Oral Pathology (created by another user) Flashcards
4 Most Common Non-Odontogenic Bone Pathology
Idiopathic Bone Sclerosis
Simple Bone Cyst
Fibrous Dysplasia
Focal cemento-osseous dysplasia
Idiopathic bone sclerosis
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
Simple Bone Cyst
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
Fibrous Dysplasia
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
Focal cemento-osseous dysplasia
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
What is the most common cyst in the jaws?
Radicular cyst
Radicular cyst
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
Buccal Bifurcation Cyst
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
2nd most common cyst in the jaw?
Dentigerous cyst
Dentigerous Cyst
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
Odontogenic Keratocyst
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
Naso-palatine canal cyst
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
Adenomatoid Odontogenic Tumor (AOT)
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
Ameloblastic Fibroma
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)
Odontoma - Compound
Malformation in which all dental tissues are represented in an orderly pattern
Many little tooth structures
More common than complex
Odontoma - Complex
Unorganized dental tissue pattern
Golf ball
Radiopaque surrounded by radiolucent area
Cementoblastoma
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
Ewing’s Sarcoma
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
Acute Lymphocytic Leukemia
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
Hypophosphatasia
Alkaline phosphatase deficiency
Plays a role in bone mineralization
Multiple fractures, premature exfoliation of teeth
Epstein Pearls
Islands of epithelium that are trapped during fusion of palatal shelves
Palatal midline
Bohn Nodules
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
Gingival cyst of the newborn
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
Melanotic Neuroectodermal Tumor of Infancy
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
Congenital Epulis of the Newborn
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
Premature Teeth
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
Hemangioma
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
What is the most common tumor of infancy?
Hemangioma
Vascular Malformations
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
Recurrent Aphthous Stomatitis
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
What is the most common ulcerative disease of oral mucosa?
Recurrent Aphthous Stomatitis
Types of recurrent aphthous stomatitis
Minor: most common, small size (1cm or less)
Major: larger, heals with scars
Herpetiform: mimics herpes
Is there a prodrome for RAS ulcers?
Yes, many patients experience a short burning sensation that lasts 2-48 hours before ulcer appears
Is there gingivitis in RAS cases?
No
Marginal gingivitis is connected more with primary herpes
Prevalence of RAS
20% of population is affected
If present in parents, increased likelihood for children to have it
Etiology of Recurrent Aphthous Ulcers
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
Underlying medical conditions associated with recurrent aphthous ulcers
Behcet’s
MAGIC (mouth and genital ulcers with inflammation of cartilage)
Crohn’s
Cyclic Neutropenia
PFAPA (periodic fever, RAS, pharyngitis, cervical adenines)
What type of virus is Coxsackie?
RNA virus
Herpangina
Oral ulcerations limited to soft palate, uvula, tonsils
Incidence peaks in summer/fall
Sudden fever, malaise, headache, dysphagia
Caused by coxsackie virus
Hand Foot Mouth
Frequently seen in epidemic outbreaks in daycare or school
Mild headache and malaise followed by skin and oral lesions
Caused by coxsackie virus
What virus is erythema multiforme connected with?
Herpes
Erythema multiforme
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
Clinical presentation of EM
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
What type of virus is herpes?
DNA
Herpes
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
What type of virus is HPV?
DNA
Localized Juvenile Spongiotic Gingival Hyperplasia
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
4 most common causes of gingival overgrowth
Medications
Hygiene
Idiopathic (familial)
Leukemia
Medications causing gingival overgrowth
Calcium channel blockers (ex: verapamil, nifedipine)
Anticonvulsants (phenytoin, dilantin)
Cyclosporine (immunosuppressants for transplants)
Gingival fibromatosis
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
Benign migratory glossitis
AKA Geographic Tongue
Affects 2% of the population, more common in females
Etiology is unknown
What systemic condition is associated with geographic tongue?
Psoriasis
Median Rhomboid Glossitis
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
IBS/Crohn’s Disease Oral Manifestations
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
Immune Thrombocytopenic Purpura
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
Selective IgA Deficiency
One of the most common types of primary immunodeficiency
Patients produce other Ig
Cause is unknown
Increased risk for anaphylactic reactions
Clinical features that may indicate immunodeficiency
- 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
Behcet’s Disease
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
Intrinsic tooth staining
Unlike extrinsic, due to presence of chromogenic material within the enamel or dentin
Can occur pre-eruptive or post-eruptive
Most common pre-eruptive cause of intrinsic discoloration?
Fluorosis
Others: DI, AI, hematologic disorders, medications
Most common post-eruptive cause of intrinsic discoloration?
Trauma
Congenital hyperbilirubinemia
Congenital issue that is complex and results in high bilirubin levels
Causes green discoloration of teeth (intrinsic)
Consequence of biliary atresia
Congenital erythropoietic porphyria
Causes red intrinsic discoloration of teeth
Mucocele
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
Most common oral lesion in children?
Mucocele
Pyogenic Granuloma
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
Peripheral Ossifying Fibroma
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
Peripheral Giant Cell Granuloma
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
Eruption Cyst
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
Giant Cell Fibroma
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
HPV transmission
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
Oral manifestations of HPV (broad)
Low risk HPV genotypes are often responsible for benign oral mucosa lesions
Patients with HIV are more likely to develop genital and anal HPV
Most common low-risk genotype of HPV?
6, 11
Squamous Papilloma
HPV 6, 11
Benign proliferation of stratified squamous epithelium
Most common on tongue, lips, palate
Single lesion, finger-like projections
Verruca vulgaris (common wart)
HPV 2, 4
Benign, virus-induced focal hyperplasia of stratified epithelium
frequent in children - self-inoculation from fingers to mouth
Condyloma Acuminatum
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
Multifocal epithelial hyperplasia (Heck’s)
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
Syndromes associated with supernumerary teeth
Cleidocranial dysplasia
Gardner’s syndrome
Cleft lip/palate
Supernumerary teeth
1-4% familial tendency
Mesiodens, paramolar
Male 2:1
Can delay or impact normal tooth eruption, can have dentigerous cyst
Missing teeth
3-10% (excluding 3rd molars)
Hypodontia and colon and ovarian cancer has an association
Syndromes associated with missing teeth
Ectodermal dysplasia
Orofacialdigital syndrome
Macrodontia - associated systemic conditions
Hemangioma
Hemihypertrophy of face
Pituitary gigantism
Microdontia - associated conditions
Pituitary dwarfism
Gemination
Most common in primary dentition, especially incisors
Increases tooth number
Pulp chamber is single and enlarged
Division of a single tooth bud
Fusion
Adjacent tooth germs combined with dentin or enamel
Bifid crown or two recognizable teeth
Reduces tooth number
More common in primary dentition, especially anterior
Concrescence
Fusion after root formation
2nd and 3rd molars common
Caused by traumatic injury
Taurodontism
Normal crown size ad tooth length, shortened roots
Not recognizable clinically
Mostly in molars
Seen in Trisomy 21, Kleinfelters
Dilaceration
Maxillary premolars common
Sharp curve in root likely from trauma
Dens in dente
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
Amelogenesis Imperfecta
Disturbance in enamel development
Normal dentin and root
Autosomal dominant, autosomal recessive and X-linked
Type 1 AI
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
Type 2 AI
Hypomaturation type
Normal thickness of enamel but mottled surface, cloudy white, yellow or brown, opaque
Softer than normal
Same density as dentin
Type 3 AI
Hypocalcified type
Normal thickness of enamel, density is less than dentin
Permeability increases, darkened and stained
Type 4 AI
Hypomaturation-hypocalcified with taurodontism
Type 1 DI
Autosomal dominant
DI + Osteogenesis imperfecta
COL1A1 and 2 genes
Type 2 DI
Autosomal dominant
Isolated DI
1:8000 individuals
DSPP gene
Type 3 DI
DI of Brandywine type
DSPP gene
DI + multiple pulp exposures in deciduous teeth
Radiographic features of DI
Bulbous crowns, normal size, constriction of cervical area
Short and slender roots
Occlusal attrition
Partial or complete obliteration of pulp chamber, root canals
Dentin Dysplasia
Rare autosomal dominant disorder
1:100,000 individuals affected
Type I DD
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)
Type II DD
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
Regional Odontodysplasia
“Ghost teeth”
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
Enamel Pearl
Small globule of enamel on root furcation of molars
3% prevalence
Talon Cusp
Anomalous hyperplasia of cingulum of a maxillary or mandibular incisor
T shaped in incisal view
Differential diagnosis with supernumerary tooth
Rubenstein-Taybi
Turner’s Hypoplasia
Type of enamel hypoplasia associated with defect in crown of permanent tooth from infection/trauma from. primary predecessor
Congenital Syphilis
Hutchinson’s incisors
Mulberry molars
30% have dental hypoplasia
Not all patients with Hutchinson’s teeth or mulberry molars will have congenital syphilis
Acquired Pathologic Conditions
Attrition
Abrasion
Erosion
Hypercementosis
Attrition
Physiologic wearing from occlusal contacts
Bruxism is pathologic condition, also diet, salivary factors, mineralization, emotional tension
Crowns shorten, pulp chamber and canals reduce
Abrasion
Non-physiologic wearing by contact with foreign substance
Factitious habits or occupational hazards
Tooth brushing, flossing, pipe smoking, nail biting
Erosion
Chemical action, not involving bacteria
GI disorders or acidic diet
GI: lingual surfaces
Diet: labial surfaces
Industrial exposure: all surfaces
Hypercementosis
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
Formed Elements of Blood
Red blood cells
White blood cells
Platelets
Prothrombin Time (PT)
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
INR
International normalized ratio
PT (patient) / PT (control) ISI
Partial thromboplastin time (PTT)
Intrinsic pathway
Normal 25-35 seconds
Prolonged in patients deficient in any plasma-clotting factors except VII or XII
PFA-100
Looks at normal platelet function
Types of Anemia
Hypoproliferative (not enough cells)
Hemolytic (bursting cells)
Sickle cell
Macrocytic (big cells)
Microcytic (little cells)
Normocytic
Macrocytic anemia causes
Folate deficiency
Vitamin B12 deficiency
Microcytic anemia causes
Iron deficiency
Thalassemia
Normocytic anemia causes
Anemia of chronic disease
Bone marrow aplasia
Thrombocytopenia
Decreased platelet quantity
Increased destruction or decreased production or splenic sequestration
Platelet quality disorders
Bernar Soulier syndrome
Drug induced (aspirin, penicillin, indometacin)
Disease related (uremia, paraproteins, myeloproliferative disorders)
Normal HCT values
Males: 40-54%
Females: 38-47%
Normal Hb values
Males 13.5-18.0 g/dL
Females: 12-16 g/dL
RBC count
Males: 4.6x10^6
Females 4.2x19^6
WBC count
4500-11000/uL
Neutrophils: 56% Bands: 3% Eosinophils: 2.7% Monocytes: 4% Lymphocytes: 34%
Platelet count
150-450000/uL
Sedimentation rate (ESR)
0-15mm/hour
Reticulocyte count
0.5-1.0%
