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Oral Pathology (created by another user) Flashcards

1
Q

4 Most Common Non-Odontogenic Bone Pathology

A

Idiopathic Bone Sclerosis
Simple Bone Cyst
Fibrous Dysplasia
Focal cemento-osseous dysplasia

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2
Q

Idiopathic bone sclerosis

A

Focal solitary sclerotic lesion that arises in the late 1st or early 2nd decade of life

Radiopaque, well-defined lesion, localized, non-corticated at apex of vital teeth

Cause = unknown

Asymptomatic (not associated with inflammation, no root resorption or tooth displacement)

May remain static or demonstrate slow growth that usually stops with skeletal maturity

Location: posterior mandible, usually by 1st molar

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3
Q

Simple Bone Cyst

A

AKA Idiopathic bone cavity, solitary bone cyst

Well-defined radiolucent lesion with no effect on surrounding teeth and intact lamina dura

Cavity within bone that is lined with connective tissue (may be empty or contain fluid)

Not a true cyst

Cause = unknown

Occurs in first 2 decades of life

Females 2:1

Location: posterior mandible

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4
Q

Fibrous Dysplasia

A

Ill-defined, radiopaque lesion with “ground glass” or “orange peel”

Localized change in normal bone metabolism = replacement of all components of normal bone by fibrous tissue containing varying amounts of abnormal bone

More common in females

Asymmetrical and usually solitary (monostotic 70%)

Rarely associated with pain

Patients between 10-20 years old, may become active in pregnancy

Most common in maxilla

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5
Q

Focal cemento-osseous dysplasia

A

3 stages: radiolucent, mixed, radiopaque

Localized range in normal bone metabolism = replacement of components of normal bone with fibrous tissue and cementum-like material, abnormal bone or mix

Occurs near apex of tooth as incidental finding

Well-defined but irregularly shaped

More common in females 9:1, especially middle age, AA/Hispanic

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6
Q

What is the most common cyst in the jaws?

A

Radicular cyst

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7
Q

Radicular cyst

A

AKA periapical cyst, dental cyst

Cyst most likely originated when cell rests of Malassez of epithelial cells in PDL are stimulated to proliferate and undergo cyst degeneration by inflammatory products from a non-vital tooth

Asymptomatic unless it grows

60% in maxilla

Well-defined cortical border, if secondarily infected the inflammatory reaction may result in loss of bone

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8
Q

Buccal Bifurcation Cyst

A

Inflammatory odontogenic cyst that usually occurs at the buccal region of the first or second primary mandibular molar

Children 5-13 years of age

Delayed tooth eruption and swelling at the affected area is commonly observed

Well-defined radiolucent area, often corticated around the roots of the involved teeth

Treatment = surgical excision

Often associated with pulp therapy

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9
Q

2nd most common cyst in the jaw?

A

Dentigerous cyst

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10
Q

Dentigerous Cyst

A

Well-defined corticated radiolucency around crown of unerupted tooth

Begins from accumulation in layers of reduced enamel epithelium or between the epithelium and the crown of unerupted tooth

can displace and resorb teeth

DDX: hyperplastic follicle, OKC, cystic ameloblastoma

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11
Q

Odontogenic Keratocyst

A

Non-infammatory odontogenic cyst that arises from dental lamina

Well-corticated and radiolucent, minimal expansion but can resorb teeth

Unlike other cysts, OKC epithelium has innate growth potential

Most common in posterior mandible - epicenter is usually SUPERIOR to IA canal (inferior is salivary gland defect)

Slight male predilection

High recurrence

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12
Q

Naso-palatine canal cyst

A

Not an odontogenic cyst

Remnant of nasopalatine canal

Well-defined, corticated, circular or oval in shape (heart shape) radiolucent lesion

Can cause roots of central incisors to diverge, occasionally can resorb roots of incisors

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13
Q

Adenomatoid Odontogenic Tumor (AOT)

A

Frequently found in child or adolescent

Associated with maxillary canine

Unilocular, well-defined radiolucency - can later develop calcified “floccules”

Snowflake calcification

Tends to displace rather than resorb adjacent teeth

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14
Q

Ameloblastic Fibroma

A

Frequently in children and adolescents - uncommon overall

Unilocular, crenelated, or multilocular with well-delineated and corticated border

Homogeneous radiolucency

Commonly at angle of mandible

May cause displacement of teeth; less aggressive locally than non-unicystic ameloblastomas

Small, subtle calcifications in lesion (this is what makes it different from DC or OKC)

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15
Q

Odontoma - Compound

A

Malformation in which all dental tissues are represented in an orderly pattern

Many little tooth structures

More common than complex

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16
Q

Odontoma - Complex

A

Unorganized dental tissue pattern

Golf ball

Radiopaque surrounded by radiolucent area

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17
Q

Cementoblastoma

A

Slow growing mesenchymal neoplasm composed of cementum-like tissue and attached to apex of tooth root

Well-defined radiopaque lesion with cortical border

Most often in mandibular premolar/molar area

More common in males

Pulp vitality is unrelated - involved tooth is painful

Usually occurs before 18, in 2nd or 3rd decade of life

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18
Q

Ewing’s Sarcoma

A

Tumor of long bones that is relatively rare in jaws

Swelling, pain, loose teeth, paresthesia and trismus are clinical features

Radiographic features are radiolucency that is ill-defined and never corticated with destruction of bone, sunray appearance, floating teeth

Lesions arise in medullary portion of the bone and spread to endosteal and later periosteal surface

Most common in middle of second decade (15 years)

Males 2:1 affected

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19
Q

Acute Lymphocytic Leukemia

A

Malignant tumor of hematopoietic stem cells

Most common leukemia in children

Radiographic changes include periapical lesions, ill-defined radiolucent and radiopaque lesions

No expansion of bone, but displacement of unerupted teeth

Premature loss of teeth

Similar in appearance to hypophosphatasia

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20
Q

Hypophosphatasia

A

Alkaline phosphatase deficiency
Plays a role in bone mineralization

Multiple fractures, premature exfoliation of teeth

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21
Q

Epstein Pearls

A

Islands of epithelium that are trapped during fusion of palatal shelves

Palatal midline

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22
Q

Bohn Nodules

A

Arise from epithelial remnants from minor salivary glands

Junction of hard/soft palate; buccal or lingual surface of alveolar ridge (not crest) or in hard palate, away from midline

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23
Q

Gingival cyst of the newborn

A

AKA dental lamina cyst
Small keratin filled cysts found on alveolar mucosa of infants

Common - up to 50% of infants

Maxilla more common, no treatment necessary

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24
Q

Melanotic Neuroectodermal Tumor of Infancy

A

Relatively uncommon osteolytic - pigmented neoplasm

Primarily affects jaw of newborns

Locally aggressive, benign lesion of neural crest origin - high recurrence rate

High urinary excretion of vanilla-mandalic acid

Most common in anterior maxilla

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25
Congenital Epulis of the Newborn
Benign soft tissue tumor - AKA Gingival Granular Cell Tumor Almost exclusively on alveolar ridges of newborns - 3x more in maxilla Typically a pink, red smooth mass 9:1 female
26
Premature Teeth
Natal: Erupted deciduous teeth present at birth Neonatal: deciduous teeth erupting in first 30 days of life 85% primary mandibular incisors Rarely supernumerary teeth Etiology unknown Prevalence 1:2000
27
Hemangioma
Begins at birth, proliferates, than proliferation is reduced - many lesions will not require surgery 20% are disfiguring and can destroy normal tissue and compromise life of baby Etiology = unknown Follows branches of trigeminal nerve
28
What is the most common tumor of infancy?
Hemangioma
29
Vascular Malformations
Appear later in life (not born with lesions) Classified based on vascular channel (artery, vein, lymphatic, etc.) - most common is venous Many become evident in puberty Clinical presentation is variable Most asymptomatic, sometimes pain Doppler US and MRI are diagnosis/assessment tools
30
Recurrent Aphthous Stomatitis
Typical age is teenagers and up Healthy individuals Involvement of heavily keratinized mucosa of palate and gingiva is not common Several factors proposed as etiology - immune factors most prevalent but still not known
31
What is the most common ulcerative disease of oral mucosa?
Recurrent Aphthous Stomatitis
32
Types of recurrent aphthous stomatitis
Minor: most common, small size (1cm or less) Major: larger, heals with scars Herpetiform: mimics herpes
33
Is there a prodrome for RAS ulcers?
Yes, many patients experience a short burning sensation that lasts 2-48 hours before ulcer appears
34
Is there gingivitis in RAS cases?
No Marginal gingivitis is connected more with primary herpes
35
Prevalence of RAS
20% of population is affected If present in parents, increased likelihood for children to have it
36
Etiology of Recurrent Aphthous Ulcers
Definitive etiology is not known Local factors (trauma, changes in saliva) Microbial factors Medical conditions Genetic - heredity is the best underlying cause Allergic factors (hypersensitivity) Immune factors (abnormal CD4/CD8, IL-2, TFNa) Nutrition factors
37
Underlying medical conditions associated with recurrent aphthous ulcers
Behcet's MAGIC (mouth and genital ulcers with inflammation of cartilage) Crohn's Cyclic Neutropenia PFAPA (periodic fever, RAS, pharyngitis, cervical adenines)
38
What type of virus is Coxsackie?
RNA virus
39
Herpangina
Oral ulcerations limited to soft palate, uvula, tonsils Incidence peaks in summer/fall Sudden fever, malaise, headache, dysphagia Caused by coxsackie virus
40
Hand Foot Mouth
Frequently seen in epidemic outbreaks in daycare or school Mild headache and malaise followed by skin and oral lesions Caused by coxsackie virus
41
What virus is erythema multiforme connected with?
Herpes
42
Erythema multiforme
Typically mild, self-limiting and recurring mucocutaneous reaction characterized by target lesions of skin and mucous membranes Typical age 7-21 years old, more in females Symmetrical Etiology: HSV, drugs
43
Clinical presentation of EM
Lesions in fixed position with symmetric distribution Central blister (target shape) Oral mucosa lesions in more than 70% - lips, alveolar mucosa, palate More severe = Stevens Johnson Syndrome
44
What type of virus is herpes?
DNA
45
Herpes
Causes primary infection and then remains latent Transmitted by direct contact Incidence of primary infections with HSV1 increases after 6 months and peaks at 2-3 years Significant prodrome with generalized marginal gingivitis Self-limiting, treatment is palliative
46
What type of virus is HPV?
DNA
47
Localized Juvenile Spongiotic Gingival Hyperplasia
Unique and distinctive form of inflammatory gingival hyperplasia seen in young patients Average age 11.8 years, more in female Not plaque related Usually in anterior maxilla, bright red raised overgrowth with papillary of finely granulated surface Small lesion that can bleed easily Etiology = unknown; lesion does not respond to perio treatment
48
4 most common causes of gingival overgrowth
Medications Hygiene Idiopathic (familial) Leukemia
49
Medications causing gingival overgrowth
Calcium channel blockers (ex: verapamil, nifedipine) Anticonvulsants (phenytoin, dilantin) Cyclosporine (immunosuppressants for transplants)
50
Gingival fibromatosis
Hereditary or idiopathic Idiopathic = enlarged localized or generalized gingival tissue with connective tissue (collagen 1) growth Enlargement more prominent during eruption of teeth Diagnosis through thorough history, clinical exam, histopathology
51
Benign migratory glossitis
AKA Geographic Tongue Affects 2% of the population, more common in females Etiology is unknown
52
What systemic condition is associated with geographic tongue?
Psoriasis
53
Median Rhomboid Glossitis
AKA central papillary atrophy Area of redness and loss of lingual papilla on dorsal surface of tongue Related to chronic fungal infection Sometimes have mirror lesion on palate
54
IBS/Crohn's Disease Oral Manifestations
IBS = Crohn's and ulcerative colitis Oral ulcers in CD have indurated borders, are histologically different from RAS and may be nonpainful Cobblestoning of buccal mucosa Oral symptoms may precede GI symptoms
55
Immune Thrombocytopenic Purpura
Autoimmune disorder involving destruction of platelets by the spleen No treatment necessary in majority of cases, but sometimes splenectomy Contact sports and IM infections require caution
56
Selective IgA Deficiency
One of the most common types of primary immunodeficiency Patients produce other Ig Cause is unknown Increased risk for anaphylactic reactions
57
Clinical features that may indicate immunodeficiency
- 3 or more episodes of otitis media in 6 months - persistent purulent ear discharge - 2 or more serious sinus infections within 1 year - failure to thrive - 2 or more pneumonia in 1 year - recurrent deep skin infections - family history - persistent candidiasis
58
Behcet's Disease
Prevalence in higher in countries around Mediterranean Sea More common in females in North America, but males elsewhere Sores in eyes, mouth, genitals Autoimmune condition No pathognomonic lab test for BD, diagnosis is based on clinical criteria Management is challenging - use of anti-TNFa or other immunomodulators
59
Intrinsic tooth staining
Unlike extrinsic, due to presence of chromogenic material within the enamel or dentin Can occur pre-eruptive or post-eruptive
60
Most common pre-eruptive cause of intrinsic discoloration?
Fluorosis Others: DI, AI, hematologic disorders, medications
61
Most common post-eruptive cause of intrinsic discoloration?
Trauma
62
Congenital hyperbilirubinemia
Congenital issue that is complex and results in high bilirubin levels Causes green discoloration of teeth (intrinsic) Consequence of biliary atresia
63
Congenital erythropoietic porphyria
Causes red intrinsic discoloration of teeth
64
Mucocele
Most common on lower lip Some heal spontaneously, others are chronic and require surgical removal Excellent prognosis Not a true cyst - no epithelial lining Results from rupture of salivary gland duct and spillage of mucin into surrounding soft tissues
65
Most common oral lesion in children?
Mucocele
66
Pyogenic Granuloma
Exuberant tissue response to local irritation or trauma Smooth, lobulated mass usually pedunculated High vascular proliferation, red in color and bleeds easily More common in females Often on lips, buccal mucosa, or gums
67
Peripheral Ossifying Fibroma
Bony changes involved Reactive or inflammatory hyperplasia of gingiva (trauma or irritation) More common in young children and females More common in maxilla Painless mass of gingiva or alveolar mucosa, requires excisional biopsy
68
Peripheral Giant Cell Granuloma
Can also have bone changes Only occurs in gingiva (soft tissue part of CGCG) Usually distal to incisors More common in females Red or blue mass Can cause bone resorption Requires excision
69
Eruption Cyst
Develops from separation of dental follicle from around crown of tooth that is erupting Soft swelling in gingiva overlying crown of erupting primary or permanent tooth No treatment usually required
70
Giant Cell Fibroma
Uncommon lesion Fibrous tumor that is probably unrelated with chronic trauma Slight female predilection, most common in mandibular gingiva or palate Presence of fibroblasts within superficial connective tissue Treatment = excision
71
HPV transmission
HPV most commonly is transmitted by means of close contact Sexual, but also vertical and autoinocculation Horizontal transmission among family members is possible in childhood
72
Oral manifestations of HPV (broad)
Low risk HPV genotypes are often responsible for benign oral mucosa lesions Patients with HIV are more likely to develop genital and anal HPV
73
Most common low-risk genotype of HPV?
6, 11
74
Squamous Papilloma
HPV 6, 11 Benign proliferation of stratified squamous epithelium Most common on tongue, lips, palate Single lesion, finger-like projections
75
Verruca vulgaris (common wart)
HPV 2, 4 Benign, virus-induced focal hyperplasia of stratified epithelium frequent in children - self-inoculation from fingers to mouth
76
Condyloma Acuminatum
HPV 16, 18 STD appearing most frequently as a soft, pink cauliflower like growth Highly contagious, affects both genders equally with peak incidence at 17-20 years
77
Multifocal epithelial hyperplasia (Heck's)
HPV 13, 32 Virus induced, localized proliferation of oral squamous epithelium More in Alaska Native, Mexico Multiple members of same family Multiple, flattened, soft, nontender papular lesions that are the same color as oral mucosa
78
Syndromes associated with supernumerary teeth
Cleidocranial dysplasia Gardner's syndrome Cleft lip/palate
79
Supernumerary teeth
1-4% familial tendency Mesiodens, paramolar Male 2:1 Can delay or impact normal tooth eruption, can have dentigerous cyst
80
Missing teeth
3-10% (excluding 3rd molars) Hypodontia and colon and ovarian cancer has an association
81
Syndromes associated with missing teeth
Ectodermal dysplasia | Orofacialdigital syndrome
82
Macrodontia - associated systemic conditions
Hemangioma Hemihypertrophy of face Pituitary gigantism
83
Microdontia - associated conditions
Pituitary dwarfism
84
Gemination
Most common in primary dentition, especially incisors Increases tooth number Pulp chamber is single and enlarged Division of a single tooth bud
85
Fusion
Adjacent tooth germs combined with dentin or enamel Bifid crown or two recognizable teeth Reduces tooth number More common in primary dentition, especially anterior
86
Concrescence
Fusion after root formation 2nd and 3rd molars common Caused by traumatic injury
87
Taurodontism
Normal crown size ad tooth length, shortened roots Not recognizable clinically Mostly in molars Seen in Trisomy 21, Kleinfelters
88
Dilaceration
Maxillary premolars common Sharp curve in root likely from trauma
89
Dens in dente
Infolding of outer enamel surface into interior Caires -> pulp disease Coronal type: enamel organ infolding into dental papilla Radicular type: invagination of Hertwigs epithelial root sheath, lined with cementum
90
Amelogenesis Imperfecta
Disturbance in enamel development Normal dentin and root Autosomal dominant, autosomal recessive and X-linked
91
Type 1 AI
Hypoplastic type Thin enamel with pitted rough or smooth and glossy surface, yellow to brown Undersized, squared crown, lack of contact Flat occlusal surfaces and low cusps due to attrition
92
Type 2 AI
Hypomaturation type Normal thickness of enamel but mottled surface, cloudy white, yellow or brown, opaque Softer than normal Same density as dentin
93
Type 3 AI
Hypocalcified type Normal thickness of enamel, density is less than dentin Permeability increases, darkened and stained
94
Type 4 AI
Hypomaturation-hypocalcified with taurodontism
95
Type 1 DI
Autosomal dominant DI + Osteogenesis imperfecta COL1A1 and 2 genes
96
Type 2 DI
Autosomal dominant Isolated DI 1:8000 individuals DSPP gene
97
Type 3 DI
DI of Brandywine type DSPP gene DI + multiple pulp exposures in deciduous teeth
98
Radiographic features of DI
Bulbous crowns, normal size, constriction of cervical area Short and slender roots Occlusal attrition Partial or complete obliteration of pulp chamber, root canals
99
Dentin Dysplasia
Rare autosomal dominant disorder 1:100,000 individuals affected
100
Type I DD
Normal color and shape of crowns in both dentitions Misaligned arch, drifting and exfoliation of teeth with little or no trauma Short or abnormal root shape, pulp chamber and root canals obliterated Apical radiolucencies in 20% of teeth (vitality is normal)
101
Type II DD
Primary dentition appears as DI, but permanent dentition is normal Obliteration of pulp chamber and reduced root canals after eruption Roots are normal in shape and proportion Thistle tube pulp
102
Regional Odontodysplasia
“Ghost teeth” Hypoplastic and hypocalcified dentin and enamel Only a few adjacent teeth in a quadrant are affected Central incisors > lateral incisors > canines Delayed eruption Large pulp chamber and wide root canals, roots are short and poorly outlined Thin enamel and less dense = ghost teeth
103
Enamel Pearl
Small globule of enamel on root furcation of molars 3% prevalence
104
Talon Cusp
Anomalous hyperplasia of cingulum of a maxillary or mandibular incisor T shaped in incisal view Differential diagnosis with supernumerary tooth Rubenstein-Taybi
105
Turner's Hypoplasia
Type of enamel hypoplasia associated with defect in crown of permanent tooth from infection/trauma from. primary predecessor
106
Congenital Syphilis
Hutchinson's incisors Mulberry molars 30% have dental hypoplasia Not all patients with Hutchinson's teeth or mulberry molars will have congenital syphilis
107
Acquired Pathologic Conditions
Attrition Abrasion Erosion Hypercementosis
108
Attrition
Physiologic wearing from occlusal contacts Bruxism is pathologic condition, also diet, salivary factors, mineralization, emotional tension Crowns shorten, pulp chamber and canals reduce
109
Abrasion
Non-physiologic wearing by contact with foreign substance Factitious habits or occupational hazards Tooth brushing, flossing, pipe smoking, nail biting
110
Erosion
Chemical action, not involving bacteria GI disorders or acidic diet GI: lingual surfaces Diet: labial surfaces Industrial exposure: all surfaces
111
Hypercementosis
Excessive deposition of cementum on roots - smooth or irregular with intact lamina dura and PDL space Supraerupted tooth after opposing tooth loss Periapical inflammatory lesions Hyperocclusion or fractures Paget's disease, Hypopituitarism
112
Formed Elements of Blood
Red blood cells White blood cells Platelets
113
Prothrombin Time (PT)
Extrinsic and common pathway Normal 10-12 seconds Prolonged by deficiencies in factor VII, X, V, prothrombin and fibrinogen Used to monitor Warfarin, evaluate liver disease, vitamin K deficiency and DIC
114
INR
International normalized ratio PT (patient) / PT (control) ISI
115
Partial thromboplastin time (PTT)
Intrinsic pathway Normal 25-35 seconds Prolonged in patients deficient in any plasma-clotting factors except VII or XII
116
PFA-100
Looks at normal platelet function
117
Types of Anemia
Hypoproliferative (not enough cells) Hemolytic (bursting cells) Sickle cell Macrocytic (big cells) Microcytic (little cells) Normocytic
118
Macrocytic anemia causes
Folate deficiency Vitamin B12 deficiency
119
Microcytic anemia causes
Iron deficiency Thalassemia
120
Normocytic anemia causes
Anemia of chronic disease Bone marrow aplasia
121
Thrombocytopenia
Decreased platelet quantity Increased destruction or decreased production or splenic sequestration
122
Platelet quality disorders
Bernar Soulier syndrome Drug induced (aspirin, penicillin, indometacin) Disease related (uremia, paraproteins, myeloproliferative disorders)
123
Normal HCT values
Males: 40-54% Females: 38-47%
124
Normal Hb values
Males 13.5-18.0 g/dL | Females: 12-16 g/dL
125
RBC count
Males: 4.6x10^6 | Females 4.2x19^6
126
WBC count
4500-11000/uL ``` Neutrophils: 56% Bands: 3% Eosinophils: 2.7% Monocytes: 4% Lymphocytes: 34% ```
127
Platelet count
150-450000/uL
128
Sedimentation rate (ESR)
0-15mm/hour
129
Reticulocyte count
0.5-1.0%

* (22 decks)

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