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Oral Pathology Exam I Review Slides. Physical/Chemical Injury.

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Presentation on theme: "Oral Pathology Exam I Review Slides. Physical/Chemical Injury."— Presentation transcript:

1 Oral Pathology Exam I Review Slides

2 Physical/Chemical Injury

3 Items covered: Physical/Chemical injury – Traumatic bone cyst – Osteoporotic (Hematopoietic) bone marrow defect – Surgical ciliated cyst of maxilla (aka traumatic ciliated cyst or postoperative maxillary cyst) – Pulse granuloma – Lipid granuloma – Cotton roll injury – Saliva ejector injury – Air emphysema – Injection hematoma – Amalgam tattoo – Cheek biting (morsicatio buccarum) – Tongue biting (morsicatio linguarum) – Traumatic (eosinophilic) granuloma – Pizza burn (thermal food injury) – Palatal petechiae – Riga-fede disease – Keratotic lesions Nicotine stomatitis Snuff dipper’s keratosis – Mass Lesions Mucocele Ranula Pyogenic granuloma Fibroma Linea alba Peripheral ossifying fibroma Peripherial giant cell granuloma Traumatic (amputation) neuroma Aspirin Burn Mecication reactions Gingival fibromatosis Tetracycline/minocycline stain Stomatitis medicamentosa Stomatitis veneata cinnamon reaction Angioedema Lesions affected by prosthesis Denture sore mouth Denture base allergy Papillary hyperplasia Epulis Fissuratum Angular Cheilits Osseous and chondromatous metaplasia Subpontic osseous hyperplasia Florid osseous dysplasia

4 Occurs primarily in the mandible, medullary hemorrhage leaves clot which dissolves, leaving empty cavity. Radiographic: small to large well-defined radiolucency with sclerotic borders, upper margin scalloped between roots, typically above mandibular canal, can be multilolulcar/expansile. Does NOT displace teeth, usually located in anterior, does not go beyond 3 rd molar, teeth are vital, no epithelial lining. Traumatic Bone Cyst

5 Located in posterior mandible, usually in the 3 rd molar site, red marrow fills socket instead of bone, Female predilection, asymptomatic, Radiographic: ill defined radiolucency, Histologic: normal red bone marrow (adipose and megakaryocytes Osteoporotic (Hematopoietic) Bone Marrow Defect

6 Maxilla only, sequella of antral sinus surgery or sinus perforation, fragment of sinus epithelium is pushed and entrapped in maxilla and proliferates into a cyst, Radiographic: well defined radiolucency in posterior maxilla Histologic: Cyst with sinus lining (pseudostratified ciliated columnar epithelium) Surgical Ciliated Cyst of the Maxilla

7 Vegetable (often leguminous) material lodged into mandibular 3 rd molar extraction site, evokes foreign body inflammatory reaction Radiographic: ill defined lytic lesion Histologic: Spherical bodies surrounded by a foreign body giant cell reaction Pulse Granuloma

8 Petroleum jelly containing substance is squeezed into third molar extraction site, lipid evokes a foreign body giant cell response, causes deep gnawing pain approximately 3 months or so later Histologic: Clear lipid vacuoles surrounded by a foreign body giant cell reaction Lipid Granuloma

9 Cotton absorbs moisture from mucosa and sticks- removal of cotton rips off part of the mucosa Cotton Roll Injury

10 Mucosa gets caught in saliva ejector and is ripped out Saliva Ejector Injury

11 Instant swelling associated with air blown into laceration where bone is exposed, palpation of the area will have crepitus (little bubbles of air), usually resolves itself, but can cause respiratory distress and is an emergency Air Emphysema

12 Usually a PSA, anesthetic solution gets into the pterygoid plexus of veins in the area of the buccal fat pad and cause pain. Injection Hematoma

13 Implantation of amalgam fragments into the connective tissue, slate gray in appearance, looks similar to melanoma, occurs with: flossing vigorously soon after proximal amalgam placement, fractured amalgam during surgical extraction, apicoectomy with retrofill Histology: Fine to coarse black/brown/green pigment granules in connective tissue, distributed along reticulin/elastin fibers appearing as tobacco strands, no inflammatory reaction Amalgam Tattoo

14 Necrosis of localized mucosa due to injection of anesthetic containing epinephrine, local blood supply is cut off, resulting in ischemia and necrosis Anesthetic Necrosis

15 Rough, masserated, white, torn lesion (usually bilateral), with or without red areas, in area easily accessible by the teeth Histology: Macerated hyperparakeratosis, acanthosis, with vacuolated cells. Cheek Biting (Morsicatio Buccarum) Tongue biting (Morsicato Linguarum) Cheek Biting (Morsicatio Buccarum) Tongue biting (Morsicato Linguarum)

16 Lateral tongue lesion with central deep ulcer that normally goes to the muscle layer and has firm elevated borders, caused by chronic local (sharp edges on teeth) and non-local (tardive dyskinesia) factors, resembles SCC clinically Histology: Surface ulcer with fibrin coating, deep inflammation into muscle with histiocytes and eosinophils Traumatic (eosinophilic) granuloma

17 Injury caused by hot food contacting the hard palate, occurs in the region of the incisive papilla (turns red and mucosa sloughs off) Pizza Burn

18 Clinically descriptive term for small, focals areas of submucosal hemorrhage, caused by: forcible retching, forcible fellatio, influenza, measles, scarlet fever, mononucleosis, clotting disorders, thrombocytopenias Palatal petechiae

19 Laceration in the lingual frenum area in the midline of the floor of the mouth in infants due to tongue thrust during feeding against premature tooth or teeth Riga-fede disease

20 Seen on the hard palate of pipe smokers, heat of the pipe causes reactive hyperkeratosis, white fissured palate with multiple papules having central red spots representing inflamed salivary ducts, resolves within 2 weeks of cessation of pipe smoking Nicotine Stomatitis

21 White fissured lesions (dry river bottom) in the area where the tobacco is held, usually in the vestibule area extending onto alveolar mucosa and the lip, may transform after many years, associated with gingival recession, periodontal bone loss, tooth abrasion and stains, resolves 2-6 weeks after cessation Histology: Chevron shaped hyperparakeratosis and acanthosis. Snuff dipper’s keratosis

22 Occurs only where salivary tissue is located, primarily on the lower lip, mostly in children, laceration of lower lip tears a salivary duct, saliva pumps into CT and is walled off by granulation tissue, blows up like a balloon and is encapsulated. Soft, fluctuant, pink or blue submucosal mass Histology: mucous sac lined by thin layer of granulation tissue, will eventually becom a fibrous lump and needs to be removed and submitted for biopsy Mucocele

23 Occurs in the floor of the mouth (salivary tissue), due to tearing of the sublingual gland or Wharton’s duct, unilateral (never on midline), Soft, fluctuant, pink or blue, differential diagnosis-could be malignancy, needs to be biopsied Ranula

24 Low grade, persistent irritation that stimulates the healing reaction to produce excessive granulation tissue, common reactive lesion of the gingiva (75%), lips and tongue, pregnant women are more prone (top left shows pyogenic granuloma during pregnancy [top] and 3 months after [bottom], can resemble cancer, soft, bleed easily, red and never hyperkeratinized Pyogenic Granuloma

25 Granulation tissue that wells up in a recent extraction site due to irritant. Epulis Granulomatosum

26 Reactive smooth fibrous hyperplasia to a low grade chronic irritant (cheek biting, resolution of a pyogenic granuloma, resolution of mucocele, rough margin/defective restoration, irritating RPD clasp, irritating ortho band Fibroma

27 Band of white tissue (hyperkeratosis/fibrosis) that goes across the entire occlusal line on the buccal mucosa, due to cheek sucking Linea Alba

28 Firm, pink,fibroma which is initiated by an irritant, then enlarges independently, occurs only on gingiva, mostly tooth bearing, derived from the PDL and sometimes the periosteum, will displace teeth Radiographic: Triangulation of radiolucency along root surface with some radiopacity Histologic: Spindly cellular fibrous stroma forming bone and/or cementum Peripherial Ossifying Fibroma

29 Soft, red, painless mass caused by low grade trauma to gingiva, PDL or periosteum, bleeds easily, seen only on gingiva (usually anterior) Radiographic: Can show cupping of underlying bone Histologic: Cellular spindly stroma containing clusters of foreign body multinucleated giant cells and vessels with hemorrhage Peripheral giant cell granuloma

30 Tearing or crushing a peripheral nerve, nerve twigs attempt to re- establish path but become blocked by fibrous scar and proliferate in a hyperplastic twisted, tangled mass lesion which is painful. Seen on tongue after bite injury, 3 rd molar area or mandibular canal after extraction, mental nerve area after ill fitting denture or atrophic ridge. Looks just like a fibroma but is painful. Histologic: Dense fibrous tissue like a fibroma but contains many hyperplastic nerve endings Traumatic (amputation) neuroma

31 Chemical cautery (protein denaturation) of mucosa due to placing aspirin directly on source of tooth pain. Similar reactions occur with: nitroglycerine, bisphosphonates, chlorpromazine, eugenol, phenol, hydrogen peroxide, formocreosol, listerine Histology: necrosis and sloughing of epithelium Aspirin Burn

32 Generalized firm and fibrous non-hemorrhagic growth of the gingiva, 3 drugs involved- anticonvulsants (dilantin), Calcium Channel Blockers (nifidipine), Cyclosporine. Hyperplasia is increased with poor oral hygiene and increased dose of offending drug Gingival Fibromatosis

33 Tetracycline uptake in growing calcifying tissues (bone, dentin, enamel) causes a yellow, grey or brown intrinsic stain, severity is dependent on length of usage and dose (note: Minocycline will stain teeth in a similar manner, except that it can stain formed teeth as well) Tetracycline Stain

34 Oral hypersensitivity and lesion reaction to a systemic drug, similar to stevens- johnson syndrome, slough of oral cavity Stomatitis Medicamentosa

35 Oral hypersensitivity to a topical agent (contact allergy), presents as white and/or red lesions adjacent to contacting material, occurs commonly with corroded amalgam, can occur years after placement of amalgams Stomatitis Venenata

36 Unilateral, burning white or red lesion on buccal mucosa and lateral tongue due to cinnamon Histologic: perivascular inflammation in the submucosal tissue, lichenoid reaction Cinnamon Reaction

37 Type 1 hypersensitivity due to multiplecauses (non- hereditary form, hereditary form, ACE inhibitors) which causes rapid, painless swelling of lips, face, eyelid, tongue, floor of mouth, larynx. Lasts hours before it completely dissipates Angioedema

38 Diffuse red velvety area that outlines the denture base and does not extend beyond, caused by ill-fitting dentures or a dirty denture that a patient does not remove at night, predisposes to candida infection Denture Sore Mouth

39 Velvety red area outlining the denture base of a recently repaired denture. Due to allergy of excess monomer present in recently repaired denture. Denture Base Allergy

40 Pyogenic granulomas that mature and become tiny fibromas, occurs in longstanding DSM where granulation tissue develops and matures into fibrous papules with a cobblestone appearance. Seen exclusively on hard palate. Candida is almost always involved. Patients with high palatal vaults are more prone to this Histology: Inflammatory fibrous hyperplasia, each papillary nodule is a fibroma, inflamed salivary gland ducts show reactive squamous metaplasia resulting in pseudoepitheliomatous hyperplasia Papillary Hyperplasia

41 Inflammatory fibrous hyperplasia (similar to fibroma) under an overextended denture, parallel fibrous folds grow on each side of the flange separated by a longitudinal fissure where the flange sits, the central fissure is usually ulcerated, rarely transform Epulis Fissuratum

42 Bilateral inflammation of commissures of the lips, caused by candida (perleche), B-vitamin deficiency, overclosed VDO Angular cheilitis

43 Chronic irritation of periosteum causes painful spurs of bone or cartilage to form arising clinically as bumps in the vestibule, occurs when unstable denture rocks anteriorly on a thin, atrophic anterior ridge, presses on the periosteum and causes spurs of bone or cartilage to form, primarily occurs in the anterior Osseus and chondromatous metaplasia

44 Crestal bone proliferation associated with an irritating pontic that touches the ridge with too much pressure or cantilever pontic that is rocking Radiographic: radiopacity above edentulous restal bone under a pontic Subpontic osseous hyperplasia

45 Dense masses of sclerotic bone and cementum form in the mandible for unknown reasons, remains stable until a denture is made, the normal bone resorption that accompanies dentures exposes the sclerotic bone which becomes infected and sloughs Florid (Cemento) Osseous Dysplasia


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