Let's Study Oral Pathology

Bismillahirrahmanirrahim...

Tomorrow will be my first paper of Third Year Professional Exam. The subject is Oral Pathology, which is concerned with the scientific study of the causes and effects of oral diseases.

As the final preparation, I would like to create an entry regarding this subject, briefly. Hopefully I can remember all the facts easier by doing this, insyaAllah. Kalau tak mampu ingat semua, jangan tinggal semua. Betul tak? Hehe. Please pray for me, dear readers :)

My Cawson

Chapter 1: Intro to Oral Pathology

Types of biopsy:

-excisional= total excision

-incisional= removal of a small piece of tissue from a too large lesion

Biopsy techniques:

-use a sharp scalpel

-don't inject anaesthetic solution directly into lesion

-don't paint the surface area by a higly coloured antiseptic

-remove a border of the normal tissue

-hold specimens with tissue forceps

-fix the tissue with 10% buffered formalin / 70% alcohol

Chapter 2: Dental caries

Theories of dental caries:

1. Acidogenic theory

Acidogenic bacteria cause fermentation of staches+sugar -> acid production ->preliminary decalcification of enamel ->total destruction of enamel ->decalcification of dentine ->dissolution of the softened residue

2. Proteolytic theory

Organic portions of tooth (enamel lamellae) -> serve as a pathway for microorganisms ->acids produced by bacteria+invasion to the organic pathways -> destruction of the organic compounds = proteolysis

Zone of lesions in smooth surface caries (from dentinal side):

1. Translucent zone -more porous, not always present

2. Dark zone - result of demineralization

3. Body of the lesion -area of greatest demineralization

4. Surface zone - greater degree of remineralization from saliva

Pit and fissure caries

-triangular/cone shaped lesion

apex; toward outer surface

base; toward the DEJ

Root caries

Bacteria invades cementum along Sharpy's fibres -> cementum decalcify -> matrix destruct ->invasion to the dentinal tubules -> pulp inflamed + periapical spread (if left untreated)

Dentinal caries

Dentinal changes:

dentinal scleroses ->fatty degeneration of the Tome's dentinal fibre ->decalcification of wall dentinal tubule + packing of the tubules by microorganisms ->liquefaction foci -> clefts

Zones of dentinal caries

1. fatty degeneration of Tome's fibres

2. dentinal sclerosis

3. decalcification of dentine

4. bacterial invasion to the intact but decalcified dentine

5. zone of decomposed dentine

Chapter 3: Disease of the pulp & periapical tissues

Diseases of the pulp:

1. Focal reversible pulpitis

2. Acute pulpitis

3. Chronic pulpitis

4. Chronic hyperplastic pulpitis

Diseases of the periapical tissues:

1. Periapical granuloma

2. Periapical abcess

3. Periapical cyst

Chapter 4: Healing of extraction wound

Factors affecting healing:

1. location of the wound: rich blood supply>poor blood supply, immobilization>constant movement

2. physical factors: mild>severe, low dose>larger dose

3. nutritional factors

-proteins: multiply fibroblast

-vitamins: vit. A&D

4. age: young>old

5. infection :mild>completely protected

6. hormonal factors: ACTH and cortisone delay healing

7. miscellaneous

-enzymes: trypsin, alkaline phosphatase, stryptokinase

-suture materials: absorbable>non absorbable

-chemical tissue adhesives : butyl and isobutyl cyanoacrylate

Complications of extraction wound healing:

1. dry socket/postoperative osteitis/ localized alveolar acute osteomyelitis/ alveolar osteitis

2. blood clot infection

Chapter 5: Bone infections and spread of oral infections

Cellulitis:

1. Ludwig's angina:cellulitis of submandibular region

2. Cavernous sinus thrombosis

Osteomyelitis:

1. acute suppurative osteomyelitis

2. chronic suppurative osteomyelitis

3. focal sclerosing osteomyelitis/condensing osteitis

4. diffuse sclerosing osteomyelitis

5. chronic osteomyelitis with proliferative periostitis (periostitis ossificans)

Chapter 6: Cysts of the oral region

1. True cyst

-odontogenic

*REE:eruption, dentigerous

*Rest of Malassez: radicular, residual

* Rest of dental lamina: odontogenic keratocyst, lateral periodontal, gingival cyst of adult, dental lamina cyst of newborn, glandular odontogenic

*unclassified: paradental

-non odontogenic

2. Pseudo cyst/ non epithelial primary bone cyst

- traumatic bone cyst

-aneurysmal bone cyst

-static bone cyst/ stafne's bone cavity

Chapter 7: Odontogenic tumours

1. Benign epithelial odontogenic tumours

-ameloblastoma

-adenomatoid odontogenic tumour

-calcifying epithelial odontogenic tumour/ Pindborg tumour

-calcifying odontogenic cyst

-squamous odontogenic tumour

2. Benign mixed odontogenic tumour

-ameloblastic fibroma

-odontoameloblastoma

-ameloblastic fibroodontoma

3. Benign connective tissue odontogenic tumour

-odontogenic fibroma

-odontogenic myxoma

-cementoblastoma

4. Hamartomas

-odontomas (complex/compound)

5. Malignant epithelial odontogenic tumours

-odontogenic carcinoma

Chapter 8: White lesions and pre-malignant lesions

Etiology of leukoplakia:

1.tobacco

-heavy smokers

-smokeless tobacco

2.alcohol; synergistic effect

3.ultraviolet radiation; + actinic cheilosis

4.microorganism ;candida albicans -> candidal hyperplasia/candidal leukoplakia

5.trauma; frictional keratosis/ nicotinic stomatitis

Chapter 9: Ulcerative, Vesicular and Bullous Lesions

1. Allergic and immunologic disease

-Apthous ulcer

-Behcet's disease

2. Viral infections

-Herpes Simplex virus

-Varicella zoster virus infection

3. Dermatologic immune mediated diseases

-pemphigus vulgaris

-erythema multiforme

Chapter 10: Oral Cancer

- squamous cell Ca

-lip vermillion Ca

Chapter 11: Oral mesenchymal tumours

1. Fibrous connective tissue

-fibroma

-giant cell fibroma

-peripheral ossifying fibroma

-fibromatosis

-fibrosarcoma

-fibrous histiocytoma

-malignant fibrous histiocytoma

2. Vascular tissue origin

-hemangioma

-lymphangioma

-juvenile angiofibroma

-glomas tumour

-hemangiopericytoma

-hemangioendothelioma

-angiosarcoma

3. Adipose tissue origin

-lipoma

-angiolipoma

-liposarcoma

4. Smooth muscle origin

-leiomyoma

-angiomyoma

-leiomyosarcoma

5. Skeletal muscle origin

-rhabdomyoma

-rhabdomyosarcoma

-granular cell myeblastoma

6. neural tissue origin

-neurilemoma

-neurofibroma

-neurofibrimatosis

-melanotic neuroectodermal tumour of infancy

-neurofibrosarcoma

7. Metastatic tumour

-metastatic melanoma

-metastatic renal carcinoma

-metastatic adenocarcinoma of colon

Chapter 12: Pigmented and Melanotic Lesions of the Oral Mucosa

1. Blue/purple vascular lesions

-hemangioma

-varices/varicosities

-kaposi's sarcoma

2. Brown melanotic lesion

-ephelis and oral melanotic macule

-nevocellular nevus and blue nevus

-malignant melanoma

-drug-induced melanosis

-smoker's melanosis

3. Brown heme-associated lesions

-ecchymosis

-petechia

4. Gray/ black pigmentations

-amalgam tattoo

-graphite tattoo

-hairy tongue

-pigmentation related to heavy-metal ingestion

Chapter 13: Neoplastic and non-neoplastic diseases of the salivary gland

1. Reactive lesions

-mucocele

-ranula

-sialolithiasis

-sialadenitis

2. Immune-mediated salivary gland diseases

-Sjogren syndromes

3. Benign neoplasms

-pleomorphic adenoma

-Warthin's tumour

-Oncocytoma

-monomorphic adenomas

-basal cell adenoma

-canalicular adenoma

-myoepithelioma

4. Malignant neoplasms

-mucoepidermoid carcinoma

-adenoid cystic carcinoma

-acinic cell carcinoma

-adenocarcinoma

-carcinoma ex-pleomorphic adenoma

-carcinosarcoma

-metastatic mixed tumour

-squamous cell carcinoma

-clear cell carcinoma

Ok...i've to stop now...tired already...what I have to remember is not just the name of the diseases, but also the prevalence, clinical features, radiographical appearance, histology as well as the treatment...aduh...boleh ke ingat ni...

"Bismillahi tawakkaltu 'alallah... " :)