PBL Exam 2

Ground Glass Radiopacity and Chinese Character are features of what disease

Fibrous Dysplasia

Why was the pt in the case not diagnosed with McCune Albright Syndrome

The pt only had monostotic fibrous dysplasia

McCune Albright involves polystotic, cafe-au-lait, and Endocrine issues (at least 2)

What happens to the bone in sclerotic phase

Bone becomes dense and hypovascular

Prone to osteomyelitis

How is pagets disease ruled out through lab value?

ALP level being normal would eliminate Pagets disease

What kind of COD do you see in middle aged black female

Florid COD

Soap bubble appearance is associated with what disease?

Ameloblastoma Multicystic

What is the 3 criteria of MRONJ

Current or previous treatment of bisphosphonates or denosumab

Exposed bone

No history of radiation

What does empty howship lacunae means

Osteocytes had died

What does Ginkgo biloba potentially cause

Uncontrolled bleeding

Same with garlic, ginger

What does palisaded basal cels indicate (fence)

OKC

Cotton Wool Appearance and jigsaw puzzle Indicates what disease

Pagets

Simian stance is seen in what disease?

Pagets

Tibia affected

Peripheral vs Central Ossifying fibroma

Peripheral: Occurs in soft tissue

Central: originate from bone

Echinacea is used for?

Common cold

Boost immune system

Valerian extract is used for?

Sedative

Should not be used with benzodiazepine

How long can you wait for lesion to heal?

2 weeks

What kind of lesion can resolve in 2 weeks?

Surface

Soft Tissue Enlargement and Radiographic lesion does not

Long term surface lesion (over 2 years)

Not benign

Incisinal vs Excisional Biopsy

Incisional: Large lesion over 1 cm

Excisional: Small lesion under 1 cm

Sublingual Varices

Hairy tongue is elongated _______ papillae

filiform

Transient Lingual Papillitis

Enlarged fungiform papillae

Fordyce Granules

Ectopic sebaceous glands

Yellow white papules of lip and buccal mucosa

Normal

Leukoedema

In smokers

Gray-white wrinkled buccal mucosa

No treatment needed

Freely Movable compared to bound down soft tissue masses

Freely movable: Attached to surface, origin in submucosal tissue, benign

Bound down: Attached to surface or deeper, malignant

Papule

Nodule

Sessile

Pedunculated

Papule: Solid raised lesion less than 5 mm
Nodule: Solid, raised lesion over 5 mm

Sessile: Base widest part

Pedunculated: Base narrower

Nasopalatine Duct cyst are more likely found in ______

midline

What is the most common benign salivary neoplasm

Pleomorphic adenoma

Mucoepidermoid Carcinoma

Most common malignant salivary neoplasm

Blue or red mass

Where in the oral cavity have most fat tissues

Buccal mucosa

Most likely for lipoma

Mucocele never occur where?

Upper lip

Only in lower lip

Where is the most common location for fibroma?

Buccal mucosa

Should you biopsy fibroma?

Yes you should still biopsy fibroma because malignant tumor may mimic clinical appearance of fibroma

Which is caused by chronic irritation: Fibroma or Giant Cell Fibroma

Fibroma

Retrucuspid Papilla

Microscopically identical to giant cell fibroma

Lingual to mandibular cuspid

Epulis Fissuratum vs Inflammatory Papillary Hyperplasia

Epulis Fissuratum: Folds

Inflammatory Papillary Hyperplasia: Cobblestone appearance

Both from ill fitting dentures

Fibromatosis is common in young people and associated with _______ syndrome

Gardner

Peripheral Giant Cell Granuloma occur

Exclusively on gingiva or edentulous alveolar ridge

Peripheral Ossifying Fibroma

Exclusively on gingiva

Schwannoma vs Neurofibroma

Schwannoma: NF2

Neurofibroma: NF1

Osteogenesis Imperfecta

Treatment

Brittle bone disease (Osteopenia)

Mutation in type 1 collagen

IV bisphosphonates

Type 1 vs Type 2 Osteogenesis Imperfecta

Type 1: Most common (mild form)

Type 2: Most severe and lethal

Blue Sclerae is seen in what disease?

Osteogenesis Imperfecta

White of eye appear blue

What are opalescent teeth?

Teeth look translucent or brown

Prone to rapid wear

Common in Osteogenesis Imperfecta (systemic) and Dentinogenesis Imperfecta (only opalescent teeth)

What is Osteopetrosis?

Marble bone disease

Osteoclast not funtion well (bone sclerotic)

Treated by bone marrow transplant

Infantile vs Adult

Infantile: Autosomal Recessive malignant and in infants

Adult: Autosomal Dominant benign and in adults

Osteogenesis Imperfecta vs Osteopetrosis

OI: Bone not building well

Osteopetrosis: Osteoclast not working

Cleidocranial Dysplasia

Delayed osteoblast

Cause lots of supernumerary teeth

Common to have small clavicles (sometimes none)

Ortho is needed

Idiopathic Osteosclerosis

Dense bone island

Teeth is vital

No treatment needed

Idiopathic Osteosclerosis vs Condensing Osteitis

IO: Vital teeth, no inflammation

CO: Non vital, inflammation present

Massive Osteolysis

Gorham or Vanishing bone disease

Bone disappear and replaced by vascular proliferation and dense fibrous tissue

Hallmark: Nonspecific vascular proliferation

Paget Disease

Excessive and unorganized remodeling of bone

Causes leontiasis Ossea (lion face)

Cotton wool appearance (x-ray bone look)

Jigsaw puzzle or mosaic pattern (Histo)

What is the lab value in Pagets Disease

Elevated serum alkaline phosphatase while blood calcium and phosphorus remain normal

What is the treatment for Pagets Disease?

What happens if it becomes malignant?

Bisphosphonates

Osteosarcoma

Central Giant Cell Granuloma

Benign jaw lesion affecting most common in anterior mandible

Need to differentiate from hyperparathyroidism because it looks identical (brown cells)

Cherubism

Bilateral swelling of cheek

Histo is identical to central giant cell granuloma

Eyes upturned to heaven is a hallmark for what disease

Cherubism

What kind of cyst is a simple bone cyst

Pseudocyst (lack epithelial lining)

Treated by curretage

Aneurysmal Bone Cyst

Pseudocyst

Treated with curretage

Have pooling of blood but no vessels

Blood-soaked sponge and blow-out distention

Central Xanthoma

Lipid-laden macrophages inside of the bone

Fatty pseudotumor

Treated by curettage

Look for foam cells

________ lesions are characterized by replacement of normal bone by fibrous tissue

Fibro-osseous

Fibrous Dysplasia is caused by a _______ gene mutation

GNAS

Monostotic, Polyostotic, and McCune-Albright

Monostotic: Single bone

Polyostotic: Multiple bones

McCune-Albright: Triad of polyostotic FD, Cafe au Lait pigmentation, Coast of maine jagged borders, endocrone issues

What is the main radiographic appearance of FIbrous Dysplasia?

Ground Glass

Cafe au lait spots of neurofibromatosis compared to fibrous dysplasia

Neurofibroma: Coat of california (smooth borders)

Fibrous dysplasia: Coat of main (jagged margins)

Fibrous Dysplasia can transform into malignant _________

osteosarcoma

Highest in history of radiation therapy

Focal COD

Periapical COD

Florid COD

Common in posterior mandible

Almost all in anterior mandible

Widespread

What is important to know about COD

The teeth is still vital so no surgery needed

Extraction is bad cause bone will not heal

Middle age black women is common

Familial Gigantiform Cementoma

Used to be known as florid COD

Not anymore and is hereditory Autosomal Dominant

Not only black female

Gets big during pregancy

Requires surgery unlike florid COD

Cemento-ossifying fibroma

True neoplasm

Resemble Focal COD

Treated by enucleation or curettage

What is Gardner Syndrome

Pt develop colorectal polyps that transform into adenocarcinoma

Osteoma can be one of the first symptom before polyps

Treated by colectomy

Osteoid Osteoma vs Osteoblastoma

Osteoid Osteoma: Small with nocturnal pain (Relieved by NSAIDS)

Osteoblastoma: Large and not relieved by NSAIDS

Cementoblasoma

Rare benign neoplasm

Fused to tooth root

Osteosarcoma most likely metastasize to where?

Lung

Ewing Sarcoma

Most common malignant bone tumor of children (Osteosarcoma first)

Difference between noninflamed and inflammed dentigerous cyst

Noninflamed: Loosely arranged

Inflammed: More collagenized, chronic inflammatory cells

Primordial Cyst

Called OKC now

Cyst instead of tooth that grow

Which cyst cause bony expansion? OKC or Dentigerous and Radicular cysts

Dentigerous and Radicular cause bony expansion

Where is OKC most commonly found

Mandible involving posterior body and ramus

What is the name when there is multiple OKC

Nevoid basal cell carcinoma (Gorlin)

Which causes resorptions of the roots? OKC or Dentigerous and Radicular cysts

Dentigerous and Radicular cysts

How is OKC diagnosed?

Histology

Radiograph is highly suggestive but not diagnostic

Hyperchromatic (dark staining) Palisaded (fence) (but can be lost in inflammation)

Treatment of OKC

Enucleation and Curettage

Due to thin wall, use bone cutting bur to shave bone

Some use carnoy’s solution

What is OOC and treatment

Orthokeratinized Odontogenic Cyst

Orthokeratin (no nuclei) and Not palisaded unlike OKC

Lower recurrence and less aggressive than OKC so only curretage needed

Nevoid Basal Cell Carcinoma

Autosomal dominant (mutation in PTCH tumor suppressor of sonic hedgehog)

Multiple OKC and Multiple Basal Cell Carcinoma

Precaution to sun for carcinoma

Palmar/Plantar pits (holes on hands and feets)

Calcified falx cerebri

Hypertelorism (widely spaced eyes) and Frontal bossing (prominent forehead)

Gingival Alveolar Cyst of Newborn

White nodules common in maxillary

No treatment needed

Gingival Cyst of Adult

Blue bump common on facial gingiva

Treated by surgical excision

What is Botryoid Odontogenic Cyst

Lateral Periodontal Cyst (common in mandibular premolar area)

Treated by enucleation

Calcifying Odontogenic Cyst

Also called gorlin cyst

Histo feature: Ghost cells

Treated with simple enucleation

Glandular Odontogenic Cyst or Sialo-Odontogenic Cyst

Rare cyst that can be aggressive

Goblet Cells (produce mucus)

Need to differentiate fgrom mucoepidermoid carcinoma (bone cancer) (MAML2 gene)

Treated by enucleation

Buccal Bifurcatio Cyst

Where does root tip?

Cyst caused by inflammation (pericoronitis) instead of dental remains

Common in children

Root apices tip toward lingual side

Treated with enucleation and tooth is kept

What is the most common type of ameloblastoma?

Convention solid/Multicystic

Unicystic less common

What is the radiographic features of Multicystic Ameloblastoma

What is the histo hallmark of Multicystic Ameloblastoma

Treatment of ameloblastoma

Large Radiolucent: Soap bubble

Small Radiolucent: Honeycombed

Root resorption is very common

Follicular and Plexiform

Curretage and remove bone 1-2 cm due to high reccurence

Which type of Unicystic Ameloblastoma is worst?

What is the treatment?

Luminal

Intraluminal

Mural

Mural is worst (tumor invading fibrous wall)

Luminal (limited to lining) Intraluminal (nodule buds into lumen)

High recurrence if just curretage need to resect 1-2 cm of bone

Metastasis of Malignant Ameloblastoma is common where?

Lung

What is the main difference between ameloblastoma and ameloblastic fibroma

Ameloblastoma is neoplastic epithelium only

Ameloblastic fibroma and others also have neoplastic mesenchyme which can make dentin (tooth like structures) (mixed tumor)

Compound vs Complex Odontoma

Compound (multiple small toothlike)

Complex (Mass of enamel and dentin with no resemblance of tooth)

What is a Hamartoma

Benign and noncancerous developmental anomalies (not cancerous)

Odontoma are Hamartoma

Ameloblastoma and Ameloblatic Fibroma are neoplastic