MJDF Oral & Dental Pathology 4 — Questions and Answers
Question 1: What is the most likely diagnosis when a patient presents with multiple painless cervical lymphadenopathy and persistent oral ulcers not healing after 3 weeks?
- Oral squamous cell carcinoma until proven otherwise — urgent 2-week wait referral required (Correct answer)
- Aphthous ulcers
- Herpes labialis
- Vitamin B12 deficiency
Correct answer: Oral squamous cell carcinoma until proven otherwise — urgent 2-week wait referral required
Persistent oral ulceration exceeding 3 weeks with cervical lymphadenopathy raises strong suspicion for oral malignancy; urgent referral via the 2-week wait pathway is mandatory.
Question 2: What systemic disease is associated with multiple periapical radiolucencies without obvious dental causes?
- Multiple myeloma (Correct answer)
- Type 2 diabetes
- Hypertension
- Coeliac disease
Correct answer: Multiple myeloma
Multiple myeloma can present with multiple punched-out radiolucencies throughout the jaw that mimic periapical pathology; systemic investigation including serum electrophoresis is required.
Question 3: What is the most common benign tumour of the gingiva?
- Fibrous epulis (fibroma) (Correct answer)
- Pyogenic granuloma
- Peripheral giant cell granuloma
- Peripheral ossifying fibroma
Correct answer: Fibrous epulis (fibroma)
A fibrous epulis (gingival fibroma) is the most common benign gingival swelling, resulting from chronic irritation causing fibroblastic proliferation; it is firm, pale, and usually near the gingival margin.
Question 4: What is the significance of Stafne's bone cavity (static bone cyst) on a dental radiograph?
- A developmental depression of the lingual mandibular surface (normal variant) — no treatment required (Correct answer)
- Indicates active infection
- A true cyst requiring enucleation
- Associated with bone malignancy
Correct answer: A developmental depression of the lingual mandibular surface (normal variant) — no treatment required
Stafne's cavity is a developmental lingual cortical depression below the inferior alveolar canal, typically seen as a well-defined radiolucency — it is a normal variant requiring only confirmation by CT, not treatment.
Question 5: What is the mechanism of action of bisphosphonates that predisposes to osteonecrosis of the jaw (MRONJ)?
- Inhibit osteoclast function and promote osteoclast apoptosis, impairing normal bone remodelling and healing (Correct answer)
- Activate osteoblasts excessively
- Block calcium absorption from gut
- Increase bone vascularity
Correct answer: Inhibit osteoclast function and promote osteoclast apoptosis, impairing normal bone remodelling and healing
Bisphosphonates inhibit farnesyl pyrophosphate synthase in osteoclasts, causing their apoptosis; without normal bone remodelling, avascular necrosis develops, particularly after dentoalveolar surgery.
Question 6: Which viral infection is associated with hairy leukoplakia on the lateral tongue in immunocompromised patients?
- Epstein-Barr virus (EBV) (Correct answer)
- Herpes simplex virus (HSV)
- Human papillomavirus (HPV)
- Cytomegalovirus (CMV)
Correct answer: Epstein-Barr virus (EBV)
Oral hairy leukoplakia is caused by Epstein-Barr virus replicating in lateral tongue epithelium in immunosuppressed patients (most commonly HIV-positive); it appears as a white corrugated lesion that cannot be wiped off.
MJDF Oral & Dental Pathology 4
What is the most likely diagnosis when a patient presents with multiple painless cervical lymphadenopathy and persistent oral ulcers not healing after 3 weeks?