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Oral Pathology - NEETMDS- courses
NEET MDS Lessons
Oral Pathology

  • Schilling Test: Done to identify the deficiency of either extrinsic (dietary vitamin B12) or intrinsic factor involved in Pernicious Anemia.

  • Fanconi's Syndrome: Associated with Aplastic Anemia.

  • "Safety-Pin" Cells: Characteristic finding in Thalassemia / Erythroblastic Anemia.

  • Radiographic Features of Anemias:

    • "Salt and Pepper" effect (Intraoral Periapical Radiograph): Found in Cooley's Anemia (Thalassemia) and Sickle Cell Anemia.

    • "Hair-on-End" pattern (Skull Radiograph): Found in Thalassemia, Sickle Cell Anemia, Congenital Hemolytic Jaundice, Chronic Iron Deficiency Anemia.

  • "Rh Hump" (Erythroblastosis Fetalis): Describes a ring-like defect.

  • Plummer-Vinson Syndrome: Associated with Iron Deficiency Anemia.

  • Chediak-Higashi Syndrome: Giant abnormal PAS positive granules found in peripheral circulating leukocytes are basically altered lysosomes.

  • Philadelphia Chromosome: Translocation of chromosomal material from chromosome 22 to chromosome 9; found in Chronic Myeloid Leukemia (CML).

Shape Recognition (Classic Boards Question)

  • Heart/Oval Shape → Nasopalatine cyst
  • Inverted Pear/Teardrop → Globulomaxillary cyst
  • No Radiographic Feature → Nasolabial cyst

Location-Based Diagnosis

  • Midline Maxilla (anterior) → Nasopalatine cyst
  • Between maxillary lateral incisor & canine → Globulomaxillary cyst
  • Midline Mandible → Median mandibular cyst
  • Nasolabial fold → Nasolabial cyst

Clinical Correlations

  • Spacing between centrals → Nasopalatine cyst
  • Root divergence → Globulomaxillary cyst
  • Nasal obstruction → Nasolabial cyst
  • Usually asymptomatic → Median mandibular cyst

DIFFERENTIAL DIAGNOSIS PEARLS

For Midline Radiolucencies:

  1. Nasopalatine cyst - Oval/heart shape, above centrals
  2. Median palatine cyst - Posterior to nasopalatine
  3. Central giant cell granuloma - More aggressive, may show septations

For Interradicular Radiolucencies:

  1. Globulomaxillary cyst - Classic pear shape
  2. Lateral periodontal cyst - More cervical location
  3. Radicular cyst - Associated with non-vital tooth

 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.

Species Role
Streptococcus mutans Initiates caries; highly acidogenic/aciduric
Streptococcus sobrinus Similar to S. mutans, less adhesive
Lactobacillus spp. Progression in dentin; acid-loving
Actinomyces naeslundii/viscosus Linked with root surface caries
Veillonella spp. Lactate metabolizers in advanced lesions
Scardovia wiggsiae Emerging cause in early childhood caries
Propionibacterium, Bifidobacterium, Rothia Found in deep dentinal lesions

  • Stevens-Johnson Syndrome (SJS):

    • Characterized by ulcers with hemorrhagic crusts.

    • Typically has an acute onset following drug exposure (mainly sulfa group drugs).

  • Biopsy for Vesiculobullous Pathology: Should be taken from the margin of the vesicle/bulla, including a significant amount of normal-appearing mucosa, to capture the pathological changes and adjacent healthy tissue for comparison.

  • Linea Alba: A white, bilateral line on the buccal mucosa associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth.

  • Morsicatio Buccarum: Chronic irritation seen on the buccal mucosa as a result of suction and glassblowers (chewing habits).

  • Riga-Fede Disease: Sublingual ulcerations in infants resulting from chronic mucosal trauma from adjacent primary teeth (often natal/neonatal teeth).

Intraepithelial Bulla

  • Location: Within the epithelium

  • Associated Conditions:

    • Herpes simplex

    • Herpes zoster

    • Chicken pox

    • Pemphigus

    • Hailey-Hailey disease (Familial benign pemphigus)

    • Epidermolysis bullosa (dystrophic recessive form)

    • Oral lesions of erythema multiforme

 Subepithelial Bulla

  • Location: Below the epithelium

  • Associated Conditions:

    • Pemphigoid

    • Bullous pemphigoid (most common subepithelial blistering disease)

    • Bullous lichen planus

    • Dermatitis herpetiformis

    • Epidermolysis bullosa

    • Skin lesions of erythema multiforme

  • Pioneer bacteria invade dentinal tubules before clinical signs
  • Tubules contain pure forms:
    • One tubule → cocci
    • Adjacent tubule → bacilli or threads
  • No mixed forms within a single tubule
MDS SUBJECTS

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