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Oral Pathology

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4- Black Hairy Tongue

-Characterized by the elongation and hyperkeratosis of the filiform papillae, resulting in this hairlike appearance. The elongated papillae usually exhibit brown, yellow, or black pigmentation. Most patients are asymptomatic, but occasionally patients complain of irritation, gagging, or an altered taste. Patients are usually heavy smokers with poor oral hygiene and some have vitamin deficiencies, GI problems, or radiation therapy. Cures range from just brushing the tongue to corticosteroid therapy.

5- Cleft Palate

-Congenital defect in which the lateral halves of the palate fail to fuse during embryonic development. It may be localized to the uvula, the soft and/or hard palate, or the lip. Combined cleft lip and palate is more common in males, whereas isolated cleft palate occurs more frequently in girls. Corrective surgery is usually successful if approached after 18 months of age.

6- Torus Mandibularis

-Common pattern exostosis usually located above the mylohyoid line adjacent to the bicuspids. Typically bilateral and consist of lamellar bone with an occasional overlay of cancellous bone. Some believe it's hereditary with an increased prevalence in early adult males who possess increase masticatory stresses. Some tori have been known to resorb and remodel as stresses decrease with age. Treatment is not necessary unless it interferes with prosthetic appliances.

7- Lymphoepithelial Cyst (I also see a lot of this out here) *two slides

-Cyst that arises from epithelium entrapped within lymphoid tissue. It presents as a superficial submucosal mass that is yellow or whitish in coloration. The most frequent location is in the floor of the mouth followed by the posterior lateral border of the tongue, soft palate, tonsillar pillars, orophorynx, and the ventral tongue. The entrapped epithelium may have originated from salivary gland ducts or from the lining epithelium of surface invaginations plugged with desquamative keratin. Surgical excision can be performed; however, it is not necessary.

10- Internal Resorption

-The removal of tooth structure that involves the inner dentinal walls by cells originating from the dental pulp. Most instances occur during adulthood and have no sex predilection. Initiation is either idiopathic or associated with some form of trauma or dental decay. The walls of the canal are smooth and well defined. Root canal therapy may prove beneficial if the resorption area can be properly instrumented, otherwise, extraction is warranted. (First time I saw this was just last week)

11- Talon Cusp

It's an accessory cusp usually located on the lingual surface of permanent or deciduous incisors. The cusp often demonstrates a deep developmental groove where it joins the lingual surface. This groove is prone to caries and should be restored prophylactically to prevent carious exposure of the pulp. An interesting trick I learned is that when this cusp is interfering with occlusion, there is a good way to remove the cusp without the need for root canal therapy. This is to take down the cusp in stages and go only so much as to not get a big exposure. Then place calcium hydroxide on the dentin (or pin point exposure) and the pulp will eventually recede from the its surface.

12- Taurodontism

-A developmental abnormality in which the body is enlarged and the roots are usually shortened. Increased prevalence of this abnormality is noted in patients demonstrating oligodontia, which is the congenital absence of more than just a couple of permanent teeth. May be a good help with resistance form for core buildups.

13- Fusion *two slides

-Is a joining of teeth due to the union of two normally separated tooth germs. These teeth may appear as one large tooth, as one incompletely fused crown, or as two crowns sharing completely or incompletely fused roots. No matter what pattern, the fusion must involve the dentin.

15- Chronic Hyperplastic Pulpitis

-An overgrowth of chronically inflamed granulation tissue that originates from the dental pulp of a tooth with a large pulp exposure. Usually seen in deciduous molars and first permanent molars of young patients whose teeth contain large vascular pulps with high tissue reactivity. Tooth must be extracted or treated endodontically.

16- Parulis

-Inflammed granulation tissue that arises on the oral mucosa after an intraosseous abscess perforates through the cortical plate and channels through the overlying soft tissue into the oral cavity. Once the source of the abscess is removed the parulis will usually resolve. When it doesn't, it should be excised.

17- Dilantin Hyperplasia

-A marked enlargement of the facial and lingual gingival that occasionally occurs after about 1-3 months use of the anticonvulsant drug, Dilantin. When discontinuation of the drug is not an option, surgical excision of the affected gingiva will become a repetitive process. (And this what this one lady I saw had to go through every other week)

19- Cellulitis

-An enlargement of soft tissue resulting from the diffuse spread of an infection through the tissue spaces or fascial planes. Pain, fever, and lymphadenopathy are usually seen. The focus of infection should be resolved and antibiotics administered. Penicillin is choice along with a warm compress. It should be manually drained if possible.

20- Osteoradionecrosis *two slides

-The osteomyelitis that has occurred subsequent to therapeutic radiation in the area. Most radiation in the area is a treatment for carcinomas of the head and neck in which elimination of the jaws from the fields of irradiation was not possible. The radiation damages the osteocytes and the microvascular system of the affected bone which renders it more susceptible to necrosis when exposed to minor infection or trauma. Prevention of dental imperfections is the best therapeutic approach. Hyperbaric oxygen often improves healing and decreases the prevalence of progression and recurrence. (I saw a few cases of this at my teacher's cancer clinic)



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