DH228 Midterm & Final Packet

Bulla

- Circumscribed

- Elevated lesion ( >5mm in diameter)

Lobule

segment/lobe that is part of a whole; sometimes fused together

Macule

Area distinguished by a color diff than surrounding tissue (ex: freckle)

Papule

small, circumscribed lesion <1cm in diameter; elevated above surrounding tissue surface

Pedunculated

attached by stem-like base similar to mushroom

Pustule

Varying in size, circumscribed elevations containing pus

Sessile

Describing the base of lesion that is flat or broad instead of stem-like

Vesicle

Small, elevated lesion less than 1 cm in diameter that contains serous fluid

Nodule

- Palpable

- Solid up to 1 cm in diameter

- In soft tissue

- Can occur above, level with, or beneath skin

Erythema

Abnormal redness of mucosa or gingiva

Leukoplakia

White, plaque-like lesion on oral mucosa that cannot be rubbed off or diagnosed as a specific disease

Radiolucent

Describes black/dark areas on rad; less dense tissue such as pulp

Radiopaque

Light/white areas on rad (inability of energy to pass through) dense = lighter/whiter

Retrocuspid papillae

extra papilla; on margin of lingual aspect of mand cuspids "sessile nodule"

Black hairy tongue

filiform papilla is elongated (dead skin cells aren't being shed) and keratinized = stain catching i.e. coffee, smoking

Neutrophils

1st responders, decrease as inflammation becomes chronic, polymorphonuclear leukocytes

Acute

acute injury is minimal, brief, and source is removed from tissue

Chronic

chronic is if the injury to the tissue continues and the inflammatory response is longer lasting

Localized

Redness, Heat, Swelling, Pain, and Loss of normal tissue function

Systemic

Fever, Leukocytosis, Elevated C-reactive protein, and Lymphadenopathy

Macrophages

Phagocytosis and plays a role in immune system. Longer life span than PMN's. Microscopic. Constitutes 3% to 8% of WBC population. Derived from stem cells in bone marrow

inflmmatory response

Extent and duration of injury → extent and duration of inflammatory response

inflmmatory response Sequence

Transudate - into tissue, Exudate - interferes with repair, Edema, Heat, Abscess, Fistula - fistulous tract, and Pain

White hairy tongue

elongation of filiform papilla; increased keratinization or decrease in normal desquamation; instruct pt to brush tongue with toothbrush wet with water only

amalgam tattoo

iatrogenic lesion caused by traumatic implantation of dental amalgam into soft tissue - A flat, bluish-gray lesion of the oral mucosa, caused by the introduction of amalgam into tissue. Commonly seen on gingiva or alveolar ridge - focal argyrosis

What can be seen on a rad

periapical pathosis, internal and external resorption, heavy interproximal calculus, caries, compound odontoma, and complex odontoma

Compound odontoma

multiple, small tooth-like structures ;tend to occur between teeth

Variant of normal

fordyce granules, torus palatinus, mandibular tori, melanin pigmentation, retrocuspid papilla, lingual varicosities, linea alba, leukoedema (seen in people with dark skin tones)

Benign conditions

lingual thyroid, median rhomboid glossitis, erythema migrans, fissured tongue, hairy tongue

Viral infection

inc in lymphocytes

Bacterial infection

Inc in neutrophils

allergic reaction

inc in eosinophils

Hyperplasia

inc in # of cells

Hypertrophy

Enlargement of individual cells

Clinically seen

fordyce granules, tori, melanin pigmentation, retrocuspid papillae, lingual variscosities, lingual thyroid, median rhomboid glossitis, erythema migrans, fissured tongue, hairy tongue, amalgam tattoo

atrophy

dec in size of or function of cell, tissue, organ or entire body - muscular wasting - use it or lose it

Primary intention healing

Initial healing where there is little loss of tissue - margins are close together and little granulation tissue forms (closed edges)

Secondary intention

the edges of the injury cannot be joined during healing. A large clot forms, resulting in increased granulation tissue. May result in excess scar tissue: A keloid. (not closed)

Tertiary intention

Delaying surgical tissue repair until infection is resolved. An injured area may become infected, especially with puncture wounds. In some situations, an infected injury is left open until infection is controlled. (not closed and infected)

attrition

tooth-to-tooth wear; primary and permanent dentitions; bruxism

abrasion

pathologic wearing away of tooth structure resulting from repetitive mechanical habit; notching of root surface with gingival recession

Necrosis

irreversible cellular response - cell death

abfraction

micro-fracture of tooth structure in areas of concentration of stress; fatigue, flexure, fracture and deformation of tooth structure; wedge shaped lesions at cervical area

Erosion

Loss of tooth structure as a result of chemicals, without bacterial involvement. Tooth structure may be lost around a restoration.

Erosion causes

Industrial factors, Intra-orally applied cocaine drug abuse, Overuse of soft drinks, Baby bottle caries, Sucking on lemons, and Chronic vomiting

aspirin burn

Topical application is a common misuse of this product. The tissue becomes necrotic and white. The surface may slough off, leaving a painful ulcer. The ulcer usually heals in 7 to 21 days.

Mucocele

salivary duct is severed and the mucous secretion spills into the adjacent CT when mucous is walled off

Sialolith

Salivary gland stone; minor or major salivary glands; can be seen radiographically

PA abscess

fistula tract; exudate seeks path of least resistance out of the tissue; warrants radiographic evaluation; presents as a distinct radiolucent area

lichen planus

white lines or dots are known as "wickham striae"

Humoral immunity

Antibody-mediated immunity -

Production of antibodies

Protection against bacteria and viruses

B cells are the primary cells

Cell-mediated immunity

Cellular immunity -

T cells are the primary cells

Regulates both major immune responses

Hypersensitivity Types I

anaphylactic type; hay fever, asthma, anaphylaxis

Hypersensitivity type II

cytotoxic type; autoimmune hemolytic anemia

Hypersensitivity type III

immune complex type; autoimmune disease

Hypersensitivity type IV

cell-mediated type; granulomatous disease, tuberculosis

Aphthous Ulcer

Painful oral ulcers with an unclear cause. Trauma is the most common precipitating factor. May be associated with certain systemic diseases. Thought to have an immunologic pathogenesis.

Minor

Major

Herpetiform

Urticaria

Hives. Appear as multiple areas of well-demarcated swelling of skin. May include itching (pruritus). Lesions are caused by localized areas of vascular permeability in superficial connective tissue

Erythema Multiforme

triggered by HSV, TB; Based on clinical features and by exclusion of other diseases; eye lesions may lead to blindness

Lichen Planus

white lines or dots are known as “wickham striae”; most commonly found on buccal mucosa bilaterally, does not wipe off, worsens with stress; Pt may be at increased risk for development of squamous cell carcinomas

Reticular: Buccal mucosa and tongue

Erosive and Bullous: buccal mucosa and lips

*For a definitive diagnosis you need a biopsy*

Sjogren Syndrome (board alert)

Autoimmune disease. Affects salivary and lacrimal glands; resulting in decrease of saliva and tears, causing dry mouth (xerostomia) and dry eyes (xerophthalmia); dryness of eyes can lead to damage to eyes known as “keratoconjunctivitis sicca”

Primary Sjogren

When it's present on its own

Secondary Sjogren

cooccurs w/ another autoimmune disease; 50% have other associated disorders

20% of pts w/ Sjogren will have ___

Raynauds

Sjogren Diagnosis

Diagnosis is made when two of the three components are present: xerostomia, keratoconjunctivitis sicca, rheumatoid arthritis

SLE – Systemic Lupus Erythematosus (Lupus)

acute and chronic inflammatory autoimmune disease with no known cause; three times more frequent in black women than in white women

SLE Skin lesions

occur in 85% of individuals - butterfly rash on nose, erythematous lesions on fingertips, arthritis and arthralgia = common

Pemphigus Vulgaris

A severe, progressive autoimmune disease affecting the skin and mucous membranes. Characterized by intraepithelial blister formation resulting from acantholysis.

Pempphigus Vulgaris first signs

minor apthous ulcers occur in 50% + of cases

Behcet Syndrom

chronic, recurrent autoimmune disease (rare). Primarily oral ulcers, genital ulcers, and ocular inflammation. Mean onset is 30 years. Looks like canker sores - symptoms due to blood vessel inflammation

Behcet syndrome diagnosis

requires two of three types of lesions to be present

Behcet syndrome treatment

systemic and topical corticosteroids; chlorambucil is used for ocular lesions

Rheumatic fever

childhood disease that follows a group A β-hemolytic streptococcal infection. Characterized by an inflammatory reaction involving the heart, joints, and central nervous system. Heart valve damage may occur. No longer requires pre-medication

Scarlet fever

Usually occurs in children. Generalized red skin rash caused by a toxin released by the bacteria. Oral manifestations in addition to streptococcal tonsillitis and pharyngitis include: Petechiae on the soft palate and strawberry tongue

Syphilis

Caused by a spirochete: Treponema pallidum. Requires active lesion and break in skin surface. Organisms die when exposed to air and changes in temperature. Sexual contact or mom to baby. Most infectious during secondary stage and tx is penicillin

Syphilis board alert

Treponema pallidum can cross the placenta and enter the fetal circulation

Tuberculosis

Usually caused by the organism Mycobacterium tuberculosis. Rare oral ulcerations. Painful. Non-healing. Slowly enlarging ulcers. Mantoux test is not definitive; must have chest x-ray to confirm

Actinomycosis

An infection caused by a filamentous bacterium: Actinomyces israelii. Organisms common in the oral cavity, not clear why causes disease. Draining abscesses. Treatment: Long-term, high doses of antibiotics

Impetigo

A bacterial skin infection BQ! Caused by Streptococcus pyogenes and Staphylococcus aureus. Requires direct contact of non-intact skin for infection. Infectious!

Impetigo diagnosis

vesicles that rupture, crust, or longer lasting bullae.

Impetigo treatment

topical or systemic antibiotics

Pericoronitis

Inflammation around the crown of a partially erupted, impacted tooth. Most commonly a lower third molar. Trauma from an opposing molar and impacted food under the soft tissue flap (operculum) may precipitate.

Pericoronitis treatment

-Mechanical debridement

- Irrigation of the pocket

- Systemic antibiotics

- Removal of the offending tooth

Candidiasis

The outcome of an overgrowth of Candida albicans. Normal oral microflora, particularly diabetes and denture patients, antibiotics, HIV patients. This can result from many different conditions. Most common associated with immunodeficiency. The organisms can be identified in a scraping of the lesion.

Acute osteomyleitis

Acute inflammation of the bone and bone marrow. Most commonly the result of a periapical abscess extension. May follow fracture of a bone or surgery. May result from a bacteremia

Condyloma Acuminatum:

A benign papillary lesion caused by a papillomavirus. Papillary, bulbous pink masses that can occur anywhere in the oral mucosa. Multiple lesions may be present

*If seen in a child it may be a sign of sexual abuse

HIV

The virus infects cells of the immune system, particularly CD4 T-helper lymphocytes. Oral candidiasis is the most common oral characteristic. Fatigue, weight loss, lymphadenopathy, dementia, kaposi sarcoma on palate and attached gingiva are other symptoms

HIV antibody tests

2: ELISA (enzyme-linked immunosorbent assay) is used first.

and When this test is positive twice, it is followed by the Western blot test.

Kaposi sarcoma

Cancerous; An opportunistic neoplasm that may occur in patients with HIV infection. Most commonly located on the palate and gingiva, herpes virus 8.

Inherited

Caused by an abnormality in genetic makeup (exp: heart disease and cancers)

Congenital

Present at birth. May be inherited or developmental (exp: cleft palate)

Anomaly

something that deviates from normal

Developmental

a failure during the process of cell division and differentiation in various tissues and structure

Congenital Lip pit

Epithelium-lined blind tracts located in midline of the lip (pits)

Commissural lip pit

Epithelium-lined blind tracts located at the corners of the mouth (commissure)

Radicular cyst (periapical cyst)

most common oral cyst. Basically, an abscessed tooth

Dentigerous cyst (follicular cyst)

Forms around the crown of an un-erupted or developing tooth. Most commonly occurs around the crown of an un-erupted or impacted third molar.

Eruption Cyst

similar to dentigerous cyst; tooth erupts through the cyst. no treatment needed

Primordial

Develops in place of a tooth. Most commonly in place of a third molar and most commonly seen in young adults. TX: SX removal

Odontogenic Keratocyst

unique appearance; lined by 8-10 cells of epithelium. usually in mandibular third molar area; can move teeth and cause resorption. has high recurrence rate; Sx extraction and osseous curettage rec’d. Radiographic appearance: well-defined, multilocular, radiolucent lesion