Glossary of Oral Path Section I

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PATH - Oral - Section 1 Exam
Developmental Disturbances
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.
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?
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?
Which is almost always bilateral: Commissural or paramedian Lip pits?
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?
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?
What other disease is often associated with fissured tongue?
Geographic tongue
What is the incidence of fissured tongue?
What is the incidence of geographic tongue?
What kind of papillae/taste buds are missing with geographic tongue?
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?
In hairy tongue, keratin accumulates on which type of papillae?
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.
VonEbner's salivary glands are special because they are (serous/mucous).
Physical and Chemical Injuries
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?
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?
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?
What occurs within a few days of starting chemo?
Chemo mucositis
Abnormalities of Teeth
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?
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?
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?
True or False denticles: Look like secondary dentin (dentinal tubules).
True or False denticles: Does NOT look like dentin, shows lamellar pattern.
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?
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 ___________.
Name the antibiotic that turns teeth yellow to yellow-brown with no pitting, which may occur in band-like fashion.
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?
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.
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?
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?
What is the most common type of dentinal dysplasia?
Type I
Diseases of Pulp/Periapical Region
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).
If the pulp vital or non-vital if you hae acute periapical abcess?
(Acute/Chronic) abcesses are symptomatic.
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?
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
Allergies/Immunologic Reactions
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?
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).
Inappropriate complement activation due to C1-INH problems will cause...
What is the most common location for angioedema to occur?
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?
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?
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.
What is the most common, but rare, oral manifestation of Wegener granulomatosis?
Strawberry gingivitis
Epithelial Lesions
What term is used when epithelium has a granular layer and the nuclei are lost in the keratin layer?
What term is used when there is no granular cell layer and the epithelial nuclei are retained in the keratin layer?
What term is used when there is intercellular edema of the spinous cell layer, which turns a whitish color?
What term is used when the spinous layer is thickened?
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?
What white lesion does NOT disappear when the tissue is stretched?
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?
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.
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?
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.
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?
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?
If a lab report comes back with hyperkeratosis, is it benign, premalignant, or malignant?
If a lab report comes back with dysplasia, is it benign, premalignant, or malignant?
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?
How long does it take to get color changes with smokeless tobacco?
1-5 years
Is oral submucous fibrosis premalignant or not?
What causes oral submucous fibrosis?
Chewing betel quid
Do smokeless tobacco lesions go away after quitting?
Does oral submucous fibrosis go away after quitting betel quid?
What other oral lesion is often on top of/associated with oral submucous fibrosis?
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?
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.
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?
What is more common, leuko or erythroplakia?
___ - ____% of erythroplakias show dysplasia/carcinoma.
Does erythroplakia have keratin?
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.
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

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