SCC
- twice more in men
- 90% 5 year survival for lip cancer (half for tongue)
- 50% 5 year survival for oral and pharyngeal cancer
- Erythroplakia is more malignant
Granuloma vs Cyst
Granuloma (Not vital)
- defined growth that is continuous with PDL due to pulp necrosis (toxins diffuse into PA area)
- This can progress to an acute abscess, phoenix abscess (recrudescent abscess)
Cyst
- Inflammatory response of the PA area from a pre-existing granuloma
- fluid filled, epi lined
- chronic infection
Both are usually asymptomatic, radiolucent with defined borders.
Types of Cysts
VITAL teeth
- cementoma (PA cemental dysplasia) = anterior mandible = radiolucent that calcifies
- traumatic bone cyst = not a true cyst = scallops roots
- globulomaxillary cyst (developmental cyst) = junction of globular and maxillary process, btwn LI and canine roots.
- Lateral Periodontal Cyst = from cystic degeneration of clear cells on dental lamina
NON-vital teeth
- Apical scar = results from granuloma, cyst or abscess healing = well-circumscribed like their predecessor
- Radicular cyst = occurs in a pre-existing granuloma
Ameloblastoma and Cementoblastoma
Ameloblastoma = benign = locally agressive (root resorption) = multilocular radiolucencies = mand. prevalence
Cementoblastoma = cementoblast proliferation making large cementum-like tissue on roots
PA infection bacteria
Strep may initiate infection, but PA pathology is due to anaerobic bugs (Porphyromonas, Bacteroides, Eubacterium, Prevotella, Fusobacterium)
All cells in immune system originate where?
BW as hematopoietic stem cells which give rise to:
1. Myeloids (monocytes, MO, granulocytes, histiocytes, PMNs) = Innate = non-pecific
- Lymphoid (Lymphocytes: T, B cells, NK cells, plasma cells) = Adaptive = specific
Mast cells = lysosomes = histamine + heparin = anaphylaxis
Histiocytes = dermal MO = acute inflam. = Langerhans in subdermal squamous epithelium
PMN, MO (monocytes once they leave the blood) = phagocyte
T cells = antigens are presented to T cells via macrophages.
B cells = bacteria, fungus, virions
NK cells = tumors and viruses
3 stages of inflammation AND 2 phases of acute inflammation
- immediate
- acute (PMN)
- chronic (lymphocytes, MO)
Every stage is controlled by WBCs
Phase 1 of acute inflam:
- Vasoconstriction
- compliment activation (c3a and c5a cause chemotaxis, where c3b cause opsonization
- Tissue injury releases bradykinin –> prostaglandins and leukotrienes
- Vasodilation from histamine (skin redness)
Phase 2
- Adhesion of WBCs and margination (accumulation to a certain spot)
- WBC diapedesis (squeeze through endothelial cells)
- Chemotaxis
- Phagocytosis
First to arrive are PMNs, then MO. With parasites its eosinophils. With viruses its lymphocytes.
Treatment of gingivitis via two ways:
OTC essential oil rinse (Listerine)
Rx 0.12% Chlorohexidine Gluconate (12% EtOH)
Dentigerous cyst
Due to degenerative changes in reduced enamel epithelium
Any tooth is associated with it
Unerupting tooth = dentigerous = primordial cyst
- TX: derive and keep it exposed
When its erupting, its called erupting cyst
osteomyelitis
starts in the medullary space of trabecular bone
Suppurative (acute, infantile) vs non-suppurative (chronic, sclerosing, Garre, actincomytic) groups
Cavernous sinus thrombosis via:
(1) anteriorly through the angular and inferior ophthalmic veins (canine space/deep temporal space infections via ophthalmic veins) and
(2) posteriorly through the transverse facial vein and pterygoid plexus of veins
CN 3,4,5,6 pass through the cavernous sinus
malignant lesions
- Bleeds easy
- Paresthesia (painless)
- metastatic = malignant = cancer
- immobile/fixed to tissue
- anaplastic
- Hyperchromatic (Nu)
- pleomorphic
- ulcerated
- erythroplasia
- duration (meaning time)
- induration (surroudning tissue is firm to touch)
pin point dots of blood on skin
Petechiae
Bone vs Cartilage growth
Cartilage Growth:
- appositional = recruits chondroblasts to add new surface matrix
- interstitial = no recruitment needed, chondrocytes already present = mandibular condyle
Bone:
Only appositional growth. Its rigid structure inhibits interstitial growth
NOTE: cartilage is the primary determinant of skeletal growth, where bone follows passively.
Ectopic teeth
Max 1M > Mand. Incisors > Mand. 1M
Max > Mand.
Class II patient’s
Bone Formation (Not Growth)
messenchyme –> fibrous membrane OR cartilage
- Intramembranous ossification = occurs in membranes of CT = osteoproginator cells –> osteoblasts –> collagen matrix forms around it to ossify = maxilla, mandible, cranial vault
- Endochondral ossification = occurs in hyaline cartilage = cartilage cells replaced by bone (osteocytes replace chondrocytes) = short and long bones, cranial BASE (sphenoid, ethmoid, occipital bones)
Cranial vault grows in response to the brain (max in 5 yrs)
Cranial base grows are independent of growth potential
Deposition and reposition may not occur in equal amounts
Remodeling = osteons = endosteal and periosteal surfaces
Hutchinson and mulberry teeth
4-6 weeks in utero prior to calcification.
Maxillary incisors and molars are only affected bc they are the only teeth forking during this time
