Term
What are the first and second most common sites for dentigerous cysts?
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Definition
mandibular third molar; maxillary canine
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Term
What lesions can potentially arise from an epithelial cystic lining?
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Definition
ameloblastoma, squamous cell carcinoma, and muoceoepidermoid carcinoma
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Term
What are the differences between the odontogenic keratocyst and the keratinizing odontogenic cyst?
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Definition
OKC - epi thin lining 6-8 cells thick with prominent palisaded basal cell layer and a corrugated parakeratin surface - High recurrence rate; highest of any jaw cyst KOC - epi lining may be thin also but lacks a palisaded basal cell layer and has an orthokeratin surface - Low recurrence rate |
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Term
| What are the clinical signs associated with the nevoid basal cell carcinoma syndrome? |
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Definition
(Gorlin syndrome)
autosomal dominant with high penetrance but variable expressitivity
Multiple basal cell carcinomas, multiple OKCs of the jaws, bifid ribs, scoliosis, calcification of falx cerebri, frontal bossing, ocular hypertelorism, spina bifida, palmer & planter skin pits w/ basal cell carcinoma at base of the pits
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Term
Which odontogenic cysts only occur in the soft tissues?
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Definition
Eruption cyst (hematoma) variant of dentigerous cyst; gingival cyst of the adult; dental lamina cysts
of the newborn
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Term
What is the most common jaw site for the lateral periodontal cyst?
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Definition
Mandibular canine-premolar
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Term
Which odontogenic cyst exhibits ghost cells?
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Definition
Calcifying Odontogenic Cyst (Gorlin cyst)
Ghost cell = loss of nuclear staining; become calcified with time
Unilocular, mixed RL/RO (scattered calcifications)
Two types: Type 1 (cystic) & Type 2 (solid = odontogenic ghost cell tumor
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Term
What is marsupialization?
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Definition
Drainage to reduce the size of large intrabony lesion prior to its definitive surgical procedure
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Term
| What are the 3 types of unicystic (unilocular) ameloblastoma and how does their treatment differ? |
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Definition
Luminal – lining affected only
Intraluminal – lining with proliferation into the lumen
Mural – within the CT wall and may spread beyond wall into surrounding bone trabeculae
Tx - enucleation and curettage w/ minimal local bone removal for luminal & intraluminal types but en bloc
resection w/ surgical margin evaluation for mural type
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Term
| What are the gross, microscopic and radiographic features of an adenomatoid odontogenic cyst/tumor? |
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Definition
associated with an impacted tooth, esp. the ant. maxilla (e.g. canine) of teenage females; expansive but painless
Gross: very thick capsule
Radiographic: well circumscribed RL w/ increasing RO over time of scattered calcifications; surrounds crown & portion of the root, adjacent roots may be displaced
Histo: duct-like appearing odontogenic structures, thick fibrous capsule, amyloid deposition rarely but not as frequent as Pindborg tumor
Tx: enucleation only (b/c thick capsule); no recurrence
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Term
What is the most common site for an ameloblastic fibro-odontoma?
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Definition
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Term
What are the clinical features of a conventional (solid and multicystic cystic) ameloblastoma?
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Definition
| most often posterior mandible, may be assoc w/ unerupted tooth in equal gender incidence; slow expansile growth; tooth displacement or mobility; root resorption; may cross midline |
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Term
What disease is characterized by the sign of increased body temperature in correlation to rising ambient temperature?
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Definition
Hypohidrotic Ectodermal Dysplasia – due to lack of sweat glands
Fever of unknown origin is 1st sign |
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Term
. What genetic disease shows the signs of sparse hair, absence of sweat glands and malformed or missing teeth?
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Definition
| Hypohidrotic Ectodermal Dysplasia |
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Term
Where are oral lesions of white sponge nevus seen?
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Definition
bilateral, buccal mucosa is most common site - thick, white, folded - - but can be any oral
mucosa site; also seen in nasal, esophageal, laryngeal, anogenital mucosa – NOT CONJUNCTIVA OF
EYE |
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Term
What is the treatment for white sponge nevus?
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Definition
No tx needed; observation only; can be diagnosed with cytology rather than biopsy
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Term
. What genodermatosis is characterized by corrugated white plaques on the oral mucosa and conjunctival mucosa?
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Definition
| Hereditary Benign Intraepithelial Dyskeratosis (HBID) |
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Term
| What disease is characterized by abnormal collagen production resulting in hypermobility of the joints and extreme elasticity of the skin? |
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Definition
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Term
What is Gorlin's sign and what is it associated with?
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Definition
Hypermotility of tongue seen in Ehlers-Danlos syndromes - - touch the tip of the nose with the tip of the
tongue. |
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Term
What disease is characterized by the formation of cutaneous angiofibromas and mental retardation?
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Definition
Tuberous sclerosis; genetic disease w/ shagreen patches, ash leaf spots, CNS hamartomas (“tubers”)
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Term
| What autoimmune disease attacks desmosomal attachments? |
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Definition
Pemphigus vulgaris – intraepithelial split; can be diagnosed with cytology
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Term
What disease produces acantholytic, intraepithelial blisters?
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Definition
Pemphigus vulgaris. Blisters (vesicles, bullae) b/c epithelial cells no longer bond to each other
(acantholysis); can be preceded by lymphoma/leukemia
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Term
Blistering of non-lesional skin or mucosa from lateral pressure is known as?
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Definition
Positive Nikolsky sign; seen in pemphigus vulgaris, benign mucous membrane pemphigoid (cicatricial pemphigoid)
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Term
Which autoimmune disease shows positive indirect immunofluorescence in the majority of cases?
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Definition
Pemphigus vulgaris – direct immunofluorescence is also used.
Indirect immunofluorescence = pt’s blood on monkey tissue to show antibodies in blood
Both pemphigoid and erosive lichen planus require direct IF since there is not much circulating antibodies in the blood to be detected by indirect IF.
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Term
What chronic blistering disease exhibits sub¬epithelial separation with positive direct immunofluorescence at the basement membrane?
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Definition
Benign mucous membrane pemphigoid
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Term
What is a major complication associated with benign mucous membrane pemphigoid?
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Definition
Involvement of the eye (scarring) which can lead to blindness
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Term
. What is the clinical term for superficial erosion of the attached gingiva (and nowhere else!) due to a blistering process?
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Definition
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Term
What blistering disease can cause scarring and fusion of the digits and may cause death at an early age?
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Definition
Epidermolysis Bullosa (dystrophic, recessive type)
Fusion of digits = “mitten-like” deformity; may also have esophageal strictures
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Term
. What tissue is primarily affected by discoid lupus erythematosus?
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Definition
Skin -scaly patches made worse w/ sunlight that heal w/ scarring; may be hyper or hypo-pigmented
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Term
What disorder has cutaneous lesions that are exacerbated by ultraviolet radiation?
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Definition
Chronic discoid lupus erythematosus
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Term
What disease is associated with Liebman-Sachs endocarditis?
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Definition
Systemic lupus erythematosus (SLE); heart valve damage is common.
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Term
. What disease will show positive lab findings for serum rheumatoid factor, antinuclear antibodies and antibodies to double-stranded DNA? What can oral form look like?
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Definition
| Lupus erythematosus; oral can look like erosive lichen planus |
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Term
. What condition is characterized by vasoconstriction of the extremities triggered by emotion or cold?
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Definition
Raynaud’s phenomenon seen in progressive systemic sclerosis (scleroderma)
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Term
. What disease advances its course by deposition of dense collagen in tissues and organs?
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Definition
Scleroderma (PSS); leads to mask-like facies, loss of ala of nose, and fibrosis of vital organs (fatal)
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Term
. What disease produces diffuse, generalized widening of the periodontal ligaments seen on radiographic exam?
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Definition
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Term
What is the name for the localized variant of progressive systemic sclerosis?
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Definition
Morphea; when its a linear scar on the face that can extend into the mouth = coupe de sabre
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Term
. What is the name for the lace-like lines seen with reticular lichen planus?
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Definition
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Term
What is the most common site for oral lichen planus to be seen?
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Definition
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Term
What are the different oral forms of lichen planus and where do they occur?
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Definition
Reticular form - lace-like appearance; buccal mucosa most common, Coalescing papules form Wickham’s striae
Erosive form - ulcer w/ erythematous border; buccal mucosa, gingiva, tongue
Hyperplastic (plaque) form – dorsal tongue
Bullous form – skin; uncommon in oral cavity
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Term
Lymphatic destruction of the basal layer with vacuolopathy and liquifactive necrosis are histologic hallmarks of what disease?
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Definition
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Term
What disease has cutaneous target lesions as a classic presentation?
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Definition
Erythema multiforme = blistering, ulcerative, mucocutaneous disease of skin; extreme form is Stevens- Johnson syndrome with oral, skin, genital and eye involvement
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Term
Erythematous, (flat lesions of the tongue from atrophy of the filiform papillae is pathognomonic for what disease?
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Definition
Geographic tongue (aka benign migratory glossitis, erythema migrans)
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Term
What is the classic triad of signs seen in Reiter's syndrome?
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Definition
Non-gonococcal urethritis (first sign), arthritis, conjunctivitis
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Term
What is the condition in which papillary oral and cutaneous lesions present as an early sign of internal malignancy?
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Definition
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Term
What are the inheritance patterns of the various lipid reticuloendothelioses? Inheritance patterns of mucopolysaccharidoses?
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Definition
Lipid Reticuloendotheliosis- Affected patients lack certain enzymes necessary for processing specific lipids
Gaucher’s (most common), Neiman-Pick, Tay-Sacks = autosomal recessive
Mucopolysaccharidosis- Lack of any one of several enzymes required to process glycosaminoglycans Hurler, Scheie, Sanfilippo A, Morquio, Maroteaux Lamy = autosomal recessive; Hunter = x-linked
recessive
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Term
. What causes Neiman-Pick disease?
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Definition
Types A & B - deficiency of acid sphingomyelinase causes accumulation of sphingomyelin in macrophage
lysosomes.
Type C - NPC-1 gene mutation (cholesterol processing)
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Term
What are the oral manifestations of jaundice?
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Definition
Yellow discoloration of mucosa
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Term
What is the ultrastructural appearance of amyloid?
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Definition
Beta-pleated sheet pattern
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Term
What is the characteristic appearance of the red blood cells in pernicious anemia?
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Definition
megaloblastic (enlarged), hyperchromic
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Term
| What serum levels are elevated or decreased in hypoparathyroidism, primary hypothyroidism, Graves disease, secondary hypothyroidism, and primary hyperthyroidism? |
|
Definition
HyPOparathyroidism ↓PTH, ↓ Ca, ↑Phosphorous (from med book) Primary HyPOthyroidism ↑ TSH due to abnormal thyroid gland
Grave’s Disease ↑ thyroid hormone due to AI stimulation
Secondary HyPOthyroidism ↓ to normal TSH due to pituitary dysfxn, iatrogenic or AI disease (Hashimoto’s thyroiditis)
Primary HyPERthryoidism ↑ thyroid hormone due to thyroid tumor
TSH is released from pituitary gland to stimulate thyroid gland |
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Term
Which endocrine disorder(s) is (are) of autoimmune etiology?
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Definition
Graves disease (a type of hyperthyroidism)
Hashimoto’s thyroiditis (a type of secondary hypothyroidism)
Addison’s Disease (Hypoadrenocorticism; other etiologies also possible)
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Term
. What causes secondary hyperparathyroidism?
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Definition
Kidney disease →↓Active Vit D → ↓ GI Ca absorption → ↓ Serum Ca → ↑ PTH
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Term
. What causes Addison’s disease?
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Definition
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Term
What are the various conditions often associated with diabetes mellitus?
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Definition
Diabetic sialadenosis (salivary gland enlargement), oral candidiasis, delayed healing, rapidly progressing perio disease, gingival
enlargement & erythema, zygomycosis (fungal infections), benign migratory glossitis, xerostomia, sailadenosis |
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Term
. What causes the premature tooth loss in hypophosphatasia?
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Definition
Lack of cementum on root’s surface
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Term
What are the clinical and histologic findings in pyostomatitis vegetans
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Definition
Clinical: multiple yellow pustules (may have snail track appearance), swollen & red oral mucosa, papillary
folds & grooves w/ pebbly surface, most common on facial gingiva, vestibule, buccolabial mucosa, not
uncomfortable
Histologic: eosinophilia
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Term
. What is the cranial nerve mechanism involved with glossopharyngeal neuralgia?
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Definition
Ninth; usually unknown etiology; may be due to neoplasms at skull base or aneurysms in the posterior
cranial fossa.
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Term
. What cranial nerve is involved with Bell’s palsy?
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Definition
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Term
What is helpful in the diagnosis of trigeminal neuralgia?
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|
Definition
anatomic trigger point; extreme, paroxymal pain; carbamazepine- used to treat
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Term
| What are the trigger points of trigeminal neuralgia and glossopharyngeal neuralgia and which neuralgia is more likely to have intraoral trigger points? |
|
Definition
Trigeminal neuralgia - nasolabial fold, lip vermilion, periorbital skin; intraoral - intraoral rare but alveolar ridge has been seen
Glossopharyngeal neuralgia - internal trigger points (except ear canal) so more likely to have intraoral
trigger points Pain precipitated by:
Talking
Chewing
Swallowing
Yawning
Touching the tonsillar area on the affected side |
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Term
What are the characteristics of a cluster headache?
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|
Definition
severe, lacinating painful esp around eyes, occurs at same time of day; lasts 15 min -3 hrs up to 8x day unilateral (simulates toothache); pt. may pace restlessly, no trigger zone, alcohol or nitroglycerin may precipitate pain, occurs over period of weeks then months of remission
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Term
What kind of test(s) help(s) provide a positive diagnosis for myasthenia gravis?
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|
Definition
↑ serum AChR (acetylcholine receptor ) antibody levels
improved strength after edrophonium injection (cholinesterase inhibitor)
Ice pack test: neuromuscular transmission improves w/ cold (test eye)
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Term
What techniques/medicines help relieve the symptoms of burning mouth syndrome?
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Definition
Anti-anxiety meds (e.g., clonazepam)
Fight fire w/ fire → tobasco sauce or capsaicin cream
Correct underlying condition
Supportive techniques if idiopathic type
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Term
| What are the clinical signs and symptoms of Frey syndrome (auriculotemporal syndrome)? |
|
Definition
Unilateral sweating, flushing, brought on by chewing food & salivating
Parasymp fibers are cut during surgery (e.g., parotid) and incorrectly regenerate along sympathetic
pathways
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Term
What is the mechanism and initial pathologic site of osteoarthritis?
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Definition
Slower and less complete replacement of chondroblasts and chondrocytes in joint cartilage leaving bone
exposed; may have inflammatory components; occurs in weight bearing joints (hip)
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Term
What kind of test(s) help(s) provide a positive diagnosis of rheumatoid arthritis?
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Definition
↑Rheumatoid factor (RF); only 50% have + ANA titer
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Term
What is the mechanism and initial pathologic site of rheumatoid arthritis?
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Definition
Elevated titer of antinuclear antibodies
Initially a synovitis (attack against synovial membrane)
Pannus (destruction of cartilage and bone by collagenases released by reactive macrophage-laden
fibroblasts
Small joints in hands and feet are initial sites of involvement
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Term
| What are the characteristic findings in the joints of osteoarthritis and rheumatoid arthritis? |
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Definition
OA - thinned cartilage and bone ends rub together; “joint mice” form
RA - bone erosion and swollen/inflamed; “rice bodies” form
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