Oral Path Exam 1 sweep 1 Flashcards by Tyler Brown

Fluctuant –

wavelike on palpation due to fluid content

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hardened

Indurated –

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lines forming a skin pattern

Dermatoglyphics –

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scalloped

Crenated –

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flakes of retained surface keratin

Scale –

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dried blood, serum or purulent exudate on the skin surface

Crust –

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Amelogenesis Imperfecta 3 divisions

Hypoplastic
Hypomaturation
Hypocalcified

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inadequate deposition of

enamel matrix

Hypoplastic AI

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incomplete mineralization

Hypomaturation AI

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no significant degree of mineralization

Hypocalcified AI

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Dentin Dysplasia

—— inheritance, 2 types:

Autosomal dominant

Type I: Radicular Dentin Dysplasia
Type II: Coronal Dentin Dysplasia

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Dentin Dysplasia

Type II:

Coronal Dentin Dysplasia
Thought to be related to dentinogenesis
imperfecta
Enlarged pulps with “thistle tube” appearance, pulp stones

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Dentin Dysplasia

Type I:

Radicular Dentin Dysplasia
Radicular roots are very short “rootless teeth”, obliteration of pulp (crescent-shaped remnant in crown), periapical radiolucencies

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Syphilis - Primary
 Relatively painless ulceration – “chancre”  Develops —- days after exposure
 Most affect genital region; ~4% are oral
 Lip, buccal mucosa, tongue
 Resolves spontaneously in —-weeks

3-90

3-8

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Syphilis - Secondary
 Develops —- weeks after initial infection
 Generalized ——
 —– cutaneous eruption
 Mucous patches & —– of oral mucosa
 Split —- at angles of mouth

4-10

lymphadenopathy

Erythematous maculopapular

condylomata lata

papules

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Syphilis - Tertiary
 Develops after a latency period of —- years
 Approximately 30% of patients affected
 May affect any tissue; vascular, CNS, skin, bones, soft tissues
 —- formation
 Oral involvement may produce palatal perforation

1-30

Gumma

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 Hutchinson’s triad:

Malformed incisors (“Hutchinson’s incisors”)
and molars (“mulberry molars”) 
 Ocular interstitial keratitis
 Eighth nerve deafness

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Syphilis - Histopathology
 Primary and secondary lesions show intense ——- infiltrate
 Tertiary (gumma) is characterized by ——- inflammation
 Spirochetes can be identified using the ——- stain

plasmacytic

granulomatous

Warthin-Starry

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 Often associated with local trauma

actinomycosis

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May follow dental extraction or untreated dental disease
 Diffuse swelling and erythema
 Draining sinus tracts
 “Sulfur granules” – colonies of organisms in purulent exudate

cervicofacial actinomycosis

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Histopathology
 Filamentous bacteria that form colonies
 Bacterial colonies surrounded by neutrophils
 Adjacent tissue may show granulomatous inflammation or granulation tissue

Actino

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Actino - Treatment

 Removal of offending tooth
 High-dose antibiotics, usually IV PCN for 2
weeks, then oral PCN for 2 weeks
 Periapical actinomycosis usually responds to less aggressive treatment
 Good prognosis with appropriate therapy

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Histopathology: fluid accumulation within the epithelial cells of the spinous layer

leukoedema

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Upper lip, lateral to midline; along nasolabial groove; 10% bilateral

nasolabial cyst

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aka- “follicular cyst of the skin

epidermoid cyst

(Milia are simply very

small epidermoid cysts)

Uncommon Lined by epidermis-like epithelium Cyst wall contains adnexal skin structures hair follicles, sebaceous glands, sweat glands May be classified as “benign cystic form of teratoma” (composed of tissue derived from multiple germ layers)

dermoid cyst

Sistrunk procedure for

thyroglossal duct cyst

Cervical variant of lymphoepithelial cyst Presumably arises from remnants of the branchial arches; usually 2nd arch Fluctuant swelling of upper lateral neck Usually anterior to the sternocleidomastoid May develop fistula tract (1/3 of cases)

branchail cleft cyst

Lined by stratified squamous epithelium with lymphoid tissue in cyst wall.

branchial cleft cyst

Oral counterpart to branchial cleft cyst Arises from epithelial rests trapped in oral lymphoid tissue (Waldeyer’s ring or accessory lymphoid aggregates)

Oral Lymphoepithelial Cyst

Soft to firm, yellowish-white nodule Usually <1 cm and asymptomatic Treatment: Surgical excision is curative Histopathology: Lined by stratified squamous epithelium with lymphoid tissue in cyst wall.

oral lymphoepithelial cyst

Patient management: Incisional biopsy is necessary for definitive diagnosis. with

desquamative gingivitis

Slowly progressive collagenous overgrowth | of the gingiva

gingival fibromatosis

Can Brutus Describe the Easy Lesion?

Color – Borders – Diameter (size) – Elevation (character) - Location

vareigated

(uneven color

An area of color change with NO elevation or depression of the surface  May be any shape or color

macule

 A macule over 2 cm in diameter

PATCH

Solid, elevated lesion |  0.5 cm or less in diameter

papule

Solid, elevated lesion |  Larger than 0.5 cm in diameter  Sessile or pedunculated

nodule

 A slightly-elevated lesion  Can be of any surface area

Plaque

 A fluid-filled elevation |  0.5 cm or less in diameter

Vesicle

 A fluid-filled elevation |  Larger than 0.5 cm in diameter

Bulla

 A slightly-raised lesion |  Caused by increased production and retention of keratin

Keratosis

- Flat, pinpoint areas of hemorrhage

Petechiae

area of hemorrhage that is larger than | petechiae but not larger than 1 cm in diameter

Purpura

– area of hemorrhage that is larger than 1 cm in diameter

Ecchymosis

diffuse atrophy of dorsal tongue papillae, particularly after broad-spectrum antibiotics acute onset typically associated with “burning” sensation

acute atrophic candida

Probably referred to as “median rhomboid glossitis” in the past Most are due to chronic candidiasis Well-defined area of redness, mid-posterior dorsal tongue Usually asymptomatic

central papillary atrophy

Often associated with lip-licking or chronic use of petrolatum-based materials Usually related to candidiasis, but may have other cutaneous bacterial microflora admixed Redness, cracking of cutaneous surface Typically responds well to topical antifungal therapy

perioral candida

Patient will have angular cheilitis, central papillary atrophy and a “kissing lesion” of the posterior hard palate

chronic multifocal candida

Also known as “candidal leukoplakia” White patch that cannot be rubbed off Uncommon; generally anterior buccal mucosa May be problematic because a true leukoplakia may have candidiasis superimposed on it Should resolve with antifungal therapy

hyperplastic candida

associated with specific immunologic defects related to how the body interacts with Candida albicans

Chronic Mucocutaneous Candidiasis –

– seen in situations of severe uncontrolled diabetes mellitus or immune suppression

Invasive Candidiasis

Imidazole antifungal agent No significant systemic absorption or side effects Pleasant-tasting lozenges (troches) Disadvantage – dosing schedule (should be dissolved in mouth 5 times per day)

Clotrimazole (Mycelex)

Triazole antifungal agent Readily absorbed systemically- no significant degree of side effects (potential drug interactions) Daily dosing is convenient Relatively expensive

Fluconazole (Diflucan)

- combination of nystatin and triamcinolone

Mycolog II Cream

- combination of iodoquinol and hydrocortisone

Vytone Cream

Most cases are asymptomatic – calcified hilar lymph nodes seen coincidentally Acute – may have flu-like illness Chronic – cavitary pulmonary lesions Disseminated – elderly, debilitated, or immunocompromised

histo

Granulomatous inflammation, with or without necrosis | 1-2 micron yeasts, usually within macrophages Best visualized by silver stain (GMS) or PAS

histo

Acute – no treatment is usually necessary Chronic or disseminated histoplasmosis – may require amphotericin B Ketoconazole or itraconazole for mild cases or as maintenance therapy

histo

Endemic to desert Southwest U.S. 100,000 people infected annually in U.S. “Valley fever” represents a hypersensitivity reaction

coccidiomycosis

Inhalation of spores Flu-like illness in 40% of infected patients Dissemination in <1% Skin of central face may be affected; oral lesions are rarely described

coccidiomycosis

Histopathologically shows large (20-60 micron) spherules that contain endospores Variable host response, ranging from acute to granulomatous inflammation Diagnosis can be made by culture or biopsy

coccidiomycosis

Amphotericin B for disseminated cases Fluconazole or itraconazole for milder cases May be more aggressive in persons of color Generally good prognosis if patient is not immunocompromised

tx coccidiomycosis

Organism lives in pigeon droppings Transmitted by air-borne spores Affects immunosuppressed patients almost exclusively

cryptococcosis

Histopathologically, 4-6 micron yeasts with a clear halo (representing a mucopolysaccharide capsule) Organisms may be visualized with mucicarmine, PAS, or silver stain (GMS) Diagnosis based on culture or identification of organisms in tissue sections

cryptococcosis

Severe cases treated with amphotericin B and flucytosine Fluconazole for less severe cases and for maintenance Poor prognosis because most patients are immunocompromised

tx crypto

Diagnosis is usually based on histopathologic findings because culture is too slow Large, branching, nonseptate hyphae with extensive tissue necrosis Hyphae are often seen plugging small blood vessels

Zygomycosis

Common; second in frequency to Candidiasis Spectrum of disease that includes allergy, localized infection or invasive ---------- Spores in soil, water, decaying organic debris May be “nosocomial” infection

Aspergillus

Features vary, depending on immune status and extent of tissue invasion Allergy- Allergic fungal sinusitis (may trigger asthma) “-------” – maxillary sinus fungus ball Tissue damage - locally invasive Immunocompromised patient - disseminated

aspergillus Aspergilloma

Non-invasive disease: debridement Invasive disease: Voriconazole or itraconazole, with or without debridement Good prognosis if normal immune status Poor prognosis if patient is immunocompromised

tx aspergillus

First oral antifungal agent that could be absorbed systemically- imidazole Requires acidic stomach environment Single daily dose is convenient Problems with drug interactions and idiosyncratic hepatotoxicity (1 in 12,000)

ketoconazole

) Approved for treating histoplasmosis Well-absorbed; daily dosing Minimal side effects Quite expensive

Itraconazole (Sporanox

Triazole compound; IV or oral Approved for treating Candida, Aspergillus and several other species Side effects include photosensitivity 1st line therapy - invasive aspergillosis Quite expensive ($460)

Voriconazole

Oral Path Exam 1 sweep 1 Flashcards

(75 cards)