Finals Flashcards
Periapical abscess
Clinical:SPT/non-vital
Rad: widened PDL + PA RL
Hist: central core necrosis + fibrous CT w/ inflm cells
Tx: RCT/exo
Periapical granuloma
Clin: asym/ non-vital
Rad: loss of LD/ PA RL
Hist: inflm granulation tissue, dense inflm infiltrate, cholesterol clefts, extravasated RBC, hemosiderin
Radicular cyst
Clin: non-vital
Rad: loss of PDL, apical RL
Hist: non-K SSE, inflm infiltrate, cholesterol cleft, giant cells, Rushton bodies
Tx: RCT, exo
Acute suppurations osteomyelitis
Clin: mostly Md, swelling, sig sensitivity, paresthesia, lymphadenopathy, fever
Rad: ill defined RL in bone, may have RO of necrotic bone
Hist: non-vital bone, bacterial colony, inflm cells
Tx: surgical
Fibroepithelial Polyp
Clin: occurs anywhere, asym
Hist: modular mass of CT; may be inflm or hyperK
Tx: excision
Epulis Fissuratum
Clin: F>M, associated with denture; ulcerated, may have papillary component
Hist: ulcer, inflm infiltrate, hyperK, may have osseous or chondromatous hyperplasia
Tx: excision
Pyogenic granuloma
Clin: red, reactive, bleeds easily, painless; associated with pregnancy
Hist: CT, vascularized, inflm, granulation tissue, often ulcerated
Tx: excision; 15% recurrence
Peripheral giant cell granuloma
Clin: only on gingiva, nodular mass, mostly middle age female, clinical feature similar to PG
Hist: giant cells, mesenchymal cells in the background, hemorrhage, may be ulcerated, sometimes reactive bone
Tx: excision down to bone, 10% recurrence
Peripheral ossifying fibroma
Clin: only on gingiva, mostly young women, ant mx
Hist: giant cell, mineralized product
Tx: excision down to periosteum, 10% recurrence
Inflammatory papillary hyperplasia
Clin: palate, red, pain, papillary, mostly under denture
Hist: papillary projection, inflm cells, hyperplastic SSE, elongate rete ridges, hyperplastic CT,
Reasons for hyperplastic gingivitis
Hormone status, drug, calculus
Drug induced = not real hyperplasia, just more CT
- can be treated with folic acid and metronidazole+azithromycin
Radicular cyst
Clin: asym, non-vital
Rad: PA RL, common root resorption
Hist: SSE, inflm cells, Hyaline bodies
Tx: RCT, exo
Residual cyst
Everything same as radicular cyst but without teeth
Dentigerous cyst
Clin: asym
Rad: RL around crown, attached to CEJ
Hist: Fibrous CT wall, cords of odontogenic epi, thin epi cells, epi and CT interface is flat
Tx: nucleation and exo
Eruption cyst
Soft tissue counter part of dentigerous cyst
- everything is the same except no tx needed
Dental lamina cyst of the new born
Proliferating rests of serres
KERATINIZED EPI
OKC
Clin:mostly post Md, asym
Rad: Multicoluar, expansion
Hist: wavy epi, thin CT wall, flat interface between CT and epi, palisading basal cell, hyperchromatic basal cell, paraK,
Tx: excision, high recurrence
Goblin Golts clinical
Multiple OKC Falx cerebri, bifid ribs Eyes apart Palmar pits on palm and soles Risk for basal cell carcinoma Autosomal dominant
Lateral periodontal cyst
Clinical: asym, mostly Md PM
Rad: beside root, RL, corticated, unicystic
Hist: Glycogen rich clear cells, focal plaque on epithelium
Tx: enucleation
Note: gingival cyst of adult = soft tissue version of lateral periodontal cyst
COC
Clin: mostly anterior to 1M, asym
Rad: unilocular, RL rim with RO interior, displacement
Hist: mineralization, ghost cell; odontogenic epi similar ameloblast w/ stellate reticulum
Tx: enucleation
Buccal bifurcation cyst
Clin: buccal expansion, asym, arise when molars are erupting (young pt)
Rad: RL around molar furcation
Hist: SSE, inflm infiltrates; possible hyaline bodies, cholesterol cleft, mucous cell in epi
Tx: enucleation
Nasopalatine duct cyst
Clin: asym, near nasopalatine area
Rad: radiolucency around U1, well defined, displacement
Hist: BV,N; ciliated columnar/cuboidal/SSE
Tx: enucleation
Lymphoepithelial cyst
Clin: around Waldeyer ring or lateral tongue or FOM, yellow superficial submucosal mass, asym
Rad: none
Hist: lymphoid tissue, para-K SSE
Tx: excision
Dermoid cyst
Clin: midline soft tissue cyst, teratoma; mostly FOM
Rad: none
Hist: orthoK SSE, dermal appendages; lumen filled with keratin and sebum
Tx: excision
Simple bone cyst
Clin: mostly post MD, just cavity within bone, biopsy needed unless signs of healing
Rad: scalloped boarder, rarely any effect on surrounding structure
Hist: none
Tx: none
Stafne bone defect
Clin: under IAN; concavities in the bone surface
Mucous retention pseudocyst
Focal thickening of mucosa lining of Mx sinus
Dome-shaped, non corticated RO in sinus
Tx: none
Conventional ameloblastoma
Clin: locally aggressive, expansion; 20yo+; post Md, painless
Rad: multilocular, expansion, resorption, displacement, septa; well defined and corticated
Hist: fibrous stroma, islands of ameloblast-like lining with central stellate reticulum; palisading and reverse polarity of ameloblast-like cell, cystic degeneration
Tx: resection; 15% recurrence
Note: could be from basal cells of oral mucosa, rests of dental lamina, developing enamel organ, or lining of odontogenic cyst
Unicystic ameloblastoma
Clin: younger pt, painless
Rad: unilocular, pericoronal
Hist: fibrous stroma with odontogenic epi; lumina/intralumina/mural
Tx: local curettage and Carnoy’s solution; 10% recurrence
CEOT (calcifying epithelial odontogenic tumour)
Clin: asym, post Md
Rad: corticated, RO/RL, displacement and expansion
Hist: CALCIFICATION WITH CONCENTRIC RING; fibrous CT, INTERCELLULAR BRIDGES + AMYLOID
Tx: resection
AOT (adenomatoid odontogenic tumour)
Clin: painless
Rad: corticated, pericoronal, attaches lower to CEJ, RO/RL
Hist: duct like structure; whorled masses of spindle shaped cells; Nuclei away from central space; calcification common
Tx: resection
Ameloblastic fibroma
Clin: young male (0-20); post Md, coronal to developing tooth; asym
Rad: well defined, RL; may expand cortex and inhibit eruption
Hist: cell-rich mesenchymal tissue like dental papilla with proliferating island, odontogenic epi palisading at periphery
Tx: excision
Ameloblastic fibro-odontoma
Clin: asym, associated with unerupted tooth
Rad: basically ameloblastic fibroma with RO
Hist: AF with calcification
Tx: excision
Odontoma compound
Clin: Ant Mx, asym
Rad: corticated with RL capsule
Hist:multiple tooth shaped
Tx: excision
Odontoma complex
Clin: posterior Mx/Md
Rad: irregular masses of calcified tissue
Hist: mature tubular dentin Admixed with dental pulp and enamel matrix - no order
Tx: excision
Odontogenic myxoma
Clin:posterior Md
Rad: multilocular, tennis racquet septa; may scallop; no expansion; loosen teeth but no resorption
Hist: haphazardly arranged stellate cells
Tx: curettage or wider excision; 25% recurrence
Odontogenic fibroma
May have hard tissue
For peripheral OF, 50% recurrence
Cementoblastoma
Clin: PAIN
Rad: wheel spoke appearance of root expansion, attached to root; RO; root absorption and expansion
Hist:fusion of the lesion to root, GIANT CELLS PRESENT, sheets of mineralized material
Gardner syndromes SS
Multiple osteoma
Multiple dense bone islands
Multiple supernumerary teeth
Multiple intestinal polyps (may need prophy resection to prevent colon cancer)
Giant cell lesions (6)
Peripheral giant cell granuloma Central giant cell granuloma Cherubism Brown tumour Aneurysmal bone cyst Fibrous dysplasia
Central giant cell granuloma
Clin: red, Md before 1M, <30 yo
Rad: well defined but no cortication, multilocular with septa, expansion, displace, resorption
Hist: giant cells, blood, vascularization, granular tissue
Aneurysmal bone cyst
Clin: post Md (very rare, should be bottom of DDx)
Rad: looks like CGCG (expansion, displacement, absorption, well defined but no cortication, RL, septa)
Hist: cellular, blood filled spaces, giant cells
Cherubism
Clin: bilateral expansion, autosomal dominant, 10yo, expose inferior sclera
Rad: bilateral expansion, RL with septa, epicentre = posterior Md, displace teeth, radiographic signs persist after involution
Langerhan cells histiocytosis
Clinical: appears like parulis, Md>Mx; occurs in children
Rad: well defined periphery, ice cream scoop shaped, teeth look floating, RL; no displacement and resorption
Hist: lots of eosinophils and langerhan cells
Birbeck granules in electron microscopy
Fibrous dysplasia
Clin: young ppl, Mx expansion, can displace IAN canal upward; also displace teeth, encroachment of Mx sinus
Rad: different patterns (ground glass/cotton wool/amorphous/ orange peel)
Hist:irregularly shaped trabeculae, few OB, no OC, no OB rimming of bone
Tx: cosmetic contouring
Cemento-osseous dysplasia
Clin: middle age women, ant md, vital teeth, asym
Rad: RL -> RO; well defined rim; multilocular
Hist: irregular trabeculae, fibrous stroma; cementum-like particles
Tx: none
Oral Squamous papilloma
HPV, solitary, painless
Tx: leave it or excision
Verruca vulgaris
Wart, also HPV
Common in skin but not oral cavity
Usually children and contagious
Condyloma acuminatum
HPV 16
Genital warts, STD, multiple
Hist: koilocytes
Acquired melanocytic nevus
Mole
Common, produce melanin
Junctional/compound/intramucosal
Upward maturation
Schwannoma (Neurilemoma)
Usually uncommon but most occur on H/N; painless
Spindle cells
Antoni A (with verocay body) and Antoni B
Neurofibroma
Cafe Au lait
May be component of neurofibromatosis type 1
- common, autosomal dominant, mutation of tumour suppressor gene that codes for neurofibromin
Granular cell tumour
Clin: dorsal tongue mostly
Hist: pseudoepitheliomatous hyperplasia, granular cells
Hemangioma
Hamartomas of infancy; mostly H/N
Dx: diascopy
Vascular malformation - port wine stain
Sturge-Weber Angiomatosis
Encephalotrigeminal angiomatosis - non-hereditary developmental condition
Unilateral vascular malformation (brain and face)
- facial port wine stain, neurological complication, intra-oral involvement
Hereditary hemorrhagic telangiectasia
Autosomal dominant
Lesions on skin/oral/other mucosa (epistaxis and GI bleeding)
Arteriole venous malformation in brain/lung/liver
- pulmonary hypertension, brain abscess, portal hypertension
- biliary disease, heart failure
- problem with shunting blood
Lymphangioma
Hamartomas of lymphatic vessels
Mostly congenital and H/N