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ABPD 2021 > Oral Pathology > Flashcards

Oral Pathology Flashcards

1
Q

4 Most Common Non-Odontogenic Bone Pathology

A

Idiopathic Bone Sclerosis
Simple Bone Cyst
Fibrous Dysplasia
Focal cemento-osseous dysplasia

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2
Q

Idiopathic bone sclerosis

A

Focal solitary sclerotic lesion that arises in the late 1st or early 2nd decade of life

Radiopaque, well-defined lesion, localized, non-corticated at apex of vital teeth

Cause = unknown

Asymptomatic (not associated with inflammation, no root resorption or tooth displacement)

May remain static or demonstrate slow growth that usually stops with skeletal maturity

Location: posterior mandible, usually by 1st molar

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3
Q

Simple Bone Cyst

A

AKA Idiopathic bone cavity, solitary bone cyst

Well-defined radiolucent lesion with no effect on surrounding teeth and intact lamina dura

Cavity within bone that is lined with connective tissue (may be empty or contain fluid)

Not a true cyst

Cause = unknown

Occurs in first 2 decades of life

Females 2:1

Location: posterior mandible

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4
Q

Fibrous Dysplasia

A

Ill-defined, radiopaque lesion with “ground glass” or “orange peel”

Localized change in normal bone metabolism = replacement of all components of normal bone by fibrous tissue containing varying amounts of abnormal bone

More common in females

Asymmetrical and usually solitary (monostotic 70%)

Rarely associated with pain

Patients between 10-20 years old, may become active in pregnancy

Most common in maxilla

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5
Q

Focal cemento-osseous dysplasia

A

3 stages: radiolucent, mixed, radiopaque

Localized range in normal bone metabolism = replacement of components of normal bone with fibrous tissue and cementum-like material, abnormal bone or mix

Occurs near apex of tooth as incidental finding

Well-defined but irregularly shaped

More common in females 9:1, especially middle age, AA/Hispanic

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6
Q

What is the most common cyst in the jaws?

A

Radicular cyst

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7
Q

Radicular cyst

A

AKA periapical cyst, dental cyst

Cyst most likely originated when cell rests of Malassez of epithelial cells in PDL are stimulated to proliferate and undergo cyst degeneration by inflammatory products from a non-vital tooth

Asymptomatic unless it grows

60% in maxilla

Well-defined cortical border, if secondarily infected the inflammatory reaction may result in loss of bone

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8
Q

Buccal Bifurcation Cyst

A

Inflammatory odontogenic cyst that usually occurs at the buccal region of the first or second primary mandibular molar

Children 5-13 years of age

Delayed tooth eruption and swelling at the affected area is commonly observed

Well-defined radiolucent area, often corticated around the roots of the involved teeth

Treatment = surgical excision

Often associated with pulp therapy

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9
Q

2nd most common cyst in the jaw?

A

Dentigerous cyst

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10
Q

Dentigerous Cyst

A

Well-defined corticated radiolucency around crown of unerupted tooth

Begins from accumulation in layers of reduced enamel epithelium or between the epithelium and the crown of unerupted tooth

can displace and resorb teeth

DDX: hyperplastic follicle, OKC, cystic ameloblastoma

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11
Q

Odontogenic Keratocyst

A

Non-infammatory odontogenic cyst that arises from dental lamina

Well-corticated and radiolucent, minimal expansion but can resorb teeth

Unlike other cysts, OKC epithelium has innate growth potential

Most common in posterior mandible - epicenter is usually SUPERIOR to IA canal (inferior is salivary gland defect)

Slight male predilection

High recurrence

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12
Q

Naso-palatine canal cyst

A

Not an odontogenic cyst

Remnant of nasopalatine canal

Well-defined, corticated, circular or oval in shape (heart shape) radiolucent lesion

Can cause roots of central incisors to diverge, occasionally can resorb roots of incisors

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13
Q

Adenomatoid Odontogenic Tumor (AOT)

A

Frequently found in child or adolescent

Associated with maxillary canine

Unilocular, well-defined radiolucency - can later develop calcified “floccules”

Snowflake calcification

Tends to displace rather than resorb adjacent teeth

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14
Q

Ameloblastic Fibroma

A

Frequently in children and adolescents - uncommon overall

Unilocular, crenelated, or multilocular with well-delineated and corticated border

Homogeneous radiolucency

Commonly at angle of mandible

May cause displacement of teeth; less aggressive locally than non-unicystic ameloblastomas

Small, subtle calcifications in lesion (this is what makes it different from DC or OKC)

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15
Q

Odontoma - Compound

A

Malformation in which all dental tissues are represented in an orderly pattern

Many little tooth structures

More common than complex

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16
Q

Odontoma - Complex

A

Unorganized dental tissue pattern

Golf ball

Radiopaque surrounded by radiolucent area

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17
Q

Cementoblastoma

A

Slow growing mesenchymal neoplasm composed of cementum-like tissue and attached to apex of tooth root

Well-defined radiopaque lesion with cortical border

Most often in mandibular premolar/molar area

More common in males

Pulp vitality is unrelated - involved tooth is painful

Usually occurs before 18, in 2nd or 3rd decade of life

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18
Q

Ewing’s Sarcoma

A

Tumor of long bones that is relatively rare in jaws

Swelling, pain, loose teeth, paresthesia and trismus are clinical features

Radiographic features are radiolucency that is ill-defined and never corticated with destruction of bone, sunray appearance, floating teeth

Lesions arise in medullary portion of the bone and spread to endosteal and later periosteal surface

Most common in middle of second decade (15 years)

Males 2:1 affected

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19
Q

Acute Lymphocytic Leukemia

A

Malignant tumor of hematopoietic stem cells

Most common leukemia in children

Radiographic changes include periapical lesions, ill-defined radiolucent and radiopaque lesions

No expansion of bone, but displacement of unerupted teeth

Premature loss of teeth

Similar in appearance to hypophosphatasia

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20
Q

Hypophosphatasia

A

Alkaline phosphatase deficiency
Plays a role in bone mineralization

Multiple fractures, premature exfoliation of teeth

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21
Q

Epstein Pearls

A

Islands of epithelium that are trapped during fusion of palatal shelves

Palatal midline

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22
Q

Bohn Nodules

A

Arise from epithelial remnants from minor salivary glands

Junction of hard/soft palate; buccal or lingual surface of alveolar ridge (not crest) or in hard palate, away from midline

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23
Q

Gingival cyst of the newborn

A

AKA dental lamina cyst
Small keratin filled cysts found on alveolar mucosa of infants

Common - up to 50% of infants

Maxilla more common, no treatment necessary

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24
Q

Melanotic Neuroectodermal Tumor of Infancy

A

Relatively uncommon osteolytic - pigmented neoplasm

Primarily affects jaw of newborns

Locally aggressive, benign lesion of neural crest origin - high recurrence rate

High urinary excretion of vanilla-mandalic acid

Most common in anterior maxilla

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25
Q

Congenital Epulis of the Newborn

A

Benign soft tissue tumor - AKA Gingival Granular Cell Tumor

Almost exclusively on alveolar ridges of newborns - 3x more in maxilla

Typically a pink, red smooth mass

9:1 female

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26
Q

Premature Teeth

A

Natal: Erupted deciduous teeth present at birth
Neonatal: deciduous teeth erupting in first 30 days of life

85% primary mandibular incisors

Rarely supernumerary teeth

Etiology unknown

Prevalence 1:2000

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27
Q

Hemangioma

A

Begins at birth, proliferates, than proliferation is reduced - many lesions will not require surgery

20% are disfiguring and can destroy normal tissue and compromise life of baby

Etiology = unknown

Follows branches of trigeminal nerve

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28
Q

What is the most common tumor of infancy?

A

Hemangioma

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29
Q

Vascular Malformations

A

Appear later in life (not born with lesions)

Classified based on vascular channel (artery, vein, lymphatic, etc.) - most common is venous

Many become evident in puberty

Clinical presentation is variable

Most asymptomatic, sometimes pain

Doppler US and MRI are diagnosis/assessment tools

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30
Q

Recurrent Aphthous Stomatitis

A

Typical age is teenagers and up

Healthy individuals

Involvement of heavily keratinized mucosa of palate and gingiva is not common

Several factors proposed as etiology - immune factors most prevalent but still not known

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31
Q

What is the most common ulcerative disease of oral mucosa?

A

Recurrent Aphthous Stomatitis

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32
Q

Types of recurrent aphthous stomatitis

A

Minor: most common, small size (1cm or less)

Major: larger, heals with scars

Herpetiform: mimics herpes

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33
Q

Is there a prodrome for RAS ulcers?

A

Yes, many patients experience a short burning sensation that lasts 2-48 hours before ulcer appears

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34
Q

Is there gingivitis in RAS cases?

A

No

Marginal gingivitis is connected more with primary herpes

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35
Q

Prevalence of RAS

A

20% of population is affected

If present in parents, increased likelihood for children to have it

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36
Q

Etiology of RAS

A

Definitive etiology is not known

Local factors (trauma, changes in saliva)

Microbial factors

Medical conditions

Genetic - heredity is the best underlying cause

Allergic factors (hypersensitivity)

Immune factors (abnormal CD4/CD8, IL-2, TFNa)

Nutrition factors

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37
Q

Underlying medical conditions associated with recurrent aphthous ulcers

A

Behcet’s

MAGIC (mouth and genital ulcers with inflammation of cartilage)

Crohn’s

Cyclic Neutropenia

PFAPA (periodic fever, RAS, pharyngitis, cervical adenines)

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38
Q

What type of virus is Coxsackie?

A

RNA virus

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39
Q

Herpangina

A

Oral ulcerations limited to soft palate, uvula, tonsils

Incidence peaks in summer/fall

Sudden fever, malaise, headache, dysphagia

Caused by coxsackie virus

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40
Q

Hand Foot Mouth

A

Frequently seen in epidemic outbreaks in daycare or school

Mild headache and malaise followed by skin and oral lesions

Caused by coxsackie virus

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41
Q

What virus is erythema multiforme connected with?

A

Herpes

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42
Q

Erythema multiforme

A

Typically mild, self-limiting and recurring mucocutaneous reaction characterized by target lesions of skin and mucous membranes

Typical age 7-21 years old, more in females

Symmetrical

Etiology: HSV, drugs

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43
Q

Clinical presentation of EM

A

Lesions in fixed position with symmetric distribution

Central blister (target shape)

Oral mucosa lesions in more than 70% - lips, alveolar mucosa, palate

More severe = Stevens Johnson Syndrome

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44
Q

What type of virus is herpes?

A

DNA

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45
Q

Herpes

A

Causes primary infection and then remains latent

Transmitted by direct contact

Incidence of primary infections with HSV1 increases after 6 months and peaks at 2-3 years

Significant prodrome with generalized marginal gingivitis

Self-limiting, treatment is palliative

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46
Q

What type of virus is HPV?

A

DNA

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47
Q

Localized Juvenile Spongiotic Gingival Hyperplasia

A

Unique and distinctive form of inflammatory gingival hyperplasia seen in young patients

Average age 11.8 years, more in female

Not plaque related

Usually in anterior maxilla, bright red raised overgrowth with papillary of finely granulated surface

Small lesion that can bleed easily

Etiology = unknown; lesion does not respond to perio treatment

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48
Q

4 most common causes of gingival overgrowth

A

Medications

Hygiene

Idiopathic (familial)

Leukemia

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49
Q

Medications causing gingival overgrowth

A

Calcium channel blockers (ex: verapamil, nifedipine)

Anticonvulsants (phenytoin, dilantin)

Cyclosporine (immunosuppressants for transplants)

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50
Q

Gingival fibromatosis

A

Hereditary or idiopathic

Idiopathic = enlarged localized or generalized gingival tissue with connective tissue (collagen 1) growth

Enlargement more prominent during eruption of teeth

Diagnosis through thorough history, clinical exam, histopathology

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51
Q

Benign migratory glossitis

A

AKA Geographic Tongue

Affects 2% of the population, more common in females

Etiology is unknown

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52
Q

What systemic condition is associated with geographic tongue?

A

Psoriasis

53
Q

Median Rhomboid Glossitis

A

AKA central papillary atrophy

Area of redness and loss of lingual papilla on dorsal surface of tongue

Related to chronic fungal infection

Sometimes have mirror lesion on palate

54
Q

IBS/Crohn’s Disease Oral Manifestations

A

IBS = Crohn’s and ulcerative colitis

Oral ulcers in CD have indurated borders, are histologically different from RAS and may be nonpainful

Cobblestoning of buccal mucosa

Oral symptoms may precede GI symptoms

55
Q

Immune Thrombocytopenic Purpura

A

Autoimmune disorder involving destruction of platelets by the spleen

No treatment necessary in majority of cases, but sometimes splenectomy

Contact sports and IM infections require caution

56
Q

Selective IgA Deficiency

A

One of the most common types of primary immunodeficiency

Patients produce other Ig

Cause is unknown

Increased risk for anaphylactic reactions

57
Q

Clinical features that may indicate immunodeficiency

A
  • 3 or more episodes of otitis media in 6 months
  • persistent purulent ear discharge
  • 2 or more serious sinus infections within 1 year
  • failure to thrive
  • 2 or more pneumonia in 1 year
  • recurrent deep skin infections
  • family history
  • persistent candidiasis
58
Q

Behcet’s Disease

A

Prevalence in higher in countries around Mediterranean Sea

More common in females in North America, but males elsewhere

Sores in eyes, mouth, genitals

Autoimmune condition

No pathognomonic lab test for BD, diagnosis is based on clinical criteria

Management is challenging - use of anti-TNFa or other immunomodulators

59
Q

Intrinsic tooth staining

A

Unlike extrinsic, due to presence of chromogenic material within the enamel or dentin

Can occur pre-eruptive or post-eruptive

60
Q

Most common pre-eruptive cause of intrinsic discoloration?

A

Fluorosis

Others: DI, AI, hematologic disorders, medications

61
Q

Most common post-eruptive cause of intrinsic discoloration?

A

Trauma

62
Q

Congenital hyperbilirubinemia

A

Congenital issue that is complex and results in high bilirubin levels

Causes green discoloration of teeth (intrinsic)

Consequence of biliary atresia

63
Q

Congenital erythropoietic porphyria

A

Causes red intrinsic discoloration of teeth

64
Q

Mucocele

A

Most common on lower lip

Some heal spontaneously, others are chronic and require surgical removal

Excellent prognosis

Not a true cyst - no epithelial lining

Results from rupture of salivary gland duct and spillage of mucin into surrounding soft tissues

65
Q

Most common oral lesion in children?

A

Mucocele

66
Q

Pyogenic Granuloma

A

Exuberant tissue response to local irritation or trauma

Smooth, lobulated mass usually pedunculated

High vascular proliferation, red in color and bleeds easily

More common in females

Often on lips, buccal mucosa, or gums

67
Q

Peripheral Ossifying Fibroma

A

Bony changes involved

Reactive or inflammatory hyperplasia of gingiva (trauma or irritation)

More common in young children and females

More common in maxilla

Painless mass of gingiva or alveolar mucosa, requires excisional biopsy

68
Q

Peripheral Giant Cell Granuloma

A

Can also have bone changes

Only occurs in gingiva (soft tissue part of CGCG)

Usually distal to incisors

More common in females

Red or blue mass

Can cause bone resorption

Requires excision

69
Q

Eruption Cyst

A

Develops from separation of dental follicle from around crown of tooth that is erupting

Soft swelling in gingiva overlying crown of erupting primary or permanent tooth

No treatment usually required

70
Q

Giant Cell Fibroma

A

Uncommon lesion

Fibrous tumor that is probably unrelated with chronic trauma

Slight female predilection, most common in mandibular gingiva or palate

Presence of fibroblasts within superficial connective tissue

Treatment = excision

71
Q

HPV transmission

A

HPV most commonly is transmitted by means of close contact

Sexual, but also vertical and autoinocculation

Horizontal transmission among family members is possible in childhood

72
Q

Oral manifestations of HPV (broad)

A

Low risk HPV genotypes are often responsible for benign oral mucosa lesions

Patients with HIV are more likely to develop genital and anal HPV

73
Q

Most common low-risk genotype of HPV?

A

6, 11

74
Q

Squamous Papilloma

A

HPV 6, 11

Benign proliferation of stratified squamous epithelium

Most common on tongue, lips, palate

Single lesion, finger-like projections

75
Q

Verruca vulgaris (common wart)

A

HPV 2, 4

Benign, virus-induced focal hyperplasia of stratified epithelium

frequent in children - self-inoculation from fingers to mouth

76
Q

Condyloma Acuminatum

A

HPV 16, 18

STD appearing most frequently as a soft, pink cauliflower like growth

Highly contagious, affects both genders equally with peak incidence at 17-20 years

77
Q

Multifocal epithelial hyperplasia (Heck’s)

A

HPV 13, 32

Virus induced, localized proliferation of oral squamous epithelium

More in Alaska Native, Mexico

Multiple members of same family

Multiple, flattened, soft, nontender papular lesions that are the same color as oral mucosa

78
Q

Syndromes associated with supernumerary teeth

A

Cleidocranial dysplasia
Gardner’s syndrome
Cleft lip/palate

79
Q

Supernumerary teeth

A

1-4% familial tendency

Mesiodens, paramolar

Male 2:1

Can delay or impact normal tooth eruption, can have dentigerous cyst

80
Q

Missing teeth

A

3-10% (excluding 3rd molars)

Hypodontia and colon and ovarian cancer has an association

81
Q

Syndromes associated with missing teeth

A

Ectodermal dysplasia

Orofacialdigital syndrome

82
Q

Macrodontia - associated systemic conditions

A

Hemangioma
Hemihypertrophy of face
Pituitary gigantism

83
Q

Microdontia - associated conditions

A

Pituitary dwarfism

84
Q

Gemination

A

Most common in primary dentition, especially incisors

Increases tooth number

Pulp chamber is single and enlarged

Division of a single tooth bud

85
Q

Fusion

A

Adjacent tooth germs combined with dentin or enamel

Bifid crown or two recognizable teeth

Reduces tooth number

More common in primary dentition, especially anterior

86
Q

Concrescence

A

Fusion after root formation

2nd and 3rd molars common

Caused by traumatic injury

87
Q

Taurodontism

A

Normal crown size ad tooth length, shortened roots

Not recognizable clinically

Mostly in molars

Seen in Trisomy 21, Kleinfelters

88
Q

Dilaceration

A

Maxillary premolars common

Sharp curve in root likely from trauma

89
Q

Dens in dente

A

Infolding of outer enamel surface into interior

Caires -> pulp disease

Coronal type: enamel organ infolding into dental papilla

Radicular type: invagination of Hertwigs epithelial root sheath, lined with cementum

90
Q

Amelogenesis Imperfecta

A

Disturbance in enamel development

Normal dentin and root

Autosomal dominant, autosomal recessive and X-linked

91
Q

Type 1 AI

A

Hypoplastic type

Thin enamel with pitted rough or smooth and glossy surface, yellow to brown

Undersized, squared crown, lack of contact

Flat occlusal surfaces and low cusps due to attrition

92
Q

Type 2 AI

A

Hypomaturation type

Normal thickness of enamel but mottled surface, cloudy white, yellow or brown, opaque

Softer than normal

Same density as dentin

93
Q

Type 3 AI

A

Hypocalcified type

Normal thickness of enamel, density is less than dentin

Permeability increases, darkened and stained

94
Q

Type 4 AI

A

Hypomaturation-hypocalcified with taurodontism

95
Q

Type 1 DI

A

Autosomal dominant

DI + Osteogenesis imperfecta

COL1A1 and 2 genes

96
Q

Type 2 DI

A

Autosomal dominant

Isolated DI

1:8000 individuals

DSPP gene

97
Q

Type 3 DI

A

DI of Brandywine type

DSPP gene

DI + multiple pulp exposures in deciduous teeth

98
Q

Radiographic features of DI

A

Bulbous crowns, normal size, constriction of cervical area

Short and slender roots

Occlusal attrition

Partial or complete obliteration of pulp chamber, root canals

99
Q

Dentin Dysplasia

A

Rare autosomal dominant disorder

1:100,000 individuals affected

100
Q

Type I DD

A

Normal color and shape of crowns in both dentitions

Misaligned arch, drifting and exfoliation of teeth with little or no trauma

Short or abnormal root shape, pulp chamber and root canals obliterated

Apical radiolucencies in 20% of teeth (vitality is normal)

101
Q

Type II DD

A

Primary dentition appears as DI, but permanent dentition is normal

Obliteration of pulp chamber and reduced root canals after eruption

Roots are normal in shape and proportion

Thistle tube pulp

102
Q

Regional Odontodysplasia

A

Hypoplastic and hypocalcified dentin and enamel

Only a few adjacent teeth in a quadrant are affected

Central incisors > lateral incisors > canines

Delayed eruption

Large pulp chamber and wide root canals, roots are short and poorly outlined

Thin enamel and less dense = ghost teeth

103
Q

Enamel Pearl

A

Small globule of enamel on root furcation of molars

3% prevalence

104
Q

Talon Cusp

A

Anomalous hyperplasia of cingulum of a maxillary or mandibular incisor

T shaped in incisal view

Differential diagnosis with supernumerary tooth

Rubenstein-Taybi

105
Q

Turner’s Hypoplasia

A

Type of enamel hypoplasia associated with defect in crown of permanent tooth from infection/trauma from. primary predecessor

106
Q

Congenital Syphilis

A

Hutchinson’s incisors
Mulberry molars

30% have dental hypoplasia

Not all patients with Hutchinson’s teeth or mulberry molars will have congenital syphilis

107
Q

Acquired Pathologic Conditions

A

Attrition
Abrasion
Erosion
Hypercementosis

108
Q

Attrition

A

Physiologic wearing from occlusal contacts

Bruxism is pathologic condition, also diet, salivary factors, mineralization, emotional tension

Crowns shorten, pulp chamber and canals reduce

109
Q

Abrasion

A

Non-physiologic wearing by contact with foreign substance

Factitious habits or occupational hazards

Tooth brushing, flossing, pipe smoking, nail biting

110
Q

Erosion

A

Chemical action, not involving bacteria

GI disorders or acidic diet

GI: lingual surfaces
Diet: labial surfaces
Industrial exposure: all surfaces

111
Q

Hypercementosis

A

Excessive deposition of cementum on roots - smooth or irregular with intact lamina dura and PDL space

Supraerupted tooth after opposing tooth loss

Periapical inflammatory lesions

Hyperocclusion or fractures

Paget’s disease, Hypopituitarism

112
Q

Formed Elements of Blood

A

Red blood cells
White blood cells
Platelets

113
Q

Prothrombin Time (PT)

A

Extrinsic and common pathway

Normal 10-12 seconds

Prolonged by deficiencies in factor VII, X, V, prothrombin and fibrinogen

Used to monitor Warfarin, evaluate liver disease, vitamin K deficiency and DIC

114
Q

INR

A

International normalized ratio

PT (patient) / PT (control) ISI

115
Q

Partial thromboplastin time (PTT)

A

Intrinsic pathway

Normal 25-35 seconds

Prolonged in patients deficient in any plasma-clotting factors except VII or XII

116
Q

PFA-100

A

Looks at normal platelet function

117
Q

Types of Anemia

A

Hypoproliferative (not enough cells)

Hemolytic (bursting cells)

Sickle cell

Macrocytic (big cells)

Microcytic (little cells)

Normocytic

118
Q

Macrocytic anemia causes

A

Folate deficiency

Vitamin B12 deficiency

119
Q

Microcytic anemia causes

A

Iron deficiency

Thalassemia

120
Q

Normocytic anemia causes

A

Anemia of chronic disease

Bone marrow aplasia

121
Q

Thrombocytopenia

A

Decreased platelet quantity

Increased destruction or decreased production or splenic sequestration

122
Q

Platelet quality disorders

A

Bernar Soulier syndrome

Drug induced (aspirin, penicillin, indometacin)

Disease related (uremia, paraproteins, myeloproliferative disorders)

123
Q

Normal HCT values

A

Males: 40-54%
Females: 38-47%

124
Q

Normal Hb values

A

Males 13.5-18.0 g/dL

Females: 12-16 g/dL

125
Q

RBC count

A

Males: 4.6x10^6

Females 4.2x19^6

126
Q

WBC count

A

4500-11000/uL

Neutrophils: 56%
Bands: 3%
Eosinophils: 2.7%
Monocytes: 4%
Lymphocytes: 34%
127
Q

Platelet count

A

150-450000/uL

128
Q

Sedimentation rate (ESR)

A

0-15mm/hour

129
Q

Reticulocyte count

A

0.5-1.0%

ABPD 2021 (14 decks)

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