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Dental Boards
Oral Diagnosis
| Question | Answer |
|---|---|
| Cleft lip malunion- what, when, who | developmental condition causing failure of median nasal process maxillary process to fuse; 5-6 weeks in utero; males > females; more common on left side |
| Cleft Palate Malunion- what, when, who | developmental condition causing failure of palatal shelves to fuse 6-8 week in utero; females > males; impaired speech and swallowing because soft palate cannot close for aiflow into NP |
| Syndromes that may cause clefting | Stickler's; Vander Woude's; Di George |
| Causes of Clefts | Syndromes (bilateral); Genetics; Environment |
| Class I cleft lip | unilateral notching of vermillion border not extending onto the lip |
| class II cleft lip | unilateral notching of vermillion border extending to the lip |
| class III cleft lip | unilateral notching of vermillion border extending to lip and floor of nose |
| Class IV cleft lip | bilateral clefts |
| where do clefts occur that involve the alveolar ridge? | lateral incisor and canine *** |
| true or false...most cleft lips are unilateral | unilateral cleft lips are more common **** |
| when should primary cleft lip closure occur? | 10 weeks, 10 g/dl hemoglobin, 10 ibs *** |
| when should palate repair occur for cleft lip | 12-18 mo ******* |
| when should interceptive ortho be done for cleft lip? | 5-7 years *** |
| when should bone grafts for cleft lip occur? | 9-11 years *** |
| when should comprehensive ortho and orthognathic surgery occur for cleft lip | 12 years *** |
| what is complete cleft lip | involves the entire lip and underlying premaxilla or alveolar arch; nostril |
| What is incomplete cleft lip | only involves the lip, but no the underlying premaxilla or alveolar process. |
| Cherubism- cause, appearance, treatment | autosomal dominent disease; bilateral swelling of mandible "Soap Bubble"; giant cells and fibroblasts; developing teeth often displaced or fail to erupt; multilocular RL of mandible; treatment= may remit after puberty |
| Cleidocranial dysplasia- cause, appearance | autosomal dom. disease of bones in skull and clavical; delayed tooth eruption; supernumerary teeth; hyp/aplastic clavicle; short stature with large head and frontal bossing |
| Lip Pits | Invaginations at commissures or near midline |
| Fordyce Granules | developmental condition of ectopic sebaceous glands common in the buccal mucosa and lip |
| Leukoedema | developmental condition of no significance; bilateral opacification of B. mucosa which when stretched it disapears(differentiate from white sponge nevus |
| Macroglossia | developmental condition caused by tumors, hyperplasia,endocrine abnormalities, lymphatic destruction, or Beckwith-Wiedemann syndrome |
| Lingual Thyroid | congenital abnormality causing thyroid tissue mass at midline of tongue due to incomplete decent of thyroid anlage. ; do not biopsy! |
| Thyroglossal Tract Cyst | congenital abnormality causing swelling of the midline neck due to cystic change in thyroid tract remnants along the embryonic path of descent (developmental soft tissue cyst) |
| Rendu-Osler-Weber Syndrome | hereditary hemorrhagic telangiectasis= profuse/recurrent nosebleeds, multiple telang., GI bleeding, red and blue papules in the mouth |
| Stafne bone cyst | developmental jaw cyst caused by invagination of the lingual surface of the jaw; diagnosed by a RL below the mandibular canal |
| Nasopalatine Duct Cyst | developmental jaw cyst caused by crystification of NP remnants and diagnosed by heart shaped RL in nasopalatine canal |
| Globulomaxillary Lesion | developmental jaw cyst like lesion that is a RL between the maxillary canine and lateral; it is pear shaped and the tooth is vital (does not exist) |
| Traumatic Bone Cyst | Developmental Jaw pseudocyst commonly found in the mandible of teenagers which may be associated with truama ; ("dead space"=scalloping between roots) |
| Focal osteoporotic bone marrow defect | developmental jaw cyst causing a RL that contains hematopoietic bone marrow; this is often found in extraction sites |
| Focal Hyperkeratosis | common white lesion due to chronic friction on mucosa |
| Linea Alba | type of focal (frictional) hyyperkeratosis which is a mucosal lesion caused by physical trauma and appears as a linear white line in the buccal mucosa |
| Traumatic Ulcer mimic what? | oral cancer and chronic infectious ulcers may be confused with what |
| nicotinic stomatitis | mucosal lesion caused by smoking; white palate with red dots (inflammed salivary ducts); this is not premalignant unless reverse smoking |
| amalgam tattoo | most common oral pigmented lesion; |
| smoking associated melanosis | mucosal lesion on anterior gingival caused by chemicals in tobacco that stimulate melanin; this is reversable |
| melanotic macule | most common melanocytic lesion |
| melanotic macule causes | post inflammatory, peutz jegher, idipathic |
| peutz jegher charectoristics | melanotic macules (most common melanotic lesion), benign polyps (familial polyposes), freckles |
| most common drugs to induce pigmentation | minocycline, chloroquine, cyclophosphamide, AZT **** |
| Hairy Tongue | elongation of filiform papillae; strictly cosmetic concern; causes include AB, corticosteroids, h202 |
| dentifrice-associated slough | superficial chemical burn of buccal mucosa; common cause is stannous F. |
| what is the most common cause of oral infections | viruses; but may also be bacterial or fungal *** |
| what is the most common oral infection | HSV *** |
| focal hyperkeratosis is also known as | frictional hyperkeratosis is also known as |
| clinical presentation of HSV | appear as mucosal ulcerations (preceeded by vesicles) |
| clinical presentation of HPV | appear as verruciform (warts) |
| clinical presentatin of epstein barr | appear as hairy leukoplakia = white lesions |
| clinical presentation of bacteral and fungal infections | appear as chronic ulcers |
| clinical presentation of candida | appear as white/red lesions depending on type |
| Herpetic Whitlow | name for HSV when found on finger |
| Primary lesions of HSV are usually found in _______? REactivation is due to ________? | kids; sunlight, stress, immunosupression |
| HSV 1 causes what disease | primary herpes simplex (acute herpetic gigivostomatitis) or secondary herpes simplex (recurrent herpetic stomatitis/herpes labialis) found in trigeminal nerve are caused by what virus |
| varicella virus causes what disease | varicella (uncommon orally) and herpes zoster (reactivation of varicella) found in the sacral ganglia are caused by waht virus |
| what do you treat herpetic outbreaks with | acyclovir and symptomatic**** |
| as stated on another card, herpes, varicella and herpes zoster all have what clinical sign associated with them | all herpes outbreaks appear as mucosal ulcerations preceeded by vesicles...therefore what diseases would have this appearance |
| what are the two common forms of coxsackievirus | herpangina and hand/foot/mouth |
| location and sings of herpangina | palate, uvula, anterior tonsil; sore throat, fever, n,v,d, lymphendonapathy; caused by cox. virus |
| location and signs of hand/foot/mouth | h,f,m; oral lesions resemble herpangina but bigger; caused by coxsac. virus. |
| what is the treatment for the two coxsac. viruses? | hand/foot/mouth and herpangina are both self limiting, childhood diseases that are treated symptomatically |
| measels is caused by what virus? | paramyxovirus causes what illness? |
| what is another name for measels? | rubeola is another name for what? |
| signs/symptoms of measles (rubeola) | koplik spots on buccal mucosa preceded by rash, fever, cough |
| treatment for measels | 1-2 weeks incubation and supportive therapy |
| papillomas are commonly known as; what virus causes them | warts scientific name; hpv 6 & 11 |
| condyloma accuminatum is commonly known as; what virus causes them: | genital warts scientific name; hpv 6 & 11 |
| define papilloma | beingn epithelial proliferation of little significance that can be pedunculated or sessile. it is soft and painless and has a cauliflour surface |
| focal epithelial hyperplasia is also known as | heck's disease is also known as |
| focal epithelial hyperplasia (heck's disease) is caused by waht virus, who contracts it and what is its appearance | HPV 13 and 32. most common in native/central americans, multiple samll dome warts or oral mucosa |
| focal epithelial hyperplasia | multiple small dome warts on oral mucosa |
| verruca vulgaris is caused by what virus and where is it found | hpv 2,4, 40 commonly presents as a skin lesion on kids and less common to be found orally; |
| verruca vulgaris cause | contagious induced squamous proliferation usually found in kids |
| verruciform xanthoma | unkown cause; hyperplastic condition with lipid-laden histocytes in oral cavity |
| signs and symptoms of verruciform xanthoma | well demarcated, soft, painless, sesile slightly elevated, white yellow, red,<2cm found on gingiva and alveolar tissue |
| waht conditions are associated iwth epstein barr infections? | hairy leukoplakia, burketts lymphoma, nasopharyngeal carcinoma, mononucleosis |
| hairy leukoplakia | opertunisitc infection resulting in white patches of the lateral tongue. commonly seen in aids patients. diagnose by biopsy. caused by epstein barr |
| infections associated with aids | HS/HZV,EBV, CMV, HPV, TB, histoplasmosis, candida |
| oral complications of aids | infections (see other card), xerostomia, karposi sarcoma, apthous ulcers, perio disease |
| are bacterial infections common in the oral cavity? why | no, due to proliferative effects of saliva on stratified squamous epithelium. |
| what causes syphilis | treponema pallidum causes what |
| Congenital Syphilus sequela | Hutchenson's Triade- eight nerve deafness, interstital keratitis, Hutchenson's -tertiary s. |
| Primary syphilis | contaius, painless chancre with spontaneous healing around 3 weeks |
| Secondary syphilis | maculopapular rash, lues malinga and condylomata lata resembling viral papilloma; appears 4-10 weeks after primary and heals in 3-12 weeks |
| Tertiary syphilis | Gumma and leutic glossitis which is atrophy ofdorsal tongue papillar. Neurosyphilis and Hutchinson's triade |
| neurosyphilis | psychosis, dementia, death |
| signs and symptoms of TB | oral, non healing crhonic ulcers follow lung infections with caseating granulomas and langerhan's giant cells. |
| TB treatment | rifampin, isoniazid, pyrazinamide, ethambutol (RIPE) |
| Most common cause of actinomycosis | A. israelli (gram + anerobe) in oral flora |
| Actinomycosis-cause, signs and symptoms | chronic jaw infections may follow dental surgery and spread does not follow lymph or facial channels; signs include wooden induration with central soft spots and sulfer granules |
| cause of scarlet fever | group a strep |
| scarlet fever s/s | pharyngitis, fever, malaise, skin rash, strawberry tongue (white coat with red fungiform papillae); |
| if untreated scarlet fever may progress to | rheumatic fever; penicillin |
| Histoplasmois-description, location, cause, signs/symptoms | most common systemic fungal infection; deep fungal infection caused by soil exposure in humid areas of the midwest. Coin lesions similar to TB and chronic proliferative granulomas ; most commonly found in lung |
| Coccidomycosis, blastomycosisand cryptomycosis location | found in west; commonly found in lung and must differentiate from oral cancer or chronic oral lesions just like histo. |
| Other names for Candida include | Thrush, monoliasis |
| predisposing factors to candida | 1. prolonged AB/corticosteroid use, 2. chemo/immunosuppresion,3. endocrine abnormalities such as diabetes, preg, hypopara or adrenalism, stress, 4. poor oral hygeine 5. xerostomia |
| Causes of Candida | fungal or yeast cause |
| general appearance of candida | acute= white due to fungal colonies; chronic are erythematous |
| treatment of candida | topical-nystatin, clotrimazole; systemic- fluconazole, ketoconazole |
| tests for candida | PAS (periodic acid -schipp), KOH prep, scrape test |
| Pseudomembranous candida apperance and location | removable, white, cottage-cheese like plaques with burning sensation and foul taste located on dorsum of tongue, buccal mucosa and palate |
| Hyperplastic (Candidal leukoplakia)appearance and location | non-removable white plaques that are asymptomatic located on anterior buccal mucosa adjcent to commisures |
| 3 types of erythematous candida | angular chelitis,median rhomboid glossitis (central papillary atrophy) and denture stomatitis |
| angular chelitis apperance and location | type of erythematous candida that appear as red, fissured lesions that are irritated and raw located on the lip commissure |
| median rhomboid glossitis (central papillary atrophy) appearance and location | type of erythemaous candida that causes red/atrophic mucosa that may or may not be painful located on the midline posterior dorsal tongue anterior to cv papillae |
| denture stomatitis apperance and location | type of erythematous candida that is red and asymptomatic located on the mucoas under a palatal denture |
| Geographic Tongue | relativly common disease of unkown cause with whitae annular lesions around a red zone |
| Fissured Tongue location | dorsum of tongue |
| Melkerson-Rosenthal Syndrome | fissured tongue, granulomatous chelitis, facial paralysis |
| Congential Hemangioma | focal proliferation of capillarieswhich commonly undergos involution |
| Vascular Henamgioma | persistent malfromation of capillaries, veins and artieres sometimes seen in sturge weber syndrome |
| sturge weber syndrome | skin lesions along one of the brances of V3 that may involve the leptomeninges of the cerebral cortex casuign retardationa nd seizres. associated iwth vascular hemangioma |
| types of vascular hemangiomas | capillary, cavernous, artervenous--thrill and bruit |
| lymphangioma | congenital focal proliferation of lymphatic channels |
| hygroma coli | lymphangioma found in the neck |
| dermoid cyst | type of developmental S.T. cyst= teratoma with epithelium |
| branchial cyst | developmental s.t. cyst that originates from salivary glands and is located in lymph nodes of the neck (epithelial cyst) and counterpart to oral lymphoepithelial cyst |
| oral lymphoepithelial cyst | soft tissue cyst located in thesoft palate, oral floor, and lateral tongue; counterpart to branchial cyst (epithelial) |
| mucosal immunologic diseases appearance | ragne from vesicles/bullae, ulcers,erythema, white patches |
| apthous ulcer (recurrent apthous stomatitis) apperance | immunologic mucosal disease that appears as rccurent ulcers not preeceded by vesicles (HSV) |
| location of apthous ulcers | wet nonkeratinized oral mucosa (not the lip) |
| minor apthous ulcer | most common; 1+ painful ulcers <.5cm that lasts 7-10 days ; begins as red macule and becomes removable membrane with erythematous halo. |
| major apthous ulcer | up to 10 craterform ulcers >.5cm that are painful and debilitating and last 2-6 weeks with possible scaring; associated with aids |
| Herpetiform apthous ulcer | reccurent crops of minor apthous ulcers that are painful and last 1-2 weeks. similar to hsv clinically with large number of lesions on any mucosal surface |
| minor apthous ulcers are associated with waht diseases | crohn's, behcet's syndrome, cyliac sprue |
| behcet's syndrome | immunologic mucosal lesion; oral/genital apthous-type ulcers, conjunctivits, uveitis, arthritis, headache; multisystem disease of immunodysfunction in which vasculitis is prominent |
| erythema multiforme | immunologic mucosal lesion; self-limiting hypersensitivity reaction that affects the skin and mucosa-mainly extremities and face; ofeten due to drugs |
| signs and symptoms of erythema multiforme | target lesions, widespread oral vesicles and ulcers on buccal mucosa that are symmetric, may aslo have skin lesions, crusting and bleeding lips |
| types of erthema multiforme | minor-hsv; major-steven johnson's syndrome; TEN-most severe, females, 1/3 mortality |
| steven johnson's syndrome | immunologic mucosal lesions; major form of erythmea multiforme trigerred by drugs; lesions on skin, mucosa, conjuctiva and genitals |
| acquired angiodema | immunologic mucosal lesion; caused by a drug or food (shellfish or nuts) allergy; mast cell release IgE, soft difuse swelling of lips, neck and face; may be hereditary (rare) |
| Wegner's granulomatosis | immunologic mucosal lesion destructive granulomatous lesions with necrotizing vasculitis located in the upper resp tract, lungs and kidneys; strawberry gingivitis |
| midline granuloma | immunologic mucosal lesion; destructive necrotizing midfacial phenomenon thatclinically mimics Wegner's; T-cell lympomas of URT and mouth with or without perforation of hard palate |
| Lichen Planus-description, cause, appearance, location | relatively common immunologic mucosal lesion caused when t-lymphocytes destory basal keratinocytes; presents with "saw tooth" pattern, rete pegs, hyperkeratosis. Cutaneous lesions are purple pruitic papules on arms and legs; may also be on tongue; gingiva |
| Types of Lichen Planus | reticular and erosive |
| Reticular Lichen Planus | most common form; asymptomatic; Wickham's striae charectorize this immunologic mucosal disease |
| Erosive Lichen Planus | painful ulcers and erythematous gingiva charectorize this immunologic mucosal disease which has malignant potential |
| Types of Lupus erythematosus and treatment | Discoid-chronic; Systemic-acute; treat with corticosteroids |
| Discoid (chronic) Lupus erythematosus- description, appearance, who, location | immunologic mucosal lesion that is erythematous with no systemic s/s; it mimics LP and rarely progresses. It is common in middel aged women andaffects the skin (face/scalp) and/or oral mucosa (buccal gingiva and vermillion) |
| Systemic (acute) Lupus erythematosus-apperance, location, tests | immunologic mucosal lesion with charectoristic butterfly rash over the bridge of the nose; it affects multiple organs including hte heart, kidney, joints, skin, and oral cavity. Tests include ANA and LE cell tests |
| Scleroderma (systemic sclerosis)-description, cause | immunologic mucosal lesion that is an autoimmune multi-organ disease of adults esp. women caused by excessive deposition of collagen in tissues leading to fibrosis and organ dysfunction |
| Signs and symptoms of Scleroderma | cutaneous induration, rigidity, atrophy, telangectasis; oral signs (see other notecard), mouth inelasticity, facial skin is "mask-like", dysphagia, pulmonary fibrosis, cor pulmanole, malignant HT |
| Oral signs and symptoms of scleroderma | restriction of orifice, widenign of PD membrane, loss of attached gingiva and bony resorption of post. margin of condyle, ramus, coronoid p. |
| Treatment for scleroderma | steroids, d-penacillamine to inhibit collagen, ca-channel blocers for raynaud's |
| CREST Syndrome | mild variant of scleroderma with: Calcinosis cutitis (multiple nontender nodules); Raynaud's phenomonen; Esophageal dysmobility; Sclerodactyly (claw like fingers); Telangectasis (spider veins=red macules on face/vermillion) |
| Raynaud's phenomonon | hands and feet are white in color when exposed to cold due to severe vasosapsm. May go blue if venous stasis and red upon warming= throbbing pain. may be idiopathic or syndrome associated--CREST syndrome |
| Pemphigus Vulgaris-description, s/s, treatment | immunologic mucosal lesion; autoimmune, mucocutaneious disease against desmosomes. s/s include nikolisky sign (rubbing of uninvolved mucosa), vesicles and bullae which rupture and form slow healing ulcers, tzanck cells, may be fatal ; treatcorticosteroids |
| Pemphigoid-description, s/s, treatment | immunologic mucosal lesion; autoimmune disease of mucous membranes against basement membrane; possible nikolisky, older adults, bullae to ulcers, gingival involvment with diffuse erythema; topical corticosteroids |
| Cicitricial type pemphigoid | seen in oral cavity; benign muc. memb type; vesicles ulcers heal with scarring outside the oral cavity but no scarring in oral cavity. ocular involvment. |
| Idiopathic leukoplakia-descrption, cause | premalignant mucosal lesion; white patch/plaque that cannot be rubbed off and cannot be diagnosed clinically; may be associated with OH, tobacco, UV; 85% of oral cancers present as leukoplakia |
| Idiopathic leukoplakia transforamtion to cancer | most commonly become hyperkeratosis; may also be dysplasia, in-situ or SCC ; SCC is 5% and tongue/floor of mouth |
| Proliferative verrucous leukoplakia-description, cause, apperance, who, treatment | high risk premalignant mucosal lesion; cause is unknown but may be associated with HPV 16/18; common in people 50-70 females; begin as flat profile but slowly progress to wart-like lesion; no treatment |
| Proliferative verrucous leukoplakia transformation | verrucous carcinoma and SCC on floor, tongue and retromolar area commonly come from which premalignant lesion? |
| Erythroplakia | premalignant mucosal lesion; red plaque with no clincial diagonsis which does not resolve and requires biopsy; most are dyspastic, pm, or malignant |
| Erythroplakia transformation | carcinoma in situ 90% of the time SCC 50% may arise from what |
| Actinic chelitis | premalignant mucosal lesion caused by uv light, especially uvb 2900-3200nm; presents iwth lower lip atrophy, focal keratosis, the vermillion border is less distinct and upper lip is less commonly affected; may progress to SCC |
| Smokeless Tobacco-white lesion= location | labial and buccal vestibules; premalignant mucosal lesion |
| Oral Submucous Fibrosis | premalignant mucosal lesion; irriversable mucosal changes due to hypersensitivity to dietary substances (nuts) which causes the mucosa to become opaque and may progress to SCC |
| Verrucus Carcinoma- cause, description, apperance | mucosal malignancy caused by chewing/smokeless tobacco or HPV 16/18; it is a well differentiated, slow growing carcinoma tat infrequently metastisises; it appears as a wart-like, exophylytic papillary leukoplakic lesion |
| Squamous cell Carcinoma-description and location | malignant mucosal lesion which is the most common oral cancer; commonly located on the lower lip, lateral/ventral tongue, floor of mouth or soft palate |
| SCC S/S | most are indurated, nonpainful, nonhealing ulcers presenting as a erythro or leukoplakia; more common in males; abnormal bleeding; pain/numbness; lump or thickening mucosa, glands, LN |
| Predisposing Factors for SCC | vitamin deficency, immunosuppresion, iron-def anemia (plummer vinson syndrome) are all predisposing factors for what |
| SCC on the lip | middle aged men, loss of vermillion architecture, pipe smokers; metastisis is rare |
| SCC on Tongue | most common location, lateral/ventral surface; 75% male; tobacco/Oh; when on posterior tongue it is poor prognosis |
| SCC on floor of mouth | second most common site; 90% males; tobacco and OH, |
| SCC on gingiva | males more common, mand>maxilla, early bone involvement; may have lymph node metastisis |
| SCC on palate | more common on sp then hp; commonly see salivary gland neoplasms and melanomas as well |
| Treatment of SCC | surgical resection followed by radiation or vice versa; 70% 5 year survival if local; 15% if metastisis. |
| Radiation therapy and ORN | low risk if <45 Gy or 4500 rads; high risk if > 65 Gy or 6500 rads |
| Tumor staging depends on what factors | T=tumor; N=node; M= metastisis |
| T0 | no evidence of tumor |
| Tis | carcinoma in situ |
| T1 | tumor <2cm |
| T2 | tumor >2cm |
| T3 | tumor >4cm |
| T4 | invasive in deep tissues |
| N0 | no nodal involvement |
| N1 | single ipsilateral node <3cm |
| N2a | single ipsilateral node >3cm <6cm |
| N2b | multiple ipsilateral nodes <6cm |
| N2c | bilateral/contralateral node <6cm |
| N3 | atleast 1 node <6cm |
| M0 | no metastisis |
| M1 | distant metastisis |
| stage 0 tumor | Tis No M0 (carcinoma in situ, no nodal involvement, no metastesis) |
| stage 1 tumor | T1 N0 M0 ( tumor <2cm, no nodal or metastesis) |
| stage 2 tumor | T2 N0 M0 ( tumor >2cm , no nodal or metastesis) |
| stage 3 tumor | T3 N0 MO (tumor > 4cm, no nodal or metastesis); or T1-3 with N1 M) (tumor ranges from <2cm to >4cm with a single ipsilateral node <3cm and no metastesis) |
| stage 4 tumor | T4 with any N1 M0 (invasive in deep tissue with single ipsi node <3cm and no metastesis); any T with N2 M0 or N3 M0; any T any M with M1 |
| Basal Cell Carcinoma- description, location, appearance, prognosis | malignant mucosal lesion which is a common low grade skin caner that rarely metastesises and is never found in OC. Usually in sun damaged skin; non-healing, indurated, chronic ulcer; excellent prognosis |
| Oral Melanoma-description, location, prognosis | malignant mucosal lesion of melanocytes almost always in adults located ont he palate and gingiva, poor prognosis if oral lesions rpesent |
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munchkelly22
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