NEET MDS Lessons
Oral Pathology
Infantile Osteomyelitis
- Osteomyelitis Maxillaries Neonatarum, Maxillitis of infancy
- Osteomyelitis in the jaws of new born infants occurs almost exclusively in maxilla.
Etiology
- Trauma – through break in mucosa cause during delivery.
- Infection of maxillary sinus
- Paunz & Ramon et al believe that disease caused through infection from the nose.
- Hematogenous spread through streptococci & pneumococci
Clinical features
- Fever, anorexia & intestinal disturbances.
- swelling or redness below the inner canthus of the eye in lacrimal region.
- Followed by marked edema of the eyelids on the affected side.
- Next, alveolus & palate in region of first deciduous molar become swollen.
- Pus discharge from affected sites
D/D for Infantile Osteomyelitis
- Dacrocystitis neonatarum
- Orbital cellulitis
- Ophthalmia neonatarum
- Infantile cortical hyperostosis
TREATMENT
- Intravenous antibiotics, preferably penicillin.
- Culture & sensitivity testing
- Incision & drainage of fluctuant areas
- Sequestrectomy
- Supportive therapy
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Actinomycosis (Sulfur Granules):
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Yellow sulfur granules: Are actually bacterial colonies.
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Histopathology: Colonies appear "cotton wool" shaped. (Note: "Cotton wool appearance" is seen radiographically in Paget's disease).
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Tuberculosis (TB):
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Diagnosis (Gold Standard): Presence of acid-fast bacilli in sputum.
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Staining Method: Ziehl-Neelsen staining method is used to identify acid-fast bacilli.
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Scrofula: TB of cervical lymph nodes.
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Lupus Vulgaris: TB of skin.
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Tongue & Gingival Appearance in Systemic Conditions:
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Strawberry tongue and Raspberry tongue: Seen in stomatitis of Scarlet Fever.
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Strawberry Gingivitis: Seen in Wegener's Granulomatosis.
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Benign Migratory Glossitis
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Also called Erythema migrans, wandering rash, or geographic tongue.
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Associated with fissured tongue.
Fissured Tongue
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Seen in:
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Melkersson-Rosenthal syndrome
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Down syndrome
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Benign migratory glossitis
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Melkersson-Rosenthal Syndrome
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Triad:
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Bell’s palsy
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Cheilitis granulomatosa (lip/facial swelling)
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Fissured tongue
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Ankyloglossia
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Tongue-tie may cause speech defects.
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Affects articulation of: l, r, t, d, n, th, sh, z
Intraepithelial Bulla
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Location: Within the epithelium
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Associated Conditions:
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Herpes simplex
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Herpes zoster
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Chicken pox
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Pemphigus
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Hailey-Hailey disease (Familial benign pemphigus)
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Epidermolysis bullosa (dystrophic recessive form)
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Oral lesions of erythema multiforme
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Subepithelial Bulla
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Location: Below the epithelium
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Associated Conditions:
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Pemphigoid
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Bullous pemphigoid (most common subepithelial blistering disease)
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Bullous lichen planus
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Dermatitis herpetiformis
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Epidermolysis bullosa
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Skin lesions of erythema multiforme
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Leukoplakia
- Type: Clinical term
- Histology: Hyperkeratosis ± Dysplasia
Verrucous Carcinoma
- Type: Variant of SCC
- Features:
- Intact basement membrane
- Parakeratin plugging
- Broad "elephant-foot" rete ridges
Adenosquamous Carcinoma
- Features: Mixed adenocarcinoma + SCC
Streptococcus mutans Mechanism
- Key Substrate: Sucrose
- Metabolic Pathway: Phosphorylation → Glycolysis → Lactic acid
- Enzymes:
- Invertase: Converts sucrose to glucose + fructose
- Glucosyltransferase (GTF): Forms sticky glucans
- Fructosyltransferase (FTF): Produces fructans
Actinomyces naeslundii
- Fimbriated surface → fuzzy texture
- Type 1 fimbriae: Bind tooth surfaces/collagen
- Type 2 fimbriae: Bind galactose/galactosamine (epithelial/bacterial targets)
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Radicular Cysts: Derived from Rests of Malassez.
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Impacted Canine Associations:
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Most common odontogenic cyst: Dentigerous cyst.
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Most common odontogenic tumor: Adenomatoid Odontogenic Tumor (AOT).
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Eruption Cyst: Considered an extra-alveolar dentigerous cyst (soft tissue counterpart).