Oral Pathology Final Oral Manifestations Of Systemic Disease

Front 1

What is a Heterogenous group of inherited metabolic disorders characterized by a lack of One or More Enzymes for Glycosaminoglycan synthesis.

Back 1

Mucopolysaccharidoses

Front 2

How are Heparin sulfate, Dermatan sulfate, Keratin sulfate, & Chondroitin sulfate related to Mucopolysaccharidoses?

Back 2

One or more of these ma be deficient in mucopolysaccharidoses. These GAGs are needed to form the connective tissue of the body

Front 3

What are common signs of Mucopolysaccharidoses?

Back 3

Obliterated pulp chambers and root canals (kind of like teeth you would see in dentinogenesis imperfecta, this is common (50%) in sanfilippo syndrome
Macroglossia
Gingival Hyperplasia
Pointed cusps on posterior teeth
Diastemas
Impacted teeth with large follicles

Front 4

What vitamin deficiency might contribute to oral leukoplakia?

Back 4

Vitamin A

Front 5

What vitamin deficiency might present as Glossitis, Stomatitis, Angular cheilitis, Glossodynia, Glossopyrosis, and Atrophy of papilla?

Back 5

Vitamin B deficiency

Front 6

In vitamin B1 (thiamin)deficiency Beriberi occurs in alcoholics/malnourished, what symptoms of pain are unique to this condition?

Back 6

Glossodynia - Pain in tongue
Glossopyrosis - Burning tongue

Front 7

What is the underlying problem associated with Scurvy, a vitamin C (ascorbic acid) deficiency?

Back 7

Vitamin C is necessary for the formation of Collagen, which would result in poor healing if there was a deficiency

Front 8

What would a deficiency in vitamin D lead to?

Back 8

Childhoo Rickets
Adult Osteomalacia

Front 9

What is the most common reason why someone becomes vitamin K deficient?

Back 9

Dicumarol or Coumadin

Front 10

Which of the following would most commonly manifest itself as a brown pigmentation of the skin with perioral and oral melanotic macules?
a) addison's disease
b) hyperparathyroidism
c) cretinism
d) nevoid basal cell carcinoma syndrome
e) graves disease

Back 10

Addison disease

Front 11

If extraoral signs and symptoms accompany recurrent aphthous stomatits, a diagnosis of which of the following should be considered?
a) Diabetes mellitus
b) Addison disease
c) SLE
d) Erythema migrans
e) Behcet syndrome

Back 11

Behcet syndrome

Front 12

Deficiency states reported to produce glossitis include which of the following?
a) Plummer-Vinson syndrome
b) Vitamin B complex deficiencies
c) Iron deficiency anemia
d) All of the above
e) A & C

Back 12

All of the above

Front 13

All of the following soft tissue lesions would have a female gender predilection except?
a) Lichen planus
b) Cicatricial pemphigoid
c) Squamous cell carcinoma
d) Desquamative gingivitis
e) Salivary gland tumors

Back 13

SCC

Front 14

This 50 year old patient was told recently by her physician that her serum calcium level was quite high. All of her dental radiographs present with features similar to the one projected. The patient's history and x-rays would suggest that this patient may be suffering from which of the following?
a) Hyperparathyroidism
b) Paget disease
c) Fibrous dysplasia
d) Florid cemento-osseous dysplasia
e) Osteomalacia

Back 14

Hyperparathyroidism

Front 15

Which of the following is the most likely diagnosis of the firmly adherent white lesion seen bilaterally in this 50 year old patient? The lesion does NOT disappear when stretched?
a) Leukoedema
b) Leukoplakia
c) White sponge nevus
d) Lichen planus
e) Hairy leukoplakia

Back 15

Lichen planus

Front 16

Which of the following should be included in the differential diagnoses of this red lesion of the maxillary gingiva/alveolar ridge?
a) Peripheral giant cell granuloma
b) Mucocele
c) Pyogenic granuloma
d) All of the above
e) A & C only

Back 16

A & C only

Front 17

Which of the following is the most likely diagnosis of the solitary, reddish, ulcerated lesion observed in this projected photograph?
a) Traumatic fibroma
b) Pyogenic granuloma
c) Parulis
d) Papilloma
e) Pulp polyp

Back 17

Pyogenic granuloma

Front 18

Which of the following should be included in the differential diagnosis of the projected exophytic mass?
a) Peripheral ossifying fibroma
b) Peripheral giant cell granuloma
c) Pyogenic granuloma
d) All of the above
e) A & C

Back 18

All of the above

Front 19

The lesion observed on the dorsal surface of this tongue have a history of changing pattern. Which of the following is the most likely diagnosis?
a) Hairy tongue
b) Median rhomboid glossitis
c) Erythema multiforme
d) Geographic tongue
e) Fissured tongue

Back 19

Geographic tongue

Front 20

Lesions such as the ones seen at the corners of the mouth, in this elderly female patient have been associated with which of the following?
a) Deficiency of riboflavin
b) Loss of vertical dimension
c) Infection with Candida albicans
d) All of the above
e) A & C

Back 20

All of the above

Front 21

Which of the following factors may play a role in the pathogenesis of xerostomia?
a) Mouth breathing
b) Sjogren's syndrome
c) Local radiation therapy
d) All of the above
e) A & C only

Back 21

All of the above

Front 22

Which of the following are causes of xerostomia?
a) Sjogren syndrome
b) Antihistamines
c) Postradiation changes
d) All of the above
e) A & C only

Back 22

All of the above

Front 23

Deficiency states reported to produce glossitis include which of the following?
a) Plummer-Vinson syndrome
b) Vitamin B complex deficiencies
c) Iron deficiency anemia
d) All of the above
e) A & C

Back 23

All of the above

Front 24

If extraoral signs and symptoms accompany recurrent aphthous stomatitis, which of the following disease entities should be considered foremost in the differential diagnosis?
a) Addison disease
b) Behcet syndrome
c) Crohn disease
d) Darier disease
e) Epidermolysis bullosa

Back 24

Behcet syndrome

Front 25

For a diagnosis of Stevens-Johnson syndrome to be made which of the following should be affected in addition to oral and skin lesions?
a) Kidney and liver
b) Gastrointestinal
c) Either ocular or genital mucosa
d) Either kidney or lungs
e) Platelet and granulocyte levels

Back 25

Either ocular or genital mucosa

Front 26

Which of the following must be considered when pigmented macules are found on the skin and oral mucosa?
a) Addison disease
b) Peutz-Jeghers syndrome
c) McCune Albright syndrome
d) All of the above
e) A & C only

Back 26

All of the above

Front 27

What are the 3 targets for PTH?

Back 27

Kidney: Reabsorbs calcium from the urine
Bone: Mobilizes calcium from the bone
Gut: Augments the absorption of calcium from the diet

Front 28

What is the symptoms and treatment for Hypoparathyroidism?

Back 28

Hypocalcemia, Chvostek's sign (twitching of the upper lip by tapping facial nerve just below zygomatic process), enamel hypoplasia (if present during odontogenesis), oral candidiasis
Tx: Vitamin D & Calcium Supplements

Front 29

What are tooth abnormalities associated with Pseudohypoparathyroidism?

Back 29

Enamel hypoplasia
Wide Pulp Chambers
dagger shaped pulp chambers, oligodontia, delayed eruption & blunt apices

Front 30

What type of Hyperparathyroidism is associated with Parathyroid adenoma (80-90%)

Back 30

Primary Hyperparathyroidism

Front 31

What is the most common type of hyperparathyroidism after 60 years old?

Back 31

Primary hyperparathyroidism

Front 32

What are the symptoms of Hyperparathyroidism?

Back 32

Stones: nephrolithiasis and metastatic calcifications
Bones: subperiosteal resorption in phalanges, Loss of Lamina Dura Surrounding the Teeth
abdominal Groans: duodenal ulcers
psychic Moans: depression, lethargy, weakness, seizures, confusion & dementia

Front 33

What systemic condition produces Benign Tumor-like Lesions of Bone Radiographically and Microscopically Indistinguishable from the Central Giant Cell Granuloma of the Jaws?

Back 33

Hyperparathyroidism produces Brown tumors of bone (osteitis fibrosa cystica) which is indistinguishable from the Central Giant cell granuloma of the jaws

Front 34

What demographic does a Brown tumor apply to?

Back 34

Children

Front 35

Why are brown tumors brown?

Back 35

They contain blood and Hemosiderin. They are not neoplasms.

Front 36

What is Secondary hyperparathyroidism usually associated with?

Back 36

End Stage Renal Disease (Lack of Metabolism of Vitamin D)

Front 37

What is the normal range of calcium un the blood?

Back 37

9-11 mg/dl

Front 38

How are bones affected by Hyperparathyroidism?

Back 38

Subperiosteal resorption in phalanges
Loss of lamina dura surrounding teeth**
Ground glass bone due to decreased density and blurring loss of trabeculae
Brown tumors of bone (these giant cells are osteoclasts. they are mobilized and form a mass within the bone and are reabsorbing the bone from the inside out.)

Front 39

What is the major difference between primary & secondary hyperparathyroidism when it comes to phosphate and calcium?

Back 39

Both are Hypercalcemia, Hypercalciuria, Hyperphosphaturia

Primary = Hypophosphatemia
Secondary = Hyperphosphatemia

Front 40

What is the most common form of Hypercortisolism?

Back 40

Cushing syndrome - a sustained level of exogenous glucocorticoids (moon face, buffalo hump)

Front 41

Why do patients with Hypercortisolism, like cushing, make bad dental patients?

Back 41

Anything you do will take longer to heal and may be prone to infection
Periodontitis incidence will increase
Put off tx until they are stable

Front 42

What is caused by an insufficient production of adrenal corticosteroid hormone?

Back 42

Addison's Disease

Front 43

What are the causes of Primary type Addison's disease?

Back 43

Autoimmune destruction (most common)
Infection
TB & deep fungal (AIDS)
Metastasis
Sarcoidosis
Hemochromatosis
Amyloidosis

Front 44

What are symptoms of Addison's Disease?

Back 44

Oral Freckling first followed by skin hyperpigmentation
fatigue
irritability
depression
weakness
hypotension
GI problems
Salt craving

Front 45

What are some dental related problems that diabetes mellitus patients experience?

Back 45

Periodontitis (incidence & severity)
Oral candidiasis (traced to decreased immune surveillence)
Diabetic Sialeadenosis (salivary glands become enlarged)
Zygomycosis (fungal infection in the maxillary sinus)
Migratory Glossitis (geographic tongue)
Delayed wound healing
Xerostomia

Front 46

What should you suspect if you have:
Obliterated pulp chambers & root canals
Macroglossia
Gingival hyperplasia
Pointed cusps on posterior teeth
Diastemas
Impacted teeth with large follicles
Corneal clouding
Joint stiffness
Mental retardation
Coarse facial features

Back 46

Mucopolysaccharidoses

Front 47

What leads to cretinism in infancy and myxedema in adults?

Back 47

Hypothyroidism

Front 48

In Hypothyroidism, there is systemic deposition of glycosaminoglycan ground substance in their connective tissue. What will this lead to?

Back 48

Non-pitting edema

Front 49

What disease has the symptoms of:
Enlarged Tongue & Lips
Swollen Face
Delayed eruption of teeth
Non-pitting peripheral edema

Back 49

Hypothyroidism

Front 50

Who is most affected by Grave's disease?

Back 50

Hyperthyroidism is 5-10x more common in Women

Front 51

Why is Hyperthyroidism important to dentistry?

Back 51

Increased sensitivity to EPINEPHRINE, exagerating tachycardia & hypertension
Risk of Thyroid Storm (large release of thyroxine due to stress or infection) death in20-40%

Front 52

What causes Gigantism?

Back 52

Rare condition of increased growth hormone from PITUITARY ADENOMA
(associated with McCune-Albright syndrome - Cafe au lait spots, fibrous dysplasia of bone, precocious puberty)

Front 53

What are some dental signs of pituitary Dwarfism?

Back 53

delayed tooth eruption
Often missing 3rd molars

Front 54

In Crohn's disease, oral lesions are reported in 30% of cases and can precede gut lesions. What do these lesions look like?

Back 54

Diffuse or nodular oral/perioral swellings
Cobblestone appearance of mucosa
Mucosal ulcers and fissures or present as pyostomatitis vegetans

Front 55

What is a rare manifestation of ulcerative colitis or Crohn's Disease?

Back 55

Pyostomatitis vegetans
Yellowish, slightly elevated linear, serpentine pustules on an erythematous mucosa (snail tract ulcerations)
Most often on buccal, labial soft palatal mucosa and tongue
Oral pain and discomfort possible

Front 56

What do the lesions of pyostomatitis vegetans (a rare manifestation of ulcerative colitis or crohn's disease) manifest as?

Back 56

Yellowish, slightly elevated, linear, serpentine pustules on an erythematous mucosa (snail tract ulcerations)

Front 57

Where do oral manifestations of pyostomatitis vegetans manifest?

Back 57

Buccal, labial, soft-palatal mucosa, and tongue

Front 58

What type of Iron-deficiency Anemia is considered premalignant due to high incidence of oral, hypopharyngeal and esophageal carcinomas?

Back 58

Plummer-Vinson Syndrome (Paterson-Kelly syndrom, sideropenic dysphagia)
Fatigue, weakness & SOB
Chronic iron deficiency anemia, glossitis & dysphagia
Esophageal webs and koilonychias (spoon-shaped nails)
Scandinavian Women 30-50 years old
Glossopyrosis, Glossodynia, & Angular cheilitis

Front 59

Patients on anticoagulation therapy need a recent _________ to measure their ability to clot prior to dental treatment if there is any chance that dental care can cause bleeding.

Back 59

Prothrombin Time

Front 60

What is a normal Prothrombin time?

Back 60

10-13 seconds

INR =1-4