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1098 Cards in this Set

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Name the two things that fail to fuse in cleft lip.
1 Medial nasal process 2 Maxillary process
When does the upper lip form?
6-7 weeks
What fails to form in cleft palate?
Palatal shelves
When does the palate form?
6-12 weeks
Cleft lip alone and Cleft Lip/Palate have (the same/different) etiology.
The same
Cleft Palate and Cleft Lip/Palate have (the same/different) etiology.
Different
What ethnic group has the highest rate of cleft lip and palate?
Native americans
Place in order of highest to lowest occurence: Cleft lip alone = Cleft palate alone = Cleft lip and palate together
Cleft lip and palate together >Cleft palate alone > Cleft lip alone
Cleft lip and palate together is more common in (males/females). Isolated cleft palate is more common in (males/females).
Males. Females
Name the three characteristic features of Pierre Robin syndrome.
1 Cleft palate 2 Mandibular micrognathia 3 Glossoptosis (small tongue that cuts off airway)
What is the possible reason for commissural lip pits?
Failure of the normal fusion of the maxillary and mandibular processes in the embryo
What is more common, commissural or paramedian lip pits?
Commissural (12-20% of the population)
Are commissural lip pits more common in whites or blacks?
Blacks
What is the possible reason for paramedian lip pits?
Persistence of the lateral sulci on the embryonic mandibular arch
Which is associated with other developmental anomalies such as cleft lip/palate: Commissural or paramedian Lip pits?
Paramedian
Which is almost always bilateral: Commissural or paramedian Lip pits?
Paramedian
Name three characteristic features of Ascher's syndrome.
1 Double lip 2 Blepharochalasis (droopy eyelid due to edema) 3 Nontoxic thyroid enlargement
What are Fordyce's Granules?
Ectopic sebacious glands
How common are Fordyce Granules? Who gets them?
80% incidence. All ages get them
How is fibromatosis Gingivae transmitted?
Hereditary - Autosomal dominant
What is the term used for fibrous hyperplasia of the gums that is not painful, but may prevent teeth from erupting?
Fibromatosis Gingivae
When does Fibromatosis Gingivae usually begin?
Before age 20
What is a differential diagnosis for Fibromatosis Gingivae?
Dilantin hyperplasia
Name three systemic diseases that may cause macrognathia.
1 Paget's dz 2 Acromegaly 3 Fibrous dysplasia
What term is used for unilateral enlargemnt of the body/parts?
Hemihyperplasia
What is a synonym for Progressive Hemifacial Atrophy?
Romberg Syndrome
What disease features unilateral atrophy of the face, delayed eruption, but stabilizes after several years?
Progressive Hemifacial Atrophy
What is more common, macro/microglossia?
Macroglossia
What other disease is often associated with fissured tongue?
Geographic tongue
What is the incidence of fissured tongue?
2-5%
What is the incidence of geographic tongue?
1-3%
What kind of papillae/taste buds are missing with geographic tongue?
Filiform
Name a distinct, pathognomonic feature of geographic tongue.
Outlined by yellow-white line
If lesions resemble geographic tongue lesions but are located on other parts of the oral cavity, what are these lesions called?
Stomatitis areata migrans
What dermatologic disease does geographic tongue resemble?
Psoriasis
In hairy tongue, keratin accumulates on which type of papillae?
Filiform
Hairy tongue affects (non/smokers) and its incidence is ___% of all adults.
Smokers, 1/2%
If a lingual thyroid nodule is present, what is a differential diagnosis to worry about?
Thyroglossal duct cyst
Name the three lymphoid tissues that make up Waldeyer's ring.
1 Palatine 2 Pharyngeal 3 Lingual tonsils (and sometimes foliate papillae)
Minor glands are usually (serous/mucous) glands.
Mucous
VonEbner's salivary glands are special because they are (serous/mucous).
Serous
How do you differentiate linea alba from Morsicatio Buccarum?
Linea alba is smooth, MB has a rough, ragged surface
What is the most common cause of focal oral ulcerations?
Trauma
Define traumatic granuloma
A deep ulcer that occurs in the mucosa over muslce (usually on the tongue)
If a lesion does not heal in ___ days to ____ weeks of conservative therapy, what must be done?
10 days-2 weeks. Biopsy!
Name 3 common examples of chemical burns.
1 Aspirin 2 Anbesol 3 Hydrogen peroxide
Do submucosal hemorrhages blanch with pressure?
NO
Name 8 possible head and neck effects of radiation therapy.
1 Mucositis 2 Xerostomia 3 Hemorrhage 4 Loss of taste 5 Trismus 6 Osteoradionecrosis 7 Dermatitis 8 Developmental abnormalities
What usually occurs during the second week of radiation treatment?
Radiation mucositis
Name two possible clinical features of chronic dermatitis.
1Dry, atrophic skin 2 Telangiectasias
When xerostomia is due to radation therapy, is it reversible?
No
What occurs within a few days of starting chemo?
Chemo mucositis
What is the difference between enamel hypoplasia and hypocalcification?
Hypoplasia is defective formation of the enamel matrix itself; hypocalfication is when the matrix cannot be mineralized correctly
What two things can cause enamel hypoplasia?
Heredity and Environment
If the insult causing enamel hypoplasia occurs during the first two years of life, what two groups of teeth are usually involved?
Anteriors and first molars
If the insult causing enamel hypoplasia occurs at 4-5 years of age, what three types of teeth are usually involved?
Cuspids, bicuspids, and second molars
Exanthemous diseases, nutritional deficiency, congenital syphilis, hypocalcemia, ingestion of chemicals can all cause what two tooth diseases?
Enamel hypoplasia and hypocalcification
Enamel hypoplasia and hypocalcification often occur together in what other tooth disease?
AI
What is the treatment for Enamel hypoplasia or hypocalcification?
Composites/veneers for aesthetics
What chalky white spots does your cousin M have (you think)?
Enamel hypocalcification
At .6-1.0 ppm of Fluoride exposure, what are the dental effects?
Ideal for caries reduction, normal appearance
At 1.0-1.8 ppm of Fluoride exposure, what are the dental effects?
Chalky white mottling, hypocalcified enamel
At >1.8 ppm of Fluoride exposure, what are the dental effects?
Hypocalcification increases proportionally
At >5 ppm of Fluoride exposure, what are the dental effects?
Severe enamel pigmentation with brown/white mottling, enamel may fracture or wear easily
At >6 ppm of Fluoride exposure, what are the dental effects?
Permanent dentition affected (90% chance)
At >9 ppm of Fluoride exposure, what are the dental effects?
Systemic effects occur!!
What are two differential diagnoses for dental fluorosis?
1. Tetracycline stains 2. Dentinogenesis Imperfecta
A pt comes in wtih eroded labial surfaces of maxillary anterior teeth. What is the most likely source of erosion?
Citrus fruits
A pt comes in with lingual surfaces of the maxillary teeth eroded. What is the most likely source of erosion?
Stomach acid from bulimia or GERD or stress
Which is more common: Internal or external resorption?
External
If you can see a pink area through the tooth (caused by the showing of blood of pulp), what is the most likely diagnosis?
Internal resorption
Is it easy to treat external resorption?
No, it requires flap surgery/alloy patch
What are the only two treatments for internal resorption?
RCT and EXT
True or False denticles: Look like secondary dentin (dentinal tubules).
TRUE
True or False denticles: Does NOT look like dentin, shows lamellar pattern.
FALSE
What is the most common type of extrinsic stain?
Tobacco stain
What is the second most common type of extrinsic stain?
Brown stain
Which two extrinsic stains are seen frequently in non-smokers?
Brown and Black stain
Are the following easy or hard to remove? Tobacco, Type II brown, Black, Green, Orange, Metallic
Hard, Easy, Hard, Easy, Easy, Enamel easy/Dentin and Cementum hard
What type of extrinsic stain has Two types, one that is film-like and one that is a dark line at cervical margin?
Brown Stain
What is the treatment for intrinsic staining of non-vital teeth?
Bleaching
Name three systemic conditions that can cause intrinsic tooth staining.
1. Erythroblastosis Fetalis 2. Biliary Atresia 3. Congenital Porphyria
Congenital Porphyria is caused by overproduction of ___________.
Uroporphyrin
Name the antibiotic that turns teeth yellow to yellow-brown with no pitting, which may occur in band-like fashion.
Tetracycline
Tetracycline is contraindicated for children under age ___ and for _______ women.
8, Pregnant
What are the three most commonly missing teeth?
1. 3rd molars 2. 2nd Bis 3. Maxillary laterals
What developmental tooth condition is often associated wtih hereditary ectodermal dysplasia?
Hypodontia
What is the most common type of hyperdontia? Where is it located?
Mesodens. Located at the midline of the maxillary centrals
What is the second-most common type of hyperdontia?
4th molars
Name the two diseases that hyperdontia is often associated with.
1. Cleidocranial dysostosis 2. Gardner's syndrome
Name two syndromes commonly associated wtih microdontia.
1. Dwarfism 2. Down's syndrome
What two teeth are most commonly affected by microdontia?
1 Laterals 2 Third molars
Gemination or fusion: Tooth count is normal.
Gemination
What is concrescence?
Teeth are united by cementum only
What is the most common location for a talon cusp?
Lingual (cingulum area) of the maxillary lateral
Define dens evaginatus.
Cusp-like elevation of enamel in the central groove on lingual ridge of buccal cusp of posterior teeth
Name a dental syndrome featured in Paget's dz.
Hypercementosis with missing lamina dura
What is the most common tooth to have a dilaceration?
3rd molars
Describe hypoplastic amelogenesis imperfecta.
Enamel does not form to full thickness
Describe hypocalcified amelogenesis imperfecta.
Enamel is soft and removed easily, chips off
Describe hypomaturation amelogenesis imperfecta.
Normal thickness of enamel, but can be pierced by an explorer.
Is caries incidence significant with amelogenesis or dentinogenesis imperfecta?
NO
What are three differential diagnoses for amelogenesis imperfecta?
1 Fluorosis 2 Attrition 3 Erosion
How are Type I, II and III Dentinogenesis imperfecta classified?
I: Occurs with Osteogenesis imperfecta II. Never occurs with OI III. Brandywine type/Shell teeth
How do you distinguish DI from AI?
DI has no pulp chambers left
How can you distinguish Type III DI from the others?
Very large pulp chambers
Type II Dentinal dysplasia is often associated with what other dental syndrome?
DI
What is the most common type of dentinal dysplasia?
Type I
What is the treatment for reversible pulpitis?
Remove the irritant! Or else, pulp death could occur
What is another name for Chronic Hyperplastic Pulpitis? Who is affected? What is it? What is the treatment?
Pulp Polyp. Children/Young adults. Inflammed granulation tissue overgrows out of pulp. Ext or RCT
What pulpal condition shows the following: Sensitivity to cold, heat, sweets, sensitivity to explorer probing, normal response to EPT?
Reversible pulpitis
What pulpal condition shows the following: Spontaneous/stimulated/no pain, lingering sensitivity to cold, heat, sweets, sensitivity to explorer probing, normal response to EPT?
Irreversible pulpitis
What pulpal condition shows the following: Spontaneous/stimulated/no pain, sensitivity to heat?
Necrotic pulp
What periapical condition shows the following: Sensitivity to biting/chewing, sensitivity/pain to percussion and palpation?
Acute apical periodontitis
What periapical condition shows the following: Low-grade diffuse pain/asymptomatic, none/slight sensitivity to percussion and palpation?
Chronic apical periodontitis
What periapical condition shows the following: Pain, swelling, fever, exudate, sensitivity to percussion/palpation?
Apical abcess
What is the only pulpal condition that has a feeling of 'different' upon percussion?
Chronic pulpitis
Name two reasons why pulp is different from other tissues (and has different symptoms).
1 No collateral circulation lowers immune response 2. Surrounding by non-expandable tissue causes pressure and pain
The majority of abcesses are (a/symptomatic).
Asymptomatic
If the pulp vital or non-vital if you hae acute periapical abcess?
Nonvital!
(Acute/Chronic) abcesses are symptomatic.
Acute
The difference between Acute apical periodontitis and periapical abcess is that periapical abcess is characterized by...
Swelling (and lots of pain, rapid onset)
Which is more likely to be localized pain (only the involved tooth hurts): Acute apical periodontitis or periapical abcess?
Acute apical periodontitis
Name the two deadly complications of an untreated abcess.
1 Ludwig's angina (tongue blocks airway) 2 Cavernous Sinus Thrombosis (infection into entire head)
If your patient 'died of a toothache', what was the most likely cause?
Cavernous sinus thrombosis
What is the most common direction of drainage/spread of infection with an abcess?
Buccal
Name two key characteristics of Chronic apical periodontitis AKA periapical granuloma AKA dental granuloma.
1 Painless 2 Only radiolucent up to 1 cm
How do you tell a cyst from a granuloma?
Cysts are lined by epithelium!
Is condensing osteitis associated with teeth?
Yes, teeth with pulpitis!
Where is the most common location (tooth-related) for condensing osteitis?
Mandibular first molar
What is the appropriate term to use when oral lesions occur due to systemically administered drugs? What kind of hypersensitivity reaction is this?
Stomatitis Medicamentosa. Type ONE
If stomatitis medicamentosa occurs and the patient cannot be taken off of the offending drug, what is the treatment option?
Topical corticosteroids
What is the best term to use when an oral mucsoal allergic reaction is confined to the areas of direct contact with the allergen (2)? What kind of hypersensitivity reaction is this?
Contact Stomatitis, or Stomatitis Venenata. Type FOUR
What is a very tell-tale sign for Contact stomatitis/Stomatitis venenata?
Pebbly surface
Name 2 things that make stomatitis venenata different from a chemical burn.
Stomatitis venenata 1) Affects for weeks 2) More red than white
How is stomatitis venenata different from stomatitis medicamentosa?
No runny nose, itchy/watery eyes
Who is more prone to stomatitis venenata, males or females?
Females
Name a highly antigenic agent that often causes contact stomatitis.
Cinnamon aldehyde (artificial flavoring)
What is the most common pattern of reaction to dental amalgams?
Contact lichenoid reaction
What is the most common mechanism for angioedema?
Immediate IgE-mediated hypersensitivity
Name a likely diagnosis for a patient who has an onset of swelling that is rapid (within minutes/hours).
Angioedema
Inappropriate complement activation due to C1-INH problems will cause...
Angioedema
What is the most common location for angioedema to occur?
Lips
What is the concern if your patient has angioedema from a local anesthetic? What is the treatment?
Airway blockage; perscribe Benadryl (OTC)
What is a differential diagnosis for angioedema?
Cheilitis granulomatosis
How long does angioedema last?
1-3 days
Name the triad for the rare Behcet Syndrome.
1 Apthous ulcers for more than a year 2 Genital ulcerations 3 Eye ulcerations
Can a DDS diagnose Behcet Syndrome?
No, only an MD can - refer them to a rheumatoid specialist
Name the three systemic diseases that we discussed that cause granulomatous inflammation.
1 Sarcoidosis 2 Orofacial Granulomatosis 3 Wegener
Does sarcoidosis have non or caseating Granulomatosis?
Non
In sarcoidosis, who is affected more: Whites/blacks? Males/females? Young adults/older adults?
Black, females, young adults (Kari M!)
Name two clinical syndromes of sarcoidosis. Which one is related to H/N?
1 Lofgren syndrome 2 Heerfordt's syndrome - H/N
Name the three characteristic features of Lofgren's syndrome.
1 Erythema nodosum 2 Bilateral hilar lymphadenopathy 3 Arthralgia
What three H/N features are present with Heerfordt's syndrome?
1 Parotid enlargement 2 Anterior uveitis of the eye 3 Facial paralysis
Where in the oral cavity can sarcoidosis occur?
Anywhere
Is there a specific diagnostic test for sarcoidosis?
No, diagnose by R/O
What is the treatment for sarcoidosis?
Ranges from no tx to corticosteroids to death
What term is used when any granulomatous inflammation is present in the head and neck area? Is it a diagnostic or clinical term?
Orofacial granulmatosis. CLINICAL only - unless no specific term applies
Name the more common pattern of orofacial granulomatosis. Name one unique characteristic.
Cheilitis granulomatosis. It's persistent (over months!)
Name the less common pattern of orofacial granulomatosis.
Melkersson-Rosenthal syndrome
Name three unique characteristics of Melkersson-Rosenthal.
1 Blisters, 2 facial paralysis, 3 fissured tongue
What two things characterize both cheilitis granulomatosis and Melkersson-Rosenthal syndrome?
1 Non-tender 2 Labial swelling
Name the immune-mediated type of granulomatosis.
Wegener.
What is the most common, but rare, oral manifestation of Wegener granulomatosis?
Strawberry gingivitis
What term is used when epithelium has a granular layer and the nuclei are lost in the keratin layer?
Hyperorthokeratosis
What term is used when there is no granular cell layer and the epithelial nuclei are retained in the keratin layer?
Hyperparakeratosis
What term is used when there is intercellular edema of the spinous cell layer, which turns a whitish color?
Spongiosis
What term is used when the spinous layer is thickened?
Acanthosis
What term is used when the squamous epithelium proliferates to a papillary, exophytic appearance?
Verrucous hyperplasia
Name 4 oral areas that have keratin.
1 Hard palate 2 Gingiva 3 Alveolar mucosa 4 Dorsal tongue
(Non/keratinized) (thin/thick) epi is particularly vulnerable to development of premalignancy/malignancy.
Non-keratinized, thin
Leukoedema, a psuedopathologic lesion, is (rare/common), is more predominant in (blacks/whites), (non/smokers).
Common, blacks, smokers
Where does leukoedema usually occur?
Buccal mucosa, bilaterally
What white lesion disappears when the tissue is stretched?
Leukoedema
What white lesion does NOT disappear when the tissue is stretched?
Leukoplakia
What five other diseases must be ruled out when it looks like leukoedema?
1 Keratosis 2 White sponge nevus 3 Smokeless tobacco lesions 4 Cheek biting lesions 5 Leukoplakia
What disease histologically features acanthosis, perakeratosis, and intracellular edema?
Leukoedema
A cauliflower-like lesion is present. What is the differential diagnosis?
1 Squamous papilloma 2 Verucca vulgaris 3 Verrucous carcinoma 5 Condyloma acuminatum 6 Verruciform xanthoma
Where is squamous papilloma usually found (5)?
1 Soft palate 2 Tongue 3 Lips 4 Buccal mucosa 5 Gingiva
What disease histologically features projection of squamous epi, containing a thin CT core?
Squamous papilloma
What is the treatment for Squamous papilloma?
Excisional biopsy
What disease histologically features pointed projections from surface epi, thickened keratin, and viral inclusion in the upper spinous layer?
Verrucous vulgaris
What disease clinically looks like little white peaks of frosting?
Verrucous vulgaris
Name three places that vurrucous vulgaris is usually seen.
1 Vermillion border 2 Labial mucosa 3 Anterior tongue
How long after sexual contact does condyloma acuminatum show up?
1-3 months
What disease clinically shows multiple, papillary masses, are white/pink, and are up to 2 cm in diameter
Condyloma acuminatum
What is the differential diagnosis for condyloma acuminatum, and what is the difference between the two?
Squamous papilloma - grows slower
How do differentiate squamous papilloma from verrucous vulgaris and condyloma acuminatum?
Squamous papilloma - usually adults; Verrucous vulgaris - usually kids and young adults; Condyloma acuminatum - Multiple masses and STD
What ethnic group and age groups are affected by focal epithelial hyperplasia (Hecks' dz)?
American indians - children/middle-aged adults
What is the treatment for Heck's dz?
None, it is benign.
Rare verruciform xanthoma has a surface texture that is ________ and is usually seen in (young/old) (men/women). It (does/does not) have potential for malignant transformation.
rough(pebbly), older women over 40, Does NOT have potential to be malignant
Name 5 common places to find verruciform xanthoma.
1 Lower alveolar ridge 2 Palate 3 Floor of the mouth 4 Lip 5 Tongue
Whsat is the only way to diagnose verruciform xanthoma?
Presence of 'foam cells' - histiocytes and xanthoma cells in connective tissue papilla between epi pegs
What two types of cells are 'foam' cells?
1 Histiocytes 2 Xanthoma cells
Name a benign lesion that clinically resembles squamous cell carcinoma.
Keratoacanthoma
Where does keratoacanthoma usually occur? What does it look like?
Sun-exposed SKIN (not in the mouth). Elevated crater-like lesion with depressed central plug of keratin
Keratoacanthoma usually grows to full size in __ to ___ weeks, stays static for ___ to ___ weeks, then...
4-8, 4-8, totally disappears
How is white sponge nevus transmitted?
Autosomal dominant
Where is the most common place to see white sponge nevus? Where else might you find it?
Buccal mucosa is most common. Palate, gingiva, floor of the mouth, and tongue
At what age does white sponge nevus appear?
Childhood
What are 4 histologic features of white sponge nevus?
1 Acanthosis 2 Hyperparakeratosis 3 Intracellular edema 4 Parakeratin plugs running into the spinous layer
Name the clinical term for a white patch on the mucosa that does not wipe off and is no other specific dz.
Leukoplakia
What are the three clinical types of leukoplakia, and is each malignant or not, usually?
1 Frictional keratosis - not malignant 2 Smoking related leukoplakia - mal 3 smokeless tobacco keratosis - mal
Is leukoplakia premalignant or not?
PREMALIGNANT!
What is the incidence for leukoplakia?
3% of all adult whites; 8% of 70+ males
Name the two most common sites for leukoplakia.
1 Buccal mucosa 2 Mandibular alveoloar mucosa
What % of leukoplakias turn malignant?
1-18%
If a lab report comes back with hyperkeratosis, is it benign, premalignant, or malignant?
Benign
If a lab report comes back with dysplasia, is it benign, premalignant, or malignant?
premalignant
If a lab report comes back with squamous cell carcinoma, is it benign, premalignant, or malignant?
Malignant (duh)
We worry most about leukoplakia that is located...
On the floor of the mouth
Name 3 other worrisome sites for leukoplakia to be seen (besides the floor of the mouth).
1 Lateral border of the tongue 2 Lower lip 3 Palate
Name 3 histologic features of leukoplakia.
1 Acanthosis 2 hyperkeratosis 3 hyperparakeratosis
T/F: Leukoplakia must always be biopsied.
TRUE - it's the only way to determine if it's malignant or not
Which is more likely to cause alterations in oral tissue, snuff or chewing tobacco?
Snuff
How long does it take to get color changes with smokeless tobacco?
1-5 years
Is oral submucous fibrosis premalignant or not?
PREMALIGNANT!
What causes oral submucous fibrosis?
Chewing betel quid
Do smokeless tobacco lesions go away after quitting?
Yes
Does oral submucous fibrosis go away after quitting betel quid?
NO
What other oral lesion is often on top of/associated with oral submucous fibrosis?
Leukoplakia
Nodular keratotic areas with red depressions in the center (minor salivary glands) are pathognomonic for what dz?
Nicotine Stomatitis
What three things can cause nicotine stomatitis?
1 Pipe 2 Cigar 3 Reverse smoking
Does nicotine stomatitis go away with quitting?
Yes, usually
Is nicotine stomatitis premalignant or not?
Not alone, but it shows that nicotine levels are high enough for cancer
Is actinic cheilitis premalignant or not?
PREMALIGNANT!
What term is used when the lesion is white due to degenerating CT?
Senile elastosis
Name the four 'officially' pre-malignant lesions.
1 KEratosis with dysplasia 2 Proliferative verrucous leukoplakia 3 Erythroplakia 4 Speckled leukoplakia
__ - ___% of keratosis with dysplasia transforms to squamous cell carcinoma.
7-36%
What are 5 histologic features of Keratosis with dysplasia?
1 Increased keratin 2 Hyperchromatism 3 Increased mitoses 4 Loss of polarity/disoriented cells 5 Bulbous rete ridges
Proliferative verrucous leukoplakia has a strong predilection for (males/females), (non/smokers) and (are/are not) likely to recur once removed. What is the mortality rate?
Females, nonsmokers, ARE VERY likely to recur. 70% mortality rate
What is a clinical term that refers to a red patch that is not any other condition, trauma, or inflammation?
Erythroplakia
What is more common, leuko or erythroplakia?
Leukoplakia
___ - ____% of erythroplakias show dysplasia/carcinoma.
60-90%
Does erythroplakia have keratin?
No
What is a clinical term for a lesion that is red with granular/nodular white plaques on the surface?
Speckled leukoplakia
What has a higher degree of malignancy, erythroplakia or Speckled leukoplakia?
Speckled leukoplakia
Place in order of highest to lowest chance of malignancy: Leukoplakia, erythroplakia, and Speckled leukoplakia.
Speckled leukoplakia >> Erythroplakia > Leukoplakia
Name two ways you can differentiate White Sponge Nevus from leukoplakia.
White sponge nevus 1) Affects kids 2) Is autosomal dominant - transmitted
Define carcinoma-in-situ.
Carcinoma that does not invade the basal cell layer (basement membrane intact)
Squamous cell carcinoma is the (#) leading cause of cancer deaths.
6th
T/F: Squamous cell carcinoma kills fewer people than cervical cancer and melanoma.
False, kills more
Of all oral cancers, ___% are Squamous cell carcinoma.
94%, all others are sarcomas
What is the average age of diagnosis for Squamous cell carcinoma? Is the incidence higher in males or females?
50 +. Males get it more than females
What is a leading cause of cancer mortality (and is seen in 8/10 of oral cancers)?
Smoking cigarettes
What is worse to smoke, cigarettes or pipes/cigars?
Pipes/cigars
The rate of smokers developing oral cancer is ____ times as high than non-smokers.
Five!
Name a nutritional deficiency syndrome that is implicated in Squamous cell carcinoma development.
Plummer-Vinson syndrome
Are the following factors considered important for developing Squamous cell carcinoma? Alcohol, Mechanical trauma, sunlight, viruses, heredity, immunosuppresion, syphilis, submucous fibrosis.
Alcohol - yes when over 7 oz/day, Mechanical trauma - no, sunlight - yes, viruses - yes HPV, heredity - no, immunosuppresion - yes, syphilis - yes, submucous fibrosis - yes.
Name the 6 most common sites for Squamous cell carcinoma.
1 Tongue (lateral and ventral) 2 Floor of the mouth 3 Lips 4 Soft palate 5 Gingiva 6 Buccal mucosa
When Squamous cell carcinoma is found on the tongue, what does it look like?
White and ulcerated
When Squamous cell carcinoma is found on the floor of the mouth, what does it feel like?
Velvety
Name two important histological features of Squamous cell carcinoma.
1 Invasion 2 Degree of differentiation
If you were to get Squamous cell carcinoma, would you want it well differentiated or poorly?
WELL
Define exophytic.
Mass forming
Define endophytic.
Ulcerating
Define 'field cancerization'.
If patient has one cancer, he has a greater risk of second primary cancer
List the relative incidence of sites of Squamous cell carcinoma (in order). There are 6.
1 Lips 2 Tongue (lateral and ventral) 3 Floor of the mouth 4 Soft palate 5 Gingiva 6 Buccal mucosa
What is the 5 year survival for Squamous cell carcinoma if the following is true: No metastasis? Cervical lymph nodes involved? Metastasis below the clavicle? On the Lower lip?
No metastasis - 76% Cervical lymph nodes involved - 41% Metastasis below the clavicle - 9% On the Lower lip - 95%
Is lower lip Squamous cell carcinoma (fast/slow) to metastasize?
Slow
Where is the most common INTRAoral malignancy of Squamous cell carcinoma?
Tongue (50% of all intraoral cancers)
(Males/Females) (under/over) 40 get Squamous cell carcinoma on the tongue.
Males over 40
Why does Squamous cell carcinoma on the posterior tongue have a poor prognosis?
It is detected late and has early metastasis
At which three locations is Squamous cell carcinoma likely to present as an ulcer/exophytic mass?
1 Buccal mucosa 2 Mandibular alveoloar mucosa 3 Palate
What location is Squamous cell carcinoma more common: Hard or soft palate?
Soft palate
Name a slow-growing, exophytic, well-differentiated lesion.
Verrucous carcinoma AKA Snuff Dipper's Cancer
T/F: Verrucous carcinoma is invasive. Verrucous carcinoma does not metastasize.
Both are true
Name the two most common sites for verrucous carcinoma.
1 Buccal mucosa (vestibule) 2 Gingiva
What is the most common type of carcinoma overall?
Basal cell carcinoma
Where does basal cell carcinoma usually occur?
Middle third of the face (or hair bearing areas)
Is basal cell carcinoma fast or slow growing?
Slow
What is the most common form of basal cell carcinoma?
Nodulo-ulcerative
What does the superficial form of basal cell carcinoma look like?
Psoriasis
What causes basal cell carcinoma?
Sunlight
T/F: Basal cell carcinoma is invasive. Basal cell carcinoma does not metastasize.
Both are true
The most common site for bone metastasis to the head and neck area is to the _________.
Mandible
In men, what type of cancer is most responsible for metastasis? What about in women?
Lung for men, breast for women
What is the prognosis for metastatic cancer to the head and neck?
Poor
Reactive lesion, or 'true' neoplasia? Overgrowth is in response to irritation
Reactive lesion
Reactive lesion, or 'true' neoplasia? Associated with a stimulus
Reactive lesion
Reactive lesion, or 'true' neoplasia? Usually inflammation a consistent finding
Reactive lesion
Reactive lesion, or 'true' neoplasia? Growth continues after stimulus is removed/no stimulus required
'true' neoplasia
Reactive lesion, or 'true' neoplasia? No regression with normal therapy
'true' neoplasia
Reactive lesion, or 'true' neoplasia? Unrestricted new growth
'true' neoplasia
What is the most common 'tumor'/lesion in the oral cavity?
Irritation fibroma
Where is the most common location to find an irritation fibroma?
Buccal mucosa, at the occlusal plane
What age group and gender is most often affected by irritation fibromas?
40-60 year old females
What two colors are irritation fibromas (usually)?
1 Pink (same shade as mucosa) 2 White from hyperkeratosis
Name 3 histological findings in irritation fibromas.
1 Dense CT 2 Inflammatory cells 3 Stratified squamous epithelium
What is the term used for an irritation fibroma caused by a denture?
Epulis Fissuratum
What characterizes Epulis Fissuratum?
Long folds of dense CT
Name 3 common causes for papillary hyperplasia.
1 Ill-fitting dentures 2 Dentures worn 24 hours/day 3 Poor denture hygiene
What clinical feature is pathognomonic for Epulis Fissuratum?
Raspberry, bubbly, papillary look, usually on hard palate
What microorganism is often to blame for Epulis Fissuratum?
Candida
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Usually on gingiva, but occur anywhere
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Bright red color
Pyogenic granuloma OR ulcerated peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Bleeds easily
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Painless
Pyogenic granuloma and peripheral giant cell granuloma for sure
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Caused by irritation
All three
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Develops rapidly
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? More common in children and young adults
Pyogenic granuloma and peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Found in pregnant women
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Female predilection
All three
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Histologically has endothelial lined vascular spaces
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Most common of the three
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Bluish-purple in color
Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Pink color
peripheral fibroma OR Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Affects individuals around age 30
Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Can only occur on the gingiva
Peripheral Giant Cell Granuloma or Peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Histologically has CT stroma, mesenchymal cells, and multinucleated giant cells
Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Results from pyogenic granuloma developing over time
Peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Histologically has dense CT with mineralization (calcified or ossified)
Peripheral (ossifying) fibroma
What term is used for red vascular tissue growing out of recent extraction site or socket?
Epulis Granulomatosa
Name the most common oral area to have a lipoma.
Buccal mucosa
What color is a lipoma?
Yellowish
What kind of cells are subject to neurolemoma?
Schwann cells (it's also called a schwannoma)
Are neurolemomas fast or slow-growing?
Slow-growing
Name the most common oral area to have a neurolemoma.
Tongue
What soft tissue lesion is associated with Antoni A and B tissue types?
Neurolemoma (Schwannoma)
What soft tissue lesion is associated with Verocay bodies?
Neurolemoma (Schwannoma)
Name the most common peripheral nerve neoplasm, which is rare but not uncommon.
Neurofibroma
What soft tissue lesion is associated with spindle cells, and Mast cells intermingled with neurites?
Neurofibroma
Name the hereditary/systemic form of neurofibromas.
Von Recklinghausen's Disease of the Skin
Name two clinical features of Von Recklinghausen's Disease of the Skin.
1 Multiple neurofibromas 2 Café au lait spots
What 'neoplasm' occurs when a damaged nerve attempts to repair itself?
Traumatic neuroma
Is a Traumatic neuroma painless or painful?
Painful
What lesion has the following histology: Neurofibrils and Schwann cells in CT?
Traumatic neuroma
What is the most common tumor of infancy?
Hemangioma
What causes a hemangioma?
Proliferation of blood vessels
What color is a hemangioma?
Deep blue (this helps diagnose)
If a hemangioma is present as a large, flat lesion of the skin, what term is used?
Birthmark
If a hemangioma is present as a large, unilateral lesion on the face following the division of the trigeminal nerve, what term is used?
Port-wine stain
What type of biopsy must be done on a hemangioma: Incisional or excisional?
Excisional, because it bleeds profusely with incisional
What is "diascopy"?
Blanching with pressure
A hemangioma (does/does not) blanch with pressure.
DOES
If a hemangioma is present due to small capillary proliferation, what disease is this?
Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu)
What disease features Port-wine stian, and maybe convulsive disorders and mental retardation due to calcifications in the brain?
Sturge-Weber Syndrome
What is more common, hemangioma or lymphangioma?
Hemangioma
How can you differentiate a lymphangioma from a hemangioma?
Lymphangiomas are pink, or colorless, not red.
If a lymphangioma is present in the tongue, what syndrome could occur secondarily?
Macroglossia
Name the most common oral area to have a granular cell tumor.
Tongue
What lesion has the following histology: Large, granular cells with eosinophils, keratin production, and pseudoepitheliomatous hyperplasia?
Granular cell tumor
What soft tissue lesion may be confused with carcinoma?
Granular cell tumor
What disease features fibroma-looking lesion at birth?
Congenital Granular Cell Epulis
Where is the most common location to find a Congenital Granular Cell Epulis?
Maxillary anterior gingiva
T/F: Congenital Granular Cell Epulis most commonly affects males.
False; the predilection is 90% female, suggesting a hormonal link
What disease features rapidly-growing dark, pigmented lesion at birth?
Melanotic Neuroectodermal Tumor of infancy
What disease is associated with high levels of vanilmadelic acid in the urine?
Melanotic Neuroectodermal Tumor of infancy
What lesion has the following histology: Mass of cells arranged in a pattern of alveolus-like spaces, lined by cuboidal cells, maybe containing melanin?
Melanotic Neuroectodermal Tumor of infancy
Pigmented Lesions
What is another name for physiologic (racial) pigmentation?
Melanoplakia
Name the most common location for physiologic (racial) pigmentation/melanoplakia.
Attached gingiva
What causes physiologic (racial) pigmentation/melanoplakia?
Increased ACTIVITY (not number) of melanocytes
Name two risk factors (besides smoking) for Smoker's Melanosis.
1 Female 2 Females on the Pill
Name the three most common areas to see Smoker's Melanosis.
1 Mandibular anterior (gingiva) 2 Buccal mucosa 3 Palate
Is Smoker's Melanosis premalignant?
No, not alone
Does Smoker's Melanosis go away after quitting smoking?
Yes, probably
T/F: Oral Melanotic Macules are due to sun-exposure.
False, freckles are
What disease histologically features an increase in melanin granules, which is confined to the basal cell layer?
Oral melanotic macule
What is the most common of all human 'tumors'?
Pigmented Cellular Nevus/ Acquired melanocytic nevus/Mole
Name 2 synonyms for a mole.
1 Pigmented Cellular Nevus 2 Acquired melanocytic nevus
What's the difference between a mole and a freckle (ephelis)?
A mole does NOT depend on sun exposure; freckles do.
What do nevus cells look like (4)?
1 Large 2 Oval 3 Epithelioid 4 Arranged in clumps
What type of mole do all moles start out as?
Junctional nevus
What variant of mole is the second most common intraoral nevus?
Blue
Malignant melanoma is the (#) most common skin cancer. ____% of skin melanomas occur in the head/neck area. (Chronic/acute) sun damage is more important when it comes to malignant melanoma. The lifetime risk for a __(ethnicity)__ to get malignant melanoma is 1 in _____.
3rd most common. 25% in head and neck. Acute is worse. Caucasians 1:100 will get them.
What is the most common type of Malignant melanoma?
Superficial spreading melanoma
What type of Malignant melanoma is multicolored and flat?
Superficial spreading melanoma
1/3 of this type of Malignant melanoma are in the head and neck area.
Nodular melanoma
What type of Malignant melanoma is elevated, and sometimes has no pigmentation?
Nodular melanoma
What type of Malignant melanoma is melanoma in situ?
Lentigo maligna melanoma
What is the most common type of oral Malignant melanoma?
Acral lentiginous melanoma
Name the two most common sites for oral Malignant melanoma.
1 Maxillary anterior mucosa 2 Hard palate
Most oral Malignant melanomas are (primary/metastatic) and have (good/bad) prognosis.
Metastatic, bad
How does Addison's disease manifest in the skin/mucous membranes?
Bronzing
What are two clinical features of Peutz-Jeghers Syndrome?
1 Oral freckles (melanotic macules) 2 Intestinal polyposis
What are the three structural parts of a cyst?
1 Central cavity (containing fluid, etc) 2 Lining (usually strat squa) 3 CT Capsule
How are cysts usually discovered?
Routine exam/xrays
Name the cyst characterized by a non-vital tooth, inflammation, radiolucent, derived from rest of Malassez, either asympomatic or acute pain.
Dental Granuloma
Name the cyst characterized by a non-vital tooth, cholesterol clefts, radiolucent, either asympomatic or acute pain.
Radicular/Periradicular/Periapical Cyst
Name the cyst that develops from fragments of an apical cyst after removal of a tooth.
Residual cyst
Name the cyst that is associated with the crown of a normal/supernumerary impacted tooth.
Dentigerous cyst
What is the origin of a dentigerous cyst?
Reduced enamel epithelium, after the crown has formed
Name the 2 most common sites for a dentigerous cyst.
1 3rd molars 2 Maxillary cuspids
Dentigerous cysts usually occur from age ____ to ____, and is lined by ______ _________ epithelium.
10-30, stratified squamous epi
Name 3 possible progressions of a dentigerous cyst.
1 Ameloblastoma 2 Squamous cell carcinoma 3 Mucoepidermoid carcinoma (salivary gland tumor)
If a radiolucency is less than 2.5 mm, it is probably not a dentigerous cyst, but is probably…
Perifollicular fibrosis
Can you see an eruption cyst on an xray?
NO
Name the cyst that is a soft-tissue counterpart of a dentigerous cyst.
Eruption cyst
Name the cyst that develops in place of a tooth (no history of extraction or existing tooth).
Primordial cyst
What is the origin of a primordial cyst?
Remnants/degeneration of the enamel organ
Where is the most common location to find a primordial cyst?
3rd molar area
T/F: Primordial cysts can be multilocular.
TRUE
Name the cyst that shows keratinization.
Odontogenic keratocyst
What is the origin of an Odontogenic keratocyst?
Dental lamina/cell rests
Odontogenic keratocysts are (rare/common) make up ___-____% of all odontogenic cysts. OKC affects ____-____ year olds. They are lined by (thin/thick) epithelium.
Common, 3-11% of all odontogenic cysts, 10-40 year olds. Thin
What is the most common location to find an Odontogenic keratocyst?
Mandibular molar area
T/F: Odontogenic keratocysts can be aggressive.
True, can cause tooth movement and resorption
Name the syndrome which features multiple Odontogenic keratocysts.
Jaw cyst-basal cell nevus-Bifid rib syndrome
T/F: Odontogenic keratocysts can be multilocular.
TRUE
On an xray, name two things that Odontogenic keratocysts may resemble (and cannot be differentiated from).
1 Dentigerous cyst 2 Lateral periodontal cyst
Name a unique histologic feature of Odontogenic keratocysts.
Satellite cysts
T/F: Recurrence rate is high for Odontogenic keratocysts.
True, due to satellite cysts and wavy epi lining
Name a variant of Odontogenic keratocysts. Is its recurrence rate higher or lower than Odontogenic keratocysts?
Orthokeratinized odontogenic cyst. Recurrence is much lower (2% instead of 30%)
T/F: Gingival cyst of the newborn is rare.
False, it is found in 50% of all newborns!
What is the origin of Gingival cyst of the newborn and adult?
Remnants of the dental lamina
T/F: Gingival cyst of the adult is rare.
TRUE
Where is the most common area to find a Gingival cyst of the adult?
Mandibular bicuspid/anterior area
Name the cyst that is the bony counterpart to a gingival cyst of the adult.
Lateral periodontal cyst
T/F: Lateral periodontal cysts can be multilocular.
True, it would be called a Botryoid odontogenic cyst
Where is the most common area to find a Lateral periodontal cyst?
Mandibular premolar/cuspid area
Name the multilocular variant of a Lateral periodontal cyst.
Botryoid odontogenic cyst (grape-like cluster)
T/F: Recurrence rate is high for Lateral periodontal cysts.
False, it is low
Name the cyst that is more like a neoplasm than a cyst.
Calcifying Odontogenic Cyst (Gorlin cyst)
Where is the most common area to find a Calcifying Odontogenic Cyst (Gorlin cyst)?
Trick question - it's found equally in maxilla and mandible, but tends to be in the anterior area
Name a unique histologic feature of a Calcifying Odontogenic Cyst (Gorlin cyst).
Ghost cells, usually with calcifications (diffuse or clumpy)
Name the cyst that has glandular differentiation.
Glandular Odontogenic Cyst
Where is the most common area to find a Glandular Odontogenic Cyst?
Mandibular anteriors
What is a (better) synonym for a paradental cyst?
Buccal bifurcation cyst
Name the cyst that usually occurs on mandibular molars that have a history of pericoronitis.
Paradental/Buccal bifurcation cyst
What is the cause of Paradental/Buccal bifurcation cysts?
Infection stimulates Inflammation, which stimulates rests of Malassez to make enamel
What is the age predilection for Paradental/Buccal bifurcation cysts?
20-30 years old
Name the most common site to find a Paradental/Buccal bifurcation cyst.
Mandibular second/third molars
Name the cyst that is small, white, and found on the palate of newborns. Name 2 synonyms.
Palatal cyst of the newborn. 1 Epstein Pearls 2 Bohn's Nodules
Name the cyst that is caused by ectoderm entrapped in median palatal fusion line and/or epithelial remnants of developing palatal salivary glands.
Palatal cyst of the newborn/ Epstein Pearls/Bohn's Nodules
What is one differential diagnosis for Palatal cyst of the newborn?
Gingival cyst of the newborn
Name the rare soft tissue cyst affecting the lower portion of the nasolacrimal duct.
Nasolabial or Nasoalveolar cysts
Nasolabial or Nasoalveolar cysts affect more (males/females).
Females
Name the characteristic histological feature of Nasolabial or Nasoalveolar cyst.
Psuedostratified columnar epithelium
Name the cyst that occurs between the roots of the maxillary lateral and canines.
Globulomaxillary cyst
What shape is a Globulomaxillary cyst, usually?
Pear-shaped
Name 3 differential diagnoses for Globulomaxillary cysts.
1 Periapical cysts 2 Odontogenic cysts 3 Lateral periodontal cysts
Name the cyst that occurs in the incisive canal.
Nasopalatine Duct/Incisive Canal cyst
What is the soft-tissue counterpart of the Nasopalatine Duct/Incisive Canal cyst?
Palatine papilla cyst
Does the Nasopalatine Duct/Incisive Canal cyst affect (non/vital) teeth?
Vital
Nasopalatine Duct/Incisive Canal cysts usually occur in (males/females) age ____-_____.
Males, 40-60
What is the rule of thumb for Nasopalatine Duct/Incisive Canal cysts?
If it is less than .6 mm, it is probably just an enlarged incisive canal
Where is the most common location for Nasopalatine Duct/Incisive Canal cysts?
Between the maxillary centrals
What shape is a Nasopalatine Duct/Incisive Canal cyst, usually?
Heart-shaped
Name the cyst that is located posterior to the incisive papilla in the midline of the hard palate.
Median palatal cyst
Name the cyst that is lined by keratinized stratified squamous epithelium and is often filled with keratin.
Epidermoid cyst
Name the cyst that is lined by keratinized stratified squamous epithelium and is often filled with sebaceous glands, hair follicles, bone, muscle, etc.
Dermoid cyst
What other neoplasm does a dermoid cyst resemble?
Teratoma
Where is the most common location for an epi/dermoid cyst?
Floor of the mouth
If the patient has a bulge in the floor of the mouth/has no neck, the epi/dermoid cyst is (above/below) the mylohyoid.
Above
If the patient has a double chin, the epi/dermoid cyst is (above/below) the mylohyoid.
Below
Name the cyst that occurs on the midline, between the foramen cecum of the tongue and the suprasternal notch.
Thyroglossal duct cysts
What causes a thyroglossal duct cyst?
Epithelial remnants of the thyroid migration turn into cysts
What is the treatment for a thyroglossal duct cyst, and why?
Remove, because it may turn malignant
What % of thyroglossal duct cysts occur below the hyoid?
70%
Name the cyst that comes from epithelium trapped in lymph nodes.
Cervical Lymphoepithelial cyst (Branchial Cleft Cyst)
Name the cyst that occurs in the lateral neck as an asymptomatic, slow-growing fluctuant mass.
Cervical Lymphoepithelial cyst (Branchial Cleft Cyst)
Name the cyst that occurs in oral lymphoid tissue, is yellow, and has no rete pegs.
Oral lymphoepithelial cyst
Where do 50% of oral lymphoepithelial cysts occur?
Floor of the mouth
Name the cyst that occurs in the maxilla, after a maxillary sinus surgery/extraction.
Surgical Ciliated Cyst of the maxilla
What type of lining does a Surgical Ciliated Cyst of the maxilla have?
Respiratory epi
What causes a surgical ciliated cyst of the maxilla?
Epi becomes implanted/trapped at the site of surgery and starts to proliferate and cavitate
Name the cyst that is similar to dermoid but has gastric/intestinal mucosa lining.
Heterotropic Oral Gastrointestinal Cyst/Anterior Median Lingual Cyst/Gastric Cystic Choristoma
What is the age and gender predilection for Heterotropic Oral Gastrointestinal Cysts?
Infants/young children, males
Where is the most common location for a Heterotropic Oral Gastrointestinal Cyst (2)?
1 Tongue 2 Floor of the mouth
Name the pseudocyst that should be completely obvious on a radiograph.
Simple bone cyst/Traumatic Bone cyst
Why is a Simple bone cyst not a cyst?
It has no epithelium, and the cavity is empty
What is a key characteristic on the radiographs for a Simple bone cyst?
Scalloped border
What is the age group for Simple bone cysts?
Young adults
Are simple bone cysts associated with (non/vital) teeth?
Vital
What is the treatment for a Simple bone cyst?
Curette to start bleeding, then it heals on its own
Name the pseudocyst that has salivary gland tissue in it.
Lingual Mandibular Salivary Gland Depression (Static bone cyst/Stafne bone cyst)
Name the pseudocyst that radiographically occurs as an ovoid lucency between the mandibular canal and inferior border, with a sclerotic border.
Lingual Mandibular Salivary Gland Depression (Static bone cyst/Stafne bone cyst)
Name the uncommon vascular lesion of jaws/bones that resembles a "blood-soaked sponge".
Aneurysmal Bone Cyst
Do Aneurysmal bone cysts occur mainly in the maxilla or mandible?
Mandible
What is a differential diagnosis for an Aneurysmal Bone Cyst?
OKC
Name three other lesions that may be associated with an Aneurysmal Bone Cyst.
1 Fibrous dysplasia 2 Hemangioma 3 Traumatic bone cyst
What is the most common type of oral change?
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lowest recurrence rate of the three types.
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Childhood/Late teens - 20s
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Affects more females than males
All three
Minor, Herpetiform, or Major Aphthous: Affects 20% of the general population
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Affects non-smokers
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Caused by - Inherited and immunodysregulation, mucosa decrease, and antigen increase
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Trauma, stress, allergies provoke them
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Single and maybe Multiple, but no more than 3-5 at once
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Non-keratinized sites
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lasts 5 days - 2 weeks
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Tx is Antibiotics and topical corticosteroids, Levamisole
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Looks a lot like herpes simplex
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Most number of lesions of the three types
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Most frequent recurrence of the three types
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Young adults
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Multiple, 50-100 at once
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Sometimes on keratinized surfaces
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Lasts 7-10 days, with recurrence
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Tx is topical steroids
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: 2nd most common of the three types
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Longest duration of the three types
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Very painful, may scar because they are large and deep
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Most common on labial mucosa and soft palate
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Lasts up to 6 weeks, with recurrence
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Cannot be treated with antibiotics
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Tx is Non-systemic steroids, Orabase-Kenalog, Decadron, topical Tetracycline
Aphthous Major
Other than viral respiratory infections, what is the most common viral disease that affects humans?
Herpes Simplex I and II
What is the primary mode of transmission, during a/symptomatic?
Asymptomatic
What is another name for primary herpes simplex?
Acute Herpetic Gingivostomatitis
When does Primary herpes simplex usually occur?
1-5 years old
Which features ulcers on the gingiva: Aphthous ulcers or primary herpes simplex?
Primary Herpes simplex
Name the only place that Recurrent Intraoral Herpes Simplex can occur.
Mucosa that is bound to periosteum (gingiva and hard palate)
What often causes Recurrent Intraoral Herpes Simplex?
Dental treatment
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
Common, Unicystic, or Peripheral Ameloblastoma: Average age of occurrence is 30 years old.
Common
Common, Unicystic, or Peripheral Ameloblastoma: Benign aggressive
Common
Where do 85% of Common ameloblastomas occur?
Posterior mandible
Common, Unicystic, or Peripheral Ameloblastoma: Multilocular radiolucency with small compartments
Common
How do you differentate the multilocular radiolucency of a common ameloblastoma from a cyst?
Ameloblastoma has SMALL compartments, but cysts have BIG compartments
What disease features nests of odontogenic epithelium with stellate reticulum inside a rim of columnar ameloblasts?
Common Ameloblastoma
What disease features connective tissue stroma separating epithelial nests?
Common Ameloblastoma
Common, Unicystic, or Peripheral Ameloblastoma:Not encapsulated
Common
Common, Unicystic, or Peripheral Ameloblastoma: Resection is the typical treatment
Common
If a Common ameloblastoma is curetted, what is the recurrence rate (____-____%)?
50-90%
Name a differential diagnosis for Common ameloblastoma, and why it is similar.
Simple bone cyst - Scalloped border
Common, Unicystic, or Peripheral Ameloblastoma:Benign and not locally destructive
Unicystic
Common, Unicystic, or Peripheral Ameloblastoma:Average age of occurrence is 23 years old
Unicystic
Where do 90% of unicystic ameloblastomas occur?
Posterior mandible
Common, Unicystic, or Peripheral Ameloblastoma: Unilocular radiolucency, well-circumscribed
Unicystic
What disease features a cystic cavity, lined by ameloblasts, filled with stellate reticulum?
Unicystic Ameloblastoma
Common, Unicystic, or Peripheral Ameloblastoma: Capsulated
Unicystic
Name 3 differential diagnoses for Unicystic Ameloblastoma.
1 OKC 2 Dentigerous cysts 3 Simple bone cysts
How do you differentate Unicystic Ameloblastoma from Dentigerous cysts?
Unicystic Ameloblastomas are larger on radiographs
Name 3 differential diagnoses for Peripheral Ameloblastoma.
1 Pyogenic granuloma 2 Peripheral Giant Cell Granuloma 3 Peripheral Fibroma
Does peripheral Ameloblastoma look more like a well defined Common or Unicystic Ameloblastoma?
Common
What is the age and gender predilection for Adenomatoid odontogenic tumors?
10-19 years old, females
What is the MOST common site for an Adenomatoid odontogenic tumor?
Anterior maxilla, which is VERY unusual for an odontogenic tumor
T/F: Adenomatoid odontogenic tumors never occur around teeth.
False, 75% occur around unerupted teeth
How do you differentiate Adenomatoid odontogenic tumors from Dentigerous cysts?
Adenomatoid odontogenic tumors attach somewhere other than the CEJ, and occur in kids (not adults)
What disease histologically features columnar cells in duct-like arrangement, and polyhedral cells arranged in loose sheets?
Adenomatoid odontogenic tumors
Why are Adenomatoid odontogenic tumors so easy to remove, and have rare recurrence?
Because of their thick fibrous capsules, excision is curative
What is the age predilection for Calcifying Epithelial Odontogenic Tumors/Pindborg tumors?
Adults, 30-50 (a 40+ disease)
Name the tumor that most commonly presents as a painless, slow-growing swelling.
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors can be (radiolucent/opaque/mixed/more than one)?
Pure radioluent or mixed
If Calcifying Epithelial Odontogenic Tumors/Pindborg tumors are mixed radiolucencies, what two patterns of radioopacity are often seen?
1 Ground glass 2 Cotton wool
What disease histologically features polyhedral epithelial cells, and amyloid or amyloid-like material?
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors are classified as (innocuous, benign, benign aggressive, malignant).
Benign
Name the exceptionally rare tumor that appears to arise from neoplastic transformation of the rests of Malassez.
Squamous odontogenic tumor
What age range can squamous odontogenic tumor occur within?
8-74 years old
Name the disease that radiographically looks like a periodontal defect, destroyig crestal bone, and occurring as a triangular lucency lateral to tooth roots.
Squamous odontogenic tumor
What disease histologically features nests of bland stratified squamous epithelium?
Squamous odontogenic tumor
What uncommon tumor has both epithelial and mesenchymal tissue that are neoplastic?
Ameloblastic fibroma
What age group is most often affected by ameloblastic fibroma?
Teens, or younger
What is the site predilection for ameloblastic fibroma?
Posterior mandible
If any child presents with a radiolucent lesion in the posterior mandible, what disease is it until proven otherwise?
Ameloblastic fibroma
What disease histologically features islands of odontogenic epithelium, and developing tooth germ, with plump fibroblasts?
Ameloblastic fibroma
How does ameloblastic fibroma histologically differ from ameloblastoma?
Epithelial islands are small,and too skinny to be filled with stellate reticulum
What is the most common type of odontogenic tumor, exceeding the prevalence of all other odontogenic tumors combined?
Odontoma
What disease features multiple, small structures with recognizable tooth morphology?
Compound odontoma
What disease features masses/globs of tissue with no anatomic resemblance to a tooth?
Complex odontoma
During what age range are odontomas usually detected?
0-20
What is the site predilection for compound odontomas?
Anterior maxilla
What is the site predilection for complex odontomas?
Posterior mandible
If you cannot tell the type of odontoma by looking at the morphology,what is a reliable indicator of type?
Site of occurrence
If an odontoma is associated with a tooth, will it be around the crown or the root?
Crown
Name the unique neoplasm that feature islands of odontogenic epithelium with amyloid protein,plus enamel and dentin structures.
Ameloblastic fibro-odontoma
What is the age predilection for ameloblastic fibro-odontoma?
Children
What is the more common pattern of odontogenic fibroma; peripheral or central?
Peripheral
Name the tumor that most commonly presents as a painless, slow-growing gingival swelling, which occurs at any age.
Peripheral odontogenic fibroma
What disease histologically featues fibrous connectiv tissue and odontogenic epithelial nests?
Peripheral odontogenic fibroma
What is gender predilection for central odontogenic fibroma?
Females, 2.2:1
What are the two most common site predilections for odontogenic fibromas?
Anterior maxilla, or posterior mandible
What disease is often associated with a palatal mucosal groove when the lesions are in the maxilla?
Central odontogenic fibroma
What is the age predilection for odontogenic myxomas?
Young adults
Name the disease that radiographically has small honeycomb loculations, and often has a delicate, wispy appearance.
Odontogenic myxoma
Why is an odontogenic myxoma hard to remove?
It is soft, mushy, and gelatinous, like an umbilical cord, and clean margins are hard to get
What disease is histologically indistinguishable from osteoblastoma?
Cementoblastoma
What is the age predilection for cementoblastomas?
Young adults, under 25
What is the single-most common site for cementoblastomas to occur?
Mandibular first molars
With cementoblastomas, are the teeth (non/vital)?
Vital *KEY
What tumor should be easily identifiable only by radiographs?
Cementoblastoma
What does a cementoblastoma look like on radiographs?
Mixed, well-defined radiolucency/opacity, with a central opaque portion that obscures the root outline of the tooth
Why might cementoblastoma be mistaken for osteoblastoma/sarcoma?
Histologically indistinguishable
How is a cementoblastoma treated?
Remove, with the entire tooth, or do root canal and do partial amputation
Name the systemic disease defined as an absolute decrease in amount of bone due to bone resorption.
Osteoporosis
What is the age and gender predilection for osteoporosis?
50+ females
What is the generic term for increased amounts of calcified bone, and thus, increased density?
Osteosclerosis
Name 3 conditions that would produce osteosclerosis.
1 Metastatic tumors from prostate/breast 2 Lead poisoning 3 Hypothyroidism
Name two synonyms for Hyperparathyroidism.
1 Von Recklinghausen's 2 Osteitis fibrosa cystica
What generally characterizes hyperparathyroidism?
Generalized bone loss, replaced by fibrous tissue
What is the age and gender predilection for hyperparathyroidism?
Middle-aged females
What causes primary hyperparathyroidism?
Parathyroid adenoma
What causes secondary hyperparathyroidism?
Poor renal function, leading to decreased vitamin D, and decreased calcium
Name the two classic radiographic features of hyperparathyroidism.
1 Ground glass 2 Loss of lamina dura
Name 3 histological findings in hyperparathyroidism.
1 Cellular fibrous stoma 2 Vascular brown tumors 3 Giant cells
Name the disease that is characterized by abnormal/no bone resorption, so new bone is added on top of a crumbling foundation.
Osteopetrosis
Name the disease that features blue sclera.
Osteopetrosis
How is benign osteopetrosis transmitted?
Autosomal dominant
What is the age of onset for benign osteopetrosis?
Middle-to-older age
What disease has common manifestations of: Multiple pathologic fractures, pain, cranial nerve palsy, and osteomyelitis?
Benign osteopetrosis
How is malignant osteopetrosis transmitted?
Autosomal recessive
What is the age of onset for malignant osteopetrosis?
Birth; none survive to 20 years old
What disease has common manifestations of: Optic atrophy, hepatosplenomegaly, loss of hearing, pathological fractures, and osteomyelitis/secondary infections?
Malignant osteopetrosis
Name four dental findings in osteopetrosis.
1 Delayed eruption 2 Enamel hypoplasia 3 Osteomyelitis risk 4 Pathologic jaw fracture
What are the 2 radiographic features of osteopetrosis?
1 Milky, opaque changes 2 Increased cortical thickening
What disease classically features bilateral, symmetrical swelling of the mandible?
Cherubism
What is the 100% site predilection for cherubism?
Mandible
What is the age and gender predilection for cherubism?
Children, males
Why is the inheritance pattern for cherubism unique?
100% penetrance for males, 75% for females
What is the classic radiographic feature for cherubism?
Soap-bubble pattern radiolucencies
What disease is cherubism histologically similar to? How do you differentiate the two?
Hyperparathyroidism, but kids are too young to get it
What histologic feature is classic for cherubism?
Pink zone of eosinophilic cuffing
What is the most common bony lesion in the jaw?
Tori/exostoses
If a tori is located in the palate at the midline,what is it called? What about those that are anywhere other than midline palate?
Tori palatinus = Palate midline. Palatal tubercles/Buccal or palatal exostoses if anywhere else
Name the disease characterized by inflamed/necrosing bone that occurs in bone that was previously iradiated.
Osteoradionecrosis
What is the cause of osteoradionecrosis?
Compromised blood supply from radiation
What is the best treatment for osteoradionecrosis?
PREVENTION
What type of drugs can cause the same pattern as osteoradionecrosis?
Bisphosphonate drugs
Name the disease that is an inflammatory condition spreading in the medullary saces or cortical surface of bone.
Osteomyelitis
What causes most of the cases of osteomyelitis in the jaws?
Odontogenic infection
What radiographic features are seen in osteomyelitis after 1-2 weeks of acute onset?
Moth-eaten, skip radiolucencies
What is unique about the lacunae in osteomyelitis?
They are empty!
Name the disease that is a unique proliferative reaction in inflamed or irritated bone.
Osteomyelitis with proliferative periostitis
Name the age predilection for Osteomyelitis with proliferative periostitis.
Young people, way below 25 years old
What is the classic radiographic feature for Osteomyelitis with proliferative periostitis?
Onion-skin layering of new bone over the cortex
What is the treatment for Osteomyelitis with proliferative periostitis and osteomyelitis?
Remove the source of infection
Name the disease that is a localized area of osteosclerosis associated with the apex of a tooth with pulpal inflammation.
Condensing osteitis
What is the radiographic feature of condensing osteitis?
Radioopacity that blends with adjacent patterns
Name the disease that is radiographically indistinguishable from condensing osteitis. What is the difference? Which is more common?
Idiopathic osteosclerosis. Idiopathic has no obvious source of trauma/inflammation. Idiopathic is more common
Where do 90% of idiopathic osteosclerosis occur?
Mandible
Name the three types of Cemento-Osseous Dysplasias.
1 Periapical 2 Focal 3 Florid
What are the most common fibro-osseous lesions encountered in dentistry that we WILL see?
Cemento-Osseous Dysplasias
Cemento-osseous dysplasia is (almost always/very rarely) biopsied.
Very rarely
Name the three stages of Cemento-osseous dysplasia that are common to all three types.
1 Osteolytic 2 Blastic 3 Mature
What stage of Cemento-osseous dysplasia is always radiolucent, and features proliferating cellular fibroblastic tissue?
Osteolytic
What stage of Cemento-osseous dysplasia is mixed radiolucent/opaque, and features irregular immature bone/cementum within a fibrous stroma?
Blastic
What stage of Cemento-osseous dysplasia is mostly opaque, with a lucent rim, and features a central core of dense cementum/bone with fibrous tissue at the periphery?
Mature
What is the basis for determining the type of Cemento-osseous dysplasia?
Site of occurrence
What is the most common form of Cemento-osseous dysplasia?
Periapical
What is the age, gender, and ethnic predilection for Periapical Cemento-osseous dysplasia?
30-50 years old, Black, Women
What is the site predilection for Periapical Cemento-osseous dysplasia?
Anterior mandibular teeth ONLY
With Cemento-osseous dysplasia (all types), teeth are (non/vital).
Vital
What is the age, gender, and ethnic predilection for Focal Cemento-osseous dysplasia?
30-60 years old, White, Women
What is the site predilection for Focal Cemento-osseous dysplasia?
Trick question- It can occur anywhere, but is SOLITARY
What is the age, gender, and ethnic predilection for Florid Cemento-osseous dysplasia?
Middle-aged Black females
What classifies a Florid Cemento-osseous dysplasia?
At least one lesion in all four quadrants
What type of Cemento-osseous dysplasia may require attention because complications will require treatment?
Florid Cemento-osseous dysplasia
Name 5 complications of Florid Cemento-osseous dysplasia if teeth are not well-maintained.
1 Secondary infection 2 Poor healing after ext 3 Simple bone cysts 4 Resorption of ridges 5 OSTEOMYELITIS (yuck)
Name the disease that is classified as a developmental anomaly and features ground-glass radiographs, with no distinguished borders, and bone trabeculae that appear to arise directly from bone.
Fibrous dysplasia
What name is used for fibrous dysplasia that involves multiple bones, but not the entire skeleton, and features café-au-lait spots but no endocrine involvement?
Jaffe-Lictenstein Syndrome, a type of polyostotic fibrous dysplasia
What radiographic features are seen in Jaffe-Lictenstein syndrome that are not seen in other fibrous dysplasias?
Cotton-wool appearance, NOT ground glass
What is more important for diagnosing Jaffe-Lictenstein syndrome, radiographs or clinical findings?
Clinical findings
What name is used for fibrous dysplasia that involves multiple bones, features café-au-lait spots with endocrine involvement?
McCune-Albright syndrome
What is the most common type of fibrous dysplasia?
Monostotic
What is the classic radiographic appearance for fibrous dysplasia?
Finely stippled ground glass appearance, with ill-defined borders
If Richards shows an occlusal film with ground glass appearance, what is the most likely diagnosis?
Fibrous dysplasia
What is another name for Osteitis Deformans?
Paget Disease of Bone
Describe the etiologic development of Paget Disease of bone.
Osteoblasts exceed osteoclasts
What is the age predilection for Paget Disease of bone?
Adults over 40
What dental complaints will be seen with Paget Disease of bone?
"Occlusion is changing" "Denture doesn't fit anymore"
What is the classic radiographic presentation for Paget Disease of bone?
Cotton-wool appearance, loss of lamina dura, and hypercementosis
Besides biopsy, what can be used to diagnose Paget Disease of bone?
Serum alkaline phosphatase
What disease is associated with a 30X risk for developing osteosarcoma, and therefore patients should not be radiographed?
Paget Disease of Bone
What disease might come from fibroblasts, cementoblasts, or osteoblasts, but we're not sure?
Cemento-ossifying Fibroma
Where does cemento-ossifying fibroma occur more: Maxilla or mandible?
Mandible
What is the age predilection for Cemento-ossifying fibroma?
Young adults, rarely over 40
Cemento-ossifying fibroma should never be used on a differential diagnosis if the unknown lesion is (pure radiolucent/opaque/mixed).
Pure radiolucent - COF is usually mixed
What is the only bone disease (besides benign/malignant bone tumors) that must be excised? Why?
Cemento-ossifying Fibroma - It continues to grow
How can you differentiate a Cemento-ossifying fibroma from a Cemento-osseous dysplasia?
Osteoblastic/Cementoblastic rimming is common with COF
What shape are benign bone tumors, usually?
Round
What disease looks similar to tori/exostoses, and fibrous dysplasia? How do you tell the difference?
Osteoma - osteomas grow!
What systemic disease is associated with Osteomas?
Gardner's syndrome
Name 5 clinical features of Gardner's syndrome.
1 Multiple osteomas 2 Epidermoid cysts 3 Adenomatous polyps 4 Impacted/supernumerary teeth 5 Colon cancer risk
Name two closely related fibro-osseous neoplasms that are only distinguished on size.
Osteoid osteomas and osteoblastomas
What is the age predilection for osteoblastoma/osteoid osteoma?
Adolescents/young people
Name the clinical feature of osteoblastoma/osteoid osteoma.
Pain and swelling
What rare disease features knobby growths on cartilage?
Chondroma
Name the disease that is Richards' favorite, which is histologically indistinguishable from the brown tumor of hyperperathyroidism.
Central Giant Cell Granuloma
What is the age and gender predilection for central giant cell granulomas?
Children/young adult females
What is the site predilection for central giant cell granuloma?
Mandible
What is the usual clinical presentation for a central giant cell granuloma?
Bony swelling
What is the radiographic appearance of a central giant cell granuloma?
Pure radiolucency, NOT multilocular
What disease histologically features multinucleated giant cells resembling osteoclasts and resembles brown tumors of hyperparathyroidism?
central giant cell granuloma
Name 2 congenital anomalies that may occur centrally in the jaws.
Central Hemangioma and Vascular Malformations
What is the age and site predilection for Central Hemangioma and Vascular Malformations?
Adolescents, Mandible
List 4 clinical features of Central Hemangioma and Vascular Malformation.
1 Bony destruction 2 Expansion 3 Facial asymmetry 4 Purple gingiva
What is the most common primary malignancy of bone?
Osteosarcoma
List 3 contributing factors for osteosarcoma.
1 Paget Disease of Bone 2 Prior irradiation tx 3 Osteogenesis Imperfecta
What is the age and site predilection for Osteosarcoma?
Avg. age 33, Mand=Max
List 4 S/S of osteosarcoma.
1 Pain/swelling 2 Loose teeth 3 Toothache 4 Paresthesia
Describe the radiographic presentation of osteosarcoma.
Bony expansion, mixed opacity, Sunburst, widened PDLspace
Name a malignancy that closely resembles Odontogenic myxoma.
Chondrosarcoma
What is the age and site predilection for chondrosarcoma?
Peak incidence in 7th decade, Max:Mand 4:1
Describe the radiographic presentation of chondrosarcoma.
Expansile radiolucent mass, poorly defined margins, possibly speckled opacities
What is the most important histologic feature of chondrosarcoma?
Appearance/architecture of cells
What is the cell of origin of Ewing Sarcoma?
Neuroectoderm
What is the age, race and site predilection of Ewing Sarcoma?
2nd decade, strong white predominance, Mandible
What is the classic radiographic presentation of Ewing Sarcoma?
Onion-skin layering of new bone over the cortex
Describe the S/S of Ewing Sarcoma.
pain/swelling, paresthesia, loose teeth, fever, leukocytosis
What is the histologic presentation of Ewing Sarcoma?
Small dark round cells, scant cytoplasm, little stroma, cells contain glycogen
What is the most common malignancy in bone?
metastatic tumor
Name 3 tumors that tend to metastisize to bone.
Prostate, Breast, Lung
Name 3 tumors that tend to metastisize to jaws.
Breast (30%), Lung (20%), Kidney (15%)
Describe the radiographic presentation of Metastatic lesions.
Diffuse radiolucencies, poorly defined (but can be well circumscribed)
What are the two most common PRIMARY malignant bone tumors?
Osteosarcoma and Chondrosarcoma
Name the 5 most common MALIGNANT tumors occurring in bone.
1 Metastatic Tumor 2 Multiple Myeloma 3 Osteosarcoma 4 Chondrosarcoma 5 Ewing Sarcoma
What is the most common type of oral change?
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lowest recurrence rate of the three types.
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Childhood/Late teens - 20s
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Affects more females than males
All three
Minor, Herpetiform, or Major Aphthous: Affects 20% of the general population
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Affects non-smokers
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Caused by - Inherited and immunodysregulation, mucosa decrease, and antigen increase
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Trauma, stress, allergies provoke them
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Single and maybe Multiple, but no more than 3-5 at once
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Non-keratinized sites
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lasts 5 days - 2 weeks
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Tx is Antibiotics and topical corticosteroids, Levamisole
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Looks a lot like herpes simplex
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Most number of lesions of the three types
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Most frequent recurrence of the three types
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Young adults
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Multiple, 50-100 at once
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Sometimes on keratinized surfaces
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Lasts 7-10 days, with recurrence
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: Tx is topical steroids
Herpetiform Aphthous
Minor, Herpetiform, or Major Aphthous: 2nd most common of the three types
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Longest duration of the three types
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Very painful, may scar because they are large and deep
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Most common on labial mucosa and soft palate
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Lasts up to 6 weeks, with recurrence
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Cannot be treated with antibiotics
Aphthous Major
Minor, Herpetiform, or Major Aphthous: Tx is Non-systemic steroids, Orabase-Kenalog, Decadron, topical Tetracycline
Aphthous Major
Other than viral respiratory infections, what is the most common viral disease that affects humans?
Herpes Simplex I and II
What is the primary mode of transmission, during a/symptomatic?
Asymptomatic
What is another name for primary herpes simplex?
Acute Herpetic Gingivostomatitis
When does Primary herpes simplex usually occur?
1-5 years old
Which features ulcers on the gingiva: Aphthous ulcers or primary herpes simplex?
Primary Herpes simplex
Name the only place that Recurrent Intraoral Herpes Simplex can occur.
Mucosa that is bound to periosteum (gingiva and hard palate)
What often causes Recurrent Intraoral Herpes Simplex?
Dental treatment
Name the two diseases caused by varicella-zoster virus.
1 Chicken pox 2 Shingles
How does varicella-zoster usually enter the body?
Respiratory tract
Name the maculopapular eruption that occurs on the trunk and face first, then extremities.
Chicken pox
What are the oral manifestations of chicken pox?
Small vesicles on buccal mucosa, palate, and gingiva
Name the 3 type of aphthous.
1 Minor 2 Major 3 Herpetiform
T/F: Aphthous is more common in non-smokers.
TRUE!
Aphthous Minor or Aphthous Major: Duration 3-7 days
Minor
Aphthous Minor or Aphthous Major: Most common for of aphthous
Minor
Aphthous Minor or Aphthous Major: 3 to 10 mm in diameter
Minor
Aphthous Minor or Aphthous Major: May be up to several cm in diameter
Major
Aphthous Minor or Aphthous Major: May have genital lesions
Major
Apthous Minor or Aphthous Major: Etiology includes primary immunodysregulation, decrease of mucosal barrier, increase of antigenic exposure.
BOTH
Aphthous Minor or Aphthous Major: Mucobuccal fold most common site, also tongue, palate, labial mucosa and gingiva
BOTH
Trauma, endocrine conditions, psychic factors and allergic factors may precipitate this condition
Aphthous Minor and Major
Condition characterized by as many as 100 lesions averaging 1-3 mm in diameter.
Herpetiform Aphthous
This condition clinically resembles primary herpes.
Herpetiform Aphthous
Should you treat a patient with topical steroids if they present with primary herpes-like lesions?
Only if they've had multiple recurrence
What is the age and gender predilection for herpetiform aphthous?
Young adult, Female
Besides respiratory viral infections, what is the most common viral infection?
Herpes Simplex
Which HSV type affects predominantly face, lips and oral cavity?
HSV Type I
Which HSV type affects predominantly genitals and skin of lower body?
HSV Type II
HSV resides in cells of which origin?
Ectodermal
Primary HSV infection usually occurs at age?
Child, 1-10 y.o.
What percent of infections have clinical dz?
1-10%
What percent of the population display antibodies?
50-90%
How is HSV transmitted?
Direct contact with saliva or droplet carrying virus
Primary Herpetic Gingivostomatitis may be characterized by what 4 clinical features?
1 2-4 mm vesicles and ulcers 2 Bleeding/Painful ginigiva (early sign) 3 Painful, ragged ulcers 4 Pharyngotonsilitis (primary infection in adults)
How long do primary herpetic lesions last?
7-14 days
"Ballooning degeneration" and Lipshutz bodies (intranuclear inclusions) are characteristics of which infection?
Primary Herpetic Gingivostomatitis
What are 3 other synonyms for Recurrent Herpes Simplex?
1 Herpes Labialis 2 Fever Blister 3 Cold Sore
Which HSV infection usually occurs on the muco-cutaneous junction?
Recurrent Herpes Simplex
What is the usual progression of a Recurrent Herpes Simplex lesion?
1 Preceded by burning sensation 2 Swelling 3 Vesicle formation 4 Ulceration
How long does a Recurrent Herpes Simplex lesion last?
4-10 days
Where do Recurrent Intraoral Herpes Simplex lesions occur?
Mucosa bound to periosteum (hard palate and gingiva)
Which HSV lesion consists of multiple small painful ulcers, often are precipitated by dental Tx, and last 7-10 days?
Recurrent Intraoral Herpes Simplex
Name the virus that causes chickenpox.
Varicella-zoster virus
What is the probable entry point for the varicella-zoster virus?
Respiratory
What dz is characterized by maculopapular or vesicular eruptions on skin, seen in ages 5-9 usually, appear on trunk and face and then extremities and may leave scars?
Chickenpox
What are the 4 stages of chickenpox lesions?
1 Erythema 2 Vesicle 3 Pustule 4 Hardened crust
T/F: Chickenpox lesions are painless.
TRUE (diff. from HSV which are painful)
Which virus causes herpes zoster (shingles)?
Varicella-zoster virus
Which dz is characterized by very painful lesions, inflammation of dorsal root ganglia and is the recurrent form of chickenpox?
Herpes Zoster
Which dz is characterized by fever, pain and tenderness along nerve, migraine headache?
Herpes Zoster
Is herpes zoster displayed unilaterally or bilaterally?
Unilaterally
Which virus causes infectious mononucleosis?
Epstein-Barr virus
How is the Epstein-Barr virus transmitted?
Intimate contact, usually contaminated saliva
Lymphadenopathy, pharyngitis, hepatosplenomegaly, rhinitis, cough, etc. are characteristic of what dz?
Infectious Mono
What are 2 possible oral manifestions of infectious mono?
1 Petechiae on hard/soft palate 2 Possible ANUG
Which virus causes Herpangina (aphthous pharyngitis)?
Coxsackie group A, types 1-6, 10, 16, 22
What time of year and in what age group does herpangina occur?
Usually summer, children
Which virus causes Hand, Foot and Mouth Dz?
Coxsackie group A16
What is the age predilection for Hand, Foot and Mouth Dz?
Young children (5 mos to 5 yrs)
What dz is characterized by maculopapular, exanthematous and vesicular lesions of the skin (esp. hands, feet, legs and mouth)?
You better get this one!
What do the intraoral lesions look like in Hand, Foot and Mouth Dz?
Small, multiple vesicular lesions on hard palate, tongue and buccal mucosa
What dz is characterized by fever, malaise, conjuntivitis, photophobia and eruptive lesions on the skin and oral mucosa (rash)?
Measles (rubeola)
These spots occur on the buccal mucosa 2-3 days before skin rash and appear as bluish-white specks surrounded by a white margin.
Koplik's spots
What area of the body do measles rash first occur?
Face
Which mild viral illness is caused by togavirus?
Rubella (German measles)
Which dz can cause fetal deaths or Congenital Rubella Syndrome?
Rubella (German measles)
In Rubella, what do you call the small, discrete, dark-red papules that develop on the soft palate and arise about 6 hours after the first symptoms, but do not last longer than 12-14 hours?
Forchheimer's sign
What is the classic triad of Congenital Rubella Syndrome?
1 Deafness (80%) 2 Heart Dz 3 Cataracts
Which HPV types cause Condyloma Acuminatum?
HPV 6,11,16,18
Which dz appears clinically as solitary or multiple pinkish, sessile papules with pebbled surface?
Condyloma Acuminatum
Condyloma Acuminatum makes up about __% of all STDs.
20%
What fungal infection is a yeast-like infection caused by a common inhabitant of the oral cavity?
Candidiasis
This incection affects the young, debilitated persons, patients w/ chronic dz and diabetics, and is seen in overuse of antibiotics.
Candidiasis
Describe the clinical appearance of candidiasis.
Milk curds, white elevated plaque consist of fungal hyphae, bleed when wiped off
What is it called when the corners of the mouth are involved in a candida infection?
Angular cheilitis (Perleche)
Name the six types of candidiasis.
1 Pseudomembranous candidiasis 2 Erythematous Candidiasis 3 Median Rhomboid Glossitis 4 Angular Cheilitis 5 Chronic Hyperplastic Candidiasis 6 Mucocutaneous Candidiasis
What is the most recognized form of candidiasis, often assoc. with antibiotics, steroid use and immunosuppression?
Pseudomembranous Candidiasis
Where does Pseudomembranous candidiasis occur orally?
Buccal mucosa, hard palate, dorsal tongue
This form of candidiasis has red macules w/ burning sensation, often found in patients wearing dentures, after antibiotic therapy, and may have loss of filiform papillae.
Erythematous Candidiasis (Denture stomatitis)
Which type of candidiasis looks like geographic tongue and is asymptomatic?
Median Rhomboid Glossitis
Which type of candidiasis is associated with decreased VDO, has red fissured area at the corner of the mouth and is generally seen in older persons?
Angular cheilitis (Perleche)
This is the least common type of candidiasis. It has a white patch that cannot be removed (looks like leukoplakia) and occurs on the anterior buccal mucosa.
Chronic Hyperplastic Candidiasis
This form of candidiasis is seen in some patients with immunologic disorders and occurs on mucous membranes, skin, and nails. It has thick white plaques that don't wipe off.
Mucocutaneous Candidiasis
Name the disease that histologically features hyphae, viewable with 20% potassium hydroxide or PAS stain.
Candidasis
Name the most commonly used topical/systemic agent used to treat Candidiasis.
Nystatin
Name the disease acquired by inhalation of spores from bird excrete.
Histoplasmosis
Name the two common areas of the US to find Histoplasmosis infection.
1 Mississippi Valley 2 Northeastern US
What three clinical manifestations do Histoplasmosis and Infectious Mono have in common?
1 Splenomegaly 2 Hepatomegaly 3 Lymphadenopathy
What system does Histoplasmosis have a predilection to infect?
Reticulo-endothelial
What do oral lesions from Histoplasmosis look like?
Nodular/ulcerations on buccal mucosa, gingiva, tongue, palate, and lips
What fungus produces tuberculosis-like symptoms?
Blastomycosis
What do oral lesions from Blastomycosis look like? What two other diseases do they resemble?
Ulcerations of the tongue with irregular, rolled borders. Actinomycosis or Squamous Cell carcinoma
Why do you have to biopsy blastomycosis?
It has pseudoepithiomatous hyperplasia! (Just like granular cell tumor)
What fungus causes Valley Fever?
Coccidiomycosis
Name the area of the US where it is likely to find Coccidiomycosis.
Southwestern US
Name the two forms of coccidiomycosis infection.
1 Primary, non disseminated 2 Disseminated
Name the one clinical manifestation of primary coccidiomycosis infection. What two other skin diseases can be triggered?
Cough. 1 Erythema nodosum or 2 Multiforme
What is special about secondary coccidiomycosis infection?
It is bad, and 50% are fatal
Name the two bacteria that cause impetigo.
1 Strep pyogenes 2 Staph aureus
What disease causes fragile vesicles or long-lasting bullous lesions that are amber-colored?
Impetigo
What is the age predilection for impetigo?
Young children
What is the age predilection for scarlet fever?
Children
Name 3 oral manifestations of scarlet fever.
1 "stomatitis scarlatina" 2 Strawberry tongue (white), followed by 3 Raspberry tongue (red)
Name the specific bacteria that causes scarlet fever.
Group A Beta-hemolytic strep
Name the bacteria that causes syphilis.
Treponema pallidum
What two stages of syphilis are highly infectious?
Primary, secondary
Name the primary lesion fo syphilis.
Chancre
Name the three lesions of secondary syphilis.
1 Maculopapular rash 2 Mucous patches 3 Condylomata lata
During which syphilis stage might you have mild fever, hoarseness, dysphasia, inflamed tonsils, redness of soft palate (NOT hard)?
Secondary
Name the tertiary lesion for syphilis.
Gumma (painless, necrotic granuloma)
During which syphilis stage might you haveCNS, skin, CVS, skeleton, joint involvement?
Tertiary
During which syphilis stage might you see syphilitic glossitis in males, and perforation of the palate?
Tertiary
After which month of gestation can congenital syphilis be transmitted through the placenta?
4th month
Name the two types of congenital syphilis.
1 Generalized 2 Late congenital
Name the pathognomonic sign for generalized congenital syphilis.
Rhagades (cracking and healing with scars)
Name two other clinical manifestations of generalized congenital syphilis, besides the pathognomonic sign.
1 Snuffles (rhinitis) 2 Saddle nose (necrosis of nasal septum)
Name the three components of Late congenital syphilis' pathognomonic Hutchinson's triad.
1 Hutchinson's teeth (screwdriver incisors and mulberry molars) 2 Ocular interstitial keratitis 3 8th nerve deafness
How could gonococcal stomatitis affect the oral cavity (this is rare)?
Fellatio, etc.
Name 3 other diseases that gonococcal stomatitis may resemble.
1 Erythema multiforme 2 Erosive lichen planus 3 herpetic stomatitis
Name a disease that is a rapidly progressive infection by opportunistic bacteria, in immunocompromomised patients.
Noma
Name the periodontal disease that noma may begin as.
ANUG
Name the anaerobic, gram +, non acid-fast, filamentous bacteria that usually lives in the oral flora but can cause infections in wounds.
Actinomycosis
What disease is associated with "Sulfur granules"? What are sulfur granules?
Actinomycosis. Large yellowish clumps of bacteria that are in pus from abcesses
Name the disease that can cause lymphadenitis in children and is self-limiting.
Cat Scratch
Prior to HAART, this condition was often first seen in the late asymptomatic stage of HIV infection.
Hairy Leukoplakia
What is the etiology of hairy leukoplakia?
Epstein-Barr virus (seen only in immunocompromised host)
What are 4 clinical features that characterized hairy leukoplakia?
1 Usually bilateral 2 Rough, shaggy, dense leukoplakia that won't wipe off 3 Irregular borders w/ vertical extensions 4 Corduroy-like surface
What condition is usually bilateral and almost invariably involves the lateral borders of the tongue?
Hairy Leukoplakia
What are 4 histologic features of hairy leukoplakia?
1 Hyperparakeratosis 2 Acanthosis 3 Balloning of spinous cells 4 Minimal inflammation in supporting C.T. (good for Dx!)
List 6 predisposing factors for Simple Oral Candidiasis.
1 Immature immune system 2 Antibiotic therapy 3 Dentures (or retainers!) 4 Smoking 5 Poor OH 6 Debilitating systemic dz (usually in the elderly)
T/F: A person who gets Candidiasis for the first time should be considered to have HIV infection.
False-this is a very common oral infection in the general population.
Candidiasis in what specific region should be considered highly suspicious for being HIV-related?
Oropharynx
Erythema, white "curds" which wipe off leaving raw/bleeding surface, and white plaque-like areas that do not wipe off are clinical features of what oral infection?
Candidiasis
What are 2 histologic features of candidiasis?
1 Budding yeasts and pseudohyphae invading into superficial epith 2 Inflammation (primarily acute)
What malignant neoplasm derived from endothelial cells may be the first presentin sign of AIDS?
Kaposi Sarcoma
What are 2 etiological factors that may cause K.S.?
1 Infection by HSV-8 2 Immunocompromised host
Kaposi sarcoma is multicentric. What are the 4 primary areas that may be involved?
1 Skin 2 Mucous membrane 3 Lungs 4 GI tract
What is the single most common oral site for K.S.?
Palate (Ant. Max. gingiva is second)
What oral dz has well-circumscribed, red to purple, often flat lesions (early) or elevated (advanced) with no surface ulcerations expected?
Kaposi Sarcoma
What is the Dx technique used to establish a definitive Dx?
Biopsy
Name 2 HIV-associated Perio diseases.
1 Linear Gingival Erythema 2 Necrotizing Ulcerative Periodontitis
What perio dz has markedly reddened gingiva, out of proportion to plaque levels?
Linear Gingival Erythema
What perio dz may be focal or generalized, may or may not have color changes, pronounced attachment loss, possible spontaneous exfoliation of teeth, necrosis, sloughing of bone and/or soft tissue and spontaneous bleeding ulcerations? (is that enough hints for you?!!)
Necrotizing Ulcerative Periodontitis
Name 3 Herpes family viruses that may have more frequent reactivation in HIV-AIDS patients.
1 HSV 2 Herpes zoster 3 Cytomegalovirus (usually retinitis, oral is rare)
What is the most common deep (invasive) fungal infection in the AIDS population?
Histoplasmosis
T/F: Non-Hodgkin Lymphoma is common in AIDS patients.
TRUE (and oral lesions are common)
What is the prognosis for and HIV+ person with non-Hodgkin Lymphoma?
POOR
Name the term used for a group of inherited conditions in which two or more - of hair, sweat glands, teeth, and nails fail to develop
Ectodermal Dysplasia
What are three oral manifestations of ectodermal dysplasia?
1 Hypodontia 2 Abnormal-shaped teeth 3 Tapered anterior crowns
What is the mode of transmission for white sponge nevus?
Autosomal dominant
When does white sponge nevus appear?
Birth or childhood
Where is the most common site for white sponge nevus?
Buccal mucosa
Name the disease that histologically features hyperparakeratosis and acanthosis.
White Sponge nevus
Name 3 skin diseases with oral manifestations that are discussed in other sections of oral path.
1 White sponge nevus 2 Peutz-Jegher 3 Hereditary Hemorrhagic Telangiectasia
Name the most common skin disease with oral manifestations.
Lichen Planus
What is the etiology of lichen planus?
T-cell mediated autoimmune process
What liver disease is often associated with lichen planus in Mediterranean countries?
Hepatitis C