Oral Pathology - ABGD Oral Board Review Flashcards

Question

What is going on here?

Answer 1

Periapical Cemento-Osseous Dysplasia

Answer 2

Ameloblastoma (crossing the midline) * Most common odontogenic tumor

Answer 3

Buccal Birfurcation Cyst Inflammatory Cyst

Answer 4

* Geographic Tongue * Erythema Migrans or Migratory Glossitis

Answer 5

17 yo, multiple central giant cell granulomas - cherubism

Answer 6

* Inflammatory * Secondary to sinus inflammatory process (sinusitis) * Secondary to dental inflammatory process (periapical pathosis) * "Relative Radiopacity" in sinus * Consider vitality testing of the teeth in the quadrant * Consider periodontal evaluation ofthe teeth in the quadrant

Answer 7

* Autoimmune process (against epithelial cell-cell attchments) * Look for ragged/irregular ulcers elsewhere (buccal, palatal) * You are likely to elicit a Nikolski (blister formation) * Histology: "suprabasilar acantholytic process"

Answer 8

Stafne Defect * Lingual mandibular salivary gland defect

Answer 9

* Diagnosis: (ulcerated) fibroma * Differential Diagnosis: * Fibroma * Pyogenic Granuloma * Soft Tissue Tumor (Neuroma, Neurofibroma, Neuroma) * Biopsy to exclude other soft tissue lesionsd (ex. pyogenic granuloma, neuroma, neurofibroma, lipoma)

Answer 10

* Magnetic Resonance Imaging * No harmful radiation (uses a magnetic field) * Caution: * cardiac pacemakers * certain metallic implants

Answer 11

Primary Herpetic Gingivostomatis

Answer 12

Odontogenic Myxoma

Answer 13

* Allergy to contrast agent * Compromised renal function

Answer 14

Better hard tissue contrast

Answer 15

* Option A * No treatment * Avoidance of irritating agents * Option B * Fluocinonide (Lidex), 0.05% gel * Apply to affected areas 2-3x per day * Option C * Clobetasol (Temovate), 0.05% gel * Apply to affected areas 2-3 times per day * Caution: Oral Candidiasis

Answer 16

Pemphigoid

Answer 17

Crouzon and Apert Syndromes Hypophosphatasia

Answer 18

Herpes Labialis and Whitlow

Answer 19

Squamous Papilloma (human papilloma virus)

Answer 20

Pyostomatitis Vegetan (ulcerative colitis)

Answer 21

* Gingival Overgrowth (medication induced) * Anti-seizure medications * Dilantin * Chemotherapeutics * Cyclosporine * Calcium Channel Blockers * Enalapril

Answer 22

Hyperparathyroidism 39 yo M, parathyroid disease, elevated PTH; biopsy; central giant cell granuloma

Answer 23

Hemangioma

Answer 24

Multiple Myeloma 67 yo F, history of myeloma; prior pathologic fractures of L mandible

Answer 25

* Pink to red * Associations: none specific * Histology: epithelial odontogenic rests

Answer 26

Squamous Cell Carcinoma (Stage IV; lymph node metastases arrows)

Answer 27

Pemphigoid

Answer 28

PET scan of primary/nodal disease

Answer 29

* Streptococcal and Staphylococcal species * Treponema * Bartonella * Actinomycetes

Answer 30

Squamous Cell Carcinoma * Differential Diagnoses: * Exclusion of malignancy in an otherwise unexplainable red/white lesion

Answer 31

* Differential Diagnoses: * Pyogenic Granuloma * Peripheral Ossifying Fibroma, Odontogenic Fibroma, Giant Cell Granuloma * Langerhans Cell Histiocytosis

Answer 32

* Traumatic Bone Cyst * Central Giant Cell Granuloma * Aneurysmal Bone Cyst * Langerhans Cell Histiocytosis

Answer 33

* Nutritional counseling can be performed by a dentist if an appropriate food diary is developed by the patient * Nutritional supplementation, however, should be managed by a physician, nutritionist/dietician or other health care professional trained in these areas; a thorough analysis including bloodwork may be required, and GI or other metabolic diseases may need to be excluded

Answer 34

* Lymphoepithelial Cyst * Can be found * Adenoids * Palatine Tonsil * Lingual Tonsil * Foliate Papillae

Answer 35

Amelogenesis Imperfecta (Hypoplastic)

Answer 36

* Peripheral Giant Cell Granuloma * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 37

Cat Scratch Disease (Bartonella)

Answer 38

* Consider (direct) immunofluorescence (IF) * Submit fresh tissue directly to the lab if you have capability * Submit in Michel's solution if you have to send the specimen * Split specimens (half formalin, half MIchel's)

Answer 39

Dense Bone Island/Idiopathic Osteosclerosis

Answer 40

Osteosarcoma Condrosarcoma Hemangioma

Answer 41

Multiple Odontogenic Keratocysts; consider nevoid basal cell carcinoma syndrome

Answer 42

Ranula = mucocele in the floor of the mouth

Answer 43

Dentinogenesis Imperfecta with Opalescent Dentin

Answer 44

Pyostomatitis Vegetans (ulcerative colitis)

Answer 45

Central Giant Cell Granuloma * May consider: * Calcitonin * Corticosteroids * a-interferon

Answer 46

Fibrous Dysplasia

Answer 47

Dentinogenesis Imperfecta with Opalescent Dentin

Answer 48

12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

Answer 49

Granular Cell Tumor

Answer 50

Herpes Zoster

Answer 51

Myeloma (in adults) Lngerhands Cell Histiocytosis (in children)

Answer 52

Multiple Myeloma

Answer 53

* Pulpal defects * Defects in or absence of root morphology * Osteogenesis imperfecta * Overlaps with dentin dysplasia

Answer 54

* Mucosal Slough * Consider * Mouthwash * Dentifrice * Dietary

Answer 55

* Pyogenic Granuloma * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 56

Lymphoma (non healing periradicular lesion following NSRCT)

Answer 57

* Erosive Lichen Planus * Pemphigoid * Pemphigus

Answer 58

* Neuroma * Neurofibroma * Lipoma * Granular Cell Tumor

Answer 59

Dentinogenesis Imperfecta with Opalescent Dentin

Answer 60

Acinic Cell Adenocarcinoma This would also be a common site for mixed tumor and Warthin Tumor

Answer 61

Syphilis (Treponema) * Primary * Chancre * Secondary * Mucus patch * "Split papule" * Condyloma lata * Tertiary * Gumma * Congenital * Dental deformities * Developmental delay

Answer 62

Mucocele (superficial)

Answer 63

Taurodontism

Answer 64

Morsicatio (frictional keratosis)

Answer 65

10% buffered formalin for routine histology

Answer 66

* Peripheral Odontoma * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 67

Apthous Ulcer (apthous stomatitis)

Answer 68

Sialolith | (painful hard nodule, Stensel's duct)

Answer 69

Little or none in our context

Answer 70

* Pain * Rapid Onset * Rapid Ulceration ("part of palate fell out")

Answer 71

Favors Monomorphic (canalicular) adenoma Favors pleomorphic adenoma

Answer 72

* Consider spectrum of tricho-dento-osseous syndrome * Consider spectrum of ectodermal dysplasias

Answer 73

Paraneoplatic Pemphigus

Answer 74

Paraneoplastic Pemphigus

Answer 75

9 yo F, nelarged tongue, multiple cafe au lait macules Multiple Endocrine Neoplasia

Answer 76

* HHV-1 (HSV-1): Oral and mucosal herpetic lesions * HHV-2 (HSV-2): Oral and mucosal herpetic lesions * HHV-3 (VZV): Chicken pox, Herpes zoster * HHV-4 (EBV): Infectious Mononucleosis, Oral Hairy Leukoplakia, Malignancies (Hodgkin's, Nasopharynx)

Answer 77

* Setting aside causes of HPV-related disease (early sexual activity, multiple partners, non-vaccinated) vs lymphoma (multiple including genetics, cancer causing agents, some infectious diseases such as EBV-related Hodgkin lymphoma’ and Helicobaacter pylori association with GI mucosal related lymphomas), each may require chemoradiotherapy in addition to any surgical intervention; the chemotherapy agents will differ, and outcomes may differ [HPV related oral and oropharynx cancers are noted to have higher survival rates vs non-HPV related oral cancers; lymphomas are highly variable in therapeutic response, depending on the specific diagnosis and genetic alterations]

Answer 78

* Asymptomatic: not required, though biopsy may be indicated to exclude other diseases * Symptomatic: consider topical steroid * Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, REFILLS = 1 (one) Clobetasol Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, REFILLS = 1 (one)

Answer 79

Hyperparathyroidism

Answer 80

Usually begin radiolucemt and may opacity over time

Answer 81

Lichenoid Mucositis | (with associated lichenoid dermatitis)

Answer 82

Mucoepidermoid Carcinoma

Answer 83

Cherubism Parathyroid/renal disease

Answer 84

Amelogenesis Imperfecta (Hypoplastic)

Answer 85

Syphilis (Treponema) * Primary * Chancre * Secondary * Mucus patch * "Split papule" * Condyloma lata * Tertiary * Gumma * Congenital * Dental deformities * Developmental delay

Answer 86

Morsicatio (frictional keratosis)

Answer 87

* Diagnosis: Mixed Tumor (pleomorphic adenoma) * Differential Diagnoses: * Salivary Gland Tumor * Salivary PAthology (mucocele, necrotizing sialometaplasia) * Other tumors (e.g. lymphoma)

Answer 88

Mild to Moderate Epithelial Dysplasia

Answer 89

* Periapical: Usually limited to man anterior * Focal: Usually limited to man or max posterior * Florid: Multiple Sites

Answer 90

Erythema Multiforme

Answer 91

* Viral: HHV, HPV, enteroviruses * Bacterial: Mycobacterium, Treponema, Actinomycetes * Fungal: Histoplasmosis * Parasitic: Myasis (fly larvae)

Answer 92

Alveolar Ridge Keratosis (frictional keratosis)

Answer 93

Leukoedema

Answer 94

* Tissues may be submitted in (10% buffered) formalin for routine histology, or Michel solution for IF; the specimen should be split, laid on a suture card or sterilization wrapper to minimize curling, and then sent to a lab that manages IF (the Michel solution can often be obtained by Dermatology or directly from the supporting lab) * Lichen planus demonstrates a linear deposition of fibrinogen at the basement membrane Pemphigus demonstrates a ‘chicken wire’ deposition of immunoglobulins and/or complement Pemphigoid demonstrates a linear deposition of immunoglobulins and/or complement at the basement membrane * Lichen planus demonstrates a band like lymphocytic infiltrate at or into the the epithelial base Pemphigus demonstrates acantholysis (the epithelial cells detached from each other and leave a ‘row of tombstones’) Pemphigoid demonstrates a complete epithelial split from the connective tussue

Answer 95

* Radiolucent: Implies minimal or no hard tissues * Mixed Radiodensity: Implies hard tissue component * Radiopaque: Implies predominantly hard tissue

Answer 96

Dense Bone Island/Idiopathic Osteosclerosis

Answer 97

* Peripheral Ossifying Fibroma * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 98

Ameloblastoma (in the periapical position; multiple failed endodontic procedures) * Most common odontogenic tumor

Answer 99

Melanocytic Blue Nevus

Answer 100

Simple hemorrhagic/idiopathic/traumatic/soliary bone cyst Surgeon reports entering into an empty cavity...

Answer 101

Langerhans Cell Histiocytosis

Answer 102

Coxsackievirus & Echovirus

Answer 103

Amelogenesis Imperfecta (Hypoplastic)

Answer 104

Sick Cell Anemia Thalassemia

Answer 105

Florid Cemento - Osseous Dysplasia

Answer 106

Palatal Perforation Secondary to Cocaine Abuse

Answer 107

Adenomatoid Odontogenic Tumor * Often second decade; often mimics dentigerous cyst, may be associated with impaction/failure to erupt

Answer 108

12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

Answer 109

* Calcifying Odontogenic Cyst (Gorlin Cyst); often included as tumor * Calcifying Epithelial Odontogenic Tumor (Pindborg tumor)

Answer 110

Focal Cemento-Osseous Dysplasia

Answer 111

Antral Pseudocyst | (incidental radiographic finding)

Answer 112

* Surgery * Radiation * Chemotherapy

Answer 113

* Hyperparathyroidism * Renal Osteodystrophy

Answer 114

Apthous Ulcer (apthous stomatitis)

Answer 115

* Fungal infections, burning sensation with some topical agents * Immune/marrow suppression (opportunistic infections)

Answer 116

Histoplasma

Answer 117

* This medication is used to treat a variety of skin conditions (e.g., eczema, dermatitis, allergies, rash). * Fluocinonide reduces the swelling, itching, and redness that can occur in these types of conditions. * This medication is a strong corticosteroid.

Answer 118

* Pheochromocytoma (a hormone secreting tumor that can occur in the adrenal glands) * Throid medullary carcinoma * Mucosal neuromas

Answer 119

Gingival Overgrowth (necrotizing gingivitis)

Answer 120

* Differential Diagnoses: * (Primary) Herpetic Gingivostomatitis * Apthous Stomatitis * AMnifestation of Systemic Disease (Crohn's Disease, inflammatory bowel disease, autoimmune)

Answer 121

Ameloblastoma (in the dentigerous position) * Most common odontogenic tumor

Answer 122

* Nasopalatine Duct Cyst, medial palatal cyst * Nasoalveolar Cyst, lacrimal duct cyst * Nasolabial Cyst * Stafne Defect/Lingual Mandibular Salivary Gland Defect

Answer 123

* "Fat Image" * Differentiate water from fat * Highlights differences in soft tissue densities

Answer 124

* Overlaps other malignancies in location (tonsils… lymphoma) * Higher stage on diagnosis (often detected first as metastatic disease to lymph nodes of head and neck) * Often requires additional diagnostic tests (PET/CT or ENT endoscopy to locate unknown head/neck primary) * Higher 5-year survival rates * Vaccinations are available for HPV-related disease; long term preventive and therapeutic benefits are well documented in HPV-related cervical cancer and pathophysiology of HPV-related disease in other sites such as anal cancers, oropharyngeal and nasopharyngeal cancers may herald similar results [long term studies are ongoing] * HPV salivary testing is available; it’s highly specific and sensitive but there is little to no evidence base for predictive value (just because HPV is detected in saliva, there’s no known correlation with disease) * There are social, moral, ethical and religious implications and as such we must be sensitive to our patients and their beliefs

Answer 125

Herpes Zoster

Answer 126

Metastatic Adenocarcinma 56 yo M being treated for "cancer" with extensive caries; periapical tissues #31 submitted for histologic evaluation

Answer 127

Lichenoid Mucositis

Answer 128

Herpes Zoster

Answer 129

* Apthous Stomatitis * Bachet's Disease * Lichenoid Mucositis

Answer 130

* Sublingual Gland: 70-90% (usually malignant) * Minor Glands: 46-82% (50/50) * Submandibular: 37-45% (50/50) * Parotid: 15-32% (usually benign)

Answer 131

* Tonsillolith * Tonsilloliths * HPV-related carcinoma * Lymphoma

Answer 132

Dentin Dysplasia

Answer 133

* Single or multiple coalescing ulcers * Usually (but not always) on 'attached/keratinized mucosa' * Gingiva * Tongue * Palate * Primary forms may occur anywhere in the oral cavity

Answer 134

* Consider Dentinogenesis Imperfecta * Consider Dentin Dysplasia * Consider Osteogenesis Imperfecta

Answer 135

Osteo (chemo) necrosis 72 yo M, non-healing extraction site, history of myeloma and IV zolendronic acid exposure (bisphosphonate)

Answer 136

* Usually pink to red * Associations: none specific * Histology: bone or dystrophic calcifications (make a radiograph)

Answer 137

Necrotizing Sialometaplasia | (47 yo M, palatal mass)

Answer 138

Multiple Myeloma 67 yo F, history of myeloma; prior fractures of L mandible

Answer 139

* "Water Image" * Differentiate water from fat * Highlights edema * Highlights CSF

Answer 140

Pemphigoid

Answer 141

Recurrent Herpes Labialis

Answer 142

* Parotid: 64-80% * Minor glands: 9-23% * Submandibular: 8-11% * Sublingual: 0.3-1%

Answer 143

Is dislodgment of intact superficial epidermis by a shearing force, indicating a plane of cleavage in the skin at the dermal-epidermal junction. The histological picture involves thinner, weaker attachments of the skin lesion itself to the normal skin, resulting in easier dislodgement

Answer 144

Human Herpes Simplex Virus, Type 1

Answer 145

Herpes Zoster

Answer 146

* No; however, lichenoid or interface mucositis as a histologic diagnosis is made in several situations and the clinician may need to investigate and ask the patient questions: * Lichen planus, both oral and dermatologic (may also associate with eczema and psoriasis) * Lichenoid reaction to mouthwash, dentifrice, dietary elements (ex. cinnnamon) * Lichenoid reaction to topical and systemic medications * Tobacco (both smoked and inhaled) and vaping products * Autoimmune diseases such as systemic lupus * Graft versus host disease in the context of marrow transplant

Answer 147

Oral Candidiasis (erythematous) * Sample the patient * Sample the prosthesis * Request study for Candida

Answer 148

Periapical Cyst

Answer 149

* Papillary (bumpy), usually white to pink * Associations: Human Papillomavirus 6, 11 (low risk) * Histology: bland papillary fronds, viral effects on nuclei

Answer 150

* Fungal infections * Decreased efficacy of birth control * Erythema multiforme reactions

Answer 151

0.017 - 0.04%

Answer 152

Osteomyelitis 67 yo F presented with associated pain and fever

Answer 153

Focal Cemento - Osseous Dysplasia

Answer 154

10 yo, multiple Odontogenic Keratocysts, front bossing, calcified falx (NBCCS)

Answer 155

Amelogenesis Imperfecta (Hypoplastic)

Answer 156

* Michel's solution (presevative) * Potassium citrate buffered

Answer 157

Calcifying or Ghost Cell Odontogenic Cyst 12 yo * May mimic dentigerous cyst or 'AOT', often associated with impacted tooth

Answer 158

* Pleomorphic Adenoma * Myoepithelioma * Warthin Tumor * Oncocytoma * Monomorphic Adenoma * Canalicular Adenoma * Basal Cell Adenoma * Trabecular Adenoma * Cystadenoma

Answer 159

Hemangioma / AV Malformation Ameloblastoma

Answer 160

Gladnular Odontogenic Cyst * Developmental cyst; most often 6th decade up

Answer 161

Nasopalatine Duct Cyst

Answer 162

Osteosarcoma Patient presented with pain, expansiona and sensory changes * Consider Osteosarcoma: * PDL widening * Suprecrestal bone * "Sun Ray" and sensory changes

Answer 163

Pyostomatitis Vegetan (ulcerative colitis)

Answer 164

Recurrent Herpetic Gingivostomatis

Answer 165

* Diagnosis: Geographic Tongue/Migratory Glossitis/Erythema Migrans * Differential Diagnoses: * Geogrpahic tongue/migratory glossitis/erythema migrans * Nutritional disorder * Exclude taste or sensory changes that may suggest 'burning mouth syndrome'

Answer 166

Lymphangioma

Answer 167

Virus, Not Apthous!

Answer 168

* Radiopaque * Radiolucent * Mixed density

Answer 169

Melanotic Macule

Answer 170

Osteo (chemo) necrosis 69 yo F, exposed bone R maxilla, history of lung cancer with bone metastases, IV Zometa treatment

Answer 171

Dense Bone Island/Idiopathic Osteosclerosis

Answer 172

Amelogenesis Imperfecta (Hypoplastic)

Answer 173

Paraneoplastic Pemphigus

Answer 174

* Viral Infections * Local Ischemia * Anorexia/Bulimia Nervosa

Answer 175

Herpes Zoster

Answer 176

White Sponge Nevus

Answer 177

Squamous Papilloma

Answer 178

Simple/hemorrhagic/idiopathic/trauamtic/bone cyst Surgeon reports entering into an empty cavity...

Answer 179

* Pleomorphic Adenoma (mixed tumor) * Mucoepidermoid Carcinoma

Answer 180

Melanotic Macule

Answer 181

Langerhans Cell Histiocytosis (mimicking periapical lesion)

Answer 182

Squamous Cell Carcinoma

Answer 183

48 yo M, multiple nodules, face/upper extremities Neurofibromas associated with Neurofibromatosis Type I

Answer 184

* Lymphoepithelial Cyst * Gingival Cyst * Nasolabial Cyst * Fordyce Granules

Answer 185

Stafne Defect * Lingual Mandibular Salivary Gland Defect

Answer 186

Ameloblastoma (crossing the midline) * Most common odontogenic tumor

Answer 187

* Positron Emission Tomography * Assess metabolic activity and physiologic function

Answer 188

Mucosal Burn (thermal/pizza)

Answer 189

Hypercementosis

Answer 190

Polymorphous Adenocarcinoma

Answer 191

Volume Render

Answer 192

* Pink to red * Associations: none specific * Histology: depends on the tumor! * Consider odontomas (make a radiograph) * Consider ameloblastomas, odontogenic kertocysts, etc

Answer 193

* Godalinium * Iron oxide, Iron platinum * Manganese

Answer 194

Ranula (mucocele)

Answer 195

Primary Herpetic Gingivostomatis

Answer 196

* T2 * Fat suppression * Squamous cell carcinoma, base of tonuge

Answer 197

* Fibroma * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 198

Ameloblastoma (in the periapical position) * Most common odontogenic tumor

Answer 199

Oral Candidiasis (Pseudomembranous, secondary to inhaled corticosteroids)

Answer 200

* Taurodontism * Hair, nail and ectodermal defects (including ectodermal dysplasia) * IS NOT associated with osteogenesis imperfecta

Answer 201

* Autoimmune process (against basement membrane components) * Look for bullae (blisters or large vesicles) elswhere * Look for other mucosal lesions (ocular, intranasal) * You may elicit a Nikolski (blister formation) * Histology: subepithelial split

Answer 202

Squamous Cell Carcinoma (Stage IV: cancer invades osseous structures)

Answer 203

* Excisional biopsy; this is favored to be benign and excisional biopsy provides both diagnosis and treatment * Yes; any fractured cusps, prosthetic clasps, sources of trauma should be resolved to minimize recurrence

Answer 204

* NF (type I) is associated with mucosal and skin neurofibromas * The significance lies with an association with these neurofibromas trnasforming to sarcomas and with multiple bening and malignant nerve tumors in areas such as the GI tract * Dentists may recognize the neurofibromas as well as cafe-au-lait spots

Answer 205

* Pain responsive to aspirin/NSAIDs * Lesion thought to produce prostaglandins (pain mediators)

Answer 206

Medication Induced Pigmentation (quinine)

Answer 207

Lichenoid Mucositis

Answer 208

* Salivary tumors are typically treated surgically (excision), + lymph node dissections if encountered * Lymphoma, though potentially excisable, will often also have associated bone marrow analysis (to exclude marrow or leukemia involvement) * In either case, distant metastases may require chemotherapy and/or radiation therapy * IMPORTANT: nodules can be many things; salivary gland tumors and lymphomas can both occur in the oral cavity and present as soft tissue nodules, ulcerated or fiungating masses, or resemble other cancers

Answer 209

Nevoid Basal Cell Carcinoma Syndrome

Answer 210

Lichenoid Mucositis

Answer 211

0.7 - 6.7%

Answer 212

* It may, especially if it’s a component of nutritional, anxiety or other disorders * Diagnosis and treatment is controversial but may be associated with neuropathies and rheumatologic disorders in a Specific patient population * Engage primary care, neurology and rheumatology; these providers may aide in management and medications used (such as anti-anxiety medications) may best be prescribed by them

Answer 213

Focal Cemento-Osseous Dysplasia or Ossifying Fibroma

Answer 214

Fibrous Dysplasia

Answer 215

Ameloblastoma (in the periapical position) * Most common odontogenic tumor

Answer 216

0.00038-0.21%

Answer 217

Liver Toxicity

Answer 218

Adenoid Cystic Carcinoma

Answer 219

12 yo, muiltiple odontogenic keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

Answer 220

Nasopalatine Duct Cyst

Answer 221

Primary Herpetic Gingivostomatis

Answer 222

Garnder Syndrome Potential for malignant GI polyps

Answer 223

Sialolith | (painful hard nodule, floor of mouth)

Answer 224

Osteo (chemo) necrosis 69 yo F, exposed bone R maxilla, hisotry of lung cancer with bone metastases, IV Zometa treatment

Answer 225

Carcinoma In Situ * Differential Diagnoses * Exclusion of malignancy in an otherwise unexplinable red/white lesion

Answer 226

Osteo (chemo) necrosis 72 yo M, non-healing extraction site, history of myeloma and IV zolendronic acid exposure (bisphosphonate)

Answer 227

* Lymphoepithelial Cyst * Adenoids * Palatine Tonsil * Lingual Tonsil * Foliate Papillae

Answer 228

Fibrous Dysplasia

Answer 229

Gingival Overgrowth (leukemic infiltrate)

Answer 230

* Fibroma * Pyogenic Granuloma * Mucocele

Answer 231

Osteosarcoma Chrondrosarcoma

Answer 232

Multiple Odontogenic Keratocysts; consider nevoid basal cell carcinoma syndrome

Answer 233

Osteomyelitis Patient presented with associated pain and fever

Answer 234

Osteomyelitis with Proliferative Periostitis Ewing Sarcoma

Answer 235

7 yo, multiple central giant cell granulomas - cherubism

Answer 236

* This medication is used in adults to treat a variety of skin conditions (such as eczema, dermatitis, psoriasis). * Clobetasol reduces the swelling, itching and redness that can occur in these types of conditions. * This medication is a very strong (super-high-potency) corticosteroid.

Answer 237

Traumatic Ulcer

Answer 238

Condyloma Acuminatum (human papillomavirus)

Answer 239

Apthous Ulcer (apthous stomatitis)

Answer 240

* Breast * Lung * Thyroid * Colon * Kidney * Prostate

Answer 241

Periapical Cemento-Osseous Dysplasia

Answer 242

Dense Bone Island (another variant)

Answer 243

HPV - Related Squamous Cell Carcinoma

Answer 244

Herpes Labialis and Whitlow

Answer 245

* Extravasation Type * Mucus pooling outside the duct system * Most common type of mucocele * Retention Type * Mucus pooling within the duct system * May see terms ductal ectasia, salivary duct cyst or cystadenoma (describe increasing dilation of the duct)

Answer 246

Syphilis (Treponema) * Primary * Chancre * Secondary * Mucus patch * "Split papule" * Condyloma lata * Tertiary * Gumma * Congenital * Dental deformities * Developmental delay

Answer 247

* Acyclovir 400-800mg, DISP 25 tabs, SIG take 1 (one) tablet 5 (five) times per day, REFILLS = 1 (one) * Valacyclovir 1000mg, DISP 4 (four) tabs, SIG take 2 (two) immediately then 2 (two) 12 hours later REFILLS = 1 (one) * Valacyclovir (Valtrex) may be exended to twice per day for immunosuppressed, recurrent cases * There is no evidence base for efficacy of either drug over the other; both are equally effective but patient compliance may improve with a twice per day regimen rather than 5 times per day

Answer 248

Dentigerous (follicuar) cyst Developmental cyst; most common developmental odontogenic cyst - usually simple cyst lining

Answer 249

Dense Bone Island/Idiopathic Osteosclerosis

Answer 250

Dense Bone Island (one variant)

Answer 251

1. Sialoliths 2. Rhinoliths 3. Antroliths Other Include: * Tonsilloliths * Phleboliths * Choristomas (osseous, chondroid) * Stylohyoid Ligament * Vascular Calcifications * Lymph Nodes * Foreign Bodies

Answer 252

* Surgery * Chemotherapy (often therapies are now personalized or targeted) * Radiation therapy (often this is intensity modulated radiotherapy or IMRT, and spares many tissues * Effects may include: * Mucositis that may mimic other oral ulcerative diseases * Xerostomia and xerostomia-related caries * GI disturbances (nausea, vomiting) * Dermatopathologic changes (hair loss, skin ulcerations, etc.) * Poor wound healing * Secondary malignancies (radiation induced sarcomas, chemotherapy induced leukemia, etc.)

Answer 253

Cryoptococcus

Answer 254

Dentigerous Cyst * Developmental cyst; most common developmental odontogenic cyst

Answer 255

* Differential Diagnoses: * Apthous ulcer/apthous stomatitis * Traumatic ulcer (physical, thermal, chemical) * Suggestions focus on topical corticosteroids and include: * Flucinonide 0.05% gel, DISP 30 gram tube, SIG apply to affecged area twice per day, refills = 1 * Clobetasol Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, Refills = 1 * Note that both may result in oral candidiasis (thrush); this may be treated with a topical antifungal * This case also affords opportunity to discuss approprite prescription writing

Answer 256

Paget's Disease

Answer 257

Cementoblastoma

Answer 258

* Allergy less a concern * Pacemakers * Metallic (cochlear) implants * Aneurysm clips

Answer 259

Varicella Zoster Virus

Answer 260

Pemphigoid

Answer 261

Minocycline Pigmentation

Answer 262

Physiologic Pigmentation

Answer 263

Cat Scratch Disease (Bartonella)

Answer 264

* Squamous Papilloma * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 265

Antral Pseudocyst (59 yo F, incidental radiographic finding)

Answer 266

* Pemphigus * Pemphigoid * Systemic Lupus

Answer 267

* Pyogenic Granuloma * Peripheral Ossifying Fibroma * Peripheral Giant Cell Granuloma

Answer 268

* May vary in radiodensity but usually have some radiopaque component * Often expansile * May be symptomatic * Usually do not affect tooth vitality (test for it!) * Usually do not affect the PDL (make periapical XRs!) * Often displace teeth as they expand * Often excised as a discrete (firm/fibrous) mass

Answer 269

Melanoma in situ

Answer 270

Ameloblastic Fibroma 12 yo * Often first 2 decades, often impaction or failure of eruption

Answer 271

* Mucoepidermoid Carcinoma * Adenoid Cystic Carcinoma * Polymorphous Adenocarcinoma * Acinic Cell Adenocarcinoma * Carcinoma ex. mixed tumor * Salivary Duct Carcinoma * Epithelial-Myoepithelial Carcinoma

Answer 272

* More often ill-defined (as compared to the other BFOLs) * May vary in radiodensity * The term "cotton wool" is used for Paget's Disease * May be symptomatic (if impinging on nerves) * May affect the PDL (make periapical XRs!) * Often will result in loss of all PDL architecture * Often displace teeth as they expand * Age is not necessarily helpful as these lesions can expand, 'recur' and continue to present throughout life * A diagnosis warrants full body evaluation for polyostotic disease and possibly other disturbances (endocrine)

Answer 273

* High signal intensity * Low signal intensity

Answer 274

Fibrous Dysplasia

Answer 275

* Odontomas are often considered Harmartomas * Harmartomas (normal tissue, but malformed or excess)

Answer 276

* Soft tissues * Bone appears dark on image * Soft tissue appear lighter/whiter (high signal intensity) * Bone and air appear darker/black (low signal intensity)

Answer 277

Fibrous Dysplasia Endocrine Disorder (McCune-Albright)

Answer 278

Oral Mucosal Melanoma Primary tumor circled, lymph node metastases arrows

Answer 279

Granular Cell Tumor

Answer 280

Osteoblastoma

Answer 281

CEOT Celcifying Epithelial Odontogenic Tumor

Answer 282

* Union of the lesion with the root = cementoblastoma * Lesion discrete from root = osteoblastoma

Answer 283

* Ocular Symptoms * Dry eyes * Need artificial tears * Oral Symptoms * Dry mouth sensation * Frequent liquid intake

Answer 284

Metallic Tattoo

Answer 285

* Hyperparathyroidism * Osteodystrophy

Answer 286

Odontogenic Keratocyst (appearing in the "dentigerous' position)

Answer 287

* Cherubism is a syndrome with a genetic association; these children often have endocrinopathies

Answer 288

Ameloblastoma

Answer 289

Ameloblastic Fibrom-Odontoma 14 yo Image seen with Odontoma Component

Answer 290

Oral Candidiasis (Erythematous) * Sample the patient * Sample the prosthesis * Request study for Candida

Answer 291

* HHV-5 (CMV): Ocular Disease, Herpangina-like diseases * HHV-6: Pediatric skin rashes (roseola) * HHV-7: Pediatric skin rashes (roseola) * HHV-8 (KSV): Kaposi sarcoma, some lymphomas

Answer 292

Melanotic Macule

Answer 293

The best tests will have high sensitivity and high specificity

Answer 294

Human Herpes Simplex Virus, Type 2

Answer 295

Lichenoid Mucositis

Answer 296

10 yo, multiple Odontogenic Keratocysts, front bossing, calcified falx (NBCCS)

Answer 297

Focal Cemento-Osseous Dysplasia or Ossifying Fibroma

Answer 298

* Geographic Tongue * Erythema Migrans or Migratory Glossitis

Answer 299

Osteosarcoma 49 yo F, enlargement of L mandible, with aching pain * Consider Osteosarcoma * PDL widening * Suprecrestal bone * "Sun Ray" and sensory changes

Answer 300

* MEN type IIb (III) is associated with mucosal neuromas * The significance lies not with the neuromas but with endocrine tumors such as pheochromocytoma and thyroid medully carcinoma * Dentists may recognize the neuromas as well as the cafe-au-lait spots described in this syndrome and other endocrine syndromes such as McCune-Albright Syndrome (fibrous dysplasia, cafe-au-lait spots, endocrinopathies)

Answer 301

Odontogenic Kertocyst (appearing in the 'primordial' or 'residual' position)

Answer 302

T2 of an Medulloblastoma Highlights edema, highlights CSF

Answer 303

* Mucosal Slough * Consider: * Bleaching * Mouthwash * Dentifrice * Dietary

Answer 304

Periapical (radicular) Cyst Inflammatory cyst; most common odontogenic cyst

Answer 305

* Physical * Thermal * Chemical * Electrical

Answer 306

Garnder Syndrome, multiple osteomas and odontomas/supernumerary teeth

Answer 307

Squamous Cell Carcinoma

Answer 308

Hyperparathyroidism 39 yo M, parathyroid disease, elevated PTH; biopsy: central giant cell granuloma

Answer 309

Amelogenesis Imperfecta (Hypoplastic)

Answer 310

Smokeless Tobacco Use

Answer 311

Langerhans Celll Histiocytosis (mimicing intrafurcal lesion in a 4 yo)

Answer 312

* Basal cell carcinoma before 20 years of age or excessive numbers of basal cell carcinomas out of proportion to prior sun exposure and skin type * Keratocystic odontogenic tumor before 20 years of age * Palmar or plantar pitting * Lamellar calcification of the falx cerebri * Medulloblastoma, typically desmoplastic * First degree relative with nevoid basal cell carcinoma syndrome

Answer 313

* Multiple neurofibromas * Cafe au lait spots (6 or more) * Axillary/inguinal freckling * Osseous (sphenoid) dysplasia * First-degree familial history

Answer 314

Focal Cemento - Osseous Dysplasia

Answer 315

* Fibroma (Giant Cell Type) * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 316

Stafne Defect When these cysts are located in proximity to teeth, it is advisable to test the teeth for vitality, consider periodontal probing, gutta percha tracting (radiograph) and evaluate the periodontal ligament space (best accomplished with a periapical radiograph

Answer 317

Traumatic Ulcer

Answer 318

* Differential Diagnoses * Multiple Fibromas * Neuromas (and exclusion of endocrine neoplasia syndromes) * Neurofibromas (and exclusion of neurofibromatosis)

Answer 319

Gardner Syndrome, multiple osteomas and odontomas/supernumerary teeth

Answer 320

* Thought to be a T-cell mediated process * Look for a striated component somewhere else (buccal mucosa) * Look for restorations (including composites) nearby * You may elicit a Nikolski (blister formation)

Answer 321

Dentinogenesis Imperfecta with Opalescent Dentin

Answer 322

* Computed Tomography * Without contrast * With contrast * Iodine (Isovue) * Barium Sulfate

Answer 323

Osteomyelitis Ewing Sarcoma

Answer 324

Melanocytic Nevus ('mole')

Answer 325

* Usually non-expansile * Usually asymptomatic * Usually do not affect tooth vitality (test for it!) * Usually do not affect the PDL (make periapical XRs!) * Often excised in multiple fragments * Gender and ethnicity not as helpful as though * Do tend to bre more common in black, Hispanic, Oriental * Do tend to be more common in females

Answer 326

Dentigerous Cysts

Answer 327

* More often ill-defined (as compared to the other BFOLs) * May vary in radiodensity * The term "ground glass/orange peel" is used for fibrous dysplasia * May be symptomatic (if impinging on nerves) * May affect the PDL (make periapical XRs!) * Often will result in loss of all PDL architecture * Often displace teeth as they expand * Age is not necessarily helpful as these lesions can expand, 'recur' and continue to present throughout life * A diagnosis warrants full body evaluation for polyostotic disease and possibly other disturbances (endocrine)

Answer 328

Florid Cemento - Osseous Dysplasia

Answer 329

* Perioral Dermatitis (lip licking, often circular erythema around one or more lips) * Impetigo (lips, face, often crusted or 'corn flake' appearance) * Fungating and granulomatous ulcers * Non-healing sites of trauma (denture sores) * Non-healing sites of surgery (extractions, periodontal) * Palatal perforation

Answer 330

Better soft tissue contrast

Answer 331

Mixed Tumor (pleomorphic adenoma)

Answer 332

Carcinoma in situ

Answer 333

* No; however, a history and questions to exclude nutritional deficiency, burning mouth, etc. may be warranted * Geographic tongue has also been reported to have association with psoriasis in some studies

Answer 334

Cherubism (bilateral central giant cell granulomas)

Answer 335

Ameloblastoma (in the dentigerous position) * Most common odontogenic tumor

Answer 336

Odontogenic Kertocyst (appearing in the 'lateral periodontal" position)

Answer 337

Myoepithelioma

Answer 338

AOT Adenomatoid Odontogenic Tumor

Answer 339

Squamous Cell Carcinoma

Answer 340

Paraneoplastic Pemphigus

Answer 341

Cementoblastoma

Answer 342

Lichenoid Mucositis | (with associated eczema/psoriasis)

Answer 343

* Apthae typically do not affect the gree gingiva; when gingival ulcerations are present, along with fever/malaise, a viral origin should be considered

Answer 344

* Tonsillar Hyperplasia * Hyperplasia (sleep apnea) * Tonsilloliths * Tonsilitis

Answer 345

Ameloblastoma 30-90% Odontogenic Keratocyst 5% up to 60%

Answer 346

Dentinogenesis Imperfecta with Opalescent Dentin

Answer 347

Histoplasma

Answer 348

Mucosal Burn (aspirin)

Answer 349

Syphilis (Treponema) * Primary * Chancre * Secondary * Mucus patch * "Split papule" * Condyloma lata * Tertiary * Gumma * Congenital * Dental deformities * Developmental delay

Answer 350

Dense Bone Island/Idiopathic Osteosclerosis

Answer 351

Central Giant Cell Granuloma

Answer 352

Nasopalatine Duct Cyst

Answer 353

Erythema Multiforme

Answer 354

Gingival Overgrowth (local factors)

Answer 355

Pyogenic Granuloma

Answer 356

Melanoacanthosis

Answer 357

Fibrous Dysplasia

Answer 358

* Fibroma, Odontogenic Type * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 359

* Lateral/ventral tongue (50%) * Floor of mouth (35%) * Oropharynx * Retromolar trigone

Answer 360

Syphilis (Treponema) * Primary * Chancre * Secondary * Mucus patch * "Split papule" * Condyloma lata * Tertiary * Gumma * Congenital * Dental deformities * Developmental delay

Answer 361

* Epidermoid Cyst * Midline Developmental Cysts: * Epidermoid Cyst * Dermoid Cyst * Cystic Teratoma * Thyroglossal Duct Cyst

Answer 362

Ameloblastoma

Answer 363

Pemphigoid

Answer 364

* Dx: Lichenoid Mucositis * Differential Diagnoses: * Lichen planus or other inflammatory/immune mediated diseases * Lichenoid reaction to dental materials, dentifrice, mouthwash, medications, etc. * Frictional keratosis

Answer 365

* Papillary (bumpy), usually pink * Associations: none specific * Histology: enlarged/stellate/multinucleated fibroblasts

Answer 366

Focal Cemento-Osseous Dysplasia or Ossifying Fibroma

Answer 367

* Diagnosis: Lymphoma * Differential Diagnoses: * Lymphoma * Oropharyngeal or nasopharyngeal carcinoma (esp. HPV-related carcinoma) * Infectious and Inflammatory (fungal, bacterial, tonsillitis, tonsillolith, etc.)

Answer 368

* Usually red, often ulcerated, bleed easily * Associations: Trauma, poor hygiene, pregnancy * Histology: granulation tissue

Answer 369

* Most often on palata * Cases reported in tongue and in prior surgical sites

Answer 370

Apthous Ulcer (apthous stomatitis)

Answer 371

* Natural Killer/T Cell Lymphoma * Palatal perforation and midline/nasal destructive lesion

Answer 372

* Because either of these entities can resemble a nodule, ulcer or even cancer, at minimum an (incisional) biopsy is indicated to exclude these other entities * NSM will often resolve once the inciting agent/process resolves or runs its course (ischemia, trauma) but NSM may be associated with infections (often viral) or eating disorders (anorexia, bulimia) so those may require intervention * A mucocele may be associated with an obstruction (sialolith, mucus plug, mass/tumor in the area); this may require removal of the obstruction and/or excision of the gland; additionally, removal of any feeder glands is recommended to minimize recurrences

Answer 373

0.7 - 1.9%

Answer 374

* Fluid Attenuated Inversion Recovery * Suppressed fluid/water signals * ex. brain imaging, to suppress CSF and highlight intracranial pathology

Answer 375

* Option A * Fluocinonide (Lidex), 0.05% gel * Apply to affected areas 2-3x per day * Doxycycline (Periostat) 20 mg * 2x per day * Option B * Clobetasol (Temovate), 0.05% gel * Apply to affected areas 2-3 times per day * Doxycycline (Periostat) 20 mg * 2x per day * Caution: Oral Candidiasis

Answer 376

* Tobacco * Alcohol/phenols * Betel nut * Radiation * Vitamin Deficiency * Genetics * Immunosuppression * Infectious agents (esp. HPV, HHV-8, EBV)

Answer 377

* Hemangioma * Diascopy * Diascopy is a test for blanchability performed by applying pressure with a finger or glass slide and observing color changes. It is used to determine whether a lesion is vascular, nonvascular, or hemorrhagic. Hemorrhagic inflammtory lesion and nonvascular lesions do not blanch; inflammatory lesions do.

Answer 378

* Tumor size (T), presence of involved lymph nodes (N) and metastasis (M) are married as a group of histologic, microscopic and advanced imaging studies (MRI, PET, CT scan) to determine a stage; higher stage tumors herald lower (5 year) survival rates and may drive additional therapy (surgery, chemotherapy, radiation therapy, targeted therapy)

Answer 379

Paraneoplastic Pemphigus

Answer 380

* May vary in radiodensity but usually have some radiopaque component * May be expansile * May be symptomatic * May affect tooth vitality (test for it!) * May affec the PDL (make periapical XRs!) * May displace teeth if they expand * Cementoblastoma excised attached to the tooth * Osteoid osteoma are often (but not always) painful

Answer 381

Necrotizing Sialometaplasia (40 yo M, sudden onset of pain/swelling)

Answer 382

Florid Cemento - Osseous Dysplasia

Answer 383

Dense Bone Island/Idiopathic Osteosclerosis

Answer 384

Paraneoplastic Pemphigus

Answer 385

* Fibroma (Giant Cell Type) * Consider * Periodontal Probing * Periapical Radiographs * Vitality Testing

Answer 386

Lichenoid Mucositis

Answer 387

Cytomegalovirus

Answer 388

* Option A * Palliative * Analgesia * Contact percautions * Option B * Topical or systemic antiviral (most effective @ prodrome) * No significance acyclovir 5x/day vs. valacyclovir 2x/day * Consider: * Ophthalmology/Dermatology referral for zoster * Post herpetic neuralgia management

Answer 389

Early to late Cemento Osseous Dysplasias (variations from radiopaque to mixed density to radiolucent)

Answer 390

* Traumatic: Traumatic ulcer of tongue * Bacterial: Mycobacterium, Treponema, Actinomycetes * Fungal: Histoplasmosis * Sarcoidosis * Wegener's Granulomatosis

Answer 391

Favor Apthous! Not Virus...

Answer 392

* Primordial (no tooth develops) * Dentigerous/follicular cyst * Odontogenic Keratocyst * Orthokeratinizing Odontogenic Cyst * Glandular Odontogenic Cyst

Answer 393

* Periapical Cyst * Buccal Bifurcation Cyst * Residual Cyst (remaining cyst after treatment)

Answer 394

12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

Answer 395

Recurrent Herpes Labialis

Answer 396

Pyostomatitis Vegetans (ulcerative colitis)

Answer 397

* Immune compromise (HIV/AIDS, organ/marrow transplant, marrow suppression) * Poorly controlled endocrine disorders (diabetes mellitus, etc.) * Antibiotic use * Oral inhaled steroid use (asthma) * Systemic steroid use (immunosupppresion for SLE) * Dental prostheses (i.e. poorly managed prostheses, overnight wear) * Substance abuse (ex. cocaine abuse)