Oral Pathology

Study Notes
3/30/17
Bulla
- Circumscribed, elevated lesions (+5mm), contains serious fluid - blister
Lobule
- Lobe that is part of a whole ; fused together
Macula
- Freckle flat, different colour
Papule
- Circumscribed lesion ( -1cm), elevated
Pedunculated
- Stemlike or stalk base
Pustules
- Circumscribed elevated contained pus
Sessile
- Base of a lesion flat or broad instead of stemlike
Vesicle
- Small, elevated lesion less than 1cm contains serious
Nodule
- Solid lesion up to 1cm- can occur above or beneath the skin
Erythema
- Redness
Pallor
- Paleness
Corrugated
- Wrinkled
Fissure
- Groove with depth
Papillary
 - Small, nipple-shaped projections in clusters

Wound healing
Primary repair
- Edges are brought together (coapt)
- Clean cut
- Surgical incision little loss of tissue
Secondary repair
- Biggest scar
- Abrasion -edges are far apart (tooth extraction)
- 4-5 days to re-epithelialize (1mm/day)
- Connective tissue (1mm/2-3 days)
Tertiary repair
- Granulation form inside out
- Large scar
- Delayed healing
- Wound kept open to allow for drainage
- Health granulation bed formed may be closed with sutures
Guided tissue regeneration
- Cotex on root
- Putting back original tissue/cells
- Allows the PDL to come out of tissues
- GCT fills in
- Bone regrows to some degree
-
Biologic width
- Must be maintained
- PDL/GCT/JE
Regeneration
- Repair with the same cells (re-populating) no scar
Repair
- Repair with new cells (scar)
Stages of wound healing
1. Haemostasis (stop bleeding)
a. Vasoconstriction
b. Platelet activation
c. Coagulation
2. Inflammation INITIATES HEALING PROCESS -info below
 3. Proliferative
a. Revascularisation/ angiogenesis
b. Granulation
c. Epithelialisation
d. contraction
e. Initial tissue granulation tissue (immature cells)
f. Epithelial cells prepare new tissue at the same time granulation tissue
is building connective tissue
g. +7 days fibrin digested by tissue enzymes off
h. Surface appears redder (thinner epithelium)
i. +14 days scar if formed, mature granulation tissue
4. Remodelling
a. Initial granulation and fiber is remodeled
b. Wound is healed and the initial scar tissue is reconstructed
Healing takes about 2 weeks
2. inflammation
Occurs almost simultaneously in epithelium and connective tissue
- Epithelium is faster
Acute inflammation
- Neutrophils (PMNS)
- Emigrate by chemotaxis
B-lymphocytes are in saliva
Integrins on the surface of the leukocyte bind to adhesion molecules on the inner
surface of the vascular endothelial cells.
Leukocytes flatten out and squeeze between endothelial cells to leave blood vessels
(diapedesis) and enter tissue
Neutrophils decrease in number
Macrophages, lymphocytes and plasma cells predominate with CHRONIC
INFLAMMATION
3 systems
1. Kinin system
a. Increased blood vessel dilation/increased vessel permeability
2. Clotting mechanism
a. The clot contains fibrin, clumped red blood cells (RBCs), and activated
platelets.
3. Complement system
a. Plasma protein
b. Polysaccharides found on the surface of bacteria can activate the
system
c. Specific immune response can activate the system
Mediators of inflammation
- Endotoxin
o Produced by cell walls of GRAM NEGATIVE bacteria
o Chemotactic factor, can activate complement, function as an antigen
+damage+bone+tissue
- Lysosomal enzymes
o Similar chemical composition and action as those released by WBC

Manifestations of inflammation
1. Fever
a. Pyrogens
i. Fever producing substances produced by WBC and pathogens
ii. Act on hypothalamus
iii. Hypothalamus increased body temp by prostaglandins
2. Leukocytosis (osis always means increase) -penia means decrease
a. Increased number of WBC from 4000-10000
b. Neutrophil is the primary cell
3. Elevated C-reactive protein-produced in liver
a. Interacts with complement system
b. Chronic increased level is associated with caridio. Disease
4. Lymphadenopathy
a. Enlarged lymph nodes
b. Hyperplasia
i. Increase in number of cells
c. Hypertrophy
i. Enlargement of individual cells
NB:
Oral mucosa less prone to scar tissue than skin
Complications in wound healing
1. Dehiscence (burst)
a. Too few capillaries = ischemia
b. Develop into ulcer
2. Scar herniation (bulge)
a. Build from too much collagen are either hypertrophic scars or keloids
b. Overgrowth of healed area
3. Contractures
a. Excess scars from tight ridges along the skin and permanently interfere
with normal movement
b. Scar tissue is larger
--
Microphnathia
- Abnormally small jaw
- Primarily mandible -maybe because it develops by its self (max develops with
the face)
 - May be hereditary
- Orthognathic surgeon -surgeon of the jaw
Macrognathia
- Abnormally large jaw
- Primarily mandible
- Resulting in Class III malocclusion
- Hereditary
- Pituitary gigantism
- Pagets disease
- Acromegaly
Agnostic (A-means without)
- Without a jaw
Cleft Palate
- Develops in weeks 7-9
- Cleft soft palate if untreated problems with speech and swallowing develop
- Extension from lip through soft palate and uvula
Fordyces granules (lips) **
- Misplaced sebaceous glands
- Ectopic misplaced
- Normally around hair follicles, lips and buccal mucosa
Congenital lip pits
- Mandible forms in one piece-slows towards the middle -forms pits
- Commissural lip pits max joins the man (corner of the mouth)

Van der Woude syndrome

- Genetic
- Depressions in the mand. Lip
Failure for the max to meet the mand fully is macrosomia (wide mouth)
Incomplete cleft lip rare
Etiology of all clefts
- Hereditary
- Rubella
- Insult to the fetus at the stage of development
- Multifactorial
ALL CLEFTS ARE DEFINED BY LOCATION AND SEVERITY
- Unilateral
- Bilateral
- Multilateral
 - Complete/incomplete

Injuries to oral soft tissues

Aspirin burn
- Tissue becomes necrotic and white
- Surface may slough off leaving an ulcer
- heal in 7-21 days
Phenol burn
- used in chemistry as a cavity sterilizing agent + a cauterizing agent
- whitening and sloughing of the area as a result of tissue destruction
- phenol used regularly in root canals
Electric burn
- seen in children chewing through electric cords
- constriction of corners of the mouth when health
- damage tissue and even tooth buds underneath tissue
Other burns
- hot food or drinks
- products containing hydrogen peroxide (20%) in certain concentrations or
eugenol (oil of cloves)
Thermal food burn
- area of yellow-white epithelia necrosis
- will slough off
Formocresol burn
- tissue necrosis
- can be caused by secondary leakage of endodontic material
Cocaine use lesions
- nasal lining
- goes through ethmoid and vomer bone
- goes through palate
Factitious injury means without function **
- anything you do that causes injury to your body that causes loss of function
- habits-chronic lip biting, cheek of tongue biting, trauma to teeth from
fingernail
- hyperplasia and hyperkeratosis can occur
Morsicatio buccarm
-hyperkeratosis, lots of cheek biting
Persistent trauma may cause hard, raised traumatic granuloma
- heals in 7-14 days
- may require biopsy
Frictional keratosis
- happens on buccal mucosa, under the tongue and under dentures
- - eliminate the cause to cure
- Friction can cause dysplasia and could cause cancer
Nicotine stomatitis
- Minor salivary glands that after burning from many chemicals in cigarettes
keratinise
- They get plugged and bulge
Traumatic neuroma
- Nodule made up of nerve tissue from trauma
- Requires biopsy (removal) and examination
Amalgam tattoo
- Little piece of amalgam that has broken off the tooth and travelled and
causes and dark staining in the gingival tissue
Melanosis
- Freckle looking mark on the gingival mucosa
- Flat, well circumscribed lesion
Solar cheilitis (actinic cheilitis)
- Sun
- Lower lip is more involved than upper- lower is more protrusive
- Epithelium thinner
- Vermillion is pink and mottled
- Relationship between epithelia and connective tissue changes and the
development of basal cell carcinoma of the skin or squamous cell carcinoma
of the lips and skin
- Actinic cheilosis- loss of the basal layer
Mucocele
- Minor salivary gland that is damaged
- Not a true cyst no lining of epithelium
- Fluid filled
- Most common in the lower lip
- Increase or decrease in size over time
- Bluish
Ranula
 - Same as above but on the floor of the mouth
Necrotizing Sialometaplasia
- Blockage of a blood supply
- In the salivary glands most often
- Necrosis of salivary is seen
- Painful/selling/ulceration
- Gets replaced by a different type of tissue than normal metaplasia/dysplasia
Sialolith
- Salivary stone
- Calcification

Reactive connective tissue hyperplasia

Pyogenic Granuloma
- Proliferation of connective tissue containing blood vessels and inflammatory
cells as a response to injury
- Exaggerated response due to hormones
- Lesion is not pyogenic (pus formation) nor a granuloma
- Develops rapidly
- PREGNACY TUMOR
- Not caused by pregnancy, made worse by
Peripheral giant cell granuloma
- Multinucleated giant cells, well-vascularized connective tissue, RBC and
chronic inflammatory cells
- Occurs ONLY in jaw
- Originate from perio ligament or periosteum in response to injury
- Radiolucent
- Boarders not well defined

Irritation fibroma
- Result from trauma
- Check biting
- Lots of keratinized tissue
Epilus fissuratum
- From ill fitting dentures
Papillary hyperplasia
- Denture induced hyperplasia
- Projection are fibrous connective tissue
- Superficial infection of candida albicans
Gingival enlargement
- Chronic inflammation
- Hormone changes
- Medications
Chronic hyperplastic pulpitis
- Pulp is inflamed due to carries
- Chronic is treated by extraction and endodontic treatment