Oral Pathology Marathon Flashcards by Tim Agee

4 types of pathologies:

Developmental

Hereditary/Genetic

Familial

Congenital

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Of the Genetic abnormalities, what % is unknown etiology?

% inherited ?

% known environmental causes?

85%

10%

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3 Characteristics of Developmental conditions:

Present at young age/congenital

Bilaterally symmetrical

Asymptomatic

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Without jaw development (type of aplasia):

Small, underdeveloped jaw:

Large jaw:

Agnathia

Micrognathia

Macrognathia

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Primary Macrognathia:

Secondary (acquired) Macrognathia:

Developmental

tumors, acromegaly, Paget’s

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A _______ is characterized by multiple different abnormalities

Syndrome

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Teeth come from what germ layer?

Ectoderm

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Micrognathia is a type of _____plasia

Hypo

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Cleft lip/palate is a _______ anomaly occurring ______

developmental

1st trimester

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Cleft lip occurs in 1/____ white births

1/1000

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T/F

The etiology of cleft palate is unknown

True

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Mutations in cleft lip/palate have been shown in how many genes involved in the development of the palat/lip?

6-12 genes

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The lateral palatal shelves fuse anteriorly at the junction with the _______ and fuse posteriorly

Premaxilla

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The upper lip (development) is a ______ epithelium

What penetrates/develops into CT and muscle in the upper lip adding bulk?

bilayered

Mesoderm

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Where does the mesoderm (forms CT/muscle in upper lip) originate?

Globular portion of median nasal process and Maxillary processes bilaterally

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When a cleft forms there is a lack of ______ penetration

Mesoderm

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Cleft lip is on the upper lip, off the midline, ___% bilateral

20%

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Cleft palate is _____ to the Premaxilla over the _____

Alveolar Ridge

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T/F

Bifid Uvula is related to Cleft Palate

False

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Bifid Uvula is associated with what?

submucosal cleft of muscle

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Most common cleft?

2nd most common?

Least common?

Cleft lip with cleft palate

cleft lip

cleft palate

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There are over _____ syndromes that include clefting, making up about ____% of all clefting cases.

400

30%

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What is the Rule of 10’s in treating cleft lip?

When do you treat cleft Palate?

10 weeks old / 10 lbs / 10 gm% Hb

1.5 years

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An oft-missed congenital malformation that may be present with other anomalies:

Lip pits

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T/F | Cleft lip is Familial but not Inherited

True

T/F There isn't a single gene that gives you clefting, rather 10-12 genes that are involved with the development of your palat

True

T/F | Clefting is the result of abnormal genes plus environmental factors

True

The palatal shelves fuse anteriorly at the junction with the ________

Premaxilla

In Utero, there is nothing in between the bilayered epithelium of the upper lip, but is filled with _______ from the ______ portion of the median nasal process and maxillary process bilaterally

mesoderm globular

T/F | Chelitis glandularis is developmental

False *infection salivary glands lower lip

An infection of the salivary glands of the lower lip, often found in those that work outside (promotes retrograde infection):

Chelitis glandularis

T/F | Chelitis glandularis is a premalignant condition

False *does NOT lead to lower lip cancer

Ectopic sebaceous glands that develop after puberty in 80% of the population

Fordyce granules

Asymptomatic, superficial yellow plaques that are bilaterally symmetric. (an increase of buccal mucosa)

Fordyce granules

T/F | Fordyce granules can be treated

False no treatment, recognition only

Inherited, mostly Autosomal Dominant that genetically programs the over production of collagen:

Fibromatosis gingivae

Fibromatosis gingivae can be either ____ or found with ______ and is clinically found to be _______ generalized gingival hyperplasia

isolated syndromes asymptomatic

T/F | Tx of Fibromatosis gingivae can be surgical but tends to come back

True

No tongue development (an aplasia) Small, underdeveloped tongue Enlarged, overdeveloped tongue

Aglossia Microglossia Macroglossia

Macroglossia can either be developmental or acquired by what 2 means?

Tumor Acromegaly

The fusion of the tongue to the floor of the mouth (tongue tied):

Ankyloglossia

Bifid or midline fissure of the anterior 2/3 of the tongue

Cleft Tongue

Deep grooves in the Tongue of unknown etiology (may be genetic) associated with familial pattern of heritability and Age:

Fissured tongue *not associated with anything systemic

2 terms for Geographic Tongue:

Benign migratory glossitis Erythema migrans

T/F | Geographic Tongue is developmental

False

Benign Migratory Glossitis (geo tongue) occurs __:__ females to males On the ___/____ borders of the tongue Borders color:

2:1 Dorsal/Lateral Yellowish-Whitish

T/F | Benign Migratory Glossitis (geo tongue) is recommended for biopsy and is infectious

False to both

Benign Migratory Glossitis may burn or hurt (otherwise asymptomatic)

True

Hairy Tongue is hypertrophy of _______ papillae

Filiform

Hairy Tongue has unknown etiology, but name 3 predisposing factors:

Drugs (ABx, H2O2) Smoking Radiation Therapy

What is the Tx for Hairy Tongue?

Debridement CHX

The aging phenomenon of Varix (varicose veins) usually happens where in the mouth? Also occurs on mouth/lips where color blanches with pressure, but only treated for ______

Ventral Tongue Esthetics

Using a Glass Slide to determine presence of Varix, blanch through the glass to see it better.

Diascopy

A Lingual Thyroid Nodule is b/c of a breakdown in the ______ Tract with is a ______ invagination starting ________

Thyroglossal Tract Endodermal Foramen Cecum

Lingual Thyroid Nodule appears where? What images? Tx surgical or ________

Posterior, mid dorsal tongue Radioactive Iodine Thyroid Replacement Therapy

2 Lymphoid Tissue oral pathologies:

Hyperplastic Lingual Tonsil Lymphoepithelial Cyst

Lymphoepithelial Cysts come from _____ ducts Are a true cyst, meaning they are lined with what? Present as superficial ______ bumps ***are common in floor of mouth, ventral lateral tongue

Salivary Epithelium Yellowish

Tx for Lymphoepithelial Cysts:

Excision

Lymphoepithelial Cysts are Asymptomatic

True

Developmental Lingual Mandibular Salivary Gland Depression: Located:

Stafne's Bone Cavity Below IA canal

In Stafne's Bone Cavity, the ______ salivary glands develop along the Lingual _____, which produces an indentation

Submandibular Cortex

T/F | Stafne's Bone Cavity is inflammatory and changes with time

False *to both - no swelling, doesn't change

Stafne's Bone Cavity is a ______ diagnosis

Radiographic

A group of inherited disorders which program the oral mucosa to abnormally keratinize and generally develop early in life

Genokeratoses

The most common Genokeratosis: Genetically...

White sponge nevus autosomal dominant

White sponge nevus Hereditary benign intraepithelial dyskeratosis Pachyonychia Congenita Dyskeratosis congenital Dariers Diseas - keratosis follicularis

Genokeratoses

The most common form of Developmental Cyst (non-odontogenic)

Incisive Canal Cyst

The Incisive Canal Cyst appears as a Radiolucency of over _____ mm between the roots of the ______

6 mm Max CI's

Incisive Canal Cyst does what to the teeth? Tx? Tx complication? Variant:

Moves CI's apart Surgical anesthesia lasts for months Incisive papilla cyst (outside bone)

Most common radiolucency between Maxillary Lateral and Cuspid?

Globulomaxillary Cyst

The Globulomaxillary Cyst is a ___________ radiolucency btwn Mx LI's and Cuspids that probably _________

asymptomatic doesn't really exist *meaning they are really other cysts/tumors

A Cyst from entrapped epithelium during palatal closure producing a Radiolucency at MIDPALATE. Tx surgical removal

Median Palatal Cyst

Cyst from the embryologic nasolacrimal duct producing upper lip cyst R or L of midline

Naso-alveolar cyst (nasolabial cyst)

The Naso-alveolar cyst (nasolabial cyst) is soft, fluctuant, and often elevates what? 3/4 occurs in _______ ___% bilateral Tx:

ala Females 10% Surgical

What cyst classicaly moves when a pt swallows?

Thyroglossal duct tract cyst *goes through hyoid bone

The Thyroglossal Duct Cyst is a ______ cyst brom the base of tongue to the thyroid gland Soft, fluctuant, more likely to occur in _____ Tx:

Midline Females Surgical

Cyst from entrapped salivary gland ducts in the paraparotid lymph nodes

Cervical Lymphoepithelial Cyst (Branchial Cleft Cyst)

Cervical Lymphoepithelial Cyst, aka... it is a cyst from entrapped ____ glands in the ______ lymph nodes OR a cyst from _______ arch and pouch development

Branchial Cleft Cyst salivary paraparotid branchial

Epidermoid/Dermoid Cysts occur in the Midline and form from trapped _____ during surface closure Common in what demographic? Where?

Epithelium young FOM, ventral tongue

Epidermoid Cysts are lined by what? Dermoid Cysts are lined by what?

Stratified Squamous Epithelium Stratified Squamous w/ Dermal appendages (sebaceous, sweat, hair follicles)

Small teeth: Large teeth:

Microdontia Macrodontia

Attempted division of tooth germ with incomplete formation of 2 teeth, usually a single root

Gemination

Union of 2 teeth - often individual roots

Fusion

Fusion of teeth when joined by Cementum:

Concrescence

Bend or curve in a tooth or root, possibly due to trauma, causing problems with RCT/extraction:

Dilaceration

Dens Invaginatus

Dens in Dente

Dens in Dente results from the invagination of the enamel organ before ______ Most often found where? Can be ______ Often a sequelae of _____ infection

calcification Mx LI's bilateral periapical

A toothlike structure found in the Central Fossa: Where does this happen more often?

Dens evaginatus Mn Premolars

Block like teeth with large pulps, associated with Klinefelter's Syndrome: This can be one or multiple teeth, isolated or w/ syndromes, or a _____ expression of a gene pool

Taurodontism phenotypic

Excess of enamel at a bi or trifurcation of Molars at the CEJ

Enamel Pearl

A few teeth, not enough: No teeth (associated w/ systemic probs):

Oligodontia Anodontia

Anodontia is most associated with what?

Heriditary Ectodermal Dysplasia

Supernumerary teeth usually occur where? Called _____, and usually occurs between ______

Maxilla Mesiodens, Mx CI's

What Syndrome associated with Supernumerary teeth? What Dysplasia?

Garner's Syndrome Cleidocranial Dysplasia

A Hereditary disturbance in Enamel Structure: This is a defect in what cell? Genetic pattern: How many types?

Amelogenesis imperfecta Ameloblasts Autosomal dominant, recessive, sex linked 12-15 types

Amelogenesis Imperfecta presents clinically what 2 ways?

Hypoplasia Hypocalcification Hypomaturation

Amelogenesis Imperfecta - all teeth, both dentitions, Family Hx some teeth, one dentition, no family Hx

Hereditary Environmental

Rickets, Exanthematous diseases, Congenital Syphylis, Turner's tooth, Fluorosis, Tetracycline, - can all cause what?

Hypoplasia/hypocalcification *enamel defects

Congenital Syphilis causes Hutchinsons... Mulberry...

Incisors Molars

What is a Local Infection or Trauma that can cause Enamel Defects?

Turner's Tooth

Dentinogenesis Imperfecta is inherited how? Can be with or independent of what? Affect what teeth?

Dominantly Osteogenesis imperfecta all teeth, both dentitions

Dentinogenesis Imperfecta affects type ___ Collagen Teeth look... Radiographic findings: Tx:

I grayish to yellowish brown Obliteration of pulp chambers/canals (may have attrition and root fractures) Crowns to prevent attrition

Autosomal dominant condition characterized by pulpal obliteration with abnormal dentin, defective root formation and tendency for periapical pathology

Dentinal Dysplasia

Dentinal dysplasia affects all teeth and both dentitions but differs from Dentinogenesis Imperfecta b/c the teeth look_______ Radiographic findings:

normal Obliteration of pulp, short underdeveloped roots, periapical radiolucencies

In Dentinal Dysplasia, the teeth look normal, but there is abnormal....

Root Formation

Regional Odontodysplasia, aka... Mostly affects ____ teeth what teeth have increased chance of being unerupted?

Ghost teeth Permanent Mx

Radiographic findings of Regional Odontodysplasia:

Thin enamel/dentin anomalous teeth

Teeth that lack eruptive force: *if generalize, think systemic (hypothyroidism)

Pseudoanodontia (embedded teeth)

Teeth that are unerupted b/c of mechanical block Most often in the Mn: Most often in the Mx:

Impacted 3M Canine

Tooth roots fused to bone (often in Primary teeth with underlying succedaneous permanent tooth missing) They have a distinctive _______ ***no PDL, fused to bone

Ankylosed teeth percussion

Loss of tooth structure occlusally and interproximally due to direct tooth to tooth contact: If Pathological:

Attrition Bruxism

Loss of tooth structure from mechanical force (cervical tooth brushing)

Abrasion

Loss of tooth structure from chemical process, most often non-bacterial acid dissolusion:

Erosion

Erosion due to exposure of Gastric Secretions:

Perimylosis

Loss of tooth structure due to repeated tooth flexure from occlusal stresses

Abfraction

The combined effect of attrition and abrasion (chewing tobaccos between opposing teeth):

Demastication

Physiologic deposition of dentin throughout life: Localized formation of dentin on pulp-dentin border (protective response of pulp to seal itself off from external stimuli):

Secondary Dentin Reparative Dentin

Dentinal tubules devoid of cytoplasmic processes of odontoblasts:

Dead Tracts

3 types of Pulp Calcifications:

Denticles Pulp Stones Diffuse Linear Calcifications

Dentin dysplasia II, Pulpal dysplasia, Regional odontodysplasia, Tumoral calcinosis, Calcinosis universalis, and Ehlers-Danlos Syndrome are all associated with what?

Pulpal Calcifications

Abnormal thickening of cementum:

Hypercementosis

Hypercementosis can be localized (trauma/idiopathic) or Generalized, which is associated with what disease?

Paget's

Calcification is PDL with no clinical significance:

Cementicles

External Dental Root Resorption can be Physiologic or Pathologic

True

Internal Dental Root Resorption presents as what? Most often occurs following injury to _______ Process continues as long as there is _______ Pathologic, asymptomatic, Pink tooth of _______

Radiolucent enlargement of Root Canal/Chamber Pulp tissue vital pulp Mummery

Early vascular response to injury is ______ followed by _______

vasoconstriction, vasodilation

Vasodilation is caused by histamine, prostaglandins, etc

True

What transforms into fibroblasts during the Inflammatory Stage of Wound Repair?

Undifferentiated mesenchymal cells

in the migratory phase of Fibroplastic stage of wound repair, fibroblasts migrate into the wound following _______ strands

Fibrin

In the proliferative phase, collagen fibers are laid down in what manner?

Haphazardly

6 stages of Healing:

Early vascular response Inflammatory stage Migratory phase Proliferative phase Remodeling Wound contraction

5 types of Biopsy:

Excisional Incisional Punch Needle (FNA - fine needle aspiration) Aspiration

T/F | A biopsy specimen goes into 10% buffered Formalin

True

4 biopsy artifacts

Crushing (hemostats) Burning Anesthetic injection Fixation

Use incisional biopsy if larger than ______ or suspicion of _______ *diagnostic

1 cm malignancy

T/F | Use Excisional biopsy if small and confident they are benign

True

T/F | Do not Excise if think something is malignant

True

Primary healing Secondary healing Tertiary healing

wound closes wound is apart graft

The removal of individual cells - usually does NOT provide definitive diagnosis

Cytology

3 Indications for Cytology:

premalignant/malignant lesions HSV Candidosis

Cytology for HSV - for what 2 things?

Cytopathic viral effect Multinucleation

Oral CDX brush "biopsy" has improved what due to the brush? improved diagnostic accuracy due to... is NOT a _______ diagnosis

cell harvesting - all cell layers computer screening Definitive

DIF IIF Both detect what?

Direct Immnofluorecencse Indirect Immunofluorecense Autoantibodies

T/F Reserve Immunofluorescence testing for suspected autoimmune disorders like pemphigus vulgaris, mucous membrane pemphigoid

True

Most oral diseases are Positive on ______ immunofluorescence but Negative on ________ immunoflurescence

Direct Indirect

DIF biopsies cannot be placed in what?

traditional fixative *use transport media

Extraction, 1st week healing, blood clot organization begins

True

Extraction 2nd week healing, organization continues and what degrades? What proliferates over wound surface?

PDL Epithelium

Extraction 3rd week healing, clot is organized into what? What is formed arising in PDL and adjacent bone? Alveolar crest rounded off by what? _____ covers entire surface

Granulation tissue Osteoid Osteoclasts Epithelium

Extraction 4th week healing, is bone evident on radiographs? When does it appear? New bone in alveolar socket will persist for how long?

No - not fully calcified 6-8 weeks can see on radiographs 4-6 months

Dry Socket, aka... Caused by loss of what?

Localized Acute Alveolar Osteomyelitis blood clot

If a difficult extraction removes Lingual and Buccal bone along with Periosteum, what might occur? How does this appear on a Radiograph?

Fibrous Healing of Extraction Wound Radiolucent *may be mistaken for cyst/granuloma

Focal Osteoporotic Bone Marrow defect is from marrow expansion and may not be _______ Many are in ______ Might occur in response to what? Occurs in what sex more frequently? Where in mouth most frequently?

Pathologic Extraction sockets chronic anemia Females (75%) posterior Mn

Fragment of bone in a healing socket after extraction can cause what? Tissue growing from socket can also be what?

Localized Tissue overgrowth malignancy along path of least resistance

Physiologic response of mucosa to chronic physical injury producing hyperkeratosis This is reversible and presents as a white ______

Frictional keratosis plaque

shredded keratinized tissue along linea alba

cheek chewing *morsicatio buccarum

Loss of surface epithelium (trauma, more in kids, lateral tongue)

Traumatic ulcer

Self induced:

Factitional

Type of Traumatic Ulcer w/ injury to underlying muscle: (increased prevalence on tongue, rolled borders) This has the clinical features of what?

Traumatic Granuloma Carcinoma

T/F | The silver compounds in an Amalgam Tattoo stain and sometimes a biopsy must be done to rule out melanoma

True

Extravascular bleeding into tissues, resolves: Pinpoint bleeding from capillaries (thrombocytopenia vs Local cause):

Hematoma Petechiae

1 acute complication to Radiation Therapy for H/N cancer: When does it arise? 2 chronic complications:

Dermatitis Stomatitis 2nd week therapy Xerostomia, Osteoradionecrosis

Chemical burn injuries to the Oral cavity may or may not rub off

true

3 Drugs causing Generalized Gingival Hyperplasia:

Phenytoin/dilantin (epilepsy) Cyclosporine (immunosuppressant) Calcium channel blockers (heart)

If someone is on Phenytoin/dilantin for epilepsy, what is the chance of developing gingival hyperplasia? The severity of which is related mostly to what?

50% oral hygiene

Heavy metal ingestion presents how?

staining of marginal gingiva

Type I hypersensitivity is anaphylaxis by what immunoglobulin? Type IV hypersensitivity is ____ mediated Angioedema is swelling where?

IgE cell Lips

stomatitis medicamentosa (systemic) is what? stmatitis venenata (topical) is what? Cinnamon can cause... icreased desquamative gingivitis cheek + buccal mucosa on SAME side suggests

Allergy