Exam 3: Red Terms

What sex is Graves disease more common in? ***

women

What happens to the thyroid in Graves disease? ***

diffuse thyroid enlargement

What happens to the eyes in Graves disease? ***

occular involvement - unique to graves disease:

-characteristic stare w/ eyelid retraction and lid lag

-exophthalmos (protrusion) due to accumulation of glycoasminoglycans in retro-orbital CT

What is a thyroid storm? ***

abrupt onset of severe hyperthyroidism w/ an inappropriate release of large amounts of thyroid hormone at one time

What may a thyroid storm precipitated by? ***

stress (i.e. dental appt)

infection

psychologic trauma

How does a thyroid storm present and how should it be treated? ***

-delirium, convulsions, elevated temp, tachycardia

-hospitalize immediately to prevent mortality

What are laboratory findings of hyperthyroidism? ***

-elevated T4

-TSH depressed

What is parathyroid hormone secretion by the parathyroid glands stimulated vs suppressed by? ***

-stimulated by hypocalcemia & hyperphosphatemia

-suppressed by hypercalcemia & hypophosphatemia

What 2 compounds regulate calcium levels? ***

parathyroid hormone (PTH)

vitamin D

What is a Chvostek Sign? ***

-oral manifestation of hypoparathyroidism

-twitching of upper lip when facial nerve is tapped just below zygomatic process

What is a catchy saying for the clinical and radiographic features of hyperparathyroidism? ***

stones, bones, and abdominal groans

What are "stones" as clinical and radiographic features of hyperparathyroidism? ***

-increased tendency to develop renal calculi due to elevated serum calcium

-metastatic calcifications of soft tissues including blood vessel walls, subcutaneous soft tissues, sclera, dura, and tissues around joints

What are "bones" as clinical and radiographic features of hyperparathyroidism? ***

-variety of osseous changes

-early sign - subperiosteal resorption of phalanges of index and middle fingers

-osteoporosis

-chondrocalcinosis

-osteitis fibrosa cystica

What are oral manifestations of hyperparathyroidism? ***

-generalized loss of lamina dura

-brown tumor

-alteration in trabecular pattern

-decreased trabecular density + blurring of normal trabecular pattern -> ground glass appearance

What is a Brown Tumor? ***

-oral manifestation of hyperparathyroidism

-commonly affect mandible + clavicle, ribs, pelvis

-dark-red tissue color due to abundant hemorrhage and hemosiderin deposition

-well-demarcated uni or multi-locular radiolucencies

-usually multiple (may be solitary)

-long standing lesions may cause expansion

What is a brown tumor identical to histopathologically? ***

central giant cell granuloma

What are "abdominal groans" as clinical and radiographic features of hyperparathyroidism? ***

pts develop duodenal ulcers

What bone disorder occurs in secondary hyperparathyroidism? ***

renal osteodystrophy

How does renal osteodystrophy in secondary hyperparathyroidism present in the oral cavity? ***

-striking enlargement of the jaws

-ground glass appearance radiographically

What is the most common cause of hypercortisolism? ***

prolonged corticosteroid therapy

What are clinical features of hypercortisolism? ***

signs develop slowly:

-weight gain in central area of body; accumulation in dorsocervical spine region -> buffalo hump

-facial deposition -> moon facies

-red-purple abdominal striae

-hirsutism

-osteoporosis

-hypertension

-mood changes

-hyperglycemia w/ thirst and polyuria

-muscle wasting w/ weakness

What are 3 medical conditions that diabetes mellitus is the leading cause of for in the US? ***

-kidney failure

-lower limb amputations

-adult-onset blindness

What are complications of diabetes mellitus? ***

microangiopathy:

-occlusion of small blood vessels -> peripheral vascular disease

-ischemia predisposes to infection (gangrene)

-amputation of lower limbs often required

-occlusion of coronary or carotid arteries and branches may lead to MI or stroke

-blindness

-kidney failure

What are oral manifestations in Diabetes Mellitus? ***

-usually Type 1

-progressive periodontal disease

-enlarged erythematous gingiva

-delayed healing

-diabetic sialadenosis (diffuse bilateral enlargement of parotid glands)

-increased risk for candidiasis

-mucormycosis

-xerostomia

What is insulin shock in Type 1 DM and how is it treated? ***

-carbohydrates not consumed after insulin injection -> blood glucose levels drop below 40 mg/dL -> insulin shock

-treated w/ sublingual dextrose paste, IV infusion of dextrose solution or injection of glucagon

What may be the first presenting sign of hypophosphatasia? ***

premature loss of primary teeth

What are 4 examples of systemic disorders with premature attachment loss? ***

-blood dyscrasias: agranulocytosis, cyclic neutropenia

-hypophosphatasia

-langerhans cell disease

What are oral features of childhood hypophosphatasia? ***

-premature loss of primary teeth

-enlarged pulp chambers

How is hypophosphatasia diagnosed? ***

-decreased levels of serum alkaline phosphatase

-increased amts of phosphoethanolamine in urine and blood (bc normally broken down by alp)

What are oral manifestations of Vitamin D-Resistant Rickets? ***

-large pulp chambers w/ pulp horns extending to DEJ

-cuspal enamel may be worn down by attrition causing pulpal exposure

What is ectodermal dysplasia? ***

-RARE inherited conditions in which 2 or more ectodermally derived anatomic structures fail to develop (skin, hair, nails, teeth, sweat glands)

-inherited in several genetic patterns

What are clinical features of hypohidrotic ectodermal dysplasia? ***

hypo triad: hypohidrosis (decreased sweat glands, heat intolerance), hypotrichosis (fine sparse hair), hypodontia w/ delayed eruption

-X-linked

-mid face hypoplasia

-dystrophic and brittle nails

-xerostomia

-fine periocular wrinkling

-sparse eyelashes and eyebrows

How may teeth appear in ectodermal dysplasia? ***

-oligodontia

-conical crown forms

What is the significance of intraoral lesions in dyskeratosis congenita? ***

tongue and buccal mucosa bullae and erosions become leukoplakic lesions which are premalignant (1/3 become malignant)

What are hematologic problems in dyskeratosis congenita? ***

-aplastic anemia develops in 80% (bone marrow stops making blood cells)

-thrombocytopenia

What are 3 key cutaneous manifestations of tuberous sclerosis? ***

-facial angiofibromas

-shagreen patches

-ash-leaf spots

-also periungual fibromas

How do facial angiofibromas appear in tuberous sclerosis? ***

multiple, smooth-surfaced papules primarily in nasolabial fold area

What are shagreen patches in tuberous sclerosis? ***

connective tissue hamartomas of the skin (benign, tumor-like malformation w/ abnormal mix of mature cells and tissues)

What are Ash-leaf spots in tuberous sclerosis? ***

ovoid areas of hypopigmentation

What are oral manifestations of tuberous sclerosis? ***

-developmental enamel pitting on facial sapect of anterior dentition

-multiple fibrous papules predominately in anterior gingiva

-diffuse fibrous gingival hyperplasia (usually due to anti-seizure meds)

-+/- radiolucencies of jaws

What is there an increased risk for in epidermolysis bulla? ***

cutaneous squamous cell carcinoma

What is often the 1st sign of systemic sclerosis? ***

Raynaud phenomenon - vasoconstrictive event triggered by emotional stress or cold

What are oral manifestations of systemic sclerosis? ***

-microstomia due to collagen deposition on perioral tissues

-furrows radiating from mouth - "purse string"

-loss of attached gingiva

-dysphagia

-firm hypomobile tongue

-xerostomia

What are radiographic features of systemic sclerosis? ***

-diffuse widening of periodontal ligament

-resorption of ramus, coronoid process, or condyle

What do laboratory studies reveal for diagnosis of systemic sclerosis? ***

anticentromere antibodies or anti-topoisomerase I antibodies

What is mucopolysaccharidosis? ***

deficiency of lysosomal enzymes needed to degrade glycosaminoglycans, an intercellular substance, leading to accumulation of substances such as heparan, dermatan, keratan, and chondroitin sulfate in tissues

What are clinical features of mucopolysaccaridosis? ***

-cloudy degeneration of the cornea may lead to blindness

-vary depending on specific syndrome

-some degree of intellectual disability

-coarse facial features w/ heavy brow ridges

-skeletal changes including stiff joints

What are intraoral manifestations of mucopolysaccaridosis? ***

-macroglossia

-gingival hyperplasia, esp anterior regions

What is lacking in those with lipid reticuloendotheliosies and what does this lead to? ***

lack enzymes neccessary for processing specific lipids -> accumulation of lipids within a variety of cells

What is the most common reticuloendothelioses? ***

Gaucher disease

How do long bones appear in Gaucher Disease? ***

erlenmeyer flask deformities of long bone

What are oral manifestations of Gaucher Disease? ***

-ill-defined radiolucencies of the jaws

-walls of mandibular canal may be obliterated

-decreased salivary flow

-increased bleeding tendency

-increased risk of post-op infection

What are those with Gaucher disease at an increased risk for? ***

hematologic malignancies

What is a key feature found in Types A and C of Niemann-Pick Disease but not Type B? ***

Types A and C = neuronopathic features

Type B = visceral involvement only

What are neuronopathic features of Types A and C of Niemann-Pick Disease? ***

-psychomotor impairment

-dementia

-spasticity

-hepatosplenomegaly

-death during 1st 2 decades

What occurs in Lipoid Proteinosis? ***

-rare autosomal recessive; mutation of ECM1 gene which encodes glycoprotein ECM protein 1

-deposition of waxy material in the dermis and submucosal connctive tissue

What are oral manifestations of lipoid proteinosis? ***

-tongue, labial mucosa, and buccal mucosa: nodular, diffusely enlarged and thickened due to infiltration

-dorsal papillae destroyed -> smooth appearance of tongue

-tongue may become bound to floor of mouth

What is jaundice caused by? ***

-excess bilirubin in the bloodstream -> yellowish discoloration of skin and mucosa

-increased bilirubin production or impaired liver fx

What 2 factors are associated with increased serum levels of bilirubin? ***

1. increased production of bilirubin

2. impaired liver function

How does jaundice appear? ***

-diffuse uniform yellowish discoloration of skin and mucosa

-sclera, lingual frenum, soft palate

What is amyloidosis characterized by? ***

Deposition of misfolded extracellular proteins (amyloid) in β-pleated sheet configuration leading to tissue and organ dysfunction

How may organ-limited amyloidosis present as? ***

amyloid nodule - solitary, asymptomatic submucosal deposit

What is the etiology of most cases of primary and myeloma-associated types of amyloidosis? ***

most cases idiopathic

What are 15% of primary and myeloma-associated types of amyloidosis associated with? ***

myeloma (cancer of plasma cells)

What are oral manifestations of primary and myeloma-associated types of amyloidosis? ***

-macroglossia - diffuse or nodular enlargement

-may show ulceration or submucosal hemorrhage

-rare xerostomia

What does secondary amyloidosis develop as a result of? ***

-result of chronic inflammatory process (AA - cleavage fragments of circulating acute-phase reactant protein)

-causes: sarcoidosis, tuberculosis, osteomyelitis

-liver, kidney spleen, adrenal involvement (heart spared)

-rare in developed countries

What is the histopathology of amyloidosis? ***

-extracellular deposition in the submucosal CT of an amorphous, eosinophilic material

-stains positively for congo red and appears apple-green on birefringence

What are clinical features of Vitamin A Deficiency? ***

-adult: night blindness, dryness of skin and conjuctiva

-infancy: blindness

What population is beri-beri rare vs common in? ***

rare in western world except in alcoholics

may be seen after gastric bypass

What are oral manifestations of Vitamin B2 deficiency? ***

-glossitis

-angular cheilitis

-sore throat

-swelling and erythema of oral mucosa

-seborrheic dermatitis - skin

-+/- anemia

What are clinical features of Vitamin B3 deficiency? ***

3 D's for B3:

-dermatitis (symmetric on sun-exposed areas)

-dementia

-diarrhea

What are oral manifestations of Vitamin B3 deficiency? ***

-stomatitis

-glossitis

-red and smooth tongue

What are oral manifestations of Vitamin B6 deficiency? ***

cheilitis and glossitis

What disease is caused by Vitamin C deficiency? ***

scurvy

What sx occur in Scurvy from vitamin C deficiency? ***

inadequate collagen synthesis (fragile vessels and tissues):

-widespread petechial hemorrhage and ecchymosis

-delayed wound healing

What are oral manifestations of Scurvy from vitamin C deficiency? ***

scorbutic gingivitis:

-generalized gingival swelling w/ spontaneous hemorrhage

-ulceration

-tooth mobility

-periodontal disease

What disease is caused by Vitamin D deficiency? ***

rickets = infancy

osteomalacia = adults

When does rickets from a Vitamin D Deficiency develop? ***

infancy

What are clinical features of rickets from Vitamin D Deficiency? ***

-irritability

-growth impairment

-prominence of costochondral jxs (rachitis rosary)

-bowing of long bones due to poor mineralization

What is an oral manifestation of rickets from Vitamin D Deficiency? ***

hypomineralization of teeth:

-large pulp chambers of primary teeth

-pulp horns extend to DEJ

-taurodont-type pulp chamber

When does osteomalacia from a Vitamin D Deficiency develop? ***

adults

How does a cyst appear radiographically? ***

-radiolucent lesion bc bone replaced by soft tissue or air (less dense than bone)

-usually well-defined, +/- cortication, spherical, unilocular

What 5 components should be included in a radiographic description of a lesion? ***

-size

-borders (well-defined, corticated, punched out, poorly-defined)

-location (below or tooth bearing area of jaw, apex of non-vital tooth, lateral root, pericoronal)

-effect on neighboring teeth (displacement/root resorption, destruction surrounding intact roots)

-effect on cortical bone (no effect, expansion but cortex intact, destruction of cortex but no expansion)

What does a corticated border look like and what does this typically indicate? ***

radiopaque line around border = slow growing, benign

What are the radiographic borders typically like of a cyst? ***

-well-defined and corticated

What does a punched out border look like and what does this typically indicate? ***

-no border

-rapidly growing -> langerhans cell disease, multiple myeloma

What does a poorly defined border look like and what does this typically indicate? ***

-cannot draw boundaries

-think malignancy or infection (i.e. osteomyelitis)

What lesions can be ruled out if the lesion if located below tooth bearing areas of the jaw? ***

rule out lesions associated w/ tooth development

i.e. stafne defect

What are common lesions found in the tooth bearing areas of the jaw at the apex of a non-vital tooth? ***

periapical cyst

periapical granuloma

What are common lesions found in the tooth bearing areas of the jaw at the lateral root? ***

-lateral periodontal cyst

-periapical granuloma or cyst along lateral canal

-anything else (esp odontogenic keratocyst)

What are common lesions found in the tooth bearing areas of the jaw in the pericoronal area? ***

-dental follicle

-dentigerous cyst

-other odontogenic neoplasm/cyst (adenomatoid odontogenic tumor)

What does destruction of surrounding intact roots often indicate regarding the etiology of a lesion? ***

-"teeth floating in air"

-aggressive, rapidly growing lesion

What is the etiology and location of a lateral radicular cyst? ***

inflammatory cyst appearing along the lateral aspect of the root

What is the etiology and cause of a residual cyst? ***

peripapical inflammatory tissue that is not curetted at time of tooth removal

What are 3 examples of non-odontogenic developmental cysts? ***

nasopalatine duct cyst (most common one)

nasolabial cyst

median palatal cyst

What is the most common non-odontogenic cyst of the oral cavity? ***

nasopalatine duct cyst

What is a nasopalatine duct cyst called if only soft tissue is involved? ***

cyst of incisive papilla

What are radiographic features of a nasopalatine duct cyst? (size, shape, density, border, effect on neighboring teeth) ***

- >6 mm

-well-circumscribed radiolucency near midline of anterior maxilla

-round-oval w/ sclerotic border

-inverted pear or heart shaped

-+/- root divergence

What is the most common developmental odontogenic cyst? ***

dentigerous cyst

Where can a dentigerous cyst ONLY be found? ***

crown of an unerupted tooth

attached at the CEJ