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DMD3 > ORAL PATHOLOGY > Flashcards

ORAL PATHOLOGY Flashcards

1
Q

Which teeth are most commonly affected by taurodontism?
A) Wisdom teeth
B) First molar
C) Second molar
D) Premolars

A

A)

WT > Second molar > First molar

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2
Q

Which three teeth are most commonly affected by internal root resorption?

A

1, 6 and 7s

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3
Q

Which of the following pathologies are commonly associated with the anterior maxilla region and dental abscesses?
A) Taurodontism
B) Dental dysplasia
C) Regional odontodysplasia
D) Dens evaginatus

A

C)

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4
Q

Distinguish the two types of dentinal dysplasia

A

Type 1 - Radicular
- pA radiolucency
- Pulp obliterated
- Unremarkable clinical appearance

Type 2 - Coronal
- Primary dentition only
- Opalescent apperance
- Thistle tubed pulp space
- May have pulp stones

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5
Q

Briefly distinguish the clinical features of acute periapical periodontitis vs chronic periapical periodontitis.

A

APP:
- Constant severe tooth ache
- Hypersensitivity to testing and TTP
- Tooth elevated in socket
- Swelling

CPP:
- Asymptomatic
- Occasional dull ache
- Minimal to no response to testing

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6
Q

A patient presents to your clinic with an asymptomatic bony, hard swelling. Histology: Osteoclast and osteoblasts, marrow spaces filled with fibrous tissue and lymphocytes
Radiology: Irregular, predominantly radiolucent lesion, expansion of PDL with concentric/parallel opaque layers (onion skin)

Which of the following is most likely?

A) Fibrous dysplasia
B) Tori
C) Acute suppurative osteomyelitis
D) Garre’s osteomyelities

A

D)

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7
Q

Explain the radiographic appearance of a dentigerous cyst.

A

Development cyst

  • Attached to CEJ and covering crown
  • Well-defined round corticated radiolucency
  • > 3mm (requirement to dx from normal follicle)
    Can become very large
  • Unilocular
  • Displaces/resorbs adjacent teeth and structures
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8
Q

Explain clinical feature of dermoid/epidermoid cysts - where are they commonly found? Distinguish the two based on histology.

A

Slowly growing doughy cysts - usually <2cm

Dermoid
- Stratified squamous epithelium
- Keratinised debris
- Hair follicles, sebaceous glands and sweat glands

Epidermoid
- Stratified squamous epithelium
- Keratinised debris

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9
Q

In relation to pyogenic granuloma:
- Aetiology?
- Three common places to appear?
- Clinical appearance?
- Histology?

A
  • Aetiology: response to local irritation or trauma
  • Common: Gingiva, lips, tongue
  • Clinical: red mass, may be ulcerated, lobulated, spongy feeling
  • Histology: Granulation tissue - highly vascular
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10
Q

A 13 year old patient presents to your clinical with a bilateral swelling of the cheeks. On radiographic examination, you note a multilocular, soap-bubble radiolucency. Histological examination indicates large amounts of multinucleated osteoclast-like giant cells in a vascular fibrous tissue. Which is the most likely diagnosis?
(A) Fibrous dysplasia
(B) Cherubism
(C) Central giant cell granuloma
(D) Ameloblastoma

A

(B) Factors that indicate this is most likely diagnosis:
- Young age
- Bilateral involvement
- Histology and radiographic examination match

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11
Q

A 24 year old male presents to your clinic with a brown-black pigmented lesion on the buccal gingiva region of tooth 46. Radiographic examination is unremarkable and histological examination indicates an increase in melanin pigment in basal layer. Which of the following is the most likely diagnosis?
(A) Amalgam tatoo
(B) Acquired melanocytic naevus
(C) Melanotic macule
(D) Melanoma

A

(C)

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12
Q

Briefly explain the histology of true oral lichen planus.

A

o Band-like lympho-histiocytic infiltrate in lamina propria – hugging overlying surface epithelium
o Varying degrees of ortho/parakeratosis
o Rete ridges may be atrophic or hyperplastic – classically described as saw-toothed
o Destruction of basal keratinocytes – hydropic degeneration – NO DYSPLASIA
o Necrotic keratinocytes – civatte / colloid bodies
o NO PLASMA cells
o Superadded Candida infection

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13
Q

What are the three common drugs that cause drug-induced gingiva hyperplasia?

A
  • Phenytoin (anticonvulsant)
  • Cyclosporine
  • CCB - Nifedipine, verapamil
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14
Q

Explain the following in relation to peripheral ossifiying fibroma.
- Clinical appearance
- Histology

A
  • Clinical: same appearance as normal mucosa (unless ulcerated), sessile or pedunculated, growth is NOT self-limited, usually <2cm in size
  • Histology: Proliferation of fibroblasts, calcified deposits of bone, cementum-like material and dystrophic calcifications
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15
Q

Distinguish junctional, compound and intradermal acquired melanocytic naevus.

A

Lesion becomes increasingly raised and pale in appearance the deeper the naevus cells are located → Evolve lifetime from junctional to deeper regions

Junctional:
Well circumscribed brown-black macule

Compound:
Central raised area with surrounding flat pigmentation
Brown-tan

Intradermal:
Elevated/dome shaped
Pale

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16
Q

Distinguish the histology between acquired melanocytic naevus, melanotic macule (ephelis), and melanoma

A

Acquired melanocytic naevus: Cluster of naevus cells in the wrong location (normal in appearance)
Melanotic macule: Size, number and appearance of melanocytes are normal but increase melanin production
Melanoma: Pleomorphic - increased number and atypical appearance of melanocytes

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17
Q

Merkel cells are located in:
(A) Prickle layer of masticatory mucosa
(B) Basal layer of masticatory mucosa
(C) Prickle layer of lining mucosa
(D) Basal layer of lining mucosa

A

B)

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18
Q

Under a histological slide, you note the following:
- Large flat keratinocytes
- Keratohyalin granules
- Odland bodies dishcarging extracellular contents

Which of the following is this layer of the mucosa most likely to be?
(A) Basal layer
(B) Prickle layer
(C) Granular layer
(D) Keratinised layer

A

(C)

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19
Q

On radiographic examination in an 8 year old patient. You notice that in general, the dentition appears to:
- Have short roots
- Pulpal obliteration
- Radiolucency of the dentine

What would your list of ddx be based on the information above? (List characteristic signs for each that would help narrow down the ddx if further info was provided)

A
  • Dentinogenesis imperfecta –> Bulbous crowns, exaggerated CEJ, amber/opalescent appearance of teeth
  • Dentinal dysplasia
    > Type 1 Radicular: clinically unremarkable, pA radiolucencies
    > Type 2 Coronal: primary teeth only, pulpal stones may be present, amber/opalescent appearance –> UNLIKELY as coronal pulp is large and canals described as thistle shaped rather than obliterated
  • X-linked Hypophosphataemia (Vit D resistant rickets): pulp horns enlarged to DEJ, enamel hypoplasia
20
Q

List three ddx for condensing osteitis and note where possible, distinguishing features that can ascertain the definitive diagnosis

A

Diffuse sclerosing osteomyelitis: chronic form of OM with pronounced sclerotic response

Fibrous scarring post RCT

Late periapical osseous dysplasia → Vital teeth and nil history of pain/pulpal infection, radiolucent rim around radiopacity

Cementoblastoma → Spokes of wheel appearance with radiolucent rim just inside the corticated border

Dense bony islands → Nil history of pain/pulpal infection, radiopacity is less symmetrical and not as centred/attached to root apex

21
Q

List radiographic and clinical ddx for radicular cyst and note where possible, distinguishing features that can ascertain definitive diagnosis.

A

Radiographic:
- Chronic apical periodontitis → Ill-defined borders that blend into the bone and <1cm
- Early cemento-osseous dysplasia → Teeth remain vital and become radiopaque/mixed upon maturation
- Radiolucent apical scar
- OKC
- Lateral periodontal cyst
- Central giant cell granuloma → Vital teeth and clinically present as a swelling

Clinically - Red/blue swelling:
- Pyogenic granuloma → Removal of irritant will resolve lesion and minimal to nil radiographic evidence
- Periapical giant cell granuloma → Minimal to nil radiographic evidence

22
Q

List radiographic and clinical ddx for dentigerous cyst and note where possible, distinguishing features that can ascertain definitive diagnosis.

A

Paradental/BBC → Covers coronal ½ of root and epicentre at buccal bifurcation

Pericoronitis → WT is partially erupted

OKC → Does not expand bone to same degree, lack of resorption and often attaches further apically on root rather than CEJ

Unicystic ameloblastoma → Difficult to distinguish

Ameloblastic Fibroma

Rare
Adenomatoid odontogenic tumour

Calcifying odontogenic cyst

23
Q

List clinical features/patient complaints in relation to xerostomia and salivary hypofunction

A

1.Xerostomia
Dry mouth
Difficulty masticating and swallowing
Speech affected
Taste disturbance
Sleep disturbance

2.Salivary hypofunction
Minimal pooling in FoM
Stringy/frothy saliva
Mirror sticking to mucosa
Fissured and depapillated tongue
Atypical caries
Candidiasis

24
Q

What are the four pillars of managing a patient with salivary hypofunction?

A
  1. Symptomatic relief –> Biotene, Oral 7 or GC Dry mouth (note: biotene and oral 7 spray are identical) - no brand or type is more superior than the other. Advise patient reapplication required
  2. Caries control
    - Regular recalls
    - Dietary advice and OHI
    - Home fluoride regime
  3. Sialagogues
    - Gustatory
    - Masticatory (e.g. sugar free gum
    - Pharmacology = Pilocarpine
    > Contraindicated in narrow angle glaucoma
    > Relative contraindication in asthma and cardiac patients
    > Need good residual functioning tissue
  4. Disease modifying agents –> Beyond scope of dentist
25
Q

Name the site and common age group that dentigerous cyst appear in. What is the treatment for teeth affected?

A

Mandible
WT > Mx. Canines > Md. 2nd premolar
Male adults
20s-40s years

  1. Removal of tooth + Enucleation of cyst (other recurrence)
  2. Decompression of larger cyst (allows drainage and thickening of epithelium for easier dissection) + Future enucleation
26
Q

In regards to OKC:
- Most common age group?
- Treatment?
- What syndrome is this related to?

A

20-30years

Treatment:
Referral for specialist management - complete radiologic examination advisable due to high recurrence
Surgical tx: resection, curettage or marsupialisation
Carnoy’s solution (chloroform) used → effective but carcinogenic
Other options have higher recurrence
Important for periodic post-treatment clinical and radiographic examination to detect recurrence → Usually within first 5 years

Gorlin Goltz Syndrome (Basal cell nevus syndrome) = Two major criteria or 1 major criteria w/ 2 minor criteria for diagnosis
Major
Multiple OKC
3+ cutaneous palmar pits
Bifid, fused or splayed ribs
Minor
Cleft lip/palate, frontal bossing, hypertelorism
Calcification of falx cerebri

27
Q

What is a lymphoepithelial cyst?
- Most common age group
- Treatment

A

Development cyst that arises in lateral area of neck (deep to SCM commonly or anterior mandible).
Common age group = 20-40years
Treatment = Excision (low recurrence)

28
Q

What microorganism causes Syphillis and what are the clinical features?

A

Infection from Treponema pallidum (spirochaete)

Primary
Chancre: Single indurated painless ulcer
Upper lip → Male
Lower lip → Females
Nil exudate
Develops 3 - 90 days after exposure
Genital area (<2% oral)
Spontaneous healing 4-6 weeks
Highly infectious

Secondary
Develops 6 weeks after primary chancre
Maculopapular skin rash
Oral ulcers covered by membrane
“Snail-track” ulcers
Condyloma latum
Multiple lesions typical of secondary compared to primary syphilis
Highly infectious

Tertiary
Signs can appear years later
CVS lesions, CNS lesions
Atrophic glossitis
Syphilitic Leukoplakia
Gumma (type IV hypersensitivity response)
Often affects the palate or tongue

29
Q

What are some reasons for decreased immunosurveillance resulting in candidiasis?

A

Local:
Salivary hypofunction
Smoking

Systemic alteration:
Extremes of age
Malnutrition - iron, folate and B12 deficiency
Drugs
Inhaled corticosteroids
Antibiotics
Severe immunodeficiency = HIV/AIDS, immunosuppressant agents, chemotherapy, malignancies

30
Q

Explain the treatment options for candidiasis per TGA guide.

A

-Treatment relies on adequate contact time with antifungal

<2 years
- Nystatin 100,000 units/ML suspension 1mL topically then swallowed → 4x daily for 7-14 days and then 2-3days after
- Miconazole 2% gel 1.25mL topically then swallowed → 7-14 days and at least 7 days after resolution

> 2 years: 4x daily for 7-14 days and at least 7 days after resolution
- Nystatin 100,000 units/ML suspension 1mL topically then swallowed → 4x daily for 7-14 days and then 2-3days after
- Miconazole 2% gel 2.5mL topically then swallowed
- Amphotericin 10mg lozenge

Angular cheilitis: 2x daily for 14 days and 14 days after resolution
- Miconazole 2% topical cream
- Clotrimazole 1% topical cream
- Hydrocortisone 1% cream can be added to manage inflammation → 2x daily for 2-3days
- Note: Combination products should only be used until inflammation subsides and antifungal used alone for 14 days after symptoms resolve

31
Q

Briefly explain the virus lifecycle of HSV1 and HSV2

A
  1. Entry into cell
  2. Uncoating and release of viral genome
  3. Transcription of viral genome → Viral DNA transcribed into mRNA
  4. Translation of viral proteins → Early proteins aid in genome replication while late proteins aid in assembly
  5. Post translation modifications → Cleavage and glycosylation
  6. Assembly of virion components
  7. Release → Budding or cell death
32
Q

Explain features of primary and secondary infection in HSV1/HSV2

A
  1. Primary infection
    Children
    Fever, malaise, headache
    Vesicular eruptions on skin, vermillion border and I/O
    Oral presentation referred to as Primary Herpetic Gingivostomatitis
    Lesions persist for 1-10 days and resolve with no scarring
    Pharyngotonsillitis = Inflammation of tonsils, fever, sore throat
  2. Secondary infection → Primary infection reactivated
    Prodromal symptoms: burning, tingling and pain at the site
    Within hours vesicles appear → Rupture and coalesce to form map like ulcers
    Lesions heal in 1-2 weeks with no scarring
    Herpes Labialis = “Cold sores” on vermillion border
    Herpes stomatitis = Vesicles appear on lip and throughout oral mucosa (severe and extensive) - Generally in severely immunosuppressed patients
    Herpes-associated erythema multiforme = Extensive ulceration of oropharynx and crusting of lips
    Herpetic Whitlow = Vesicles on finger tips due to infection of nail bed - Uncommon today
33
Q

What is treatment for herpes per TGA?

A

Herpes labialis: at prodromal stage or at first sign of recurrence
-Advise patient to use SPF lipbalm
-Acyclovir 5% topical cream - 5x daily for 5 days
-Famciclovir 1500mg single dose
-If severe and high recurrence → Referral to GP for management to systemic antivirals and underlying risk factors

Primary herpetic gingivostomatitis
-Ensure patient remains hydrated
-Benzydamine 1% gel for analgesia - 2-3hrs

34
Q

What are the key points to assess for the following lesions when considering ddx and malignancy:
a) White lesions
b) Ulcers
c) Pigmented lesion

A

a) Site - High risk areas = FoM, lateral, ventral tongue, anterior buccal mucosa, retromolar trigone, anterior fauces
Size - Only useful yo consider whether it could be linked to trauma
Homogeneity - Colour and texture - considerations for malignancy
Wipeable - Lesions wipeable: pseudomembraneous candidiasis, traumatic keratotic slough, desquamative gingivitis (partially), white hairy tongue
b) Site
Size
Number
Duration +/- recurrences
Border
Systemic involvement - fever, cutaneous ulcerations/blisters
c) Asymmetry
Border - regular or irregular
Colour - Homogeneity
Diameter - Consider biopsy when >6mm
Evolvement - Rapid or not

35
Q

Histopathology of radicular cyst?

A

Lined by stratified squamous epithelium

Wall composed of inflamed fibrous or granulation tissue

Reactive hyperplasia

Rushton’s hyaline bodies

Mucous goblet cells and respiratory metaplasia

Occasionally cholesterol clefts

Hemosiderin

Foamy Macrophages

36
Q

What is granulation tissue?

A

Granulation tissue = Inflammatory cells, fibroblasts and new blood vessels

37
Q

What age group and site is the peripheral giant cell granuloma most common?

A

50-60yrs
Females
Mandible - Premolar/Molar

38
Q

Common site and age for CGCG? What would be on your ddx?

A

20-30yrs, female, anterior mandible
DDx:
- Ameloblastoma (older predilection in posterior mandible)
- Odontogenic Myxoma (tennis racquet, one or two straight septae)
- ABC (younger age group)
- Simple bone cyst (no effect on surrounding structures)

39
Q

What is the treatment for geographic tongue?

A

Nil treatment required except reassurance (based on TGA) –> May suggest difflam for symptomatic management if required

40
Q

What are the name of the ducts of the parotid, submandibular and sublingual. What type of secretions for each gland?

A

Parotid = Stenson’s duct –> Serous
Submandibular = Wharton’s duct –> Mixed
Sublingual = Bartholin’s duct –> Mucous

41
Q

What are Von Ebner’s gland?

A

Minor glands associate with circumvallate papilla - they are the only minor glands that are serous (all other are mucous)

42
Q

Distinguish serous vs mucous acini

A

o Serous – thin watery secretion
 Pyramid shaped cells
 Spherical nucleus
 Intensely stained
 Highly synthetic cell
 Microvilli extend into luminal surface
 Complex folding of basal plasma membrane
o Mucous – more viscous secretion
 Pyramid shaped
 Flattened
 Flattened nucleus at basal end
 Apical portion – weakly stained
 Fewer interdigitations between cells
 More secretory granules

43
Q

Where does active transport of electrolytes of saliva occur (which duct) and what electrolytes are exchanged?

A

Sodium and chloride pumped out and potassium and bicarbonate are pushed into saliva prior to excretion

44
Q

What is the treatment modality of AOT and describe histopatholgoy

A

Treatment = Nothing (benign)
Histology = Duct like structures - central space surrounded by columnar or cuboidal epithelial cells

45
Q

On radiographic examination of a 50 year old female, you notice a well-defined radiolucency with various calcifications in the centre in the anterior maxilla. What is most likely ddx?
(A) Adenomatoid odontogenic tumour
(B) Ameloblastic fibroodontoma
(C) Calcifying odontogenic tumour
(D) Complex odontome

A

(C)

(A) 20-30 years
(B) Young children - 10-20 years and usually posterior mandible
(D) Does not fit radiographic description

46
Q

What is the pathogenesis of sialadenosis?

A

Peripheral autonomic neuropathy
Results in disordered salivary metabolism and secretion
Accumulation of secretory granules = Gland enlargement

47
Q

Pleomorphic adenoma
- What age commonly occurs?
- What is histological presentation?

A

Common age = 30-50years

Epithelial component
Duct-like and cystic structures
Sheets of epithelial cells
Myoepithelial cells → Spindled, epithelioid, plasmacytoid

Stroma component
Produced by myoepithelial cells
Myxoid and chondromyxoid areas
Hyalinised stroma

DMD3 (13 decks)

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