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WorksheetsDental Decks: ORAL PATHOLOGY
Total questions: 125
Worksheet time: 4hrs 10mins
Congenital absence of many, but not all, teeth:
hypodontia - absence of only a few teeth
oligodontia
diphyodontia - having 2 successive sets of teeth as opposed to polyphyodontia
anodontia - all teeth are missing
hypsodontia - teeth with high crowns
Which type of dentinogenesis imperfecta features multiple pulp exposures, periapical radiolucencies, and a variable radiographic appearance
type I - patients with osteogenesis imperfecta; blue sclera
type II - no bone development
type III
Most common supernumerary tooth with a cone-shaped crown and a short root between the maxillary central incisors.
mesiodens
concrescence - cementum of two teeth becomes united
fusion - developmental union of two teeth
dens in dente - tooth within a tooth; by deep invagination of the enamel organ during formation
Teeth that are most frequently involved in hypercementosis - excessive deposition of secondary cementum
molars
incisors
premolars
canines
Enamel defect resulting from the incomplete formation of the enamel matix
enamel pearls
enamel hypocalcification - defective mineralization and maturation of ameloblasts
enamel hypoplasia
regional odontodysplasia - ghost teeth
Division of a single tooth germ by invagination
gemination
fusion - union of two tooth germs by dentin during development
concrescence - union of the roots of two teeth by cementum
twinning - complete division of a single tooth bud
ankylosis - fusion of cementum/dentin to surrounding alveolar bone after loss of PDL
True about amelogenesis imperfecta
inherited condition transmitted as a dominant trait
often discolored, sensitive to temperature changes and painful to brush
only affects permanent teeth
causes enamel to be soft and thin; easily damaged and susceptible to decay
teeth appear yellow because dentin is visible through thin enamel
Abnormal loss of tooth structure due to nonmasticatory physical friction
erosion - loss of tooth structure from nonmechanical means; acid
abfraction - cervical erosive lesions
attrition - wearing away of enamel and dentine due to normal function, grinding/gritting
abrasion
Causes intrinsic staining of teeth
dentinogenesis imperfecta - opalescent hue; gray to bluish-brown
erythroblastosis fetalis - bluish-black, greenish-blue, tan or brown
porphyria - red or brownish | internal resorption - pinkish hypomineralized enamel - white to brown | fluorosis - white opacities
diabetes mellitus
pulpal injury - starts pink, becomes orange-brown to bluish-black
tetracycline - varies from light yellow-orange to dark gray-brown
bacteria, iron, tobacco, foods, beverages, gingival hemorrhage, restorative materials, medications
What is the most probable diagnosis of the x-ray where tooth has appearance of a pink-hued area on the crown of the tooth?
internal resorption
idiopathic external resorptive lesion - invasion of the cervical region of the root by fibrovascular tissue which resorbs dentin, enamel and cementum while the dental pulp remains protected
A patient with which type of amelogenesis imperfecta will have teeth that demonstrate enamel that varies from thin and smooth to normal thickness with grooves, furrows and/or pits?
Type I (Hypoplastic)
Type II (Hypomaturation) - normal thickness with enamel that often chips and abrades easily
Type III (Hypocalcified) - normal thickness with enamel that often chips and abrades easily
In Type I dentin dysplasia, roots appear extremely short, and pulps are:
normal
somewhat smaller
extremely large - Type II (coronal dysplasia)
completely obliterated
Leukemia is a group of bone marrow diseases involving an uncontrolled increase in
red blood cells
platelets
plasma cells
white blood cells
A 48 year old female patient walks into your office. She states that she is diagnosed with some disease which she can't remember the name of. Her physician wants her to follow up with you, her dentist, regularly to watch out for cancer of the tongue and throat. She also has a bald tongue, and states that her fingernails "look funny." What disease does she have?
aplastic anemia - affects young adults, pallor, weakness, malaise, dyspnea (difficulty breathing), headache and vertigo. Oral symptoms include spontaneous bleeding, bruising (petechiae) and gingival infections.
Plummer-Vinson syndrome
pernicious anemia
Cushing's syndrome
What disorder is a result of a genetic mutation causing the substitution of glutamic acid by a valine and results in dental radiographs with enlarged marrow spaces?
cystic fibrosis
muscular dystrophy
polio
sickle-cell anemia
Pigmented (purple; 3-10mm) lesions in the skin, mucous membrane and internal organs caused by extravasation of blood from the capillaries
petechiae - small size (<3mm)
purpura (pinpoint spots)
ecchymosis - large purpura spots (>10mm)
varicose veins
All statements are true EXCEPT
Acute leukemias have a slow onset and progression
(Acute leukemias have a rapid onset and progression)
Acute leukemias are characterized by the appearance of immature, abnormal cells in the bone marrow and peripheral blood and frequently in the liver, spleen, lymph nodes, and other parenchymatous organs
The clinical picture of acute leukemias are marked by the effects of anemia, which is usually severe (fatigue, malaise), an absence of functioning granulocytes (proneness to infection and inflammation), and thrombocytopenia (hemorrhagic diathesis)
The spleen and liver usually are moderately enlarged, while enlarged lymph nodes are seen mainly in acute lymphocytic leukemia. Fever and a very high ESR are found
Leukocyte counts vary greatly in the acute leukemias
You have a patient who has an "overactive thyroid." You ask him about his medications and he states that he took methimazole (antithyroid drugs: propylthiouracil, carbimazole). He has ragged necrotic ulcers covered by gray membrane on gums and palate. This condition also has signs and symptoms of sudden onset of high fever, chills, jaundice, weakness, sore throat, and rapid periodontal destruction.
thrombocytopenic purpura
agranulocytosis/granulocytopenia
sickle-cell anemia
Peutz-Jeghers syndrome
The term used to describe a leukemia where leukemic cells appear in the blood but there is no significant increase in the number of white blood cells
aleukemic leukemia - there are leukemic cells present in the bone marrow, but the circulating white blood cells are neither immature nor increased in number
subleukemic leukemia
stem cell leukemia - abnormal cells that are poorly differentiated but are considered to be precursors of lymphoblasts, myeloblasts or monoblast
leukemoid - marked increase in the number of circulating granulocytes
The patient has pernicious anemia - chronic, progressive, megaloblastic anemia caused by lack of secretion of intrinsic factor in normal gastric juice.
The patient consults the dentist for relief of
denuded gingiva
sore & painful tongue (atrophic glossitis); also angular cheilitis, tingling numbness of extremities, difficulty in swallowing (dysphagia), painful swallowing (odynophagia)
edematous buccal mucosa
severe gingivitis
A 6 month old child's teeth appear green, blue, brown due to deposition of blood pigment in enamel and dentin. Which of the following conditions did the mother have during her pregnancy?
sickle-cell anemia
erythroblastosis fetalis - anemia in the baby caused by Rh incompatibility. The mother produced antibodies which crossed the placenta, destroying the fetus' RBCs.
patent ductus arteriosus
low-weight preterm birth
True about chronic leukemias
they have rapid onset and progression
they have slower onset and progression
they have shorter, more devastating clinical course than the acute leukemias
they have a longer, less devastating clinical course than acute leukemias
they are characterized by proliferation of lymphoid or hematopoietic cells that are more mature than those of the acute leukemias
they constitute 75% of all leukemias
they constitute about 50% of all leukemias
Leukemias are evenly split between the acute and chronic forms; but among children, this form accounts for about two-thirds of cases.
acute lymphocytic leukemia (ALL)
acute myeloid leukemia (AML) - common type in adults
chronic lymphocytic leukemia (CLL) - most common type in adults
acute monoblastic leukemia (AMoL)/acute monocytic leukemia - least common leukemia
chronic myelogenous leukemia (CML) - Philadelphia chromosome: translocation of 22 to 9
Patient has Osler's disease caused by living at a high altitude. His tongue is deep purplish-red and his gingiva bleed easily.
polycythemia vera (primary)/erythemia - occurs when
excess erythrocytes are produced as a result of tumorous abnormalities.
secondary polycythemia - increase in the total number of erythrocytes due to chronic tissue hypoxia of advanced pulmonary disease, high altitude, or the secretion of erythropoietin by certain tumors
hemophilia B
thalassemia major
porphyria
The translocation of the long arm of chromosome 22 to chromosome 9 or the Philadelphia chromosome is a finding of this leukemia. Symptoms include spongy bleeding gums, fatigue, fever, weight loss, splenomegaly, joint and bone pain, and repeated infections.
acute lymphocytic leukemia (ALL)
chronic myeloid(myelocytic, myelogenous, granulocytic) leukemia (CML) - characterized by the abnormal overgrowth of granulocytic precursors (myeloblasts and promyelocytes) in bone marrow, peripheral blood and body tissues.
acute myeloid leukemia (AML) - malignant disease of the bone marrow in which hematopoietic precursors are arrested in an early stage of development
chronic lymphocytic leukemia
Which of the following is a troublesome fibroblastic neoplasm that is locally aggressive and infiltrative?
neurilemmoma (Schwannoma) - encapsulated mass presents as asymptomatic lump
traumatic neuroma - nodule which may be painful to digital pressure
nodular fasciitis (pseudosarcomatous fasciitis) - firm mass, rapid growth, pain and tenderness
fibromatosis (extra-abdominal desmoids)
neurofibroma - solitary neurofibroma: asymptomatic nodule; multiple: syndrome neurofibromatosis
A 3 month old has a large (20cm) fluid-filled, fluctuant, painless mass on her neck. The diagnosis is a cystic hygroma (cystic hygroma/hygroma coli). This lesion is under which umbrella of lesions, which also contains enlarged tissue on the posterior and lateral border of the tongue? Lesions can also be seen on lips and labial mucosa?
angiomas
lymphangiomas - no sex predilection, do not undergo malignant change, aspirated first before excision
Schwannomas
fibrosarcomas
A 24-year-old female patient comes into your office complaining of 14-mm exophytic, red mass present on the gingiva between teeth 5 and 6. A health history reveals that she is a smoker and is 3 months pregnant. Her oral hygiene is poor. A likely diagnosis of the mass is
lipoma
pyogenic granuloma
epulis granulomatosum - caused by retained foreign material in the post-extraction socket (iatrogenic)
peripheral fibroma - reactive hyperplastic mass that occurs in the gingiva
focal fibrous hyperplasia/traumatic fibroma/irritation fibroma/ hyperplastic scar - caused by chronic trauma to oral mucous membranes; giant cell fibroma
A patient presents to your clinic with multiple exophytic masses covering the buccal mucosa, tongue and lips. A biopsy reveals that these are mucosal neuromas - alert for early diagnosis and treatment. Patient should be referred to a physician because of the risk of related:
squamous cell carcinoma of the tongue
pituitary hyperplasia
medullary carcinoma of the thyroid - ability to metastasize and cause death
Sipple's syndrome/MEN2/subtype 2A - parathyroid hyperplasia adenoma, pheochromocytomas of adrenal medulla, medullary carcinoma of thyroid gland
Which of the following is probably the most common benign peripheral nerve tumor?
traumatic neuroma - trauma to a peripheral nerve
neurilemmoma (Schwannoma) - benign neoplasm of Schwann cells
neurofibroma - tumor of the nerve fibers itself; appears as a sessile, firm, pink nodule
nodular fasciitis/pseudosarcomatous fasciitis - reactive lesion; proliferation of fibroblasts
fibromatosis/extra-abdominal desmoids - benign fibrous proliferation of fibroblasts
A patient presents to the dermatologist light brown birthmark-like (Cafe-au-lait) spots on his back. A thorough scan reveals freckles in his armpits (Crowe sign) and pigmented lesions within the iris (Lisch spots). Intraorally, this patient has multiple lesions on the gingiva and alveolus. What is the most likely diagnosis of these oral lesions?
neurilemmoma
neurofibroma - Von Recklinghausen's disease/neurofibromatosis
neuroma
fibroma
A 55-year-old patient has a tooth fracture (due to decay) of tooth #31. A smooth, firm, asymptomatic lesion is noted on the lateral border of the tongue adjacent to the sharp enamel of tooth #31. The patient states that the lesion has been there for years and accidentally bites it sometimes. Name this most frequently encountered intraoral benign neoplasm of connective tissue origin,
leiomyosarcoma
traumatic fibroma
leiomyoma - slow-growing, asymptomatic submucosal masses
rhabdomyoma - asymptomatic, well-defined submucosal mass
rhabdomyosarcoma - rapidly growing mass, causes pain with jaw involvement
Scleroderma is a systemic disease that affects many organ systems. The symptoms result from inflammation and progressive tissue fibrosis and occlusion of the microvasculature by excessive production and deposition of:
types II and IV collagens
types I and III collagens
elastin and reticulin
all of the above
A newborn baby girl was delivered via caesarian section due airway patency concerns. During ultrasound, there was the discovery of a tumor of the oral cavity. Upon delivery, the pink, compressible tumor of the anterior maxilla was deemed to be a congenital epulis of the newborn/gingival granular cell tumor. This lesion is composed of cells that are identical to those of the:
traumatic neuroma
Schwannoma
granular cell myoblastoma/granular cell tumor - uninflamed, asymptomatic mass less than 2cm in diameter, more in females; pseudoepitheliomatus hyperplasia
lipoma
Patient has a swelling of the left submandibular space. He says his lower left molar recently 'broke down" and has been very painful especially when something cold hits it or when chews down on it. What is the most likely etiology of this swelling.
orthodontics
trauma
infection of the pulp of the tooth
periodontal disease
Radiopaque lesion periapical to tooth #19. Tooth #19 has a deep amalgam restoration with recurrent decay underneath. You can see the entire outline of the mesial root of tooth #19 - the lesion seems to stem from the tooth. What is the most likely diagnosis of the lesion?
focal sclerosing osteomyelitis/condensing osteitis/bony scar/sclerotic bone
cementoblastoma
cementoma
fibrocementoma
Most cases of acute osteomyelitis are infectious. Which two of the following are the most frequently cited as part of the etiology?
bacteroides and campylobacter
clostridia and corynebacterium
staphylococci and streptococci
enterococci and lactobacilli
Cleft palate occurs in the ___ to ____ week of embryonic life.
1st; 3rd
4th; 6th
8th; 10th - more common in female, 1 in 2000
12th; 14th
6th; 7th - cleft lip, medial nasal process, more frequent in males, bilateral(20%) unilateral(80%), left>right, 1 in 1000
A child with achondroplasia - most common type of dwarfism has a
relatively normal torso and long arms and legs
short torso and long arms and legs
long torso and long arms with short legs
relatively normal torso and short arms and legs - upper arms and thighs are shorter than forearms and lower legs, large head, prominent forehead, saddle-like nose, mandibular prognathism, overcrowded teeth, otitis media
Type I dentinogenesis imperfecta is associated with which genetic disease?
osteogenesis imperfecta (OI) - prone to fracture, pale blue sclera, otosclerosis, bulbous crowns with cervical constriction, obliterated pulps, narrow and shorter roots
Marfan's syndrome
Ehlers-Danlos syndrome
cystic fibrosis
Hypophosphatasia is a genetic metabolic disorder of bone mineralization caused by a deficiency in:
acid phosphatase
vitamin K
alkaline phosphatase - essential to calcification of bone
phosphorus
Pituitary adenoma - benign tumor that causes the overproduction of growth hormone; in a 9-year-old will most likely lead to:
gigantism - prior to adolescence (nonfusion of epiphysis)
acromegaly - after to adolescence (fusion of epiphysis)
achondroplasia
dwarfism - arrested growth
A new 6 year old patient has a prominent forehead and flattened nose, initially seems to have no eyebrows but you later realize that the hair is just very fine and sparse, has missing teeth and the ones she has are cone shaped. What is her most likely systemic condition?
Pierre-Robin syndrome - severe micrognathia, mandibular hypoplasia, glossoptosis, high-arched/cleft palate in neonates
ectodermal dysplasia - hypotrichosis, anhidrosiss, anodontia/oligodontia, depressed nose bridge, lack salivary glands, child appears older
cleidocranial dysplasia - hypoplasia/aplasia of clavicles, cranial bossing, ocular hypertelorism, retained primary teeth, multiple supernumerary teeth, unerupted teeth
Peutz-Jeghers syndrome - hyperpigmentation/freckles on lips, hamartoma/benign polyps in the intesitines
osteopetrosis/Albers-Schonberg/marble bone disease - absence of physiologic bone resorption due to reduced osteoclastic activity, bone pain, sclerosis of ostia(blindness, deafness), bone marrow(anemia), osteomyelitis, delayed eruption, enamel hypoplasia, congenitally absent teeth, unerupted and malformed teeth
An old patient presents to your office with ill-fitting dentures. Radiographs reveal hypercementosis on roots and the patient is speaking embarrassingly loudly to you that she is more conscious of his baldness now that his hat doesn't fit anymore." These signs all point to what possible diagnosis?
Paget's disease/osteitis deformans - hypercementosis, enlarged cranium, headaches, hearing loss, bone of increased density
osteosarcoma
fibrous dysplasia
Albers-Schonberg disease
You are consulting on a pathological case for a fellow dentist. The biopsy of the lesion shows multinucleated giant cells and perivascular collagen cuffing. After asking about the clinical signs, your colleague mentions that the young patient seems always to be "staring off into space. and that she has puffy cheeks." The most likely diagnosis of this case is:
aneurysmal bone cyst
central giant cell granuloma
tumor of hyperparathyroidism
cherubism
A deficiency of parathyroid hormone can be treated with
vitamin A
vitamin C
vitamin D
vitamin K
The most acute and severe type of hyperthyroidism is:
Plummer's disease/toxic nodular goiter - present with cardiac disease
Grave's disease/diffuse toxic goiter - exophthalmus, thickened skin over shin
Hashimoto's disease
Addison's disease
Severe hypothyroidism in a child is called:
dwarfism
myxedema - extreme hypothyroidism in adults
cretinism - retardation of growth, abnormal development of bones, mental retardation
acromegaly
The clinical features of the primary form of which disease is classically described as "stones, bones, groans, and moans?"
Paget's disease
hypophosphatasia
hyperparathyroidism/von Recklinghausen's disease of the bone - bone pain, pathologic fracture, well-defined cystic radiolucencies, multinucleated giant cells, brown tumor
hyperthyroidism
On a hospital rotation you see an infant who displays bowed legs and muscular weakness. Upon dental examination you notice a delayed eruption pattern. The child has rickets, which is a deficiency in which vitamin?
vitamin A
vitamind D
vitamin C
vitamin E
Which of the following conditions may be seen in a patient with cerebral palsy?
difficulty with mastication and swallowing
higher incidence of periodontal disease and caries
attrition of the teeth
multilocular radiolucencies of the jaws
Which of the following diseases is associated with a decrease in caries?
Sjögren's syndrome
cystic fibrosis - due to alterations in saliva and long-term use of antibiotics
cerebral palsy
Down syndrome
You are listening to a story about oyster fishing from a fellow classmate concerning his trip to the East Coast. He mentions that he got sick and had to be taken to the ER where he was told he had hepatitis. He is fine now. Which hepatitis is the most likely culprit in your colleague?
hepatitis A/infectious/viral/short-incubation - fecal-oral route, parenterally, ingestion of contaminated seafood, polluted water, RNA enterovirus
hepatitis B
hepatitis C
Which type of hepatitis is found only in patients with acute or chronic episodes of hepatitis B?
hepatitis A
hepatitis C - higher incidence of chronic disease, cirrhosis and hepatocellular carcinoma
hepatitis D - causes serum/long-incubation hepatitis, makes the hepatitis B infection more severe
hepatitis E - causes occasional epidemics
Aid in wound healing
highly vascular areas
hyperthermia
younger age
cortisone
Indicated for incisional/diagnostic biopsy
3mm well-encapsulated fibroma
necrotizing sialometaplasia of the hard palate
2mm papilloma of left commissure of lips
aneurysmal bone cyst
Epstein-Barr virus is associated with:
nasopharyngeal carcinoma
oral hairy leukoplakia - white patches of the lateral tongue, nonmalignant, AIDS
Burkitt's lymphoma
Rubeola - paramyxoviruses, Koplik spots - small bluish-white lesions opposite the molars surrounded by a red ring
Mumps - paramyxoviruses, enlargement of parotid glands, deafness, orchitis - inflammation of testis
Epithelioid cells and multinucleated giant cells (Langerhans giant cells and foreign body giant cells) are derived from macrophages and are important in the development of
initial inflammation
granulomatous inflammation - chronic inflammation, caseous necrosis: Mycobacterium tuberculosis
acute inflammation
subacute inflammation
A patient had minor swelling of the submandibular space associated with a carious #31 and was prescribed with amoxicillin. The swelling has gotten worse. You notice that he has trouble breathing. You call an ambulance to escort him to the ER and tell the paramedics that he has Ludwig's angina. Ludwig's angina is a severe and spreading infection that involves the:
sublingual
submental
submandibular
unilateral
bilateral
Elevated sedimentation rate rises during
inflammation
administration of hydrocortisone
necrosis, tissue degeneration
suppuration
pregnancy
Symptoms of acute fluoride poisoning include nausea, abdominal pain, vomiting, diarrhea, convulsions, and hypotension. What is the estimated toxic dose for fluoride ingestion?
1-2mg/kg
5-10mg/kg -
8-10mg/kg
12-15mg/kg
16mg/kg - death
The most common cause of xerostomia is
hereditary
medications - antihistamines, antidepressants, anticholinergics, anorexiants, antihypertensive, antipsychotics, diuretics, sedatives
tooth decay and periodontal disease - result
Sjögren syndrome - most common disease that causes xerostomia; other diseases: sarcoidosis, amyloidosis, rheumatoid arthritis, lupus erythematous, scleroderma
failure of salivary glands to function - also but not most
The ABCD's of melanoma are asymmetry, border irregularity, color variability, and diameter greater than 1⁄4 inch. Malignant melanoma in the oral cavity is found in
tongue and mandibular alveolar ridge
buccal mucosa and pharyngeal pillars
palate and maxillary gingiva
mucobuccal fold of lower lip
The features of basal cell carcinoma
begins as a papule and enlarges peripherally
develops a central crater that erodes, crusts and bleeds
nonhealing, indurated chronic ulcer
located primarily on sun exposed areas of head and neck especially the nose
Patient, who recently had lumbar/thoracic vertebrae pains, complains of swelling, painful, loose mandibular molars. Lateral skull radiograph reveals punched-out radiolucencies.
non-Hodgkin's lymphoma
Hodgkin's lymphoma
multiple myeloma/plasma cell myeloma
Langerhan's cell disease
The most common type of malignant melanoma
superficial spreading melanoma - flat and irregular in shape and color, radial growth phase
Lentigo maligna melanoma - elderly, sun-damaged skin in head/neck/arms, large, flat and tan, develops from pre-existing Lentigo maligna/Hutchinson freckle, radial growth phase
Acral lentiginous melanoma - least common, palms/soles/under nails, radial growth phase
nodular melanoma - raised, dark blackish-blue/bluish-red, poorest prognosis, vertical growth phase
When using the TNM method in assessing the prognosis and therapy of malignant neoplasms, T represents the size of primary tumor; M represents the presence of distant metastases; while N represents:
the presence of Nikolsky sign
the presence of nodules
the presence of regional lymph node involvement
the presences of erythroplakia
The most common site of squamous cell carcinoma of the tongue is the
dorsum
ventral surface
tip
posterior lateral border
The least common type of squamous cell carcinoma
squamous cell carcinoma of the palate
squamous cell carcinoma of the nasopharynx
squamous cell carcinoma of the oropharynx
squamous cell carcinoma of the maxillary sinus
At which growth stage is metastasis most likely for malignant melanoma?
"horizontal" growth phase - initial development of melanomas as a flat phase without competence for metastasis
"circular" growth phase
"vertical" growth phase - begins when neoplastic cells populate the underlying dermis, characterized clinically by an increase in size, a change in color, nodularity, and at times, ulceration
"radial" growth phase - described by the ABCD's of melanoma
Cancer of which oral cavity structure that is most commonly associated with mortality
lip - 90% occur on the lower lip due to increased sun exposure, pipe smoking
tongue - richly endowed with lymphatics and blood vessels which facilitate metastases, posterior lateral border of the tongue
floor of the mouth - most commonly in the anterior segment on either side of the midline, near the orifices of the salivary glands, very poor prognosis
buccal mucosa - occurs along the plane of occlusion, midway anteroposteriorly
gingiva - more common in the mandible than in the maxilla, and posterior sites are seen more frequently than anterior
A 47-year-old HIV+ patient has an exophytic growth in the maxillary left mucobuccal fold. A starry-sky morphology was found in the biopsy and a dismal diagnosis of Burkitt lymphoma was made. Which virus is thought to be responsible for this lymphoma?
herpes virus
Epstein-Barr virus - also associated with infectious mononucleosis, oral hairy leukoplakia and nasopharyngeal carcinoma
cytomegalovirus
human papillomavirus
Ewing sarcoma - an uncommon, highly lethal, round cell sarcoma of bone (pelvis, thigh trunk, ramus of the mandible) between ages 5-30 years; most often presents radiographically as
multiple radiolucent/radiopaque lesions resembling "cotton ball" or "cotton wool" appearance
multiple "punched-out" radiolucencies
"moth-eaten" destructive radiolucencies of medulla and erosion of the cortex with expansion or "onion-skin"
lytic lesion that may be ill-defined or sharply defined
A 15-year-old patient feels localized pain in his right femur and rapidly enlarging swelling. A radiograph of the area shows a "sun-ray" appearance.
chondrosarcoma - painless swelling and expansion of affected bones, loose teeth/ill-fitting dentures, moth-eaten radiolucencies
osteosarcoma/osteogenic sarcoma - may have loosening and displacement of teeth, paresthesia, epistaxis, widening of PDL space, moth-eaten radiolucencies (advanced)
scleroderma
chronic osteomyelitis
In Ethiopia, you notice purplish-brown nodules on the hard palate, arms and legs of a 32-year-old female patient. HIV infection has an almost 5% prevalence. What neoplasm are you suspicious of?
nicotinic stomatitis
hemangioma
Kaposi sarcoma - malignant neoplasm of endothelial cells (angiosarcoma), abnormal vascular proliferation, small red papules which enlarge and fuse forming purple-brown spongy nodules, human herpes virus-8
leukemia
Presents as a movable, painless submucosal, 0.6cm-diameter nodule similar to an epidermoid/dermoid cyst with a yellowish-pink discoloration most commonly in the floor of the mouth.
lipoma
ranula
lymphoma - Hodgkin/non-Hodgkin type
oral lymphoepithelial cyst
Metastatic tumors of the jaws
may be completely asymptomatic
patient is usually aware of slight discomfort or pain
maxilla is affected far more frequently than the mandible
(mandible is affected far more than the maxilla)
molar region is predominantly involved
Carcinoma of the oral cavity has T1, N2, M1 designation
T - tumor, N - lymph nodes, M - metastasis
less than 2cm diameter, palpable contralateral/bilateral lymph nodes suspected metastases, clinical/radiographic evidence of metastasis
TX, NX, MX - cannot be assessed
T0, N0, M0 - no evidence, not clinically palpable
Tis - carcinoma in situ, T2 - 4cm, T3 - greater than 4cm
N1 - palpable homolateral lymph node(s), not fixed but metastases suspected
N3 - palpable lymph node(s), fixed metastases suspected
65-year old with a thick white, painless, exophytic mass with a coral/cauliflower-like appearance on the maxillary alveolar tuberosity. Patient has been chewing a betel nut concoction for over 40 years.
papilloma
erythroplakia
verrucous carcinoma - well-differentiated squamous cell neoplasm of soft tissue of the oral or laryngeal cavity, may transform into an invasive form
hyperkeratosis
A 73-year old patient complains of a lasting ulceration on the right side of his tongue. He has a history of hypertension, high cholesterol and smokes for 40 years. The patient takes antihypertensives and antilipidemics and has no allergies. No sources of trauma are found. After 2 weeks, the ulcer has grown in size. What is the likely diagnosis of this most common malignancy of the oral cavity?
adenoid cystic carcinoma
mucoepidermoid carcinoma
basal cell carcinoma
squamous cell carcinoma - early leukoplakia/erythroplakia, painless ulcer, tobacco, invasion
If you inject the anesthetic solution into the capsule of the parotid gland, you may cause a Bell palsy-like feeling for the patient by anesthetizing the
trigeminal nerve
glossopharyngeal nerve
hypoglossal nerve
facial nerve
A 25-year-old college student complains that when she wakes up, she has trouble opening her mouth. When conducting a TMJ exam, you note tenderness of the right lateral pterygoid and nonreciprocal clicking of the right TMJ. What is the most likely cause of the patient's myofacial pain
trauma
muscle spasm
periodontal disease
tumor
A 53-year-old patient says he gets a sharp' jolt" on the right side of his throat when he swallows. He says the pain is severe and he can even feel it in his ear. The most likely diagnosis is:
postherpetic neuaralgia - persistent burning, aching, itching, and hyperesthesia following a herpes zoster attack
orolingual paresthesia
Frey syndrome/auriculotemporal syndrome - reinnervation of sweat glands resulting to gustatory sweating following surgical removal of parotid tumor or parotid infection damaging the auriculotemporal nerve
glossopharyngeal neuralgia
Ramsay Hunt syndrome - facial paralysis and otalgia (earache) from postherpetic neuralgia involving the facial nerve and geniculate ganglion
A relatively rare autoimmune disorder of peripheral nerves in which antibodies form against acetylcholine (ACh) nicotinic postsynaptic receptors at the myoneural junction?
myasthenia gravis - flattened smile, difficulty in chewing and swallowing, slurring of words, droopy eyes, slow papillary light responses, xerostomia, rampant caries
myelofibrosis
multiple sclerosis - chronic, disabling disease that attacks the CNS, tingling and numbness to paralysis and blindness, facial and jaw weakness, may develop Bell palsy and trigeminal neuralgia
Grave's disease
If you touch a particular trigger zone above the lip, patient gets sharp, sudden stabbing jolts of excruciating pain lasting less than 2 minutes with several minutes of refractory period. Carbamazepine is the drug of choice for this illness.
glossopharyngeal neuralgia
trigeminal neuralgia
postherpetic neuralgia
diabetic neuarlgia
Within soft tissue and may mimic inflammatory lesions of odontogenic origin
median alveolar cyst
globulomaxillary cyst
nasolabial cyst - represents a soft tissue cyst not involving the alveolus, extraosseous, not seen on a radiograph
nasopalatine cyst
Congenital cysts
thyroglossal duct cyst - midline position, dark in color, resembles a hemangioma, hemorrhage into the mouth
branchial cleft/cervical lymphoepithelial cyst - anterior to sternocleidomastoid - lined with ciliated stratified squamous epithelium, contains milky/mucoid fluid
globulomaxillary cyst - large pear-shaped radiolucency between lateral incisor and canine, asymptomatic, all regional teeth are vital, cause divergence of roots
dermoid cyst - contains hair, sebaceous and sweat glands, tooth structures, midline of floor of the mouth/mass in the upper neck
Developmental/fissural cysts
nasopalatine duct (canal)/incisive canal cyst - heart-shaped radiolucency in midline, non-odontogenic cyst, asymptomatic, teeth are vital
nasolabial (nasoalveolar) - soft tissues of upper lip, extraosseous
branchiogenic
median palatal - swelling along median palatal raphe
median alveolar - in bony alveolus between central incisors, adjacent teeth are vital
Circular radiolucent area seen in this radiograph is clinically seen as a marked swelling in the region of the palatine papilla. It is situated mesial to the roots of the central incisors. The pulps of the anterior teeth in this patient tested vital.
nasopalatine duct (canal)/incisive canal cyst
globulomaxillary cyst - between the roots of the lateral incisor and those of the canine, pear-shaped, often causes the roots of involved teeth to diverge
median palatal cyst - midline of the hard palate, firm swelling that is usually painless
The soft tissue, and far less common, variant of the nasopalatine duct (canal) cyst
median mandibular cyst
nasolabial cyst
cyst of the palatine papilla
aneurysmal bone cyst
An 8-year-old girl who looks like 14 years old, premature puberty is the hallmark of McCune-Albright syndrome also characterized by
congenital heart defects
polyostotic fibrous dysplasia, pathologic fractures
irregular shaped Café au lait spots on torso and intraorally
endocrine dysfunction, sexual precrocity
increased level of serum alkaline phosphatase
An 8-year-old child has complained of pain on the left side of his head for 5 weeks. A panoramic radiograph reveals multiple radiolucent lesions on the left side of the maxilla. The lesions give the appearance of teeth that are "floating in space." The lesions are sharply circumscribed with a punched-out appearance.
Langerhans cell disease/idiopathic histiocytosis/histiocytosis X - loosening of teeth, gingival tissues are inflamed, hyperplastic and ulcerated, eosinophils are mixed with the tumor Langerhans cells
hyperparathyroidism
cherubism
Paget's disease
Central giant cell granuloma
appear more frequently than peripheral giant cell granulomas
(less frequently)
found predominantly in children and young adults - aggressive type
affects females more than males
present almost exclusively in the small bones of the hands and feet
(almost exclusively within jaw and bones)
A 21-year-old male patient says his "bite seems off", his chin is deviated to the right. Panoramic radiograph reveals the left condylar neck seems to have elongated.
condylar agenesis - absence of all or portions of the coronoid process, condylar process, ramus, and mandibular body
condylar hyperplasia - idiopathic disease characterized by a progressive, unilateral overgrowth of the mandible, chin is deviated toward the unaffected side
condylar hypoplasia - shortness of the mandible with deviation of the chin toward the affected side
hemifacial microsomia
A 6-year-old boy has been hospitalized multiple times for broken bones. It was noted that his alkaline phosphatase levels were quite high. You notice multiple impacted teeth. If this patient has a form of polyostotic fibrous dysplasia, which radiographic feature may you find?
the lesions are usually radiolucent, well-circumscribed, and may have a "cotton wool" appearance - Paget's disease
the lesions are usually a saucer-shaped radiolucency
the lesions are usually radiopaque, not well-circumscribed, and may have a "ground glass" appearance
the lesions are usually well-demarcated unilocular or multilocular radiolucencies
the lesion is well-circumscribed varying from radiolucent to radiopaque and may have a "sun-ray" pattern of new bone production - osteoblastoma
Mandibular tori most often appear
in the retromolar pad region
on the lingual surface of the mandible, most often in the premolar region
on the lingual surface of the mandible, inferior to the mylohyoid ridge
(superior)
along the midline of the hard palate - Maxillary torus
Clinical features of ossifying fibroma
slow growing expansile lesion
more often in maxilla
asymptomatic
common in young adults around 35 years of age
more common in females
Multiple cysts of the skin were found in a 17-year-old patient after head and neck examination. Her panoramic exams have always shown multiple impacted teeth and today shows multiple radiopacities of the jaws, especially at the angle of the mandible. You suspect Gardner syndrome. What is the most serious complication she should be concerned with when consulting her physician?
odontomas
osteomas
epidermoid cysts
multiple polyps that affect the large intestine; change into adenocarcinoma by the 4thdecade of life; leads to invasive colorectal cancer
A 10-year-old boy has a painless swelling of his maxilla. Radiographic exam reveals an irregularly shaped radiopaque mass with a ground-glass appearance. No other bulges have been noted by the mother. A biopsy reveals fibrous tissue in the bone.
monostatic fibrous dysplasia
polyostotic fibrous dysplasia - alkaline phosphatase may be elevated
McCune-Albright syndrome - cafe-au-lait macules, endocrine abnormalities
Jaffe-Campanacci syndrome
Patient's eyes are set wide and that he has predispositions for skin cancer: multiple lesions of the skin, the skin of his palm is very thick and has palmer pitting. He sees a neurologist and he has some calcified structures in his brain. Patient has nevoid basal cell carcinoma/basal cell nevus-bifid rib/Gorlin-Goltz syndrome. A panoramic radiograph may likely reveal
osteomas
keratocystic odontogenic tumors, calcification of the falx cerebri
odontomas
dentigerous cysts
A 2-year-old boy has a "swelling" on his alveolar ridge. A smooth-surfaced bluish lesion with fluctuance is seen where tooth #K will be erupting. The most likely diagnosis of this is:
dentigerous cyst
eruption cyst
hematoma
hemangioma
A panoramic x-ray of a 14-year-old patient reveals a well-defined multilocular radiolucency with scalloping around the roots on the left side of the mandible apical to the canine and first premolar. No clinical symptoms are present. Teeth are not carious and respond normally to vitality tests. Medical history is unremarkable. On opening the area, no fluid or tissue is evident.
dentigerous/follicular cyst - contains a crown of an unerupted tooth/odontoma, apical displacement of teeth due to presence of accumulated fluid
traumatic (simple) bone cyst
primordial cyst - contains no calcified structures, lined by stratified squamous epithelium, unilocular/multilocular/multiple
residual cyst - a tooth associated with a radicular cyst is extracted but the cyst is left undisturbed, persists in the jaw
stafne (static) bone defect - radiolucency of the mandible due to invagination of the lingual surface of the jaw, posterior mandible below the mandibular canal
A 19-year-old patient's panoramic radiograph reveals a well-corticated, unilocular radiolucency surrounding the crown of impacted tooth #17. The lesion is asymptomatic.
keratocystic odontogenic tumor
dentigerous/follicular cyst
cystic ameloblastoma
central ossifying fibroma
focal osteoporotic bone marrow defect - radiolucency in the jaw that contains hematopoietic bone marrow, extraction site
The keratocystic odontogenic tumor (KOT) (formerly known as the odontogenic keratocyst [OKC]) is derived from
Hertwig epithelial root sheath
reduced enamel epithelium
remnants of the dental lamina
pre-existing osteoma
A cyst that arises from cystic changes in a developing tooth bud before the formation of enamel and dentin matrix
residual cyst
traumatic bone cyst
primordial cyst
periodontal cyst
Radiographically appears as a well-defined, round or teardrop-shaped radiolucency with an opaque margin
lateral periodontal cyst - non-keratinized, non-inflammatory, adjacent /lateral to root, derived from proliferation of rests of dental lamina, soft tissue counterpart: gingival cyst of adulthood
dentigerous/follicular cyst - well-defined, usually unilocular radiolucency associated with the crown of an unerupted tooth
keratocystic odontogenic tumor - well-circumscribed radiolucency with smooth margins and thin radiopaque borders
calcifying odontogenic cyst - unilocular/multilocular radiolucency with discrete, well-demarcated margins, "salt and pepper" type of pattern
Dental granuloma and radicular cyst, can only be differentiated
based on symptoms - both asymptomatic
radiographically - both have a circumscribed radiolucency at the apex of tooth
histologically
by an electric pulp tester - both have a non-vital tooth
A 37-year-old patient complains of a slowly growing, painless swelling of his lower left jaw. A panoramic shows a multilocular radiolucency with well-defined and sclerotic margins along the left mandibular molar-ramus area. All teeth test as vital. A biopsy is conducted and shows odontogenic epithelium (ameloblastoma). What is the most likely diagnosis for the most aggressive type of this tumor?
solid (multicystic/polycystic)
unicystic - less aggressive, histologic variant: plexiform unicystic ameloblastoma
extraosseous peripheral ameloblastoma - benign non-aggressive, gingiva/buccal mucosa
A 30-year-old patient complains of a painless swelling of his lower left jaw. A panoramic radiograph shows a well-circumscribed multilocular radiolucency with a "honeycomb" pattern and cortical expansion. The teeth have been displaced. The pathology report calls this an odontogenic myxoma. This tumor:
is composed of large polyhedral, neoplastic, epithelial cells
is composed of neoplastic epithelium and mesenchyme
arises from follicular connective tissue resembling pulp tissue
is composed of spindle-shaped mesenchymal cells and aggregates of multinucleated giant cells
Cementoblastoma/true cementoma is a well-circumscribed radiopaque lesion that replaces the root, surrounded by a radiolucent ring, and it is more often seen
in the mandible than in the maxilla, and more often in the posterior than in the anterior regions
(mandible>maxilla, posterior>anterior)
in the mandible than in the maxilla, and more often in the anterior than in the posterior regions
in the maxilla than in the mandible, and more often in the posterior than in the anterior regions
in the maxilla than in the mandible, and more often in the anterior than in the posterior regions
Periapical cemental/periapical cemento-osseous dysplasia is a reactive process of apical bone, and has
a predilection for persons younger than 20 years old
a predilection for middle-aged Caucasian men
a predilection for middle-aged Black women
no age, racial, or sex predilection
The Pindborg/calcifying epithelial odontogenic tumor (CEOT) presents jaw expansion, unilocular/multilocular radiolucent lesion which may have opaque foci, sheets of large polygonal epithelial cells that have concentric calcified deposits/Liesegang rings, and are located at the
tuberosity area
maxillary anterior area
mandibular premolar area
molar-ramus area
The ameloblastic fibroma (completely lucent) and ameloblastic fibro-odontoma (with opaque focus - odontoma) are well- circumscribed, surrounded by a sclerotic margin, may be associated with the crown of an impacted tooth, These neoplasms occur predominantly in
adults with a mean age of 40
elderly people with a mean age of 75
young adults with a mean age of 25
children and young adults with a mean age of 12 (upper limit of 40)
How would you refer to the group of small radiopacities between the mandibular canine and first premolar on the periapical x-ray?
complex - amorphous opaque masses that don't look like a tooth typically in a tooth-bearing area, between roots/over the crown of an impacted tooth
compound - multiple, small tooth-like structures typically in a tooth-bearing area, between roots/over the crown of an impacted tooth
A 45-year-old African-American female has periapical cemental/periapical cemento-osseous dysplasia/ cementoma. Periapical x-ray of the mandibular incisors show multiple radiopacities with radiolucent rims. Teeth #23 through #26 test as vital. There is no pain on percussion or palpation. Treatment for these lesions should be
do nothing (observe) - osteolytic stage: radiolucency, osteoblastic stage: calcification, mature/sclerotic stage: radiopacity with thin radiolucent line around the area, lesion stabilizes
RCT treatment for teeth #23 through #26
surgical excision of lesions
A 5-year-old boy has a normally developing dentition, but you notice multiple "freckles" on his lower lip and on the buccal mucosa, gingiva, hard palate.
Gorlin-Goltz syndrome
Gardner syndrome
Peutz-Jegher's/hereditary intestinal polyposis syndrome
cleidocranial dysplasia
What caused the discoloration of the gingiva?
amalgam tattoo - locate amalgam on x-ray if tattoo is suspected; if you can not locate any amalgam
aspirin burn - blanched/whitened surface necrosis, subsequent sloughing of epithelium from placing tablet against aching tooth
bismuth line - thin, blue-black line in the marginal gingiva that is sometimes confined to the gingival papilla
smoking-associated melanosis - chemical in tobacco smoke that stimulates melanin production, not associated with risk of melanoma/carcinoma
melanotic macule - can be associated with Peutz-Jegher's syndrome
The most common location for an intraoral congenital nevi/moles/birthmark
buccal mucosa
tongue
hard palate - usually large (>10cm), may change from flat and pale tan macules to elevated, verrucous hairy lesions, have higher incidence of malignant transformation
alveolar mucosa
Conditions that demonstrate pigmentation of the intraoral mucous membranes
Addison disease/chronic adrenocortical insufficiency - hypofunction of adrenal cortex, bronzing
McCune- Albright syndrome - severe form of polyostotic fibrous dysplasia, cafe-au-lait spots, endocrine dysfunction, osteosarcoma
Cushing syndrome - prolonged exposure to high levels of cortisol, upper body obesity, round face, buffalo hump, thin limbs
Peutz-Jegher's/hereditary intestinal polyposis syndrome - intraoral melanin pigmentation
A 40-year-old patient complains of muscle weakness and loss of appetite. He has noticed a loss of weight and also that his skin has started to "bronze.' His labs show lowered blood glucose and sodium and increased potassium.
Peutz-Jegher's syndrome
Cushing syndrome
Addison disease - adrenal glands do not produce enough cortisol
McCune-Albright syndrome
Focal melanosis is a common circumstance in which brownish areas of pigmentation occur in the oral cavity. Once properly diagnosed
surgical excision is required
radiation is required
no treatment is necessary
antibiotics are required
The intraoral nevus is usually an
intradermal nevus - skin
compound nevus - epithelium/lamina propria interface, also deep in the dermis, raised and solid
junctional nevus - interface between the epithelium and lamina propria, flat, may transform into malignant melanoma
blue nevus - congenital, painless, color based on the deep cutaneous/subcutaneous/submucosal deposits of melanin
intramucosal nevus - solid and slightly raised
Radiographic presentations of traumatic bone cysts
well-defined unilocular or multilocular radiolucency with scalloping around the roots
poorly circumscribed radiopaque lesion which may have a "ground-glass" appearance
saucer-shaped radiopaque lesion
poorly defined multilocular radiolucency with a "pear-shaped" appearance between the maxillary central incisors
Aneurysmal bone cyst
it is an uncommon expansile osteolytic lesion of bone consisting of a proliferation of vascular tissue that forms a lining around blood-filled cystic lesions
most aneurysmal bone cysts occur in patients under 20 years of age, and it is uncommon after the age of 30
it commonly involves the jaws
(proximal humerus, femur, tibia, and pelvis)
the lesions are usually tender or painful, particularly upon motion of the bone affected
upon entering the lesion surgically, excessive bleeding is encountered
A patient presents with an asymptomatic, elongated, erythematous patch of atrophic mucosa of the mid-dorsal surface of the tongue due to a chronic Candida albicans infection.
thyroglossal duct cyst
lymphangioma
hemangioma
median rhomboid glossitis
