Oral Pathology - ABGD Oral Board Review Flashcards Preview

Oral Pathology - ABGD Oral Board Review > Oral Pathology - ABGD Oral Board Review > Flashcards

Flashcards in Oral Pathology - ABGD Oral Board Review Deck (443)
Loading flashcards...
1

What is going on here?

Hereditary Hemorrhagic Telenglectasia

2

What should you examine a mucocele for?

  • Examine carefully for presence of obstruction
    • Foreign body
    • Sialolith

3

What is going on here?

Melanoacanthosis

4

What is going on here?

Peutz-Jeghers Syndrome

5

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

6

What is the suggested treatment for Minor Apthous Stomatitis?

  • Option A
    • No treatment
    • Avoidance or irritating agents
  • Option B
    • Fluocinonide (Lidex), 0.05% gel
      • Apply to affected areas 2-3 times per day
  • CAUTION: Oral candidiasis

7

What is the suggested treatment for Erythema Multiforme?

  • Patients often admitted
  • Systemic steroids
    • Prednisone, tapering dose
  • IV immunoglobulins
  • IV fluids

8

What are the 5 most common Odontogenic Tumors?

  • Ameloblastoma
  • Adenomatoid Odontogenic Tumor
  • Ameloblastic Fibroma
  • Ameloblastic Fibro-Odontoma
  • Odontoma

9

What is going on here?

Fibrous Dysplasia

10

Describe a Peripheral Giant Cell Granuloma...

  • Usually red/purple, bleed
  • Associations: hyperparathyroidism (if intraosseous component)
  • Histology: multinucleated giant cells

11

What is this an image of?

T1 of a Medulloblastoma

"Highlights differences in soft tissue densities"

12

What usually always favored the lower lip?

Mucocele

13

What is going on here?

Mucocele

14

What is going on here?

Fibroma, Giant Cell Type

15

What is going on here?

37 yo M with known Garner Syndrome, multiple osteomas

16

What are 3 terms to describe images in CT imaging?

  • Hyperdense
  • Hypoedense
  • Mixed intensity/heterogeneous

17

What other diagnostic tests may be indicated in cases such as these (mixed red white lesions)?

  • Incisional biopsy, with either routine histology (10% formalin) or immunofluorescence (Michel solution)
  • Diagnostic devices that use cytology, reflectance, fluorescence or saliva analysis may be highly sensitive (they will
    indicate disease when present) but less specific (many false positives); the evidence indicates these tests are less
    specific than visual exam with magnification and illumination

18

What is a good rule of thumb regarding Salivary Gland Tumors and location?

80 - 50 - 20 rule

80% parotid benign, 50% submandibular/minor benign, 20% sublingual benign

19

What is going on here?

Lateral Periodontal Cyst (and/or botryoid variant)

20

What is going on here?

Dentinogenesis Imperfecta with Opalescent Dentin

21

What is going on here?

Leukemic Infiltrate

22

What is going on here?

Ameloblastic Fibro-Odontoma 14 yo

Image is seen with Odontoma Component

23

What is going on here?

Mucoepidermoid Carcinoma

24

What is going on here?

Fibrous Dysplasia

25

What is going on here?

Periapical Cemento-Osseous Dysplasia

26

What view is this?

Coronal

27

What is going on here?

Ameloblastoma (crossing the midline)

  • Most common odontogenic tumor

28

What is going on here?

Buccal Birfurcation Cyst

Inflammatory Cyst

29

What is going on here?

  • Geographic Tongue
  • Erythema Migrans or Migratory Glossitis

30

What is going on here?

17 yo, multiple central giant cell granulomas - cherubism

31

What kind of process is going on in regards to antral pseudocyst and what should you do about it?

  • Inflammatory
  • Secondary to sinus inflammatory process (sinusitis)
  • Secondary to dental inflammatory process (periapical pathosis)
  • "Relative Radiopacity" in sinus
  • Consider vitality testing of the teeth in the quadrant
  • Consider periodontal evaluation ofthe teeth in the quadrant

32

What do you know about Pemphigus?

  • Autoimmune process (against epithelial cell-cell attchments)
  • Look for ragged/irregular ulcers elsewhere (buccal, palatal)
  • You are likely to elicit a Nikolski (blister formation)
  • Histology: "suprabasilar acantholytic process"

33

What is going on here?

Stafne Defect

  • Lingual mandibular salivary gland defect

34

What is going on here?

How would you treat this?

  • Diagnosis: (ulcerated) fibroma
  • Differential Diagnosis:
    • Fibroma
    • Pyogenic Granuloma
    • Soft Tissue Tumor (Neuroma, Neurofibroma, Neuroma)
  • Biopsy to exclude other soft tissue lesionsd (ex. pyogenic granuloma, neuroma, neurofibroma, lipoma)

35

What does MRI stand for?

What must you caution for?

  • Magnetic Resonance Imaging 
  • No harmful radiation (uses a magnetic field)
  • Caution: 
    • cardiac pacemakers
    • certain metallic implants

36

What is going on here?

Primary Herpetic Gingivostomatis

37

What does a Cobweb Trabeculation apperance go with?

Odontogenic Myxoma

38

What are some contraindications to CT?

  • Allergy to contrast agent
  • Compromised renal function

39

What is CT imaging best used for?

Better hard tissue contrast

40

What is the suggested treatment for Major Apthous Stomatitis?

  • Option A
    • No treatment
    • Avoidance of irritating agents
  • Option B
    • Fluocinonide (Lidex), 0.05% gel
      • Apply to affected areas 2-3x per day
  • Option C
    • Clobetasol (Temovate), 0.05% gel
      • Apply to affected areas 2-3 times per day
  • Caution: Oral Candidiasis

41

Observe this helpful image...

42

What is going on here?

Pemphigoid

43

What does Beaten Copper/Beaten Metal appearance go with?

Crouzon and Apert Syndromes

Hypophosphatasia

44

What is going on here?

Herpes Labialis and Whitlow

45

What is going on here?

Squamous Papilloma (human papilloma virus)

46

What is going on here?

Pyostomatitis Vegetan (ulcerative colitis)

47

What is going on here?

Lipoma

48

What % of all cases of idiopathic osteosclerosis are associated with root resorption?

9-12%

49

What is going on here?

What can cause this?

  • Gingival Overgrowth (medication induced)
  • Anti-seizure medications
    • Dilantin
  • Chemotherapeutics
    • Cyclosporine
  • Calcium Channel Blockers
    • Enalapril

50

What is going on here?

Hyperparathyroidism

39 yo M, parathyroid disease, elevated PTH; biopsy; central giant cell granuloma

51

What is going on here?

Hemangioma

52

What is going on here?

Multiple Myeloma

67 yo F, history of myeloma; prior pathologic fractures of L mandible

53

Describe a Peripheral Odontogenic Fibroma...

  • Pink to red
  • Associations: none specific
  • Histology: epithelial odontogenic rests

54

What is going on here?

Squamous Cell Carcinoma (Stage IV; lymph node metastases arrows)

55

What is going on here?

Pemphigoid

56

What is this imaging dipicting?

PET scan of primary/nodal disease

57

What are some common bacteria in Oral Ulcers and Lymphadenopathies?

  • Streptococcal and Staphylococcal species
  • Treponema
  • Bartonella
  • Actinomycetes

58

What is going on here?

Squamous Cell Carcinoma

  • Differential Diagnoses:
    • Exclusion of malignancy in an otherwise unexplainable red/white lesion

59

What is going on here?

 

  • Differential Diagnoses:
    • Pyogenic Granuloma
    • Peripheral Ossifying Fibroma, Odontogenic Fibroma, Giant Cell Granuloma
    • Langerhans Cell Histiocytosis

60

What are some common Non-Odontogenic Tumors?

  • Traumatic Bone Cyst
  • Central Giant Cell Granuloma
  • Aneurysmal Bone Cyst
  • Langerhans Cell Histiocytosis

61

How can the dental team manage nutritional deficiencies, and should they?

  • Nutritional counseling can be performed by a dentist if an appropriate food diary is developed by the patient
  • Nutritional supplementation, however, should be managed by a physician, nutritionist/dietician or other health care
    professional trained in these areas; a thorough analysis including bloodwork may be required, and GI or other metabolic
    diseases may need to be excluded

62

What is going on here?

Where can they be found?

  • Lymphoepithelial Cyst
  • Can be found
    • Adenoids
    • Palatine Tonsil
    • Lingual Tonsil
    • Foliate Papillae

63

What is going on here?

Amelogenesis Imperfecta (Hypoplastic)

64

What is this?

What would you consider doing about it?

  • Peripheral Giant Cell Granuloma
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

65

What is going on here?

Cat Scratch Disease (Bartonella)

66

If you are uncertain about what is going on when you observe Desquamative Gingivitis, what would you consider doing?

  • Consider (direct) immunofluorescence (IF)
  • Submit fresh tissue directly to the lab if you have capability
  • Submit in Michel's solution if you have to send the specimen
  • Split specimens (half formalin, half MIchel's)

67

What is going on here?

Pemphigus

68

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

69

What does a Sunburst/Sunray Opacification apperance suggest?

Osteosarcoma

Condrosarcoma

Hemangioma

70

What is going on here?

Multiple Odontogenic Keratocysts; consider nevoid basal cell carcinoma syndrome

71

What exactly is a Ranula?

Ranula = mucocele in the floor of the mouth

72

What is going on here?

Dentinogenesis Imperfecta with Opalescent Dentin

73

What is going on here?

Pyostomatitis Vegetans (ulcerative colitis)

74

What is going on here?

Pemphigus

75

What is going on here?

Central Giant Cell Granuloma

  • May consider:
    • Calcitonin
    • Corticosteroids
    • a-interferon

76

What is going on here?

Fibrous Dysplasia

77

What is going on here?

Dentinogenesis Imperfecta with Opalescent Dentin

78

What is going on here?

12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

79

What is going on here?

Granular Cell Tumor

80

What is going on here?

Pemphigus

81

What is going on here?

Herpes Zoster

82

What does a Punched Out Lesion appearance suggest?

Myeloma (in adults)

Lngerhands Cell Histiocytosis (in children)

83

What is going on here?

Multiple Myeloma

84

What is Dentinogenesis Imperfecta/opalescent dentin associted with?

  • Pulpal defects
  • Defects in or absence of root morphology
  • Osteogenesis imperfecta
  • Overlaps with dentin dysplasia

85

What is going on here?

What do you think is the etiology?

  • Mucosal Slough
  • Consider
    • Mouthwash
    • Dentifrice
    • Dietary

86

What is this?

What would you consider doing about it?

  • Pyogenic Granuloma
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

87

What is going on here?

Lymphoma (non healing periradicular lesion following NSRCT)

88

If you see desquamative gingivitis, what are your 3 top differentials?

  • Erosive Lichen Planus
  • Pemphigoid
  • Pemphigus

89

What is going on here?

Melanoma

90

What are 4 Soft Tissue Masses that are Neoplastic?

  • Neuroma
  • Neurofibroma
  • Lipoma
  • Granular Cell Tumor

91

What is going on here?

Dentinogenesis Imperfecta with Opalescent Dentin

92

What is going on here

Acinic Cell Adenocarcinoma

This would also be a common site for mixed tumor and Warthin Tumor

93

What is going on here?

Syphilis (Treponema)

  • Primary
    • Chancre
  • Secondary
    • Mucus patch
    • "Split papule"
    • Condyloma lata
  • Tertiary
    • Gumma
  • Congenital
    • Dental deformities
    • Developmental delay

94

What is going on here?

Mucocele (superficial)

95

What is going on here?

Taurodontism

96

What is going on here?

Morsicatio (frictional keratosis)

97

What % of formalin do you put biopsies in?

10% buffered formalin for routine histology

98

What is this?

What would you consider doing about it?

  • Peripheral Odontoma
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

99

What is going on here?

Apthous Ulcer (apthous stomatitis)

100

What is going on here?

What duct is near this location?

Sialolith

(painful hard nodule, Stensel's duct)

101

What are some treatment complications for Antivirals?

Little or none in our context

102

Describe the clinical history of Necrotizing Sialometaplasia?

  • Pain
  • Rapid Onset
  • Rapid Ulceration ("part of palate fell out")

103

What usually favors the upper lip?

Favors Monomorphic (canalicular) adenoma

Favors pleomorphic adenoma

104

What are some abnormalities that have Enamel Defects?

  • Consider spectrum of tricho-dento-osseous syndrome
  • Consider spectrum of ectodermal dysplasias

105

What is going on here?

Paraneoplatic Pemphigus

106

What is going on here?

Paraneoplastic Pemphigus

107

What is going on here?

9 yo F, nelarged tongue, multiple cafe au lait macules

Multiple Endocrine Neoplasia

108

In the world of Herpesviruses, what are HHV-1 through HHV-4 associated with?

  • HHV-1 (HSV-1): Oral and mucosal herpetic lesions
  • HHV-2 (HSV-2): Oral and mucosal herpetic lesions
  • HHV-3 (VZV): Chicken pox, Herpes zoster
  • HHV-4 (EBV): Infectious Mononucleosis, Oral Hairy Leukoplakia, Malignancies (Hodgkin's, Nasopharynx)

109

How would a lymphom and an HPV-related oropharyngeal carcinoma be treated (differently)?

  • Setting aside causes of HPV-related disease (early sexual activity, multiple partners, non-vaccinated) vs lymphoma
    (multiple including genetics, cancer causing agents, some infectious diseases such as EBV-related Hodgkin lymphoma’
    and Helicobaacter pylori association with GI mucosal related lymphomas), each may require chemoradiotherapy in
    addition to any surgical intervention; the chemotherapy agents will differ, and outcomes may differ [HPV related oral
    and oropharynx cancers are noted to have higher survival rates vs non-HPV related oral cancers; lymphomas are highly
    variable in therapeutic response, depending on the specific diagnosis and genetic alterations]

110

Does Lichen Planus require treatment?

  • Asymptomatic: not required, though biopsy may be indicated to exclude other diseases
  • Symptomatic: consider topical steroid
  • Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, REFILLS = 1 (one)
    Clobetasol Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, REFILLS = 1 (one)

111

What is going on here?

Hyperparathyroidism

112

Describe the transition of Cemento - Osseous Dysplasia

Usually begin radiolucemt and may opacity over time

113

What is going on here?

Lichenoid Mucositis

(with associated lichenoid dermatitis)

114

What is going on here?

Mucoepidermoid Carcinoma

115

If you see Central Giant Cell Granulomas...consider...

Cherubism

Parathyroid/renal disease

116

What is going on here?

Amelogenesis Imperfecta (Hypoplastic)

117

What is going on here?

Syphilis (Treponema)

  • Primary
    • Chancre
  • Secondary
    • Mucus patch
    • "Split papule"
    • Condyloma lata
  • Tertiary
    • Gumma
  • Congenital
    • Dental deformities
    • Developmental delay

118

What is going on here?

Morsicatio (frictional keratosis)

119

What is going on here?

  • Diagnosis: Mixed Tumor (pleomorphic adenoma)
  • Differential Diagnoses:
    • Salivary Gland Tumor
    • Salivary PAthology (mucocele, necrotizing sialometaplasia)
    • Other tumors (e.g. lymphoma)

120

What is going on here?

Mild to Moderate Epithelial Dysplasia

121

Where is Periapical, Focal, and Florid Cemento - Osseous Dysplasia typically found?

  • Periapical: Usually limited to man anterior
  • Focal: Usually limited to man or max posterior
  • Florid: Multiple Sites

122

What is going on here?

Erythema Multiforme

123

What are 4 etiologies of Infectious Ulcerative Disorders?

  • Viral: HHV, HPV, enteroviruses
  • Bacterial: Mycobacterium, Treponema, Actinomycetes
  • Fungal: Histoplasmosis
  • Parasitic: Myasis (fly larvae)

124

What is going on here?

Alveolar Ridge Keratosis (frictional keratosis)

125

What is going on here?

Leukoedema

126

How do you determine the diagnosis via histology or immunofluorescence?

  • Tissues may be submitted in (10% buffered) formalin for routine histology, or Michel solution for IF; the specimen should
    be split, laid on a suture card or sterilization wrapper to minimize curling, and then sent to a lab that manages IF (the
    Michel solution can often be obtained by Dermatology or directly from the supporting lab)
  • Lichen planus demonstrates a linear deposition of fibrinogen at the basement membrane
    Pemphigus demonstrates a ‘chicken wire’ deposition of immunoglobulins and/or complement
    Pemphigoid demonstrates a linear deposition of immunoglobulins and/or complement at the basement membrane
  • Lichen planus demonstrates a band like lymphocytic infiltrate at or into the the epithelial base
    Pemphigus demonstrates acantholysis (the epithelial cells detached from each other and leave a ‘row of tombstones’)
    Pemphigoid demonstrates a complete epithelial split from the connective tussue

127

When you diganose by radiography, what does radiolucent, mixed radiodensity, and radiopaque apperances indicate?

  • Radiolucent: Implies minimal or no hard tissues
  • Mixed Radiodensity: Implies hard tissue component
  • Radiopaque: Implies predominantly hard tissue

128

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

129

What is this?

What would you consider doing about it?

  • Peripheral Ossifying Fibroma
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

130

What is going on here?

Ameloblastoma (in the periapical position; multiple failed endodontic procedures)

  • Most common odontogenic tumor

131

What is going on here?

Melanocytic Blue Nevus

132

What is going on here?

Simple hemorrhagic/idiopathic/traumatic/soliary bone cyst

Surgeon reports entering into an empty cavity...

133

What does a Floating in Air appearance go with?

Langerhans Cell Histiocytosis

134

What are Enteroviruses associated with?

Coxsackievirus & Echovirus

135

What is going on here?

Amelogenesis Imperfecta (Hypoplastic)

136

What does a Hair on End Pattern Suggest?

Sick Cell Anemia

Thalassemia

137

What is going on here?

Florid Cemento - Osseous Dysplasia

138

What is going on here?

Palatal Perforation Secondary to Cocaine Abuse

139

What is going on here?

Adenomatoid Odontogenic Tumor

  • Often second decade; often mimics dentigerous cyst, may be associated with impaction/failure to erupt

140

What is going on here?

12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

141

What are 2 less common Odontogenic Tumors?

  • Calcifying Odontogenic Cyst (Gorlin Cyst); often included as tumor
  • Calcifying Epithelial Odontogenic Tumor (Pindborg tumor)

142

What is going on here?

Focal Cemento-Osseous Dysplasia

143

Observe the flow of treatment...

144

What is going on here?

Antral Pseudocyst

(incidental radiographic finding)

145

What are the 3 pillars of oral cancer treatment?

  • Surgery
  • Radiation
  • Chemotherapy

146

When you see central giant cell granulomas - one should consider what 2 pathologies?

  • Hyperparathyroidism
  • Renal Osteodystrophy

147

What is going on here?

Apthous Ulcer (apthous stomatitis)

148

What are some treatment complications for Steroids/immune suppressants?

  • Fungal infections, burning sensation with some topical agents
  • Immune/marrow suppression (opportunistic infections)

149

What is going on here?

Histoplasma

150

What is Lidex?

  • This medication is used to treat a variety of skin conditions (e.g., eczema, dermatitis, allergies, rash).
  • Fluocinonide reduces the swelling, itching, and redness that can occur in these types of conditions.
  • This medication is a strong corticosteroid.

151

What are some signs of MEN IIB?

  • Pheochromocytoma (a hormone secreting tumor that can occur in the adrenal glands)
  • Throid medullary carcinoma
  • Mucosal neuromas

152

What is going on here?

Gingival Overgrowth (necrotizing gingivitis)

153

What is going on here?

How would you treat this?

  • Differential Diagnoses:
    • (Primary) Herpetic Gingivostomatitis
    • Apthous Stomatitis
    • AMnifestation of Systemic Disease (Crohn's Disease, inflammatory bowel disease, autoimmune)

154

What is going on here?

Ameloblastoma (in the dentigerous position)

  • Most common odontogenic tumor

155

What are the most common Non-Odontogenic Cysts?

  • Nasopalatine Duct Cyst, medial palatal cyst
  • Nasoalveolar Cyst, lacrimal duct cyst
  • Nasolabial Cyst
  • Stafne Defect/Lingual Mandibular Salivary Gland Defect

156

Regarding an MRI weighting and enhancements, what does a T1 image help with?

  • "Fat Image"
  • Differentiate water from fat
  • Highlights differences in soft tissue densities

157

What is the importance of understanding HPV-related oropharyngeal cancer?

  • Overlaps other malignancies in location (tonsils… lymphoma)
  • Higher stage on diagnosis (often detected first as metastatic disease to lymph nodes of head and neck)
  • Often requires additional diagnostic tests (PET/CT or ENT endoscopy to locate unknown head/neck primary)
  • Higher 5-year survival rates
  • Vaccinations are available for HPV-related disease; long term preventive and therapeutic benefits are well
    documented in HPV-related cervical cancer and pathophysiology of HPV-related disease in other sites such as anal
    cancers, oropharyngeal and nasopharyngeal cancers may herald similar results [long term studies are ongoing]
  • HPV salivary testing is available; it’s highly specific and sensitive but there is little to no evidence base for
    predictive value (just because HPV is detected in saliva, there’s no known correlation with disease)
  • There are social, moral, ethical and religious implications and as such we must be sensitive to our patients and their
    beliefs

158

What is going on here?

Herpes Zoster

159

What is going on here?

Metastatic Adenocarcinma

56 yo M being treated for "cancer" with extensive caries; periapical tissues #31 submitted for histologic evaluation

160

What is going on here?

Lichenoid Mucositis

161

What is going on here?

Herpes Zoster

162

What are some Autoinflammatory Ulcerative Disorders?

  • Apthous Stomatitis 
  • Bachet's Disease
  • Lichenoid Mucositis

163

What are the most common sites for Malignancy regarding Salivary Gland Tumors?

  • Sublingual Gland: 70-90% (usually malignant)
  • Minor Glands: 46-82% (50/50)
  • Submandibular: 37-45% (50/50)
  • Parotid: 15-32% (usually benign)

164

What is going on here?

What can asymmeric tonsils suggest?

  • Tonsillolith
    • Tonsilloliths
    • HPV-related carcinoma
    • Lymphoma

165

What is going on here?

Dentin Dysplasia

166

How do Viral Diseases commonly present in the oral cavity?

  • Single or multiple coalescing ulcers
  • Usually (but not always) on 'attached/keratinized mucosa'
    • Gingiva
    • Tongue
    • Palate
  • Primary forms may occur anywhere in the oral cavity

167

What are 3 Dentin Defects?

  • Consider Dentinogenesis Imperfecta
  • Consider Dentin Dysplasia
  • Consider Osteogenesis Imperfecta

168

What is going on here?

Osteo (chemo) necrosis

72 yo M, non-healing extraction site, history of myeloma and IV zolendronic acid exposure (bisphosphonate)

169

Describe a Peripheral Ossifying Fibroma...

  • Usually pink to red
  • Associations: none specific
  • Histology: bone or dystrophic calcifications (make a radiograph)

170

What is going on here?

Necrotizing Sialometaplasia

(47 yo M, palatal mass)

171

What is going on here?

Multiple Myeloma

67 yo F, history of myeloma; prior fractures of L mandible

172

Regarding MRI weight and enhancements, what does a T2 image help with?

  • "Water Image"
  • Differentiate water from fat
  • Highlights edema
  • Highlights CSF

173

What oral pathology is this picture related to?

Pemphigoid

174

What is going on here?

Recurrent Herpes Labialis

175

What is the most common site of Salivary Gland Tumors?

  • Parotid: 64-80%
  • Minor glands: 9-23%
  • Submandibular: 8-11%
  • Sublingual: 0.3-1%

176

What is a Nikolsky sign?

Is dislodgment of intact superficial epidermis by a shearing force, indicating a plane of cleavage in the skin at the dermal-epidermal junction. The histological picture involves thinner, weaker attachments of the skin lesion itself to the normal skin, resulting in easier dislodgement

177

What is HHV-1 (HSV-1) associated with?

Human Herpes Simplex Virus, Type 1

178

What is going on here?

Herpes Zoster

179

Do restorations need to be replaced in asymtomatic cases of Lichen Planus?

  • No; however, lichenoid or interface mucositis as a histologic diagnosis is made in several situations and the clinician may
    need to investigate and ask the patient questions:
    • Lichen planus, both oral and dermatologic (may also associate with eczema and psoriasis)
    • Lichenoid reaction to mouthwash, dentifrice, dietary elements (ex. cinnnamon)
    • Lichenoid reaction to topical and systemic medications
    • Tobacco (both smoked and inhaled) and vaping products
    • Autoimmune diseases such as systemic lupus
    • Graft versus host disease in the context of marrow transplant

180

What view is this?

Sagittal

181

What is going on here?

How would you manage this?

Oral Candidiasis (erythematous)

  • Sample the patient
  • Sample the prosthesis
  • Request study for Candida

182

What is the most common Odontogenic Cyst?

Periapical Cyst

183

Describe Squamous Papillomas...

  • Papillary (bumpy), usually white to pink
  • Associations: Human Papillomavirus 6, 11 (low risk)
  • Histology: bland papillary fronds, viral effects on nuclei

184

What are some treatment complications regarding antibiotics?

  • Fungal infections
  • Decreased efficacy of birth control
  • Erythema multiforme reactions

185

What are the chances of RANKL inhibitors like Denosumab which is used in Osteoporosis causing Medication Related Osteonecrosis of the jaw?

0.017 - 0.04%

186

What is going on here?

Osteomyelitis

67 yo F presented with associated pain and fever

187

What is going on here?

Focal Cemento - Osseous Dysplasia

188

What is going on here?

10 yo, multiple Odontogenic Keratocysts, front bossing, calcified falx (NBCCS)

189

What is going on here?

Amelogenesis Imperfecta (Hypoplastic)

190

What solution is used for immunofluorescence?

  • Michel's solution (presevative)
  • Potassium citrate buffered

191

What is going on here?

Calcifying or Ghost Cell Odontogenic Cyst 12 yo

  • May mimic dentigerous cyst or 'AOT', often associated with impacted tooth

192

Can you name some Benign Salivary Gland Tumors?

  • Pleomorphic Adenoma
    • Myoepithelioma
  • Warthin Tumor
  • Oncocytoma
  • Monomorphic Adenoma
    • Canalicular Adenoma
    • Basal Cell Adenoma
    • Trabecular Adenoma
  • Cystadenoma

193

What does a Honeycomb Pattern apperance suggest?

Hemangioma / AV Malformation

Ameloblastoma

194

What is going on here?

Gladnular Odontogenic Cyst

  • Developmental cyst; most often 6th decade up 

195

What is going on here?

Nasopalatine Duct Cyst

 

196

What is going on here?

Osteosarcoma

Patient presented with pain, expansiona and sensory changes

  • Consider Osteosarcoma:
    • PDL widening
    • Suprecrestal bone
    • "Sun Ray" and sensory changes

197

What is going on here?

Pyostomatitis Vegetan (ulcerative colitis)

198

What is going on here?

Recurrent Herpetic Gingivostomatis

199

What is going on here?

  • Diagnosis: Geographic Tongue/Migratory Glossitis/Erythema Migrans
  • Differential Diagnoses:
    • Geogrpahic tongue/migratory glossitis/erythema migrans
    • Nutritional disorder
    • Exclude taste or sensory changes that may suggest 'burning mouth syndrome'

200

What is going on here?

Lymphangioma

201

If you see gingival lesions present (erythema/ulcer/vesicle) would should you favor?

Virus, Not Apthous!

202

What are 3 terms to describe images in Plain Radiography?

  • Radiopaque
  • Radiolucent
  • Mixed density

203

What is going on here?

Melanotic Macule

204

What is going on here?

Osteo (chemo) necrosis

69 yo F, exposed bone R maxilla, history of lung cancer with bone metastases, IV Zometa treatment

205

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

206

What is going on here?

Amelogenesis Imperfecta (Hypoplastic)

207

What is going on here?

Paraneoplastic Pemphigus

208

What is necrotizing sialometaplasia typically associated with?

  • Viral Infections
  • Local Ischemia
  • Anorexia/Bulimia Nervosa

209

What is going on here?

Herpes Zoster

210

What is going on here?

White Sponge Nevus

211

What is going on here?

Squamous Papilloma

212

What is going on here?

Simple/hemorrhagic/idiopathic/trauamtic/bone cyst

Surgeon reports entering into an empty cavity...

213

What are the most common benign and malignant salivary gland tumors respectively?

  • Pleomorphic Adenoma (mixed tumor)
  • Mucoepidermoid Carcinoma

214

What is going on here?

Melanotic Macule

215

What is going on here?

Langerhans Cell Histiocytosis (mimicking periapical lesion)

216

What is going on here?

Squamous Cell Carcinoma

217

What is going on here?

Pemphigus

218

What is going on here?

48 yo M, multiple nodules, face/upper extremities

Neurofibromas associated with Neurofibromatosis Type I

219

What are 4 Soft Tissue Masses that are Developmental in orgin?

  • Lymphoepithelial Cyst
  • Gingival Cyst
  • Nasolabial Cyst
  • Fordyce Granules

220

What is going on here?

Stafne Defect

  • Lingual Mandibular Salivary Gland Defect

221

What is going on here?

Ameloblastoma (crossing the midline)

  • Most common odontogenic tumor

222

What does "PET" stand for?

What does it assess?

  • Positron Emission Tomography
  • Assess metabolic activity and physiologic function

223

What is going on here?

Mucosal Burn (thermal/pizza)

224

What does this image depict?

Hypercementosis

225

What is going on here?

Polymorphous Adenocarcinoma

226

What view is this?

Volume Render

227

Describe Peripheral Odontomas...

  • Pink to red
  • Associations: none specific
  • Histology: depends on the tumor!
  • Consider odontomas (make a radiograph)
  • Consider ameloblastomas, odontogenic kertocysts, etc

228

What contrast mediums are used for an MRI?

  • Godalinium
  • Iron oxide, Iron platinum
  • Manganese

229

What is going on here?

Ranula (mucocele)

230

What is going on here?

Primary Herpetic Gingivostomatis

231

What is this an image of?

  • T2 
  • Fat suppression
  • Squamous cell carcinoma, base of tonuge

232

What is this?

What would you consider doing about it?

  • Fibroma
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

233

What is going on here?

Ameloblastoma (in the periapical position)

  • Most common odontogenic tumor

234

What is going on here?

Oral Candidiasis

(Pseudomembranous, secondary to inhaled corticosteroids)

235

What is Amelogenesis Imperfecta associated with?

  • Taurodontism
  • Hair, nail and ectodermal defects (including ectodermal dysplasia)
  • IS NOT associated with osteogenesis imperfecta

236

What do you know about Pemphigoid?

  • Autoimmune process (against basement membrane components)
  • Look for bullae (blisters or large vesicles) elswhere
  • Look for other mucosal lesions (ocular, intranasal)
  • You may elicit a Nikolski (blister formation)
  • Histology: subepithelial split

237

What is going on here?

Squamous Cell Carcinoma (Stage IV: cancer invades osseous structures)

238

For a fibroma, is excisional or incisional biopsy indicated?

Are there other things to look for?

  • Excisional biopsy; this is favored to be benign and excisional biopsy provides both diagnosis and treatment
  • Yes; any fractured cusps, prosthetic clasps, sources of trauma should be resolved to minimize recurrence

239

What's the significance of Neurofibromatosis?

  • NF (type I) is associated with mucosal and skin neurofibromas
  • The significance lies with an association with these neurofibromas trnasforming to sarcomas and with multiple bening and malignant nerve tumors in areas such as the GI tract
  • Dentists may recognize the neurofibromas as well as cafe-au-lait spots

240

What can you take for pain if you have Osteoid Osteoma?

  • Pain responsive to aspirin/NSAIDs
  • Lesion thought to produce prostaglandins (pain mediators)

241

Observe this helpful image...

242

What is going on here?

Medication Induced Pigmentation (quinine)

243

What is going on here?

Lichenoid Mucositis

244

How wold a lymphoma be treated differently (if at all) from a salivary tumor?

  • Salivary tumors are typically treated surgically (excision), + lymph node dissections if encountered
  • Lymphoma, though potentially excisable, will often also have associated bone marrow analysis (to exclude marrow or
    leukemia involvement)
  • In either case, distant metastases may require chemotherapy and/or radiation therapy
  • IMPORTANT: nodules can be many things; salivary gland tumors and lymphomas can both occur in the oral cavity and
    present as soft tissue nodules, ulcerated or fiungating masses, or resemble other cancers

245

If you see multiple Odontogenic Keratocysts...consider...

Nevoid Basal Cell Carcinoma Syndrome

246

What is going on here?

Lichenoid Mucositis

247

What is the % chance of getting medication relatd osteonecrosis of the jaw after taking IV Zolendronic acid?

0.7 - 6.7%

248

Does 'burning mouth syndrome' require treatment, and by whom?

  • It may, especially if it’s a component of nutritional, anxiety or other disorders
  • Diagnosis and treatment is controversial but may be associated with neuropathies and rheumatologic disorders in a
    Specific patient population
  • Engage primary care, neurology and rheumatology; these providers may aide in management and medications used
    (such as anti-anxiety medications) may best be prescribed by them

249

What is going on here?

Focal Cemento-Osseous Dysplasia or Ossifying Fibroma

250

What is going on here?

Fibrous Dysplasia

251

What is going on here?

Ameloblastoma (in the periapical position)

  • Most common odontogenic tumor

252

What is the % chance of getting medication related osteonecrosis of the jaw from oral bisphosphonates?

0.00038-0.21%

253

What are some treatment complications for antifungals?

Liver Toxicity

254

What is going on here?

Adenoid Cystic Carcinoma

255

What is going on here?

12 yo, muiltiple odontogenic keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

256

What is going on here?

Nasopalatine Duct Cyst

257

What is going on here?

Primary Herpetic Gingivostomatis

258

If you see multiple osteomas, odontomas, unerupted supernumerary teeth...consider...

Garnder Syndrome

Potential for malignant GI polyps

259

What is going on here?

Sialolith

(painful hard nodule, floor of mouth)

260

What is going on here?

Osteo (chemo) necrosis

69 yo F, exposed bone R maxilla, hisotry of lung cancer with bone metastases, IV Zometa treatment

261

What is going on here?

Carcinoma In Situ

  • Differential Diagnoses
    • Exclusion of malignancy in an otherwise unexplinable red/white lesion

262

What is going on here?

Osteo (chemo) necrosis

72 yo M, non-healing extraction site, history of myeloma and IV zolendronic acid exposure (bisphosphonate)

263

What is going on here?

Where else can these be found?

  • Lymphoepithelial Cyst
    • Adenoids
    • Palatine Tonsil
    • Lingual Tonsil
    • Foliate Papillae

264

What does a Ground/Etched glass/Orange Peel appearance suggest?

Fibrous Dysplasia

265

What is going on here?

Gingival Overgrowth (leukemic infiltrate)

266

What are 3 Soft Tissue Masses that are reactive?

  • Fibroma
  • Pyogenic Granuloma
  • Mucocele

267

What does a Symmetric PDL widening suggest?

Osteosarcoma

Chrondrosarcoma

268

What is going on here?

Multiple Odontogenic Keratocysts; consider nevoid basal cell carcinoma syndrome

269

What is going on here?

Osteomyelitis

Patient presented with associated pain and fever

270

What does Onion Skin Opacification apperance go with?

Osteomyelitis with Proliferative Periostitis

Ewing Sarcoma

271

What is going on here?

7 yo, multiple central giant cell granulomas - cherubism

272

What is Clobetasol?

  • This medication is used in adults to treat a variety of skin conditions (such as eczema, dermatitis, psoriasis). 
  • Clobetasol reduces the swelling, itching and redness that can occur in these types of conditions.
  • This medication is a very strong (super-high-potency) corticosteroid.

273

What is going on here?

Traumatic Ulcer

274

Observe the flow of treatment...

275

What is going on here?

Condyloma Acuminatum (human papillomavirus)

276

What is going on here?

Apthous Ulcer (apthous stomatitis)

277

What structures do malignant lesions typically travel to?

  • Breast
  • Lung
  • Thyroid
  • Colon 
  • Kidney
  • Prostate

278

What is going on here?

Periapical Cemento-Osseous Dysplasia

279

What does this image depict?

Dense Bone Island (another variant)

280

What is going on here?

HPV - Related Squamous Cell Carcinoma

281

What is going on here?

Herpes Labialis and Whitlow

282

What are the 2 types of Mucoceles?

Which one is the most common?

  • Extravasation Type
    • Mucus pooling outside the duct system
    • Most common type of mucocele
  • Retention Type
    • Mucus pooling within the duct system
    • May see terms ductal ectasia, salivary duct cyst or cystadenoma (describe increasing dilation of the duct)

283

What is going on here?

Mucocele

284

What is going on here?

Syphilis (Treponema)

  • Primary
    • Chancre
  • Secondary
    • Mucus patch
    • "Split papule"
    • Condyloma lata
  • Tertiary
    • Gumma
  • Congenital
    • Dental deformities
    • Developmental delay

285

How would treatment differ between apthae from viral ulcers?

  • Acyclovir 400-800mg, DISP 25 tabs, SIG take 1 (one) tablet 5 (five) times per day, REFILLS = 1 (one)
  • Valacyclovir 1000mg, DISP 4 (four) tabs, SIG take 2 (two) immediately then 2 (two) 12 hours later
    REFILLS = 1 (one)
  • Valacyclovir (Valtrex) may be exended to twice per day for immunosuppressed, recurrent cases
  • There is no evidence base for efficacy of either drug over the other; both are equally effective but patient compliance may improve with a twice per day regimen rather than 5 times per day

286

What is going on here

Dentigerous (follicuar) cyst

Developmental cyst; most common developmental odontogenic cyst - usually simple cyst lining

287

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

288

What does this image depict?

Dense Bone Island (one variant)

289

What are some different 'liths' you could note in your differential diagnosis list?

  1. Sialoliths
  2. Rhinoliths
  3. Antroliths

Other Include:

  • Tonsilloliths
  • Phleboliths
  • Choristomas (osseous, chondroid)
  • Stylohyoid Ligament
  • Vascular Calcifications
  • Lymph Nodes
  • Foreign Bodies

290

What types of treatment can be performed for Squamous Cell Carcinoma?

  • Surgery
  • Chemotherapy (often therapies are now personalized or targeted)
  • Radiation therapy (often this is intensity modulated radiotherapy or IMRT, and spares many tissues
  • Effects may include:
    • Mucositis that may mimic other oral ulcerative diseases
    • Xerostomia and xerostomia-related caries
    • GI disturbances (nausea, vomiting)
    • Dermatopathologic changes (hair loss, skin ulcerations, etc.)
    • Poor wound healing
    • Secondary malignancies (radiation induced sarcomas, chemotherapy induced leukemia, etc.)

291

What is going on here?

Cryoptococcus

292

What is going on here?

Mucocele

293

What is going on here?

Dentigerous Cyst

  • Developmental cyst; most common developmental odontogenic cyst 

294

What is going on here?

How would you treat this?

  • Differential Diagnoses:
    • Apthous ulcer/apthous stomatitis
    • Traumatic ulcer (physical, thermal, chemical)
  • Suggestions focus on topical corticosteroids and include:
    • Flucinonide 0.05% gel, DISP 30 gram tube, SIG apply to affecged area twice per day, refills = 1
    • Clobetasol Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, Refills = 1
  • Note that both may result in oral candidiasis (thrush); this may be treated with a topical antifungal
  • This case also affords opportunity to discuss approprite prescription writing

295

What does a Cotton Wool Opacification appearance go with?

Paget's Disease

296

What is going on here?

Cementoblastoma

297

What are some contraindications/conerns for MRI imaging?

  • Allergy less a concern
  • Pacemakers
  • Metallic (cochlear) implants
  • Aneurysm clips

298

What is HHV-3 associated with?

Varicella Zoster Virus

299

What is going on here?

Pemphigoid

300

What is going on here?

Minocycline Pigmentation

301

What is going on here?

Physiologic Pigmentation

302

What is going on here?

Cat Scratch Disease (Bartonella)

303

What is this?

What would you consider doing about it?

  • Squamous Papilloma
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

304

What is going on here?

Antral Pseudocyst

(59 yo F, incidental radiographic finding)

305

What are 3 Autoimmune Ulcerative Disorders?

  • Pemphigus
  • Pemphigoid
  • Systemic Lupus

306

What are the 3 Ps?

  • Pyogenic Granuloma
  • Peripheral Ossifying Fibroma
  • Peripheral Giant Cell Granuloma

307

What are some characteristics of Ossifying Fibroma?

  • May vary in radiodensity but usually have some radiopaque component
  • Often expansile
  • May be symptomatic 
  • Usually do not affect tooth vitality (test for it!)
  • Usually do not affect the PDL (make periapical XRs!)
  • Often displace teeth as they expand
  • Often excised as a discrete (firm/fibrous) mass

308

What is going on here?

Melanoma in situ

309

What is this?

Fibroma

310

Observe the flow of treatment...

311

What is going on here?

Ameloblastic Fibroma 12 yo

  • Often first 2 decades, often impaction or failure of eruption

 

312

Can you name some Malignant Salivary Gland Tumors?

  • Mucoepidermoid Carcinoma
  • Adenoid Cystic Carcinoma
  • Polymorphous Adenocarcinoma
  • Acinic Cell Adenocarcinoma
  • Carcinoma ex. mixed tumor
  • Salivary Duct Carcinoma
  • Epithelial-Myoepithelial Carcinoma

313

What are some chaacteristics of Paget's Disease?

  • More often ill-defined (as compared to the other BFOLs)
  • May vary in radiodensity
    • The term "cotton wool" is used for Paget's Disease
  • May be symptomatic (if impinging on nerves)
  • May affect the PDL (make periapical XRs!)
    • Often will result in loss of all PDL architecture
  • Often displace teeth as they expand
  • Age is not necessarily helpful as these lesions can expand, 'recur' and continue to present throughout life
  • A diagnosis warrants full body evaluation for polyostotic disease and possibly other disturbances (endocrine)

314

What are 2 terms to describe images in MR imaging?

  • High signal intensity
  • Low signal intensity

315

What is going on here?

Fibrous Dysplasia

316

Is an Odontoma considered a Hamartoma?

What is a Hamartoma?

  • Odontomas are often considered Harmartomas
  • Harmartomas (normal tissue, but malformed or excess)

317

What does an MRI highlight?

  • Soft tissues
  • Bone appears dark on image
  • Soft tissue appear lighter/whiter (high signal intensity)
  • Bone and air appear darker/black (low signal intensity)

318

If you see multiple Fibro-osseous/bone remodeling lesions consider...

Fibrous Dysplasia

Endocrine Disorder (McCune-Albright)

319

What is going on here?

Oral Mucosal Melanoma

Primary tumor circled, lymph node metastases arrows

320

What is going on here?

Granular Cell Tumor

321

What does this image depict?

Osteoblastoma

322

What does Snow driven/Snowplow Calcification apperance suggest?

CEOT

Celcifying Epithelial Odontogenic Tumor

323

What is the difference between a Cementoblastoma and Osteoblastoma?

  • Union of the lesion with the root = cementoblastoma
  • Lesion discrete from root = osteoblastoma

324

Can you describe some of the symptoms of Sjogren's Syndrome?

  • Ocular Symptoms
    • Dry eyes
    • Need artificial tears
  • Oral Symptoms
    • Dry mouth sensation
    • Frequent liquid intake

325

What is going on here?

Metallic Tattoo

326

When you have an absense of PDL, one would think which two pathologies?

  • Hyperparathyroidism
  • Osteodystrophy

327

What is going on here?

Odontogenic Keratocyst (appearing in the "dentigerous' position)

328

Observe the flow of treatment...

329

What is the significance of Central Giant Cell Granulomas + cherubism in a child?

  • Cherubism is a syndrome with a genetic association; these children often have endocrinopathies

330

What does a Soap Bubble Trabeculation apperance suggest?

Ameloblastoma

331

What is going on here?

Ameloblastic Fibrom-Odontoma 14 yo

Image seen with Odontoma Component

332

What is going on here?

How would you manage this?

Oral Candidiasis (Erythematous)

  • Sample the patient
  • Sample the prosthesis
  • Request study for Candida

333

In the world of Herpesviruses, what are associated with HHV-5 through HHV-8?

 

  • HHV-5 (CMV): Ocular Disease, Herpangina-like diseases
  • HHV-6: Pediatric skin rashes (roseola)
  • HHV-7: Pediatric skin rashes (roseola)
  • HHV-8 (KSV): Kaposi sarcoma, some lymphomas

334

What is going on here?

Melanotic Macule

335

The best oral cancer diagnostics will have high or low sensitivity and specificity?

The best tests will have high sensitivity and high specificity

336

What is HHV-2 (HSV-2) associated with?

Human Herpes Simplex Virus, Type 2

337

What is going on here?

Lichenoid Mucositis

338

What is going on here?

10 yo, multiple Odontogenic Keratocysts, front bossing, calcified falx (NBCCS)

339

What is going on here?

Focal Cemento-Osseous Dysplasia or Ossifying Fibroma

340

What is going on here?

  • Geographic Tongue
  • Erythema Migrans or Migratory Glossitis

341

What is going on here?

Osteosarcoma

49 yo F, enlargement of L mandible, with aching pain

  • Consider Osteosarcoma
    • PDL widening
    • Suprecrestal bone
    • "Sun Ray" and sensory changes

342

What's the significance of multiple endocrine neoplasia?

  • MEN type IIb (III) is associated with mucosal neuromas
  • The significance lies not with the neuromas but with endocrine tumors such as pheochromocytoma and thyroid medully carcinoma
  • Dentists may recognize the neuromas as well as the cafe-au-lait spots described in this syndrome and other endocrine syndromes such as McCune-Albright Syndrome (fibrous dysplasia, cafe-au-lait spots, endocrinopathies)

343

What is going on here?

Odontogenic Kertocyst (appearing in the 'primordial' or 'residual' position)

344

What is this an image of?

T2 of an Medulloblastoma

Highlights edema, highlights CSF

345

What is going on here?

What should you do about it?

  • Mucosal Slough
  • Consider:
    • Bleaching
    • Mouthwash
    • Dentifrice
    • Dietary

346

What is going on here?

Periapical (radicular) Cyst

Inflammatory cyst; most common odontogenic cyst

347

What are 4 causes of Traumatic Ulcertive lesions?

  • Physical
  • Thermal
  • Chemical
  • Electrical

348

What is going on here?

Garnder Syndrome, multiple osteomas and odontomas/supernumerary teeth

349

What is going on here?

Squamous Cell Carcinoma

350

What is going on here?

Hyperparathyroidism

39 yo M, parathyroid disease, elevated PTH; biopsy: central giant cell granuloma

351

What is going on here?

Amelogenesis Imperfecta (Hypoplastic)

352

What is going on here?

Smokeless Tobacco Use

353

What is going on here?

Langerhans Celll Histiocytosis (mimicing intrafurcal lesion in a 4 yo)

354

What is the diagnostic criteria for Nevoid Basal Cell Carcinoma?

  • Basal cell carcinoma before 20 years of age or excessive numbers of basal cell carcinomas out of proportion to prior sun exposure and skin type
  • Keratocystic odontogenic tumor before 20 years of age
  • Palmar or plantar pitting
  • Lamellar calcification of the falx cerebri
  • Medulloblastoma, typically desmoplastic
  • First degree relative with nevoid basal cell carcinoma syndrome

355

What are some signs and symptoms of Neurofibromatosis I?

  • Multiple neurofibromas
  • Cafe au lait spots (6 or more)
  • Axillary/inguinal freckling
  • Osseous (sphenoid) dysplasia
  • First-degree familial history

356

What is going on here?

Focal Cemento - Osseous Dysplasia

357

What is this?

What would you consider doing about it?

  • Fibroma (Giant Cell Type)
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

358

What cyst isn't truly a cyst but rather an anatomic variation?

Stafne Defect

When these cysts are located in proximity to teeth, it is advisable to test the teeth for vitality, consider periodontal probing, gutta percha tracting (radiograph) and evaluate the periodontal ligament space (best accomplished with a periapical radiograph

359

What is going on here?

Traumatic Ulcer

360

What is going on here?

 

  • Differential Diagnoses
    • Multiple Fibromas
    • Neuromas (and exclusion of endocrine neoplasia syndromes)
    • Neurofibromas (and exclusion of neurofibromatosis)

361

What is going on here?

Gardner Syndrome, multiple osteomas and odontomas/supernumerary teeth

362

What do you know about Erosive Lichen Planus?

  • Thought to be a T-cell mediated process
  • Look for a striated component somewhere else (buccal mucosa)
  • Look for restorations (including composites) nearby
  • You may elicit a Nikolski (blister formation)

363

What is going on here?

Dentinogenesis Imperfecta with Opalescent Dentin

364

What does CT stand for regarding imaging?

What contrast can you use with it?

  • Computed Tomography 
  • Without contrast
  • With contrast
    • Iodine (Isovue)
    • Barium Sulfate

365

What does a Motheaten Radiolucency apperance suggest?

Osteomyelitis

Ewing Sarcoma

366

What would you call the foreign body in this Pano?

Sialolith

367

What is going on here?

Melanocytic Nevus ('mole')

368

What are some characteristics of Cemento Osseous Dysplasia?

  • Usually non-expansile
  • Usually asymptomatic 
  • Usually do not affect tooth vitality (test for it!)
  • Usually do not affect the PDL (make periapical XRs!)
  • Often excised in multiple fragments
  • Gender and ethnicity not as helpful as though
    • Do tend to bre more common in black, Hispanic, Oriental
    • Do tend to be more common in females

369

What is the most common Developmental Odontogenic Cyst?

Dentigerous Cysts

370

What view is this?

Axial

371

What are some characteristics of Fibrous Dysplasia?

  • More often ill-defined (as compared to the other BFOLs)
  • May vary in radiodensity
  • The term "ground glass/orange peel" is used for fibrous dysplasia
  • May be symptomatic (if impinging on nerves)
  • May affect the PDL (make periapical XRs!)
  • Often will result in loss of all PDL architecture
  • Often displace teeth as they expand
  • Age is not necessarily helpful as these lesions can expand, 'recur' and continue to present throughout life
  • A diagnosis warrants full body evaluation for polyostotic disease and possibly other disturbances (endocrine)

372

What is going on here?

Florid Cemento - Osseous Dysplasia

373

How can Bacterial Diseaeses present in the oral cavity?

  • Perioral Dermatitis (lip licking, often circular erythema around one or more lips)
  • Impetigo (lips, face, often crusted or 'corn flake' appearance)
  • Fungating and granulomatous ulcers
  • Non-healing sites of trauma (denture sores)
  • Non-healing sites of surgery (extractions, periodontal)
  • Palatal perforation

374

What is an MRI best used for?

Better soft tissue contrast

375

What is going on here?

Mixed Tumor (pleomorphic adenoma)

376

Observe the flow of treatment...

377

What is going on here?

Carcinoma in situ

378

Does Geographic Tongue require interevention?

  • No; however, a history and questions to exclude nutritional deficiency, burning mouth, etc. may be warranted
  • Geographic tongue has also been reported to have association with psoriasis in some studies

379

What is going on here?

Cherubism (bilateral central giant cell granulomas)

380

What is going on here?

Ameloblastoma (in the dentigerous position)

  • Most common odontogenic tumor

381

What is going on here?

Odontogenic Kertocyst (appearing in the 'lateral periodontal" position)

382

What is going on here?

Myoepithelioma

383

What does a Snowflake Calcification apperance suggest?

AOT

Adenomatoid Odontogenic Tumor

384

What is going on here?

Squamous Cell Carcinoma

385

What is going on here?

Paraneoplastic Pemphigus

386

What is going on here?

Cementoblastoma

387

What is going on here?

Lichenoid Mucositis

(with associated eczema/psoriasis)

388

How do you distinguish apthae from viral ulcers?

 

  • Apthae typically do not affect the gree gingiva; when gingival ulcerations are present, along with fever/malaise, a viral origin should be considered

389

What is going on here?

What are 3 differentials?

  • Tonsillar Hyperplasia
    • Hyperplasia (sleep apnea)
    • Tonsilloliths
    • Tonsilitis

390

What odontogenic cysts has the highest recurrence rate?

Ameloblastoma

30-90%

Odontogenic Keratocyst

5% up to 60%

391

What is going on here?

Dentinogenesis Imperfecta with Opalescent Dentin

392

What is going on here?

Histoplasma

393

What is going on here?

Mucosal Burn (aspirin)

394

What is going on here?

Syphilis (Treponema)

  • Primary
    • Chancre
  • Secondary
    • Mucus patch
    • "Split papule"
    • Condyloma lata
  • Tertiary
    • Gumma
  • Congenital
    • Dental deformities
    • Developmental delay

395

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

396

What is going on here?

Central Giant Cell Granuloma

397

What is the most common non-odontogenic cyst?

Nasopalatine Duct Cyst

398

What is going on here?

Erythema Multiforme

399

What is going on here?

Gingival Overgrowth (local factors)

400

What is this?

Pyogenic Granuloma

401

What is going on here?

Fibroma

402

What is going on here?

Melanoacanthosis

403

What is going on here?

Fibrous Dysplasia

404

What is this?

What would you consider doing about it?

  • Fibroma, Odontogenic Type
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

405

What are the high risk sites in the oral cavity?

  • Lateral/ventral tongue (50%)
  • Floor of mouth (35%)
  • Oropharynx
  • Retromolar trigone

406

What is going on here?

Syphilis (Treponema)

  • Primary
    • Chancre
  • Secondary
    • Mucus patch
    • "Split papule"
    • Condyloma lata
  • Tertiary
    • Gumma
  • Congenital
    • Dental deformities
    • Developmental delay

407

What is going on here?

What are 4 other differentials this could be?

  • Epidermoid Cyst
  • Midline Developmental Cysts:
    • Epidermoid Cyst
    • Dermoid Cyst
    • Cystic Teratoma
    • Thyroglossal Duct Cyst

408

What is the most common Odontogenic Tumor

Ameloblastoma

409

What is going on here?

Pemphigoid

410

What is going on here?

  • Dx: Lichenoid Mucositis
  • Differential Diagnoses:
    • Lichen planus or other inflammatory/immune mediated diseases
    • Lichenoid reaction to dental materials, dentifrice, mouthwash, medications, etc.
    • Frictional keratosis

411

Describe a Giant Cell Fibroma...

  • Papillary (bumpy), usually pink
  • Associations: none specific
  • Histology: enlarged/stellate/multinucleated fibroblasts

412

What is going on here?

Focal Cemento-Osseous Dysplasia or Ossifying Fibroma

413

What is going on here?

  • Diagnosis: Lymphoma
  • Differential Diagnoses:
    • Lymphoma
    • Oropharyngeal or nasopharyngeal carcinoma (esp. HPV-related carcinoma)
    • Infectious and Inflammatory (fungal, bacterial, tonsillitis, tonsillolith, etc.)

414

Describe a Pyogenic Granuloma...

  • Usually red, often ulcerated, bleed easily
  • Associations: Trauma, poor hygiene, pregnancy
  • Histology: granulation tissue

415

Where is necrotizing sialometaplasia typically found?

  • Most often on palata
  • Cases reported in tongue and in prior surgical sites

416

What is going on here?

Apthous Ulcer (apthous stomatitis)

417

What is going on here?

  • Natural Killer/T Cell Lymphoma
  • Palatal perforation and midline/nasal destructive lesion

418

Does necrotizing sialometaplasia or a mucocele require treatment? If so, what?

  • Because either of these entities can resemble a nodule, ulcer or even cancer, at minimum an (incisional) biopsy is
    indicated to exclude these other entities
  • NSM will often resolve once the inciting agent/process resolves or runs its course (ischemia, trauma) but NSM may be
    associated with infections (often viral) or eating disorders (anorexia, bulimia) so those may require intervention
  • A mucocele may be associated with an obstruction (sialolith, mucus plug, mass/tumor in the area); this may require
    removal of the obstruction and/or excision of the gland; additionally, removal of any feeder glands is recommended to
    minimize recurrences

419

What are the chances of a RANKL inhibitor like Denosumab which can be used to treat cancer of causing Medication Related Osteonecrosis of the Jaw?

0.7 - 1.9%

420

In regards to MRI weight and enhancements what does a "FLAIR" image stand for and help visulize?

  • Fluid Attenuated Inversion Recovery
  • Suppressed fluid/water signals
  • ex. brain imaging, to suppress CSF and highlight intracranial pathology

421

What is the suggested treatment for Lichenoid Mucositis?

  • Option A
    • Fluocinonide (Lidex), 0.05% gel
      • Apply to affected areas 2-3x per day
    • Doxycycline (Periostat) 20 mg
      • 2x per day
  • Option B
    • Clobetasol (Temovate), 0.05% gel
      • Apply to affected areas 2-3 times per day
    • Doxycycline (Periostat) 20 mg
      • 2x per day
  • Caution: Oral Candidiasis

422

What are the main etiology/factors that contribute to oral cancer?

  • Tobacco
  • Alcohol/phenols
  • Betel nut
  • Radiation
  • Vitamin Deficiency
  • Genetics
  • Immunosuppression
  • Infectious agents (esp. HPV, HHV-8, EBV)

423

What is this and what would you consider?

  • Hemangioma
  • Diascopy
    • Diascopy is a test for blanchability performed by applying pressure with a finger or glass slide and observing color changes. It is used to determine whether a lesion is vascular, nonvascular, or hemorrhagic. Hemorrhagic inflammtory lesion and nonvascular lesions do not blanch; inflammatory lesions do.

424

What is staging of cancer and why is it important?

  • Tumor size (T), presence of involved lymph nodes (N) and metastasis (M) are married as a group of histologic,
    microscopic and advanced imaging studies (MRI, PET, CT scan) to determine a stage; higher stage tumors herald lower
    (5 year) survival rates and may drive additional therapy (surgery, chemotherapy, radiation therapy, targeted therapy)

425

What is going on here?

Paraneoplastic Pemphigus

426

What are some characteristics of Osteoblastoma/Cementoblastoma/Osteoid Osteoma?

  • May vary in radiodensity but usually have some radiopaque component
  • May be expansile
  • May be symptomatic
  • May affect tooth vitality (test for it!)
  • May affec the PDL (make periapical XRs!)
  • May displace teeth if they expand
  • Cementoblastoma excised attached to the tooth
  • Osteoid osteoma are often (but not always) painful

427

What is this?

Necrotizing Sialometaplasia

(40 yo M, sudden onset of pain/swelling)

428

What is going on here?

Florid Cemento - Osseous Dysplasia

429

What is going on here?

Dense Bone Island/Idiopathic Osteosclerosis

430

What is going on here?

Paraneoplastic Pemphigus

431

What is this?

What would you consider doing about it?

  • Fibroma (Giant Cell Type)
  • Consider
    • Periodontal Probing
    • Periapical Radiographs
    • Vitality Testing

432

What is going on here?

Lichenoid Mucositis

433

What is HHV-5 associated with?

Cytomegalovirus

434

What is the suggested treatment of Viral Stomatitis?

  • Option A
    • Palliative
    • Analgesia
    • Contact percautions
  • Option B
    • Topical or systemic antiviral (most effective @ prodrome)
    • No significance acyclovir 5x/day vs. valacyclovir 2x/day
  • Consider:
    • Ophthalmology/Dermatology referral for zoster
    • Post herpetic neuralgia management

435

What does this image show?

Early to late Cemento Osseous Dysplasias (variations from radiopaque to mixed density to radiolucent)

436

What are 5 etiologies of Granulamatous Ulcerative Disorders?

  • Traumatic: Traumatic ulcer of tongue
  • Bacterial: Mycobacterium, Treponema, Actinomycetes
  • Fungal: Histoplasmosis
  • Sarcoidosis
  • Wegener's Granulomatosis

437

If you do not see gingival lesions, you should favor what?

Favor Apthous! Not Virus...

438

What are 5 Developmental Odontogenic Cysts?

  • Primordial (no tooth develops)
  • Dentigerous/follicular cyst
  • Odontogenic Keratocyst
  • Orthokeratinizing Odontogenic Cyst
  • Glandular Odontogenic Cyst

439

What are 3 Inflammatory Cysts?

  • Periapical Cyst
  • Buccal Bifurcation Cyst
  • Residual Cyst (remaining cyst after treatment)

440

What is going on here?

12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome

441

What is going on here?

Recurrent Herpes Labialis

442

What is going on here?

Pyostomatitis Vegetans (ulcerative colitis)

443

What are some common patient scenarios where you would likely encounter fungal infections?

  • Immune compromise (HIV/AIDS, organ/marrow transplant, marrow suppression)
  • Poorly controlled endocrine disorders (diabetes mellitus, etc.)
  • Antibiotic use
  • Oral inhaled steroid use (asthma)
  • Systemic steroid use (immunosupppresion for SLE)
  • Dental prostheses (i.e. poorly managed prostheses, overnight wear)
  • Substance abuse (ex. cocaine abuse)