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Dental Boards

Oral Diagnosis

QuestionAnswer
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
Created by: munchkelly22
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