ORE Part 1 Oral Biology & Pathology 4 — Questions and Answers
Question 1: What is the clinical significance of 'Ramsay Hunt syndrome' in dental practice?
- Varicella-zoster virus reactivation in the geniculate ganglion causing unilateral facial palsy, ear pain, and vesicles in the ear canal and soft palate — requiring antiviral treatment and dental/neurological awareness (Correct answer)
- A salivary gland condition causing xerostomia
- Trigeminal neuralgia secondary to herpes
- A TMJ condition causing pain
Correct answer: Varicella-zoster virus reactivation in the geniculate ganglion causing unilateral facial palsy, ear pain, and vesicles in the ear canal and soft palate — requiring antiviral treatment and dental/neurological awareness
Ramsay Hunt syndrome (herpes zoster oticus) involves VZV reactivation in CN VII (geniculate ganglion), causing lower motor neuron facial palsy, severe ear pain (otalgia), and vesicles in the EAC and soft palate. Urgent antiviral therapy is needed.
Question 2: What oral manifestation is characteristic of Addison's disease?
- Diffuse melanotic (brown) pigmentation of the oral mucosa, particularly the buccal mucosa (Correct answer)
- White patches on the tongue
- Petechiae on the palate
- Painful ulcers on the lip
Correct answer: Diffuse melanotic (brown) pigmentation of the oral mucosa, particularly the buccal mucosa
Addison's disease (primary adrenal insufficiency) causes excess ACTH secretion which stimulates melanocytes, producing diffuse mucosal hyperpigmentation, characteristically on the buccal mucosa, gingivae, and lips.
Question 3: What is 'leukoplakia' and when should it be biopsied?
- A white patch on the oral mucosa that cannot be scraped off and cannot be attributed to any other disease — biopsy indicated if it does not resolve in 2 weeks, is dysplastic, or is in a high-risk site (Correct answer)
- A white fungal infection that can be scraped off
- A normal anatomical variant
- A traumatic ulcer that turns white
Correct answer: A white patch on the oral mucosa that cannot be scraped off and cannot be attributed to any other disease — biopsy indicated if it does not resolve in 2 weeks, is dysplastic, or is in a high-risk site
Leukoplakia is a clinical diagnosis of exclusion. All suspicious white patches should be biopsied if not resolving in 2 weeks or after removal of any obvious cause, particularly in high-risk sites (floor of mouth, lateral tongue).
Question 4: What is the pathogenesis of periapical abscess formation?
- Bacterial products from pulp necrosis spread beyond the apex, triggering acute inflammation with neutrophil accumulation and pus formation in the periapical tissues (Correct answer)
- Direct bacterial spread from the gingival pocket
- An allergic reaction to pulp bacteria
- Viral infection of the periapical tissues
Correct answer: Bacterial products from pulp necrosis spread beyond the apex, triggering acute inflammation with neutrophil accumulation and pus formation in the periapical tissues
Pulp necrosis from caries/trauma allows bacteria to colonise the root canal. Bacteria and their products exit the apex, stimulating acute inflammatory infiltrate (mainly neutrophils), resulting in pus accumulation (abscess) in periapical bone or soft tissue.
Question 5: What is the difference between a primary and secondary herpetic infection in the oral cavity?
- Primary (herpetic gingivostomatitis) is a widespread severe first infection; secondary (herpes labialis, cold sores) is recurrent localised reactivation at mucocutaneous junction (Correct answer)
- Primary is always more severe than secondary
- Secondary only occurs in immunocompromised patients
- Primary affects only children; secondary only adults
Correct answer: Primary (herpetic gingivostomatitis) is a widespread severe first infection; secondary (herpes labialis, cold sores) is recurrent localised reactivation at mucocutaneous junction
Primary HSV-1 infection (gingivostomatitis) causes widespread vesicles and ulcers on gingiva and mucosa with systemic upset, typically in children. Recurrent cold sores (herpes labialis) represent localised reactivation at the lip vermilion.
Question 6: What is 'pericoronitis' and which tooth is most commonly affected?
- Inflammation of the soft tissue operculum overlying an incompletely erupted tooth — most commonly the mandibular third molar (wisdom tooth) (Correct answer)
- Inflammation around the apex of any tooth
- Gingival inflammation around all erupting teeth
- An abscess within the dental pulp
Correct answer: Inflammation of the soft tissue operculum overlying an incompletely erupted tooth — most commonly the mandibular third molar (wisdom tooth)
Pericoronitis is acute or chronic inflammation of the pericoronal flap (operculum) covering an incompletely erupted tooth. It is most commonly associated with the lower third molar, often complicated by bacterial colonisation under the flap.
ORE Part 1 Oral Biology & Pathology 4
What is the clinical significance of 'Ramsay Hunt syndrome' in dental practice?