Handbook of Oral Pathology and Oral Medicine. Edition No. 1

Table of Contents

Foreword

Preface

Acknowledgements

Standard Abbreviations

Terminology used in oral pathology and oral medicine

PART 1. PATHOLOGY OF TEETH AND SUPPORTING STRUCTURES

1. Disorders of tooth development and eruption

1 1. Anodontia, hypodontia and oligodontia

1 2. Hyperdontia (supernumerary teeth)

1.3. Microdontia and macrodontia

1.4. Gemination, fusion and concrescence

1.5. Taurodontism and dilaceration

1.6. Amelogenesis imperfecta

1.7. Dentinogenesis imperfecta

1.8. Dentinal dysplasia

1.9. Regional odontodysplasia

1.10. Delayed tooth eruption

1.11. Tooth impaction

1.12. Dens invaginatus and dens evaginatus

1.13. Fluorosis

1.14. Tetracycline induced discolouration of teeth

1.15. Enamel pearl,

1.16. Talon cusp

1.17. Hutchinson’s incisors and mulberry molars

1.18. Tooth ankylosis

1.19. Supernumerary roots

2. Dental caries

2.1. Definition/description

2.2. Incidence/prevalence

2.3. Aetiology/risk factors/pathogenesis

2.4. Classification of caries

2.5. Clinical features

2.5.1.      Primary caries

2.5.2.      Secondary caries

2.5.3.      Arrested caries

2.5.4.      Rampant caries

2.5.5.      Early childhood caries

2.5.6.      Methamphetamine-induced caries (MIC)

2.5.7.      Radiation caries

2.6. Differential diagnosis

2.7. Diagnosis

2.8. Microscopic features of enamel caries

2.9. Microscopic features of dentinal carries

2.10.        Management

2.11.        Prevention

1. 3.      Diseases of the pulp and apical periodontal tissues

Classification of diseases of the pulp and apical periodontal tissues

3.1. Pulpitis

3.2. Apical periodontitis and periapical granuloma

3.3. Apical Abscess

3.4. Condensing osteitis

4. Tooth wear, pathological resorption of teeth, hypercementosis and cracked tooth syndrome

4.1.   Tooth wear: Attrition, Abrasion, Erosion and Abfraction

4.2.   Pathological resorption of teeth

4.3.   Hypercementosis

4.4.   Cracked tooth syndrome

5. Gingival and periodontal diseases.

Classification of gingival and periodontal diseases

5.1. Gingivitis: Chronic gingivitis

5.2. Necrotizing periodontal diseases

5.3. Plasma cell gingivitis

5.4. Foreign body gingivitis

5.5. Desquamative gingivitis

5.6. Chronic periodontitis

5.7. Aggressive periodontitis

5.8. Fibrous epulis

5.9. Peripheral ossifying/cementifying fibroma

5.10. Peripheral giant cell granuloma

5.11. Angiogranuloma: Pyogenic granuloma and pregnancy epulis

5.12. Inflammatory gingival hyperplasia

5.13. Generalized gingival hyperplasia in pregnancy

5.14. Drug-induced gingival hyperplasia

5.15. Familial gingival hyperplasia

5.16. Gingival and periodontal abscesses

5.17. Pericoronitis/pericoronal abscess

5.18. Gingival enlargement in granulomatosis with polyangiitis (Wegener’s granulomatosis)

5.19. Gingival enlargement in leukaemia

5.20. Gingival enlargement in ascorbic acid deficiency

PART 2. PATHOLOGY OF JAW BONES

6. Infections and necrosis of the jaws

6.1. Acute suppurative osteomyelitis

6.2. Chronic suppurative osteomyelitis

6.3. Sclerosing osteomyelitis

6.4. Proliferative periosteitis (Garre’s osteomyelitis)

6.5. Actinomycosis

6.6. Cervicofacial cellulitis (Cervicofacial space infections)

6.7. Osteoradionecrosis of the jaws (ORNJ)

6.8. Medication related osteonecrosis of the jaws (MRONJ)

7. Cysts of the jaws

7.1. Radicular cyst, Lateral radicular cyst, and Residual radicular cyst

7.2. Dentigerous cyst

7.3. Eruption cyst

7.4. Odontogenic keratocyst

7.5. Lateral periodontal cyst

7.6. Calcifying odontogenic cyst

7.7. Orthokeratinized odontogenic cyst

7.8. Glandular odontogenic cyst

7.9. Nasopalatine duct cyst

7.10. Pseudocysts of the jaws: Solitary bone cyst, Aneurysmal bone cyst, and Stafne’s bone cyst

7.11. Nasolabial cyst

8. Odontogenic tumours of the jaws

Classification of odontogenic tumours

8.1. Ameloblastoma

8.2. Unicystic ameloblastoma

8.3. Squamous odontogenic tumour

8.4. Calcifying epithelial odontogenic tumour

8.5. Adenomatoid odontogenic tumour

8.6. Ameloblastic fibroma

8.7. Ameloblastic fibrodentinoma and ameloblastic fibro-odontome

8.8. Odontome (Odontoma)

8.9. Dentinogenic ghost cell tumour

8.10. Odontogenic myxoma

8.11. Odontogenic fibroma

8.12. Cementoblastoma

9. Non-odontogenic benign and malignant tumours of the jaws

9.1. Osteoma

9.2. Multiple osteomas in Gardner’s syndrome

9.3. Central haemangioma

9.4. Melanotic neuroectodermal tumour of infancy

9.5. Osteosarcoma

9.6. Chondrosarcoma

9.7. Ewing’s sarcoma

9.8. Multiple myeloma

9.9. Solitary plasmacytoma

9.10. Burkitt’s lymphoma

10. Fibro-osseous and related lesions of the jaws

10.1. Ossifying fibroma/Cemento-ossifying fibroma

10.2 Cemento-osseous dysplasias:

10.2.1. Periapical cemento-osseous dysplasia

10.2.2. Focal cemento-osseous dysplasia

10.2.3. Florid cemento-osseous dysplasia

10.2.4. Familial gigantiform cementoma

10.3. Central giant cell granuloma

11. Genetic, metabolic, and other non-neoplastic bone diseases

11.1. Osteogenesis imperfecta

11.2. Cleidocranial dysplasia

11.3. Cherubism

11.4. Gigantism and acromegaly

11.5. Hyperparathyroidism (Brown tumour)

11.6. Paget’s disease of bone

11.7. Fibrous dysplasia and McCune Albright syndrome

11.8. Mandibular and palatine tori

11.9. Focal osteoporotic bone marrow defect (FOBMD)

PART 3. PATHOLOGY OF THE ORAL MUCOSA

12. Developmental anomalies and anatomical variants of oral soft tissues

12.1. Fordyce granules

12.2. Double lip

12.3. Leukoedema

12.4. Ankyloglossia

12.5. Geographic tongue

12.6. Hairy tongue

12.7. Fissured tongue

12.8. Lingual thyroid

12.9. Microglossia and macroglossia

12.10. Bifid tongue

12.11. Bifid uvula

12.12. Cleft lip

12.13. Caliber persistent artery

12.14. Epstein pearls and Bohn’s nodules

12.15. Dermoid and Epidermoid cysts

12.16. Oral varicosities

12.17. Lymphoid aggregates

12.18. Parotid papilla

12.19. Circumvallate papillae

12.20. Physiological pigmentation

13 Bacterial infections of the oral mucosa

13.1. Scarlet fever

13.2. Syphilis

13.3. Gonorrhoea

13.4. Tuberculosis

14. Fungal infections of the oral mucosa

14.1. Candidosis:

14.1.1. Pseudomembranous candidosis

14.1.2. Erythematous candidosis

14.1.3. Angular cheilitis

14.1.4. Denture stomatitis

14.1.5. Chronic hyperplastic candidosis (Candida leukoplakia)

14.1.6. Median rhomboid glossitis

14.2. Histoplasmosis

14.3. Blastomycosis

15. Viral infections of the oral mucosa

15.1. Primary herpetic gingivostomatitis

15.2. Herpes labialis (Secondary herpes infection)

15.3. Varicella (Chicken pox)

15.4. Herpes zoster (Shingles)

15.5. Infectious mononucleosis

15.6. Oral hairy leukoplakia

15.7. Cytomegalovirus infection

15.8. Herpangina

15.9. Hand-foot and mouth disease

15.10. Squamous papilloma

15.11. Condyloma acuminatum 

15.12. Multifocal epithelial hyperplasia

15.13. Verruca vulgaris

15.14. Measles

16. Non-infective inflammatory disorders of the oral mucosa

16.1. Recurrent aphthous ulcers (Recurrent aphthous stomatitis)

16.2. Oral lichen planus

16.3. Oral lichenoid reactions

16.4. Pemphigus vulgaris

16.5. Mucous membrane pemphigoid

16.6. Erythema multiforme

16.7. Lupus erythematosus

16.8. Traumatic ulcer

16.9. Oral lesions in Behcet’s disease

16.10. Oral lesions in Crohn’s disease

16.11. Oral lesions in reactive arthritis (Reiter’s disease)

16.12. Uremic stomatitis

16.13. Chronic ulcerative stomatitis

16.14. Radiation-induced mucositis

16.15. Medication-induced oral ulceration

16.16. Stevens-Johnson syndrome and Toxic Epidermal Necrolysis

17. Non- neoplastic mucosal swellings

17.1. Irritation fibroma

17.2. Denture induced granuloma

17.3. Fibrous epulis/ peripheral fibroma/ fibrous polyp

17.4. Pyogenic granuloma

17.5. Peripheral giant cell granuloma

17.6. Peripheral ossifying fibroma

17.7. Traumatic neuroma

17.8. Squamous papilloma

17.9. Congenital epulis

18. Benign neoplasms of the oral mucosa

18.1. Lipoma     

18.2. Schwannoma (Neurilemmoma)

18.3. Granular cell tumour

18.4. Haemangioma

18.5. Lymphangioma

18.6. Leiomyoma

18.7. Rhabdomyoma

19. Oral potentially malignant disorders

19.1. Erythroplakia

19.2. Leukoplakia

19.3. Chronic hyperplastic candidosis

19.4. Palatal lesions in reverse smokers

19.5. Oral lichen planus

19.6. Oral submucous fibrosis

19.7. Oral lichenoid lesion

19.8. Discoid Lupus erythematosus

19.9. Actinic keratosis

19.10. Graft versus host disease

19.11. Dyskeratosis congenita

!9.12. Sublingual keratosis

19.13. Syphilitic leukoplakia

19.14. Darrier’s disease

20. Malignant neoplasms of the oral mucosa

20.1. Squamous cell carcinoma and verrucous carcinoma

20.2. Melanoma

20.3. Kaposi’s sarcoma

20.4. Fibrosarcoma

20.5. Rhabdomyosarcoma

20.6. Leiomyosarcoma

PART 4. PATHOLOGY OF THE SALIVARY GLANDS

21. Non-neoplastic salivary gland diseases

21.1. Salivary calculi

21.2. Mucoceles

21.3. Sjögren’s syndrome

21.4. Sialadenitis

21.5. Necrotizing sialometaplasia

22. Salivary gland neoplasms

WHO classification of Salivary Gland Tumours

22.1. Pleomorphic adenoma

22.2. Warthin’s tumour

23.3. Mucoepidermoid carcinoma

23.4. Adenoid cystic carcinoma

PART 5. CLINICAL PRESENTATION OF MUCOSAL DISEASE

23. White lesions of the oral mucosa

23.1. Actinic cheilitis

23.2. Chemical burn

23.3. Chronic hyperplastic candidosis

23.4. Darier’s disease (Darier-White disease)

23.5. Dyskeratosis congenita

23.6. Fordyce spots

23.7. Frictional keratosis

23.8. Hereditary benign intraepithelial dyskeratosis

23.9. Leukoedema

23.10. Leukoplakia

23.11. Oral hairy leukoplakia

23.12. Oral lichen planus

23.13. Oral squamous cell carcinoma

23.14. Pseudomembranous candidosis

23.15. Smokeless tobacco induced keratosis

23.16. Smoker’s keratosis

23.17. Sublingual keratosis

23.18. Syphilitic leukoplakia

23.19. Verrucous carcinoma

23.20. White hairy tongue

23.21. White sponge nevus

24. Red and purple lesions of the oral mucosa

24.1. Contact stomatitis

24.2. Desquamative gingivitis

24.3. Erythema migrans

24.4. Erythema multiforme

24.5. Erythematous candidosis

24.6. Erythroplakia

24.7. Haemangioma

24.8. Hereditary haemorrhagic telangiectasia

24.9. Infectious mononucleosis

24.10. Kaposi’s sarcoma

 24.11. Linear gingival erythema

24.12. Lupus erythematosus

24.13. Median rhomboid glossitis

24.14. Mucosal ecchymosis, haematoma and petechiae

24.15. Plasma cell gingivitis

 24.16. Port wine nevus

24.17. Radiation mucositis

24.18. Thermal erythema

25. Blue, black, and brown lesions of the oral mucosa

25.1. Addison’s disease

25.2. Amalgam tattoo

25.3. Black and brown hairy tongue

25.4. Drug induced pigmentation

25.5. Heavy metal pigmentation

25.6. Laugier-Hunziker syndrome

25.7. Melanoma

25.8. Melanotic macule

25.9. Peutz-Jeghers syndrome

25.10. Physiologic pigmentation

25.11. Pigmented nevi

25.12. Smoker’s melanosis

26. Vesiculobullous lesions of the oral mucosa

26.1. Angina bullosa haemorrhagica

26.2. Bullous lichen planus

26.3. Dermatitis herpetiformis

26.4. Epidermolysis bullosa

26.5. Hand-Foot and Mouth disease

26.6. Herpes zoster

26.7. Mucous membrane pemphigoid

26.8. Pemphigus vulgaris

26.9. Primary herpetic stomatitis

26.10. Secondary (recurrent) herpetic stomatitis (Herpes labialis)

27. Ulcerative lesions of the oral mucosa

27.1. Oral ulceration in agranulocytosis

27.2. Oral ulceration in Behcet’s disease

27.3. Oral ulceration in celiac disease

27.4. Chronic ulcerative stomatitis

27.5. Oral ulceration in Crohn’s disease

27.6. Oral ulceration in cyclic neutropenia

27.7. Cytomegalovirus ulcers

27.8. Eosinophilic ulcer

27.9. Gangrenous stomatitis

27.10. Necrotizing sialometaplasia

27.11. Necrotizing ulcerative gingivitis

27.12. Reactive arthritis

27.13. Recurrent aphthous ulcers

27.14. Squamous cell carcinoma presenting as an ulcer

27.15. Syphilitic ulcers

27.16. Traumatic ulcer

27.17. Tuberculous ulcer

27.18. Oral ulceration in ulcerative colitis

28. Papillary lesions of the oral mucosa

28.1. Condyloma acuminatum

28.2. Multifocal epithelial hyperplasia (Heck’s disease)

28.3. Oral proliferative verrucous leukoplakia

28.4. Squamous papilloma

28.5. Squamous cell carcinoma

28.6. Verruca vulgaris (oral warts)

28.7. Verrucous Carcinoma

PART 6. OROFACIAL PAIN

29. Orofacial pain

29.1. Odontogenic orofacial pain

29.1.1. Pain of reversible pulpitis and dentine hypersensitivity

29.1.2. Pain of irreversible pulpitis

29.1 3. Pain of periodontitis or infected root canals

29.1.4. Pain of fractured or cracked tooth

29.1.5. Pain of spreading odontogenic infection without severe or systemic features

29.1.6. Cellulitis/Ludwig’s angina with systemic features

29.1.7. Pain of dry socket

29.2. Neuropathic orofacial pain

29.2.1. Trigeminal neuralgia

29.2.2. Glossopharyngeal neuralgia

29.2.3. Postherpetic neuralgia

29.2.4. Burning mouth syndrome

29.3. Other conditions with orofacial pain

29.3.1. Acute necrotizing ulcerative gingivitis

29.3.2. Temporomandibular joint disorders

29.3 3. Atypical facial pain

29.3 4. Migraine

29 3.5. Sinusitis

29.3 6. Temporal arteritis

29.3 7. Cardiogenic jaw pain

29.3 8. Pain of sialolithiasis

PART 7. MISCELLANEOUS TOPICS OF CLINICAL RELEVANCE

30. Oral manifestations of systemic disorders

30.1. Oral manifestations of gastrointestinal and liver disorders

30.1.1 Gastroesophageal reflux disease

30.1 2. Bulimia and nervosa

30.1 3. Crohn’s disease

30.1.4. Ulcerative colitis

30.1.5. Celiac disease

30.1.6. Irritable bowel syndrome

30.1.7. Alcoholic liver disease

30.1.8. Liver cirrhosis

 30.2. Oral manifestations of cardiovascular disease

30.2.1. Angina pectoris and myocardial infarction

30.2.2. Congenital heart disease

30.2.3. Rheumatic fever and infective endocarditis

30.2.4. Hypertension

30.3. Oral manifestations of respiratory disease

30.3.1. Chronic obstructive pulmonary disease

30.3.2 Lung abscess and bronchiectasis

30.3.3. Pulmonary tuberculosis

30.3.4. Cystic fibrosis

30.4. Oral Manifestations of Kidney diseases

30.4.1. Chronic renal failure

30.4.2. Nephrotic syndrome

30.4.3. Patients on kidney dialysis: Dental considerations

30.5. Oral Manifestations of endocrine and metabolic disorders

30.5.1. Hyperthyroidism

30.5.2. Hypothyroidism

30.5.3. Hyperpituitarism

30.5.4. Hypopituitarism

30.5.5. Diabetes insipidus

30.5.6. Addison’s disease

30.5.7. Cushing syndrome

30.5.8. Diabetes mellitus

30.5.9. Hypocalcaemia

30.5.10. Hypercalcaemia

30.6. Oral Manifestations of nervous system disorders

30.6.1. Stroke

30.6.2. Epilepsy

30.6.3. Parkinson’s disease

30.6.4. Multiple sclerosis

30.6.5. Myasthenia gravis

30.6.6. Bell’s palsy

30.7. Oral manifestations of hematologic disorders

30.7.1. Anaemia

30.7.2. Thrombocytopenia

30.7.3. Haemophilia

30.7.4. Multiple myeloma

30.7.5. Non-Hodgkin’s lymphoma

30.7.6. Burkitt’s lymphoma

36.7.7. Leukaemia

30.8. Oral manifestations of immune system disorders

30.8.1. Allergic mucositis

30.8.2. Angioedema

30.8.3. Sjogren’s syndrome

30.8.4. Temporal arteritis

30.8.5. Granulomatosis with polyangiitis (Wegener’s granulomatosis)

30.8.6. Behcet’s disease

31. Systemic diseases associated with periodontal infections

31.1. Cardiovascular disease

31.2. Coronary heart disease

31.3. Infective endocarditis

31.4. Bacterial pneumonia

31.5. Low birth weight

31.6. Diabetes mellitus

32. Other signs and symptoms related to the oral environment

32.1. Halitosis

32.2. Taste disturbances

32.3. Dry mouth (Xerostomia)Trismus

32.4. Sialorrhea

32.5. Trismus

32.8. Basic facts and oral manifestations associated with Covid-19 infection

33. Outline of diagnostic procedures employed in oral pathology and oral medicine

33.1. History

33.2. Clinical examination

33.3. Clinical differential diagnosis

33.4. Biopsy: Histopathology, immunofluorescence, and immunohistochemistry

33.5. Special tests: Polymerase chain reaction and In situ hybridization

33.6. Microbiology: Smears, swabs, oral rinse, culture tests and antibiotic sensitivity tests

33.7. Molecular biological investigations

33.8. Blood tests: Haematology, serology, clinical chemistry,

33.9. Imaging: Intraoral views, skull radiography, OPG, CBCT, digital imaging, CT scan, MRI and diagnostic ultrasound,

33.10. Other tests: Urine for diabetes and Bence-Jones Protein estimation for myeloma

Index

Authors