Oral Path Review

Name this oral lesion:

Varix (Varices, pl.) Sometimes called

caviar tongue Distended vein (like a

hemorrhoid) No treatment usually

required Diff. diagnosis:

mucocele and hemangioma

Name this oral lesion:

Mucocele Collection of saliva in the

oral mucosa Common symptom: gets

bigger, then smaller, bigger, etc.

Traumatic severance of salivary ducts

Treated by surgical excision of the entire gland that feeds the duct

Could be confused with salivary gland neoplasm, varix, and hemangioma

Name this oral lesion:

You should know this by now…

Torus palatinus and Torus mandibularis

Bony bumps in the mouth…midline if on the hard palate…single or bilateral for mandibular

Could be inherited…developmental overgrowths Won’t grow past their “programmed size” May require removal if they interfere with prosthetics

Name this oral lesion:

Leukoedema

Filmy, white/grey discoloration of oral mucosa (mostly buccal)

Variation of normal caused by intracellular edema of the superficial epithelial cells

Seen primarily in blacks (90%) and smokers

No treatment required Could only be confused for a

bunch of really rare conditions.

Name this oral lesion:

Papillary hyperplasia (PH) and/or Denture sore mouth (DSM)

PH and DSM may be the same thing, thought to be caused by Candida albicans

Can be small red spots. When it worsens, it turns bright red and produces the red, pebbly look of papillary hyperplasia.

Treatment with antifungals, but recurrence is common

Good oral/denture hygiene may help

Benign and unmistakable

See the book for other picturesand more detailed information.This can be highly variable inappearance.

Name this oral lesion:

Geographic tongue (AKA: benign migratory glossitis)

Usually asymptomatic Hard to misdiagnose

this “maplike” nastiness on the dorsal tongue

Affects all ages Cause is unknown Chronic: lasts months to

years with periods of remission and exacerbation.

Name this oral lesion:

Nicotine Stomatitis Caused by smoking

(particularly pipe) Asymptomatic and

usually disappears after quitting smoking

Name this oral lesion:

Periapical dental granuloma Periapical radiolucency

found at the apex of a tooth with chronic inflammation

Usually round or oval with a distinct border

If there is a sinus tract, may be asymptomatic

Endo therapy or extraction necessary

Could be confused with radicular cyst or periapical abscess

Name this oral lesion:

Periapical cyst (Radicular cyst)

Looks a lot like the last one, eh?

ONLY difference is the presence of an epithelium lined central cavity in the cyst.

Name this oral lesion:

Angular cheilosis Dry corners of the

mouth May be caused by

slobber accumulating in the corners of the mouth in patients with a deep bite. Candida likes to hang out in the drool.

May be a riboflavin defficiency???

Name these oral lesions:(Hint: they’re different!)

Top: Periferal FibromaBottom: Pyogenic Granuloma

Usually in children & young adults

Histologically, this is mostly connective tissue

Can be excised, but may recur

Histologic examination may be the only way to distinguish this from Periferal Fibroma

Vascular and sometimes painful Common in pregnancy

Name this oral lesion:

Peripheral giant cell granuloma

Much the same as peripheral fibroma and pyogenic granuloma, but these are histologically different (contain fibroblasts and multinucleated giant cells)

Surgical excision May recur

Name this oral lesion:

Amalgam tattoo Blue-grey and

permanent Caused by accidental

implantation amalgam into soft oral tissues

No treatment required, but didn’t your Mama warn you against getting tattoos?

Name this oral lesion:

Condensing Osteitis

Sclerotic reaction to infection commonly seen in young patients

Caused by infection of periapical tissues of low virulence

Treat only cases where the infection is symptomatic or carious in the associated tooth. Follow up with regular x-rays.

Name this oral lesion:

Nasopalatine duct cyst Heart-shaped radiolucency

at theincisive canal Developmental from

epithelial remnants of the nasopalatine duct

Can be confused with other types of cysts (remember the radicular cysts?)

Surgical removal is treatment

Name this oral lesion:

Dentigerous Cyst

Very common & found around an unerupted tooth

Most commonly around 3rd molars, but any tooth could be affected (rarely on deciduous teeth)

Large cysts can cause parasthesia and/or pain

Surgical enucleation should be followed up with histological examination

Name this oral lesion:

Lichen planus

Lacy, white lines are characteristic of reticular type. Erosive type and plaque type are variations.

Only erosive type requires treatment May predispose patient to oral cancer

Name this oral lesion:

Dilantin gingival hyperplasia

Can also be caused by cyclosporin and nephedapine (sp?)

Fibrous overgrowth of the gingiva, particularly the anterior (as opposed to the posterior and lingual areas)

Scrupulous dental hygiene recommended

Overgrowth requires surgical removal. Or ceasing to take the anticonvulsant may cause gradual recession within one year.

Name this oral lesion:

Papilloma Sessile or pedunculated

& look like cauliflower Usually on palate-uvula

area, or on tongue or lips Lasts weeks to years, but

usually months Could be viral origin Surgical removal No evidence that they

are premalignant

Name this oral lesion (be specific):

Herpes Labialis

Recurrent oral infection caused by herpesvirus

Recurrences vary from person to person and are thought to be triggered by exposure to sunlight, fever, trauma, and other irritants.

Virus “hides” in the nearest ganglion and lies dormant

Acyclovir ointment shortens healing time …systemic acyclovir doesn’t work for oral herpes

Name this oral lesion:

Primary herpetic stomatitis

Generalized involvement of the oral cavity infected with herpesvirus

Usually seen in children

Blisters break easily and are VERY painful (can’t eat or drink)

Accompanied by fever

Name this oral lesion:

Fordyce granules

Ectopic sebaceous glands caused by a developmental anomaly

Seen in greatest numbers during puberty Most common on buccal mucosa No treatment required

Name this oral lesion:

Ideopathic osteosclerosis

Area of dense but normal bone found anywhere in the jaw, but usually in mandibular molar-premolar area

Shape varies and may be associated with a tooth, but does not require treatment

Name this oral lesion:

Candidosis (Candidiasis, Moniliasis, Thrush)

Infection with Candida albicans

Involved mucus membrane develops a white, necrotic slough.

White lesions can be wiped off, leaving a bleeding, white surface

Occurs in the very young, very old, those with reduced resistance and those on long-term antibiotic therapy or immunosuppression (AIDS victim shown here)

Name this oral lesion:

Squamous Cell Carcinoma

90% oral cancers are SCC May appear as leukoplakia or

erythroplasia or a mixture (white and/or red, respectively)

More often in men than women, and higher incidence in smokers and drinkers

5 year survival rate is 50% Can be confused with a lot of

things…need a biopsy to confirm diagnosis

Name this oral lesion:

Aphthous stomatitis (Canker sore)

One of the most common oral diseases (20-60% of the population)

Major aphthae known as Sutton’s disease Begins as a macule or papule until ulceration Occurs on freely movable mucosa (herpes, in contrast, can

occur on palate or gingival mucosa) Unknown etiology and very painful

Name this oral lesion:

Kaposi’s Sarcoma Found in AIDS patients Appear as red or

purple bruises, but can progress to a hemorrhagic mass

Painful and invasive Radiation therapy

Name this oral lesion:

Leukoplakia Means a white lesion

of the mucous membrane

Biopsy will usually show hyperkeraosis (harmless)

Some may be premalignant

More common in males and older patients

Unknown etiology

Name this oral lesion:

Hairy leukoplakia Found in AIDS patients and

other immunocompromised patients

Usually on the lateral tongue

Caused by Epstein-Barr virus

Can easily be confused with candidiasis

Treat with anti-fungal first…if it doesn’t heal, then it is most likely hairy leukoplakia

Name this oral lesion:

Erythroplakia (erythroplasia)

Red but non-ulcerated area

Usually asymptomatic, but could be early carcinoma

Lots of things this could be

Prognosis and treatment varies according to histologic findings

Name this oral lesion:

Epulis Fissuratum Two or more folds of

soft tissue separated by a central groove caused by an ill-fitting denture

Inflamatory hyperplasia that can surgically removed (denture border should also be reduced to prevent recurrence)

Name this oral lesion:

Foliate papillae…not really a lesion

Vertical grooves, typically bilaterally symmetrical

Normal anatomical structures, but can be prominent in some people

Name this oral lesion:

Hairy Tongue Dorsal tongue

becomes discolored and “hairy” due to hyperkeratinization of the filliform papillae

Color can vary Unknown etiology, but

frequent in heavy smokers

Brushing the tongue can help

Name this oral lesion:

Periapical cemental dysplasia (listed in the book as cementoma but this is a misnomer; AKA periapical cementodysplasia) Lesion around the apices

of vital teeth Principally in the lower

anteriors; mostly women; more common in blacks

Asymptomatic and does not require treatment

Begins as proliferation of benign fibrous connective tissue… cementum forms… the mass becomes mineralized

Name this oral lesion:

Snuff lesion: Develops adjacent to

where smokeless tobacco is held

Biopsy should be done, but no treatment necessary

Carcinomas often occur

I think half the guys in my high school had this (I lived in Georgia…where it was cool to have a gun rack and wear flannel)

Name this oral lesion:

Osteoporotic bone marrow defect

Localized increase of marrow, usually in the mandible at molar extraction sites

Common in middle aged women

They don’t have sharp borders like cysts (scattered trabeculae may interrupt the space)

Unknown etiology; no treatment necessary

Irritation fibroma Dome-shaped soft

tissue found on buccal mucosa near line of occlusion

Don’t you hate it when you bite your cheek… and then you bite it OVER and OVER AGAIN?

Good luck on

finals!!!