B1

Question 1

List development defects of jaw

Answer 1

1) Agnathia / otocephaly / holoprosencephaly agnathia
2) Micrognathia
3) Macrognathia
4) Facial Hemihypertrophy
5) Facial Hemiatrophy / Parry - Romberg syndrome

Question 2

Micrognathia is associated with conditions such as ( ……………… ) , (…………..) and follows a ( ………….. ) pattern

Macrognathia is associated with conditions such as ( …………… ) , (…………….. ) , (……………. ) & ( ………………)

Answer 2

Micrognathia is associated with conditions such as ( Pierre-Robin syndrome ) , ( congenital heart disease ) and follows a ( hereditary ) pattern

Macrognathia is associated with conditions such as ( pituitary gigantism ) , ( acromegaly ) , ( Paget disease ) & ( Leontiasis ossea ( fibrous dysplasia )

Question 3

State some clinical feature of facial Hypertrophy

Answer 3

1) Enlargement of one side of the face / body
- sometimes maybe crossed

2) Unilateral macroglossia with enlarged lingual papillae

3) Effect on teeth ( canine , PM and 1st Molar )
- increase size of dentition , rate of eruption on one side
- increase rate of exfoliation of affected deciduous teeth
- thicker but shorter roots

4) Velvety , pendulous folds of buccal mucosa

Question 4

Describe the clinical features of facial hemiatrophy

Answer 4

1) Painless demarcation scar — ‘coup de sabre’

2) Wasting of tissue of the half face
- eg fat , skin , cartilage , bone , muscle , SG , tongue
- causing enophthalmous , hollowing of cheeks , atrophy of lip exposing teeth
- can also lead to difficulties in mastication and facial asymmetry

3) Trigeminal neuralgia

4) Facial paraesthesia

5) Contralateral Jacksonian epilepsy

6) Deviation of mouth and nose

7) Oral manifestations
- incomplete tooth root formation
- Hemifacial microsomia
- retarded eruption of teeth

Question 5

State the types of orofacial clefts

Answer 5

1) Cleft lips
2) Cleft palate
3) Lateral facial cleft
4) Oblique facial cleft
5) Median cleft of upper lip

Question 6

Cleft lips arises due to failure of fusion of ( …………………. )

Cleft palate arises due to failure of fusion of ( …………….. )

Oblique facial cleft arises due to failure of fusion of ( ………………. )

Lateral facial cleft arises due to failure of ( ………………… )

Median cleft of upper lip arises due to failure of fusion of ( …………….. )

Answer 6

Cleft lip arises due to failure of fusion of ( median nasal process with lateral nasal process and maxillary process )

Cleft palate arises due to failure of fusion of (palatial shelves )

Oblique facial cleft arises due to failure of fusion of ( lateral nasal process and maxillary process )

Lateral facial cleft arises due to failure of ( maxillary process and mandibular process )

Median cleft of upper lip arises due to failure of fusion of ( both median nasal processes )

Question 7

Classify cleft lip (Veau system)

Answer 7

I. Unilateral incomplete
II : Unilateral complete
III : bilateral incomplete
IV : Bilateral complete

Complete cleft lip extends from lip -> alveolus between maxillary LI& C -> palate

Question 8

Classify Cleft palate ( Veau system )

Answer 8

I. Limited to soft palate and uvula only
II : Involving uvula , soft and hard palate , not further than incisive foramen
III : Involves uvula , soft and hard palate , incisive foramina and alveolar process
IV : Same as III but bilaterally

Question 9

Describe the clinical appearance of Micrognathia in the maxilla and mandible

Answer 9

Maxilla
I) Deficient middle 1/3rd of face
II) mouth breathing

Mandible
I) Severe retrusion of chin
II) deficient chin button
III) Steep mandibular angle

Question 10

Classify Micrognathia

Answer 10

1) True

2) Acquired : due to damage to TMJ exmp: from ankylosis , infection to mastoid , middle ear or TMJ

Question 11

Classify microdontia and macrodontia

Answer 11

1) True generalised microdontia / macrodontia

2) Relative generalised microdontia / macrodontia
- eg : small teeth in large jaws ( illusory effect )
- jaw size is hereditary hence consider heredity

3) Microdontia / macrodontia involving only a single tooth
- common teeth involved in microdontia are max . LI and 3rd molar
- eg : peg lateral
- macrodontia is rare , associated with hemifacial hypertrophy

Question 12

State the development defects of teeth according to size , number and shape

Answer 12

1) According to size
I) Microdontia
- eg peg lateral
II) macrodontia

2) According to number
- anodontia
- hypodontia
- oligodontia ( >6 teeth missing )
- hyperdontia ( distomolar , mesiodens , paramolar )

3) According to shape
I) Gemination ( 1 tooth attempts to split )
II) fusion ( 2 teeth join )
III) concresence ( 2 teeth fused through cementum only )
IV) dilaceration ( angulated / bent / curved root )

Question 13

The teeth which are frequently congenitally missing are the ( ………. ) , ( …………. ) & ( ……….)

Answer 13

The teeth which are frequently congenitally missing are the ( 3rd molars ) , ( maxillary LI ) & ( maxillary and mandibular 2nd PM)

Question 14

Gardner’s syndrome is characterised by clinical symptoms such as multiple osteomas of jaw , multiple polyposis of intestine , multiple epidermoid or sebaceous cyst of the skin ( esp scalp and back ) and ( …………… )

Answer 14

Gardner’s syndrome is characterised by clinical symptoms such as multiple osteomas of jaw , multiple polyposis of intestine , multiple epidermoid or sebaceous cyst of the skin ( esp scalp and back ) and ( impacted supernumerary and permanent teeth )

Question 15

Ascher syndrome is characterised by nontoxic goitre , blepharochalasia ( swelling of eyelids ) and ( ………………. )

Answer 15

Ascher syndrome is characterised by nontoxic goitre , blepharochalasia ( swelling of eyelids ) and ( double lip )

Question 16

Amelogenesis imperfects can be divided into 3 variants : hypoplastic , hypomaturation , hypocalcified

Hypoplastic variant is a ( ……………. ) defects .The enamel is ( ………… ) and ( …………………. ) radiographically

Hypomaturative and hypocalcified variant is a ( …………… ) defect . The enamel thickness is ( …….. ) and radiographically ( ………….. ) to the dentin

*** Hypomaturation + hypocalcified —> hypomineralised

Answer 16

Amelogenesis imperfects can be divided into 3 variants : hypoplastic , hypomaturation , hypocalcified

Hypoplastic variant is a ( quantitative ) defects .The enamel is ( thin ) and ( contrasts well against the dentin ) radiographically

Hypomaturative and hypocalcified variant is a ( qualitative ) defect . The enamel thickness is ( normal ) and radiographically ( identical ) to the dentin

*** Hypomaturation + hypocalcified —> hypomineralised

Question 17

Describe the clinical features of amelogenesis imperfecta ( hypoplastic , hypoclacified and hypomaturation variants )

Answer 17

Hypoplastic
1) Thin enamel but contrasts well against dentin radiographically
2) Teeth shaped like crown preps
3) Open contact points
4) Pitted surface
5) Color may be opaque white , yellow , brown

Hypomaturation
1) Normal enamel thickness but radiographically identical to dentin
2) Snow capping at incisal or occlusal 1/3rd of crown
3) Enamel chips and fractures easily but does not demonstrate massive loss on eruption

Hypocalcified
1) Normal enamel thickness , radiographically identical to dentin
2) Enamel has cheesy-like consistency which is soon after lost after eruption
3) Normal tooth shape but stains brown x black and exhibits rapid calculus apposition

Trichi-dento-osseus syndrome

Question 18

Mutation in the ( …………….) gene and the resultant mutant ( …………….. ) and (…………………… ) results in dentinogenesis imperfecta

Answer 18

Mutation in the ( dentin sialophosphoprotein ) gene and the resultant mutant ( dentin sialoprotein ) and ( dentin phosphoprotein ) results in dentinogenesis imperfecta

Question 19

Describe the clinical features of dentinogenesis imperfecta

Answer 19

1) Blue-brown discolouration with a distinctive translucence

2) Enamel easily separates from defective dentin and then the dentin undergoes accelerated attrition

3) Radiographically
- bulbous crowns
- thin roots
- cervical constriction
- Obliterated pulp chamber and root canals

4) Shell teeth
- some teeth have enlarged pulp chamber , extremely thin dentin but with normal enamel thickness

Question 20

Describe the clinical features of dentin dysplasia I

Answer 20

• also known as ‘ radicular dentin dysplasia ‘ / rootless teeth

-enamel & coronal dentin is normal

• radicular dentin is greatly affected leading to disorganisation and short roots
• teeth are very mobile and exfoliated easily
• radiographically , the pulp chamber may appears as small and crescent- shaped , absent root canals and dramatically shortened roots
• ‘ stream flowing around the boulders ‘ appearance in histological sections due to presence of whorls of tubular dentin and atypical osteodentin

Question 21

Describe the regional odontodysplasia

Answer 21

• “Ghost teeth” with very thin enamel and dentin , enlarged pulps with short roots and open apices —wispy appearance of teeth ( radiographically )
• affects contiguous teeth
• bimodal peak correlating to normal time of eruption of deciduous ( 2-4 yrs ) and permanent ( 7-11 ) dentition
• erupted teeth have have irregular crowns which are yellow- brown and have a very rough surface

Question 22

Describe dentin dysplasia type II

Answer 22

• also known as ‘coronal dentin dysplasia’
• deciduous teeth have similar appearance to DGI ( bulbous crown , obliterated pulps , short roots , cervical constriction , amber- brown translucence )
• permanent teeth appears normal clinically , but on radiograph the pulp is enlarged with apical extension ( thistle-tube / flame shaped )
• pulpal dysplasia also exhibits thistle tube / flame shaped pulp chambers but it is not related to DDII

Question 23

State the dental manifestations of congenital syphilis

Answer 23

1) Hutchinson’s incisors
- teeth that appears like screw drivers
- mesiodistal width is the largest at the middle 1/3rd of crown
- presence of a notch on the middle 1/3rd of incisal edge due to Hypoplasia of enamel

2 Mulberry molars

** Congenital syphilis —> Hutchinson’s teeth with interstitial keratitis
- Together with 8th nerves deafness they constitute Hutchinson’s triad

Question 24

The ideal concentration of fluoride in water fluoridation programs should be ( …………… )

Answer 24

The ideal concentration of fluoride in water fluoridation programs should be ( 0.7-1.2ppm )

Question 25

Describe about Stafne’s defect/ static bone cyst

Answer 25

• Stafne defect / static bone cyst associated with aberrant submandibular gland tissue posteriorly and sublingual gland tissue anteriorly
• Asymptomatic and develops at a later age
• Appears as a focal concavity of the cortical bone on the lingual surface of the mandible
• Well-circumscribed , sclerotic radiolucency present at the posterior mandible , below the mandibular canal between the molar teeth and the inferior angle of the mandible. Can interrupt the continuity of the inferior border of the mandible and manifest as a palpable notch
• Anterior lingual salivary defects associated with sublingual gland present as radiolucencies over the apices of anterior teeth.

Question 26

State the most commonly impacted teeth

Answer 26

1) 3rd molars

2) Maxillary canines

Question 27

State the risks of an impacted tooth

Answer 27

1) Crowding
2) Development of infections , cysts , tumors , caries
3) Damage to adjacent tooth via resorption
4) Pericoronitis

Question 28

Describe ankylosis , how it is occurs and it’s clinical significance

Answer 28

• It is the cessation of eruption after emergence
• It is due to fusion of cementum / dentin with the alveolar bone , absence of PDL space may be noted on radiography
• may be due to absence of PDL barrier , trauma , injury , chemical / mechanical irritation , defects in local metabolism or abnormal tongue pressure.

Clinical significance
- can lead to infraocclusion , causing the supraeruption of antagonist teeth & malocclusion
- it can lead to inclination of adjacent teeth twds the affected tooth
- can lead to impaction of succedaneous teeth
- can lead to localised deficiency of alveolar ridge
- complicate orthodontic movement

Question 29

Teeth present in the newborn at the birth are called ( ………… ) , teeth present within 30 days of birth are ( ………….)

Answer 29

Teeth present in the newborn at the birth are called ( natal teeth ) , teeth present within 30 days of birth are ( neonatal teeth )

Question 30

Describe the Riga-Fede disease

Answer 30

• ulcerations on the tongue or labial mucosa associated with presence of natal teeth
• can occur on the anterior ventral surface of the tongue if natal teeth are the mandibular incisor or anterior dorsal surface if the teeth are maxillary incisors
• occurs due to trauma to the tongue during breastfeeding

Question 31

Describe Turner’s Hypoplasia

Answer 31

• enamel Hypoplasia of single tooth
• occurs due to periapical inflammation or trauma of the deciduous tooth , leading to deformation of rhe succedaneous tooth
• enamel defects vary from focal areas of white , yellow or brown discolouration to extensive Hypoplasia which can involve the entire crown
• occurs frequently in permanent premolars because of their r/s to overlying deciduous molars

Question 32

Describe the Deans Index

Answer 32

Normal - smooth , glossy , pale creamy white translucent surface
Questionable - a few white flecks or white spots
Very mild - small opaque , paper white areas covering less than 25 % of the tooth surface
Mild - Opaque white areas covering less than 50% of the tooth surface
Moderate - All tooth surface affected ; marked wear on biting surface ; brown stain may be present
Severe - All tooth surface affected ; discrete or confluent pitting ; brown stain present

Question 33

List the development disturbance of tongue

Answer 33

1) Aglossia
2) Microglossia
3) Macroglossia
4) Fissured tongue / scrotal tongue / lingual plicata
5) Black hairy tongue / lingua nigra / Lingua villosa
6) Ankyloglossia
7) Crenated tongue
8) Median rhomboid glossitis
9) Benign migratory glossitis / geographic tongue / erythema migrans
10) Bifid tongue
11) Lingual thyroid
12) Lingual varix

Question 34

Microglossia is associated with ( ……………. ) syndrome

Answer 34

Microglossia is associated with ( oromandibular - limb - hypogenesis ) syndrome

Characterised by :
- hypodactylia ( absence of digits )
- hypomelia ( Hypoplasia of part or all of a limb )

Question 35

Macroglossitis / glossocele is associated with ( ………………….. ) syndrome , (…………………………………….)

Answer 35

Macroglossitis / glossocele is associated with ( Beckwith- Wiedemann ) syndrome , ( cretinism , Down’s syndrome , hemangiomas , hemihyperplasia , lymphangiomas , edentulousness , acromegaly , angiodedema , amyloidosis )

• other features of Beckwith-Wiedemann syndrome
  I) omphalocele
  II) gigantism
  III) Visceromegaly
  IV ) Neonatal hypoglycaemia
  V) increased risk of childhood visceral tumors ( adrenal carcinoma , Wilma tumors , hepatoblastoma …. )
  VI) Neveus flames of forehead
  VII) linear earlobe indentations
  VIII) maxillary Hypoplasia

Question 36

Fissured tongue is associated with ( ………………. ) syndrome

Answer 36

Fissured tongue is associated with ( Melkersson- Rosenthal ) syndrome

• Recurrent facial paralysis
• Swelling of lips

Question 37

Describe about hairy leukoplakia

Answer 37

• associated with EBV in patients suffering from HIV / immunocompromised
• white patches seen only on the lateral border of the tongue

Question 38

Describe about fissure tongue / scrotal tongue / lingua plicata

Answer 38

• benign condition , usually asymptomatic except for slight burning , soreness ( associated with trapped food debris )
• Fissures , grooves 2-6mm in depth seen on the dorsal surface of tongue
• strong genetic association with geographic tongue — GT has been suggested to cause fissured tongue
• a component of Melkersson- Rosenthal syndrome

Question 39

Describe about hairy tongue ( clinical features , sites )

Answer 39

• accumulation of keratin on the filiform papillae of the dorsal tongue , anterior to circumvallate papillae but sparing the anterior & lateral portions of tongue
• results in a hair-like appearance
• discolouration can be due to smoking , bismuth salicylate
• there is elongation & hyoerkeratosis of the filiform papillae

Question 40

List the types of exostoses and the areas they can occur

Answer 40

1) Buccal exostoses
- along the facial aspect of alveolar ridges

2) Palatal extoses / Palatal tubercles
- lingual aspect of maxillary tuberosities

3) Solitary exostoses
- wherever a bone graft is placed

4) Reactive subpontine exostosis
- develop Pontic of a posterior bridges

5) Torus palatines
- midline vault of hard palate

6) Mandibular torus
- lingual aspect of mandible

Question 41

Describe about erythema migrans / benign migratory glossitis / benign tongue / wandering rash of the tongue microscopically ( symptoms , site , description of lesion , ddx )

Answer 41

• benign condition of tongue
• usually asymptomatic , burning or sensitivity to spicy foods may be noted
• seen on anterior 2/3rds of dorsal tongue , especially at tip and lateral borders of tongue
• rarely on buccal , labial mucosa , soft palate , floor of mouth
• multiple erythematous , well demarcated zones surrounded by a white / yellow serpentine / scalloped border which appears in one area , heal then develop in another area
• erythema is due to atrophy of filiform papillae
• lesions develop as small white patches which enlarges centrifugally
• /3rd of pts with fissured tongue can develop erythema migrans
• ddx : erythoplakia , candidiasis

Question 42

Describe the microscopic / histopathological features of erythema migrans / geographic tongue / benign migratory glossitis

Answer 42

1) Neutrophil infiltration in the epithelium ( Munro abscess )
- maybe responsible for destruction of epithelium -> erythema

2) Hyperkerathosis

3) Spongiosis ( intercellular edema of epidermis )

4) Acanthosis ( thickening and widening of stratum spinosum )

• such features are common in psoriasiform hence e.migrans is also known as PSORIASIFORM MUCOSITIS

Question 43

Describe the median rhomboid glossitis / central papillary atrophy of tongue ( theories , clinical symptoms )

Answer 43

Theories
1) Related to erythematous candidiasis ( most probable )
2) Developmental defects - tuberculin impar fails to be covered by lateral process of tongue
3) Caused by inflammation

Clinical symptoms
- well demarcated , erythematous zone affecting the midline of posterior of dorsal tongue , anterior to foramen caecum
- can also appear at the soft palate — ‘ kissing lesion ‘ angles of mouth
- lesions appear reddish , symmetrical & surface maybe smooth or lobulated
- lesion resolve with anti fungals

Question 44

Describe and identity the lesions ( Crenated tongue )

Answer 44

• indentations of teeth on lateral margins of tongue
• due to abnormal tongue pressure , tongue thrusting habits
• associated with macroglossia
• asymptomatic

Question 45

Identify the lesion and describe its possible clinical symptoms ( Bifid tongue )

Answer 45

• due to fusion of lateral halves of tongue
• Mild form may just present as deep groove in midline
• Can result in trapping of food debris & halitosis , infections

Question 46

Identify and describe the lesion ( appearance , sites , ethology , treatment ) ( Sublingual varix )

Answer 46

• related to age ( common in >60 y) , rarely in children
• due to degeneration of CT which support the veins resulting in dilated veins

-appears as blue-purple , elevated or popular bless on the ventral & lateral border of tongue
- sometimes on low , buccal mucosa

• no treatment indicated
• solitary varicosities of lips & buccal mucosa can be removed surgically for confirmation of diagnosis or aesthetics
• H/F shows dilated vein , with little smooth muscle & poorly developed elastic tissue as well as lines of Zahn

Question 47

Identify the lesion and describe it ( clinical symptoms , site , treatment ) ( Lingual thyroid )

Answer 47

• commonly located at the posterior dorsal surface of tongue ( at foramen caecum )
• 4-7x more common in females , because of hormonal influence
• clinical symptoms include dysphagia , dysphonia , dyspnoea ( airway obstruction ) and hypothyroidism
• should not be biopsied as it may represent the only thyroid tissue in the patient
• If asymptomatic -> leave it be , If symptomatic -> give thyroid supplementations to reduce swelling , or remove surgically & transplant to another body sites
• rarely , carcinoma may occur

Question 48

The permanent teeth which are frequently congenitally missing are the ( …………….. ) , ( …………….. ) and ( ………………….. )

The decidous teeth which are frequently missing are the ( …………………….. )

Answer 48

The permanent teeth which are frequently congenitally missing are the ( 3rd molars ) , ( maxillary LI) and ( max & and mand 2nd PM )

The decidous teeth which are frequently missing are the ( mandibular incisor )

Question 49

State some syndrome associated with hypodontia

Answer 49

1) Down syndrome

2) Cleft lip / cleft palate

3) Ectodermal palate

4) Lacrimo-auriculo-dento-digital ( LADD )

5) Turner syndrome

6) Ehler’s Danilo’s syndrome

Question 50

Total anodontia is rare but is seen in association with ( ……………….)

Answer 50

Total anodontia is rare but is seen in association with ( hereditary ectodermla dysplasia )

Question 51

State the types of supernumerary teeth

Answer 51

1) Mesiodens
- b/w maxillary central incisor
- most common

2) Distomolar / 4th molar
- distal to 3rd molar
- 2nd most common

3) Paramolar
- buccal / lingual to the molars

Question 52

State the clinical features associated with cleft lip / palate

Answer 52

1) Respiratory difficulties
2) Nasal regurgitation
3) Speech difficulties
4) Missing teeth ( max LI)
5) Poor aesthetic -> psychological effect
6) van Dee Wounde syndrome
7) Pierre-Robin sequence

Question 53

State some cause of enamel Hypoplasia

Answer 53

1) Excess fluoride during tooth development
2) Turner’s Hypoplasia ( trauma , caries)
3) Congenital syphilis
- Hutchinson’s teeth , mulberry molars , interstitial keratitis , CN VII deafness
4) Nutritional deficiencies ( Vit D , Vit A , malnutrition , hypoclacemia )
5) Syndromes eg : amelogenesis imperfecta
6) Birth injuries
7) Rh disease
8) Premature delivery
9 ) Exanthematous delivery

Question 54

Describe how epithelial dysplasia is graded

Answer 54

1) Mild
- alterations / dysplasia features limited to the basal / parabasal layers

2) Moderate
- dysplasia features seen from basal layer up to mid-portion of spinous layer

3)Severe
- dysplastoc features seen from basal layer to a level above the midpoint of the epithelium

4) Carcinoma in situ- dysplasia involving the entire thickness of epithelium
- an important feature of CIS is absence of invasion — no metastasis

Question 55

Describe the clinical features of oral submucous fibrosis ( predilection , symptoms , site )

Answer 55

1) Young adult betel quid chewers

2) Common sites : buccal mucosa , retromolar area , soft palate

3) Trimus due to fibrosis
- normal : 3 fingers
- severe : <1mm , sometimes jaws may be inseparable

4) Stomatopyrosis ( mouth burning and intolerance to spicy food )

5) Blotchy ,marble-like pallor and stiffness of oral mucosa
-submucous fibrous bands are palpable

6) Tongue alterations
-devoid of papillae
- Decreased mobility
- Decreased tongue size

7) Betel chewer’s mucosa
- brown-red discolouration of oral mucosa with irregular surface which tends to desquamate

8) Vesicles , petechiae , Melanosis

9) Xerostomia

10) Betel quid lichenoid reactions
- white parallel wavy striae resembling OLP

11) tooth attrition , staining , periodontal disease

Question 56

Describe the etiopathogenesis of oral submucous fibrosis

Answer 56

Due to betel quid chewing which results in abnormal collagen metabolism

1) Component of are a nut -> fibrosis -> by inhibiting collagenase enzyme
2) Slaked lime contain alkaloids -> increase collagen production , and also increase permaebility of oral epithelium to the active ingredient
3) Copper (used in production ) upregulates lysyl oxidase -> increase resistance of collagen to degradation by collagenase
4) Tobacco -> Carcinogenesis , epithelial alteration

Growth factors , cytokines also promote fibrosis

Another theory ( not widely accepted )
- Capsaicin in chilli in spicy foods affects collagen metabolism

Question 57

Describe the histopathological features of oral submucous fibrosis

Answer 57

1) Juxtaepithelial and submucosal deposition of densely collagenized , hypo vascular CT with chronic inflammatory cells

2)Hyperkeratosis

3) Marked epithelial atrophy

4) Subepithelial vesicles

5) Betel chewers mucosa appears similar to morsicatio buccarum
- hyperparakeratosis with encrusted betel quid ingredients

Question 58

Vital staining of suspected dysplastic tissues can be done using ( ……………… ) and ( ……………… )

Answer 58

Vital staining of suspected dysplastic tissues can be done using ( Toluidine blue ) and ( Lugol’s iodine )

Chromoendoscopy
Lugol’s iodine -> lighter stained areas -> did not take up glycogen -> more dysplastic

Question 59

Describe the etiopathogenesis of oral lichen planus

Answer 59

• chronic , immunologic inflammatory mucocutaneous disorder
• autoimmune disorder in which auto-cytotoxic CD8 T cells trigger apoptosis of basal cells of oral epithelium
• Hep C virus may or may not be an etiologic factor in OLP

Question 60

Describe the clinical symptoms of oral lichen planus ( age , gender predilection , site , symptoms )

Answer 60

1) Occurs in middle aged adults ( 3rd - 5th decade ) , rare in children

2) Female predominance of 3:2

3) Skin lesions of lichen planus ( 4P)
- pruritic
- Polygonal
- purple
- papules

4) Sites : posterior buccal mucosa , tongue , gingiva , palate , vermillion border

5) If involving the gingiva : desquamative gingivitis

6) Reticular type OLP
- asymptomatic , unless there is superimposed candidiasis
- Wickham’s striae ( fine lace like network of white lines consisting of coalesced papules )
- lesions are not static but wax and wane over weeks or months
- Post-inflammatory melanosis esp in people of Color

7) Erosion type OLP
- symptomatic due to open sores , sensitivity to hot & cold , spice & alcohol
- atrophied erythematous areas with central ulceration with bordering fine , white radiating striae
- can lead to bulbous LP ( epithelial separation from underlying CT )

8) Plaque-type OLP
- on dorsal tongue
- appears as keratosis plaques with loss of papillae
- indistinguishable from leukoplakia

Question 61

State the types of Oral Lichen Planus

Answer 61

1) Reticular
- non symptomatic
- Wickham striae

2) Erosive
- symptomatic
- accompanied by central ulcerations on atrophic areas with peripheral white striae

3) Bullous type
- if the epithelial separation from the underlying CT
- a severe form of erosive OLP

4) Plaque
- on tongue
- indistinguishable from leukoplakia

Question 62

Describe the histopathological features of oral lichen planus

Answer 62

1) Hyperkerathosis
- maybe hyperorthokerathosis / hyperparakeratosis

2) Acanthosis

3) Sawtooth appearance of rete ridges

4) Basal cell layer degeneration ( hydropic degeneration )

5) Intense, band like infiltrate of T - lymphocytes below the epithelial layer ( in the superficial lamina propria )
- T cells at migrate into the epithelium itself

6) Presence of eosinophilic , degenerated keratinocytes ( Civatte / colloid / hyaline /cytokines bodies )

Question 63

State the types of benign and malignant fibrous neoplasms

Answer 63

Benign
1) Fibroma
2) Giant cell fibroma
3) Epulis Fissuratum / inflammatory fibrous hyperplasia
4) Denture papillomatosis / inflammatory papillary hyperplasia
5) Peripheral ossifying fibroma
6) Central ossifying fibroma
7) Peripheral giant cell granuloma
8) Central GC granuloma
9) Oral focal mucinosis
10) Myofibroma
11) Fibromatosis
12) Benign fibrous histocytoma

Malignant
1) Fibrosarcoma
2) Malignant fibrous histocytoma

Question 64

Giant cell fibromas appear clinically similar to fibromas , however on staining , they demonstrate ( …………………….. )

Answer 64

Giant cell fibromas appear clinically similar to fibromas , however on staining , they demonstrate ( large , Stellate ,-shape fibroblasts with multiple nuclei )
- rete ridges also appear narrower & elongated

Question 65

Describe the clinical feature of fibroma

Answer 65

Age : 4-5th decade of life

Seen at areas commonly exposed to trauma ( buccal mucosa , labial frenum — frenal tag ) examples : sharp teeth and cause trauma on oral mucosa

Asymptomatic

Smooth , modular mass which may be Pedunculated or sessile

May exhibit pigmentation depending on pt race

Differential Diagnosis : lipoma , giant cell fibroma , neuroma

Question 66

Describe the histopathological finding of fibromas

Answer 66

1) Nodular mass of fibrous CT ( densely collagenized ) covered by ssqe

2) Unencapsulated lesion , fibrous tissue blend into surrounding CT

3) Atrophy & flattening of rete ridges

4) Hyperkeratosis secondary to trauma

5) Chronic inflammation - presence of IF cells

Question 67

Describe the clinical features of epulis fissuratum ( inflammatory fibrous hyperplasia ) ( age group , site , appearance )

Answer 67

Population : denture wearers in which the denture is ill fitting

• More in Female
  Single / multiple folds of Hyperplastic fibrous tissue
• flange of denture fits conveniently between the 2 folds of tissue

-Variable size (<1cm -> involve whole of vestibule )
- Usually on facial aspect of alveolar ridges , sometimes lingual to mandibular alveolar ridges

Question 68

Talon cusp is associated with ( ……………….. ) syndrome

Answer 68

Talon cusp is associated with ( Taybi- Rubinstein ) syndrome

• condition characterised by short operate-severe intellectual disability , distinctive facial features & broad thumbs & first toes )

Question 69

Explain the conditions of inflammatory papillary hyperplasia / denture papillomatosis

Answer 69

• seen with poor denture hygiene using denture for 24h and I’ll fitting dentures

DDx : median rhomboid glossitis ( kissing lesions )

Question 70

Describe the clinical features and histopathological features of peripheral giant cell granuloma

Answer 70

• not true neoplasm — reactive lesion

C/F
- associated with plaque & calculus
- site : exclusively on gingiva , edentulous alveolar ridges
- red blue nodular , sessile / Pedunculated mass which may show ulcerations
- develop at any age

H/F
-presence of multinucleated giant cell
- background of plump ovoid , spindle shaped mesenchymal cells
- abundant haemorrhage -> hemosiderin pigment deposition
- Acute , chronic IF cells

Question 71

Describe the clinical features and histopathological features of peripheral ossifying fibromas

Answer 71

• reactive lesion
• relatively common
• some believe it is due to calcification of pyogenic granuloma ( DDx)

C/F
- age : teenager -> young adults ( peak between 10-19 )
- gender : F>M
- site : exclusively on gingiva
- nodular mass which is sessile / Pedunculated , pink red , surface usually ulcerated
- also associated with poor oral hygiene

H/ F :
- fibrous proliferation associated with deposition of mineralised product ( dystrophic calcification , bone , cementum-like material ) which appears as basophillic mass

Question 72

The malignant neoplasms which demonstrate herringbone pattern on histopathological examination is ( ……….. )

Other histopathological findings include : ( ……………………………………… )

Answer 72

The malignant neoplasms which demonstrate herringbone pattern on histopathological examination is ( fibrosarcoma )

Other histopathological findings include : (
i) dysplastic features ( Pleomorphism , frequent mitotic activity )
II) negative IHC markers except for vine tin and minimal smooth muscle actin )

Herringbone pattern : interlacting pattern of sheets of spindle shaped fibroblasts in a collagen background

Question 73

Describe the clinical & histopathological features of neuroma

Answer 73

• not a true neoplasm , but a reactive lesion due to damage to nerve bundle
• DDx : lipoma , fibroma

Clinical features :
- Age : Middle age
- Site : area over mental foramen , lower lip , tongue
- History of trauma ( extraction , surgery )
- Altered nerve sensations : anaesthesia , dysesthesia , overt pain

Histopathological Features
- haphazard proliferation of nerve bundles within a fibrous Ct stroma ( which may be densely collagen Ed or myxomatous in nature )
- mild chronic inflammatory cell infiltrates present

Question 74

Bilateral schwannomas of the auditory-vestibule nerve are a characteristics feature of the hereditary condition , ( …………………………………. )

Answer 74

Bilateral schwannomas of the auditory-vestibule nerve are a characteristics feature of the hereditary condition , ( neurofibromatosis type II)

Question 75

The characteristics histopathological finding of schwannomas / neurilemmomas are ( …………………………………………………)
(………………………………………………….)

Answer 75

The characteristics histopathological finding of schwannomas / neurilemmomas are
( Antoni A areas : Schwann cels arranged in a palisading pattern around central , acellular eosinophilic areas knows as Verocay bodies )

( Antoni B areas : spindle cels arranged in a haphazard manner within a loose , myxomatous stroma )

( IHC is positive for S100 protein )

Question 76

Neurofibromas are the most common type of ( ………………………. ) neoplasm

On histopath , it present as well-circumscribed , interlacing bundles of spindle cells with wavy nuclei. the cells are associated with collagen bundles & a myxoid matrix

A diagnostic features of neurofibroma is the presence of numerous ( ……………. )

IHC is positive for ( ……………..)

Answer 76

Neurofibromas are the most common type of ( peripheral nerve ) neoplasm

On histopath , it present as well-circumscribed , interlacing bundles of spindle cells with wavy nuclei. the cells are associated with collagen bundles & a myxoid matrix

A diagnostic features of neurofibroma is the presence of numerous ( mast cell )

IHC is positive for ( S100)

Question 77

State some clinical features neurofibromatosis type I and some oral manifestation

Answer 77

1) Elephantiasis neuromatosa
- small macular - > large soft nodules -> massive , baggy pendulous masses on skin

2) Cafe au lait pigmentation on skin

3) Freckles on axilla and intertriginous zones ( Crowe’s sign )

4) Lisch spots
- translucent brown pigmented spots on iris

Oral manifestations
I) Fungiform papillae
II) Enlargement of mandibular foramen
III) Enlargement , branching off mandibular canal
IV) increased bone density
V) Concavity of medial surface of ramus
VI) Increase in dimension of coronoid notch
VII) may mimic hemifacial hyperplasia

Question 78

( ……………………………… ) refers to Hyperplastic growths of granulation tissue that sometimes arises in healing extraction sockets

Answer 78

( Epulis granulomatosa ) refers to Hyperplastic growths of granulation tissue that sometimes arises in healing extraction sockets

• another name for pyogenic granuloma

Question 79

Pyogenic granulomas in pregnant women are known as ( ……………… )

Answer 79

Pyogenic granulomas in pregnant women are known as ( pregnancy tumor / granuloma gravidarum )

Question 80

State features of epithelial dysplasia

Answer 80

1) Increased N: C ratio
2) Hyperchromasia
3) Cellular and nuclear Pleomorphism
4) Basilar hyperplasia
5) Dyskeratosis ( premature keratinisation of individual cells )
6) Large , prominent nucleoli
7) Increased mitotic activity
8) Bulbous , tear drop rete ridges
9) Loss of polarity
10) Presence of keratin / epithelial pearls
11) Loss of typical epithelial cells cohesiveness

** Hyperkeratosis , Acanthosis are not features of dysplasia

Question 81

Describe the clinical features of pyogenic granuloma

Answer 81

• not related to infection but due it is an exuberant tissue response to local trauma or irritation
• associated with poor oral hygiene , gingival irritation and inflammation

C/F
- bleeds easily due to high vascularity
- smooth , lobulated mass which may be Pedunculated / sessile
- usually painless
# common sites : gingiva ( 75%) , lips tongue , buccal mucosa
- Common in children and pregnant women

Question 82

Describe the histopathological features of pyogenic granuloma / lobular capillary hemangioma

Answer 82

• presence of a highly vascular proliferation in lobules ( resembles granulation tissue )
• small and large endothelial-lined channels containing RBCs
• mixed IF cell infiltrate of neutrophils , plasma cells and lymphocytes
• older lesions -> fibrous appearance

Question 83

Identify Sturge - Weber syndrome & state it’s associated clinical features

Answer 83

• developmental condition associated with hamartomatous vascular proliferation involving tissue of face & brain
• due to failure of primitive Cephalic venous plexus to regress

1) Port- wine stain / flammeus nevus
-distribute unilaterally along 1 or more segments of CN V

2) gyriform ‘tramline’ calcifications

3) Leptomeningeal angiomas

4) Glaucoma

5) Gingival hyperplasia / massive hemangiomatous proliferation intraorally

Question 84

Intraoral lymphangiomas affecting the tongue may characteristics ( …………….. ) appearance resembling ( ………………………. )

Answer 84

Intraoral lymphangiomas affecting the tongue may characteristics ( pebbly ) appearance resembling ( frog eggs or tapioca pudding )

Question 85

Identify the lesion and state it’s associated conditions ( denture papillomatosis )

Answer 85

Seen with poor denture hygiene , using denture for 24h and I’ll fitting dentures

DDx : median rhomboid glossitis ( kissing lesion )

Question 86

Kaposi sarcoma is an unusual vascular neoplasm frequently associated with ( ……………….. )

It is caused by the ( ………………………………………….. )

The lesion most likely arises from endothelial cells

Answer 86

Kaposi sarcoma is an unusual vascular neoplasm frequently associated with ( HIV/AIDS )

It is caused by the ( human herpesvirus 8 ( Kaposi sarcoma associated herpesvirus KSHV) )

The lesion most likely arises from endothelial cells

Question 87

State the different presentations of Kaposi sarcoma

Answer 87

1) Classical
2) African
- benign nodular -> similar to classical type
- aggressive -> locally invasive
- Florid -> rapid progressive and widely disseminated lesion with visceral involvement & spares skin involvement

3) Iatrogenic / transplant associated

4) AIDS related

Question 88

Describe the histopathological features of Kaposi sarcoma

Answer 88

3 stages :
I) Patch stages
- proliferation of miniature vessels results in a jagged irregular vascular network

II) plaque stages
- further proliferation of vessels along with development of a spindle cell component

III) Nodular stage
- spindle cells increase -> nodular , tumor like mass resembling fibrosacroma
- numerous extravasated RBCs and slitlike vascular spaces seen

Question 89

State the diagnosis of the lesion ( Kaposi sarcoma- associated herpesvirus )

Answer 89

Kaposi sarcoma
- associated with HIV
- multiple bluish , purple Macule / plaques on skin lower extremities
- lesions grow slowly -> painless nodules
- present on palate , gingiva

DDx : amalgam tatto , melanoma , nevus

Question 90

The ( …………………….. ) variant of rhabdomyosarcoma has marked predilection for occurrence in the head and neck region and the most common variant of rhabdomyosarcoma.

It I seen in children and it dues to mutation in chromosome 11p15

Answer 90

The ( embryonal ) variant of rhabdomyosarcoma has marked predilection for occurrence in the head and neck region and the most common variant of rhabdomyosarcoma.

It I seen in children and it dues to mutation in chromosome 11p15

Question 91

State the clinical features of Gardner syndrome

Answer 91

1) Multiple of osteomas
2) Supernumerary and impacted teeth
3) Intestinal polyps
4) Epidermoid cyst

Question 92

Describe the radiographically features of osteosarcoma

Answer 92

1) Codman triangle
- triangular elevation of periosteum

2) Sunbrust periosteum reaction

3) Widening of PDL space

4) May be radiopaque ( if a lot of bone ) or radiolucent ( if little bone )

Question 93

The essential microscopic criterion for diagnosis of osteosarcoma is ( ……………………………. )

Answer 93

The essential microscopic criterion for diagnosis of osteosarcoma is ( production of osteoid by malignant mesenchymal cells )

Question 94

Describe the histopathological findings of osteoma

Answer 94

Presence of bone -> cancellous or cortical

If cancellous -> bone trabeculae + fibrofatty marrow

If compact -> minimal marrow tissue

Lesion is most often will circumscribed

Question 95

State the diagnosis of this lesion ( *refers to smoker palate / nicotine stomatitis / nicotine palatinus )

Answer 95

• associated with smoking but develops due to heat rather than chemicals esp pipe smoking
• similar changes also seen in association with long term use of hot beverages
• does not have potential for malignancy , unlike reverse smokers palate

Question 96

Describe the clinical features of squamous papillomas

Answer 96

1) Sessile / Pedunculated

2) Numerous papillary projections resembling cauliflowers

3) Depending on keratinization , may appear white , red or pink

4) Soft and painless

5) No gender predilection

6) Site : soft palate , hard palate , tongue

Question 97

State the etiological factors of these benign epithelial lesions :

1) Squamous papilloma : ( …………………………. )
2) Verruca vulgaris / common wart : ( ……………………… )
3) Condyloma accuminatum / venereal warts : (………………………. )
4) Focal epithelial hyperplasia ( Heck’s disease ) : ( ………………………. )
5) Molluscum contagiosum : ( ………………………….)
6) Verruciform xanthoma : ( ………………………………… )
7) Melasma / mask of pregnancy : ( ……………………………………. )
8) Kerathoacanthoma : ( ………………… )
9) Nevus

Answer 97

State the etiological factors of these benign epithelial lesions :

1) Squamous papilloma : ( HPV 6 ,11 )
2) Verruca vulgaris / common wart : ( HPV 2,4,6,40)
3) Condyloma accuminatum / venereal warts : ( HPV 2,6 ,11 , 16,18 , 53, 54 )
4) Focal epithelial hyperplasia ( Heck’s disease ) : ( HPV 13, 32 )
5) Molluscum contagiosum : ( molluscum contagiosum virus ( MCV) )
6) Verruciform xanthoma : ( unusual reaction , immune response to localised epithelial trauma )
7) Melasma / mask of pregnancy : ( increase in female hormones ( pregnancy , oral contraceptives ) , sun exposure )
8) Kerathoacanthoma : ( sun exposure )
9) Nevus

Question 98

Describe the histopathological features of squamous papilloma

Answer 98

1) Presence of koilocytes
- epithelial clear cell with pyknotic nuclei
- seen in spinous layer

2) Papillary projections of squamous epithelium

3) Hyperkeratosis

4) Fibrovascular CT core

Question 99

A rare complications of squamous papillomas are (……………………………… )

It includes 2 distinct types :
( …………………………………………..)

PRESENTING Features :
( ……………………………………. )

Risk factors :
(…………………………………………… )

Answer 99

A rare complications of squamous papillomas are ( recurrent respiratory papillomatosis ( RRP) )

It includes 2 distinct types :
( I) juvenile onset II) Adult onset )

PRESENTING Features :
( 1) Hoarseness 2) Airway obstruction -> death )

Risk factors :
( I) maternal history of genital warts during pregnancy )

Question 100

Molluscum contagiosum is caused by the ( …………………………… )

It may be sexually trasmitted in adults.
In children , clothes sharing , wrestling , swimming can transmit the virus.
The histological hall mark of Molluscum contagiosum is the presence of ( ………………………………………………. )

Answer 100

Molluscum contagiosum is caused by the ( Molluscum contagiosum virus ( MCV))

It may be sexually trasmitted in adults.
In children , clothes sharing , wrestling , swimming can transmit the virus.
The histological hall mark of Molluscum contagiosum is the presence of ( Molluscum bodies / Henderson - Paterson bodies ( intranuclear , basophillic inclusion bodies ) )

Question 101

Differential diagnoses for keratoacanthoma include ( ………………………. ) ( clinically ) and ( ………………………….. ) ( histopathologically )

Answer 101

Differential diagnoses for keratoacanthoma include ( basal cell carcinoma ) ( clinically ) and ( squamous cell carcinoma ) ( histopathologically )

Question 102

Describe the clinical features of keratoacanthoma ( site , gender predilection , age , appearance , etiology , associated syndromes )

Answer 102

-site : sun - exposed skin ( vermillion border of lips )

• M>F
• age : > 45 yrs
• appearance : firm , well-demarcated , sessile , dome-shaped nodule with central plug of keratin
• grows , remains stationary and eventually regresses — benign lesion
• etiology : sun exposure , HPV 26 &37 , burns , tattoo , tar exposure , immunosuppression , BRAF inhibitors , TK inhibitors , trauma.
• associated syndromes : Muir - Torre syndrome , Ferguson- Smith syndrome m Witten-Zak syndrome , Grzybowski syndrome , Xeroderma pigmentosum

Question 103

Describe the histopathological features of keratoacanthoma

Answer 103

1j Dyskeratosis of keratin cells

2) Presence of keratin pearls

3) Surface epithelium at edge of tumor is normal but a characteristics Acute angle ( buttress) is formed between the overlying epithelium and lesion

4) Keratin filled crater

5) Downwards proliferation of epithelium ( but does not extend beyond level of sweat glands / into underlying muscle )

Question 104

Classify nevi and describe their histopathological appearance

Answer 104

1) Intramucosal / intradermal
- theques ( rounded nest ) of nevus cells arranged within the CT ( not near the junctional areas)

2) Junctional
- theques of nevus cells arranged at the junctional area b/w epithelium & CT ( at basilar region of epithelium , at the tips of rete ridges )

3) Compound
- theques of nevus cells arranged both at the junctional area within the CT

4) Blue
- nevus cells are located within the CT but not in the theques , instead they are arranged parallel to the overlying epithelium.

Question 105

Differential diagnosis for nevi in the oral cavity are ( ………………… )

Answer 105

Differential diagnosis for nevi in the oral cavity are ( amalgam tattoo , melanoma )

Question 106

( …………………………. ) nevus can occasionally undergo malignant to melanoma

Answer 106

( Junctional ) nevus can occasionally undergo malignant to melanoma

Question 107

The diagnosing features of verruciform xanthoma is ( ……………………………………………………… )

Answer 107

The diagnosing features of verruciform xanthoma is ( accumulation of numerous , large macrophages with foamy cytoplasm which are typically confined to the CT papillae ( xanthoma cells )

Question 108

Describe melasma /mask of pregnancy /chloasma

Answer 108

• appearance of acquired , symmetrical , light - dark brown cutaneous Macule ( hyperpigmentation ) in adult women
• influenced by hormones ( pregnancy , oral contraceptives ) and sun exposure
• also cosmetics , anti epileptic drugs , HRT , thyroid disorder , phototoxic meds
• usually on mid face , forehead , upper lip , chin — rarely arms
• occurs bilaterally

Question 109

A characteristics features of multifocal epithelial hyperplasia ( Heck’s disease ) is the presence of ( ……………………….. )

Answer 109

A characteristics features of multifocal epithelial hyperplasia ( Heck’s disease ) is the presence of ( mitosoid cells and koilocytic changes )

Mitosoid cells — cells with an altered nucleus that resembles a mitotic figures

Question 110

Describe the histopathological features of oral squamous cell carcinoma

Answer 110

Border’s grading
I) grade I / well differentiated
- keratin pearls
- islands of malignant sake invading into CT
- hyperchromatic nuclei
- increased mitosis

II) Grade II / moderately differentiated
- tumors produce little or no keratin but epithelium still recognisable as stratified squamous
- more anaplastic features

III) grade III / poorly differentiated / anaplastic
- tumors produce no keratin
- cells have little resembles to ssqe
- lacks of normal architectural pattern
- loss of cohesiveness
- extensive dysplastic features

Question 111

Describe the histopathological features of BCC

Answer 111

1) Islands of basal cells carcinoma with a peripheral layer of palisaded cells and a central area of uniform basal & parabasal cells which invade into the underlying CT

2) Basal cells appears more blue as they take up hematoxylin stain due to increased mitosis

3) Cleft separating the basiloid cells fro the CT stroma
- retraction artefact

Question 112

Describe the clinical features of BCC and its types ( site , risk factors , metastasis , occurrence )

Answer 112

-most common skin cancer

• site : only on sunexposed skin , 70% cases on H&N region ( never intraoral )
• age : 40x79
• risk factors : fair skin / Caucasian , UV exposure ( tanning bed , sunlight )
• never / extremely rarely metastasize
• types :
  I) noduloulcerative
• firm , painless papules which enlarges & ulcerates
• edge of ulcer -> rolled border
• Telangiectasia
• can cause destruction of underlying tissue — rodent ulcer