differential diagnosis of oral masses
TRANSCRIPT
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Differential Diagnosis of Oral MassesGingival Lesions
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Gingival/Alveolar Ridge Masses• Parulis• Periodontal Abscess• Tori and Exostoses• Reactive Proliferations• Peripheral Odontogenic Cysts• Peripheral Odontogenic Tumors• Squamous Cell Carcinoma• Expansile Central Bone Tumors
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Parulis
• Buccal or Lingual• Odontogenic Source of Infection• Nonvitall Tooth• Periapical Radiolucency• Purulent exudate• Gutta purcha/radiographic tracer
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Parulis
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Periodontal Abscess
• Erythematous• Deep Periodontal Pocket• Alveolar Bone Loss• Vital Teeth• Pululence upon Probing• Diabetes Mellitus
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Periodontal Abscess
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Torus Mandibularis
• Bilateral Lingual Premolar Region• Adult Onset• Lobulated, Bone Hard• May become ulcerated• May interfere with prostheses
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Mandibular Tori
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Exostoses
• Typically buccal posterior• May occur anywhere on alveolus• Adult onset• Bone hard• May interfere with prostheses
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Exostoses
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Congenital Epulis
• Bosselated tumor of the anterior alveolar ridge in newborns
• Maxilla > Mandibular ridge• Microscopic: tumor is comprised of large
granular cells with small nuclei. IHC staining is suggestive of smooth muscle origin
• Tx:Simple excision, excellent prognosis
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Congenital Epulis of the Newborn
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Reactive Lesions of the Gingiva
• Pyogenic Granuloma– Pregnancy Tumor
• Peripheral Fibroma• Peripheral Ossifying Fibroma• Peripheral Giant Cell Granuloma
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Reactive Lesions of the Gingiva
• All tend to occur during 2nd/3rd decades• Females>Males• Interdental Papilla most commonly• Irritant in Sulcus
– Foreign substance, physical irritant– Calculus
• Vary in aggressiveness
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Color Characteristics of Reactive Gingival Masses
• RED – Pyogenic Granuloma• PINK – Peripheral Ossifying Fibroma
– Peripheral Fibroma• BLUE/PURPLE – Peripheral Giant Cell
Granuloma
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Pyogenic Granuloma
• Bright red, often ulcerated pseudomembrane• Granulation tissue• Pyogenic Bacteria are not etiologic• Growth is superfical, rarely causing
underlying bone loss• Treatment: excision, thorough curettage
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Pyogenic Granuloma
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Pyogenic Granuloma
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Peripheral Fibroma
• De Novo, or sclerosis of a Pyogenic Granuoma
• Interdental Papilla• Coral Pink or White• Noninvasive• Histology
– Reactive Fibrous Hyperplasia– Giant Cell Variant– Fasciculated Spindle Cell variant
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Peripheral Fibroma
Giant Cell Fibroma
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Retrocuspid PapillaA fibrous papule, mandibular cuspid lingual gingiva
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Peripheral Fibroma• Fibrous Hyperplasia
• Giant Cell Variant
• Fasiculated Variant
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Peripheral Ossifying Fibroma
• Arises from PDL• Not seen in edentulous regions• Coral Pink or White• Opacities may be seen on Xray• Hypercellular Fibroblastic
– Osseous, cemental, dystrophic calcifications
• Excise down to PDL
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Peripheral Ossifying Fibroma
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Peripheral Ossifying Fibroma
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Peripheral Giant Cell Granuloma
• Arises from Periostium• Dentulous or Edentulous Regions• Bluish Purple• Invasive, erodes underlying bone• Hypercellular Fibrovascular
– Multinucleated Giant Cells
• Excise deeply, subperiosteal
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Peripheral Giant Cell Granuloma
erosion Earlyrecurrence
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Peripheral Giant Cell Granuloma
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Peripheral Odontogenic Cysts and Tumors
• Cysts– Dental Lamina Cysts of the Newborn– Adult Gingival Cyst– Peripheral CEOC (Gorlin)
• Tumors– Ameloblastoma– Calcifying Epithelial Odontogenic Tumor– Dentinogenic Ghost Cell Tumor– Odontogenic fibroma
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Gingival Cysts• Dental Lamina Cyst
– Edentulous ridges of newborn– Keratinizing diminutive cysts– Spontaneous resolution
• Adult Gingival Cyst– Buccal Attached Gingiva– Peripheral Counterpart to Lateral
Periodontal Cyst– Nonkeratinizing (squamous/cuboidal)
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Dental Lamina Cyst of the Newborn
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Adult Gingival Cyst
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Mesenchymal tumors
neurofibroma
hemangioma
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Peripheral Odontogenic Tumors are Not Aggressive
• Gingiva and Tooth Bearing Alveolar Ridge• May erode underlying bone• Simple excision• Histologic Types:
– Ameloblastoma– Calcifying Epithelial Odontogenic Tumor– Dentinogenic Ghost Cell Tumor– Odontogenic fibroma
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Peripheral Odontogenic Tumors• Odontogenic Ghost Cell tumor • Odontogenic Fibroma
Peripheral Ameloblastoma
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Peripheral Odontogenic Tumors• Ameloblastoma
• Pindborg (CEOT)
• Gorlin Cyst (OGCT)
• Odontogenic Fibroma
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Squamous Cell Carcinoma
• Indurated and Ulcerated Mass• Mandibular gingiva>Maxillary• Associated Risk Factors• Periosteal and Osseous Invasion• Regional and Distant Mets• Resection and XRT
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Squamous Cell Carcinoma
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Squamous Cell Carcinoma
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Metastatic Carcinoma
Primary inkidney
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Intraosseous Lesions
• Infections• Cysts• Odontogenic Tumors• Nonodontogenic Tumors
Most are diffuse, fusifornenlargements of the alveolus
Radiographs will disclose a central lesion
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Diffuse Gingival Enlargments
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Diffuse Gingival Enlargement• Hormonal Gingivitis
– Pregnancy, Puberty• Drug Induced Hyperplasia
– Dilantin, Cyclosporin, Calcium Channel Blockers
• Fibromatosis Gingivae• Plasma Cell Gingivitis• Wegener’s Granulomatosis• Leukemia
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Plasma Cell Gingivitis
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Cyclosporin
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Dilantin
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Pregnancy Gingivitis
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Leukemia
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Wegener’s Granulomatosis
“strawberry gums”