Essentials of Oral Pathology

Transcription

1 Contents Developmental Anomalies of Oral and Paraoral Structures Introduction 1 Developmental anomalies of oral soft tissues 1 Anomalies of lips and palate 1 Lip pits and fistulas 1 Double lip 2 Frenal tag 2 Hereditary intestinal polyposis (Peutz-Jeghers) syndrome 3 Oral melanotic macule (ephelis) 4 Uvula elongata 4 Cheilitis glandularis 5 Cheilitis granulomatosa 6 Anomalies of oral mucosa 7 Fordyce s granules 7 Focal epithelial hyperplasia 8 White sponge nevus 9 Developmental defects of the gingiva 10 Fibromatosis gingivae 10 Retrocuspid papilla 11 Developmental anomalies involving the jawbone 11 Agnathia 11 Micrognathia 11 Macrognathia 13 Facial hemihypertrophy 13 Facial hemiatrophy 15 Cleft lip and cleft palate 16 Developmental anomalies of the tongue 20 Aglossia 20 Microglossia 20 Macroglossia 20 Ankyloglossia 22 Cleft tongue 22 Fissured tongue (scrotal tongue) 23 Median rhomboid glossitis 23 Lingual varices 25 Geographic tongue 25 Hairy tongue 27 Lingual thyroid nodule 28 Thyroglossal tract cyst 29 Anomalies of oral lymphoid tissue 30 Reactive lymphoid aggregate 30 Lymphoepithelial cyst (branchial cyst) 30 Angiolymphoid hyperplasia with eosinophilia (ALHE) 31 Anomalies of the salivary gland 32 Developmental anomalies involving oral hard tissues 32 Abnormalities of teeth 32 Disturbance in size of teeth 32 Microdontia 32 Macrodontia 33 Disturbance in number of teeth 34 Anodontia 34 Complete or total anodontia 34 Partial anodontia 35 Supernumerary teeth 36 Disturbances in eruption of teeth 38 Premature eruption 38 Delayed eruption 38 Impacted teeth 39 Eruption sequestrum 41 Disturbances in the shape of teeth 41 Gemination (twinning) 41 Fusion 42 Concrescence 43 Dilaceration 44 Taurodontism 45 Dens-in-dente (dens-invaginatus) 45 Densevaginatus 46 Talon cusp 47 Enamel pearl 47 Disturbance in the structure of teeth 48 Disturbance in the structure of enamel 48 Acquired disturbances of enamel 48 Focal enamel hypoplasia 48 Idiopathic enamel opacities 49 Generalized enamel hypoplasia 49 Effect of individual systemic conditions on enamel hypoplasia 49 Nutritional deficiency 49 Congenital syphilis 49 Hypocalcemia 50 Exanthematous disease 50 Birth injuries and Lowbirth weight 50 Fluorides and mottling 51 Hereditary disturbance of enamel formation 51 Amelogenesis imperfecta 51 Syndrome associated enamel defects 53 Disturbances in structure of dentin 54 Dentinogenesis imperfecta (hereditary opalescent- dentin) 54 Dentinal abnormality due to systemic or environmental disturbances 57 Dentin dysplasia 58 Regional odontodysplasia (ghost teeth) 60 Disturbance in structure of cementum 61 Hypercementosis 61 Hypocementosis Benign and Malignant Neoplasms of the Oral Cavity Neoplasm (tumor) 64 Classification of oral non-odontogenic neoplasms 65 Neoplasms of epithelial tissue origin 65 Neoplasms of mesenchymal tissue origin 65 Benign neoplasms of the epithelial tissue origin 66 Papilloma 66 Keratoacanthoma 68 Pigmented cellular nevus 70 Intradermal (intramucosal) nevus 70 Junctional nevus 71 Compound nevus 71 Blue nevus 72 Malignant neoplasms of the epithelial tissue origin 72 Squamous cell carcinoma 72 Oral cancer in different intraoral locations or subsites 80 Carcinoma of the lip 80 Carcinoma of the tongue 81 Carcinoma of the floor of the mouth 83 Carcinoma of the palate 83 Carcinoma of the buccal mucosa 84 Carcinoma of the gingiva/alveolar ridge 84 Carcinoma of the maxillary antrum 85 Basal cell carcinoma (rodent ulcer) 94 Verrucous carcinoma 96 Malignant melanoma 98 Spindle cell carcinoma 101 Primary intra-alveolar carcinoma 102 Neoplasms of mesenchymal tissue origin 103 Benign neoplasms of fibrous connective tissue 103 Fibroma 103 Desmoplastic fibroma 104 Giant-cell fibroma 105 Myofibroma 106 Peripheral ossifying fibroma 107 Central ossifying fibroma 108 Peripheral giant cell granuloma 110 Central giant cell granuloma 113 Benign fibrous histiocytoma 116 Myxoma 117 Nodular fascitis 118 Benign neoplasm of adipose tissue origin 119 Lipoma 119 Benign neoplasm of vascular tissue origin 120 Hemangioma 120 Benign neoplasm of lymphatic vessels 124 Lymphangioma 124 Benign neoplasm of bone 127 Osteoma 127 Osteoid osteoma 129 Osteoblastoma 129 Benign neoplasm of cartiliage tissue 130 Chondroma 130 Benign chondroblastoma 131 Benign neoplasm of smooth muscles 131 Leiomyoma 131 Benign neoplasm ofstriated muscle 133 Rhabdomyoma 133 Granular cell myoblastoma 133 Benign neoplasms of neural tissue 135 Neurilemmoma (schwannoma) 135 Neurofibroma 137 Melanotic neuroectodermal tumor of infancy 139 Malignant neoplasms of mesenchymal

2 xx Essentials of Oral Pathology tissue 140 Fibrosarcoma 140 Malignant fibrous histiocytoma 143 Liposarcoma 144 Hemangioendothelioma 144 Hemangiopericytoma 145 Kaposi s sarcoma 147 Ewing s sarcoma 148 Chondrosarcoma 150 Mesenchymal chondrosarcoma 152 Osteosarcoma 153 Lymphomas 157 Non- Hodgkin s lymphoma (NHL) 157 Burkitt s lymphoma 161 Hodgkin s lymphoma 164 Multiple myeloma 165 Solitary plasmacytoma 167 Leiomyosarcoma 168 Rhabdomyosarcoma 169 Neurogenic sarcoma 169 Metastatic tumors of the jaws Oral Precancerous Lesions and Conditions Leukoplakia 175 Oral hairy leukoplakia 182 Leukoedema 183 Carcinoma in situ 184 Erythroplakia 185 Stomatitis nicotina 186 Oral submucous fibrosis (OSF) 187 Sideropenic dysphagia 191 Lichen planus Diseases of the Salivary Glands Classification of salivary gland diseases 198 Non-neoplastic disorders 198 Neoplastic disorders 199 Developmental anomalies of the salivary gland 199 Aplasia or agenesis of the salivary gland 199 Hypoplasia of the salivary glands 199 Ectopic salivary glands (aberrant) 200 Atresia 200 Accessory ducts 200 Diverticuli 200 Lingual mandibular salivary glands depression 201 Reactive lesions of the salivary gland 201 Salivary gland cysts 201 Sialolithiasis 201 Postradiation sialadenitis 205 Chronic sclerosing sialadenitis 205 Necrotizing sialometaplasia 206 Infective lesions (sialadenitis) 207 Bacterial sialadenitis 207 Acute bacterial sialadenitis 207 Chronic bacterial sialadenitis 208 Recurrent parotitis 209 Viral sialadenitis 209 Mumps (endemic parotitis) 209 Cytomegalic inclusion disease 209 Immune-mediated disease 209 Mikulicz s disease 209 Sjogren s syndrome 210 Miscellaneous disorders of salivary gland 213 Heerfordt s syndrome 213 Sialosis 213 Ptyalism 213 Aptyalism (xerostomia) 214 Neoplasm of the salivary glands 215 Pleomorphic adenoma 216 Monomorphic adenoma 220 Myoepithelioma 221 Oncocytoma (oxyphilic adenoma) 222 Adenolymphoma (warthin s tumor) 222 Malignant salivary gland neoplasms 224 Malignant pleomorphic adenoma (mixed tumor) 224 Adenoid cystic carcinoma (cylindroma) 225 Mucoepidermoid tumor 229 Acinic cell tumor 231 Adenocarcinoma Odontogenic Neoplasms Classification of odontogenic tumors (modified WHO classification) 236 Ameloblastoma 236 Unicystic ameloblastoma 242 Adenomatoid odontogenic tumor (AOT) 244 Calcifying epithelial odontogenic tumor (CEOT) 247 Squamous odontogenic tumor 250 Ameloblastic fibroma 251 Ameloblastic fibroodontome 253 Odontomes 254 Odontogenic fibroma 257 Peripheral odontogenic fibroma 257 Central odontogenic fibroma 258 Odontogenic myxoma 259 Periapical cementral dysplasia (cementoma) 261 Familial gigantiform cementoma 262 Cementoblastoma 262 Malignant odontogenic neoplasms 264 Malignant ameloblastoma 264 Ameloblastic carcinoma 264 Odontogenic carcinoma 265 Odontogenic sarcomas 265 Clear cell odontogenic carcinoma 265 Primary intra-alveolar carcinoma Cysts of the Oral Regions Classification of cysts 268 Cysts associated with the maxillary antrum 269 Cyst of the tissue of the mouth, face and neck 269 Odontogenic cysts 270 Odontogenic keratocyst (primordial cyst) 270 Dentigerous cyst 276 Radicular cyst 281 Eruption cyst 286 Lateral periodontal cyst 287 Dental lamina cyst (gingival cyst) of the newborn 288 Gingival cysts of the adult 288 Sialo-odontogenic cysts (glandular odontogenic cyst) 289 Botryoid odontogenic cysts 290 Calcifying epithelial 290 Odontogenic cyst (CEOC) 290 Paradental cyst 292 Non-odontogenic cysts 293 Globulomaxillary cyst 293 Nasolabial cyst (kelstadt s cyst) 294 Nasopalatine duct cyst (incisive canal cyst) 295 Solitary bone cyst (traumatic/hemorrhagic bone cyst) 297 Aneurysmal bone cyst 298 Cyst of the salivary gland 300 Ranula 302 Dermoid cyst 303 Surgical ciliated cyst of maxilla Regressive Alterations of Teeth Attrition of teeth 306 Abrasion of teeth 307 Tooth abfraction 309 Erosion of teeth 309 Role of salivary function in the prevention of dental erosion 311 Resorption of teeth 311 External resorption of tooth 312 Internal resorption of tooth 314 Pulp calcification 315 Hypercementosis 316 Age changes in teeth 317 Cementicles 318 Dentinal sclerosis 318.

3 xxi Contents 8. Bacterial, Viral and Fungal Infections Specific bacterial infections 320 Tuberculosis 320 Syphilis 324 Gonorrhea 328 Actinomycosis 329 Scarlet fever 331 Diphtheria 332 Sarcoidosis 332 Leprosy 333 Tetanus 334 Midline lethal granuloma 335 Wegener s granulomatosis 335 Noma (cancrum oris) 336 Pyogenic granuloma 337 Viral infections 339 Acquired immunodeficiency syndrome (AIDS) 339 Herpes virus infections 344 Herpes simplex virus type I infections 345 Herpes simplex virus type-ii infections 347 Varicellazostervirus 348 Infections 348 Cytomegalovirus infection 350 Epstein-barr virus infections 351 Human papillomavirus infection 352 Paramyxovirus infection 352 Measles (rubeola) 352 Mumps 353 Coxsackie virus infections 353 Herpangina 353 Hand, foot and mouth disease 354 Aphthous ulcers 354 Behçet s syndrome 357 Reiter s syndrome 357 Rabies 357 Fungal infection 358 Candidiasis 358 Deep fungal infections 362 Coccidioidomycosis 362 Histoplasmosis 362 Cryptococcosis 363 North american blastomycosis 364 Mucormycosis Dental Caries Dental caries 368 Acidogenic theory 369 Proteolytic theory 374 Proteolytic chelation theory 375 Sucrose chelation theory 375 Autoimmune theory 375 Contributing factors in dental caries 375 Clinical aspects of dental caries 378 Histopathological aspect of dental caries 382 Histology of dentinal caries (caries in dentin) 383 Protective responses of dentin and pulp against caries 384 Caries activity tests 385 Methods of caries prevention 386 Caries vaccine Diseases of Dentin-Pulp Complex and Periapical Tissues Pulpal diseases 389 Focal reversible pulpitis 391 Acute pulpitis 392 Chronic pulpitis 393 Aerodontalgia 395 Pulp necrosis 395 Diseases of the periapical tissues 398 Primary acute apical periodontitis 398 Periapical granuloma (Chronic apical periodontitis) 398 Acute exacerbation of chronic periapical granuloma (phoenix abscess) 400 Periapical abscess (dentoalveolar abscess) 400 Osteomyelitis 401 Acute suppurative osteomyelitis 403 Chronic suppurative osteomyelitis 406 Chronic focal sclerosing osteomyelitis (Condensing osteitis) 408 Diffuse sclerosing osteomyelitis 409 Chronic osteomyelitis with proliferative periostitis (Garre s osteomyelitis) 410 Giant cell periostitis with hyaline change (Pulse granuloma) 411 Endodontic-periodontic lesions Spread of the Oral Infection Space infections 414 Space infections related to maxilla 414 Space infections related to mandible 416 Cellulitis 419 Ludwig s angina 420 Cavernous sinus thrombosis (thrombophlebitis) 421 Maxillary sinusitis 422 Focal infection Physical and Chemical Injuries of the Oral Cavity Physical injuries 426 Fractures of teeth 426 Root fracture 426 Cemental tear 426 Bruxism 426 Ankylosis of teeth 428 Submerged teeth 428 Toothbrush injury 429 Toothpick injury 430 Traumatic atrophic glossitis 430 Chronic ulcers of the tongue 430 Traumatic ulcer 431 Factitious injuries (self-inflicted oral wounds) 432 Denture related injuries or lesions 433 Electrical burns in the mouth 434 Thermal burns in mouth 435 Radiation injuries 435 Various damaging effects of radiation on individual organs or tissues 436 Osteoradionecrosis 438 Chemical injuries 440 Congenital porphyria 440 Biliary atresia 440 Erythroblastosis fetalis 440 Fluorosis 441 Oral manifestations of various metal poisoning 441 Oral manifestations of cytotoxic drug therapy 442 Oral manifestations of tetracycline staining 442 Angioneurotic edema 442 Chemical burns 443 Chemical burns due to other medicaments Biopsy and Healing of Oral Wounds Biopsy 445 Exfoliative cytology 447 Healing of oral wounds 448 Healing of biopsy wound 449 Healing of gingivectomy wound 450 Healing of the extraction wound 450 Dry socket (alveolar osteitis) 451 Healing of the fractured jawbone 451 Replantation of tooth 452 Transplantation of teeth 453 Healing around osteointegrated implants 454.

4 xxii Essentials of Oral Pathology 14. Oral Aspects of Metabolic Disorders Disturbances in mineral metabolism 456 Calcium 456 Phosphorus 457 Iron 458 Magnesium 458 Zinc 458 Disturbance in vitamin metabolism 458 Vitamin D 458 Osteoporosis 459 Rickets 459 Vitamin A 460 Vitamin B complex 460 Vitamin C (ascorbic acid) 461 Vitamin K 462 Disturbances in protein metabolism 462 Amyloidosis 462 Porphyria 463 Disturbances in carbohydrate metabolism 463 Hurler s syndrome 463 Disturbance in lipid metabolism 464 Handschuller-christian disease 464 Eosinophilic granuloma 465 Letterer-siwe disease 465 Gaucher s disease 466 Niemann-pick disease 466 Disturbance in hormone metabolism 466 Hypopituitarism 466 Pituitary insufficiency in adults 467 Diabetes insipidus 467 Hyperpituitarism 467 Hypothyroidism 469 Hyperthyroidism 469 Hyperparathyroidism 470 Hypoparathyroidism 472 Adrenal hormones 473 Mineralocorticoids 474 Chronic adrenocortical insufficiency (addison s disease) 474 Hyperfunction of adrenocortical hormone (cushing s syndrome) 474 Pancreatic hormone (insulin) 475 Progeria 476 Imbalance of sex hormones Diseases of Bone Paget s disease of bone (osteitis deformans) 479 Fibrous dysplasia of bone 482 Cherubism 486 Osteogenesis imperfecta 489 Cleidocranial dysplasia 491 Osteopetrosis (marble bone disease) 492 Pierre robin syndrome 494 Gardner syndrome 494 Marfan s syndrome 494 Down syndrome (trisomy 21) 495 Infantile cortical hyperostosis (caffey s disease) 496 Mandibulofacial dysostosis (treacher-collins syndrome) 497 Achondroplasia 497 Massive osteolysis (vanishing bone disease) Diseases of Temporomandibular Joint Developmental disorders 502 Hypoplasia of the mandibular condyle 502 Hyperplasia of the mandibular condyle 502 Traumatic disorders 502 Luxation and subluxation 502 Ankylosis of temporomandibular joint 503 Inflammatory disorders 505 Ankylosing spondylitis 505 Osteoarthritis 505 Rheumatoid arthritis 506 Acute traumatic arthritis 506 Myofacial pain dysfunction (MPD) syndrome 507 Neoplasia of temporomandibular joint Oral Aspects of Hematological Disorders Pernicious anemia 509 Iron deficiency anemia 510 Aplastic anemia 511 Hemolytic anemia 512 Thalassemias 513 Sickle cell anemia 515 Erythroblastosis fetalis 515 Polycythemia vera 516 Leukemias 517 Agranulocytosis (granulocytopenia) 521 Cyclic neutropenia 522 Purpura 522 Hemophilia Periodontal Disease Gingival hyperplasia 535 Desquamative gingivitis 537 Acute necrotizing ulcerative gingivitis (ANUG) 538 Lateral periodontal abscess 539 Pericoronitis 540 Staining of teeth Oral Aspects of Dermatological Disorders Hereditary ectodermal dysplasia 543 Psoriasis 544 Pityriasis rosea 545 Incontinentia pigmenti 545 Erythema multiforme 546 Dermatitis herpetiformis 548 Keratosis follicularis 549 Acanthosis nigricans 549 Dyskeratosis congenita 550 White sponge nevus 550 Polymyositis 551 Pemphigus 552 Pemphigoid 555 epidermolysis bullosa 558 Lupus erythematosus 559 Discoid lupus erythematosus 561 Scleroderma 563 Ehlers-Danlos syndrome Diseases of the Nerves and Muscles Diseases of the nerves 569 Trigeminal neuralgia 569 Sphenopalatine neuralgia 571 Glossodynia and glossopyrosis 571 Auriculotemporal syndrome (Frey s syndrome) 572 Glossopharyngeal neuralgia 572 Bell s palsy (facial nerve paralysis) 572 Causalgia 574 Eagle s syndrome 574 Disease of the muscles 574 Generalized familial muscular dystrophy 574 Myasthenia gravis 575 Myositis ossificans Oral Manifestations of Generalized Diseases Vitamin deficiencies 577 Important causes of lymphadenopathy 578 Blood dyscrasias 578 Metabolic disorders 579 Heavy metal poisoning 580 Endocrine disturbances 580

5 xxiii Contents Granulomatous diseases 581 Dermatological diseases 582 Bone diseases 582 Acute infective diseases 583 Helminthic diseases 583 Renal diseases 583 Neural diseases 584 Sexually transmitted diseases 584 Cardiovascular diseases 584 Genetic disorders 585 Allergic conditions 585 General manifestations of oral diseases Syndromes Related to Oral Diseases Important Classifications of Oral Diseases White lesions of the oral cavity 598 Red-blue lesions of the oral cavity 599 Pigmented lesions of the oral cavity 599 Classification of vesiculobullous diseases 600 Classification of ulcerative conditions 600 Classification of discoloration of tooth 601 Classification of cysts of the oral region 601 Classification of odontogenic neoplasms 602 Classification of giant cell lesions 602 Classification of verrucal papillary lesions of oral cavity 602 Classification of diseases of salivary glands 602 Classification of fibro-osseous lesions 603 Classification of vascular tissue diseases 603 Classification of diseases of the hemopoietic tissues and lymphoreticular system 604 Classification of stomatitis 604 Classification of severe infections of the orofacial tissues 604 Classification of chronic orofacial pain 605 Classification of diseases of tongue 605 Classification of gingival enlargements 606 Classification of skin diseases 607 Classification of taste disorders 608 Classification of oral swellings 608 Classification of neck swellings 609 Classification of oral soft tissue 609 Classification of yellow conditions of oral mucosa 609 Anatomic radiolucencies of jawbones 610 Radiolucent lesions of the periapical region 610 Classification of pericoronal radiolucent lesions 610 classification of inter-radicular radiolucent lesions 610 Classification of multilocular radiolucent lesions of the jaws 611 Mixed radiolucent-radiopaque lesions associated with teeth 611 Mixed radiolucent-radiopaque lesions not necessarily associated with teeth 611 Multiple separate radiopaque lesions of the jaws 611 Generalized radiopacities of the jaws 612 Classification of causes of trismus 612. Index...613