OPath III MT

Question 1

intradermal nevus

Answer 1

Benign melanocytic lesion. Often notice a decrease in pigmentation as nevi progress from junctional to compound to intradermal.

Tx: none, cosmetic concern only, excise if it causes irritation

Question 2

ephilides

Answer 2

“Freckles” Brown pigmentation that develops following sun exposure. More common in children and fair skinned individuals.

Tx: none, encourage limited sun exposure / increased use of sun blocking agents

Question 3

Actinic lentigo

Answer 3

Another benign melanocytic lesion. Macular (flat), increase in number in Caucasians with age
“liver spots” appear most often on sun-exposed areas, such as the face, hands, shoulders, and arms

Tx: none, encourage limited sun exposure / increased use of sun blocking agents

Question 4

seborrheic keratosis

Answer 4

Benign skin lesion with a “stuck on” appearance. Looks like “dropped on candlewax”.

Tx: none, cosmetic concern only

Question 5

dermatosis papulosa nigra

Answer 5

Variant of seborrheic keratoses that occur in African Americans. Usually characterized by multiple, small, hyperpigmented, asymptomatic papules on the face

Tx: none

Question 6

actinic keratosis

Answer 6

Precursor lesion for cutaneous squamous cell carcinoma. “Sandpaper” texture

Tx: Either surgical excision or topical, immune-activating agents such as Aldara (2 or 3x weekly for 4-6 weeks, repeated if necessary after 4 week break)
Encourage limited sun exposure/ increased use of sun blocking agents

Question 7

telangiectatic capillaries

Answer 7

Prominent vessels, often an indication of sun damage, can also be result of alcohol abuse.

Tx: none, encourage limited sun exposure / increased use of sun blocking agents

Question 8

sebaceous hyperplasia

Answer 8

Development of sebaceous glands correlates with puberty. Often seen on forehead, once achieve 1 to 2 mm size, minimal to no further growth.

Tx: none

Question 9

basal cell carcinoma

Answer 9

Most common cancer in humans.
Can be pink, brown, or black, shiny, scaly, waxy or hard.
At first, a basal cell carcinoma may appear as a small “pearly” bump that looks like a flesh colored mole or a pimple that doesn’t go away. It may also appear as shiny pink or red patches.

Basal cell carcinomas are fragile and can bleed easily

Tx: biopsy and excise (Moh’s micrographic surgery)

Question 10

fordyce granules

Answer 10

Ectopic sebaceous glands. Can be seen anywhere in the mouth, buccal mucosa most common location

Tx: none

Question 11

angular cheilitis

Answer 11

Associated with loss of vertical dimension. Candida, some may have co-infection with Candida and Staph.

Tx: clotrimazole 10mg troche PO 5 times daily for 14 days
Nystatin 400,000 units (4-6 mL) PO 6h
soak denture in 10% bleach to water solution for 24hrs
- If external only, can use topical application of
Vytone cream (1% iodoquinol, 1% hydrocortisone).

Question 12

regressing HHV-1

Answer 12

Lower lip most common site for recurrent HHV-1.

Tx: topical acyclovir may shorten attacks if applied early

Question 13

melanotic macule

Answer 13

Reactive melanosis in response to local trauma

Tx: none, cosmetic concern only

Question 14

mucocele

Answer 14

Focal deposition of mucous. Cause is damage to associated minor salivary gland duct.

Tx: conservative excision of duct and associated minor salivary glands.

Question 15

leukoedema

Answer 15

Increased water content between epithelial cells.

Tx: none

Question 16

linea alba

Answer 16

Found along occlusal plane.

Tx: none

Question 17

cheek chewing

Answer 17

Shredded keratin, at a site(s) accessible to teeth.

Tx: suggest pt chew sugarless gum to help with prevention

Question 18

fibroma

Answer 18

Benign collection of dense fibrous connective tissue.

Tx: Conservative excision.

Question 19

lichen planus

Answer 19

Immunologically mediated process. Often has “striae” or lacy clinical presentation. Does not wipe off.

Tx: none

Question 20

maxillary torus

Answer 20

Comprised of dense, vital lamellar bone.

Tx: none, refer to OMFS if removal necessary for denture fabrication

Question 21

inflammatory papillary hyperplasia

Answer 21

Found under sub-optimally fitting RPD or full denture, may also reflect nearly constant wear.

Tx: conservative excision, new denture.

Question 22

nicotinic stomatits

Answer 22

Obstruction of minor salivary gland orifices in palate. Most commonly seen in pipe smokers.

Tx: none, suggest smoking cessation

Question 23

black hairy tongue

Answer 23

overgrowth of chromagenic bacteria and filliform papillae.

Tx: tongue scraper, improve oral hygiene

Question 24

geographic tongue

Answer 24

patients may be symptomatic e.g. tongue sensitive to spicy or acidic food, when lesions are present.

Tx: none

Question 25

foliate papilla

Answer 25

part of Waldeyer’s ring. Active lymphoid tissue at posterior lateral tongue. High risk site for squamous cell

Tx: none, improve oral hygiene, encourage smoking cessation

Question 26

mandibular tori

Answer 26

vital lamellar bone

Tx: none, refer to OMFS if removal necessary for denture fabrication

Question 27

amalgam tattoo

Answer 27

silver in amalgam stains reticulin fibers in associated connective tissue.

Tx: radiograph to confirm. Follow up, if unusual presentation, may need to excise to rule out melanoma.

Question 28

parulis

Answer 28

(Aka Sinus Tract) (pl. parulides)
rule out an odontogenic source of infection. Tooth vitality testing

Tx: endo tx / ext

Question 29

pericoronitis

Answer 29

Most common in mandibular third molars. Food, etc. gets caught between the overlying soft tissue (operculum) and crown of partially impacted tooth.

Tx: Ideally, remove opposing third molars. May need to initially decrease local inflammation e.g. with rinses, then surgery.

Question 30

acute necrotizing ulcerative gingivitis

Answer 30

Punched out interdental papillae that do not regenerate. Seen in persons with poor oral hygiene and/or poor diet and stress

Tx: debridement, improve oral hygiene, alcohol free peridex.
- If systemic involvement : Amoxicillin 500mg PO TID for 10d plus Metronidazole 250mg PO TID for 10d OR Clindamycin 300 mg PO TID for 10d

Question 31

inflammatory fibrous hyperplasia

Answer 31

Associated most often with poorly fitting dentures.

Tx: Conservative excision, construct well fitting dentures.

Question 32

varix

Answer 32

Most often older patients, lower lip frequent site. If thrombosed, will NOT blanch with diascopy.

Tx: none

Question 33

ulcer

Answer 33

Loss of continuity of an epithelial or epidermal covered surface.

Tx: should heal in 7-10 days, if not reassess -if larger biopsy (risk of squamous cell)

Question 34

aphthous ulcer

Answer 34

Immune mediated. Found on freely movable oral mucosa.“Canker sore” laypersons term.

Tx: OTC Zilactin for pain

Question 35

papilloma

Answer 35

Associated with NON-oncogenic human papillomaviruses.

Tx: excision

Question 36

leukoplakia

Answer 36

Rule out dysplasia. White patch that does not rub off.

Tx: perform a biopsy to identify exact nature of the lesion.

Question 37

periapical cyst

Answer 37

Need to do biopsy to confirm. Access vitality of adjacent teeth.

Tx: enucleate cyst, endo tx/ ext

Question 38

dentigerous cyst

Answer 38

Develops due to fluid entrapment between crown of impacted tooth and reduced enamel epithelium.

Tx: enucleation and ext of involved tooth.

expansile radiolucency : before cutting
-palpate, auscultate, aspirate

Question 39

antral pseudocyst

Answer 39

Collection of fluid below maxillary sinus. Maxillary sinus lining will be superior to the fluid collection. May get referred pain to maxillary teeth with altitudes e.g. during flying

Tx: none

Question 40

condensing osteitis

Answer 40

look for tooth or teeth with pulpal issues in the vicinity

Tx: endo tx or ext of involved tooth

Question 41

exostoses

Answer 41

Bone prominence

Tx: none unless removal necessary for denture fabrication

Question 42

Idiopathic osteosclerosis

Answer 42

Dense vital bone, no identifiable etiology.

Tx: none