Oral Pathology Summary


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Oral Pathology I
Third Year

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Oral Pathology Summary

  1. 1. Oral pathology TEETH DEVELOPMENTAL CONDITIONS "Production of a 'double crown' or 'double' root from single tooth germ" is the definition of A. fusion. B. gemination. C. concrescence. D. hyperplastic enamel. E. amelogenesis imperfecta. Of the following conditions, which is characterized by "opalescent teeth?" A. Cleft palate B. Dens invaginatus C. Enamel hypoplasia D. Amelogenesis imperfecta E. Dentinogenesis imperfecta "Pink teeth" are most often caused by A. mesiodens. B. dens invaginatus. C. internal resorption. D. enamel hypoplasia. E. external resorption. Which of the following is produced by an inherited defect in collagen synthesis? A. Cleft lip B. Cleft palate C. Dilaceration D. Amelogenesis imperfecta E. Dentinogenesis imperfecta
  2. 2. Oral pathology LISIONS A flat lesion is known as a A. fistula. B. papule. C. macule. D. pustule. E. erythule. Of the following, which is not a likely cause of a red lesion? A. Hemosiderin pigment B. Dilated blood vessels C. Thin covering epithelium D. Influx of new blood vessels E. Hemorrhage under the surface A raised mucosal lesion through which suppuration from a fistulous track drains is a A. parulis. B. papule. C. macule. D. pustule. E. petechia. A lesion within bone composed solely of uncalcified soft tissue will produce which of the following radiographic images? A. Radiopacity B. Radiolucency C. Thickened trabeculae
  3. 3. Oral pathology D. Mixed radiolucency/radiopacity "A surface defect in which the covering epithelium is lost exposing underlying connective tissue" is the definition of a(n) A. ulcer. B. papule. C. erosion. D. macule. E. varicosity. Extra surface keratin usually produces a mucosal lesion that is A. red. B. blue. C. white. D. black. E. yellow. The prefix "leuko-" (like in "leukoplakia" and "leukocyte") means white A dentist discovered a flat red patch on the floor of the mouth. What are some reasons this lesion may have developed? What is the most common name given this lesion? Red lesions may be caused by 1) thinning of the epithelium, 2) increased number of blood vessels under the surface, and 3) hemorrhage under the surface. The term "erythroplakia" is used to describe a red patch of any cause. What is a "differential diagnosis?"
  4. 4. Oral pathology A "differential diagnosis" is making a list (mental or written) of the possible diseases a given lesion might represent. For example, a white lesion in the floor of the mouth might be disease "A", disease "B", disease "C", or even disease "D."
  5. 5. Oral pathology CARIOUS & PULP When, in the development of a carious lesion, is it physically possible for bacteria to enter the pulp? A. When caries enters dentin B. When decalcification of enamel begins C. When plaque adheres to the enamel surface D. When enamel caries is just detectable with x-rays E. When confluence of tubules formation of dentin clefts occurs Dental caries is a disease of A. immune origin. B. chemical origin. C. microbial origin. D. neoplastic origin. E. degenerative origin. Of the following, which is another term for "focal reversible pulpitis"? A. Pulp stone B. Pulp polyp C. Pulp abscess D. Pulp hyperemia E. Pulp granuloma A soft growth sometimes extends from a large carious lesion in the crown of a young permanent tooth in a youngster. This lesion is called A. apical scar. B. focal reversible pulpitis. C. chronic apical periodontitis. D. chronic hyperplastic pulpitis.
  6. 6. Oral pathology E. suppurative apical Of the forms of pulpal necrosis presented in lecture, which is characterized by the presence of neutrophils, microabscesses, and dilated blood vessels? A. Acute pulpitis B. Chronic pulpitis C. Focal reversible pulpitis D. Chronic hyperplastic pulpitis Inflammation of the dental pulp may kill it. Of the following which is NOT a feature of the dental pulp that explains its vulnerability? A. The pulp is avascular ??? B. Rigid, unyielding walls C. Inadequate blood supply D. Difficulty in relieving pressure E. Difficulty of inflammatory cell entry Cemental caries was uncommon two decades ago. Now it is seen with increasing frequency. How do you explain this change? Explain your answer. Dental caries used to be a disease of youngsters. With the wide use of fluoridated water supplies the caries rate has declined in this population. On the other hand, people are living longer and are retaining their teeth longer. As passive eruption occurs in the elderly, cementum is exposed. This soft bone-like tissue attracts plaque and caries follows. In terms of size and complexity, the dental pulp is a relatively insignificant tissue. Nevertheless, inflammation of this thin strand of connective tissue causes inordinate pain and suffering. What is it about the dental pulp that explains this paradox? Explain your answer. The dental pulp is surrounded by solid,unyielding walls and receives its blood
  7. 7. Oral pathology supply from a small blood vessel also surrounded by unyielding walls. As a result of this environment, pulp swelling causes great increase in intrapulpal pressure and, at the same time, causes strangulation of its blood supply. Often after the placement of a metallic restoration over a deep area of dental caries, the patient experiences sensitivity to hot and cold. Often this sensation disappears with time with no loss of pulp vitality. Under what classification of pulp pathology would this situation fall? If the a pulp so affected could be examined microscopically, what to you suspect you would find? Explain your answer. The described events were reversible; most pulp diseases, with exception of pulp hyperemia, are irreversible. Pulp hyperemia is the likely cause here. The microscopic features would include dilated and engorged blood vessels and little else. How do you explain the common clinical observation that an initial carious lesion extending from the interproximal surface of a tooth (say a lower first molar) is cone-shaped with the cone's narrow end pointing toward the pulp? Enamel rods run perpendicular to the tooth surface. On a convex surface they will form a broad cone. Decalcification follows enamel rods; additionally decalcification starts at a point and subsequently invoves enamel rods around the point. The general direction of rods plus the timing of decalcification give the cone shape. This is also noted on radiographs. What do acute and chronic pulpitis have in common? How do they differ? By the names "acute" and "chronic" as well as the suffix "-itis," you would be correct to assume that "acute pulpitis" displays acute inflammation while "chronic pulpitis" displays chronic inflammation. Therefore, acute pulpitis should have a sudden onset, and the cardinal signs of inflammation
  8. 8. Oral pathology (predominately intense pain); on the other hand chronic pulpitis should have a more insidious onset and with fewer signs and symptoms (dull pain). As you will soon learn, most pulpal and periapical disease is caused by bacterial infections. How do most of these infections originate? How do the bacteria get access to the pulp and periapical areas? Most microorganisms that end up infecting the pulp and periapical tissues come from the oral microbiota. They gain access to the dental pulp when the surface of dentin is exposed (usually by caries). They can traverse a dentinal tubule (killing the odontoblast in the processes) and enter the pulp. Once in the pulp they can enter blood vessels or lypmphatics to enter the periapical tissues. When dental caries was more prevalent in young people than now, it was not uncommon to see a soft, red mass of tissue, unattached to the surrounding gingiva, extending from the center of a large occlusal carious lesion. What is this condition? What makes up the soft red mass? Why is this condition seen almost exclusively in children? The description is typical for a "pulp polyp" or, more properly, "chronic hyperplastic pulpitis." The protruding mass is composed of granulation tissue and is covered with epithelium (transplanted, presumably, from the oral mucosa). Children's teeth have an unusually good blood supply due in combination to "wide-open" apical foramena and large pulp chambers and root canals. It is the excellent blood supply that caused "pulp polyps" rather than necrotic pulps.
  9. 9. Oral pathology PERIAPICAL Of the following which is a periapical lesion associated with a non-vital pulp that contains mostly lymphocytes and macrophages? A. Apical cyst B. Apical abscess C. Condensing osteitis D. Acute apical periodontitis E. Chronic apical periodontitis Of the following, which is NOT found at the apex of a tooth? A. Residual cyst B. Phoenix abscess C. Condensing osteitis D. Chronic apical periodontitis Of the following which will appear as a radiopacity on radiographic examination? A. Apical cyst B. Apical scar C. Apical abscess D. Condensing osteitis E. Chronic apical periodontitis Which lesion is characterized by bone formation? A. Apical cyst B. Apical abscess C. Condensing osteitis D. Chronic apical periodontitis E. Suppurative apical periodontitis Which of the following is most likely to be associated with pain?
  10. 10. Oral pathology A. Apical cyst B. Condensing osteitis C. Acute apical periodontititis D. Chronic apical periodontitis E. Suppurative apical periodontitis A periapical lesion associated with a non-vital pulp that demonstrates an epithelial lined space on histologic examination is a(n) A. apical cyst. B. apical scar. C. apical abscess. D. condensing osteitis. E. chronic apical periodontitis What do chronic apical periodontitis, apical cysts, and acute apical periodontitis have in common? A. All possess suppuration B. All are lined with epithelium C. All are associated with non-vital teeth D. All are associated with excruciating pain E. All show chronic inflammation on histologic examination A 22 year-old man came to the dentist because of severe pain in the lower left jaw. The onset of his pain was quite sudden and he soon began to feel ill. Examination revealed a severely decayed mandibular left first molar with some swelling and redness in the buccal vestibule. Percussion on the tooth resulted in excruciating pain. Examination of a periapical film exposed during the visit revealed extension of the carious lesion into the pulp chamber. There was a thickening of the periodontal ligament space, but no other significant periapical radiolucency. What was the most likely diagnosis? What do you think the buccal swelling was? What treatment should be rendered to alleviate pain and eliminate
  11. 11. Oral pathology the problem? Explain your answer. The sudden onset, excruciating pain, periodontal ligament thickening, and buccal swelling all suggest an acute inflammatory process, probably a periapical abcess. Drainage must be extablished (through the root canal or otherwise) and antibiotic therapy instituted. When examining a routine panorex film, a dentist discovers a well-defined radiopacity in the periapical region of a lower second bicuspid tooth. The tooth had endodontic treatment performed a year previously. Examination of a periapical film confirmed the presence of the radiopaque lesion. What are the two most likely diagnoses? How can a definitive diagnosis be made? What treatment should be rendered and eliminate the problem in either case? Explain your answer. This is a dilemma that happens from time to time in endodontic practices. The presistent radiolucent lesion could be 1) chronic apical periodontis (suggesting a failed root canal filling) or 2) an apical scar (occuring with successful ones). Biopsy is the only way to surely determine the tissue responsible for the radiolucency. A 54 year-old woman came to the dentist for evaluation of a vague, but persistent pain in the lower right bicuspid region. Examination revealed a second bicuspid with a large gold restoration. Application of cold to the tooth elicited virtually no response; similar application for the opposite one elicited a definite reaction. Examination of a periapical radiograph exposed during the visit revealed a very deep filling the extended almost to the pulp chamber and a well-defined periapical radiolucency measuring about 1.5 cm. in diameter. What were the two most likely diagnoses? How could a definitive diagnosis be made? What treatment should have been rendered to alleviate pain and eliminate the problem? Explain your answer.
  12. 12. Oral pathology The woman has a nonvital tooth with a periapical radiolucency. The most likely diagnoses are (1) chronic apical periodontitis and (2) apical cyst. Given that the tooth is nonvital, endodontic therapy or extraction should be performed. Usually, the periapical regions are "cleaned-out" as part of either procedure. CYSTS Of the following, which probably originates from a tooth germ that forms a cyst instead of a tooth? A. Apical cyst B. Primordial cyst C. Nasolabial cyst D. Dentigerous cyst E. Globulomaxillary cyst Of the following, which is most likely to be found at the apex of a non-vital tooth? A. Apical cyst B. Primordial cyst C. Nasolabial cyst D. Dentigerous cyst E. Globulomaxillary cyst Of the following, which is most likely to be confused with a globulomaxillary cyst? A. A keratocyst B. An apical cyst C. A nasolabial cyst D. A dentigerous cyst E. A median palatal cyst
  13. 13. Oral pathology The lining of median palatal and globulomaxillary cysts is derived from epithelium A. left behind after tooth eruption. B. pinched off the lining of the mouth. C. left over from break-up of Hertwig's epithelial root sheath. D. trapped during fusion of process during face development. Which of the following cysts is most likely to be found at the root-end of a nonvital tooth? A. Primordial cyst B. Nasolabial cyst C. Dentigerous cyst D. Apical (radicular) cyst E. Globulomaxillary cyst "True" cysts differ from "false" cysts in that "true" cysts A. are lined with epithelium. B. manifest as empty cavities in bone. C. are associated with pain and swelling. D. show well-demarcated radiolucencies. E. show radiolucencies with scattered radiopacities. A common cyst associated with the crown of an unerupted (or impacted) tooth is a(n) A. apical cyst. B. primordial cyst. C. dentigerous cyst. D. median palatal cyst.
  14. 14. Oral pathology E. globulomaxillary cyst. A 21 year-old man was referred to a oral surgeon for the evaluation of four impacted third molars. A panorex radiograph revealed the presence of a 2.0 x 2.0 cm. radiolucency around the crown of the impacted mandibular left third molar. The radiographic appearance of the others was within normal limits. Was that the most likely diagnosis? What another more serious condition that could be present here? What should the oral surgeon have done next? Explain your answer. The differential diagnosis should include the dentigerous cyst (a non-recurring lesion) and the keratocyst (a cyst that can recur). You will later add a potentially serious benign tumor known as the "ameloblastoma." In any case removal of the tooth and the cyst should be performed and the submitted for histologic examination. A 43 year-old man had a vague discomfort in his left mandible for some time; he went to see his dentist. Clinical examination revealed little except the presence of several teeth with large restorations. The lower left first molar tested lower than the surrounding teeth to standard pulp vitality tests. Examination of a panorex and periapical films exposed at the visit revealed the presence of a 1.5 x 1.5 cm. radiolucency immediately at the apex of the distal root of the first molar. Endodontic therapy was performed on the first molar; the apical lesion was excised. The pathologist reported the presence of a well-developed c.t. with some chronic inflammation wall lined with stratified squamous nonkeratinizing epithelium. What was the diagnosis? What features led you to your choice? Where did the epithelium come from? What was the prognosis? Explain your answer. The presence of a c.t. wall lined with epithelium indicates the lesion was a cyst; the chronic inflammation suggests an inflammatory origin (i.e., presence of microorganisms). The association with a nonvital tooth clinches the diagnosis: it was an apical cyst. A radiolucency was discovered between the maxillary lateral incisor and cuspid teeth. Clinical examination revealed no swelling in the maxilla and no caries or large restorations in the central incisors. The anterior maxillary teeth responded normally to vitality tests. What should the dentist have done next? Assuming the lesion was eventually removed, what do you think the pathologist would have
  15. 15. Oral pathology reported. What was the prognosis? Explain your answer. Here is a radiolucency not associated with infected teeth (they were vital). The dentist should have arranged for the lesion to be removed and submitted for histologic examination. As you will see in future chapters, there are a number of possiblities in the differential diagnosis. Highest on the list is a globulomaxillary cyst. The pathologist would have reported a lesion with a central cavity lined with epithelium. Complete excision will be curative. Most odontogenic cysts are lined with stratified squamous nonkeratinizing epithelium. Sometimes they are lined with stratified squamous keratinizing epithelium. It is well-known that the behavior differs with keratinizing cysts. How does the prognosis differ? Why is the prognosis different? Explain your answer. When primordial or dentigerous cysts keratinize, their recurrence rate increases dramatically. It is the nature of lining that makes these cysts difficult to remove intact (i.e., it is thin, tortuous, and may have "cul-de-sacs").
  16. 16. Oral pathology NEOPLASMS Which of the following contains enamel and dentin? A. Ameloblastoma B. Nasolabial cyst C. Complex odontoma D. Ameloblastic fibroma E. Adenomatoid odontogenic tumor Of the following, which is most likely to recur after initial surgery? A. Ameloblastoma B. Complex odontoma C. Ameloblastic fibroma D. Globulomaxillary cyst E. Adenomatoid odontogenic tumor Of the following, which statement about osteosarcoma is true? A. It is a very common malignancy B. It often arises in osseous dysplasia C. It most commonly arises in young people D. It can be cured by conservative local excision Most ameloblastomas are located in the A. posterior maxilla. B. posterior mandible. C. midline of the mandible. D. maxillary anterior region. E. midline of the hard palate. Which of the following neoplasms typically manifests as a "sunburst" radiopacity?
  17. 17. Oral pathology A. Odontoma B. Osteosarcoma C. Ameloblastoma D. Metastatic malignancy E. Adenomatoid odontogenic tumor An odontogenic tumor consisting of miniature tooth-like structures is (DHNB88) A. an odontoma. B. an ameloblastoma. C. a condensing osteitis.. D. an odontogenic myxoma. E. a cementoma (periapical cemental dysplasia). Which one of the following features of ameloblastoma makes it necessary to treat all but the smallest by surgical excision with a border of normal bone? A. Reverse polarity of nuclei B. Infiltrative growth pattern C. Tendency for large lesions to be cystic D. Common association with an impacted tooth E. Tendency for regional lymph node metastasis An uncommon benign odontogenic neoplasm in which BOTH epithelial and connective tissue (parenchyma and stroma) components are neoplastic, which affects young people, occurs in the posterior mandible, and does not infiltrate the surrounding tissues is a(n) A. mixed tumor. B. ameloblastoma. C. ameloblastic fibroma. D. adenoid cystic carcinoma. E. odontogenic adenomatoid tumor (OAT).
  18. 18. Oral pathology A well circumscribed radiolucency was discovered surrounding the crown of an impacted maxillary cuspid tooth in a 13 year-old girl who lived in a rural community. The local dentist curetted the lesion and submitted it to a local hospital M.D. pathologist. The pathologist reported the neoplasm to be "ameloblastoma" and recommended en-bloc resection of the anterior maxilla. The dentist was disturbed by the diagnosis and asked the pathologist to send the slides to a university-based oral pathologist for review. Why was the dentist disturbed? Why did the dentist ask for a second opinion? Explain your answer. The dentist was disturbed because he/she knew that ameloblastomas do not occur in children. They also don't occur very often in the anterior maxilla. The dentist was correct in referring the slides to some more familiar with oral lesions. The lesion was probably the harmless odontogenic adenomatoid tumor (OAT). The ameloblastoma is a benign neoplasm. Nevertheless, large ameloblastomas are often treated by "radical" procedures such as hemimandibulectomy; smaller ones are treated with en-bloc resections. Why is such treatment appropriate for this neoplasm? Explain your answer. While ameloblastomas are benign, they can "push" into marrow spaces making them difficult to remove in one piece; therefore recurrences are high. To prevent recurrence surgeons may be forced to remove a piece of the mandible for very large ones and a block from the mandible for smaller ones.
  19. 19. Oral pathology Fibro-Osseous Despite presence at tooth apices, in which of the following diseases should pulp tests indicate that the associated teeth are nonvital? A. Fibrous dysplasia B. Simple bone cyst C. Osseous dysplasia D. Chronic apical periodontitis Which of the following conditions appears on surgery as an empty cavity in bone? A. Apical cyst B. Primordial cyst C. Simple bone cyst D. Osseous dysplasia E. Chronic apical periodontitis Exotoses, enostoses, and tori are comprised of which of the following tissues? A. Bone B. Glandular epithelium C. Peripheral nerve sheaths D. Fibrous connective tissue E. Adipose connective tissue A 50 year-old patient is found to have radiolucent/radiopaque lesions at the apices of the four lower incisor teeth. The teeth are vital. The most likely diagnosis is A. apical cysts. B. fibrous dysplasia. C. simple bone cysts. D. osseous dysplasia. E. chronic apical periodontitis (CAP). ???
  20. 20. Oral pathology A self-limiting fibrosseous developmental condition of young people that may cause a facial swelling that usually does not cross the midline, has a "ground glass" x-ray appearance is A. fibrous dysplasia. B. simple bone cyst. C. osseous dysplasia. D. ossifying fibroma. E. florid osseous dysplasia. The "salivary gland depression" most often occurs in the A. incisive canal. B. anterior maxilla. C. posterior maxilla. D. posterior mandible. E. maxillary cuspid area. Of the following, which disease is characterized by the presence of giant cells on microscopic examination? A. Cherubism B. Torus palatini C. Paget's disease D. Fibrous dysplasia E. Osseous dysplasia The radiolucent lesions that often accompany hyperparathroidism are typically filled with A. nothing. B. salivary gland tissue.
  21. 21. Oral pathology C. malignant epithelium. D. fibrous c.t. and bone spicules. E. vascular loose fibrous c.t. with giant cells. Some radiolucent lesions were noted on routine panoramic examination of a 44 year-old woman. The lesions were located in the anterior mandible immediately beneath the apices of the incisor teeth. They were fairly welldemarcated and, on closer examination, showed radiopacities as well. What conditions should the dentist have considered? What steps should the dentist have taken next to determine the exact nature of the process? What was the appropriate treatment for the most likely candidates? What was the prognosis for the most likely candidates? Explain your answer. Given the location, mixed radiopaque and radiolucent appearance, osseous dysplasia the most likely diagnosis with the unlikely possible of apical cysts or chronic apical periodontitis completing the list (the opacities almost surely rule them out). Pulp vitality test is the next order of business. If they are vital, the diagnosis of osseous dysplasia is confirmed. No treatment is necessary for osseous dysplasia. A 54 year-old man asked his dentist to investigate some "bumps" in his mouth. Examination revealed projections extending from the midline of the hard palate and from the anterior lingual surface of the mandible, bilaterally. The projections were hard and covered with normal-appearing mucosa. How long do you think the "bumps" were present? What was the relationship, if any, of the maxillary and mandibular lesions? What were they made of? What was the prognosis? What treatment was appropriate? The location and consistency of the lesions indicate that they most assuredly were tori palatini and tori mandibularis. The same "lesions" can occur in either site. They consisted of normal bone. They are harmless "lesions" and do not need to be treated unless denture construction is contemplated.
  22. 22. Oral pathology In reviewing panoramic radiographs of a 16 year-old girl, a dentist noted bilateral radiolucencies in the posterior mandible. The radiolucencies were located between the inferior alveolar nerve canal and the inferior border of the mandible in the region of the second molar teeth. The dentist expressed his concern about finding the lucencies and recommended that an oral surgeon enucleate each and submit the tissue for microscopic examination. Was the dentist's analysis correct? Would you have recommended something else? What do you think the lucencies were? Explain your answer. Bilateral lesions are often of developmental origin. The location in the posterior mandible near its inferior border suggest that the "lesions" were "salivary gland depressions" ("Stafne bone depressions, etc.). The dentist's analysis was incorrect. If there is doubt, injection of radiopaque dye into the submandibular gland will show extension into the "lesion."
  23. 23. Oral pathology Oral Cancer Of the following, which is a reversible slight variation in cellular size and shape that will surely become irreversible and life-threatening if is not removed? A. Anaplasia B. Dysplasia C. Neoplasia D. Hyperplasia E. Parakeratosis Of the following which is the LEAST common site for the development of an oral squamous cell carcinoma? A. Soft palate B. Dorsal tongue C. Lateral tongue D. Ventral tongue E. Floor of the mouth Which of the following indicates the probable development of oral squamous cell carcinoma? A. Carcinoma-in-situ -> mucosal dysplasia -> invasive squamous cell carcinoma. B. Mucosal dysplasia -> carcinoma-in-situ -> invasive squamous cell carcinoma. C. Invasive squamous cell carcinoma -> carcinoma-in-situ -> mucosal dysplasia D. Mucosal dysplasia -> invasive squamous cell carcinoma -> carcinoma-insitu E. Carcinoma-in-situ -> invasive squamous cell carcinoma -> mucosal dysplasia
  24. 24. Oral pathology "Leukoplakia," as defined by the USC pathology faculty, is synonymous with which of the following? A. Red patch B. White patch C. Hyperkeratosis D. Carcinoma-in-situ E. Mucosal dysplasia Examination of a 54 year-old male revealed a diffuse whitening of the hard palate and many small elevated mounds with red centers. The most likely etiology for the condition is A. Alcohol abuse B. Heavy smoking C. Reaction to stress D. Denture irritation E. Autoimmune disease With regard to oral squamous cell carcinoma, which statement regarding the relationship to lesion size and invasion/metastasis is true? A. Larger lesions = better prognosis B. No relationship between size and prognosis C. Smaller lesions = lower chance of invasion and metastasis D. Smaller lesions = higher chance of invasion and metastasis E. No relationship between size and invasion and metastasis Which is the LEAST common site for the occurence of oral squamous cell carcinoma?
  25. 25. Oral pathology A. Lateral tongue B. Ventral tongue C. Buccal mucosa D. Floor of mouth E. Soft palate and tonsillar pillars A dentist discovered an area of leukoplakia and erythroplasia on the ventral surface of the tongue of a 54 year-old woman. The lesion covered an area of 2.0 x 1.5 cm., was painless, and was made up of alternating irregular white and red patches. Further examination revealed no additional findings. Examination of the neck revealed nothing abnormal. An incisional biopsy was performed. The pathologist reported that "many cells in the stratum basale and lower stratum spinosum showed nuclear pleomorphism and hyperchromatism along with a general loss of polarity. There was no extension of these changes below the basement membrane." What was the most likely diagnosis? What was the prognosis? Was any further treatment necessary? What etiologies should have been considered? Explain your answer. Cell changes were restricted to the lower epithelial layers and there was no invasion; therefore the diagnosis that fits these features is "mucosal dysplasia." Since incisional biopsy was performed, excision of the remain lesion is necessary. Cigarette smoking and/or alcohol abuse is usually associated with lesions of this kind. A 65 year-old man visited a dentist because of a "sore in his mouth." The dentist saw a reddish, granular lesion with a depressed center that seemed ulcerated. The lesion measured about 2.0 cm. in diameter. On palpation, the lesion was firm and "fixed" to the surrounding tissues. The patient was referred to an oral surgeon to have a biopsy performed. Prior to the biopsy, the oral surgeon palpated a firm, painless 2.0 cm. mass on the left neck. Subsequently a pathologist reported the oral lesion to be "invasive squamous cell carcinoma." What did the pathologist mean by that diagnosis? What do you think the treatment was to rid the patient of this disease? What was the prognosis? Explain your answer. The patient had a malignancy that showed microscopic evidence of invasion
  26. 26. Oral pathology into the underlying c.t.; also clinically the "fixation" of the neoplasm to the surrounding tissue also indicated that invasion occured. The detection of a neck mass indicated that metastasis to regional lymph nodes has occured. Given the extent of the disease, a radical surgical procedure was required. The prognosis was poor.
  27. 27. Oral pathology Other Keratotic Fordyce granules are composed of: A. Salivary glands B. Sebaceous glands C. Adipose connective tissue D. Hematopoietic bone marrow E. Hyperplastic filiform papillae Wickham's striae are associated with which of the following diseases? A. Hairy tongue B. Lichen planus C. Fordyce's disease D. Mucosal dysplasia E. Geographic tongue Of the following, which is NOT located on the dorsum of the tongue? A. Hairy tongue B. Lingual tonsils C. Geographic tongue D. Median rhomboid glossitis E. Prominent circumvallate papillae The reticular form of lichen planus manifests as A. blisters and ulcers. B. thin white intersecting lines. C. enlarged circumvallate papillae. D. thick plaque-like keratotic lesions. E. hair-like projections from the tongue dorsum
  28. 28. Oral pathology A relatively common oral keratotic condition that has a persumed stress-related or autoimmune origin and that may be accompanied by lesions on the flexor surfaces of the extremities is A. lichen planus. B. actinic cheilosis. C. nicotine stomatitis. D. mucosal dysplasia. E. geographic tongue. Yellowish, pin-point spots on the buccal mucosa and anterior vestibules composed of sebaceous glands are A. hemangioma. B. lingual tonsils. C. Fordyce's granules. D. median rhomboid glossitis. E. congenital epulis of the newborn. Enlarged lingual tonsils are most likely to resemble which of the following? A. Epulis fissuratum B. Lingual varicosities C. Squamous cell carcinoma D. Median rhomboid glossitis E. Prominent circumvallate papillae A "bald area" in the midline of the posterior dorsum of the tongue most likely represents A. lingual tonsils.
  29. 29. Oral pathology B. Fordyce's granules. C. globulomaxillary cyst. D. squamous cell carcinoma. E. median rhomboid glossitis A dentist noted an unusual lesion on the buccal mucosa of a 32 year-old woman. Closer examination revealed irregular white intersecting lines on both buccal mucosae. The lesions were asymptomatic and the patient denied the use of alcohol or tobacco. What was the most likely clinical diagnosis? What should the dentist have done next? What was the prognosis? Bilateral occurrence of "Wickham's striae" are very suggestive of lichen planus. Alcohol and tobacco are not related to the onset of this disease. An incisional biopsy is warranted to confirm the diagnosis. This is a chronic disease that does not threaten life; the prognosis is good. Compare (a) reticular lichen planus and (b) geographic tongue with regard to (1) location, (2) relationship to "stress," and (3) prognosis. (1) Reticular lichen planus (intersecting lines pattern) often occurs on the buccal mucosa -- it may occur on the tongue dorsum; geographic tongue always occurs on the tongue dorsum; (2) "stress" has been suggest as an component of etiology in both conditions; (3) both have an excellent prognosis, however, reticular lichen planus may develop into the more painful erosive form.
  30. 30. Oral pathology Blistering The lesions of which of the following diseases are the result destruction of desmosomes by the patient's antibodies with resultant formation of clefts within the stratum spinosum of skin and/or oral mucous membrane? A. Pemphigus vulgaris B. Minor aphthous stomatitis C. Primary herpetic gingivostomatitis D. Recurrent herpetic gingivostomatitis E. Benign mucous membrane pemphigoid Which of the following conditions appears as vesicles only on the lips and the oral mucosa attached to bone (masticatory mucosa)? A. Geographic tongue B. Minor aphthous stomatitis C. Major aphthous stomatitis D. Primary herpetic gingivostomatitis E. Recurrent herpetic gingivostomatitis Which of the following conditions is easily transmitted in crowed living conditions? A. Lichen planus B. Geographic tongue C. Aphthous stomatitis D. Median rhomboid glossitis E. Primary herpetic gingivostomatitis Of the following which is a "fluid-filled blister smaller than one centimeter (1.0 cm) in diameter"? A. Bulla B. Ulcer
  31. 31. Oral pathology C. Nodule D. Vesicle E. Granuloma Which of the following diseases may be fatal? A. Herpes whitlow B. Aphthous stomatitis C. Pemphigus vulgaris D. Recurrent herpetic gingivostomatitis E. Benign mucous membrane pemphigoid Which of the following is the usual way the lesions of pemphigus vulgaris appear? A. Oral lesions do not appear at all B. Skin lesions do not appear at all C. Oral and skin lesions appear simultaneously D. Skin lesions appear first, then oral lesions appear E. Oral lesions appear skin lesions appear "Lymphadenopathy" is a term used to describe A. enlargement of lymph nodes. B. formation of a lymphangioma. C. formation of a purulent exudate. D. accumulation of lymphocytes in connective tissue. E. enlargement of ulcers in major aphthous stomatitis. After primary herpetic gingivostomatitis, the herpesvirus may remain dormant in (DHNB88) A. epithelium.
  32. 32. Oral pathology B. sensory ganglia. C. connective tissue. D. the blood stream. "Herpes whitlow" is A. infection with HSV-1 around the finger nails. B. severe scarring associated with major aphthous stomatitis. C. swelling of lymph nodes in acute herpetic gingivostomatitis. D. involvement of minor salivary glands in periadenitis aphthae. E. sloughing ("shedding") of the oral mucosa in pemphigus vulgaris. Differentiate between secondary herpetic gingivostomatitis and minor aphthous stomatitis with regards to (1) etiology, (2) signs and symptoms, (3) clinical appearance, and (4) prognosis. Secondary herpes is a stress-related re-eruption of HSV-1 while there is no virus involved in aphthous stomatitis. Herpes is associated with multiple vesicles that become ulcers while aphthae start as painful ulcers. Both will resolve in 7-10 days. Briefly compare (a) erosive lichen planus, (b) benign mucous membrane pemphigoid, and (c) pemphigus vulgaris with regard to (1) possibility of skin lesions, (2) possibility of a fatal outcome, and (3) possibility of eye involvement. (1) Erosive lichen planus and pemphigus vulgaris may have accompanying skin lesions; (2) only pemphigus vulgaris is a potentially fatal disease; (3) only benign mucous membrane pemphigoid may be accompanied by eye lesions.
  33. 33. Oral pathology Reactive A "pregnancy tumor" is not a tumor at all but only a A. irritation fibroma. B. epulis fissuratum. C. pyogenic granuloma. D. peripheral granuloma. E. epulis granulomatosum. An irritation fibroma is composed of A. granulation tissue only. B. misplaced sebaceous glands. C. granulation tissue and giant cells. D. dense fibrous connective tissue only. E. dense fibrous connective tissue and giant cells An common firm, pale, pink lesion of the buccal mucosa that often is caused by cheek biting is a(n) A. irritation fibroma. B. epulis fissuratum. C. pyogenic granuloma. D. peripheral granuloma. E. inflammatory papillary hyperplasia. A large mucous escape reaction in the floor of the mouth is a(n) A. ranula. B. mucocoele. C. irritation fibroma. D. epulis granulomatosum. E. inflammatory papillary hyperplasia.
  34. 34. Oral pathology A patient presented with a red ‫ذ‬purple sessile lesion on an interdental papilla. The lesion was about 0.5 cm. in diameter, was soft, bled easily, and was relatively painless. Of the following, the most likely diagnosis was A. epulis fissuratum. B. pyogenic granuloma. C. mucous escape phenomenon. D. irritation fibrosis ("fibroma"). E. peripheral fibroma ("granuloma"). In which condition are mature fibroblasts and dense collagen least likely to be found on microscopic examination? A. Irritation fibrosis B. Epulis fissuratum C. Pyogenic granuloma D. Peripheral fibroma (granuloma) E. Inflammatory papillary hyperplasia Which of the following lesions does NOT typically consist of granulation tissue? A. Irritation fibrosis B. "Pregnancy tumor" C. Pyogenic granuloma D. Epulis granulomatosum E. Giant cell reparative granuloma In which condition are mature fibroblasts and dense collagen LEAST likely to be found on microscopic examination? A. Irritation fibroma B. Epulis fissuratum
  35. 35. Oral pathology C. Pyogenic granuloma D. Peripheral fibroma (granuloma) E. Inflammatory papillary hyperplasia Patient A has a soft, red-purple enlargement of the gingiva that bleeds easily but was relatively painless on probing Patient B has a firm, pinkish enlargement in a similar location that does not bleed but was painful on probing. What was it about the two lesions that explains the difference in color, texture and tendency to bleed? Explain your answer. Lesion "A" was probably composed of granulation tissue while lesion "B" was probably composed of dense fibrous c.t. Granulation has many blood vessels while dense c.t. does not. A 12 year-old boy presented at the dentists office with a "blister" on the lower lip. Examination revealed a solitary (there was only one) soft, bluish, enlargement of the surface of the lip that measured about 1 cm in diameter. Orthodontic brackets had been recently placed on the lower teeth. What condition does this lesion most likely represent? What would most likely be found on microscopic examination? Explain your answer. Given the history of potential irritation to the area and the clinical features,the lesion was probably a mucocoele. It was caused by damage to a minor salivary gland duct that leaked saliva into the surrounding connective causing a foreign body reaction. Microscopically, there would be a central pool of saliva surrounded by a wall of chronic inflammation and fibrous c.t.
  36. 36. Oral pathology Submucosal Neoplasms Of the following, which neoplasm is most likely to be the cause of multiple disfiguring skin nodules, pigmented skin splotches and deep seated masses? A. Hemangioma B. Neurofibroma C. Neurilemmoma D. Granular cell tumor E. Squamous papilloma Which of the following features represent the most likely reason for the poor longterm prognosis of patients with adenoid cystic carcinoma? A. Lesion spreads early and wide B. Lesion usually large when discovered C. Malignant epithelial cells invade nerves D. Malignant epithelial cells are poorly differentiated E. Lesion appears clinically benign delaying diagnosis A malignant salivary gland neoplasm that can manifest in "high grade (malignant)" or "low grade (more benign)" forms: A. Mixed tumor B. Hemangioma C. Neurilemmoma D. Adenoid cystic carcinoma E. Mucoepidermoid carcinoma Which of the following neopolasms do many oral pathologists consider BOTH the parenchyma and stroma to be neoplastic? A. Hemangioma B. Neurilemmoma C. Squamous papilloma
  37. 37. Oral pathology D. Squamous cell carcinoma E. Mixed tumor of salivary glands A 3.0 x 1.5 cm submucosal lesion was discovered in the left hard palate. The overlying mucosa is the same color as the surrounding tissue and shows no signs of ulceration, discoloration, or other change. Assuming that this lesion arose in this location, which is the LEAST LIKELY possibility? A. Mixed tumor B. Neurilemmoma C. Squamous cell carcinoma D. Adenoid cystic carcinoma E. Mucoepidermoid carcinoma "A developmental overgrowth of tissues native to a part" defines A. anaplasia. B. dysplasia. C. neoplasia. D. hamartoma. E. carcinoma-in-situ. An enlarged tongue was discovered in an infant. The left dorsum and lateral surface has a shaggy texture and a surface made up of clear, bubbly nodules. Of the following, which is the most likely diagnosis? A. Mixed tumor B. Lymphangioma C. Benign keratosis D. Squamous papilloma E. Granular cell tumor (congenital epulis of the newborn)
  38. 38. Oral pathology Of the following, which is the most likely to be responsible for "birthmarks" often described as "port-wine stains" or "strawberry nevi?" A. Lipoma B. Hemangioma C. Osteosarcoma D. Neurofibroma E. Mucosal dysplasia A palatal swelling was discovered on intraoral examination in a 55 year-old man who sought care for canker sores in the "roof of his mouth." The swelling extended from the midline into the left hard palate and measured about 4-5 cm. in dimensions. There were two deep ulcers on the overlying mucosa. The patient didn't know how long the swelling had been present, but did complain of some pain as from and some numbness in the "roof of his mouth." An incisional biopsy was performed. The pathologist reported the presence of malignant ductal epithelial cells arranged in sheets possessing a "honeycombed" appearance. The lesion was not encapsulated and there was evidence of "perineural invasion." What was the diagnosis? What should have been done next? What was the explanation for the numbness? What was the prognosis? The patient had a large ulcerated lesion of the hard palate, common location for salivary gland neoplasms. The biopsy revealed an malignant epithelial tumor with a honey-combed appearance, the classic features of adenoid cystic carcinoma. The perineural invasion was also typical of ACC and was responsible for the paresthesia. The prognosis is poor. A palatal swelling was noted in a 54 year-old man. The swelling measured about 3 x 2 cm. and extended about 0.5 cm. above the surrounding mucosa. It was located in the left posterior hard palate and extended posteriorly into the soft palate. The overlying mucosa appeared normal in color and configuration. An incisional biopsy was performed. The pathologist reported the swelling was "...surrounded by a dense band of c.t. The central part was composed of well-differentiated duct epithelium in a stroma composed of areas of dense fibrous c.t., loose c.t., and small islands of cartilage. There was no evidence of anaplasia or of extension of neoplastic cells into or beyond the capsule." What was the most likely diagnosis?
  39. 39. Oral pathology What should have been done next? What was the prognosis? The histologic and clinical appearance indicate that this was a benign mixed tumor. Since the diagnosis was made on incisional biopsy, the lesion needs to be removed entirely. If removed completely this lesion should not recur; therefore, the prognosis is excellent.