top 1-15 oral lesions

irritation fibroma

giant cell fibroma
epulis fissuratum (hyperplasia)

reactive from chronic irritation or trauma

along occl plane of buccal mucosa

well circumscribed, slow grow polyp/nodule

fixed to mucosa

may be ulcerated

asymptomatic

prolif of dense fibrous CT

vascular network

inconscpicuous inflam

excision biopsy

recur not common

neoplastic PLURIPOTENTIAL dev of fibroblasts

retrocuspid papilla of HIRSHFIELD

teenagers, YA

<1cm solitary papule

bosselated/ papillary

sessile/ pedunculated

dense collagen

enlarged stellate fibroblasts

elongated rete pegs

excisional biopsy

good prog

possible gingival defect

no recur

chronic apical periodontitis

inflamed granulation tissue around apex

complication of pulpitis
2ndary to bact w/in RC

asympto

radioluc at apex

loss of lamina dura

resorption or cystic degen

russell bodies (inclusions in plasma cell)

cholesterol clefting (elongated empty spaces)

extravasated blood

endo/apicoectomy

ext if nonrestorable

cortical bone destroyed

cortical bone destroyed

lesion w/histologic alterations, likely for malignant transformation

white lesions mostly mild

speckled usually severe, rare mild

red are always severe never mild

individual cell keratinization
bulbous rete ridges
pleomorphism
hyperchromatic/prominent nucleus
mitosis

mild, moderate, severe

invasive carcinoma from less than full thickness dysplasia

de novo carcinoma without pre-existing dysplastic change

dysplasia will have mitotic figures

thickness of the basal layer (thicker = more severe)

mild - watch closely
moderate to severe - completely excised

microscopic dx of epithelial dysplasia

frictional keratosis

no

yes, remove traumatic agent

sanguinaria

inflam or protective response to pressure

due to genetics on surfaces not irritated

determine probable cause and eliminate the source of irritation; biopsy if therapy no respond

pooling of salivary mucous within a cyst or cyst-like cavity

trauma, dental tx

escape of salivary fluid to surrounding CT from trauma to salivary gland duct

no, not true cyst

mucous pool confined within epith lined cyst

extravasation

lower lip

term for mucocele on floor of mouth

small ones spontaneously rupture and heal

excision, remove surrounding minor glands to prevent recurrence

laser tx

cyst separating the follicle from the crown of an unerupted tooth

exact unknown; inc osmotic pressure within cystic lumen

dentigerous cyst (follicular cyst)

males

10-30yrs

mandibular 3M
max canine

usually asympto

if larger: expansion, asymmetry, root resorb/ displace

unilocular

pericoronal radioluc

grow along anatomic borders, no expansion

loose CT wall; GLYCOSAMINOGLYCAN GROUND SUBSTANCE

islands/ cords of inactive odontogenic rests

2-4 cells thick epithelium

more collagen in fibrous wall

cell infiltrate

epith hyperplasia, RETE RIDGES

enucleate/ curettage or masupialization

they are occasionally associated with other developing tumors

ameloblastoma

dysplasia/ sqm cell carcinoma

central mucoepidermoid carcinoma

HPV 6/11

both sexual and nonsex

tongue

soft palate

soft, painless, pedunculated lesion

papillary or verrucoid (cauliflower) surface

light pink, white, or mucosa color

~.5cm solitary

cauliflower hyperparakeratotic epithelium

finger like fronds, fibrovascular core

cytopathic effect in koilocytes

epithelial cell w/ nuclear enlarged, darker staining, halo around nuc, and irregular nuc memb

excision including base of lesion

no malignant transformation

no recur but can get laryngeal papillomatosis

lichen planus

chronic inflam disease causing white strige, papules, plaques on buccal mucosa, tongue, gingiva

45-60

women 2x more than men

T cell med AID; apoptosis of oral epith by CD8 T

other immunologically mediated diseases

oral LP > skin lesions
cutaneous LP > oral lesions

more in women

in pts with persistent mouth sores

inc risk with alc/ tobacco

medication induced

allergic/immunologic

chronic hep C

graft vs host disease

dental mats

poor man's magic mouthwash: benadryl

magic mouth wash

topical gel

radicular cyst

result from pulpal inflammation

epithelium from malassez

non vital teeth

well circumscribed radiolucency

usually pericapical

can involve lateral root

root resorption

strat sqm epith, with lining

some cholesterol clefts in wall

dx as periapical granuloma instead

endo therapy
apicoectomy
follow up impt!

exuberant granulation tissue, reactive lesion

alarming rapid growth initially

very vascular

gingiva; usually ulcerated

pregnancy and puberty

granulation

delicate collagen

excision

can recur if irritant not removed

hemangioma

60% in head/neck

hemangioma

flat red-blue or red exophytic

capillary subtype regresses spontaneously

plump endothel cells

for infancy: can regress spont.
excision
sclerosing agents
SYSTEMIC STEROIDS

cavernous require surgery

invasive neoplasm, invasion thru BM, angioinvasion

squamous cell carcinoma

leuko/erythroplakia
exophytic
endophytic

well/moderately/poorly differentiated

tumor has almost normal sqm epith

midway between well and poor diff

poor cytomorphologic/architectural resemblace to normal epith

tongue
soft palate/oropharynx
floor of mouth
lower lip

posterior lateral border

pts unaware due to posterior location

delay in dx > lesion larger and metast'd by then

difficulty swallowing

males more than females

midline near frenum

light skinned ppl w sun expose

crusted oozing indurated ulcer

gingiva

gingiva

benign hyperpigmentation of mucous memb

vermillion border of lip (lower)

peutz-jegher's syndrome

women

~40yrs

inc melanin prod and deposition along basal layer, no inc in melanocytes

melanin incontinence

drug induced melanosis
amalgam tattoo
kaposi sarcoma

biopsy

odontogenic keratocyst

adolescents, YA

mandible; posterior body and ramus

unilocular

grow w/o symptoms
within normal anatomic jaw

tooth displacement
root resorb
loss cortical bone

myxoma
ameloblastoma
central giant cell
hemangioma
odontogenic keratocyst

corrugated parakeratin surface
perpendicular hyperchromatic basal cell

aspiration-decompression

enucleate

segmental resection

nevoid basal cell carcinoma syndrome (gorlin)

autosomal dom
PTCH chromosome 9 defect
or solar damage

caucasians; start at teens 20s

pits on hands/feet (due to impairment of normal basal cell maturation)

multiple odontogenic keratocyst

calcification of falx cerebri

bifid ribs
hypertelorism
frontal bossing

Moh's surgery
pt usually has normal life span

reactive lesion of periosteum or periodontal ligament origin

found on tooth bearing areas of gingiva

fixed to mucosa

adolescents and YA

cellular fibrous CT

dystrophic calcification formation

excision down to periosteum

20% recur