Oral Pathology Marathon Flashcards
4 types of pathologies:
Developmental
Hereditary/Genetic
Familial
Congenital
Of the Genetic abnormalities, what % is unknown etiology?
% inherited ?
% known environmental causes?
85%
10%
5%
3 Characteristics of Developmental conditions:
Present at young age/congenital
Bilaterally symmetrical
Asymptomatic
Without jaw development (type of aplasia):
Small, underdeveloped jaw:
Large jaw:
Agnathia
Micrognathia
Macrognathia
Primary Macrognathia:
Secondary (acquired) Macrognathia:
Developmental
tumors, acromegaly, Paget’s
A _______ is characterized by multiple different abnormalities
Syndrome
Teeth come from what germ layer?
Ectoderm
Micrognathia is a type of _____plasia
Hypo
Cleft lip/palate is a _______ anomaly occurring ______
developmental
1st trimester
Cleft lip occurs in 1/____ white births
1/1000
T/F
The etiology of cleft palate is unknown
True
Mutations in cleft lip/palate have been shown in how many genes involved in the development of the palat/lip?
6-12 genes
The lateral palatal shelves fuse anteriorly at the junction with the _______ and fuse posteriorly
Premaxilla
The upper lip (development) is a ______ epithelium
What penetrates/develops into CT and muscle in the upper lip adding bulk?
bilayered
Mesoderm
Where does the mesoderm (forms CT/muscle in upper lip) originate?
Globular portion of median nasal process and Maxillary processes bilaterally
When a cleft forms there is a lack of ______ penetration
Mesoderm
Cleft lip is on the upper lip, off the midline, ___% bilateral
20%
Cleft palate is _____ to the Premaxilla over the _____
Anterior
Alveolar Ridge
T/F
Bifid Uvula is related to Cleft Palate
False
Bifid Uvula is associated with what?
submucosal cleft of muscle
Most common cleft?
2nd most common?
Least common?
Cleft lip with cleft palate
cleft lip
cleft palate
There are over _____ syndromes that include clefting, making up about ____% of all clefting cases.
400
30%
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
An oft-missed congenital malformation that may be present with other anomalies:
Lip pits
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
