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Oral Pathology p1-66 of 149

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oeshnoeugo123's version from 2018-02-13 23:22

Oral Pathology Review (2018) - p1-50/149

Question Answer
Fordyce Granules• Ectopic sebaceous glands
• Yellow papules most commonly located on
buccal mucosa or lips
• Seen in >75% of adults after puberty
• Asymptomatic
• Range in number
Leukoedema• Intracellular edema of cells
• More often seen in African-Americans
• Common, bilateral on buccal mucosa
• May be diagnosed with chairside
evaluation
• No treatment required
Physiologic Pigmentation• Melanocytic pigmentation of the oral
mucosa
• More common in individuals with
darkly pigmented skin
• May appear anywhere on the oral
mucosa
varicosities• Prominent veins most often seen on the
ventral and lateral tongue
• May also be seen on the buccal or labial
mucosa
• Most common in individuals older than 60
years
ankyloglossia• Congenital abnormality
• Thick lingual frenum
• “Tongue- tied”
Pierre-Robin Sequence• Micrognathia
• Cleft palate
• Glossoptosis
Oral Lymphoepithelial Cyst• Commonly found in Waldeyer ring
– Ventral tongue, floor of mouth, soft palate
• Yellow soft tissue cyst
• Well circumscribed swelling
Nasolabial Cyst• Developmental cyst
• Soft tissue swelling adjacent to
maxillary lateral incisor
• Pseudostratified squamous epithelium
cystic lining
Dermoid Cyst• Developmental cyst
• Slightly compressible (“doughy”)
• Often in midline
Nasopalatine Duct Cyst• a.k.a. incisive canal cyst
• Most common non-odontogenic cyst
• Develops in midline maxilla
• Teeth vital
Stafne Bone Defect• Focal concavity of cortical bone on
lingual surface
• Developmental defect containing
portion of submandibular gland
• 80-90% male predilection
• Affects 0.5% of population
-UNILOCULAR
-WELL CIRCUMSCRIBED
mandibular tori• Mandible lingual to canine/pre-molars
• 90% are bilateral
• May be superimposed over periapical
region as radiodensities
Cleidocranial Dysplasia• Multiple unerupted supernumerary teeth
• Retention of primary teeth
• Delayed eruption of permanent teeth
• Missing clavicles, frontal bossing, large head
Eagle Syndrome• Impingement or
compression of nerves
or vessels by elongation
and/or calcification of
the stylohyoid ligament
• Head and neck pain is
elicited by chewing,
yawning, opening mouth
Condylar Hyperplasia• Irregular, elongated condyle
• Chin deviates away from affected
side upon closure
Turner Tooth• Hypoplastic enamel defect due to local
trauma or infection in area of developing tooth bud
Intrinsic Tooth Staining• Tetracycline – deposition within the dentin
Hypercementosis– Excess cementum, often seen in
posterior maxillary teeth
– Parallels normal contour of tooth root
• Unlike cementoblastoma
– Radiopacity with intact PDL
– Generalized in acromegaly
– May be seen in Paget disease
Internal Resorption• Teeth appear pink clinically
– “pink tooth of Mummery”
• Endodontics indicated
Dens-in-Dente (Dens Invaginatus)• Most often found in anterior jaw,
especially maxillary lateral incisor
• Attrition - physiological
• Abrasion - pathological
– Mechanical wear
– Habits / occupations
• Erosion
– Chemical loss of tooth structure
• Attrition - ___
• Abrasion - ___
• Erosion - ___
Amelogenesis Imperfecta– Teeth exhibit defective enamel
– Dentin and cementum unaffected
– Shapes of root and crown are normal
– Multiple genetic mutations identified,
corresponding to different patterns
Dentinogenesis Imperfecta– Hereditary disorder affecting dentin
– Involves mutation of DSPP gene
– Seen in the absence of any
systemic disorder
• Once thought to be associated with
osteogenesis imperfecta (mutation of
COLIA1 or COLIA2), with blue sclera
and multiple bone fractures
– Opalescent dentin – blue/gray
– Radiographs may demonstrate lack
of pulp chambers and root canals
– Bell-shaped crown with constricted
cervical region
Dentin Dysplasia• Type I
– “Rootless teeth”
• Type II
– Currently thought to be a variation of DI (dentinogenesis imperfecta?)
– Blue-brown primary teeth
– Clinically-normal permanent teeth
Gemination• Single tooth bud attempts to divide forming a bifid
crown
• Common root, common root canal
• Tooth count is normal when the anomalous tooth is
counted as one
Fusion• Union of two normally separate tooth buds forming a
joined tooth
– Confluence of dentin, two root canals
– Tooth count reveals a missing tooth when the
anomalous tooth is counted as one
Periapical Granuloma• Not actually a granuloma
• Mass of granulation tissue
• a.k.a. apical periodontitis
• Apex of non-vital tooth
• Most found on radiographic examination
• Radiographically indistinguishable from
periapical cyst
Parulis• a.k.a. “gum boil”
• Inflamed granulation tissue
at intra-oral opening of sinus
tract
• Classically a dome-shaped
yellow-pink papule
• Usually on gingiva facial to
non-vital tooth
• May or may not exhibit
active suppuration
Ludwig Angina• Bilateral swelling of
sublingual,
submandibular, and
submental spaces
• 70% associated with
infection from
mandibular molar
• Potential for airway
compromise
Cavernous Sinus Thrombosis• 10% result from odontogenic infections
• Edematous periorbital enlargement
Chronic Osteomyelitis– Often best seen in lateral oblique
radiographic view
– Radiolucent and radiodense
Proliferative Periostitis• a.k.a. periostitis ossificans
• Reactive lesion
characterized by
subperiosteal bone
formation
• Improperly associated with
Garrè
• Onion-skin pattern is
characteristic, but nonspecific
• Also seen in Ewing Sarcoma
Desquamative Gingivitis• NOT a diagnosis
• Clinical manifestation of lichen
planus, mucous membrane
pemphigoid, pemphigus
vulgaris, or contact reaction
• Biopsy is necessary for
definitive diagnosis
-anticonvulsants
-calcium channel blockers
-others:
--cyclosporine
--erthryomycin
--contraceptives
Meds associated with gingival hyperplasia
Actinomycosis• Gram + BACTERIAL infection
• Associated with sulfur granules
• Often presents with indurated
abscess at angle of mandible
Tuberculosis• Incidence is increasing worldwide with
emergence of AIDS, but has decreased in U.S.
• Chest radiograph may support diagnosis
• Rarely presents with oral lesions
– Non-specific ulcer of tongue may mimic SCCA
Scarlet fever• Group A, beta-hemolytic
strep infection
• Characteristic oral finding
of “strawberry tongue”
– White coating of tongue
sloughs off, leaving red
surface with swollen
hyperplastic fungiform
papillae
Pseudomembranous Candidiasis– 30-50% of population carries C. albicans
– Opportunistic infection
– Predisposing factors
• Immune suppression
– Infancy (“thrush”)
– Steroid usage (topical or systemic)
– Underlying diagnosis
• Antibiotic usage
• Chronic denture wear
• Hyposalivation
– White membrane may (sometimes) be scraped
away, leaving red base
– Pseudohyphae and conidia
• May be diagnosed by cytologic smear or biopsy
Erythrematous Candidiasis
-Median Rhomboid glossitis
• Atrophy of filiform papillae
• Midline tongue, junction of anterior
2/3 and posterior 1/3 at tuberculum
impar
• Not a developmental disorder as once
believed
Erythematous Candidiasis
-Chronic atrophic candidiasis
• (a.k.a. “denture stomatitis”)
• Erythema in area of denture base
• Associated with chronic denture wear, not
irritation or allergy
• Both tissue AND denture must be treated with
antifungal medication
HSV (Herpes Simplex Virus)• U.S. incidence estimate of herpes
infection is 80-85%
• Primary herpetic gingivostomatitis
– Rare- most infections are subclinical
– Involves keratinized and nonkeratinized
mucosa
• Secondary herpetic recurrences
– Herpes labialis
– Prodrome precedes vesicle formation
Primary Herpetic Gingivostomatitis• Affects ~10% of patients exposed to HSV
(most infections subclinical)
• Inflamed, enlarged marginal gingiva;
gingival bleeding
• Malaise
• Low grade fever
• Sore throat, lymphadenopathy
• Painful vesicles and ulcers throughout
keratinized and nonkeratinized mucosa
HSV
-Recrudescent herpetic lesions
– Oral lesions (generally associated with
HSV 1) seen in up to 45% of population
– Keratinized tissue in healthy individuals
– Vesicles rupture and leave shallow
ulcers
– Often triggered by stress, hormones,
allergies, UV light, trauma
Herpes Zoster• Reactivation of HHV-3
• Painful vesicles and ulcers
• Unilateral distribution
Oral Hairy Leukoplakia• Caused by Epstein-Barr virus (HHV-4)
• Typically seen in
immunocompromised patients
• Vertical white striations on lateral
border of tongue
• Benign condition
Infectious Mononucleosis– Associated with Epstein-Barr virus (HHV-4)
– Presents with lateral cervical swelling
– Sore throat
– Often affects teenagers
– Positive monospot test
Squamous Papilloma– Usually associated with low risk human
papillomavirus types 6 or 11
– White, pink, or red
– Rough surface (may resemble cauliflower)
– Elevated lesion
– May appear on any intraoral site
Condyloma Acuminatum– Sexually-transmitted HPV-induced
infection
– 90% associated with HPV 6 and 11, but
some associated with high risk types
Morsicatio• Chronic mucosal chewing
– Morsicatio buccurum
– Morsicatio labiorum
– Morsicatio linguarum
• White patches of parakeratin
• Often bilateral
• Poorly-defined borders
memorize

Oral Pathology Review (2018) - p51-66/149

Question Answer
Aspirin Burn• Discoloration from necrosis of
epithelium, not hyperkeratosis
• Other medicaments
• Mouthwashes / hydrogen peroxide
• Tooth-whitening products
Extravasated Blood– Purpura – generalized term
– Petechia- pinpoint bleeding
– Ecchymosis – larger area of involvement
– Hematoma – large, elevated areas
Cervical Emphysema• Introduction of air into oral soft tissues
with resulting sudden painless swelling
Allergic Mucositis• Often due to flavoring agents in
toothpastes, candies, and chewing
gums
– Cinnamic aldehyde (not cinnamon) is a
common culprit
Complications of Radiotherapy• Osteoradionecrosis due to vascular
compromise
• Causes cervical caries secondary to
xerostomia
• Does not result in pulp necrosis
Recurrent APTHOUS ulcers• Non-keratinized oral mucosa
– Only herpetiform pattern reported on
keratinized tissue
• Recurrent
• Not preceded by vesicle
• Associated with specific HLA types
– Immune-mediated disorder
– Not caused by a virus, bacteria, fungus
• Minor, major, and herpetiform patterns
– Painful round, regular ulcers with red halos
• Treatment
– Corticosteroids often prescribed
Sarcoidosis– Multisystem granulomatous disorder
– Bilateral hilar lymphadenopathy noted
on chest radiograph
– Cutaneous and oral lesions
– Treated with corticosteroids
Crohn Disease• Aphthous-like ulcers
• Tags of mucosa (resemble epulis
fissuratum)
• Linear ulcers
• Cobblestone swelling of oral mucosa
• GI symptoms
Nicotinic Stomatitis• Hard palate
• Red, inflamed minor salivary
gland ducts with keratotic background
• Benign condition
– Response to heat
– Classically associated with pipes or cigars
Leukoplakia60
• White patch or plaque that cannot be
characterized clinically or pathologically as
any other disease
– Does NOT refer to all white lesions
• Must be biopsied for definitive diagnosis
Erythroplakia• Similar to leukoplakia in that it is a clinical term of
exclusion, not a specific histopathologic diagnosis
• Refers to a red patch or plaque that cannot be
characterized as another disease
• Less common than leukoplakia
• More likely than leukoplakia to show dysplasia or
invasive SCCA at the time of biopsy
Epithelial Dysplasia• Mild
• lower 1/3 of the epithelium
• Moderate
• lower 2/3 of the epithelium
• Severe
• greater than 2/3 of the epithelium
• Carcinoma-in-situ
• full-thickness of epithelium
SCC (Squamous Cell Carcinoma)• Lower lip
– May be preceded by actinic cheilitis
– Often presents as firm, indurated
ulcer
– Submental node is most common
lymph node involved by metastasis
• Most common intraoral site is
ventrolateral border of tongue
– Other high risk intraoral/oropharyngeal
sites are floor of mouth and soft palate
• Least likely oral site is hard
palatal mucosa
• Metastasis most often to
ipsilateral cervical lymph nodes
SCC (Squamous Cell Carcinoma)• Staging and Prognosis
– Higher stages associated with worse
outcomes
– Overall 5 year survival for oral and
pharyngeal carcinomas = 64%
Keratoacanthoma– Well-differentiated SCCA
– Seen on sun-exposed skin
– Present for many months; spontaneously
resolve in ~ 4 months
– Keratin plug in the center of the ulcer
Actinic Cheilitis• Epithelial dysplasia of the lip, with
potential to develop into SCCA
• SCCA of lip has improved prognosis
compared to intraoral SCCA and other
oral cancers
memorize

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