Oral Pathology

Front 1

What is the difference between Epstein pearls, Bohn's nodules and dental lamina cysts?

Back 1

Inclusion cysts appear as small white or gray lesions on the mucosa, alveolar ridge and hard palate, and are present in 75% of newborns. All three types – Epstein’s pearls, Bohn’s nodules and dental lamina cysts are asymptomatic and are usually shed within the first three months of life:

* Epstein’s pearls may be found on the mid-palatal raphe of the hard palate.
* Bohn’s nodules, remnants of salivary glands, are located on the buccal or lingual mucosa, or on the hard palate, away from the raphe
* Dental lamina cysts are located on the crests of the alveolar ridges.

Front 2

Describe this lesion and give differential diagnoses.

Back 2

Hyperplastic foliate papilla

Normal lymphoid tissue along the lateral border of the tongue.

Ddx: fibroma, pyogenic granuloma, hamartoma, choristoma

Front 3

Describe this lesion and give differential diagnoses.

Back 3

Oral lymphoepithelial cyst

Pale yellowish white nodule of entrapped epithelium within lymphoid tissue.

Ddx: soft tissue abscess, lipoma, sialolithiasis, tonsillar concretions

Front 4

Describe this lesion and give differential diagnoses.

Back 4

Fordyces granules

Yellowish papules of ectopic sebaceous glands.

Ddx: pustules or scar

Front 5

List 2 associations with fissured tongue.

Back 5

Geographic tongue, Down syndrome, Melkersson-Rosenthal syndrome

Front 6

What is pathognomonic of leukoedema? List 3 differential diagnoses.

Back 6

-Diminishes when cheek is streched (bilateral presentation)

Ddx: linea alba, cheek biting keratosis, white sponge nevus

Front 7

What is a syndrome associated with bifid tongue?

Back 7

Oro-facial-digital syndrome I

Front 8

What are paramedian lip pits and what syndrome are they associated with? List 2 differential diagnoses.

Back 8

-Congenital invaginations of the lower lip

-Often associated with Van der Woude syndrome

-Ddx: draining mucocele, median lip fissure, scar from lip piercing

Front 9

List 4 potential causes of macroglossia.

Back 9

-Congenital (hemangioma, lymphangioma)

-Hereditary (Down syndrome, mucopolysaccharidosis)

-Inflammatory (angiodema)

-Traumatic (hematoma)

-Neoplastic (tumor)

-Endocrine (acromegaly)

Front 10

List 4 potential problems associated with macroglossia.

Back 10

-Airway obstruction, drooling, difficulty eating, speech, malocclusion, cosmetics, crenations/ulcerations of the tongue

Front 11

Describe this lesion and give differential diagnoses.

Back 11

Lingual thyroid

Ectopic thyroid tissue in the tongue, significance: most lack normal thyroid tissue

Ddx: lymphangioma, hemangioma, lymphoid hyperplasia

Front 12

List 4 signs of a vascular malformation?

Back 12

-Thrill, bruit, warmth, pain, bleeding, ulceration, tooth mobility

E.g. Hemagioma, lymphangioma

Front 13

List 4 findings in Sturge-Weber angiomatosis.

Back 13

Seizures, mental disability, hemiplegia, ocular defects, vascular malformation, facial Portwine stain that follows the trigeminal nerve, calcification of the cerebral cortex

Front 14

List 4 oral findings in Sturge-Weber angiomatosis.

Back 14

Pyogenic granuloma, gingival hyperplasia, bleeding, alveolar bone loss, hypervascular mucosal changes

Front 15

What syndrome is associated with hemangiomas?

Back 15

PHACE syndrome:

* Posterior fossa –These are brain malformations that are present at birth.
* Hemangioma – The hemangioma usually covers a large area on the skin of the head or neck (greater than 5 cm). The term "segmental" is sometimes used to describe these hemangiomas.
* Arterial lesions – Abnormalities of the blood vessels in the neck or head.
* Cardiac abnormalities/aortic coarctation – These are abnormalities of the heart or the blood vessels that are attached to the heart.
* Eye abnormalities.

Front 16

List 4 complications of a hemangioma.

Back 16

-Recurrent bleeding and infection, ulceration and scarring, facial deformity, ocular disease, interference with function or airway obstruction

Front 17

What is the Kasabach-Merritt phenomenon?

Back 17

Serious coagulopathy with vascular tumors and thrombocytopenia.

Front 18

Describe this lesion and give differential diagnoses.

Back 18

Lymphangioma

-Congenital hamartoma of lymphatics

-Ddx: hemangioma, granular cell tumour

Front 19

Describe this lesion and give differential diagnoses.

Back 19

Neonatal alveolar lymphangioma

-Translucent fluctuant swelling that resolves spontaneously

-Ddx: congenital epulis, eruption cyst, dental lamina cyst

Front 20

Describe this lesion and give differential diagnoses.

Back 20

-Red, ulcerated reactive lesion

-Sites: gingiva>lips>tongue>mucosa

-Variants: pregnancy tumor, pulp polyp, epulis

Ddx: Soft tissue abscess, hemangioma, foreign body, peripheral ossifying granuloma, peripheral giant cell granuloma

Front 21

List 3 causes of tongue trauma in infants and young children.

Back 21

-Riga-Fide disease, seizure disorders, incorrect use of a pacifier, cerebral palsy, Lesch-Nyhan syndrome, Tourette's syndrome

Front 22

Describe this lesion and give differential diagnoses.

Back 22

Giant cell fibroma

-Fibrous hyperplasia of unknown cause

-Ddx: papilloma, irritation fibroma, oral warts

Front 23

List 4 human papilloma virus induced oral lesions.

Back 23

- Squamous papilloma, verruca vulgaris, condyloma accuminatum, Heck's disease, multifocal epithelial hyperplasia, oropharyngeal squamous cell carcinoma

Front 24

Describe this lesion and give differential diagnoses.

Back 24

HPV induced oral lesions:

Squamous papilloma (HPV 6, 11): may be pink white or red, solitary, tx with surgical removal, no malignant potential

Verruca vulgaris (HPV 2, 4, 6, 40): stippled pink or white, usually multiple, tx with surgical removal, no malignant potential

Condyloma accuminatum (HPV 6, 11, 16, 18): sites can be anogenital and oral mucosa, coalescing pink nodule with malignant potential

Front 25

Describe this lesion and give differential diagnoses.

Back 25

Heck's disease (multifocal epithelial hyperplasia)

-HPV 13, 32

-Multiple soft plaques or nodules, pink or white in appearance

-Risk factors: HIV, poverty, malnutrition, poor hygiene

Front 26

List 4 findings associated with neurofibromatosis type 1.

Back 26

-Cafe-au-lait spots, subcutaneous neurofibromas, Lisch nodules, axillary freckling, opitic glioma, osseous lesions, CNS disorders

-Oral findings: enlarged mandibular foramina and canals, oral neurofibromas, enlarged fungiform papillae

Front 27

List 4 oral findings in Ehlers-Danlos syndrome.

Back 27

-Periodontal disease, Gorlin's sign (tongue touches nose), oral bleeding, delayed healing, pulp stones, short roots, prominent cusp tips, hypoplastic enamel

Front 28

List 4 medical conditions associated with Down syndrome.

Back 28

-Congenital heart defects, increased incidence of acute lymphoblastic leukemia, atlanto-axial instability, cognitive disability, short stature, immune dysfunction, GI anomalies

Front 29

List 4 oral findings associated with Down syndrome.

Back 29

-Relative macroglossia, microdontia/conical teeth, oligodontia, class 3 malocclusion, fissured tongue, increased risk of periodontal disease, delayed eruption or overretained teeth, abnormal palate, abnormal root, enamel hypoplasia

Front 30

What are mucopolysaccharidosis disorders?

Back 30

Metabolic disorders that lack the enzymes to process glycosaminoglycans

E.g. Hurler, Hunter, San Fillipo, Marquio

Front 31

List 4 oral findings of Hurler syndrome

Back 31

Macroglossia, spacing of teeth, gingival hyperplasia, anterior open bite, unerupted teeth, (also short stature and decreased IQ)

Front 32

What syndrome is associated with these findings (see image)

Back 32

-Beckwith-Wiedemann syndrome

(microcephaly, macroglossia, umbilical hernia), severe hyperglycemia and renal anomalies

Front 33

Describe this lesion and give differential diagnoses.

Back 33

Benign migratory glossitis (geographic tongue or erythema migrans)

-Oval red patches with white borders that move around

-Ddx: candidiasis, contact allergy, traumatic erosion, erosive lichen planus

Front 34

List 4 causes of glossitis.

Back 34

Anemia, vitamin B deficiency, candidiasis, oral allergies, diabetes, xerostomia, hypothyroidism, idiopathic

Front 35

What is this mass and list 4 differential diagnoses?

Back 35

Mucuous retention in oral floor, unilateral and fluctuates in size, involves submaxillary or sublingual gland

Tx: excision or marsupialization

Ddx: hematoma, hemangioma, salivary gland tumor, dermoid cyst, cellulitis

Front 36

What is the most commonly involved gland with sialolithiasis? List 3 differential diagnoses.

Back 36

Submandibular gland (Wharton's duct, opening near midline of the floor of the mouth)

Ddx: lipoma, oral lymphoepithelial cyst, soft tissue abscess

Front 37

List 3 differential diagnoses for this lesion.

Back 37

-Traumatic ulcer, aphthous ulcer, contact allergy, HSV ulcer (orofacial herpetic infection)

Front 38

List 3 types of candidiasis and their differential diagnoses.

Back 38

Common oral microorganism: candida albicans

Increased susceptibility with long term abx, corticosteroids and drugs that cause xerostomia

-Pseudomembranous: mucosal sloughing, plaque coated tongue

-Hyperplastic

-Erythematous: mucosal burn, benign migratory glossitis, traumatic erosion, contact allergy

-Tx: nystatin or other antifungals

Front 39

Describe this lesion and list 3 differential diagnoses.

Back 39

White sponge nevus

Persistent condition more prominent in adolescence

Ddx: frictional keratosis, leukoedema, hyperplastic candidiasis, hereditary benign intraepithelial dyskeratosis (also affects eyes)

Front 40

Describe oral lesions found in lupus erythematosis.

Back 40

Prevalence is 25%, sites: lip, palate, buccal mucosa and gingiva

Oral lesions mimic lichen planus and atypical gingivitis

Front 41

What is a syndromes associated with these findings?

Back 41

Darrier-White disease (Dyskeratosis follicularis)

-Cutaneous lesions: red, pruritic papules on body, face and scalp

-Warty appearance and foul odour

-Oral lesions in 15-50%: white papules, cobblestone