochemistry: S100
310
What are some malignant tumours found in the mouth?
1. Epithelial
- Squamous Cell Carcinoma
- Melanoma
2. Mesemchymal
- Peripheral Nerve Sheath Tumour
- Sarcomas (Fibrosarcoma, Liposarcoma, Angiosarcoma, Leimyosarcoma, Rhabdomyosarcoma)
3. Hematolymphoid
- Lymphoma (Hodgkin/Non-Hodgkin)
311
What are some benign mesenchymal lesions found in the mouth?
```
Fibrous Tissue Neoplasm: Fibroepithelial Polyps, Irritation Fibromas
Solitary Fibrous Tissue
Myoma
Leiomyoma
Peripheral Giant Cell Granuloma
Lipoma
Neuroma
Neurofibroma
Schwannoma
Granular Cell Tumour
Granular Cell Congenital Epulis
```
312
What histological feature of myxoma is different to other benign tumours
Unencapsulated mass - most benign tumours are encapsulated
313
What are the histological signs of myxoma?
Unencapsulated lesions - most benign tumours are encapsulated
Infiltrative Growth
“Stellate” and “Spindle Cell” shaped fibroblasts
Myxoma ('Loose' pale-to-lightly basophilic, like mucus) stroma appearance
314
Where is Solitary Fibrous Tissue typically found?
Lung Plura, but can be found anywhere
315
What is the most common mesenchymal malignancy?
Fibrosarcoma
316
What is the aetiology of Fibrosarcoma?
Unclear but can progress from pre-existing benign lesions and in previously irradiated tissue
317
What is the clinical presentation of a Fibrosarcoma?
Lobulated, Sessile Painless Mass
Variable Growth Rate
May be haemorrhagic
318
What is the histology and immunochemistry of Fibrosarcoma?
```
Vimentin marker positive
High level of variability
Lots of spindle cells
Odd anaplastic cells
Big nuclei
Increased mitotic figures
```
319
How does a lipoma present clinically?
Asymptomatic Yellow Mass in Buccal Mucosa, Tongue, Floor of Mouth
Intact Overlying Epithelium
320
Is a Lipasarcoma a fast or slow growing malignancy?
Slow growing - well differentiated and pleomorphic
321
What is the histology and immunochemistry of Angiosarcoma?
Immunochemistry: Factor VIII Positive
Unencapsulated
Atypical/anaplastic endothelial cells
322
What do leiomyoma, leiomyosarcoma and rhabdomyosarcoma affect?
- Leiomyoma: benign smooth muscle tumour
- Leiomyosarcoma: malignant smooth muscle tumour
- Rhabdomyosarcoma: malignant striated muscle
323
Peripheral Nerve Sheath Tumour can progress from what benign growth?
Neurofibroma
324
Which lesions test positive to S100 immunochemistry?
Schwannoma
Neurofibroma
Peripheral Nerve Sheath Tumour
Melanoma
325
How do neurofibromas present clinically?
Cutaneous cafe au lait macules, bone and CNS abnormalities
326
What dental diganostic tool can be used to identify a Peripheral Nerve Sheath Tumour?
Mass can appear as a rapidly growing radiolucent mass on an OPG
