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Oral Pathology Lesions, Inflammation & Repair Lesions, Infectious…
Oral Pathology Lesions
Lesion Description
Base
Pendunculated
Sessile
Color
red, salmon, pink, white, black, brown, blue-black, grey
erythroplakia: smooth, red, grainy, velvety patch
erythema: abnormal redness
leukoplakia: white, plaque-like & cannot be rubbed off
Pallor: paleness
Texture
corrugated: wrinkled
fissured: cleft/groove
Papillary: small, nipple-shaped projections
Flat Lesions
Patch: >5mm
Macule: <5mm
Petechiae/ecchymoses: burst blood vessels/submucosal hemorrhage
Radiographic Lesions
In bone
Multilocular: extends beyond confines of one distinct area, defined by many lobes or parts that are somewhat fused together, resembled soap bubbles (odontogenic keratocyst)
Well circumscribed: borders that are specifically defined and can clearly see the margins and extent
Unilocular: having one compartment or unit that is well defined or outlined, simple radicular cyst
Scalloping around the root: RL lesions extends between the roots, traumatic bone cyst, extends up PDL
Diffuse: borders not well defined, impossible to detect exact parameters
Root resorption: apex of root appears shortened/blunted and irregularly shaped; response to stimuli
Coalescence: process by which parts of whole join together, or fuse to make one
Raised Lesions
scar
plaque: >1cm slightly raised solid lesion (lichen planus, leukoplakia)
wheal: raised area of dermal edema (hives)
papule: round lesion <1cm (mole)
nodule: solid 1-2mm (wart, basal cell carcinoma, pyogenic granuloma
tumor: solid, greater than 2cm
Lobule: segment/lobe part of a whole
cyst: pouch/sac w/o opening/membranous containing morbid matter
Benign Tumor: better defined/slower growth rate
Malignant tumor: neoplasms/painful ulceration
Fluid-filled Lesions
Vesicle: small serous fluid/<1cm (varicella zoster) AKA blister that's membrane bound
Bulla: >1cm (bullous Pemphigoid)
hemidesmosomes
: small stud-like structures found in keratinocytes of epidermis of skin that attach to extracellular matrix
desmosomes: attach to adjacent cells
Pustule: pus filled vesicle (insect bite)
Sinus: Tract connecting cavity lined w/ granulation tissue to epithelial surface
Depressed Lesions
Erosion (sunburned lips) - LOSS OF EPIDERMIS
Ulcer: tissue loss into connective tissue layer (aphthous ulcer) - LOSS OF EPIDERMIS & DERMIS
Fissure: into underlying mucosa/connectivetissue (fissured tongue, angular cheilitis)
Crater
Inflammation & Repair Lesions
Phenol/Chemical Burns: used in dentistry to sterilize
Abscess: collection of purulent exudate accumulated in contained space formed by surrounding tissue
Fistula: a channel through tissue allowing exudate to drain, forming a drainage passage through tissue - healthy turns to necrosis
Aspirin burns: misuse in topical application heals in 7-12 days
Electric Burn
Chronic Hyperplastic Pulpitits: asymptomatic, STRATIFIED SQUAMOUS extraction/endo for tx - CAUSED BY INFLAMMED DENTAL PULP
hematoma: accumulation of blood
Frictional Keratosis
smokeless tobacco keratosis (premalignant)
traumatic neuroma
Palisaded Encapsulated Neuroma (solitary circusscribed neuroma)
melanosis
Smokers melanosis: melanin produced to protect mucosa from tobacco smoke
actinic cheilitis: fair-skinned, linked to SSC & basal cell carcinoma
Mucocele: lower labial mucosa in young people
Mucous retention cyst: less common that mucocele (NOT a TRUE cyst, >50, upper lip mucosa, removal of minor salivary gland for tx
Ranula "frog": obstruction of sublingual & submand. glands by sialolith
Sialolith: stone made of calcium salts occurring in major & minor salivary glands
Necrotizing Sialometaplasia: males>, painful, salivary duct epithelium is replaced
Sailadenitis: major salivary glands = infectious mumps, decreased salivary flow
Reactive Connective Tissue Hyperplasia: exuberant growth of reparative tissue
Gingival hyperplasia: Calcium Channel Blockers
Infectious Diseases
HIV & AIDS: CDT4 helper cells, antibodies detectible 6 weeks after infection (window of inactivity)...AIDS = fewer than 200 CDT4 cells, normal is 500-1000
Oral candidiasis (thrush)
Herpes Simplex
Herpes zoster/shingles
Hairy leukoplakia
HPV
Karposi sarcoma, most common on gingiva & palate
Lymphoma
Linear Gingival Erythema - not related to oral hygiene status
HSV
type 1: oral infections
Type 2: genital infections
Primary herpetic gingivostomatitis: initial infection, swollen gingiva & multiple tiny vesicles 6 mo. - 6 years
Recurrent Herpes (cold sore): latent state, trigeminal ganglion, HIGHEST AMT OF VIRUS IN VESICLE STAGE! KERITINZED MUCOSA and can cause eye infection, herpetic whitlow
Syphillis: spirochete (Treponema pallidum)
Secondary Stage: 6 weeks after primary lesion, diffuse eruptions on skin & mucous membranes
Tertiary stage: lesions appear years after initial infection, cardio & nervous system (gumma)
Primary stage: 21 days (CHANCRE)
HPV: Koliocytes
verruca vulgaris (common wart):
Condyloma acuminatum: benign, sexual contact, papillary bulbous pink masses
Multifocal epithelial hyperplasia (heck disease): multiple whitish to pale pink nodules, children, asymptomatic & resolve spontaneously
Coxsackievirus Infections
Hand-foot-mouth disease: <5, multiple macules, resolves in 2 weeks
Acute Lymphonodular Pharyngitis: soft palate/tonsillar pillars, yellowish/dark pink nodules
Herpangina: throat infection affecting tonsils & soft palate
Epstein-Barr Virus
Infectious mononucleosis: adolescents/young adults/kissing
Hairy Leukoplakia
Varicella zoster: chicken pox/shingles, very contagious
Herpes Zoster: secondary chicken pox
scarlet fever: children, red skin rash, petechiae on soft palate, strawberry tongue can progress to rheumatic
rheumatic fever: childhood disease, b-hymolytic, heart valve damage
TB: mycobacterium tuberculosis
Actinomycosis: bacterial infection, draining abscesses, sulfur granules
chronic hyperplastic candidiasis (candidal leukoplakia)
Chronic Mucocutaneous candidiasis: severe form in immunocompromised - chronic oral & genital mucosal candidiasis, skin lesions
Impetigo: very infectious bacterial skin infection
Immunity Lesions
Sjogren Syndrome: salivary & lacrimal glands, parotid gland in 1/2 pts, IgG, Middle-aged feamles
Primary: occurs alone
secondary: w/ other w/ auto immune disorders
Minor Salivary Glands: lymphocytes surrounding salivary gland ducts
Major Salivary Glands: replacement w/ lymphocytes and presence of epimyoepithelial islands
Langerhans Cell Histiocytosis: hystiocyte cells & eosinphils (Histiocytosis X), caucasians, children >15, single bone lesions = most common (PUNCHED OUT RL)
Histiocytosis X
chronic: disseminated/multi-facial form (Hand Schuller-Christian - skull lesions)
Solitary eosinophilic granulome
acute (letterer-Siwe disease): disseminated
Langerhans
Single-system: unifocal & multifocal - bone, skin, nodes, lungs
multisystem: w/ or w/o organ dysfunction - bone, skin, liver, spleen, bone marrow, higher risk of death!
Lichen Planus: benign, unknown cause, Wickham striae, middle-aged women
Reticular = most common form
erythema multiform: target's/bulls eye
Stevens-Johnson syndrome: type IV hypersensitivity, rxn to medication, painful, encrusted & bloody lips
Reactive Arthritis (reiter syndrome): HLA-B27, caused by microbial antigen
angioedema & uticaria (hives)
Plasma Cell Gingivitis: benign, generalized edematous & erythematic, allergic response Type IV hypersensitivity, rete ridges
SLE: 50% kidney involvement, women & black women>, ANAs, skin lesions in 85%, hydroxychloroquine
Pemphigus Vulgaris: most common, intraepithelial blister, nikolsky sign
Mucous Membrane Pemphigoid: sub-epithelial blister, not as severe as pemhigus vulgaris, women >50, no degeneration of epithelium, nikolsky sign
Bullous Pemphigoid: large fluid-filled blisters, >70, negative nikolsky sign
Behcet Syndrome: 30-40, rare in US
Variants of Normal
Fordyce Granules: oil glands/ males>, no tx
Torus Palatinus & Mand. tori & exostoses
: Most common in Asians, Native Americans, Inuit, no tx, mandibular tori is more common in males, hereditary
Melanin Pigmentation: common in young-middle-aged females, common in darker-skinned people
Retrocuspid papilla: nodule attached to lingual mand. canines, younger people, unilateral & resolves w/ age
Lingual Varicosities/Varix/Thrombus: 0 correlation to disease AKA varicose veins, no tx
Leukoedema: rupture of intercellular bridges of intermediate/prickle cell layer of epithelium AKA desmosomes/white, opalescent hue, thick & wrinkled appearance- more common in African Americans & no tx
Median Rhomboid Glossitis: fungal!, midline-dorsal of tongue, smooth texture from no filiform papillae, tx is anti-fungal
Hairy tongue: elongation & hyperkeratosis of filiform papillae (NOT CANDIDIASIS or LEUKOPLAKIA), tobacco use
Etiology is hydrogen peroxides, pepto-bismo use
Transient Lingual Papilitis: enlarged, painful fungiform papillae, resolve spontaneously, unknown cause
White Sponge nevus: common on buccal mucosa, slightly benign
Lipoma: benign consists of adipocytes
Fibroma: made of fibrous tissue/connective tissue
Denture/Palate Irritation Lesions
Denture Epulis: epulis fissuratum - ill-fitting denture
Inflammatory Hyperplasia of Palate: denture-induced (
papillary hyperplasia
)
Nicotinic Stomatitis: inflamed openings of minor salivary glands by obstruction of keratin
cocaine use: midline of hard palate
Pseudomembranous candidiasis (white curd-like material)
Erythematous candidiasis
denture stomatitis (MOST COMMON CANDIDIASIS)
Differential Diagnosis
Radiographic
Internal Tooth Resorption: reddish hinge to tooth is the first sign
external root resorption
Compound odontoma: anterior MAXILLA surrounded by fibrous capsule
Complex Odontoma: posterior MAND.
Mesiodens: supernumerary tooth in midline between incisors
Calcified tooth
Periapical cemento-osseious dysplasia (
cementoma
)
Mineralization of stylohyoid ligament: Upper segment, complete mineralization is EAGLES SYNDROME - tonsillectomy or traumatic scarring
Historical
Amelogenesis
Dentinogenesis
ulcerative colitis
skin graft
Laboratory
Paget disease: bone interferes with body's normal recycling process where new bone tissue gradually replaces old bone tissue- can become fragile and misshapen over time
Microscopic
GOLD STANDARD
erythroplakia: red lesion that cannot be diagnosed by clinical features (most diagnosed as severe epithelial dysplasia/squamous cell carcinoma
Surgical
Traumatic Bone Cyst: uncommon NON-epithelial lined cavity of jaws/young pt's/ mand. between canine and 3rd molar
Static Bone Cyst (mand.): lingual salivary gland inclusion defect - near angle of mand. below mand. canal
Therapeutic
NUG: responds to hydrogen peroxide rinses bc anaerobic bacteria can't survive O2 environment
Angular Chelitis: fungal caused by candida, decrease in vitamin B2 (riboflavin)
cysts
abnormalities in tooth shape
gemination: single tooth divides in 2
Fusion: union of 2 separate adjacent teeth
hypercementosis: excessive cementum on roots
concrescence: 2 adjacent teeth united by cementum
dilaceration: abnormal curve/bend in root
enamel pearl: max. molars
Talon cusp: + cusp on incisor
taurodontism: elongated pulp chambers, associated w/ down syndrome
Dens Invaginatus: "tooth structure within a tooth" enamel organ invaginates into crown of tooth before mineralization, mand. PM's
supernumerary roots
Non-odontogenic cysts
Nasopalatine canal (incisive canal cyst): males 40-60, small pink bulge near roots of max. lingual incisors
median palatine: midline hard palate
globulomaxillary: between roots of max. lateral incisor & cuspid
nasolabial: soft tissue, lower anterior portion of nasolacrimal duct, 40-50 females, MB fold area
median mandibular: midline of mand. lined w/ squamous epithelium
lymphoepithelial: major salivary glands, stratified squamous epithelium, arise from epithelium trapped in lymph node during development, most commonly found on floor of mouth & lateral borders of tongue
epidermal: raised nodule on skin of face/neck, less common IO, keritinzed, originate from hair follicles when epidermis does not shed properly
Dermoid & benign cystic teratoma: developmental, floor of mouth IO
Thyroglossal tract (duct): forms along tract of thyroid gland in development, <20 years
odontogenic cysts
Dentigerous (follicular): crown of erupting/developing tooth
Eruption
Primordial: develops in place of tooth (3rd molar)
keratocyst: 3rd molar region
calcifying odontogenic: ghost cells
Intraosseous Lateral Periodontal: mand. cuspids & premolar, males 50-70
Botryoid odontogenic: multilocular variant
Granular odontogenic: multi-cystic, posterior mand. anterior max., 50-59 years
abnormalities of tooth structure
enamel hypoplasia: incomplete/defective formation of enamel
febrile illness, vitamin deficiency, ameloblasts are most sensitive, trauma, local infection (turner tooth= only one tooth affected, fluoride ingestion, congenital syphilis, birth defect/idiopathic
enamel hypo-calcification: developmental anomaly resulting in disturbance in maturation of enamel matrix
endogenous staining of teeth: result of deposition of substances circulating systemically during tooth development (tetra stain, fluoride, liver disease)
Regional Odontodysplasia (GHOST TEETH): thin enamel & dentin
Pseudocysts (not true cysts)/no epithelium
static bone cyst (stafne defect): inferior to mand. canal
simple bone (traumatic bone):
Aneurysmal bone: blood-filled spaces by multinucleated giant cells & fibrous connective tissue (HONEYCOMB/SOAP BUBBLE)
abnormalities of tooth eruption
impacted/embedded teeth
ankylosed teeth: cementum fused to bone, prevents exfoliation of primary teeth, PDL lacking
Neoplasia naming
peripheral odontogenic, bone, cartilage & metastatic tumors
soft tissue
tumors of nerve tissue
nuerofibroma/schwannoma
granular cell
congenital epulis
tumors of muscle
rhabdomyoma (striated)
leiomyoma (smooth)
lipoma (fat)
vascular tumors
hemangioma
lymphangioma
malignant vascular
kaposi sarcoma & HIV
angiosarcoma
peripheral odontogenic
peripheral ossifying fibroma (females, young)
other peripheral odontogenic tumors
tumors of melanin-producing cells
melanotic nevi (women)
malignant melanoma (>40)
tumors of bone & cartilage
osteosarcoma: >40 males
tumors of cartilage
chondroma: benign
chondrosarcoma: malignant
osteoma : RO Gardner syndrome
metastatic tumors (male adults) - primary site to secondary
salivary gland tumors
monomorphic adenoma: adult females (Warthin tumor <men)
adenoid cystic carcinoma: parotid gland
mucoepidermoid carcinoma: wide age range
PLGA: minor salivary glands
Pleomorphic adenoma: most common! females >40
tumors of squamous epithelium
squamous cell carcinoma: >40 years
verrucous carcinoma
premalignant lesions (leukoplakia, erythroplakia, epithelial dysplasia)
basal cell carcinoma
papilloma (soft palate or tongue)
tumors of blood-forming tissues
leukemia: overproduction of WBC
acute: children YA
chronic: middle aged
lymphoma: malignant of lymphoid tissue
multiple myeloma: malignant proliferation of plasma cells
Odontogenic tumors
central
mesenchymal
central cementifying and ossifying fibromas
benign cementoblastoma
odontogenic myxoma
mixed
ameloblastic fibro-odontoma: ~10 years
odontoma = MOST COMMON
ameloblastic fibroma: children
epithelial
calcifying epithelial odontogenic
Adenomatoid
ameloblastoma (soap bubble/honey comb
calcifying odontogenic cyst <40
peripheral
-oma: tumor (ex: Lipoma = benign tumor of fat, Osteoma = benign tumor of bone, carcinoma = malignant tumor of epithelium, sarcoma: =
Inflammatory Periapical Lesions
periapical granuloma: non-vital, asymptomatic, EPITHELIAL RESTS OF MALASSEZ PRESENT
Radicular (periapical) cyst:
True cyst
Residual Cyst: tooth removed
Focal Sclerosing Osteomyelitis (Condensing Osteitis): RO, inflammation of pulp, decayed or restored tooth, 1st molars, no tx
.
Alveolar Osteitis (dry socket): post-op complication of tooth extraction, pain, swelling, odor, bad taste, CHX, saline for tx
nonneoplastic diseases of bone
Giant Cell Granuloma
Osteomalacia (Vit. D deficiency)
Aneurysmal Bone cyst (blood-filled spaces)
Benign Fibro-Osseous Lesions
forid cemento-osseous dysplasia
fibrous dysplasia
monostotis fibrous dysplasia
polyostotic fibrous dysplasia
craniofacial
Jaffe type
Albright syndrome
focal cemento-osseous dysplasia
periapical cemento-osseous dysplasia
Paget Disease (cotton wool)
Aphthous ulcers:
Minor: moveable mucosa, 1cm, 1-2 days prodrome
Major: >1cm, deeper & longer lasting than minor, associated w/ HIV, Behcet syndrome, Crohn, reactive arthritis
Recurrent: canker sores, aphthous stomatitis
Herpetiform: resemble HSV, tiny
Orofacial Pain & TMJ
Burning Mouth Disorder
Trigeminal Neuralgia: sharp pain, unilateral, shock-type pain
Bell's Palsy: limiting muscle control
TMD
Myofasial pain & dysfunction (50%, regional pain, tenderness, reduced opening
Internal derangements: positional relationship of disk to mand. condyle, continuous pain
Arthritis
Osteoarthritis: dengenrative
Rheumatoid: inflammatory
NOT VARIANT OF NORMAL
Benign Migratory Glossitits = geographic tongue, females>, no tx - ectopic is found on other surfaces other than tongue
Melanin pigmentation (HIV)
Hairy Leukoplakia (HIV)
Oral Manifestations of Systemic Diseases
Blood Disorders
RBCs & hemoglobin
polycythemia: deep red mucosa, submucosal petechiae, easily bleeding gums, ecchymosis, hematomas
Aplastic anemia: infection, spontaneous bleeding, petechiae, purpuric spots
Sickle cell anemia
Thalassemia: prominent maxilla, yellow skin, protrusion max. anterior teeth, thinning lamina dura, SALT/PEPPER xrays
Anemia: pallor, angular chelitis, erythema & atrophy, loss filiform & fungiform papillae
Bleeding disorders
Thrombocytopenia Purpura: petechiae/ecchymoses, spontaneous gingival bleeding
nonthrombocytopenic purpura: petechiae/ecchymoses, spontaneous gingival bleeding, hemorrhagic blisters
hemophilia: petechiae/ecchymoses, spontaneous gingival bleeding, hemorrhage after oral surgery/scaling
WBCs
Agranulocytosis: oral infection, necrotizing ulcerations, excessive oral bleeding, rapid destruction of tooth-support structures, lymphadenopathy
Leukemia: excessive WBCs - gingival enlargement, oral infections, bleeding gums, petechiae, ecchymoses, toothache, NUG
chronic: pallor of lips & gingiva, gingival enlargement, petechiae/ecchymoses, gingival bleeding,
Endocrine Disorders
Cushing Syndrome: overproduction of cortisol, weight gain
Hyperpituitarism: thickened lips & macroglossia
Addison disease: stimulation of melanocytes
Hyperthyroidism: Grave's, Goiter, rosy complexion, excessive sweating, softened nails, erythema of palms, premature exfoliation & premature eruption, caries/perio disease. burning tongue
Diabetes:
Type 2
Type 1: hypoglycemia
Hypothyroidism: thickened lips, enlarged tongue
Hypoparathyroidism: spasming hands/feet, muscle twitching & cramping, headache, increased bone density
Hyperparathyroidism: asymptomatic, joint pain/stiffness, lethargy, loosening of teeth, GROUND-GLASS APPEARANCE
Oral Manifestations of Therapy for Oral Cancer
Radiation Therapy: mucositis, xerostomia, candidiasis,
Chemotherapy: mucositis/oral ulceration
Other Drugs
Medication-Related Osteonecrosis of the jaw: antiresorptive meds & bisphosphonates therapy
GINGIVAL ENLARGEMENT: Phenytoin (Dilantin), Nifedipine (Procardia), Cyclosporine
Prednisone: candidiasis/ulcerations
Granulomas
Pyogenic: no exudate, response to injury, mx anteriors, common in teens and women, pregnancy
Giant cell: Peripheral (GINGIVA) & Central (BONE): common in 30-45 women, alveolar process or gingiva, anterior to molars, surgical excision, resembles pyogenic
Fibromas
Peripheral ossifying: females 10-19, derived from PDL, cellular fibrous connective tissue w/ scattered bone & cementum-like calcifications - no bone involvement
irritation: trauma! small, few blood vessels = light in color, surgical removal & biopsy, surface covered by STRATIFIED SQUAMOUS EPITHELIUM
