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OMPR Exam 3 With Complete Solution
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OMPR Exam 3 With CompleteSolution
What is the most common reactive inflammatory lesion? - Answer Irritation fibroma
Clinical features of irritation fibroma? - Answer exophytic, usually less than 1cm in
diameter, location: buccal, tongue, lips, gingiva, color: lighter pink than surrounding
mucosa
can be sessile OR pedunculated
What causes irritation fibroma and what is it composed of? - Answer Chronic trauma
Composed of dense, scar like, fibrous connective tissue
Pyogenic granuloma: - Answer - reactive CT hyperplasia, exuberant granulation tissue
- response to injury - calculus
- misnomer its NOT pyogenic and NOT a true granuloma
oftern occurs in pregnant women ("pregnancy tumor") also associated with puberty
90% of gingival lesions will be: - Answer The 3 Ps
typically occur in interdental papilla (mostly more anterior, can be max or mandibular)
they can occur, buccally, lingually, or palatally
What's the most common of the 3P lesions? - Answer Pyogenic granuloma (so this would
be at the top of your differential!)
What are the clinical features of pyogenic granuloma? - Answer - usually ulcerated
- soft exophytic lesion, either sessile or pedunculated
- *deep red to purple in color, bleeds easily*
- location: *most common gingiva*, also occurs in other areas of the oral mucosa*** can
happen anywhere!
size: small to large (mm to cm)
develop rapidly then remain static
any age!
Tx of all 3 P lesions? - Answer Excisional biopsy
,and deep SRP of teeth in the area to reduce recurrence
Key microscopic features of pyogenic granuloma? - Answer - multiple variously sized
blood vessels and inflammatory cells (usually acute neutrophils)
What is a parulis? - Answer a proliferation of granulation tissue at the opening of a
fistula
typically in apical area (not interdental papilla)
(be able to differentiate this from a pyogenic granuloma)
What is peripheral giant cell granuloma? Clinical features? - Answer - probably a
reactive lesion, local irritating factors
- location: gingiva, usually anterior to the molars
- age: most frequent between *40-60 yrs*
radiographic features: usually none but superficial destruction of the alveolar bone may
occur
blueish/purple hue
What is clinically intermediate of the 3 Ps? - Answer peripheral giant cell granuloma (its
between pyogenic granuloma and peripheral ossifying fibromas)
Microscopic features of peripheral giant cell granuloma? - Answer very cellular, lots of
extravasated RBCs, *multi nucleated giant cells*
Peripheral Ossifying Fibroma: - Answer - well demarcated, sessile or pedunculated
lesion that appears to originate from the gingival interdental papilla
- derived from cells of the periodontal ligament
- age: children and young adults
- sex: females more than males
- *recurrence rate 16%*
Of the 3 Ps which has the HIGHEST recurrence rate? - Answer Peripheral ossifying
fibroma
16%!
T/F all 3 "P" lesions usually occur on gingival interdental papillae
T/F all are treated the same way - Answer both true
tx: since they can look similar clinically, excisional biopsy necessary to determine
diagnosis, complete excision and removal of local irritant (SRP)
,Epulis fissuratum
Caused by?
Location?
Clinical features?
Tx? - Answer AKA denture induced fibrous hyperplasia, inflammatory hyperplasia
cause: ill fitting denture
location: vestibule (maxilla or mandible) along the denture border
clinical features: arranged in elongated folds of tissue into which the denture flange fits
surface ulceration within folds is common
composed of dense fibrous CT
Tx: surgically excise tissue, denture hygiene, denture reline
What is the most common location for epulis fissuratum? - Answer Maxillary anterior
but can occur anywhere
What is papillary hyperplasia of the palate? - Answer a form of denture stomatitis,
associated with a removable full or partial denture or orthodontic appliance
palatal vault is covered by multiple erythematous papillary projections (fibrous CT
surfaced by epi), *granular or cobblestone appearance*, erythema is usually due to
superinfection with *candida*
Tx of papillary hyperplasia of the palate? - Answer Treat with antifungal like nystatin
ointment in denture base or rinse, cure candida, see whats left, the hyperplasia wont
reverse (denture made around it or maybe laser resurfacing needed)
What is chronic hyperplastic pulpitis?
location?
age?
clinical appearance?
tx? - Answer AKA: pulp polyp
an excessive proliferation of chronically inflamed dental pulp tissue, granulation
tissue/fibrous tissue with inflammatory cells.
location: teeth with large, open carious lesions, primary or permanent molars *typically
primary molars*
, age: children and young adults
clinical appearance: a red or pink nodule of soft tissue protruding from the pulp
chamber and fills the entire cavity of the tooth
tx: RCT or ext of tooth
What are the causes of gingival enlargement (gingival hyperplasia/hypertrophy)? -
Answer - response to chronic inflammation
- idiopathic
- genetic/inherited (gingival fibromatosis)
- drug induced (CCB i.e. nifedipine, phenytoin/dilantin, cyclosporine etc)
- hormonal changes (pregnancy/puberty)
What cancer can present with gingival enlargement? - Answer leukemia!
pt would need CBC and blood work to confirm (increase in WBC and immature bands)
Viral lesions, what is the most common? - Answer Papilloma
Papilloma is caused by what? - Answer HPV typically types 6 and 11 associated with oral
lesions
Common location of papilloma? - Answer tongue, lips, soft palate
often have long finger like projections not always!, can be keratotic or mucosa colored
Microscopic: fibrovascular cores, bumpy projections, *koilocytes* are indicative of: -
Answer papilloma
Verruca vulgaris is caused by:
common or uncommon?
transmission?
location?
clinically? - Answer HPV usually types 2, 4, 6
very common on skin, much less frequent on oral mucosa
contagious self inoculation
location: labial mucosa, tongue
very white and keratotic!!
Micrscopically: lots of keratin!!, bumpy surface, koilocytes (shrunken nucleus, white
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