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Oral Pathology

 General Features

  • Caused by mutation in DSPP gene (dentin sialophosphoprotein).

  • Teeth appear translucent or opalescent.

  • Enamel fractures easily due to poor dentin support.

  • Pulp chambers are obliterated or enlarged depending on type.

  • Also called Hereditary Opalescent Dentin or Shell Teeth.

Type II DI

  • Pulp chambers are normal but rapidly obliterate.

  • Associated with progressive hearing loss.

Type III DI

  • Pulp chambers are large and shell-like.

  • Seen in Brandywine isolate population.

Condition

Key Features

Paget's Disease

- Denture tightening (arch expansion)
- Chalk-stick fractures
- Leontiasis ossea

Osteopetrosis

- Rugger jersey spine
- Chalk-stick fractures

Fibrous Dysplasia

- Leontiasis ossea
- Chinese script trabeculae
- Ground glass appearance
- Hockey stick femur

Cemento-Ossifying Fibroma

- Leontiasis ossea
- Chinese script trabeculae

Hyperparathyroidism

- Ground glass appearance (Brown tumor)
- Giant cells + vascular stroma + hemosiderin

Cherubism

- Giant cells + vascular stroma + hemosiderin

Central Giant Cell Granuloma

- Giant cells + vascular stroma + hemosiderin

Juvenile Ossifying Fibroma

- More aggressive than COF
- Trabecular type → jaws
- Psammomatoid type → skull base

Mnemonics Flashcards

Mnemonic

Meaning

Paget's Patients Prefer Tight Dentures

Paget's → Denture tightening due to arch expansion

Fibrous Faces Feel Funny

Fibrous dysplasia → Leontiasis ossea, Chinese script, Ground glass, Hockey stick femur

Giant Cells Have Three Homes

Seen in: Hyperparathyroidism, Cherubism, CGCG

Leukoplakia

  • Type: Clinical term
  • Histology: Hyperkeratosis ± Dysplasia

Verrucous Carcinoma

  • Type: Variant of SCC
  • Features:
    • Intact basement membrane
    • Parakeratin plugging
    • Broad "elephant-foot" rete ridges

Adenosquamous Carcinoma

  • Features: Mixed adenocarcinoma + SCC

Viral Infections

Herpes Simplex Virus (HSV-1)

  • Dormancy Sites: Trigeminal > Nodose (Vagus) > Dorsal Root > Brain
  • Inclusions: Lipschutz bodies (intranuclear)
  • Herpetic Whitlow: Finger lesions in dentists
  • Location Difference:
    • Herpangina: Posterior palate
    • Herpes: Anterior palate

Herpes Zoster

  • Key Feature: Lesions do not cross midline
  • Ramsay Hunt Syndrome: Zoster of geniculate ganglion → facial paralysis

Measles

  • Koplik's Spots: Disappear after skin rash onset

Rubella

  • First Trimester: Blindness, deafness, cardiovascular defects

Mumps

  • Complications: Orchitis, oophoritis (sterility), pancreatitis, meningoencephalitis

  • Blood: Aneurysmal bone cyst, Vascular lesion, Vessel puncture.

  • Air: Traumatic bony cyst (Simple Bone Cyst/Hemorrhagic Bone Cyst), Maxillary sinus.

  • Chocolate Colored Fluid: Warthin's Tumor (salivary gland cyst).

Osteomyelitis

Osteomyelitis is an extensive inflammation of a bone. It involves the cancellous portion, bone marrow, cortex, and periosteum

Conditions that alter HOST IMMUNITY

Leukemia, Severe anemia, Malnutrition, AIDS, IV- drug abuse, Chronic alcoholism, Febrile illnesses, Malignancy, Autoimmune disease, Diabetes mellitus, Arthritis, Agranulocytosis

Conditions that alter vascularity of bone

Osteoporosis, Paget’s disease, Fibrous dysplasia, Bone malignancy, Radiation, Virulence of the organisms

Certain organisms precipitate thrombi formation by virtue of their destructive lysosomal enzymes.

Organisms proliferate in enriched host medium while protected from host immunity.

Etiology

- Odontogenic infections
- Trauma
- Infections of oro facial region
- Infections derived from hematogenous route
- Compound fractures of the jaws.

PATHOGENESIS

DEV . OF INFECTION --> BACTERIAL INVASION -->  PUS FORMATION -->  SPREAD OF INFECTION --> INCREASED INTRAMEDULLARY PRESSURE , BLOOD FLOW , OSTEOCLASTIC ACTIVITY --> INFLAMMATORY RESPONSES --> INCREASED PERIOSTEAL PRESSURE --> PROCESS BECOMES CHRONIC GRANULATION TISSUE FORMATION --> LYSIS OF BONE --> SEQUESTRUM FORMATION

Classification

Classification based on clinical picture, radiology, and etiology

Suppurative osteomyelitis

I. Acute suppurative osteomyelitis

II. Chronic suppurative osteomyelitis

– Primary chronic suppurative osteomyelitis

– Secondary chronic suppurative osteomyelitis

III. Infantile osteomyelitis

Nonsuppurative osteomyelitis

I. Chronic sclerosing osteomyelitis

  – Focal sclerosing osteomyelitis

  – Diffuse sclerosing osteomyelitis

II. Garre's sclerosing osteomyelitis

III. Actinomycotic osteomyelitis

IV. Radiation osteomyelitis and necrosis

  • Radicular Cysts: Derived from Rests of Malassez.

  • Impacted Canine Associations:

    • Most common odontogenic cyst: Dentigerous cyst.

    • Most common odontogenic tumor: Adenomatoid Odontogenic Tumor (AOT).

  • Eruption Cyst: Considered an extra-alveolar dentigerous cyst (soft tissue counterpart).

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