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114 Cards in this Set
- Front
- Back
Wilms tumor (kidney) and hepatoblastoma
Enlarged crowns, open bite |
Hemihyperplasia
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Coup de sabre
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Progressive hemifacial atrophy (Romberg syndrome)
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Autosomal dominant
*beaten copper skull |
Crouzon syndrome (craniofacial dysostosis)
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Features of Crouzon syndrome and limb defects (syndactyly)
Mandibular prognathism (class III occlusion) with midface hypoplasia 75% cleft soft palate or uvula |
Apert syndrome
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Narrow depressed cheeks
Downward slanting palpebral fissures Deformed pinna Underdeveloped mandible |
Treacher-Collins syndrome (mandibulofacial dysostosis)
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Seen in Ascher syndrome along with double eyelids (blepharochalasis), goiter
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Double lip
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Ectopic sebaceous glands on oral mucosa
80%, normal variant Clinical Multiple yellow-white papules plaques Most commonly on buccal mucosa, labial mucosa, retromolar area |
Fordyce granules
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Common in African-Americans
~90 adults and ~50% children “normal anatomic variant” Diffuse opalescent white mucosal surface, folded, wrinkled Whiteness diminishes when mucosa stretched |
Leukoedema
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Diff Dx for Leukoedema
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White sponge nevus (WSN) – No eye involvement
Hereditary Benign Intraepithelial Dyskeratosis (HBID) – eye involvement Neither will dissipate upon mucosa stretching |
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Congenital Causes of Macroglossia
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Lymphangioma, hemangioma
Down syndrome Mucopolysaccaridosis Neurofibromatosis MEN syndrome |
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Acquired causes of Macroglossia
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Edentulous patients
Amyloidosis Myxedema Acromegaly Angioedema Carcinoma and other tumors |
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Macroglossia presenting with multinodular surface
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Amyloidosis
Neurofibromatosis MEN syndrome |
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Multiple grooves and furrows in dorsum
Associated with Geographic tongue Melkersson-Rosenthal syndrome |
Fissured Tongue
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Keratin accumulation on filiform papilla
Heavy smokers Secondary to antibiotics Poor hygiene Debilitation Mouthwashes Oral infections |
Hairy tongue
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Most common site for oral Varix
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sublingual
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In what population (sex, region) does Torus Palatinus occur?
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Female 2:1, Asian
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Prevalence of Torus Mandibularis
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7-10% pop. in US
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Elongation of the process or mineralization of ligament causes impingement
Diagnosis Pano x-ray Palpation of tonsillar fossa producing pain Affects cranial nerves #5, 7, 9, 10 |
Eagle Syndrome
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Well circumscribed radiolucency always below inferior alveolar canal
Usually corticated border |
Staphne defect
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Stafne defect occurs most often in Men or Women?
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80-90% in men
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Newborn palatal cysts along median raphe
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epstein's pearls
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Newborn palatal cysts scattered
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bohn's nodules
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Who more often gets nasiolabial cysts
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females 3:1
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location of globulomaxillary cyst
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between max lat and canine
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*Most common non-odontogenic cyst of the oral cavity
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Nasopalatine duct cyst
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predilection of nasopalatine duct cyst
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males
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Fluctuant swelling midline hard palate
Clinical enlargement of the palate |
median palatal cyst
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Common on skin, rare in oral cavity
Associated with Gardner’s syndrome |
epidermoid cyst
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Midline floor of mouth intraoral swelling displacing tongue if above geniohyoid
*double chin if below geniohyoid Mass doughy or rubbery in consistency |
Dermoid cyst
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Midline swelling anywhere along tract of descent
60-80% below hyoid bone 50% occur by age 20 Most < 3 cm May move during swallowing or tongue protrusion |
thyroglossal duct cyst
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Soft, fluctuant mass 1-10 cm in size
Upper lateral neck on the anterior border of SCM Young adults Pain, if secondarily infected |
Cervical Lymphoepithelial cyst (aka branchial cleft cyst)
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Submucosal mass, white-yellow
Floor of mouth most often Remainder of Waldheyer’s ring tissue |
Oral lymphoepithelial Cyst
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Teeth are caries resistant
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Dental fluorosis
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Enamel defect in developing permanent tooth due to PA INF of overlying primary tooth
Usually permanent premolar from primary molar trauma |
Turner's tooth
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presentation of internal resorption
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Pulpal cells destroyed pink tooth of Mummery
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most commonly impacted teeth
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3rd molars and max canines
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oligodontia
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6 or more teeth fail to develope
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most common supernumerary
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mesiodens
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multiple supernumerary teeth associated with what two conditions
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cleidocranial dysplasia and gardner's syndrome (also assosciated with epidermoid cyst)
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most common microdont
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peg lateral
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# normal when anomalous tooth is counted as one
Single tooth bud divides, common root, common canal |
gemination
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# missing one tooth with anomalous tooth counted as one
Union of dentin in two separate buds |
fusion
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joined cementum
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concrescence
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where does talon cusp occur?
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anterior tooth lingual aspect
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where does cusp of carabelli occur?
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mesiolingual aspect of max molar
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Cusp-like elevation of enamel on lingual ridge of buccal cusp
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dens evaginatus
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Invagination of crown lined by enamel
Usually effects max lat and central incisors Tx: restore opining |
dens invaginatus
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Enlargement and displacement of pulp chamber apically in multi-rooted tooth
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taurodontism
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Excess cementum layered on apical portion of root’s surface
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hypercementosis
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dilaceration
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Abnormal angulation or bend in root
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types of amelogenesis imperfecta
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Hypoplastic – inadequate deposition of enamel matrix
Hypocalcification – no mineralization of enamel matrix (enamel and dentin equal radiodense) Hypomaturation – enadequate enamel crystal structure, chips off (dentin and enamel equal density radiographically) |
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taurodontism of first molar associated with what condition?
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amelogenesis imperfecta
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what condition is associated with kinky hair
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amelogenesis imperfecta
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Autosomal dominant (100% penetrance, variable expressivity)
Opalescent teeth, transparent Bulbous crown, constricted at CEJ Obliterated pulp chambers Can occur with Osteogenesis Imperfecta (blue sclera) |
Dentinogenesis Imperfecta
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Autosomal dominant inheritance
Atypical dentin with atypical pulp morphology Type I – roots are messed “rootless” Type II – crowns are messed (flame shaped pulp chambers) |
Dentin Dysplasia
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“ghost teeth” – thin enamel and dentin surrounding large pulp
Rare, idiopathic, more common on maxilla |
Regional Odontodysplasia
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Four main types of noxious stimuli
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Mechanical
Thermal Chemical Bacterial |
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Presentation of reversible pulpitis
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Responds to electrical stimulation at lower level of current than control
No mobility, no sensitivity to percussion Easy to localize affected tooth Radiographically - normal root apex appearance |
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Sharp, severe pain upon thermal stimulation, especially cold
Spontaneous or continuous pain Exacerbated by lying down |
EARLY irreversible pulpitis
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Throbbing pain keeps patient awake at night; dull prolonged pain
Cold may produce relief; heat makes it worse Responds at higher levels of electrical current than control or no response |
LATE irreversible pulpitis
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Unique pattern of inflammation seen in children and young adults
Large clinical exposure of the pulp Primary/permanent molars with large pulp chambers |
Chronic Hyperplastic Pulpitis (Pulp Polyps)
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when does primary dentin form
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before crown completion
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Significant trauma to _____ can lead to early calcification of pulp chambers and canals (calcific metamorphosis)
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secondary dentin
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In areas of focal injury
More haphazard Dead tracts Result from severe damage with dead odontoblasts and their processes in dentinal tubules |
reparative dentin
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three types of pulpal calcifications
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Diffuse linear calcifications
Pulp stones Denticles |
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Pulp chamber and root canals adj. to furcation
Most attach or become embedded in dentin |
pulp stones
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Develop around a central nidus in concentric fashion
Pulp chamber Most free or attached; rarely embedded |
denticles
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most common periapical lesion
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periapical granuloma (70%)
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how do you distinguish radiographically between PA cyst and PA granuloma
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trick Q. you cannot
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PA cyst more commonly in maxilla or mandible?
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maxilla
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diff dx for PA radiolucency
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Periapical granuloma
Periapical Cyst Bone scar Periapical cemento-osseous dysplasia (early stage) Langerhans cell disease Benign and malignant tumors |
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what is a "phoenix lesion"
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PA abscess that arises from a chronic PA lesion
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fistula
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intraoral sinus tract, Epithelial-lined drainage path or abnormal
communication between two epithelial-lined surfaces |
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granulation tissue swelling at drainage site, soft gingival nodule at the surface opening (stoma) of a fistulous tract; full of pus
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parulis or gum boil
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can occur when an abscess is not able to establish drainage thru the surface of the skin or into the oral cavity
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cellulitis
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two severe forms of cellulitis
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ludwigs angina and cavernous sinus thrombosis
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Cellulitis of the submandibular region
70% arise from infection of lower teeth |
ludwigs angina
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where does cavernous sinus thrombosis arise from if odontogenic
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canine space
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what veins communicate with cavernous sinus
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Anterior facial veins
Angular veins Ophthalmic veins |
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what percent of cavernous sinus thrombosis are odontogenic?
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10%
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Acute or chronic inflammation in medullary spaces or cortical surfaces of bone that extends away from the initial site
Usually a bacterial infection Arise following odontogenic infections, jaw fractures, ANUG and noma |
osteomyelitis
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3 predisposers of osteomyelitis
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Chronic systemic illness
Immunocompromised Decreased vascularity of bone |
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diff. between acute and chronic osteomyeltis
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chronic can cause pathological fracture, starts 1 mo after acute infection, smoldering
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Initiated and exasterbated by chronic overuse of masticatory muscles
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Chronic Tendoperiostitis
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Localized area of bone sclerosis associated with apices of teeth with pulpitis or pulpal necrosis
To make diagnosis must know inflammatory component since other pathoses appear similar Involved tooth exhibits necrosis or pulpitis |
Condensing Osteitis (sclerosing osteitis; focal sclerosing osteomyelitis)
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in what age group does condensing osteitis occur? what teeth most often affected?
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children, mandibular molars and premolars
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Form of inflammatory periosteal hyperplasia with an onion skin-like reduplication of the cortical plate
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Osteomyelitis with Proliferative Periostitis (Garrè’s osteomyelitis)
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condition presentation: Mean age = 13; equal gender
Most frequent cause is dental caries with associated periapical disease (also periodontal, fractures, cysts, other infections) Usually premolar and molar of mandible, inferior border |
Osteomyelitis with Proliferative Periostitis (Garrè’s osteomyelitis)
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what condition is associated with Inexperienced surgeons
Traumatic extractions Oral contraceptive use Presurgical infections Inadequate irrigation at surgery Patient use of tobacco products |
Alveolar Osteitis (Dry Socket)
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Localized tumor proliferation of subacutely inflamed granulation tissue
NOT granuloma OR pyogenic |
Chronic hyperplastic focal gingivitis (pyogenic granuloma)
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Clinical
Blunted interdental papilla Punched out, crater like necrosis (covered by gray-yellow pseudomembrane) Fetid odor, exquisite pain Spontaneous hemorrhage and necrotic debris |
ANUG (Acute Necrotizing Ulcerative Gingivitis)
Aka Vincent’s infection or Trench Mouth |
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Implicated organizisms
Fusobacterium nucleatum Borrelia vincentii Treponema spp. Selenomonas spp. Prevotella intermedia |
ANUG (Acute Necrotizing Ulcerative Gingivitis)
Aka Vincent’s infection or Trench Mouth |
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Tx for ANUG (Acute Necrotizing Ulcerative Gingivitis)
Aka Vincent’s infection or Trench Mouth |
Debridement
Topical or LA Rinses Antibiotics: metronidazole |
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Seen in late 1960s due to chewing gum component substitution
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Plasma Cell Gingivitis (Atypical gingivostomatitis)
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clinical presentation of plasma cell gingivitis
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Entire free and attached gingival has diffuse enlargement with bright erythema and loss of normal stippling
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Diagnosis of Exclusion (unexplained)
Rule out histologically distinct granulomatous diseases Can be due to foreign body material from dental procedures |
granulomatous gingivitis
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Chronic vesiculoerosive process in which gingival spontaneously sloughs or can be removed with minor manipulation
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desquamative gingivitis
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age and sex most common for desquamative gingivitis?
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females over 40
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conditions attributed to desquamative gingivitis
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pemphigoid, erosive lichen planus, pemphigus vulgaris
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what is Nicolsky sign
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Manipulation of affected area with an object or compressed air can results in sloughing
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Tx of desquamative gingivitis
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Perilesional incisional biopsy and direct/indirect immunofluorescence
Topical and systemic corticosteroids |
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drugs associated with Drug-Related Gingival Hyperplasia
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Anticunvulsants
Phenytoin (Dilantin) – younger patients Calcium channel blockers Nifedipine, diltiazem, felodipine, nitredipine, verapamil Cyclosporine – immunosupression in transplant patients (any age) |
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Slowly progressive enlargement
May be assosciated with syndromes, epilepsy, mental retardation Usually before age 20 Firm and normal color Can overgrow clinical crowns, may delay tooth eruption |
gingival fibromatosis
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pathogenesis theory behind periodontits
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Shift in proportion of bacterial species in the plaque
Changes in the dentogingival environment Facultative gram-positive organisms (actinomycetes, strep) anaerobic and microaerophilic gram-negative Actinobacillus actinomycetemcomitans, bacteroides forsythus, porphyromonoas gingivalis, prevotella intermedia |
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what is the primary cause of tooth loss after age 35?
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chronic periodontitis
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By definition, occurs in otherwise healthy people
Correlated with a deficiency of the immune system rather than plaque Histology similar to chronic perio, so to dx, need leukocyte function test |
aggressive periodontitis
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what did aggressive periodontitis used to be called?
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early onset
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By definition, occurs in otherwise healthy people
Correlated with a deficiency of the immune system rather than plaque Histology similar to chronic perio, so to dx, need leukocyte function test |
aggressive periodontitis
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what is the presentation of localized aggressive periodontitits
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Attachment loss localized to first molars and incisors; no more than two other teeth involved.
Vertical bone loss, symmetrical and bilateral |
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Usually under age 30 but any age possible
Generalized loss of attachment that must affect at least three teeth other than the first molars and incisors |
Generalized Aggressive Periodontitis
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Accelerated Periodontitis
Associated with mutation of cathepsin C gene altered immune response, chemotactic defects, reduced intracellular killing of both bacterial and fungal organisms |
Papillon-Lefevre syndrome
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Manifests in first 3 yrs of life
Palmar/plantar keratosis that spread to dorsa Radiographic: teeth “floating” in soft tissue |
Papillon-Lefevre syndrome
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Like NUG but with bone loss
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Necrotizing Ulcerative Periodontitis (NUP)
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pericoronitis
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Inflammation around impacted or partially erupted tooth due to food debris and bacteria beneath the gingival flap (mand 3rd molars)
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