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0

According to Jones and Franklin, what percentage of specimens from oral and max pathology were for children under 16?

10%

1

What percentage of lesions were benign and what percentage were malignant?

Majority of lesions were benign
Less the 1% malignant

2

Which lesions predominate?

AOT
Ameoloblastic fibroma

3

Which lesions were rare?

Odontogenic tumours

4

What were the most frequently diagnosed mucosa lesions?

Mucous extravasion cyst 16%

5

How frequent were tooth pathology, salivary gland disease and mucosal path?

Tooth: 22%
Salivary gland: 19%
Mucosal: 12%

6

What percentage of Periapical path was seen and what type of lesions were they?nand how frequent were they?

Radicular cyst
Residual cyst
Chronic apical gran

13% of cases

7

Now can you classify lesions?

Newborn
Infective/ulcerative
Pigmented, vascular and red lesions
Exophytic
Gingival enlargement

8

Which newborn pathology is there?

Gingival cysts of infancy which include:
1. Bohns nodules
2. Gingival cyst of newborn
3. Epstein pearl

Rare:
congenital epulis of newborn
Melanotic nueroectoderma, tumour of infancy

Other
Partial ankyloglossa

9

How do gingival cysts appear?

Small
White
Grey lesions on mucosa, alveolar ridge and hard palate

10

How common are gingival cysts of newborn?

75% of new borns

11

Why may parents not know their babies have gingival cysts?

Asymmptomic and rupture witching first three months of life

12

What is the name of the gingival cyst that occurs on the alveolar ridge?

Bohns nodules

13

Where do Bohns nodules arise from?

They arise from the remanants of the dental lamina

14

What is the dental lamina?

It is the earliest epithelium to grow into ectomesenchyme

15

What are the remnants of dental lamina called?

Epithelial cell rests of serres

16

Where are the epithelial cell rests of serres located?

In the CT between the developing tooth crowns and oral mucosa

17

What can happen to the Bohns nodules?

Can undergo cystic degen

18

What are the midline raphe cysts called?

Epstein pearls

19

How do Epstein pearls develop?

Small lesions located along the Palatal midline and they develop from trapped epithelium in the Palatal raphe which then undergo cystic change

20

What are Epstein pearls lined by?

Keratinising stratified squamous epithelium

21

Wheee do you find a congenital epulis?

Rare lesion seen in neonates
Usually in the anterior maxilla along the alveolar ridge

22

What is the clinical appearance of a congenital epulis?

Soft round exophytic swelling

23

In which gender a congenital epulis err common amongst?

Females
80% seen in females

24

What is inside congenital epulis?

Granular cells which are covered by epithelium

25

How do you manage congenital epulis?

Benign
Excise

26

When does a melanocytic tumour develop??

This develops withing the first few mths of life.
60% are found in those less than 6 months

27

Where are the majority of the MNT?

70% anterior maxilla

28

What is the composition of a MNE?

Epithelial cells containing melanin with a fibrous stroma

Neoplasm of neuroblsstic pigmented epithelial cells of neural crest origin

29

T/F MNE are rapidly growing?

T

30

How do you manage MNT?

Excision

31

What is partial ankyloglossa?

Lingual frenum has a short attachment to the FOM
May be seen in up newborn but may resolve with tongue use

32

Which infective lesions are there?

Infective
Bacterial: odontogenicninfection
Fungal: thrush
Viral: primary herpetic gingivostomatitis, hero angina, HFM, VZV,

33

What causes thrush?

Candida

34

What is the clinical appearance of thrush?

White plaques on labial,buccal and gingival mucosa and tongue

35

What happens when the white plaques are removed?

Raw, bleeding mucosa

36

How does an acute odontogenicn infection present?

Pyrexia
Red swollen face
Anxious child

37

How would you manage an acute odontogenic infection?

Antibiotics are indicted for oyredia and spreading infection

The cause of infection does also need to be eliminated

38

How does a chronic odontogenic infection present?

Sinus
Mobile tooth
Halitosis
Discoluree tooth

39

How would you manage a chronic infection?

Xla tooth

40

How does primary herpetic gingivostomatitis present?

This presents as inflamed gingiva
Small vesicles throughout mouth oral mucosa, tongue, lips, and gingiva
Vesicles can then coalesce forming a highly infectious exudate
Painful
Bleeding and crusting lips
Lymphadenopathy
Temperature
Headache malaise

41

What. Age is primary herpetic usually seen in?

2-5
Maternal antibodies in young children protect young

42

What is the incubation period for primary herpetic gingival?

6-7 days

43

How long does it take for primary herpetic to go resolve?

14 days

44

What are rare complications of primary herpetic?

Aseptic meningitis and encephalitis

45

How do you manage primary herpetic?

Paracetamol for pyrexia
0.2% CHX
Acilovir: 2+ 200mg 5 times a day , 5 days (half dose for less then 2 yrs and double dose for immunology risked)
Fluids
Bed rest
Soft diet

Review in 7 days to check healing

46

How does herpangina present?

Small vesicles on soft palate and fauces
Febrile , irritatble, cervical lymphadenopathy , young children
NOT ON GINGIVAE

47

What causes herpangina?

Coxsackie
Usually A4 or A10 but can be 1-6,8,12,22

48

How does HFM present?

Vesicles on tongue and oral mucosa
Macula papillary rash on hand and feet

49

Hat causes HFM?

Coxsackie usually a16 but occasionally 5,7,9,10 or B9

50

How is HFM caused?

Faeco oral transmission

51

What causes herpes zoster?

VZV virus

52

How does Herpes zoster present in the mouth?

Vesicles on palate which rupture and produce ovoid ulcers with halos

53

What else is associated with intra oral ulceration in herpes zoster?

Skin lesions following dermatome

54

What causes EM?

It is a VB disorder with unknown aetiology but is predicated by infections, drugs and various other things

55

What intra oral lesions are seen in EM?

Subepithekual blisters
Crusting or the lips
Affects anterior region

56

What extra oral lesions are seen in EM?

Target lesions of squamous epithelium

57

What infective lesions can have similar appearances as primary herpetic?

Herpangina
HFM
herpes zoster
EM
Thrush

58

What ulcerative lesions are there?

Those caused by infection
Others: self induced post anaesthetic, Riga fede ulceration, RAS (seen in EM, SJS, Bechets, Epidermilysis bullosa, Lupus, neutropenia)

59

What is Riga fede ulceration?

Traumatic ulcer on ventral of tongue caused by rubbing of the tongue on newly erupted mandib teeth

60

How do you mange Riga fede ?

Smooth incisa edge

61

In which children is Riga fede more common amongst?

Indifference to pain
Familial dysautonomia
Cerebral palsy

62

What are examples of pigmented and vascular lesions?

Eruption cyst
Eruption heamatoma

Haemangioma

Petechia and purpura

63

What is an eruption cyst and how does this become a heamatoma?

Asymptomatic and resolve once tooth has erupted
Cyst: Fluctuations fluid filled cyst that may appear 2-3 weeks prior to tooth eruption

Heamatoma: as tooth emerges the cyst may become blood filled and appear bile or purple in colour

64

How do you manage eruption cysts?

Do not excise as risk of infection

65

What are haemaginomas?

This are typically present at birth and may grow with the infant and may then regress with time and even disappear

66

How do you manage haemajngiomas?

Monitor

67

Which syndrome can you see haemajngiomas in?

Sturge weber

68

What are the feature of Sturge weber?

Haemajngiomas of face and oral mucosa
Ipsilateral haemangiomas and calcification of the meninges
Contralateral focal epileptiform fits and transient or permanent paralysis
Mental retardation

69

Which exophytic lesions are there?

Congenital epulis of newborn
Squamous papilloma
Epulis
Eruption cyst haemaoma
Mucocele
Ranula

70

What is a mucocele?

There are three types
1. Retention
2. Extravasion: arises due to damage of the salivary duct of a minor gland
3. Superficial

71

What is a common cause of mucocele in children?

Cheek biting

72

What causes the mucosa to swell up in mucous extravasion cysts?

Mucous builds up in the connective tissue and appears as a blue swelling which may have a keratinised surface

73

What is the management for mucoceles?

Monitor
Some heal spontaneously
Others need surgical excision

74

What are the causes of gingival enlargements?

Drug induced : phenytoin, cyclosporin
Hereditary: gingivofibromatosis
Vascular: Sturge weber
Syndromes: gorlon goltz

75

What other pathology is seen in the young ?

Odontogenic tumours

76

What are the three common type of odontogenic tumours in children?

AOT
Ameloblastic fibroma
Odontoma

77

How common are Ameloblastic fibromas?

Rare

78

Which age group do Ameloblastic fibromas affect?

Patients below 20

79

Which site is most commonly affected by Ameloblastic fibromas?

Mandib molar premolars site

80

How do Ameloblastic fibromas appear radiographically?

Well defined
Usually unilocular radiolucency

81

T/F radiopacities are found in Ameloblastic fibromas?

F
They are seem in Ameloblastic fibro odontomas

82

Where do Ameloblastic fibromas develop from?

Mixed tumour: Odontogenic epithelium and mesenchymal tissue

83

What effect do Ameloblastic fibromas have in eruption?

May affect normal eruption of teeth in that area

84

What can an Ameloblastic fibroma be mistaken for occasionally?

Dentigerous

85

How do you manage Ameloblastic fibromas?

Excise or curettage

86

What is the microscopy of Ameloblastic fibromas?

Proliferating strands and cords of epithelium
Cellular fibroblastic stroma
May have inductive changes

87

How do adenomatoid odeontgenic tumours present?

Asymmptomatic slow growing associated with an unerupted tooth
More common in maxilla than mandible

88

How does an AOT appear radiographically?

Radiolucency with well defined margins

89

How do you mange AOT?

Enucleation

90

What is the microscopy behind AOt?

Whirls of epithelium
Duct like microsysts lined by columnar cells
Convoluted eosinophilia bands and sometimes calcification

91

What do complex odontomes appear as?

Disorganised mass of dentine, enamel and pulp
More commonly seen in posterior mandibl e

92

How do compound odontomes appear?

Denticles
Anterior maxilla

93

What is the effect of odontomes?

Prevent eruption of teeth

94

Which type of odontome is more common?

Compound 4x more common than complex