OMF Pathology Exam I

Introduction and Development

Soft Tissue esions site, morphology, color, size, consistency
o Site perioral skin, lips, tongue, floor of mouth, gingiva, vestibule, buccal mucosa, edentulous alveolar
ridge, retromolar pad, trigone area, hamular notch, maxillary tuberosity, soft / hard palate, oropharynx
o Morphology elevated / depressed / flat
Elevated
Blisterform (fluid-filled), soft and can be pressed
o !esicle ! "#$ cm
o "ulla % "#$ cm
o Pustule ! "#$ cm and % "#$cm filled &ith pus
'onblisterform (no fluid), &ill be firm &hen pressed
o Papule ! "#$ cm
o #odule % "#$ cm and ! ( cm
o Tumor % ( cm
o Pla$ue % "#$ cm
Depressed most &ill be ulcers, others include scar, pit, blind pouch
#um%er& single/multiple
Outline regular/irregular
Margin raised/smoot
Depth superficial/deep
Flat
macule circumscribed area of abnormal color change
Tongue lesion not a macule but sho&s loss of dorsal papillae (this loss is the flat lesion)
o i#e# )eographic tongue - lesion comes and goes
o 'olor& * primary pigments oxy-+b (red), reduced +b (blue), melanin (bro&n), carotene (yello&)
,ed -.'/,01023450,6 dilation (hyperemia) / proliferation
-78/,01023450,6 purpura (petechiae Ecchymosis
hematoma)
o Si*e& greatest diameter in length / &idth
o 'onsistency&
fixed, movable, indurated (firmness due to fibrosis suspicious for malignancy), firm, doughy,
fluctuant
'repitus pushing on area of lesion produces a crunching sound loss of bone &here it should
be present
o Miscellaneous
ulceration (complete loss of epithelium &ill be red because the vasculature shines through) vs#
erosion (partial loss)
9eratosis &hite (excess) vs# frictional keratosis (excess rubbing)
2essile (one diameter throughout) vs# :edunculated (base narro&er than elevated area)
2mooth vs# rough
+ard Tissue esions generally focus on radiographic interpretation; in con<unction &ith +x
o = of lesions position structure of abnormality %order behavior age/gender/ethnicity
o density
radiolucent unilocular vs# multilocular (soap-bubble, tennis racket, honey-combed, spider &eb)
>ixed radiolucent radiopa?ue (mottled, felcks, driven sno&, shperules)
completely radiopa?ue (ground glass, cotton &ool, homogenous)
o "orders &ell circumscribed, poorly circumscribed, and shape (round/ovoid, irregular, pear/inverted)
,ell circumscri%ed corticated (evenly thick), sclerotic (mixed), +yperostotic (evenly thin)
Punched out &ell circumscribed but no opacity
o "ehavior effect on ad<acent structures
/eeth &idended :@5
cancellous bone floating in air
cortical bone expansion, perforationalveolar nerve canal, infiltration
o -no. /0 handout definitions beaten copper, corticated, cotton &ool, cyst-like expansion, etc#
,adiolucent patterns (,5 pericoronal / periapical / other / poorly defined / ragged border)
,adiopa?ue patterns (,A &ell-demarcated / poorly-demarcated / multifocal / generalized)
>ixed ,5/,A patterns (,5/,A &ell-demarcated / poorly-demarcated / multifocal / generalized)
Developmental Defects
3lassification by tissue (e#g# mucosa-bone-teeth), type (e#g# developmental cyst), incidence (common/rare)
,are anomalies
o +emihyperplasia asymmetric enlargment, ("B mental retardation, enlarged tongue/cro&ns, open bite
o Progressive hemifacial atrophy prior trauma/infection, 3' 1 dermatome, pigmentation of skin and
coup de sabre scar on forehead; /x reconstructive surgery and orthodontics
o 2kipped 'rou*on syndrome1 2pert syndrome1 Treacher3'ollins Syndrome
Dou%le ip Credundancy of tissue posterior to the lipD not actually a second lip
o 3ongenital or ac?uired from trauma; /x surgical excision
2scher Syndrome autosomal dominant; double lip; biepharochalasis (recurring edematous, sagging eyelids)
o 045 have goiter (thyroid enlargement)
OMF Pathologies
Fordyce 6ranules ectopic sebaceous glands on oral mucosa; E"B incidence in adults (CnormalD)
buccal, labial F genital mucosa; yello&-&hite papules (due to se%um) pla?ues
eu7oedema most prevalent in G"B adult 0frican 0mericans, $"B children; 8normal9; more severe in smokers
@iffuse, opalescent .hite folded mucosal surface usu# Bilateral, buccal; disappears upon stretching
'linical Dx
o &hite sponge nevus no eye involvement
o hereditary benign intraepithelial dyskeratosis (+B.@) eye involvement
'either of these t&o conditions dissipate upon stretching of the mucosa
Macroglossia pressure of tongue against teeth produces scalloped border; open bite; speech/air&ay impairment
2myloid deposition is critical multinodular surface
/x determine etiology; reduction glossectomy
ingual Thyroid failure of thyroid to descend to neck (anterior of trachea); %>; :45 lac7ing any other thyroid
@x iodine isotope test
Tx hormone therapy, surgical removal excision (only &hen malignant)
Fissured Tongue grooves (-H mm# deep, dorsum tongue; (-$B incidence
assoc# &ith geographic tongue (brush tongue), >elkersson-,osenthal syndrome
+airy Tongue keratin accumulation on filiform papilla smokers, antibiotics, mouth&ashes, oral infections
asymptomatic; /x improve oral hygene
!aricosities (1arix) dilated veins, adults, no hypertension association, su%lingual most common, then lips/buccal
mucosa
2econdary calcification may present thrombus, phlebolith
Exostoses formation of ne& bone on existing bone
I in I,""";
/ypes facial alveolar ridge, torus palatinus, torus mandibularis, subpontine (dense cortical %one)
Torus palatinus midline of hard palate; multifactoral; J%>, 0sians, secondarily ulcerated, no real /x#
Torus mandi%ularis G"B bilateral, lingual mandible, K-I"B incidence in 42, >%J slightly
Eagle Syndrome elongation of styloid process or stylohyoid ligament mineralization causes impingement
@x panoramic radiograph, palpation of tonsillar fossa pain; 3's $, K, G, I" affected; pain on <a& opening,
head turning, s&allo&ing
/x steroids, surgery
Stafne Defect (aka 2tafne/static/latent bone cyst, lingual salivary gland depression)
0symptomatic, unilateral, E"-G"B >
Lell circumscribed radiolucency belo& inferior alveolar canal &ith corticated border; no /x
#on3odontogenic Developmental 'ysts of +ead ;#ec7
Palatal 'ysts of ne.%orn 7psteinMs pearls (midline hard palate) and BohnMs nodules (lateral hard palate)
H$-E"B incidence, asymptomatic (no /x), I-N mm# vesicles
#asola%ial 'yst rare soft tissue lesion (no radiographs); unkno&n etiology; J> (NI) N"-*" yrs
5ateral upper lip s&elling elevating ala of the nose and filling maxillary vestibule nasal o%struction
3yst lined by pseudo stratified &ith cilia and goblet cells
/x excision by intra-oral approach
6lo%ulomaxillary 'yst bet&een >ax# 5. and 3anine
ad<acent teeth are vital radiographs O &ell delineated inverted pear3shaped radiolucency
#asopalatine Duct 'yst most common non-odontogenic cyst of oral cavity; etiology arising from spontaneous cystic
degeneration of remnants of nasopalatine ducts, > % J, anterior palatal s&elling and vital ad<acent teeth
=adiographically % H mm diameter &ith heart3shaped or inverted pear shape
/x palatal flap approach for enucleation
Median Palatal 'yst almost identical to incisive canal cyst but more posterior
Jluctuant midline s&elling on +: &ith enlargements of the palate
2/2 pain and expansion &ith &ell-defined radiolucency of ( cm#
/x enucleation
Median Mandi%ular 'yst ?uestionable existence
Epidermal 'yst common on skin and rare in oral cavity unless trauma presents; > % J
9eratin filled, inflamed hair follicle
/x conservative excision
Dermoid 'yst midline floor of mouth &ith intraoral s&elling
displaces tongue if above geniohyoid muscle
dou%le chin if belo& geniohyoid muscle
Mass is doughy or ru%%ery in consistency
Tx& surgical approach based on location (above muscle intraoral, belo& muscle skin)
Thyroglossal Duct 'yst midline s&elling along the tract of descent (H"-E"B belo& the hyoid bone) &ith $"B
occurrence by age ("
e?ual gender occurrence &ith most less than / cm si*e; may move during s&allo&ing
/x cystectomy, removal of hyoid bone &ith generous portion of muscle along length of tract (Sistrun7
procedure)
'ervical ymphoepithelial 'yst the only cyst to occur in the lateral nec7
2oft, fluctuant mass of I-I" cm, upper lateral neck, anterior border of 23>, young adults, pain if infected
/x surgical removal
Oral ymphoepithelial 'yst su%mucosal .hite3yello. (pus) mass, floor of mouth
uncommon, young adults, asymptomatic, PIcm
/x surgical excision &ith no recurrence
Pulpal and Periapical Disease Dr> +all
:athogenesis noxious stimuli Q rigid dentinal &all &ith increased BJ increased pulp pressure
o results in vessel damage; since pulp is solid chamber, s&elling stays constricted to pulp dies
Pulpitis four types of noxious stimuli (mechanical, thermal, chemical, bacterial); reversible or irreversible
=eversi%le mild-moderate short duration pain &ith extreme temperatures (cold ? hot)
o ,esponds to electrical stimulation via pulp tester; easily localize infected tooth, no mobility and
radiograph reveals normal looking apex, may lead to irreversi%le pulpitis if untreated
Irreversi%le early: sharp / severe / continuous pain (cold % hot), &orse &hen lying do&n, and less of a
response to electrical pulp tester, pain can still %e locali*ed
o Late throbbing pain keeps patient a&ake (hot ? cold), need higher electrical stimulation to react
:ain may be referred, and responds to palpation
2traight dx &hen tooth is identified (pulpal pain does not cross midline, may be referred from arch to arch, and
pulp testing may be helpful); little correlation in histopathology and clinical 2/2
'hronic +yperplastic Pulpitis Pulp Polyp uni?ue inflammation in children @ young adults
o arge pulp exposure in prim> @ perm> molars .ith large pulp cham%ers (granulation tissue)
+istology @eeper layers &ill be filled &ith 3.3.
/x ,eversible (remove irritant), .rreversible (,3/ or extraction)
Dentin forms throughout life try having basic idea of histology
:rimary before cro&n completion
Secondary slo& first, faster after N$-*" y#o#; trauma may lead to early pulpal canal calcification
Tertiary @ =eparative irregular in areas of in<ury, had dead tracts resulting from severe damage
Pulpal 'alcifications @enticles / pulp stones / diffuse linear calcifications; radiopa?ue
Denticles in pulp chamber and root canals; attach to embedded dentin
Pulp stones develop in concentric fashion in pulp chamber / free or attached
D' fine and irregular, parallel to vasculature, in pulp chambers and canals, likely &ith aging
Periapical 6ranuloma mass of chronically inflamed granulation tissue at apex of nonvital tooth; reaction toxic
bacterial products spreading into apex of tooth; de novo or acute exacerbation can lead to periapical cyst or abscess;
:05 of periapical lesions, not sensitive to percussion, immobile, no response to pulp test/temperature and $"B &ill
fail after ,3/
,adiographically circumscribed or ill-defined // root resorption // canAt distinguish from cyst
Periapical Scar dense fibrous / collagenous tissue filling effect in lieu of normal bone if %oth cortical plates
lost
Tx removal of insult, nonsurgical ,3/ if tooth can be saved, extraction (and scaling)
Periapical 'yst epithelium at apex of nonvital tooth stimulated by inflammation to form true epi-lined cyst
3ommon, maxilla // lumen has debris, epithelium s?uames, protein content, slo& enlargement
3an also be on lateral aspect of canal, not necessarily at apex (ateral =adicular 'yst)
=esidual Periapical 'yst inflammatory tissue not curetted, left behind (may spontaneously resolve)
3linical asymptomatic unless exacerbated, no response to pulp test
,adiographically 5,3 (lucency along lateral root), ,:3 (lucency at previous extraction site)
+istopathology lumen filled &ith fluid / cellular debris, giant cells, acute/chronic inflammation of lumen
Tx same as granuloma removal of insult / conservative ,3/ if salvageable / extraction if not
Periapical 2%scess accumulation of acute inflammatory cells at apex of nonvital tooth; de novo or from chronic
:eriapical lesion // trauma, decay, perio disease
3linical tenderness relieved by direct pressure, intense sensitivity to percussion, tooth extrudes and tissue
s&ells, no response to temperature or pulp test
o :uruluence may extend to bone (osteomyelitis) or perforate cortical plate and spread to tissue (cellulitis)
// accumulate in 3/ as sessile s&elling or drain into oral cavity under skin (cutaneous sinus) // fistula
intraoral sinus tract // parulis or gum %oil granulation tissue s&elling
+istopathology :>'s, exudate, cellular debris, necrotic material
Tx drainage and elimination of focus of infection; ,3/ or extraction; antibiotics, surgical removal
'ellulitis acute edematous spread of inflammation through fascial planes of soft tissue; occurs &hen abscess is
unable to drain through skin surface or into oral cavity t&o types
ud.igAs 2ngina submandibular region (communication eventually &ith mediastinum), K"B from lo&er
teeth infection
o 'linical s&elling of floor of mouth, tongue, 2> region (above hyoid), unilateral bilateral, pain &ith
restriction of neck movement; can be fatal if 5# pharyngeal space causes air&ay obstruct
o /x maintain air&ay, antibiotics, and drainage
'avernous Sinus Throm%osis typically from canine space; reaches orbit via inferior orbital fissure and
cavernous sinus (maxillary anterior teeth)
o 'linical edematous :eriorbital enlargement &ith eyelid / con<unctiva involvement; protrusion of
eyeball, pupil dilation, lacrimation, loss of vision, pain over eye along 1I and 1( / fever, chillsR
o /x antibiotics, extractions, drainage, corticosteroids in pituitary dysfunction
Osteomyelitis acute / chronic inflammation in spaces or surfaces of bone that extends a&ay from initial site, caused
by %acterial infection; arises from odontogenic infections, <a& fractures, 0'4), 'A>0
=is7 factors immunocompromised, chronic illness / bone vasculature patients // alcohol/tobacco, .1@4,
diabetes, hypovascular %one (contraindicates antibiotic /x hard because they travel through blood)
0cute lack of time for body to react
o @rainage / exfoliation of fragments of necrotic bone O sequestrum (free) and involucrum (encased)
o ,adiograph reveals patchy, ill-defined, ragged lucency &ith central opa?ue se?uestrum
o /x antibiotics and drainage // typically non-surgical
'hronic I month post-acute phase, granulation tissue, scar &alls of dead spaces, hard to manage
o 'linical de novo or from acute phase; s&elling/pain, sinus formation and purulence, tooth loss
o =adiograph same as acute
o /x hyperbaric oxygen (+BA) therapy, especially in hypovascular bone (if failure of antibiotics)
Diffuse Sclerosing Osteomyelitis infectious process is responsible for bone sclerosis (hardening); rare
3linical adulthood (mandibular % maxillary), pain/s&elling not typical (see radiograph / histology)
/x resolve ad<acent chronic inflammation, sclerotic area may resolve or persist
Primary 'hronic Osteomyelitis affected area of bone is thickened causing facial asymmetry
'hronic Tendoperiostitis reactive hyperplasia of bone (like :3A above); initiated and exacerbated by chronic overuse of masticatory muscles; clinically,
occurs near *", recurrent pain and s&elling of cheeks; /x muscular relaxation / relaxation drugs, rotation therapy
'ondensing Osteitis localized area of bone sclerosis associated &ith apices of teeth &ith pulpitis or pulpal necrosisB
need to kno& inflammatory component for diagnosis, involved tooth exhibits necrosis and pulpitis
'linical children / young adults, mandi%ular PMs and Ms, no expansion
,adiograph uniformly increased radiodensity ad<acent to apex; no radiolucent border, :@5 &ide at apex
/x resolution of infection, called bone scar if it does not regress (typically regresses)
Osteomyelitis .ith Proliferative Periostitis 6arrCAs Osteomyelitis inflammatory periosteal hyperplasia &ith
onion-like reduplication of cortical plate
'linical mean at IN, mostly caused by caries &ith associated periapical disease, mand> PMs and Ms
,adiograph laminations of I-I( &ith lucent separations in ne& bone and original cortex
/x eliminate source of infection, %one .ill remodel to original state in D3EF months
2lveolar Osteitis (Dry Soc7et) instead of clot forming at site, it is lost secondary to transformation of plasminogen
to plasmin lysis of fibrin and kinin formation (stimulated by trauma)
,isk factors inexperienced surgeons, trauma, :A contraceptives, presurgical infection, tobacco use
'linical more in posterior / mandible (($-N"B of impacted N>s), bare bony socket, foul odor / pain
/x radiograph, socket irrigated &ith saline and packed &ith antiseptic dressing (changed (* hours)
:revention topical/systemic antibiotics and rinses, intraoperative irrigation Q antibiotics in socket (tetra)
Periodontal Diseases Dr> -ahn
4nderstand that there are both gingival and periodontal conditions
6ingivitis inflammation of soft tissues surrounding teeth (due to pla?ue, medication, allergy, infection, derm#)
Aften associated &ith lack of oral hygiene &ith increased incidence started at puberty (peak during $"s)
-no. for "oards causes of gingivitis (dia%etes, trauma, mouth breathers, smoking, malnutrition)
Lomen generally less prone except for progesterone effects in pregnancy
7arly on starts &ith 3/ inflammation, progresses &ith intensity /fibrosis /hyperemia /edema /hemorrhage
/x elimination of causes / improve oral hygiene / chlorhexidine rinse
Pyogenic 6ranuloma chronic hyperplastic focal gingivitis, a#k#a# Cpregnancy tumorD (happens to all, but more likely
during pregnancy) a type of gingivitis
Jilled &ith granulation tissue, so it is firm (nodule/papule/tumor)
5ocalized tumor proliferation of subacutely inflamed granulation tissue (anterior/maxillary/facial)
'eeds to be removed excisionally (complete removal)
2#G6 2cute #ecroti*ing Glcerative 6ingivitis
.mplicated organisms Jusobacterium nucleatum, borrelia vincentii, /reponema spp, selenomas spp, prevotella
intermedia
0ssociated factors stress / smoking / trauma / malnutrition and mal-hygiene, immunocompromised
"lunted interdental papillae &ith high inflammation / punched3out crater necrosis / fetid odor /
spontaneous hemorrhage and necrotic debris
#GM #ecroti*ing Glcerative Mucositis extension of epithelial necrosis to&ard <unction &ith alveolar
mucosa and ad<acent oral mucosal tissue
+istology 0.3. (acute inflammatory cellular infiltrate) / >.3. (mixed) / 3.3. (chronic)
Tx debridement (perio /x &ith scaling, curettage) slight 50 rinses antibiotics
Plasma 'ell 6ingivitis three categories (allergy / neoplastic / idiopathic) originally due to che&ing gum substitute
in IGH"s entire free and attached gingiva has diffuse enlargement .ith %right erythema and loss of normal
stippling
3an eventually go so far as to extend unto palate / lip / tongue
:soriasiform hyperplasia, spongiosis, exocytosis, microabscesses, vasodilation
Tx dietary +x, allergy testing (diet elimination may be necessary), steroids (idiopathic /x)
6ranulomatous 6ingivitis Cdiagnosis of exclusionD unexplained after ruling out other granulomas; can be due to
foreign body material from dental procedures O foreign %ody reaction
>ay be either solitary or multifocal, and generally onsets in adulthood, red or ,-&hite macules at interdental
papillae (possible extension to attached gingiva)
:atient &ill have good oral hygiene, may be flossing / brushing normally
Pain .ill %e present (a%sent in typical gingivitis)
termed Cforeign body granulomaD if a foreign body is found
Tx excise if foreign body found, corticosteroids / intralesional if no foreign body is present
Des$uamative 6ingivitis chronic vesiculoerosive process &here gingiva easily sloughs off &ith minor
manipulation; not definitive diagnosis
3linical, more likely in *" y#o# J; chronic onset; initially small area multifocal or generalized pattern
o Smooth erythema (loss of stippling) and vesicle/bulla formation filled &ith clear fluid/blood
o #i7ols7y Sign minor manipulation of affected area &ill result in sloughing of gingiva
Drug3=elated 6ingival +yperplasia abnormal gingival tissue gro&th due to medications
Dilantin (younger anticonvulsant), #ifedipine (older 3a
(Q
channel blockers), 'yclosporine (all)
+yperplasia amount positively related &ith level of oral hygiene / susceptibility
'linical hyperplasia (enlargement) I-N months after starting drugs, starts interdentally across tooth
surfaces, (anterior / facial areas), spares edentulous areas, firm but has normal color, smooth or granular // A,
can present &ith inflamed dark red &ith very easy %leeding
Tx stop / substitute drugs; if not possible, pla?ue control, scaling, gingivectomy, chlorhexidine rinse
6ingival Fi%romatosis slo&ly progressive enlargement &ith collagenous overgro&th of fibrous 3/
3linical familial or idiopathic / generalized or local
o 'linical %efore age F4, firm, normal color, smooth or stippled, may overgro. cro.ns thereby
delaying eruption of teeth
>ay be associated &ith mental retardation, sensorineural / gro&th / thyroid problems
3ommonly found in maxilla, but may be found on palate (thicker) bilateral maxillary posterior enlargement
&hich may extend to meet in the midline
+istologically dense collagenous tissue &ith surface epithelium having long rete edges
/x gingivectomy and rigorous oral hygiene program may recur so follo&-up is important
Periodontitis inflammation that affects supporting structures of teeth (PD @ alveolar %one @ cementum)
Bone loss is present here, not in gingivitis and perio pockets &ill be visible, teeth loosen (Q host factors)
Pathogenesis theory shift in proportion of bacterial species in pla?ue and changes in dentogingival
environment 00 (actinobacillus actinomycetemcomitans presence of )ram bacteria
#e. classification system chronic periodontitis / aggressive / systemic and necrotizing diseases of
periodontium as &ell as abscesses
3hronic most common reason for tooth loss % N$ y#o# , more common in men (smokers / diabetics)
o :receded by gingivitis, and probe &ill illustrate bone attachment loss
#ecroti*ing Glcerative Periodontitis (#GP) similar to '4) but also demonstrates attachment loss de novo or
arises from previous perio disease immunocompromised often associated &ith '4:; younger
Periodontal 2%scess arises out of preexisting perio lesion, and precipitated by microflora / host resistance changes;
associated factors; adult patients
Sone of gingival enlargement along lateral aspect of tooth (dark red hemorrhagic surface), throbbing pain
presents &ith extreme palpation sensitivity, fever, leukocytosis, malaise
Pericoronitis inflammation around impacted/partially erupted tooth due to food debris and bacteria beneath gingival
flap overlying the cro&n (especially /M) asymptomatic for a long time, and abscess may develop
:ain (may radiate to throat / ear / floor of mouth), foul taste, /rismus, fever, malaise
2ggressive Periodontitis occurs in healthy people, correlated &ith immunocompromised patients, and overall history
is similar to chronic periodontitis radiographs, histopath, microbio findings, study organisms
5ocalized familial, attachment loss locali*ed to EMs and incisors (only up to F other teeth); lack of
gingival inflammation, minimal supragingival pla?ue, destroys N-$x speed of chronic periodontitis
)eneralized de novo or preexisting localized; usually under age /4, poor serum antibody response, / or more
teeth including incisors and EMs; heavy pla?ue/calculus/gingival inflammation involved
Papillon3efCvre Syndrome oral and dermatologic manifestations / accelerated periodontitis
0ssociated &ith mutation of cathepsin 3 gene altered immune response, chemotactic defects, reduced
intracellular killing of bacteria and fungi / reduced neutrophil function, +aim->unk 2yndrome
o Jirst three years of life palmar / plantar 7eratosis that spread to dorsum (elbo&s/knees also)
,adiograph &ill reveal Cteeth floating in airD R in the soft tissue / advanced perio, hyperplasia
22 is chief pathogen (leukocyte dysfunction) responsible for development of periodontal component
Tx skin lesions, extract perio-compromised teeth, pla?ue control, antibiotics (even periodically for long-term
management), chlorhexidine rinse, oral hygiene and prophylaxis
"acterial Infections Dr> Solomon
@iseases and associated pathogenic organisms
Impetigo young children transmission via skin contact strep. Pyogenes; staph. Aureus '
,uptured vesicles &ith golden yello. crust, +21 resemblance &ithout fever
/x antibiotics after culture (@x)
Erysipelas young, elderly and diabetics dermal infection &ith lymphatic spread strep. Pyogenes
C2t# 0nthonyMs JireD on face, also presents on legs and skin &ith /x penicillin
Streptococcal Tonsillitis @ Pharyngitis sudden onset of sore throat spread by :(: contact streptococci - '
Bacterial Jever, dysphagia, tonsillar hyperplasia, petechiae, 35 (($B) &ith /x penicillin
o 3omplications ,h# Jever, glomerulonephritis, bacteremia
1iral rhinitis, laryngitis, bronchitis, con<unctivitis, cough, diarrhea (K$B)
Scarlet Fever children systemic infection group. A, -hemolytic strep. &ith erythrogenic toxin affecting blood
vessels rash
Jever, 7nanthem (rash in mouth palate, tongue, pharynx, tonsils), 7xanthem (rash on skin surface)
Jirst ( days stra.%erry tongue &ith circumoral pallor and peak fever of I"NTJ fever, 7xanthem
*
th
-$
th
days .hite stra.%erry tongue
,ash clears in a &eek &ith skin des?uamation &eeks N-E flaking of skin
/x penicillin avoids ,h# Jever / glomerulonephritis complications
Tonsillolithiasis all ages calcified structures in enlarged tonsillar crypts packed &ith bacteria and debris
>ass of des?uamated epithelium, serum, food debris, bacterial colonies
Aften asymptomatic but may lead to pain, abscess, ulcers, dysphagia, halitosis; /x is removal
Diphtheria :(: transmission lethal exotoxin causing tissue necrosis for gro&th/spread corynebact. Diphtheriae
Jever, headache, sore throat, malaise, anorexia
Oropharyngeal exudate thin film adherent gray soft palate / uvula / larynx / trachea air&ay
obstruct
8"ull nec79 enlarged cervical lymph nodes and neck enlargement '
4nderstand that soft palate is paraly*ed because of the bacterial toxin rather than bacteria myocarditis
@x culture Tx antitoxin administration &ith antibiotics (penicillin, erythromycin, procaine)
Syphilis IT, (T, NT - Treponema pallidum
EH - ( &eeks post-exposure; chancre (painless ulcer)
FH - I-( months post-exposure; may arise before chancre healing
o >ucous patch, condyloma lata (cauliflo&er, papillary gro&th s7in rash), tongue / lip / buccal
mucosa / palate
o >ay resolve and relapse I-N" years later
/H - only N"B develop aortic aneurysms, 3+J, neurologic
o Aral lesion 6umma (palatal perforation) and atrophic @ luetic glossitis (loss of dorsal tongue papillae)
o C3harcotMs UointD
'ongenital after *
th
month gestation, stillbirth or miscarriage may occur
o +utchinsonMs /riad +utchinsonAs Incisors and Mul%erry Molars / keratitis of eyes / 3' E deafness
o 2addle nose, clavicle enlargement (+igoumenakiMs sign), ,hagades (perioral fissuring)
@x fluorescence antibody, assay Tx penicillin
6onorrhea purulent penile discharge (>), pruritis (itching) and discharge (J) Neisseria onorrhoeae
0c?uired transmission through kissing, fellatio 3ongenital neonatal blindness if ac?uired during birth
'eed to rule out other 2/@s
>ost common reportable bacterial infection in the 42
Tx doxycycline and ceftriaxone (penicillin ineffective)
Tu%erculosis airborne droplet transmission mycobacterium T! infection doesnMt mean active phase (only $B)
:rimary fever and pleural effusion
2econdary reactivation later in life apex of lungs, progressive cough, consumption
Scrofula involvement of neck lymph nodes '
upus !ulgaris skin involvement
)ranulomatous inflammation &ith caseating necrosis
Tx .'+ (isoniazid) and ,ifampin for G months; non-compliant patients resistance V
eprosy mycobacterium "eprae starts at nasal or oropharyngeal mucosa
( types tuberculoid (immune-reaction &ith Q skin test), lepromatous (cell-mediated &ith ulceration)
( 3linical types pauci%acillary (tuberculoid) &ell-circumscribed &ith nerve involvement
o Multi%acillary (lepromatous) ill-defined, distorted face, neural involvement, hard tissue of floor, and
bridge of nose (saddle nose also in syphilis) oral lesions more common
2/2 facies leprosa (triad of facial bone destruction), maxillary teeth involvement in children, pulpal necrosis
#OM2 children begins as 0'4), and predisposed by malnutrition, malignancy, immunocompromise
#usobacterium nucleatum, borrelia vincentii, staph. Aureus, prevotella intermedia, streptococcus
Fetid odor, pain, fever, '
Tx penicillin, metronidazole &ith later reconstruction
2ctinomycosis tonsillar crypts, gingival sulci, pla?ue (synergistic &ith strep. and staph.) actinomyces israelii
$"B are in +F' drainage of fistula contains colonies in exudate that look like sulfur granules
0bscess indurated or C&oodenD &ith soft central area upon palpation
Tx incise and drain &ith prolonged antibiotics (penicillin)
'at Scratch Disease young children most common cause of chronic regional lymphadenopathy in children '
!artonella $enselae
"acillary angiomatosis 0.@2 patients (reaction to cat scratch bacillusW) &ith resemblance to 9aposiMs
sarcoma
'ot contagious :(:
/x self-limiting disease by around H months, but can use antibiotics to expedite the process
!iral Infections Dr> -ahn
+erpes Simplex !irus (+S!) @'0 virus (/ype I and () also includes 1aricella-Soster (1S1), 7pstein-Barr
(7B1), 3ytomegalovirus (3>1), ++1H-K-E (&ith I linked to 9aposiMs 2arcoma)
5ifelong infection, but latency makes for only periods of active disease (reactivation)
o /ype I salivary spread or oral lesion contact (oral lesions) /ype ( 2/@
Type E Primary +S! (after one &eek of incubation) young >/J, asymptomatic, &hen undergoing
remission, virus is taken by sensory nerves to '# ! ganglion to be colonized (pharyngotonsillitis in adults)
H mo# to $ yr# acute gingivostomatitis high fever, irritability, mouth sore and '; resolution in I-( &ks#
o 3luster of vesicles (smaller than bullas) rupture coalesce on attached and movable mucosa
o >ay present on labial and buccal mucosa, hard palate and attached gingival areas
Type F =ecurrent +S! vermillion border and ad<acent skin of lips, 8recurrent herpes la%ialis9
o >ay also present on hard palate and gingiva (nonmovable mucosa) pain, burning, itch/tingling (* hrs
o :athogenesis papules cluster rupture to form coalescing ulcers due to spreading of fluid; K-I* days
o Accurs upon reactivation of the virus associated &ith stress, 41 light, allergy, trauma, hormone XV
o 'ot restricted to lips (labialis), also occurs on 7eratini*ed mucosa %ound to %one, i#e# gingiva and +P
+erpetic &hitlo& finger skin infection
+erpes neonatorum (congenital) via cervix or vagina &ith $"B mortality rate
o Multinucleated cells 8T*anc7 cells9
@x viral isolation, 0b titers, exfoliative cytology (cytopathologic effect 8'PE9)1 biopsy
/x primary analgesics, fluid, topical lidocaine secondary A/3 0breva cream, ,x 0cyclovir (antivirals)
!aricella3Joster !irus (!J!) primary infection is chic7enpox, latent is shingles via air droplets, direct contact
( &k# incubation &ith oral lesions preceding skin lesions (B# mucosa, palate, gingiva), no aspirin Tx; acyclovir
o 4se of aspirin &ill result in ,eyeMs syndrome fatal iatrogenic damage
'hic7enpox G"B under age I$; sho&s symptoms unlike +21 2/2 pain, malaise, rash starts on face/trunk
Shingles recurrent 1S1 in I"-("B, latent in dorsal spinal ganglion, recurrence occurs once unlike +21
o Aral vesicles ulcers &ith lesions limited to %eing unilateral; resolution in (-N &ks#
4nderstand that post-infection neuralgia may last up to I year damage to sensory nerves persists / ear canal
/x supportive therapy (analgesics), antibiotics and antivirals in severe cases
Infectious Mononucleosis (8Mono9) transmitted via Epstein3"arr !irus (E"!) through intimate contact, via saliva
on ob<ects in children, and shared saliva in adults lifelong infection; *-H &eeks resolution; possible fatality in
immune compromise
7B1 also associated &ith oral hairy leukoplakia, BurkittMs lymphoma, nasopharyngeal carcinoma
@x children have asymptomatic exposure, adults fever, stomatitis, pharyngitis, tonsillitis commonly
o 2dults& G"B lymph node enlargement in cervical chains, E"B tonsillitis, palatal petechiae, 2#G6
o ,"' elevated, atypical lymphocytes present, antigen screening (monospot test), heterophile 0b test
'ytomegalovirus ('M!) in neonates and +.1Q adults universal exposure by $" years of age (G"B asymptomatic)
5atency after initial infection resides in salivary glands, endothelium, macrophages, may reactivate
/ransmission sexual, blood, organ transplant, placenta, breast milk
2/2 developmental tooth defects (congenital) enamel hypoplasia, attrition, enamel hypomaturation, dentin
discoloration
o 0dult 2/2 like >ono, but no pharyngitis and lymphadenopathy; 0.@2 patients blindness and colitis
/x spontaneous resolution, but )anciclovir (antiviral) for +.1Q patients
+erpangina enterovirus related to coxsac7ie 2 virus unrelated to HSV; I &eek incubation (summerQ)
Anset is acute &ith 2/2 sore throat, dysphagia, fever, myalgia (muscle pain), headache; K-I" day resolution
2l.ays in the %ac7 of the mouth (throat); presents orally &ith (-H lesions, 2: or tonsillar pillar, red
macules/vesicles/ulcers
=u%eola (measles) via respiratory droplets 2/2 fever, malaise, con<unctivitis, cough; rash (face / trunk)
>iddle ear infection, pneumonia &ith $"B mortality in +.1Q, encephalomeningitis; sometimes enamel hypopl#
-oplic7 spots precedes skin rash &ith blue-&hite macules on labial and buccal mucosa
,arthin3Fin7leday 6iant 'ells histological finding
/x analgesics and prevention via MM= vaccine
=u%ella )erman >easles birth defects, transmission via respiratory droplets, lymphadenopathy, arthritis
Aral lesions ("B of cases; ForchheimerAs Sign dark red papules on 2: at time of skin rash
'lassic Triad Deafness1 +eart Disease1 'ataracts
MM= vaccine to prevent, but no /x
Mumps most common site is parotid gland, body fluid transmission, I day prior - ( &ks post-resolutionO contagious
2/2 fever, headache, myalgia (muscle pain) 3linical K$B bilateral s&elling increased &/ salivation
3omplication testicular epididymis inflammation (Orchitis) to *x normal size &ith sterility upon resolution
/x supportive (analgesics, pain management), prevented &ith MM= vaccine
+uman Immunodeficiency !irus (+I!) I""B mortality &ith increasing life expectancy &ith extensive drug /x
.nitial exposure has self-limiting viral symptoms I-H &ks after infection (similar to >ono), clears in fe& &eeks
0.@2-related 3omplex (0,3) 0.@2 symptoms present &eight loss, diarrhea, candidiasis, hairy
leukoplakia, 1S1, no pneumonia, and 'DK3T cells are failing (it is a target of the virus)
3@* /-lymphocyte helper cell facilitating antibiotic production; symptoms P $"" / mm
N
, threatening P (""
-aposiAs Sarcoma @ Pneumocystis 'arinii Pneumonia @ =ecurrent other pneumonias @ pulmonary T"
o .n particular, the pneumocystis carinii bacteria is death-producing bacteria in 0.@2
o 3ervical carcinoma, esophageal candidiasis, 3>1, +21, other opportunistic infections
/ransmission sexual, blood to blood, placental, organ transplant and artificial insemination
o ,isk via occupational exposure (puncture or cut) 4 in dentists
2creening EIS2 test viral antigens present, and antibodies to p(* (+.1 antigen) confirmation of +.1
-aposiAs Sarcoma malignant tumor of endothelium lining blood vessels, $"B incidence, gingiva or +:, flat
or raised occurrence in full blo&n 0.@2 (++1 E causative)
o Tx radiation, pain mgmt#, treat dissemination to lymph nodes
'andidiasis often the sign leading to +.1 @x; ,x generally only cause temporary remission
o ,apid locali*ed alveolar bone loss, and gingivitis is unresponsive to improved pla?ue control
Oral +airy eu7opla7ia via 7B1 resembles Ccandidiasis on lateral tongueD in both 0,3 and 0.@2
2phthous Glcers ma<or type is % I cm, 3@* count drop causes these lesions / thrombocytopenia
Bilateral parotid glands s&elling
+uman :apilloma virus condyloma acuminatum +epatitis, /B, mycoplasmosis, 9lebsiella pneum#