Oral Pathology Test 1

Question 1

Median rhomboid glossitis may be associated with

Answer 1

Chronic fungal infection (Candida albicans) in conjunction with smoking or change in oral pH

Question 2

Characteristics of median rhomboid glossitis

Answer 2

Well demarcated, flat or slightly raised erythematous oval or rectangular area in the midline of the dorsal surface of the tongue extending posterior to circumvallate papillae

*devoid of Filiform papillae- so it’s smooth

Question 3

Prevalence of median rhomboid glossitis is higher in clients with

Answer 3

Diabetes
Immunosuppressed
Or have completed a course of broad spectrum antibiotics

Question 4

Macule description

Answer 4

A circumscribed area of the epidermis or mucosa distinguished by colour different from surrounding tissues
- flat, does not raise above the surface and may appear alone or in groups and may be blue, brown, black or red
-usually 1cm or smaller in diameter

Question 5

Papule description

Answer 5

Circumscribed often inflammatory elevated lesion protruding above surface of surrounding tissue
-a solid lesion that is less than 1cm in diameter
-may be any colour
-may be attached by a stalk or firm base
-represents a benign or slow growing lesion

Question 6

Nodule description

Answer 6

Solid mass of tissue that has the dimension of depth (extends deep into the dermis)
-up to 1 cm in diameter
-can be detected by palpation
- overlying skin is usually nonfixed and can move easily
-can occur above, level with or beneath skin surface

Question 7

Sessile refers to

Answer 7

Describing the base of a lesion that is flat attached directly by the base

Question 8

Pedunculated refers to

Answer 8

Attached by a stem like or stalk base similar to that of a mushroom

Question 9

Describe bulla

Answer 9

Diameter of the circumscribed elevated lesion exceeds 5mm
-bulla is larger than vesicle
-usually containing serous fluid and looks like a blister

Question 10

Exophytic refers to

Answer 10

Growing outward from the surface of the tissue

Question 11

Endophytic refers to

Answer 11

Lesion growing into the surrounding tissues which present as palpable masses with or without noticeable swelling

Question 12

Acrochordon refers to?
Appearance?

Answer 12

Skin tag
Appear stalk like or pedunculated
Small, slender flesh coloured tags of skin
Benign

Question 13

Milia is?

Answer 13

Small subepidermal keratinous cysts
Develop when tiny skin flakes become trapped in small pockets near surface of the skin

Question 14

Primary milia are formed directly from

Answer 14

Entrapped keratin and are usually found on the faces of infants and adults

Question 15

Secondary milia are also tiny cysts and look similar but these develop after

Answer 15

Something clogs the ducts leading to the skin surface, such as after an injury, burn, blistering of the skin or heavy creams

Question 16

Describe solar lentigo

Answer 16

Benign macules from sun exposure
Sometimes called liver or age spots
Usually larger than freckles and fade when sun exposure is diminished

Question 17

Describe melasma

Answer 17

Skin condition presenting as brown patches on the face of adults; usually bilateral (most common sites of involvement are cheeks, bridge of nose, forehead and upper lip
-also known as chloasma or the mask of pregnancy when present in pregnant women
-thought to be stimulation of melanocytes or pigment producing cells by the female sex hormones estrogen and progesterone (birth control or pregnancy) to produce more melanin pigments when the skin is exposed to sun

Question 18

Xanthelasma characteristics

Answer 18

-pale yellow orange raised area at the corner of the eye
-predominantly lipid material; 50% affected will have high triglycerides or high cholesterol
-more common in females
-most commonly located on or around eyelids

Question 19

Describe vitiligo

Answer 19

Characterized by lighter appearance of the tissue due to loss of pigment and destruction of melanocytes
-affects skin and mucous membranes
-avoid sun exposure, susceptible to skin cancer

Question 20

Describe gingival fibrous nodules

Answer 20

-exophytic small asymptomatic pink fibrous nodules with sessile base
-composed of dense collagen
-are a variant of normal that may be mistaken for disease
-will recur if surgically removed
-located on Mucogingival zone of the mandibular anterior gingiva

Question 21

Describe Exostosis

Answer 21

Asymptomatic bony outgrowths of the outer cortex of the mandible and maxilla
-may occur on buccal or lingual alveolar bone as rounded bony nodules
-surface mucosa is firm, taut and white to pale pink
Tori and Exostosis increase slowly in size with age but remain asymptomatic unless traumatized

Question 22

Describe linea alba

Answer 22

Elevated greyish white wavy line on the buccal mucosa
-usually bilateral and asymptomatic
-1-2mm wide and extends anteroposteriorly along the occlusal plane
-thickened epithelial changes consist of hyperkeratotic tissue due to frictional activity of teeth
-localized form of frictional keratosis
-often seen in clients who clench or grind and associated with scalloped tongue

Question 23

Describe leukoedema

Answer 23

Opalescent, milky white or gray surface change of the buccal mucosa with fine lines and folds; more prominent in smokers
-fades and almost disappears when stretched
-bilateral and cannot be removed

Question 24

Describe Fordyce granules

Answer 24

White or yellow granular papules found on the buccal mucosa and vermillion border of the lip
-arose from sebaceous glands embryologically entrapped during fusion of the maxillary and mandibular processes
-appear as plaques, clusters, or patches of ectopic sebaceous glands

Question 25

Describe lingual varicosity

Answer 25

Commonly seen on clients 60 years of age -related to aging process due to venous dilation caused by reduced elasticity of vascular wall -maybe related to leg varicosity -commonly appear superficial on the ventral surface of the anterior two thirds of the tongue and extend into lateral border and floor of mouth

Question 26

Describe venous varix

Answer 26

Similar to lingual varicosities Usually less than 5mm Appear as deep blue, red or purple broad based elevations of mucosa Common in older adults Occurs singularly on the lip or buccal mucosa when vessel wall becomes weak from chronic sun exposure, loss of elasticity aging and trauma

Question 27

Describe petechiae

Answer 27

A pinpoint, non raised circular red spots located on skin or mucous membranes caused from a minute intradermal or submucosal hemorrhage. Size ranges from 1-2mm

Question 28

Describe purpura

Answer 28

Local circumscribed purplish/brownish red discolouration caused by skin bleeding into the skin or tissues -vary in size and severity less than 1cm -is a symptom rather than disease entity. Fragile blood vessels, drugs that affect platelet function, associated with thrombocytopenia, aplastic anemia, Rocky Mountain spotted fever

Question 29

Describe Ecchymoses

Answer 29

Hemorrhagic spots in the skin or mucous membranes; larger than purpura over 1cm May be associated with leukaemia, polycythemia (increased RBC) and hemophilia

Question 30

Primary intention healing

Answer 30

Minimal loss of tissue, clean edges, sutured forming small clot, less scarring

Question 31

Secondary intention healing

Answer 31

Loss of tissue which cannot be joined, large clot, increased granulation tissue (extraction site) and scarring

Question 32

Tertiary intention healing

Answer 32

If infection occurs at the site of primary intention surgical site due to increase duration of inflammation and immune response triggered by pathogenic microorganisms

Question 33

Describe attrition

Answer 33

Produced by ordinary forces of occlusion and abrasive stresses of mastication -tends to increase with aging -signs include: disappearance of Mamelons on incisal teeth and flattening of occlusal cusps -surface appears burnished or polished Pulp exposure is rare -occurs at slow rate to allow for deposition of secondary dentin and pulpal recession

Question 34

Causes of attrition? Attrition is accelerated by?

Answer 34

Caused: diet-fibrous, cultures ( day long chewing betel nuts) tooth to tooth frictional contact Accelerated by: bruxism, chewing tobacco

Question 35

Describe bruxism

Answer 35

Intense grinding and clenching for nonfunctional purposes Signs: wear facets, abnormal rate of attrition, hypertrophy of Masticatory muscles, muscle tenderness, fatigue, cheek biting, TMJ pain, Hypercementosis, fractured teeth and fillings, tooth mobility

Question 36

Describe abrasion

Answer 36

The pathologic (abnormal) wearing away of tooth structure from repetitive mechanical habit over a long period of time -premolars and cuspids are most commonly affected teeth -most commonly seen on exposed root surfaces: cementum and dentin softer -present as U or V shaped notch above gingival margin

Question 37

Describe abfraction

Answer 37

Loss of tooth structure (wedge shaped lesions) at the cervical neck area of teeth from transmission of forces during occlusion and mastication

Question 38

Describe erosion

Answer 38

Defined as irreversible loss of tooth structure by a chemical process that does not involve bacteria -Clinical appearance: broad concavities within smooth surface enamel, cupping of occlusal surfaces, increased incisal translucency, hypersensitivity

Question 39

Describe aspirin burn

Answer 39

Tissue becomes necrotic and white; painful Tissue can slough, resulting in an ulcerative lesion which heals slowly (7-21days)

Question 40

Describe phenol burns

Answer 40

Phenol is used in dentistry as a cavity sterilizing, cauterizing agent, and root canal paste when mixed with zinc oxide -tissue becomes white, sloughs, resulting in a painful ulcer -if phenol is ingested, client should drink large amounts of water

Question 41

Thermal burns

Answer 41

Mucosal burns from hot foods are common -most often occur on palate and tongue

Question 42

Traumatic ulcer. Factitial and latrogenic

Answer 42

Factitial: toothbrush trauma aggressive flossing Latrogenic: saliva ejector trauma, mucosa touched by drill

Question 43

Traumatic granuloma

Answer 43

Caused by persistent trauma resulting in a hardened raised lesion (hyperkeratosis)

Question 44

Hematoma

Answer 44

Lesion- results from the accumulation of blood within the tissue as a result of trauma Red bluish grey mass Not a vascular lesion- does not blanch Most frequently seen on buccal or labial mucosa

Question 45

Frictional keratosis

Answer 45

Chronic rubbing or friction Is a protective response Thickening of the keratin hyperkeratosis Appears opaque, white appearance Like a callous on skin

Question 46

Nicotine stomatitis

Answer 46

Benign lesion of hard palate Heavy smokers often develop keratotic changes of their palatal mucosa Most common in heavy pipe and cigar smoking Palate may develop a similar appearance from chronic intake of hot liquids

Question 47

Tobacco pouch keratosis

Answer 47

Forms in the area where tobacco is placed Commonly used by athletes in sports In early lesions epithelium is granular/wrinkled Longstanding lesion-opaque and corrugated

Question 48

Melanosis

Answer 48

Normal, psychological pigmentation is common mostly in dark skinned individuals -may be a result of inflammation or trauma called post inflammatory melanin pigmentation

Question 49

Smokers melanosis

Answer 49

Caused by the use of tobacco products that stimulate the production of melanocytes within the tissue -melanin functions as defense mechanism against toxic agents Related to amount and duration of smoking -anterior labial gingiva is common site, palate and tongue

Question 50

Solar cheilitis

Answer 50

Caused by excessive solar radiation damage Most commonly found on lower lip Also known as actinic cheilitis Affects vermillion border, pale pinkish mottled, fissures appear at right angles to the skin vermillion border junction

Question 51

Mucocele

Answer 51

Occurs anywhere in mouth where minor salivary glands are found- most common lower lip -occurs when a salivary gland duct is severed through trauma and the contents of the duct collect in the tissue

Question 52

Ranula

Answer 52

Forms unilaterally on the floor of the mouth -associated with duct obstruction of sublingual and submandibular glands which results in inflammatory response -treat by surgery; often a salivary gland stone is obstructing the duct

Question 53

Sialoth

Answer 53

Salivary gland stone -formed by accretion of calcium complexes within salivary gland or duct that obstructs salivary flow -high mucous content and alkaline pH of the saliva are significant factors in stone formation -occurs in major and minor glands

Question 54

Necrotizing sialometaplasia

Answer 54

Moderately painful benign condition of salivary glands -size varies and is characterized by a deep central ulcer with grayish pseudomembrane -located at the junction of hard/soft palate Occurs in adults over 40 Cause unknown may be blockage of blood supply to the area of the lesion from trauma, vomiting, radiation therapy, or surgery causing necrosis of tissue

Question 55

Pyogenic granuloma

Answer 55

Benign inflammatory lesions that are tissue responses to trauma or local irritation -does not produce pus -characterized by proliferation (growth) of connective tissue containing numerous blood vessels and inflammatory cells -bleeds easily; red to purple because of vascularity of tissue

Question 56

Pyogenic granuloma is also called

Answer 56

Pregnancy tumor -most common on gingiva -in pregnancy cause is changing hormonal levels and increased response to plaque Regress after delivery

Question 57

Giant cell granuloma

Answer 57

Contains many multinucleated giant cells, well vascularized connective tissue, RBC and chronic inflammatory cells -thought to be response to injury -occurs on the gingiva (peripheral) and alveolar process (central)

Question 58

Peripheral giant cell granuloma

Answer 58

Usually occurs in gingiva or alveolar process anterior to the molars -reactive lesion occurring from tooth extractions, plaque and calculus, faulty dental restorations, implants or dentures -occurs as a result to tissue injury or trauma casing the connective tissue to response with a more hyperplastic tissue -resemble a Pyogenic granuloma- deep red to bluish and bleeds easily. More frequent in people 40-60years and more common in women

Question 59

Irritation fibroma

Answer 59

Broad based exophytic lesion composed of dense, scar like connective tissue containing a few blood vessels -results from chronic trauma and irritation from dentures, restorations, Subgingival calculus, cheek biting or chewing

Question 60

Denture induced fibrous hyperplasia

Answer 60

Commonly called epulis fissuratum or inflammatory hyperplasia -cause is from an ill fitting denture -location vestibule along denture border -composed of dense, fibrous connective tissue -larger than irritation fibroma and arranged in elongated folds of tissue -does not resolve with removal of denture -Trx is signal removal of extra folds

Question 61

Chronic hyperplastic pulpitis aka pulp polyp

Answer 61

Excessive proliferation of chronically inflamed pulp tissue which had a characteristic clinical appearance - teeth have large open various lesions -clinically a red or pink nodule of tissue protruding from pulp changed in occlusal surface

Question 62

Periapical abscess

Answer 62

Acute periapical abscess contains exudate/ pus -client complains of severe pain from inflammation causing pressure on nerves -abscess develops in an area of previously existing chronic inflammation -the pus seeks a path of least resistance and find a path or fistula out of the tissue through oral or facial spaces

Question 63

Periapical granuloma

Answer 63

Localized mass of chronic granulation tissue made up of lymphocytes, plasma cells and mast cells Usually forms at apex of non vital tooth root Chronic process

Question 64

Radicular/periapical cyst

Answer 64

Most common cyst in the oral region -asymptomatic/discovered in a radiograph - develops fork proliferation of epithelial lining in a periapical granuloma that increases in size -

Question 65

Radiographic appearance of a radicular cyst

Answer 65

Same as periapical granuloma -radiolucency usually well circumscribed and may be attached to tooth apex lateral to tooth apex -not possible to differentiate radicular cyst from periapical granuloma on basis of radiographic appearance only

Question 66

Residual cyst

Answer 66

Forms when tooth is removed and part of a radicular cyst is left behind -radiograph: well circumscribed radiolucency at site of extracted tooth

Question 67

External resorption

Answer 67

Occurring outside the tooth -destruction of tooth structure initiated from outside the tooth from osteoclasts like cells that originate in the PDL Commonly affects multiple teeth May involve root or a crown of an impacted tooth Most common cause is trauma or pressure not reversible

Question 68

Internal root resorption

Answer 68

Associated with destruction of tooth structure initiated from inflammatory response within the pulp -inflammatory cells transform into osteoclast like cells destroying dental hard tissue -usually involves a single tooth -clinically may appear as a pinkish area in crown

Question 69

Focal sclerosing osteomyelitis also called condensing osteitis

Answer 69

Inflammatory reaction that usually involves pulpal inflammation and necrosis however it may be associated with a normal tooth as well -proliferating reaction of dense bone within the marrow spaces due to low grade infection or trauma -mand first molar most common tooth

Question 70

Alveolar osteitis aka dry socket

Answer 70

Post operative complication of tooth extraction Most common in 3rd molar extractions Blood clot breaks down and is lost before healing Severe pain bad odor and taste Pain relief and medicated dressing

Question 71

3 forms of recurrent apthous ulcers

Answer 71

Minor Major Herpetiform

Question 72

Minor apthous ulcer

Answer 72

Most common of 3 types -discrete, round to oval ulcers -up to 1cm in diameter -less than 5 ulcers present at any one time -on moveable oral mucosa, lavial, buccal and vestibular mucosa, soft palate and oral pharynx

Question 73

Ulcerative

Answer 73

Craterlike ulcer will develop a fibrinous membrane cover appearing white or yellow surrounded by a halo of erythema -lesion usually develops within 24-48hrs and heals spontaneously in 7-10 days

Question 74

Major apthous ulcers

Answer 74

“Suttons disease” -is largest of the 3 types -ulcers are crater form with irregular borders -larger than 1cm; deeper; lasts longer; pain is severe with a depressed necrotic center -frequently results in scarring -more common in posterior of the mouth -pt may suffer with the chronic disease for years

Question 75

Herpetiform aphthous ulcers

Answer 75

Least common of recurrent 3 - very tiny widely distributed gray white erosions that enlarge coalescence and become irregular ulcers -painful -may develop anywhere in mouth -occur in groups of 10 and more in cluster formation

Question 76

Urticaria and angiodema

Answer 76

Similar lesions both are hypersensitivities -occur in acute episodes -associated with trauma, stress, allergies and infections -may also occur after infections Urticaria= hives; localized multiple areas of well demarcated swelling of the skin accompanied by itching Angioedema= appears as diffuse swelling of tissue caused by permeability of deeper blood vessels; skin covering the swelling appears normal with no itching

Question 77

Erythema multiforme

Answer 77

Affects skin and mucous membranes, acute self limiting disease -called this bc it refers to the multiple forms that it appears in. Skin lesions ranging from macules to plaques to bullae therefore it has been divided into 2 subgroups; erythema multiforme (minor) or Steven’s Johnston syndrome (severe

Question 78

Clinical appearance intraorally of erythema multiforme

Answer 78

Oral lesions are usually ulcers Frequently on lateral borders of tongue Crusted and bleeding lips frequently seen

Question 79

Steven’s Johnson syndrome

Answer 79

Most severe form of erythema multiforme Mortality rate 5-15% Severe mucosal lesions Genital mucosa and mucosa of eyes involved Lips have black hemorrhagic crust Severe pain Medications are though to be main causative factor ie. drug related nevirapine (HIV) Trx= palliative but short term, systemic corticosteroids, scaring and blindness may occur, antiviral meds for episodes stimulated by herpes,

Question 80

Contact mucositis

Answer 80

Local reaction from direct contact of an allergen with mucosa -involves cell mediated immunity; hypersensitivity of lymphocytes to additives Clinical features: tissue sloughing

Question 81

Lichen planus: reticular (Wickham straie)

Answer 81

Most common Several white lines and tiny papules Arranged in a lacy web like pattern Buccal mucosa is most common

Question 82

Types of lichen planus: erosive/bullous

Answer 82

Epithelium surface is completely lost and results in erosion -mature lesion has irregular borders; is red, raw and ulcerative -yellow necrotic center with a white patch at periphery (painful) -buccal mucosa and tongue are most commonly effected areas -erosive form associated with increased malignancy

Question 83

Reactive arthritis also known as reiters syndrome

Answer 83

Courses the triad of 3 features ( arthritis, conjunctivitis and urethritis) Most patients have an antigenic marker HLA-B27

Question 84

3 main forms of Langergans cell histiocytosis

Answer 84

Letterer-Siwe disease Hand schuller Christian disease Solitary eosinophilic granuloma

Question 85

Hand schuller Christian disease

Answer 85

Occurs in children under 5 -punched out radiolucent areas in skull or jawbone caused my collections of macrophages, exophthalmos (bulging eyes) and diabetes insipudus Mimics advanced perio -oral lesions include ulcerative lesions, halitosis, gingivitis, loose and sore teeth, easily exfoliation of teeth -Trx includes radiation chemotherapy and corticosteroids

Question 86

Sjögren’s syndrome

Answer 86

Autoimmune disorder decreases saliva and tears -chronic condition requiring long term management and lifestyle adaptations -symptoms: affects salivary and lacrimal glands -Xerostomia -second most common connective tissue disorder after lupus erythematosus

Question 87

50% if clients with sjogrens also have

Answer 87

Another autoimmune disease (rheumatoid arthritis or systemic lupus)

Question 88

Systemic lupus erythematous

Answer 88

Acute and chronic inflammatory autoimmune disease of body connective tissue Classified into 2 groups; discoid and systemic -most common is chronic with periods of illness and remission -affects women 8x more than men -classic butterfly rash occurs over bridge of nose and cheeks -oral lesions resemble lichen planus

Question 89

Treatment of lupus

Answer 89

Vary depending on severity of disease -anti inflammatory agents -anti malaria drugs, NSAIDs cyclosporine -oral and skin lesions respond to topical and systemic corticosteroids -renal failure is the most common cause of death

Question 90

Pemphigus vulgaris

Answer 90

Progressive severe autoimmune disease affecting skin and mucous membranes -characterized by intra epithelial vesicle formation from a breakdown of cellular adhesion between epithelial cells. Epithelial cell separation is called acantholysis -bullae rupture and gray membrane remains, ulcers are painful