ORAL PATH II exam 1-BONE pathology Flashcards Preview

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Flashcards in ORAL PATH II exam 1-BONE pathology Deck (49):
1

Radiolucencies can be a number of things, what is the first clinical test you do when you notice one?

VITALITY TEST

2

What are the two causes of a NON-vital tooth?

1.Infection (pulpal) 2. Trauma

3

What is the most common cause of a RL in a jaw?

infection

4

What is the Diff Dx (3 of them) for a 1 cm radiolucency at the apex of the right maxillary central incisor that tests non-vital? Whats the TX?

1.PeriApical Granuloma 2. Apical Periodontal Cyst (Radicular) Cyst (One of the odontogenic cysts) 3.Periapical Abcess (but will usually cause pain)...TX non-surgical endo therapy (or ext)

5

How can you tell a cyst vs a granuloma on a radiograph?

Trick question, you cant

6

What is the Diff Dx (3) for a well circumscribed radiolucency between the mandibular right cuspid and central incisor. The lateral incisor has been extracted...

1.Residual (Apical Periodontal) Cyst 2.Primordial Cyst 3. Odontogenic Keratocyst (many more)

7

What is the Diff Dx (3) of a LARGE, WELL CIRCUMSCRIBED R.L. between the roots of two maxillary anterior teeth that have diverged and the teeth have tested VITAL?

1. NasoPalatine Duct Cyst 2.Giant Cell Granuloma 3.Odontogenic Keratocyst

8

Which RL pathology CLASSICALLY crosses the midline?

Central Giant Cell Granuloma

9

What is the RED FLAG raised when a pt describes symptoms of paresthesia?

typcially benign growths will not invade nerves, so this is likely malignant

10

What is the Diff Dx (3) of pain and PARESTHESIA in the left mandible with radiographs revealing a poorly circumscribed lucency and soft tissue swelling of her edentulous alveolar ridge?

ALL ANSWERS should point to malignancy!! 1. Squamous Cell Carcinoma 2.Osteosarcoma 3. Metastatic Cancer

11

What is the most common malignancy affecting the jaws? How is it different in men and women?

metastatic cancer: Women-breast, men-lung...25% is first seen in jaws

12

What % of metastatic cancer is first seen in the jaws?

25%

13

What is the Diff Dx of a LARGE radiolucency around the crown of an impacted third molar, with the tooth being displaced to the inferior border of the mandible?

**BENIGN** 1.*DENTIGEROUS CYST*2. Odontogenic Keratocyst 3.Ameloblastoma

14

What is the common thread among 1. Dentigerious Cyst 2. Odontogenic Keratocyst 3.Ameloblastoma?

They are all odontogenic (tooth forming tissue)...lesion is in proximitiy to tooth!

15

Almost all pericoronal radiolucencies are ________

odontogenic

16

What is the Diff Dx of a 14 y/o male with an asymptomatic radiolucency of the R post mand that has no swelling or tenderness, vital teeth, and the RL extends up between the roots of the teeth?

1.Traumatic Bone Cyst 2.Aneurysmal Bone Cyst 3. Giant Cell Granuloma

17

What is the classic sign of a Traumatic Bone Cyst? What is the best Tx?

Boarder Scallops into roots of the teeth...Remove the cyst and CURETTE the borders to stimulate bleeding and healing

18

What is the Diff Dx:
A small discrete well circumscribed radiolucency is found midway between the roots of the mandibular cuspid and lateral incisor on a 37 year old white male. The patient was asymptomatic and unaware of the lesion...the teeth tested VITAL

1.Lateral Periodontal Cyst (60% in Lower PMs) 2.Ameloblastoma 3.Odontogenic Keratocyst

19

What are the BIG THREE pathologies associated with MULTILOCULAR RadioLucent lesions??

1. Ameloblastoma 2.Giant Cell Granuloma 3.Odontogenic Keratocyst

20

Are multilocular radiolucent lesions more likely to be benign or malignant?

Benign..only a mucoepidermoid carcinoma is the malignant exception

21

What is the recurrence rate for an odontogenic keratocyst?

33%

22

Once a multilocular lesion was biopsied it was found to have an epithelial lining and palisaded basal cells...what is it?

Odontogenic Keratocyst

23

What is the treatment of an odontogenic keratocyst?

Enucleate and leave open or place a port

24

Whats the Diff Dx? This 34 year old female complained of swelling of the body of her left mandible. Radiographs of the area showed an EXPANSILE LUCENCY containing numerous FINE OPAQUE bony trabeculations.

1.Odontogenic Myxoma 2.Central Odontogenic Fibroma 3. Peripheral Odontogenic Fibroma

25

What does LINEAR multilocularity indicate (vs. like a subtle multilocular radiographic lesion)?

odontogenic myxoma

26

Which type of lesion will show a microscopic diagnosis of MESODERMAL CELLS and glycosaminoglycans?

Odontogenic Myxoma

27

What is the key to removing an odontogenic myxoma?

Making the incision/border BEYOND the lesion...(they don't comeout that easily)

28

Diff Diagnosis AND Provisional Clinical Dx:
An 18 year old African-American female came to your office complaining that her lower front teeth "seemed to be moving". Tenderness to percussion, slight labial expansion. Radio: LARGE UNILOCULAR RADIOLUCENCY from #28 to #21

1. Ayneurismal Bone Cyst (ABC) 2.Amelioblastoma 3.Central Giant Cell Granuloma...Provisional Clinical Dx: Central Giant Cell Granuloma (**CROSSES MIDLINE)

29

What is a systemic condition that is HISTOLOGICALLY IDENTICAL to a Central Giant Cell Granuloma? So what can it clinically be confused with?

HYPERPARATHYROIDISM!!...can be confused with Benign Adenoma

30

What are the two most associated oral pathologies with African American females?

P-CODs and C-GGs...Periapical Cemento-Osseus Dysplasia and Central Giant cell Granuloma

31

So we believe that an African American female has a P-COD (Periapical Cemento-Osseus Dysplasia) (the teeth tested vital). Whats the Tx?

NOTHING. The radiopaque lesions will eventually ossify/MATURE over time

32

What are the two types of COD (Cemento-Osseus Dysplasia)?

Focal (one location) vs Florid (multiple lesions)

33

MRONJ: Radiographically an area of ill-defined (LUCENCY or OPACITY?) was seen in the right maxilla.

opacity

34

IV aka (_____ type) bisphosphonates have a ___x more risk for MRONJ

aka AMINO type...5x

35

Hmmm Diff Dx plz (LETS DO 4 OPTIONS, WITH a Provisional Clinical Dx)...A 34 year old white male is a new patient in your practice. He is asymptomatic but in routine radiographs, you discover a roughly 4-5 mm radiopacity distal to #18. There is no expansion. (Teeth test VITAL)

(Condensing osteitis-ONLY IF TOOTH WAS NON VITAL!!) 1.Idiopathic Osteosclerosis 2.Cementoblastoma 3. Cemento-Osseus Dysplasia (COD) 4.Odontoma....Provisional Clinical Dx: IDIOPATHIC OSTEOSCLEROSIS

36

What are the 3 go to's when we see a RADIOPAQUE lesion? (if really narrows things down for us!)

Ok, well these are just a start I Guess.. 1.Condensing Osteitis (teeth test NON-vital) 2.COD (Cemento-Osseus Dysplasia) 3. Idiopathic Osteosclerosis

37

GET READY: 6 for the Diff Dx.... 26 y/o AA female. RL lesion in body of Left mandible. Expansion of Buccal cortex...After 1 year, expansile RL with MULTIPLE FOCI of opacification

1. Ossifying Fibroma 2.Fibrous Dysplasia 3.Pinborg Tumor (aka CEOT: Calcifying Epithelial Odontogenic Tumor) 4.Gorlan Cyst (aka COC lol Calcifying Odontogenic Cyst) 5.Osteoblastoma 6.Ameloblastic Firbro-Odontoma

38

So our 26 y/o AA female with the RL multifocal opacifications got biopsied and found fibroblasts making Calcium deposits...what is the Dx?

Ossifying Fibroma (holy S! FIBROblasts making BONE-ossifying)

39

Diff Dx (3) & Provisional Clincial Dx: 17y/o while male, pain in R post mand. Radio:2cm RO mass ATTACHED to D root of #30. The mass is surrounded by a THIN RL ZONE.

1.Cementoblastoma 2.COD 3.Odontoma...Provisional Clinical Dx: Benign CementoBlastoma

40

What are the three things we see radiographically to make a Dx of a Benign Cementoblastoma?

1.RadiOpaque 2.RadioLucent Lining 3.Ankylosed to the root causing RESORPTION

41

What are the two R.O. pathologies that are very similar radiographically but one occurs on vital teeth and one on non-vital?

Condensing Osteitis=non-vital...Benign CementoBlastoma =vital

42

THIS WILL BE ON THE EXAM: A well circumscribed RL on a 15 y/o male between #5 and #6...Inferior half of the lesion contains OPACITIES resembling TOOTH-LIKE structures..NO Diff Dx, just a Provisional Clinical Dx

ODONTOMA (young in age, tooth like opacities)

43

What are the two types of ODONTOMAS?

Compound and Complex. Compound=little calcifications look like teeth....Complex=a mass of enamel and dentin that does NOT look anything like a tooth

44

What is the thin RL lining in an odontoma?

the FOLLICLE (fibrous sac)

45

What is the Tx for an odontoma?

Excision, they can block permanent teeth from erupting

46

What is the name for an odontoma that just stops growing? (exceedingly rare-hint: it is a neoplasm that resembles the surrounding tissue)

Hamartoma

47

Diff Dx (only 2) and Provisional Clinical Dx...16 y/o Hisp. female w. LARGE R.O. mass OVERLYING the crown of an impacted #18.

1.Ossifying Fibroma 2.Odontoma...Prov Clin Dx: COMPLEX ODONTOMA

48

Diff Dx (5) and Prov Clin Dx: 52 y/o AA female w. MULTIPLE GLOBULAR OPACITIES throughout the maxilla and mand

1.Florid COD 2. Ossifying Fibroma 3.Idiopathic osteosclerosis 4.Pagets disease 5.Gardner Syndrome...Prov Clin Dx: Florid COD (based on gender and race)

49

What is the Tx for Florid COD?

monitor and try to avoid surgery-areas are of low blood supply and are prone to infection