oral pathology

Write your text here!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 @ birthCleidocranial 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 boneSickle 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