ABOMP Oral Pathology cheat sheet

Lymphoma red flags in a neck mass: >3 cm, firm or fixed, supraclavicular location, male sex, age >40, or persistent >4-6 weeks - warrant imaging and tissue sampling rather than antibiotics alone.

Odontogenic versus non-odontogenic pain: pain reproduced by percussion, thermal testing, or biting on a specific tooth favors odontogenic origin; pain crossing dermatomes without a provokable tooth favors neuropathic or referred origin.

Sinus tract with a draining skin or mucosal sinus and a nonvital tooth = chronic apical abscess until proven otherwise; trace with gutta-percha and confirm vitality before excisional biopsy.

Candidiasis clinical variants: pseudomembranous (wipes off), erythematous (denture-bearing palate, angular cheilitis), and hyperplastic (non-wipeable, requires biopsy to exclude dysplasia).

White lesion that cannot be wiped off = leukoplakia by definition (a clinical term, not histologic); biopsy is required because 10-20% harbor dysplasia or carcinoma.

Red velvety patch (erythroplakia) carries a higher malignant transformation risk than homogeneous leukoplakia and should be biopsied at first visit.

Pigmented lesion warning signs: recent enlargement, irregular border, variegation, ulceration, or bleeding - biopsy any pigmented oral lesion that is not clearly amalgam tattoo.

Temporomandibular disorder screening: pain modified by jaw function, familiar headache, and limited or deviating opening favor TMD; unilateral persistent deep ear/jaw pain with normal imaging suggests referral workup.

Xerostomia workup: sialometry (unstimulated whole saliva <0.1 mL/min = hyposalivation), labial minor gland biopsy, and autoantibody testing (anti-Ro/SSA, anti-La/SSB) support Sjögren syndrome diagnosis.

Squamous cell carcinoma grading: well-differentiated tumors show keratin pearls and intercellular bridges; poorly differentiated tumors show pleomorphism, high mitotic rate, and loss of keratinization.

Dysplasia grading uses architectural and cytologic features: basal cell hyperplasia, loss of polarity, nuclear pleomorphism, hyperchromatism, increased and abnormal mitoses; severe dysplasia extends into the middle third of epithelium.

Verrucous carcinoma: broad pushing rete ridges, prominent keratinization, minimal atypia, and no true invasion of the basement membrane.

Odontogenic keratocyst: parakeratinized stratified squamous lining, corrugated surface, palisaded hyperchromatic basal layer, and satellite cysts in the wall.

Ameloblastoma: islands of odontogenic epithelium with reverse nuclear polarity, subnuclear vacuolization, and peripheral palisading in a fibrous stroma; plexiform and follicular patterns are common.

Pleomorphic adenoma: epithelial and myoepithelial cells in a chondromyxoid stroma; capsule may be incomplete, so recurrence risk follows enucleation.

Giant cell granuloma versus brown tumor: multinucleated giant cells in a vascular stroma; brown tumor has identical histology and requires hyperparathyroidism exclusion via calcium, PTH, and phosphate.

Lichen planus: band-like lymphocytic infiltrate at the epithelial-connective tissue interface with basal cell liquefactive degeneration; saw-tooth rete ridges are supportive but not required.

Pemphigus vulgaris: suprabasal acantholysis with intraepithelial clefting; direct immunofluorescence shows intercellular IgG in a chicken-wire pattern, while pemphigoid shows linear IgG/C3 at the basement membrane.

Suspicious lesion biopsy decision rule: any ulcer or mass persisting >2 weeks after removing local irritants should be biopsied; incisional biopsy is preferred for large lesions, excisional for small well-defined ones.

Odontogenic infection with airway compromise (floor-of-mouth elevation, dysphagia, stridor, trismus) is a surgical emergency - secure the airway and incise/drain before definitive dental treatment.

Antibiotic selection for odontogenic infection: amoxicillin or penicillin V first-line; add metronidazole or use amoxicillin-clavulanate for anaerobic coverage in severe or spreading infections.

Osteoradionecrosis prevention: extract teeth before radiotherapy when possible; after radiation, limit extractions to teeth with poor prognosis and consider hyperbaric oxygen only per current evidence-based protocols.

Antiresorptive-related osteonecrosis of the jaw: defined by exposed bone >8 weeks in a patient on antiresorptive or antiangiogenic therapy without head/neck radiation history; conservative management with chlorhexidine and antibiotics is first-line.

Oral cancer management: stage with imaging (CT/MRI for primary, neck ultrasound or CT for nodes); T1N0 may be treated with single-modality surgery, while advanced disease warrants multimodality therapy.

Sialolithiasis: small distal stones may pass with sialogogues and hydration; larger or proximal stones require sialendoscopy or surgical removal.

Recurrent aphthous ulcers: topical corticosteroids are first-line; systemic therapy (colchicine, dapsone, or immunomodulators) is reserved for severe or refractory cases.

Post-extraction bleeding: apply pressure with gauze, identify local causes (retained root, arteriovenous malformation), and screen for coagulopathy if bleeding persists despite local measures.