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Autoimmune & Immune-related Skin, Eye, Oral (anywhere)

Subepithelial split (epithelial-CT separates from


SLE / Systemic Lupus Erythematosus lamina dura)
Autoimmune, >young adult females Starts as vesicle/bulla erosions & ulcers
Butterfly rash, photosensitivity Conjunctiva scarring / blindness, dry eyes
Diff Dx: Lichen Planus Autoimmune, AB against basement membrane
Complications: Heart (endocarditis) & Kidney More common & Milder than Pemphigus
(glomerulonephritis) POS Nikolsky

Sjogrens Syndrome
NOT infectious
>Elderly women
Dry eyes & dry mouth = sicca
Secondary to Lupus or RA

Recurrent Aphthous Stomatitis / Ulcers / Pemphigus Vulgaris (desmosome)


Canker Sores Vesiculoerosive, IgG immunofluorescence
Moveable mucosa (uvula, labial mucosa, buccal >Lips, palate, gingiva
mucosa, ventral tongue, FOM, soft palate) INTRAepithelial split/acantholysis
Immune-mediated (CD4, CD8), HLA associated (SUPRAepithelial) epithelial cells dont bind
NOT contagious Autoimmune, AB against desmoglein
NOT preceded by vesicle (UNLIKE Herpes) POS Nikolsky (blisters w/lateral pressure/air)
Herpetiform (rare, 50+ small painful lesions) POS Direct + Indirect immunofluorescence
Tx: cauterize w/laser or acid, OraBase & (UNIQUE), Tzanck cells (round epithel cells)
Kenalog (corticosteroid) Tx: skin grafts
Minor (shallow, red halo) heal in 5-10 days
Major heal in weeks
H/O trauma, stress, UV exposure
Risk Factors: Behcets disease, Crohns, familial

Pseudomembranous Candidiasis / Thrush


Common in elderly & infants, ABs & steroids
Anywhere (>B mucosa, palate, dorsal tongue)
Hyphae & Spores (Dx: cytology smear)
White patch, wipes off
>Buccal mucosa & Palate
Scarlet Fever
Tx: Nystatin or Clotramizole (topical),
Strawberry tongue = swollen fungiform papilla
Fluconazole (systemic)
White Strawberry (1-2 days) = sloughs off
Often req AB prophylaxis for prevention
Group A, Beta-hemolytic Strep
Erythrogenic toxin affects bl vessels
Pastias Lines: red streaks on skin
Fever, Circumoral pallor, soft palate petechiae
Complications: Rheumatic fever, bacteremia,
glomerulonephritis, TSS, cellulitis
Chronic Erythematous Candidiasis
Benign Mucous Membrane Pemphigoid (BM) A) Median Rhomboid Glossitis
Cicatricial (scars), Vesiculoerosive
>Mid-aged females
Red atrophy / bald tongue of filiform papilla (in
front of circumvallate) Actinomycosis
Midline tongue, Jx of ant 2/3 & post 1/3 @ Soft granular / woody swelling
tuberculum impar Multiple draining fistulas
Tx: Nystatin, Clotramizole Enlarged, red, inflamed
Sulfur granules (bacteria), neutrophils

Chronic Osteomyelitis
B) Denture Stomatitis / Sore Mouth Best seen in LATERAL OBLIQUE xray view
Tx: rinse & soak denture in antifungal Mixed radiolucent & radiopaque
Diff Dx: methylmethacrylate allergy (acrylic) Painful, swelling, fever, purulent
Dx with Cytology smear Etiology: dental infx, ANUG, NOMA,
Osteopetrosis & Florid Cemento-Osseous
Dysplasia

Oral Hairy Leukoplakia (EBV)


Lateral tongue, white rough plaque
HIV+ pts progressing to AIDS
Epstein Barr Virus
Necrotizing Sialometaplasia
Rapid onset
Deep ulcer of palate
Self-resolving

Infections

Cavernous Sinus Thrombosis (cellulitis)


Abscess of upper lip or intrabony Ant Max tooth Infectious Diseases & STDs
10% from orofacial infx (>Max canine)
Valveless facial veins orbit Condyloma Acuminatum: Venereal wart
Proptosis, orbital edema, conjunctiva HPV>16, 18
>Females age 20-24
Ludwigs Angina: (cellulitis) Labial mucosa, soft palate, lingual frenum
Submandibular space infx (70% Mand infx) Causes 95% of cervical cancer (NOT oral)
Worst Complication = glottis edema
obstructs airway

Sarcoidosis
Bilateral hilar lymphadenopathy (chest xray)
Cutaneous lesions (violet)
Tx: corticosteroids Squamous Papilloma: HPV 6, 11
= gender, age 30-50
Rough cauliflower papule/nodule, >2cm
>Gingiva, Soft Palate, Tongue
NOT precancerous! NO Dysplasia
Histo: Epithelial proliferation (NOT CT)
Tx: Excision
Herpes Zoster / Shingles
Dorsal root ganglion
Prodrome (fever, headache)
Vesicles painful ulcers
Unilateral skin & oral (palate, tongue)
Recurrent/Secondary Herpes Simplex: Type 1
80-85% of US ppl, CONTAGIOUS, NO fever
NON-movable mucosa (hard palate, gingiva)
Lip & vermillion
Vesicles rupture into ulcers
Tzanck Test: rupture a vesicle, look for MNGs
Mostly subclinical, Trigeminal ganglion
Prodrome: burning, tingling
H/O trauma, stress, UV exposure
Tx: heals in 7-10 days

Primary Herpes / Gingivostomatitis


Kids 6mo-5yrs, INFECTIOUS
Non-movable mucosa: hard palate, gingiva
Inflamed enlarged marginal gingiva, bleeding
Vesicles coalescing ulcers in mouth & lips
Low fever, malaise, sore throat,
Tuberculosis lymphadenopathy
INC incidence Tx: analgesics 1-2wks, Antiviral if <2 days S/S
Non-healing ulcers (like cancer)
Dx: chest xray
May spread by infected sputum to oral lesions
(ie. Ulcer mimicking cancer on tongue)

Varicella Zoster / Chickenpox


Trigeminal ganglion Infectious Mononucleosis (EBV)
Buccal mucosa, palate, gingiva >Teens
Dx: Cytopathologic effect in smear Lateral neck swelling, Sore throat
Complications: Encephalitis POSITIVE Monospot test
Palatal petechiae
Transected nerve w/scar tissue
Erythema Multiforme Painful or tender, firm nodule
Young adult males Sites of chronic trauma (Mand alveolar ridge in
Sudden acute explosive onset denture pts, near Mental N, tongue)
Causes: Viral, Herpes, Pneumonia, Allergy, med Diff Dx: Fibroma (no pain, >tongue)
Crusted bleeding vesicles & ulcers
>Lips, labial mucosa, hands & feet (bulls-
eye/target /iris), NOT on gingiva!
Supportive Tx (self-limiting in 2-6wks):
steroids, analgesics, ABs, electrolytes

Pyogenic Granuloma (Pregnancy Tumor)


Any age, >Females
Causes: local irritation (food trap, overhang)
Can be ANYWHERE, >Max anterior, buccal
Stevens Johnson Syndrome >Gingiva (interdental papilla)
Like Erythema Multiforme but WORSE Bleeds, red, NOT painful, fast growth
Oral (conjunctiva), Ocular, Genital Histo: granulation tissue, AICI, CICI
Toxic Epidermal Necrolysis/Lysells Disease Tx: excision + eliminiate trigger

Developmental

Treacher Collins Syndrome /


Mandibulofacial Dystosis / Deficit
Mand retrognathism (lower 1/3 face deficit)
External ear changes, 30% cleft palate, Peripheral Giant Cell Granuloma
Hypoplastic or absent parotid gland
Middle-aged
Downward slant of eyes / palpebral fissures
GINGIVA ONLY (>ant to 1st molar)
Outer canthus is lower than inner (reversed) Purple/Liver (hemosiderin + RBCs)
Autosom dom or spontaneous mutation (60%) Pressure resorption (cupping/saucer)
1st & 2nd branchial arches
Histo: MNG cells (PDL osteoclasts),
hemosiderin, granulation, AICI, CICI
Turner Tooth Tx: excision to periosteum + elim trigger
Local trauma or infx in developing tooth bud
>Mand premolar = #1 affected tooth

Peripheral Ossifying Fibroma


Intrinsic Staining
>Teenage females
Stained dentinal tubules
GINGIVA ONLY, NOT in bone but makes osteoid
Causes: Tetracycline, A. Imperfecta, D.
Reactive bone formation, PDL origin
Imperfeca, Fluorosis
Scattered light radiopacities
Histo: collagenous stroma w/osteoid,
Traumatic
granulation tissue, AICI, CICI
Tx: excision down to bone
Traumatic Neuroma
Monomorphic Adenoma (Benign)
Central Giant Cell Granuloma #1 Benign MSG tumor in upper lip
>Young Females (<age30) >Females
Intrabony (jaws), >Ant mandible (70%) Canalicular (upper lip), Basal (parotid)
Asymptomatic expansion, >crosses midline NO H/O trauma or infx
Complications: root resorption, move teeth
Chronic renal disease bone destruction
Same Histo as: brown tumor
(hyperparathyroid), Cherubism, PGCG

Mucoepidermoid Carcinoma (MALIGNANT)


Salivary Gland Tumors Most common salivary gland malignancy
>Females, Bimodal (30s & 60s)
Salivary Glands >Parotid, Palate, Submandibular, B mucosa
Parotid: serous Least common intraoral site: sublingual, FOM
Submandibular: >serous, some mucous Histo: mucocytes/goblet cells
Sublingual: mucous
Palate: MUCOUS Adenoid Cystic Carcinoma (MALIGNANT)
Labial mucosa: mucous + serous >Middle-aged Females
>Submandibular, MSGS (>palate)
Nicotine Stomtatitis / Leukokeratosis Parotid: RARE, perineural invasion w/NO
Hard palate, Red inflamed MSGs upper lip paresthesia), BEST prognosis
Due to HEAT (NOT precancer) Worst Px: MSG (lung & bone mets)
Histo: hyperkeratosis, keratin, squamous
metaplasia of MSG ducts Cheilitis Glandularis
Mucous MSGs of lips are inflamed
Salivary Neoplasms Mucous secretions
>Parotid (major) & Palate (MSG) Premalignant! SCC
Most common location = Hard Palate
Benign: >Pleomorphic Adenoma
Malignant: >Mucoepidermoid > Adenoid Cystic
Perineural invasion: Adenoic Cystic Carcinoma,
Polymorphous Low-Grade Adenocarcinoma

Pleomorphic Adenoma (Benign)


Most common salivary gland tumor Warthins Tumor / Papillary Cystadenoma
>Females ~age 30-40 Lymphomatosum
>Parotid >Palate (jx of SP + HP) > Parotid gland NOT in oral cavity!
Encapsulated >Males
Histo: ductal, squamous, myxoid, chondroid
Cheilitis Glandularis
Mucous MSGs inflamed on lower labial mucosa
NOT sun-induced
Premalignant SCC
Lip swelling, lip everts (can see labial mucosa)
Erosive
Benign
Aspirin / Chemical Burn
Benign Migratory Glossitis / Geographic White coagulative necrosis
Tongue / Erythema Migrans Wipes off with difficulty (UNLIKE
Red & white serpentine/circinate (keratin) hyperkeratosis which doesnt wipe off)
Filiform papilla atrophy / depapillated
Sore, burning tongue, migrates daily
Tx: corticosteroid rinse (Dexamethasone)

White Sponge Nevus


Bilateral buccal mucosa
Nasal, esophageal, laryngeal, anogenital
Lichen Planus Autosomal dominant
>Buccal mucosa, bilateral, >Reticular Thick white folds, NO eye involvement
>Mid-aged women Does NOT dissipate when stretched
Skin (purple polygonal prurititic papules) Histo: hyperkeratosis, acanthosis, perinuclear
Oral: Wickams stria (white coalescing papules) eosinophilic condensation (fried egg)
Reticular: white NOT wipe off, asymptomatic
Erosive: tongue, painful, looks like geographic
Hyperplastic: plaque-like, NOT wipe off
Bullous: Skin, looks like Benign Pemphigoid
Diff Dx of Hyperplastic: Candida, Leukoplakia
Histo: hyperkeratosis, BM necrosis
(Colloid/Civatte bodies = degenerating
keratinocytes), saw tooth rete ridges
Tx: Steroids HBID / Hereditary Benign Intraepithelial
Dysplasia
Auto dom
Oral & Ocular B&L mucosa, conjunctiva
Histo: dyskeratosis cell within a cell

Reticular

Hyperplastic

Leukoedema
Bilateral buccal mucosa, >Afr Ams
Stretch buccal mucosa disappears
Histo: intraepithelial edema, acanthosis
Diff Dx: White sponge nevus, HBID (eyes)
Malignancies

Kaposis Sarcoma
HIV+ pts progressing to AIDS
Etiology: Herpes virus type 8

Osteosarcoma
Rapid onset of localized pain & swelling
Morsicatio Buccarum / Cheek Nibbling Tingling lower lip
> Buccal mucosa, lingual, lip, tongue Late 20s-early 30s
White rough tissue tags BELOW occlusal plane Most common primary malignancy of bone in
Partially removable ppl <25yo
Early radiolucency later radiopacity
Symmetrical PDL widening, trabeculae changes

Fordyce Granules: ectopic sebaceous glands


Yellow plaque/papules (sebum) Malignant Melanoma
>Buccal mucosa (inner cheek) & >Labial >Hard palate & gingiva
mucosa (inner lip), retromolar pads, genital
80% of adults Multiple Myeloma
Elderly males
Bence-Jones proteinuria, Ig spike
Calvaria, spine, pelvic girdle, jaws
Punched out radiolucencies

(Black) Hairy Tongue


Keratin on filiform papilla
Physiologic / Racial Pigmentation Smokers, ABs, poor hygiene, infx
Lower lip, vermilion, attached gingiva, tongue,
buccal mucosa Oral Hairy Leukoplakia
Symmetrical brown macules Lateral border of tongue
Epstein-Barr Virus
Acquired Melanocytic Nevus / Mole Uncontrolled HIV+ pts
Jx type: most likely malignant transformation
Intramucosal/Intradermal type
Compound type

Abrasion
Cervical mechanical wear
Exposed Roots Leukoplakia
MOST common premalignant lesion!
Precedes 85% of all oral cancers
20% are precancerous
White hyperkeratosis, does NOT wipe off
>Tongue (25% dysplastic)
Most Dysplasia: FOM (50% dysplastic)
Dx: biopsy (NOT cytology)

Basal Cell Carcinoma (EXTRAORAL)


Painless ulcer of upper lip & sun-exposed areas
Erythroleukoplakia (speckled) NOT intraoral!
>Posterior lateral tongue, FOM, soft palate, Papule, telangiectasia
alveolar ridge Rarely Mets
May be dysplasia or malignant carcinoma
Initial Tx: incisional biopsy of red component

Metastatic Disease to the Jaws


>Posterior mandible
Radiolucency with NO sclerotic border
SCC / Squamous Cell Carcinoma
Most commonly mets from: lung, breast,
95% of all oral cancers!
kidney, colon, prostate
>Posterior 2/3 of lateral tongue
Batsons/Paravertebral Venous Plexus: route
>Lower lip (Actinic Cheilitis)
of mets of distant tumor emboli to H&N
LEAST common oral site: hard palate
Worst Prognosis: FOM Lung mets
Leukemia (malignant WBCs)
Tongue lateral neck LNs
Red, swollen, hyperplastic, boggy gums
Palate preauricular LNs
Spontaneous gingival bleeding (>interdental
Staging (spread) is more important than
papilla) w/ ulcers
Grading (differentiation)
Punched out oral ulcers, necrotic
Pallor, red skin macules & bruising (purpura)
Infx, malaise, anemia (DEC RBCs), DEC platelets
Green lesion (Chloroma/Granulocytic
Sarcoma): palatal necrosis

Verrucous Carcinoma
Actinic Cheilitis Well-diff SCC, >Smokeless tobacco
Lower lip vermilion sun damage Large, papillary, exophytic
Premalignant Dysplasia SCC BEST prognosis of all oral cancers (NO mets!)
>Buccal vestibule, >Mand, palate
Field Cancerization Theory of SCC NO Dysplasia, NO pleomorphism
Oral cancer likely to spread throughout mouth
p53 tumor suppressor gene = most associated
Mets to jaw: >Posterior mandible

Keratocanthoma = BENIGN!
Looks like SCC of face & lip
Sun-exposure
Spontaneously resolves in 4months Bone Pathology
Ulcer w/central keratin plug
Lateral Periodontal Cyst
True cyst (epithelial lining)
>Mand premolars
Remnants of dental lamina
Pure Radiolucency btwn roots of adj Vital teeth
Histo: Zellerballen (thin epith, focal thickening)
Botryoid Odontogenic Cyst: multilocular

Ameloblastic Fibro-Odontoma
Radiolucency & Radiopacity (odontoma)
= gender, ~10yo
Cap Stage (highly diff)

Ameloblastoma
Most common true odontogenic tumor
Avg age 34, high recurrence
>Post mand, >impacted tooth
Can be anywhere & cross midline, Multilocular
Dental lamina remnants
Asymptomatic swelling, B-L expansion Odontoma
Complications: root resorption, displacement, Teens & 20yos
destroys bone, thinning of cortical plates Radiopaque w/radiolucent rim ( = follicle)
Histo: Reverse polarization of nuclei of Compound: >Ant maxilla, looks like a tooth
peripheral columnar cells Complex: >Post jaws, unidentifiable mass
Tx: en bloc resection, curettage Contains enamel, dentin, cementum, pulp
DONT recur

Ameloblastic Fibroma
MISNOMER (NO Fibroma!)
Young males (age 10-13yo) Adenomatoid Odontogenic Tumor / AOT
Slight pain, swelling, not aggressive Young females (kid or teen)
>Post Mand, Pure radiolucency, multiloc >Impacted tooth in Ant Maxilla, >Canine
Complications: transformation into Radiolucency w/snowflake calcifications
Ameloblastic Fibrosarcoma, delays eruption, Expansile, painless
root resorption, displaces teeth Histo: duct-like (UNIQUE), amyloid
Tx: simple enucleation (scoop it out)
Osteopetrosis
Young pts & adults
Expansion
Over-prod of dense NON-vital bone in jaws
Periapical Cemento-Osseous Dysplasia Complication: Osteomyelitis
Mid-aged black women
NO pain, NO expansion
Mand Anteriors, VITAL
Periapical radiolucencies mature & become
mixed lucent/opaque mostly opaque

Odontogenic Myxoma
Young adult onset
Looks like Ameloblastoma on xray
Multilocular radiolucency w/soap bubble

Focal Cemento-Osseous Dyslasia


>Mid-aged white females
MOST common benign fibro-osseous lesion
>Posterior Mandible Genetic / Inherited
Florid Cemento-Osseous Dysplasia Amelogenesis Imperfecta
>Mid-aged black females Yellow brown teeth, E
Multiquadrant, intrabony, avascular namel hypoplasia
>Posterior mandible Crowns look more bulbous bc narrower @ neck
Complication: 2 Osteomyelitis Normal roots & pulp & crown
Radiolucent & Radiopaque Crowns, veneers
NO Tx req!

Dentinogenesis Imperfecta
Proliferative Periostitis / Garres Blue/gray opalescent dentin
Young pts, visible swelling NO pulp chambers or root canals
Inf border of Post Mand Bell-shape crown w/constricted cervical region
Onion skin pattern Type 1 (Hereditary Opalescent Dentin): not
systemic
Type 2 (Osteogenesis Imperfecta): Blue
sclera, bone fractures, systemic
Tx: dentures or implants (NO Crowns bc would Young pts (3-7yo), Auto dom
fracture) Multilocular bilateral radiolucencies
Many unerupted teeth, displaces teeth
Facial disfiguration, BOTH jaws
Histo: MNG cells
Tx after puberty (expansion ceases)

Dentinal Dysplasia
Draining fistulas, misshapen teeth
Type 1 / Radicular: Rootless, periapical
radiolucencies, short roots
Type 2 / Coronal: thistle/flame pulp,
interglobular dentin

Crohns Disease
Oral: cobblestone nodules, aphthous-like
ulcers, granulomatous gingivitis
Rectal bleeding (>small intestine skip lesions)
Histo: Langerhans giant cells
Hypohydrotic Ectodermal Dysplasia Tx: Sulpha drugs + Steroids
Hypodontia, anodontia
Lack skin appendages & hair
Heat intolerance
Diff Dx: White sponge, HBID, Morsicatio,
Leukoedema

Scleroderma / Progressive Systemic Sclerosis MEN / Multiple Endocrine Neoplasia IIB


Induration, no sweat glands, stiff soft tissue Auto dom, 50% spontaneous dom
Trismus, generalized widening of PDL space 1st sign = oral mucosa neuromas
Thickened CT Marfan body type, thick lips / papules
Multiple mucosal neuromas (tongue)
Complications: 90% Medullary thyroid
carcinoma, 50% Adrenal pheochromocytoma

Peutz-Jeghers
Pigmented brown macules
Lips, tongue, buccal mucosa, vermilion
Intestinal polyposis

Cherubism
Cleidocranial Dysplasia
Many supernumerary unerupted teeth Condensing / Sclerosing Osteitis
Retention of primary teeth Young pts, reactive bone formation
No clavicles! Frontal bossing, large head NON-vital tooth, Pulpitis, deep caries
NOT connected to root you can trace PDL
Neurofibromatosis Type 1 (von Tx: RCT or extraction
Recklinghausen)
Multiple neurofibromas (nodules)
Skin & oral (especially tongue)
Caf au lait pigmentations (brown macules)

Idiopathic Osteosclerosis
VITAL tooth, NO Tx bc benign
>Posterior mandible
NOT connected to root you can trace PDL
Calcifying Odontogenic Cyst / Gorlin Cyst Radiopacity with NO radiolucent rim
Ghost cells (no nuclei) calcify, amyloid

Melanotic Neuroectodermal Tumor of Infancy


Rapid onset, newborns
INC VMA (vanillylmandelic acid)
Ant maxilla, soft & hard tissue
Mobile teeth, tooth floating in air
Intrabony radiolucency, looks malignant
5% Malignant (brain, skull) Hypercementosis
VITAL Mand 1st molar
Generalized acromegaly
Sometimes seen in Pagets
Radiopacity w/intact PDL, attached to root

Fibrous Dysplasia
Young pts (10yo), Onset before puberty
>Maxilla
Ceases by age 20yo (Tx: bone shaving) Cementoblastoma
No pain, teeth do not fit PDL NOT intact
Unilateral expansion, 1 jaw, painless
Ground glass radiopacity

McCune Albrights Syndrome: Fibrous


Dysplasia + Caf au lait pigmentations +
Precocious puberty (ie. 4yo w/breasts & period)
Traumatic / Hemorrhagic / Solitary /
Simple Bone Cyst / Idiopathic Bone Cavity
(Pseudocyst)
>Young males
>Mandible, NOT expansile, can cross midline
Radiolucency w/scalloped margins
NO root resorption, NO swelling, NO pain
No Tx: Spontaneously heals

Langerhans Cell Histiocytosis X / Eosinophilic


Granuloma
Pagets Disease / Osteitis Deformans Young adults, solitary lesion
Older white pts, CC: Dentures too small Bone destruction, reticuloendotheliosis
Bilateral maxilla Xray: Punched out radiolucencies, tooth
Complications: Osteosarcoma, CHF, CN deficits floating in air (perio disease)
(if foramen compressed) Histo: Langerhans cells / eosinophilic
Elevated AP (extra bone growth) granuloma (NOT histiocytes), Birbeck bodies
NO hyperglobulinemia or premature exfoliation (cytoplasm)
of primary teeth *Hans-Schuller-Christian Triad =
Xray: punched out radiolucencies, cotton wool, Diabetes Insipidus + Exophthalmos + Bone
50% hypercementosis lesions (Langerhans cells)
Histo: reversal lines (mosaic, jigsaw) *Letterer-Siwe: WORST, infants, organomegaly
Tx: Calcitonin, Bisphosphonates, Aspirin Tx: radiation, chemotherapy

Gardner Syndrome
Colon polyps + Mutiple osteomas + skin nodules
Supernumerary/Hyperdontia, unerupted tooth
Osteomas @ angle of mandible
Complications: risk of colon carcinoma
(remove polyps by age 20 or will turn into
cancer) Cysts

Nasolabial Cyst (soft tissue)


Swelling adj to Max LI
Histo: PSSE lining (respiratory)
NOT on xray bc soft tissue only!

Lymphoepithelial Cyst (soft tissue)


>Ventral tongue / FOM
Pale yellow (lymph), compressible

Odontogenic Keratocyst / OKC / KOT / Dens-in-Dente / Dens Invaginatus


Keratocystic Odontogenic Tumor >Ant jaw (>Max lateral incisor)
Any age, 10-15% of jaw cysts Developmental pit in cingulum area
>Post mand, intrabony, can be anywhere Tx: restore opening or may lose vitality
Multilocular radiolucency, bilateral
NO B-L expansion! NO root resorption
High recurrence 30%
Histo: parakeratin
Multiple lesions: Gorlin/Nevoid basal cell
carcinoma
Tx: enucleate + curettage, cautery + osteotomy,
resection + bone graft
Dens Evaginatus
>Posterior mandible, bilateral
15% Asians
Cusp-like elevation of enamel on lingual ridge of
buccal cusp
Shovel-shaped incisors may req RCT
Tx: remove for occlusion

Nevoid Basal Cell Carcinoma / Basal Cell Soft Tissue


Nevus / Gorlin Syndrome
Basal cell carcinomas + Multiple OKCs + Bifid Traumatic Fibroma / Fibrous Nodule / Focal
ribs + Calcified falx cerebri Fibrous Hyperplasia
Childhood onset Most common CT tumor!
Genetic: Mutated PTCH gene, chromosome 9 >Tongue (trauma)
Skin: basal cell carcinomas, epidermal cysts, Reactive Hyperplasia (not true tumor)
palmar/plantar pits Firm smooth, pink, sessile (wider base)

Epulis Fissuratum
Hyperplastic CT (like fibroma)
Ill-fitting denture
NO ABs req

Dermoid Cyst (developmental)


Doughy / slightly compressible
Midline distrib Ie) Ant FOM
>Ant FOM or neck

Gingival Cyst of the Adult


Facial attached gingiva
>Ant mandible
Vesicle

Mucocele / Mucous Retention/Extravasation


Kids & young adults, bite lip
>Lower lip, PSEUDOcyst
Trauma vesicle/bulla, bluish color, dome
Free Mucin extravasation from MSG, histiocytes
Tx: excision + severed duct/gland
Granular Cell Tumor
>Females, age 30-50
Origin: Schwann cells
>Dorsal tongue
Lysosomal granular cytoplasm
Smooth or papillated nodule
Histo: pseudoepitheliomatous hyperplasia Ranula
(resembles SCC) FOM Mucocele, frogs belly
Bluish, Recurrent, Viscous aspirate (mucous)
>sublingual gland
Histiocytes, granulation tissue, mucin

>Dorsal tongue

Hemangioma
Hamartoma, red-blue, blanches
RBCs

Mucous Retention Cyst


Sialolith or bacterial plug obstruction
True cyst (Lined by epithelium)
>FOM
Lymphangioma Antral / Mucous Retention Pseudocyst
Lymph-filled superficial vessels Asymptomatic, NO Tx req
Most common cause of macroglossia! Radiopaque dome-shaped
Max sinus floor

Dentigerous Cyst
Doughy / compressible
Midline distrib
Sialolithiasis
80% submandibular (Whartons)

Sialadenitis
Inflamed salivary glands
Etiology: mumps, viral infx, bacterial (Staph
Aureus), xerostomia, Sjogren, Sarcoid

Dentigerous Cyst
>Post Mand, >impacted 3rd molars
Mand 3rd M > Max 3rd M > Can > Mand PM Allergic Mucositis
Epithelial lining Ameloblastoma, SCC, Due to toothpaste, candy, gum, cinnamon
Mucoepidermoid carcinoma
Xray: Pericoronal radiolucency attached @ CEJ
of unerupted tooth

Eagle Syndrome
Elongated calcified stylohyoid ligament
H&N pain when chewing, yawning, opening

Incisive Canal / Nasopalatine Duct Cyst


Most common developmental non-odonto cyst
Vital teeth, Max midline btwn CIs
Bad taste, heart-shaped radiolucency

Stafne Defect
Developmental, >Males
Asymptomatic, VITAL Teeth
Radiolucency near angle of Mand under Mand
Varices
canal
Tongue & Lip, >elderly
Dilated veins, bluish
Phlebolith: lip varices thrombose & calcify

Nerve
Xray: enlarged mandibular canal & foramina

Parulis / Gum Boil (fistula)


Incomplete RCT w/ sensitivity
Elevated yellow-red color, draining fistula
Pemphigus Vulgaris

Erosion: MOST of epithelium is gone


Ulcer: ALL epithelium is gone

Cytology Smear is useful to Dx:


-Candidiasis
-Recurrent Herpes
Neurofibroma (axons) -NOT if suspect precancer/Dysplasia
>Tongue & Buccal mucosa
No pain Caf Au Lait Pigmentations = McCune
Albrights Syndrome (fibrous Dysplasia) &
Schwannoma / Neurilemoma (myelin) Neurofibromatosis / von recklinghausen
Neoplasm, No pain, rarely in bone (papules/neurofibromas)
>Tongue, gingiva, lips, mucosa
Histo: encapsulated, Antoni A, Verocay bodies Extravasated Blood
Purpura = generalized
Bells Palsy (CN 7 unilateral facial paralysis) Petechiae = pinpoint
Drooping corner of lip, cant close eye Ecchymosis = medium
Etiology: viral, lyme disease (Borrelia), Hematoma = large, elevated
earache, infx, MS
Melkersson-Rosenthal / Orofacial Radiation Cervical caries due to xerostomia,
Granulomatosum: fissure tongue + facial N NOT pulp necrosis!
paralysis + Cheilitis Granulomatosum
Self-limiting within 6 months Internal root resorption pink tooth (if crown
involved)
Trigeminal Neuralgia / Tic Douloureux
Onset >35yo Herpes = NON-movable mucosa (hard palate &
Highest suicide rate of any disease gingiva)
>Mandibular branch, >Unilateral Aphthous Ulcers = MOVABLE mucosa (labial
Pain duration <60 secs mucosa, uvula)
Triggers: touching nasolabial fold, vermilion,
periorbital, alveolar ridge Vit D deficiency / Scurvy = does NOT cause
Tx: Phenytoin, Gabapentin, inject alcohol or xerostomia
glycerin near Gasserian ganglion, Btx, Capsaicin
cream, Peripheral neurectomy, microvascular Mand fracture Dx w/Pano & Occlusal xray
decompression
Condylar hyperplasia chin deviates AWAY
Neuritis from affected side on closing
Unilateral pain >1wk (forehead & eye)

Auriculotemporal / Frey Syndrome


CN 5
Often after parotid surgery
Unilateral face sweating after meal

NOTES
Radiology Facts
Causes of Desquamative Gingivitis
Xray & High voltage = shortest wavelength &
Erosive Lichen Planus
highest energy
Benign Pemphigoid
Doubled mA = doubled intensity of xray beam
kVP determines penetration & controls contrast
Focal spot size influences resolution
Acute xray damage @ 4Gy = erythema
Nerve & Muscle = most radio-resistant
Hematopoetic stem cells = most radio-sensitive
Density of processed film is affected by
-INC mA, INC exposure time
-DEC object-thickness distance, DEC target-
object distance
-NOT by over-fixation
Intensifying screens: DEC exposure time & DEC
radiation exposure
8-bit digital image = 256 shades of gray
Coin tests: detect light leakage
Double distance from xray source = DEC
radiation by 4x (inverse square law)

Cleft Palate
Btwn LI & Canine

Globulomaxillary Cyst
Btwn LI & Canine

SCC: no sclerotic border bc cancer has a rapid


onset & spread