Oral Pathology
Posted by John Doe at Dental Assistant on February 18, 2012.
Categories: Dental Secrets
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NONVASCULAR PIGMENTED LESIONS
122. What drugs can cause mucosal pigmentation?
- Oral contraceptives • Minocycline
- Antimalarial agents (e.g., plaquenil) • Zidovudine (possible)
123. Why does heavy metal poisoning primarily cause staining of the ging iva?
Heavy metals such as le ad, bismuth, and silve r may cause a grayish-black li ne to appear on the gingival margins, especially in patients with poor oral hygiene. Plaque bacteria can produce hydrogen sulfide, which combine s with the heav y metals to form heavy metal sulfides that are usually black.
12 4. What can cause mucosal melanosis?
Benign: physiologic pigmentation, postinflammatory hyperpigmentation (esp ecially in dark-skinned people), oral melanotic macule, smokin g, mucosal nevu s, melanoacanthosis
Malignant: melanoma Systemic conditions: Peutz-Jegher's syndrome, Albright's syndrome, Addison's disease neurofibromatosis
125. What are the different forms of oral melanocytic nevi?
- Intramucosal nevus: tends to be elevated. papular or nodular.
- Junctional nevus: tends to be macular.
- Compound nevus: tends to be papular.
- Blue nevus: tends to be macular
126. What is the most com mon site for oral melanoma?
Hard palate.
127. What is the difference between a melanocyte and a melanophage?
A melanocyte is a neuroectodermally derived dendritic cell that contains the intracellular apparatus to man ufacture melanin. A me lanophage is a macrophage th at has phagocytosed melan in pigment and therefor e can look like a melanocyte because it co ntains melanin. However, it lacks the enzymes to produce melanin .
METABOLIC LESIONS ASSOCIATED WITH SYSTEMIC DISEASE
128. What are the three presentations of Langerhans cell disease (his tiocytosis X)?
Chronic localized diseas e: eosinophilic granuloma; usually in adults.
Chronic disseminated disease: limited to a few o rgan systems in adults.
Hand-Schuller-Christian disease is a well-recognized form, characteri zed by exophthalmos; diabetes insipidus and bony lesions; sometimes with skin and visce ral involvement.
Acute disseminate d disease: Letterer-Siwe disease in children; wide spread involvement of multiple organ systems, especially skin; usually runs a rapidly progressive, often fatal course; considered a malignancy for the most part.
129. What are Birbeck granules?
Birbeck granules are racket-shaped cytoplasmic inclusions seen in Langerhans cells of histiocytosis X.
Racket-shaped Birbeck granule of Langerhans cell histiocytosis.
130. What are the oral changes associated with pregnancy?
Gingivitis and p yogenic granuloma (epulis gravidarum).
131. An elderly man complains that his jaw seems to be getting too big for his dentures and that his hat does not fit him anymore. What do you susp ect?
Paget's disease (ostejtis deformans), a metabolic bone disease in which initial bone resorption is followed by haphazard bone repair, with resulting marked sclerosis. This condition may lead to narrowing of skull base foramina and neurologic deficits. The maxilla is often affected; a "cotton-wool" appearance has been described on radiographs.
13 2. What oral lesions are associated with gastrointestina l disease?
The most common gastrointestinal disease associated with oral signs is infla mmatory bowel disease, especially Crohn's disease. Patients may manifest cobblestoning of the mucosa and papulous growths, which represent granulomatous inflammation similar to what is seen in the gastrointestinal tract. Occasionally, patients also develop a pyostomatitis vegetans. In addition, they may have aphthouslike ulcers as well as symptoms of glossitis associated with vitamin B 12 deficiency if part of the ileum has been resected for the disease.
Patients with gluten-sensitive enteropathies also may present with aphthouslike ulcers.
13 3. what is primary and secondary Sjögren's syndrome?
Primary Sjogren's syndrome, which used to be called the si cca syndrome, cons ists of dry eyes (keratoconjunctivitis sicca) and dry mouth (xero stomia) in the absence of other systemic conditions. Secondary Sjogren's syndrome consists of primary Sjogren's syndrome plus a connectivetissue disorder such as rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, or polymyositis. Most patients with Sjogren's syndrome have circulating auto antibodies.
134. What is the dental significance of the Sturge-Weber syndrome?
This syndrome is characterized by vascular malformations of the lep tomeninges, facial skin innervated by the fifth nerve (nevus flammeus), and the corresponding ipsilateral areas in the oral mucosa and bone. Bleeding is therefore an important consideration in dental treatment. Patients also may exhibit mental ret ardation and seizure disorders. Tr eatment ma y include phenytoin.
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