Oral Cavity Pathology Flashcards Preview

Gastrointestinal System > Oral Cavity Pathology > Flashcards

Flashcards in Oral Cavity Pathology Deck (36):
1

Name the most important microbiota of the mouth

  • Anaerobic bacteria
    • Peptostreptococcus
    • Fusobacterium
    • Prevotella
    • Actinomyces
  • Streptococcus viridans
  • Streptococcus mutans
  • Candida albicans

2

  • Pseudocyst of minor salivary gland origin
  • Formed when salivary duct is blocked or ruptured (usually secondary to trauma such as biting lip or cheek)
  • Causes secretions to dissect into the soft tissues surrounding the gland with pooling of mucus
  • Typically presents as painless swelling of lower lip/buccal mucosa
  • May resolve spontaneously or may have to excise (with the involved salivary gland to prevent recurrence)

Mucocele

3

  • Etiologies:
    • Mumps
    • Duct obstruction (sialolithiasis)
      • Often S. aureus
      • Dehydration increases risk
    • Sjogren's syndrome
  • Firmness, pain, swelling
  • MC involves either parotid or submandibular gland

Sialadenitis

4

  • Relatively uncommon and slow-growing but aggressive, propensity for perineural invasion
  • Poor long-term prognosis with risk of distant metastasis, even many years later

Adenoid cystic carcinoma

5

Parotid tumors drain into ___ first then to ___ 

  1. Intraparotid lymph nodes
  2. Upper cervical lymph nodes

6

  • MC due to S. pyogenes (GAS)
  • Potential for RF
  • Complication of acute illness
    • Peritonsillar abscess
    • Lemierre's syndrome (Fusobacterium necrophorum)

Bacterial pharyngitis

7

  • Melanin pigmentation of lips and oral mucosa + hamartomatous polyps of GI tract
  • Autosomal dominant; de novo cases can develop

Peutz-Jeghers syndrome

8

  • Produces a gray-blue line along the junction of the teeth and gum

Lead poisoning

9

  • Due to Rhinovirus, Adenovirus, Coronavirus, and others
  • Presents as sore throat
  • Erythema and edema of pharynx, +/- exudate

Viral pharyngitis

10

  • Due to failure of the 2nd branchial cleft to involute during development
  • Entrapped remnant forms a cyst in the lateral neck anterior to the SCM
  • Presents in late childhood to early adulthood
  • Many asymptomatic but can become enlarged and inflamed; may even develop draining sinus tract to pharynx or skin

Branchial cleft cyst

11

  • Due to EBV
  • Painless, white plaque-like lesion on lateral tongue
  • Cannot be scraped off
  • Patients typically immunosuppressed

Oral hairy leukoplakia

12

  • Not a specific diagnosis
  • Clinical term used to describe a "white plaque"
  • Can not be scraped off, asymptomatic
  • Risk (low) of dysplasia/malignancy
  • MC associated with tobacco 

Leukoplakia

13

  • Usually infected during childhood (HSV1)
  • Recurrent painful (and contagious) vesicular lesions of oral mucosa, gingiva, lips (herpes labialis)
  • Vesicles reupture quickly leaving shallow ulcers
  • Heal spontaneously in 1-2 weeks without scarring
  • Virus remains latent in trigeminal ganglia
  • May have prodromal symptoms of itching and burning prior to reactivation 
  • Triggers for reactivation: sunlight, cold, trauma, stress, or immunosuppression

Herpetic gingivostomatitis

14

  • Asians > whites > blacks
  • Due to failure of palatal shelves to fuse

Cleft palate

15

  • Mildly painful, shallow, yellow ulcers surrounded by red halos
  • Oral ulcers on lips, buccal mucosa, tongue, or soft palate
  • Rash also involves hands, feet, and sometimes the buttocks
  • Mouth and throat pain, throat pain, +/- low grade fever
  • Coxsackivirus

Hand foot and mouth disease

16

  • 2nd MC benign salivary gland neoplasm
  • Arises in parotid only
  • M>F
  • Marked associated with smoking
  • No malignant change
  • Histology: Double layer of palisading neoplastic columnar and cuboidal epithelial cells resting on a dense lymphoid stoma (sometimes with GCs)

Warthin tumor

17

Drug-Induced Gingival Overgrowth

Associations include: ___, ___, ___

  1. Phenytoin
  2. Cyclosporine
  3. CCBs

18

  • Malignancy neoplasm of endothelial cells
  • Associated with HHV-8
  • Mucous membrane involvement common; also skin, viscera (GI tract)
  • Types
    • AIDS-associated
    • Transplant-associated 
    • Classic (sporadic) 
    • Endemic African 

Kaposi sarcoma

19

  • Infection of the submandibular sace usually arising from a dental infection
  • May spread rapidly to involve surrounding soft tissue and skin
  • Usually polymicrobial (anaerobic and aerobic)
  • Risk of airway obstruction due to edema
  • Typical presentation
    • Fever
    • Dysarthria (difficulty with speech)
    • Mouth pain
    • Drooling
    • Dysphagia
    •  

Ludwig's angina

20

  • MC primary malignant tumor of salivary glands
  • Most (60-70%) parotid
  • Low, intermediate, and high grade based on the degree of anaplasia
  • Clinical course and prognosis depend on grade
  • Admixture of 3 cells types
    • Mucocytes 
    • Epidermoid cells
    • Intermediate cells 

Mucoepidermoid carcinoma

21

Enlargement of the tongue

Associations:

  • Hypothyroidism
  • Amyloidosis
  • Acromegaly
  • Neoplastic infiltration

Macroglossia

22

  • Single or multiple small (few mm) painful ulcers usually involving the inner lip or tongue
  • Typically arise in kids/adolescents and often recur, becoming less frequent in adulthood
  • Lesions spontaneously resolve in 1-2 weeks
  • Cause uncertain; may be allergic or autoimmune

Aphthous ulcers (canker sores)

23

  • Autoimmune destruction of lacrimal and salivary glands
  • Usually seen in middle-aged females
  • Clinical
    • Dry eyes
    • Dry mouth
  • Anti-Ro (SS-A) and Anti-La (SS-B) autoantibodies
  • Diagnosis: Lip biopsy, serology
  • Increased risk of dental caries, lymphoma

Sjogren syndrome

24

  • Oranism that produces acid that leads to loss of tooth enamel and ultimately dental caries
  • Fluoridation of water sources helps prevent 

Streptococcus mutans

25

  • Salivary duct stone
  • Can cause duct obstruction
  • Risk factors
    • Dehydration
    • Meds that decrease amount of saliva
  • Complications: Sialadenitis
  • MC in Wharton duct

Sialolithiasis

26

  • Risk factors
    • Immunosuppresion
    • Broad spectrum antibiotic use (altered normal flora)
  • Clinical
    • White, curd-like discharge on red background involving the oral mucosa
    • Can be scraped off but may bleed
  • Symptoms
    • Dysphagia
    • Mouth soreness
    • Pain

Oropharyngeal candidiasis (thrush)

27

  • Excess fluoride consumption early in life can cause hypomineralization of dental enamel
  • Thought to be a direct effect on the rate of mineral formation resulting in disruption of the enamel
  • White to brown tooth discoloration

 

Fluorosis

28

  • Exhibits epithelial and mesenchymal differentiation
  • MC benign salivary gland neoplasm
  • MC in middle-aged adults (F>M)
  • Radiation exposure increases risk
  • Risk of recurrence if not completely excised 
  • Low risk malignant transformation
  • Painless, slow-growing, mobile mass

Pleomorphic adenoma

29

  • Asians > whites > blacks
  • Due to failure of fusion of maxillary and medial nasal processes

Cleft lip

30

  • Adrenocortical insufficiency leads to increased production of pro-opiomelanocortin (a prohormone that is cleaved into ACTH, MSH, and others)
  • The elevates MSH results in increased melanin synthesis, causing hyperpigmentation on buccal mucosa

Addison's disease

31

  • Usually on gingiva, may be on lips, buccal mucosa, tongue
  • AKA "pregnancy tumor" because occsationally occurs during pregnancy
  • Histologically comprised of a lobular proliferation of capillary-sized vessels "lobular capillary hemangioma"

Pyogenic granuloma

32

  • Clinical term for "red plaque"
  • More likely dysplastic/malignanct than leukoplakia
  • Red because of subepithelial vascular dilation
  • Tobacco major risk factor

Erythroplakia

33

  • Mucosal breach (dental infection or trauma) → introduces organism to mucosa → infection → abscesses and draining sinus tracts ("lumpy jaw")
  • Sulfur granules (yellow aggregates of pus + Actinomyces)
  • Adults males with poor oral hygiene at greatest risk
  • Other risk factors
    • DM
    • Immunosuppresion
    • Malnutrition

Cervicofacial actinomycosis

34

  • MC malignant neoplasm of oral cavity
  • Risk factors
    • Tobacco (all types)
    • ALcohol
    • HPV (particularly HPV-16)
    • Sunlight (lower lip)
  • Sites in descending order:
    1. Lower lip (vermilion border)
    2. Floor of mouth
    3. Lateral border of tongue

Squamous cell carcinoma

35

  • Benign, tumor of the oral cavity
  • Located in mandible
  • Arises from odontogenic epithelium
  • Radiographically: Radiolycency of bone → "soap bubble" appearance
  • Locally invasive, does not metastasize

Ameloblastoma

36

  • Usually children
  • Presentation
    • Acute onset fever (102-104)
    • Oropharyngeal lesions (MC in soft palate) begin as papules → vesicles → rupture leaving yellow/gray ulcers
  • Recovery within a few days
  • Coxsackievirus A