DEN 103 Oral Pathology Quiz #1 Review

Oral Pathology

the study of abnormalities and diseases of the oral cavity, teeth, tongue, and lips

Basic Ingredients too a description

• number

• location

• size (mm/cm)

• color

• duration (change over time)

• shape

• borders

• surface character

• consistency

Lesion Growth Patterns (Ways to describe them)

• flat

• exophytic

• endophytic

Exophytic (Outies)

• papule

• pustule

• vesicle

• bulla

• nodule

• mass

Endophytic (Innies)

• fissure/crack

• erosion

• ulcer

Flat/Colored

• pigmented/stained (macule, plaque/patch)

• blood (contusions: petechia, purpura, ecchymosis; hemotoma)

How do exophytic lesions attach?

• pedunculated (stalk-like)

• sessile (wide-based)

Pedunculated

growing from a stalk (narrow-based lesion)

e.g. mushrooms, polyps, some papules, some warts (papillomas)

Sessile

wide-based lesion (the base is the widest part of the lesion)

e.g. some papules (vesicles/bullae, pustules), nodules

Papule

• elevated lesion

• ONLY exophytic

• pedunculated/sessile

• usually less than 1 cm

Nodule

• raised solid mass with depth

• deeper

• usually 1 cm or larger

• appears to be arising within the connective tissue (below epithelium)

Papules filled with fluid

• bulla

• vesicles

Vesicle

• small blisters

• filled with fluid

• small (less than 1 cm)

• think viral/allergy

Crop

multiple vesicles

Bulla

• much larger vesicle

• greater than 1 cm

• severe burns

• immune reactions

Pustule

• elevated

• superficial

• pus-filled

• less than 1 cm

• a pus-filled vesicle

Abscess

• a localized collection of pus

• usually caused by bacterial infection

Cyst (Cystic Lesion)

• epithelium-lined

• usually fluid-filled

• can be in soft tissue/bone

• ONLY microscopic term (CAN’T see a cyst with your eyes)

• compressible/firm/rubbery/fluctuant

Macule

• circumscribed area with different color

• same texture as surround tissue

• flat and smooth

Patch/Plaque

• circumscribed area with different color and/or texture

• no elevation or depression JUST a different texture

Leukoplakia

white

What color plaques are worse than the other?

white plaques are less worrisome than red plaques

Erythroplakia

red

Why are white Lesions White?

• increased thickness (hyperkeratosis: too much keratin/hyperplasia: too many cells)

• surface coating (gack/smutchz

Why are things Red?

• inflammation (increased blood flow)

• extravastated RBCs (contusions/trauma)

• vascular lesions (increased number of blood vessels)

• epithelial atrophy/dysplasia (decreased thickness of epithelium; if cause 60-90% are cancer)

Erythroleukoplakia

red and white lesions mixed

Fissure/Crack

• endophytic

• linear crack/cleft (lips/tongue/commissures)

• normal/pathologic

Erosion

• endophytic

• disruption of epithelium ABOVE the connective tissue

• looks reddened (thin epithelium)

• no pseudomembrane

• pain common

Ulcer

• complete loss of epithelium

• beyond basal layer

• tan/grey fibrinopurulent membrane

Differential Diagnosis (DDX)

when clinical appearance is similar for two or more conditions

Biopsy

the surgical removal of living tissue to allow microscopic examination

(definitive way to make diagnosis from a DDX)

Cytology

removal of living cells and fluids to examine them microscopically

Fordyce Granules

sebaceous glands visible in mucosa (lips/buccal mucosa)

Exostoses

protrusion of normal bone from surfaces of jaws

Lingual Varices

dilated/enlarged veins normally seen on underside of tongue

Hairy Tongue

overgrowth of filiform papillae of the tongue

DINIRS

pathologic processes

D in DINIRS

Developmental

I in DINIRS

INFECTIOUS (most common)

N in DINIRS

neoplastic (tumors)

second I in DINIRS

IMMUNE MEDIATED (most common)

R in DINIRS

REACTIVE (most common)

S in DINIRS

systemic

Contusions

• blood in the tissue spaces

• NOT in the vessels

• bruises

Petechia

• pin-point

• often multiple

• flat

(contusion)

Purpura

• medium

• flat

• sometimes large

(contusion)

Ecchymosis

• large

• flat

(contusion)

Hematoma

• raised mass of blood beneath the surface

(contusion)

Idiopathic

unknown cause

Congenital

present at birth

Focal

occurring only in one place

Diffuse

covering a large area or located in many places

Signs

• what you observe

(objective, can be measured)

Symptoms

• what the patient describes

(subjective, can’t be measured)

Purulent

description of a lesion that contains or produces pus

Pus

a collection of dead neutrophils

(usually caused by bacterial infection)

Mass

large lesion arising from beneath the surface