dental

Question 1

1. Dental inclusion and root ankylosis

Answer 1

Dental inclusion
Definition: Tooth eruption is halted before its emergence on the alveolar ridge. The tooth is surrounded by bony tissue and is unable to erupt.
Etiology:
Lack of parallelism between the tooth bud and the eruption axis
Ectopic position of the tooth bud
Gingival fibromatosis, tumors, cysts on the eruption tract
Pathology:
- Position of the included tooth’s axis
Vertical
Oblique (mesio – angular, distal – angular)
Horizontal
Inverted
Complications:
Dental «crowding»
Resorbtion of the roots of neighbouring teeth
Changes in the eruption order and in the position of neighboring teeth
Inflammation in the involved region
Development of a dentigerous cyst
Included teeth with complications and clinical manifestations must be surgically removed!!

Radicular ankylosis
Definition: Tooth eruption is halted after its emergence on the alveolar ridge. Bony union of the radicular surface of a tooth to the surrounding alveolar bone in an area of previous partial root resorption.
It occurs in the first two decades of life
Microscopy:
! Fusion between cementum and the alveolar bone with the disappearance of periodontal structures
Etiology:
Idiopathic
Hereditary
Macroscopy:
The incisal margins and occlusal surfaces of the ankylosed teeth are located below the level of adjacent teeth: sub-occlusion.
Diagnosis Rx:
Disappearance of the alveolar ligament
Complications:
Adjacent teeth lean towards the ankylosed one
The antagonist tooth (from the opposite arcade) develops excessively
Bone fractures in case of extraction – previous diagnosis of ankylosis is required

Question 2

2. Dental transposition and ectopy

Answer 2

Transposition
Growth of a tooth in the place of another one on the same arch, and vice versa.
E.g.: the first molar in the place of the second molar

Ectopy
Development of teeth outside the dental arches.
Examples:
Supranumerary teeth
Included in gingiva, the mental protuberance, soft palate and in the spheno-maxillary fissure
Sometimes normal teeth with abnormal location

Question 3

3. Hypodontia and anodontia

Answer 3

Hypodontia/Partial oligodontia
Absence of a few teeth . Less than five for hypodontia and more than 6 for partial oligoodntia. 
Differiential Diagnosis
Frequently hereditary origin
Frequently associated with MICRODONTIA

Anodontia/agenesis/total oligodontia
Total absence of teeth.
Rare; since birth.
Frequently a part of HEREDITARY ECTODERMAL DYSPLASIA

Question 4

4. Hyperdontia (mesiodens, paramolar and distomolar)

Answer 4

Hyperodontia
The number of teeth is higher than normal
AD,
Associated with MACRODONTIA

MESIODENS= most common supernumary tooth, located in the maxilla’s midline.
90% of supranumerary teeth
Between the central superior incisors (75%)
PARAMOLARS= Paramolar is a supernumerary molar usually small and rudimentary, most commonly situated buccally or palatally to one of the maxillary molars.
The fourth molar/DISTOMOLAR/distodens= supernumary tooth in a distal position in relation to the third molar

Question 5

5. Hypercementosis

Answer 5

HYPERCEMENTOSIS = Hypercementosisis anidiopathic, non-neoplasticcondition characterized by the excessive buildup of normalcementum(calcified tissue) on the roots of one or more teeth.
Growth lines which are parallel to the root
Increases with age – especially in the apical region in order to compensate for the occlusal damage.

Question 6

6. Dilaceration

Answer 6

DILACERATION = Dilacerationis a developmental disturbance in shape of teeth. It refers to an angulation, or a sharp bend or curve, in the root or crown of a formedtooth.
Increased curvatures or angulations of the roots or of root-crown junctions
Causes :
Traumas during root formation:

Question 7

7. Germination/Fusion

Answer 7

GERMINATION/FUSION
Large teeth with two crowns, more or less separated or fused = tooth with doubled dimensions
GERMINATION = Incomplete division (cleavage) of a tooth bud→ two crowns, common root. The divided (double) tooth is considered as a single one→ the number of teeth is normal.
FUSION = Fusion between the dentin of two adjacent tooth buds→ two fused crowns on one or two roots.
Causes: traumatc crowding, lack of space

Question 8

8. Concrescence

Answer 8

CONCRESCENCE = Reuniting of the roots of two already formed adjacent teeth. Exclusive through cementum, the dentin remaining distinct
Etiology: 
Growth disturbances 
Trauma 
Hypercementosis caused by chronic inflammation
Deep caries
Open root canals
Periapical inflammatory lesions

Question 9

9. Dental invagination and taurodontism

Answer 9

DENS INVAGINATUS = «dens in dente» = Invagination of the dental crown in the pulp chamber or the root pulp (radicular dens invaginatus). The outer surface folds inwards.
Fusion of two dental buds
Enamel – towards inside
Dentin – towards outside
DENS IN DENTE
It opens through a very prominent dental cingulum (foramen caecum), with a hypomineralized enamel.
Consequences:
Acummulation of food, microbial plaque at the opening => caries, pulpitis, pulp necrosis – quickly

TAURODONTISM = is a condition found in themolar teethof humans whereby the body of the tooth andpulpchamber is enlarged vertically at the expense of the roots.
Very large pulp chamber
The neck diameter of the tooth is larger than normal
+ The root division is placed lower, close to the apex
Diagnosis Rx
Three types:
Hypotaurodontism
Mesotaurodontism (moderate)
Hypertaurodontism (severe)

Question 10

10. Amelogenesis imperfect: hypoplastic A.I.

Answer 10

HEREDITARY ENAMEL DYSPLASIAS!! = AMELOGENESIS IMPERFECTA (A. I.)
Ectodermal anomaly – dysfunction of the adamantine organ (of the ameloblasts)
It doesn’t involve the dentin (mesodermal origin)
Genetically inherited: AD (most frequent), AR, X-linked
Involves the enamel of all the teeth
HYPOPLASTICA.I. – two forms:
ENAMEL APLASIA:
The teeth which remain included are often resorbed
If the teeth erupt:
No enamel deposits (Rx)
Covered with dentin
Yellow-brown colour
Rough surface
ENAMEL HYPOPLASIA:
Reduced production of protein matrix
Normal degree of mineralization

Question 11

11. Secondary enamel dysplasia: Turner hypoplasia (local infection), dental trauma, fluorosis, congenital syphilis

Answer 11

TURNER HYPOPLASIA !!!
Definition: Hypoplastic enamel on the crown of a permanent tooth due to the periapical inflammation of the subjacent temporary tooth!!!

TRAUMAS:
= Enamel hypoplasia in a permanent tooth, when the subjacent temporary tooth is traumatized

FLUOROSIS: developmental disturbance of dental enamel caused by excessive exposure to high concentrations offluorideduringtooth development.
Excess of fluorine → Enamel hypomaturation → increased porosity

CONGENITAL SYPHILIS
Spirochetes enter the fetal circulation after the 16th week of intrauterine life – after formation of tooth buds
Involves only the permanent dentition

Question 12

12. Dentinogenesis imperfecta

Answer 12

DENTINOGENESIS IMPERFECTA = Dentinogenesis imperfecta(DI) is agenetic disorder (AD)oftooth development. This condition is a type of dentin dysplasia that causesteethto be discolored (most often a blue-gray or yellow-brown color) and translucent giving teeth an opalescent sheen.[1]Teeth are also weaker than normal, making them prone to rapid wear, breakage, and loss.

Question 13

13. Enamel caries: white plaque, cavitary lesion

Answer 13

Enamel 95% of hydroapatite – very hard tissue. Due to the action of proteolytic enzymes and cariogenic acids > succession of demineralization and remineralization phases. The enamel caries start below the bacterial plaque. Plaque… strep lactob…
Cavitary lesion due to a slow dissolution of the enamel, along the prisms and the interprismatic areas.

Question 14

14. Dentin caries

Answer 14

DENTIN CARIES:
Secondary to enamel caries (coronal caries) or cementum caries (cervical caries)
Evolves more rapidly
Large amount of organic substances in the dentin -30%
Dentin is injured
Initially by the bacterial cariogenic acids
Different bacterial species than the ones for enamel:
Role of anaerobes (lactobacilli) is more important
Later, bacteria penetrate the dentinal tubules
As a result, the organic component is demineralized and then liquefied
Dentin caries are cone shaped, with the tip pointing towards the pulp chamber
LAYERS:
NECROTIC (surface)
INFECTED / AFFECTED
SCLEROTIC (DEEP)

Question 15

15. Internal and external resorbtion

Answer 15

RESORBTION= Loss of dental tough subtance on the surfaces which are not exposed to the outside.
In contact with the pulp region (crown, roots)
In contact with the periodontal ligament (roots)

INTERNAL RESORBTION:
Rare
Causes: 
Pulp traumas
Pulpitis secondary to caries
Pulpotomy
Starts in the pulp and evolves towards the surface of the cementum or the crown => until it produces a communication between the pulp and the periodontal space or the external surface of the crown

EXTERNAL RESORBTION:
Much more frequent
Starts at the surface of the tooth, in contact with the periodontal ligament

Question 16

16. Acute reversible and irreversible pulpitis

Answer 16

REVERSIBLE PULPITIS (PULP HYPEREMIA): Reversible pulpitis is generally characterized by sharp sensitivity to cold, sometimes to sweets and sometimes to biting.
The initial stage of pulp inflammation
Closed
Partial – the tissue zone is expanded only a little
Aseptic
Acute
Causes:
Deep, but closed caries
Large, incorrect metallic obturations
Evolution:
Healing after the disappearance of irritant factors
Towards a total acute pulpitis if the agression persists

ACUTE IRREVERSIBLE PULPITIS: Irreversible pulpitis is generally characterized by prolonged sensitivity to cold and/or heat, and sometimes to sweets. Swelling may be present.
Etiopathogenesis:
Exacerbation of a reversible pulpitis by opening the pulp chamber

Question 17

17. Chronic pulpitis and the pulp polyp

Answer 17

CHRONIC PULPITIS:
Can appear directly, spontaneously
After an acute pulpitis, when the pus is drained through the carious orifice

CHRONIC HYPERPLASTIC PULPITIS (PULP POLYP): Apulp polyp, also called as Chronic Hyperplastic Pulpitis, is found in an opencarious lesion, fracturedtoothor when adental restorationis missing. Due to lack of intrapulpal pressure in an open lesionpulpnecrosisdoes not take place as would have occurred in a closed caries case.

Question 18

18. Periapical granuloma

Answer 18

PERIAPICAL GRANULOMA
(CHRONIC APICAL PERIODONTITIS) = Aperiapical granulomais a mass of chronically inflamedgranulation tissuethat forms at the apex of the rootof anonvital(dead) tooth. However, a periapical granuloma does not containgranulomatous inflammation, and therefore is not a truegranuloma.
Etiology:
Apical defense reaction to the presence of bacteria and their toxins in the root canal

Question 19

19. Apical periodontal (radicular) cyst

Answer 19

APICAL PERIODONTAL CYST = APICAL RADICULAR CYST = Theperiapical cyst(also termedradicular cyst, and to a lesser extentdental cyst) is the most commonodontogeniccyst. It is caused bypulpalnecrosissecondary todental cariesortrauma. The cyst lining is derived from thecell rests of Malassez. Usually, the periapical cyst is asymptomatic, but a secondaryinfectioncan causepain.

Question 20

20. Periapical abscess

Answer 20

PERIAPICAL ABSCESS (ACUTE PERIAPICAL PERIODONTITIS) = collection of pus usually caused by an infection that has spread from a tooth to the surrounding tissues.
Well delimited purulent inflammation located at the apex of a tooth
EVOLUTION:
DRAINAGE OF PUS TOWARDS THE GINGIVA:
FISTULIZATION→ the symptoms disappear

Question 21

21. Acute gingivitis, acute ulcero-necrotic gingivitis

Answer 21

ACUTE GINGIVITIS = 
Initial form of a periodontopathy  
The acute nature is established by the intensity of the local irritation: 
Sulcular plaque  
The patient’s immune resistance 

ACUTE ULCERATIVE NECROTIC GINGIVITIS (AUNG)= Acute necrotizing ulcerative gingivitis is a common, non-contagious infection of the gums with sudden onset. The main features are painful, bleeding gums, and ulceration of inter-dental papillae. In the early stages some patients may complain of a feeling of tightness around the teeth. Three signs/symptoms must be present to diagnose this condition: Severe gingival pain, Profuse gingival bleeding that requires little or no provocation, Interdental papillae areulceratedwithnecroticslough

Question 22

22. Chronic gingivitis

Answer 22

HRONIC GINGIVITIS = gingivitis is a non destructive periodontal disease.
An inflammatory process of reduced intensity, without symptoms
Elderly people
Causes:
A. From the start
Defective hygiene – chronic accumulation of bacterial plaque
Mechanical and chemical irritation
B. Evolution of an acute gingivitis
C. Down syndrome, diabetes mellitus, increased progesterone levels (pregnancy)

Question 23

23. Drug induced gingival hyperplasia and gingival fibromatosis

Answer 23

DRUG RELATED GINGIVAL HYPERPLASIA = Drug-related gingival hyperplasiais a cutaneous condition characterized by enlargement of the gums noted during the first year of drug treatment.[1]There are three drug classes that are associated with this condition namely, anticonvulsants (such as phenyotoin and phenobartibal), calcium channel blocker( such as amlopidine, nifedipine and verapamil) and cyclosporine, an immunosuppressant.

Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth.[1] HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva. It can cover teeth in various degrees, and can lead to aesthetic disfigurement.[2] Fibrous enlargement is most common in areas of maxillary and mandibular tissues of both arches in the mouth.

Question 24

24. Adult chronic periodontitis

Answer 24

ADULT CHRONIC PERIODONTITIS = Chronic periodontitisis a commondiseaseof theoral cavityconsisting ofchronicinflammationof theperiodontal tissuesthat is caused by accumulation of profuse amounts ofdental plaque. Redness + bleeding, gum swelling, halitosis, gingival recession, deep periodontal pockets, loose teeth.
The most frequent cause of dental loss

Question 25

5. Lateral periodontal abscess and acute pericoronitis

Answer 25

LATERAL PERIODONTAL ABSCESS = is a localized collection of pus (i.e. anabscess) within the tissues of the periodontium. It is a type of dental abscess. Complication of a chronic periodontitis Cause: Closure of the periodontal pocket in the superior gingival region Inside the closed pocket: Foreign bodies can be found  Fish bones, food Bacteria multiply, sometimes even change their composition Pus is formed = lateral abscess of the root ACUTE PERICORONITIS Inflammation located around the crown of a partially erupted tooth The third permanent molar, especially the mandibular one The pain: Appears during swallowing Radiates in the neck, ear and floor of the mouth Prevents the opening and closure of the mouth General signs: fever, altered general status, leukocytosis, enlarged lymph nodes

Question 26

26. Clefts of the upper lip and the palate

Answer 26

PPER LIP AND PALATE CLEFTS Deff: UPPER LIP CLEFT (ULC) = Lack of joning of the intermaxillary and median nasal buds with the lateral nasal and maxillary buds Location of the cleft – laterally It also involves the alveolar bone and sometimes the nostril ``` PALATE CLEFT (PC) = Lack of joining in the palatal processes of the maxillary buds It also involves the palate in a secondary fashion ``` UPPER LIP MEDIAN CLEFT: Rare Caused by the total lack of the philtrum From the intermaxillary bud

Question 27

27. Malformations of the tongue

Answer 27

MALFORMATIONS OF THE TONGUE AGLOSSIA = missing tongue or underdeveloped Exceptionally rare The lingual papillae are on the mouth’s floor Sometimes – incompatible with life MICROGLOSSIA = abnormal smallness of the tongue Rare Small, rudimentary tongue ``` MACROGLOSSIA = unusually large tongue. The most frequent causes HEMANGIOMA Lingual LYMPHANGIOMA A lot of dilated vascular channels scattered over the surface FACIAL HEMIHYPERTROPHY TYPE I NEUROFIBROMATOSIS CONGENITAL HYPOTHYROIDISM (myxedema) DOWN SYNDROME SECONDARY MACROGLOSSIA: Amyloidosis Myxedema Acromegaly Angioedema Tumors In the newborn: Noisy breath, difficult suckling In childhood: Difficulties in pronouncing lingual consonants ``` ANKYLOGLOSSIA : Rare (2-3/10.000) The lingual frenulum is short, thick and is inserted until the tip of the tongue When it interferes with speech, surgical removal is necessary BIFID TONGUE (LINGUAL CLEFT) = Anomaly of the first branchial arch - mandibular bud Lack of median joining of the lingual buds Anatomical and clinical forms Two tongues A deep fossette on the dorsal surface Inside the fossette food rests accumulate → inflammation (glossitis) Intermediate situations

Question 28

28. Benign migratory glossitis

Answer 28

BENIGN MIGRATORY GLOSSITIS (GEOGRAPHIC TONGUE) = is an inflammatory condition of the mucous membrane of the tongue, usually on the dorsal surface. It is a common condition, affecting approximately 1–3% of the general population. It is characterized by areas of smooth, red depapillation (loss of lingual papillae), which migrate over time. The name comes from the map-like appearance of the tongue, with the patches resembling the islands of an archipelago

Question 29

29. Herpes stomatitis (HSV-1 infection)

Answer 29

Gingivostomatitis (also known as primary herpetic gingivostomatitis or orolabial herpes) is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection. It is of greater severity than herpes labialis (cold sores), which is often the subsequent presentation. Primary herpetic gingivostomatitis is the most common viral infection of the mouth. HSV-1: The most frequent viral infection of the oral mucosa Involves the oral cavity, lips, pharynx, eyes, the skin of the upper body

Question 30

30. Ulcero-necrotic stomatitis

Answer 30

ULCERATIVE NECROTIC STOMATITIS (gangrenous, noma) = Very severe SPECIAL MICROBIAL FLORA : Anaerobic bacteria (Fusobacterium nucleatum, Borelia vincenti, Prevotella intermedia) Staphylococcus aureus Streptococcus PATHOLOGY: Oral ulcerative necrotic lesions, which are extensive, deep and mutilating Can expand around the mouth, nose, orbit

Question 31

31. Oral candidosis

Answer 31

PSEUDOMEMBRANOUS CANDIDOSIS = Acute pseudomembranous candidiasis is a classic form of oral candidiasis,[6] commonly referred to as thrush. It is characterized by a coating or individual patches of pseudomembranous white slough that can be easily wiped away to reveal erythematous, and sometimes minimally bleeding mucosa beneath.[7] These areas of pseudomembrane are sometimes described as "curdled milk",[4] or "cottage cheese".[7] The white material is made up of debris, fibrin, and desquamated epithelium that has been invaded by yeast cells and hyphae that invade to the depth of the stratum spinosum.[4] APPEARS in: Newborns, Malnourished infants Adults: HIV infection, antibiotics, chemotherapy, radiotherapy, leukemia Debilitated older people LOCATION: jugal mucosa, dorsum of the tongue, palate, oropharynx ANATOMIC - CLINICAL: MACRO: White, soft, creamy aspect (like coagulated milk) They are adherent, but can be easily removed by friction or scraping The underlying mucosa is normal or erythematous Rarely with hemorrhage (in anticancer treatment) EVOLUTION : Acute After antibiotic treatment Chronic Depressed immunity ERYTHEMATOUS CANDIDOSIS = Erythematous (atrophic) candidiasis is where the condition appears as a red, raw-looking lesion. ACUTE ATROPHIC CANDIDOSIS: After antibiotic treatment (tetracycline, topical treat.) Rare today (because of the addition of antifungal drugs to antibiotic treatment) Burns (like the ones which appear after a hot drink) Macroscopy: Diffuse loss of filiform papillae on the dorsal surface of the tongue → red depapillated tongue GENERALIZED CANDIDOSIC ERYTHEMA  : In xerostomia (Sjögren syndrome) FOCAL CANDIDOSIC ERYTHEMA  : In HIV seropositive patients Red spots on the dorsum of the tongue, soft and hard palate CENTRAL PAPILLARY ATROPHY : (median rhomboid glossitis) Initially considered a malformation Chronic evolution, without symptoms Macroscopy On the median line of the dorsum of the tongue, posterior region A red, swollen, rhomboid, well delineated area The surface is smooth or lobulated Loss of filiform papillae PROSTHESIS CANDIDOSIS : On the palate – in case of a total prosthesis or a dental plate with prolonged usage (rarely removed for cleaning) Under the plate: reaction to Candida or other microorganisms Macroscopy: Erythema, edema and petechiae on the palate – well delineated at the edge of the prosthesis Minimal clinical signs If it is resistant to treatment – associated iron deficiency anemia CHRONIC HYPERPLASTIC CANDIDOSIS (candidal leukoplakia) = The most common appearance of hyperplastic candidiasis is a persistent white plaque that does not rub off. Controversial Leukoplakia + secondary Candida infection Leukoplakia produced by Candida Disappears after antifungal treatment Macroscopy White plaque which cannot be removed by scraping, of variable thickness and irregular aspect Dorsum of the tongue, on the retro commissural region in the oral mucosa Floor of the mouth, ventral tongue ANGULAR STOMATITIS (CHEILITIS) = is inflammation of one, or more commonly both,[7] of the corners of the mouth. It is a type of cheilitis (inflammation of the lips). Angular cheilitis often represents an opportunistic infection of fungi and/or bacteria, with multiple local and systemic predisposing factors being involved in the initiation and persistence of the lesion.[4][8] Such factors include nutritional deficiencies,[1] overclosure of the mouth,[9] dry mouth,[1] a lip-licking habit,[9] drooling,[7] immunosuppression,[10] and others, such as the wearing of poor fitteddentures or syphilis ``` 20% Candida albicans / 60% Candida albicans+ Staphylococcus aureus / 20% Staphylococcus aureus Etiopathogenesis : accumulation of saliva infected with Candida Associated with : Pseudomembranous Candidosis Rhomboid median glossitis Prosthesis stomatitis Chronic hyperplastic Candidosis Macro (clinical) : Erythema Fissures Squames ```

Question 32

2. Complications of oral and dental inflammatory lesions

Answer 32

OMPLICATIONS OF ORO-DENTAL INFLAMMATORY PROCESSES DISSEMINATION OF MICROORGANISMS IN SOFT TISSUES : CELLULITIS : Definition: acute, edematous, non suppurative expansion of an oro-dental inflammatory process in soft tissues ANATOMY and CLINICAL: The region is swollen, with red and warm skin EVOLUTION : Healing Suppuration   Abscess LUDWIG’S ANGINA: Def. : suppurative evolution of a cellulitis in the submandibular space Fast laterocervical and mediastinal expansion Direct pathway from the mouth’s floor to the mediastinum through the anatomical laterocervical regions of the neck BONE DISSEMINATION : OSTEOMYELITIS SINUS DISSEMINATION PURULENT SINUSITIS BLOOD DISSEMINATION OF THE MICROORGANISMS : SEPTICEMIA : Septic endocarditis, meningitis, encephalitis CAVERNOUS SINUS (DURA MATER) THROMBOPHLEBITIS : Infections of maxillary teeth – dissemination through the pterygoid venous plexus Infections of the upper lip and the face – dissemination through the angular, facial and ophthalmic veins

Question 33

33. Minor and major aphts

Answer 33

PYOGENIC GRANULOMA = is a vascular lesion that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors. DEF. : A pseudotumor produced due to irritation and trauma in the presence of a special oral microbial flora More frequent In children, adolescents and pregnant women Appears in the first semester of pregnancy, grows until birth and then decreases in size = PREGNANCY TUMOR ``` GIANT CELL PERIPHERAL GRANULOMA (EPULIS WITH MYELOPLAXES) DEF. : Gingival pseudotumor due to a deep gingival irritation PREDISPOSING FACTORS : Dental extraction, dental fracture Periodontal treatments Irritation given by prostheses Chronic infections EVOLUTION : Slowly, towards fibrosis ```

Question 34

35. Leukoplakia and erythroplakia

Answer 34

``` LEUKOPLAKIA = normally refers to a condition where areas of keratosis appear as firmly attached white patches on the mucous membranes of the oral cavity. Leukoplakia in the mouth (oral leukoplakia), is defined as "a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion". MACROSCOPICAL FORMS : THIN (MINIMAL) LEUKOPLAKIA: GRANULAR (NODULAR) LEUKOPLAKIA: VERRUCOUS LEUKOPLAKIA: VERRUCOUS PROLIFERATIVE LEUKOPLAKIA : ``` ERYTHROPLAKIA (de Queyrat) = is a clinical term to describe any erythematous (red) area on a mucous membrane,[2]that cannot be attributed to any other pathology ``` MICRO : 90% of cases: Invasive carcinoma, in situ carcinoma, severe dysplasia (superficial multifocal carcinoma) 10% of cases : Minimal dysplasia Red color : ```

Question 35

6. Anatomo-clinical forms of oral cancer

Answer 35

``` CARCINOMA OF THE LIP: The most frequent Ulceration >1cm, 12-16 months old Location : Lower lip, M Upper lip, F ``` CARCINOMA OF THE TONGUE : 40% of all oral cancers (without the lips) Nodule or painless ulceration Location : 2/3 on the posterior margin 20% on the anterior-lateral and ventral surfaces of the tongue 4% on the dorsal surface of the base of the tongue (on syphilitic lesions) The ones at the tongue base – the most malignant ``` MOUTH FLOOR CARCINOMA : 35% of oral cancers Growing frequency in women Predisposing factors : Leukoplakia, erythroplakia Secondary neoplasm ``` CARCINOMA OF THE CHEEK MUCOSA: 15% of oral cancers At or under the occlusion line from the molar region Rapidly metastasizing ``` GINGIVAL, ALVEOLAR CARCINOMA: 10% of oral cancers Location : posterior mandible On an area of keratosis In the beginning : Can mimic a dental inflammation ``` PALATE OR OROPHARYNX CARCINOMA: Tonsillar region, posterior palate, base of tongue

Question 36

37. Spreading of oral cancer

Answer 36

SPREADING OF ORAL CANCER INVASION OF ADJACENT TISSUES : Invasion !!! Under the tongue mucosa between muscle bundles, with a posterior orientation (difficult to detect during surgery) In the mylohyoid and hyoglossus muscles (of the mouth floor) : much more rare In the submandibular space or behind the mylohyoid muscles –posterior tumors (of the glossotonsillar sulcus)  PERINEURAL INVASION  : Rare in the case of squamous carcinoma Usually along the mandibular nerve Invasion and expansion takes place along the nerve tract in both directions (cranial and distal) Most frequent → intracranial expansion of the tumor VASCULAR INVASION: Invasion of lymph vessels - correlates with lymph node metastases Invasion of the internal jugular vein – is not correlated with hematogenous metastases Arteries – are rarely invaded, because of their elastic tissue ``` BONE INVASION : Facilitated by : Inferior dental canal Incisive foramen, palatine foramen More frequent in the mandible ``` LYMPH NODE METASTASES : Difficult to appreciate clinically : A large lymph node is not necessarily involved by metastases and a normal sized lymph node may contain metastases !! Location: Cancer of the tongue, mouth floor, alveolar ridge : metastases on the same side in submandibular, jugulodigastric and middle deep cervical lymph nodes Cancer of the retromolar trigone : submandibular, jugulodigastric, middle and superior deep cervical and parapharyngeal lymph nodes Cancer of the lips and tip of the tongue : submental and submandibular lymph nodes Cancer of the median line (lips, mouth floor, tongue): bilateral cervical lymph nodes

Question 37

38. Xerostomia

Answer 37

``` XEROSTOMIA  DEFINITION: Decreased or absent secretion of saliva → dry mouth syndrome CAUSES : Salivary gland aplasia Atresia/Obstruction of salivary ducts Aging Excessive smoking Oral breathing Radiation Sjögren syndrome (autoimmune) HIV infection Dehydration FAVORS : Oral candidosis Ascending infections of salivary glands (sialadenitis) Frequent and rapidly evolving caries, periodontitis, dental loss in both dentitions ```

Question 38

39. Mucocele

Answer 38

MUCOCELE : CYSTIC LESION OF OBSTRUCTIVE ORIGIN: Characteristic for minor salivary glands, rarely in major ones MUCOCELE DUE TO EXTRAVASATION : Def: retention of saliva in the surrounding connective tissue due to a traumatic rupture of the excretory canal of a salivary gland, which is: Minor Or major – in the case of ranula

Question 39

0. Sialolithiasis

Answer 39

SIALOLITHIASIS At all ages, more frequent in adults Formation of small « stones », called calculi or sialoliths, inside the salivary ducts 70-90% - submandibular glands Rare – parotid, sublingual or minor glands Deposits of Ca COMPLICATIONS : Obstruction → retention of saliva → favors ascending infection and CHRONIC SCLEROSING

Question 40

41. Necrotizing sialometaplasia

Answer 40

NECROTIZING SIALOMETAPLASIA Benign destructive lesion which favors macroscopical and microscopical confusion with a squamous carcinoma In minor salivary glands 75% in the posterior hard palate, 2/3 of the lesions are unilateral Rarely – in lips, retromolar area of the tongue, parotid (8%), nose, maxillary sinus, larynx PATHOGENESIS : Local ischemia by trauma, injections in the dental region, maladapted prostheses, neighboring cysts and tumors, surgical procedures, allergy

Question 41

42. Inflammation of salivary glands

Answer 41

INFLAMMATION OF SALIVARY GLANDS NOMENCLATURE: sialadenitis (inflam. of the gland), sialoangiitis (infl. of the ducts) ACUTE POSTOPERATIVE PAROTIDITIS Rare, in adults, unilateral/bilateral (20-25%) At 2-20 days after surgery, with fever, trismus After prolonged open mouth surgery – e.g. dental extraction EVOLUTION : Can fistulize to the skin Can spread around the pharynx towards the mediastinum Can cause thrombosis of the superior longitudinal sinus in the dura mater CHRONIC SCLEROSING SIALADENITIS: CAUSES : sialolithiasis In adults, more frequent in males MACROSCOPY/CLINICAL Swelling and recurrent pain in a gland Usually the submandibular gland, which has an increased volume and is tough – called KÜTNER’S TUMOR MICROSCOPY : In easy/medium cases : Periductal and intralobular inflammation, with a moderate acinar atrophy In severe cases : Acinar destruction with fibrous replacement + ductal ectasia  

Question 42

3. Glandular cheilitis

Answer 42

is characterized by progressive enlargement and eversion of the lower labial mucosa that results in obliteration of the mucosal-vermilion interface. With externalization and chronic exposure, the delicate lower labial mucous membrane is secondarily altered by environmental influences, leading to erosion, ulceration, crusting, and, occasionally, infection.

Question 43

44. Pleiomorphic adenoma

Answer 43

PLEIOMORPHIC ADENOMA (mixed tumor of the salivary glands) = is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland.

Question 44

45. Warthin’s tumor

Answer 44

WARTHIN’S TUMOR = is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers. Its etiology is unknown, but there is a strong association with cigarette smoking. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population 4-11% of salivary gland tumors Exclusively in the parotid, the second most frequent tumor of the parotid EVOLUTION : Benign Sometimes the lymphoid component can become malignant → lymphoma A carcinoma may develop on this tumor

Question 45

46. Mucoepidermoid carcinoma

Answer 45

MUCOEPIDERMOID CARCINOMA = Mucoepidermoid carcinoma is the most common type of salivary gland malignancy in adults. Mucoepidermoid carcinoma can also be found in other organs, as bronchi, lacrimal sac [1] and thyroid. Presents as painless, slow-growing mass that is firm or hard. Most appear clinically as mixed tumors. This tumor is not encapsulated and is characterized by squamous cells, mucus-secreting cells, and intermediate cells.

Question 46

47. Adenoid cystic carcinoma

Answer 46

ADENOID CYSTIC CARCINOMA (formerly called cylindroma) = Adenoid cystic carcinoma (AdCC) is a rare type of cancer that can exist in many different body sites. It most often occurs in the areas of the head and neck, in particular the salivary glands. This tumor is generally well-differentiated and slow growing. ``` 3-10% of salivary gland tumors 70% in minor glands 30% in major glands (especially the submandibular, where it is the most frequent malignant tumor) MACRO : Painful nodule First mobile, then fixed EVOLUTION : Metastasis : rare and late ```

Question 47

48. Coronoid hyperplasia, torus palatinus and torus mandibularis

Answer 47

CORONOID HYPERPLASIA = Coronoid hyperplasia is a rare condition which is macroscopically characterized by an increase in the dimensions of the coronoid process resulting from an abnormal bony elongation of histologically normal bone. Unilateral cases are more frequent than bilateral ones and can recognize a number of etiological factors, such as exostoses, osteochondroma, traumatic events, inflammatory reactions, neoplasia. CLINICAL : the hyperplastic coronoid process presses on the zygomatic bone and prevents the opening of the mandible, which deviates towards the lesion Progressive limitation in opening of the mouth TORUS PALATINUS = is a bony protrusion on the palate. Palatal tori are usually present on the midline of the hard palate.[1] Most palatal tori are less than 2 cm in diameter, but their size can change throughout life. TORUS MANDIBULARIS = is a bony growth in themandible along the surface nearest to the tongue. Mandibular tori are usually present near the premolars AND above the location of the mylohyoid muscle's attachment to the mandible.

Question 48

9. Osteoradionecrosis

Answer 48

OSTEORADIONECROSIS = is a condition of nonvital bone in a site of radiation injury. ORN can be spontaneous, but it most commonly results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury. 5-13% of the people with head and neck radiation therapy Dose : 4000-8000 R Latency : months → years Yellowish, with sequestrums (fragments of necrotic bone inside the bone marrow), hemorrhage ± osteomyelitis (infection of bone and its marrow)

Question 49

50. Rickets

Answer 49

RICKETS = Rickets is defective mineralization of bones before epiphyseal closure in immature mammals due to deficiency or impaired metabolism of vitaminD, phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries. Maxillary prognathism, ogival hard palate Mandible like a boxer Teeth : Temporary incisors and canines : microdontia Both dentitions : late eruption, in an abnormal order Permanent teeth developed in the first two years of life: enamel and dentin hypoplasia

Question 50

51. Cherubism

Answer 50

CHERUBISM = Cherubism is a rare genetic disorder that causes prominence in the lower portion of the face. AD, starts in infants Involves Mandibular angle, in a symmetrical manner : chubby aspect In severe cases, also the upper jaw - symmetrical

Question 51

2. Acute suppurative and chronic osteomyelitis

Answer 51

CUTE SUPPURATIVE OSTEOMYELITIS = Osteomyelitis is an inflammatory reaction of bone to infection which originates from either a tooth, fracture site, soft tissue wound or surgery site. The dental infection may be from a root canal, a periodontal ligament or an extraction site. Suppurative osteomyelitis can involve all three components of bone: periosteum, cortex, and marrow. Acute osteomyelitis is similar to an acute primary abscess in that the onset and course may be so rapid that bone resorption does not occur. MACROSCOPY/CLINICAL : Pain, trismus, fever, altered general condition Redness and swelling of soft tissues EVOLUTION : if it’s not quickly and radically resorbed – it becomes chronic CHRONIC SUPPURATIVE OSTEOMYELITIS : Follows an acute osteomyelitis Sometimes directly On and off evolution (remissions and recurrences with sequestrum discharge): 20-25 years

Question 52

53. Dentigerous cyst and eruption cyst

Answer 52

DENTIGEROUS (FOLICULAR) CYST = A dentigerous cyst or follicular cyst is an odontogenic cyst - thought to be of developmental origin - associated with the crown of an unerupted (or partially erupted) tooth. The cyst cavity is lined by epithelial cells derived from the reduced enamelepithelium of the tooth forming organ. Histologically a normal dental follicle is lined by enamel epithelium, whereas a dentigerous cyst is lined by non-keratinized stratified squamous epithelium. ERUPTION CYST = an eruption cyst, or eruption hematoma, is a bluish swelling that occurs on the soft tissue over an erupting tooth. It is usually found in children.

Question 53

54. Nasopalatine and nasolabial duct cyst

Answer 53

NASOPALATINE DUCT CYST = The nasopalatine duct cyst (abbreviated NPDC) occurs in the median of the palate, usually anterior to first molars. It often appears between the roots of the maxillary central incisors. It is usually asymptomatic, but may sometimes produce an elevation in the anterior portion of the palate. ``` Rare Age: 40-60 , M>F On the median line of the anterior maxilla Variants : Nasopalatine cyst Incisive canal cyst Median palatine cyst Palatine papilla cyst Median alveolar cyst No symptoms ``` NASOLABIAL DUCT CYST = This nasolabial cyst, also known as a nasoalveolar cyst, is located superficially in the soft tissues of the upper lip. Unlike most of the other developmental cysts, the nasolabial cyst is an example of an extraosseous cyst, one that occurs outside of bone. Rare In soft tissues : rests of nasolacrimal canal

Question 54

5. Ameloblastoma

Answer 54

AMELOBLASTOMA = is a rare,benign tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. While these tumors are rarely malignant or metastatic, and progress slowly, the resulting lesions can cause severe abnormalities of the face and jaw. The most frequent odontogenic tumor (equal to all the others combined)

Question 55

56. Odontoma

Answer 55

ODONTOMA = An odontoma is a benign tumour[1] of odontogenic origin (i.e. linked to tooth development).[2] Specifically, it is a dentalhamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way. Dental tissue hamartomas (malformations) Contain denticles with a normal proportion between enamel, dentin and pulp 10-20 years old More frequent in the maxilla (anterior) than in the mandible (posterior) COMPOUND ODONTOMA = A compound odontoma still has the three separate dental tissues (enamel, dentin and cementum), but may present a lobulated appearance where there is no definitive demarcation of separate tissues between the individual "toothlets" (or denticles). It usually appears in the anterior maxilla. COMPLEX ODONTOMA = The complex odontoma is unrecognizable as dental tissues, usually presenting as a radioopaque area with varying densities. It usually appears in the posterior maxilla or in the mandible. Osteosarcoma is the most common histological form of primary bone cancer. It is most prevalent in children and young adults.

Question 56

57. Osteosarcoma

Answer 56

STEOSARCOMA = Osteosarcoma is a cancerous bone tumor. Specifically, it is an aggressive malignant neoplasm—arising from primitive transformed cells of mesenchymal origin (and thus a sarcoma)--that exhibits osteoblastic differentiation and produces malignant osteoid. Osteosarcoma is the most common histological form of primary bone cancer. It is most prevalent in children and young adults.

Question 57

8. Malformations of the temporomandibular joint

Answer 57

``` MANDIBULAR CONDYLE APLASIA = Rare Uni/bilateral Unilateral Facial asymmetry Malocclusion When the mouth opens, the mandible deviates towards the involved side ``` ``` HYPOPLASIA OF THE MANDIBULAR CONDYLE  : CONGENITAL : Mandibulofacial dysostosis Oculoauriculovertebral syndrome Hemifacial microstomia SECONDARY : Trauma Irradiation Arthritis Uni/Bilateral Less prominent signs than in the case of aplasia ``` ``` HYPERPLASIA OF THE MANDIBULAR CONDYLE  : ETIOLOGY : Respiratory, endocrine disturbances Trauma Proliferative osteomyelitis Macro: Prognathism Deviation towards the healthy side Facial asymmetry Malocclusion Sometimes: compensatory enlargement of the maxilla ```

Question 58

9. Traumatic lesions of the TMJ

Answer 58

LUXATION : Dislocation of the TMJ The condyle’s head is displaced forward, above the articular eminence Blocks movements of the mandible Cannot be reduced voluntarily (in case you succeed, you actually get a subluxation) Causes: Sudden and very wide opening of the mouth : FRACTURES OF THE MANDIBULAR CONDYLE : Traumatic Limitation of mandibular movement, pain, swelling At the condyle’s head or neck The head is in the cavity or anterior and median to it (infra-temporal) Neglected fractures --> facial deformities LESIONS OF THE ARTICULAR MENISCUS : Produced by a malocclusion Starts suddenly after a trauma (ex. wide opening of the mouth) Pain in the TMJ, ears, teeth and paresthesia in the tongue A slight coarse sound Blockage with the mouth closed ANKYLOSIS : permanent blockage of the joint

Question 59

60. Rheumatoid arthritis of the TMJ

Answer 59

RHEUMATOID ARTHRITIS = Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that primarily affects joints.[1] It may result in deformed and painful joints, which can lead to loss of function. Chronic synovitis which leads to ankylosis

Question 60

34. Pyogenic granuloma, giant cell peripheral granuloma

Answer 60

PYOGENIC GRANULOMA = is a vascular lesion that occurs on both mucosa and skin, and appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors. DEF. : A pseudotumor produced due to irritation and trauma in the presence of a special oral microbial flora More frequent In children, adolescents and pregnant women Appears in the first semester of pregnancy, grows until birth and then decreases in size = PREGNANCY TUMOR ``` GIANT CELL PERIPHERAL GRANULOMA (EPULIS WITH MYELOPLAXES) DEF. : Gingival pseudotumor due to a deep gingival irritation PREDISPOSING FACTORS : Dental extraction, dental fracture Periodontal treatments Irritation given by prostheses Chronic infections EVOLUTION : Slowly, towards fibrosis ```