Contents
Chapter 01: Introduction to Preliminary Diagnosis of Oral Lesions ........................................................................................ 1
Chapter 02: Inflammation and Repair ......................................................................................................................................... 18
Chapter 03: Immunity and Immunologic Oral Lesions............................................................................................................ 38
Chapter 04: Infectious Diseases .................................................................................................................................................... 58
Chapter 05: Developmental Disorders ........................................................................................................................................ 76
Chapter 06: Genetics ...................................................................................................................................................................... 95
Chapter 07: Neoplasia .................................................................................................................................................................. 123
Chapter 08: Nonneoplastic Diseases of Bone .......................................................................................................................... 152
Chapter 09: Oral Manifestations of Systemic Diseases ........................................................................................................... 163
Chapter 10: Orofacial Pain and Diseases Affecting the Temporomandibular Joint .......................................................... 185
Chapter 01: Introduction to Preliminary Diagnosis of Oral Lesions
MULTIPLE CHOICE
1. Which descriptive term is described as a segment that is part of the whole?
a. Bulla
b. Vesicle
c. Lobule
d. Pustule
ANS: C
A lobule is described as a segment or lobe that is part of a whole. A bulla is a large, elevatedlesion that
contains serous fluid and may look like a blister. A vesicle is a small, elevated lesion that contains serous
fluid. Pustules are circumscribed elevations containing pus.
REF: Vocabulary, Clinical of Soft Tissue Lesions, page 1 OBJ: 1
2. A lesion with a sessile base is described as
a. an ulcer.
b. stemlike.
c. pedunculated.
d. flat and broad.
ANS: D
Sessile describes the base of a lesion that is flat and broad. An ulcer is a break in the surface epithelium. A
stemlike lesion is referred to as pedunculated. A pedunculated lesion is stemlikeor stalk-based (similar to a
mushroom).
REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1
OBJ: 1
3. Which condition is not diagnosed through clinical appearance?
a. Mandibular tori
b. Fordyce granules
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, c. Black hairy tongue
d. Compound odontoma
ANS: D
The compound odontoma is initially identified radiographically as a radiopaque area in whichtooth
structure can be identified. No clinical component exists. Mandibular tori are identified clinically as areas
of exostosis on the lingual aspects of mandibular premolars. Fordyce granules are yellow clusters of
ectopic sebaceous glands diagnosed through clinical appearance. Black hairy tongue is diagnosed clinically.
The filiform papillae on the dorsal tongue elongate and become brown or black. Causes include tobacco,
alcohol, hydrogen peroxide, chemical rinses, antibiotics, and antacids.
REF: Radiographic Diagnosis, page 9 OBJ: 3
4. Another name for geographic tongue is
a. median rhomboid glossitis.
b. benign migratory glossitis.
c. fissured tongue.
d. black hairy tongue.
ANS: B
Benign migratory glossitis is another name for geographic tongue. Research suggests that median
rhomboid glossitis is associated with a chronic fungal infection from Candida albicans. Sometimes the
condition resolves with antifungal therapy. Fissured tongue is seen in5% of the population. It is a variant
of normal. Genetic factors are typically associated with the condition. Black hairy tongue is caused by a
reaction to chemicals, tobacco, hydrogen peroxide, or antacids. The filiform papillae on the dorsal tongue
become elongated and are dark brown to black.
REF: Geographic Tongue, page 24 OBJ: 7
5. This bony hard structure in the midline of the hard palate is genetic in origin and inherited inan
autosomal dominant manner. The diagnosis is made through clinical appearance. Which condition is
suspected?
a. Palatal cyst
b. Torus palatinus
c. Mixed tumor
d. Ranula
ANS: B
A torus palatinus is developmental and bony hard and is found on the midline of the palate. Diagnosis is
made on the basis of clinical appearance. A palatal cyst appears radiolucent on a radiographic examination
and is not diagnosed through clinical appearance. A mixed tumor orpleomorphic adenoma is a benign
tumor of salivary gland origin, found unilaterally off the midline of the hard palate. It is composed of
tumor tissue that is not bony hard to palpation.
Ranula is a term used for a mucocele-like lesion that forms unilaterally on the floor of themouth.
REF: Torus Palatinus, page 21 OBJ: 4
6. The gray-white opalescent film seen on the buccal mucosa of 85% of black adults is a variantof normal
that requires no treatment and is termed
a. linea alba.
b. leukoedema.
c. leukoplakia.
d. white sponge nevus.
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, ANS: B
Leukoedema is a diffuse opalescence most commonly seen on the buccal mucosa in black individuals.
Linea alba is a “white line” that extends anteroposteriorly on the buccal mucosa along the occlusal plane.
It is most prominent in patients who have a clenching or grinding habit. Leukoplakia is a clinical term for a
white lesion, the cause of which is unknown. Whitesponge nevus is a genetic (autosomal dominant) trait.
Clinically, it is characterized by a soft white, folded (or corrugated) oral mucosa. A thick layer of keratin
produces the whitening.
REF: Leukoedema, page 23 OBJ: 8
7. Which condition most likely responds to therapeutic diagnosis?
a. Angular cheilitis
b. Amelogenesis imperfecta
c. Paget disease
d. Stafne bone cyst
ANS: A
Angular cheilitis most commonly responds to antifungal therapy once nutritional deficiencies have been
ruled out. Amelogenesis imperfecta is a genetic condition associated with abnormaldevelopment of the
enamel. Paget disease is a chronic metabolic bone disease. A highly elevated serum alkaline phosphatase
level contributes significantly to the diagnosis. A Stafne bone cyst is determined through surgical diagnosis
in which entrapped salivary gland tissue isidentified.
REF: Therapeutic Diagnosis, page 18 OBJ: 3
8. The gingival enlargement in this patient was caused by a calcium channel blocker.Which
medication is the likely cause?
a. Dilantin
b. Nifedipine
c. Quinidine
d. Clozapine
ANS: B
Nifedipine is a calcium channel blocker. Dilantin is an anticonvulsant used to prevent orcontrol seizures.
Quinidine is an antiarrhythmic agent used to treat cardiac arrhythmias. Clozapine is an antipsychotic used
in the management of psychotic symptoms in schizophrenia.
REF: Historical Diagnosis, Fig. 1.38, page 17 OBJ: 3
9. Radiographic features, including cotton-wool radiopacities and hypercementosis, areespecially
helpful in the diagnosis of
a. Paget disease.
b. dentinogenesis imperfecta.
c. anemia.
d. diabetes.
ANS: A
Paget disease is a chronic metabolic bone disease. Radiographically, cotton-wool radiopacitiesand
hypercementosis are characteristic features. Dentinogenesis imperfecta is a genetic condition involving a
defect in the development of dentin. Anemia, a decrease in red blood cells, requires blood tests to
determine the etiologic factors. Diabetes is a chronic disorder of carbohydrate metabolism characterized
by abnormally high blood glucose levels.
REF: Laboratory Diagnosis, Fig. 1.40, pages 16, 18 OBJ: 3
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, 10. In internal resorption, the radiolucency seen on radiographic examination is usually
a. well circumscribed.
b. diffuse.
c. multilocular.
d. unilocular.
ANS: B
Diffuse borders are ill defined, making it impossible to detect the exact parameters of the lesion.
Therefore treatment is more difficult. Well circumscribed describes borders that are specifically defined.
Exact margins of the lesion are identified. Multilocular has also been described as resembling “soap
bubbles”; lobes seem to fuse together to make up the lesion. This term has been used to describe the
odontogenic keratocyst. Unilocular means having onecompartment or unit that is well defined. This term is
often used to describe the radicular cyst.
REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5
OBJ: 1
11. Which condition is diagnosed through clinical appearance?
a. Fordyce granules
b. Unerupted mesiodens
c. Periapical cemento-osseous dysplasia
d. Traumatic bone cyst
ANS: A
Fordyce granules are diagnosed on the basis of their clinical appearance. They are ectopic sebaceous
glands seen on the lips and buccal mucosa. Clinically, they appear as yellow lobules in clusters and are
considered a variant of normal. Unerupted mesiodens requires aradiographic image for diagnosis.
Periapical cemento-osseous dysplasia requires a radiographic image, specific patient history, and a pulp
test to evaluate tooth vitality.
Traumatic bone cyst requires a radiographic image and surgical intervention to establish adiagnosis.
REF: Clinical Diagnosis, page 7 | Fordyce Granules, page 20 OBJ: 3
12. Retrocuspid papillae are located on the
a. palate.
b. floor of the mouth.
c. gingival margin of the lingual aspect of mandibular cuspids.
d. canine eminence.
ANS: C
Retrocuspid papillae are located on the gingival margin of the lingual aspect of mandibularcuspids.
Retrocuspid papillae are not located on the palate. Retrocuspid papillae are not located on the floor of
the mouth. Retrocuspid papillae are not located on the canine eminence.
REF: Retrocuspid Papilla, page 22 OBJ: 3
13. Which condition is not considered a variant of normal?
a. Fordyce granules
b. Leukoedema
c. Linea alba
d. Pyogenic granuloma
ANS: D
Pyogenic granuloma is a reactive inflammatory response to injury. It is not a variant of normal. Fordyce
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