***Oral Pathology Flashcards
What details are required when describing a pathological radiographic finding? (7)
- Site
- Size
- Shape
- Outline or edge
- Relative radiodensity
- Effect on adjacent structures
- Time present, if known
Describe the types of details that should be recorded when talking about “site”
The location of the lesion, as well as whether it is generalised or localised.
- Mandible
- Maxilla
- Both jaws
- Other bones
Describe the types of details that should be recorded when talking about “size”
- Centimetres: vertical and horizontal dimensions
* Boundaries
Describe the types of details that should be recorded when talking about “shape”
- Monolocular
- Multilocular
- Pseudoloculated
- Round
- Oval
- Irregular
Describe the types of details that should be recorded when talking about “outline”
- Definition of the outline
* Cortication of the outline: radiopaque margins
Describe the types of details that should be recorded when talking about “relative radiodensity”
- Uniformly radiolucent
- Of variable radiolucency
- Radiolucent with patchy opacities
- Radiopaque
Describe the types of details that should be recorded when talking about “effect on adjacent structures”
Impact on:
• Teeth
• Bone
• Soft tissues
Describe the types of details that should be recorded when talking about “time present”
The time it has occurred
Define the following terms:
- Periapical abscess
- Periodontal abscess
- Granuloma
- Cyst
- Tumour
- Periapical abscess: suppuration around the apices due to acute or chronic inflammation
- Periodontal abscess: localised area of acute or chronic inflammation of the gingival tissues, infra-bony pockets or periodontal ligament
- Granuloma: structure filled with immune cells and is formed due to inflammation
- Cyst: a pathologic space in bone or soft tissue containing fluid. Clinically, it is lined with epithelium
- Tumour: an abnormal and excessive growth of tissue, inconsistent with the growth of normal tissue.
List the types of radiographic lesions that are normally seen
· Radiolucent lesions of the jaw
· Apical lesions: Acute inflammation and chronic inflammation
· Periodontal lesions
· Cysts
· Radiopaque lesions of jaw: odontomas, bony lesions, soft tissue calcification and foreign bodies
· Mixed radiolucency lesions: periapical cemental dysplasia
List radiolucent lesions of the jaw
Osteoradionecrosis
Osteomyelitis
Describe the diagnosis of an apical lesion
· The diagnosis of an abscess, granuloma or cyst cannot be determined on radiographic appearance alone
· Histological investigation is necessary for confirmation and definitive diagnosis
· When describing a radiolucent apical lesion (without clinical or histological evidence), the correct term is Apical Periodontitis
Describe the general appearance apical lesion
· Areas of radiolucency often appear ill-defined and may be located at the apex or in the furcation area
List the two main types of apical lesions
Acute apical inflammation
Chronic apical inflammation
List the types of chronic apical inflammation
- epithelial tissue/ granuloma
- granulation tissue and fibrous tissue
- Neutrophil domination
Describe causes and appearance of acute apical inflammation
- Inflammatory exudate accumulates in the apex of tooth
- Occurs due to bacterial invasion of pulp
Radiographic appearance:
• May see widened PDL space
• As inflammation spreads, there is loss of the lamina dura and eventually bone
Describe chronic apical inflammation: epithelial tissue/ granuloma
Radiographic appearance
• Radiopaque border
• Well defined radiolucency
Describe chronic apical inflammation: granulation tissue and fibrous tissue domination
Radiographic appearance:
• Radiolucent area
• No radiopaque border
Describe chronic apical inflammation: neutrophil domination
Radiographic appearance:
• Diffuse radiolucent area
• Accompanied by resorption of root apex
Describe apical lesions in the primary dentition
Apical lesions in the primary dentition is usually seen as a radiolucency. For molars, this is located in the furcation area. For other teeth, it is seen in the apex. However, a developing tooth bud follicle may obscure pathology.
Describe the radiographic appearance of periodontal lesions
- Any radiolucency off the alveolar bone and PDL
* Common to see “J” shaped lesions
Discuss the difference between Endodontic-Periodontal Lesion and Periodontal-Endodontic Lesion
Endodontic-Periodontal Lesion
• Pulpal necrosis precedes periodontal changes
• May drain to the oral cavity through the periodontal ligament resulting in destruction of the periodontal ligament and the adjacent alveolar bone
Periodontal-Endodontic Lesion
• Bacterial infection from the periodontal pocket associated with the loss of attachment and root exposure
• May spread to the pulp – resulting in pulp necrosis
List the two main types of cysts that occur and their associated sub-categories
Odontogenic (related to teeth) • Periodontal • Radicular • Residual • Dentigerous
Non- odontogenic (not related to teeth)
• Median mandibular cyst
• Nasopalatine duct
Describe the four types of odontogenic cysts
- Periodontal: occurs on lateral aspect of root. Has a radiopaque border
- Radicular: Occurs on apex of root
- Residual: Cyst that remain after the tooth causing it is extracted
- Dentigerous: Radiolucency around the crown of the tooth of a developing tooth
Describe the two types of non- odontogenic cysts and their causes
Nasopalatine duct/ incisive canal cyst
• Radiolucency between central incisors, extending to nasopalatine ridge and beyond
• Develops from epithelial remnants of the nasopalatine duct/ incisive canal
Median mandibular cyst
• Radiolucency on the mandible behind the central incisors
• Due to embryonic epithelial remnants
List the radiopaque lesions of the jaw
Pulp stones
Condensing osteitis
Odontoma
Enostosis (bone island)
Exostoses (tori)
Soft tissue calcifications: salivary calculi
Lymph node and tonsil calcifications
Hypercementosis
Describe pulp stones, hypercementosis and odontoma
Pulp stones:
• Radiopaque calcification within the pulp with radiolucent border
Hypercementosis:
• Excessive deposition of cementum on the roots
Odontoma:
• Overgrowth of dental tissue
• Complex: not like tooth
• Compound: like tooth
Describe enostosis
Round radiopacity (calcification) in the cancellous bone
Describe exostosis
- Calcifications in places where soft tissue should be
* Superimpositions of diffuse radiopacity on teeth
Describe soft tissue calcifications
• Calcified masses where salivary glands should be: submandibular and sublingual salivary glands
Describe lymph node and tonsil calcifications
• Calcified masses where lymph nodes should be
Describe condensing osteitis
• Increased osteoblastic activity due to long term irritation
Radiographic appearance
• Increase radiopacity in alveolar bone
• Common site: near apices of premolars and molars
Name the mixed radiolucency lesion seen in the jaw and describe it
Periapical cemental dysplasia
• Tooth or teeth are still vital
- 3 variations in appearance can occur
- Early stage: Radiolucent;
- Mixed stage: Radiolucent with radiopacity inclusion
- Mature stage: may appear as a mixed radiolucent or radiopaque lesion
