Oral Pathology and Diagnosis Flashcards

A 25-year-old female presents with multiple, asymptomatic, bilateral, white, folded lesions on her buccal mucosa. The lesions have a spongy texture and have been present since childhood. When the mucosa is stretched, the whiteness diminishes. Her family history reveals that her mother has a similar condition. Which of the following is the most likely diagnosis?

Answer: White Sponge Nevus

White Sponge Nevus is a rare, benign, inherited condition characterized by thick, white, and spongy plaques, typically affecting the buccal mucosa bilaterally. Its onset in childhood and familial link are key diagnostic features. Leukoedema also appears as a diffuse, grayish-white lesion but typically disappears when the cheek is stretched. Lichen Planus often presents with a lace-like pattern (Wickham's striae) and is less commonly seen in early childhood. Candidiasis is an infection that can usually be wiped off, leaving a red, bleeding surface.

A panoramic radiograph of a 16-year-old male reveals a well-defined, unilocular radiolucency associated with the crown of an unerupted mandibular third molar. The lesion is asymptomatic. Which of the following is the most probable diagnosis?

Answer: Dentigerous Cyst

A dentigerous cyst is a developmental odontogenic cyst that encloses the crown of an unerupted tooth and is attached at the cementoenamel junction. It is the most common developmental cyst of the jaws and frequently involves mandibular third molars. While ameloblastomas and odontogenic keratocysts can have a similar appearance, a dentigerous cyst is the most common lesion fitting this classic radiographic presentation. A radicular cyst is associated with the apex of a non-vital tooth, not the crown of an unerupted one.

A 55-year-old male, who is a heavy smoker and consumes alcohol regularly, presents with a persistent, velvety red patch on the floor of his mouth. The lesion is asymptomatic and does not rub off. What is the most appropriate next step in management?

Answer: Perform an incisional biopsy

The lesion described is clinically consistent with erythroplakia, which has a very high potential for malignant transformation to squamous cell carcinoma. Given the high-risk location (floor of the mouth) and the patient's risk factors (smoking, alcohol), an incisional biopsy is mandatory to establish a definitive diagnosis and rule out malignancy. Delaying diagnosis or treating it as a fungal infection would be inappropriate.

A patient with Crohn's disease presents for a routine dental examination. Which of the following oral manifestations is most commonly associated with this systemic condition?

Answer: Cobblestone appearance of the buccal mucosa

Crohn's disease, an inflammatory bowel disease, can have various oral manifestations. One of the most characteristic findings is a cobblestone appearance of the oral mucosa, along with deep, linear ulcerations and mucosal tags. Atrophic glossitis is more commonly associated with nutritional deficiencies like iron, B12, or folate deficiency. Bilateral parotid enlargement is linked to conditions like Sjögren's syndrome or diabetes. Strawberry gingivitis is a rare but pathognomonic sign of granulomatosis with polyangiitis (formerly Wegener's granulomatosis).

Which of the following is the most common benign salivary gland tumor, typically presenting as a slow-growing, painless, firm mass, most often in the parotid gland?

Answer: Pleomorphic Adenoma

Pleomorphic adenoma (also known as a benign mixed tumor) is the most common salivary gland neoplasm, accounting for the majority of tumors in the parotid gland. It is characterized by its slow, painless growth. Mucoepidermoid carcinoma is the most common malignant salivary gland tumor. Adenoid cystic carcinoma is another malignant tumor known for perineural invasion. Warthin's tumor is a benign tumor almost exclusively found in the parotid gland, often in older male smokers.

A patient presents with bilateral, lacy, white striations (Wickham's striae) on the buccal mucosa. The patient reports occasional soreness, especially with spicy foods. What is the most likely diagnosis?

Answer: Lichen Planus

The clinical description of bilateral, lacy white striations (Wickham's striae) is the classic presentation of reticular oral lichen planus. It is a chronic inflammatory condition that can also have erosive or ulcerative forms, leading to symptoms of soreness. Oral candidiasis typically presents as white plaques that can be wiped off. Pemphigus vulgaris and Erythema Multiforme are vesiculobullous diseases characterized by more severe ulceration and blistering.