Aandrews Oral Path Osce

Front 1

• Clinical Information:
o This patient started a course of antibiotics 2 weeks ago. He does not report having a fever or any other symptoms. Medical history includes asthma. The lesion is mildly symptomatic and wiped off with a q-tip swab. (P.H.P)
• Description:
o Diffuse white slough on the soft palate that is easily removed

Back 1

o Pseudomembranous candidiasis (Thrush)
o Herpes Simplex
o Plaque-type lichen planus.
• Treatment:
o Limit use of inhaler, Nystatin rinse or Mycelex Troche (clotrimazole lozenge) is very effective.

Front 2

o 29-year-old female. Patient presents today for exam & prophy. This patient has been aware of an intermittent mild pain of her lingual dorsum for the past three months. The white/red lesions were present many months before the symptoms occurred. Patient has asthma and uses Flovent inhaler(E.E.L.)
• Description:
o Irregular well-defined smooth red and white scalloped patches on the dorsum of the tongue where the filiform papillae stop short.

Back 2

o Erythema Migrans (Geographic Tongue)
o Erythema Multiforme
o Lichen planus???
• Treatment:
o No Treatment. Triamcinolone if necessary to decrease inflammation if uncomfortable.

Front 3

o 30 year old female. This patient has been experiencing very painful ulcers of multiple oral mucosal sites as long as she can remember. She now presents with the latest ulcer, which is so tender that it interferes with eating. It is the only such ulcer in her mouth. It has been present for 4 weeks. (R.T.H.)
• Description:
o Large well-defined ovoid white ulcerated lesion approximately 1cm in diameter with a diffuse erythematous border.

Back 3

o Recurrent aphthous stomatitis per hx. (major apthous ulcer seen here)
o Traumatic Ulcer
o Herpetiform aptha
• Treatment:
o Viscous Lidocaine for pain relief or topical triamcinolone with orobase for pain relief and to lower inflammation.

Front 4

o 55 yr old female who is a lawyer and has a very stressful job. Patient grinds her teeth and says her husband sees her chewing her cheek. No other significant medical history . (T.W.P.)

• Description:
o Diffuse rough white lesion on buccal mucosal associated with occlusal plane.

Back 4

o Traumatic Hyperkeratosis
o White sponge nevus
o Pseudomembranous candidiasis
• Treatment:
o Extinguish habit with a mouthguard and the lesion should disappear. If lesion persists after irritant or habit is removed, biopsy.

Front 5

o This patient just returned from a trip to the desert (and her first stop is at the dentist office?). She reports a tingling feeling about a day before this lesion appeared. She also reports she kissed a camel that had Herpes Simplex Type 1 while in the desert. (H.I.H.)

• Description:
o Multiple white coalescing ulcerated vesicles surrounded on an erythemeatous lesion associated with the labial tissue (often the vermillion border)
o Triggered by exposure to sunshine or physiologic/emotional stress herpes labialis latent activation starts with prodromal symptoms of burning or tingling leading to vesicles that coalesce and rupture forming a scab that heals generally without a scar.

Back 5

o Herpes Labialis
o Impetigo (bacterial infection)
o Hand Foot and Mouth Disease (Coxsackie A virus)
• Treatment:
o Herpes Simplex Type 1: From the time prodromal symptoms are noted to healing is 10 days. Topical application of acyclovir at the start of prodromal symptoms will shorten the healing time by 10%.

Front 6

o This male patient has lost his deciduous upper molars. The permanent premolars have not erupted. The radiograph shows permanent teeth present, but the enamel and dentin are very thin & indistinct.
o Lesion looks (R.A.I.D.D.)
• Description:
o Present permanent maxillary premolars with thin indistinct enamel and dentin present.

Back 6

o Regional Odontodysplasia (“ghost teeth” unusual in cases probably less likely than having 2 “Turner” teeth in right next to each other
o Amelogenesis imperfecta
o Dentin Dysplasia
• Treatment:
o Teeth may never erupt and if they do restorability is unlikely – Extraction and space management.

Front 7

o This 15 year old patient reports that he had a injury to his teeth and maxilla 3 months ago. This lesion had a purulent exudate which had a yellow appearance with granules in it. (A.E.O.)
• Description:
o Red/purple abscess with an open draining sinus tract to the skin producing yellow colored granules termed “sulfer granules”

Back 7

o Actinomyces israelii Abscess
o Epidermal cellulitis
o Odontogenic infection with facial sinus tract
• Treatment:
o Surgical I&D with IV Penicillin G

Front 8

o 50 year old black female ($$90% in blacks!!) is worried about the white lesions on her cheeks. She heard that they could be pre-cancer (she heard wrong). Her health history is positive for hypertension treated with atenolol (bottom pic is stretched and the lesion magically disappears thanks to Dr. Houdini D.D.S.) (Leukies.White.Trauma.)

Back 8

o Leukoedema
o White sponge nevus
o Traumatic hyperkeratosis
• Treatment:
o No treatment required. Just reassure the patient.

Front 9

o 6 year old female with abnormally shaped permanent central incisors.

Back 9

o Turners Hypoplasia (T.H.A.t hypo hippo)
o Hutchinson Incisors
o Amelogenesis imperfecta II - hypomaturation
• Treatment:
o Bleach the staining or restore the caries

Front 10

o This patient presents to your office for a tooth infection. You notice that there face has an abnormal appearance. (He’s not P.H.A.t, S.O. needs He Man)

Back 10

o Progressive Hemifacial Atrophy
o Segmental odontomaxillary dysplasia
o Hemifacial Microsomia
• Treatment:
o Plastic surgery for cosmetic and ortho for malocclusion

Front 11

o This patient reports that the area in the lower left has been tender for about 2 months. He is going through orthodontics.
o That a PERI G. RAD PERI A

Back 11

o Periapical granuloma
o Radicular cyst
o Periapical abscess
• Treatment:
o Endo therapy or extraction

Front 12

o This 40 YO male presented for a routine exam. He reports that he has noticed this hard bump on the roof of his mouth for a long time. He worries that he may have a tumor because it hurts some times. He has a history of hypertension and takes Diltiazem to control it. What is your diagnosis and the treatment options? (T.M.O.)

Back 12

o Torus palatinus
o Median palatal cyst
o Osteoma
• Treatment:
o No treatment necessary unless it interferes with normal function

Front 13

o 41 year old female. Three weeks ago this woman noticed a stinging sensation of her right and left buccal mucosae during the eating of spicy dressings and spaghetti sauces. The buccal mucosae are similar, with white nonsloughing streaks on an erythematous background, with occasional ulcers. What is your differential and the next step you should take? (E Li. C.U.Ses at.LUP-E)

Back 13

o Erosive lichen planus
o Chronic ulcerative stomatitis
o Lupus erythematous
• Treatment:
o Corticosteroids and biopsy if lesion does not go away

Front 14

o 19 year old female. This somewhat pedunculated mass of the lower right lip mucosa has been present intermittently for more than 8 weeks. It is slightly tender and has a tingling sensation associated with it. There are no other similar oral lesions. (MU,MU,HE)

Back 14

o Mucocele
o Mucus retention cyst
o Hemangioma
• Treatment:
o Surgical excision deep enough to include underlying gland

Front 15

o 60 year old male. This man’s dentist noticed an asymptomatic white plaque of his oral floor during a routine annual exam. The patient smokes two packs of cigarettes daily and has been doing so since his late teens. He has COPD and emphysema.

Back 15

o Squamous Cell CA
o Dysplasia
o Hyperkeratosis
• Treatment:
o Surgical excision and possible irradiation

Front 16

o 16 year old male presents for evaluation of painless swelling of retromolar pad area of right mandible. Large radiolucency of mid-portion of mandible is nontender and nonexpansile. Overlying mucosa is normal. Duration: unknown. What is your differential?

Back 16

o Traumatic Bone Cyst
o Ameloblastic Fibroma
o KCOT
• Treatment:
o Aspiration for dx, surgical

Front 17

o 40 year old male with painless, sessile bulge or bosselation of his right mandibular first premolar region. It has not enlarged since he first noted it 5 months earlier.

Back 17

o Lateral Periodontal Cyst
o Radicular Cyst
o Botryoid cyst
o KCOT

• Treatment:
o Surgical enucleation. Recurrence is uncommon.

Front 18

o 8 year old female. This irregular radiopacity was noted above the crown of the impacted maxillary left premolars during a routine dental visit. She had not been to the dentist for more than two years. There is a cortical swelling over the site and the area is asymptomatic. The patient has a hockey-stick deformity of her left femur secondary to fibrous dysplasia.

Back 18

o McCune Albright Syndrome
o Complex odontotoma
o Calcifying Epithelial Odontogenic Tumor (CEOT)
• Treatment:
o Pursued only when lesions are cosmetically unacceptable or interferes with sight, breathing, mastication, or speech.

Front 19

o 68 year old male. Four months ago this man began experiencing a bilateral facial palsy which has become somewhat more severe since then. A neurologic examination reveals irregular opacities of a thickened calvaria. He has normal calcium , elevated cholesterol, and alkaline phosphatase. A skull radiograph shows intense and mottled radiopacity& thick calvaria.

Back 19

o Pagets Disease
o Osteomalacia
o Osteopetrosis
• Treatment:
Bisphosphonates and Calcitonin

Front 20

o 25 year old male. He reports that he noticed this bump on his cheek a month ago. It does not hurt and is freely movable.

Back 20

o Irritation Fibroma
o Giant Cell Fibroma
o Fibrolipoma
• Treatment:
o Conservative excision or it will last forever

Front 21

o 60 year old female. A head and neck exam revealed this sessile painless mass. Pt has a history of osteoporosis and breast cancer.

Back 21

o Granular cell tumor
o Giant cell fibroma
o neurofibroma
• Treatment:
o Conservative surgical excision

Front 22

o This 65 YO male has a 25 year history of tobacco use. He also reports social alcohol use. On palpation this lesion feels firm and indurated.

Back 22

o Squamous Cell Carcinoma
o Polymorphous low grade adenocarcinoma
o Chronic traumatic ulcer
• Treatment:
o Wide (radical) surgical excision, radiation therapy, or a combination of surgery and radiation therapy

Front 23

o 45 YO male. Has no reported health problems. He takes vitamins and is an avid runner. He wants his teeth cleaned today and would like to whiten his teeth. He has tried over the counter products, but wants a better result. On exam you note this firm mass at the angle of the mandible.

Back 23

o Pleomorphic Adenoma
o Cervical lymphadenitits
o Wartin’s tumor
• Treatment:
o Surgical excision, 95% Cure rate

Front 24

o 40 year old AA female with this non-expansile radiographic finding. The teeth are all vital.

Back 24

o Periapical Cemento Dysplasia
o ossifying fibroma
o Periapical granuloma
• Treatment:
o None required → vitality test

Front 25

o 21 year old male. This was discovered during a routine oral surgical examination. The patient was referred for removal of several impacted third molars. The area is asymptomatic and nonexpansile.

Back 25

o Dentigerous Cyst
o KCOT
o ameloblastoma
• Treatment: enucleation. Marsupialization if lesion is large.

Front 26

o A 17 y.o. Asian male presents to ER with CC of a bee sting. Upon examination, the patient reports pain in left mandible. After radiographic exam the patient is sent to the dental ER.

Back 26

o Unicystic Ameloblastoma
o KCOT
o CGCG
TX: En bloc resection.

Front 27

●Chief Complaint: 5 year old comes to the screening clinic at his Head Start Summer Day Camp.
●Medical History: Unremarkable.
●Dental History: Never been to the dentist, but the teacher notes that he had a toothache recently.
●Clinical Findings: Multiple red macules that were blisters yesterday.

Back 27

- Impetigo
- Recurrent Herpes Simplex
- Pemphigus Foliaceus
Treatment:
- Remove crust and apply topical mupirocin, systemic oral antibiotics

Front 28

o 48 year old female. This lesion was noted between 27 & 28 during a routine dental visit. She had not been to the dentist for more than15 years. There is a cortical swelling over the site and the area is asymptomatic.

Back 28

o Compound odontoma
o Complex odontoma
o CEOT
• Treatment:
o Enucleation or curettage

Front 29

o 17year old male. Three weeks ago he was hit in the mouth during his basketball game. This lesion seems to get large and then small, but has not gone a way.

Back 29

o Mucocele
o Mucus rentention cyst
o hemangioma
• Treatment:
o Surgical excision

Front 30

o This 40 YO male presented for a routine exam. He reports that he has noticed these hard bumps next to his tongue for a long time. He worries that he may have a tumor because they hurt sometimes. He has a history of hypertension and takes Diltiazem to control it.

Back 30

o Torus mandibularis
o Compact Osteoma
o Cancellous osteoma
• Treatment:
o no treatment unless interference with prosthesis then surgical excision is warranted.

Front 31

o 30 year old male. This somewhat pedunculated mass of the right buccal mucosa has been present for more than 3months. It is soft and moveable on palpation.

Back 31

o Irritation fibroma
o Giant cell fibroma
o fibrolipoma
• Treatment:
o conservative excision

Front 32

o 60 year old male. This man’s dentist noticed the lesion on his buccal mucosa during a routine annual exam. The patient smokes two packs of cigarettes daily and has been doing so since his late teens. He has COPD and emphysema.

Back 32

o Erythroplakia
o Carcinoma in situ
o Invasive carcinoma
• Treatment: Locate source, return 2wks, still remain biopsy

Front 33

o 50 year old male. He reports that he noticed this bump on his gum a month ago. It does not hurt but it bleeds sometimes when he brushes

Back 33

o Irritation fibroma
o Pyogenic granuloma
o Gingival abscess
• Treatment:
o Excision

Front 34

o This 65 YO male has a 25 year history of tobacco use. He also reports social alcohol use. He says this lesion has only been here for a few months. On palpation this lesion feels firm and indurated.

Back 34

o SCCA
o Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)
o Hyperkeratosis
• Treatment:
o Surgery excision

Front 35

o 60 year old female. A head and neck exam revealed this lesion on her palate. Pt has a history of osteoporosis.

Back 35

o Blue cell nevus
o Oral melanotic macule
o Malignant melanoma
• Treatment:
o Surgical removal

Front 36

• Clinical Information:
o 25 YO female. No medical problems noted on health history.
• Description:
o Soft, painless, pedunculated, exophytic nodule with fingerlike projections that import wartlike appearance

Back 36

o Squamous papilloma
o Verruca vulgaris
o Verruciform xanthoma
• Treatment:
o Surgical excision

Front 37

o 22 YO male. Reports a history of fever and swollen lymph nodes. He is a college student and is taking a heavy load of classes. He has not had a lot of time to brush and floss regularly and his gums bleed easily.

Back 37

o Leukemia
o Tuberous sclerosis
o Vitamin C deficiency
• Treatment:
o Chemotherapy

Front 38

o 45 YO male. Has no reported health problems. He takes vitamins and is an avid runner. He wants his teeth cleaned today and would like to whiten his teeth. He has tried over the counter products, but wants a better result. On exam you note this area on his ginigiva.

Back 38

o Amalgam tattoo
o Oral melanotic macule
o Blue nevus
• Treatment:
o No treatment

Front 39

o Chief Complaint: 22 yo female college student requests a routine examination.
o Medical History: Patient takes tetracycline, 250 mg twice a day, for acne.
o Clinical Findings: Bilateral white plaques are present on the middle and anterior portion of the lateral surfaces of the tongue. The white plaques are firm, rough, non-tender, and fixed to surface mucosa but not underlying structures. They will not rub off. An erythematous base is associated with the plaques. The patient was unaware of the lesions.

Back 39

o Hyperkeratosis
o Geographic tongue
o Oral Hairy Leukoplakia
• Treatment:
o Discontinue etiology (tongue biting or tongue chewing)

Front 40

o Chief Complaint: The patient has had a sore mouth associated with a white lesion for three weeks. Drinking orange juice makes the discomfort worse. The lesion has been in the same location during the three weeks. The patient has not recently burned the roof of her mouth.
o Medical History: The patient is taking Erythromycin, 250 mg, twice a day for acne.
o Clinical Findings: Soft, white plaques which rub off are diffusely present on the hard palate. The mucosa underlying the plaques is tender and erythematous.

Back 40

o Pseudomembranous Candidiasis
o Antibiotic stomatitis
o Erythema Migrans

• Treatment:
o Antifungal → Clotrimazole or Fluconazole

Front 41

o Chief Complaint: The patient requests a routine examination. The patient has been aware of the lesion since childhood. The lesion has not changed in size.
o Clinical Findings: The lesion is extending from the left buccal mucosa to the left commissure area. The lesion bleeds only if it is pierced by a sharp instrument. The lesion is compressible, non-tender, and fixed to the surface mucosa.

Back 41

o Capillary hemangioma
o Varicosities
o Vascular malformation
• Treatment:
o Monitor lesion → do not treat bc will bleed a lot

Front 42

o Chief Complaint: Patient's parents request a routine examination.
o Clinical Findings: A solitary, well-circumscribed lesion is present at the junction of the hard and soft palate. The lesion is thickened, firm to palpation and non-tender. It is fixed to surface mucosa.

Back 42

o Amalgam tattoo
o Blue Cell Nevus
o Melanoma
• Treatment:
o Biopsy to rule out cancer

Front 43

o Chief Complaint: 29 year old patient complains of painful oral ulcers of five days duration. The patient has not noticed blisters. The lesions have occurred five times previously, always in the same location. The lesions resolved in two weeks for each episode.
o Dental History: An amalgam restoration was placed in a maxillary right tooth one week ago.
o Clinical Findings: Multiple ulcers are present on the right hard palate in the first molar region. The lesions are tender when palpated and are not thickened. :

Back 43

o Herpes Zoster
o Herpes Simplex
o Hand foot mouth disease
• Treatment:
o Antiviral

Front 44

o Chief Complaint: The patient complains of oral discomfort. She has had multiple oral ulcers constantly for the past three years. Individual ulcers heal in seven to ten days. No treatment has helped the lesions. The patient reports that the ulcers have occurred in various locations in the oral cavity. Her mother, sister and brother have had similar oral lesions.
o Clinical Findings: The lesions consist of flat ulcers, approximately 4 mm in diameter, surrounded by an erythematous zone, located on the ventral surface of the tongue, floor of the mouth and soft palate. The ulcers are tender to palpation and are fixed to the surface mucosa but not to underlying structures.

Back 44

o Minor Apthus ulcer
o Traumatic ulcer
o Erythema multiforme
• Treatment:
o Topical steroids

Front 45

o Chief Complaint: The patient is concerned about a persistent, non-tender lesion first noticed one year ago.
o Clinical Findings: The lesion is a well-circumscribed, pale, submucosal nodule, 4 mm in diameter, located on the left posterior lateral border of the tongue, in the area of the filiform papillae. The lesion is firm and non-tender to palpation. Because of its posterior position in the oral cavity, it was difficult to determine if the lesion was fixed to surrounding structures.

Back 45

o Oral Lymphoepithelial cyst
o Lipoma
o Neurofibroma
• Treatment:
o Biopsy and surgical excision (lymphoepithelial cyst)

Front 46

o Chief Complaint: Patient complains of pain and swelling associated with a front tooth.
o Clinical Findings: A fluctuant compressible soft tissue swelling is associated with the lingual of the affected area. Probing of the swelling causes discharge of pus. The tooth is non-vital. Fever and lymphadenopathy are not present.

Back 46

o PA abscess
o PA granuloma
o Periodontal abscess
• Treatment:
o Vitality test #10

Front 47

o Chief complaint: Young person with painful oral ulcers of sudden onset
o Medical History: Blisters on hand and feet and had a fever. No other medical problems.
o Clinical Findings: Multiple red macules that form vesicles which rupture and ulcerate.

Back 47

o Hand foot mouth disease
o Herpangina
o Apthous Ulcer
• Treatment:
o Self-limiting

Front 48

o Chief Complaint: 28 year old male reports a painful tongue of a few days duration. It hurts when he eats salsa.
o Medical History: Asthma controlled with Flovent.
o Dental History: Last cleaning was 10 years ago.
o Clinical Findings: Diffuse regular and smooth red areas with a sharply-defined edge which is yellow and slightly raised.

Back 48

o Geographic tongue
o Erythema Multiforme
o Candidiasis
• Treatment:
o None → topical corticosteroids used if burning sensation

Front 49

o Chief Complaint: 25 year old with sensitive teeth and dislikes the color of his teeth
o Clinical Findings: Reduced enamel thickness, abnormal contour and absent interproximal contact points evident

Back 49

o Amelogenesis imperfecta (Type I)
o Enamel Hypoplasia
o Fluorosis
• Treatment:
o Restoration of affected teeth

Front 50

o Chief complaint: This 2 year old boy presents to the pediatric clinic with his mom for a cleaning.
o Medical History: This patient has been followed closely since birth for various problems. He is deaf and uses sign language for communication. His sister also is deaf and has a similar appearance.

Back 50

o Treacher Collin’s Syndrome
o Goldenhar syndrome
o Acrofacial dysostosis
• TX: Refer to Craniofacial Team

Front 51

o 40 year old HIV positive male on HAART therapy. On exam you find these lesions on the buccal mucosa and he has similar lesions on the soft palate.

Back 51

o Condyloma Accuminatum
o Squamous cell papilloma
o Heck’s Disease (Multifocal epithelia hyperplasia)
• Treatment:
o Cauterization or laser

Front 52

o 55 year old female
o Lesion of right anterior buccal mucosa, commissure area present since childhood

Back 52

o Hemangioma
o Vascular malformation
o Variscosities
• Treatment:
o Reassure the patient and refer to MAC

Front 53

• Clinical Information:
o 48 year old female with an asymptomatic white lesion

Back 53

o Lichen Planus
o Hyperkeratosis
o Chronic ulcerative stomatitis?
• Treatment:
o Oral or topical steroid

Front 54

o 25 year old female patient with impacted third molars.
o Patient was in with a CC of pain in the area.

Back 54

o Dentigerous cyst
o KCOT
o Ameloblastoma
• Treatment: Marsupilization or excision

Front 55

• Clinical Information:
o 70 year old male who reports that his denture does not fit anymore.
o No pain

Back 55

o Paget’s Disease
o Hyperparathyroidism
o Pleomorphic Adenoma
• Treatment:
o Surgical excision

Front 56

o This 72-year-old woman had just recovered from an episode of herpes zoster in her sacral region when she noticed soreness of her left mandible. Her dentist had removed a tooth in this area one year earlier. Antibiotics given by her physician did not resolve her condition. Her dentist referred her for evaluation, thinking this might be a fungal infection.

Back 56

o Oral Manifestation of Herpes Zoster
o SCCA
o Mucoepidermoid carcinoma
• Treatment:
o Surgical excision

Front 57

o 62 yo African American female with a chief complaint of a “lump” in her lower jaw.
o It has been slowly growing over several months
o There is no pain or paresthesia

Back 57

o Central Giant Cell Granuloma
o KeratoCyctic Odontogenic Tumor
o Ameloblastoma
• Treatment:
o Surgical resection

Front 58

o 36y female, a professional soprano
o History of ‘aphthous ulcer’ on the tongue for two years
o Treated by a ENT friend for ‘aphthous ulcer’ over two years with no biopsies done.

Back 58

o Traumatic Granuloma
o Traumatic Ulcer
o Squamous Cell Carcinoma
• Treatment:
o biopsy and excision

Front 59

o 36 y o female with chief complaint of an area of “soreness” on the tongue
o A raised, rough and somewhat papillary lesion noted on the dorsal aspect of the tongue
o Patient’s history was significant for lichen planus

Back 59

o Granular Cell Tumor
o Lymphangioma
o Neurofibroma,
• Treatment:
o conservative excision

Front 60

• Clinical Information:
o Adult female with an asymptomatic lesion of lower lip that has been present for 3 years.

Back 60

o labial melanotic macule
o Nevus
o Ephelis
• Treatment:
o Observe, excise or laser removal if patient desires

Front 61

o 50 year old asian male with a radiolucency associated with tooth # 32

Back 61

o Ameloblastoma
o KCOT
o Dentigerous cyst
• Treatment:
o En-bloc resection

Front 62

o A 13-year-old female went to her dentist because of an asymptomatic lump that she had discovered on her gingiva. She had no systemic problems and was taking no medications.

Back 62

o Eruption cyst
o Pyogenic granuloma
o Hemangioma
• Treatment:
o no tx, tooth erupts and resolved.

Front 63

o 54 year old black female comes in because she noticed this growth on her palate.

Back 63

o Leaf shaped fibroma
o Epulis fissuratum
o giant cell fibroma
• Treatment:
o Conservative excision

Front 64

o 85 year old female presents to your office with a complaint of an ulcerated area on her lip
o When you examine this you note that it has a rodent ulcer look
o History of squamous cell carcinoma of the lower lip

Back 64

o Basal cell carcinoma
o Actinic keratosis
o Squamous cell carcinoma
• Treatment:
o biopsy and excision

Front 65

o 61 year old female with a round, sessile lesion on keratinized gingiva, right anterior mandible with adjacent less prominent lesions.

Back 65

o Gingival cyst of adult
o Irritation fibroma
o parulis
• Treatment:
o conservative excision

Front 66

o 40 year old female with an asymptomatic lesion on the radiograph. Teeth are vital

Back 66

o Lateral Periodontal cyst
o KCOT
o Central Giant Cell Granuloma
• Treatment:
o Enucleation and biopsy to rule out KCOT

Front 67

o This fluctuant mass has been present for 10 days. Patient reports biting it often.
• Description:
o Round erythmatic fluctuant mass located on lower lip right mucosal area

Back 67

o Mucocele
o Mucus retention cyst
o Hemangioma
• Treatment:
o Unplug or remove cyst/gland

Front 68

o This 23 yo female presented with a swelling of the right maxilla for 2 weeks.
• Description:
o One large irregular shaped radiolucent multilocular lesion located around the root of tooth #6 displacing teeth #7 and #5

Back 68

o Desmoplastic ameloblastoma
o KCOT
o myxoma
• Treatment:
o Surgical curettage (almost no recurrence)

Front 69

o This gentleman reports this firm, nonpainful mass has been growing slowly for several months. Other than nicotine stomatitis, he has no other intra-or extraoral lesions.

Back 69

o Non-hodgkins lymphoma
o Warthins Tumor
o Sialadenitis
• Treatment:
o Chemotherapy/radiotherapy → depends on subtype

Front 70

o 14 year old male
o This boy had his right mandibular first molar extracted 6 months earlier because of severe caries.
o He now revisits his dentist because of an enlarging alveolar swelling of the facial surface of his posterior left mandible.
o The area is slightly tender to palpation.

Back 70

o Ossifying Fibroma
o Complex odontoma
o CEOT
• Treatment:
o Burns out by 35 years of age, may become large and conservative surgery (curettage)

Front 71

o 19 year old female.
o This lesion was noticed during a routine dental examination.
o The lesion is asymptomatic and has expanded the facial cortex.
• Description:
o One large well defined radiolucent multilocular irregular shaped lesion located around root apices on tooth #18 and resorbing root apices of tooth #19

Back 71

o Ameloblastoma
o KCOT
o Central giant cell granuloma
• Treatment:
o Enucleation → >50% recurrence rate
o En block resection → <15% recurrence rate

Front 72

o 8 year old male
o This boy’s mother brought him to the family dentist for evaluation of the reason for lack of eruption of his right mandibular first molar.
o The alveolar bone was slightly expanded and the surface mucosa was unremarkable
• Description:
o One medium size, irregular shape, well defined radiopacity containing dense radiopacities and radiolucent rim surrounds the lesion. Located coronal to impacted tooth #30.

Back 72

o Complex odontoma
o Osteoma
o Osteoblastoma
• Treatment:
o Local excision, enucleation/curettage, no recurrence

Front 73

o 21 y.o. Caucasian female
o Presents to general dentist for routine care
o No health problems per patient
• Description:
o Generalized white and brown discoloration of enamel surfaces with enamel pitting.

Back 73

o Amelogenesis Imperfecta – Hypoplastic
o Enamel Hypoplasia
o Fluorosis
• Treatment:
o Surface microabrasion, resin restoration, labial veneers, full crowns

Front 74

o 18-year-old Caucasian female who previously underwent surgical removal of teeth #1, #16, #17, and #32. The patient presents today for a routine exam
o Patient would like to have her teeth whitened

Back 74

o Central giant cell granuloma
o Ameloblastoma
o Aneurysmal bone cyst
• Treatment:
o Curettage → block resection required if size is large

Front 75

55 year AA Female
Presented for routine dental evaluation
Asymptomatic
Pt. has HTN controlled with Lopressor
Family history of cancer

Multiple, small, irregular shape, well defined, non corticated radiopacities surrounded by radiolucent rims. These lesions are localized to the mandibular arch. Lesions are located around the apices of all mandibular

Back 75

o Florid cemento osseous dysplasia
o Ossifying fibroma
o Odontoma
• Treatment: Non require unless very large

Front 76

o A 45-year-old male developed a sore mouth after eating fish. His oral pain has been continuous for 2 months. He had no history of eye, genital, or skin lesion. He had no systemic problems. He was given symptomatic treatment and was asked to return in 2 weeks.

Back 76

o Pemphigus vulgaris
o Contact stomatitis
o Apthous ulcer
• Treatment:
o Aggressive and requires prolonged high dose of Prednisone for 6-10 weeks

Front 77

o During routine exam of a 34-year-old male, a lesion was discovered in the floor of his mouth. He was unaware of the lesion. He did not smoke and was a “light drinker.” He had no history of an associated traumatic event or habit that might result in irritation to the area.
o Does not rub off
• Description:
o One, large, mixed leukoplakic-erythroplakic lesion located on the left floor of the mouth

Back 77

o Hyperkeratosis
o Dysplasia
o SCCA
• Treatment:
o ID possible trauma, remove etiology, return 2 weeks, remaining lesion – biopsy

Front 78

o 55 year old female
o Health history positive for menopause
o Patient has a 30 pack year history
o She noticed this area on her cheek 1 month ago
o Exam shows a similar lesion on the other side and on her tongue
• Description:
o Two, large, mixed leukoplakic-erythroplakic reticular lesions, no erosion present.

Back 78

o Reticular lichen planus
o leukoedema
o Epithelial dysplasia
• Treatment:
o Not necessary to treat unless become symptomatic. Erosive types needs to be treated with topical steroids

Front 79

o A 29-year-old male presented because of a slowly enlarging anterior mandible. The swelling was noted several weeks after an auto accident. He had no symptoms.
o One large well defined, corticated multilocular radiolucent lesion associated with the mandibular anterior apices that crosses the midline and is causing knife edge resorption and displacement of teeth.

Back 79

o Ameloblastoma
o Central Giant Cell Granuloma
o KCOT
• Treatment:
o Enucleation, En bloc resection

Front 80

o A 45 year old male patient has a chief complaint of a pizza burn that has not healed
o He reports it has been about 2 weeks since he noticed the area
o Health History is positive for type 2 diabetes controlled with diet
o He is also a former meth user
• Description:
o Large slightly raised poorly demarcated black/brown patch with ulceration.

Back 80

o Malignant Melanoma
o Melanotic macule
o Trauma
• Treatment: Wide Surgical excision with a 2-5 cm margin(if possible) followed by radical radiation/chemo

Front 81

o 63 YO white female
o No Health Hx problems
o Previous use of Fossamax
o # 19 ext 5-06
o Intermittent pain and swelling
o Improved with course of antibiotics
• Description:
o One large ill-defined unilocular radiolucent lesion located in the lower left mandible, apical to extraction site of tooth #19. Rapid growth with moth eaten appearance with expansion of the inferior border of the mandible.

Back 81

o Chronic Osteomyelitis
o Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ)
o Metastasis of the Jaw. (DR. ANDREWS TOLD THIS GROUP THAT THE ACTUAL DX IS METASTASIS TO THE JAW FROM BREAST CANCER. THEY GOT 100% BY LISTING CHRONIC OSTEOMYELITIS. THE CLINICAL INFO STATES NO HEALTH HX PROBLEMS OTHER THAN USE OF FOSSAMAX).
• Treatment:
o Initial tx: Antibiotics (bacterial sampling and culture to determine Ab), drainage, remove source of infection if possible. Adjunctive tx: Sequestrectomy, decortications, Hyperbaric oxygen, resection and reconstruction if extensive bone destruction.

Front 82

o 5 year old female. This girl has had “loose teeth” for several years, starting with her primary dentition. She has 2 brothers with the same problem and one sister without the problem. Her mother had all of her teeth extracted when she was 19 years of age.
• Description:
o Radiographically: normal crown, dramatically shortened roots, absence of pulp canals, and small, crescent shaped pulp chambers.

Back 82

o Dentin Dysplasia I
o Hypophosphatasia
o Dentinogenesis Imperfecta.
• Treatment:
o Stage one: removal of source of infection or pain. Stage two: restore aesthetics and functional occlusion (overdentures, dental implants depending on the age of the patient)

Front 83

o This 23 yo f presented with a swelling of the right maxilla x 2 weeks.
o She had ortho completed 6 years ago
• Description:
o Multilocular radiomixed lesion in the right anterio-lateral maxilla

Back 83

o Desmoplastic ameloblastoma
o Odontogenic Myxoma
o KCOT
• Treatment: Excision and curettage

Front 84

o A 19 year-old female presented with a history of slowly enlarging palatal mass over the past several years.
o She has not been to the dentist in 5 years
o Patient has asthma controlled with Flovent
• Description:
o slowly enlarging palatal mass in the posterior lateral hard palate

Back 84

o Pleomorphic adenoma
o Lymphoma
o Neurofibroma
• Treatment:
o Excision

Front 85

o 72 year old male.
o Treated (surgery and radiotherapy) 8 years ago for squamous cell carcinoma of the right ventral tongue.
o Has developed this area over the last year
o The lower portion of the buccal lesion is indurated; the lesion is asymptomatic.
• Description:
o asymptomatic indurated white lesion on the right buccal mucosa

Back 85

o Recurrent squamous cell carcinoma
o Polymorphous low grade adenocarcinoma
o Hyperkeratosis
• Treatment:
o surgical excision and radiation therapy.

Front 86

o 65 year male with a chief complaint of sore tongue
o Patient reports that he frequently bites his tongue
o Patient is a social smoker and drinker
o His father has a history of GI cancer
• Description:
o ulcerated lesion with elevated margins on the lateral border of the tongue covered by yellow pseudo membrane

Back 86

o Traumatic ulcerated granuloma
o Apthous Ulcer
o Squamous cell carcinoma
• Treatment:
o Remove etiology, and palliative care

Front 87

o 45 year old female
o This woman has noticed a steadily enlarging, lesion over the past 5 month
o All lesions are asymptomatic
o The patient has hypothyroidism, cirrhosis and COPD.
o She smokes 2 packs of cigarettes daily for 20 yrs.
• Description:
o Large, purple, smooth, painless mass on buccal gingival. ABCDE: Asymmetry Border irregularity, Color variegation, Diameter (greater than 6 mm), Evolving (change over time, color, shape, size, surface, symptoms)

Back 87

o Malignant Melanoma
o Peripheral Giant Cell Granuloma
o Pyogenic Granuloma,
• Treatment:
o Wide surgical excision

Front 88

o A 60-year-old male was referred to the WU clinic for evaluation of a mass in his tongue which the patient felt was just infection.
o The lesion was first noticed by his dentist two months ago and considered to be due to local trauma caused by a “sharp-edged” tooth, which was extracted without improvement.
o The patient was a heavy smoker (two packs per day) and his medical history was significant for hypertension, epilepsy (controlled by medications) and food allergy.
• Description:
o White lesion on lateral border of tongue that does not wipe off.

Back 88

o Squamous Cell Carcinoma
o Epithelial Dysplasia
o Hyperkeratosis
• Treatment:
o Clinical stage of the disease guides the treatment of intraoral squamous cell carcinoma. Wide (radical) surgical excision, radiation therapy, or a combination of surgery and radiation therapy. ¨Tumor location may influence the treatment plan.

Front 89

o 38 year old male
o This man has had a painful area of his tongue for more than 3 months.
o It has remained unchanged since it first appeared.
o He remembers biting his tongue at the start of the lesion.
o He has been diagnosed with ulcerative colitis and hyperlipidemia.
• Description:
o Red, circular, granulomatous lesion on the ventral tongue. Secondary to trauma. Lesion is painful. Deep pseudoinvasive inflammatory reaction and is typically slow to resolve.

Back 89

o Traumatic Ulcerative Granuloma with Stromal Eosinophilia
o Chronic traumatic ulcer
o SCC
• Treatment:
o Remove offending cause. If still not resolved, then an incisional biopsy is required. Many of these lesions resolve after incisional biopsy.

Front 90

o Healthy 14-year old African-American male with complaint of a “growth” on his palate, first noticed 2-3 months ago.
o Radiographs do not show any signs of bony change
• Description:
o Nodular, lobulated firm pink mass on lingual gingival in maxillary incisor region.

Back 90

o Peripheral Ossifying Fibroma
o Peripheral Giant Cell Granuloma
o Pyogenic Granuloma
• Treatment:
o Conservative surgical excision with curettage of base and cleaning and shaping of adjacent teeth.

Front 91

o 72 year old female
o This woman has been aware of a painless mass of her palate for at least 5 months.
o It has enlarged continuously since she first noted it.
o She has a history of breast adenocarcinoma, treated 9 years earlier.
• Description:
o Pink painless mass of the hard or soft palate. Most common salivary gland neoplasm.

Back 91

o Mucoepidermoid Carcinoma
o Polymorphous Low Grade Adenocarcinoma
o Pleomorphic Adenoma
• Treatment:
o Depends on grade. Remove tissue based on grade of tumor.

Front 92

o 44 year old female
o This woman experienced a sudden-onset sharp pain of her palate 1 week ago.
o At that time she noticed a “lump” in the region, which ulcerated shortly thereafter.
o Pain has persisted unchanged
o She has a history of sarcoidosis and a 10 year history of smoking.
o She is unaware of any trauma to the palate
• Description:
o Painful, non-ulcerated swelling of the palatal salivary glands of the hard palate that is normally unilateral. Lesion generally ulcerates 2-3 weeks after swelling, leaving a crater.

Back 92

o Necrotizing Sialametaplasia
o Mucoepidermoid Carcinoma
o Squamous Cell Carcinoma
• Treatment:
o Biopsy due to clinical presentation. Once malignancy is ruled out, lesion will resolve on its own in 5-6 weeks.

Front 93

o A 60 year old male has an appointment at your office for a COE
o He has a 30 year history of smoking and no other medical problems
o Indurated lesion of the lateral border of his tongue.
o You also note a rock hard left submandibular lymph node.

Back 93

o SCCA
o Traumatic ulcer
o Traumatic granuloma
• Treatment:
o Wide surgical excision

Front 94

• Clinical Information:
o 24 year old male presents for routine dental exam. Lower lip whiteness has been present for at least 7 years, is asymptomatic and has not changed in “many years.”
• Description:
o Diffuse leukoplakic lesion located on lower lip

Back 94

o Hyperkeratosis
o Epithelial dysplasia
o Tobacco pouch keratosis
• Treatment:
o See If wipes off, if not ID possible trauma, remove etiology, return 2 weeks, if present biopsy

Front 95

• Clinical Information:
o 44 year old female. This woman’s dentist first noticed bilateral buccal white plaques 6 weeks earlier, with little change since. A course of antifungal therapy was not effective. No other oral membranes are involved. She also has polyarthritis, chronic kidney damage, facial erythema, and biopsy proven vasculitis (of legs).
• Description:
o Bilateral leukoplakia with erythema on buccal mucosa

Back 95

o Lupus erythamatosus
o Lichen planus
o White sponge nevus
• Treatment:
o Corticosteroids and avoid sunlight

Front 96

o A 17-year-old male presented with a persistent swelling of his jaw of several months’ duration. He had no associated pain or paresthesia. He had no history of jaw infection or trauma. His systemic health was excellent. All teeth tested vital.
o One, Large, Multilocular lesion, Mixed RL/RO, Radiopaque at mesial root of #19 and apex of #20, ill defined, Not corticated, Crossing the anterior midline, involves the apices of teeth #18-26, Expansion of lingual and buccal cortex. Displacement of #21 mesially. No root resorption present.

Back 96

o Ameloblastic fibroma
o Central Giant Cell Granuloma
o Central Ossifying Fibroma
• Treatment:
o Conservative surgical excision

Front 97

45 YO male. Has no reported health problems. He takes vitamins and is an avid runner. He wants his teeth cleaned today and would like to whiten his teeth. He has tried over the counter products, but wants a better result. On exam you note this area on his ginigiva.

Back 97

Differential
1- Amalgam Tattoo
2-Oral melanotic macule
3-Blue nevus

Treatment: Nothing