Dental Pathology and Pulpitis Quiz

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Questions and Answers

What is a characteristic feature of fordyce granules?

They contain hair follicles.

They appear as red lesions.

They are bilateral on the buccal mucosa.

They represent a collection of sebaceous glands. (correct)

What distinguishes a double lip?

It consists of horizontal folds of mucosal tissue. (correct)

It features vertical folds of mucosal tissue.

It usually appears unilaterally.

It is primarily caused by genetic inheritance.

Which of the following correctly describes paramedian lip pits?

Are primarily an acquired condition.

Can reach depths of up to 2 cm. (correct)

Can extend as deep as 5 cm.

Typically found at the midline of the lower lip.

What is a potential consequence of enamel hypoplasia?

Increased susceptibility to caries. Signup and view all the answers

What describes a frenal tag?

Typically associated with an autosomal dominant trait. Signup and view all the answers

What is the main characteristic of reversible pulpitis?

The pulp can return to an uninflamed state after stimulus removal. Signup and view all the answers

Which of the following is NOT a histological feature of reversible pulpitis?

Vascular necrosis and abscess formation Signup and view all the answers

What is a common etiology for acute irreversible pulpitis?

Acute dental caries Signup and view all the answers

In reversible pulpitis, which of the following occurs in response to a stimulus?

Localized reactions adjacent to the cause. Signup and view all the answers

Which of the following histopathological features is observed in acute irreversible pulpitis?

Granular cell infiltration Signup and view all the answers

What typically happens to the pulp in a few days with acute irreversible pulpitis?

It undergoes liquefaction and necrosis. Signup and view all the answers

Which of the following conditions is described as affecting a tooth with dull, bearable pain?

Chronic pulpitis Signup and view all the answers

What histological change occurs in reversible pulpitis due to vascular damage?

Collection of edema fluid. Signup and view all the answers

What is a primary characteristic of denture stomatitis?

Localized erythema in denture-bearing areas Signup and view all the answers

Which type of Newton's classification describes nodular hyperplastic areas interspersed with normal mucosa?

Type III Signup and view all the answers

What histological feature is NOT associated with chronic inflammatory changes in denture stomatitis?

Thickening of the denture material Signup and view all the answers

Where is hyperplastic candidiasis most commonly found?

Buccal mucosa and palate Signup and view all the answers

What condition is believed to be superimposed on a preexisting leukoplakic lesion?

Hyperplastic candidiasis Signup and view all the answers

Which of the following is commonly used to culture the palatal mucosa and denture surface?

Sabouraud's agar Signup and view all the answers

What is the common presentation of Type I denture stomatitis according to Newton's classification?

Pinpoint erythema Signup and view all the answers

Which statement accurately describes the surface characteristics of the epithelium in denture stomatitis?

Can be either parakeratinized or non-keratinized Signup and view all the answers

Which presentation is typical for erythematous candidiasis?

Presence of PAS positive candidal hyphae invading epithelium Signup and view all the answers

What is a common histological feature found in patients with central papillary atrophy?

Hyperplastic epithelium with superficial necrosis Signup and view all the answers

Which site is not typically affected by erythematous candidiasis?

Lower lip Signup and view all the answers

Which clinical feature is associated with central papillary atrophy?

Depapillation and dekeratinization of the tongue Signup and view all the answers

In chronic inflammatory conditions of the oral cavity, what is often observed in the connective tissue?

Lymphocytic infiltration Signup and view all the answers

Which of the following is NOT a histological feature of fungal infections in the oral cavity?

Necrosis in the connective tissue Signup and view all the answers

What type of inflammatory cells are commonly found in the epithelium during fungal infections?

Neutrophils Signup and view all the answers

Which statement best describes the condition known as central papillary atrophy?

It appears on the midline, posterior dorsal tongue as an asymptomatic region. Signup and view all the answers

Which organism is primarily associated with the histological features described?

Histoplasma capsulatum Signup and view all the answers

What is a common clinical feature of lesions caused by Blastomyces dermatitidis?

Irregular, erythematous or white intact surfaces Signup and view all the answers

Which staining method is used to identify Histoplasma capsulatum in tissue sections?

Grocott-Gomori methenamine silver stain Signup and view all the answers

How do the yeasts of Blastomyces dermatitidis appear histologically?

Large with a doubly refractile cell wall Signup and view all the answers

Which inflammatory response is typically seen in tissue affected by Blastomycosis?

A mixture of acute and granulomatous inflammation Signup and view all the answers

What characteristic differentiates the lesions from squamous cell carcinoma?

Histological examination via biopsy is needed Signup and view all the answers

What type of cell is primarily observed in the histopathology of infections caused by Histoplasma capsulatum?

Epithelioid macrophages Signup and view all the answers

Which statement is true regarding the appearance of ulcerated lesions mentioned?

They may resemble malignancy clinically. Signup and view all the answers

What characteristic is often observed in leukoplakic lesions associated with candidal infection?

Presence of intermingling red and white areas Signup and view all the answers

Which histological feature is associated with the epithelium in candidal infection?

Para keratinized epithelium Signup and view all the answers

What is a common histological finding in lesions of Histoplasmosis?

Granulomas with multinucleated giant cells Signup and view all the answers

What is typical regarding the presentation of Histoplasmosis in the oral cavity?

Usually appears as solitary, variably painful ulceration Signup and view all the answers

What condition is primarily associated with Histoplasma capsulatum?

Granulomatous fungal disease Signup and view all the answers

In cases of candidal infection, what is often observed in the para keratinized layer of epithelium?

Edema with numerous neutrophils Signup and view all the answers

Which area of the body is most commonly affected by Histoplasmosis?

Gingiva, tongue, and palate Signup and view all the answers

What type of inflammation is typically associated with granulomas in Histoplasmosis?

Granulomatous inflammation Signup and view all the answers

Study Notes

Routine Histotechnique and Staining

Histology is the microscopic study of normal tissues.
Histopathology studies structural changes due to diseases.
Histotechnology prepares tissues for study.
Fixation preserves tissues in a lifelike state.
Grossing isolates the tissue area.
Tissue processing replaces the aqueous environment with a hydrophobic one, allowing infiltration with paraffin wax.
Embedding secures the specimen in a wax block for section cutting.
Sectioning on a microtome cuts very fine sections.
Staining techniques demonstrate tissue components, such as carbohydrates.

Classification of Stains

Periodic Acid Schiff (PAS) stain: Oxidizes substances with vicinal glycol groups. Used to show glycogen and neutral mucoprotein. Can aid in diagnoses for conditions such as poorly differentiated adenocarcinoma, hepatocellular carcinoma.
Lipid stains: Oil red O and Sudan Black B stain lipids. Oil red O stains lipids red, while nuclei stain blue.
Nucleic acid stains: Feulgen stain, Methyl green pyronin stain
Connective tissue stains: Reticulin, Masson's Trichrome, Van Gieson stains.
Stains for pigments and minerals: Perl's stain.
Stains for microorganisms: Ziehl-Neelsen stain, Gomori methenamine silver stain.
Enzyme digestion technique,
Stains for amyloid,
Congo red stain,
Crystal/Methyl violet stain.

Developmental Disturbances of Oral and Para Oral Structures

Developmental anomalies refer to defects from growth and development disturbances.
Malformation: An abnormal shape or structure, interfering with function (e.g., cleft palate).
Deformation: An alteration in shape of previously normally formed structures (e.g., torticollis).
Anomaly: Any deviation from normal, without functional interference (e.g., peg-shaped lateral).
Anomalad: A developmental malformation and structural changes (e.g., Robin anomalad).

Developmental Disturbances of Soft Tissue

Lip pits: Congenital pits, usually at lip corners.
Frenal tag: Autosomal dominant, extra labial frenum.
Fordyce granules: Bilateral sebaceous glands on buccal mucosa.

Developmental Disturbances of Hard Tissues

Microdontia: Teeth smaller than normal.
Macrodontia: Teeth larger than normal.
Rhizomicri: Smaller than normal tooth roots.
Rhizomegaly: Larger than normal tooth roots.
Anodontia: Absence of teeth.
Supernumerary teeth: Extra teeth.
Gemination: Incomplete division of a tooth germ, creating a single root, multiple crowns.
Fusion: Union of two adjacent tooth germs, resulting in a single crown and root.
Concrescence: Union of roots of adjacent teeth by cementum.
Dilaceration: Abnormal bend/curve in root or crown.
Talon's cusp: Anomalous projection on the lingual side of incisor.
Dens invaginatus: Deep surface invagination of a dental crown or root, lined by enamel.
Dens evaginatus: A small, globe-shaped projection on a tooth crown.
Taurodontism: Enlargement of pulp chamber and body of a tooth.
Ectopia: Tooth in an abnormal location.
Rotation: Tooth turned.
Transposition: Teeth switch positions.
Inversion/Transmigration teeth occur in a different direction from normal.

Tooth Eruption & Structure

Premature eruption
Delayed eruption
Embedded tooth
Submerged tooth
Eruption sequestrum
Enamel, dentin, enamel+dentin, and cementum (structures) affected

Microdontia/Macrodontia

Generalized micro/macrodontia: Uniformly small/large teeth. Associated syndromes include pituitary dwarfism/gigantism, Down's syndrome.
Focal micro/macrodontia: Irregular small/large teeth. Associated syndromes include facial hemihypertrophy.
Total anodontia: Absence of all teeth.

Anomalies Numbers of Teeth

Hypodontia: Absence of one or more teeth (<6).
Oligodontia: Absence of more than 6 teeth.

Types of Developmental Anomalies

Enamel hypoplasia: Defective enamel formation
Amelogenesis imperfecta: Hereditary enamel dysplasia.
Dentinogenesis imperfecta: Hereditary dentin dysplasia.
Dentin dysplasia - Rootless
Regional odontodysplasia.

Pulp and Periapical Pathology

Pulpitis: Inflammation of the dental pulp.
- Reversible pulpitis: Mild, pulp to normal after stimulus removal. Signs include pulp hyperemia, edema, and inflammation.
- Irreversible pulpitis: Severe, pulp cells die. Signs include edema, vascular dilation, inflammation, odontoblast destruction, pulp abscess
- Chronic pulpitis: Inflammation for longer period.
- Acute suppurative pulpitis: Pulp liquefaction & necrosis by abscess formation.
- Chronic hyperplastic pulpitis (pulp polyp): Overgrowth in pulp chamber as a mass. Signs include granulation tissue, inflammatory cells, and sometimes an epithelial lining like oral mucosa.
Pulpal Resorption:
- Internal resorption: Odontoclastomas.
- External resorption: Not in these notes
Pulpstones:
- True (rare) includes dentin with distinct tubules, lined by odontoblasts
- False (common): Layers of mineralized tissue, arise from degenerating cells.
Apical periodontitis: Inflammation of periodontium (around tooth root) due to trauma/irritation/infection.
Periapical Abscess: Acute or chronic suppuration; often arises from a periapical granuloma.
- Clinical:Painful, sometimes systemic. Microscopic: Neutrophils, cellular debris, bacteria, dilated PDL, bone tissue showing inflammation.
Periapical granuloma: A chronic lesion resulting from inflammation, typically sterile.
- Microscopic: Fibrous tissue, inflammation, possible macrophages, lymphocytes, plasma cells. Can be sterile, or secondary infection can occur.
Osteomyelitis: Severe bone infection, a sequela of apical infection.
- Necrotic bone, inflammatory exudates.
Cellulitis: Diffuse inflammation of soft tissues.
- Micro: Inflammatory cell infiltration, serous fluid, fibrin formation.

Bacterial Infections

Scarlet Fever: Streptococcus infection. May involve the oral cavity with small red spots on the palate and uvula, 'strawberry tongue'. Microscopic: Neutrophils with spongiosis, parakeratosis, necrosis
Tuberculosis: Mycobacterium tuberculosis. Oral cavity ulcerations, mainly on the tongue, palate, lips, gingiva, and buccal mucosa. Microscopic: Epithelioid cells and multinucleated giant cells (Langhan's giant cells).
Diphtheria: Corynebacterium diphtheria. Characterized by a pseudomembrane from suppurative exudates; ulceration. Microscopic: fibrin, necrotic cells, and neutrophils
Actinomycosis: (Lumpy jaw) Chronic granulomatous infection, with sulfur granules. Microscopic: Granulomatous, suppurative, colonies of organisms, radiating filaments
Syphilis: Treponema pallidum.
- Primary: Chancre, indurated nodule, ulceration. Microscopic: Acanthetic epithelium, lymphocytic response
- Secondary: Mucous patches, generalized skin/mucosal lesions. Microscopic: Psoriasiform hyperplasia, neutrophils
- Tertiary: Gummas (chronic granulomatous lesions). Microscopic: Necrotizing granulomatous inflammation.
NOMA: (Cancrum oris, Gangrenous stomatitis). Destructive oral tissue necrosis. Microscopic: Extensive necrosis, destruction of soft tissues and bone.
Acute Necrotizing Ulcerative Gingivitis (NUG): also known as Vincent's infection. Microscopic: Bacterial, including rods, fusiform, spirochetes. Necrotic zone
Leprosy: Mycobacterium leprae. Macules, nodules(leproma) that ulcerate. Microscopic: Granulomatous inflammation, histiocytes, lymphocytes, giant cells.
Botriomycosis: Localized granulomatous infection. Microscopic: Suppurative foci; "sulfur granules," radiating actinomycetes.
Granuloma Inguinale: Chronic granulomatous infection. Microscopic: Granulation tissue, macrophages, and Donovan bodies (intracellular cysts, rod-shaped structures)
Pyostomatitis vegetans: Large papillary projections, abscesses. Microscopic: Hyperplastic surface epithelium, densely infiltrated by inflammatory cells including plasma cells, lymphocytes, and neutrophils.

Fungal and Viral Infections

Pseudomembranous candidiasis (thrush): White plaques on oral mucosa, adhere to surface and are removable. Microscopic: PAS-positive hyphae, hyperkeratosis, neutrophils, chronic inflammatory infiltrate
Erythematous candidiasis: Red patches, depapillated/de-keratinized tongue. Microscopic: Hyperplastic epithelium; yeasts, hyphae, neutrophils
Angular cheilitis: Erythema, fissuring, and scaling at corners of mouth. Microscopic: Superficial candidal infection, perioral skin involvement
Denture stomatitis: Erythema, petechial hemorrhages in denture-bearing areas. Microscopic: Epithelial hyperplasia/atrophy, leucocytes.
Central papillary atrophy: (median rhomboid glossitis). Erythematous area, mid-posterior dorsal tongue. Microscopic: Atrophic mucosa, loss of papillae
Hyperplastic candidiasis (leukoplakia): Least common, superimposed candidiasis on a leukoplakic lesion. Microscopic: candidal infection.
Histoplasmosis: Granulomatous fungal disease. Microscopic: Macrophage aggregates, granulomas, yeasts
Blastomycosis: Microscopic: Large yeasts (Blastomyces dermatidis), acute/granulomatous inflammation.
Cryptococcosis: Rare fungal disease, presenting with ulcers or erythematous plaques. Microscopic: Granulomatous response, yeasts, mucopolysaccharide capsule identified by staining
Zygomycosis (Mucormycosis; Phycomycosis): Nasal obstruction, pain, swelling. Microscopic: Extensive necrosis, large, non-septate hyphae
Aspergillosis: Microscopic: Septate hyphae; invasive form
Toxoplasmosis: Intracellular protozoa. Microscopic, Lymph node changes include germinal centers. Accumulations of eosinophilic macrophages
Herpetic Simplex Infection: HSV-1 or HSV-2. Vesicles, ulcerations. Microscopic: Acantholysis, ballooning degeneration, intranuclear inclusions (Lipschütz bodies)
Varicella: Varicella-zoster virus (VZV). Vesicles, ulcerations. Microscopic: Acantholysis
Herpes Zoster: Reactivation of VZV.
Infectious Mononucleosis: Epstein-Barr virus (EBV), HHV-4. Transient petechiae. Microscopic details not found
CMV (Cytomegalovirus) Infection: Microscopic features include swollen cells with inclusions.
Other infections: Rubeola, Measles, Oral hairy leukoplakia

Allergic and Immunologic Diseases

Transient lingual papillitis: Painful, recurrent crops of ulcers, affecting oral mucosa.
Recurrent aphthous stomatitis (RAS): Recurrent oral ulcers, classified into minor, major, or herpetiform types.
Minor: Most common, small, shallow ulcers with a yellow-white membrane.
Major: Less common, larger, deeper ulcers.
Herpetiform: Dozens of tiny ulcers.
Behçet's syndrome: Chronic multi-system inflammatory disorder. Oral manifestations include aphthous ulcers, and other systemic symptoms. Microscopic findings are nonspecific, often resembling recurrent aphthous ulcers. May include vasculitis.
Sarcoidosis: Multisystem granulomatous disorder, causing oral granulomas. Microscopic: Epithelioid histiocytes, lymphocytes, giant cells.
Orofacial granulomatosis: Idiopathic immune disorder; clusters of noncaseating granulomas.
- Melkersson-Rosenthal syndrome: Combination of oral lesions (cheilitis granulomatosa), facial nerve paralysis, and fissured tongue. Microscopic: Edema, lymphatics, lymphocytes, histiocytes present.
Wegener's granulomatosis: Necrotizing granulomatous lesions and vasculitis. Microscopic: Mixed inflammation centered around blood vessels, neutrophilic infiltration, necrosis, 'nuclear dust' (leukocytoclastic vasculitis.
Reiter's syndrome: Associated with urethritis, balanitis, conjunctivitis. Microscopic: Parakeratosis, acanthosis
Angioedema: Swelling of skin and mucosa due to fluid accumulation.
Drug allergy: Lesions including ulcers, necrosis, hyperplasia, pigmentation, altered saliva/taste. Microscopic: Subacute mucositis, lymphocytes, eosinophils, neutrophils

Premalignant Lesions and Conditions

Leukoplakia: White patch/plaque, often from tobacco.
- Homogenous: Well-defined white patch, low malignant potential.
- Non-homogenous (nodular): Mixed red & white regions, high malignant transformation potential
- Verrucous: Rough surface, papillary projections, high malignant potential - Proliferative verrucous leukoplakia specifically has thicker white lesions with raised projections.
Leukoedema: White/gray patch on oral mucosa, intracellular edema. Microscopic: Increased thickness, abnormal rete pegs
Erythroplakia: Red patch, high-risk for malignancy. Microscopic: Mild changes in cellular arrangement & size
Carcinoma in situ: Precancerous condition, where cells display malignant changes. Microscopic: Intraepithelial dysplasia, sometimes keratin production issues present.
Actinic cheilitis: Precancerous lesion from sun exposure. Microscopic: Atrophy/hyperplasia, inflammation, dysplasia, elastosis
Stomatitis nicotina: Palate lesions from tobacco. Microscopic: hyperorthokeratosis
Snuff dipper lesion: Lesion in reverse smokers/smokers who don't use direct flame sources. Microscopic: parakeratin, hyperplasia
Oral submucous fibrosis: Abnormal rigidity of mucosa; fibrotic transformation. Microscopic: hyalinization, atrophy, collagen bundles
Lichen planus: Chronic inflammatory disease, presents with six Ps. Microscopic: epidermal damage, hyperkeratosis, atrophy, lymphocytes.
- Lichenoid reaction: Similar to LP but drug-induced
Discoid lupus erythematosus: Skin and mucous membrane disorder. Microscopic: hyperkeratosis, sub-epithelial hydropic change

Histopathology of Dental Caries

Morphology based on Chronology:
- Incipient caries, mild discoloration
Morphology based on location of enamel:
- Pit & fissure caries, found in pits and fissures
- Smooth surface caries
- Cervical caries, located near the neck of the tooth, crescent shaped cavity.
- Root caries, initiated at dentin root, occurs in older age
Morphology based on severity:
- Rampant caries (rapid destruction).
- Arrested caries (growth stops)
- Recurrent caries(regrowth beneath fillings)
Initial stages of caries: Enamel caries. Microscopic/physical changes include loss of inter-rod substance, mucopolysaccharides
Dentin caries: Demineralization of dentin, bacterial invasion, changes such as fatty degeneration of Tomes' fibers, dentinal sclerosis occur in response to bacterial colonization, may lead to liquefaction of dentin.
Different zones of dentin caries:
Zones of fatty degeneration of Tomes' fibers; Dentinal sclerosis;
Demineralization and a zone of bacterial invasion;
Zone of decomposed and dead dentin.
Salivary factors: Saliva's role in preventing caries; composition and buffering capacity of saliva and factors like lysozymes, lactoperoxidase, and lactoferrin

Histopathology of Periodontal Diseases

Incipient gingivitis: Mild polymorphonuclear leukocyte infiltration.
Chronic gingivitis: Increased lymphocytes, plasma cells, monocytes.
Necrotizing ulcerative gingivitis (NUG): Ulceration, intense polymorphonuclear leukocyte infiltration, bacteria.
Plasma cell gingivitis: Intense plasma cell infiltrate.
Granulomatous gingivitis: Granulomas with histiocytes, lymphocytes, and giant cells.
Drug-induced gingival enlargement: Not hyperplasia/hypertrophy.
Hormonal/nutritional/systemic-induced gingival enlargement: Increased vascularity, fibroblasts, leukocytes with edema
Gingival fibromatosis: Dense, hypocellular, hypovascular fibrous tissue.
Gingival Abscess: Localized polymorphonuclear leukocyte exudate with secondary changes in epithelium (Possible cell swelling, ulcerations.
Pericoronitis: Inflammation around impacted or partially erupted teeth. Microscopic: Hyperplasia, edema, lymphocytes

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Test your knowledge on dental pathology with this quiz that covers topics such as fordyce granules, pulpitis, and dental anomalies. Understand the characteristics and consequences of various oral conditions. Ideal for dental students and professionals looking to reinforce their understanding.