30 most common

Question 1

1 leukoplakia

Answer 1

intraoral white plaque, doesn’t rub off, not any well know entity.
may show benign hyperkeratosis, epithelial dysplasia, squamous cell carcinoma, carcinoma-in-situ.
remove potential causes and biopsy after 2 weeks.
diagnose by exclusion of other diseases.
premalignant: 5-25% dysplastic at biopsy
4% malignant transformation if allowed to grow.
etiology: tobacco, alcohol, sanguinaria, UV radiation, microorganisms & frictional keratosis.

Question 2

white lesions that rub off

Answer 2

materia alba
white coated tongue
burn (thermal, chemical, cotton roll, etc.)
pseudomembranous candidiasis
toothpaste/mouthwash overdose

Question 3

white coated tongue

Answer 3

asymptomatic
tongue scraping/brushing
looks like a white/yellow dirty tongue

Question 4

thermal/electrical burn

Answer 4

most common burn is from microwaved foods.

children sometimes bite electrical cords.

Question 5

aspirin burn

Answer 5

chemical coagulation necrosis
stop aspirin use
similar burns from peroxide, silver nitrate, phenol, endo material

Question 6

toothpaste/mouthwash overdose

Answer 6

chronic overuse causes topical burn.
mucosa sloughs
listerine 21-27% ethanol

Question 7

cotton roll burn

Answer 7

drying effect of cotton on mucosa.

chemicals may be absorbed by cotton against mucosa.

Question 8

candidiasis

Answer 8

most common oral infection
fungal: candida albicans
2 forms: spore & hyphae
30-50% population (spores)
predisposing: immune deficient, medications, dentures
increases white cell count (neutrophils & myelocytes)
treat with antifungals (nystatin)

Question 9

other candidiasis forms

Answer 9

white pseudomembranous
red erythematous
central papillary atrophy of tongue (median rhomboid glossitis)
angular cheilitis
denture stomatitis
mucocutaneous

Question 10

readily identifiable white plaques

Answer 10

linea alba
leukoedema
nicotine stomatitis
oral hairy leukoplakia
tobacco pouch keratosis
lichen planus

Question 11

linea alba

Answer 11

bilateral at occlusal plane of buccal mucosa.

no treatment

Question 12

leukoedema

Answer 12

70-90% blacks
disappears when stretched
gray-white, milky appearance
no treatment

Question 13

nicotine stomatitis

Answer 13

smoker’s palate, white hyperkeratotic hard palate from cigar/pipe smoking
males 45+yrs
fissured white mucosa, red punctate orifices of glands
stop smoking

Question 14

oral hairy leukoplakia

Answer 14

epstein-barr virus related in AIDS patients.
white hyperkeratotic folds bilaterally on lateral tongue.
candidiasis on surface.
treat AIDS

Question 15

tobacco pouch keratosis

Answer 15

young males (10-30yrs old)
white plaque, horizontal furrows in snuff pouch.
gingival recession & root caries.
dose response leads to verrucous carcinoma.
stop dipping

Question 16

lichen planus

Answer 16

chronic mucocutaneous disease
middle aged, women 3:2 men
purple, pruritic, polygonal, papules on skin
oral: reticular & erosive
- reticular more common, posterior buccal mucosa bilaterally, striae of wickham, wax & wanes.
- erosive: less common, more symptomatic, needs steroid therapy, ulcers with radiating striae.
lichenoid drug reactions can produce similar appearance.

Question 17

2 tori

Answer 17

palatal: 20-35% 2F:1M
mandible: 7-10% M>F
only treat for repeated trauma/ulceration or preprosthetic surgery

Question 18

3 inflammation or irritation

Answer 18

traumatic ulcer
pericornitis
perio abscess
ANUG

Question 19

4 fibroma

Answer 19

MOST COMMON BENIGN NEOPLASM OF ORAL CAVITY
buccal mucosa > labial mucosa > tongue > gingiva
surgical removal
smooth surface, pink, white, or gray
0.1-2.0cm elevation
asymptomatic
2F:1M, adults

Question 20

fibroma look-a-likes

Answer 20

3 P's and FIFH:
pyogenic granuloma
peripheral giant cell granuloma
peripheral ossifying fibroma
focal inflammatory fibrous hyperplasia

Question 21

pyogenic granuloma

Answer 21

excessive tissue reaction to irritation/trauma, red.
75% on gingiva, 25% on lips, tongue & buccal mucosa.
young adults, more female (‘pregnancy turmor’)
excision & scaling/root planing

Question 22

peripheral giant cell granuloma

Answer 22

local irritation/trauma on alveolus, blue-purple.
31-41yrs old average, 60% female.
excision to bone & scaling/root planing

Question 23

peripheral ossifying fibroma

Answer 23

mature pyogenic granuloma or peripheral giant cell granuloma??
sessile gingival mass, ulcerated often.
10-19 yrs old average, 67% female.
bone with fibrous tissue.
excision & scaling/root planing

Question 24

focal inflammatory fibrous hyperplasia

Answer 24

local irritation cause increased fibrocytes and collagen production.
remove cause and hyperplastic tissue.

Question 25

#5 fordyce's granules

Answer 25

ectopic sebaceous glands, 80% population. yellow/white papules. buccal mucosa > lips no treatment

Question 26

#6 hemangioma

Answer 26

benign proliferative blood vessels, 60% in head & neck, 80% as single lesions. 10-12% children, most common birth mark, 3F:1M. blanches under pressure, red = arteriolar, blue = venous. associated with sturgeweber angiomatosis surgery/lasers to remove

Question 27

#7 inflammatory ulcer

Answer 27

recurrent aphthous ulcer, canker sore (not cold sore/fever blister). 20-25% population non-keratinized, non-bound down mucosa (never palate or attached gingiva). 1-2 lesions, 0.5-1.0cm treat with steroids & antibiotics, but recurrent. diagnose with location + size + number

Question 28

#8 papilloma

Answer 28

benign proliferation of squamous epithelium. tongue > soft palate wart-like pedunculation, soft, painless, finger-like projections. 0.1-1.0cm single lesion, M=F. surgical removal

Question 29

#9 epulis fissuratum

Answer 29

inflammatory fibrous hyperplasia, ill-fitting denture. folds of tissue in vestibule. F>M, middle aged or elderly. surgical removal, remake denture.

Question 30

#10 varicosities

Answer 30

dilated & tortuous veins age (not disease) related sublingual no treatment

Question 31

#11 fissured tongue

Answer 31

scrotal tongue, deep grooves on dorsal tongue, 2-6mm. 2-5% population, increase with age mild burning/soreness brush tongue

Question 32

#12 geographic tongue

Answer 32

``` 1-3% population, 2F:1M dorsal tongue, rarely ventral erythema due to atrophy of filiform papillae, moves around. asymptomatic no treatment ```

Question 33

#13 papillary hyperplasia

Answer 33

denture papillomatosis, 20% patients who wear dentures 24/7, candidiasis. pebbly surface on hard palate. asymptomatic surgical excision, new denture

Question 34

#14 herpes viral infection

Answer 34

initial exposure 6months-5yrs old. 60-100% population exposed to HSV-1. <1% require treatment. chills, nausea, fever, ulcers, erythematous gingiva. antiviral meds (acyclovir, best by day 3), resolution 10-14days. cold sore or fever blister, 15-45% population. UV light, trauma, hormones trigger. pain, burning, itching, tingling before vesicular stage. vesicles 2-4 days, vesicles rupture, scab, crust, dry up by 10-12 days. palatal/gingival herpes: cluster of lesions (10-15) grows to ulcer. diagnose with location + size + number

Question 35

#15 mucocele

Answer 35

rupture & spillage of saliva into soft tissue. young adults, trauma related. lower lip (60%), buccal mucosa, ventral tongue, floor of mouth, retromolar pad, soft palate. ranula - mucocele of floor of mouth. surgical excision

Question 36

#16 scar tissue

Answer 36

post trauma/surgery | no treatment

Question 37

#17 angular cheilitis

Answer 37

reduced vertical dimension, salivary pooling, candidiasis. often bilateral antifungals, increase vertical dimension.

Question 38

#18 lingual tonsil

Answer 38

lymphoid hyperplasia, posterior lateral tongue borders, bilateral. discrete 1cm, enlarges with infection, red no treatment part of waldeyer's ring

Question 39

#19 hematoma

Answer 39

accumulation of blood in tissues after trauma, blood blister. no treatment.

Question 40

#20 tobacco pouch

Answer 40

gray-white lesion of mucosa at site of snuff pocket. dose response changes, recession & root caries. stop dipping before progression to verrucous carcinoma.

Question 41

#21 chronic cheek biting

Answer 41

2F:1M irregular, ragged white mucosa bite guard or no treatment

Question 42

#22 lichen planus

Answer 42

``` chronic mucocutaneous disease 3F:2M, middle aged purple, pruritic, polygonal, papules. striae of wickham steroid treatment ```

Question 43

#23 buccal exostoses

Answer 43

bony growth on buccal of max. or mand. remove only with repeat trauma or preprostetic surgery. rare: palatal, subpontic, subgraft

Question 44

#24 amalgam tattoo

Answer 44

amalgam in soft or hard tissue. black, blue, grey soft tissue tattoo. possible radiopacity, no treatment. rule out melanoma with biopsy or radiograph.

Question 45

#25 oral melanotic macule

Answer 45

oral freckle, well-demarcated brown macule, 1-7mm. 2F:1M lower lip > buccal mucosa > gingiva biopsy to rule out melanoma, no other treatment

Question 46

#26 median rhomboid glossitis

Answer 46

central papillary atrophy of tongue. asymptomatic red zone in posterior midline dorsal tongue. antifungals, brushing tongue

Question 47

#27 black hairy tongue

Answer 47

elongated filiform papillae 0.5% population usually asymptomatic, or bad taste, gagging. tongue scraping or brushing. smoking, antibiotics, poor hygiene, radiotherapy, breath mints

Question 48

#28 smooth red tongue

Answer 48

pernicious anemia (systemic problem), medications, avitaminosis. burning and pain treat underlying cause

Question 49

#29 epidermoid cyst

Answer 49

skin cyst, inflammed hair follicle. oral cysts in midline floor of mouth. slow growing, painless surgical removal

Question 50

#30 lipoma

Answer 50

benign fat tumor buccal mucosa > tongue > floor of mouth > lips. yellowish soft nodular mass. surgical excision