Midterm:

Tooth Structure, Wear, Development, and Bone Findings:

Bruxism

• Grinding or clenching teeth together for non-functional purposes

  • Associated with attrition

Attrition

• Slow process of tooth wear due to mastication

Abfraction

• Wedge-shaped lesions at cervical areas of the teeth

  • Related to fatigue, flexure, and fracture from biomechanical forces

Erosion

• Loss of tooth structure from chemical action

  • Influenced by diet, vomiting, and GERD

Abrasion

• Pathologic wearing away of tooth structure from repeated mechanical force

  • Influenced by toothbrush technique

Anodontia

• Definition: Congenital lack of ALL teeth (primary and permanent)

• Treatment: prosthetic replacement of missing teeth

• Diagnostic: clinical or radiographic

Hypodontia

• Definition: lack of one or more teeth (developmental)

  • Permanent teeth MORE common

  • Common teeth: third molars (both arches), maxillary lateral incisors and mandibular 2nd premolars

• Treatment: prosthetic replacement of missing teeth

• Diagnosis: clinical or radiographic

Concrescence

• Definition: two adjacent teeth are united by cementum ONLY

  • maxillary molars

• Causes: developmental after tooth formation, crowding, or trauma

• Treatment: none

• Diagnostic: radiographic

Amelogenesis imperfecta

• Definition: broad group of conditions that affect the structural formation of enamel

• Divided into 4 types:

  • type I (hypoplastic)

  • type II (hypocalcified)

  • type III (hypomaturation)

  • type IV (hypoplastic-hypomaturation)

dens en dente (dens invaginatus)

• Definition: tooth within a tooth → results when enamel invaginates into the crown before mineralization

  • Common in maxillary lateral incisors

• Diagnosis: Clinical (tooth appears normal or peg-shaped) or radiographic

• Treatment: replacement of prophylactic restoration (vital) or RCT (non-vital)

Compound odontoma

• Definition: collection of numerous small teeth

resorption

• Definition: observed radiographically when the apex of the tooth appears shortened or blunted and irregularly shaped

• Two types: internal and external

traumatic bone cyst (simple bone cyst)

• Definition: pathologic cavity in bone that is not lined with epithelium

stafne bone cyst (static bone cyst or lingual mandibular bone concavity)

• Definition: radiolucency in the posterior region of the mandible inferior to the mandibular canal (NOT A TRUE CYST)

• Cause: developmental concavity containing normal salivary tissue on lingual aspect of mandible

• Diagnosis: radiographs

• Treatment: none

Periapical cemento-osseous dysplasia

• Definition: apical lesion that appears as a mass of fibrous connective tissue with spicules of cementum or a calcified mass resembling cementum

  • Found commonly in black women

Paget disease (osteitis deformans and leontiasis ossea)

• Definition: chronic metabolic bone disease characterized by resorption, osteoblastic repair, and remineralization of involved bone

Gingiva, Mucosa, Healing and Clinical Signs

Gingival Enlargement:

• Phenytoin (Dilantin) and nifedipine (Procardia)

Gingival hyperplasia

• Definition: enlargement of the gingiva

Hyperplasia

• Increase in number of normal cells due to stress

Hypertrophy

• Increase in cell size due to stress

Atrophy

• Decrease in size and number of normal cells due to stress

Necrosis

• Definition: cell nucleus dies and releases enzymes → whole cell dies → membranes disintegrate → cell contents released into tissue causing inflammatory response

  • in short, premature death of cells or body tissue

Acute vs chronic inflammation

• acute → early or immediate response

  • short duration (days)

  • several PMNs and monocytes

  • outcome: complete resolution, scarring (fibrosis), abscess formation, and progresses to chronic inflammation

• chronic → response to persistent infection (can progress from acute)

  • long duration

  • several macrophages, lymphocytes, and plasma cells

  • outcomes: repair not complete until source of injury is REMOVED

frictional keratosis

• Definition: chronic rubbing or friction against oral mucosal surface that may result in hyperkeratosis → appears as a white patch

Xerostomia

• Definition: dryness of the mucous membrane

• Causes: BY HYPOSALIVATION OR DECREASED SALIVARY FLOW

Operculum

• Definition: flap of soft tissue covering a portion of the crown or partially erupted tooth

Exudate

• Definition: inflammatory fluid formed as a reaction to injury of tissues and blood vessels

Fistula

• Definition: Underlying tunnel that connects deep infection to that surface opening

Epulis fissuratum (denture-induced fibrous hyperplasia)

• Definition: lesion caused by ill-fitting denture and located in the vestibule along the denture flange

pyogenic granuloma

• Definition: intraoral lesion characterized by a benign growth of granulation tissue that occurs in response to injury

  • NO PUS and NOT TRULY A GRANULOMA

• Treatment: excision and removal of local irritants

• Causes: pregnancy-induced (pregnancy tumor)

erythema migrans/geographic tongue

• Definition: erythematous patches surrounded by a white or yellow border

  • Area has no filiform papillae but has fungiform papillae

  • genetic factor or stress-induced

  • NO treatment

median rhomboid glossitis

• Definition: appears as flat or slightly raised erythematous area in CENTER of tongue (extends to circumvallate papillae)

  • associated with Candida albicans

  • NO treatment, but antifungal may be used

lingual varicosities

• Definition: appears as red-to-purple enlarged vessels that are on the ventral/lateral surface of the tongue

  • Common in older patients (60+)

  • Associated with smoking, CV disease, and varicosities in legs

Linea alba (treatment)

• Definition: white line extends on the buccal mucosa along the occlusal plane

  • PROMINENT in clenching or bruxing habits

Fordyce granules

• Definition: Sebaceous glands that appear as yellow-white papules on buccal mucosa and vermilion upper lips

• Present in 80% of the population (normal, no treatment)

keloid

• Definition: excessive scarring in skin

  • Appears raised and extends past injury

  • High occurrence in dark skin or family history

Angular Cheilitis

• Definition: associated with deficiencies of B-complex vitamins; commonly a fungal condition OR Candida infection

• located on the labial commissures

  • responds to antifungal cream and ointment

wickham striae

• Definition: associated with lichen planus that appears as interconnecting lines

traumatic neuroma

• lesion caused by injury to peripheral nerve

macule

• area that is distinguished by a color different from that of the surrounding tissue

  • flat; does NOT protrude above tissue (freckle)

papule

• small, circumscribed lesion that is elevated above the surface of surrounding tissues

lobule

• segment or lobe that is a part of a whole

  • appeared fused

pedunculated

• Attached by a stem-like base similar to that of a mushroom

coalescence

• parts of a whole join together, or fuse, to make one

lymphadenopathy

• Definition: abnormal enlargement of lymph nodes

urticaria (hives)

• Definition: Localized redness and swelling due to increased vascular permeability

margination

• movement of WBCs to vessel wall at the sight of injury

Pavementing

• the adhesion of white blood cells to blood vessels during inflammation

Immunology, Infection, and Diagnostic Concepts

Plasma cells = B lymphocytes

• B-lymphocytes differentiate into plasma cells

  • Make specific antibodies that bind to antigens

antigens

• any substance able to induce a specific immune response

antibodies: natural, passive, acquired active and passive

• natural active:

  • Antibodies produced due to exposure

• natural passive:

  • Antibodies through the placenta to the developing fetus or via breast milk

• acquired active:

  • antibodies produced due to vaccination

• acquired passive:

  • antibodies injected

humoral immunity (antibody-mediated immunity)

• type of immunity in which B-cell lymphocytes and antibodies they produce as plasma cells play predominant role

immunoglobin

• proteins that, when secreted by plasma cells, serve as antibodies that respond to antigens

types of hypersensitivity

• Type 1: immediate response to previously encountered antigen

  • Examples: allergies, urticaria, angioedema, and anaphylaxis

• Type II: antibody-mediated

  • Examples: Rh incompatibility, pemphigus, pemphigoid, Graves disease, or myasthenia gravis

• Type III: immune complex disease

  • Examples: SLE, serum sickness, fever, vasculitis, and arthralgias

• Type IV: delayed reaction caused by T-cells

  • Example: contact mucositis or dermatitis

PPD skin test for TB:

• Definition: antigen called purified protein derivative injected into the skin → if immune system has previously encountered antigen, positive skin reaction occurs → Type IV delayed-hypersensitivity reaction

incubation period

• period between infection of an individual by a pathogen and manifestation of disease

latent period

• period when an infectious agent is present but not producing obvious symptoms

parenteral administration of drugs

• injection in which administration is more widespread and severe because the allergen is carried quickly

primary/secondary/tertiary healing

• primary intention: wound margins are closely adapted to each other; promotes rapid, clean healing with minimal scar formation

  • most desired

  • example: cut with sharp knife

• secondary intention: wound margins are NOT closely adapted; healing occurs from the base of the wound upward and inward

  • slower and less predictable

  • examples: tooth extraction

• tertiary intention: wound cleaned and purposely left open to drain before closing

  • Used when infection is present

diagnostic processes

• Clinical diagnosis → color, shape, location, and history

  • fordyce granules

  • torus palatinus

  • mandibular tori

  • melanin pigmentation

  • retrocuspid papillae

  • fissured tongue

  • geographic tongue/benign migratory glossitis

  • median rhomboid glossitis

  • white/black hairy tongue

  • circumvallate papilla

• radiographic diagnosis → provides sufficient info to establish diagnosis

  • periapical pathosis

  • heavy interproximal calculus

  • external resorption

  • caries

  • compound/complex odontoma

  • supernumerary or impacted teeth

  • calcified pulp

  • nutrient canal

  • unusual findings (instruments, frames, piercings)

• historical diagnosis → personal or family history, medical history, drug ingestion

  • presenting disease or lesion

  • amelogenesis imperfecta

  • dentinogenesis imperfecta

• laboratory diagnosis

  • clinical lab tests (blood chemistries, organismal cultures, urinalysis)

  • helpful in determining the diagnosis of oral infections

• microscopic diagnosis

  • main component of definitive diagnosis

  • certain pathology cannot be diagnosed on clinical appearance alone

• surgical diagnosis

  • lingual mandibular bone cavity (static or Stafne bone cyst)

• therapeutic diagnosis

  • nutritional deficiencies are common conditions

  • angular cheilitis (deficiency of B-complex vitamins)

  • necrotizing ulcerative gingivitis (responds to hydrogen peroxide)

• differential diagnosis

  • decides which test is required to rule out conditions originally suspected and to establish definitive diagnosis

anaphylaxis

• Definition: severe allergic reaction that can occur from exposure to an allergen

Disease and Conditions

Mucous membrane pemphigoid-symblepharon

• Autoimmune disease that affects oral mucosa, conjunctiva, genital mucosa, and skin

  • Also called mucous membrane pemphigoid or cicatricial pemphigoid

Reiter Syndrome (Reactive arthritis)

• Chronic disease compromising triads: arthritis, urethritis, and conjunctivitis

Aphthous ulcers (canker sore)

• Definition: painful oral ulcers recurring in episodes

  • minor → canker sores with movable mucosa and red border (heals in 8-10 days) MOST common form

  

  • major → larger, appearing as multiple painful lesions, can be associated with HIV, (heals in a few weeks)

  

  • herpetiform → least common, resembles primary herpes and NOT related to HSV

fever blister = recurrent oral herpes = herpes labialis

• Definition: most COMMON type of recurrent oral herpes simplex infection that occurs on the vermilion border of the lips

herpes zoster

• Definition: reactivation of primary infection (varicella zoster/chickenpox) due to predisposing factors → immunosuppression, radiation, etc.

  • 3 phases: prodrome, acute, and chronic

• Treatments: antiviral drugs, pain medication, or vaccine

• Diagnosis: clinical

varicella-zoster/chicken pox

• Definition: highly contagious disease caused by varicella zoster virus that is characterized by vesicular and pustular eruptions of the skin and mucous membrane

  • Systemic symptoms: headache, fever, and malaise

Koplik spots/measles (rubeola)

• Definition: small red macules with white necrotic centers seen intraorally with macules (Koplik spots)

  • caused by paramyxovirus

scrofula (tuberculous lymphadenitis)/TB

• scrofula: TB that presents as enlargement of the submandibular and cervical lymph nodes

• TB: infectious granulomatous disease caused by Mycobacterium tuberculosis that is the primary infection of the lung

  • treatment: antibiotics

  • diagnosis: PPD skin test

pseudomembranous candidiasis

• white curd-like material is present on mucosal surface

  • underlying mucosa is red

minor erythema multiforme

• self-limited disease that affects the skin and mucous membrane

  • cause is unknown but can be a hypersensitivity reaction

Behçet syndrome (pathergy test)

• recurring autoimmune disease consisting of oral ulcers, genital ulcers, and ocular inflammation

infectious mononucleosis

• Definition: Characterized by sore throat, fever, lymphadenopathy, enlarged spleen, malaise, and fatigue

• Causes: Epstein-Barr virus

• Treatments: resolves on its own

Scarlet fever and strawberry tongue

• Definition: childhood disease caused by Group A beta-hemolytic streptococcus

  • characterized by red rash, strawberry tongue (fungiform papillae are red and prominent), sore throat, fever, enlarged lymph nodes

impetigo (treatment)

• most commonly involves lesions on the skin of the face or extremities

  • APPEARS AS STICKY, HONEY-COLORED CRUST

• treatment: topical antibiotics

• diagnosis: clinical presentation

leukoplakia

• Definition: white, plaque-like lesion on the oral mucosa that cannot be rubbed off or diagnosed as a specific disease

verruca vulgaris (common wart)

• Definition: white papillary exophytic lesion caused by human papillomavirus

syphilis (treponema pallidum)

• Definition: disease caused by the spirochete treponema pallidum that is transmitted from one person to another by 1. sexual contact 2. direct contact with blood 3. transplacental transmission

  • associated with Candida albicans

Candida albicans in newborns

• associated with candidiasis, median rhomboid glossitis, and monillasis

chancre

• lesion of the primary stage of syphilis

mucous patch

• lesions of the secondary stage of syphilis that appear as multiple, painless, grayish-white plaques