Exam 1

true. ❖Associated with cardiovascular disease, respiratory diseases, and low-birth weight babies. Note: • Systemic disorders with premature attachment loss need to be ruled out (Acrodynia, Leukemia, Cyclic neutropenia, Crohn disease, Diabetes mellitus, Sarcoidosis, Langerhans cell disease, Papillon-Lefѐvre, Trisomy 21)

True or False - Periodontitis is associated with LOW BIRTH WEIGHT BABIES.

D is answer [Mesenchymal Malignant Tumors = stem + "sarcoma" e.g. liposarcoma]. __oma = Benign, epithelial or mesenchymal (Lipoma is epithelial w. mesenchymal differentiation). __carcinoma = Malignant, Epithelial, Surface Differentiation. ___adenocarcinoma = Malignant, Epithelial, Glandular differentiation.

Which of the following is a malignant tumor of mesenchymal origin? a. Lipoma b. Squamous Cell Carcinoma c. Basal Cell Adenocarcinoma d. Liposarcoma [know red path- all of it]

C is answer. ACTINOMYCOSIS is NOT fungal (its bacteria)

Which of the following is considered a FUNGAL DISEASE THAT CAN BE NON-INVASIVE OR INVASIVE and CAN OCCUR IN A HOSPITAL SETTING (NOSOCOMIAL)? a. Candidiasis b. Cervicofacial Actinomycosis c. Aspergillosis d. Mucormycosis

VESICLE - SMALL ELEVATED FLUID-FILLED LESION <0.5-1 CM IN DIAMETER. know definition! red diamond]

Which of the following is the correct term to describe these lesions: a. Plaque b. Papule c. Vesicle d. Ulcer

c. all the other answers are generalized aggressive periodontitis.

Which of the following is true of LOCALIZED aggressive periodontitis? a. occurs between ages of 12 and 32 b. pronounced destruction of periodontal attachment and alveolar bone. c. Attachment loss seen at first molars and incisors. d. 3 teeth other than 1st molars and incisors affected

PALATAL TORUS. This image is provided primarily to review descriptive terminology. Based on the site, morphology, and color, a palatal torus is clearly at the top of a reasonable differential diagnosis.

a. Mandibular Torus b. Palatal Torus c. Mandibular Exostoses d. Palatal Exostoses (should see picture)

(1) c is answer and also known as "Periapical Cyst" Radicular can give rise to RESIDUAL periapical cyst. Radicular can MIMIC LATERAL "periodontal" cyst if LATERAL VARIANT of radicular DEVELOPS ALONG LATERAL ASPECT OF ROOT AT ORIFICE OF ACCESSORY CANAL. (2) EPITHELIUM AT APEX OF *NON-VITAL* TOOTH MAY BE STIMULATED TO FORM CYSTIC LINING: USU. DERIVED FROM RESTS OF MALASSEZ.

(1) Most COMMON ODONTOGENIC CYST is? a. Primordial Cyst b. Medial Periapical Cyst c. Radicular Periapical Cyst c. Lateral Periodontal Cyst (2) Cystic lining usually derived from?

- ❖Caused by Fusobacterium NUCLEATUM, Prevotella INTERMEDIA, Porphyromonas GINGIVALIS, TREPONEMA, and/or SELENOMONOAS. [Necrotizing Gingival Infection That Smells] - ❖Factors contributing: Smoking, Local trauma, Immunocompromised status, & Poor oral hygiene. - ❖Clinical features: Interdental papilla affected- inflamed, edematous, hemorrhagic, "PUNCHED OUT" appearance with gray; pseudomembrane appearance; Foul odor, fever, lymphadenopathy, malaise; If extends through mucosa of skin to face known as noma (cancrum oris) (path red know)

(1) Name the organisms that cause NECROTIZING ULCERATIVE GINGIVITIS (VINCENT'S INFECTION/TRENCH MOUTH) (2) The factors that contribute to it

CONDENSING OSTEITIS - A.K.A. FOCAL SCLEROSING OSTEITIS - LOCALIZED AREA OF BONE SCLEROSIS - RADIOPAQUE LESIONS *WITHOUT* RADIOLUCENT BORDER ASSOCIATED WITH APICES OF TEETH W. PULPITIS OR PULPAL NECROSIS = MAY BE MISTAKEN FOR IDIOPATHIC OSTEOSCLEROSIS OR CEMENTO-OSSEUS DYSPLASIA. - SEEN MOST OFTEN IN CHILDREN AND YOUNG ADULTS. - NO SWELLING GENERALLY SEEEN. - POSTERIOR MANDIBLE IS WHERE OFTEN SEEN. - ADJACENT TO APICES OF TEETH W. CARIES, FRACTURES, OR LARGE RESTORATIONS. - Treatment: 1. ENDODONTIC THERAPY OR EXTRACTION OF OFFENDING TEETH 2. 80% of cases with resolve or regress -> bone scar may result following resolution of inflammation. [caps means red diamond]

13 year old. No swelling. (see image)

b and c are the answers.

A radiograph of CONDENSING OSTEITIS (Focal Sclerosing Osteitis) typically shows radiopaque lesions WITHOUT radiolucent border. Which of the following may this be mistaken for? (choose all that apply): a. Suppurative Osteomyelitis b. Cemento-osseous Dysplasia c. Idiopathic Osteosclerosis d. Secondary Syphilis e. Chronic Osteomyelitis

PERIAPICAL ABSCESS (it DOESNT look as dark as periapical cyst on X-ray) (1) Clinical Features - NON-SPECIFIC SYMPTOMS MAY INCLUDE: HEADACHE, FEVER, MALAISE, AND CHILLS. - TENDERNESS OF AFFECTED TOOTH. - ABSCESS MAY SPREAD THROUGH BONE (OSTEOMYELITIS) OR PERFORATE CORTEX AND SPREAD THROUGH SOFT TISSUE (CELLULITIS) = SOFT TISSUE INFECTIONS MAY PRESENT AS SWELLINGS OR DRAIN THROUGH SINUS TRACT; PARULIS. (2) Radiographic Features: - widening of periodontal ligament space - ill-defined radiolucency. (3) histopathologic Features: - acute inflammatory cells, cellular debris, necrotic material, and bacterial colonies. - Phoenix abscesses may include soft tissue component. (4) Treatment and Prognosis: - DRAINAGE - ELIMINATION OF INFECTION. - ANTIBIOTICS FOR MEDICALLY COMPROMISED PATIENTS. [caps means red diamond]

Affected tooth is tender. Patient has headache, fever, malaise, and chills. Based on image and these findings, whats the dx?

a

An involucrum, or a sheath of new bone forming around sequestrum, is very rarely but sometimes found in: a. Acute Suppurative Osteomyelitis b. Condensing osteitis c. Secondary Syphillis d. Alveolar Osteitis

Cavernous Sinus Thrombosis: - cavernous sinus contains carotid artery and cranial nerves 3, 4, V1, V2, and 6. - may result from infection of maxillary posterior teeth. (2) TREATMENT: - DRAINAGE - ANTIBIOTICS - EXTRACTION OF OFFENDING TOOTH (3) PROGNOSIS - MORTALITY = 30% [know it!] [caps means red diamond]

Based on the clinical features below, how would you treat this patient, and what's the prognosis of this condition? - PERIORBITAL EDEMA ENLARGEMENT W. INVOLVEMENT OF EYELIDS & CONJUNCTIVA. - LATERAL NOSE AND MEDIAL EYE MAY BE AFFECTED IF INFECTION INVOLVES CANINE SPACE. - PROPTOSIS (eye bulging), CHEMOSIS (eye swelling watering), AND PTOSIS SEEN IN 90% OF PATIENTS. - other symptoms: fever, chills, headache, sweating, tachycardia, nausea, vomitting; Meningitis and brain abscesses may result.

Oncology Nomenclature Exceptions: [know red path]

Benign-Sounding Malignancies: 1. Melanoma 2. Lymphoma 3. Plasmacytoma 4. Mesothelioma [memorize the list]

Blisterform: - serous, mucous, hemorrhagic, purulent. - Hematoma - Pustule. Non-Blisterform: - PLAQUE - Papule - Nodule - TUMOR (nothing red diamond)

Blisterform vs. Non-Blisterform - Papule - Hematoma - Tumor - Serous, Mucous - Nodule - Hemorrhagic - Plaque - Purulent - Pustule

BLASTOMYCOSIS • Uncommon fungal infection • Inhaled spores typically after rainfall • Acute variant resembles pneumonia with fever, chest pain, productive cough ❖Chronic variant mimics tuberculosis but no calcification in lungs ❖Oral lesions resemble squamous cell carcinoma = - Ulcerated, rolled borders - Irregular erythematous or white surface with pain • Treatment is rarely needed unless seriously ill [know red diamonds]

Boy has been hanging outside a lot. Based on image, whats the dx?

❖Common Predisposing Factors = - Chronic Debilitating Disease - Nutritional and Endocrine Disturbances - Broad-spectrum Antibiotic Therapy - Systemic Corticosteroid Therapy - Partial or Complete Dentures - Immune Deficiency ❖Clinical Forms = 1) Pseudomembranous (Thrush) 2) Erythematous: > Central Papillary Atrophy (Median Rhomboid Glossitis) > Denture Stomatitis > Angular Cheilitis 3) Chronic Hyperplastic (Candidal Leukoplakia)

Candidiasis - list the common predisposing factors and the clinical forms of it

c. Lumpy Jaw = Cervicofacial Actinomycosis is NOT a fungal infection (tx antibiotics and drainage sinus tracts). [all rest are fungal infections]

Caused by anaerobic, gram-positive branching organism, Actinomyces israeli a. Coccidiomycosis b. Blastomycosis c. Lumpy Jaw d. Mucormycosis

b is answer.

Craniosynostosis, or premature closing of cranial sutures, is associated with which condition: a. Segmental Odontomaxillary DYsplasia b. Crouzon Syndrome c. Trecher Collins Syndrome d. Apert Syndrome

Lobule - segment oR lobe that is part of a whole.

Descriptive Term for this

Plaque - broad, flat, raised lesion. [note linea alba = Linear white plaque typically along buccal mucosa at the occlusal plane]

Descriptive Term for this

Exostoses = FACIAL ASPECT OF ALVEOLAR RIDGE = exophytic growth of normal compact bone {so is Tori} [path red know]

Descriptive word to describe these exophytic growths.

PULPAL CALCIFICATIONS (calcifcations in the pulp chambers): NO TREATMENT REQUIRED, ALTHOUGH ENDODONTICS MAY BE MORE CHALLENGING. - denticles, PULP STONES (THE IMAGE), and diffuse linear calcifications. - seen in up to 20% of teeth radiographically. - Begin as free bodies within the pulp, but may attach to the dentinal walls. - Associated w. Diseases: Dentin and Pulpal dysplasia, Tumoral calcinosis, Calcinosis universalis, Ehlers-Danlos syndrome, & End-stage renal disease (1) Denticles - Form during root development • Occur adjacent to furcation areas of multi-rooted teeth • Believed to form around epithelial strands originating from root sheath • Most become attach to or become embedded within dentinal walls (2) Pulp Stones - Form after tooth formation • Occur within coronal portion of pulp • Develop around a core of pulp tissue • May be free or attached to walls (3) Diffuse Linear Calcifications - Frequency increases with age • Fine irregular calcifications that parallel vasculature • May occur in pulp chamber or root canals [caps means red diamond]

Does this require treatment?

CANDIDIASIS [know red diamonds]

Dont need to label each separately. What are they all characteristic of? (should see images)

d is answer. PROGRESSIVE HEMIFACIAL ATROPHY (AKA PARRY-ROM) has SHARP LINE OF DEMARCATION = large linear scar near midline of forehead between normal/abnormal skin.

En coup de sabre - strike of sword a. Apert Syndrome b. Treacher Collins Syndrome c. Segmental Odontomaxillary Dysplasia (Hemimaxillofacial Dysplasia) d. Parry-Romberg Syndrome e. Crouzon Syndrome

Tori and Exostoses: Torus Palatinus = midline of hard palate. Tori Mandibularis = mandible lingual to canine/pre-molars. Exostoses = facial aspect of alveolar ridge. [path red know] non-red: may become symptomatic if thin overlying mucosa is traumatically ulcerated.

Exophytic growths of normal compact bone are called? Which one is located at midline of hard palate.

b

For rare symptomatic case of BENIGN MIGRATORY GLOSSITIS, which of the following should be considered to help with the symptoms? a. IV antibiotics b. Topical Benadryl or Steroid c. Anti-fungals

NECROTIZING ULCERATIVE PERIODONTITIS • Similar to Necrotizing Ulcerative Gingivitis (NUG) ❖ Was known as HIV-associated periodontits • Involves loss of clinical attachment and alveolar bone • Destructive • Patients are usually immunosuppressed or malnourished • Patients younger than those with chronic periodontitis • Gingival ulceration and necrosis with rapidly progressing loss of periodontal attachment but deep pockets not seen • Edema and severe pain [know red diamonds] fix see other

HIV patient comes into your office in severe pain . (should see image) Whats the dx?

MUMPS (EPIDEMIC PAROTITIS) ❖Paramyxovirus infection • Transmitted through urine, saliva, respiratory droplets ❖Affects salivary glands (esp. parotid) • Swelling occurs along lower half of external ear to posterior border of mandible • Pain increases upon chewing ❖Twenty-five (25%) males experience testicular swelling with pain (Orchitis) • Sterility is rare • Palliative treatment [know red diamonds] THINK - MUMPS LOOKS LIKE UNILATERAL VERSION OF LUDWIG'S.

Half face swelling around parotid gland area. Whats the dx based on that and this image?

Heck = HPV 13 and 32. HFM disease = Coxsackie A16 or Enterovirus 71 - note: Squamous Papilloma = epithelial proliferation (HPV 6, 11)

Heck Disease is caused by: a) HPV 6 and 11 b) Coxsackie A16 or Enterovirus 71 c) EBV 4 and 13 d) HPV 13 and 32 Hand, Food, Mouth Disease is Caused by: a) HPV 6 and 11 b) Coxsackie A16 or Enterovirus 71 c) EBV 4 and 13 d) HPV 13 and 32

c and d are answers.

How is SYPHILIS transmitted? Circle all that apply. a. Blood (IV) b. Respiratory Droplets c. Sexual Contact d. Mother to Fetus e. Oral-Fecal Route

a and b. SQUAMOUS PAPILLOMA: ❖ If virally altered, BINUCLEATED cells AND koilocytes may be seen in epithelium ❖ Koilocyte - EPITHELIAL CELL LAYER W. CLEAR CYTOPLASM AND SMALL NUCLEUS.

In which of the following would you find KOILOCYTES and binucleate cells in the epithelium Select all that apply: a. Condyloma Acuminatum (venereal wart) b. Squamous Papilloma c. Heck Disease d. Primary Syphillis

❖Medications affecting gingiva: - Cyclosporine, Erythromycin, Oral Contraceptives - Anticonvulsants-ex. Phenytoin (Dilantin) - Calcium Channel Blockers-ex. Nifedipine.

List of medications that affect gingiva and can lead to DRUG-RELATED GINGIVAL HYPERPLASIA (DRUG-RELATED GINGIVAL OVERGROWTH): [WB Memorize]

❖Most serious complications = 1) Vascular complications - aneurysm of ascending aorta, congestive heart failure 2) Psychosis, Dementia, Death 3) Ocular involvement - iritis, choroidoretinitis, Argyll Robertson pupil 4) Argyll Robertson pupil - pupil does not respond to bright light but constrict on focus

List the most serious complications of TERTIARY Syphilis:

B

Loss of function of cathepsin C gene a. HIV ASSOCIATED PERIODONTAL DISEASE b. PAPILLON-LEFЀVRE SYNDROME c. CROUZON SYNDROME

Answers ❖COMMON PRESCRIPTIONS - memorize list = (1) Candidiasis (Pseudomembranous/Erythematous) - Clotrimazole (Mycelex) troches 10 mg - Disp: Seventy (70) troches - Sig: Dissolve one (1) troche in mouth five times a day for 14 consecutive days (2) Denture Stomatitis - Nystatin ointment - Disp: Fifteen (15) g or Thirty (30) g tube - Sig: Apply thin film to affected area and to inner surface of denture after each meal and at bedtime until healing occurs (3) Angular Cheilitis - Clotrimazole 1% cream - Disp: Fifteen (15 ) gm - Sig: Apply thin film at corners of mouth four times a day (3 also) Over-the-Counter (OTC-Inexpensive) - Lotrimin AF - Sig: Apply thin film at corners of mouth four times a day

Match the following medications with the conditions they are used to treat: - Clotrimazole (Mycelex) troches 10mg of 70, dissolve one troche in mouth five times a day for 14 consecutive days. - Clotrimazole 1% cream, fifteen gm, apply thin film at corners of mouth four times a day. - Lotramin AF, apply thin film at corners of mouth four times a day. - Nystatin ointment, bottle of 15g or 30g tube, apply thin film to affected area AND to inner surface of denture after each meal and at bedtime until healing occurs. (1) Candidiasis (Pseudomembraneous / Erythematous) (2) Denture Stomatitis (3) Angular Chelitis

b

May represent a vesiculobullous condition (e.g. PEMPHIGUS vulgaris, or Mucous membrane Pemphigoid) or other conditions (e.g. LICHEN PLANUS or SLE): a. Necrotizing Ulcerative Gingivitis b. Desquamative Gingivitis c. Granulomatous Gingivitis d. Puberty Gingivitis

d [NICHOLE IS DE-SQUISHY sister - positive test has blister formation] ❖Nikolsky sign - Manipulate affected epithelium with object or compressed air that results in sloughing or vesicle formation

Nikolsky sign is characteristic of: a. Drug-Related Gingival Hyperplasia b. NUG c. Granulomatous Gingivitis d. Desquamative Gingivitis

c is answer MUST KNOW BELOW - Forchheimer is german measles (rubella) caused by toga virus . [IT SOUNDS GERMAN] Koplik is measles (rubeola) caused by paramyx. Cancre is PRIMARY syphilis. Hutchinson's signs is CONGENITAL syphilis.

Oral Lesions found in SECONDARY SYPHILIS? a. Koplik Spots on buccal mucosa caused by paramyxovirus b. Forchheimer Sign on soft palate caused by Togavirus c. Condyloma Lata in papilla caused by Treponema Pallidum. d. Chancre on dorsal tongue caused by Treponema Pallidum. e. Hutchinson's Incisors and Mulberry Molars caused by Treponema Pallidum.

HISTOPLASMOSIS ❖Most common systemic FUNGAL infection in United States ❖Seen in the OHIO-MISSISSIPPI River Valley • Spores inhaled from bird or bat droppings • Majority of cases produce no symptoms or mild symptoms • Noted on radiographs as calcification of hilar lymph nodes • Acute form-self-limiting lung infection • Chronic form-similar to tuberculosis and affects the lungs • Disseminated form-spread to extrapulmonary sites ❖Oral lesions present as a painful solitary ulceration of tongue, palate (resemble carcinoma) • Histopathology: Organisms seen in granulomatous inflammation [KNOW red diamonds]

Oral lesions are PAINFUL (see image) in this patient from ohio. Whats the diagnosis?

COCCIDIOIDOMYCOSIS ❖Fungal infection commonly seen in Southwestern United States and Mexico ❖ Chronic variant mimics tuberculosis ❖Valley Fever [Hypersensitivity rxn; Coccidioido. in conjunction w erythema multiforme/nodosum] • Organism grows in desert soil • Infections are asymptomatic • 40% flulike symptoms after inhaling spores • Disseminated variant involves immunocompromised patients = - Affects skin-papules, abscess, verrucous plaques - Lymph nodes - Bone, joints, meninges • Erythema nodosum is painful erythematous nodules in subcutaneous connective tissue. • Histology reveals: - Large, round spherules - Spherules contain numerous endospores • Special stains such as PAS or GMS can reveal organisms • Treatment depends on severity and extent of infection [know red diamonds]

Painful erythematous nodules found in the patient from Mexico valley

NECROTIZING ULCERATIVE GINGIVITIS (NUG) (VINCENT'S INFECTION/TRENCH MOUTH): Interdental papilla affected- inflamed, edematous, hemorrhagic, "punched out" appearance with gray; pseudomembrane appearance; Foul odor, fever, lymphadenopathy, malaise; If extends through mucosa of skin to face known as noma (cancrum oris) (path red know)

Patient complains of bad breath, fever, and swollen glands. Based on this image and signs, whats your dx? (should see image)

ACUTE HERPETIC GINGIVOSTOMATITIS • Caused by HSV-1 ❖Affects people never exposed to virus usually children and young adults ❖Symptoms include = - Fever, headache, irritability - Lymphadenopathy - Acute gingivitis *WITHOUT NECROSIS* (bold) of interdental papillae Crops of vesicles that ulcerate. ❖Affects tongue, palate, gingiva, buccal/labial mucosa (keratinized/non-keratinized tissue) • Diagnosis made by cytologic smears • Treatment includes antiviral medications and palliative care [know red diamonds and realize there are other images of the other herpes family so the "herpes virus:" slide/ info above is on other fcards]

Patient has fever, headache, irritability. Has swollen lymph nodes. There's no necrosis of the gingivitis of the interdental papillae. (see image)

CHRONIC PERIODONTITIS ❖Bacteria associated (organized in a biofilm): 1. Treponema denticola 2. Tannerella forsythensis 3. Porphyromonas gingivalis • Primary cause of tooth loss in people > 35 years old • Can be seen in : Advancing age , Smoking , Diabetes mellitus, Osteoporosis, HIV infection, Low socioeconomic level. • Clinical and Radiographic findings: Loss of gingival attachment-blunting and apical positioning of margins; Pocket depths of more than 3 to 4 mm with periodontal probe; Tooth mobility with significant bone loss; Vertical bone loss seen on radiographs. • Treatment: Eliminate causing factors; Disrupt biofilm; Develop good oral hygiene practices (scaling, root planing, curettage, plaque control); & Surgical flaps, antibiotic delivery if needed. [know red diamonds]

Patient is 40 years old. Biopsy reveals the following bacteria organized in a biofilm: Treponema denticola, Tannerella forsythensis, and Porphyromonas gingivalis. What is the diagnosis? (should see picture)

Infectious Mononucleosis ("glandular fever") - EBV (HSV4): petechiae on palate, Nerotizing Ulverative Gingivitis. Resovles in 4 to 6 weeks.

Patient presents with fever, lymphadenopathy, pharyngitis, tonsillitis. And Also has an elevated White Blood Cell Count. What would you expect to see in his mouth ?

PERIODONTAL ABSCESS • Localized purulent infection involving periodontal attachment and alveolar bone • Seen in adults; rare in children • Occurs in a preexisting periodontal lesion and changes in subgingival flora • Clinical presentation: Gingival enlargement along lateral aspect of a tooth; Erythematous and edematous • Symptoms: Throbbing pain, Sensitivity to palpation of involved gingiva; Foul taste; Fever, lymphadenopathy,. • Treatment: - Drain and/or incise affected area - Antibiotics and analgesics if needed [no red on this] [PERIAPICAL ABCESS = TENDERNESS OF AFFECTED TOOTH]

Patient presents with throbbing pain and affected gingiva are sensitive to palpation. He's got foul taste, fever, lymphadenopathy. Based on this and image, whats the dx?

NOMA ❖Rapidly progressive, polymicrobial, opportunistic infection • Results from normal oral flora becoming pathogenic due to compromised immune status • Recent debilitating illness causes infection Measles Herpes (Simplex, Varicella) Tuberculosis ❖Starts as NUG (happens when NUG extends thru mucosa to skin to face). • Affects children 1 to 10 years old and adults with debilitating disease [ path red know idamonds]

Patient suffering measles and has really bad necrotizing gingivitis. Whats the diagnosis?

AGGRESSIVE PERIODONTITIS • Two forms = Localized Aggressive Periodontitis, & Generalized Aggressive Periodontitis ❖Occurs in healthy individuals without a systemic disease process. (1) LOCALIZED AGGRESSIVE PERIODONTITIS = THE IMAGE. • Was known as early-onset periodontitis • Begins at age 11 to 13 with strong familial tendency ❖Attachment loss seen at first molars and incisors ❖Radiographic findings: 1. 1st molars- bilateral, symmetrical, vertical bone loss 2. May be arc-shaped 3. Incisors- similar findings as 1st molars • A. actinomycetemcomitans bacterial pathogen (90% of cases) (2) GENERALIZED AGGRESSIVE PERIODONTITIS: ❖Occurs between ages 12 and 32 • Heavy plaque, calculus, gingival inflammation can be seen ❖Pronounced destruction of periodontal attachment and alveolar bone ❖ 3 teeth other than 1st molars and incisors affected • Bacterial pathogens involved (similar to those in chronic perio): A. actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythensis, Fusobacterium nucleatum, Campylobacter rectus, & Treponema denticola [know red diamonds]

Radiograph shows first molars and incisors with bilateral, symmetrical, vertical bone loss. May be arc-shaped. What is the likely diagnosis? (pic should show)

(1) Radiolucent (2) Radiopaque (3) Unilocular (4) Multilocular (5) Corticated: - Hyperstotic = thin border. - Sclerotic = non-uniform, wide border.

Radiology Terminology: - know this even tho its not red (1) Black or dark areas on radiograph (2) Light or white areas on a radiograph (3) Radiolucent lesion with one well-defined compartment (4) Radiolucent lesion with more than one well-defined compartment (5) Radiolucent lesion with radiopaque border

Idiopathic Osteosclerosis - Based on the well-circumscribed opacity NOT in continuity with the root's tooth (the PDL space is intact throughout), and absence of symptoms, the likely diagnosis is idiopathic osteosclerosis. However, the tooth's vitality must be confirmed to rule out CONDENSING OSTEITIS, which is the other REASONABLE consideration.

Really asking - what's the differential diagnosis and how do you decipher between those differentials?

b is answer. Treatment Scarlet fever w. antibiotics (penicillin V or amoxicillin) c is HIV.

Scarlet Fever (Scarlatina) is caused by: a. Staph Aureus b. Group A, Beta-Hemolytic Streptococci c. Single straned RNA virus that's part of Retroviridae family

b and d are answers. Segmental (unilateral) = no maxillary premolars, primary teeth with enamel defects or hypoplasia. Unilateral enlargement of maxillary. Craniofacial fibrous dysplasia - ground glass on radiograph. Hemifacial hyperplasia (unilateral) = macroglossia, inc. sie mandibular canal; increased pigmentation, risk of abdomen tumor (films or hepatoblastoma).

Segmental Odontomaxillary Dysplasia (Hemimaxillofacial Dysplasia) is commonly mistaken for (circle all that apply): a. Mandibulofacial Dystosis b. Craniofacial Fibrous Dysplasia c. Apert Sydnrome d. Hemifacial Hyperplasia

B and C are answers. Blastomycosis chronic looks like Tb but no calcification in lungs.

The chronic variant of which fungal infection MIMICS TUBERCULOSIS? (select all that apply) a. Mucormycosis b. Blastomycosis c. Coccidiomycosis d. Aspergillosis

c is answer. Anytime question has word cat in it, think cat-scratch disease and swollen lymph nodes.

The most common cause of chronic regional Lymphadenopathy in CHILDREN is? a. Puberty Gingivitis b. Aspergillosis c. Cat-Scratch Disease d. Hand, Foot, Mouth Disease

B is answer. DIMORPHIC organism, meaning it exists in YEAST and HYPHAE form. (note it exists as a component of NORMAL oral flora!)

The most common oral fungal infection is what? What is the structure of this organism? a. Blastomycosis b. Candidiasis c. Mucormycosis D. Histoplasmosis

SUPPURATIVE OSTEOMYELITIS: - ACUTE OR CHRONIC INFECTION OF BONE - BACTERIAL INFECTION SECONDARY TO FRACTURES OR ODONTOGENIC INFECTIONS. - SUPPURATION AND SEQUESTRUM FORMATION TOP = ACUTE Suppurative Osteomyelitis - ill-defined radiolucency of right body mandible = TREATMENT: RESOLVE INFECTION, DO DRAINAGE, DEBRIDGE INFECTED BONE, & CULTURE. MIDDLE = Acute - radiolucency of right body of mandible w. central radiopaque mass of necrotic bone. Bottom = CHRONIC Suppurative Osteomyelitis - enlarged radiolucency round 2 years after extraction which patient didn't return to follow-up bc didn't have pain = TREATMENT: SURGICAL REMOVAL OF INFECTED TISSUE & IV ANTIBIOTICS. [caps means red diamond]

These patients bacterial infections came secondary to fractures. What is your diagnosis and how should each be treated?

PARACOCCIDIOMYCOSIS (granular, erythematous, ulcerated lesion of the maxillary alveolus) ❖Deep fungal infection seen in South or Central America, also known as South American Blastomycosis ❖Male predilection = - Ratio of 15:1 - Middle-aged agriculture worker • Female hormone (beta-estradiol prevents hyphae form from transforming to yeast form) • Oral lesions have "mulberry ulcerations" of alveolar mucosa, gingiva, palate • Histopathology: Organisms resemble "Mickey Mouse ears" or a "ship's steering wheel" • Treatment depends on severity of disease [know red diamonds]

This infection looks pretty deep. MALE patient is from Mexico and works in agriculture. Whats your dx based on this and the image?

c

This is a rapidly progressive, polymicrobial, opportunistic infection that is a result of NUG extending through mucosa to skin to face: a. AMU b. NUGA c. NOMA d. NOPA

SCARLET FEVER (SCARLATINA) ❖Caused by Group A, β-hemolytic Streptococci • Begins as a tonsillitis with pharyngitis ❖Organisms attack blood vessels and produce skin rash ❖Rash develops within two days and spreads within 24 hours ("sunburn with goose pimples") • Pastia's lines-transverse red streaks in skin folds ❖Dorsal tongue = - Fungiform papillae become erythematous - "White strawberry tongue" first two days - "Red strawberry tongue" fourth to fifth day • Treatment = Antibiotics (Penicillin V or Amoxicillin). [know red diamonds]

This pathology in picture was most likely caused by what organism: a. bacteria b. fungus c. virus d. none of the above

MEASLES (RUBEOLA): ❖ PARAMYXOVIRUS - Transmitted by respiratory droplets ❖ EXAN-THEMATOUS RASH - on face and spreads downward to extremities. Lasts 4 to 7 days. ❖ KOPLIK SPOTS = Bluish-white macules on buccal mucosa, "grains of salt" • Complications include: Ear infections (otitis media) Pneumonia, Croup Diarrhea [know red diamonds] GERMAN MEASLES (RUBELLA) = no image given, but still know red diamonds and keep here so u don't confuse. ❖Caused by Togavirus • Transmitted by respiratory droplets • Asymptomatic • First sign of infection = Exanthematous rash on face and neck that Spreads over body in 1 to 3 days. • Arthritis common complication ❖Oral lesions known as Forchheimer sign = Small, dark-red papules on soft palate. ❖Congenital Rubella syndrome = - Deafness (affects 80%) - Heart Disease - Cataracts • Antipyretics and antipruritics for treatment [know red diamonds]

This patient also presents with an exanthematous rash on face that spreads down to extremities. Whats the diagnosis? (should see image)

CONDYLOMA ACUMINATUM (VENEREAL WART) ❖Caused by HPV (6,11,16,18) • Occurs from oral-genital contact ❖Considered a sexually transmitted disease ❖Clinical features - memorize list and compare to verruca vulgaris list = 1. Sessile, well-demarcated, pink exophytic mass 2. Short, blunted surface projections 3. Clustered together 4. Larger than a papilloma • Histopathology = - Stratified squamous epithelium with broad based rete ridges and vascular core - Binucleated cells and koilocytes • Treatment = - Surgical excision - *Contagious entity-laser should NOT BE USED* (bold) HUMAN PAPILLOMAVIRUS = • SQUAMOUS PAPILLOMA • VERRUCA VULGARIS • CONDYLOMA ACUMINATUM • MULTIFOCAL EPITHELIAL HYPERPLASIA (HECK DISEASE) [know red diamonds, caps information is just reference so u don't get confused and is on all the other cards of these HPV's].

This patient had sex last night (see image).

CRYPTOCOCCOSIS • Uncommon fungal disease caused by Cryptococcus neoformans ❖Most life-threatening to immunocompromised patients (i.e. HIV) • Associated with pigeon droppings • Acquired by inhalation • Asymptomatic • Can develop "flulike" illness • Frequent sites of involvement = - Meninges - Skin - Bone - Prostate gland. • Erythematous pustules or papules • Oral lesions-nonhealing ulcers tender to palpation • Histopathology = - Granulomatous response - Round-to-ovoid structure - 4-6 micrometer in diameter - Capsule surrounds the organism • Treatment = Systemic amphotericin B HUMAN IMMUNODEFICIENCY VIRUS (HIV) & ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS): • ORAL HAIRY LEUKOPLAKIA • CRYPTOCOCCOSIS HIV/AIDS: ❖Single stranded RNA virus part of Retroviridae family ❖Targets CD4+ Helper T-cell lymphocyte ❖CD4 count decreases with increase of viremia results in AIDS • Cause loss of immune function • Virus found in body fluids (semen, blood, saliva, tears) • Mode of transmission = - Sexual contact - Injection drug use • Treatment = cART (Combination AntiRetroviral Therapy) [know red diamonds]

This patient has HIV (see image)

b is answer. __oma = Benign, epithelial or mesenchymal (papilloma is epithelial w. surface differentiation) (Lipoma is epithelial w. mesenchymal differentiation). __sarcoma = Malignant, mesenchymal.

Which of the following is a benign tumor of epithelial origin with glandular differentiation? a. Papilloma b. Pleomorphic Adenoma c. Lipoma d. Liposarcoma [know red path- all of it]

D is answer. ❖Oral lesions present as a painful solitary ulceration of tongue, palate (resemble carcinoma)

What is the most COMMON SYSTEMIC FUNGAL INFECTION IN THE UNITED STATES? a. Blastomycosis b. Candidiasis c. Mucormycosis d. Histoplasmosis

b

What is the most recognized form of Candidiasis? a. Denture Stomatitis b. Pseudomembraneous (Thrush) c. Central Papillary Atrophy d. Angular Chelitis

1. MAINTAIN AIRWAY 2. INCISION AND DRAINAGE 3. ANTIBIOTIC THERAPY (mandibular molar infection) 4. ELIMINATE ORIGINAL INFECTION

What is the treatment for LUDWIG ANGINA? (don't forget the #1 goal)

b is answer - tuberculosis secondary disease spreads extra-pulmonary. A is cause ot cervicofacial actinomycosis (sulfer) SCROFULA [KNOW THIS, RED] is non-tuberculosis mycobacterium found in contaminated milk and patient's oropharyngeal lymphoid tissues and cervical lymph nodes are enlarged.

When an infection with this bacteria involves the SKIN, it is known as LUPUS VULGARIS. What is the bacteria? a. Actinomycosis Israelli b. Mycobacterium Tuberculosis c. Scrofula d. Streptococci

d is answer. __adenocarcinoma = malignant, epithelial, glandular differentiation. __sarcoma = Malignant, mesenchymal. __oma = Benign, epithelial or mesenchymal (papilloma is epithelial w. surface differentiation)

Which of the following is a malignant tumor of epithelial origin with surface differentiation? a. Basal Cell Adenocarcinoma b. Liposarcoma c. Papilloma d. Squamous Cell Carcinoma [know red path- all of it]

a is answer. Mucormycosis branches at Right angles. [know red diamonds]

When looking at a biopsy of ASPERGILLOSIS infection, the fungi would be seen branching at what type of angle? a. Acute b. Right c. Obtuse d. No angle

c is answer. KNOW IF ERYTHEMATOUS CANDIDIASIS IS ON TONGUE, FILIFORM PAPILLAE R LOST RESULTING IN RED OR "BALD" APPEARANCE. - Median rhomboid glossitis is form of erythematous with central papillary atrophy, but its asymptomatic.

Which form of candidiasis presents as burning sensation? a. Median Rhomboid Glossitis b. Pseudomembraneous (Thrush) c. Erythematous Candidiasis d. Angular Chelitis

B is answer. ❖Oral lesions present as a painful solitary ulceration of tongue, palate (resemble carcinoma)

Which fungal infection do you see in the OHIO-MISSISSIPPI river valley? a. Blastomycosis b. Histoplasmosis c. Mucormycosis D. Candidiasis

b ❖Associated with cardiovascular disease, respiratory diseases, and low-birth weight babies. ❖Factors: 1. Dental plaque 2. Shift in bacterial plaque due to changes in dentogingival environment - Facultative gram-positive organisms (actinomycetes, streptococci) to anaerobic and microaerophilic gram-negative organisms. •Note - Systemic disorders with premature attachment loss need to be RULED OUT (Acrodynia, Leukemia, Cyclic neutropenia, Crohn disease, Diabetes mellitus, Sarcoidosis, Langerhans cell disease, Papillon-Lefѐvre, Trisomy 21)

Which of the following MOST accurately describes the factors influencing PERIODONTITIS: a. There is a shift from anaerobic and microarophilic gram-negative organisms to facultative gram-positive organisms (actinomycetes, streptococci). b. There is a shift from facultative gram-positive organisms (actinomycetes, streptococci) to anaerobic and microaerobic gram-negative organisms. c. It has no association with cardiovascular disease, respiratory diseases, and low-birth weight babies. d. Diagnosis of periodontitis always includes ("rules-in") those systemic disorders with premature attachment loss such as Acrodynia and Leukemia.

answer is d and f. HUMAN IMMUNODEFICIENCY VIRUS (HIV) & ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS): • ORAL HAIRY LEUKOPLAKIA • CRYPTOCOCCOSIS

Which of the following conditions are MOST life-threatening to immunocompromised patients (i.e. HIV)? Choose all that apply: a. Aspergillosis b. Blastomycosis c. Coccidiomycosis d. Cryptococcosis e. Mucormycosis f. Oral Hairy Leukoplakia g. Paracoccidiomycosis

d is answer.

Which of the following conditions caused by HPV is considered a sexually-transmitted disease? a. Multifocal Hyperplasia (Heck Disease) b. Squamous Papilloma c. Verruca Vulgaris d. Condyloma Acuminatum

c is answer (chronic bacterial infection of bone that happened after a fracture. There IS suppuration and sequestrum formation). B is for condensing osteitis (periapical) a is for acute osteomyelitis.

Which of the following correctly describes the treatment for Chronic Osteomyelitis: a. Resolve the infection, establish drainage, debride infected bone, and culture the bacteria. b. Endodontic therapy or extraction of offending teeth. c. Surgically remove the infected tissue and provide IV antibiotics. d. Nothing, it will resolve on its own.

c is answer. MUCORMYCOSIS (PHYCOMYCOSIS/ZYGOMYCOSIS) is an opportunistic fungal infection .

Which of the following fungal infections is most commonly found in UNCONTROLLED INSULIN-DEPENDENT DIABETICS WITH KETOACIDOSIS , bone marrow transplant recipients, systemic corticosteroid use, AIDS patients a. Blastomycosis b. Candidiasis c. Mucormycosis D. Cryptococcosis

c FISSURED TONGUE: - cracked appearance o dorsal tongue. - increasing with age; 2-5% population. - male predilection? - asymptomatic - ASSOCIATION W. BENIGN MIGRATORY GLOSSITIS - fissure = cleft or groove. (path red know).

Which of the following is ASSOCIATED WITH BENIGN MIGRATORY GLOSSITIS? a. Median Rhomboid Glossitis b. Hairy Tongue c. Fissured Tongue

c [Peel = De- ]

Which of the following is a CLINICAL TERM for the "Superficial peeling of epithelium with formation of vesicles or bulla": a. Localized Juvenile Spongiotic Gingivitis (Hyperplastic Gingiva) b. Benign Migratory Glossitis c. Desquamative Gingivitis d. Puberty Gingivitis

ALVEOLAR OSTEITIS - AKA "DRY SOCKET" - POST-OPERATIVE COMPLICATION OF TOOTH EXTRACTION. - CAUSED BY PREMATURE FIBRINOLYSIS - INCRAESED INCIDENCE ASSOCIATED WITH - memorize list: 1. SMOKING 2. ORAL CONTRACEPTIVES 3. PRE-OPERATIVE INFECTIONS 4. TRAUMATIC EXTRACTIONS 5. INADEQUATE IRRIGATION - MOST COMMON IN POSTERIOR MANDIBLE. - NO GENDER PREDILECTION - 1-3% OF ALL EXTRACTIONS, BUT UP TO 1/3 OF IMPACTED THIRD MOLAR EXTRACTIONS. - OFTEN DEVELOPS BETWEEN AGES 40-45. (1) Clinical Features: - Lost clot leaves bare bony socket - Exposed bone exquisitely tender - Pain, odor, and possible swelling and lymphadenopathy develop 3-4 after extraction -pain may radiate to ear or eye - Signs and symptoms may last 10 days (2) Treatment: - rule out retained root tip or foreign body - remove sutures - irrigate thoroughly with warm saline - Iodoform gauze with eugenol controversial: replace dressing every day for 3 days, then every 2-3 days until exposed bone is covered by granulation tissue. - provide plastic syringe for home irrigation. - pain medications. [caps means red diamond]

Which of the following is a POST-OPERATIVE COMPLICATION OF TOOTH EXTRACTION CAUSED BY PREMATURE FIBRINOLYSIS: a. Condensing Osteitis b. Alveolar Osteitis c. Periapical Ggranuloma d. Chronic Hyperplastic Pulpitis

c

Which type of periodontitis OCCUS IN HEALTHY INDIVIDUALS WITHOUT A SYSTEMIC DISEASE PROCESS? a. Chronic Periodontitis b. Necrotizing ulcerative Periodontitis c. Aggressive Periodontitis d. None of the above

GRANULOMATOUS GINGIVITIS ❖Unexplained granulomatous inflammation, diagnosis of exclusion ❖Foreign body gingivitis (FBG) -damage to epithelium (CT) during dental procedures and foreign material into gingiva • Occurs at any age. [path red know diamonds]

Which would this image be: a. Necrotizing Ulcerative Gingivitis b. Granulomatous Gingivitis c. Desquamative Gingivitis d. Puberty Gingivitis

b is answer. • Candidiasis Diagnosis: - Cytologic smear or scalpel biopsy - Cytology smear = ❖ Least invasive of all biopsy techniques - Histopathology reveals: Elongated hyphae that may branch Yeast that appear ovoid

You think your patient might have Candidiasis. Which of the following is the LEAST INVASIVE method of all BIOPSY techniques? a. Scalpel Biopsy b. Cytology Smear