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Flashcards in Oral Pathology Deck (243):
1

Osteogenesis Imperfecta "Brittle Bones"

genetic defect, affects production of COLLAGEN
-weak bones that break easily
-blue sclera, deaf, loose joints, low muscle tone, triangle face, curved spine
-dentally: bulbous crowns with cervical constriction, obliterated pulps, narrow and short roots, dentin malformation (dentinogenesis type I)

tx: no cure

2

Hypophosphatasia

resembles Osteogensis Imperfecta
-inherited
-LOW levels of ALKALINE PHOSPHATASE (important for calcifying bone)
-characteristics: looseness, hypocalcification, premature loss of deciduous teeth, large pulp chambers, bone loss

1. Perinatal - fails to form skeleton, stillborn
2. Infantile - severe rickets, hypercalcemia, bone abnormalities, most cases lethal

3. Childhood - premature exfoliation of teeth, more infxn, skeletal anormalities, DWARFS
4. Adult - spontaneous fractures, hx of ricks, osseous radiolucencies

3

Paget's Disease (Osteitis Deforman)

chornic, non-metabolic disease
-INCREASE in serum ALKALINE PHOSPHATASE
-bones big, deformed, dnse but fragile, has potential to undergo malignant transformation
-affects middle aged and old ppl
-pts predisposed to OSTEOSARCOMAS

clinical features - hx of increasing size of hats or new denture made (bony changes), bones warm

lab tests - high serum alkaline phosphatase, urinary calcium and hydroxyproline

xray - COTTON WOOL, hypercementosis, loss of lamina dura

tx: antimetabolites or CALCITONIN, or tx with high protein and calcium

4

Osteomalacia

SOFTENING of bones in adults (adult form of Rickets)
-lack of VIT D

-STEATORRHEA one of the common causes due to fat malabsorption

signs and symptoms - pain in bones of arm, leg, spine, pelvis

5

Rickets

osteomalacia in kids, accompanied by listelessness, irritable, muscle weakness

-bowlegs, pigeon breast, protruding stomach
-dentally: delayed eruption, malocclusion, dentin and enamel abnormality, higher caries rate

6

Dwarfism (pituitary dwarfs)

arrested growth from undersecretion of growth hormone

oral manifestation - delayed eruption and exfoliation, smaller crowns and roots, small dental arch, malocclusion, underdeveloped mandible

ACHONDROPLASIA is most common type of dwarfism - kid is short, stubby fingers, bowed legs, bulging forehead

7

Cerebral Palsy

body movement and muscle coordination, damage to motor control centers
-spastic paralysis, impairment of coordination over voluntary muscles, accompanied by MR, seizures, vision and communication disorders

-NO oral manifestations unique to them but more commmon for: perio disease, caries, bruxism, malocclusion, gingival hyperplasia (if Dilantin for seizures), trauma

8

Down Syndrome

oral manifestations - mandibular prognathism, incr. perio disease, thick tongue, delayed tooth eruption, more missing teeth, malocclusion, enamel dysplasia

9

Muscular Dystrophy

weakness and degeneration of skeletal or voluntary muscles that control movement

oral manifestations - incr. in dental disease if OH neglected, weak in muscles of mastication, mouth breathing, open bite

10

Fibrous Dysplasia

GROUND GLASS appearance of bone

1. Monostotic - 1 bone
2. Polyostotic - 1+ bone
3. Polyostotic with ENDOCRINE disturbances (Albright's Syndrome -> pathologic fractures

swelling mass of bone

tx - surgery

11

Ectodermal Dysplasia

HEREDITARY, abnormal development of skin and hair, nails, teeth, sweat glands

Clinical signs - hypothrichosis, anhidrosis (no sweat or sebaceous glands, heat intolerance), anodontia, oligodontia, lack of salivary glands, kid looks old

no tx

12

Cleidocranial Dysostosis

INHERITED, absent or incomplete collar bones, supernumerary teeth, unerupted teeth

13

Pierre-Robin Syndrome

INHERITED, following findings in the neonate:
micrognathia, glossoptosis, breathing problems, cleft palate

14

Lateral clefting of lip

failure of MAXILLARY and FRONTAL NASAL PROCESSES to merge

in 5th-6th week of life

more common in males; more common left side

15

Cleft palate

6th-8th week of life, more common in females
-fissure in midline of palate
-speech and swallowing

16

Exostosis

slow growing, benign knots on hard palate, tori

17

Cherubism

BENIGN INHERITED autosomal dominant disease, in kids by 5 yrs., 2x affects males, mostly MANDIBLE

BILATERAL expansion of jaw gives kid a round face

histo - looks like central giant cell granulomas

xrays - multiple, well defined, multi-locular radiolucencies

-perivascular collagen cuffing is pathognomonic
-no systemic manifestations
-may have early exfoliation, delayed eruption
-tends to regress in adulthood so don't radiate!

18

Acromegaly

hormonal disorder, when pituitary gland produces excess growth hormone due to a BENIGN tumor after adolescence (fusion of epiphyses)
-in > 90% it's from ADENOMA

clinical signs - soft tissue swelling of hands and feet, change in ring or shoe size, brow and lower jaw protrude, nasal bone enlarges, teeth spacing increases

oral manifestation - enlarged tongue, mand prognathism, teeth tipped to side, long roots

gigantism - caused by benign tumor BEFORE adolescence

19

Cystic fibrosis

congenital/heredity metabolic disorder involving EXOCRINE glands, affect GI and respiratory systems
-thick secretions
-most common inherited disease causing death in white ppl in US

characterized by COPD, exocrine pancreatic insufficiency, high sweat electrolytes

oral manifestations - staining of teeth (dark), reduced caries rate

signs and symp - poor growth, malabsorption, steatorrhea, COPD, clubbed fingers/toes, barrel chest

20

Osteomyelitis

inflammation of bone marrow and adj. bone, caused by Staphylococci due to trauma/surgery

signs - pain, red, swelling, malaise

xray - poorly circumscribed radiolucency with central sclerotic nidus

21

Condensing osteitis (chronic focal sclerosing osteomyelitis)

bone rxn to infxn, mandibular 1st molar most involved

xray - well circumscribed radiopaque sclerotic bone surruound and extending below apex of root (entire root visible! distinguishes from benign cementoblastoma)

tx - RCT, EXT (sclerosing bone will remain)

22

Periapical Abscess

from pulpal infxn of tooth, follows caries

Acute - painful to percussion, mobile
Chronic - presents as granuloma or cyst (radiolucent at apex), asymptomatic

tx - DRAIN or ext

23

Osteoporosis

rdxn of total skeletal mass due to increased bone resorption
-predisposed to fractures caused by clacium or estrogen hormone deficiences
-thin, old, white women

tx - estrogen therapy, calcium, vit D

24

Osteopetrosis "Albers-Schonberg Disease" or "Marble Bone Disease"

HEREDITARY/congenital, manifests in infancy
-overgrowth and denseness of bones from defect in osteoclasts
-long bones dense and hard so bone marrow is obliterated

signs - abnormal bone and dental development, fragile bones, stunted growth anemia, spleen and liver enlargement, blind, deaf

25

Von Recklinghausen's Disease (Neurofibromatosis)

multiple tumors of nerve tissue origin, inherited autosomal dominant trait by multiple neurofibromas, cutaneous cafe-au-lait macules, bone abnormalitis, CNS changes

signs - 6 or more cafe-au-lait macules > 1.5 cm in diameter

tx - no good ones, run high risk of transforming into malignancy

26

Scleroderma

rare autoimmune disease affecting blood vessels and CT
-hard and rigid skin/subcutaneous tissue
-deposition of collagen in major organs
-middle age females (4:1)

x-rays - wide PDL (also a finding in osteosarcomas)

tx - none really

27

Oral Traumatic Neuroma

lesion caused by trauma to nerve, small nodule of mucosa by the MENTAL FORAMEN, but also wherever a tooth was ext
-painful on palpation, "electric shock"

tx - excise

28

multiple neuromas on lips, tongue, palate can indicate pt has

MEN III (multiple endocrine neoplasia syndrome)

29

Neurilemoma (Schwannoma)

benign soft tissue tumor of Schwann cells around nerve, usually on tongue

tx - excise

can be derived from Schwann cell or perineural fibroblast

1. Solitary - asymptomatic nodule -> excise
2. Multiple - part of Neurofibromatosis syndrome -> can transform to malignant!!

30

Fibroma (Irritation or Traumatic)

most common intra-oral benign neoplasm of CT
-most common on buccal mucosa, lateral tongue, lower lip

clinical - pink, smooth, sessile
microscopic - bundles of collagen interspersed with fibroblasts and small blood vessels
histogenesis - fibrous CT

comparable to hyperplasias from denture irritation (epulis fissuratum)

31

Peripheral Fibroma

hyperplastic tissue with sessile or pedunculated base, may be ulcerated, rare recurrence

1. peripheral ossifying - calcified islands of bone, ulcerated surface, young adult females, this may recur

2. peripheral odontogenic fibroma - well vascularized, non-encapsulated fibrous CT

3. giant cell fibroma - fibrous hyperplasia of multi-nucleated CT cells

32

Giant cell tumor

multinucleated giant cells, resemble osteoclasts scattered in matrix of spindle cells
-myelomas can be benign or malignant, can cause pain, sometimes bone fracture

33

Papillary fibroma

benign CT neoplasm

34

Lipoma

benign soft tissue tumor from ADIPOSE tissue
-yellowish mass, soft, smooth
-FLOAT in FORMALIN

35

Rhabdomyoma

rare benign tumor of SKELETAL MUSCLE

tongue most common place

sessile, non painful

36

Leiomyoma

benign tumor of smooth muscle, not painful

37

Lymphangioma

benign, yellow-tan tumor made of DILATED LYMPH VESSELS
-most common is TONGUE

microscopic characteristics - simple, circumscriptum, cystic

38

Benign tumors of Epithelium

1. Papilloma - viral, caulfiflower-like, white, verrucous, pedunculated, must do surgery
2. Verruca (warts) - not pedunculated, VIRAL, excise
3. Keratocanthoma - VIRAL, crater lesion growing in skin that looks like SCC or BCC, can heal by itself

39

Multiple Endocrine Neoplasia Syndromes (MEN)

endocrine glands
-MEDULLARY CARCINOMA of THYROID

1. Men I - tumors/hyperplasias of pituitary, parathyroids, adrenal cortex, pancreatic islets

2. Men II (Sipple's) - parathyroid hyperplasia or adenoma, NO tumor of pancreas, have PHEOCHROMOCYTOMAS of adrenal medulla and medullary carcinoma of thyroid!!

3. MEN III - mucocutaneous neuromas, pheochromocytomas of adrenal medulla, medullary carcinoma of thyroid gland, presence of neuromas in oral cavity!!

40

Epulis granulomatosum

caused by retained foregin material due to iatrogenic error

41

Congenital Epulis of Newborns (Gingival Granular Cell Tumor)

cells identical to cell of a granular cell myoblastoma (granular cell tumor)

anterior gingiva of newborns, non-inflamed, pedunculated or broad based mass

42

Granular cell myoblastoma

unknown eitiology, uninflamed asymptomatic mass
-most common on TONGUE

*congenital epulis and granular cell myoblastoma are histologically identical BUT congenital epulis does not have pseudoepitheliomatous hyperplasia of overlaying epithelium

43

Pyogenic granuloma (pregnancy tumor)

bleeds easily, more common in females

microscopic - GT

44

Pregnancy tumor

pyogenic granuloma, maybe secondary to hormone changes, during FIRST trimester

remove AFTER pregnanc

45

Autograph (autologous graph)

tissue/organ transferred to new position in SAME body

46

Biopsy

fixative?

formalin 10%

only way to distinguish btw a granuloma and cyst

47

choristoma

hamartoma

overgrowth of tissues abnormal to organ from which it arises

overgrowth of tissues NORMAL to organ from which it arises

48

anaplasia

dysplasia

hyperplasia

metaplasia

feature of malignancy, absence of cell differentiation

non-malignant, structureless, disorganized, atypical cells without invasion, epithelium exhibits acanthosis

increase in size of tissue from incr. in # of cells

cell changes to another type in response to stress, NOT a feature of malignancy

49

hypertrophy

incr. in size of tissue from SIZE of cells

50

nosocomial

infxn from hospital

51

teratoma

benign or malignant made of multiple tissues foreign to organ from which it arises

52

carcinoma vs. sarcoma

carcinoma - malignant EPITHELIAL neoplasm

sarcoma - malignant MESENCHYMAL (C.T.) neoplasm

53

Lymphoepithelioma

poorly differentiated SCC involving lymphoid tissue in tonsils and nasopharynx regions

swelling of lymph nodes, sore throat, nasal obstruction

METASTASIS at early stage to cervical lymph nodes

tx - radiation, POOR PROGNOSIS (30% 5 yr survival)

54

Metastatic Carcinoma

most common malignancy of SKELETAL bones

clinical features - paresthesia or anesthesia of lip/chin

55

metastases to jaws originate from primary cancers of:

Breast
Lung
Thyroid
Kidney
Prostate
Colon

56

most common osseous malignancies are

OSTEOSARCOMAS
then chondrosarcomas, fibrosarcomas, Ewing's sarcom

57

Osteosarcoma (osteogenic sarcoma)

malignant bone tumor, in LONG BONES, peak before epiphyseal fusion (10-25 yr.s)

early xray feature is SYMMETRIC WIDENED PDL SPACE, sclerotic SUN-RAY appearance, lytic, mixed

58

diff dx for osteosarcoma of jaw include

chondrosarcoma, metastic carcinoma, pindborg tumor

ossifying subperiosteal hemangioma, peirpheral odontogenic fibroma

scleroderma, chronic osteomyeleitis

symp - tumor, mass swelling, pain, loose teeth, paresthesia, bleeing

59

histo classification of osteosarcoma based on dominant type of tissue cell

1. osteoblastic - produces osteoid
2. chrondroblastic - makes cartilage
3. fibroblastic - makes fibrous tissue

60

osteosarcomas classified by site of origin

1. conventional - medullary cavity
2. juxtacortical - periosteal surface
3. extraskeletal osteosarcomas - soft tissue

61

Ewing's Sarcoma

malignant tumor from bone marrow, long bones or pelvis of young boys, HIGHLY LETHAL

sites - pelvis, thigh, body trunk

cells contain GLYCOGEN

when jaw is involved, predilection for RAMUS of mandible

xray MOTH EATEN radiolucency of medulla with erosion of cortex, periosteal ONION-SKIN rxn

62

Multiple Myeloma (Plasma Cell Myeloma)

bone marrow and plasma cells, MOST LIKELY FATAL
-elevated blood levels of BENCE JONES PROTEIN
-plasma cells that destroy osseous tissues
-older males
-mostly involves vertebrae, ribs, skull
-jaws rarely a primary site but become involved 70% of the time -> molar-ramus area

63

xray features of Multiple Myeloma

lab findings?

tx?

PUNCHED OUT radiolucencies
take a lateral ceph

lab - hypergammaglobulinemia (IgG), BENCE JONES proteinuria

tx by chemo, radiation. POOR PROGNOSIS, survival 2-3 yrs

64

Odontogenic Myxoma

rare slow growing, asymptomatic jaw tumor in mandible
-localized expansion of jaw

tx - curettage

65

TNM - stage, assess prognosis and therapy of malignant neoplasma (tumors)

T = SIZE of tumor
N = presence of regional lymph node involvement
M = presence of distant metasasis

66

melanoma exhibits 2 growth phases in skin

1. Radial (horizontal) - INITIAL phase, just above and below dermo-epidermal jxn in horizontal plane

2. Vertical - neoplastic cells populate the underlying dermis. METASTASIS is possible

67

Malignant Melanoma

MOST SEVERE and serious type of SKIN CANCER
-from excessive exposure to UV radiation
-often develops from a MOLE (nevus)

-uncommon in oral mucosa but has predilection for palate and maxillary gingiva/alveolar ridge
-5 yr. survival is 7%

68

what cancer is the most common malignancy in the US. 1 in 100 will develop it

SKIN CANCER

69

most common intra-oral site for melanoma is

hard palate

70

4 clinical types of Melanoma

1. Superficial Spreading - most COMMON, tan, brown, sun-exposed skin, radial growth, clinically macular or slightly elevated

2. Nodular - no radial growth

3. Lentigo Maligna - elderly, radial before vertical

4. Acrolentiginous - hands and feet

71

Nevus

mole

atypical (dysplastic) - bigger, can mark a greater risk of malignant melanoma

72

Basal cell carcinoma

malignant epithelial cell tumor
-central crater that erodes, crusts, bleeds
-ONLY skin (never mouth)
-caused by sun exposure

tx by electrodessication or cryotherapy

73

Squamous Cell Carcinoma (Epidermoid Carcinoma)

sites?

most common malignancy in oral cavity (90%)
-malignant epithelial tumor, more in males

-more on lower lip than intra-orally
-intra-orally on LATERAL and VENTRAL tongue -> cervical lymph nodes
-FOM is 2nd most common site with worst prognosis

-can be red, irregular, non-painful, or white

74

risk factors for SCC

tx?

smoking, smokeless tobacco, alcohol, painful and ill fitting dentures, chronic inflammation

tx by surgery and radiation

75

most reliable histologic criterion for dx of oral SCC

INVASION

76

SCC H&N locations (9)

1. nasopharynx
2. palate
3. oropharynx
4. maxillary sinus
5. tongue** lateral and ventral surface
6. lips** lower lip (most easily managed when it's here)
7. FOM
8. buccal mucosa
9. gingiva and alveolar mucosa

77

3 types of SCC

1. Verrucous Carcinoma
2. Carcinoma IN SITU
3. Carcinoma Invasive

78

Verrucous Carcinoma

rare form of SCC, does NOT metastasize
-from tobacco, smoking, snuff
-old men
-UPPER ALVEOLAR RIDGE

-white, cauliflower/coral like papillary appearance

-can transform into invasive kind of carcinoma

79

Carcinoma IN SITU

only intraepithelial, atypical mitosis, hyperchromatism, but DOES NOT INVADE C.T.
-can't metastasize cause lack of blood in epithelium

ex. old alcoholic female with red FLAT area in FOM

80

Carcinoma Invasive

ex. old alcoholic female with red area in FOM, med hx non-contributory

81

Erythroplasia

red, or speckled, non-ulcerated
-early carcinoma often begins as erythroplasia

82

characteristics of lesions that may be malignant include

erythroplasia
rapid growth
ulceration
bleeding
induration (firm to touch)
fixation

83

abrasion

attrition

erosion

1. abnormal pathologic wearing away ex. toothbrush (V-shaped wedges); occlusal (flat cusps)

2. physiologic wearing of enamel and dentin from NORMAL FUNCTION, or bruxism

3. chemical loss from non-mechanical means, ex. acid

84

internal resorption

begins in root canal (looks like balloon)
-first evidence may be pink-hued area on crown

85

intrinsic staining of teeth can be caused by the following

dentinogenesis imperfecta
erythroblastosis fetalis
porphyria
fluorosis
pulpal injury
internal resorption
tetracyclines

NOT DIABETES

86

ankylosis

fusion of alveolar bone to tooth

87

gemination (twinning)

division of single tooth germ by invagination causing incomplete formation of 2 teeth

88

gomphosis

fibrous joint where conical process is inserted into socket-like portion

89

taurodontism

enlarged pulp, shortened roots, usually molars

90

hypercementosis

excess cementum around/on root after tooth eruption
-seen in ACROMEGALY
-affects VITAL teeth
-usually premolars

91

enamel hypoplasia

incomplete formation of matrix
-enamel hard, but thin and deficient
-genetic forms are types of amelogenesis

clinically - lack of contact, rapid breakdown of occlusal, yellow-brown stain that appears from exposed dentin

92

enamel hypocalcification

hereditary defect, enamel is soft and undercalcified
-normal in quantitiy due to defective maturation of ameloblasts
-defect in mineralization of formed matrix

93

amelogenesis imperfecta

hereditary ectodermal condition
-enamel is soft, thin, yellow
-dentin, pulp, cementum NOT affected

94

3 types of amelogenesis imperfecta

Type 1 Hypoplastic AI: enamel not formed to full thickness or might be absent on newly erupted teeth due to defective FORMATION of enamel matrix

Type 2 Hypomaturation AI: enamel can be pierced and chipped away, has IMMATURE CRYSTALLITES

Type 3 Hypocalcified AI: quantity of enamel is normal but so soft it can be removed during prophy due to defective MINERALIZATION

95

Dentinogenesis Imperfecta (Hereditary Opalescent Dentin)

features?

sometimes assoc. with what condition?

RARE, only 1:7,000 kids. Hereditary MESODERMAL defect.

clinical features - amber, gray, purple teeth, pulp chambers obliterated, short and bulbous crowns, narrow roots, constriction at enamel-cementum junction

-sometimes linked to osetogenesis imperfecta, blue sclera common

96

3 types of dentinogenesis imperfecta

Type 1 - in pts with osteogenesis imperfecta, blue sclera, hx bone fractures

Type 2 - most common, only dentin is weird

Type 3 (Brandywine) - only dentin abnormal, but variations incl. multiple pulp exposures

97

dentin dysplasia (rootless teeth)

hereditary disease, autosomal dominant

clinical features - normal enamel, atypical dentin, pulp obliteration, defective roots, radiolucencies, early exfoliation

Type 1 (Radicular) - more common, mobile teeth, premature exfoliation, short roots, obliterated pulp, CRESCENT shaped pulpal remnant, radiolucencies, "CHEVRON" shaped pulp chambers

Type 2 (Coronal) - blue gray, obliterated pulp, amorphous and atubular dentin, THISTLE tube pulp and stones, true denticles, pulp stones

98

Oral Candidiasis (Thurs or Moniliasis)

symptoms?

predisposing factors?

tx?

fungal infxn caused by Candida
-diffuse, curly, velvety white mucosal plaque
-CAN BE WIPED OFF -> red, raw, bleeding surface
-symptoms = discomfort, burning, altered taste

-factors that stimulate growth = abx, steroids, diabetes, pregnancy, vit deficiency (iron, folate, b12, zn)

tx - lozenges (trouches) and Nystatin rinse

99

Angular Cheilitis (Perleche)

predisposing factors?

tx?

inflammatory lesion at corners of mouth

predisposing factors - candida infxn, loss of vertical dimension, trauma, vit deficiency (riboflavin, thiamine)

tx - NYSTATIN

100

Actinic Cheilitis (Solar Cheilitis)

premalignant, caused by sun

-counterpart of actinic keratosis
-can develop into SCC

-thick, white discoloration of lip at border and sharp demarcation btw red of lip and normal skin

101

White sponge nevus (familial white folded dysplasia)

buccal mucosa abnormality often mistaken for leukoplakia
-soft, thick, corrugated folds

NO TX

102

Leukoplakia

PREMALIGNANT, white patch or plaque, WON'T RUB OFF, DOESN'T DISAPPEAR WHEN STRETCHED

-etiologic factors = tobacco, alcohol, oral sepsis, chronic irritation

tx = biopsy! all leukoplakias must be biopsied and completely excised

103

carcinoma in situ

mucosal lesions that resemble leukoplakia except that dysplasia is prnounced and involves almost all epithelial layers, shows no tendency to metastasize or invade

-exhibits all histo characteristics of malignancy but DOES NOT show invasiveness or extension

104

diff dx of white patch includes

leukoplakia
lupus erythematosus
leukoedema
white sponge nevus
chemical burn
candidiasis
lichen planus
migratory glossitis

105

Stomatitis Nicotina (Pipe Smoker's Palate, Nicotinic Stomatitis)

related to pipe smoking, ONLY ON PALATE, mostly males

-palate red, inflamed, then diffuse gray-white multi-nodular appearance with small red "spot" in center of each nodule
-leathery white hyperkeratosis (inflamed minor salivary glands)
-the only lesion produced by tobacco that is not cancerous

tx = stop smoking

PREMALIGNANT

106

Leukoedema

mimics leukoplakia, along occlusal line, DISAPPEARS on STRETCHING

tx = none

histo - epithelium is parakeratotic and acanthotic, marked with edema

diff dix = leukoplakia, white sponge nevus, herditary benign intraepithelial dyskeratosis

107

Lichen Planus

oral lesion on buccal mucosa, appears as white or gray-white STRIAE in a lace-like pattern "WICKMAN'S STRIAE"'
-may be autoimmune

microscopic features = hyperparakeratosis, thickened granular layer, saw-tooth appearance of rete pegs, degeneration of basal cell layer, infiltration of inflammatory cells
-more common in women

tx - topical STEROIDS

2 forms
1. Bullous lichen planus - fluid filled vesicles
2. Erosive lichen planus - RED, when involves gingiva looks like desquamative gingivitis

108

Hairy Tongue

hypertrophy of FILIFORM PAPILLAE
-BENIGN condition
-discolaration of dorsum tongue
-can be white, green, brown (stained from debris)

etiology - overgrowth of fungal microorganisms from smoking or poor OH

109

4 types of Papillae on Tongue

taste buds are on which ones?

1. Filiform - most numerous, V-shaped rows, NO taste buds

2. Fungiform - scattered along filiform, flat, mushroom shaped at tip and lateral margins

3. Circumvallate - largest but least numerous, circular in V-shaped row at back of tongue, assoc. with ducts of von Ebner

4. Foliate - lateral margins as 3-4 vertical folds

Taste buds are on fungiform, circumvallate, foliate

110

Benign Migratory Glossitis "Geographic Tongue" or "Erythema Migrans"

harmless, desquamation of filiform papillae
-slight burning of tongue
-often occurs with fissured tongue

111

Fissured tongue "Scrotal Tongue"

found in what Syndrome?

deep, asymptomatic MEDIAN FISSURE with laterally radiating grooves, arranged across dorsum of tongue

found in Melkersson-Rosenthal Syndrome (along with Cheilitis Granulomatosum and Facial Nerve paralysis)

112

Fordyce's Granules

ectopic sebaceous glands in oral mucosa, in > 75% adults
-yellow clusters, NORMAL

113

Purpura

hemorrhages, looks like purple spots or patches
-extractions are contraindicated due to potential excess bleeding

2 types
1. Thrombocytopenic Purpura (Werlhof's Disease) - deficiency in # of platelets, can be caused by heparin
2. Thrombotic Thrombocytopenic Purpura (TTP) - fatal form, low platelets and thrombosis in terminal arterioles and capillaries

114

Agranulocytosis

rdxn in # of neutrophils
-LEUKOPENIA with rdxn in # of PMNs
-toxic effect of certain ANTITHYROID DRUGS (propylthiouracil, methimazole, carbimazole)

WBC < 2000, almost no nutrophils

-high fever, chills, sore throat, infection in oral cavity
-oral lesions - necrotizing ulcerations, ragged ulcers covered by gray membrane

tx - figure out what drug and stop it, give abx

115

Cyclic Neutropenia

form of agranulocytosis where pts exhibit severe gingivitis, usually no ulcerations

116

Sickle Cell Anemia (Sickle Cell Disease)

inherited anemia, crescent shaped RBCs, characterized by fever, leg ulcers, jaundice, pain in joints
-production of abnormal hemoglobin (hemoglobin S)
-usually blacks, females
-signs of anemia (weak short breath, joint pain)

dental xrays are diagnostic -> marrow spaces are enlarged, trabeculae are prominent, osteosclerotic areas noted in midst of large radiolucent marrow spaces

117

Leukemia

what agents are assoc. with its development?

cancer, uncontrolled proliferation of leukocytes -> replacement of red bone marrow with leukemic cells
-unknown etiology

agents assoc. with its development
1. ionizing radiation
2. viruses - herpes like viral particles, and they have high titer to Epstein Barr
3. genetic mutations - Philadelphia chromosome in 90% pts with CML; in Down's
4. Other - benzol, aniline dyes

118

3 types of Leukemia

1. Myelogenous - granulocytes and megakaryocytes
-CML is 4 yrs. with death from hemorrhage or infxn
-Philadelphia chromosome and low levels of leukocyte alkaline phosphatease
-massive splenomegaly

2. Lymphocytic Leukemia - lymphocytes
-CLL variable course
-lymph node enlargement main finding

3. Monocytic Leukemia - monocytes
-oral lesions (gingivitis, gingival hemorrhage, gingival hyperplasia, petechiae, ecchymoses, ulcerations)
-RARE

119

clinical features of chronic leukemia

-insidious (slow) onset with weakness and weight loss
-organ involvement similar to acute leukemia: skin involved, manifest as petechiae or ecchymoses, recurrent hemorrhages, bacterial infxns
-lab findings: leukocytosis > 100K with mature forms (granulocytes and lymphocytes) predominating

120

Chronic Myelogenous Leukemia (CML)

myeloproliferative disorder
-the least malignant leukemia
-affects middle age

clinical signs - spongy bleeding gums, fatigue, fever, weight loss, moderate splenomegaly, joint pain

PHILADELPHIA CHROMOSOME - translocation btw chromosomes 9 and 22

survival time = 4 years with death due to hemorrhage or infxn

121

Polycythemia Vera (Primary Erythemia)

chronic myeloproliferative disorder of TOO MANY RBCs
-blood is too thick to pass through small vessels -> clot formation and blockage -> CVA
-splenomegaly in 75% pts

clinical features - headache, weak, weight loss, pruritis, hemorrhage, thrombosis

oral manifestations - gingiva and tongue deep purple-red, gingiva swollen and bleeds, submucosal petechiae, hematomas

Secondary Polycythemia - incr. in total # of RBCs due to another condition

122

Acute Myeloid/Myelogenous Leukemia (AML)

malignant disease of bone marrow, hematopoietic precursors arrested in early development
-has > 30% myeloblasts in blood, which contain AUER RODS
-MOST MALIGNANT leukemia

123

Acute Leukemia

abrupt onset of few months
-pt dies within 6 due to brain hemorrhage or bacterial infxn

clinical features - anemia, hemorrhages, enlargement of lymph nodes or spleen, petechiae

primary organs involves = bone marrow, spleen, liver

lab findings - leukocytosis with immature forms predominating (myeloblasts, lymphoblatss); anemia, thrombocytopenia, prolonged bleeding and coagulation times, tournique test +

124

acute myelogenous leukemia more common in kids or adults?

adults

125

Acute Lymphocyt (Lymphoblastic) Leukemia more common in kids or adults?

CHILDREN
-most common leukemia in children
-lymph node enlargement
-lymphocytes are not B or T cells but "null" cells

126

Aleukemic Leukemia

-leukemic cells in bone marrow, but circulating WBC are neither immature nor increased in number

127

Leukemoid Reaction

increase in # circulating granulocytes (neutrophils)

128

Stem Cell Leukemia

abnormal cells are the precursors of lymphoblasts, myeloblasts, monoblasts

129

Subleukemic Leukemia

leukemic cells appear in blood but no significant increase in # of circulating WBC

130

Plummer Vinson Syndrome

severe and chronic IRON DEFICIENCY anemia, mainly mid aged women
-predisposition to carcinoma in oral mucous membranes

systemic symp - weak, pallor, dysphagia, dyspnea

oral symp - angular stomatitis, smooth, red painful tongue with atrophy of papillae

131

Aplastic Anemia


2 types?

capacity of bone marrow to produce RBCs is defectie
-most serious and life threatening blood dyscrasia assoc. with drug toxicity

1. Primary - unknown cause, affects young adults, usually fatal. oral symp = bleeding, petechiae, gingival infxns

2. Secondary - exposure to toxic agents, any age, good prognosis

132

Pernicious Anemia

deficiency in what?

what are the symptoms?

inability to absorb Vit B12 from digestive tract
-megaloblastic anemia caused by lack of INTRINSIC FACTOR

triad of symptoms = weak, sore painful tongue, tingling of extremities

133

Thalassemia Major and Minor

hemolytic anemias caused by genetic defect
-low level of erythrocytes and abnormal hemoglobin

oral manifestations - oral mucosa shows anemic pallor, flaring of max anteriors

134

Erythroblastosis Fetalis (hemolytic disease of newborn)

production of maternal antibodies for fetal RBC
-involves RH FACTOR INCOMPATIBILITY
-destruction of RBCs
-only occurs when MOM is RH(-) and KID is RH(+)

oral manifestations - teeth green blue, brown, enamel hypoplasia

135

Erythrocyte Sedimentation Rate (ESR)

non-specific test that monitors progression of disease
-rate at which RBC settle out in a tube of unclotted blood
-elevated sedimentation rates indicates presence of inflammation (makes blood proteins heavier)

ESR rises in inflammation, tissue degen., suppuration, necrosis, pregnancy

136

Wiskott-Aldrich Syndrome

only boys, causes eczema, low platelets, deficiency of B and T cells
-if they survive past 10 -> lymphoma and leukemia

137

Trigeminal neuralgia

stab-like pains, provoked by a trigger zone near nose or mouth, caused by degen. of trigem nerve or pressure

tx - CARBAMAZEPINE (tegretol), an analgesic/anticonvulsant

138

Multiple Sclerosis

chronic, attacks CNS (brain, spinal cord) due to AI response, facial and jaw weakness
-predisposed to Bell's Palsy, Trigem. Neuralgia

139

Glossopharyngeal Neuralgia

sharp, sudden, shooting, UNILATERAL

140

Postherpetic Neuralgia

burning, aching, itching, hyperesthesia along a cutaneous nerve after attack by HERPES ZOSTER
-facial nerve CN VII and geniculate ganglion -> Ramsey Hunt Syndrome

141

Myasthenia Gravis

extreme muscle weakness due to AI dosrder, antibodies against Ach receptors in NMJs.

-xerostomia, caries
-more in women
-droopy eyelids, double vision, fatigue

tx - pyridostigmine, neostigmine

142

Eaton-Lambert Syndrome

like myasthenia gravis, AI disease
-caused by inadequate release of Ach

143

Muscle spasm

prime factor that initiates Myofascial Pain-Dysfunction Syndrome (MPD). Mostly in women, unilateral.

Usually LATERAL PTERYGOID

tx - self limiting but can use NSAIDS and diazepam (valium)

144

4 cardinal signs and symp of MPD

pain, muscle tenderness, clicking/popping, limited jaw movement

145

Frey's Syndrome (Auriculotemporal)

damage of auriculotemporal nerve and innervation of sweat glands

146

Bell's Palsy

facial paralysis from damge to facial nerve

signs - unilateral paralysis with loss of wrinkles, drooping eyebrows, etc.

if you do IA block into parotid gland can get Bell's Palsy

147

Congenital Cysts

1. Branchiogenic - anterior border of sternocleidomastoid

2. Dermoid - contains hair, sebaceous and sweat glands, tooth structures, in FOM

3. Thyroglossal Duct Cyst - midline, dark, vascular, hemorrhage into mouth

148

Developmental Cysts (Fissural)

1. Nasopalatine Duct Cyst (Incisive) - heart shaped, non-odontogenic, teeth are VITAL; soft tissue counterpart is Palatine Papilla Cyst

2. Nasolabial Cyst - swelling by nostril, NOT in bone, fibrous CTs

3. Globulomaxillary Cyst - pear shaped btw roots of max. lateral and canine, IN BONE, epithelial remnants at line btw globular and mx processes

4. Median Palatal Cyst
5 Median Alveolar Cyst - btw central incisors, adjacent teeth are vital

149

Fibrous Dysplasia (3 types)

1. Monostotic Fibrous Dysplasia - most common, GROUND GLASS xray. Craniofacial Fibrous Dysplasia (of the jaw) causes EXPANSION and deformity, see a thickening at skull base

2. Polyostotic Fibrous Dysplasia - during childhood, long bones, face, clavicles

3. McCune-Albright Syndrome - bones, pigmentation, premature puberty (endocrine), hallmark is FEMALE PREMATURE PUBERTY
-triad of symp - polyostotic fibrous dysplasia, Cafe au lait spots, endocrine abnormalities
-malignant transformation potential into osteosarcomas
-tx is nonspecific but can use something that inhibits estrogen production

150

Gardner's Syndrome

POLYPOSIS -> usually malignant transformation -> colon cancer

-impacted, supernumerary teeth
-COTTON WOOL appearance
-fibromatosis, epidermoid skin cysts

151

Central Giant Cell Granuloma

within jawbones caused by trauma, more in kids
-anterior jaw

152

Condylar Hyperplasia

unilateral enlargment, unknown cause, deviate chin away from affected side

153

Central Ossifying Fibroma

slow-growing, painless, asymptomatic

154

Histiocytosis X

abnormal scavenger cells (histiocytes/macros), eosinophils proliferate -> scars
-defects in reticuloendothelial system, proliferation of macros of loose CT

1. Eosinophilic Granuloma - most benign
2. Letterer-Siwe Disease - before 3, usually fatal, pneumothorax
3. Hand-Schuller-Cristian - exophthalmos, diabetes insipidus

can treat with corticosteroids and cyto-toxic drugs, should radiate bone

death from respiratory or heart failure

155

Eosinophilic Granuloma

benign form of Histio X, affects bones and lungs as a result of metabolic defects in the reticuloendothelial system
-pneumothorax a complication

156

Verruciform Xanthoma (Histocytosis Y)

benign, soft tissue tumor, large FOAM cells in CT papilla

157

Nevoid Basal Cell Carcinoma (Basal Cell Nevus - Bifid Rib Syndrome/Gorlin & Goltz Syndrome)

1. multiple basal cell carcinomas
2. multiple OKCs, bifid ribs
3. blindness
4. MR, dural calcification, hydrocephalus
5. sexual anomalies - hypogonadism, ovarian tumors

158

Dentigerosu Cyst (Follicular)

assoc. with crown of unerupted tooth or dental anomaly, usually by 3rd molar

AMELOBLASTOMA most likely to develop in wall

159

Eruption Cyst

swelling of alveolar ridge over crown, can be mistaken for hemangioma or hematoma

160

Primordial Cyst (Follicular)

no calcified structures, found in place of a tooth

161

Odontogenic Keratocyst

follicular and dentigerous cysts that contain keratinizing material
-tendency to RECUR (over 30%)
-grow cause of epithelial cell multiplication

162

Traumatic Bone Cyst

-usually btw mand canine and ramus
-teeth are vital
-case: radiolucency apical to PM and molars

163

Lateral Periodontal Cyst

inflammatory, a RADICULAR cyst
-most in mandibular canine-premolar area
-apposition with root of vital tooth, asymptomatic

164

Dental Granuloma

-sequelae of pulpitis, can only be distinguished by histo
-asymptomatic, tooth NON-VITAL
-histo - fibrous CT with macros, lymphocytes

tx -> RCT or EXT

165

Radicular Cyst (Apical Periodontal Cyst or Periapical Cyst)

most common odontogenic cyst, develops within a pre-existing dental granuloma, incr. osmotic pressure in cyst lumen

-histo: lumen (true cyst)

tx -> RCT with apico or ext

166

Residual Cyst

tooth with a radicular (periapical) cyst is ext, but the radicular cyst persists, asymptomatic -> curette

167

Gingival Cyst

canine and premolar areas of mandible

168

MOST COMMON EPITHELIAL (ECTODERMAL) odontogenic tumor

Ameloblastoma

169

Ameloblastoma

-odontogenic epithelium that shows differentiation of histologic layers of enamel organ
-slow growing, invasive, usually BENIGN

1. Multicystic (Solid) - most cases, more aggressive, do marginal resection
2. Unicystic - usually younger, most in mandible, tx by ENUCLEATION
3. Peripheral (Extraosseous) = uncommon, from rests of dental lamina

170

radiographic appearance of ameloblastoma

microscopic feature?

recurrence?

lesion on VITAL teeth with SOAP bubble (if big) or HONEYCOMB (if small)
-irregular scalloped borders, looks like a central giant cell granuloma

-nonencapsulated

recurs 50-90% if not treated well

171

Adenomatoid Odontogenic Tumor (Adenoameloblastoma)

ectodermal origin, younger ppl, in ANTERIOR MAXILLA, females, asymptomatic
-looks like gingival fibrous lesion

histo - well defined, surounded by thick fibrous capsule, enamel organ, lining of dentigerous cyst, reduced enamel epithelium, rests of malassez

SPINDLE SHAPED epithelial cells -> form sheets, strands, whorls

BENIGN -> enucleate

rare recurrence, not aggressive

172

Calcifying Epithelial Odontogenic Tumor "Pindborg Tumor"

derived from ectoderm (epithelial), amyloid production

xray - scalloped margin, assoc. with impacted tooth (3rd molar)

histo - islands of epithelial cells

173

Squamous Odontogenic TUmor

BENIGN, ectodermal (epithelial), asymptomatic

xray - radiolucency lateral to roots

histo - rests of malassez

174

Cementoma (Periapical Cemental Dysplasia)

mandible (incisor region), VITAL teeth, black women

175

Benign Cementoblastoma (True Cementoma)

young males, md premolars/molars, vital tooth

176

Gigantiform Cementoma (Familial Multiple Cementomas)

middle aged black women, can cause jaw expansion, multiple (often symmetrical)

tx -> excise

177

Cementifying Fibroma

well defined radiolucency with scattered radiopaque foci, mandible

178

Complex Odontoma

may prevent eruption, posterior, from ectodermal and mesenchymal, in md premolar/molar area, asymptomatic, unorganized mass of dental tissues (enamel, dentin, cementum)

tx -> enucleation

179

Compound Odontoma

from ecto and mesenchymal parts of tooth germ, more common in max incisor-canine rea, can cause delayed eruption

xray - small tooth-like structures

microscopic features - small, malformed teeth

180

Odontogenic Myxoma

aggressive tumor from papilla, dental sac, or PDL

xray - poorly defined, multilocular, assoc. with unerupted or displaced teeth

tx -> curette, cauterize

181

Odontogenic Fibroma

from dental papilla, dental sac, PDL. painless swelling in mandible of young ppl

tx -> enucleation

182

Odontogenic Tumors of MIXED origin (Eco-Mesodermal components)

1. Ameloblastic Fibroma - often mistaken for ameloblastoma, young ppl, in md premolar-molar area, painless swelling, assoc. with unerupted tooth, see nests and strands of odontogenic epithelium, young cellular fibrosis
-tx by excision

2. ameloblastic fibro-odontoma - kids under 20, may have foci of calcification with dentin and enamel (induction effect)
-tx by excision

3. Ameloblastic Odontoma - painless swelling, looks like ameloblastoma with combo of composite odontoma

183

Peutz-Jeghers Syndrome (Hereditary Intestinal Polyposis Syndrome)

inherited, AD, intestinal polyps (tendency to go malignant), intraoral pigmentations,

184

Dilantin

anticonvulsant to control epileptic seizures, causes fibrous hyperplasia

185

Acquired nevi (5 kinds)

intramucosal nevus - most common in mouth, in CT or lamina propria

blue nevus - congenital, painless

compound nevus - rare, at epithelium-lamina propria interface, raised and solid

jxn nevus - rare, btw epithelium and lamina propria, flat, can undergo transformation into malignant melanoma

intradermal nevus (common mole)

186

BK Mole Syndrome and Dysplastic Nevus Syndrome

numerous large pigmented atypical nevi with high risk for developing malignant melanoma

187

Focal Melanosis (2)

mostly LOWER LIP

1. labial melanotic macule - lower lip, midline, < 5 mm

2. oral melanotic macule - intra-orally, < 1 cm

tx -> excise to rule out malignant melanoma

188

3 conditions with PIGMENTATION of intra-oral mucosa

1. Addison's - adrenocortical insufficiency, hypocorticolism, lab shows low blood conc. of Na and glucose and incr. K+

2. Albright's - polyostotic fibrous dysplasia, cafe au lait spots, endocrine dysfunction, incr. incidence of osteosarcoma

3. Petuz-Jegher's - intestinal polyps, intraoral pigmentations

3. Peutz-Jegher's

189

Aneurysmal Bone Cyst

benign lesion of bone, expansile, proliferaiton of vacular tissue that forms a lining around blood-filled cysts, in humerus/femur/tibia/pelvis

xray - honeycomb or soap bubble

190

Median Rhomboid Glossitis

chronic candida albicans infection
-smooth, denuded, beefy, red lesion devoid of filiform papillae
-located in midline of dorsum of tongue anterior to circumvallate papillae

no tx

191

Pyogenic Granuloma

interdental gingiva, from trauma, pregnant pts
-soft, pedunculated, smooth red surface, hyperplastic granulation

tx -> excision

192

Erythroplakia

red patch, most common in md mucobuccal fold, oropharynx and FOM, especially old ppl

193

Rendu-Osler-Weber Disease (Hereditary Hemorrhagic Telangiectasia)

congenital hereditary form of hemangioma, SPIDER-LIKE telangiectases
-epistaxis (nosebleeds)

194

Encephalotrigeminal Angiomatosis (Sturge-Weber Disease)

unilateral facial lesion (PORT WINE STAIN) over trigem nerve

195

Juvenile Nasopharyngeal Angiofibroma

adolescent males, benign, produces a nasopharynx mass

tx - surgery

196

Burning Tongue Syndrome

no detectable lesions, usually mid-aged females

etiologic factors - anemias, diabetes mellitus, gastric disturbances, psychogenic factors, trigem neuralgia, bacteria, xerostomia, vit B deficiency

197

Peripheral Giant Cell Granuloma

pedunculated broad absed with smooth surface, on gingiva btw 1st perm molar and incisors or alveolar process

-histo is diagnostic - non-encapsulated with multi nucleated giant cells

198

Hemangioma

benign, proliferation of blood vessels, more in females

etiology - endothelial cells, C. T. origin

microscopic features - capillary, cavernous, hemangioendothelioma

tx - laser or surgery

199

Benign Salivary Gland Tumors (2)

1. Pleomorphic Adenoma (Mixed) - most common benign one

2. Monomorphic - basal cell, etc.

common site for MINOR = palate
for MAJOR = parotid

200

Necrotizing Sialometaplasia

of MINOR salivary glands, necrosis of glandular parenchyma with assoc. squamous metaplasia and hyperplasia of ductal epithelium

hard palate most common

201

Mumps

most common viral disease of salivary glands caused by RNA-Paramyxovirus
-salivary gland swelling without purulent discharge
-PAROTID GLAND involved

complications - orchitis, epididymitis, can cause sterility, meningitis, encephalitis

serum AMYLASE may be elevated

202

RNA paramyxoviruses cause what 2 diseases

1. Rubeola - KOPLIK SPOTS (small blue white lesions surrounded by red ring), can't be wiped off

2. Mumps - enlarged parotid glands, can cause deafness and orchitis

203

Mucocele

usually lower lip, minor salivary glands and ducts

204

Ranula (True Retention Cyst)

fluctuant, painless, occurs UNILATERALLY, assoc. with SUBMANDIBULAR or SUBLINGUAL glands

hx - incr. before meal and decr. in size btw meals

tx -> excise

205

Mikulicz's Disease (Benign Lymphoepithelial Lesion)

related to Sjogren's, asymptomatic enlargement of PAROTID and SUBMANDIBULAR glands, unilateral, middle aged women

histo - scattered epimyoepithelial islands

-most are benign but malignant transformation of island can happen

206

Malignant Salivary Gland TUmors

1. Adenocarcinoma (NOS) - major and minor glands, asymptomatic mass

2. Adenoid Cystic Carcinoma - minor glands of palate, pain, facial paralysis, weakness

3. Acinic Cell Carcinoma - parotid gland, pain, facial weakness or paralysis

4. Mucoepidermoid Carcinoma - in parotid gland, asymptomatic, facial weakness or parlysis

207

Metabolic Conditions assoc. with Chronic Salivary Gland Enlargement

diabetes, alcoholism, malnutrition, obesity, HTN, hyperlipidema, not hypothyroidism, PAROTID GLAND

208

Conditions assoc. with parotid gland enlargement

1. Sjogren's and Sarcoidosis
2. Warthin's tumor (papillary cystadenoma lymphomatosum)
3. Infxn - mumps, actinomycosis, TB
4. benign lymphoepithelial lesion (Mikulicz's disease)
5. Acute epidermic parotitis
6. Malnutrition

209

Sjogren's Syndrome

autoimune, inflammation of sliavary and lacrimal glands, progresses to fibrosis and atroph, post menopausal women

symp - rheumatoid arthritis, xerostomia, keratoconjunctiva sicca

-some pts get malignant lymphomas and pseudolymphomas

210

Sialoliths

more common in submandibular gland and duct > parotid or sublingual

use occlusal xray to detect it in Wharton's duct (submand)

211

Oncocytomas (Oxyphilic/Acidophilic Adenoma)

benign, made of large cells with granular and eosinophilic cytoplasm, related to aging

-seen in parotid glands
-histo - bright pink cytoplasm, small round nuclei

212

Sialoscintigraphy

separate Warthin's tumor and oncocytoma from malignant tumors

213

Warthin's Tumor (Papillary Cystadenoma Lymphomatosum)

in parotid gland
-old males
-over angle or ramus of mandible

histo - eosinophilic coagulum

214

Stevens Johnson Syndrome

severe bullous form of Eythema Multiforme

clinically - BULLS EYE shaped lesions

triad - eye lesion, genital lesion, stomatitis

tx - steroids, abx

215

Erythema Multiforme

allergic hypersensitivity

TARGET or BULLS EYE shaped SKIN lesion

oral lesions - red macules, papules, vesicles

216

Granulomas

nodules of epithelioid cells that are modified macrophages with eosinophilic tyoplasm

217

Granulomatous infxns include

mycobacterial diseases
fungal
parasitic
syphilis
silicosis and berylliosis
sarcoidosis

218

acute/chronic inflammation is involved with pneumonia?

acute, where there is purulent exudates in response to a bacterial infxn

219

Actinomycosis

gram + filamentous, can cause abscesses and sinus tracts -> CHRONIC SUPPRATIVE LESION

220

Cervicofacial Actinomycosis "lumpy jaw"

most common manifestation of actinomycosis

221

Histoplasmosis

caused by fungus Histoplasma Capsulatum
-affects lungs

oral manifestations - nodular, ulcerative, vegetative lesions, covered by gray membrane, indurated

222

Mucormycosis "Phycomycosis/Zygomycosis"

caused by water mold fungus Mucorales

Rhinocerebral Mucormycosis - in nose and brain, usually fatal, in pts with diabetes or chronic diseases
-symp - orbital cellulitis, bulging eye

tx - Amphotericin B

223

Syphilis

by spirochete Treponema Pallidum, tx with penicillin

1. Primary - CHANCRE< non painful ulcer
2. Secondary - rash, brown sores
3. Tertiary - GUMMA (focal mass), on palate and tongue

CONGENITAL Syphilis
Sequela - Hutchinson's teeth, mulberry molars, NO chancre

224

HSV 1

oral herpes, transmitted by direct contact
-NO CORTICOSTEROID tx

1. Primary Herpetic Gingivostomatitis (Acute Herpetic) - young kids, flue like symp, on free and attached mucosa
-stays inactive in CN V Trigeminal Ganglion then later appears as RECURRENT HERPES LABIALIS (cold sore)

2. Secondary (Recurrent) Herpetic Stomatitis - adults, cold sores, localized, dormant in CN V ganglion

3. Herpes Labialis (Fever Blisters or Cold Sores) - BALLOONING degeneration of epithelial cells with loss of cohesion to adjacent cells, intra-nuclear inclusions called LIPSCHULTZ BODIES

225

HSV 2

GENITAL, via sexual contact

226

HSV 3

by herpes varicella zoster, does NOT cross midline, causes recurrent herpes and chickenpox, lesion follows path of trigeminal nerve

227

Varicella Virus

can cause Herpes Zoster lesions

1. chickenpox - pruritic vesicular lesions, contagious

2. shingles - reactivate latent varicella zoster, reaches sensory ganglia of spinal and cranial nerves, does NOT CROSS midline

228

HSV 4

caused by Epstein Barr Virus

1. Hairy Leukoplakia - in HIV pts, white furry lingual lesions on latearl border, can coexist with recurrent herpes

2. Infectious Mononucleosis - no oral manifestations, neck swellings

3. Burkitt's Lymphoma - high grade Non-Hodgkin's with viral etiology, looks MOTH EATEN

229

HSV 5

cytomegalovirus affects salivary glands

230

HSV 8

assoc. with Kaposi's sarcoma - AIDS/HIV, lesions on palate, negative to pressure test

231

Kaposi's Sarcoma

common with AIDS, MALIGNANT neoplasm, usually hard palate

232

Tests to dx Herpes

1. Tzanck smear - exam of fluid from unopened vesicle, look for epithelial cells with intranuclear inclusions called LIPSHULTZ BODIES

2. Fluorescent stasining - use HSV immune serum and globulin, to distinguish btw herpes zoster and herpes simplex

3. Isolation in tissue culture

4. Antibody titiers (Anti HSV Ab)

5. Biopsy

233

Herpangina

acute disease, affects young kids by GROUP A COXSACKIE virus
-stomatitis, papules/vesicles form in pharynx -> ulcers

heals on its own

234

Hand, Foot, and Mouth Disease

VIRAL infx, makes red lesions
-self healing

235

Benign Mucous Membrane Pemphigoid (BMMP)

autoimmune, vesiculobullous disease, act against basement membrane (SUBEPITHELIAL)

-oral lesions look like desquamative gingivitis

tx - biopsy and steroids!

236

Pemphigus Vulgaris

chornic, rare, vesicles and bullae made by dyhesion (ACANTHOLYSIS) of epidermal cells, autoimmune

oral lesions - NIKOLSKY'S SIGN (also in BMMP)

histo - suprabasilar vesicles, intercellular edema, loss of intercellular bridges, clumps of cells floating around called TZANCK CELLS

237

Rubella

German measles - rash, flat pink spots on face, swollen tonsils, red macules

238

Hep A

caused by RNA enterovirus, transmitted by fecal-oral route, disease of LIVER, shellfish is a source too


-damage to liver causes incr. serum levels of TRANSAMINASES

self-limiting

239

Hep B

LIVER disease caused by DNA virus
-transmission is contaminated blood or serum, sexually

signs - longer incubation of mounths

carrier state - presence of surface antigen (a or b) indicated pt might be infected

VERY heat resistant

240

Verruca Vulgaris (Squamous Papilloma)

common wart of viral etiology (caused by papilloma)
-sessile, soft, cauliflower like

microscope - shows alternating hyperkeratosis, parakeratosis, long epithelial ridges

241

Papilloma

most common benign neoplasm of epithelial tissue origin, pedunculated, sessile

microscope - projections of stratified sq. epithelium, cores of vascular fibrous CT

tx - excise

242

Inflammatory Fibrous Hyperplasia (Epulis FIssuratum)

area of denture borders, more in max

clinically - rolls of tissue in muco labial fold

tx - excise; re-evaluate prosthesis or remake

243

Inflammatory Papillary Hyperplasia (Palatal Papillomatosis)

hard palate, caused by bad OH and ill fitting dentures

clinically - numerous red papillary projections

tx - excise; correct prosthesis