Introduction to Oral Pathology

Base of Lesion : flat base

sessile

Base of Lesion : between sessile and pedunculated

polypoid

Base of Lesion : stalk like

pedunculated

Surface Texture : wrinkled

corrugated

Surface Texture : a cleft or groove, normal or otherwise, show prominent depth

fissure

Surface Texture : resembling small projection or elevation found in clusters

papillary

Surface Texture : a term used to describe the surface texture of a lesion

folded

a color different from that of the surrounding tissue; it is flat and does not protrude above the surface of the normal tissue (i.e. freckle)

macule

a small, circumscribed lesion usually <1cm in diameter that is elevated or protrudes above the surface of normal surrounding tissue

papule

a palpable solid lesion up to 1 cm in diameter found in soft tissue; it can occur above, level with, or beneath the skin surface

nodule

a segment or lobe that is a part of the whole lesion; these lobes sometimes appear fused together

lobule

a small, elevate lesion <1cm in diameter that contains serous fluid

vesicle

variously sized circumscribed elevations containing pus

pustule

a circumscribed, elevated lesion >5mm in diameter, usually contains serous fluid, looks like a blister

bulla

Radiographic Borders : borders that are not well demarcated, making it difficult to detect exact parameters

ill defined

Radiographic Borders: borders that are defined and in which one can clearly see the exact margins and extent of pathology

well circumscribed

Radiographic Density : less dense tissue (e.g. pulp, periapical lesions)

radiolucent

Radiographic Density : a mix of dense tissues (e.g. odontogenic lesions)

mixed radiopacity

Radiographic Density : highly dense structure (calcifications, bone, tooth)

radiopaque

what is shown in the red circle

an artifact

Radiographic Shape : multiple single-chambered lesions that are somewhat fused together, making up the entire lesion; sometimes described as resembling soap bubbles

multilocular

Radiographic Shape: having on compartment or unit that is well defined or outlined

unilocular

Radiographic Adjacent Structures : the apex of the tooth appears shortened or blunted and irregularly shaped; occurs as a response to stimuli, which can include a cyst, tumor, trauma, malignancy

resorption

Radiographic Adjacent Structures : radiolucent lesion that extends between the roots, as seen in a traumatic bone cyst (TBC)

scalloping

What is the term used to describe a pus filled lesion?

pustule

how would you describe this lesion?

a flat brown macule

how would you describe this radiographic lesion?

an apical well-defined radiopaque lesion

how would you describe this radiographic lesion?

a multilocular radiolucent lesion

clusters of “ectopic” sebaceous glands; 80% of the population

fordyce granules

fordyce granules appearance

yellow or yellow-white papular lesions

fordyce granules most common locations

buccal mucosa and lateral portion of vermillion of upper lip

Do fordyce granules require tx?

no

variation of normal; up to 90% of Black adults and 50% children (does not rub off)

leukoedema

leukoedema appearance

diffuse, gray-white, milky, opalescent

leukoedema most common locations

bilaterally on buccal mucosa

Does leukoedema require tx?

no

may be bilateral, can be more prominent in patients who have a clenching/ bruxing habit

linea alba

Linea Alba most common locations

anteroposterior on the buccal mucosa along the occlusal plane

most commonly observed in patients of color, variant of normal

melanin pigmentation

not associated with other systemic diseases, most commonly observed in individuals +60 years

lingual varicosities

lingual varicosities most common locations

ventral and lateral surfaces of the tongue

used to determine if a lesion is caused by blood within vessels (erythema) or hemorrhage (petechiae/purpura); plastic slide is pressed against lesion to produce temporary blanching by forcing blood out of superficial tissues

diascopy (positive test = blanching; redness fades, indicating inflammatory or vascular lesions)

a sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids

retrocuspid papilla

exophytic growth of normal compact bone on the hard palate

torus palatinus

outgrowths of normal dense bone found on the lingual aspect of the mandible premolars are

mandibular tori

how would you describe this lesion?

generalized grey/ white lesion

lingual thyroid

thyroid gland develops __ and descends into the neck by __

3-4 wks of life; 7th wk

__ % of ectopic thyroids are in this position

90

lingual thyroid is more common in

females (7:1)

In cases of lingual thyroid, this is the only thyroid tissue __% of the time

70

Is tx needed for lingual thyroid?

no tx needed unless a problem develops (adenoma or adenocarcinoma)

etiology unknown; if symptomatic, burning sensation may be due to candida; 10% of psoriasis patients have it, more common in females (2:1)

geographic tongue (benign migratory glossitis)

erythematous patches surrounded by white/ yellow serpentine borders

erythema migrans

excess keratin on surface of filiform papillae; starts white, may become black, brown, orange, green, yellow

hairy tongue

cause of hairy tongue

uncertain but can be due to smoking, drugs, xerostomia, hx of radiotherapy to H&N, poor oral hygiene

tx of hairy tongue

remove offending agent, brush/ scrape tongue

stain is from food/ drink stains, chromogenic bacteria, may cause halitosis

hairy tongue

abnormally small tongue

microglossia

commonly associate w/ hypoplasia of the mandible; oromandibular-limb hypogenesis syndromes

microglossia

abnormally large tongue

macroglossia

most commonly caused by vascular malformations, muscular hypertrophy; other etiologies are down syndrome, amyloidosis, angioedema, tumors

macroglossia

abnormally short, thick lingual frenum resulting in limitation of tongue movement

ankyloglossia

tx for ankyloglossia

frenectomy

mucosal invagination that occur at the corners of the mouth on the vermillion border, not associated with facial or palatal clefts, no tx required

commissural lip pits

common vascular anomaly seen in the upper or lower lip of adults

caliber persistent artery

unique feature of caliber persistent artery

pulsation

is tx recommended for caliber persistent artery

no, tx may cause brisk bleeding

Which of the following is FALSE regarding lingual thyroid?

biopsy is recommended

what is the management?

none (geographic tongue)

Cyst of Newborn: occurs along the median palatal raphe; due to epithelial entrapment by palatal fusion

epstein’s pearls

Cyst of Newborn: occur along the buccal and lingual aspects of the alveolar ridge

bohn’s nodule

localized bony protuberance that arise from the cortical plate; may be due to stress placed on the bone

exostosis

excessive growth of condyle; due to neoplasms and endocrine disturbances

condylar hyperplasia

underdeveloped condyle; due to congenital or acquired

condylar hypoplasia

elongation of styloid process or mineralization of the stylohyoid ligament; pain during opening, swallowing, turning head sideways; usually bilateral

eagle syndrome

Which of the following is TRUE for eagle syndrome?

pain when turning head sideways

defective fusion of the medial nasal process with the maxillary process

cleft lip

failure of the palatal shelves to fuse

cleft palate

disturbances in the growth of tissue processes or their fusion may result in __

orofacial cleft

Cleft Lip + Cleft Palate

45%

Cleft Palate only

30%

Cleft Lip only

25%

most common major congenital defects

CL + CP is more common in

males

CP is more common in

females

__% of CL is unilateral

80

__% of unilateral CL are associated with CP

70

__% of bilateral CL are associated with CP

extends to the nostril

complete cleft lip

does not involve the nose

incomplete CL

complete clefts involving the alveolus usually occur between __ and __

lateral incisor and canine

minimal manifestation of CP

bifid uvula

surface is intact but defect exists in the underlying musculature of the soft palate

submucous palatal cleft

cleft palate, mandibular micrognathia, glossoptosis (post. motion of tongue)

pierre robin syndrome (sequence)

congenital invagination of the lower lip, usually bilateral, no tx except to evaluate for van der woude syndrome

paramedian lip pits

AD, CL+CP or CP only, paramedian lip pits

van der wounde syndrome

syndromes with orofacial cleft lip

pierre robin and van der woude

double lip