Oral Medicine #1

Notes

Cysts and Odontogenic Tumors

Odontogenic keratocyst → basal-cell naevus syndrome

Gingival cysts = Bohn's nodules / Epstein's pears → spontaneous resolution

Pathology

Radicular / residual cyst -  a layer of simple, non-keratinizing squamous epithelium

OKC - stratified squamous epithelium, corrugated, parakeratinizing

Dentigerous / eruption cyst - a thin layer of squamous / cuboidal epithelium, some 2 - 5 cells thick

Gingival cyst - cuboidal / flattened epithelium resembling dental follicle

Nasopalatine cyst - pseudostratified ciliated columnar epithelium / stratified squamous epithelium

Nasolabial cyst - pseudostratified non-ciliated columnar epithelium

Surgical Management

Enucleation = removal of whole cyst, cavity dressed with bismuth iodoform paraffin paste (BIPP) on ribbon gauze

Marsupialization = a window is cut and removed from cyst lining, allowing decompression of cyst, slowly heals by bone deposition in the base of cavity

Ameloblastoma - epithelial

Odontome - mixed epithelial and ectomesenchymal

Odontogenic myxoma, cementoblastoma - mesenchymal

Mucosal Diseases

Conditions related to friction / trauma

• frictional keratosis
• smoker's palatal keratosis = stomatitis nicotina
• fibrous hyperplasia and neoplasia
• fibroepithelial polyp - leaf fibroma ↓

Ulceration

• Traumatic ulceration - mechanical, thermal, chemical
• Drug-related ulceration - nicorandil, indomethacin, phenytoin
• Recurrent aphthous stomatitis - minor (<10mm), major (>10mm), herpetiform

Infections

Bacterial :

• Syphilis - primary chancres, secondary snail track ulcers, tertiary focal necrosis (gumma), syphilitic leukoplakia
• Tuberculosis - granular ulceration, secondary to pulmonary lesion
• Leprosy - raised red-white mucosal plaques (lepromas)

Viral :

• HHV 1 - primary herpetic gingivostomatitis, herpes labialis
• HHV 2 - genital ulcers
• HHV 3 - chicken pox, shingles
• Coxsackie virus - hand, food and mouth disease, herpangina
• Epstein-Barr virus (HHV 4) - hair leukoplakia
• Human papillomavirus (HPV 16 and 18) - squamous papillomas (warts)
• HHV 8 - Kaposi's sarcoma
• HIV - erythematous candidiasis, Kaposi's sarcoma, hairy leukoplakia, gingivitis, periodontitis, thrombocytopenia, bacillary angiomatosis, atypical ulceration, melanotic pigmentation, multiple viral papillomas

Fungal :

Angular cheilitis - candida + staphylococcus aureus + β-hemolytic streptococci

Lichen Planus

Lichenoid mucositis - lichenoid reaction, lupus erythematosus, graft-versus-host disease

Vesiculo-bullous Lesions

Granulomatous Disorder

• Foreign body
• Orofacial granulomatosis (oral mucosa) - lip swelling, lymphoedema, perilymphatic chronic inflammation
• Crohn's disease (GIT) - diffuse swellings of lips and cheeks, cobblestone mucosa, mucosal tags, angular cheilitis, slit-like ulcers, granular gingivitis, glossitis
• Sarcoidosis - submucosal nodules, erythema, granular gingival patches 
• Wegener's granulomatosis - strawberry hyperplastic gingival lesions, palatal ulceration, delayed healing

Potentially Malignant Disorders

• Oral submucous fibrosis
• Atrophic lichen planus
• Sideropenic dysphagia - Patterson-Kelly-Brown / Plummer-Vinson syndrome
• Dyskeratosis congenita
• Fanconi's anemia
• Leukoplakia and erythroplakia

Oral Cancers