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Oral and Maxillofacial PathologyOral and Maxillofacial PathologyReview for NBDE Part 2 Review for NBDE Part 2

20102010

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Michael A. Kahn, DDSMichael A. Kahn, DDSProfessor and ChairmanProfessor and Chairman

Department of Oral and Maxillofacial PathologyDepartment of Oral and Maxillofacial PathologyTufts University School of Dental MedicineTufts University School of Dental Medicine

Systemic Lupus ErythematosusSystemic Lupus Erythematosus

ClinicalClinical–– AutoimmuneAutoimmune

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–– Young adult femalesYoung adult females–– Butterfly rashButterfly rash of faceof face

Sun exposure worsens itSun exposure worsens it

–– Systemic involvement complicationsSystemic involvement complications Heart Heart –– endocarditisendocarditis Kidney Kidney –– renal glomeruli (glomerulonephritis)renal glomeruli (glomerulonephritis)

Cavernous sinus thrombosisCavernous sinus thrombosis

Can arise from an infection Can arise from an infection -- -- a a subcutaneous abscess of the upper lip or a subcutaneous abscess of the upper lip or a intrabony abscess of an anterior maxillary intrabony abscess of an anterior maxillary t tht th

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toothtooth–– Valveless facialValveless facial

veinsveins

Ludwig’s anginaLudwig’s angina

Submandibular space infectionSubmandibular space infection Most serious complication is edema of Most serious complication is edema of

the glottisthe glottis

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the glottisthe glottis

Treacher Collins SyndromeTreacher Collins Syndrome

Has external ear changesHas external ear changes

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Scarlet feverScarlet fever

White coating of the tongue that sloughs off White coating of the tongue that sloughs off leaving a deep red surface with swollen leaving a deep red surface with swollen hyperplastic fungiform papillae (“strawberry hyperplastic fungiform papillae (“strawberry tongue”)tongue”)

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tongue )tongue )

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Fordyce granules Fordyce granules

Ectopic sebaceous glands Ectopic sebaceous glands –– yellow yellow papules/plaquespapules/plaques

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Turner toothTurner tooth

Due to local trauma or infection associated Due to local trauma or infection associated with the developing tooth budwith the developing tooth bud

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Intrinsic tooth stainIntrinsic tooth stain

Tetracycline Tetracycline –– deposition within the dentindeposition within the dentin

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Recurrent Aphthous StomatitisRecurrent Aphthous Stomatitis

ClinicalClinical–– Moveable mucosaMoveable mucosa

Ex. Uvula, labial mucosaEx. Uvula, labial mucosa

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–– Recurrent Recurrent –– NOT PRECEDED BY VESICLENOT PRECEDED BY VESICLE–– Associated with certain HLA typesAssociated with certain HLA types

NOT caused by a virus, bacteria, fungusNOT caused by a virus, bacteria, fungus–– TreatmentTreatment

Corticosteroids are often prescribedCorticosteroids are often prescribed–– Herpetiform typeHerpetiform type

Many smallMany small–– Minor and major typesMinor and major types

Very painfulVery painful Size, depth, time to heal (minor 5Size, depth, time to heal (minor 5--10 days)10 days) Minor Minor –– small, shallow ulcer with red halosmall, shallow ulcer with red halo

Benign Mucous Membrane Pemphigoid Benign Mucous Membrane Pemphigoid (cicatricial)(cicatricial)

ClinicalClinical–– AutoimmuneAutoimmune

Antibody reaction at the Antibody reaction at the epithelialepithelial--connective tissue connective tissue interface (BMZ)interface (BMZ)

Subepithelial splitSubepithelial splitl ll l

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–– Vesiculoerosive, ulcersVesiculoerosive, ulcers–– > women > women -- middle agedmiddle aged–– Skin and eyeSkin and eye–– OralOral

Any site: gingiva, soft palate, etc.Any site: gingiva, soft palate, etc. Ulcers, erosions following vesicles, bullaUlcers, erosions following vesicles, bulla

HistologyHistology–– Subepithelial separation at basement membrane zoneSubepithelial separation at basement membrane zone

Condyloma AcuminatumCondyloma Acuminatum

ClinicalClinical–– Venereal wartVenereal wart–– Extensive Extensive

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–– EtiologyEtiology Human papilloma virus (HPV)Human papilloma virus (HPV)

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Candidiasis Candidiasis ––pseudomembranous pseudomembranous

ClinicalClinical–– Opportunistic infection (“yeast”)Opportunistic infection (“yeast”)

Immature or deficient immune Immature or deficient immune systemsystem

Antibiotics usageAntibiotics usageC ti t idC ti t id

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Corticosteroids usageCorticosteroids usage–– Hyphae and sporesHyphae and spores

May be diagnosed by cytology May be diagnosed by cytology smearsmear

–– White, wipeable “patch” with red, White, wipeable “patch” with red, underling base; palate and buccalunderling base; palate and buccalmucosa are often involvedmucosa are often involved

–– “Thrush”“Thrush” Newborns and infantsNewborns and infants

Candidiasis Candidiasis –– Chronic Chronic Median rhomboid glossitisMedian rhomboid glossitis

–– ClinicalClinical Red Red –– atrophy of filiform papillaeatrophy of filiform papillae Midline tongue, junction of anterior Midline tongue, junction of anterior

2/3 and posterior 1/3 at tuberculum 2/3 and posterior 1/3 at tuberculum imparimpar

Not a developmental disorder as Not a developmental disorder as

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once thoughtonce thought TreatmentTreatment

–– Antifungal agents are sometimes effective, such as nystatin Antifungal agents are sometimes effective, such as nystatin or clotrimazoleor clotrimazole

Denture sore mouthDenture sore mouth–– ClinicalClinical

RedRed Patient does not remove Patient does not remove

or clean denture or clean denture –– NOT acrylic allergyNOT acrylic allergy Tx Tx –– rinse mouth and soak denture with antifungalrinse mouth and soak denture with antifungal

Recurrent (Secondary) Herpes Recurrent (Secondary) Herpes SimplexSimplex

ClinicalClinical–– U.S. incidence estimate of herpes infection is 80U.S. incidence estimate of herpes infection is 80--

85%85%M t b li i lM t b li i l

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Most cases are subclinicalMost cases are subclinical Reactivation from nerve cells of trigeminal ganglion Reactivation from nerve cells of trigeminal ganglion

–– LipLip Skin or vermilionSkin or vermilion Vesicle ruptures Vesicle ruptures -- -- --> ulcer that heals in 7> ulcer that heals in 7--10 days 10 days

(not present for weeks or months if immunocompetent (not present for weeks or months if immunocompetent person) person)

Recurrent (Secondary) Herpes Recurrent (Secondary) Herpes SimplexSimplex

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Recurrent Herpes Simplex InfectionRecurrent Herpes Simplex Infection

ClinicalClinical–– HSV Type 1 in humans, most oftenHSV Type 1 in humans, most often–– IntraoralIntraoral

Hard palate and gingiva = nonmoveable, overlying boneHard palate and gingiva = nonmoveable, overlying bone Small coalescing shallow ulcers preceded by small vesiclesSmall coalescing shallow ulcers preceded by small vesicles Can be subclinical even though person has primary infectionCan be subclinical even though person has primary infection

U ll hi t f t t UV t i iU ll hi t f t t UV t i i

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Usually history of trauma, stress, UV exposure, as triggering Usually history of trauma, stress, UV exposure, as triggering event several days earlier (ex. restorative procedure) event several days earlier (ex. restorative procedure)

No history of allergy or chemical burnNo history of allergy or chemical burn

Traumatic NeuromaTraumatic Neuroma

ClinicalClinical–– Wandering transected nerve with scar tissueWandering transected nerve with scar tissue–– Painful or tender, firm “lump” or nodulePainful or tender, firm “lump” or nodule–– Oral siteOral site

O t it f h i tO t it f h i t

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Occurs at sites of chronic traumaOccurs at sites of chronic trauma Ex. mandibular alveolar ridge in denture wearer, Ex. mandibular alveolar ridge in denture wearer,

especially near mental nerve, denture flange especially near mental nerve, denture flange traumatrauma

Ex. tongue Ex. tongue

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Pyogenic GranulomaPyogenic Granuloma

ClinicalClinical–– Occur at any ageOccur at any age–– Any location but usually on Any location but usually on

gingivagingiva Most common is interdentalMost common is interdental

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Most common is interdental Most common is interdental papillapapilla

–– Local reactive growthLocal reactive growth Irritation Irritation

–– Bleeds readily Bleeds readily –– Exophytic Exophytic –– Not painful Not painful –– Grows very fast Grows very fast –– likelike

malignanciesmalignancies–– ProliferativeProliferative

Peripheral Giant Cell Peripheral Giant Cell GranulomaGranuloma

ClinicalClinical–– Somewhat similar in appearance to pyogenic Somewhat similar in appearance to pyogenic

granulomagranuloma–– Moderate soft massModerate soft mass

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–– Often “liverOften “liver--colored” [brownish purple]colored” [brownish purple]–– Distinctive histology Distinctive histology

Multinucleated giant cellsMultinucleated giant cells–– Limited to alveolar ridge/Limited to alveolar ridge/

gingivagingiva Usually anterior to first molar Usually anterior to first molar

regionregion

Central Giant Cell GranulomaCentral Giant Cell Granuloma

ClinicalClinical–– IntrabonyIntrabony–– Same histology as:Same histology as:

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Peripheral giant cellPeripheral giant cellgranulomagranuloma

Brown tumor of hyperparaBrown tumor of hyperpara--thyroidismthyroidism

–– No effect on saliva production No effect on saliva production –– Bone destruction secondary to chronic renal Bone destruction secondary to chronic renal

diseasedisease

Squamous Papilloma (Papilloma)Squamous Papilloma (Papilloma)

ClinicalClinical–– Etiology Etiology -- epitheliumepithelium–– White to whiteWhite to white--pink usually but can be reddenedpink usually but can be reddened–– Rough surface (cauliflower)Rough surface (cauliflower)–– Elevated lesion (papule, nodule)Elevated lesion (papule, nodule)–– Common sitesCommon sites

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Facial or lingual gingivaFacial or lingual gingiva Soft or hard palateSoft or hard palate TongueTongue

–– More frequent than some More frequent than some other “omas”other “omas” RhabdomyomaRhabdomyoma LeiomyomaLeiomyoma LymphangiomaLymphangioma NeurofibromaNeurofibroma

Fibroma Fibroma (fibrous nodule, focal fibrous hyperplasia, (fibrous nodule, focal fibrous hyperplasia, traumatic fibroma, irritation fibroma)traumatic fibroma, irritation fibroma)

ClinicalClinical–– Most common Most common connective tissueconnective tissue tumortumor

Reactive not true tumorReactive not true tumor

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–– Reactive, not true tumorReactive, not true tumor–– Hyperplasia; NOT neoplasia, Hyperplasia; NOT neoplasia,

anaplasia, dysplasia, etc.anaplasia, dysplasia, etc.–– Firm, smooth, pink, Firm, smooth, pink,

elevated papule/nodule elevated papule/nodule –– Common site is tongue (due to trauma)Common site is tongue (due to trauma)

Granular Cell TumorGranular Cell Tumor

ClinicalClinicalDorsum of tongue #1 siteDorsum of tongue #1 site

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–– Dorsum of tongue #1 siteDorsum of tongue #1 site–– Nodule with smooth or papillated surface Nodule with smooth or papillated surface –– Histology distinctHistology distinct

Granular cells Granular cells -- cytoplasmcytoplasm 50% of time exhibit 50% of time exhibit

pseudoepitheliomatous pseudoepitheliomatous hyperplasiahyperplasia

–– Resembles squamous cell carcinoma histologicallyResembles squamous cell carcinoma histologically

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LeukoplakiaLeukoplakia

ClinicalClinicalWhite patch that does not wipe offWhite patch that does not wipe off

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–– White patch that does not wipe offWhite patch that does not wipe off–– Cytology smear does not help determine specific Cytology smear does not help determine specific

diagnosisdiagnosis–– Appropriately managed by biopsyAppropriately managed by biopsy–– Floor of mouth hyperkeratosis most common site to Floor of mouth hyperkeratosis most common site to

exhibit dysplasiaexhibit dysplasia–– If two separate areas in person’s mouth then both If two separate areas in person’s mouth then both

areas should have incisional biopsyareas should have incisional biopsy

ErythroplakiaErythroplakia and and ErythroleukoplakiaErythroleukoplakia (speckled)(speckled)

ClinicalClinical–– Red plaque that does not wipe offRed plaque that does not wipe off–– Studies show that it is likely to have severe Studies show that it is likely to have severe

dysplasia or worse and undergo malignant dysplasia or worse and undergo malignant

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transformation to carcinomatransformation to carcinoma–– Treatment Treatment

Initial Initial –– incisional biopsyincisional biopsy

Squamous Cell CarcinomaSquamous Cell Carcinoma ClinicalClinical

–– Lower lipLower lip Can be preceded by actinic Can be preceded by actinic cheilitischeilitis Firm, Firm, induratedindurated ulcer; painless with v. good prognosisulcer; painless with v. good prognosis SubmentalSubmental node is most common lymph node involved by node is most common lymph node involved by

metastasismetastasis–– Most common oral siteMost common oral site

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–– Most common oral siteMost common oral site MidMid--lateral border of tonguelateral border of tongue

–– Least likely oral siteLeast likely oral site Hard palateHard palate

–– Site with greatest likelihood or Site with greatest likelihood or riskrisk of developing of developing squamous cell carcinomasquamous cell carcinoma Floor of mouth Floor of mouth –– worse prognosis when lung worse prognosis when lung metsmets (not (not

size, local spread or size, local spread or anaplasticanaplastic cells)cells)–– MetastasisMetastasis

Most likely to a lymph nodeMost likely to a lymph node2828

Squamous Cell CarcinomaSquamous Cell Carcinoma

Staging vs. GradingStaging vs. Grading–– Stage III has a worse prognosis than I or IIStage III has a worse prognosis than I or II

RadiographicRadiographic–– When invasive into the alveolar ridge it will When invasive into the alveolar ridge it will

appear poorly defined lucencies without aappear poorly defined lucencies without a

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appear poorly defined lucencies without a appear poorly defined lucencies without a reactive sclerotic borderreactive sclerotic border

Metastatic Disease to the JawsMetastatic Disease to the Jaws

Clinical and RadiographicClinical and Radiographic–– Most common site is posterior mandibleMost common site is posterior mandible–– Does not cause a shift of patient’s occlusionDoes not cause a shift of patient’s occlusion–– Usually a poorly defined lucency withoutUsually a poorly defined lucency without

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Usually a poorly defined lucency without Usually a poorly defined lucency without sclerotic bordersclerotic border

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Monomorphic AdenomaMonomorphic Adenoma(Canalicular Adenoma)(Canalicular Adenoma)

ClinicalClinical–– Most common site Most common site

Upper lipUpper lip> W> W

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> Women> Women May beMay be

multinodularmultinodular AsymptomaticAsymptomatic Do not confuse Do not confuse

with mucocelewith mucoceleof the of the lowerlower liplip

LeukoedemaLeukoedema

ClinicalClinical–– Intracellular edema of cellsIntracellular edema of cells–– More often seen in AfricanMore often seen in African--AmericansAmericans

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More often seen in AfricanMore often seen in African AmericansAmericans–– Common, bilateral on buccal mucosaCommon, bilateral on buccal mucosa–– Diagnostic test Diagnostic test chairsidechairside

Pull on buccal mucosa Pull on buccal mucosa -- -- -- --> disappears or > disappears or dissipatesdissipates

–– Normal mucosa variation so no treatment Normal mucosa variation so no treatment requiredrequired

LeukemiaLeukemia Clinical/LabClinical/Lab

–– Red, swollen (hyperplastic), Red, swollen (hyperplastic), boggy, bleeding gingiva boggy, bleeding gingiva (interdental papilla) with ulcers(interdental papilla) with ulcers

–– Lab tests orderedLab tests ordered Complete blood countComplete blood count White blood count differentialWhite blood count differential

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White blood count differentialWhite blood count differential Decreased Decreased neutrophilsneutrophils Leukemic infiltrate leaves blood Leukemic infiltrate leaves blood

and into soft tissue (esp. acute and into soft tissue (esp. acute monocyticmonocytic type)type)

–– Red Red maculesmacules on skin (on skin (purpurapurpura ==extravasatedextravasated blood) & skin infectionsblood) & skin infections

–– Decreased plateletsDecreased platelets–– Tired feeling (malaise)Tired feeling (malaise)–– Anemia (decreased Anemia (decreased RBCsRBCs))

Verrucous CarcinomaVerrucous Carcinoma

ClinicalClinical–– Very well differentiated Very well differentiated

form of squamous cell form of squamous cell carcinomacarcinoma

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carcinomacarcinoma–– Large, elevated, papillary oftenLarge, elevated, papillary often

associated with smokeless tobacco associated with smokeless tobacco habithabit

–– Most common site is buccal Most common site is buccal vestibulevestibule

–– No tendency to metastasizeNo tendency to metastasize Chief difference from Chief difference from

typical squamous cell carcinoma typical squamous cell carcinoma

Field Field CancerizationCancerization ––Squamous Cell CarcinomaSquamous Cell Carcinoma

Patient diagnosed and treated for squamous Patient diagnosed and treated for squamous cell carcinoma of the tonguecell carcinoma of the tongue

Much more likely to have future premalignant Much more likely to have future premalignant

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y p gy p gor malignant lesions anywhere in the oral or malignant lesions anywhere in the oral cavity cavity –– Ex. Ex. –– speckled leukoplakia of the floor of mouth speckled leukoplakia of the floor of mouth

likely to be a second primary lesionlikely to be a second primary lesion

p53 tumor suppressor gene is most common p53 tumor suppressor gene is most common associated associated

Salivary Gland TumorsSalivary Gland Tumors

Most common tumor of salivary gland origin Most common tumor of salivary gland origin is the pleomorphic adenomais the pleomorphic adenoma–– BenignBenign–– Most common intraoral site is palateMost common intraoral site is palate

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pp Major and minor salivary glands potential Major and minor salivary glands potential

sitessites–– Neoplasm most likely to arise in the parotidNeoplasm most likely to arise in the parotid–– Neoplasm most likely to arise in the palateNeoplasm most likely to arise in the palate

Adenoid cystic carcinomaAdenoid cystic carcinoma–– Characteristic perineural invasion Characteristic perineural invasion –– most likely most likely

Parotid Parotid –– facial nerve involvement but no upper lip facial nerve involvement but no upper lip paresthesiaparesthesia

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Physiologic Pigmentation (Racial Physiologic Pigmentation (Racial Pigmentation)Pigmentation)

ClinicalClinical–– Darkens with time; presentDarkens with time; present

most of a person’s lifetimemost of a person’s lifetime

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most of a person s lifetimemost of a person s lifetime–– AfricanAfrican--American patientsAmerican patients

Upper or lower lip vermilion, attached gingiva, Upper or lower lip vermilion, attached gingiva, tongue, buccal mucosatongue, buccal mucosa

Series of splotchy brown Series of splotchy brown maculesmacules

Lateral Periodontal CystLateral Periodontal Cyst

ClinicalClinical–– True cyst (epithelial lining), True cyst (epithelial lining),

not pseudocystnot pseudocyst

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p yp y

Radiographic appearanceRadiographic appearance–– Well circumscribed radioluceny between the Well circumscribed radioluceny between the

roots of adjacent, erupted, vital teeth (most roots of adjacent, erupted, vital teeth (most commonly seen at mandibular premolars)commonly seen at mandibular premolars)

–– Radiographic differential diagnosis does NOT Radiographic differential diagnosis does NOT include dentigerous cyst (impacted tooth)include dentigerous cyst (impacted tooth)

AmeloblastomaAmeloblastoma

ClinicalClinical–– Average age is 34Average age is 34–– Most common in posterior Most common in posterior

mandible but anterior mandible mandible but anterior mandible also (can cross midline)also (can cross midline)

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a so (ca c oss d e)a so (ca c oss d e) RadiographicRadiographic

–– Most common true odontogenic tumorMost common true odontogenic tumor–– Multilocular radiolucencyMultilocular radiolucency–– Superimposed over posterior teeth (> mand.)Superimposed over posterior teeth (> mand.)–– Often associated with impacted toothOften associated with impacted tooth

HistologyHistology–– Reverse polarization of the nuclei of the tall, Reverse polarization of the nuclei of the tall,

columnar cells of the peripherycolumnar cells of the periphery

AmeloblasticAmeloblastic FibromaFibroma

ClinicalClinical–– Young personYoung person–– More often in posterior jaws, esp. mandibleMore often in posterior jaws, esp. mandible–– Slight pain, swelling; not aggressiveSlight pain, swelling; not aggressive

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g p , g; ggg p , g; gg–– Ameloblastic fibroAmeloblastic fibro--odontoma odontoma

is similar except for odontomais similar except for odontomacomponentcomponent

RadiographicRadiographic–– Pure lucency; no Pure lucency; no

radiopaque componentradiopaque component–– AFO AFO –– also has radiopaque component (i.e., the also has radiopaque component (i.e., the

odontoma)odontoma)

OdontomaOdontoma Clinical Clinical –– primarily first two decades of life (young primarily first two decades of life (young

persons)persons) RadiographicRadiographic

–– Radiopacity with radiolucent rim (= follicle)Radiopacity with radiolucent rim (= follicle) Compound vs. Complex typesCompound vs. Complex types

–– Compound Compound -- identifiable toothletsidentifiable toothlets

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> Anterior maxilla> Anterior maxilla–– Complex Complex –– unidentifiable massunidentifiable mass

> Posterior of jaws > Posterior of jaws

Adenomatoid Odontogenic Adenomatoid Odontogenic Tumor (AOT)Tumor (AOT)

ClinicalClinical–– Young person (child or teenager)Young person (child or teenager)

Unerupted tooth of the anterior maxilla (#6, Unerupted tooth of the anterior maxilla (#6, #11)#11)

RadiographicRadiographic

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RadiographicRadiographic–– Snow flake calcifications in the radiolucency Snow flake calcifications in the radiolucency

surrounding the crown and a portion of the surrounding the crown and a portion of the impacted tooth’s rootimpacted tooth’s rootTreatment Treatment –– simple simple enucleationenucleation

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Amelogenesis ImperfectaAmelogenesis Imperfecta

ClinicalClinical–– Teeth lack enamel; Teeth lack enamel; –– Dentin and cementum Dentin and cementum

unaffectedunaffected

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unaffectedunaffected–– Shapes of root and Shapes of root and

crown are normalcrown are normal RadiographicRadiographic

–– Enamel is missingEnamel is missing–– Pulp chambers and Pulp chambers and

root canals normal root canals normal

Dentinogenesis ImperfectaDentinogenesis Imperfecta

ClinicalClinical–– Opalescent dentin Opalescent dentin –– blue/grayblue/gray–– Often associated with osteogenesis Often associated with osteogenesis

imperfectaimperfecta

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imperfectaimperfecta Blue scleraBlue sclera Multiple bone fracturesMultiple bone fractures

RadiographicRadiographic–– BWXs and PAs demonstrate classic BWXs and PAs demonstrate classic

lack of pulp chambers and root canalslack of pulp chambers and root canals–– BellBell--shaped crown with constricted shaped crown with constricted

cervical regioncervical region

CherubismCherubism RadiographicRadiographic

–– Multilocular, bilateralMultilocular, bilaterallucencieslucencies

ClinicalClinical–– Bilateral jawsBilateral jaws

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–– Young personsYoung persons–– Jaw expansion Jaw expansion -- -- ceases after childhoodceases after childhood

Fibrous Dysplasia Fibrous Dysplasia ClinicalClinical

–– UnilateralUnilateral mandibular or maxillary expansion; onset mandibular or maxillary expansion; onset before puberty; C.C. of “teeth do not fit”before puberty; C.C. of “teeth do not fit”

–– Painless swelling, usually ceases at age 20 Painless swelling, usually ceases at age 20 –– Root canal therapy will not help since nonRoot canal therapy will not help since non--infectiousinfectious

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Root canal therapy will not help since nonRoot canal therapy will not help since non infectious infectious process (i.e., fibroprocess (i.e., fibro--osseous lesion)osseous lesion)

–– Café au lait pigmentation Café au lait pigmentation Polyostotic form Polyostotic form –– McCune Albright syndromeMcCune Albright syndrome

RadiographicRadiographic–– Ground glass appearanceGround glass appearance

TreatmentTreatment–– After age 20 when stabilizedAfter age 20 when stabilized–– Cosmetic bone shavingCosmetic bone shaving

Condensing OsteitisCondensing Osteitis(Sclerosing Osteitis)(Sclerosing Osteitis)

ClinicalClinical–– Associated with Associated with pulpitispulpitis (ex. very carious posterior (ex. very carious posterior

mandibular tooth); mandibular tooth); nonvitalnonvital toothtooth–– Associated tooth will test Associated tooth will test nonvitalnonvital or signs and or signs and

symptoms or tooth destruction will support symptoms or tooth destruction will support nonvitalnonvitalstatusstatus

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RadiographicRadiographic–– PeriapicalPeriapical opacity so does opacity so does

NOT mimic a NOT mimic a periapicalperiapicalgranuloma granuloma radiographicallyradiographically

–– Does not connect with rootDoes not connect with root

Idiopathic OsteosclerosisIdiopathic Osteosclerosis

ClinicalClinical–– No apparent reason including no pulpitis in adjacent No apparent reason including no pulpitis in adjacent

toothtooth–– No expansion, painNo expansion, pain

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p , pp , p

RadiographicRadiographic–– Radiopacity without Radiopacity without

peripheral lucent rimperipheral lucent rim–– Not connected to tooth’s Not connected to tooth’s

rootroot

TreatmentTreatment–– NoneNone

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Traumatic Bone Cyst Traumatic Bone Cyst (Simple Bone Cyst; Idiopathic Bone Cavity; (Simple Bone Cyst; Idiopathic Bone Cavity; Unicameral Cyst; Hemorrhagic Cyst)Unicameral Cyst; Hemorrhagic Cyst)

ClinicalClinical–– Undergoes spontaneous healing without Undergoes spontaneous healing without

treatment following exploratory surgerytreatment following exploratory surgery–– PseudocystPseudocyst

RadiographicRadiographic

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RadiographicRadiographic–– Radiolucent with scalloped marginsRadiolucent with scalloped margins

Paget’s Disease of BonePaget’s Disease of Bone

ClinicalClinical–– Older age groupOlder age group–– Bilateral maxilla affectedBilateral maxilla affected–– Involved bone can undergo malignant Involved bone can undergo malignant

(sarcomatous) transformation (i.e., osteosarcoma)(sarcomatous) transformation (i.e., osteosarcoma)–– Cranial nerve deficits as foramen compressed, Cranial nerve deficits as foramen compressed,

dd

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narrowednarrowed–– Does NOT have hyperglobulinemia or premature Does NOT have hyperglobulinemia or premature

exfoliation of primary teethexfoliation of primary teeth RadiographicRadiographic

–– Cotton wool appearanceCotton wool appearance–– 50% 50% -- hypercementosis hypercementosis

HistologyHistology–– Reversal lines with a mosaic patternReversal lines with a mosaic pattern

Langerhans Cell Disease Langerhans Cell Disease (Histiocytosis X)(Histiocytosis X)

ClinicalClinical–– Composed of Composed of LangerhansLangerhans cells, cells,

not not histiocyteshistiocytes–– Etiology is still unknownEtiology is still unknown

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Etiology is still unknownEtiology is still unknown–– EosinophilicEosinophilic granulomagranuloma

Solitary lesion, young adultsSolitary lesion, young adults–– HandHand--SchullerSchuller--Christian triadChristian triad

Diabetes Diabetes insipidusinsipidus ExophthalmosExophthalmos Bone lesionsBone lesions

Radiographic Radiographic –– Tooth “floating in air or space”Tooth “floating in air or space”

Benign vs. Malignant Bone Benign vs. Malignant Bone Involvement Involvement

ClinicalClinical–– Ominous malignant signOminous malignant sign

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Spontaneous paresthesia of the lower lipSpontaneous paresthesia of the lower lip

Radiographic Radiographic -- Benign Benign –– Cortex remains intact Cortex remains intact –– thinned or thinned or

expandedexpanded

Central Neural LesionsCentral Neural Lesions

Neurofibroma and Neurofibroma and SchwannomaSchwannoma RadiographicRadiographic

–– Enlargement of canals and foraminaEnlargement of canals and foramina

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–– Enlargement of canals and foraminaEnlargement of canals and foramina

Nasolabial CystNasolabial Cyst

ClinicalClinical–– MucolabialMucolabial, smooth swelling adjacent to a , smooth swelling adjacent to a

maxillary lateral incisormaxillary lateral incisor

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–– Soft tissue involvement; not boneSoft tissue involvement; not bone HistologyHistology

–– PseudostratifiedPseudostratifiedsquamous epithelium squamous epithelium cystic liningcystic lining

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Lymphoepithelial CystLymphoepithelial Cyst

ClinicalClinical–– Commonly on ventral tongue/floor of mouthCommonly on ventral tongue/floor of mouth–– Well circumscribed swelling Well circumscribed swelling

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gg–– Pale, yellowish at timesPale, yellowish at times

Odontogenic KeratocystOdontogenic Keratocyst ClinicalClinical

–– High recurrence!High recurrence!–– Intrabony, posterior mandible Intrabony, posterior mandible

but anywhere; but anywhere; BCNSBCNS associationassociation RadiographicRadiographic

–– Radiolucent, usually Radiolucent, usually multilocularmultilocularM i i hM i i h

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–– May mimic many other May mimic many other types of lucent cysts and types of lucent cysts and odontogenicodontogenic tumors includingtumors includingameloblastomaameloblastoma

parakeratinparakeratin

surfacesurface

Nevoid Basal Cell Carcinoma Syndrome Nevoid Basal Cell Carcinoma Syndrome (Gorlin syndrome; basal cell nevus syndrome)(Gorlin syndrome; basal cell nevus syndrome)

Clinical Clinical –– Onset is childhoodOnset is childhood–– Cysts of the jaws = Cysts of the jaws =

odontogenic keratocystsodontogenic keratocystsHi h tHi h t

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High recurrence rateHigh recurrence rate–– Basal cell carcinomas Basal cell carcinomas

Face especiallyFace especially–– Bifid ribBifid rib

RadiographicRadiographic–– Keratocysts Keratocysts -- unilocular or unilocular or

multilocular lucencies multilocular lucencies –– Calcification of the falx cerebriCalcification of the falx cerebri 5858

Cheek Nibbling Cheek Nibbling (Morsicatio Buccarum)(Morsicatio Buccarum)

ClinicalClinical–– Buccal mucosa siteBuccal mucosa site–– White, rough, tissue tags White, rough, tissue tags

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above and below the above and below the occlusalocclusal plane (line alba)plane (line alba)

Other sites Other sites –– lip and tonguelip and tongue

Gardner SyndromeGardner Syndrome ClinicalClinical

–– Multiple facial osteomas & Multiple facial osteomas & skin nodules skin nodules

–– Hyperdontia; unerupted teethHyperdontia; unerupted teeth–– Multiple GI (colon) polyps [familial intestinal Multiple GI (colon) polyps [familial intestinal

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polyposis] polyposis] -- -- -- --> colon carcinoma> colon carcinoma

Epidermoid cystEpidermoid cystOdontomaOdontoma

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Bell’s PalsyBell’s Palsy ClinicalClinical

–– 77thth nerve paralysis nerve paralysis -- -- -- --> unilateral lip > unilateral lip droop at corner, inability to close or wink droop at corner, inability to close or wink eyelideyelid

–– Last usually less than one monthLast usually less than one month

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Temporomandibular Temporomandibular Dysfunction (TMD)Dysfunction (TMD)

ClinicalClinical–– Pain and tenderness of palpated TMJPain and tenderness of palpated TMJ–– Deviation of jaw Deviation of jaw towardtoward painful side upon openingpainful side upon opening–– TMJ disc moves anterior and medially due to contraction of the TMJ disc moves anterior and medially due to contraction of the

lateral pterygoid musclelateral pterygoid muscle

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lateral pterygoid musclelateral pterygoid muscle–– Popping and clicking indicate Popping and clicking indicate

internal derangement with internal derangement with reductionreduction

–– Does Does notnot cause dizzinesscause dizziness–– Reduce opening to ~ 45 mmReduce opening to ~ 45 mm–– Will get neuritis of VII cranialWill get neuritis of VII cranial

nervenerve

Erythema MultiformeErythema Multiforme

ClinicalClinical–– Young adult malesYoung adult males–– Sudden, explosive onsetSudden, explosive onset–– Triggered by drug or viralTriggered by drug or viral

6363

Triggered by drug or viral Triggered by drug or viral infectioninfection

–– Crusted, bleeding, vesicles, Crusted, bleeding, vesicles, ulcers of vermilion of lips; ulcers of vermilion of lips; intraoral sites excluding gingivaintraoral sites excluding gingiva

–– “Target, iris, or bulls“Target, iris, or bulls--eye lesions” eye lesions” of the hands and feetof the hands and feet

StevensStevens--Johnson syndrome Johnson syndrome (Erythema Multiforme Major)(Erythema Multiforme Major)

6464

••Eye (conjunctiva), mouth (labial mucosa, Eye (conjunctiva), mouth (labial mucosa, tongue, etc.), genitaliatongue, etc.), genitalia

Clinical/Lab Clinical/Lab –– Vesiculoerosive (oral and skin)Vesiculoerosive (oral and skin)–– Demonstrates immunoglobulin fluorescence Demonstrates immunoglobulin fluorescence

intraepithelial (intraepithelial (supraepithelialsupraepithelial) cementing substance) cementing substance Most often immunoglobulin type G (Most often immunoglobulin type G (IgGIgG))

–– Positive Positive NikolskyNikolsky sign sign –– Common sites Common sites –– lips, palate, gingivalips, palate, gingiva

Pemphigus VulgarisPemphigus Vulgaris

6565

Pemphigus Vulgaris

6666

12

Progressive Systemic Sclerosis Progressive Systemic Sclerosis (Scleroderma)(Scleroderma)

ClinicalClinical–– Demonstrates induration Demonstrates induration

of the soft tissue (maskof the soft tissue (mask--like) and like) and

6767

generalized widening of the PDL spacegeneralized widening of the PDL space–– TrismusTrismus

6868

Benign Migratory Glossitis (Geographic Benign Migratory Glossitis (Geographic Tongue, Tongue, ErythemaErythema MigransMigrans))

ClinicalClinical–– Red and white Red and white

Red = flat, Red = flat, depapillateddepapillatedareas of tongue (filiform areas of tongue (filiform papillae atrophied)papillae atrophied)

White = keratin, epithelial White = keratin, epithelial cell debriscell debris

6969

–– Periodically appearsPeriodically appears–– Can cause soreness or burning Can cause soreness or burning

occasionallyoccasionally–– Treatment Treatment

Corticosteroid rinse (Corticosteroid rinse (dexamethasonedexamethasone))–– Moves around from day to dayMoves around from day to day–– Dorsum of tongue most oftenDorsum of tongue most often

Also lateral, ventral surfacesAlso lateral, ventral surfaces

Aspirin Burn (Chemical Burn)Aspirin Burn (Chemical Burn)

ClinicalClinical–– White = coagulative White = coagulative necrosisnecrosis of the surface, of the surface,

NOT hyperkeratosisNOT hyperkeratosisWhite rubs off with difficulty, hyperkeratosis does White rubs off with difficulty, hyperkeratosis does

not wipe offnot wipe off

7070

Basal Cell CarcinomaBasal Cell Carcinoma––ClinicalClinical

Painless ulcer of upper lip, elsewhere on Painless ulcer of upper lip, elsewhere on sunsun--exposed face (UV); raised marginsexposed face (UV); raised margins

Does NOT occur intraorallyDoes NOT occur intraorally Begins as pearly papule; assoc. Begins as pearly papule; assoc.

telangiectasiatelangiectasia

7171

gg Can be highly destructive if not treatedCan be highly destructive if not treated Usually does not metastasizeUsually does not metastasize

MucoceleMucocele(mucus retention phenomenon, mucus (mucus retention phenomenon, mucus extravastion phenomenon)extravastion phenomenon)

ClinicalClinical–– Children and young adultsChildren and young adults–– TraumaTrauma–– Lower lip is most common siteLower lip is most common site

7272

–– Vesicle/bulla, domeVesicle/bulla, dome--shapedshaped–– Bluish oftenBluish often–– History of recurrenceHistory of recurrence

13

Ranula Ranula (mucocele, mucus retention (mucocele, mucus retention phenomenon, mucus extravastion phenomenon, mucus extravastion phenomenon)phenomenon)

ClinicalClinical–– Floor of mouth swellingFloor of mouth swelling

Looks like a frog’s belly (Gk ‘ranu’ = frog)Looks like a frog’s belly (Gk ‘ranu’ = frog)

7373

Bluish usually; history of recurrence several timesBluish usually; history of recurrence several times Mucin will yield viscous aspirateMucin will yield viscous aspirate Microscopic Microscopic –– histiocytes visible in mucinhistiocytes visible in mucin

MSG

MUCIN

GW

Antral Pseudocyst (Mucous Antral Pseudocyst (Mucous Retention Pseudocyst)Retention Pseudocyst)

ClinicalClinical–– AsymptomaticAsymptomatic–– No treatment necessaryNo treatment necessary

RadiographicRadiographic–– Slight radiopaqueSlight radiopaque

7474

Slight radiopaque, Slight radiopaque, domedome--shaped, emanating shaped, emanating from floor of maxillary sinusfrom floor of maxillary sinus

AnkyloglossiaAnkyloglossia

Congenital abnormalityCongenital abnormality “tongue“tongue-- tied”tied”

7575

Dentigerous CystDentigerous Cyst

ClinicalClinical–– Most common site is posterior mandible Most common site is posterior mandible –– Impacted third molarsImpacted third molars

U i tiU i ti l bl tl bl t i f iti f it

7676

–– UnicysticUnicystic ameloblastomaameloblastoma can arise from itcan arise from it–– Malignant transformation of the lining is possibleMalignant transformation of the lining is possible

HistologyHistology–– Epithelial lining Epithelial lining -- -- -- --> > ameloblastomaameloblastoma, squamous , squamous

cell carcinoma, cell carcinoma, mucoepideromoidmucoepideromoid carcinomacarcinoma–– Other impacted teeth besides 3Other impacted teeth besides 3rdrd molarsmolars

Dentigerous Cyst (cont’d)Dentigerous Cyst (cont’d)

RadiographicRadiographic–– PericoronalPericoronal radiolucency attached at CEJ radiolucency attached at CEJ

of unerupted toothof unerupted tooth

7777

–– Radiographic differential diagnosesRadiographic differential diagnoses AmeloblastomaAmeloblastoma Residual cystResidual cyst Odontogenic keratocystOdontogenic keratocyst Odontogenic myxomaOdontogenic myxoma

7878

14

Varices Varices

Lingual and LipLingual and Lip–– Dilated veins Dilated veins -- blueblue–– Seen typically in the elderlySeen typically in the elderly–– Lip varices may thrombose and Lip varices may thrombose and

7979

subsequently calcify (i.e. phlebolith)subsequently calcify (i.e. phlebolith)

Parulis (Gum Boil)Parulis (Gum Boil)

ClinicalClinical–– Incomplete root canal therapy with Incomplete root canal therapy with

intermittent sensitivityintermittent sensitivity–– Elevated reddishElevated reddish--yellow yellow

8080

Clinical evidence of a draining fistula Clinical evidence of a draining fistula

Tuberculosis Tuberculosis

ClinicalClinical–– Incidence is increasing worldwide and in Incidence is increasing worldwide and in

the U.S.the U.S.–– Chest radiographChest radiograph

M d b i f t d t t lM d b i f t d t t l

8181

–– May spread by infected sputum to oral May spread by infected sputum to oral lesions (e.g., ulcer mimicking cancer on lesions (e.g., ulcer mimicking cancer on the tongue)the tongue)

Extravasated BloodExtravasated Blood

Clinical Clinical –– spontaneously resolvespontaneously resolve–– Purpura Purpura –– generalized termgeneralized term–– PetechiaPetechia-- pinpoint bleedingpinpoint bleeding

8282

–– Ecchymosis Ecchymosis –– larger area of involvementlarger area of involvement–– Hematoma Hematoma –– large, elevated areas large, elevated areas

Allergic MucositisAllergic Mucositis

ClinicalClinical–– Typically due to flavoring agents in Typically due to flavoring agents in

toothpastes, candies, and chewing gums toothpastes, candies, and chewing gums ( i fl i i l it)( i fl i i l it)

8383

(cinnamon flavoring is a common culprit)(cinnamon flavoring is a common culprit)

Eagle SyndromeEagle Syndrome

ClinicalClinical–– Elongation and/or Elongation and/or

calcification of the calcification of the

8484

stylohyoid ligamentstylohyoid ligament–– Head and neck pain is Head and neck pain is

elicited by chewing, elicited by chewing, yawning, opening mouth yawning, opening mouth

15

Herpes ZosterHerpes Zoster

ClinicalClinical–– Crop of vesicles Crop of vesicles -- -- -- > ulcers with pain> ulcers with pain–– Striking unilateral distribution on skin and Striking unilateral distribution on skin and

ll

8585

oral oral ex. ex. –– palate, tongue palate, tongue

Primary Herpes Primary Herpes GingivostomatitisGingivostomatitis

ClinicalClinical–– Inflamed, enlarged marginal gingiva; Inflamed, enlarged marginal gingiva;

gingival bleedinggingival bleeding

8686

–– Vesicles Vesicles -- -- -- --> ulcers throughout the > ulcers throughout the mouth and lips with significant painmouth and lips with significant pain

–– MalaiseMalaise–– Low grade feverLow grade fever–– Sore throat, lymphadenopathySore throat, lymphadenopathy

Primary Herpes Primary Herpes GingivostomatitisGingivostomatitis

8787

Crohn’s DiseaseCrohn’s Disease

ClinicalClinical–– Granulomatous gingivitis Granulomatous gingivitis –– AphthousAphthous--like ulcerslike ulcers

8888

–– Rectal bleedingRectal bleeding Intestinal skip lesions of small intestine, and Intestinal skip lesions of small intestine, and

to a lesser degree, large intestine and other to a lesser degree, large intestine and other regions of the GI tractregions of the GI tract

Dermoid CystDermoid Cyst

ClinicalClinical–– Slightly compressible (“doughy”)Slightly compressible (“doughy”)–– Midline distribution usuallyMidline distribution usually

8989

Example Example -- anterior floor of mouth anterior floor of mouth

Multiple Endocrine Neoplasia Multiple Endocrine Neoplasia Syndrome, Type Syndrome, Type IIBIIB (III)(III)

Clinical Clinical –– Multiple mucosal neuromas (e.g., tongue)Multiple mucosal neuromas (e.g., tongue)–– Medullary thyroid carcinomaMedullary thyroid carcinoma

9090

y yy y–– Adrenal pheochromocytomaAdrenal pheochromocytoma

16

Incisive Canal Cyst Incisive Canal Cyst (Nasopalatine Duct Cyst)(Nasopalatine Duct Cyst)

ClinicalClinical–– Most common developmental Most common developmental

nonnon--odontogenic cystodontogenic cyst–– Teeth vital; max midlineTeeth vital; max midline

9191

Teeth vital; max. midlineTeeth vital; max. midline–– True cyst (epithelial lining)True cyst (epithelial lining)

Often heartOften heart--shaped lucencyshaped lucency

White Sponge NevusWhite Sponge Nevus ClinicalClinical

–– A A genodermatosisgenodermatosis AutosomalAutosomal dominantdominant

–– Often bilateral buccal Often bilateral buccal

9292

mucosa; other mucosamucosa; other mucosa–– Moderately extensive Moderately extensive

thick, white folds of tissuethick, white folds of tissue-- No eye involvementNo eye involvement

Cleft PalateCleft Palate ClinicalClinical

–– Between lateral incisor Between lateral incisor and canineand canine

RadiographicRadiographic–– Lucent lineLucent line

9393

–– Maxillary occlusal film Maxillary occlusal film

Trigeminal NeuralgiaTrigeminal Neuralgia ClinicalClinical

–– Age of onset typically > 35 years old; trigger pointsAge of onset typically > 35 years old; trigger points

9494

NeuritisNeuritis

ClinicalClinical–– Intense pain for one week durationIntense pain for one week duration–– UnilateralUnilateral

9595

At forehead and around eyeAt forehead and around eye

Actinic CheilitisActinic Cheilitis ClinicalClinical

–– Lip’s vermilion becomes indistinctLip’s vermilion becomes indistinct–– Great potential for dysplasia to undergo Great potential for dysplasia to undergo

malignant transformation into squamous cell malignant transformation into squamous cell carcinomacarcinoma

9696

carcinoma carcinoma Therefore, a premalignant conditionTherefore, a premalignant condition

17

Cheilitis GlandularisCheilitis Glandularis

ClinicalClinical–– Mucous minor salivary glands of lips are inflamedMucous minor salivary glands of lips are inflamed–– Mucus secretionsMucus secretions–– Premalignant condition Premalignant condition -- -- -- -- > squamous cell > squamous cell

carcinomacarcinoma

9797

PostPost--Developmental Loss of Tooth Developmental Loss of Tooth StructureStructure

Attrition Attrition -- physiologicalphysiological Abrasion Abrasion -- pathologicalpathological

–– Mechanical wear at Mechanical wear at cervical region most typicallycervical region most typically

9898

g yp yg yp y–– Habits / occupationsHabits / occupations

ErosionErosion–– Chemical loss of tooth structure Chemical loss of tooth structure

exclusive of acidogenic theory exclusive of acidogenic theory of cariesof caries Chlorinated poolsChlorinated pools

–– Gastric regurgitation and GERDGastric regurgitation and GERD Hiatal hernia, bulimia Hiatal hernia, bulimia

PostPost--Developmental Loss of Tooth Developmental Loss of Tooth StructureStructure

AbrasionAbrasion

9999

PostPost--Developmental Loss of Tooth Developmental Loss of Tooth StructureStructure

ErosionErosion

100100

Oral Hairy LeukoplakiaOral Hairy Leukoplakia ClinicalClinical

–– White, rough plaque on lateral border of tongue (#1 White, rough plaque on lateral border of tongue (#1 site)site)

–– Seen in HIVSeen in HIV--positive individuals that are progressing positive individuals that are progressing to AIDSto AIDS

101101

to AIDSto AIDS–– Caused by EpsteinCaused by Epstein--Barr virusBarr virus

Periapical CementoPeriapical Cemento--osseous Dysplasia osseous Dysplasia (Periapical cemental dysplasia; periapical osseous (Periapical cemental dysplasia; periapical osseous dysplasia)dysplasia)

ClinicalClinical–– MiddleMiddle--aged black womenaged black women–– Mandibular anterior vital teethMandibular anterior vital teeth–– No pain or expansion No pain or expansion -- -- asymptomaticasymptomatic

RadiographicRadiographic–– Diagnosed by characteristic findingsDiagnosed by characteristic findings

102102

Diagnosed by characteristic findingsDiagnosed by characteristic findings Multifocal periapical lucencies which mature over time; Multifocal periapical lucencies which mature over time;

become mixed lucent/opaque and finally mainly opaquebecome mixed lucent/opaque and finally mainly opaque

Time

18

Florid CementoFlorid Cemento--osseous Dysplasia osseous Dysplasia (florid osseous dysplasia)(florid osseous dysplasia)

ClinicalClinical–– MultiquadrantMultiquadrant–– FibroFibro--osseous intrabony lesionosseous intrabony lesion–– Hard product produced is Hard product produced is avascularavascular so . .so . .

Most likely complication is a secondaryMost likely complication is a secondary osteomyelitisosteomyelitis

103103

–– Most likely complication is a secondary Most likely complication is a secondary osteomyelitisosteomyelitis

RadiographicRadiographic–– Radiolucent and Radiolucent and radiopaqueradiopaque

TreatmentTreatment–– None necessary after None necessary after dxdx

Florid Osseous DysplasiaFlorid Osseous Dysplasia

104104

Lichen PlanusLichen Planus ClinicalClinical

–– Skin and/or oral conditionSkin and/or oral condition–– Middle aged women most oftenMiddle aged women most often–– SkinSkin

Purple, polygonal, Purple, polygonal, pruriticpruritic papulespapules–– OralOral

White papules and coalescing papules = White papules and coalescing papules = Wickam’sWickam’s striaestriaeDoes not wipe offDoes not wipe off any oral siteany oral site

105105

Does not wipe off Does not wipe off –– any oral site any oral site –– Reticular form; often asymptomatic Reticular form; often asymptomatic

Erosive formErosive form–– On tongue may be mistaken for geographic tongueOn tongue may be mistaken for geographic tongue–– Sensitive, painfulSensitive, painful

Most common siteMost common site–– Buccal mucosaBuccal mucosa

Ex. Ex. –– dorsum of tongue dorsum of tongue –– White plaques, individual papules and White plaques, individual papules and striaestriae

Hyperplastic form Hyperplastic form -- -- plaqueplaque--likelike–– Does not wipe offDoes not wipe off

Lichen PlanusLichen Planus

106106

HyperplasticHyperplasticCutaneousCutaneous

ReticularReticular

Erosive Lichen PlanusErosive Lichen Planus

107107

Peripheral Ossifying FibromaPeripheral Ossifying Fibroma

ClinicalClinical–– Soft tissue lesion, not in bone but makes Soft tissue lesion, not in bone but makes

osteoid/bone osteoid/bone –– Occurs on gingiva, especially interdental papilla areaOccurs on gingiva, especially interdental papilla area–– Product may be seen on dental radiographs asProduct may be seen on dental radiographs as

108108

Product may be seen on dental radiographs as Product may be seen on dental radiographs as scattered light opacitiesscattered light opacities

19

Cleidocranial DysplasiaCleidocranial Dysplasia ClinicalClinical

–– Multiple unerupted supernumerary teethMultiple unerupted supernumerary teeth–– Retention of primary teethRetention of primary teeth–– Delayed eruption of permanent teeth Delayed eruption of permanent teeth –– Missing clavicles, frontal bossing, large headMissing clavicles, frontal bossing, large head

109109

Neurofibromatosis, type 1 (von Neurofibromatosis, type 1 (von Recklinghausen’s disease of skin)Recklinghausen’s disease of skin)

ClinicalClinical–– Multiple neurofibromas (nodules) of the skin and Multiple neurofibromas (nodules) of the skin and

oral cavity (especially tongue)oral cavity (especially tongue)–– Café au lait pigmentation (abnormal macules or Café au lait pigmentation (abnormal macules or

spots of the skin)spots of the skin)

110110

p )p ) Brown maculesBrown macules

111111

Calcifying Odontogenic Cyst Calcifying Odontogenic Cyst (Gorlin Cyst)(Gorlin Cyst)

HistologyHistology–– Ghost cellsGhost cells–– CalcificationsCalcifications

112112

CalcificationsCalcifications

Nicotine StomatitisNicotine Stomatitis

ClinicalClinical–– Hard palateHard palate–– Red, inflamed minor salivary Red, inflamed minor salivary

113113

gland ducts with background gland ducts with background of leukoplakic changeof leukoplakic change

–– Tobacco useTobacco use Pipe smokers Pipe smokers –– most oftenmost often CigarettesCigarettes

Melanotic Neuroectodermal Melanotic Neuroectodermal Tumor of InfancyTumor of Infancy

ClinicalClinical–– Rapid onset, destructive in newbornsRapid onset, destructive in newborns–– Increase of Increase of vanillylmandelicvanillylmandelic acid (acid (VMAVMA))–– Anterior maxilla, soft and Anterior maxilla, soft and

hard tissuehard tissue

114114

–– Mobile teethMobile teeth RadiographicRadiographic

–– Intrabony, lucent, destructive Intrabony, lucent, destructive –– Malignant looking but Malignant looking but

benign usuallybenign usually

20

Auriculotemporal syndrome (Frey Auriculotemporal syndrome (Frey syndrome)syndrome)

ClinicalClinical–– Often after parotid gland surgeryOften after parotid gland surgery–– Sweating of unilateral facial skin just prior to eatingSweating of unilateral facial skin just prior to eating–– Does not affect cranial nerve VII (rather V)Does not affect cranial nerve VII (rather V)

115115

Does not affect cranial nerve VII (rather V)Does not affect cranial nerve VII (rather V)

Starch Iodine TestStarch Iodine Test

AspirationAspiration

Always aspirate an anterior Always aspirate an anterior maxillary/mandibular radiolucency prior maxillary/mandibular radiolucency prior to biopsy to rule out vascular natureto biopsy to rule out vascular nature

116116

ActinomycosisActinomycosis

ClinicalClinical–– Soft tissue swelling (“woody consistency”) Soft tissue swelling (“woody consistency”)

with multiple draining fistulaswith multiple draining fistulas

117117

–– “sulfur granules” = colonies of bacterial “sulfur granules” = colonies of bacterial organismorganism

PMNsPMNs

Chronic OsteomyelitisChronic Osteomyelitis

RadiographicRadiographic–– Often best seen in lateral oblique Often best seen in lateral oblique

radiographic viewradiographic view–– Radiolucent and radiodense Radiolucent and radiodense

118118

Condylar HyperplasiaCondylar Hyperplasia

ClinicalClinical–– Irregular, elongated condyleIrregular, elongated condyle–– Chin deviates Chin deviates awayaway from affected side upon from affected side upon

119119

yy ppclosure closure

DensDens--inin--dente (dens invaginatus)dente (dens invaginatus)

ClinicalClinical–– Most often found in anterior jaw, especially Most often found in anterior jaw, especially

maxillary lateral incisormaxillary lateral incisor

120120

21

PeriapicalPeriapical Cyst and GranulomaCyst and Granuloma

ClinicalClinical–– Nonvital tooth, at apexNonvital tooth, at apex

RadiographicRadiographic

121121

–– Periapical lucency with thin radiopaque line = Periapical lucency with thin radiopaque line = reaction to apical inflammatory diseasereaction to apical inflammatory disease

Dentin DysplasiaDentin Dysplasia

ClinicalClinical–– Dentin abnormal with Dentin abnormal with

exposureexposure–– Draining fistulasDraining fistulas

122122

–– Misshapen teethMisshapen teeth

RadiographicRadiographic–– Type 1 Type 1 –– “rootless” teeth“rootless” teeth–– Periapical lucencies Periapical lucencies

(Hypohydrotic) Ectodermal (Hypohydrotic) Ectodermal DysplasiaDysplasia

Exhibits hypodontia (anodontia)Exhibits hypodontia (anodontia) Hypohidrotic Hypohidrotic -- common type common type

–– Lack of skin appendages and hairLack of skin appendages and hair–– Heat intoleranceHeat intolerance

123123

Heat intoleranceHeat intolerance

Epulis FissuratumEpulis Fissuratum

ClinicalClinical–– Hyperplastic connective tissue like fibromaHyperplastic connective tissue like fibroma–– Associated with illAssociated with ill--fitting denture flangefitting denture flange–– Treatment does NOT include antibiotic therapyTreatment does NOT include antibiotic therapy

124124

Gingival Cyst of the AdultGingival Cyst of the Adult ClinicalClinical

–– Soft tissueSoft tissue–– Facial attached gingivaFacial attached gingiva

Mandibular anterior most oftenMandibular anterior most often–– Elevated, fluid containing so a vesicleElevated, fluid containing so a vesicle

125125

Heavy Metal Systemic Heavy Metal Systemic IntoxicationIntoxication

ClinicalClinical–– Lead lineLead line

Blue line that parallels free marginal gingivaBlue line that parallels free marginal gingiva

126126

22

HemangiomaHemangioma

127127

ClinicalClinical–– HamartomaHamartoma–– Red to blue elevated lesionsRed to blue elevated lesions–– Blanches, compressibleBlanches, compressible

HistologyHistology–– Collection of small or large vessels filled with red Collection of small or large vessels filled with red

blood cellsblood cells

LymphangiomaLymphangioma ClinicalClinical

–– LymphLymph--filled superficial vesselsfilled superficial vessels–– Most common cause of macroglossiaMost common cause of macroglossia

128128

HypercementosisHypercementosis ClinicalClinical

–– Vital mandibular first molarVital mandibular first molar–– Generalized in acromegalyGeneralized in acromegaly–– Also seen, at times, in Paget’sAlso seen, at times, in Paget’s

RadiographicRadiographic

129129

–– Radiopacity with intact PDLRadiopacity with intact PDL–– Attached to root surfaceAttached to root surface

CementoblastomaCementoblastoma

Infectious MononucleosisInfectious Mononucleosis ClinicalClinical

–– Cervical swelling, lateralCervical swelling, lateral–– Sore throatSore throat–– Teenagers most oftenTeenagers most often

130130

–– Positive monospot testPositive monospot test–– EpsteinEpstein--Barr virus association Barr virus association

palatal petechiaepalatal petechiae

Internal vs. External Tooth Internal vs. External Tooth ResorptionResorption

Clinical Clinical –– pink tooth when crown involved with pink tooth when crown involved with internal typeinternal type

RadiographicRadiographic–– Cannot tell difference early in the processCannot tell difference early in the process–– Round or ovoid radiolucencyRound or ovoid radiolucency

131131

–– Round or ovoid radiolucencyRound or ovoid radiolucency

Irradiation TherapyIrradiation Therapy

Clinical Clinical –– Causes cervical caries secondary to Causes cervical caries secondary to

inducement of xerostomiainducement of xerostomiaD t lt i l iD t lt i l i

132132

–– Does not result in pulp necrosisDoes not result in pulp necrosis

23

Acquired Melanocytic Nevus Acquired Melanocytic Nevus (common mole’; ‘nevus’)(common mole’; ‘nevus’)

ClinicalClinical–– Junctional typeJunctional type

Most likely to undergo Most likely to undergo malignant transformationmalignant transformation

133133

malignant transformation malignant transformation (i.e., melanoma)(i.e., melanoma)

–– Intramucosal typeIntramucosal type Most common oral typeMost common oral type Called intradermal type on skinCalled intradermal type on skin

–– Compound typeCompound type

Kaposi’s SarcomaKaposi’s Sarcoma ClinicalClinical

–– Particular Particular maligmalig. seen in HIV positive . seen in HIV positive individual that progress to AIDSindividual that progress to AIDS

–– EtiologyEtiologyHerpes virus type 8; not HIVHerpes virus type 8; not HIV EBVEBV CMVCMV HPVHPV

134134

Herpes virus, type 8; not HIV, Herpes virus, type 8; not HIV, EBVEBV, , CMVCMV, HPV, HPV

KeratoacanthomaKeratoacanthoma ClinicalClinical

–– Difficult to differentiate from squamous cell Difficult to differentiate from squamous cell carcinoma of the face and lip (and its histology)carcinoma of the face and lip (and its histology)

–– SunSun--exposed skinexposed skin–– Present for many months; spontaneously resolve in Present for many months; spontaneously resolve in

~ 4 months~ 4 months

135135

~ 4 months~ 4 months–– Keratin plug in the center of the ulcerationKeratin plug in the center of the ulceration

KeratoacanthomaKeratoacanthoma

136136

XerostomiaXerostomia Clinical Clinical

–– Dry mouth (subjective)Dry mouth (subjective)–– Can result in retrograde infection of the Can result in retrograde infection of the

salivary glands; baldish, inflamed tonguesalivary glands; baldish, inflamed tongue

137137

Warthin’s tumorWarthin’s tumor(papillary cystadenoma lymphomatosum)(papillary cystadenoma lymphomatosum)

ClinicalClinical–– Primary site overwhelmingly is parotidPrimary site overwhelmingly is parotid

Not in oral cavity; >> malesNot in oral cavity; >> males

138138

y;y;

24

Vitamin C DeficiencyVitamin C Deficiency

ClinicalClinical–– ScurvyScurvy–– Does NOT cause xerostomiaDoes NOT cause xerostomia

139139

Does NOT cause xerostomia Does NOT cause xerostomia

Stafne Defect (salivary gland Stafne Defect (salivary gland depression defect)depression defect)

ClinicalClinical–– Developmental Developmental –– More in males More in males

AsymptomaticAsymptomatic

140140

–– Asymptomatic Asymptomatic –– Teeth vitalTeeth vital

RadiographicRadiographic–– Well demarcated lucency found near the angle of Well demarcated lucency found near the angle of

the mandible beneath the the mandible beneath the mandibular canal mandibular canal

SjSjÖÖgren’s Syndromegren’s Syndrome

ClinicalClinical–– Autoimmune disease; NOT infectious (e.g., herpes)Autoimmune disease; NOT infectious (e.g., herpes)–– Elderly womenElderly women–– Dry eyes, dry mouth = siccaDry eyes, dry mouth = sicca

P tid lliP tid lli

141141

–– Parotid swellingParotid swelling–– Often other autoimmune diseases Often other autoimmune diseases

–– lupus, rheumatoid arthritislupus, rheumatoid arthritis

SarcoidosisSarcoidosis ClinicalClinical

–– Bilateral hilar lymphadenopathy (chest xBilateral hilar lymphadenopathy (chest x--ray)ray)–– Cutaneous lesions Cutaneous lesions -- violaceousviolaceous–– Treatment Treatment –– corticosteroidscorticosteroids

142142

Proliferative Periostitis Proliferative Periostitis (Garre’s)(Garre’s) ClinicalClinical

–– Young person; swelling visibleYoung person; swelling visible

RadiographicRadiographic–– Inferior border of posterior mandible is common site Inferior border of posterior mandible is common site -- Onion Onion

skin pattern (radiographic appearanceskin pattern (radiographic appearance))

143143

Bands of radiopaque lines that parallel cortical surfaceBands of radiopaque lines that parallel cortical surface

PeutzPeutz--Jeghers SyndromeJeghers Syndrome

ClinicalClinical–– Oral and Oral and ParaoralParaoral

Pigmented Pigmented maculesmacules (brown)(brown)–– Lips, tongue, buccal mucosaLips, tongue, buccal mucosa

Vermilion and skin of lipVermilion and skin of lip

144144

–– Vermilion and skin of lipVermilion and skin of lip

–– Intestinal Intestinal polyposispolyposis

25

OsteosarcomaOsteosarcoma ClinicalClinical

–– Swift onset of localized pain Swift onset of localized pain and swelling; tingling lower lip and swelling; tingling lower lip

–– Onset in late 20s, early 30s Onset in late 20s, early 30s Most common primary Most common primary malignancy of bone in persons malignancy of bone in persons less than 25less than 25--yearsyears--oldold

145145

less than 25less than 25 yearsyears oldold

Radiographic Radiographic -- early lucency then opacity; early lucency then opacity; trabeculae changes; PDL symmetrical wideningtrabeculae changes; PDL symmetrical widening

OsteoporosisOsteoporosis

ClinicalClinical–– Decrease in serum estrogen and Decrease in serum estrogen and

calciumcalcium

146146

calcium calcium –– Older femalesOlder females

OsteopetrosisOsteopetrosis ClinicalClinical

–– Massive overproduction of dense, nonvital bone of Massive overproduction of dense, nonvital bone of both jawsboth jaws

–– Young persons or adultsYoung persons or adults–– Expansion Expansion

147147

–– Frequent complicationFrequent complication Secondary osteomyelitisSecondary osteomyelitis

OsteopetrosisOsteopetrosis

148148

OsteomaOsteoma ClinicalClinical

–– Most common site is angle of mandibleMost common site is angle of mandible

RadiographicRadiographic–– WellWell--circumscribed radiopacitycircumscribed radiopacity

149149

WellWell circumscribed radiopacity circumscribed radiopacity

Mandibular FractureMandibular Fracture

ClinicalClinical–– Often diagnosed with two radiographsOften diagnosed with two radiographs

Panoramic and occlusalPanoramic and occlusal

150150

26

Mandibular Malignant Ominous Mandibular Malignant Ominous SignSign

ClinicalClinical–– Spontaneous paresthesia of the lower lipSpontaneous paresthesia of the lower lip

151151

Mandibular TorusMandibular Torus

Radiographic Radiographic –– May be superimposed over periapical region May be superimposed over periapical region

as radiodensitiesas radiodensities

152152

Malignant MelanomaMalignant Melanoma

ClinicalClinical–– Most common oral sitesMost common oral sites

Hard palate and gingivaHard palate and gingiva

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Multiple MyelomaMultiple Myeloma

ClinicalClinical–– Elderly males (high median age)Elderly males (high median age)

Lab FindingsLab FindingsBenceBence Jones proteinuriaJones proteinuria

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–– BenceBence--Jones proteinuriaJones proteinuria–– Immunoglobulin spike Immunoglobulin spike

RadiographicRadiographic–– Multiple bone sitesMultiple bone sites

Calvaria, spine, pelvic girdle, jawsCalvaria, spine, pelvic girdle, jaws

–– PunchedPunched--out lucenciesout lucencies

Necrotizing SialometaplasiaNecrotizing Sialometaplasia

ClinicalClinical–– Rapid onsetRapid onset–– Deep ulceration of the palate (most common Deep ulceration of the palate (most common

it ) ft i iti l lli lfit ) ft i iti l lli lf l il i

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site) after initial swelling; selfsite) after initial swelling; self--resolvingresolving

Cervical emphysemaCervical emphysema

Introduction of air into oral soft tissues with Introduction of air into oral soft tissues with resulting sudden painless swelling and resulting sudden painless swelling and crepitancecrepitance

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–– Ex. Ex. –– air/water syringeair/water syringe

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Odontogenic MyxomaOdontogenic Myxoma

ClinicalClinical–– Young adult onsetYoung adult onset

RadiographicRadiographic–– Closely resemble ameloblastomaClosely resemble ameloblastoma

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Closely resemble ameloblastomaClosely resemble ameloblastoma Multilocular lucency with soap bubble patternMultilocular lucency with soap bubble pattern

Miscellaneous FactsMiscellaneous Facts

Primordial cyst Primordial cyst –– forms in place of a toothforms in place of a tooth Enamel hypoplasia is a temporary suspension Enamel hypoplasia is a temporary suspension

of of amelogenesisamelogenesis FusionFusion –– one less than normal compliment ofone less than normal compliment of

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Fusion Fusion one less than normal compliment of one less than normal compliment of teeth; primary tooth of ant. mandible; separate teeth; primary tooth of ant. mandible; separate root canalsroot canals

Gemination Gemination –– can be confused with fusioncan be confused with fusion Pleomorphic adenoma (benign mixed tumor) Pleomorphic adenoma (benign mixed tumor) ––

most common salivary gland tumormost common salivary gland tumor

Miscellaneous FactsMiscellaneous Facts

The The parotid glandparotid gland body is the most likely salivary body is the most likely salivary gland tissue to have a neoplasmgland tissue to have a neoplasm

OsteoradionecrosisOsteoradionecrosis major factor is damage to the major factor is damage to the vascular supplyvascular supplyPrognosis best for sq cell ca of lower lip comparedPrognosis best for sq cell ca of lower lip compared

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Prognosis best for sq cell ca of lower lip compared Prognosis best for sq cell ca of lower lip compared to to osteosarcomaosteosarcoma, melanoma, , melanoma, adenocarcinomaadenocarcinoma

Most common jaw metastasis site is posterior Most common jaw metastasis site is posterior mandiblemandible

Onion skin radiograph pattern is also seen in Onion skin radiograph pattern is also seen in Ewing’s sarcomaEwing’s sarcoma

DesquamativeDesquamative gingivitis includes gingivitis includes pemphigoidpemphigoid, , pemphiguspemphigus and erosive lichen and erosive lichen planusplanus

Miscellaneous Facts (cont’d)Miscellaneous Facts (cont’d)

Autoimmune diseases more common in womenAutoimmune diseases more common in women Oncocytoma = parotid swelling (tumor)Oncocytoma = parotid swelling (tumor) Gingival hyperplasia Gingival hyperplasia –– drugs such as cyclosporine, drugs such as cyclosporine,

nifedipine (Procardianifedipine (Procardia®®) phenytoin (Dilantin) phenytoin (Dilantin®®))

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nifedipine (Procardianifedipine (Procardia®®) phenytoin (Dilantin) phenytoin (Dilantin®®)) Malignant jaw lesions destroy the cortical plates of Malignant jaw lesions destroy the cortical plates of

bonebone Gingival condition with no improvement after two Gingival condition with no improvement after two

months should be biopsiedmonths should be biopsied Dysplasia Dysplasia –– abnormal maturation of the epitheliumabnormal maturation of the epithelium

Epithelial Dysplasia Epithelial Dysplasia

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Radiology FactsRadiology Facts

•• XX--ray has the shortest wavelength and the ray has the shortest wavelength and the highest energy; high voltage has the same highest energy; high voltage has the same characteristics characteristics

•• When milliamperage is doubled the intensity ofWhen milliamperage is doubled the intensity of

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•• When milliamperage is doubled the intensity of When milliamperage is doubled the intensity of an xan x--ray beam is doubledray beam is doubled

Kilovoltage (kVP) primarily controls contrast Kilovoltage (kVP) primarily controls contrast and is the penetrating characteristic of an xand is the penetrating characteristic of an x--rayray

XX--ray penetration is determined by kVPray penetration is determined by kVP Focal spot size primarily influences resolutionFocal spot size primarily influences resolution

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Radiology Facts (cont’d)Radiology Facts (cont’d)

First sign of damage from acute radiation First sign of damage from acute radiation exposure (4 Gy) is erythema exposure (4 Gy) is erythema

Most radioresistant tissue is nerve and Most radioresistant tissue is nerve and

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muscle cell; most sensitive is hematopoeticmuscle cell; most sensitive is hematopoetic Basic shadow casting principle with the Basic shadow casting principle with the

paralleling technique does not fulfill the paralleling technique does not fulfill the physics requirement of the distance from physics requirement of the distance from the object to the recording surface should the object to the recording surface should be as short as possiblebe as short as possible

Radiology Facts (cont’d)Radiology Facts (cont’d) The density of processed film is not affected by The density of processed film is not affected by

overfixation but is affected byoverfixation but is affected by–– Increase mAIncrease mA–– Increase exposure time Increase exposure time –– Decreased objectDecreased object--thickness distancethickness distance–– Decreased targetDecreased target--object distanceobject distance

B i i fil f i i i l d fB i i fil f i i i l d f

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Best imaging film for viewing internal derangement of Best imaging film for viewing internal derangement of the TMJ (e.g., articular disc) is an MRIthe TMJ (e.g., articular disc) is an MRI

Identify Normal:Identify Normal:–– Zygomatic process and base; intermaxillary suture Zygomatic process and base; intermaxillary suture –– Lingual foramen; incisive foramen; genial tubercles Lingual foramen; incisive foramen; genial tubercles –– Mylohyoid ridge; nutrient canalsMylohyoid ridge; nutrient canals–– Inverted Y of EnnisInverted Y of Ennis–– Maxillary sinusMaxillary sinus–– Tuberosity; hyoid bone; nose shadow (ant. periapical film)Tuberosity; hyoid bone; nose shadow (ant. periapical film)–– Hard palate; tori; anterior nasal spine; stylohyoid ligamentHard palate; tori; anterior nasal spine; stylohyoid ligament

Radiology Facts (cont’d)Radiology Facts (cont’d)

Intensifying screens are used to decrease Intensifying screens are used to decrease exposure time, reduce radiation exposureexposure time, reduce radiation exposure

88--bit digital image would have 256 shades of bit digital image would have 256 shades of graygray

Complication of radiation treatment in children Complication of radiation treatment in children

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ppdoes NOT include supernumerary teeth but does NOT include supernumerary teeth but does include:does include:–– Stunted rootsStunted roots–– MicrognathiaMicrognathia–– Condylar hyperplasiaCondylar hyperplasia–– MalocclusionMalocclusion

Coin testsCoin tests–– Used for detection of light leakageUsed for detection of light leakage

Radiology Facts (cont’d)Radiology Facts (cont’d)

Double the distance from the radiation source Double the distance from the radiation source then the radiation becomes diminished by a then the radiation becomes diminished by a factor of 4 (i.e., inverse square law)factor of 4 (i.e., inverse square law)

Latent period = radiobiology time between Latent period = radiobiology time between exposure and biologic onset of symptoms; notexposure and biologic onset of symptoms; not

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exposure and biologic onset of symptoms; not exposure and biologic onset of symptoms; not cell exposure and free radical formationcell exposure and free radical formation

Radiograph is rinsed with water to accomplish Radiograph is rinsed with water to accomplish getting rid of chemicals (not remove emulsion, getting rid of chemicals (not remove emulsion, diminish silver particles, remove latent image)diminish silver particles, remove latent image)

ArtifactArtifact–– Bitewing radiograph with a curved dark line through Bitewing radiograph with a curved dark line through

contact points of adjacent crowns = a break in the contact points of adjacent crowns = a break in the emulsion from film bendingemulsion from film bending

Radiology Facts (cont’d)Radiology Facts (cont’d)

A light radiograph is NOT caused by a long A light radiograph is NOT caused by a long process timeprocess time

An MRI is narrow frequency radiation of the An MRI is narrow frequency radiation of the electromagnetic spectrumelectromagnetic spectrum

The filter in a dental xThe filter in a dental x--ray machine is made ofray machine is made of

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The filter in a dental xThe filter in a dental x ray machine is made of ray machine is made of aluminumaluminum

A charged coupled device (CCD) converts xA charged coupled device (CCD) converts x--rays to electrical signals but does NOT result in rays to electrical signals but does NOT result in the same average absorbed dose as the same average absorbed dose as conventional radiology (less absorbed dose)conventional radiology (less absorbed dose)

Effective dose =comparison of the radiation Effective dose =comparison of the radiation risk in humans from different radiographic risk in humans from different radiographic exams and doses/sourcesexams and doses/sources

Radiology Facts (cont’d)Radiology Facts (cont’d)

Collimating an xCollimating an x--ray beam results in an ray beam results in an increaseincrease of the penetration of xof the penetration of x--ray photonsray photons

Radon is the greatest source of background Radon is the greatest source of background radiation on earthradiation on earth

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ad at o o ea tad at o o ea t Basic components of an xBasic components of an x--ray cathode ray ray cathode ray

tube consists of a filament and a focusing tube consists of a filament and a focusing cupcup

To change from long scale intensity (low To change from long scale intensity (low contrast) to short scale intensity (high contrast) to short scale intensity (high contrast) but maintain image density, the contrast) but maintain image density, the operator should decrease kVp and increase operator should decrease kVp and increase mAsmAs

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Radiology Facts (cont’d)Radiology Facts (cont’d)

Panoramic radiograph with one second of Panoramic radiograph with one second of movement by patient results in wavy inferior border movement by patient results in wavy inferior border of the mandible and unsharp image vertically across of the mandible and unsharp image vertically across the image at that sitethe image at that site

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Major biologic damage from ionizing radiation is Major biologic damage from ionizing radiation is primarily due to primarily due to radiolysisradiolysis of the water moleculesof the water molecules

Electrons flow from cathode to anode with the Electrons flow from cathode to anode with the energy converted to heatenergy converted to heat

Recognize MRI and CT filmsRecognize MRI and CT films Recognize technical errorsRecognize technical errors

–– Incorrect beam centering (“cone cut”)Incorrect beam centering (“cone cut”)–– Blurring due to patient movementBlurring due to patient movement

Radiology Facts (cont’d)Radiology Facts (cont’d)

Penumbra Penumbra –– the geometric unsharpness the geometric unsharpness with a fuzzy area surrounding the contours with a fuzzy area surrounding the contours of the teeth and osseous tissuesof the teeth and osseous tissues

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An intensifying screen is used with external An intensifying screen is used with external radiographs to decrease the radiation radiographs to decrease the radiation exposureexposure

The oil unit of an xThe oil unit of an x--ray tube housing ray tube housing functions to dissipate heat from the targetfunctions to dissipate heat from the target