which of the following is typically an acute metabolic complication of uncontrolled diabetes mellitis?

A. eye damage

B. Ketoacidosis

C. Atherosclerosis

D. End stage kidney failure

Which of the following oral complications is NOT typically associated with diabetes mellitis?

A. candidiasis

B. xerostomia

C. Excessive periodontal bone loss

D. multilocular radiolucencies with pathologic fracture

. Supernumerary teeth are extra teeth found in the dental arches, Gardner's Syndrome often has hypodontia.

A. both are true

B. 1st is true second is false

C. 1st is fals second is true

D. both are false

 Some clinical signs of Down's Syndrome include all of the following except:

B: Cleft Palate

stef's question cleft palate is not a sign of downs syndrome

congenital lack of teeth (all)

cause is developmental

anhydrotic ectodermal dysplasia- all teeth are often missing

Partial anodontia; the lack of one or more teeth

cause is developmental

most common are :

-max/mand 3rd molars

-max lateral incisors

-mand 2nd premolars

can be associated with a syndrome

Gemination /twinning

"Twinning." A single tooth germ attempts to divide, resulting in the in-complete formation of two teeth; the tooth usually has a single root and root canal. one common pulp

Concrescence-

In dentistry, a condition in which two adjacent teeth become united by cementum

maxillary molars most common

"A tooth within a tooth"; a developmental anomaly that results when the enamel organ invaginates into the crown of a tooth before mineralization

developmental disorder

most common location max and mand incisors and max lateral incisors

tooth may appear peg shaped

radiographic- enamel invagination noted with crown of tooth involved

if tooth is vital-prophylactic restoration placed

if non vital-root canal therapy used.

Enamel Hypoplasia



Turner’s tooth



Hutchinson’s incisors-



Amelogenesis Imperfecta



Dental Fluorosis



Enamel Hypocalcification (Odontodysplasia)



Regional Odontodysplasia (ghost teeth)

incomplete or defective formation of enamel, resulting in the alteration of tooth form or color



Results from a disturbance or damage to ameloblasts during enamel matrix formation.



Affects either the deciduous or the permanent dentition.

inherited (amelogenesis imperfecta)

febrile illness (scarlet fever, chicken pox, etc)

vitamin deficiency (A, D, C)

idiopathic factors

local infection of primary teeth

syphilis

birth injury

fluoride ingestion

TURNER’S TOOTH



enamel hypoplasia of a permanent tooth caused by infection of a deciduous tooth



Severity depends on the degree of periapical tissue involvement, severity of the deciduous tooth infection and stage of permanent tooth development



Usually affects one tooth



most often affected are permanent maxillary incisors and mandibular premolars



Color of enamel from yellow to brown



Pitting and deformity of enamel can occur

enamel hypoplasia rare disease that is cause by congenital syphilis, most who have these are blind or deaf.

incisors shaped like screwdrivers

most common permanent incisor and molars

broad at cervical and narrow at incisal (edge is notched)

mulburry molars have globules of enamel and are shaped like berries can be seen on any teeth

enamel hypoplasia resulting from ingestion of fluoride during tooth formation.

all teeth may be affected

very strong do not get decay

mottled appearance.

chalky white-brown/black staining

mild-chalky white

moderate-brown black staining pitting, corroded appearance.

mottled-irregular areas of discoloration

permanent central and lateral incisors, cuspids and 1st molars

crowns have one or more rows of tine deep pits and stain

trauma to enamel during maturation phase

can effect any teeth

crowns may have pitting, grooves, stain

chalky white spots at middle 1/3

cause unknown

soft vulnerable enamel

 radiographic-ghost teeth large pulp, thin enamel

developmental disorder

may affect several teeth in same quadrant.

affects max more than mand

affected teeth do not erupt/ or they partially erupt

TREATMENT-EXTRACTION

can be from tetracyline, Rh incompatibility

Occurs as a result of the deposition of substances circulating systemically during tooth development.

most common primary molars

a primary ankylosed tooth prevents  eruption of permanent

no pdl space radiographically also root resorption

treatment-extraction

tooth appears submerged

adjacent permanent teeth are taller

more solid percussion

incisors

crown looks normal on facial but has accessory cusp on cingulum.

radiographically-short roots, low furcation, large pulp

taurodontism affects molars

pulp chamber large and long, roots short with furcation near apices

affects mand premolars, molars,cuspids, incisors

accesory enamel cusp on occlusal

may see pulp horn extending to accessory cusp radiographically

this tooth may erupt between maxillary central incisors

appears conical and small

this is the 2nd most common supernumerary tooth

may appear small

distal to 3rd molars

tongue/floor of mouth

complete or partial fusion of lingual frenum of tongue to floor of mouth or lingual gingiva of mandibular incisors.

posterior dorsal of tongue

a mass of tissue at midline posterior to circumvallate papillae.

common among young adults

around crown of unerupted tooth (or impacted tooth)

it can displace teeth can fracture mandible

radiographically-unilocular radiolucency

this CYST IS LINED WITH CUBOIDAL TO SQUAMOUS EPITHELIUM.

CYST IN CHILDREN

AROUND SOFT TISSUE OF ERUPTING TOOTH

LINED BY CUBOIDAL  TO SQUAMOUS EPITHELIUM

TOOTH USUALLY ERUPTS THROUGH CYST

PRIMORDIAL CYST

YOUNG ADULTS

IN PLACE OF A TOOTH MANDIBULAR 3RD MOLAR MOST COMMON SITE

HAS A WELL DEFINED RADIOLUCENCY

LINED BY CUBOIDAL TO SQUAMOUS EPITHELIUM

SURGICAL REMOVAL IS NEEDED

Odontogenic keratocyst/keratocystic odontogenic tumor

HINT THIS CYST IS ASSOCIATED WITH NEVOID BASAL CELL CARCINOMA OR GORLIN CYST.

HIGH recurrence rate!!!!

dental lamina stage

age 20-30

posterior mandible is most common location

may cause buccal expansion

 can resorb teeth

radiographically-well defined usually multilocular radiolucency.

CYST IS LINED WITH THIN CORRUGATED PARAKERATOTIC SQUAMOUS EPITHELIUM 8-10 layers thick with prominent palisaded casal cell layer and flat interface between epithelium and connective tissue.

TREATMENT-SURGIVAL REMOVAL WITH CURETTAGE RECURRENCE IS HIGH.

in soft tissue of mandibular cuspid and premolar area.

occurs 50-60 yr olds

bulging/swelling of attached gingiva or interdental papilla

LINED WITH THIN NON KERATINIZED SQUAMOUS EPITHELIUM THAT MAY HAVE FOCAL THICKENINGS.

odontogenic EXTRAOSSEOUS

dentigerous

lateral periodontal

keratocyst

primordial

list of extraosseous odontogenic tumors

gingival

eruption

median palatal

incisal canal (nasopalatine)

globulomaxillary

median mandibular

epidermal

nasolabial

lympoepithelial (bronchial cleft)

thyroglossal duct

dermoid

this cyst affects men more than women ages 40-60

affects anterior maxilla, the nasopalatine canal and incisive papilla.

it is a pink bulge at incisive papilla area

radiographs show-well circumscribed radiolucency between maxillary central incisors. open heart shaped.

LINED WITH SQUAMOUS OR RESPIRATORY EPITHELIUM psuedostratified columnar ciliated epithelium, BLOOD VESSELS, AND SMALL NERVES IN CYST WALL.

INTRAOSSEOUS ODONTOGENIC CYST

LATERAL ASPECT OF TOOTH ROOT MANDIBULAR CUSPID/PREMOLAR REGION.

 LPC- UNILOCULAR RADIOLUCENCY

BC-MULTILOCULUAR RADIOLUCENCY

LINED BY NON KERATINISED SQUAMOUS EPITHELIUM WITH FOCAL THICKENINGS.

midline of hard palate posterior to palatine papilla

swelling at midline of hard palate may occur.

unilocular radiolucency

stratified squamous epithelial lining surrounded by dense fibrous connective tissue

pear shaped radiolucency in globulomaxillary region between roots of maxillary lateral incisor and cuspid.

this cyst needs to be biopsied to see if

central giant cell granuloma, OKC or lateral periodontal cyst

it is lined by squamous to cuboidal to respiratory epithelium

non odontogenic intraosseous cyst found on midline of mandible

large, may cause expansion of lingual aspect of mandible.

radiographs show-well circumscribed radiolucency below the apices of the mandibular incisors.

lined by squamous cell epithelium

nasolabial cyst

non odontogenic extraosseous cyst

ratio of men to women 4:1 ages 40-50

location is soft tissue of face in the nasolabial fold area (maxillary canine, floor of nose area)

expansion or swelling occur. can cause resorption of bone.

cyst is line with respiratory epithelium(psuedostratified ciliated columnar epithelium with goblet cells)

non odontogenic extraosseous

caused by epithelium of hair follicle

raised nodule on face or neck localized, firm moveable, swelling,

lined by keratinized stratified squamous epithelium and lumen is filled with keratin scales.

present at birth or in young children

non odontogenic exraosseous cyst

location-anterior floor of mouth

if large can displace tongue, doughlike consistency

lined by stratified squamous epithelium surrounded by a connective tissue wall.  hair follicles and glands are seen in cyst wall.

has a cystic component that resembles the dermoid cyst.



teeth, bone, muscles, and nerve tissue may be found in the wall of this lesion



teeth are usually not found in the malignant form of the teratoma.

.

non odontogenic extra osseous cyst

lateral of neck and anterior border of sternocleidomastoid

commonly found in major salivary glands

stratified squamous epithelial lining

well circumcsribed lining of lymphoid and connective tissue

apears as pinkish-yellow nodule on floor of mouth or lateral borders of posterior tongue

along thyroid gland from foramen cecum to neck

non odontogenic extraosseous

below hyoid bone

occurs in adults under age 20

Below the hyoid bone- they are lined with ciliated columnar epithelium

Above the hyoid bone- cysts are lined with stratified squamous epitheium

static bone cyst (stafne bone defect)

a psuedocyst normal salivary gland tissue found in depression.

developmental depression on the lingual aspect of the posterior mandible can be unilateral or bilateral.

predilection for men

anterior angle of ramus/inferiror to the mandibular canal

radiographs-well circumscribed radiolucency in mandible below the inferior alveolar canal.

Not true cysts



Not lined by epithelium



Appear as radiolucencies on X-ray



Static Bone Cyst



Simple bone cyst



Aneurysmal bone cyst

young adults, teens mandible most common place

pathologic cavity in bone that is not lined with epithelium.

 radiographs- scalloping around roots of teeth 

within 6-12 months bone fills in void

aneurysmal bone cyst

remember honeycomb appearance/soap bubble appearance

often associated with other bone lesions

affects women more than men affects people less than 30

posterior maxilla or mandible

expansion of involved bone

multilocular radiolucent honey comb or soap bubble appearance radiographically

has blood filled spaces surrouned by multi nucleated giant cells and cellular connective tissue.

treatment involves surgical excision or cryotherapy

a broad group of conditions that affect the structural formation of the enamel. the disease is divided into 4  main types

1. hypoplastic

2. hypocalcified

3. hypomaturation

4. hypoplastic/hypomaturation

lasts for 2-3 days

comes 21-27 days

autosomal dominant

decrease in leukocytes

gingivitis, perio, ulcers, bleeding

radiographic features-alceolar bone loss, pocketing

treatment scaling, root planing, antibiotics

Autozomal recessive

affects gingiva, palms of hands and soles of feet.

hyper keratinized (palmoplantar hyperkeratosis)

mobile teeth,pockets

alveolar bone loss, severe perio

decrease in nuetrophils

after age 14 all teeth are lost.

AD

bilateral swelling of face

displaced eyes (ocular hypertelorism increase distance between eyes)

pseudoanodontia

soap bubbles in radiograph

AD

ocular hypertelorism (increase distance between eyes)

mild prognathism

frontal and parietal bossing (large)

basil cell carcinoma

nose,eyelids, cheeks, neck, trunk, arms are affected

odontogenic keratocysts may occur

spina bifida

medulloblastoma (brain tumor)

AD

familial colorectal polyposis

osteomas (benign tumor of normal compact bone)

odontomas (compound/complex tumors composed of mature enamel, dentin, pulp, or cementum)in garder it affects frontal, maxillary and mandibular bone.

intestinal polyps are the most important about this disease. over age 30 they become malignent.

AD 30%

AR 70%

easily broken bones, blue sclera in eyes

kyphosis sclerosis

bowleged

type 1 dentinogenesis imperfecta is associated with this.

small teeth crown root and pulp

AR

x-linked recessive

little -no hair

common in males from birth

hypertricosis-no hair

few teeth formed

hypohydrosis-diminished sweating

depressed nasal bridge

protuberant lips/no vertical dimension

large frontal bone

lack of sebacious glands

teeth are conical

AD

mushroom head large frontal, parietal, occipital

affects teeth clavicle and skull

open fontanelles

supernumerary teeth common

no clavical

no vestibule

no nasal sinus

underdeveloped premaxilla

pseudo prognathism (mand appears big due to underdeveloped maxilla)

heredity intestinal polyposis syndrome

multiple melanotic macular pigments

(freckles everywhere, eyes nose mouth)

pigmentation of hands, nasal mucosa, eyes

gastro intestinal polyps

hamartomas-intestinal polyps abnormal growth.

AD

gingival neurofibroma

tumors on lateral borders of tongue

cafe au lait color skin

spine anomalies

multiple nodes on tongue, lips , cheek

moveable tumor

they come from other source

thryroid, breast, lungs, prostate glands, kidneys

most frequent intra oral site is mandible

painful, prosthesis of lip, swelling, loss of teeth

affects men 

when you see it, indication for a primary site tumor

ROOTS LOOK SPIKED

adenocarcinoma

most are epithelial in origin

bisphosphonates used in breast and prostate cancer

neoplastic cells produce immunoglobulin

men over 40

bone pain and swelling

Bence Jones proteins-in urine from immunoglobulins

extra medullary plasmacytoma-head and neck tumor

congenital

1/2 arise in head and neck

no sex predilection

tongue most common, pebbly surface, macroglossia

cystic lymphangioma in neck

herpes virus 8/neoplastic

malignent vascular tumor

purple

lower extremities 

hard palate/gingiva

spindle shaped cells unencapsulated

Muscle tumors

4 kinds

rhabdomyoma-benign, striated muscle affects tongue

leiomyoma-benign smooth muscle

rhabdomyosarcoma- malignant of striated muscle effects boys more than girls and under the age of 10 is most common. a soft tissue tumor of head and neck.

vascular leiomyoma-smooth muscle and surrounding blood vessels.

bone tumors

which 2 are psuedotumors

torus-benign made of compact bone resemble osteoma.

exostosis- small nodular normal compact bone, bruxing may cause it.

osteoma- assymptomatic benign compact bone tumor slow growing can be endosteal or periosteal.  ASSOCIATED WITH GARDNERS SYNDROME!!!

most commonly affects the posterior mandible

Osteosarcoma-malignant most common age under 40. and effects men in the mandible. swelling, tooth ache, sunburst pattern, wide pdls, pleomorphic/hyperchromatic cells. most die within 5 yrs of this.

ameolgenesis imperfecta types

if plastic-quantitiy poor

if calcified-quality poor

Type 1-hypoplastic-poor quality

type 2- hypocacified-poor quality

type 3 hypomaturation- soft enamel, defect in enamel rod sheath there are 4 types (snow capped was one, x-linked recessive)

type 4 hypoplastic hypomaturation -tourodontic teeth (bull teeth large pulp) thin enamel, yellow-brown pitting.

hypoplastic-tooth enamel doesn't develop normal thickness.

pitted, local, smooth, rough

AD but could be recessive also

no enamel on all teeth is called enamel agenesis and is the recessive type of this.

AD

soft teeth bad quality

moth like appearance interproximal

anterior open bite common

erupt yellow-orange

hypomaturation-soft enamel (tip of explorer could penetrate) 

defect in enamel rod sheath

appears like dentin

4 types snow capped was in book x-linked recessive

affects maxillary teeth more

hypoplastic hypmaturation

tourodont-bull teeth, large pulp

thin enamel, yellow, brown, pitted.

type I relates to osteogenesis imperfecta

type II- heredity opalescent dentin

AD

bulbous crowns brown-blue

soft dentin=chipped enamel=attrition=bone loss

enamel hypoplasia

no pulp chambers no root canals

roots are short and thin.

type III roots appear shell-like from brandywine maryland

radicular-normal crown, abnormal root

AD

defect in hertwigs sheath

no pulp chambers/canals

1/2 moon appearance on permanent teeth.

Coronal-AD

translucent teeth with amber color

permanent teeth pulp appears bow tie or thisle shaped

pulp stones common

Psuedocyst-not lined by epithelium

Aneurysm cyst-filled with blood, multinucleated giant cells

soap bubble/honeycomb appearance.

static-posterior linual depression of mandible.

AKA stafne anterior to angle of ramus, filled with salivary gland tissue.

Simple- (traumatic)void in bone scalloping roots

mandible of children.

ghost cells

non aggressive

non recurrent

resembles neoplasm

unencapsulated, malignent salivary tumor affects parotid the mandibular premolar most effected.

92% survive 5 yrs.

one or more extra x chromosomes

underdeveloped maxilla

tall stature gynecomastia

hypoplastic mandible

only 1 bar body in smear layer

wide hips, breasts, undecended testes, no semen

one x chromosome missing

short stature, webbed neck, edema in hands

no barr bodies in smear layer

one extra chromosome 21

slanted eyes

gingivoperiodontitis

fissured tongue

hypodontia

 on extra chromosome 13

many die in first 7 months of life

bilateral cleft lip and palate

microphthalmia(small eyes) or anopthalmia (no eyes)

superficial hemangioma of forehead or nape of the neck

severe mental handicap rocker bottom feet

malformed genitals

extra finger

condensed chromatin of inactivated x chromosome found at periphery of nucleus of cells in women.

no barr body in turners

one barr body in kleinfelters

small body in nucleus of cell that carry chemical instruction for reproduction of cell in addition to other cellular functions.

each cell has 46 half from mom and half from dad

they contain dna which directs production of amino acids

 a histologic diagnosis that indicates disordered growth. considered premalignent. 

smoking is a risk factor

floor of mouth and tongue white erythematous or mixed white and mucosal lesion.

abnormal maturation of epithelial cells

hyperplasia of basil cellls

increased nuclear/cytoplasmic ratios

no invasion of abnormal cells into underlying tissue

neoplastic

over 40 yrs old

floor of mouth

tongue

lips exophytic mass ulcerated luekoplakia, erythroplakia

invasion of tumor cells through basement membrane into CT. pleomorphic epithelial cells, normal and abnormal miotic figures

neoplastic

sun exposure

over 40 in whites  

skin on face

non healing ulcers and rolled borders

proliferation of basal epithelial cells 

broad rete pegs penentrate deep into CT

neoplastic

parotid gland effected

palate

mass is painful and ulcerated

unencapsulated infiltrating tumor composed of small, deep staining uniform epthelial cells in round oval islands.

neoplastic 55 and over

vestibule, buccal mucosa

slow growing exophytic mass with papillary projections

well differentiated epithelium with normal appearing epithelial cells.

broad based rete pegs with intact basement membrane

tobacco is a factor

middle aged black females