Oral Pathology
Posted by John Doe at Dental Assistant on February 2, 2012.
Categories: Dental Secrets
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CHEMOTHERAPY AND HIV DISEASE
72. What are the common oral manifestations in patients who have undergone chem o therapy?
Chemotherapy-associated oral ulcerative mucositis.
73. A patient who underwent cancer chemotherapy now has recurrent in traoral herpetic lesions but no history of cold sores or fever blisters. Is this likely?
Yes. Many people have bee n exposed to herpes simplex virus without their knowl edge and are completely asymptomatic. The virus becomes latent within sensory ganglia and reactivates to give rise to recurrent or recrudescent herpetic lesions. The prevalence of people who have been exposed to HSV increases with age.
74. What are the complications of leukemia in the oral cavity, aside from those associated with chemotherapy?
Leukemic infiltration of the bone marrow leads to reduced production of functional components of the marr ow. Granulocytopenia results in more frequent and more aggressive odontogenic infections; thrombocytopenia results in petechiae, ecchymoses, and hematomas in the oral cavity, which is subject to trauma from functional activities. The patient may have a more than adequate white cell count, but many of the white cells are malignant and do not necessarily function like normal white cells. In addition, some leukemias, especially acute monocytic leukemia, have a propensity to infiltrate the gingiva, causing localized or diffuse gingival enlargement.
75. A patient underwent a matched allogenic bone marrow transplantation for the treatment of leukemia. Three months later he has erosive and lichenoid lesions in his mouth .What is your diagnosis?
The likely diagnosis is chronic oral graft-vs-host disease. The allogenic bone marrow transplant or graft contains immunocompetent cells that recognize the host cells as foreign and attack them. The oral lesions of chronic graft-vs.-host disease resemble the lesions of lichen planus.
Chronic oral graft-vs-host disease of buccal mucosa.
76. What are the effects of radiation on the oral cavity? Short-term: oral erythema and ulcers, candidiasis, dysgeusia, parotitis, acute sialadenitis
Long-term: xerostomia, dental caries, osteoradionecrosis, epithelial atrophy and fibrosis
77. What factors predispose to os teoradionecrosis?
This necrotic process affects bone that has been in the radiation field. Predisposing factors include high total dose of radiation (especially if> 6,500 cGy), presence of odontogeni c infection (such as periapical pa thosis and periodontal disease), trauma (such as extractions), and site (the mandible is less vascular and more susceptible than the maxilla).
78. What is the b asic cause of osteoradionecrosis?
The breakdown of hypocellular, h povascular, and hypoxic tissue readily results in a chronic, nonhealing ulcer tha t can be secondarily infected. Some repo show that the infection is for the most part superficial.
79. What are the common oral manifestations of HIV infection?
Soft tissue: candidiasis, recurrent herpetic infections, deep fungal infections, aphthous ulcers, hair y leukoplakia, viral warts
Periodontium : nonspecific gingivitis, acute necrotizing u lcerative gingivitis, severe and rapidly destructive periodontal disease, oft en with unusual pathogens
Tumors: Kaposi's sarcoma, B-cell lymphoma, squamous cell carcinoma
80. A patient who tested positive for HIV antibodies presents with a CD4 count of 150 but has never had an opportunistic infection or been symp tomatic. Does he have AIDS?
Yes. By the CDC definition (February 1993), patie nts with CD4 counts below 200 ar e considered to have AIDS.
81. Like other leukoplakias, hairy leukoplakia has a tendency t progress to malignancy. True or false?
False. Hairy leukoplakia is associated with EBV infection and usually a superimposed hyperplastic candidiasis. HPV also has been associated with hairy leukoplakia, which is not a premalignant condition. However, patients infected with HIV are more susceptib le to oral cancer in general.
82. Are HIV-associated aphthous ulcers similar to recurrent major aphthae?
Yes. They tend to be greater than 1 cm, persist for long periods (week s to months), and are difficult to treat.
HIV-associated aphthous ulcers of the soft palate and oropharynx.
83. Should HIV-associ ated aphthous ulcers be routinely cultured?
Yes. Often the culture is positive for HSV or ev en CMV, and the patient needs to be treated appropriately.
84. Kaposi's sarcoma (KS) is seen equally in the different population risk groups. True or false?
False. Over 90% of th e epidemic cases of KS are diagnosed in homosexual or bise xual men. KS is an AIDS-defining lesion that is seen much less frequently in the other risk groups. It is associated with the presence of a new virus-Kaposi's sarcoma-associated human herpesvirus 8.
85. What management issues other than infection control and diagnosis of oral lesions should you keep in mind when treating patients with AIDS?
Hematologic dysfunction is common. HIV infection is associated with autoimmune thrombocytopenic purpura granulocytopenia and anemia. In addition, antiretroviral agents such as zidovudine are myelosuppressive, as are drugs used as prophylaxis against Pneumocystis carinii pneumonia, such as trimethoprimsulfamethoxazole. The patient's blood picture should be known before treatment, especially surgical procedures, begins.
HIV-related Kaposi's sarcoma of the palate.
86. How do you treat intraoral Kaposi's sarcoma?
Surgical excision, intralesional injections of ymca alkaloids, radiation, and possibly interferon.
BENIGN NEOPLASMS AND TUMORS
Odontogenic Tumors
87. Name the benign odontogenic tumors that are purely epithelial.
- Ameloblastoma
- Calcifying epithelial odontogenic tumor (Pindborg tumor)
- Adenomatoid odontogenic tumor
- Solid variant of the calcifying odontogenic cyst
- Squamous odontogenic tumor
- Clear-cell odontogenic tumor (rare)
88. Which odontogenic tumor is associated with amyloid production? With ghost cells?
Calcifying epithelial odontogenic tumor (Pindborg tumor) is associated with amyloid production; calcifying epithelial odontogenic cyst (Gorlin cyst) is associated with ghost cells.
89. Which two lesions, one in the long bones and one in the cranium, resèThble the ameloblastoma?
In the long bones, adamantino ma; n the cranium, craniopharyngioma. i
90. All forms of ameloblastoma behave aggressively and tend to recur. True or false?
False. One form of ameloblastoma, which occurs in adolescents and young adults, behaves less aggressively and has a lower tendency to recur. It is is called unicystic ameloblastoma.
91. Because ameloblastoma is so aggressive, it can be considered a malignancy. True or false.
False. Ameloblastoma is a locally destructive lesion that has no tendency to metastasize. However, it has two malignant counterparts: ameloblastic carcinoma and malignant ameloblastoma.
92. To which teeth are cementoblastomas usually attached?
The mandibular permanent molars.
93. Name two odontogenic tumors that produce primarily mesenchymal tissues.
Odontogenic fibroma and odontogenic myxoma.
94. An adolescent presents with a mandibular radiolucency with areas that histologically resemble ameloblastoma as well as dental papilla. What is your diagnosis?
The diagnosis is ameloblastic fibroma, one of the rare odontogenic tumors that has both a neoplastic epithelia l and mesenchymal component.
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