Oral Path Exam I

Front 1

 Wilms tumor (kidney) and hepatoblastoma
 Enlarged crowns, open bite

Back 1

Hemihyperplasia

Front 2

 Coup de sabre

Back 2

Progressive hemifacial atrophy (Romberg syndrome)

Front 3

 Autosomal dominant
 *beaten copper skull

Back 3

Crouzon syndrome (craniofacial dysostosis)

Front 4

 Features of Crouzon syndrome and limb defects (syndactyly)
 Mandibular prognathism (class III occlusion) with midface hypoplasia
 75% cleft soft palate or uvula

Back 4

Apert syndrome

Front 5

 Narrow depressed cheeks
 Downward slanting palpebral fissures
 Deformed pinna
 Underdeveloped mandible

Back 5

Treacher-Collins syndrome (mandibulofacial dysostosis)

Front 6

Seen in Ascher syndrome along with double eyelids (blepharochalasis), goiter

Back 6

Double lip

Front 7

Ectopic sebaceous glands on oral mucosa
80%, normal variant
Clinical
Multiple yellow-white papules  plaques
Most commonly on buccal mucosa, labial mucosa, retromolar area

Back 7

Fordyce granules

Front 8

Common in African-Americans
~90 adults and ~50% children
“normal anatomic variant”
Diffuse opalescent white mucosal surface, folded, wrinkled
Whiteness diminishes when mucosa stretched

Back 8

Leukoedema

Front 9

Diff Dx for Leukoedema

Back 9

White sponge nevus (WSN) – No eye involvement
Hereditary Benign Intraepithelial Dyskeratosis (HBID) – eye involvement
Neither will dissipate upon mucosa stretching

Front 10

Congenital Causes of Macroglossia

Back 10

Lymphangioma, hemangioma
Down syndrome
Mucopolysaccaridosis
Neurofibromatosis
MEN syndrome

Front 11

Acquired causes of Macroglossia

Back 11

Edentulous patients
Amyloidosis
Myxedema
Acromegaly
Angioedema
Carcinoma and other tumors

Front 12

Macroglossia presenting with multinodular surface

Back 12

Amyloidosis
Neurofibromatosis
MEN syndrome

Front 13

Multiple grooves and furrows in dorsum
Associated with
Geographic tongue
Melkersson-Rosenthal syndrome

Back 13

Fissured Tongue

Front 14

Keratin accumulation on filiform papilla
Heavy smokers
Secondary to antibiotics
Poor hygiene
Debilitation
Mouthwashes
Oral infections

Back 14

Hairy tongue

Front 15

Most common site for oral Varix

Back 15

sublingual

Front 16

In what population (sex, region) does Torus Palatinus occur?

Back 16

Female 2:1, Asian

Front 17

Prevalence of Torus Mandibularis

Back 17

7-10% pop. in US

Front 18

Elongation of the process or mineralization of ligament causes impingement
Diagnosis
Pano x-ray
Palpation of tonsillar fossa producing pain
Affects cranial nerves #5, 7, 9, 10

Back 18

Eagle Syndrome

Front 19

Well circumscribed radiolucency always below inferior alveolar canal
Usually corticated border

Back 19

Staphne defect

Front 20

Stafne defect occurs most often in Men or Women?

Back 20

80-90% in men

Front 21

Newborn palatal cysts along median raphe

Back 21

epstein's pearls

Front 22

Newborn palatal cysts scattered

Back 22

bohn's nodules

Front 23

Who more often gets nasiolabial cysts

Back 23

females 3:1

Front 24

location of globulomaxillary cyst

Back 24

between max lat and canine

Front 25

*Most common non-odontogenic cyst of the oral cavity

Back 25

Nasopalatine duct cyst

Front 26

predilection of nasopalatine duct cyst

Back 26

males

Front 27

Fluctuant swelling midline hard palate
Clinical enlargement of the palate

Back 27

median palatal cyst

Front 28

Common on skin, rare in oral cavity
Associated with Gardner’s syndrome

Back 28

epidermoid cyst

Front 29

Midline floor of mouth intraoral swelling displacing tongue if above geniohyoid
*double chin if below geniohyoid
Mass doughy or rubbery in consistency

Back 29

Dermoid cyst

Front 30

Midline swelling anywhere along tract of descent
60-80% below hyoid bone
50% occur by age 20
Most < 3 cm
May move during swallowing or tongue protrusion

Back 30

thyroglossal duct cyst

Front 31

Soft, fluctuant mass 1-10 cm in size
Upper lateral neck on the anterior border of SCM
Young adults
Pain, if secondarily infected

Back 31

Cervical Lymphoepithelial cyst (aka branchial cleft cyst)

Front 32

Submucosal mass, white-yellow
Floor of mouth most often
Remainder of Waldheyer’s ring tissue

Back 32

Oral lymphoepithelial Cyst

Front 33

Teeth are caries resistant

Back 33

Dental fluorosis

Front 34

Enamel defect in developing permanent tooth due to PA INF of overlying primary tooth
Usually permanent premolar from primary molar trauma

Back 34

Turner's tooth

Front 35

presentation of internal resorption

Back 35

Pulpal cells destroyed  pink tooth of Mummery

Front 36

most commonly impacted teeth

Back 36

3rd molars and max canines

Front 37

oligodontia

Back 37

6 or more teeth fail to develope

Front 38

most common supernumerary

Back 38

mesiodens

Front 39

multiple supernumerary teeth associated with what two conditions

Back 39

cleidocranial dysplasia and gardner's syndrome (also assosciated with epidermoid cyst)

Front 40

most common microdont

Back 40

peg lateral

Front 41

# normal when anomalous tooth is counted as one
Single tooth bud divides, common root, common canal

Back 41

gemination

Front 42

# missing one tooth with anomalous tooth counted as one
Union of dentin in two separate buds

Back 42

fusion

Front 43

joined cementum

Back 43

concrescence

Front 44

where does talon cusp occur?

Back 44

anterior tooth lingual aspect

Front 45

where does cusp of carabelli occur?

Back 45

mesiolingual aspect of max molar

Front 46

Cusp-like elevation of enamel on lingual ridge of buccal cusp

Back 46

dens evaginatus

Front 47

Invagination of crown lined by enamel
Usually effects max lat and central incisors
Tx: restore opining

Back 47

dens invaginatus

Front 48

Enlargement and displacement of pulp chamber apically in multi-rooted tooth

Back 48

taurodontism

Front 49

Excess cementum layered on apical portion of root’s surface

Back 49

hypercementosis

Front 50

dilaceration

Back 50

Abnormal angulation or bend in root

Front 51

types of amelogenesis imperfecta

Back 51

Hypoplastic – inadequate deposition of enamel matrix
Hypocalcification – no mineralization of enamel matrix (enamel and dentin equal radiodense)
Hypomaturation – enadequate enamel crystal structure, chips off (dentin and enamel equal density radiographically)

Front 52

taurodontism of first molar associated with what condition?

Back 52

amelogenesis imperfecta

Front 53

what condition is associated with kinky hair

Back 53

amelogenesis imperfecta

Front 54

Autosomal dominant (100% penetrance, variable expressivity)
Opalescent teeth, transparent
Bulbous crown, constricted at CEJ
Obliterated pulp chambers
Can occur with Osteogenesis Imperfecta (blue sclera)

Back 54

Dentinogenesis Imperfecta

Front 55

Autosomal dominant inheritance
Atypical dentin with atypical pulp morphology
Type I – roots are messed “rootless”
Type II – crowns are messed (flame shaped pulp chambers)

Back 55

Dentin Dysplasia

Front 56

“ghost teeth” – thin enamel and dentin surrounding large pulp
Rare, idiopathic, more common on maxilla

Back 56

Regional Odontodysplasia

Front 57

Four main types of noxious stimuli

Back 57

Mechanical
Thermal
Chemical
Bacterial

Front 58

Presentation of reversible pulpitis

Back 58

Responds to electrical stimulation at lower level of current than control
No mobility, no sensitivity to percussion
Easy to localize affected tooth
Radiographically - normal root apex appearance

Front 59

Sharp, severe pain upon thermal stimulation, especially cold
Spontaneous or continuous pain
Exacerbated by lying down

Back 59

EARLY irreversible pulpitis

Front 60

Throbbing pain keeps patient awake at night; dull prolonged pain
Cold may produce relief; heat makes it worse
Responds at higher levels of electrical current than control or no response

Back 60

LATE irreversible pulpitis

Front 61

Unique pattern of inflammation seen in children and young adults
Large clinical exposure of the pulp
Primary/permanent molars with large pulp chambers

Back 61

Chronic Hyperplastic Pulpitis (Pulp Polyps)

Front 62

when does primary dentin form

Back 62

before crown completion

Front 63

Significant trauma to _____ can lead to early calcification of pulp chambers and canals (calcific metamorphosis)

Back 63

secondary dentin

Front 64

In areas of focal injury
More haphazard
Dead tracts
Result from severe damage with dead odontoblasts and their processes in dentinal tubules

Back 64

reparative dentin

Front 65

three types of pulpal calcifications

Back 65

Diffuse linear calcifications
Pulp stones
Denticles

Front 66

Pulp chamber and root canals adj. to furcation
Most attach or become embedded in dentin

Back 66

pulp stones

Front 67

Develop around a central nidus in concentric fashion
Pulp chamber
Most free or attached; rarely embedded

Back 67

denticles

Front 68

most common periapical lesion

Back 68

periapical granuloma (70%)

Front 69

how do you distinguish radiographically between PA cyst and PA granuloma

Back 69

trick Q. you cannot

Front 70

PA cyst more commonly in maxilla or mandible?

Back 70

maxilla

Front 71

diff dx for PA radiolucency

Back 71

Periapical granuloma
Periapical Cyst
Bone scar
Periapical cemento-osseous dysplasia (early stage)
Langerhans cell disease
Benign and malignant tumors

Front 72

what is a "phoenix lesion"

Back 72

PA abscess that arises from a chronic PA lesion

Front 73

fistula

Back 73

intraoral sinus tract, Epithelial-lined drainage path or abnormal
communication between two epithelial-lined surfaces

Front 74

granulation tissue swelling at drainage site, soft gingival nodule at the surface opening (stoma) of a fistulous tract; full of pus

Back 74

parulis or gum boil

Front 75

can occur when an abscess is not able to establish drainage thru the surface of the skin or into the oral cavity

Back 75

cellulitis

Front 76

two severe forms of cellulitis

Back 76

ludwigs angina and cavernous sinus thrombosis

Front 77

Cellulitis of the submandibular region
70% arise from infection of lower teeth

Back 77

ludwigs angina

Front 78

where does cavernous sinus thrombosis arise from if odontogenic

Back 78

canine space

Front 79

what veins communicate with cavernous sinus

Back 79

Anterior facial veins
Angular veins
Ophthalmic veins

Front 80

what percent of cavernous sinus thrombosis are odontogenic?

Back 80

10%

Front 81

Acute or chronic inflammation in medullary spaces or cortical surfaces of bone that extends away from the initial site
Usually a bacterial infection
Arise following odontogenic infections, jaw fractures, ANUG and noma

Back 81

osteomyelitis

Front 82

3 predisposers of osteomyelitis

Back 82

Chronic systemic illness
Immunocompromised
Decreased vascularity of bone

Front 83

diff. between acute and chronic osteomyeltis

Back 83

chronic can cause pathological fracture, starts 1 mo after acute infection, smoldering

Front 84

Initiated and exasterbated by chronic overuse of masticatory muscles

Back 84

Chronic Tendoperiostitis

Front 85

Localized area of bone sclerosis associated with apices of teeth with pulpitis or pulpal necrosis
To make diagnosis must know inflammatory component since other pathoses appear similar
Involved tooth exhibits necrosis or pulpitis

Back 85

Condensing Osteitis (sclerosing osteitis; focal sclerosing osteomyelitis)

Front 86

in what age group does condensing osteitis occur? what teeth most often affected?

Back 86

children, mandibular molars and premolars

Front 87

Form of inflammatory periosteal hyperplasia with an onion skin-like reduplication of the cortical plate

Back 87

Osteomyelitis with Proliferative Periostitis (Garrè’s osteomyelitis)

Front 88

condition presentation: Mean age = 13; equal gender
Most frequent cause is dental caries with associated periapical disease (also periodontal, fractures, cysts, other infections)
Usually premolar and molar of mandible, inferior border

Back 88

Osteomyelitis with Proliferative Periostitis (Garrè’s osteomyelitis)

Front 89

what condition is associated with Inexperienced surgeons
Traumatic extractions
Oral contraceptive use
Presurgical infections
Inadequate irrigation at surgery
Patient use of tobacco products

Back 89

Alveolar Osteitis (Dry Socket)

Front 90

Localized tumor proliferation of subacutely inflamed granulation tissue
NOT granuloma OR pyogenic

Back 90

Chronic hyperplastic focal gingivitis (pyogenic granuloma)

Front 91

Clinical
Blunted interdental papilla
Punched out, crater like necrosis (covered by gray-yellow pseudomembrane)
Fetid odor, exquisite pain
Spontaneous hemorrhage and necrotic debris

Back 91

ANUG (Acute Necrotizing Ulcerative Gingivitis)
Aka Vincent’s infection or Trench Mouth

Front 92

Implicated organizisms
Fusobacterium nucleatum
Borrelia vincentii
Treponema spp.
Selenomonas spp.
Prevotella intermedia

Back 92

ANUG (Acute Necrotizing Ulcerative Gingivitis)
Aka Vincent’s infection or Trench Mouth

Front 93

Tx for ANUG (Acute Necrotizing Ulcerative Gingivitis)
Aka Vincent’s infection or Trench Mouth

Back 93

Debridement
Topical or LA
Rinses
Antibiotics: metronidazole

Front 94

Seen in late 1960s due to chewing gum component substitution

Back 94

Plasma Cell Gingivitis (Atypical gingivostomatitis)

Front 95

clinical presentation of plasma cell gingivitis

Back 95

Entire free and attached gingival has diffuse enlargement with bright erythema and loss of normal stippling

Front 96

Diagnosis of Exclusion (unexplained)
Rule out histologically distinct granulomatous diseases
Can be due to foreign body material from dental procedures

Back 96

granulomatous gingivitis

Front 97

Chronic vesiculoerosive process in which gingival spontaneously sloughs or can be removed with minor manipulation

Back 97

desquamative gingivitis

Front 98

age and sex most common for desquamative gingivitis?

Back 98

females over 40

Front 99

conditions attributed to desquamative gingivitis

Back 99

pemphigoid, erosive lichen planus, pemphigus vulgaris

Front 100

what is Nicolsky sign

Back 100

Manipulation of affected area with an object or compressed air can results in sloughing

Front 101

Tx of desquamative gingivitis

Back 101

Perilesional incisional biopsy and direct/indirect immunofluorescence
Topical and systemic corticosteroids

Front 102

drugs associated with Drug-Related Gingival Hyperplasia

Back 102

Anticunvulsants
Phenytoin (Dilantin) – younger patients
Calcium channel blockers
Nifedipine, diltiazem, felodipine, nitredipine, verapamil
Cyclosporine – immunosupression in transplant patients (any age)

Front 103

Slowly progressive enlargement
May be assosciated with syndromes, epilepsy, mental retardation
Usually before age 20
Firm and normal color
Can overgrow clinical crowns, may delay tooth eruption

Back 103

gingival fibromatosis

Front 104

pathogenesis theory behind periodontits

Back 104

Shift in proportion of bacterial species in the plaque
Changes in the dentogingival environment
Facultative gram-positive organisms (actinomycetes, strep)  anaerobic and microaerophilic gram-negative
Actinobacillus actinomycetemcomitans, bacteroides forsythus, porphyromonoas gingivalis, prevotella intermedia

Front 105

what is the primary cause of tooth loss after age 35?

Back 105

chronic periodontitis

Front 106

By definition, occurs in otherwise healthy people
Correlated with a deficiency of the immune system rather than plaque
Histology similar to chronic perio, so to dx, need leukocyte function test

Back 106

aggressive periodontitis

Front 107

what did aggressive periodontitis used to be called?

Back 107

early onset

Front 108

By definition, occurs in otherwise healthy people
Correlated with a deficiency of the immune system rather than plaque
Histology similar to chronic perio, so to dx, need leukocyte function test

Back 108

aggressive periodontitis

Front 109

what is the presentation of localized aggressive periodontitits

Back 109

Attachment loss localized to first molars and incisors; no more than two other teeth involved.
Vertical bone loss, symmetrical and bilateral

Front 110

Usually under age 30 but any age possible
Generalized loss of attachment that must affect at least three teeth other than the first molars and incisors

Back 110

Generalized Aggressive Periodontitis

Front 111

Accelerated Periodontitis
Associated with mutation of cathepsin C gene  altered immune response, chemotactic defects, reduced intracellular killing of both bacterial and fungal organisms

Back 111

Papillon-Lefevre syndrome

Front 112

Manifests in first 3 yrs of life
Palmar/plantar keratosis that spread to dorsa
Radiographic: teeth “floating” in soft tissue

Back 112

Papillon-Lefevre syndrome

Front 113

Like NUG but with bone loss

Back 113

Necrotizing Ulcerative Periodontitis (NUP)

Front 114

pericoronitis

Back 114

Inflammation around impacted or partially erupted tooth due to food debris and bacteria beneath the gingival flap (mand 3rd molars)