oral pathology
Posted on Dec 21, 2018 in Medicine & Health
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Meiosis: 2-step cellular
division of primitive germ cells (46, diploid)
mature germ cells (23, haploid)
Lyon
Hypothesis: genetic activity of 1 of the X chromo in each cell of a
female embryo; when X chromo in female is inactivated = Barr body forms; X chrome
dispersed into nucleus; gross abnormalities
Trisomy
21: Down Syndrome; 3 identical chromo at the same allele; most
frequent; fissured tongue; macroglossia, slanted eyes, low IQ, hypodontia
Trisomy 13: poor prognosis; 3
chrom on 13;
bilateral cleft lip/palate, microphthalmia/anopthalmia
Karyotype: a photographic representation of of
a person’s chromosomal make-up; gross abnormalities
Turner
Synd:
lack X chromosome from father; no Barr bodies on smear
; webbed neck, short statue
Klinefelter: extra X chrom in males; hyper
plastic max
Cat Cry (Cri Du Chat):
severe mental retardation
Autosomal-Dominant
Inheritance:
males/females equally affected; 50% of passing on condition
Autosomal-Recessive
Inheritance:
both parents of the affected child must be carriers of the trait
Papillon-Lefevre Synd: hyperkeratosis of the
palms of the hands & soles of the feet; edema, bleeding, alveolar bone
resorption, mobility of teeth; both sets of teeth are lost premature
Gingival
Fibromatosis: gingival
hyperplasia, excessive hair, multiple fibromas/very firm, granulated,
corrugated gingival surface
Laband Synd:
ADI; gingival fibromatosis (absent nails, ear & nose tissues), gingival
hyperplasia, short fingers
Cherubism:
bilateral enlargement of face, multiple radioluc of giant cell tumors/soap
bubble appearance
Congenital Epulis:
xtra kiss on max ridge/present @ birth
Cleidocranial
Dysplasia:
supernumerary teeth (crowded in jaws & don’t erupt), multiple cysts of md;
uni/bilateral hypoplasia of clavicles
Garner
Synd: supernal tth, multiple odontomas, polyps a concern
Treacher-Collins Synd (Md Facial Dysostosis): fish
shaped mouth/high arched palate, crowded tth, poor facial features, deafness
due to poorly formed structures, hypo plastic md
Osteogenesis
Imperfecta:
abnormally formed bones that fracture easily; blue sclera
DentinogenesisImperfecta: grey ->
opalescent dentin; no pulp chambers/rt canals seen; roots are short, tth
fracture easily b/c poor dentin formation
Cleft
Lip/Palate: multi factorial in nature; affects 1 in 800 births
Peutz-Jehger Synd:
must melanotic macules of the skin, eyes, oral mucosal tissue, intestinal
polyps
White Sponge Nevus: thick
layer of keratin that desquamates & leaves raw mucosal surface; free
gingiva not affected
Ectodermal Dysplasia:
partial anodontia (hypodontia); decreased hair; hearing loss (hypotrichosis);
can’t sweat (hypohidrosis); hearing loss
Hypophosphatasia:
decrease in serum alkaline phosphatase levels; no cementum & exfoliate
prematurely esp md incisors
Hypophosmatemic
Vitamin D – Resistant Rickets: dentin has cracks = pulpal infections
Taurodontism: bulls tth, large pulp
chambers, found in Klinefelter
Amelogenesis Imperfecta:
Type I: enamel does not
develop to a normal thickness; Type II: hypocalcified
AI; Type III: hypomaturation AI: softer
enamel, snow-capped
Marfan Synd:
slender build with long extremities, fish-like max, crowded tth, high max arch
Elhlers-Danlos Synd: CT disorder, flexible
joints, healing concerns due to collagen, affects skin, blood vessels, joints
Pleomorphic: varies size
Hyperchromatic: dark nuclei, increase nuclei
to cytoplasm ratio
Types of epic tumors:
squamous, salivary, odontogenic
Papilloma:
epi growth or sessile
HPV (papilloma):
verruca vulgarism (common wart):
strain 3, 4;
Condyloma acuminatum: sex
transmit strains 6, 11;
Orapharngeal
found/malignancy: strains 16, 18
Erythroplakia:
undiagnosed red patch, high potential for dysplasia
Leukoplakia:
undiagnosed white patch; most common site = dental of tongue, floor of mouth,
uvula/soft palate
Verrucas carcinoma:
squamous cell carcinoma, buccal mucosa
Basal Cell Carcinoma: high cure rate
Pleomorphic adenoma: salivary gland material,
palate
Ameloblastoma: slow growing,
invasive & aggressive, has epic & ameloblast cells, posterior md;
primordial cysts can turn into ameloblastomas
Calcifying
odontogenic cyst: cyst lined w/ ghost cells, uni/multiocular
Cementoblastoma: occurs most in md,
hypercementosis, found on rt, well defined lesion on rt apices
Odontoma (Odontogenic tumor): common areas ant
mx, posterior md, children & young adults; made of dentin, cementum, enamel
structures;
Compound: ant max, resembles teeth;
Complex: post md;
failure of tooth eruption
Lipoma: fat
cells, buck mucosa, vestibular area
Neurofibroma/
Schwannoma: prolix Schwann cells, tongue
Peripheral ossifying fibroma: derived from
cells of PDL, contains fibrous CT, found on gingival tissue
Fibroma (granula cell tumor): fibers tissue,
found on tongue & buccal mucosa, painless
Hemangioma:
vascular lesion, blue in color, capillary prolif, common = tongue then lips,
bucc mucosa
Karposi Sarcoma: malig,
HIV pt, common site = hard palate, caused by herpes virus
Melanoma: blue/black mass, aggressive, common
= palate & max ridge
Melanotic nevi:
well defined colored lesion
Osteoma:
ben bone mass, common in Gardner Syn
Osteosarcoma:
malign bone mass
Chondrosarcoma:
cartilage malig
Multiple myeloma:
Bence Jones Proteins (immunoglobulins) found in urine
Rhabdomyosarcoma: soft tissue tumor of
head/neck in children, most common, aggressive, poor prognosis
Dysplasia: abnormal & disordered
production of cementum & bone; abnormal cellular replication
Periapical Cemento-Osseous Dysplasia: common
disease of unknown cause that affects PA bone; anterior md 30+; circumscribed
& radiolucent, overtime they become calcified; teeth affected are vital;
hist exam shows fibro-fibr-osseous lesion composed of fibrous tissue &
calcifications; early lesions consist of mainly fibrous tissue, where older
lesions contain numerous calcifications; no treatment
Fibrous Dysplasia: developmental, replacement
of bone w/ abnormal fibrous CT; painless; progresive unilateral enlargement of
md or max; malocclusion due to expanding bone; radiopacities resembles
“ground glass”; lesions primarily radiolucent contain much fibrous CT;
cafe au lait spots
Paget Disease of Bone:
chronic metabolic bone disease; resorption, osteoblastic repair, &
remineralization of involved bone; maybe due to a virus; men 50+; max > md;
enlargement of bone; pain; cotton wool; hypercementosis, loss of lamina dura,
& obliteration of PDL can occur; serum alkaline phosphatase level is
elevated in active disease; treatment = bisphosphonate
Central Giant Cell Granuloma: vasculated
fibrous CT w/ giant cells; surgical removal; occurs in ant portion of max/md
(more common in md)
Aneurysmal Bone Cyst:
pseudocyst (no epic cells); blood-filled spaces w/ multinucleate giant cells &
fib CT; X-rays = honeycomb/soap bubbles
Osteomalacia:
result of Vitamin D deficiency & induced by certain tumors; rickets
Hyperpituitarism: excess hormone production by
the anterior pituitary gland; caused by ben tum, a pituitary adenoma, that
produces growth hormone; gigantism occurs before the closure of long bones;
acromegaly occurs when hyper secretion occurs during adult life; enlargement of
hands & feet; facial changes; macroglossia & thick lips; diagnosis =
measurement of growth hormone; untreated: diabetes, CVD, respiratory disease,
colon cancer
Hyperthyroidism: excess
production of thyroid hormone; Graves disease is an autoimmune disorder in
which antibodies, thyroid-stimulating; excessive sweating, bulging eyes
(exophthalmos), fine hair; premature exfoliation of deciduous teeth in children
& premature eruption of perm teeth, osteoporosis may affect alveolar bone,
burning tongue; treatment = medications to suppress thyroid activity,
administration of radioactive iodine
Hypothyroidism:
decreased output of thyroid hormone, causes = developmental disturbances,
autoimmune destruction of thyroid: Hashimoto thyroiditis, iodine deficiency, drugs,
treatment for hyperthyroidism; enlarged tongue
Hyperparathyroidism:
results from excessive secretion of parathyroid hormone (PTH) from parathyroid
glands; PTH plays a role in calcium & phosphorus metabolism;
hypercalcemia: elevated blood levels of calcium;
hypophosphatemia: low levels of blood
phosphorus; middle-aged adults; PTH increased the uptake of dietary calcium
from the GI tract & is able to move calcium from bone to circulating blood
when necessary; bone changes: loosening of teeth; well-defined uniocular or
multi ocular radiolucencies; “ground glass” appearance, loss of lamina dura;
lesions appear to be central giant cell granulomas (CGCGs); measurement of PTH
blood levels, to include serum calcium & phosphorus measurements
Diabetes Mellitus:
abnormally high blood glucose levels;
Hyperglycemia:
high blood glucose levels; results from a lack of insulin, defective insulin
that does not work to lower blood glucose levels, or increased insulin
resistance caused by obesity; glucose signals beta cells of the pancreas to
make insulin; insulin secretes into blood stream to make the uptake of glucose
into fat & skeletal muscle; fat & skeletal muscle cells can use glucose
as an energy source; absence of glucose = cells starved of energy; (
ketoacidosis: production of ketone
acid/ketones that lowers the blood pH; most common endocrine disease in the US;
breakdown of fatty tissue leads to production of ketone acid/ketones (large
cells); ketone acid lowers the blood pH; acute condition can lead to coma &
death; complications with organ systems = blindness, end-stage kidney failure,
parathesia or numbness; Atherosclerosis of large & medium-size blood
vessels: microvascular disease; diagnostic = fasting blood glucose > or
equal to 126 mg/dL
Prediabetes:
fasting blood glucose 100-125 mg/dL
Type 1:
Insulin-Dependent Juvenile Diabetes: autoimmune disease; associated
with Addison disease, Graves disease, pernicious anemia; insulin-producing
cells of the pancreas are destroyed; pts need insulin forever;
hypoglycemia: low blood sugar;
severe hypoglycemia: insulin shock; treatment
= oral hypoglycemic medications, insulin pump, drugs available today =
(Metformin, Glibizide, Glyberide, Victoza, Trulicity), injectible insulin =
(humalog, novolog, apidar, glucagon, reverses blood sugar level if too low as a
result of insulin tx)
Type 2: Non-Insulin
Dependent & Non-insulin dependent Diabetes Mellitus: insulin
resistance; gradual onset; 35-40+; weight gain; obesity decreases the # of
receptor for insulin binding in fat & muscle
Gestational
Diabetes: occurs during pregnancy; disappears after pregnancy;
increased birth weight of child = macrosomia; mother & child have higher
risk of developing type 2; vascular system adversely affected; decreased
resistance to infection; atherosclerosis causes impaired oxygenation &
nutrition in tissue; diabetic retinopathy in the eye can lead to blindness; NS
can be affected (neuraopathy); can have decreased resistance to infection; oral
candidiasis, fungal infections in general (sugar = yeast), xerostomia,
periodontal disease, accentuated response to plaque, slow wound healing,
increased susceptibility to infection
Addison
Disease (Primary Hypoadrenocorticism): insufficient production of
adrenal steroids; causes = malignant tumor, tuberculosis, deep fungal
infections, HIV infection, AI disease, unknown; to compensate, the pituitary
gland increases production of adrenocorticotropic hormone (ACTH); melanotic
macule on oral mucosa; treatment = steroid replacement
Hypercortisolism (Cushing Syndrome): caused by
sustained increase in glucocorticosteroid levels; develops slowly; weight gain;
hypertension, hyperglycemia, mood alterations, decreased ability to respond to
stress
Anemia: reduction in the
oxygen-carrying capacity of blood; related to a decrease # of circulating RBC;
pallor of skin & oral mucosa, angular cheilitis, erythema & atrophy of
oral mucosa, loss of filliform & fungiform papillae on the dorsal of the
tongue
Iron Deficiency Anemia:
insufficient amount of iron is supplied to bone marrow for RB development;
Plummer-Vinson syndrome may result from long-standing iron deficiency anemia;
lab tests show low hemoglobin content & reduced hematocrit;
hematocrit: volume of RBC in blood; treatment
= dietary supplements
Pernicious Anemia:
caused by deficiency in intrinsic factor; probably an autoimmune disorder in
most situations; vitamins B12 is needed for DNA synthesis; weakness, pallor,
fatigue on exertion, nausea, dizziness, diarrhea, abdominal pain, loss of
appetite, weight loss; angular cheilitis, painful, atrophic, & erythematous
mucosa, mucosal ulceration, loss of papillae on the dorsum of the tongue,
burning & painful tongue; schilling test detects an inability to absorb
oral vitamin B12; treatment = injection of vitamin B12
Folic Acid & Vitamin B12 Deficiency Anemia:
from dietary deficiencies, malnutrition, increased metabolic requirements,
alcoholism/pregnancy
Thalassemia (Mediterranean
or Cooley Anemia): inherited disorder of hemoglobin synthesis,
autosomal dominant inheritance pattern; yellow skin pallor, enlarged spleen
& liver, prominent cheekbones, prominent maxilla, “salt-&-pepper” pattern,
thinning of lamina dura, circular radiolucencies in alveolar bone
Sickle Cell Anemia: inherited blood disorder; black individuals,
Mediterranean, or asian origin; RBCs
develop a sickle shape when there is decreased oxygen; triggered by exercise,
exertion, admin of general anesthetic, pregnancy, or even sleep; most common
inherited disorder of RBC; can be present as early as 6 months of age; joint
pain, heart enlargement & cardiac failure; loss of trabeculation, &
large, irregular marrow spaces appear; treatment = admin of oxygen
Aplastic Anemia: severe
depression of bone activity causes a decrease in all circulating blood cells:
pancytopenia; life-threatening blood disorder; low platelets: bruising,
hematoma, ecchymosis (bruising of the skin), retinal & cerebral
hemorrhages; WBC essential in defense again infection; infection, spontaneous
bleeding, petechia, purpuric spots;
leukopenia:
decrease in WBC,
thrombocytopenia: decree
in platelets
Polycythemia: increase
in # of circulating RBC
Polycythemia Vera
(Primary Polycythemia): itching
of skin: pruritus, vascular stasis, poor circulation, thrombocytopenia; deep
red to purple oral mucosa, gingiva = edematous & bleeds easily, submucosal
petechiae, ecchymosis, hematoma formation; lab testing & measurement of
hemoglobin & hematocrit
Disorders of WBC:
3 founds found in circulation (1) granulocytes (polymorphonuclear leukocytes
(neutrophils), eosinophils, basophils) (2) lymphocytes (3) monocytes
Agranulocytosis: reduction in circulating
neutrophils;
leukopenia: abnormally low WBC count;
neutropenia:
reduction in the # of circulating neutrophils; results from a problem in
development of neutrophils or accelerated destruction of neutrophils
Cyclic Neutropenia: rare form of
angrulocytosis; severe depression of neutrophils cyclically; gingival
inflammation, ulceration of tongue, ulceration of mucosal tissue,
gingivalstomatitis; protect pt from opportunistic infections
Leukemia: malignant neoplasms of hematopoietic
(blood forming) stem cells; excessive # of abnormal WBC in circulating blood
Acute Leukemias: immature cells & rapidly
fatal course if not treated
Acute lymphoblastic
leukemia: immature lymphocytes,
children & young adults;
Acute myleoblastic
leukemia: immature granulocytes, not good prognosis; sudden &
dramatic onset, weakness/fatigue caused by anemia, enlargement of lymph nodes,
thrombocytopenia: decrease in platelets;
gingival enlargement caused by infiltration of leukemic cells; treatment = bone
marrow transplant
Normal platelet count:
200,000-400,000/mm3
Bleeding time (platelet
function): 1-6 min
PT (prothombin
time): 11-16sec
INR (internal natural
ratio value): 2-3 used to monitor anticoagulant tx (coumadin)
Purpura: red/blue discoloration of skin/mucosa
due to tissue bleeding; submucosal bleeding if larger; petechia
Thrombocytopenic purpura: bleeding disorder
from low platelet
Hemophilia:
inherited disorder of blood coagulation;
Type A
and B: x-linked recessive trait, males predominantly;
Type A: most common form
Type B:
Christmas disease, less common form
Von
Willebrand Disease: most common
form of all inherited bleeding disorders; men & women
Osteonecrosis: due to radiation of head/neck;
due to decreased blood supply to bone (less oxygen)
Chem
TX: oral mucositis, candida, Low WBC for dental TX considerations
MRONJ (Med.
Related Osteonecrosis of the Jaw): biophosphonate tx;
Fosamax; always begins as a blister, trauma, mandible most affected
Sequestration: exfoliation of bone fragment,
from tooth extraction/osteonecrosis
Osteomyelitis:
bone infection of the jaw, prob from PA infection
Meds
Affecting Gingiva: Dilantan (Phenytoin), Procardia (Nifedapine),
Calcium channel blockers, beta blockers — all cause hyper plastic tissue
Burning Mouth Disorder:
xerostomia, diabetes, candida, mouth breather, meds, oral mucositis (NOT
ALLERGIES)
Dysgeusia: altered taste
Trigeminal Neuralgia (Tic Douloureux):
5th cranial nerve, sharp/shooting/stabbing pain, electric shock-like pain,
unilateral max trigeminal nerve is affected, pt’s have trigger points; when
touched or temp change can trigger episode; pain raged by tegratol, Neurontin
Bell’s Palsy: 7th cranial nerve, unilateral
facial paralysis; may be triggered by a virus; unable to blink, smile, speech
issues; resolve in 1-2 months or 6 months
TMJ
disorders: pain, restricted opening, crepitus (audible sound when
opening (clicking, crackling)); diagnostic (MRI, panorex, CT scan); pt hx &
clinical eval very important
Trismus:
unable to open mouth fully
Subluxation:
hyper
