Orasprint 5 - crammo Flashcards
4 types of Ectodermal Odontogenic Tumors:
Ameloblastoma
CEOT - Calcifying Epithelial Odontogenic Tumor
AOT - Adenomatoid Odotogenic Tumor
SOT - Squamous Odontogenic Tumor
4 types of Mesodermal (CT) Odontogenic Tumors:
Central Odontogenic fibroma
Peripheral Odontogenic fibroma
Odontogenic myxoma
Cementum Lesions (3)
3 types of Mixed Odontogenic Tumors:
epithelial and CT
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odontoma
Ameloblastoma, common what age?
found where (%/location)
The most…
middle age (but found all ages)
75% posterior Mn
Painless
Ameloblastoma, Radiographic location: _____, always _____
Classically see what 3 things on Radiograph:
Pathology: Epithelial islands and cords where peripheral cells show ______ and ________
Tumor invades _______ but tends to expand ______
Pericoronal, Radiolucent
multilocular, moved teeth, root resorption
pallisading, reverse nuclear polarity
medullary bone, cortex
Tx, Ameloblastoma:
% recur w/ aggressive curettage:
Surgical (aggressive curettage or resection)
50%
4 variants of Ameloblastoma: Which is less aggressive?
which is a solitary confined cyst?
Which is “benign” but metastasizes?
which is malignant, aggressive, and metastasizes?
Peripheral extraosseous
Unicystic
Malignant ameloblastoma
Ameloblastic carcinoma
Unicystic Ameloblastoma is less aggressive and recurs ____% with enucleation
10-25%
You can definitively diagnose Ameloblastoma variants on incisional biopsy
False
CEOT (Calcifying Epithelial Odontogenic Tumor) aka…
Found all ages, but more in what location?
Radiographic:
Often associated with _______
Pindborg Tumor
midbody Mn
driven snow (lucent/mixed lucent/opaque)
unerupted teeth
CEOT pathology: islands and sheets of…
Tumor cells function and produce a protein matrix called…
This protein matrix may…
This stains with what?
pleomorphic epithelial cells
ODAM (odontogenic ameloblast-like protein)
calcify
amyloid stains
CEOT Tx:
Surgical
AOT…
Most prevalent at what age?
what population?
3/4 found where?
Usually under what?
symptoms?
Adenomatoid Odontogenic Tumor
1-3 decades, mostly teens
Female
Anterior Mn
unerupted teeth
asymptomatic
AOT, radiographically is…
may contain…
pericoronal lucency
flecks of opacity
Adenomatoid Odontogenic Tumor (AOT) pathologically is ________, with swirls of epithelial cells containing ________ or duct-like spaces lined by _______ cells.
Encapsulated
Rosettes
cuboidal/columnar
AOT Tx:
Enucleation
SOT…
Radiographically seen as…
Pathology, contains _______ of well-differentiated squamous epithelium with the peripheral cells _____
Tx:
Squamous Odontogenic Tumor
Lucency around Roots
islands, flattened
Curettage
Central Odontogenic Fibroma, radiographic it is…
WHO type (pathology), the stroma is _______ but may be more mature variable amounts of ________ and _____
Tx:
lucent or mixed lucent/opaque
collagenous, odontogenic epithelium, calcifications
Surgical removal
Peripheral Odontogenic fibroma is a reactive gingival lesion of what origin?
increases what age?
Where?
pathology is cellular fibrous CT with ______
PDL
young
anterior gingiva
calcifications (bone, cementum, dystrophic)
“Odontogenic” myxoma, occurs at all ages by increases when?
presents?
Radiograph is a lucency containing what?
young
asymptomatic
residual opaque trabeculae
“Odontogenic” myxoma pathology. This is a _____ tumor with scattered plump _______ cells
Has delicate ______ and abundant _______
Often mistaken for….
hypocellular, fibroblastic
collagen fibrils, ground substance (glycosaminoglycans)
normal anatomy
“Odontogenic” myxoma Tx:
Block resection
What are the 3 Cementum Lesions?
Central cemento-ossifying fibroma
Benign cementoblastoma (true cementoma)
Gigantiform cementoma
Central cemento-ossifying fibroma is a neoplasm of _____ origin.
Radiographically it is well circumscribed, and associated with what?
Lucency?
fibroblastic stoma, trabeculae, globules of acellular cemntum
Usually…
Tx:
PDL
tooth roots
lucent/mixed/opaque
fibroma, ossifying, cementifying (or both = cemento-issifying)
Encapsulated
Enucleation
Benign cementoblastoma is a _____ cementoma
what age?
where?
Looks like what?
Except the tooth is what?
true
2-4 decades
Mn 1st molar
condensing osteitis
vital
Begnign cementoblastoma is radiographically pathognomonic, including a ______ mass with peripheral _______
It is fused to the _____
sclerotic, radiolucent zone
root
Benign cementoblastoma, pathology includes ______ trabeculae of cementum
variable amounts of active fibroblastic stroma with ______ cells
Peripheral trabeculae characteristically at ______ to surface
Central trabeculae fused with ______
sclerotic
giant
right angles
root
Benign cementoblastoma Tx:
recurrence:
Surgical removal
rare
Gigantoform cementoma must be:
Radiograph, multiquadrant ______ opacities
Pathology is globular _____ masses of _______
Tx:
Autosomal dominant
globular
sclerotic, cementum
case by case
Ameloblastic fibroma, seen in what age?
Where?
symptoms:
Radiographically always:
1-3 decades
posterior Mn
asymptomatic
lucent
Ameloblastic fibroma, pathology has long strands/cords of ______ cells resembling _______ (embedded in CT of fibroblasts/delicate collagen fibrils)
Tx:
Variant:
epithelial, dental lamina
Surgical removal
Ameloblastic fibrosarcoma (rare malignant)
Ameloblastic fibro-odontoma, aka…
Age:
Symptoms:
Radiographic shade:
occurring where?
developing odontoma
1-3 decades
asymptomatic
mixed lucent/opaque
overlying unerupted tooth
Ameloblastic fibro-odontoma, pathology like ameloblastic fibroma, except areas of _______
The pallisading, reverse nuclear polarity is a manifestation of what?
Tx:
odontogenesis (enamel, dentin, cementum)
function (not pathology)
Surgical removal
What is the most common Odontogenic Tumor?
Odontoma
Odontoma is a mix of what two cells?
and produces the products of what?
Not a neoplasm, it is a…
Epithelial, mesenchymal
odontogenesis
develpmental hemartoma
Odontoma seen at what age?
symptoms?
Radiographic shade:
Radiographically either Compound (tooth-like) found where?
or Complex (random deposition) found where?
1-3 decades (young)
asymptomatic
radiopaque w/ lucent border, over unerupted teeth
anterior Mn
posterior Mn
Odontoma early lesions tend to be more active, like Ameloblastic fibro-odontoma
Late lesions more mature enamel, dentin, cementum, pulp
True
True
Odontoma Tx:
Complications:
Surgical removal
dentigerous cyst, ameloblastoma
Infective Stomatitis can be bacterial, fungal, viral
True
Impetigo is a skin infection caused by what 2 pathogens?
strep pyogenes
staph aureus
Impetigo is usually found in what population?
where?
Facial lesions usually around ____ and ______
Caused by poor ____, crowded conditions, humidity
Spread by?
young children
face/extremities
nose, mouth
hygiene
skin contact
Impetigo, _____ ruptures leaving _____ crusts
described as…
How is it unlike HSV?
Topical Abx:
Systemic Abx:
vescicles amber
cornflakes glued to surface
lesions persist until Tx
Mupirocin
Cephalexin, Dicloxacillin
Tonsillitis/pharyngitis can be bacterial or viral
bacterial class:
sore throat, headache fever, tonsillar hyperplasia, yellowish exudate, erythema, palatal petechiae, lymphadenopathy
Children aged ____ years
Spread by:
Culture/Tx w/
True
group A beta hemolytic streptococci
Strep throat
5-15
contact, nasal, oral secretions
Abx (penicillin, amoxicillin, cephalosporin)
3 complications of Strep Throat:
Scarlet Fever (3-12 y/o), attacks vessels, strawberry tongue
Rheumatic fever (heart, joints, CNS)
Glomerulonephritis
Syphilis, a bacteria called…
Spread by:
African americans, prostitutes, drug abusers, 50-100x higher prevalence in US compared to other industrialized countries
Treponema pallidum
direct contact w/ mucosa
True
Primary Syphilis, painless ulcer at inoculation site:
occurs __-___ days after initial exposure
Regional ______
TPHA + FTA-ABS (blood tests)
Highly infectious
Chancre
3-90 days
lymphadenopathy
True
True
Secondary Syphilis occurs ___-___ weeks post infection
____ patches
_____ ulcers
2 skin manifestations:
Lymphadenopathy, sore throat, fever, highly infectious
4-10 weeks
mucous
snail track
conduylomata lata, maculopapular rash
True
Latent Syphilis: ___-____ years
1-30 years
Tertiary Syphilis develops in ___% of pts
Manifests in a unique type of necrosis called:
with 3 characteristics:
Intraorally this is seen where?
3 other manifestations:
30%
Gumma
indurated, nodular, ulcerated lesion
palate
dorsal atrophic luetic glossitis, syphiulitic leukoplakia, CV/CNS involvement
Congenital Syphilis, what happens to the head?
Underdeveloped…
Palate:
Deformity:
Frontal bossing
Mx
high, arched
saddle nose
Presentation of Congenital Syphilis:
Hutchinson’t triad
Hutchinson’s Triad:
include 2 dental abnormalities
Interstitial keratitis of cornea
VIII nerve deafness
Hutchinson’t incisors (srewdriver), mulberry molars (bumps)
Sensitive but not specific blood test for Syphilis:
other one:
Why is mucosal smear not recommended?
Abx Tx:
VDRL RPR
TPHA and FTA-ABS
spirochetes
penicillin
Species causing TB:
Immunodeficiency can progress disease:
Spread through droplets in pts w/ active disease
Mycobacterium tuberculosis (acid-fast bacillus)
True
True
Fever, night sweats, fatigue, weiht loss, productive cough, hemoptysis:
TB
Scrofula:
Lupus vulgaris
lymph node involvement TB
skin involvement TB
2 TB oral manifestations:
Biopsy shows granulomas w/ central areas of ______
AFB
PCR, PPD
Tx:
chronic painless ulceration on tongue/palate, atypical periodontitis
necrosis
Acid fast bacillus stain
tests
Isoniazid/rifampin
Bacterial infection that looks like a fungus:
Actinomycosis israelii
Actinomycosis is a normal ______ anaerobic inhabitant of the oral cavity
Hx of:
% cases occur in cervicofacial areas:
saprophytic
surgery/trauma
55%
Actinomycosis manifests as…
colonies are what color?
Tx:
Localized acute infections Tx more ________
Removal of infected tissue aerates and Abx not needed
abscesses/sinus tracts
yellow “sulphur granules”
long-term high dose Abx
conservatively
True
NUG (trench mouth), 2 causative bacteria:
Highly inflamed/hemmorhagic…
punched out papillae necrotic and covered with…
Fetid odor and _____ pain
2 Tx’s:
Systemic Abx if:
Bacillus fusiformis, Borrelia vincetii
papillae
gray pseudomembrane
intense
Debridement, CHX
fever/lymphadenopathy
Candida albicans has a yeast form and a _______ pathogenic form
White matl that can be wiped off:
has what taste?
hyphal
pseudomembranous candidosis
metallic
Acute atrophic candidosis - 3 features
painful burning
affects gingiva
loss of filiform papillae on tongue
Chronic atrophic candiddosis - 3 features
Erythematous
Mx only in dentures
asymptomatic or symptoms
Chronic hyperplastic candidosis is indistiguishable from what?
This white lesion differs from pseudomembranous how?
If AF does not resolve, then…
leukoplakia
does not wipe off
biopsy
Angular chelitis is candida ___% of the time
otherwise it is _____ or ______
reduced vertical dimension predisposes
90%
strep, staph
True
Median rhomboid glossitis, aka…
Central _____ atrophy
erythematous diamond shaped area found where?
Often…
chronic atrophic candidosis
papillary
midline, posterior dorsal tongue
asymptomatic
Candida Dx w/ ____ smear, tissue culture, exfoliative cytology (PAS stain)
Nystatin Rx:
Clotrimazole Rx:
2 azoles absorbed systemically:
Fluconazole Rx:
mucosal
1 tsp 5x daily, 2 wks
10 mg 5x daily, 7-10 days
ketoconazole, fluconazole
2 tabs (200 mg) day 1, then 1 tab daily, 2 wks
Chronic, non-healing intraoral ulcers that can mimic SCC:
Deep fungal infections
Most deep fungal infections cause primary lung involvement
True
Histoplasmosis, Coccidomycosis, Blastomycosis, Cryptococcosis, Aspergillosis
Deep fungal infections
SubQ fungal infection species:
Sporotrichosis
Opportunistic fungal infection species:
Zygomycosis (mucormysosis)
HPV papilloma caused by what 2 subtypes?
White/red/normal color ______ shaped exophytic
6 and 11
cauliflower
Verruca vulgaris, HPV subtypes:
Common wart usually found where?
If oral mucosa, found where?
2, 4, 6, 40
skin of hands
vermillion border, labial mucosa, anterior tongue
Koilocytes (enlarged cells w/ cytoplasmic clearing)
Keratohyaline granules
contagious
Verruca vulgaris (HPV 2, 4, 6, 40)
Verruca Vulgaris (HPV 2, 4, 6, 40) Tx:
liquid nitrogen
Condylomata acuminatum, caused by:
This is _____ HPV
incubation:
Anogenital condylomata, what 2 HPV forms increase malignant risk?
often occur in clusters, not as exophytic as papillary/papilloma/verruca
HPV 2, 6, 11, 53, 54, 16, 18
sexually transmitted
1-3 months
16, 18
True
Focal epithelial hyperplasia caused by:
“_____ Disease”
flat, soft, _____ papules
Most common in malnourished ________
1st described in Native Americans/Eskimos
______ and _____ cells
HPV 13, 32
Heck’s
clustered
children
True
Koilocytes, Mitosoid
Focal epithelial hyperplasia caused by HPV 13,32 identified by DNA insutu hybridization, PCR, and may undergo regression after improved living conditions
True
2 types of HPV w/ cancer risk:
causes _____ cancer and MOST ______ cancer
30 years ago, 15% of throat cancer HPV, now ___%
16, 18
cervical, oropharyngeal
80%
HPV, HHV, both ____ viruses
DNA
HSV-1
HSV-2
oral infections
genital infections
More than 90% HSV (HHV) are asymptomatic
True
Acute herpetic gingivostomatitis is…
age range:
_____, lymphadenopathy, nausea, irritability
erythematous gingiva, coalescing vescicles spread to
Lesions heal ______
Very Acute in Onset
6 mo - 5 yrs
Fever
marinated ulcers
spontaneously
Recurrent herpes occurs in _-__% of population
cold sore/fever blister, called herpes _____
apthae occur where?
Intraorally limited to what?
15-45%
labialis
vermillion/skin border
keratinized mucosa
At any time, _-__% of pts will asymptomatically excrete and will have HSV DNA in saliva
5-30%
3 types of antivirals that are effective when administered in prodrome for herpes infection:
Acyclovir
Famciclovir
Valacyclovir
Varicella-zoster virus, HHV __?
Primary infection:
Reactivation:
HHV-3
Chickenpox
Shingles
Primary HHV-3 incubation:
Recovery:
10-21 days
2-3 weeks
*now vaccine
Reactivation HHV-3, occurs how often?
Oral lesions occur if what nerve is involved?
***Chronic Infection that may take months to resolve?
1 in 3
Trigeminal nerve
Postherpetic Neuralgia
Infection of external auditory canal, ipsilateral facial/auditory nerved produce facial paralysis, hearing deficits, vertigo (HHV-3)
Ramsay Hunt Syndrome
EBV, HHV-__?
Infectious ______
Prodrome has _____ on hard/soft palate
_____ antibody, elevated WBC count
HHV-4
mononucleosis
petechiae
heterophil
Hairy leukoplakia is a corrugated white lesion usually found where?
It can be wiped off.
Associated w/ candida, but often caused by what?
This is most common in ____ pts
lateral border tongue
False
EBV
HIV
2 EBV neoplasms:
Burkitt’s lymphoma (and other lymphomas)
Nasopharyngeal carcinoma
Cytomegalovirus, HHV-_?
Affects ____ and immunosuppressed adults
___% infection asymptomatic, rest mono-like
serious complications like organ failure, blindness, mental/motor retardation
HHV-5
newborns
90%
True
CMV (HHV-5) oral lesions:
resides latently where?
Infected cell appearance?
Systemic antiviral if….
chronic ulceration
salivary glands
owl eye
immunosuppressed
Kaposi’s sarcoma causative virus:
Orally most common on palate, gingiva, tongue
most cases associated w/ AIDS
HHV-8
True
True
Coxsackie A viruses cause what 3 things?
Herpangina
Hand-foot-mouth disease
Acute lymphonodular pharyngitis
Acute lymphonodular pharyngitis, caused by…
affects children under _____, often in epidemics
Painful _____ and ______ intraorally
Vescicles on ________
lymphoid tissue is ______
hand-foot-toes-fingers:
Infection resolves in ______ days
Coxsackie A virus
5
vescicles, ulcers
soft palate
hyperplastic
papules
7-10 days
Measles/Mumps caused by
Paramyxoviruses
Measles, aka…
______ spots are early intraoral manifestation
they are small, red patches w/ white _____ centers
Rubeola
Koplik’s
necrotic
Recurrent Aphthous Stomatitis is
occur in ___% of the population
immnologically, ___ cell mediated
Histocompatibility antigens are associated and suggest…
non-infective
20-50%
T-cell
genetic
Recurrent Aphthous Stomatitis is 90%
10%…
Minor aphthae
Major aphthae
Minor aphthae affect what sex more?
exclusively on ______ mucosa
Heal in 7 to ___days
recurrence variable
female
moveable
14
True
Major aphthae (5%), aka _____ disease
onset when?
***most common on soft palate and…
Sutton’s
adolescence
tonsillar fauces/pharyngeal mucosa
Herpetiform aphthae (5%), onset…
affect what sex more?
heals in 7-10 days
resembles ulcers caused by what?
adult
female
True
HSV
3 Tx’s for Aphthous ulcers:
Topical steroids (dexamethasone/flucononide)
CHX
Amlexanox
Pseudo aphthae are associated with what 3 Systemic Diseases?
GI (Crohn’s)
Vitamin deficiencies
Behcet’s syndrome
Systemic vasculitis causing chronic, recurrent disease and pseudo-aphthae:
Behcet’s syndrome
Behcet’s syndrome has an immunogenetic basis, strong associaton w/ specific HLA types
correltation w/ _____ antigens
Oral (99%), Ocular (70-85%), genital (75%)
Oral lesions like aphthous w/ ragged borders and surrounded by…
Use topical/systemic _______, other immunosuppressives, CHX
True
environmental
True
diffuse erythema
steroids
Lichen Planus, cause unknown but immune __ mediated
Slight association with:
age:
affect what sex?
Affects skin, oral mucosa, tissues irritated/traumatize: _____ phenomenon
T cell
Hep C
middle aged adults
2/3 female
Koebner
Skin: Purple, pruritic, polygonal papules
Oral: reticular/erosive/bullous, plaques
**vesiculo-bullous (blistering) diseases
Lichen Planus
Most common Lichen Planus is ______ w/ _____ Striae
reticular, Wickham’s
What is the most common cause of Desquamative Gingivitis?
also pemphigus vulgaris, pemphigoid, allergy
Lichen Planus
Saw-toothed rete ridges
Destruction basal cell layer
Lichen Planus
Lichen Planus look-alike associated w/ systemic drugs, hypersensitivity rxn (cinnamon/amalgam, etc)
Lichenoid rxns
2 topical steroids for Lichen Planus:
Fluocinonide
Clobetasol
Greek for blister
Pemphigus
Pemphigus is a ________ disease
autoimmune
severe, progressive
Pemphigus 1st appears when?
Circulating auto-Ab to what?
adults 40’s to 50’s
desmosomes (desmoglein 3)
Nikolski sign of Pemphigus:
Dx is ______ epithelial separation with acantholysis
Tx:
induces separation
suprabasilar
steroids
Type of pemphigus that affects pts w/ neoplasm, lymphoma, leukemia
it is very serious w/ high morbidity/mortality
Paraneoplastic pemphigus
Pemphigus:
Benign mucous membrane pemphigoid (cicatricial pamphigoid):
desmosomes
hemidesmosomes
Benign mucous membrane pemphigoid: more common in females, avg age:
more common than…
if untreated _____ can progress to blindness
Similar to pemphigus but not as severe
50-60
pemphigus
ocular scarring
True
Benign mucous membrane pemphigoid: +Nikolski sign
Most commonly affected site:
Bullae form where?
Dx:
True
gingiva (desquamative gingivitis)
epithelium/CT junction
biopsy epithelial separation
Benign mucous membrane pemphigoid Tx:
Ophthalmologic consult
Topical/systemic steroids
Desquamative Gingivitis can manifest from what 4 conditions?
Lichen Planus
Pemphigus vulgaris
Mucous membrand pemphigoid
Allergy
Erythema multiforme: ____ onset,
______ mediated
______ condition
follows…
acute
immune
mucocutaneous
systemic meds/post infection
Erythema multiforme affects what sex?
adults 20’s - 30’s w/ ___% recurrence
men more often
20%
Lesions highly variable (multiforme)
bulls eye lesions
palms/soles
Erythema multiforme
More severe form of Erythema Multiforme:
(has extensive mucosal ulceration, genital/ocular involved)
Most severe form of Erythema Multiforme:
(female prediliction)
Steven-Johnson syndrome
Toxic epidermal necrolysis
Erythema migrans/benign migratory glossitis
Geographic tongue
Geographic tongue is _______ condition of unknown origin
1-3% population
2x more common in what sex?
occasional burning, correlated with…
Tx:
inflammatory
True
Females
psoriasis
not needed, topical steroids if symptoms
Rare syndrome w/ urethritis, arthritis, conjuctivitis
Oral lesions look like geographic tongue
Reiter’s Syndrome
Lupus erythematosus, 8x more common in:
ave age:
50-80% have classic:
women
31
butterfly rash
Discoid LE:
Systemic LE:
lesions in skin only (25% oral)
chronic, progressive, life-threatening (CNS, heart, kidney)
LE lab test include:
ANA (antinuclear antibodies)
*Ab to own DNA
Tx LE:
systemic
corticosteroids
anti-malarials
Systemic Sclerosis (Scleroderma): rare ______ mediated deposition of _______ in skin/tissues
vasoconstrictive event in extremities:
Hide bound disease
immune, collagen
Raynaud’s phenomenon
skin hard and taut
4 oral manifestations Scleroderma:
Diffuse widening PDL
Microstomia (70%)
Dysphagia
Condylar resorption
Scleroderma can lead to organ failure
Dx: Anti ____ antibodies
Tx:
Prognosis:
True
Scl70 (topoisomerase1)
D-penicillamine/Ca channel blockers
organ involvement dependent
GVHD is what type of rxn?
acute:
chronic:
Oral lesions appear ______ and are painful
Tx:
Increased risk for:
immune
first 100 days
over 100 days
lichenoid
immunosuppressives/corticosteroids
dysplasia, oral cancer
