Images, etiologies, and treatments (random order) Flashcards

Question

**Hemophilia A & dental treatment**

Answer 1

▪ Partial thromboplastin time (PTT), prothrombin time (PT), bleeding time (BT) and platelet counts, as well as consultation with physician, should be done prior to any dental treatment ▪ (PT is like INR, Normal INR between 0.8 and 1.2) ▪ Clotting factor replacement therapy (synthetic) given as indicated ▪ Avoid aspirin

Answer 2

**Newest is Gardsail 9** against many types for both men and women ▪ 2 doses recommended for boys/girls age 11‐12 and 6mo later ▪ Recommended for everyone \<26yo (MAX) ▪ NOT recommended for 26+yo unless risk for new infections (less benefit since most already exposed) ▪ Virus like particles (VLP) of L1 capsid protein present in vaccine Results of Vaccination ▪ Drops in infections w/ HPV types that cause most HPV cancers + genital warts in teen girls, young adult women ▪ Among vaccinated women – cervical precancers dropped by 40%

Answer 3

Gingival Cyst of the Adult

Answer 4

Overall: 6.9% (CI 6.7‐8.3) ▪ Gender: **Men (10.1%) \> Women (3.6%) – women clear faster** ▪ Age: **bimodal distributio**n – 30‐34yo and 60‐64yo (she says 30‐34 but Dr. Kerr’s graph shows mid‐20s ▪ High Risk HPV (3.7%) \> Low risk HPV (3.1%) ▪ **HPV‐16 infection most prevalent** (1% or 2.13 million Americans) ▪ Based on NHANES study w/ oral rinse sampling and PCR

Answer 5

‐ Repair sharp teeth/restorations ‐ Remove plaque ‐ Optimize lubrication Ulcer

Answer 6

**Primary Oral TB** tongue ulceration

Answer 7

Leukoedema of the buccal mucosa. Laskaris,

Answer 8

* *A**. It can either be _the cyst totally within bone_ * *B**. It can actually cause _widening of the orifice and causing the soft tissue expansion in this way_

Answer 9

**Vulvovaginitis** a type of candidiasis

Answer 10

a medical CT scan of a patient with **secondary hyperparathyroidism.** We see a **lack of cortical bone** – no normal cortical bone. Inside the skull we have **a granular appearance**, with **radiolucent and radiopaque dots**, we call this **a salt and pepper dots**. This is why we call this a salt and pepper appearance, _there is no normal cortical bone._ *( systemic endocrine diseases)*

Answer 11

PLEOMORPHIC ADENOMA | (MIXED TUMOR)

Answer 12

_o Single dose of parenteral long_‐ acting **benzathine penicillin G** (primary, secondary, early latent) o **Intramuscular penicillin** weekly for three weeks (late latent and tertiary

Answer 13

§Small, non-enveloped **icosahedral DNA virus** that infects **skin or mucosal cells of humans.** **§Circular DNA** §198 types established **§High and low risk types** ## Footnote **‐ HIGH risk = CANCER ‐ LOW risk = WARTS**

Answer 14

**Gingival Cyst of the Adult**

Answer 15

**Definition:** lith = stone ;; sialolith: a salivary gland stone **Treatment**: promote passage of stone (massage, sialogogues, increase fluid intake) or surgical removal

Answer 16

Hyperparathyroidism in young children

Answer 17

* **exploration** and **curettage** of space to create bleeding. Clot will organize and allow bone repair * **Recurrence** is **_rare_**

Answer 18

**Mucocele**

Answer 19

Cat‐Scratch Disease

Answer 20

**Sickle Cell Anemia** Can see prominent trabeculae left, looks like steps on a ladder

Answer 21

_Dermoid Cyst_ a **dome shaped swelling**in _the floor of the mouth._ If these were left long enough, they could _cause issues with swallowing_

Answer 22

▪ A group of disorders of hemoglobin synthesis characterized by decreased synthesis of either the alpha‐globin or beta‐globin chains of the hemoglobin molecule Patients get a microcytic, hypochromic anemia ▪ People with the abnormal gene have a resistance to malaria ▪ People who have the trait rather than the disease are more likely to live and not die from malaria and spread that gene to their children ▪ Severity depends on the specific genetic alteration and whether it is homozygous (severe) or heterozygous (no clinical sign to mild manifestations)

Answer 23

**Lateral Periodontal Cyst**

Answer 24

we have 2 Pas of patients **with pseudohypoparathyroidism**. * hypoplasia of enamel, tooth material * hypoplastic tooth bud ( hypoplastic means arrested development) * delayed eruption, * external root resorption.

Answer 25

**Eosinophilic granuloma**

Answer 26

Palatine Torus/Torus Palatinus

Answer 27

Parotid Papillia (Stenson duct)

Answer 28

**AKA** • _Hereditary Hemorrhagic Telangiectasia_ **What is it ?** • _disorder of development of the vasculature_ characterized by **telangiectases** and **arteriovenous malformations** in specific locations. **Type of Herditary and Etiology** •Autosomal dominant with mutations i_n at least five gene_s but mutations in two **genes (ENG and ACVRL1/ALK1)** cause approximately 85% of cases. **What can it cause?** • Can cause hemorrhage

Answer 29

**▪ Paramyxovirus** ▪ Spread through _respiratory droplets_ ▪ **Symptoms**: runny nose, red/watery eyes, cough, fever, rash, desquamation of skin ▪ \***Characterized by Koplik’s spots** ‐ Pathognomonic for measles ‐ Discrete, bluish white punctate mucosal macules ‐ Surrounded by rim of erythema ‐ Represent foci of epithelial necrosis ‐ Often precedes skin manifestations **▪ Most common location for Koplok’s spots:** _Buccal mucosa_ ‐ Lesions may resemble _“grains of salt sprinkled on erythematous background”_

Answer 30

**o Removal of bacteria (scaling)** **o Chlorhexidine rinse** **o Antibiotics (fever or signs of systemic illness)** ▪ Metronidazole ▪ Penicillin **o Oral hygiene instruction** **o Supportive therapy** ▪ Rest ▪ Fluids ▪ Soft nutritious diet **o Predisposing (Immunosuppressive)factors** ▪ Smoking ▪ HIV?

Answer 31

**Cotton wool appearance** Irregullary shaped and outlined radiopacities blending in with adjacent bone

Answer 32

Primary Oral TB Oral Primary TB clinical manifestation is very rare TB is directly in the **_epithelial cells._** Person coughs ⇒ organism enters broken skin somewhere in the oral mucosa ⇒directly causing TB in the mouth -this person would NOT have any issues in their lungs **-**primary TB = infection went directly into their mucosa from another person

Answer 33

Areas with a lot of malaria

Answer 34

neurofibroma

Answer 35

Non‐Hodgkins Lymphoma (NHL) o Typically presents with painless lymphadenopathy (often unilateral) ▪ up to 40% are extranodal ▪ 5‐10% arise in Waldeyer’s ring ▪ _Inflamatory or reactive enlarged lymph nodes_ tend to be * *soft, tender, and movable** * *▪** _Lymph nodes associated with malignancy_ tend to be * *hard/firm, fixed, and non‐tender**

Answer 36

**gingival cyst of the adult?**

Answer 37

**Epulis Fissuratum**

Answer 38

**Oral candidiasis** a type of candidiasis

Answer 39

Multiple Myloma ## Footnote **Punched out translucency in crest**

Answer 40

Beta‐thalassemia ▪ Two defective genes – thalassemia major (Cooley’s anemia, Mediterranean fever) Hyperplasia of maxilla, body is trying to make more rbc so bone marrow enlarges to support space of those red blood cells but rbc are abnormal so spleen keeps destroying them

Answer 41

**Amyloidosis** _Amyloid deposition_ on the tongue is amyloid, you have papule and nodule like area, can see the **crenation** of the tooth

Answer 42

**Sensory ganglia (dorsal root ganglia)**

Answer 43

**Proliferative Verrucous Leukoplakia** **Location** ○ Gingiva (Frequent) ○ Buccal Mucosa ○ Palatal Mucosa

Answer 44

What is it? * **Defect in hemoglobin synthesis** What causes it? * **RBC with reduced hemoglobin content** and _short life span_

Answer 45

Amyloidosis ▪ different color compared to normal tongue with amyloid

Answer 46

**Frenal tag**

Answer 47

**Lipoma** Usually very orange looking lesion in site where there’s adipose tissue Very obvious, nothing as orange as lipoma

Answer 48

**Chlamydia trachomatis**

Answer 49

**Basal Cell Carcinoma (BCC)**

Answer 50

Aneurysmal Bone Cyst you can see that there is kind of a **multilocular radiolucency** in this particular area

Answer 51

**Actinomycoses** it's an external Sinus

Answer 52

**Leukemia** Acute and chronic myelo‐monocytic leukemia are the most likely types of leukemia to exhibit oral manifestations o Generalized gingival hypertrophy May create a tumor‐like mass in soft tissue o granulocytic sarcoma/chloroma (clinically looks green) ▪ mass infiltrate into soft tissue

Answer 53

* Incisional biopsy on non-keratinized, non-ulcerated mucosa ○ Asymptomatic → no tx ○ Symptomatic → 0.5mg/ml Dexamethasone Elixir.

Answer 54

Canalicular Adenoma

Answer 55

**Cystic Hygroma** a type of Lymphangioma

Answer 56

**Unencapsulated Lymphoid Aggregates** **Post-tonsillectomy** Can even develop these on area of tonsils. (left pic) Red/salmon is a lymphoid aggregate (unencapsulated lymphoid tissue). This is someone who had a tonsillectomy , and you can see these lymphoid aggregates on posterior pharyngeal wall (salmon color).They move around the area. (right pic) It grew back even in post-tonsillectomy patients.

Answer 57

 Enlarged pulp horns o Can extend up to DEJ  Abnormal globular dentin o Dentin may exhibit clefting  Enamel clefts  Bacteria noted in enamel, dentin and pulp o Pulpal involvement leads to necrosis and development of the periapical pathology

Answer 58

**Coccidioidomycosis**

Answer 59

* Treatment includes: * **Surgery** – complete or partial removal of thyroid gland * **Medications** * _Propylthiouracil_ and _methimazole_ block normal use of iodine by thyroid gland * **Radioactive iodine 131I** * Treatment often results in **hypothyroidism**

Answer 60

* endodontic therapy or extraction of involved teeth * larger lesions may require biopsy along with endodontic therapy * lesions which fail to resolve should be biopsied * follow-up at 1-2 years

Answer 61

**Aneurysmal Bone Cyst** ✎ It looks like **a blood soaked sponge** ✎ There’s these **open sinusoidal spaces** and then fibrous connective tissue surrounding them. *✎The sinusoidal spaces can vary in size; some of them are fairly small and others are large*

Answer 62

SPORES‐ when they are in this form, they do NOT invade HYPHAE‐ when they begin their invasion

Answer 63

**Focal Osteoporotic Marrow Defect** A large marrow defect that may mimic a cystic/neoplastic radiolucency in the jaw. common incidental finding a variation of normal anatomy within trabecular bone.

Answer 64

Secondary Syphilis ( Rash) here we see **muscus patches** (right) and **Condylomata lata** (left) ‐ Disseminated lesions are discovered 4 ‐ 10 weeks after initial infection ‐ Resolve in 3‐12 weeks ‐ Diffuse maculopapular (flat, raised) rash **o May involve oral cavity ‐ Mucous patches** **o Most common on tongue and lip** **‐ Condylomata lata** **o Resembles viral papillomas** ‐ Systemic symptoms

Answer 65

**Cyclic Neutropenia** ## Footnote Oral ulcerations on any mucosal surface exposed to minor trauma & can mimic recurrent aphthous ulcerations without the erythematous halo that is so typical of aphthous ▪ Gingiva is most severely affected with periodontal bone loss and tooth mobility

Answer 66

**Pernicious Anemia** ## Footnote denuded tongue and then the papillae is back again after the treatment. You have to get injections for the rest of your life

Answer 67

**_Autosomal dominant_ inheritance**

Answer 68

mature Periapical COD You can have these lesions in endentulous areas as well. So this is is an endeulous area, but if there was a tooth here, this would be in the periapicel region or near it with mixed radiolucent/radiopaque entity  the differential diagonsis of this area could include Periapical COD.

Answer 69

**o Mucocele o Mucoepidermoid Ca o Pleomorphic Adenoma**

Answer 70

* Treatment is typically **enucleation and curettage** * Reports of lower rate of recurrence (10‐20%) than conventional ameloblastoma (50‐90%) with similar treatment * Some recommend decompression prior to surgery * Use of **Carnoy's solution** ***after enucleation- resulted in a recurrence rate _lower_***

Answer 71

* Lichenoid reactions may develop after exposure to a medication for periods of \> 1 year * May develop very slowly after the problem is initiated so it can be very challenging to connect the dots **Many different medications that can lead to lichenoid reactions** * Beta blockers, ACE inhibitors, Rituxumab etc… * A number of new targeted agents “mabs” and “nibs” can cause lichenoid reactions * In cancer centers, this has become quite a problem because they are taking disease‐modifying drugs

Answer 72

Prodrome►papules►vesicles►ulcer►crust►heals►no scar

Answer 73

**Behcet’s Disease** ‐ Recalcitrant oral ulcers associated with Behcet’s Disease ‐ Later developed genital ulcers and other complications ‐ Image: o Sores in the labial mucosa have classic aphthae appearance o Other ulcers are major aphthae: ▪ Larger ▪ Irregular borders ▪ Intense proliferative erythema

Answer 74

o hematoma because of THROMBOCYTOPENIA or Trauma

Answer 75

A very mature Periapical COD ( purple arrow) Well‐defined radiopacity in the periapical region. Sometimes you may or may not be able to differentiate a very thin radiolucent line as in this case. you might include ddx of other lesions which might present with radiopacity in the preapical region There are certain tests you can do clinically to differentiate too. or do clinical tests

Answer 76

**Gingival Cyst of the Adult**

Answer 77

Florid COD Axial section of the mandible. * Notice **mixed radiolucent/radiopaque entity on the patient right side**. And **on the left the area is more radiopaque centrally and has a thin radioluceny around it.** * The arrows indicate **well‐defined radiopacities immedietly surrounded by radiolucent rims.** * Note that **the radiolucent rim on the left side is thin when compared to the lesion on the right. This likely means that the lesion on the left is more mature** ( more time has passed for the entity to produce more woven bone).

Answer 78

**Capillary Malformation (Low flow)**

Answer 79

* Saprobic (in an environment rich of oxygen) * it caused by Aspergillus flavus and Aspergillus fumigatus

Answer 80

**Cowden Syndrome** *Very rare!*

Answer 81

pt with Osteopetrosis * **Generalized increase in bone density,** increased trabeculation, loss of large bone marrow spaces. * These patients are more prone to **osteomyelitis** _because they are Hypovascular_. * We have to be careful in **extractions** because they don’t have the same vascularity as other healthy patients have. * We see an **onion skin appearance** by the white arrow.

Answer 82

_❏ **Depends on severity/frequency**_ _❏ **Preventive/suppressive vs episodic/abortive strategies** Two types of treatment:_ **Preventive/Suppressive: taking antivirals everyday to prevent an outbreak** **Episodic: taking antivirals here and there to abort the process; episodic: abortive. _❏ Drugs used:_** ❏ *Antiviral agents* ❏ *Antiviral‐steroid combination agents* **_❏ Avoid precipitating factors, like use sunscreens – avoid any triggers_**

Answer 83

**Infantile Hemangioma** **(“strawberry” hemangioma).** Infant with two red, nodular masses on the posterior scalp and neck *Neville Cr*

Answer 84

**nine‐ringed armadillos**

Answer 85

Oral Lichenoid Drug Reaction

Answer 86

Bleeding disorders associated with a genetic deficiency of any one of the clotting factors **o Hemophilia A (classic type, most common type )** ▪ Factor VIII deficiency ▪ X‐linked recessive ▪ Abnormal PTT **o Hemophilia B (Christmas disease)** ▪ Factor IX deficiency, ▪ X‐linked recessive, Abnormal PTT **o Von Willebrand’s disease** ▪ Abnormal von Willebrand’s factor, abnormal platelets ▪ Autosomal dominant ▪ Abnormal BT, abnormal PTT

Answer 87

**dentigerous cyst**

Answer 88

Fordyce Granules

Answer 89

* **uni‐ or multilocular Radiolucency** (pelvis, ribs, mandible) * seen with _persistent disease_ * histology of **giant cell lesion** (**like CGCG**)

Answer 90

**Dentigerous Cyst**

Answer 91

**Proliferative Verrucous Leukoplakia** Patient with proliferative verrucous leukoplakia but manifesting more as an erythroplakia in multiple sites than a leukoplakia **Proliferative verrucous leukoplakia has very high risk (49.5% in malignant transformation)** almost 10% risk for malignant transformation every year

Answer 92

**Addison’s Disease**

Answer 93

**o Pleomorphic adenoma o Adenoid cystic ca o Mucoepidermoid ca o PLGA o Monomorphic adenoma**

Answer 94

On a **sickle cell anemia** patient, you see: * **loss of this cortical bone area** * **the hair-on-end appearance on the skull**

Answer 95

Erythroplakia is a high risk for malignant transformation. So, if you encounter an erythroplakia, it's probably already a cancer or it's fast‐tracking towards a cancer

Answer 96

Granular Cell Tumor

Answer 97

Acute Myelogenous Leukemia (AML) Wegener’s Granulomatosis Kaposi Sarcoma Plasma Cell Gingivitis **Generalized gingival enlargement – all different cases and diseases**

Answer 98

‐ History of RAS ‐ Medical History o Medications o Review of Systems ‐ Social History ‐ Dental History ‐ Diet/Nutritional History ‐ Physical Examination ‐ LaboratoryTests

Answer 99

▪ Podophyllin resin ▪ Imiquimod (extra‐oral use only) ▪ Cidofovir ▪ Interferon

Answer 100

Periapical cyst shows inflammation at site abscess developed fistula tract thru soft tissue. Pt will have pain until pressure is released

Answer 101

* a reactive benign soft tissue lesion * **Clinical appearance:** Well-demarcated, sessile or pedunculated lesion that appears to originate from _the gingival interdental papilla_ * **Derived from:** cells of the periodontal ligament * **Age**: children and young adults * **Sex**: females more than males * **Recurrence rate** – about 16% * **Treatment**: Surgical excision

Answer 102

* Immunosuppressive medications * Diabetes * Old age * Crowded living conditions * AIDS

Answer 103

Smoking Cessation. * Nicotine stomatitis is completely reversible, even when it has been present for many decades. * The palate usually returns to normal within 1 to 2 weeks of smoking cessation.

Answer 104

* They often occur in the gingival, but can occur in multiple areas * that’s the one thing that distinguishes this from the other 2 P’s: pyogenic granuloma can occur on ANY oral site, most commonly on the gingival tissues

Answer 105

**Pseudomembranous candidiasis** on the palate. usually caused by Candida albicans Predisposing factors are local (poor oral hygiene, xerostomia, mucosal damage, dentures, antibiotic mouthwashes)

Answer 106

**Complex Odontoma** * _2‐2.5cm mass overlaying the molar_. * ***radiolucent rim/halo*** that is **mixed**, *mostly* **radiopaque**

Answer 107

● **Trimethoprim/ sulfamethoxazole** (mild‐moderate) ● **IV Amphotericin B** (severe disease)

Answer 108

**Cyclic Neutropenia** ## Footnote **▪ Oral ulcerations on any mucosal surface exposed to minor trauma (L,T, BM and oropharynx) last 5‐7 days** ▪ Depending on surface involved, **can mimic recurrent aphthous ulcerations** o Usually do not see erythematous halo that is so typical of aphthous ▪ **Gingiva is most severely affected with periodontal bone loss and tooth mobility**

Answer 109

**Condyloma Acuminatum** (Venereal Wart) HPV 6,11 – can be cancerous Genital warts “short, blunt, clusters” Characteristic clustering of multiple lesions

Answer 110

■ **Must biopsy** to make a definitive diagnosis ■ **No further treatment is then necessary** ~ You don't have to remove it; you can just leave it as it is

Answer 111

**Calcifying Epithelial Odontogenic Tumor(CEOT)** * **Multilocular radiolucency with calcifications**. * **an expansion** *up to PMs and back to 2nd molar* * as well as **bowing of mandible.**

Answer 112

Paget's disease stages ## Footnote Early Linear lines: The bone is being resorbed in a very distinct pattern \> linear patterns of trabeculation Middle -MAY see the "cotton wool" appearance (but this is more pronounced in the third stage) -the trabecular pattern may or may not be slightly affected Late - There is MORE bone deposition -the "cotton wool" appearance is very very clear in this stage! Also-hypercementosis and spacing of teeth.

Answer 113

***_What is it?_*** Group of rare conditions ***_Inhertiance type?_*** Autosomal dominant ***_Which type is associated with multiple mucosal neruoma?_*** Type 2B ***_Increase risk of which cancer?_*** **•** Increased risk for **medullary thyroid cancer (prophylactic thyroidectomy)** *_Common board questions_*

Answer 114

**Gonorrhea** looks like necrotizing gingivitis (NG) but fetor oris not present

Answer 115

 Children and young patients

Answer 116

Inflammatory Gingival Enlargement Example of someone with true hyperplastic gingivitis Maybe related to very poor plaque control In this case, either porcelain or porcelain fused to metal full coverage restorations that have very bulky margins, and that may play a role for food to pick up

Answer 117

Carcinoma Ex Pleomorphic Adenoma

Answer 118

**Peripheral Ossifying or Cementifying Fibroma** ## Footnote Lesion in the image is pedunculated – put a periodontal probe on normal gingiva and glide along underneath it, there’s a stalk

Answer 119

**Symptoms** * ▪ Initial symptoms include non‐specific symptoms of infection **malaise, sore throat, swelling, fever, chills, etc.** * Oral findings include multiple ragged ulcerations of the oral mucosa, o can mimic recurrent aphthous but no erythematous halo, Gingiva is a common site & can resemble NUG **Treatment** * Remove offending drug, numbers should replenish in 10‐14 days * Agranulocytosis secondary to cancer therapy ‐ meticulous oral hygiene, chlorhexidine rinse (non alcohol type) , etc.

Answer 120

Rhabdomyosarcoma In this case, hasn’t broken through epithelium They don’t all break through

Answer 121

Chronic Hyperplastic Pulpitis (pulp polyp)

Answer 122

**Stafne Bone Cyst** Less common location Check if the teeth were vital with vitality test Get a CBCT in that area to see what was going on first and then once you saw the CBCT you'd be able to make the diagnosis.

Answer 123

* **Paget's disease** ( t generalized areas) * **Osteomyelitis** ( localized area because we have mixed radioluecent/radiopaque areas)

Answer 124

**Pemphigus Vulgaris.** Multiple erosions of the left buccal mucosa and soft palate.

Answer 125

**Hypothyroidism** **Macroglossia** and **crenation** (scalloping) of the lateral tongue

Answer 126

Florid COD ## Footnote  **Rarefying osteitis** (radiolucent lesions) ( it would differentiate in the more early stages of the COD ( the radiolucent stage)  **Condensing osteitis** (considered in the differential when the lesion is more mature and more radiopaque lesions)  **Cementoblastoma** ( benign neoplasm of the cementum so we should be able to see certain features that reflect benign neoplastic lesions )  **Dense bone islands** ( a common differential when considering COD)

Answer 127

take two different sites ○ For H&E, still must be perilesional ○ If you get only ulcer just because the clinician thinks ○ that is the pathology → there is no epithelium! ○ The sample is useless and no diagnosis can be made

Answer 128

**Erythroplakia** of the buccal mucosa Well-demarcated erythematous patch or plaque with soft velvety texture

Answer 129

Acromegaly (Hyperpituitarism) * enlargement of the mandibular bone with a high degree of enlargement * a class III appearance * enlargement of sella tursica because of the pituitary gland enlargement

Answer 130

**Nasopalatine Duct Cyst** ## Footnote ✎This person is edentulous ✎ **an inverted pear shape** ✎The nasal spine is superimposed on your radiolucency ► **a heart shape**

Answer 131

Amyloidosis orange, red, yellow tinge

Answer 132

**Secondary Polycythemia** Oral manifestation ▪ Oral mucosa appears deep red ▪ Glossitis ▪ Gingiva appears edematous and bleeds easily ▪ Consequent “crowding out” of WBCs and platelets may result in other manifestations

Answer 133

▪ LCR: long control region ▪ P97: promoter protein ▪ E1‐E7: early region genes ▪ L1,L2: late region genes

Answer 134

**What is it?** (benign tumors that have underwent malignant transformation‐ takes a lot time, 15 to 20 years) **Growth patterns:** Mass present for many years with recent rapid growth with associated pain or ulceration **Treatment**: Best treated by wide excision, with local node dissection and radiation **Prognosis:** guarded, with 50% local recurrence or metastases and dying Prognosis is case to case scenario, may transform to high grade tumor

Answer 135

‐ Previous necrotizing periodontal disease Poverty ‐ Malnutrition or dehydration ‐ Poor oral hygiene ‐ Poor sanitation ‐ Unsafe drinking water ‐ Proximity to unkempt livestock ‐ Recent illness Malignancy ‐ Immunodeficiency disorder, including AIDS

Answer 136

**Amyloidosis** _macroglossia_

Answer 137

**Sialolithiasis**

Answer 138

**Chondrosarcoma** * Alveolar process and floor of mouth affected * **Limitations of movement of the tongue**

Answer 139

**Nasopalatine Duct Cyst** ✎Between the roots of the two teeth, a well circumscribed radiolucency, not showing any changes to the adjacent structures ✎could be an enlargement of the incisive canal due to variation in size ~ **early lesions can be hard to diagnose** ✎**the treatment in such cases**: a follow up with another radiograph in six months to see if there's been any change in size **✎ No surgical intervention until you see the cyst expanding**

Answer 140

▪Left mandible, **multilocular radiolucency associated with impacted tooth** ▪ It's **well circumscribed,** edge may be a little **bit sclerotic or corticated** ▪ It has _displaced an impacted tooth down_ towards the inferior aspect of the mandible ▪ Appears to be expanding the cortex of the mandible in areas ▪ There's **blunt resorption of the teeth adjacen**t (PMs and molar) **Ameloblastoma**

Answer 141

▪ Induces cytokines + chemokines w/ resutlant anti‐virl (HPV) effects Not FDA approved for oral warts

Answer 142

* _Expresses **Ki‐67**_ (high rate of cell proliferation) * O_verexpression of **Bcl‐2**_ (antipoptotic protein) * _Overexpression of **MMP’s 2 and 9**_ (thought to allow growth into connective tissue) * _Mutation of **PTCH**_, a tumor suppressor gene * when PTCH is non‐functional → cell proliferation

Answer 143

**Plasma cell gingivitis** ▪ Allergen causes mass infiltrate into gingival ▪ Benign ▪ Diet log to identify allergen, allergy testing

Answer 144

● **Eastern half of US** which extends _farther north_ ● _Seen in the wild_

Answer 145

surgical excision, recurrence is rare

Answer 146

▪ HPV **2**, and others (1,**4,6**,7,11,26,27,29,41,57,65,75‐77) ▪ Benign, HPV‐induced focal hyperplasia of stratified squamous epithelium ▪ **Contagious** – transmitted by direct contact ▪ **Soft, painless, usually pedunculated, exophytic lesions w/ numerous fingerlike projections** (similar to squamous papilloma) ‐ _How to tell the difference? Under microscope_

Answer 147

* more punched out radiolucency in iliac crest in the image * Bone marrow biopsy usually done in this area since it’s frequently involved multiple Myeloma MM

Answer 148

No treatment is required.

Answer 149

Fibrous Dysplasia in the left of the maxillae. Always compare both side left and right * We see granular/glass appearance of the bone ( blue arrow) and compare it to the contralateral maxillae. The trabucular pattern has changed signficantly. * Also compare the maxillary sinus space. The left maxillary sinus appears radiopaque. * That is because the maxillae has been enlarged to the point where it is pushing the floor of the maxillary sinus superiorly and reducing the total volume of the sinus. * The purple arrows indcate the displaced floor of the maxillary sinus.

Answer 150

* Coccidioides immitis * Coccidioides posadasii

Answer 151

Primary infection → Latency → Reactivationn → Recurrent infection

Answer 152

**Oral Molluscum Contagiosum** *multiple pink, dome‐shaped, smooth‐surfaced or umbilicated (like belly‐button) papules ‐ with caseous plug*

Answer 153

**Periapical Cysts** ►Would need to test both teeth for vitality.

Answer 154

* **Treatment** depends on specific type of leukemia, but includes multi‐agent chemotherapy (often an initial high dose induction and then a lower maintenance dose) * And for lymphoma * **Bone marrow transplant** has been used with limited success

Answer 155

**Osteosarcoma** ## Footnote ▪ Swelling on left side of face ▪ Difficult opening

Answer 156

Polymorphous Adenocarcinoma

Answer 157

**Dimorphic organism** (spores and hyphae)

Answer 158

**Metastatic Carcinoma to Jaw Bones** B. Occlusal image of prostate lesions causing sclerosis and spiculated periosteal reaction (arrows)

Answer 159

Mucous membrane pemphigoid SEVERE/HIGH RISK FORMS OF MMP ▪ Ocular ▪ Esophageal can result in functional blindness

Answer 160

**‐ Debacterol** (sulfonated phenolics; sulfuric acid solution) **o Chemical cautery** o Label: one time application for 5‐10 seconds ‐ NOT recommended to patients with frequent outbreaks

Answer 161

▪ Over expression of **Bcl‐2 (**anti‐apoptotic protein) ▪ **Expression of fibroblast growth factor (FGF)** ▪ **Over expression of matrix metalloproteinases (MMPs 9 and 20**) – like in OKC, allowing tumor to grow into surrounding area ▪ Surprisingly, _no significant increase in Ki‐67 expression_ (cell proliferation marker) **– ameloblastomas do NOT turn over rapidly**

Answer 162

**Herpes Zoster/ Shingles** * It is affecting the intraoral region * and the maxillary branch. * Picture on the far right looks like recurrent HSV (cluster of coalescing ulcers) * Looking at the picture on the left you can determine it is NOT a recurrent intraoral herpes **because we have vesicles that opened up and crusted over on** **the skin.** **VZV histopathology is the same as HSV.** **VZV remains latent in the dorsal root ganglion** travels down the sensory nerves to skin upon reactivation. ❏ The reactivation presents as **a painful rash in one or two adjacent dermatomes that does not cross the midline.** ❏ The rash is **maculopapular** and **develops into vesicles.** ❏ One complication of zoster is **post‐herpetic neuralgia**: pain that persists in the area where the rash once was present.

Answer 163

**Burkitt Lymphoma** *caused by **EBV***

Answer 164

**Speckled leukoplakia.** **Non-homogenous leukoplakia**

Answer 165

**Acute lymphonodular pharyngitis** Caused by **Coxsackie Virus** *Affects children* Nodules on the soft palate. -distinctive, raised, micronodular lesions occur primarily in the pharynx and related structures and regressed without ulceration.

Answer 166

**‐ o Swellings in the lymph node** **o Unilateral swellings of the neck**

Answer 167

* Leads to **disseminated TB** (miliary TB) * True, active TB

Answer 168

SQUAMOUS PAPILLOMA Benign Oral Low Risk HPV Lesion **HPV 6+11** “finger‐like projections

Answer 169

**Stafne Bone Cyst** _This is the classic look._ - a **well-circumscribed corticated radiolucency** - **below the inferior alveolar nerve**, away from the teeth. - They can be either **oval**, like this, or **round** in appearance

Answer 170

* _Definition:_ **a pseudocyst** * clinically you CANNOT tell the difference **between a mucocele & mucous cyst and** histologic features same as mucocele but will see an epithelial linin **treatment**: same as mucocele; surgical excision

Answer 171

Nicotine Stomatitis.

Answer 172

Mandibular Torus: Torus Mandibularis

Answer 173

**Botryoid Odontogenic Cyst**

Answer 174

Paradental Cyst

Answer 175

Paget's Disease Also Known As: **Osteitis Deformans.** **Skeletal disorder involving osteoclasts** **_Treatment:_** Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone

Answer 176

Cropped Panaromic showing **a case of** Cemento‐ossifying Fibroma * Appreciate the **radiolucent rim** indicated by the black arrows. * Also note the internal structure of the trabucular bone and compare it to adjacent unaffected areas. It is **more granular and radopaque** compared to adjacent areas. * Another important feature to appreciate is **the displacement of the anterior teeth** **(diverging roots)** * These features are usually seen **in lesions with benign neoplastic characterstics.**

Answer 177

**Tertiary Syphilis** **Gumma** ‐ **Latent** period for **1 ‐ 30 years** **‐ 30% of patients develop tertiary syphilis** ‐ Serious complications develop: * Vascular system * Central nervous system * Ocular lesions What is "Gumma"? * o Granulomatous inflammation with tissue destruction * o Common on palate and tongue * o Causes a hole in the palate

Answer 178

**Median Rhomboid Glossitis** *a subtype of Erythematous Candidiasis* ● “**Central Papillary Atrophy”** ● _Well‐demarcated erythematous zone_ ● **Loss of papillae on midline posterior dorsal tongue** ● Usually, **asymptomatic** ● “**Kissing” palatal lesion** ‐ Because the tongue and the palate are in contact with each other ● Can have **a diamond shape**

Answer 179

**Measles** **\*Characterized by Koplik’s spots** salts/grains

Answer 180

leukomia o Multifocal bony destruction o Widened PDL with leukemic infiltrate ▪ Symmetric widening of PDL space in a patient that doesn’t have that normal vertical bone loss that you associate with periodontal disease. ▪ If see symmetrical bone loss in PDL space think malignancy, neoplastic **● Lymphomas, leukemias, osteocarcoma, chondro scaroma can do this**

Answer 181

**Primary Syphilis** _Chancre_ at site of inoculation (3 – 90 days later) ‐ Papule ► Ulceration ‐ Most chancres occur in genital area (4% oral

Answer 182

* Immune cell tumors primarily involving bone marrow and peripheral blood are classified as leukemias * while those of lymph nodes are classified as lymphomas, * however there is often overlap of these entities

Answer 183

Florid COD ## Footnote Two periapical radiographs of the left and right posterior mandible of the same patient.  In this case, note **the areas of radiolucency and radiopacity are rather ill defined but widepsread** to affect most of the teeth. Most of the teeth noted here are restored.  So even if the radiographs suggest a cemento‐osseous process, it is important to keep an eye for these teeth in term of vitality and prevent a periapical infections which would otherwise **secondarily infect** the altered bone of COD.

Answer 184

Leukoedema

Answer 185

* Believed to be **developmental** in origin, *but usually noted only in **_adults_***

Answer 186

**_Myxoma_** ▪ Mimics the histology of **dental pulp** **▪ Stellate, spindle, and round shaped cells** set in a loose myxoid to lightly collagenized stroma (if abundant mature collagen ‐ fibromyxoma) ▪ Abundant ground substance (mucopolysaccharide extracellular matrix or GAGs) ▪ Can see **residual bone trabeculae and scattered rests of odontogenic epithelium**

Answer 187

_Etiology_ * **Decreased number of insulin receptors or defective receptors** * *Genetic abnormalities, multifactorial* * _Growing percent_ of the **US population** as well as around the world

Answer 188

**Compound Odontoma** * Mature normal appearing pulp, enamel and dentin * Organization like teeth, with enamel surrounding dentin which surrounds pulp ( Well developed rudimentary “tooth” forms) * appear as small tooth‐like structures in the Anterior jaws (esp. MX) **Complex Odontoma** * Mature pulp, enamel and dentin * No organization, mass of dentin and enamel matrix and pulp tissue (\*\*Poorly developed mass of calcified deposits) * appear as masses of radiopaque material with * variable densities in the Posterior jaws (esp. MD)

Answer 189

Sialadenitis Chronic: caused fibrosis

Answer 190

pigeon excrement (poo)

Answer 191

 Involve both major and minor glands ** Benign and malignant tumors both have similar clinical presentation**  Most malignant salivary gland tumors do not show histopathologic characteristics associated with malignancy  Most occur in adults  Warthin Tumor seen in parotid, may be bilateral ** Mucoepidermoid carcinoma** o Can occur in children o May occur centrally in bone

Answer 192

Calcifying Epithelial Odontogenic Tumor (CEOT) **Clinically:** we see **a little expansion** on _inferior aspect of mandible + lingual_ too Radiographically: we see **well‐circumscribed**, **a little corticated/sclerotic edge**, **impacted tooth** ▪ we can see bowing of inferior aspect of mandible ▪ Within areas of radiolucency, see areas of opacity **(calcified lesions = classic CEOT)** ▪ _When smaller► could have looked ***unilocular***_

Answer 193

**Ranula** Notice how it's unilateral on the floor of the mouth

Answer 194

This is another medical CT scan. You see the granular appearance of the maxilla, skull, and well-defined multilocular radiolucency with granulation. We call this a brown tumor because it is associated with **hyperparathyroidism.** **( s**ystemic endocrine diseases)

Answer 195

_What happens in Hypothyroidism?_ * Decreased levels of thyroid hormone _What it is called in children & adults?_ * **cretinism** in children * **myxedema** in adults _How it is diagnosed?_ * Diagnosed by **measuring T4** (free thyroxine) in serum

Answer 196

Hypophosphatasia

Answer 197

▪ **Benign proliferation of stratified squamous epithelium resulting** ► p*_apillary, verruciform, rugose (ridged or wrinkled) mass_* ▪ **HPV types 6 + 11** – Low risk ▪ \*\*should remove from mouth – but WOULD NOT submit for HPV typing

Answer 198

**Simple Bone Cyst** ## Footnote ✎Big lesion example: It’s going back to the molar area here. ✎You can see that the lesion extends _over to the canine on the other side_ ✎Most lesions are usually **in the anterior mandible**

Answer 199

**FD** Note the normal left maxillary sinus and the obliterated space of the right maxillary sinus ( blue arrows). **A ground glass appearing entity** (humogenous radiopaque lesion) has obliterated the space secondary to expansion of the right maxilla. These findings are consistent and quiet common in **advanced cases Firbous dysplasia**

Answer 200

Multiple Myeloma Elevated M spike in serum ‐ abnormal increase in immunoglobulin (**hyperglobulinemi**a), most commonly IgG ▪ Reversal of normal albumin/globulin ratio

Answer 201

Erythroplakia Firey red Well-demarcated patch or plaque with soft velvety texture transformed into SCC

Answer 202

**Congenital Syphilis** ‐ Hutchinson Incisors (left image) ‐ Mulberry molars (right image) - not part of the triad

Answer 203

Adenoid Cystic Carcinoma

Answer 204

‐ Usually appear exophytic and papillary ‐ Excision is warranted ‐ Consider possible recurrence

Answer 205

Epidermoid Cyst **A dome-shaped swelling.** There’s **no change** in the overlying skin color, no redness, no pain

Answer 206

_Etiology_ * Thought to be due to **an abnormal immune response to the infection**

Answer 207

ACINIC CELL ADENOCARCINOMA blue‐ish tint

Answer 208

**Multiple Myeloma** Deposition of amyloid in soft tissues o Can cause macroglossia if tongue is involved

Answer 209

Adenoid Cystic Carcinoma

Answer 210

- **Radical surgical excision** as the tumor is ***very aggressive*** *and* ***infiltrative*** - _Prognosis_ is *dependent on* **complete removal of tumor**

Answer 211

**Unilocular and unicystic** ‐ An example of **a unilocular ameloblastoma** that is not associated with an impacted tooth ▪ Is between roots of two teeth, may be confused with lateral periodontal cyst. **Well‐circumscribed radiolucency**

Answer 212

o hematoma because of THROMBOCYTOPENIA orTrauma THROMBOCYTOPENIA:▪ Markedly decreased numbers of circulating blood platelets (severe cases \< 10,000/mm³) Etiology: Can be from: o Decreased production (malignancy, drugs) o Increased destruction (immunologic, drugs) o Sequestration in the spleen (splenomegaly) ▪ Clinically see spontaneous gingival bleeding, petechiae, ecchymosis and hematomas o Clinically see some type of bleeding ▪ Treatment is usually platelet transfusion

Answer 213

Dwarfism * hypopituitarism* * We see* multiple dental anomalies: **hypodontia, radicular fusion,** fused roots of left lateral incisor and left canine **and impacted permanent teeth.** * (from google)*

Answer 214

HSV‐1: Primary Infection it is a raised blister/papule on the vermilion The bottom arrow pointing to a mucosal ulcer w/ tan pseudomembrane.

Answer 215

Etiology unclear o Demonstration that LCH cells are **clonal**, along with the recent discovery of **activating BRAF mutations in LCH cells**, ►**strongly suggests that LCH is a neoplastic disease**

Answer 216

**Metastatic Carcinoma to Jaw Bones** D. Destruction of the left mandibular condyle (arrows) from a thyroid metastatic lesion

Answer 217

_Primary Syphilis_ **Chancre** at site of inoculation (3 – 90 days later) ‐ Papule ► Ulceration ‐ Most chancres occur in genital area (4% oral

Answer 218

‐ Pathognomonic features in **Hutchinson triad**: **o 1. Hutchinson teeth** **o 2. Ocular interstitial keratitis** **o 3. Eighth nerve deafness** ‐ Other Features: o High arched palate o Saddle nose o Frontal bossing **Clinical changes secondary to fetal infection**

Answer 219

**Kaposi sarcoma--associated herpesvirus (KSHV)** **❏ Vascular neoplasm of endothelium** ❏ Associated with **immunosuppression** ❏ Usually evolves through 3 stages: **○ Patch►plaque►nodular** * **More commonly seen in patients with HIV infection.** * **Treated** with _topical agents and chemotherapy._

Answer 220

**Sickle Cell Anemia** Radiographic findings include: o decreased trabecular pattern in the mandible (due to increased extramedullary hematopoiesis) o laddering of inter‐radicular trabeculae o “hair‐on‐end” appearance of skull films (less prominent than with thalassemia) Can see spontaneous pulpal necrosis in the absence of trauma or caries

Answer 221

* after **a Caldwell-Luc procedure** * *sometimes with **difficult maxillary extractions***

Answer 222

**Pemphigus Vulgaris.** Large, irregularly shaped ulcerations involving the floor of the mouth and ventral tongue.

Answer 223

Untreated acinic cell adenocarcinoma ## Footnote  Because it is slow growing, and a low grade tumor, the patient is alive and not dead with a tumor this size.  Similar presentation to pleomorphic adenomas, but there is a lot of ulceration on the surface and prominent vascularization in acinic cell adenocarcinoma.

Answer 224

**Follicular Cyst**

Answer 225

MUCOEPIDERMOID CARCINOMA

Answer 226

**Kaposi Sarcoma** * Widespread Kaposi, can see cutaneous lesions * Oral images of this patient: on palate, starts with macule on patient’s left posterior palate –macular stage * Then in becomes proliferative – exophytic nodular stage (seen on patient’s right anterior palate,surrounding canine and some incisors) * Can see engorged blood vessels in area on histology slide

Answer 227

* **Decompression**: Try to open window in the jawand put tube into cyst lumen and have pt irrigate a few times a day for a few weeks ► release pressure and allows bone to grow back ► **cyst will shrink** * If get rid of whole area surgically► c_an risk_ _fracturing the jaw_

Answer 228

**Kaposi sarcoma** HHV 8 Kaposi sarcoma on the skin: \>1cm Different color, so this is called a **patch**. Erythematous patches present on multiple areas of the face.

Answer 229

● Brazil -south America So, also known as **South American blastomycosis**

Answer 230

Histopathology shows **malignant endothelial cells proliferating.** There are tiny spaces. Extravasation of RBCs can be seen

Answer 231

brown tumor.

Answer 232

**Nasopalatine Duct Cyst**

Answer 233

* *B‐lymphocytes (latency)**, **endothelial cells (Kaposi sarcoma) **

Answer 234

* **Since 20% of chondrosarcomas of the jaw are initially misdiagnosed as chondromas** ► any diagnosis of chondromain the jaws should be viewed with suspicion * **All cartilaginous tumors arising in the jaws should be excised widely** * (\>60% of cartilaginous tumors of the jaw recur and ~7% metastasize to the lung and/or bone )

Answer 235

* Not required * however, in some cases aciclovir or valaciclovir * can be used with success. * Topical retinoids or podophyllum resin for temporary remission

Answer 236

**Atrophy of central filiform papillae** Presumably developmental. Candida albicans may also be involved. but smokers, people with xerostomia , who use inhalation steroids and denture wearers are **at increased risk**

Answer 237

typically resolves weeks after cessation ○ if persists 6+weeks -\> biopsy to rule out dysplasia + SCC

Answer 238

``` Aphthous ulcer (“The canker sore”) ``` What would it be like to have a canker sore on your uvula? o Painful to swallow ‐ The location of the canker sore will predict the symptoms

Answer 239

**Osteosarcoma** * Classic _sunburst pattern_ * **Fuzzy appearance** _on outer edges of cortex_

Answer 240

● Surgical debridement (massive tissue destruction) ● High doses of lipid formation of amphotericin B ● Control underlying disease (main one) ● Prosthetic obturation of palatal defects

Answer 241

**▪ Family: Togavirus; Genus: Rubivirus** **▪ Respiratory droplets** lymphadenopathy ▪ Rash – **maculopapular w/ desquamation** * *▪ Forchheimer sign** * *▪ Palatal petechiae** ▪ **Congenital rubella syndrome** – pandemics in past ▪ Vaccine: **MMR** – so we barely see this anymore ▪ Diagnosis**: by serology**

Answer 242

White Sponge Nevus Diffuse, thickened white plaques of the buccal mucosa

Answer 243

we see **calcifications** forming, with both radiolucent and radiolucent areas. *▪ Dentingerous cyst, ameloblastoma, and OKC are NO LONGER in the* **differential diagnosis.** **_This is clearly AOT_** **_(_Adenomatoid odontogenic tumor)**

Answer 244

Circumvallate papillae

Answer 245

leukomia Cause of infiltrate they has bone loss

Answer 246

**Ameloblastoma** * **Small lesion** distal to impacted tooth. * **Unilocular radiolucency** with _elevation of alveolar ridge + some expansion of soft tissue_

Answer 247

Paradental Cyst

Answer 248

**Aneurysmal Bone Cyst** ## Footnote ✎ There's a **radiolucency** involving _the second molar_ that's going as far anterior as the first molar and back to the third molar ✎ There is a little bit of **spiking root resorption** and _that's one of the signs that we associate with malignancy_ ✎ It's a little bit **ill-defined** *~ hard to say exactly where it begins and ends*

Answer 249

* Often occur after _***inflammation*** of a hair follicl_e

Answer 250

Differential Diagnosis: 1. ▪ T‐cell Lymphoma 2. ▪ Cocaine abuse 3. ▪ Granulomatosis 4. ▪ Polyangiitis 5. ▪ Mucor

Answer 251

**Hairy Leukoplakia**

Answer 252

Central odontogenic fibroma (COF) * **well‐circumscribed radiolucency** *posterior to molar*

Answer 253

**Odontogenic Myxoma**

Answer 254

**Surgical Ciliated Cyst of the Maxilla** In this premolar shot (middle image) you can see a **well-circumscribed lesion** ✎Because the maxillary sinus is **radiolucent**, it almost looks like this is **radiopaque** but it's not ✎ If you did a CBCT you would see that **it's an empty space within the bone of the maxilla.** It's not actually radiopaque

Answer 255

* **Phenytoin**: (or Dilantin) – the drug that used to be given to every single person that had seizures * **Calcium-channel blockers** * Nifedipine *not as prescribed anymore* * Dilitiazem still prescribe * Amlodipine: is prescribed as one of the first line therapy for hypertension (very commonly prescribed); it doesn’t typically cause gingival overgrowth except in some selected patients, usually those with pretty poor oral hygiene * **Cyclosporine A** (used for for bone marrow transplant, graft vs host disease, solid organ transplant) * **Cyclosporine is universally recognized as causing gingival hyperplasia** * **Cyclosporine** is largely replaced with **Tacrolimus**, which typically doesn’t cause gingival overgrowth * *Some drugs have more connective tissue component, others have more epithelial component Not all identical under the microscope* * *Cyclosporine provides more epithelial change, Dilantin causes more of a connective tissue change*

Answer 256

**Extraction** of the _tooth along with the lesion_

Answer 257

**Eruption Cyst**

Answer 258

**‐ Triamcinolone acetonide** in Orabase 0.1% (intermediate) o Disp: 5g tube Dental Past o Label: apply a thin film over ulcer after meals and bedtime APOTHECON o Do not use for more than 2 weeks **‐ Fluocinonide gel or ointment** 0.05% (Potent) o Disp: 15g tube o Label: apply a thin film over o Do not use for more than 2 weeks ‐ Clobetasol ointment 0.05% (Ultra potent) o Disp: 15gtube Label: apply a thin film over ulcer bid

Answer 259

**Ameloblastic Fibroma (AF)** 1‐3 potential locules, no impacted tooth associated

Answer 260

* **Most common SG tumor to occur bilaterally** (bilateral parotid swelling), but can be unilateral * **Etiology:** Thought to arise within lymph nodes as a result of entrapment ofsalivary gland elements early in development * _Strong correlation with cigarette smoking_ * **Treatment**: surgical excision, responds very well to it

Answer 261

SQUAMOUS PAPILLOMA Benign Oral Low Risk HPV Lesion **HPV 6+11** “finger‐like projections - The projections are almost feathery - exophytic lesion

Answer 262

**Autosomal dominant skin disorder** Etiology: ● This condition is due to a defect in the normal keratinization of the oral mucosa in the 30-member family of keratin filaments, the pair of keratins known as **keratin 4 and keratin 13** is specifically expressed in the spinous cell layer of mucosal epithelium.

Answer 263

**Chronic Mucocutaneous Candidiasis** Severe infection of mucosal surfaces, nails, and skin

Answer 264

Periapical Cyst

Answer 265

**Blastomycosis**

Answer 266

_Pellagra_ Deficience in Vitamine B3 (Niacin)

Answer 267

* **AKA:** pulp polyp * An e_xcessive proliferation of chronically inflamed dental pulp tissue_ • **Treatment**: RCT or extraction of tooth

Answer 268

▪ Tx: **radiation**, better prognosis than MM ▪ Solitary better prognosis than disseminated MM

Answer 269

Amyloidosis Submucosal amyloid deposit

Answer 270

❏ Rx: **Acyclovir cream 5% (Zovirax)** Disp: 5g tube Label: dab on lesion every 2 hours for 4 days ❏ Rx: **Penciclovir cream 1% (Denavir)** Disp: 5g tube Label: dab on lesion every 2 hours for 4 days ❏ Rx: **Docosanal cream (Abreva) OTC** Disp: 2g tube Label: dab on lesion five times per day for 4 days **Acyclovir and Penciclovir should be taken during the prodrome stage** ❏ Rx: Acyclovir 5%/ hydrocortisone 1% cream (Xerese) Disp: 5g tube Label: dab on lesion 5 times a day for 5 days ❏ Rx: Acyclovir buccal tablets (Sitavig) 50mg Disp: 2 dose pack Label: apply to canine fossa within 1 hour of symptoms (single dose)

Answer 271

Many cases of resistance with antibiotics §Cephalosporins *Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated with the antibiotic ceftriaxone* — given as an injection — with oral azithromycin (Zithromax)

Answer 272

Hyperparathyroidism Here we see we see * _a granular appearance of the max and mand bone everywhere,_ it is **not localized**. * There is a **loss of bone density** and **the loss of definition of cortical bone.** * Here we see a **loss of definition of lamina dura** as well _because it is now granular, and is not as clear._

Answer 273

Swelling of gingiva ## Footnote **▪ Plasmacytoma**

Answer 274

**Hematoma** because of THROMBOCYTOPENIA or Trauma

Answer 275

o **Antibiotics** ▪ Penicillin ▪ Metronidazole **o Local wound care** _▪ Conservative debridement_ to avoid iatrogenic tissue damage **o Consider nutrition, hydration and electrolyte imbalances** **o May cause significant morbidity**

Answer 276

shows **a grape‐like cluster** of small individual cysts

Answer 277

‐ Includes: **o Necrotizing gingivitis (NG):**rapidly destructive, non-communicable microbial disease of the gingiva **o Necrotizing periodontitis (NP)**:apidly progressing disease process that results in the destruction of the periodontium o **Necrotizing stomatitis (NS):**When the bacterial infection extends further to OTHER parts of the mouth o **NOMA** (extension to skin of face) ▪ Extreme disfigurement due to bacterial infection extending onto the skin of the face

Answer 278

**Renal Osteodystrophy 1** *Presentation is variable*. Sometimes you see **denser or granular appearance of bone.** You see _increase here_ but you sometimes will also see loss of definition of lamina dura, sometimes a sclerotic appearance and trabeculation.

Answer 279

Benign neoplasm

Answer 280

**• Maxillae affected more than mandible** • **Ill‐defined borders, blends in with the surrounding bone (not necessary to be corticated)** • **Variable density and orientation of the trabecular pattern** (radiolucent, radiopaque or a combination) * *• Ground‐glass appearance** (common) * *• Peau d'orange (surface of an orange)** (common) * *• Cotton wool appearance** (common) * *• Fingerprint pattern** ( uncommon pattern) • Typically the lesionss in the **maxillae are more homogenous and radiopaque,** whereas they may appear **more heterogenous and mixed in the mandible.** *\*typically you’ll see the ground glass appearnce and Peau d’orange on the maxilla as they are homogenous the cotton wool appearance more commonly found in the mandible since it is heterogenous.*

Answer 281

**Progressive Systemic Sclerosis (scleroderma)** * presence of **widening of the PDL space everywhere** around the root of the tooth.

Answer 282

**Pyogenic Granuloma** **We can see the corresponding radiograph;** -although the radiograph suggests generalized bone loss, there is a lot of calculus on the distal of #16 \> it makes sense that this is a pyogenic granuloma

Answer 283

* You can see there's a little bit of radiolucency. * There happened to actually still be teeth in the area, but * when it was _biopsied_ it showed that it was a * **hematopoietic** or **osteopoietic bone marrow defect**

Answer 284

■**Enucleation with peripheral ostectomy** ~ Very similar to odontogenic keratosis ■ **Follow up is long term** because s_ome of the solid tumors have a more aggressive behavior_ **■ Peripheral lesions are treated with excision**

Answer 285

**Periapical Cysts**

Answer 286

‐ Caused by: o Staphylococcus aureus o Streptococcal pyogenes _Damaged skin allows infection to enter_ **Usually affects kids**

Answer 287

**Granulomas** * o Epithelioid histiocytes * o Multinucleated giant cells * ▪ \* Langhans giant cells * ● Nuclei along the periphery * o Central caseous necrosis

Answer 288

**this is when you keep the fungal infection under control for a long time** Usually **unnecessary in immunocompetent patients** ● For patients who have recurrent infections: ‐ **For HIV‐infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections** (strong recommendation; high‐quality evidence). ‐ **Fluconazole, 100 mg 3 times weekly, is recommended** (strong recommendation; high‐quality evidence). ● **Clotrimazole 10mg troches 1 week out of every month?** (no evidence

Answer 289

we have 2 Pas of patients **with pseudohypoparathyroidism**. * hypoplasia of enamel, tooth material * hypoplastic tooth bud ( hypoplastic means arrested development) * delayed eruption, * external root resorption.

Answer 290

* Due to _chronic inflammatory process_ * *(osteomyelitis, TB,** **sarcoidosis)** * Affects **liver, kidney, spleen, adrenals** *but not heart* * can affect multiple organs, _heart is usually spared_

Answer 291

**Botryoid Odontogenic Cyst**

Answer 292

**Sturge-Weber Angiomatosis** **Sturge-Weber syndrome** Notice how the vascular malformation is only one side.. Remember: Vascular changes follow trigeminal nerve, so it doesn’t cross midline

Answer 293

* _Mutation_ of **PTCH** (tumor suppressor gene) * in the **Sonic Hedge Hog pathway**

Answer 294

**Hodgkins lymphoma**

Answer 295

Erythroplakia. Erythematous macule on the right floor of the mouth. Biopsy-- Turned out to be early invasive squamous cell carcinoma.

Answer 296

**Langerhans Cell Disease** ▪ Older child ▪ Chronic disseminated form ▪ Alveolar ridge involvement ▪ Lot of bone loss and mobility ▪ Painful to brush

Answer 297

▪ Usually clears within a few days _after renal dialysis has begun_ ▪ **Mildly acidic mouth rinses** seem to clear oral lesions *(ex. diluted hydrogen peroxide)* ▪ **Palliative treatment *_for pain_*** includes _ice chips or a topical anesthetic_

Answer 298

**What is it?** Benign tumor derived from Schwann cells **Treatment** • Treated by surgical excision (Be careful with excision! no need to get all of it out, just most of it) rarely recurs

Answer 299

**Primary Syphilis** _Chancre_ at site of inoculation (3 – 90 days later) ‐ Papule ► Ulceration ‐ Most chancres occur in genital area (4% oral

Answer 300

**Non-homogenous leukoplakia** Nodular leukoplakia ~ Largely white Verrucous leukoplakia ~ Largely white Erythroleukoplakia ~ Red and white Speckled and verrucous leukoplakia have a greater risk for malignant transformation than the homogeneous form

Answer 301

❏ the **prodrome**, prodrome treatment is abortive \*\*remember this!\*\*

Answer 302

Geographic tongue/ areata migrans

Answer 303

**Aplastic Anemia** * One of the main differences between and neutropenic ulcer and an empthis ulcer? Is the red halo, the mucosa surroundingneutropenic ulcer Is pale and not red. * The center of a neutropenic ulcer has granulation tissue with a little bit of white

Answer 304

‐ Infectious disease which is seen in _lymph nodes_

Answer 305

Adenomatoid odontogenic tumor (AOT) * **Teardrop shape / inverted pear** _between roots of teeth_. * **Well-circumscribed, corticated margin** & **snowflake‐like calcifications** *within*

Answer 306

**Fingerprint pattern** The arrow indicating the inter‐radicular area of this molar. You can see the trabecular bone has been altered into a fingerprint pattern. This is a case of localized fibrous dysplasia. Very uncommon.

Answer 307

pt with Osteopetrosis we see **Hypovascular bones** so they are *more prone to osteomyelitis*. This is a sign of sequestrum which is a sign of osteomyelitis.

Answer 308

**Osteosarcoma** * _cloudy bone formation_ on surface of cortex on facial and lingual aspect

Answer 309

- if it’s on the gingival tissues, take a radiograph - always consider **SCC** as a differential diagnosis

Answer 310

**Homogeneous leukoplakia** ○ Thickened leathery, White plaque ○ Well-demarcated, Deepened fissures ○ Non-wipeable white patch

Answer 311

**Addison’s Disease**

Answer 312

**Simple Bone Cyst** * **A well-circumscribed**showing **the scalloping up between the roots of the teeth radiolucency**

Answer 313

Gingival cyst of the newborn/ Dental lamina cysts/Cysts of the Newborn-gingival

Answer 314

* consists of **conservative enucleation**

Answer 315

**Mucous Cyst**

Answer 316

**Mycobacterium bovis** **Infected milk** leads to **scrofula** **RARE** today _as milk is pasteurized_

Answer 317

■ Treatment is **surgical enucleation and curettage** ■ **lesions can recur** ~ Usually the recurrence is because you didn't get the entire thing out the first time around ■ Some surgeons follow **enucleation** with **cryotherapy** ■ **Irradiation** is _contraindicated_

Answer 318

▪ **Failure** of the **hematopoietic precursor cells to produce adequate numbers of all types of blood components** ▪ Rare, but life threatening ▪ **_Associated with_** **environmental toxins (benzene), certain drugs (antibiotic chloramphenicol), or infection with certain viruses (non‐A, non‐B, non‐C, non‐G hepatitis)** ▪ **Fanconi’s anemia and dyskeratosis congenita patients** _have an increased risk of developing this_

Answer 319

When there are **Four defective genes – Hb Bart’s hydrops fetalis** o Lethal in utero or within a few hours of birth o Not compatible with life **▪ Estimated that 5% of world population carries a variant of Alpha‐thalassemia (over 100 genetic forms)** ▪ One defective gene – o no disease detected ▪ Two defective genes – **alpha‐thalassemia trait** o Mild degree of anemia (usually not clinically significant) ▪ Three defective genes – Hb (hemoglobin) H disease **o Hemolytic anemia and splenomegaly**

Answer 320

**‐ Aphthous Ulcer of the tongue** ‐ Aphthous ulcers can occur on specialized structures of the mouth

Answer 321

**HSV‐1: Primary Infection** _pathogensis_ ❏ Usually young age ❏ Often asymptomatic ❏ Symptomatic = Primary herpetic gingivostomatitis ❏ In adults is usually pharyngotonsillitis (back of throat) ❏ Spread through infected saliva or active lesions ❏ Incubation period = 3‐9 days These photos represent **gingivostomatitis** **multiple irregularly shaped ulcers present on the fixed and movable mucosa, bilaterally**

Answer 322

When it is diagnosed? ● Usually initially *diagnosed* **in adolescents** Etiology? **●** *Etiology* **unknown‐ immunologically mediated?** o Theory of being _too clean as a child and having a negative response as we grow older since we’re not used to normal bacteria_ Prevalence? ● *Prevalence* i**ncreasing, reason unknown** What are the oral implactions? ●Oral lesions can be first sign of disease

Answer 323

Venous malformation (low flow) *Many pts can live with this without treatment*

Answer 324

* sickling of the RBCs becomes severe * precipitated by such things as **hypoxia, infection, hypothermia, or dehydration** * Symptoms include **pain (**which may be severe) due to ischemia and infarction of affected tissues ▪ Long bones, lungs and abdomen are common sites of occurrence for “crises” ▪ Episodes last from 3‐10 days, some patients have monthly crises, some may go a year or more between ▪ May need **pre‐medication prior to dental treatment** * **infections** are the most common cause of death in sickle cell patients (in the US) ▪ Patients also have impaired kidney function and CNS involvement (strokes in 5‐8%, often prior to age of 10)

Answer 325

**microcytic, hypochromic anemias (iron deficiency):** Pallor ▪ **Anemia**: reduction in O2 carrying capacity ▪ **Diagnosis**: RBC counts, Hg, HCT, red cell indices for dx of type of anemia ▪ Normal upper labial mucosa ▪ Pale lower labial mucosa

Answer 326

Mucous membrane pemphigoid

Answer 327

**Tuberous sclerosis complex** we see A lot of gingival enlargement – is this overgrowth from disease or from seizure medication? Multi organ system involvement

Answer 328

▪ No treatment is necessary ▪ Spontaneously resolve (degenerate or rupture)

Answer 329

* **surgical extraction** _of the involved tooth with attached tumor_ * **Root amputation (with attached tumor) and endo** is an option *_for smaller lesions_* * _Recurrence_ is ***unlikely***

Answer 330

**Pseudomembranous Candidiasis** *Topical Corticosteroid Use* Can be brought about from steroid use **(steroid inhaler example)** ‐ If you don’t rinse your mouth after using steroids, this can happen ■ _A proliferation of hyphae_

Answer 331

Pemphigus vulgaris is not fully understood. Experts believe that it's triggered when a person who has a genetic tendency to get this condition comes into contact with an environmental trigger, such as a chemical or a drug. In some cases, pemphigus vulgaris will go away once the trigger is removed.

Answer 332

hypothyroidism, in child, still has deciduous teeth even though its an older child Radiographically we see the teeth have not erupted in the oral cavity

Answer 333

Pellagra Deficience in Vitamine B3 (Niacin) Dermititis of the skin

Answer 334

Denture stomatitis.

Answer 335

**C. albicans** * **Candidal sepsis** means that you have the fungal moving around in your body * **Life‐threatening event** in individual with severely deficient cell * mediated immunity * Most commonly involves urinary tract infection (women/men 4:1) * _Very rare_

Answer 336

Necrotizing Sialometaplasia

Answer 337

**Cyclic Neutropenia** ▪ Gingiva is most severely affected with periodontal bone loss and tooth mobility

Answer 338

**low levels of erythropoietin – organ disease**

Answer 339

This is showing you the how the papilla can be enlarged if it's only in soft tissue or if there's a partial soft tissue partial bone expansion *Nasopalatine Duct Cyst*

Answer 340

Acute lymphoblastic leukemia (ALL) Success in treatment of a previously fatal disease Children age 1‐10 years have higher success with treatments than teenager do (10‐20yrs) o And infants (under 1yr) do the worst Chemotherapy that are given for curing ALL actaully causes problems when they are older.

Answer 341

Sublingual Varices

Answer 342

**_GNAS1 gene mutation_** in fibrous dysplasia is a potential diagnostic adjuvant, as it is not found in normal bone tissue (etiolog

Answer 343

● Most cases **asymptomatic** ● **Itraconazole** (mild to moderate disease) ● **Systemic amphotericin B** (severe cases) ● There is a connection with people taking TNF‐alpha inhibitors

Answer 344

○ Acute/Primary Herpetic Gingivostomatitis ○ The easy way to remember where the ulcerations occur? ➢ gingiva and oral cavity **gingivo** (=**gingiva** or _fixed_ keratinized mucosa) + **stoma** (= the **movable** part of the oral cavity where the CT is looser, including the **labial and buccal mucosa, and the tongue**).

Answer 345

** Most common malignancy of salivary glands  Most common malignant SG tumor in children** ** Can be mistaken for mucocele**  **Histopathology**: note the cells growing into adjacent tissue, showing infiltration

Answer 346

**Odontogenic Keratocyst “OKC”**

Answer 347

‐ Causative organism: o Bartonella henselae ‐ Previous contact with a cat (scratch or saliva)

Answer 348

**Pemphigus Vulgaris.**

Answer 349

Langerhans Cell Disease we see _lesions on maxilla_

Answer 350

**Pseudohypoparathyroidism** issues with eruption, no pulp stones present

Answer 351

Uremic Stomatitis

Answer 352

* Chronic infection * caused by *_spirochete_* **Treponema pallidum**

Answer 353

Ranula * Notice how it's unilateral* * on the floor of the mouth*

Answer 354

**Neurofibromatosis syndrome** **von Recklinghausen’s Disease** * Lisch nodules on iris, pigmented (eye picture) * Neurofibromatosis in mouth (bottom left picture) * Café au lait (bottom right picture)

Answer 355

Cherubism **Treatment**: Usually not needed as the cyst-like lesions fill in with granular bone during adolescence- conservative surgical procedures may follow for cosmetic reasons.

Answer 356

***Aspergillosis*** arrow points toward a violaceous‐ purple colour

Answer 357

**microcytic, hypochromic anemias (iron deficiency):** Pallor ▪ **Anemia**: reduction in O2 carrying capacity ▪ **Diagnosis**: RBC counts, Hg, HCT, red cell indices for dx of type of anemia ▪ Normal upper labial mucosa ▪ Pale lower labial mucosa

Answer 358

▪ Child with _disseminated form_ ▪ **Punched out radiolucency** in the skull

Answer 359

● Clinical signs ● Therapeutic diagnosis ● Cytologic smear: scrape cells and look at them under the microscope and stained with PAS stain ● Periodic Acid Schiff Stain (PAS stain) ● KOH float §Biopsy (esp. hyperplastic candidiasis) ● Culture

Answer 360

PLEOMORPHIC ADENOMA * Upper lip presentation: sometimes swelling can be seen extra orally and intraorally. * Remember the swelling will be movable, not tender, not fixed to underlying structures. | (MIXED TUMOR)

Answer 361

Mandibular Torus: Torus Mandibularis

Answer 362

**Plasma Cell Disorders** Clock face nucleaus

Answer 363

**inflammatory conditions, malignancy – organ disease**

Answer 364

Treatment can include : * **chemotherapy** _with or without Radtiaion Therapy_ * bone marrow transplant * interferon * antibodies made against tumor cells * thalidomide * Even with treatment, many patients do not survive more than 18‐24 months, however treatment modalities are improving * Older patients are treated less aggressively

Answer 365

▪ Child with **bone loss** surround the teeth **▪ Floating teeth** _disseminated form_

Answer 366

**Nicotinic Stomatitis** These papules represent _inflamed minor salivary glands_ and their ductal orifices.

Answer 367

**Cyclic Neutropenia** ▪ Depending on surface involved, can mimic recurrent aphthous ulcerations o Usually do not see erythematous halo that is so typical of aphthous

Answer 368

**Ameloblastoma** ▪ **Well‐circumscribed radiolucency** with **a sclerotic or corticated margin**. ▪ If you had a CBCT, it would probably show you that there was a thin septa in this area of residual bone trabeculae. ▪ **Fracture could be caused by very large cysts.** ▪ **Resolve by decompressing unless with odontogenic tumor** – need to remove the mandible **1cm+** on either side of lesion

Answer 369

**Aspergillosis** Histopathology includes: ●Branching septate hyphae ● Acute angle branching **● “Fruiting body**

Answer 370

**Cemento‐ossifying Fibroma** ## Footnote Note **the internal granular appearance of the trabucular bone** ( black arrows) The purple arrows shows the wall of the expanded buccal/facial and lingual cortical plates caused by the neoplastic entity. This was a confirmed cased of **ossifying fibroma\*** mainly because of two things: **1. siginficant cortical expansion on buccal and lignual side 2. altered trabacular pattern.** **ddx of fibrous dysplasia b**ut you should look for a radiolucent rim if you can and if not, they maybe considered under the same differential diagosnsis. Note that may help you in differentiating : **** The **maxilla** is affected more in **_Fibrous dysplasia_** **** The **mandible** is affected more in **_Ossifying fibroma_**

Answer 371

Hematoma because of THROMBOCYTOPENIA orTrauma

Answer 372

**Treatment**: Usually treated by surgical excision **Prognosis:** • Overall prognosis is _fairly good_ • 10% of patients die, due to local recurrence or metastasis  Low‐grade tumors have good prognosis (\>90% are cured)  High‐grade tumors the prognosis is guarded (Only 30% survive) **Therapy by gene?** *CRTC1–MAML2, CRTC3‐MAML2* gene fusions (targeted therapy)

Answer 373

Thyroglossal Duct Cyst

Answer 374

HHV3 Varicella (chickenpox) It is caused by Varicella Zoster Virus Infection a typical macular, papular, vesicular rash – it’s bilateral

Answer 375

**6, 11, 16, 18** ***(condyloma – can be malignant)***

Answer 376

``` supportive care initially, attempts to stimulate bone marrow (androgenic steroids), and bone marrow transplants for severe cases (prognosis is guarded at best) ```

Answer 377

large root canal structures, large root chambers, premature loss of teeth = **hypophosphatasia.**

Answer 378

**Lateral Periodontal Cyst**

Answer 379

**Congenital Epulis**

Answer 380

hypothyroidism woman who had hypothyroidism, lips are thickened, thick creases in the face

Answer 381

**CENTRAL MUCOEPIDERMOID CARCINOMA** * _Intrabony presentations_, may have extraoral swelling depending on the stage * Started as small swelling and progressed rapidly:, need to pick it up early! * Patient recovered, but might need radiation, lost salivary glands, needed reconstruction of palate

Answer 382

**Transient Lingual Papillitis** * ‐ Relatively rare * ‐ Canker sore meets **fungiform papilla** of tongue * Multiple papilla can become inflamed (above image) * **Very painful** * ‐ Ulcer Appearance: * Tiny * Transient * On fungiform papilla of tongue * **‐ Typically resolves in 7‐10 days**

Answer 383

Periapical COD Pink arrow Simple bone cysts may develop in regions of COD ( periapical or florid type) So look for areas void of trabucular bone and has scalopping of the lesion. green

Answer 384

Classic appearance of **Odontoma** * **multiple tooth‐like shapes** *aggregated together* * Typically with some sort of **radiolucent halo around them**

Answer 385

**Nicotinic Stomatitis** also known as Smoker’s keratosis smoker’s palate * the palatal mucosa becomes diffusely gray or white; numerous slightly elevated papules are noted, usually with punctate red centers

Answer 386

**Dermoid Cyst** * This is showing you when they occur below the **mylohyoid muscle.** * You get **an elevation under the chin.** * This is **a fairly small on**e but they can get much larger

Answer 387

Odontogenic Keratocyst Histology Notice the daughter cysts

Answer 388

‐ Associated Bacteria: **o Actinomyces israelii o Actinomyces viscosus** ‐ Normal component of oral flora -gram positive anaerobic bacteria

Answer 389

**Oral lichen planus** Lichen planus of the dorsum of the tongue this is a hypertrophic form.

Answer 390

**Metastatic Carcinoma to Jaw Bones** A. Partial panoramic image of prostate metastatic lesions involving the body and ramus; note the sclerotic bone reaction (arrows).

Answer 391

**Cleido-Cranial Dysplasia** **Treatment:** For children, facial reconstructive surgery on the bones of the face to reshape the forehead or cheekbones. Spinal fusion procedures to support the spinal column. Lower leg surgery to correct knock knees (knees that bend inward toward the center of the body)

Answer 392

-Removal * Enucleation if small * Marsupialization if large * Note:* * Enucleation* means: removal of an organ or other mass intact from its supporting tissues *Marsupialization* means: surgical technique of cutting a slit into an abscess or cyst to empty its contents and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess. Promotes Decompressing and shrinkage.

Answer 393

Etiology It is due to increased thickness of the epitheliumand intracellular edema of the prickle-cell layer. Treatment No treatment required

Answer 394

**▪ HPV associated SCCa** ‐ Wild type TP53 ‐ Low pRb _‐ Increased p16_ **▪ Tobacco and Alcohol associated SCCa** _‐ \*Mutated TP53_ – mutated by carcinogens in tobacco and alcohol► cancer ‐ pRB overexpression ‐ Decrease p16

Answer 395

Sometimes, simple bone cysts should be differentiated from odontogenic keratocysts (OKCs)

Answer 396

**Secondary Syphilis** Mucous Patch

Answer 397

* *• Definition:** locally destructive inflammatory condition — looks malignant but is _benign_ * • salivary gland ischemia* — “heart attack of the palate”; blood flow is interrupted **• predisposing factors:** - local trauma - palatal injection of local anesthesia - previous surgery - many are idiopathic.. • usually a clinical diagnosis based on history & how fast — palate uncommon for SCC * **Treatment**: no treatment, spontaneously resolves within 6 to 10 weeks * _irrigating & debriding the area_ can reintroduce vascularity & help healing

Answer 398

_What is it?_ **Chronic hemolytic blood disorder** _What causes it?_ ▪ **Abnormal hemoglobin, resulting in anemia** -\> by increasing the production of red blood cells -\> **requires compensatory hyperplasia of the bone marrow**

Answer 399

**Etiology**:Caused by **HHV-8 (human herpesvirus 8) /***part of herpes family* **Treatment** * Surgical excision, radiation therapy or systemic chemotherapy for multiple nonoral lesions, if it gets large, dose-radiation therapy!

Answer 400

**What is it?** • Benign neoplasm of Schwann cell origin • Uncommon lesion: 28-48% occur in the head and neck **• Treatment** • surgical excision **malignant transformation** reported, but rare

Answer 401

Cemento‐ossifying Fibroma Axial section of the mandible * The granular radiopacity immediately surrounded by a radiolucent rim ( purple arrow) * **Also note the extent of the expansion of the buccal and lingual cortical plates, a feature which is common of ossifying fibroma.** * This is more clear radiographically where we see a radiolucent rim surrouding a mixed radiolucent/radiopaque center and there is a siginficant expansion of the buccal and lingual plates. ► **very common in ossifying fibroma**

Answer 402

Homogeneous leukoplakia. *○ Non-wipeable white patch*

Answer 403

In addition to *fracture*, there is **semilunar loss of bone around the molars ►** (SOT) **Squamous Odontogenic Tumor**

Answer 404

**● Superficial and localized‐more common (mild disease)** ‐ Intertrigo §Paronychia/Onychomycosis ‐ “Diaper Rash” ‐ Vulvovaginitis ‐ Esophageal Candidiasis §Oral Candidiasis (Candidosis) **● Invasive, disseminated and deep infection‐rare (moderate‐severe)** ‐ Affects blood (candidemia‐hospitalized), heart, brain, eyes, bones)

Answer 405

* **Etiology unclear** * may be **hyperplasia of marrow** due to need for RBCs or * **abnormal regeneration of bone** after **an extraction or persistence of fetal marrow**

Answer 406

**o Folic Acid def o Vit B12 def (pernicious anemia)**

Answer 407

**Herpetiform aphthous stomatitis** * Apppears like **herpesvirus but unrelated to it** * account for **5% of cases (**the least common) **Appearance**: * begin as multiple (up to 100) 1- to 3-mm crops of small, painful clusters of ulcers on an erythematous base. * They coalesce to form larger ulcers that last 2 weeks. * *A bunch of smaller ulcers that coalesce*

Answer 408

**Adenomatoid odontogenic tumor** **(AOT)** An expansion _into lingual area_ as well as _into vestibule_

Answer 409

within 5 years of being diagnosed with BCC►**35%-50%** of people _develop a new skin cancer_

Answer 410

**Antral Pseudocyst** * a **Dome-shape** **swelling** on the floor of the sinus. * _They can sometimes_ be **fairly subtle** **Antral Pseduocyst** are **NOT Mucoceles** **Mucoceles** would have more of **meniscus-like appearance**where it would come up to**the edge of the sinus**

Answer 411

**Insicional biopsy Mandated to distinguish from OLP** ○ Biopsy white areas on non-keratinized mucosa NOT ulcerated OR red areas Treatment Replacement of the restorative material, polishing and smoothing, and good oral hygiene are recommended. Topical steroid treatment for a short time is also helpful.

Answer 412

● **Acute**‐Supportive (analgesics and antipyretics) ● **Chronic**‐IV lipid preparation of amphotericin B or itraconazole ● **Disseminated**‐Lipid preparation of amphotericin B (2 weeks or more) followed by daily itraconazole for 6‐18 months

Answer 413

* *of MI or CVA (cerebral vascular accident or stroke) **

Answer 414

**Periapical Cysts**

Answer 415

**Minor Recurrent Aphthous Ulcers (RAS)** * **aka‐ “Canker Sores”** * ‐ High prevalence: 5‐25% * ‐ Comprises the overwhelming majority of cases * o 75‐85% of ALL RAS cases * **‐ \<10 mm in diameter** * ‐ Ulcer appearance: * **o Shallow** * **o Round/Oval Shaped** * **o Yellow pseudomembrane** * ▪ Slightly raised margin * ▪ Erythematous Halo * **‐ Typically resolves in 7‐10 days** * o \*May take longer if in a “high‐traffic” site * **‐ No scarring** * ‐ Recurrence rates vary

Answer 416

**Kaposi Sarcoma (HHV‐8)** Right photo: we see Patch, slightly raised plaque stage ○ This is different from **hemangioma** because if you press on it, it doesn’t blanch (where all the blood goes away, and it looks white) Left photo: Nodular is when it becomes very exophytic You need to do a biopsy for this because it looks irregular.

Answer 417

Geographic tongue: well-demarcated red patch on the tongue.

Answer 418

**Odontogenic Keratocyst OKC**

Answer 419

Idiopathic Osteosclerosis AKA: Dense Bone Island  Not associated with any dysplastic, neoplastic, inflammatory or systemic disorder.  **Common incidental finding.**  Slow growing, typically stops growing by the time of skeletal maturity.  Peak prevalence in the third decade of life. ** No treatment required; monitoring is suggested.**

Answer 420

**cancrum oris**

Answer 421

**enlarged/hyperplastic follicle** Rule of thumb: * If 4‐5mm or more of radiolucency ► _dentigerous cyst_ * If \<4mm of radiolucency► can be _hyperplastic follicle_

Answer 422

**Divided into acute and chronic, myeloid and lymphoid** o Acute myeloid, chronic myeloid, acute lymphoid, and chronic lymphoid **▪ Acute leukemia** o Typical course under 6 mos o Untreated, runs an aggressive course often causing death **▪ Chronic leukemia** o 2‐6 or more years o More indolent course, although, they too often result in death **▪ Leukemia, like lymphoma, can cause bone destruction and the radiographic appearance of “teeth floating in air” in children**

Answer 423

The elevated temperature, rather than the tobacco chemicals, is responsible for this lesion.

Answer 424

**MOCHA** * **M odontogenic **_M_**yxoma** * **O **_O_**dontogenic keratocyst** * **C **_C_**entral giant cell granuloma** * **H Central **_H_**emangioma** * **A _A_meloblastoma** **Others:** * Aneurysmal bone cyst * early CEOT * ameloblastic fibroma AF * central MECa

Answer 425

o **Self‐limiting (resolves within 4 months)** o Local heat o Analgesics o Mechanical removal of suppuration (aspiration) o May use antibiotics for severe cases ▪ Azithromycin

Answer 426

* **Surgical excision** or **resection** * Because the lesion is not encapsulated and has a gelatinous loose consistency► it is difficult to remove completely * this is thought to be why myxoma **has a fairly high recurrence rate** * _**Maxillary posterior lesions** should be treated more aggressively_

Answer 427

**ACINIC CELL ADENOCARCINOMA**

Answer 428

The exact etiology remains unknown. It may be genetic.

Answer 429

YOU APPLY THE MEDICATION TO THE INTAGLIO PORTION antifungal medication (1) Topical Antifungal Agents ‐ Rx. Clotrimazole cream 1% vs OR ‐ Rx. Nystatin‐Triamcinolone Acetonide ointment or cream (why? To keep the inflammation down) ■ Disp: 15g tube ■ Label: apply to angles of mouth after meals and before bedtime (2) Denture adjustment, reline, remake YOU APPLY THE MEDICATION TO THE INTAGLIO PORTION

Answer 430

**Miliary TB** compared to miliary seeds

Answer 431

**Plasma cell gingivitis** ▪ Allergen causes mass infiltrate into gingival ▪ Benign

Answer 432

**Langerhans Cell Disease** Torus and molar involvement

Answer 433

**Thalassemia** * **osteopenic bone (***loss bone mass and bones get weaker*) * **radiolucent appearance of bone** * thinning of cortical bone around the mandible and maxilla. * Usually there is **hypoplasia of the paranasal sinuses.**

Answer 434

_Adenomatoid odontogenic tumor_ _(AOT)_ **Snowflake‐like calcifications** within ***mixed, well‐circumscribed radiolucency***

Answer 435

**Fimbriated fold/Plica semiluminaris**

Answer 436

**Do you think it’s a fibroma? No. Why?** Fibroma is covered with normal coloring epithelium – sometimes see a little white change on surface or see tiny traumatic ulcer on surface This is not like that, this is completely ulcerated Not fibroma; fibroma is a chronic bump that patient is aware of **Is it squamous cell carcinoma? Interesting, it is indeed very friable; but no** Sometimes SCC can develop and can be exophytic and don’t have deep invasion, But this is pedunculated, SCC would not be pedunculated History says there could be some kind of trauma, biting, or nick with bur – not squamous cell **Mucocele? No** Would you typically develop mucocele on lateral border of tongue? No Not going to be as many mucoceles in this area, but there are the glands of Blandin and Nuhn, so it’s possible to develop on ventral surface of tongue This bump doesn’t look like a fluid filled bump though, it has surface ulceration, redness ;Mucoceles have intact surface, would not bleed, or be red **Granular cell tumor? No** Granular cell tumor would have normal overlying epithelium (it’s pushing up from underneath) This does not have normal overlying epithelium **Hemangioma reserved for congenita**l; not a vascular malformation either **Neurofibroma? No, not the same surface** **Salivary gland neoplasms? Possible**, there are salivary glands in that area; keep this in differential The one that this is is **pyogenic granuloma**: usually red, ulcerated, and bleeds easily

Answer 437

``` **Calcifying Odontogenic Cyst (COC)** ``` * _in the mandible_ and you can see it **well circumscribed radiolucency** * a little bit of blunt root resorption in this area * _No calcifications_ in this one yet ►so this is still **unilocular radiolucency**

Answer 438

**Agranulocytosis** ## Footnote Decrease in the number of cells from the granular cell lineage (neutrophils, eosinophils, basophils, etc.) o Decreased production or increased destruction ▪ Some cases are idiopathic, most are drug induced ▪ Anticancer chemotherapeutics ‐ inhibit mitotic division and maturation of hematopoietic stem cells. ▪ In rare cases, agranulocytosis is a congenital syndrome. ▪ Increase risk of **infections**

Answer 439

▪ Floating teeth ▪ Only attached by soft tissue due to extensive bone loss _disseminated form_

Answer 440

**Angular Cheilitis** ● **Erythema**, _fissuring and scaling at angles of mouth_ and _commissures of mouth_ ● ***Loss of vertical dimension*** ● ***Pooling of saliva*** ● _May be mixed bacterial/fungal infection_ ● _Differential diagnosis_ can be **Vit B Deficiency** *a subtype of Erythematous Candidiasis*

Answer 441

**Canalicular Adenoma** * ***Mucocele*** might look this way, but what would make it lower on * differential diagnosis is the location of the swelling. Mucocele is mostly seen on lower lip and this pic shows upper lip. Salivary gland tumors and mucoceles * can have the same clinical presentation, so always do a biopsy for formal histopathology diagnosis.

Answer 442

**‐ Treatment to reduce pain** Also Consider * using Sodium Lauryl Sulfate‐Free Toothpastes * Remove Obvious Possible Causes * ‐ Repair sharp teeth/restorations * ‐ Remove plaque * ‐ Optimize lubrication

Answer 443

**Osteosarcoma** a patient with swelling with side of face

Answer 444

Gardner's Syndrome Synonym: Familial Multiple Polyposis. Remember this:  GarDENse Bone Island.  GARDEN-FOREST:  F- Familial adenomatous polyposis.  O- Osteomas.  RE- Retinal epithelial hypertropy.  ST- Supernumerary teeth. Treatment: Because people with Gardner’s syndrome have a higher risk of developing colon cancer, treatment is usually aimed at preventing this. Medications such as an NSAID (sulindac) or a COX2 inhibitor (celecoxib) may be used to help limit the growth of colon polyps. Treatment also involves close monitoring of the polyps with lower GI tract endoscopy to make sure they do not become malignant (cancerous). Once 20 or more polyps and/or multiple higher risk polyps are found, removal of the colon is recommended in order to prevent colon cancer. If dental abnormalities are present, treatment may be recommended to correct problems.

Answer 445

Palatal Rugae

Answer 446

* Consultation with an OMFR is advisable. Monitoring of the area is also advised. * Typically treatment is not needed unless there are clinical symptoms or patients present with cosmetic concerns if clinical symptoms are severe * Implants and surgical intervention should be avoided when possible as these areas are void of blood supply

Answer 447

Lymphoma * Well circumscribed ulceration in area * Associated swelling in periphery * White change in the patient’s left area * Been there for 3 weeks * It’s lymphoma

Answer 448

**Pseudohypoparathyroidism** pulp chambers are very elongated

Answer 449

**Ameloblastic Fibro-odontoma (AFO)** has expansion into oral cavity. Flecks of calcification in lesion with impacted tooth = odontoma

Answer 450

**o Recurrent Herpes Labialis** ▪ Resemblance to initial impetigo stages when still unilateral **o Perioral Dermatitis** ▪ Triggered by cosmetics and other substances on the skin **o Exfoliative Cheilitis (chapped lips)**

Answer 451

**Calcifying Epithelial Odontogenic Tumor(CEOT)** * **well‐circumscribed radiolucency with calcifications** *_in lower anteriors_*

Answer 452

● **Bleach‐**1 part bleach to 10 parts water (not for dentures with metallic clasps) ● **Polident** (NYU Carries Polident) ● **Microwave**? ( could be risky, careful not to ruin the denture) CLEANSERS FOR REMOVABLE PROSTHESIS- you have to use this everynight to avoid denture stomoatits **_NYU Carries Polident_** Formulation: **sodium bicarbonate, citric acid, potassium monopersulfate**, sodium carbonate, sodium carbonate peroxide, TAED, sodium benzoate, PEG‐180, sodium lauryl sulfate, VP/VA copolymer, flavor, cellulose gum, FD&C blue 2, blue 1 lake, yellow 5, yellow 5

Answer 453

**Diabetes mellitus** Anterior papillae are very puffy and red and fill of pus Posterior gingiva are very hyperplastic

Answer 454

**Hypophosphatemia** * Periapical lesions with radiolucency but no caries on the crown. * There is loss of definition of cortical bone. * On the teeth, you have: * large pulp chambers * hypoplasia of enamel and dentin * periodontal and periapical lesions.

Answer 455

▪ Squamous papilloma ▪ Verruca vulgaris ▪ Condyloma acuminatum ▪ Focal epithelial hyperplasia ▪ Oral florid papillomatosis

Answer 456

**Erysipelas** Superficial skin infection in immunosuppressed adults ‐ Group A beta‐hemolytic streptococci ‐ Painful ‐ Bright‐red, well‐circumscribed, swollen, indurated (firm) ‐ Warm to touch ‐ Systemic manifestations: o High fever o Swollen lymph nodes Diagnosis: Cultures not useful ‐ Treatment: **o Penicillin ‐ Complications without treatment**

Answer 457

**Amyloidosis** _Amyloid deposition_ with **ulceration** and **petechiae**

Answer 458

: taking antivirals everyday to prevent those 6 outbreak/year. There is modest evidence that systemic **acyclovir or valacyclovir** prevents recurrent herpes labialis these drugs tend to only affect virally‐altered cells. They don’t affect the mammalian cells; they’re very safe.

Answer 459

Pellagra Deficience in Vitamine B3 (Niacin) erythema of the tongue

Answer 460

**CEMENTOBLASTOMA (True Cementoma)** * First molar has **tumor attached to the root.** * Mostly **radiopaque but has some less radiodense areas within** = *_classic for cementoblastoma._* * **Radiolucent halo** around region.

Answer 461

**– environmental**

Answer 462

Hyperplastic gingiva

Answer 463

● **Polyene‐Nystatin, Amphotericin B** (not absorbed; used for deep fungal infections) ● **Imidazole‐Clotrimazole, Ketoconazole** (GI absorption) ● **Triazole‐Fluconazole, Itraconazole, Posaconazole, Echinocandins**

Answer 464

**Compound Odontoma** _little teeth‐like structures_ blocking canine eruption

Answer 465

**§Multiagent therapy for active infection to prevent mutation and resistance** §8 week course §Pyrazinamide §Isoniazid §Rifampin §Ethambutol **§Followed by 16 week course** §Isoniazid §Rifampin **‐ Chemoprophylaxis** ‐ For positive PPD but no active infection **‐ BCG vaccine** o Not used in US due to controversy regarding effectiveness

Answer 466

**Nasopharyngeal carcinoma** ❏ Associated w/ HHV‐4 (EBV) ❏ You might be one of the first people to detect this cancer – the first sign is the swelling of the lymph nodes In this case, these are late stages of the disease. *this photo from google*

Answer 467

Only **5%-10%** infections lead to active disease i

Answer 468

Children Adults with debilitating disease

Answer 469

Lymphoepithelial cyst we see a tiny yellowish cyst. we see the blood vessels on the surface; this is quite characteristic.

Answer 470

**Chondrosarcoma** * its consistent widening as opposed to seen in periodontitis and inflammatory disease

Answer 471

**Acute myelogenous leukemia***with* **granulocytic sarcoma** ## Footnote * *Complaining of lump inside of her cheek** * *Notsomuch worried about her gingiva**, despite her overgrowth – leukemic infiltrates that got into gingival tissues * *Left buccal mucosa**, kept biting on it, feeling incredibly fatigued though she was always working out * *Oral surgeon biopsied** her buccal mucosa and read by pathologist as pyogenic granuloma * *Physician** sent her for bloodwork, dental school sent her for bloodwork too

Answer 472

**CD4+ T‐Lymphocytes**

Answer 473

Sturge-Weber Angiomatosis Sturge-Weber syndrome

Answer 474

**PSEUDOMEMBRANOUS CANDIDIASIS** *UNCONTROLLED DIABETIC* When you wipe away these plaques, you might see some Erythematous areas that causes some of the symptoms that the patient feels -This is **MILD DISEASE**

Answer 475

Buccal Exostoses

Answer 476

* **Enucleation** with **curettage** or **excision** * usually d**on’t recur**

Answer 477

Recurrent HSV-1 **Bilateral** \> THIS IS KEY -differential diagnosis with a Staph infection that occurs periorally with kids -\> impetigo

Answer 478

**Aplastic Anemia** ## Footnote ▪ Failure of the **hematopoietic precursor cells to produce adequate numbers of all types of blood components** ▪ Rare, but life threatening ▪ **_Associated with_** **environmental toxins (benzene), certain drugs (antibiotic chloramphenicol), or infection with certain viruses (non‐A, non‐B, non‐C, non‐G hepatitis)** ▪ **Fanconi’s anemia and dyskeratosis congenita patients** _have an increased risk of developing this_ **Oral signs:** are associated with the **thrombocytopenia** and include **spontaneous gingival hemorrhage, mucosal petechiae, purpura,** *and* **ecchymoses** ▪ **Nonspecific oral ulcerations** **(neutropenic ulceration)** may also be seen on any mucosal surface, but especially in areas of trauma (even minor trauma, ex. gingiva) **o Neutropenic = low neutrophils**

Answer 479

‐ **A**: autoimmune ‐ **PE**: polyendocrinopathy ‐ **C**: candidiasis ‐ **E**: ectodermal ‐ **D**: dystrophy **Chronic Mucocutaneous Candidiasis** is also genetic associted with **AIRE** gene

Answer 480

**Diabetes Mellitus** Gingivitis = puffy red papillae here between the central and lateral incisors

Answer 481

Amyloidosis Macroglossis and crenation of tongue (indentation near the teeth area) _skin deposits_ on the comissure,

Answer 482

• **definition**: acute or chronic _inflammation in major or minor salivary glands_ **• causes:** • obstruction of a salivary gland duct (sialolith) • infection (mumps [viral], staph aureus [bacterial, most common], candida [fungal]) • decreased salivary flow (Sjogren’s, sarcoidosis) • parotid gland = parotitis **• Treatment:** antibiotics, rehydration, surgical drainage, or surgical removal of gland

Answer 483

**▪ Diet log** to **identify allergen,** allergy testing ▪ Ideally **eliminate offending substance** ▪ **Can manage with topical steroids**

Answer 484

* **Clotrimazole troches**, 10 mg 5 times daily or * **miconazole mucoadhesive buccal 50 mg tablet** applied to the mucosal surface over the canine fossa once daily for 7–14 days * Alternatives for mild disease include **nystatin suspension (100 000 u/mL) 4–6 mL** swished for \>1min then swallow **4 times daily.**

Answer 485

Oral Lichenoid Drug Reaction

Answer 486

**Pemphigus vulgaris** PV Lesions can affect virtually any mucosal surface (oral, nasal, ocular, pharyngeal, esophageal, genital)

Answer 487

Topical like Acyclovir or Acylovir + steroid combination There are many OTC topical medications

Answer 488

HSV1: primary herpetic gingivostomatitis there are multiple irregularly shaped ulcers present on the fixed and movable mucosa --\> most likely diagnosis is primary herpetic gingivostomatitis since the patient has fever and malaise.

Answer 489

**Agranulocytosis** **Oral findings:** * include multiple ragged ulcerations of the oral mucosa * o can mimic recurrent aphthous depending on sites involved * (but often no erythematous halo) – more like neutropenic ulcer * **Gingiva is a common site** due to the minor trauma caused bymastication (can resemble NUG)

Answer 490

**ATROPHIC CANDIDIASIS** ● Erythematous on any mucosal surface **● “Bald Tongue”** ● Typically, painful ● (Chronic multifocal, looks familiar) ***a subtype of Erythematous Candidiasis***

Answer 491

Metastatic Carcinoma to Jaw Bones B. Bilateral metastatic lesions from the lung destroying the mandibular rami.

Answer 492

○ Surgical Excision ○ Radiotherapy

Answer 493

**_Ghost cells_** They have that sort of polygonal shape or roundish shape with the pink that looks like the cytoplasm, but in the location where the nucleus would have then, there's an empty spot

Answer 494

NOMA Development of NOMA from day 1 to day 15

Answer 495

**Paracoccidioidomycosis** looks like strawberry gingiva but it is not

Answer 496

* AKA – **Fibroma, Traumatic Fibroma** * Occurs as a **result of chronic trauma** * **Locations**: buccal mucosa, tongue, lips, gingiva * _**Treatment**:_ _You don’t have to remove them, but the surgical Tx = to excise them_ _bc pts will stop biting them and they’ll heal and stop the irritation_

Answer 497

**Hypersensitivity** to * dental restorative materials, amalgam or other metal, composite resins * Foods, oral products * Especially cinnamon * dental plaque accumulation are the most common

Answer 498

Recurrent HSV-1 Punctuate ulceration erythematous border, irregular shape, fixed mucosa, unilateral

Answer 499

**Burkitt’s Lymphoma** Scattered throughout the lymphocytes are macrophages containing nuclear debris (tingible body macrophages) o Creates **a “starry sky”** appearance

Answer 500

**What causes it?** * Various genes that are implicate (Putative inherited mutations are in the SOS1 or CAMK4 genes.) Linked to both autosomal dominant and recessive patterns of inheritance **How common?** * Very rare **Treatment** * Need surgical (usually laser) treatment – just grows back, so have to get it done periodically

Answer 501

a medical CT scan of a patient with **secondary hyperparathyroidism.** We see a **lack of cortical bone** – no normal cortical bone. Inside the skull we have **a granular appearance**, with **radiolucent and radiopaque dots**, we call this **a salt and pepper dots**. This is why we call this a salt and pepper appearance, _there is no normal cortical bone._ *( systemic endocrine diseases)*

Answer 502

Adenoid Cystic Carcinoma

Answer 503

**Peripheral Ameloblastoma**

Answer 504

**Why it is a concern?** Premalignant process o ↑ incidence of oral and esophageal SCCa

Answer 505

**Necrotizing Periodontal Diseases** o During WW1, soldiers that were fighting in the trenches were under extreme stress o they commonly developed necrotizing periodontal diseases

Answer 506

* Treatment is usually **_enucleation_** * _recurrence_ is ***rare***

Answer 507

**Buccal Bifurcation Cyst** *as seen in occlusal radiographs*

Answer 508

**Verrucous Carcinoma** Large, exophytic, papillary mass of the maxillary alveolar ridge.

Answer 509

* **Dietary modification** and **weight loss** * **Oral hypoglycemic agents** * ex. tolbutamide, glyburide, metformin * *Drugs may cause* **a lichenoid drug reaction**

Answer 510

1 – **Generalized weakness** 2 – **Painful tongue** 3 – **Numbness or tingling of the extremities**

Answer 511

‐ Pathognomonic features in **Hutchinson triad**: **o 1. Hutchinson teeth** **o 2. Ocular interstitial keratitis** **o 3. Eighth nerve deafness** ‐ Other Features: o High arched palate o Saddle nose o Frontal bossing **Clinical changes secondary to fetal infection**

Answer 512

PAPILLARY CYSTADENOMA LYMPHOMATOSUM (WARTHIN TUMOR)

Answer 513

▪ Treatment is usually **platelet transfusion**

Answer 514

* Generally no treatment is indicated * Reassuring the patient that the condition is completely benign is often all that is necessary. * In case of tenderness or a burning sensation that is so severe --topical corticosteroids, such as fluocinonide or betamethasone gel, may provide relief

Answer 515

Epstein–Barr virus seems to play an important role in the pathogenesis.

Answer 516

Iron deficiency anemias Microcytic hypochromic ▪ **Atrophic glossitis** – tongue has been a little denuded of papilla ▪ **Angular cheilitis** – white and redness at angle of mouth/ commissure **▪ Plummer‐Vinson Syndrome**: type of iron deficiency anemia o Chronic iron def, dysphagia (esophageal webs), atrophic glossitis. * **Significantly increased risk of esophageal cancer (SCC)** * More commonly seen in European women * Have difficulty swallowing

Answer 517

**Proliferative Verrucous Leukoplakia** Multifocal

Answer 518

‐ Tuberculosis

Answer 519

* Midline lethal granuloma (T cell Lymphoma) * deep fungal * malignancy * TB * tertiary syphilis gumma, * cocaine abuse (necrotizing sialometaplasia‐ soft * tissue)

Answer 520

■ **surgical excision** ■ _recurrence_ are ***not uncommon*** ■ *Rare cases* of **thyroid carcinoma** developing in these cysts have been reported

Answer 521

**o Pleomorphic adenoma o Warthin’s tumor o Basal cell adenoma o Mucoepidermoid ca o Acinic cell ca o Adenoid cystic ca o Ca ex mixed tumor**

Answer 522

**Genetic**

Answer 523

•**Diagnosis**: All 3 “P” lesions usually occur on gingival interdental papillae ( however pyogenic granuloma can occur anywhere) • Since they can look similar clinically, **excisional biopsy necessary to determine diagnosis** • **Treatment**: complete excision and removal of local irritant (scaling and root planing)

Answer 524

**Eosinophilic Granulations** Erythematous area

Answer 525

**Hodgkin Lymphoma** ## Footnote **▪ Cell of origin is unknown** ▪ Often begins as a unifocal disease above diaphragm and then spreads to other sites ▪ Present with painless cervical lymphadenopathy in 60‐80% of cases ▪ **Bimodal ‐ late twenties and after 50 years old** ▪ In North America and Europe, **EBV positivity has been noted in over 50 percent of mixed cellularity cases and 10 to 50 percent of nodular sclerosis cases**

Answer 526

a low-grade variant of squamouscell carcinoma. Etiology Leading theories include * human papillomavirus (HPV) infection * chemical carcinogenesis induced by smoking and chewing tobacco * alcohol consumption * betel nut chewing (oral lesions), * chronic inflammation

Answer 527

✎An example of the **pitting** that can be seen **palmar and plantar** ~ This is a side of a hand ✎This is an early stage of basal carcinoma which never goes on (like it is aborted)

Answer 528

❏ Molding ❏ Margination ❏ Multinucleation ❏ Also Tzanck cells

Answer 529

Smokeless tobacco keratosis/TOBACCO POUCH KERATOSIS Tobacco Pouch Keratosis, Severe

Answer 530

**Myeloid cells, salivary gland cells, endothelium**

Answer 531

* **thousands of basal cell carcinoma** is developing on the skin -very difficult to manage with surgery, ~ That’s why they remove the larger ones, the deeper ones ~ They leave the one that’s less as an issue until they get to a larger size to be removed

Answer 532

Chronic Resembles **tuberculosis**

Answer 533

Erythroplakia of the buccal mucosa.

Answer 534

* **Majority occur with** _denture stomatitis_ * **Associated with** a removable full or partial denture or orthodontic appliance (Something you see in patients who wear denture all the time, don’t take it out, chronic denture wear) * **Treatment:**Treat underlying candidiasis, fix denture. These bumps can be removed, take electrosurgery loop, and scrape off the bumps – heals well

Answer 535

**Neuroma** **(Traumatic Neuroma)** Not a benign true neoplasm, it’s reactive lesion This is an edentulous patient, so resorbed bone, so flange of denture is impinging in the area of mental foramen – develop from repeated trauma Sometimes have to cut into nerve, peel the neuroma from nerve, careful not to sever nerve

Answer 536

Only **5%-10%** infections lead to active disease i

Answer 537

**– environmental, things like bensin**

Answer 538

Looks like it could be a salivary gland neoplasm, but it’s not It was another **lymphoma** Manifest in a number of different ways

Answer 539

_also known as?_ **Reactive arthritis** _Corrlate with which antigen?_ Correlation with **HLA B27 (\> 70%)** _Associated with what?_ Typically seen after patient has either **a bacterial dysentery or an STD** sometimes **chlamydia**

Answer 540

○ Biopsy required for diagnosis ○ If a source of irritation can be identified and removed, biopsy may be delayed for 2 weeks to allow lesion to heal ○ Complete excision

Answer 541

**Leukemia** This is **Chloroma**, inflitrate gets so dense they look green. On buccal or lingual mucosa chloroma are more of a solitary mass, gingival it more diffuses

Answer 542

* 1mg IM injections weekly for 1‐2 months * Monitored for lifetime

Answer 543

**LEPROSY** _Clinical features_ * *§Bone destruction** ( hole in the palate) * *§Nodular** will become **nectortic** and then **destruction** will follow

Answer 544

**Dermoid Cyst** ## Footnote ✎This is **a larger lesion on the floor of the mouth**, causing elevation of the tongue ✎If you let this go/grow, it would be similar to **Ludwig’s angina** where you would basically **eventually obstruct the airway** ✎**The difference** is this is **very slow growing** while **Ludwig’s happens** rather quickly. with **fever and other symptoms.**

Answer 545

■ Treatment is **_excision_** ■ _Recurrence_ is ***rare***

Answer 546

●Uncommon ● Cryptococcus neoformans ● Incidence increased due to AIDS epidemic in 1990s ● Pulmonary infection ● Meningitis

Answer 547

▪ Can be due to **inadvertent surgical removal** when **thyroid gland** is _excised_ or to _autoimmine destruction._ ▪ **DiGeorge syndrome** (anomaly) and **endocrine‐candidiasis syndrome** can show this.

Answer 548

Hyperparathyroidism Here we see we see * _a granular appearance of the max and mand bone everywhere,_ it is **not localized**. * There is a **loss of bone density** and **the loss of definition of cortical bone.** * Here we see a **loss of definition of lamina dura** as well _because it is now granular, and is not as clear._

Answer 549

**Acromegaly** – excess production of growth hormone **after** closure of the epiphyseal plates **Gigantism** – excess production of growth hormone **before** closure of the epiphyseal plates

Answer 550

Metastatic Carcinoma to Jaw Bones ▪ A. Metastatic breast carcinoma surrounding the apical half of the second and third molar roots and extending inferiorly. It has destroyed the inferior border of the mandible.

Answer 551

Sickel Cell Anemia enlargement of bone marrow spaces, less trabeculation, more osteoporotic bone. You see periapical pathology associated with teeth with no obvious reason. You see the radioluscencies around the apex of the mandibular teeth.

Answer 552

**❏** **Clinical**‐ if you see punctate ulcers unilaterally on the palate, it is usually recurrent herpes simplex. ❏ Culture (may take 2 weeks) ‐ takes too long ❏ Tissue biopsy‐ if it wasn't typical **❏ Cytologic smear**‐ the ideal way if you want a definitive diagnosis

Answer 553

▪ **Enucleation** **of cyst**; tooth extraction unnecessary ▪ Some cases _resolve w/o surgery_ ▪ Some resolve _w/ daily irrigation_ of buccal pocket with saline/hydrogen peroxide

Answer 554

▪ Typical appearance for **ameloblastoma** **Multilocular**, **very well‐circumscribed,** _associated with impacted tooth_. Can see bowing of _inferior aspect of mandible_ _lateral oblique radiograph.was used here_

Answer 555

Polystotic Fibrous dysplasia

Answer 556

**Pemphigus vulgaris** ● Multiple, chronic, mucocutaneous ulcers ● Many patients also have ● Relatively non‐specific ● Very superficial, only in epithelium ● Occur on any mucosal surface: oral, ocular, nasal, GI, esophageal, genital

Answer 557

**Aneurysmal Bone Cyst** ## Footnote ✎ A **dome shape swelling on the floor of the sinus** that’s associated with some _sort of inflammation of tooth of t_he **premolar** caused inflammation underneath the apex of the bone (right) and then that leads to accumulation of fluid which causes the sinus lining to elevate off the bone and fill with fluid ✎ After root canal therapy and once the infection gets under control, these will typically resolve on their own

Answer 558

* **Combined therapy with multi‐agent chemotherapy, radiation therapy and surgery** has led to 40% ‐ 80% survival rates * **Gnathic Ewing sarcoma** has *_a lower mortality rat_*_e_ than all other primary sites

Answer 559

**Irritation Fibromas**

Answer 560

‐ **If pulp alive**► **lateral periodontal cyst** or ***Lateral Okc ( if huge lesion)*** ‐ If pulp dead► **lateral radicular cyst**

Answer 561

**Oral lichen planus** White lacy appearance, with a network reticular appearance (Wickham’s striae) sometimes punctate or plaque‐like lesions predominate o **Wickham’s striae**→ very characteris► white wispy changes

Answer 562

Treated with iron supplements, extreme cases with blood infusions

Answer 563

complete removal: excision, electrocautery, cryosurgery, or laber ablation ## Footnote *Lesions rarely regress despite therapy*

Answer 564

Inflammatory Papillary Hyperplasia of the Palate

Answer 565

* ▪ Transcranial Doppler scan used to evaluate blood flow in brain ▪ **Hydroxyurea** may be used as a therapy o Induces Hb F formation (doesn’t sickle) o But can be carcinogenic and teratogenic

Answer 566

**Median Palatine Cyst**

Answer 567

Multiple Myeloma **Pathological fracture**

Answer 568

● **Mild symptoms**‐ no treatment usually ● **Amphotericin B** (‐ Immunosuppressed ‐ Severe pulmonary infection ‐ Disseminated disease ‐ Pregnant patients ‐ Life‐threatening situation ) ● **Itraconazole** or **fluconazole** (fewer side effects and complications)

Answer 569

**bones, stones, and groans (& moans)** * **Bones** – Changes in the bones: * Subperiosteal resorption of distal phalanges (early in disease) * Loss of lamina dura around roots (early in disease) * Loss/blurring of trabecular density in bone with resultant “ground glass” appearance in radiographs * Brown tumor * **Stones** – renal calculi (especially with primary disease) due to elevated serum calcium basically kidney stones * **Groans** – duodenal ulcers * **Moans** – changes in mental status mild dementia

Answer 570

**Osteopetrosis** **Osteomyelitis** is a complication in patients with **osteopetrosis** as can be seen in pan image! Treatment: Bone marrow transplant (to stimulate osteoclast formation).

Answer 571

o TB‐Test **§Delayed type hypersensitivity (Type 4)** §Checks if developed an immune response to TB §**PPD (purified protein derivative)** *(what they inject under the skin)* §**T cells** are attracted by immune system to the skin site §**Lymphokines** induce _hard raised area with clear margins_ §Need to check 48-72 hours later (measure area)

Answer 572

● Non‐septate hyphae with **90degrees branching** ● You see necrosis of tissue in the area because this attacks the blood vessels

Answer 573

**Sensory ganglia**

Answer 574

Markedly decreased numbers of circulating blood platelets (severe cases \< 10,000/mm³) Etiology: Can be from: o Decreased production (malignancy, drugs) o Increased destruction (immunologic, drugs) o Sequestration in the spleen (splenomegaly)

Answer 575

* **Oral fluconazole, 100–200mg daily for 7–14 days** ● For **fluconazole‐refractory disease:** ‐ **Itraconazole suspension 200 mg once daily OR posaconazole** su**spension 400 mg twice daily for 3 days then 400 mg once dail**y, for up to **28 days**, are recommended *_Alternatives for fluconazole‐refractory disease include:_* ‐ **Voriconazole, 200 mg twice daily**, OR **AmB deoxycholate oral suspension, 100 mg/mL 4 times daily**(strong recommendation; moderate‐quality evidence). ‐ **Intravenous echinocandin** (caspofungin: 70‐mg loading dose, then 50 mg daily; micafungin: 100 mg daily; or anidulafungin: 200‐mg loading dose, then 100 mg daily) (weak recommendation; moderate‐quality evidence). § **Intravenous Amphotericin B** deoxycholate, 0.3 mg/kg daily, are other alternatives for refractory disease (weak recommendation; moderate‐quality evidence).

Answer 576

**Oral Lichenoid** **Contact lesion** chenoid reaction to dental amalgam and cold: white and erythematous lesions on the buccal mucosa.

Answer 577

* _A developmental cyst_ that develops **from epithelial remnants of a tract which forms when the thyroid anlage descends into the neck** _from an area that later forms **the foramen caecum**_ * Follows a path that goes **anterior to the hyoid bone and ends below the thyroid cartilage**

Answer 578

**A parulis** ***It is not a pyogenic granuloma*** **A parulis** is a _proliferation of granulation tissue at the opening of a sinus tract_ When the infection breaks through the alveolar bone and presents itself, it will sometimes cause this proliferation of granulation tissue

Answer 579

It is typically **surgical removal** of _a portion or all of the parathyroid glands_

Answer 580

_Crohn Disease_ we see **more nodules**

Answer 581

_Etiology_ **ununcertain**, theories include: * **trauma** * **ischemic necrosis of medullary space** * **cystic degeneration of a primary bone lesion**

Answer 582

Reiter’s Syndrome (Reactive arthritis) Top: erythema on the palate and areas of ulceration Bottom: classic look of geographic tongue, but it is not geo tongue. They are symptoms of Reiter’s

Answer 583

**Irritation Fibromas**

Answer 584

‐ Use high power evacuation to prevent transmission ‐ Treatment = controversial ‐ Excision/ablation vs Topical vs Intralesional therapy (or combo) ‐ Consider higher rate of recurrence

Answer 585

**Botryoid Odontogenic Cyst** well circumscribed, between 2 teeth (similar to lateral odontogenic cyst), multilocular

Answer 586

Pyostomatitis vegetans

Answer 587

a Fibrous dysplasia involving **more than one bone**

Answer 588

**▪ Represents several types of malignancies derived from hematopoietic stem cells** **▪ ~ 2.5% of all cancers in US**e

Answer 589

HPV is thought to cause **70%** of oropharyngeal cancers in the US That's why we want to know if high risk HPV– better prognosis

Answer 590

Polymorphous Adenocarcinoma

Answer 591

Fordyce Granules

Answer 592

**‐ Minor Recurrent Aphthous Ulcers (RAS)‐ Rare Case** _o Keratinized Mucosal Site_ ‐ 11‐year‐old boy ‐ Canine is in process of erupting ‐ Canker sore present on his keratinized mucosa (RARE) **o 99% of canker sores occur on NON-KERATINIZED MUCOSA**

Answer 593

**HPV Types 6, 11** – _condyloma can turn cancerous_ ▪ Virually induced proliferation of stratified squamous epithelium – usually genital or anal mucosa ▪ **Contagious** – transmitted by direct contact ▪ Incubation period: 1‐3mo ▪ Considered **sexually transmitted disease** (if corroborated by history) ## Footnote **▪ Characteristic clustering of multiple lesions**

Answer 594

* **Growth patterns:** * Different growth patterns – polymorphous * _Perineural invasion ‐ common_ ‐ but considered low grade tumor * **Treatment**: Wide surgical excision; overall prognosis relatively good, with 80% cure rate

Answer 595

▪ Topical cytotoxic agent which arrests mitosis ▪ Genital warts and other papillomas ▪ Not FDA approved for oral warts ▪ Serious adverse reaction if absorbed systemically ▪ Pregnancy category X

Answer 596

Many related factors (Multifactorial etiology): o Psychological stress o Immunosuppression o Smoking o Local trauma o Poor nutritional status o Poor oral hygiene o Inadequate sleep

Answer 597

Adult acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells. We see in these images: o Hemorrhagic ulcer right vestibule o Ulcers are deep and can go down to bone o Ulcers resolved after treatment

Answer 598

**Mycobacterium leprae**

Answer 599

**Topical anesthetic agents** o To numb the pain **‐ Surface protective agents/bioadhesives** o Cover the ulcer if small enough **‐ Anti‐inflammatory/immunomodulatory agents** o Applied to ulcer surface (corticosteroids) **‐ Anti‐microbials** o Some evidence that topical tetracycline may help **‐ Chemical/physical cautery Lasers** ‐ Over‐the‐counter (OTC) versus prescription (Rx **All essentially do the same thing:** o Numbing agent o Mucosal covering agent ‐ Bottomline: **o ALL canker sores will heal on their on with time**

Answer 600

Etiology is _disputed_ * Some think it is _from_ **remnants of the branchial cleft** * Others think it is _cystic change of parotid gland epithelium_ which **became entrapped in a cervical lymph node during development**

Answer 601

● **Acute**‐ Resembles pneumonia

Answer 602

Schwannoma/ Neurilemoma

Answer 603

**Conventional/Solid Ameloblastoma**

Answer 604

**Erythroplakia** of the lateral margin of the tongue. Well-demarcated erythematous patch or plaque with soft velvety texture

Answer 605

**Buccal Bifurcation Cyst** *as seen in occlusal radiographs*

Answer 606

**Calcifying Epithelial Odontogenic Tumor(CEOT)** * **flecks of calcifications.** * **Calcifications** all around crown is common

Answer 607

**Option 1: take perilesional sample that has both intact and ulcerated epithelium** ○ This is not easily achieved **● Option 2: take two different sites** ○ For H&E, still must be perilesional ○ If you get only ulcer just because the clinician thinks ○ that is the pathology → there is no epithelium! ○ The sample is useless and no diagnosis can be made **● Option 3: just collect a large punch of normal non‐ulcerated epithelium and submit for immunofluorescence** ○ You will still get product even though it is not ulcerated

Answer 608

‐ Tuberculosis

Answer 609

**Pernicious Anemia** glossitis, denuded papillae

Answer 610

Recurrent HSV-1 crust → later crust comes off and then you'll have epithelialization underneath

Answer 611

● “**Thrush**” ● KEY FEATURE: **Wipeable** _white plaques that resemble curdled milk_ ● Underlying mucosa is **erythematous** ● Asymptomatic usually ● Mild symptoms: burning, dysgeusia ● Seen in patients with: **HIV, broad‐spectrum antibiotics, leukemia, infants**

Answer 612

**recurrent Hsv-1/Recurrent herpes** It is raised (papule), so it’s in the middle stage

Answer 613

* Biopsy to rule out malignancy * Elimination or discontinuation of predisposing factors, * systemic retinoid compounds. * Smoking cessation (leukoplakias often disappear or become smaller within first year of smoking cessation) * Complete removal with surgical excision, electrocautery, cryosurgery, or laser ablation

Answer 614

* *Pseudomembranous Candidiasis‐** * Uncontrolled HIV* ● This can be mistaken with materia alba (this is just food) ‐ Should ask patient if they just ate ● This is **MODERATE DISEASE**

Answer 615

**Langerhans Cell Disease** Infant with _Acute disseminated type_ ▪ See lesions on head/ear

Answer 616

● Treatment is n**ot well standardized**, fairly rare disease and good double blind studies rare ● Can **use topical corticosteroids** ● Werchniak et al had **good results with topical tacrolimus** ● **Sulfasalazine** or **Prednisone** *_for GI lesions_* ● If GI symptoms are under control► oral lesions will resolve

Answer 617

Smokeless tobacco keratosis/TOBACCO POUCH KERATOSIS Smokeless Tobacco–related Gingival Recession. Extensive recession of the anterior mandibular facial gingiv

Answer 618

**Hyperparathyroidism**; this is the **brown tumor** which is sometimes **well or ill defined,** **multi or unilocular radiolucency** with **granular septation.** If you have a patient that is younger than 15-20 years old that has **a central giant cell granuloma** ► you have to check that patient for hyperparathyroidism, because it could be a brown tumor.

Answer 619

Median rhomboid glossitis. a Chronic hyperplastic, erythematous candidiasis

Answer 620

**Onychomycosis** a type of candidiasis

Answer 621

❏ Episodic‐Occurring, appearing, or changing at usually irregular intervals ❏ Abortive‐Tending to cut short the course of a disease ○ Medication has to be taken during Prodrome ○ When the patient feels a burning, itching, and tingling

Answer 622

* **Medical work‐up** *to determine* **type of amyloidosis** * T**reat underlying disease** when possible * **No treatment available for most types** * **Chemo drugs** _(Colchicine, Prednisone, Melphalan, Thalidomide, Cyclophosphamide)_ for **multiple myeloma** * **Serum electrophoresis** – monoclonal gammopathy very complicated and time consuming treatment * **Renal transplant** for _dialysis‐associated type_ * *Death* **due to cardiac failure, arrhythmias or renal failure** *_is not uncommon_* within a few year of dx

Answer 623

**HYPERPLASTIC CANDIDIASIS**

Answer 624

✎**Multiple lesions**, impacted 3rd molar in mandible and displaced 3rd molar up into the sinus, ✎These too many lesions hard to manage the issue with a surgery ✎This large area on the left mandible – good example of why we do decompression because if you just remove this lesion and the entire area is left open, this would be an area risk for fracture

Answer 625

(Multifocal) Epithelial Hyperplasia/**Heck's Disease** HPV 13,32 **“Flat‐top papules”**

Answer 626

* Could be differential for lateral Odontogenic keratocyst, except this does not grow in size * Lateral radicular cysts from an accessory canal if tooth is non vital * or it could be Lateral Periodontal Cyst if tooth is vital!

Answer 627

**Chondrosarcoma** * Ill defined lesion of anterior maxilla * Areas of radiolucency * Classic area of moth‐eaten look * Circular area of radiolucency with trabecular * pattern * Patient left without surgery, not heeding medical advice Then patient came back ▪ Someone was willing to do the dentures for her ▪ CC‐ denture was not fitting ▪ Expansion of cortical plate ▪ Hyperkeratotic because of denture rubbing ▪ Still has malignancy ▪ Advise for surgery ▪ Refused again Then the lesion kept on Lesion still growing ▪ Metastasize to lungs ▪ Admitted to breathing issues ▪ About 5 ½ years from initial dx to pt passing away

Answer 628

**NOMA** This is an aid patient Figure 2: Extension of infection onto the face ‐ Figure 3: Lost bone and gingiva ‐ Figure 4 & 5 Bone destruction

Answer 629

Three stages 1. o Primary (**chancre**) 2. o Secondary (**rash**) 3. o Tertiary (**gumma**)

Answer 630

▪ **Marsupialization** (decompression) ▪ **Peripheral ostectomy** ‐ Carnoy’s solution ▪ **Resection** ▪ **Medications targeted to PTCH** ▪ ***Long term follow‐up***

Answer 631

**Histoplasmosis** ● This can be squamous cell carcinoma, shanker, ulcers ‐ Differentials for non healing ulcerations on the lateral tongue ● The white area is called the *pseudomembrane*

Answer 632

**Peripheral Giant Cell Granuloma**

Answer 633

* Probably caused by **a combination of environmental and genetic factors** * Some leukemias have specific genetic alterations (ex. **CML –** * **Philadelphia chromosome)** * t(9;22)(q34;q11) fusion gene BCR‐ABL1) * **Translocation of 9 and 22 and fusion gene BCRABL1** * **Environmental factors include**: * ionizing radiation * pesticides * benzene * viruses (ex. HTLV‐1)

Answer 634

**PCOD** ## Footnote **Differentiating factor:** Radiolucent zone surrounding the radiopacities of COD lesions. No such radiolucent areas for idiopathic osteosclerosis.  Important: The root of the tooth #28 appears to be resorbed but is likely not. Look at the root of #29. These teeth are still undergoing development in a young patient.  Left is showing dense bone island.  Right is showing Periapical COD- this is intermediate stage, not fully mature. You should see a radiolucent rim.  Another more obvious radiographic feature: you see radiolucent areas surrounding in both images, the common feature is: because PCOD and dense bone island do not affect the PDL spaces – you should be able to see the PDL spaces.  Sometimes it’s not the case. Look for the PDL, look for radiolucent area surrounding possible central radiopacity, idiopathic osteosclerosis can cause resorption; PCOD hasn’t been associated with root resorption.

Answer 635

**Lymphangioma**

Answer 636

**Uremic Stomatitis** Before and After Tx with Dialysis changes on ventral and lateral side of the tongue, better outcome after dialysis

Answer 637

Cysts of the Newborn: Palatal cysts

Answer 638

Secondary Syphilis ‐ Disseminated lesions are discovered 4 ‐ 10 weeks after initial infection ‐ Resolve in 3‐12 weeks **‐ Diffuse maculopapular (flat, raised) rash** o May involve oral cavity ‐ **Mucous patches** **o Most common on tongue and lip** _‐ Condylomata lata_ o **Resembles viral papillomas** ‐ Systemic symptoms

Answer 639

**well‐circumscribed radiolucency at crown of an impacted canine** _Hard to tell if attaches at CEJ._ If further down, *less likely **a dentigerous cyst*** and more likely **AOT, ameloblastoma, or OKC**

Answer 640

**Sialadenitis** Acute: parotid papilla purulent discharge

Answer 641

**Etiology** The exact etiology remains unknown. Tobacco, alcohol, chronic local friction, and Candida albicans are important predisposing factors. Human papilloma virus (HPV) may also be involved in the pathogenesis of oral leukoplakia.

Answer 642

White Sponge Nevus | (Canon disease)

Answer 643

Mucormycosis‐ CT Sinus opacificatio ● First thing to do is to find out more about this lesion, how did this patient get this lesion?

Answer 644

**Giant Cell Fibroma**

Answer 645

* **Well‐defined, round or oval lesion** * **Periphery of the lesion is corticated** and may **exhibit a radiolucent periphery** (sometimes referred to as **a soft tissue capsule**) * Internally, the lesion is typically **granular or radiopaque** but may show variations (**mixed radiolucent/radiopaque**) * _Strong tendency to_ **displace teeth and cortical outlines**

Answer 646

**HSV 1- Primary Herpetic Gingivostomatitis** Ulcer with an erythematous halo (top two arrows). We also have ulcerations that are irregular in shape on the gingiva (bottom two arrows). **❏ Clinical Features:** * Cervical lymphadenopathy * Chills * Fever * Nausea * Anorexia * Irritability * Sores in mouth * Ulcerations on fixed and movable mucosa * Variable number of lesions * Ulcers coalesce and form larger irregular ulcerations * Gingiva enlarged and painful * **Resolution in 5‐7 days**

Answer 647

Secondary Syphilis ( Rash) here we see **muscus patches** (right) and **Condylomata lata** (left) ‐ Disseminated lesions are discovered 4 ‐ 10 weeks after initial infection ‐ Resolve in 3‐12 weeks ‐ Diffuse maculopapular (flat, raised) rash **o May involve oral cavity ‐ Mucous patches** **o Most common on tongue and lip** **‐ Condylomata lata** **o Resembles viral papillomas** ‐ Systemic symptoms

Answer 648

HHV 5 Cytomegalovirus Infection When a person is immunocompromised, particularly those who’ve had a transplant or HIV+ patients, only these people will present with ulcerations It's very hard to identify based on photo alone - it's very nonspecific

Answer 649

**HSV Associated Erythema Multiforme** ❏ Skin immune reaction in response to infection ❏HSV implicated in trigger for erythema multiforme where you get target lesions and crusted ulcerations on the lip ❏ need to prescribe :antiviral prophylaxis

Answer 650

A deep fungal infecion causes by: Paracoccidioidomycosis brasiliensis

Answer 651

**Leiomyosarcoma**

Answer 652

Lymphoma * Well circumscribed ulceration in area * Associated swelling in periphery * White change in the patient’s left area * Been there for 3 weeks * It’s lymphoma

Answer 653

Ricket / Osteomalacia hyperplasia or thinning of mineralization of teeth. We can see hyperplasia of enamel in patients.

Answer 654

**Cementoblastoma** ## Footnote ** Differentiating Factor:** A well-defined radiolucent border that is continuous with the PDL of the tooth, similarly seen in the previous case of hypercementosis. (sometimes it is difficult to differentiate hypercementosis and cementoblastoma, in this case, the beige arrow indicates the resorbed root surface, which normally occurs in benign neoplastic cases, such as cementoblastoma.  Cementoblastoma is more of a heterogenous radiopacity- meaning you may see gaps, like radiolucent voids, in between the areas.  See radiolucent rim.  But more common feature include root resorption because it’s a neoplastic condition. It should act like a neoplasms in which it’s destroying some of the root structure.

Answer 655

Crohn Disease _Linear granulomatous ulcerations_ But they are **not** *the aphthous ulcerations* **but the more linear type**

Answer 656

**B‐Lymphocytes**

Answer 657

**Oral Lymphoepithelial Cyst** **A pale dome-shape swelling in the floor of the mouth. **because the lesion is so close to the surface; you're seeing _little capillaries of the mucosa lining the lesion_

Answer 658

Reiter’s Syndrome **Classic Triad** ▪ 1 – Polyarthritis (lasting more than one month) ▪ 2 – Conjunctivitis or uveitis ▪ 3 – Urethritis

Answer 659

## Footnote o **Accumulation of normal protein** (beta‐2 microglobulin) in plasma _o Deposits in bones and joint_s **o Carpal tunnel syndrome, cervical spine pain** o **Tongue deposits** can have **macroglossia**

Answer 660

**Plasmacytoma** **▪ Unifocal, monoclonal neoplastic ▪ proliferation of plasma cells** **▪ 30% develop into MM over 10 yrs ▪ 50% disseminate w/in 2‐3 yrs ▪ Central Bone lesion o Unilocular radiolucency o Swelling or bone pain o Non‐tender soft tissue mass** **▪ 90% occur in Head and neck**

Answer 661

**● Histoplasma capsulatum** ● **Dimorphic** (yeast at body temperature and mold in soil)

Answer 662

Pulmonary infection

Answer 663

_PLUMMER‐VINSON SYNDROME_ **Angular chelitis** (top) hard to get rid of them **Atrophic Glossitis** (bottom) red beefy tongue

Answer 664

hypothyroidism

Answer 665

**Multiple Myeloma** Monoclonal expansion of malignant plasma cell ▪ Most common in 40‐70 year old (mean 63 yo.) ▪ Present with bone pain (\> 70%) and pathologic fractures Punched out radilucency

Answer 666

▪ Treatment is **thyroid hormone replacement** ▪ Prognosis is **generally good** ▪ If children are not treated in a timely fashion ► **permanent CNS damage can occur (mental retardation)**

Answer 667

*_Originates_*: by **the separation** of the _follicle_ from the _crown of an unerupted tooth_ *_Pathogenesis_*: **accumulation of fluid** between the tooth and the _reduced enamel epithelium_

Answer 668

**Valley Fever**

Answer 669

Not specific ‐ Stage 1 and 2 similar o Ulceration o Hyperplasia (Stage 2) o Exocytosis of neutrophils into epithelium Intense Iymphoplasmacytic inflammatory infiltrate in superficial stroma and around deeper vascular channels (blood vessels)

Answer 670

**Chronic lymphocytic leukemia** o Elderly o Most common type o Considered incurable at this time o unchecked proliferation of B‐cells o no good treatment

Answer 671

HPV 16 = most prevalent

Answer 672

**Odontogenic Keratocyst OKC**

Answer 673

**Osteosarcoma** * See something in the operculum * Infection in third molar?

Answer 674

**Herpangina** casued by **_Coxsackie Virus_** *red macules and vesciles on the soft palate* a sudden viral illness in children. It causes small blisterlike bumps or sores (ulcers) in the mouth

Answer 675

**Reactive arthritis (reiter)** _o Can’t see, Can’t Pee, Can’t Climb a Tree_ ▪ _Causes_: **● Conjunctivitis ● Urethritis ● Arthritis** **Chlamydia trachomatis** _Coinfect_ with **Neisseria Gonorrhoeae**

Answer 676

**Basal Cell Nevus or Bifid Rib Syndrome** or **Gorlin syndrome**

Answer 677

**Dentigerous Cyst**

Answer 678

Cat Scratch Disease

Answer 679

**-Herpangina**‐soft palate, red macules ► fragile vesicles (back of throat) ‐ **Hand, foot, and mouth disease** – oral lesions more in anterior regions (aphthous‐like), hand/foot (vesicles) ‐ **Acute lymphonodular pharyngitis** – nodules on the soft palate ▪ Usually seen in children ▪ Self‐limiting

Answer 680

* _Important to distinguish from chondrosarcoma as treatments are different_ * **_Osteosarcoma_** is currently treated with **pre-op multi-agent chemotherapy followed by surgery** * ***Radiation therapy*** alone is ***insufficient*** for cure * **_Favorable jaw site – MD symphysis_** * **_Worst site – MX sinus_** * **5 year survival is ~ 20%** (***_up to 80% if caught early_*** and *_treated with radical resection)_*

Answer 681

Periapical COD Sagital cross section of the anterior Mandible. Mixed radiolucent/radiopaque area (green circle)

Answer 682

✎Surgery (typically MOHS) ✎Sometimes curette them ✎ Radiation therapy (RT) is typically not the first line of therapy with small lesions RT ✎Cryotherapy which means they just use a little liquid nitrogen and freeze them ✎Photodynamic therapy with photosensitizer and topical medications ■ New medication: **Vismodegib _inhibits sonic hedgehog pathway by binding smoothened (SMO)_** * *suppressive rather than curative cause it seems to work for short time and after ~7-8 months ..may also helps _suppress growth of OKC_*

Answer 683

**Unicystic Ameloblastoma** but could be **Dentigerous Cyst** based on clinical presentation! So radiograph is not diagonstic

Answer 684

**Pemphigus vulgaris** **usually suffer from Desquamative gingivitis (DG)** More superficial erosion of the marginal gingiva, typically with an intense erythema and inflammation, and very often in the absence of local factors that would typically cause a gingivitis o Hurts to brush their teeth Immediately look for areas where there are no local factors and look for inflammation there o To check the possibility of systemic factors causing local gingivitis

Answer 685

**Intertrigo** a type of candidiasis

Answer 686

**Ameloblastoma** **clinically:** Have expansion of the buccal plate, obliterating the vestibule in this area. **Radiographically:** Root resorption of molar, unilocular radiolucency in mandible

Answer 687

Recurrent HSV-1 papule bc its raised

Answer 688

Neuroectodermal tumor of infancy look how they removed it here surgically *is rare, rapidly growing, pigmented neoplasm of neural crest origin. It is generally accepted as a benign tumour despite of its rapid and locally destructive growth.*

Answer 689

**Eruption Cyst**

Answer 690

* **AKA:** denture-induced fibrous hyperplasia, fibrous inflammatory * **Cause**: ill-fitting denture • **Treatment**: **surgical excision** (scalpel vs CO2 laser -laser is better) and **reline then remake of denture**

Answer 691

■ An **asymptomatic** focal _concavity_ of the cortical bone on the _lingual aspect of the MD_ ■ A *pseudocyst*, not a true cyst

Answer 692

* we can see the **displacement of the root** * A **teardrop or pear shaped** radiolucency between the lateral and the canine * **Well circumscribed** maybe leaving **a little sclerotic edge** up here * ended up being in **a odontogenic keratocyst (OKC)**

Answer 693

* we see the **ulceration** and **hyperplastic tissue** surrounding it.

Answer 694

**Odontogenic Keratocyst OKC**

Answer 695

Oral lichen planus slightly more **red** as you move to the left of the picture ● The white lines have small sunburst effect at the periphery ○ Very very characteristic of lichen planus ○ Will never see this in a leukoplakia

Answer 696

**Vascular leiomyoma** **High-power view showing spindle-shaped cells with bluntended nuclei. Immunohistochemical analysis shows strong positivity for smooth muscle actin (inset).**

Answer 697

**FD** Radiographically: you have altered trabecular pattern Clinically: Painless mass slowly growing over time is is typical presntation of Fibrous Dysplasia

Answer 698

**Hyperthyroidism** * enlargement of the neck * characteristic stare

Answer 699

**Generalized FD** * Metabolic bone diseases (hyperparathyroidism) (any disease that incrase trabacular bone density) * Paget's disease **Localized FD** * Osteomyelitis * Osteosarcoma

Answer 700

**Denture Stomatitis** ● _Chronic atrophic candidiasis_ ● **Erythema** in _denture bearing areas of maxilla_ ● **Petechiae** may be noted ● Usually, **asymptomatic** ● _Consider denture care/fit/allergy/inadequate curing of acrylic_ ● This can occur if the patient NEVER takes off their denture ● **Inflammatory papillary hyperplasia** is associated with condition ● **Treatment**‐**Nystatin** applied to intaglio surface of denture and wear denture and patient to remove denture at night *a subtype of Erythematous Candidiasis*

Answer 701

Reiter’s Syndrome (Reactive arthritis) This not actually a geogrpahic tongue!

Answer 702

**o TB o Deep fungal infections o Traumatic ulcer o SCC o Major Aphthous ulcer**

Answer 703

Linea Alba

Answer 704

**Non‐Hodgkins Lymphoma (NHL)** ## Footnote o The most common of the lymphoproliferative diseases o Uncontrolled proliferation of B or T cell origin derived from a single cell (or clone) o Typically presents with painless lymphadenopathy (often unilateral) ▪ up to 40% are extranodal ▪ 5‐10% arise in Waldeyer’s ring

Answer 705

Early & mature Periapical COD **Preapical radiographs of the anterior mandible of the same patient at different times.** Note the differnece in density between the two radiolecency: Note the internal structure of the radiopacity is quite radiolucent ( purple arrow) The Preapical radiographs of the same region taken at a later time shows a more radiopaque internal structure (pink arrow). This reflect the maturing of the COD lesion. The lesion with Pink arrow can be described as well‐defined mixed radiolucent/radiopaque entity. ( because you have radioleucent part and radipaque part)

Answer 706

Mucormycosis‐ arrow refers to **ESCHAR**‐ always look for this and extreme-Black and necrotic ulcer ( we can see massive tissues destruction

Answer 707

- Response to chronic inflammation - Hormonal changes (pregnancy/puberty) - Immune-mediated/plasma cell gingivitis - Drug induced - Genetic/ Inherited NOTE: Gingival enlargement is not always ***hyperplastic tissue***

Answer 708

**Secondary Syphilis** Mucous Patch

Answer 709

Common factors? * _Low levels_ of **tissue-nonspecific alkaline phosphatase** * **High** blood and urinary **phosphoethanolamine** * **Rickets-like skeletal malformations** Dental manfestations? * _Premature shedding_ of **primary incisors** * **Enamel hypoplasia** * _Enlarged_ **pulp chambers** and **root canals**

Answer 710

**Growth rate**  Usually a slowly growing mass **Treatment**  Excision usually the treatment of choice ‐ but edges of tumor may have perineural invasion and remain undetected ‐ makes tumor dangerous **Prognosis**  5‐year survival rate as high as 70% (maybe 90%)  By 20 years, only 20% ‐ poor long term prognosis

Answer 711

**Burkitt’s Lymphoma** **African type (endemic**) * More common * Peak incidence 3‐8 years of age * _Twice as common in males_ * **~95% associated with the Epstein‐Barr virus** * North american or non edemic type is not associated * with EBV * ~88% under 3 yrs of age have jaw lesions * Only 25% of those older than 15 do * Typically involves: * MD, MX, (often affects all 4 quadrants) * Mandible or maxilla * Abdomen * grow quickly

Answer 712

* **conservative excision/enucleation** * So far ***no recurrence***

Answer 713

**What is it?** • Benign tumor of lymphatic vessels **Treatment**: monitor, surgery if needed, _recurrence common_

Answer 714

Gingival Cyst of the Adult notice the _bluish hue_

Answer 715

**Fibrosarcoma**

Answer 716

* Oral vitamin D precursor * vitamin D2 (or ergocalciferol) * Dietary supplements of calcium * Teriparatide (a portion of PTH) injections twice daily

Answer 717

**Sialolithiasis** Notice how it can appear radiographically as a well defined radiolucency

Answer 718

o **Antibiotics** ▪ Penicillin ▪ Metronidazole **o Local wound care** _▪ Conservative debridement_ to avoid iatrogenic tissue damage **o Consider nutrition, hydration and electrolyte imbalances** **o May cause significant morbidity**

Answer 719

**homogenous leukoplakia** Just white color

Answer 720

**Esophageal Candidiasis** a type of candidiasis

Answer 721

**No treatment is required** ‐ Resolve (degenerate or rupture) on their own in a few months ‐ Once baby eats solid foods, will go away

Answer 722

**Deficiency** pellagra **Classic triad** **D**ermatitis, **D**ementia, **D**iarrhea **Oral symptoms** _stomatitis_ and _glossitis_

Answer 723

Infective Endocardiatios Janeway lesions These are **Septic Emboli**

Answer 724

**Ewing Sarcoma** * an _expansion of tissu_e * **Dissolution of bone** in that area

Answer 725

**Basal Cell Adenoma**

Answer 726

**Untreated pleomorphic adenoma** slow growing, but can grow to enormous sizes

Answer 727

**Lateral Periodontal Cyst**

Answer 728

**Tertiary Syphilis** **Gumma** ‐ **Latent** period for **1 ‐ 30 years** **‐ 30% of patients develop tertiary syphilis** ‐ Serious complications develop: * Vascular system * Central nervous system * Ocular lesions What is "Gumma"? * o Granulomatous inflammation with tissue destruction * o Common on palate and tongue * o Causes a hole in the palate

Answer 729

central giant cell granuloma CGCG

Answer 730

When you apply pressure to it, it evacuates the lesion (disappears!), when you pull away, it refills and you see it again – that tells you it’s a vascular lesion

Answer 731

Smokeless tobacco keratosis/TOBACCO POUCH KERATOSIS Tobacco Pouch Keratosis, Mild. A soft, fissured, gray-white lesion of the lower labial mucosa located in the area of chronic snuff placement.

Answer 732

- _Chronic granulomatous infectious disease_ - Caused by **Mycobacterium tuberculosis** §Direct person-to-person spread through **airborne droplets**

Answer 733

**Candida Species** ● Over 200 species exist ● At least 15 distinct Candida species cause human disease

Answer 734

Remember ## Footnote _Median Mandibular Cyst_ is a term used to describe a cyst in a **anterior mandible** not a definitive diagnosis So, this turned out to be an early ameloblastoma. It wasn’t a cyst The lesion radiolucency in the anterior mandible and again

Answer 735

**Fordyce’s granules** on the buccal mucosa. a normal anatomical variation. ectopic sebaceous glands of the oral mucosa.

Answer 736

Diagnosis: o Presumptive from clinical features _‐ Treatment:_ **o Topical mupirocin** **o Systemic antibiotics**

Answer 737

Some controversy over this designation ‐ some think they are inflammatory cyst ‐ some think they are developmental cysts ▪ Etiology: _remains unclear_

Answer 738

**Pemphigus vulgaris** Combination of PV inflammation and gingival inflammation accumulating local factors can result in advanced loss of attachment and tooth loss

Answer 739

Hyperparathyroidism ## Footnote On our intraoral radiographs, we see **loss of definition of lamina dura** because the bone now has **a granular appearance** which extends to the lamina dura. The teeth are usually normal, but there is a loss of lamina dura around the teeth. These teeth are not mobile.

Answer 740

PLEOMORPHIC ADENOMA **Palatal presentation**: since salivary glands are only in lateral sides of the palate, **usually swellings are in one side and not the midline.** Lateral swelling is a clue that you are looking at a salivary gland lesion (left pics) On the right pic, it involved midline and crossed over to other side, so there are exceptions. But more commonly found in lateral side of the palate. | (MIXED TUMOR)

Answer 741

* **HIGH Recurrence Rate** * **Benign**, but _locally aggressive biologic behavior_ * _Solitary OKCs have_ ~**10% recurrence rate with appropriate treatment** * _Multiple OKCs hav_e ~ **30% recurrence rate**

Answer 742

Can see in the anterior region there’s an elevation histology shows it's not chondrosarcoma because it contained **_Cutright lesion_** **papule or nodule on alveolar ridge** * Osseous and/or chondromatous metaplasia within the soft tissue of the gingiva o **Lesion is NOT central in bone or connected to bone** *_▪ NOT a malignant lesion_* o Thought to be **reactive metaplasia due to a poorly fitting denture**

Answer 743

**_Hand, foot, and mouth disease_** caused by **Coxsackie Virus** affect children contagious The condition is spread by direct contact with saliva or mucus.

Answer 744

medical CT scan with a patient with **osteopetrosis**- very dense. Not a nice definition of the cortical bone. We see decreased in size of skull foramina.

Answer 745

**Epstein‐Barr Virus Infection** Latency in **lymphocytes** §Infectious mononucleosis §Oral hairy leukoplakia §Nasopharyngeal carcinoma §EBV mucocutaneous ulceration §Burkitt lymphoma §Other lymphomas (Hodgkin, post transplant)

Answer 746

**Sensory ganglia**

Answer 747

**Cyclic Neutropenia** **_o Teeth floating in air_**

Answer 748

similar to *lateral periodontal cyst* but is actually **OKC**

Answer 749

* Treatment is **conservative local excision** * _Recurrence_ is ***rare***

Answer 750

* **AKA**: Congenital epulis of the newborn * **Cells resemble** cells of the granular cell tumor **• Cell of origin** is unknown, not derived from nerve **• Treatment:**Surgical excision, does not recur

Answer 751

**Hyperparathyroidism**; this is the **brown tumor** which is sometimes **well or ill defined,** **multi or unilocular radiolucency** with **granular septation.** If you have a patient that is younger than 15-20 years old that has **a central giant cell granuloma** ► you have to check that patient for hyperparathyroidism, because it could be a brown tumor.

Answer 752

Hereditary Hypophosphatemia/vitamin D‐resistant rickets teeth look fairly normal, have a draining abscess with ulcers and perilous

Answer 753

fungal (candidiasis) --\> mucosal smear/ Empirically can give antifungals (to figure out if it is candidiasis can do a smear or give antifungal) If not candidiasis order cbc ▪ Order CBC with diff ▪ Order blood levels on Fe, Folate, B12, zinc ▪ Rule out : diabetic neuropathy If not candidiasis and blood work didn’t show anything abnormal patient has **burning mouth syndrome** ▪ **TIBC tests** to see if theres too much or too little FE in the blood, measures the bloods capacity to bind fe with transferrin ▪ **B12 def can be from pernicious anemia** ( **Schilling test for Pernicious Anemia**) lack intrinsic factor to allow proper absorption, malnutrition or malabsorption from GI conditions can lead to this as well.

Answer 754

* Surgical excision ( need to send to **biopsy** in order to confirm the diagosnsis of that) * Wider resection with bone maybe necessary in soma larger or more clincally aggressive cases.

Answer 755

■ Prognosis _depends on progression of skin tumors_

Answer 756

**Cementoblastoma** **Grossly** continuous growth from tumor to the root of the tooth. Brownish areas were more vascular. **Histologically:** tubular dentin in tooth, attached to mass of tissue with calcifications

Answer 757

**o Canalicular Adenoma o Salivary Duct Cyst\* o Pleomorphic Adenoma**

Answer 758

* **Radical surgical excision** _on initial treatment_ * _Maxillectomy/Mandibulectomy_ * If anterior region they remove the entire anterior portion of the jaw * These lesions *don’t respond to radiation or chemotherapy* * ***Although used as adjuncts for lesions that can’t be treated surgically*** * *For example **a posterior sinus** **lesion** _since that is the base of the skull_* * *These patients have **poorer prognosis** than those with more accessible sites such as the mandible* * **Prognosis is poorer** *than for osteosarcoma* (which contrasts with the prognosis in extragnathicsites) * **Treatment failure** (and ***mortality***) is usually **due to uncontrolled local disease** *not metastasis*

Answer 759

MUCOEPIDERMOID CARCINOMA ## Footnote *Request all for biopsies!*

Answer 760

* Clinical finding for this patient was **Obliteration of the vestibule space**, because the mandible is showing expansion * radiographically:we see radiolucency going as far as the first molar * This is a **mixed radiolucent radiopaque lesion** in developing calcifications. * This is an example of **Calcifying** **Odontogenic Cyst (COC)**

Answer 761

Verrucous Carcinoma Extensive papillary, white lesion of the maxillary vestibule

Answer 762

**lateral periodontal cyst**

Answer 763

``` **▪ Acute myeloid leukemia** o Adult (and children) ``` **▪ Chronic myeloid leukemia** o Peak 3rd ‐ 5th decade

Answer 764

**Fibrous dysplasia on the right mandible.** Note the superior displacement of the IAN Canal This is not odontogenic ( as they are usually above the canal) **Anything below th canal ►think of it as originiating from the bone itself**

Answer 765

Unencapsulated Lymphoid Aggregates

Answer 766

``` **E6 = degrades p53 E7 = inactivates pRb** ``` ## Footnote 1. E2 = attachment location of Integrated HPV 2. transcription of E6 + E7 3. Binding of the viral E7 protein to pRb ► release of E2F and other proteins ► signals for the cell cycle to progress ▪ **As long as the E7 protein stays attached to pRb, uncontrolled cell proliferation will continue** HPV E6 protein is: ‐ A ubiquitin ligase ‐ contributes to oncogenesis by attaching ubiquitin molecules to p53 ► making p53 inactive and subject to proteasomal degradation ▪ **Normal function of p53 = to stop cell division + repair damaged DNA so that damaged cells do not reproduce (apoptosis)** ▪ _When p53 is inactive_, cells with changes in the DNA, such as integrated viral DNA, are not repaired ► destabilizes the cell ► increases the risk of malignant transformation

Answer 767

**❏ OTC Magic Mouthwash Formulation:** helps the person to actually be able to eat bc they have so many ulcerations ○ 1 Part‐ Diphenhydramine/ Benadryl (anticholinergic) 12.5mg/5mL elixir ○ 1 Part‐ Lidocaine (topical anesthetic) ○ 1 Part‐ Magnesium hydroxide/ Maalox (mucosal coating agent) ○ Disp: 4 oz bottle ○ Label: Rinse with 5mL every 2 hours for 30 sec. then spit out **❏ Rx‐Topical Anesthetic** ○ Lidocaine 2% viscous solution\* (viscous lidocaine) ○ Disp: 100mL bottle ○ Label: Rinse with 10 mL for 2 minutes and spit out \*May diminish the gag reflex therefore better suited for older patients‐ shouldn’t be prescribed to kids. Remember serious sideeffects of seizures and methemoglobinemia in pediatric population. **❏ OTC Analgesic** ○ Acetaminophen (Tylenol) OR ibuprofen (NSAID) suspension/ tablets as directed for body weight ❏ **Rx Antivirals** ○ Generally only indicated for immunocompromised or dehydrated patients ○ Limited evidence for other cases‐ see Cochrane Oral Health Group Review\* (\*Amended recently) ○ Oral acyclovir suspension (Zovirax) is typically used ○ 15 mg/kg up to adult dose of 200mg ○ Rinse and swallow, 5 times a day for 5‐7 days

Answer 768

* **Cyclic** **neutropenia** * **aggressive periodontitist** * **pamiona fav** * **burkitts lymphoma** * **langerhan cell histocytosis** **o All these things can occur in children and lead bone destructions and look like teeth are floating**

Answer 769

**“Diaper Rash”** a type of candidiasis

Answer 770

**Rate of development?** So fast developing that it envelops and moves the teeth **Treatment?** Needs to be surgically excised **Origin?** Thought to be of **neuroectodermal source**

Answer 771

Multiple Myeloma

Answer 772

mature Periapical COD You see a nice radiolucent rim and radiopaque center  so mixed radiolucent/radiopaque entity in the periapical region of tooth #31  most likely diagonsis would be Periapical COD.

Answer 773

Nasolabial Cyst The lesion here just below the nose and you can tell that it's sort of raising the edge of the nose slightly

Answer 774

- Vitamin D and calcium supplements - Serum and urinary calcium are monitored

Answer 775

1. **SCC** 2. **Fungal Ulcer** 3. **Trumatic Ulcer**

Answer 776

Erythroplakia. Well-circumscribed red patch on the posterior lateral hard and soft palate

Answer 777

Adenomatoid odontogenic tumor (AOT) **Swelling in maxillary vestibule**

Answer 778

● Histopathology (H&E and special stain‐GMS) ● Culture ● Serology as for histology ● **Epithelioid macrophages containing histoplasma capsulatum** (white arrows) ● Lymphocytes ● Plasma cells

Answer 779

Sublingual Varices

Answer 780

**‐ Hallmarks:** o 1. Central ulceration o 2. Ring of erythema (erythematous border) ▪ Accentuated in right image

Answer 781

Multiple myeloma

Answer 782

Recurrent HSV-1 Vesicle stage (unilateral)

Answer 783

▪ Genetic disorder of hemoglobin synthesis (one of the hemoglobinopathies) **▪ Autosomal recessive pattern** ▪ **Mutation in DNA of *thymine* for adenine causes alteration of codon resulting in the substitution of the amino acid valine for glutamic acid in the beta‐globin chain of hemoglobin** ▪ This transformed hemoglobin is prone to molecular aggregation and polymerization to form a rigid and curved shape (sickle shape)

Answer 784

● Mild case: ***Fluconazole or Itraconazole*** ● Cryptococcal meningitis: ***amphotericin B + other antifungals***

Answer 785

PSEUDOMEMBRANOUS CANDIDIASIS **Severe dry mouth** **This is severe disease** we would want to use **systemic treatments/ intervention**

Answer 786

**Infectious mononucleosis** **Epstein‐Barr Virus/EBV‐induced disease** The virus spreads through saliva, which is why it's sometimes called "kissing disease." Mono occurs most often in teens and young adults. However, you can get it at any age. Symptoms of mono include: **Fever** **Sore throat** **Swollen lymph glands** * when you have salivary transfer, your lymph nodes get swollen * people feel fatigue and fever * they have tonsilitis * can lead to the secretion of white or gray‐ green tonsillar exudate * they can get petechiae on the palate too.

Answer 787

**Rhabdomyoma** ## Footnote Will see the striated muscle Differential diagnosis… looks like granular cell tumor – don’t know til you remove it If patient presents with relatively slow growing tumor like this, will I get incisional biopsy or excisional biopsy? Hard to say If confident benign tumor and it’s this size and I don’t think it’s vascular (no pulse, can do aspiration), feels firm – try to excise it If it looks different, like you think it’s malignant minor salivary gland neoplasm (won’t find it in this site, but if it’s on hard palate) – incision?

Answer 788

o 1mg PO, 5mg in malabsorptive disease o Pregnant women given folic acid to decrease spina bifida o Can be given IM injections if have malabsorption

Answer 789

_Osteoporosis_ * **reduction in bone density,** * **larger bone marrow spaces.** We **need more tests to confirm osteoporosis** besides dental radiographs.

Answer 790

**▪ Types** * **Primary polycythemia:** polycythemia vera * **Secondary polycythemia:** response to low O2 environment such as sleep apnea, living in high elevations, smoking * **Relative polycythemia** * Dehydration, diuretics, vomiting

Answer 791

Multiple Myeloma ## Footnote ▪ Radiolucency without sclerotic border ▪ Multiple and separated

Answer 792

Etiology ▪ Usually due to _a pituitary adenoma_

Answer 793

**Major Recurrent Aphthous Ulcers (RAS)** * ‐ 10 – 15% of all RAS cases * **‐ \>10 mm in diameter** * ‐ Ulcer Appearance: * **o Deeper** * **o Irregular borders (usually)** * ‐ **Typically resolves in WEEKS or MONTHS** * ‐ May be associated with fever or malaise * o The associated cytokine release can induce a fever * ‐ Predilection for the throat * **‐ Often DOES leave scarring** * ‐ Recurrence rates vary

Answer 794

(Multifocal) Epithelial Hyperplasia/**Heck's Disease** HPV 13,32 **“Flat‐top papules”**

Answer 795

 For condensing osteitis, look for heavily restored or carious teeth. Condensing osteitis typically surrounds the initial rarefying osteitis lesion. The teeth in these cases are non-vital as they represent a condition that is secondary to pulpal necrosis.  Open necrosis, eventual PDL space widening and then once the infection reaches the bone, you have bone loss.  Now you have an overreaction or inflammatory reaction surrounding the initial inflammation.

Answer 796

**Paracoccidio Mycosis** *looks like the three tail in **Naruto** lol*

Answer 797

Traumatic Erythema /Traumatic Hematoma on the lower lip.

Answer 798

Early Periapical COD well defined radiolucency surrounding the apeces of these two central When looking at such cases, it is also imporant to: 1. look at the crowns to look for carious lesions. If there is no restorations or no evidence of caries, it is likely that these lesions are arising from the bone and not secondary to pulpal involvement. 2. It also important to look at the PDL and Lamina dura, typically in COD lesions they should be visisulized and intact ( but because this is a 2D image and this area may superimpose on this region and obsecure the visulizing of the lamina dura and the PDL) **what’s the difference between COD and Inflammatory lesion?** COD won’t have effect on the PDL space itself, because it orginates from the bone! Vitality testing can help us differntiate between inflmmatory lesion and something that happeing inside of the bone.

Answer 799

**‐ Polymicrobial etiology** ‐ Normal flora become pathogenic during immunocompromised states ***‐ Key bacteria:*** o **Fusobacterium necrophorum** **o Prevotella intermedium** ‐ Other common bacteria: **o Actinomyces pyogenes** o Bacillus cereus o Bacteroides fragilis o Fusobacterium nucleatum o Prevotella melaninogenica

Answer 800

**o Hemophilia A** ▪ **A patient with only 25% of normal clotting factor VIII levels may function normally, but less than 5% will likely manifest as bruising and bleeding problems** ▪ Deep hemorrhage in joints is a major complication resulting in **arthritis, ankylosis and deformity** **▪ Oral findings include bleeding** (often uncontrolled) upon scaling and root planing, tooth extractions and any oral lacerations **▪ Pesudotumor of hemophilia** o Tissue hemorrhage can result in a submucosal tumor‐like mass **o Bone hemorrhage can result in intraosseous radiolucency**

Answer 801

▪ Stage I and II – localized disease curable with RT ▪ Stage III and IV – more widespread and treated with chemo and RT, worse prognosis ▪ Stage determined by sites involved o Above diaphragm – stage 1 and 2 o Above and Below diaphragm – stage 3 and 4 having it above diaphragm is bette than having it below so stage 1 and 2 are better than stage 3 and 4

Answer 802

Non‐Hodgkins Lymphoma (NHL) o The most common of the lymphoproliferative diseases o Uncontrolled proliferation of B or T cell origin derived from a single cell (or clone) o Typically presents with painless lymphadenopathy (often unilateral) ▪ up to 40% are extranodal ▪ 5‐10% arise in Waldeyer’s ring

Answer 803

Parotid Papillia (Stenson duct)

Answer 804

■ Thought to be caused by: * either **epithelial remnants of the nasolacrimal duct** * or **cells left after fusion of the maxillary, medial and lateral nasal processe**s during _development of the midface_

Answer 805

The eruption of ***the permanent first molar***

Answer 806

▪ Clinically see spontaneous gingival bleeding, petechiae, ecchymosis and hematomas o Clinically see some type of bleeding

Answer 807

Hereditary Hypophosphatemia/vitamin D‐resistant rickets teeth look fairly normal, have a draining abscess with ulcers and perilous

Answer 808

**Necrotizing Periodontitis (NP)** o Bone loss of the periodontium seen

Answer 809

**Lateral Periodontal Cyst** see the _alternating thin to thick epithelium_ ***a characteristic of these cysts***

Answer 810

**Lichenoid Reactions** **Contact Lesions** a sensitivity in contact with a **dental amalgam** ▪ When you replace these amalgams, the lichenoid reaction will typically disappear

Answer 811

**Kaposi Sarcoma** Solitary vascular lesion on hard palate – it was so small so he decided to just excise it in this case^

Answer 812

Sialolithiasis

Answer 813

Geographic tongue/ areata migrans Multiple, well-demarcated zones of erythema (due to filiform atrophy) surrounded by slightly elevated, yellow-white, serpentine/ scalloped border annular - serpiginous - atrophic - Fissured

Answer 814

**Burkitt Lymphoma** Epstein‐Barr Virus Infection * Fast growing tumor discovered by Dr. Burkitt * **High grade lymphoma B** **cells**‐ Usually affects the jaws of children. * **It is the fastest growing tumor/cancer**. * There is _translocation of c‐myc_

Answer 815

**Lichenoid mucositis looks like lichen planus** -same reticular white pattern, but there are areas of erosion and some ulceration as well -some diabetic medications can lead to this

Answer 816

Residual Cysts

Answer 817

Desmoplastic Ameloblastoma * **Spherical growth**. Within it, has both radiodense and radiolucent areas (is * **mixed radiolucent‐radiopaqu**e)– similar appearance to *_benign fibro‐osseous lesions._* * **Well‐circumscribed, corticated**.

Answer 818

**Beta‐thalassemia** ▪ Two defective genes – **thalassemia major (Cooley’s anemia, Mediterranean fever)** o Disease detected when fetal hemoglobin ceases to be made (~3‐4 months old) o Extramedullary hematopoiesis cause hepatosplenomegaly, bone marrow hyperplasia, and lymphadenopathy o In jaws, painless enlargement of maxilla and mandible (“chipmunk” facies) o Skull films show “hair‐on‐end” appearance o Untreated, patient dies by about one year of age o Treatment is repeated blood transfusions or bone marrow transplant this pt was treated with

Answer 819

**HHV 5** **Cytomegalovirus Infection** Histopathology look like an owl eyes means the cells are affected- they are **nuclear inclusions and cytoplasmic inclusions.**

Answer 820

**• Pyogenic granuloma/pregnancy tumor • Peripheral _ossifying***_or_***cementifying_ fibroma • Peripheral giant cell granuloma • Peripheral fibroma (4P)** _Memorize these well!_ *All benign soft tissue lesions*

Answer 821

**Ameloblastic Fibrosarcoma** in the mandible developed after two years from AF

Answer 822

* **Surgical Excision** via i**ntraoral approach**, * usually do not recur ~ **very low risk of occurrence**

Answer 823

Progressive Systemic Sclerosis (scleroderma) ## Footnote sharp areas of resorption in the bones near muscles attached to the angle of the mandible= masseter and medial pterygoid. You see resorption at the coronoid process at the attachment of the temporal bone as well.

Answer 824

**Ameloblastic Fibro-odontoma (AFO)** * _well‐circumscribed radiolucency_ * ***corticated edg***e + **calcification**

Answer 825

■ a **well-circumscribed unilocular** **radiolucency** on _the midline of the anterior hard palate_ _between and apical to the central incisors_ ■ The radiolucency often have an oval or inverted pear shape with a sclerotic border ■ Superimposition with the nasal septum can create an appearance of the classic **“heart” shape**

Answer 826

Geographic tongue/ areata migrans

Answer 827

neurofibroma -it looks like **lymphoepithelial cyst,** but this is further anterior and not where you would get lymphoid tissue – so it’s not lymphoepithelial cyst, it’s neurofibroma Yellow – nerves typically yellow

Answer 828

Bacterial infection which presents with a spectrum of lesions ‐ Vary depending upon the localization of lesion and predisposing factors

Answer 829

●affects the Alveolar mucosa, gingiva and palate lesions with “Mulberry‐like” ulceration (little bumps around it) ● Looks like **strawberry gingivitis** (differential diagnosis)

Answer 830

* Typically, no treatment is required unless these regions show clinical/radiographic evidence of secondary infection * Ex if patient complain of some pain of that area –\> we * want to follow up that region * Surgery within the dense bone has a high risk of causing osteomyelitis * Patients should be seen regularlyfor preventive treatment * Want tooth supported rather than tissue supported RPD and CD

Answer 831

If you have **positive IgM** *and* **negative IgG** → that means it’s an acute recent infection. Then you have to wait 4‐6 weeks If you do the serology then and get **positive IgG** *and* **negative IgM** → that means the person has **the established infection.**

Answer 832

* **Chemotherapy** with or without RT * **Bone marrow transplant,** interferon, antibodies made * against tumor cells, thalidomide, bisphosphonates, * corticosteroids, melphalan, etc. * Even with treatment, most patients do not survive more than * 18‐24 months * older patients – better prognosis * younger patients – more aggressive and worse prognosis * IV bisphosphonate therapy puts patients at increase risk for MRONJ

Answer 833

mature Periapical COD Coronal cross section of the posterior mandible in the region of the premolar ~ mixed radiolucent/radiopaque entity, the center is radiopaque and the periphery is radiolucent.

Answer 834

* After tooth extracted, not properly cleaned ► the residual cells of the cyst lining and inflammatory cells continue to proliferate * Has to be at site _where tooth was previously removed_

Answer 835

▪ Ferrous sulfate 325 mg TID between meals o can cause Constipation ▪ add on fiber to diet, green leafy vegetables o IV doses for absorptive problems ▪ 125mg in 100ml saline infused over 1 hour

Answer 836

**Pyostomatitis vegetans** *Snail track appearance*

Answer 837

TB Ulceration (tongue ulceration most common)

Answer 838

Mucous membrane pemphigoid Oral Hygiene: Plaque related gingival inflammation contributing to continued VB desquamative gingivitis

Answer 839

* monthly IM injections of **cyanocobalamin** * **cannot take **_**B12 orally**, you need injections_

Answer 840

**Erysipelas** Superficial skin infection in immunosuppressed adults ‐ Group A beta‐hemolytic streptococci ‐ Painful ‐ Bright‐red, well‐circumscribed, swollen, indurated (firm) ‐ Warm to touch ‐ Systemic manifestations: o High fever o Swollen lymph nodes Diagnosis: Cultures not useful ‐ Treatment: **o Penicillin ‐ Complications without treatment**

Answer 841

Florid COD Multiple regions of COD. Notice the wide areas of scelortic/radiopaque areas on mandible and also on maxillae

Answer 842

**Osteosarcoma** ▪ _Lytic lesion_ ▪ *Slightly* **ill defined** ▪ **Loss of bone** in the _inferior aspect of mandible_

Answer 843

-a Fibrous dysplasia limited to **Skull and Facial Bones.**..

Answer 844

✎A patient who has **Nevoid Basal Cell Carcinoma Syndrome** ✎We can see **multiple cystics** areas and lesions in _the jaws, maxillary and mandible_ ✎**Both 3rd molar displaced** in the maxilla because of the cyst

Answer 845

Mucous membrane pemphigoid REMEMBER: ▪ Plaque and calculus can be the consequence of painful MMP lesions ▪ When assessing MMP lesions/desquamative gingivitis, look for areas of intense inflammation WITHOUT local factors as evidence of VB disease

Answer 846

Multiple Endocrine Neoplasia (MEN) Syndrome

Answer 847

Mucocutaneous autoimmune disease characterized by sub‐epithelial blisters (bullae) which ruptures to form large, non‐healing ulcerations

Answer 848

* Results from accumulation of fluid in the follicular space when the tooth has erupted over the alveolar bone **\*NOT in bone\***

Answer 849

**•What is it?** Malignant tumor of fibroblasts • **Age?** Most common in young adults and children • **Rate of growth?** Slow growing lesion that is usually not painful (Can be slow growing, can be rapidly growing – different criteria determining high or low grade) • **Treatment**: surgical excision, recurrence is common(Aren’t always easy to surgically remove, because already metastasized into other reservoirs, spread into contiguous areas) Aren’t always radiosensitive, don’t always respond to radiation treatment • 5-year **survival rates** range from 40-70%

Answer 850

**Candida albicans**

Answer 851

‐ a Sexually transmitted (F\>M) caused by **‐ Neisseria gonorrhoeae**

Answer 852

**Plasmacytoma in Multiple Myeloma** * They already had **multiple myeloma** then developed plasmacytoma * When you biopsy this, **it’s filled with plasma cells** bc they’re producing the abnormal immunoglobulins, which are the cause of the devastating issues of multiple myeloma

Answer 853

**_Hypercementosis_** ## Footnote  **Differentiating Factor:** A well-defined radiolucent border that is continuous with the PDL of the tooth, in the case of hypercementosis. This means that whatever is happening is within the confines of the tooth-bearing region. In this case, the cementum.  Hypercementosis- Cementum is overraeacting, so there’s enlargement of cementum.  If cementum is larger, it should be pushing the PDL out (black arrow). So the PDL is enlarged meaning you should be able to see a radiolucent rim around the area. And the radiolucent rim should be continuous with the PDL of the remaining root structure.

Answer 854

* **surgical excision** * _recurrence_ is ***rare***

Answer 855

**▪ Usually a 21 day cycle** **o Dx –** when count falls below 500/ul for 4‐5 days every 21 days **▪ Patients experience recurrent fever, mallaise, anorexia, cervical lymphadenopathy, oral ulcerations, etc.** ▪ Treatment can be just supportive in mild cases, granulocyte colony‐stimulating factor for more severe cases

Answer 856

**Inflammatory Bowel Diseases** * **Specific lesions:** * o Diffuse labial and buccal swelling * o Cobblestones * o Other specific lesions * ▪ Mucosal tags * ▪ Deep linear ulcerations * o Mucogingivitis * o Granulomatous cheilitis * * **Non‐specific lesions:** * o Aphthous ulcerations * o Pyostomatitis vegetans * o Dental caries * o Gingivitis and periodontitis * o Other non‐specific lesions

Answer 857

o Erysipelas

Answer 858

● Aspergilloma‐**debridement** ● Allergic fungal sinusitis‐**debridement and corticosteroid drugs** ● Localized invasive‐**debridement & voriconazole and amphotericin B** ● Disseminated invasive‐**consider poor prognosis even with treatment**

Answer 859

**Cyclic Neutropenia** ## Footnote ▪ A rare idiopathic disorder characterized by regular periodic reductions in the neutrophil population **_Etiology:_** Underlying cause is a defect in hematopoietic stem cells in the marrow _▪ Symptoms_ usually _begin in childhood_ ▪ Most symptoms when neutrophil count is at its lowest point (nadir), usually lasts 3‐6 days (even when neutrophil counts are at their highest, it’s often lower than normal) **▪ Patients have repeated problems with infections** Oral ulcerations on any mucosal surface exposed to minor trauma & can mimic recurrent aphthous ulcerations without the erythematous halo that is so typical of aphthous ▪ Gingiva is most severely affected with periodontal bone loss and tooth mobility

Answer 860

* **simple surgical excision** * _Unlikely_ to recur/come back

Answer 861

**Verrucous Carcinoma** Early verrucous carcinoma of the buccal mucosa.

Answer 862

Central odontogenic fibroma (COF) round mass of opacity due to FCT. **Ground glass‐like appearance**

Answer 863

▪ **Bones** most commonly involved include **ribs, vertebrae and skull** **o 70‐90% will have jaw involvement at some point** ▪ **Anemia, thrombocytopenia and neutropenia** due to crowding out of normal cells within bone marrow by proliferating malignant cells ▪ **50‐60% have Bence‐Jones proteins in urine** (light chains, usually kappa) **o Due increased plasma cells ⇒ plasma cells make antibodies ⇒ antibodies/proteins gets excreted** **Solitary plasmacytoma can be the first sign of multiple myeloma** ▪ Radiographically, see **punched out radiolucencies** (no sclerotic margin) often with an irregular outline

Answer 864

o Approach is similar to PV – but generally not as aggressive unless hi‐risk areas ( ocular, esophageal ) where more intense immunosuppression indicated ▪ NON‐immunosuppressive treatments uniquely effective: * *o** **Dapsone** * *o Tetracycline + nicotinamide**

Answer 865

**Fibrous Dysplasia** * ill‐defined radiolucent/radiopaque/mixed radiolucent‐radiopaque entities that blend with normal bone. * The left side is affected. Left body of the mandible and the ramus. * The cortical outlines have been expanded near the inferior border of the mandible.

Answer 866

Diabetes Mellitus Sialadenosis

Answer 867

**Nasolabial Cyst** the lesion raising the edge of the nose slightly

Answer 868

**• definition:** a lesion that forms when a salivary gland duct is severed & secretion spills into the adjacent CT • **a pseudocyst** (not lined by epithelium) — mucous builds up in the CT & causes a bump **• treatment:** surgical excision, removal of associated minor salivary glands • may recur if don’t remove all associated injured minor salivary glands

Answer 869

Thyroglossal Duct Cyst This is **NOT** a goiter. It looks like an enlargement of the thyroid, but this ended up being just a cyst, so they had a thyroglossal duct cyst

Answer 870

Granular Cell Tumor

Answer 871

_Similar to **a paradental cyst**_ ‐ **EXCEPT**: location is _central on the buccal of mandibular first molars_

Answer 872

**Adenomatoid odontogenic tumor** **(AOT)** fibrous capsule of AOT is at least partially encapsulated. Easy to remove; “popped right out”.

Answer 873

● _Uncommon_ **fungal infection** ● **Blastomyces dermatitidis** ● **Dimorphic**

Answer 874

_What is it?_ ▪ **_Generalized decrease in bone mass_ i**n which the histologic appearance of bone is normal, it is a metabolic bone diseases (MBD) _Why it happens?_ * **Aging process (postmenopausal women)** bone mass usually increases until 30 years of age, and then there is a gradual decrease- about 8% loss in females and 3% loss in males * **Nutritional deficiencies** * **Hormonal imbalance** * **Inactivity** * **Corticosteroid or heparin therapy** _What the bone are like?_ ▪ **More prone to fracture** (distal radius, proximal femur, ribs, and vertebrae)

Answer 875

**EBV mucocutaneous ulceration** Very rare *Photos from google*

Answer 876

**What is it?** * A benign tumor arising from peripheral nerve tissue **Treatment**: surgical excision **Malignant transformation** _reported, but rare_

Answer 877

**Agranulocytosis** Oral findings: * include multiple ragged ulcerations of the oral mucosa * can mimic recurrent aphthous (but often no erythematous halo) * Gingiva is a common site due -can resemble NUG)

Answer 878

Schwannoma/ Neurilemoma

Answer 879

deep fungal infection that present as Pulmonary infection

Answer 880

**o Systemic Lupus Erythematosus (SLE)** ▪ Due to sparing of nasolabial folds ▪ Butterfly rash in SLE resembles erysipelas **o Cellulitis (dental infection induced):** ▪ Tooth infection burrowing through the tissues rather than forming an abscess **o Actinomycosis**

Answer 881

* **surgical excision** * **recurrence is rare**

Answer 882

**dentigerous cyst**

Answer 883

Geographic tongue, localized lesion.

Answer 884

**Leukemia** ## Footnote ▪ Oral findings include **gingival hyperplasia, spontaneous bleeding of gingiva, mucosal ulcerations, candidiasis, recurrent herpetic lesions, etc**. ▪ Leukemic infiltrate in soft tissues (ex. gingiva) produces a diffuse, boggy, nontender swelling that may or may not ulcerate **o most common with myelo‐monocytic types** ▪ May create a tumor‐like mass in soft tissue o granulocytic sarcoma/chloroma (clinically looks green) ▪ mass infiltrate into soft tissue If you see children and notice they have prominent areas of redness or red/purple and know the child has decent oral hygiene, leukemia should be in your differential. Need to be aware of that cause patients need to be treated in a fairly quick fashion.

Answer 885

**Periapical Cyst** **Open clear areas = Cholesterol clefts where fat used to be. Multinucleated cells (purple dots) trying to break down cholesterol**

Answer 886

**Verrucous Carcinoma** Large, exophytic, papillary mass of the maxillary alveolar ridge.

Answer 887

_dentigerous cys_t b/c **\*attachment at CEJ**

Answer 888

Palatine Torus/Torus Palatinus

Answer 889

**‐ Dexamethasone elixir 0.5mg/5ml (ETOH base) or solution (H20 base)** ‐ Indicated for difficult to reach lesions to obtain access to all of them o Disp:600ml o Label: swish with 5‐10 ml for 5 minutes up to 0.5mg/5mL 4x/day and expectorate 00s preservalve.) May be used as suppressive therapy in selected patients with close surveillance o Prevent recurrences ‐ May buy an EXTRA DAY of healing time _dr. Kerr prefers the elixir_

Answer 890

HSV‐ Cytology‐ Papanicolaou Stain (PAP)

Answer 891

PLEOMORPHIC ADENOMA Classic presentation: includes swelling in the parotid region | (MIXED TUMOR)

Answer 892

• **Definition**: mucocele-like lesion that forms unilaterally on the floor of the mouth • **associated with:** the _ducts of the sublingual & submandibular glands_ **• clinical features:** **• treatment**: surgical excision

Answer 893

* **Low grade B cell** (disseminated but slow growing) * Small lymphocytic, Mantle cell, Marginal zone * Follicular center (35‐40 % of all B cell lymphomas) * **Moderate** (aggressive) * Diffuse B‐cell, Peripheral T‐cell * **High Grade B cell** (disseminated and rapidly progressive) * Anaplastic large cell, lymphoblastic * Large cell (25‐30 % of all B cell lymphomas) * Burkitt’s * Immunoblastic (increasingly seen in AIDS) * As AIDS patients live longer we see this more * **T cell lymphoma** (less common than B cell, associated with **palatal perforation** [midline lethal granuloma]) (in differntial with deep fungal infections/candidiasis, TB, use of cocaine * Precursor T‐lymphoblastic, T cell chronic lymphocytic, * **Hodgkin’s** (bimodal ‐ late twenties and after 50 years old)

Answer 894

**dentigerous cyst**

Answer 895

■ Occurs after trauma or sinus surgery (iatrogenic - reactive not neoplastic)

Answer 896

**Ground Glass Pattern** it appears granular in nature. (Grainy)

Answer 897

Diabetes Mellitus diabetic patient who developed *Mucormycosis* Notice it is causing _necrosis_ in the palate

Answer 898

Branchial Cleft Cyst **a small one in a child.** You can see that there's a small cystic lesion here on the neck

Answer 899

● Use of _anti‐inflammatory medications_ **o Sulfasalazine or Prednisone** ● If medical means do not succeed► then **removal of part or all of colon**

Answer 900

* **Infections** caused by **molds** belonging to the order **Mucorales** * _Grow in natural state on_ **decaying organic materials** (saprobic‐ recycling) * **Spores** may be _liberated into air and inhaled by humans_

Answer 901

**Pemphigus Vulgaris.** . Multiple erosions affecting the marginal gingiva.

Answer 902

**Peau d'orange** surface of an orange – the bone shows a “pitting” appearance.

Answer 903

**keratin pearl** – can be associated w/**SCC**

Answer 904

**Oral Florid Papillomatosis** Very characteristic appearance - diffused, in multiple locations - papillary **"Multifocal, papillary lesions"** -if we biopsied these or had these removed for aesthetic regions, we’d see that the epithelium have become white, long, taller, and bumpy

Answer 905

Aneurysmal Bone Cyst

Answer 906

_o Single dose of parenteral long_‐ acting **benzathine penicillin G** (primary, secondary, early latent) o **Intramuscular penicillin** weekly for three weeks (late latent and tertiary

Answer 907

**Scrofula**

Answer 908

**HIV‐Associated Aphthous** * CD4 counts \<100 cells/mm3 are predisposed to major RAS * ‐ Other sites may be affected: * o Esophagus * o Genitals * o Anus/rectum * ‐ We see this **less frequently since ART** * ‐ Diagnosis is important, particularly if no prior history

Answer 909

* ❏ Supportive/Palliative Treatment * ❏ Fluids, nutrition, rest, avoid spreading to others * ❏ Avoid touching eyes, genitals * ❏ Possible referral to MD if infant is not drinking because of pain * ❏ Medications: 1. Topical anesthetic (OTC vs Rx) 2. Mucosal coating (OTC) 3. Analgesic (OTC vs Rx) 4. Antiviral (Rx)

Answer 910

● Increased risk of **squamous cell carcinoma**

Answer 911

**Ppl w/ HIV+ and low CD4 T‐cells lvl** = higher risk of HPV **HPV 16+ higher if CD4 \<200**

Answer 912

**NOMA** Development of NOMA from day 1 to day 15

Answer 913

**Oral hairy leukoplakia** Epstein‐Barr Virus induced disease ❏ Corrugated white keratotic lesion on the lateral tongue in HIV+ people

Answer 914

**Leukomia** ## Footnote o Leukemic infiltrate – have areas of erthema o Looks like gingival hyperplasia, but in gingivail hyperplasia you don’t have the same amount of redness. Leukemia has significant hyprotophy of gingivial papilla and areas that look like they have ptechia in them. With gingival hyperplasia drug induced they are very fibrotic

Answer 915

**Hematinic Deficiencies** ## Footnote **‐ Superficial ulcers** o Not classic aphthous ulcers ‐ Equivocal associations with iron, Vit B1, B2, B6, B12, and folate. ‐ Blood tests are not recommended routinely in all patients with RAS. ‐ Indications for blood work (CBC): o Older patient with recent RAS history o Suspicious medical history/review of systems **o Strict vegetarian patients**

Answer 916

▪ **Simple excision** or **enucleation** ▪ **Unlikely** *to* **recur**

Answer 917

* **Surgical Excision** * _Reccurance_ is ***Rare***

Answer 918

Histoplasmosis

Answer 919

* **What is it:** Benign tumor of mature fat cells; Relatively rare * **Histologically**: a well-delineated tumor composed of mature fat cells with a thin capsule * **Treatment**: surgical excision,does not recur

Answer 920

* Chronic infection * caused by *_spirochete_* **Treponema pallidum**

Answer 921

Treatment for generalized symptoms may involve: * **corticosteroids** * **immunosuppressants, such as methotrexate or Cytoxan** * **nonsteroidal anti-inflammatory drugs** Depending on your symptoms, treatment can also include: * blood pressure medication * medication to aid breathing * physical therapy * light therapy, such as ultraviolet A1 phototherapy * nitroglycerin ointment to treat localized areas of tightening of the skin *(from google)*

Answer 922

- you might think that he has an odontogenic infection but he didn't. You can see that there's a pretty significant swelling on the left side of his face This is a **Aneurysmal Bone Cysts**

Answer 923

**Periapical Cysts**

Answer 924

_▪ Pathologists order it_ ▪ Only do testing if pathologist sees cancer **No HPV testing on low‐risk HPV lesions (warts)** ▪ No medical indication for **low‐risk HPV testing** b/c ‐ infection **NOT** associated w/ disease progression ‐ no treatment or therapy change indicated when low‐risk HPV is ID’ed ▪ HPV testing using p16 surrogate on **oropharyngeal squamous cell carcinoma** **(SCC)**

Answer 925

* lesion, *was actually some other type of cyst* * * it is now thought that most of the reported Primordial cysts were actually **OKCs**

Answer 926

Primordial Odontogenic Tumor (POT) **unilocular radiolucency**

Answer 927

**❏ Rx: Valacyclovir 1g tablets** Disp: 4 tabs Label: 2 tabs stat PO, then again in 12 hours (ie 2 doses) *Given during prodrome.* **❏ Rx: Famciclovir 500mg tablets** Disp: 3 tabs Label: 3 tabs stat PO

Answer 928

Mucocutaneous Candidiasis APECED Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy Syndrome Biopsy of the tonuge revealed SCC

Answer 929

**Acromegaly**

Answer 930

**Macrocytic (megaloblastic) Anemias:** **▪ Folic acid and B12 deficiencies** * _Glossitis_ * Denuded dorsal surface * Burning, stinging pain Seen in older patients and seen in patients with poor nutrition **_Etiology:_** alcoholism, malabsorption, medications (trimethoprim, oral contraceptives, anticonvulsants

Answer 931

two manifestations: 1. **Herpes labialis:** occurs on the vermillion border 2. **Intra‐oral herpes**: occurs ONLY on the fixed keratinized mucosa (mucosa that doesn't move around) MEMORIZE THIS

Answer 932

Although the cause is not well known, T cell-mediated autoimmune phenomena are involved in the pathogenesis of lichen planus.

Answer 933

**SOT** **Squamous Odontogenic Tumor** * ***Semilunar** loss of bone*. * **Alveolar bone** is gone due to **impacted canine** that is visible

Answer 934

**PLUMMER‐VINSON SYNDROME** denuded tongue and angular chelitis

Answer 935

* Unless symptomatic, no treatment required, cysts resolve upon eruption of teeth

Answer 936

▪ **Enucleation** _with peripheral ostectom_y ▪ **Resection** _with rim of normal bone_ ▪ _Recurrence_ rate is ***~12%*** ▪ **~ 2%** demonstrate *malignant transformation*

Answer 937

Burkitt’s Lymphoma * **North American type (sporadic)** * Typically older children (mean of 11 years) * Involves abdomen as a mass * uncommon in the jaws * No association with EBV * More localized disease * **HIV type** * Adults * 25% associated with EBV * GI, marrow and CNS **Teeth floating** as shown in the image

Answer 938

**Atypical recurrent HSV** **❏ Immunocompromised host** Atypical recurrent HSV can have this appearance on the movable mucosa too, not just fixed

Answer 939

**Oral lichen planus** on the buccal mucosa (most common site reticular form.

Answer 940

* lesions in the posterior MD are usually pathognomonic * **no further treatment is necessary**

Answer 941

Stage 3 o Granulomatous inflammation o Ulceration may be present ‐ Special stain "**Warthin Starry"**, highlights _**corkscrew spirochetes** ‐_ **Immunohistochemical stain**

Answer 942

* **Growth and expansion** of this lesion due not only to osmotic effects/pressure, but to _unusual gene expressions_

Answer 943

Treatment has 3 stages: **● Stage 1: Control** ○ Suppress inflammation / lesion activity with Systemic **Corticosteroid: Remains initial / 1st‐line treatment…** ○ Then quickly add steroid‐sparing agents (mycophenolate mofetil) to minimize dose and duration of corticosteroid treatment as well as improve disease control **● Stage 2: Consolidation** ○ Reducing auto‐antibody production with the addition of Immunosuppressants ○ Assessed by the lack of development of NEW lesions **● Stage 3. Remission / Maintenance:** ○ achieving complete remission of lesion activity OFF medication is the GOAL ○ When lesion activity OFF medications cannot be achieved, principle of MINIMALLY effective therapy is the goal, typically with combination of immunosuppressant medications **○ RITUXIMAB has become the FIRST CHOICE treatment after ○ the consolidation phase to achieve DISEASE REMISSION** _● TOPICAL / INJECTABLE CORTICOSTEROID MEDICATIONS_ ○ o Can be used to help control limited number of lesions resistant to systemic therapy: it treats ONLY the disease ○ outcome (lesions) and not the systemic illness / pathologic antibody production **○ ex:clobetesol 0. 05% , halbetesol 0.05% (most potent)**

Answer 944

**Recurrent HSV-1** healing stage cause you might see this one day

Answer 945

**Pernicious – “highly injurious or deadly”** ▪ Lack of intrinsic factor protein in stomach decreases absorption of vitamin B12 **Etiology** is usually the body making antibodies against parietal cells which make intrinsic factor o Autoimmune disease effecting parietal cells leads to decreased intrinsic factor ▪ More common in **elderly** ▪ More common in patients of **Northern European and African decent** _This anemia can lead to death_

Answer 946

* **Punched out** radiolucency * **Lytic** radiolucency *without cortication* MM Multiple Myeloma

Answer 947

**Pyogenic Granuloma:**

Answer 948

**6 & 11**

Answer 949

-Fibrous dysplasia with **intramuscular myxomas**

Answer 950

_Type of Anemia?_ **_Megaloblastic_** Anemia _What difficiency?_ **Vitamin B₁₂ difficiency** _Causes?_ * Poor absorption of vitamin B12 (extrinsic factor, cobalamin) * These patients _lack intrinsic factor,_ usually **due to autoimmune destruction of parietal cells** * ***Intrinsic factor*** produced by parietal cells in the stomach is **needed for absorption of B12**

Answer 951

* **What is it?** Reactive connective tissue hyperplasia - exuberant granulation tissue; Misnomer – not pyogenic and not a true granuloma * **Etiology:** Response to injury - calculus or overhang restoration * **Assosiated with**? Often occurs in **pregnant women (“pregnancy tumor”)**, also associated with **puberty** * **Treatment**: Excision and removal of irritant (eg calculus, overhanging restorations)

Answer 952

**Clinically**: obliteration of vestibule on patient’s left mandible **Radiographically**:lesion running from posterior by third molar all the way anterior to canine. Well‐circumscribed, multilocular radiolucency is scalloping up between teeth, causing some root divergence **Grossly**: gelatinous appearance of myxoma makes it hard to remove **After treatment:** post‐surgery; had excised all the way to right 2nd PM This is **Odontogenic Myxoma**

Answer 953

▪ related to crowding out of normal hematopoietic stem cells in the bone marrow o ↓ in normal WBC, RBC, and platelets ▪ See **fatigue, bleeding, bruising, fevers and infections, etc.**

Answer 954

**CD4+ T‐Lymphocytes**

Answer 955

**Simple Bone Cyst** ## Footnote ✎**A well-circumscribed with cortication** in the **body of the mandible**, affecting _the posterior aspect (premolars and the molars )_ ✎Note the **scalloping** that happens up **between the roots**. It doesn't cause root resorption and actually the lesion will grow up between the roots of the teeth

Answer 956

**Renal Osteodystrophy 2** sometimes you see: * **increase in bone density** * **loss of definition of lamina** * **dura and cortical bone**

Answer 957

▪ Low‐risk types: clear faster, less likely to become persistent ▪ High‐risk types: clear slowly, more likely to become persistent

Answer 958

Hereditary Gingivofibromatosis

Answer 959

This is another medical CT scan. You see the granular appearance of the maxilla, skull, and well-defined multilocular radiolucency with granulation. We call this a brown tumor because it is associated with **hyperparathyroidism.** **( s**ystemic endocrine diseases)

Answer 960

**Hodgkin Lymphoma** **o Begins in lymph nodes o 70‐75% cervical/supraclavicular o Painless but unresolving,** **o Night fevers/sweats**

Answer 961

**Crohn Disease** _Nodular appearance_ of **buccal mucosa**

Answer 962

❏ Primary infection **○ Varicella/ Chicken pox** ❏ Secondary infection **○ Zoster/ Shingles** ○ May affect oral cavity/ face if reactivation along distribution of V1/2/3

Answer 963

**16, 18**

Answer 964

**T cell Lymphoma** _Less common than B cell lymphomas_ ▪ One variant associated with **palatal perforation** o Old name **midline lethal granuloma**

Answer 965

**Hairy Leukoplakia** corrugated white lesion on the lateral tongue. **• It only occurs on the lateral tongue**

Answer 966

**trigeminal ganglion**

Answer 967

* *menstruation, pregnancy, malabsorption diseases (eg. Celiac)**

Answer 968

**Odontogenic Myxoma** * Classic example of **enlargement of the mandible** caused by **multilocular radiolucency.** * Enlarged into oral cavity ‐ **alveolar ridge elevated**

Answer 969

Excision/Ablation ▪ Scalpel ▪ Carbon dioxide laser – be cautious, don’t know what is burned away ▪ Electrosurgery

Answer 970

▪ **Poxvirus** ▪ Florid cases seen in immunocompromised persons ▪ Children, young adults **Treatment** ‐ Kids can have 6‐9mo and will go away

Answer 971

**Impetigo** ‐ “Cornflakes glued to Surface" Appearance o Little papules that can form little vesicles around the mouth o Vesicles burst open and dry up around the skin of the mouth ‐ Bilateral

Answer 972

‐ Genital area usually‐**purulent discharge** ‐ **Systemic bacteremia** (myalgia, arthralgia, polyarthritis, dermatitis) ‐ **Pelvic inflammatory disease** in women (affects pregnancies) ‐ **Gonococcal ophthalmia neonatorum** (infection of infant's eyes)

Answer 973

**Leukemia** o Dilantin hyperplasia (drug induced gingival hyperplasia) – fibrotic looking o Has to an addition of thromocytopenia

Answer 974

**Do you think it’s a fibroma? No. Why?** Fibroma is covered with normal coloring epithelium – sometimes see a little white change on surface or see tiny traumatic ulcer on surface This is not like that, this is completely ulcerated Not fibroma; fibroma is a chronic bump that patient is aware of **Is it squamous cell carcinoma? Interesting, it is indeed very friable; but no** Sometimes SCC can develop and can be exophytic and don’t have deep invasion, But this is pedunculated, SCC would not be pedunculated History says there could be some kind of trauma, biting, or nick with bur – not squamous cell **Mucocele? No** Would you typically develop mucocele on lateral border of tongue? No Not going to be as many mucoceles in this area, but there are the glands of Blandin and Nuhn, so it’s possible to develop on ventral surface of tongue This bump doesn’t look like a fluid filled bump though, it has surface ulceration, redness ;Mucoceles have intact surface, would not bleed, or be red **Granular cell tumor? No** Granular cell tumor would have normal overlying epithelium (it’s pushing up from underneath) This does not have normal overlying epithelium **Hemangioma reserved for congenita**l; not a vascular malformation either **Neurofibroma? No, not the same surface** **Salivary gland neoplasms? Possible**, there are salivary glands in that area; keep this in differential The one that this is is **pyogenic granuloma**: usually red, ulcerated, and bleeds easily

Answer 975

**Ewing Sarcoma** ## Footnote ▪ Long bone ▪ Large expansion

Answer 976

Recurrent HSV-1 This is recurrent intraoral herpes. We have punctate (point‐like) ulcerations which sometimes have clusters of coalescing ulcers. That’s the words you wanna use Other features of the ulcers: ○ Erythematous border ○ Irregular shape ○ Fixed mucosa ○ Unilateral

Answer 977

**Amyloidosis** Nodular “waxy” depositions in skin **deposition on the eyelid**

Answer 978

a Fibrous dysplasia involving **one bone** o Ex: when only the mandible involved or only the maxillae (Most common type (70%)

Answer 979

**Osteosarcoma** * AP Plain Film * Most of jaw was missing * Radiolucency affecting entire ramus and condyle

Answer 980

**Behcet’s Disease** ‐ Recurrent inflammatory disorder of unknown cause: o Bacterial? ‐ Affects: o Middle Eastern Males o Asian Females ‐ Onset 3rd – 4th decade ‐ HLA‐B51 association Recurrent aphthous ulcers generally precede other signs: o Genital/skin/eye lesions & others (arthritis, Gl lesions, CNS symptoms, vascular lesions) ‐ Diagnosis based upon criteria (point system): no laboratory tests

Answer 981

Hyperparathyroidism ## Footnote On our intraoral radiographs, we see **loss of definition of lamina dura** because the bone now has **a granular appearance** which extends to the lamina dura. The teeth are usually normal, but there is a loss of lamina dura around the teeth. These teeth are not mobile.

Answer 982

Pyostomatitis Vegetans

Answer 983

Rubella caused by Family: Togavirus; Genus: Rubivirus ``` Forchheimer sign (left) Palatal petechiae (right) ``` | (German Measles)

Answer 984

* Treated with iron supplements * Need long term follow up for eval of SCCa

Answer 985

* **Resection** (treatment depends on extent of the lesion and anatomy of involved bone) * **Segmental** * **Composite** * **Long term (decades) follow up** is needed for these patients

Answer 986

**‐ Treatment to reduce pain ‐ vs. ‐ Abortive treatment to reduce healing time ‐ vs. ‐ Suppressive treatment to suppress recurrences ‐ Combination of all** Also Consider * Using Sodium Lauryl Sulfate‐Free Toothpastes * Remove Obvious Possible Causes

Answer 987

**Sialothiasis** **Also here is a histological image of it**

Answer 988

**Sialothiasis**

Answer 989

**‐ Prednisone or systemic steroids were the one systemic treatment that Dr. Kerr has has success with in practice** **o 0.5 mg/kg of Prednisone would be prescribed for about 1 week** o Very successful in patients with frequent outbreaks of multiple canker sores ‐ In some limited cases Dr. Kerr has seen some success with: o Colchicine o Pentoxifylline

Answer 990

Osler-Weber-Rendu Syndrome

Answer 991

**▪ Increase in the number of circulating red blood cells**

Answer 992

**Calcifying Epithelial Odontogenic Tumor(CEOT**) * ***Fewer calcifications here***, **well‐circumscribed and corticated, impacted** tooth. * **periosteal reaction** _causing elevation_ at the bottom of image!

Answer 993

Looks like it could be a salivary gland neoplasm, but it’s not It was another **lymphoma** Manifest in a number of different ways

Answer 994

Actinic cheilitis (Solar cheilosis) Early presetation: Smooth, blotchy, pale, dry areas Diffuse, irregular white plaque around line of the lip Crusted, Scaly ****

Answer 995

Actinic cheilitis (Solar cheilosis) Typical presentation of angular cheilitis with erythema, crusting and mild fissuring of the angles of the mouth bilaterally.

Answer 996

Actinic cheilitis has **2 times** of risk for developing SCC of the lip. SCC on the lips is 11 times as likely to metastasize compared to SCC found on other parts of the body

Answer 997

**_SCC_** arising from **Actinic Cheilitis**

Answer 998

**Oral Melanoma** Large, blue-black, irregularly bordered lesion on the upper lip of a male Japanese patient. The diagnosis is oral melanoma.

Answer 999

Amalgam tattoo This image depicts two diffusely bordered, dark gray macules in the left posterior buccal mucosa adjacent to molar teeth that have been restored. .

Answer 1000

**Oral Melanoma** a highly malignant neoplasia, arising from melanocytes, the cells that produce the brownish pigment melanin.

Answer 1001

**Oral Melanoma** an ulcerated, blue-black, slightly elevated lesion in the edentulous, posterior right maxilla. The lesion extends across the residual alveolar ridge onto the palate and onto the facial aspect of the ridge.

Answer 1002

**Oral Melanoma** patient with extensive, black-pigmented and irregularly bordered macule in the maxillary labial mucosa and midline facial gingiva, (teeth 8 and 9). (The patient's fingers are depicted.)

Answer 1003

Oral melanoacanthoma. the buccal mucosa of a middle-aged, black woman with a brown-black, irregularly bordered macule that arose suddenly. The patient was unaware of its presence.

Answer 1004

**Oral melanotic macule** an irregularly shaped, tan-brown macule on the left hard palate in an edentulous patient.

Answer 1005

due to chronic ultraviolet light exposure.

Answer 1006

* avoid sun exposure * Laser ablation is preferred for severe actinic cheilitis * surgical excision is recommended for severe actinic cheilitis with evidence of high-grade dysplasia * Lip Shaving” (Vermilionectomy) * can also use cryotherapy, electrodesiccation It requires long term follow up and **prognosis is good if caught early**

Answer 1007

Oral Melanoma

Answer 1008

Oral Melanoma

Answer 1009

Traumatic Granuloma (traumatic ulcertaive granuloma)

Answer 1010

Oral Melanoma

Answer 1011

Traumatic ulcer Most often on tongue, lips, buccal mucosa Any sites that may be injured by dentition

Answer 1012

Traumatic ulcer a chronic ulcer on the left posterior lateral border of the tongue caused by lingually tilted mandibular 3rd molar. Note central ulceration with peripheral keratosis

Answer 1013

Traumatic ulcer caused by sharp or puncturing food stuff

Answer 1014

Traumatic Granuloma

Answer 1015

**Traumatic Granuloma** | ( Traumatic Ulcerative Granuloma)

Answer 1016

Squamous cell carcinoma on the buccal mucosa)

Answer 1017

**Erythroplakia and Squamous Cell Carcinoma** Erythroplakia is a general term for red, flat, or eroded velvety lesions that develop in the mouth. In this image, an exophytic squamous cell carcinoma on the tongue is surrounded by a margin of erythroplakia

Answer 1018

Leukoplakia and Squamous Cell Carcinoma Leukoplakia is a general term for white hyperkeratotic plaques that develop in the mouth. About 80% are benign. However, in this image, squamous cell carcinoma is present in one of the leukoplakic lesions on the ventral surface of the tongue (arrow).

Answer 1019

**Graphite tattoo** Gray, black, or blue-ish macule

Answer 1020

**Graphite tattoo** Most common location on the palate and gingiva Gray, black, or blue-ish macule

Answer 1021

**Hemangioma of Infancy** a relatively common benign proliferation of blood vessels that primarily develops during childhood. display a rapid growth phase with endothelial cell proliferation, followed by gradual involution.

Answer 1022

Hemangioma of Infancy

Answer 1023

Unknown. Ultraviolet radiation is an important causative factor for skin melanoma **Acute sun damage** can cause it more than chronic exposure

Answer 1024

Traumatic ulcer of the tongue.

Answer 1025

Fair skin A history of sunburn Excessive ultraviolet (UV) light exposure. Living closer to the equator or at a higher elevation Having many moles or unusual moles A family history of melanoma Weakened immune system.

Answer 1026

* Surgical excision * Radiotherapy * Chemotherapy

Answer 1027

**Necrotizing Sialadenometaplasia** *we see two ulcers on the palate* *Mostly ● Palatal salivary glands ○ Possible for parotid ● 75% of case on posterior palate ● Hard\>Soft palate ● 2/3rd are unilateral*

Answer 1028

**dry‐mouth** from radiation Note the Ropy, frothiness on the palate. - The tissues are red and irritated due to candida infection as well.

Answer 1029

**dry‐mouth** patient a classic example **• Classic fissuring • depapillation of the tongue papilla • some white changes on the tongue.**

Answer 1030

**dry Mouth** Cervical caries related to radiation. The patient is a smoker and coffee drinker --\> explains the staining

Answer 1031

dry Mouth Incisal caries in a radiation patient: **Incisal caries is a sure sign of severe dry mouth/ significant salivary gland hypofunction**

Answer 1032

**SJÖGREN’S SYNDROME** _Dry Mouth_ very severe cervical disease & very dry lips

Answer 1033

a patient with a **_bacterial sialadenitis_** who has **_SJÖGREN’S SYNDROME_** When we examine such patients and ”milk” the gland ► you actually see a purulent drainage from the gland itself.

Answer 1034

Depapillated & Fissured Tongue ## Footnote **SJÖGREN’S SYNDROME**

Answer 1035

**Sjögren Syndrome** * bilateral enlargement of the submandibular glands * angular cheilitis, dry and cracked lips and fissured and despapilated tongue * severe ocular lesions.

Answer 1036

These patients **LOW USFR, no response to stimulation (aka abnormal USFR/SFR)** * Rehydrate if dehydrated * Treat underlying conditions (i.e. DM) * Salivary substitutes (glycerin) * Minimize damage to glands from radiation * Prevention of complications & palliative treatment * Optimal hygiene * Restore caries * Smooth sharp edges in oral cavity * Fluoride therapy * Antifungals * Chlorhexidine rinses w/o alcohol * Sialendoscopy * Salitron - salivary pacemaker * ALTENS (acupuncture like transcutaneous electrical nerve stimulation)

Answer 1037

**Etiology** * typically caused by trauma. In more than half the cases, the patient does not recall traumatizing the area although this may have occurred during sleep. * Chronic mucosal trauma from adjacent teeth * Some adjacent source of irritation

Answer 1038

Traumatic ulcer Post-anaesthesia traumatic ulcer on lower lip.

Answer 1039

**Remove cause of irritation** Topical anesthetic or film for pain relief If there is no obvious cause then ► **biopsy**

Answer 1040

**HPV + SCC** Area affected: ( Oropharynx cancers largely involved tonsils, . Posterior 3rd of the Tongue) Younger pts, 3:1 Males to females ratio, high socio-eco status Incidence is decreasing less aggressive → higher survival rates ( Better than HPV negative SCC) **HPV - SCC** The chief risk factors for oral squamous cell carcinoma are Smoking (especially \> 2 packs/day) Alcohol use Risk increases dramatically when alcohol use exceeds 6 oz of distilled liquor, 15 oz of wine, or 36 oz of beer/day. The combination of heavy smoking and alcohol abuse is estimated to raise the risk 100-fold in women and 38-fold in men. ( this affects these ares : the tongue, floor of mouth, buccal mucosa, or gingiva) mostly men, low socio-economic factors Incidence is decreasing Very aggressive → lower survival rates

Answer 1041

Early stage: Radiation and/or Surgical removal Late stage : combination of surgery, radiation therapy, or chemotherapy

Answer 1042

**Nasopalatine Duct Cyst** ✎Between the roots of the two teeth, a well circumscribed radiolucency, not showing any changes to the adjacent structures ✎could be an enlargement of the incisive canal due to variation in size ~ **early lesions can be hard to diagnose**

Answer 1043

result from pencil lead that is traumatically implanted, usually during the elementary school years

Answer 1044

If patient is concerned for cosmetic reasons ► then removal of lesion with autogenous graft

Answer 1045

○ Because most hemangiomas of infancy undergo involution, management often consists of “watchful neglect.”

Answer 1046

Necrotizing Sialadenometaplasia an uncommon, usually self-limiting, benign inflammatory disorder of the salivary glands. *Here it is on the palate*

Answer 1047

**Xerostomia-related Caries** **Or** **Dry Mouth** . Extensive cervical caries of mandibular dentition secondary to radiation-related xerostomia.

Answer 1048

*The cause is uncertain, although the hypothesis of ischemic necrosis after vascular infarction seems acceptable.*

Answer 1049

No Treatment Needed but we need to biopsy to rule out other diseases

Answer 1050

**SJÖGREN’S SYNDROME** Autoimmune exocrinopathy Dry mouth and eyes resulting from a chronic progressive loss of secretory function (Slowly but surely, the salivary glands and/or lacrimal glands (some cases are more lacrimal & less salivary or vice versa); slow & progressive Patients with Sjogren’s can have bilateral salivary gland enlargement (parotid) (Sometimes we may see a unilateral enlargement of the salivary glands due to retrograde infections.) **increased risk of lymphoma (MALT type)**

Answer 1051

Frictional keratosis on the tongue

Answer 1052

**Frictional Keratosis** **the white surrounding a a traumatic ulcer** Symptomatic traumatic ulceration of the left mid-ventral tongue associated with a sharp left lower molar. The ulcer has flat edges and is surrounded by an area of frictional keratosis.

Answer 1053

Leukoplakia Linea alba Chronic cheek chewing (bite injury) Candidiasis Oral Lichen planus Squamous cell carcinoma

Answer 1054

**Frictional Keratosis.** There is a rough, hyperkeratotic change to the posterior mandibular alveolar ridge (“alveolar ridge keratosis”), because this area is now edentulous and becomes traumatized from mastication. **Such frictional keratoses should resolve when the source of irritation is eliminated and should not be mistaken for true leukoplakia.**

Answer 1055

* Trauma from Sharp cusp & ortho appliance * Chronic mechanical irritation (chronic biting) * Masticatory function * Normal hyperplastic response * Dentures/missing teeth

Answer 1056

* Remove the cauative factor that caused the trauma * observe large lesion regularly excellent prognosis

Answer 1057

**Urticaria** Well defined erythematous papules/plaques which are pruritic (itchy) We’ll see them on the skin ‐ Not found intraorally

Answer 1058

**Urticaria** (HIVES) this person was exposed to extreme temperature developed hives ( not really red but very itchy) no skin scarring is noted it goes in about a day

Answer 1059

**Angioedema** ❖ **Diffuse edematous swelling** of the soft tissues that most commonly involves the subcutaneous and submucosal connective tissues ❖ Results from local vasodilatation and increased vascular permeability of DEEPER blood vessels

Answer 1060

**Angioedema**

Answer 1061

❖ Medications ► causing rash ❖ Foods ► like peanuts ❖ Airborne allergens ► pollen ❖ Physical stimuli ► ex cold weather

Answer 1062

❖Avoid known triggers avoid the penicillin, any of the triggers ❖ Antihistamines ( to prevent it from happening in the first place) Corticosteroids (prevents the inflammatory effect)

Answer 1063

**Cinnamon Contact Stomatitis** * It can present similar to leukoplakia * So you’d think it is pre‐malignant lesion * But after asking the patients ► you’ll realize they are chewing like 10 cinnamon gums every day.

Answer 1064

**Allergic Contact Stomatitis** ## Footnote ❖ Mild‐severe redness, edema, vesicles, erosions, ulcerations ❖ Burning, itching, stinging, tingling *●We can't know what is this right away.* *Patients may say it burns, tingles, there could be peeling (desquamation). We might think it’s a **vesiculobullous diseases.** ● So these cases require more consulative‐investigative work.*

Answer 1065

**Allergic Contact Stomatitis‐Clinical** * slight vesicales and diffused erythemya * we wouldn’t always know this is Allergic contact stomatitis * This occured due to allumnium chloride on gingival retraction cord.

Answer 1066

**Exfoliative cheilitis** Allergic Contact Reactions‐ Non‐ Mucosal dry, scaly, fissured, cracking lips This is a mild case that affect the non‐mucosal around the the skin

Answer 1067

**Exfoliative Cheilitis** *caused by titanium implants and some mercury in amalgam.*

Answer 1068

**Perioral Dermatitis** Allergic Contact Reactions‐ Non‐ Mucosal erythematous papules/vesicles – papules ( raised) & vesicles (actual blisters)

Answer 1069

**Erythema Multiforme** Rapidly rupturing vesicles/bullae forming erosions/ulcerations and hemorrhagic encrusted lip lesions, with greyish pseudomembrane Fast expansion, ► the skin is just peeling off. Type 4 hypersensitivity. Has prodrome phasesudden *Rapid onset, crusted hemorrhagic swollen lips, and desquamative gingivitis.*

Answer 1070

**Granuloma** This is a granuloma. It’s composed of histeocytes that looks epithelioid. This is a collection of epithelioid histeocytes **Found in:** * TB (**They’ll be holding TB inside. But in TB you have caseous necrosis of granuloma.** * Deep fungal infections (**they holding? fungal organisms)** * GRANULOMATOUS DISEASES **( if with Asteroid bodies & Schaumann Bodies)** **In these granulomas we don’t know why they are forming.**

Answer 1071

Orofacial Granulomatosis **Cheilitis granulomatosa=Involvement of lips alone** Non‐tender, persistent swelling NEED To BIOPSY to RULE OUT angioedema

Answer 1072

**Orofacial Granulomatosis** Papules, slightly raised areas, fissures, cobblestone appearance **DDx** We could suspect a traumatic injury early signs of Crohn’s

Answer 1073

Orofacial Granulomatosis

Answer 1074

❖ Discover cause ( we need to find out the cause.) ❖ Topical or intralesional corticosteroids (maybe try steroids) ❖ Other (topical tacrolimus, sulfazalazine, methotrexate, etc) ❖ Some cases resolve spontaneously *(This photo shows a person has puffiness because of granulomas. Sometimes it goes away on its own. We can use injection steroids on the lips too.)*

Answer 1075

**Sarcoidosis‐Organ Systems** ❖ Lungs ❖ Lymph Nodes (bilateral hilar lymphadenopathy) ❖ Skin (25% of time) ❖ Eyes ❖ Salivary Glands ❖ Other (endocrine, gastrointestinal, heart, kidney, liver, nervous system, spleen, skeletal

Answer 1076

Sarcoidosis‐Hilar Lymph Node Enlargement popcorn‐like calcifications in the hilar lymph nodes. granulomas from sarcoidosis being inside .

Answer 1077

**Sarcoidosis**‐Skin Lesions **Lupus pernio** (nose, ears, lips and face) ‐ when we have these erythematous indurated, hard on face.

Answer 1078

**Sarcoidosis** **DDX** in the oral cavity. It could be one of the three P’s: ❖ pyogenic granuloma ❖ peripheral ossifying fibroma ❖ peripheral giant cell granuloma.

Answer 1079

**❖ This is Strawberry gingivitis** Granulomatosis with Polyangiitis "Wegener’s” Orally ❖ Ulceration, ❖ Mucosal nodules ❖ Facial paralysis ❖ Enlarged major gland from granulomas * we need to biopsy, as this also looks like a deep fungal infection. *

Answer 1080

**Granulomatosis with Polyangiitis** Orally We want to biopsy to confirm because it Could be contact mucositis.

Answer 1081

**‐ Cinnamon contact mucositis** This could be oral hairy leukoplakia. It could be hyperplastic candidiasis it could be tongue chewing it could be a leukoplakia. We’ll know what it is by biopsy and investigate

Answer 1082

Urticaria.

Answer 1083

Erythema multiforme

Answer 1084

\* Erythema multiforme

Answer 1085

**‐ Orofacial granulomatosis.** We make sure there’s no tb, no fungal, no foreign material in the granulomas

Answer 1086

Sarcoidosis \*Erythemous papules (grey circle) Asteroid bodies ( blue arrow) Hilar lymph nodes (green circle)

Answer 1087

**orofacial granulomatosis.** What is the common way to describe this? **Cobblestone**. This is the classic cobblestone. Cobblestone and fissuring DDx: people with Crohn’s with oral manifestations it looks like this too.

Answer 1088

**Sarcoidosis**

Answer 1089

angioedema

Answer 1090

**Fixed Drug Eruption** –This case has both the skin and oral appearance. This happened every time this person took NSAIDs that’s not used in the USA. A person gets a reaction to a medication they take. It occurs at the same place each time because there’s s**ome memory T cell at these sites.**

Answer 1091

Causes include: ❖ **IgE mediated** ( most common types are allergy related) * Hypersensitivity reaction * drugs, foods, plants, dust * Contact allergic reactions * foods, cosmetics, topical medications, rubber dam * Physical stimuli * heat, cold, exercise, emotional stress, solar exposure, vibration ❖ Drug reaction to **ACE inhibitors** * Does not respond well to **antihistamines** ❖ Hereditary or acquired activation of the complement pathway ❖ Other (high levels of antigen‐antibody complexes and in elevated blood eosinophil counts) * Complexes in lupus, viral and bacterial infections * Patients with grossly elevated blood eosinophilia

Answer 1092

❖ **Antihistamine/IM epinephrine/IV corticosteroids** ( typical treatment for allergy) ❖ **Intubation and tracheostomy** ( if the patient can’t breathe, so we can get air in) ❖ **Avoid medications in ACE Inhibitor class of drugs** ( for people who has Ace inhibitor induced angieodema) ❖ **C1 esterase inhibitor** concentrate and esterase inhibiting drugs

Answer 1093

**Granulomatosis with Polyangiitis** extra-oral Joint pain, weakness, tiredness ❖ Known as **Saddle nose deformity** ❖ First signs may be recurrent respiratory infection, cough or runny nose ❖ Oral lesions initial presentation in 2% of patients

Answer 1094

* **Insulin injections** * **Insulin shock‐** if blood glucose falls below 40 mg/dl * Treat with **dextrose**

Answer 1095

**First line: oral prednisone** ❖ After remission immunosuppressive drugs: ❖ Methotrexate ❖ Cyclosporine ❖ Rituximab ❖ Treatment induces prolonged remission ❖ May have relapses

Answer 1096

● pseudomembranous candidiasis ● Mucosal sloughing‐ Allergic Contact Stomatitis ● Food particles

Answer 1097

**Mucosal sloughing** **Allergic Contact Stomatitis** caused by tooth paste (Colagate Total) white area‐like a film peeling out slowly **Wipeable** *could be confused with candidasis*

Answer 1098

**Definition** insulin‐dependent diabetes mellitus (IDDM) **Demographics** ``` 5‐10% of cases Juvenile onset (avg age 14) ``` **Etiology** Autoimmune disease Thought to be possible viral infection as trigger to Islet cell antibody destruction of beta cells

Answer 1099

Medications, lipsticks, sunscreens, toothpaste floss, cosmetics

Answer 1100

**Erythema Multiforme** Acute, vesiculobullous, ulcerative mucocutaneous disorder Immunologically mediated **_Target lesions on skin_** (typical board question) Healthy young adults in 20‐40’s

Answer 1101

❖ 50% of cases precipitating cause is identified * Infectious Agents: Herpes simplex virus, Mycoplasma pneumonia, Adenovirus, Enterovirus, Coccidiomycosis * **Most of the time, erythema multiforme is related to a previous infection with herpes simplex virus.** * Drugs: Penicillin, Cephalosporins, Sulphonamides, NSAID’s, Phenytoin * Other: Foods (Benzoates, Nitrobenzene), Chemicals (Perfumes) ❖ it’s not an infection, it’s our body reacting to the infectious organism or pieces of it in a wrong way

Answer 1102

**Sarcoidosis** discrete clear granulomas. 2nd schaumann body in a giant cell (3rd to the right) Asteroid bodies ( right)

Answer 1103

**Erythema Multiforme** Focal hemorrhagic crusting of the lips is seen in conjunction with diffuse shallow ulcerations and erosions involving this patient’s mandibular labial mucosa

Answer 1104

**Erythema multiforme** The concentric erythematous pattern of the cutaneous lesions on the fingers resembles a target or bull’s-eye.

Answer 1105

**Sarcoidosis** large red nodule on the lower lip.

Answer 1106

**Urticaria** developed after bites from an imported fire ant.

Answer 1107

**Erythema multiforme** multiple erosions on the lips and tongue.

Answer 1108

(Granulomatosis with polyangiitis) *formerly Wegener Granulomatosis.* Hyperplastic and hemorrhagic mucosa of the facial mandibular gingiva on the left side. ((strawberry gingivitis).

Answer 1109

**❖ Idiopathic** **❖ Abnormal immune reaction** ❖ in orofacial granulomatosis, people form granulomas and it’s idiopathic ❖ we don’t know why they’re forming them so that’s an abnormal immune reaction.

Answer 1110

Depends on the case! ❖ 60% of cases resolve within 2 years ❖ Initial diagnosis 3‐12 mo. observationàactive intervention as needed ❖ First line tx: corticosteroids ❖ Refractory dx: * Cytotoxic drugs (methotrexate, azithioprne) * TNF blockers * Hydroxychloroquine ❖ 4‐10% die of pulmonary, cardiac or CNS complications

Answer 1111

❖ **Granulomatous disorder** ❖ Multisystem ❖ Unknown cause

Answer 1112

First line: oral prednisone ❖ After remission immunosuppressive drugs: ❖ Methotrexate ❖ Cyclosporine ❖ Rituximab ❖ Treatment induces prolonged remission ❖ May have relapses

Answer 1113

* erythema multiforme * morbilliform drug eruption

Answer 1114

* Oral hairy leukoplakia * hyperplastic candidiasis

Answer 1115

**Most often associated with Type I** _but may be seen with Type II_ * **Periodontal disease‐** more frequent occurrence, more rapid progression * **Poor healing** post oral surgery/extractions * **Enlargement and erythema** of the attached gingiva * **Increased risk of infections** * **Candidiasis** * **Xerostomia**‐ 1/3 of pts complain of dryness * **Diabetic Sialadenosis**‐ both type I and type II * **Mucormycosis**‐ in uncontrolled disease and the tissue becomes necrotic because it is not getting any blood supply * **Dental Caries** * **Benign migratory glossitis** Increased prevalence in type I

Answer 1116

❖ Foods ❖ Food additives ❖ Chewing gums ❖ Candies ❖ Dentifrices ❖ Mouthwashes ❖ Gloves ❖ Rubber dam material ❖ Topical anaesthetics ❖ Restorative metals ❖ Acrylic denture materials ❖ Dental impression materials ❖ Denture adhesive preparations ❖ Cinnamon (mainly artificial flavoring)

Answer 1117

* *❖ Remove the suspected antigen** * *❖** **Severe cases‐Antihistamine** (combined with a topical anaesthetic) ( because it’s an allergy) * *❖** **Chronic cases‐Apply topical corticosteroid** **❖ Recommendations to AVOID:** * ❖ Mouthwash * ❖ Gum/mints * ❖ Cinnamon * ❖ Excessive salty, spicy, acidic ❖ **Patch testing** (we send them to allergist )

Answer 1118

❖Self‐limiting, resolves in a few weeks (It will go away on its own, you just have to manage symptomatically.) ❖Symptomatic management, IV rehydration, corticosteroids (topical and oral), antivirals in recurrent cases (We may use antivirals if they tell us they get cold sores every now and then this means they do have a history of herpes simplex.) ❖ Avoid causative drug (If drug‐related) ❖ Other second‐line systemic therapies (like cyclosporin, azathioprine and other serious drugs) ❖ Usually not life threatening unless in major form.

Answer 1119

**Xerostomia** The subjective experience of a dry mouth (ie a symptom) **Salivary Hypofunction** The objective measurement of a reduction in salivary flow (a sign)

Answer 1120

**300 ml/day ▪ Flow rate: mean 0.3 ml/min**

Answer 1121

**Stimulated Saliva Production** **▪ 200+ ml/day ▪ Flow rate: mean 1-2 ml/min, maximum 7 ml/min** o “Normal” range is very wide

Answer 1122

* **Dehydration** * **Medical conditions** * **Body posture** * **Lighting conditions** * **Circadian/circannual rhythm (lowest during)** * **Medications** Age is an independent factor for whole saliva andsubmandibular/sublingual gland secretion (but notparotid).

Answer 1123

* **Mechanical stimuli** * **Vomiting** * **Gustatory/olfactory stimuli (acid/smell)** * **Gland size** Age is an independent factor for whole saliva (but not for parotid and minor gland secretions)

Answer 1124

Central inhibition as a result of connections between the primary salivary centers and the higher centers of the brain.

Answer 1125

* **May be a reduction in baseline sialometry which is still above “normal.”** * *If they get a decrease in the salivary flow, they still may be in the normal range, but for them the experience is that they have got dry mouth.* * **Saliva film thickness** * *Palatal mucous gland secretions?* * *Anterior dorsum of tongue?* * **Relative contributions by glands** * Mucins, proteins? * **Alterations in sensory perception?** * **Mental status/central inhibition?**

Answer 1126

**● Dehydration ● Medications (Rx & OTC)** * *Direct damage to glands* * *Head and neck radiotherapy* * *As a result of radiation it’s irreversible damage to the glands* * *Chemotherapy (reversible)* * *Autoimmune diseases* * *Primary vs Secondary Sjögren’s Syndrome, GVHD* * *HIV disease* **● Decreased mastication (tooth loss, soft diet) ● Conditions affecting the CNS:** * Psychologic disorders (depression/anxiety?), Alzheimer’s, Parkinson’s, Cerebral palsy

Answer 1127

**Abnormal unstimulated USFR= \<0.1–0.2ml/min** **Abnormal stiumated SFR = \<0.5ml/min**

Answer 1128

* Salivary stimulation (OTC) to stimulate their glands * Salivary lubrication ( to improve it) * Humidification ( like a humidifier in the room at night) * Hydration/prevent dehydration (ie avoid alcohol, caffeine both will act as a * diuretic and lead to dehydration). * Monitor closely to rule out emerging disease ( to see whether they are developing Sjogren’s or something else 􀀀 we want to follow them over time)

Answer 1129

* If dehydrated ► rehydrate or treat underlying condition * People with uncontrolled diabetes, once you control the diabetes‐ their flow comes back. * All we can do is offering Salivary substitutes (sprays, gels, rinses ) * For patients with high dose radiation treatment ► makes sure they get the INRT * Minimizing damage to salivary glands ( there are other strategies for that) * Prevention and treatment of oral complications

Answer 1130

* Look for possible causes (major cause will be medications & can dehydration or others) * Restore chewing function (Masticatory issues) * Reduce medication‐induced salivary hypofunction * Prescribe Salivary stimulation OTC, Rx medications, others * Prescribe Salivary lubrication * Humidification ‐use humidifiers * Hydration/prevent dehydration (ie avoid alcohol, caffeine) * Treat oral consequences (such as candidiasis treated with an antifungal or caries with management of caries).

Answer 1131

– Muscarinic agonists: – **Pilocarpine** 5‐7.5mg tid & qhs (can go as high as 10mg qid) – **Cevimeline** 30mg tid (can go as high as 60mg tid) _Contradicated for_ : **CV disease, hepatic, renal or respiratory diseases or narrow angle glaucoma** **Pilocarpine affects M1 & M3** _side effects_ (sweating, flushing, rhinitis, increased urination, weakness and some experience the shakes. ) **Cevimeline affects M3 only** fewer side effects

Answer 1132

**Odontogenic Keratocyst OKC** 10-25% of cases show satellite or “daughter” cysts in the connective tissue wall (thought to be another reason the recurrence rate is so high for OKCs)

Answer 1133

**Calcifying Odontogenic Cyst COC** ## Footnote  Masses of ghosts cells may fuse to form sheets of eosinophilic, amorphous, acellular material within the epithelium  Calcification within the ghost cells is common and is why radiopacity is seen in radiographs  if calcifications have not yet formed, lesion will appear radiolucent, not mixed radiolucent/radiopaque  Areas of FCT adjacent to the epithelium may also show deposition of an eosinophilic material thought to be some sort of odontogenic matrix material (“dentinoid”) formed as a result of the epithelium’s inductive effects on the adjacent mesenchymal tissue

Answer 1134

▪ **Marsupialization** (decompression) ▪ **Peripheral ostectomy** ‐ Carnoy’s solution ▪ **Resection** ▪ **Medications targeted to PTCH** ▪ ***Long term follow‐up***

Answer 1135

**Odontogenic Keratocyst OKC** ## Footnote **stratified squamous epithelium which is 6 to 8 cells in thickness** **Keratin** is noted in the cyst lumen (grossly appears as a cream colored “cheesy” paste-like substance) **Epithelium lining is thin, friable and easily detached** from the FCT,

Answer 1136

✎the treatment in such cases: a follow up with another radiograph in six months to see if there's been any change in size ✎ No surgical intervention until you see the cyst expanding

Images, etiologies, and treatments (random order) Flashcards

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