Oral Pathology

Oral Pathology

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4- Black Hairy Tongue
     -Characterized by the elongation and hyperkeratosis of the filiform papillae, resulting in this hairlike appearance. The elongated papillae usually exhibit brown, yellow, or black pigmentation. Most patients are asymptomatic, but occasionally patients complain of irritation, gagging, or an altered taste. Patients are usually heavy smokers with poor oral hygiene and some have vitamin deficiencies, GI problems, or radiation therapy. Cures range from just brushing the tongue to corticosteroid therapy.

5- Cleft Palate

     -Congenital defect in which the lateral halves of the palate fail to fuse during embryonic development. It may be localized to the uvula, the soft and/or hard palate, or the lip. Combined cleft lip and palate is more common in males, whereas isolated cleft palate occurs more frequently in girls. Corrective surgery is usually successful if approached after 18 months of age.

6- Torus Mandibularis

     -Common pattern exostosis usually located above the mylohyoid line adjacent to the bicuspids. Typically bilateral and consist of lamellar bone with an occasional overlay of cancellous bone. Some believe it’s hereditary with an increased prevalence in early adult males who possess increase masticatory stresses. Some tori have been known to resorb and remodel as stresses decrease with age. Treatment is not necessary unless it interferes with prosthetic appliances.

7- Lymphoepithelial Cyst (I also see a lot of this out here) *two slides

     -Cyst that arises from epithelium entrapped within lymphoid tissue. It presents as a superficial submucosal mass that is yellow or whitish in coloration. The most frequent location is in the floor of the mouth followed by the posterior lateral border of the tongue, soft palate, tonsillar pillars, orophorynx, and the ventral tongue. The entrapped epithelium may have originated from salivary gland ducts or from the lining epithelium of surface invaginations plugged with desquamative keratin. Surgical excision can be performed; however, it is not necessary.

10- Internal Resorption

     -The removal of tooth structure that involves the inner dentinal walls by cells originating from the dental pulp. Most instances occur during adulthood and have no sex predilection. Initiation is either idiopathic or associated with some form of trauma or dental decay. The walls of the canal are smooth and well defined. Root canal therapy may prove beneficial if the resorption area can be properly instrumented, otherwise, extraction is warranted. (First time I saw this was just last week)

11- Talon Cusp

     It’s an accessory cusp usually located on the lingual surface of permanent or deciduous incisors.

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The cusp often demonstrates a deep developmental groove where it joins the lingual surface. This groove is prone to caries and should be restored prophylactically to prevent carious exposure of the pulp. An interesting trick I learned is that when this cusp is interfering with occlusion, there is a good way to remove the cusp without the need for root canal therapy. This is to take down the cusp in stages and go only so much as to not get a big exposure. Then place calcium hydroxide on the dentin (or pin point exposure) and the pulp will eventually recede from the its surface.

12- Taurodontism

     -A developmental abnormality in which the body is enlarged and the roots are usually shortened. Increased prevalence of this abnormality is noted in patients demonstrating oligodontia, which is the congenital absence of more than just a couple of permanent teeth. May be a good help with resistance form for core buildups.

13- Fusion *two slides

     -Is a joining of teeth due to the union of two normally separated tooth germs. These teeth may appear as one large tooth, as one incompletely fused crown, or as two crowns sharing completely or incompletely fused roots. No matter what pattern, the fusion must involve the dentin.

15- Chronic Hyperplastic Pulpitis

     -An overgrowth of chronically inflamed granulation tissue that originates from the dental pulp of a tooth with a large pulp exposure. Usually seen in deciduous molars and first permanent molars of young patients whose teeth contain large vascular pulps with high tissue reactivity. Tooth must be extracted or treated endodontically.

16- Parulis

     -Inflammed granulation tissue that arises on the oral mucosa after an intraosseous abscess perforates through the cortical plate and channels through the overlying soft tissue into the oral cavity. Once the source of the abscess is removed the parulis will usually resolve. When it doesn’t, it should be excised.

17- Dilantin Hyperplasia

     -A marked enlargement of the facial and lingual gingival that occasionally occurs after about 1-3 months use of the anticonvulsant drug, Dilantin. When discontinuation of the drug is not an option, surgical excision of the affected gingiva will become a repetitive process. (And this what this one lady I saw had to go through every other week)

19- Cellulitis

     -An enlargement of soft tissue resulting from the diffuse spread of an infection through the tissue spaces or fascial planes. Pain, fever, and lymphadenopathy are usually seen. The focus of infection should be resolved and antibiotics administered. Penicillin is choice along with a warm compress. It should be manually drained if possible.

20- Osteoradionecrosis *two slides

     -The osteomyelitis that has occurred subsequent to therapeutic radiation in the area. Most radiation in the area is a treatment for carcinomas of the head and neck in which elimination of the jaws from the fields of irradiation was not possible. The radiation damages the osteocytes and the microvascular system of the affected bone which renders it more susceptible to necrosis when exposed to minor infection or trauma. Prevention of dental imperfections is the best therapeutic approach. Hyperbaric oxygen often improves healing and decreases the prevalence of progression and recurrence. (I saw a few cases of this at my teacher’s cancer clinic)

22- Radiation Mucositis

     -One of the first manifestations of radiation therapy is the development of oral erythema and edema. As treatment continues, the mucosa becomes ulcerated and covered by a fibrinoid exudate. This is quite painful, making eating difficult and contributing to nutritional impairment. It is typically resolved several weeks after treatment is completed. Often supplemented with oral rinses and antibiotics.

23- Candidiasis

     -An opportunistic fungal infection produced most frequently by Candida Albicans. Present in 45% of healthy adults, with the percentage rising higher than 60% in people who wear dentures. It can be wiped off to reveal an underlying area of mucosal erythema. It consists of superficial keratin intermixed with numerous fungal organisms. Treatment consists of antifungals such as Nystatin or Fluconazole.

24- Angular Cheilitis

     -Development of symptomatic erythematous cracks or fissures at the corner of the mouth and is one of the most common oral pathologic alterations noted in the elderly. Associated with nutritional deficiencies, loss of vertical dimension, and the correlation with infection by Candida Albicans or Staphylococcus Aureus. This is treated with antifungals and by eliminating the underlying cause.

25- Recurrent Herpes Labialis

     -After initial infection, the herpes simplex virus does not remain at the site but can survive in the nerve ganglia of the area. The viral DNA is incorporated into the host DNA and is impervious to attack by the immune system or medications. Recurrence intervals vary but are triggered when reactivation allows reinfection due to a minor decrease in immune function. Ulcerations usually heal in 7-10 days.

26- Recurrent Herpetic Stomatitis

     -Once recurrent herpes cross over the lip wetline and enter the oral cavity, the lesions occur in a specific pattern. They often occur on the palate as small red vesicles that rapidly ulcerate. The sysmptoms are mild and healing occurs in 5-10 days.

27- Herpangina
     -Made up of any one of ten strains of coxsackie A, coxsackie B, or echovirus. Disease begins with symptoms of sore throat, fever, malaise, and headache. Numerous vesicles develop on the soft palate and tonsillar pillars. The vesicles quickly rupture and develop into slightly larger areas of ulceration. The disease occurs primarily in children due to the fact the body produces immunity to the offending strains with age. Therapy is palliative.

28- Acquired Immunodeficiency Syndrome *three slides

     -The virus is capable of significant suppression of the immune system through its adverse effects on CD4 helper T lymphocytes. “Indicator” diseases include a long list of opportunistic infections and cancers. Clinically evident candidiasis of the oral cavity, in the absence of other predisposing factors, is the most common intraoral manifestation of HIV infection and often initially leads to the definitive diagnosis. Up to 95% of patients with AIDS develop oropharyngeal candidiasis.

31- Kaposi’s Sarcoma

     -The most commonly diagnosed malignancy in patients with AIDS. Represents 80% of all cancers that occur in patients with AIDS and exhibits a male predominance. Kaposi’s sarcoma is a progressive malignancy that may disseminate widely to lymph nodes and various organs. The treatment typically is palliative because systemic therapy often aggravates the associated immunosuppression.

33- Recurrent Minor Aphthous Ulcerations

     -Ulcers are less than l cm in diameter and are usually extremely painful lesions that tend to heal without scarring in 10-14 days. One to many occur during an episode. The cause is unknown but seems to be related to stress, local trauma, vitamin deficiencies, or food allergies. Treatment is palliative, but in rare cases topical steroid elixirs and gels seem to be effective.

34- Condyloma Acuminatum

     -A benign proliferation of squamous epithelium caused by several subtypes of the human papillomavirus. It is sexually transmitted. Common sites are lips, floor of mouth, tongue, and the palate. Treatment is by conservative surgical excision and recurrence is common.

35- Erythema Migrans *Two slides

     -Common Inflammatory condition that usually affects the tongue, commonly known as “geographic tongue” or “benign migratory glossitis.” Has an unknown cause and occurs at any age and has a prevalence for females. Pattern is formed from the loss of the filiform papillae but with preservation of the fungiform papillae. Patterns can change daily when the condition is not in remission. Treatment is palliative in the rear cases that it is symptomatic.

37- Nicotine Stomatits

     -It’s a benign thickening of oral mucosa typically associated with tobacco smoking. Mostly observed on the hard and soft palates but may also be present on the retromolar pad and the buccal mucosa. The erythematous portion represents dilated salivary gland duct orifices that are inflamed and exhibit squamous metaplasia. The surrounding white surface represents hyperkeratosis. This process may resolve on smoking cessation. There is an increased chance of developing into dysplasia and squamous cell carcinoma in Southeast Asian patients.

38- Tobacco Pouch

     -Prolonged use of smokeless tobacco may develop into granular surfaces with varying degrees of keratosis. Persons who continue the habit may also develop squamous cell carcinoma or verrucous carcinoma in this area that presents as large, exophytic lesions. This typically occurs after using the tobacco for more than 25-30 years. Area is readily reversible once the habit is discontinued.

39- Squamous Cell Carcinoma *Two slides

-Cancer of stratified squamous epithelium. It accounts for approximately 90% of all oral cancer and has the capacity to invade vascular and lymphatic channels and metastasize to lymph nodes and distant organs. 80% of all patients with this carcinoma are smokers. In addition to smoking, those that also consume alcohol or chew betel nuts, have a synergistic risk rather than an additive one. Ultraviolet radiation from sunlight has been implicated as the principal factor in the development of squamous cell carcinoma of the lip. The carcinoma, in general, is more common in males and can occur anywhere in the oral cavity. The treatment involves any combination of surgery, radiation therapy, and chemotherapy. The 5-year survival rate varies from more than 90% for patients with localized lower lip lesions to approximately only 10% for those who have oral locations.

41- Basal Cell Carcinoma *Two slides

     -This carcinoma is the most common type of skin cancer. Most occur in adult males on the skin of the head and neck. The middle 1/3 of the face, forehead, and the ears are particularly vulnerable as well. Most common in light-complexioned people with chronic sun exposure. It develops from surface and hair follicle epithelium and is an invasive and locally destructive neoplasm. May cause death by involvement of adjacent vital structures but it rarely metastasizes. Treatment involves any combination of excision, irradiation therapy, electro- or cryo-therapy. Recurrence is possible.

43- Metastatic Carcinoma
     -Metastatic cancer to the oral cavity results primarily from the lung, breast, colon, or the prostate. Teeth may become loose or extruded. Some types of cancer will induce new bone formation that will give a mixed radiolucent/radiopaque appearance of a radiograph. Often this is the first recognizable event that a cancer exists in the body. Unfortunately, when cancers metastasize to the jaw prognosis is poor because it is now indicative of a disseminated disease.

44- Fibroma *Two slides

     -The most common soft tissue tumor of the oral cavity. Represents a reactive hyperplasia of the fibrous connective tissue in response to local irritation or trauma. Seen more frequently in adults and are most commonly located on the buccal mucosa, along the bite line. Usually asymptomatic and treatment consists of excision.

46- Pyogenic Granuloma

     -Also results from local irritation and can occur anywhere in the oral cavity. Rapid growth of this vascular epithelial mass is not uncommon. More common in females during pregnancy primarily because of the heightened tissue responsiveness from hormonal alterations. Treatment consists of local excision down to the periosteum and scaling of the adjacent teeth to remove any calculus and plaque that may be a source of irritation. Treatment is recommended after delivery because recurrence may occur or it may just regress spontaneously after birth.

47- Traumatic Neuroma

     -This is not a true neoplasm but a reactive hyperplasia of nerve elements following damage or severance of a nerve bundle. If the nerve tries to regenerate and cannot because scar tissue has formed in the way, then this tumor like mass of disorganized nerve and scar tissue will develop. Treatment should be surgical removal and recurrence is uncommon.

49- Dentigerous Cyst

     -This cyst is the most common of the developmental odontogenic cysts of the jaws. It develops when fluid or a space occurs between follicular tissue lined by reduce enamel epithelium and the crown of an unerupted tooth. Third molars are most commonly involved and the maxillary permanent canines are the second. Treatment must be enucleation and removal of the associated tooth because this cyst has been known to transform into different forms of carcinoma.

50- Ameloblastoma *Two slides

     -The most common true odontogenic tumor. Its prevalence exceeds that of all other odontogenic tumors combined. It is derived from remnants of the dental lamina, and it can arise from the lining of dentigerous cysts. 85% occur in the mandible, with 60% developing in the molar region and ramus. It is capable of causing significant oral and facial deformity and has a high recurrence rate. Sectioning and completely removing the infected jaw is the practiced treatment.

52- Compound Odontoma

     -These are benign harmatomatous proliferations composed of enamel, dentin, cementum, and pulp in varying amounts. These odontomas usually contain 100 or more tooth like structures. Compound, as opposed to complex, odontomas are more commonly located in the anterior part of the jaw and on extreme cases can cause expansion of the bone. The treatment for odontomas is enucleation. A true recurrence has not been reported.

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