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Board review: Pathology

Terms in this set (83)

- cause is unknown; may be induced by stress
- involves the dorsal and lateral borders of the tongue; loss of FILIFORM PAPILAA
- erythematous patches surrounded by a white or yellow perimeter
- condition is not static; comes and goes
- patient may complain of burning sensation; no treatment indicated
Geographic tongue (benign migratory glossitis)
- cause is unknown, but may be associated with tobacco use, chemical rinses, alcohol, or certain foods
- involves the dorsal surface; asymptomatic
- the FILIFORM PAPILLA become enlongated and may be white, yellow, brown, or black
0 may result from antibiotic, corticosteroid or radiation therapies, poor OH
- threatment involves brushing the tongue
Hairy tongue
- cause is unknown; could be variant of normal
- fissures or grooves seen on the dorsal surface
- can become irritated if food collects here
- treatment involves brushing the tongue with a soft brush
fissured tongue
- dilated superficial veins located on the VENTRAL SURFACE
- Clinically see red to purple enlarged vessels
- most commonly seen in patients >60 years old
- no treatment required
Lingual varicositities
- may be associated with the fungal infection from CANDIDA ALBICANS
- appears as a erythematous area at the midline of the dorsal surface of the tongue, anterior to the circumvallate papilla
- since it is DEVOID OF FILIFORM PAPILLA, it appears smooth
- often seen in immuno-compromised individuals; no specific treatment
Median rhomboid glossitis
- enlarged tongue
- can be described in patients with acromegaly (enlargement of hands, feet, maxilla, and mandible; enlargement of bones of the forehead and nasal bones; mucosal changes such as thickened lips)
Macroglossia
- trisomy 21; incidence increases with increased maternal age
- FISSURED TONGUE, MACROGLOSSIA, mouth breathing, hypodontia, taurodontism, gingival and periodontal disease, crowding of teeth
- decreased dental caries; possibly due to hypersalivation
Down Syndrome
- excessive adhesion of the tongue to the floor of the mouth
- caused by a short lingual frenum
Ankyloglossia
- benign lesion seem on the HARD PALATE of heavy smokers
- the intensity of smoking required to produce this lesion increases the patient risk for the development of malignancy at another site in the oral cavity or respiratory tract
- initial response to the heat on the palate is an erythematous appearance
- with time, keratinization occurs which results in an opaque appearance
- THE RAISED RED DOTS REPRESENT THE DUCT OPENINGS OF MINOR SALIVARY GLANDS (IMPORTANT)
- COARSE, WHITE, WRINKLED appearance
Nicotine stomatitis
- most common oral fungal infection, from candida albicans
- can occur in patients who are immuno-suppressed, including: antibiotic therapy, chemotherapy, DENTURE WEARERS, DIABETES, HIV infection, xerostomia
- topical application: nystatin, clotrimazole
- systemic administration: ketoconazole, fluconazole
Candidiasis
- type of candidiasis
- white plaques that wipe off with underlying red mucosa; burning metallic taste
- "thrush"; superficial candidiasis
Pseudomembranous
- type of mucosa
- red mucosa, often painful, localized or generalized
- "acute atrophic candidiasis"
Erythematous
= presents as erythematous mucosa, but limited to the mucosa covered by the partial or denture
- "denture stomatitis"; ASYMPTOMATIC
Chronic atrophic candidiasis
- redness or fissuring at the labial commissures
- may also be due to nutritional deficiencies (INSUFFICIENT RIBOFLAVIN- VITAMIN B12)
- frequently accompanies intraoral candidiasis
- may occur in persons who frequently lick their lips
Angular cheilitis
- erythematous area at the midline of the dorsum of the tongue; asymptomatic
- immuno-compromised patients
Median rhomboid glossitis
- benign anomaly which appears as a gray-to-white film on the buccal mucosa, giving the tissue an opaque quality
- STRETCHING THE MUCOSA makes the opalescence less noticable
- more commonly seen in African Americans
- no treatment requires
Leukodema
- WHITE LINE
- hyperkeratotic
- extends antero-posteriorly on the buccal mucosa along the occlusal plane
- may be bilateral; NO biopsy needed
- may be prominent in patients with a bruxing or clenching habit
Linea alba
- white patch or plaque of oral mucosa that cannot be wiped off
- cannot be characterized clinically as any other disease
- many cases are related to the use of tobacco (smokeless included)
- microscopically, can range from hyperkeratosis to squamous cell carcinoma
leukoplakia
- etiologic agent appears to be the Epstien-Barr virus in association with HIV
- associated with patients with low CD4 count
- WHITE PATCH SEEN ON THE LATERAL BORDER OF THE TONGUE
- benign lesion; does not require treatment
Hairy leukoplakia
- racial pigmentation or normal pigmentation
- variable in dark-skinned individuals
Physiologic pigmentation
- "oral focal malanosis", "oral freckle", "oral ephelis"
- flat brown lesion
- not dependent on sun exposure
- seen on lower lip, also intraoral
- no treatment required; monitor size and changes
Melanotic macule
- MOST COMMON PIGMENTED LESION
- focal argyrosis
- amalgam particles in soft tissues
Amalgam tattoo
- intraoral SEBACEOUS (OIL) GLANDS
- seen in over 80% of the patient's population
- small yellow nodules on buccal mucosa and vemilion, seen after puberty
Fordyce's granules
- dilated superficial veins
- prominent on ventral surface of tongue
Varicosities
- primary adrenal cortical insufficiency
- insufficient production of adrenal steroids due to destruction of the adrenal gland
- stimulation of melanocytes may occur leading to DIFFUSE PIGMENTATION of the skin
- oral manifestations include MELANOTIC MACULES on the buccal mucosa, gingiva and may extend to the tongue and lips; also petechiae are seen on the palate
- BRONZING, tinted skin
Addison's disease
- MOST COMMON TUMOR OF THE ORAL CAVITY
- persitent exophylic lesion composed of dense, scar-like CT
- reactive hyperplasia of fibrous CT in response to irritation or trauma, fibroma is painless
- occurs as a result of chronic trauma such as cheek biting
- usually a small lesion, has limited growth potential
- the color is usually lighter than the surrounding mucosa
- smooth, pink, firm elevated NODULE
- treatment includes surgical excision
- microscopic evaluation may also be necessary
Irritation/ traumatic fibroma
- caused by HPV
- PEDUNCULATED (stalk-like), warty, soft lesion
- these tumors are often CAULIFLOWER-LIKE in appearance
- the color of the lesion depends upon the amount of keratin present
- treatment includes surgical excision, which must include the base of the growth
- usually do not recur; the predilection for SOFT PALATE AND UVULA
Papilloma
- common vascular lesion
- considered a developmental lesion rather than a tumor due to limited growth potential
- more than half occur in the head and neck region; the TONGUE IS THE MOST COMMON INTRAORAL LOCATION
- girls > boys
Hemangioma
- lesion caused by an ILL-FITTING DENTURE located in the vestibule along the denture border
- composed of dense, fibrous CT; same type of tissue as an irritation fibroma
- surface is often ulcerated
- treatment involves surgical removal of the excess tissue and construction of new denture
Epulis fissuratum
- a form of denture stomatits seen almost on hard palate
- almost always associated with a REMOVABLE APPLIANCE that is never removed
- palatal mucosa is covered with multiple red PAPILLARY PROJECTIONS; granular appearance; no fungal infection
Papillary hyperplasia of the palate
- commonly occurring intraoral lesion seen as a result of injury
- usually ulcerated, soft to the touch, bleed easily, vascular appearance
- common on gingiva where plauqe and calculus forms
- may vary in size; develops rapidly then remains static
- often occur in pregnant women and are called PREGNANCY TUMORS
- may be caused by changing hormonal levels
- treatment involves surgical excision if the lesion does not resolve on its own
- may recur if the agent (plaque or calculus) remains
Pyogenic granuloma
- seen on gingiva or alveolar process (usually anterior to molars)
- can vary in size
- dark red in color due to numerous blood vessels
- similar to pyogenic granuloma
- seen more frequently in persons <30 years
- women > men
- treated by surgical excision; generally do not recur
Peripheral giant cell granuloma
- an increase in the bulk of the free and attached gingiva, especially involving the interdental papilla
- rounded gingival margins
- tissue color depends on the amount of inflammation; ranges from normal pink to erythematous
- may be generalized or localized
- causes include: chronic inflammation assoicated with local irritants, hormonal changes, certain medications, or hereditary causes which can begin in childhood
- medications involved: DILANTIN, CALCIUM CHANNEL BLOCKERS, CYCLOSPORINE
- treatment can include reshpaing or removing the excess gingival tissue
- good oral hygiene is also highly recommended
Gingival hyperplasia
- "pulp polyp"
- excessive proliferation of chronically inflamed dental pulp tissue
- occurs in teeth with large, open carious lesions
- red or pink module of tissue is seen protruding from the pulp chamber
- asymptomatic
- treatment includes endodontic therapy or extraction of the tooth
Chronic hyperplasia pulpitis
- acute, ulcerative condition that affects skin and mucous membranes
- women > men, young adults
- may see variety of skin lesions (papule is smaller than nodule)
- characteristic skin lesion is the BULL'S EYE (TARGET) LESION which demonstrates CIRCLES OF ERYTHEMA AND NORMAL SKIN TONE
- oral lesions commonly present as ulcers on the lateral borders of the tongue, or crusted and bleeding lips, hemorrhagic crusting
- cause is not clear; maybe a reaction to infection (such as herpes, tuberculosis)
- may have sudden, explosive onset
Erythema multiforme
- most severe form of erytherma multiforme
- mucosal lesions are larger and painful; TWO MUCOSAL SURFACES involved (genital mucosa and mucosa of the eyes may be involved)
Stevens-Johnson syndrome
- benign, chronic disease that affects the skin and oral mucosa
- classic clincial appearance is an arrangement of interconnecting, LACE-LIKE WHITE LINES, COMMONLY SEEN ON BUCCAL MUCOSA
- the slender, fine lines are termed WICKMAN'S STRAIE
- reticular type of is also lace-like; erosive type includes ulcerations
- cause is unknown; erosive lesions increase with stress
Lichen planus
- chronic, progressive with periods of remission in between
- skin lesions are the most common clinical manifestation
- most common skin lesion is the BUTTERFLY RASH over the nose
- diagnosis is based on multi-organ involvement and the presence of antinuclear antibodies in serum
- treatment may include aspirin and NSAID agents
Lupus
- ulcerated lesion due to trauma (cheek bite, dry cotton roll removed quickly, over-zealous brushing)
- diagnosis is made through the patient history
- healing usually lasts 7-14 days- unless the trauma persists
Traumatic ulcers
- painful, recurring ulcers seen ONLY ON MOVEABLE MUCOSA of the oral cavity (mucosa not covering bone)
- MINOR, MAJOR, HERPETIFORM
- can be caused by trauma, emotional stress, or certain foods
- application of topical steroids can be helpful with treatment, especially effective in the prodormal stage
- non-keratinized mucosa includes the tongue, soft palate, floor of the mouth, buccal and lingual mucosa
Apthous ulcer
- HSV can also cause a PAINFUL INFECTION OF THE FINGERS
- can either be primary or recurrent infection
- may last 4-6 weeks
Herpetic whitlow
- caused by the COXSACKIE VIRUS
- vesicles are seen on the soft palate, usually accompanied by fever, malaise, flu-like symptoms
- disease will resolve without treatment
Herpangina
- caused by COXSACKIE VIRUS
- usually seen in epidemics of young children
- oral lesions are painful, ulcerative vesicles; macules typically appear on the feet, toes, hands, and fingers as well
- treatment generally not required
Hand-Foot,and-Mouth disease
- Caused by the EPSTEIN-BARR VIRUS
- clinical symptoms include sore throat, fever, lymphadenopathy, FATIGUE
- oral manifestations include PALATAL PETECHIAE
- virus is transmitted by kissing, contact with saliva
Infectious mononucleosis
- caused by the VARICELLA-ZOSTER VIRUS
- primary infections are known as varicella or chickenpox; secondary or reactivated infections are known as herpes zoster or shingles
- UNILATERAL' see PAINFUL eruptions of vesicles along the distribution of a sensory nerve, do not cross the midline
- transmission is via inhalation of contaminated droplets
- reactivation is uncommon, but may occur with immunosuppression, drug administration or HIV infection
Varicella-Zoster infections
- maxilla; bony, radiopaque mass in the midline of the hard palate; more predominant in females, 2:1
Torus (tori)
- bony protuberance on facial and buccal surfaces of the jaws
Exostoses
- MOST COMMON ODONTOGENIC TUMOR
- composed of enamel, dentin, and pulp; "toothlets" of diffuse mass
- treatment: excision
Odontoma
- common in MIDDLE AGE, AFRICAN AMERICAN FEMALES
- mixed radiopqaue/radiolucent lesions seen at the apex of vital teeth, usually mandibular anterior
- no treatment required
Periapical cemental dysplasia
- common in MIDDLE AGE, AFRICAN AMERICAN FEMALES
- dense sclerotic masses of bone or cementum can be seen in all four quadrants
- no treatment required
Florid osseous dysplasia
- common in men older than 50 years
- enlargement of the bone and spaces between the teeth are seen; "my dentures don't fit"
- radiographically see COTTON-WOOL RADIOPACITIES
Paget's disease
- common in men older than 60 years
- tumor originates in bone marrow; condition is usually progressive and fatal
- symptoms include: anemia, painful bone lesions
- radiographically see "PUNCHED OUT" radiolucencies in the jaw
Multiple myeloma
epithelial-lined cavity or sac often filled with straw-colored fluid
cyst
a cyst in which the lining of the lumen is derived from the epithelium produced during tooth development
odontogenic cyst
- seen at the APEX OF A NECROTIC TOOTH
- radiographically see a well-defined unilocular radiolucency; asymptomatic
- most common cysts of the jaws
- tooth needs extraction or endodontic treatment
Radicular cyst (periapical cyst)
- radicular cyst that was "LEFT BEHIND"
- treatment involves removal of cyst
residual cyst
- seen AROUND THE CROWN OF AN IMPACTED OR UNERUPTED TOOTH
- commonly seen with mandibular 3rd molars, also max canines
- second to third decade of life; asymptomatic
- radiographically see a unilocular radiolucency; unerupted tooth is frequently displaced
- treatment involves removal of the tooth and enucleation
Dentigerous cyst (follicular cyst)
- OCCURS IN PLACE OF A TOOTH
- radiographically see a unilocular radiolucency
Primordial cyst
- unique epithelial lining; may see buccal expansion
- radiographically see a unilocular OR multilocular radiolucency
- HIGH RECURRENCE RATE; benign but aggressive behavior
- mandible > maxilla
Odontogenic keratocyst (OKC)
- common location is between the roots of mandibular premolars
- radiographically see a unilocular radiolucency
- CANNOT PROBE this area
- male > female
Lateral periodontal cyst
- seen between maxillary lateral incisor and canine
- radiographically see a unilocular radiolucency causing divergence of the roots
Globulomaxillary cyst
- radiographically see an oval radiolucency in the midline of the anterior maxilla
- may appear "heart-shaped" due to presence of anterior nasal spine
- most cases are asymptomatic with swelling being the clinical feature; treatment is surgical enucleation
Nasopalatine duct cyst (incisive canal cyst)
- soft tissue cyst
- often lifts the ala of the nose, see swelling over the maxillary canine region
Nasolacrimal cyst (nasolabial cyst)
- LOWER LIP IS THE MOST COMMON SITE
- clinically appears as a BLUISH-PINK FLUID-FILLED nodule
- caused by the traumatic severance of a salivary gland duct
- common in adolescents and children
- treatment is excision
Mucocele
- "mucocele of the floor of the mouth"
- caused by OBSTRUCTION OF WHARTON'S DUCT (SUBMANDIBULAR SALIVARY GLAND DUCT)
- clinically see swelling on the floor of the mouth with a soft tissue mass
may have a bluish appearance compared to a frog's belly
Ranula
- a calcification within a gland or duct
- Wharton's duct is the most common site
- may cause obstruction; swelling seen during eating
Sialolithiasis (salivary stones)
- MOST COMMON TUMOR OF THE SALIVARY GLANDS
- PAROTID GLAND IN THE MOST COMMON LOCATION
- most common intraoral site is the POSTERIOR HARD PALATE
- painless, slow-growing, well-circumscribed soft tissue swelling
- treatment is surgical excision
Benign mixed tumor (pleomorphic ademona)
- developmental depression of the mandible from the submanidbular salivary gland seen below the inferior alveolar canal toward the mandibular angle
- ovoid radiolucency; no treatment required
Stafne's bone cyst, static bone cyst
- pre-malignant skin lesion that may transform into squamous cell carcinoma
- commonly seen on sun-exposed skin
- irregular, scaly plaques
Actinic keratosis
- pre-malignant lesion of the lower lip
- clinical appearance ranges from crusted, red, white, ulcerated, glossy
Actinic cheilitis
- MOST COMMON FORM or oral cancer; malignant tumor if squamous epithelium
- clinical appearance can begin as a white plaque (leukoplakia) then become an exophytic ulcerative mass- be suspicious of a red and white lesion; INDURATED LESIONS (HARDENED)
- seen on the LATERAL BORDER OF THE TONGUE AND FLOOR OF THE MOUTH
- usually metastasizes to lymph nodes of the neck then more distant sites, such as the lungs or liver
- risk factors include tobacco use and alcohol; seen in patients >40
- generally treated by surgical excision with the possibility of radiation treatment of chemotherapy; prognosis is based on size, location and presence or absence of metastatsis
- treatment can cause skin erythema, caries, xerostomia
- do not recommend an alcohol mouthwash for patients with oral cancer
Squamous cell carcinoma
- the development of two teeth within a single root
- tooth count is normal
Gemination
- the joining of two developing tooth germs resulting in a single large tooth
- tooth count is one tooth less than normal
Fusion
- a form of fusion, teeth are joined by cementum only
- commonly seen in maxillary second and third molars
Concrescence
- extraordinary curve or bend in a tooth
- extraction, endodontics may be difficult
Dilaceration
- "tooth within a tooth"
- invagination of the crown or root that is lined with enamel - seen most commonly in maxillary lateral incisor, accentuation of the lingual pit
Dens in dente (dens invaginatus)
- large pulp chamber, location of the furcation is more apical, elongated crown
- commonly seen in people with Down Syndrome
- "bull's tooth"
Taurodontism
- developmental disturbance of enamel formation
- usually seen on the bifurcation or trifurcation areas
- may be a problem in cases of periodontal disease
Enamel pearls
- physiologic wearing of teeth resulting from mastication, TOOTH-TO-TOOTH contact
- age-related process
- BRUXISM is a pathologic form
attrition
- pathologic wearing of teeth as a result of an abnormal habit, or, the abnormal use of abrasive substances
abrasion
- seen in adults
- appears as a wedge-shaped lesion at the cervical areas of the teeth
- cause is related to fatigue, flexure, and deformation of tooth structure
abfraction
- the loss of tooth structure from a chemical process
- affects many or all teeth in an arch; shiny, glossy look
erosion
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