Oral Pathology Notes PDF

**Oral Pathology Notes** - **Macule-** Macules are flat, nonpalpable lesions usually \< 10 mm in diameter. Macules represent a change in color and are not raised or depressed compared to the skin surface - **Papule** Papules are elevated lesions usually \< 10 mm in diameter that ca...

**Oral Pathology Notes** - **Macule-** Macules are flat, nonpalpable lesions usually \< 10 mm in diameter. Macules represent a change in color and are not raised or depressed compared to the skin surface - **Papule** Papules are elevated lesions usually \< 10 mm in diameter that can be felt or palpated - **Vesicle -** small, fluid-filled blisters \< 10 mm in diameter. - **Bullae** fluid-filled blisters \> 10 mm in diameter. - **CONSIDERED NORMAL:** **Fordyce granules:** ectopic sebaceous glands found on the vermillion border of the lips or around the oral cavity ‣ **Must know:** Often most prominent around puberty, these granules appear as yellow-white papules that may be hyper-plastic or nodular ‣ **Prevalence:** Common, occurs in 70-80% of adults ‣ **Treatment:** Completely benign, no treatment necessary Fordyce spots **Torus Palatinus: Exostosis** ‣ **Etiology**---inherited, autosomal dominant; some believe the cause to be genetic or environmental factors ‣ **Age and gender related**---usually seen by the age of puberty; rarely observed in children, but peak incidence occurs before 30 years; more common in female ‣ **Location**---midline of the hard palate ‣ **Clinical features:** 1\. Bony, hard protuberance in the midline in a variety of shapes--- nodular; lobulated; smooth; spindle. Torus may appear ulcerated because of trauma to the thin overlying mucosa E. Radiographic appearance---dense radiopaque area Treatment---usually none, but surgical removal if the lesion interferes with a prosthodontic appliance **Torus Mandibularis:** ‣ **Etiology**---inherited, autosomal dominant; possibly genetic or environmental ‣ Age **and gender related**---first observed in early teen years; slightly more common in males ‣ **Location**---**lingual surface of the mandible above the mylohyoid line in the area of premolars; often bilateral** ‣ **Clinical features**: 1\. Bony protuberance varying in size and shape; common exostosis---modular, lobulated, or smooth 2\. Slow growing 3\. Bilateral incidence more common (90%) E. Radiographic appearance---dense radiopaque area f\. Treatment---surgical excision if the lesion interferes with a prosthodontic appliance **Linea Alba:** a fibrous white line in the buccal mucosa ‣ **Must know:** Linea alba is a type of focal hyperkeratosis that forms because of chronic friction on mucosa ‣ **Etiology**---pattern of occlusion; pressure of teeth on buccal mucosa ‣ **Age and gender related**---any age, no gender predilection **‣ Location**---buccal mucosa along the occlusal plane; usually bilateral **Leukoedema:** white or white/gray swollen fluid lesion of buccal or labial oral mucosa ‣ **Must know:** the lesion dissipates when tissue is stretched, as a result of the edematous quality of the lesion **‣ Prevalence:** Somewhat rare; mostly seen among black men **‣ Treatment:** Completely benign, no treatment necessary **‣ Location**---bilateral buccal and labial mucosa ‣ Clinical features 1\. Soft, diffuse, velvety, filmy opalescence of buccal mucosa 2\. Later becomes grayish white with a coarsely wrinkled surface  **Lingual Thyroid Nodule:** mass of thyroid tissue at midline base of tongue ‣ **Must know** located along embryonic path of embryonic descent; can be found between foramen cecum of tongue and just past the larynx \- If found past the foramen cecum, the condition is known as a thyroglossal duct cyst, and may be visible on the skin surface **‣ Prevalence:** Very rare, reported incidence of 1 in 100,000 ‣ **Treatment:** Surgical methods include excision or auto transplantation into muscle; non-surgical methods include hormonal therapy or radioactive ablation Ectopic Thyroid - Endocrinesurgery.net.au **Amalgam Tattoo:** \- gray/blue/black discoloration on oral mucosal membranes, can be caused due to amalgam particles being left (look for restos) ‣ **Must know:** This common and benign lesion is often mistaken for melanoma, and the radiopaque particles can be viewed on radiographs  - **NON-CANCEROUS TUMORS (BENIGN):** **Papilloma:** **-** benign noncancerous exophytic growths caused by several strains of HPV **‣ Must know:** Papillomas have pedunculate (ballooning) or sessile (mound shaped) proliferation on skin or mucosa **‣ Etiology**---benign lesion of squamous epithelium; long duration; slow development ‣ **Age and gender related**---may arise at any age, but there is a 50% incidence between ages 20 and 50 years; no gender predilection **‣ Location**---soft palate or tongue **‣ Clinical features:** **1.** Cauliflower-like appearance 2\. Usually grayish or white color; can also be pink; color depends on amount of keratin 3\. Well-delineated, exophytic nodule with a pedunculated or sessile base 4\. Under 0.5 cm in size **‣ Treatment and prognosis:** 1\. Surgical excision, including the base of the lesion to prevent recurrence 2\. Does not usually recur **Ameloblastoma:** one of the most commonly tested tumors that, while benign, behaves similar to an aggressive malignant tumor by eroding through tooth roots and the cortical plate **‣ Must know:** a typical differential diagnosis for a multilocular radiolucency (bubbly appearance, dark shadows) in the posterior mandible includes ameloblastoma, central giant cell carcinoma (CGCG), central odontogenic fibroma (COF), or keratocystic odontogenic tumor (KCOT) **‣ Treatment:** wide excision as too conservative can lead to high recurrence What is Ameloblastoma? **Lipoma:** ‣ Etiology---unknown; rare; benign tumor of mature fat cells **‣ Age and gender**---over 40 years; no gender predilection ‣ Location---most common on the buccal mucosa or in the mucobuccal fold **‣** **Clinical features** 1\. Single or lobulated, well-defined, painless mass less than 3 cm in size 2\. Sessile or pedunculated base 3\. Soft to palpation 4\. Yellowish color (if aspirated, a brown-yellow fluid is withdrawn) **‣** **Treatment and prognosis** 1\. Conservative surgical excision 2\. Recurrence is rare \* Irritation Fibroma: Often mistaken for lipoma except it is not yellow and is caused by irritation **Melanocytic Nevus = Mole (hard palate)**  - **CANCEROUS TUMORS (MALIGNANT):** **Oral Melanoma** **-** melanoma frequently impacting the hard palate and maxillary alveolar mucosa **‣ Must know:** a malignancy of melanocytes; the dark purple/black lesions metastasize more rapidly than other malignant mucosal lesions **‣ Treatment:** wide excision, continued follow-ups Oral mucosal melanoma -- A systematic review - ScienceDirect **Squamous Cell Carcinoma** exophytic or ulcerated erythroplakia or leukoplakia growth between vermillion border and junction of hard and soft palates, or poster 1/3 of tongue **‣ Must know:** this condition is caused by oncogene or tumor suppressor gene inactivation which is driven by use of tobacco and/or alcohol \- HPV 16 and 18 have been identified as risk factors for OSCC **‣ Etiology**---chemicals such as phenoxyacetic acids, viruses, and radiation; secondary to genetic mutation; immunosuppression 1\. Risk factors include use of all forms of tobacco, alcohol abuse, and increasing age 2\. A combination of these risks can be lethal 3\. Iron deficiency anemia, especially the severe form, Plummer- Vinson syndrome, also elevates the risk for SCC in the posterior mouth and esophagus 4\. SCC accounts for 90% to 95% of oral cancers **‣ Age and gender related**---young adults to adults in their 60s, 70s, and beyond **‣ Locations** 1\. **Tongue---37% to 50**% of all oral carcinomas, excluding cancer of the pharynx a\. Posterior third, including the lateral borders and ventral surfaces, account for most of these b\. The tongue is by far the primary location for SCC in the oral cavity 2\. Floor of the mouth---30% to 35%, mostly in men 3\. Lips---22%  **Basal Cell Carcinoma** true BCC of the oral cavity is extremely rare ‣ **Must know:** caused by sun damage, BCC has an ulcerated erythroplakia appearance; metastasis is extremely rare ‣ **Treatment:** simple surgery to remove lesion Other Skin Cancers - AIM at Melanoma Foundation **Osteosarcoma** sarcoma of jaws when tumor cells produce new bone **‣ Must know:** the deposition of new bone creates a sunburst pattern radiopacity  **Leukoplakia** white patch inside mouth that does not wipe/rub off ‣ **Must know:** clinical description and not a diagnosis. Once diagnosis is determined, we no longer refer to this as leukoplakia ‣ **Treatment:** mandatory biopsy for histology Leukoplakia: Causes, Symptoms, and Diagnosis - **ORAL PATHOLOGY IN BONES:** **Nasopalatine Cyst:** a nonodontogenic (non-tooth forming) developmental cyst A small pink bulge may appear near the apices of the maxillary central incisors on the palate. The condition is asymptomatic, and the adjacent teeth are usually vital ‣ **Must know:** appears as a heart-shaped radiolucency in the nasopalatine canal ‣ **Prevalence:** Most common nonodontogenic cyst ‣ **Treatment:** Surgical removal  **Median mandibular cyst**---cyst in midline of the mandible; develops from an odontogenic origin, possibly a primordial cyst; rare. occurs at the midline of the anterior mandible; surrounding teeth are vital. **Median palatine cyst**---fissural cyst; posterior form of a nasopalatine canal cyst; young adults. arises at the midline of the hard palate **Globulomaxillary Cyst** - a cyst appearing between a maxillary lateral incisor and the adjacent canine ‣ **Must know:** appears as inverted *pear-shaped* radiolucency \- Can cause roots of adjacent teeth to diverge \- Not a diagnosis, and not considered a distinct, classifiable entity \- located between the maxillary lateral incisor and canine ‣ **Prevalence:** N/A ‣ **Treatment:** Surgical removal **Static Bone Cyst (Lingual Mandibular Bone Concavity, Stafne Bone Cyst)** ‣ **Etiology**---developmental**; salivary gland extends laterally into the mandible** ‣ **Age and gender related**---young persons; slightly more common in males ‣ **Location**---posterior of the mandible, anterior to the angle of the ramus, inferior to the mandibular canal **‣ Clinical features**---asymptomatic; occasionally bilateral **‣ Radiographic appearance** - sharp, well-defined ovoid radiolucency 1 to 3 cm in diameter, anterior to angle of the ramus, **inferior to the mandibular canal; filled with salivary gland tissue** **Simple Bone Cyst (Traumatic Bone Cyst, Hemorrhagic Bone Cyst)** **‣ Etiology---**theories include: 1\. Intramedullary hemorrhage following trauma; altered bone prevents fibroblasts and endothelial cells from entering the hemorrhage; clotting does not occur; blood never organizes, leaving a void within the bone 2\. Ischemic marrow necrosis 3\. Degeneration of a benign tumor 4\. Bone did not develop in the area **‣ Age and gender related**---ages 10 to 20 years; male predilection **‣ Location** 1\. More common in the mandible than in the maxilla 2\. Most common in long bones **‣ Clinical features**---asymptomatic (discovered through radiographic examination) ‣ **Radiographic appearance** ---well-defined radiolucent area 1 to 7 cm in diameter; round, oval; may be multi-locular; the radiolucent projections extend between roots of teeth, defined as "**Scalloping around the roots**"; borders are sometimes sharp or diffuse **‣ Treatment and prognosis** 1\. Surgical intervention to establish bleeding and clotting is often sufficient 2\. Lesion heals 6 months to 1 year after surgical intervention **Aneurysmal Bone Cyst** **‣ Etiology---**reactive cyst; etiologic theories include: 1\. Arteriovenous shunt---a benign fibro-osseous lesion in the area alters blood vessels 2\. Trauma---trauma ruptures a blood vessel, and blood accumulates outside the wall a benign blood- filled pseudocyst that tends to expand or grow **‣ Must know:** this lesion has a multilocular radiolucency, and is commonly found in the posterior mandible **-** An aspiration biopsy is the first step for diagnosing a condition like this to determine, if this is, in fact, a vascular bone cavity filled with blood **‣ Clinical features** 1\. May be asymptomatic or may appear as a slightly to moderately well-defined bulge 2\. Tenderness, pain on motion; may limit movement 3\. Mobility or migration of teeth **‣ Radiographic appearance**---hazy, gray, radiolucent area; appears cystic, with a **"soap bubble" or honeycomb effect; multi-locular pattern can be present** **‣ Treatment and prognosis** 1\. Surgical enucleation and thorough curettage (sometimes with cryosurgery---a freezing technique to help control bleeding) Aneurysmal Bone Cyst -- Exodontia **Cherubism** **‣** Age and gender related---**onset at birth or early childhood (ages 2 to 5 years), females less severely affected** **‣ Location---only in the maxilla** **and the mandible** (more common in the mandible) **‣ Clinical features** 1\. **Painless bilateral facial swelling or enlargement of the posterior mandible**; firm and hard when palpated 2\. Taut facial skin; downward pull of the eyelids; **"cherubic" appearance**; eyes are displaced when maxilla is affected 3\. Regional lymphadenopathy 4\. Has been mistaken for an ameloblastoma or multi-locular cyst 5\. **Primary dentition may be prematurely shed at age 3 years** 6\. **Permanent dentition often defective**; absence of teeth (hypodontia); lack of eruption of the teeth or delayed eruption 7\. Speech problems; distortion of alveolar ridge ‣ Radiographic appearance 1\. Multi-locular radiolucencies; or typical soap bubble radiolucencies in jaw 2\. Bilateral thinning of cortical plates 3\. Numerous unerupted or displaced teeth in cyst-like radiolucent spaces  **Fibrous dysplasia** **General Characteristics** **‣Etiology**---unknown; abnormal mesenchymal cell function; rare diseases affecting bones; **replacement of bone with fibrous connective tissue** **‣**Swelling of bones with deformities in some forms of disease **‣** Benign fibro-osseous lesion **Monostotic Fibrous Dysplasia** **‣** Location 1\. Ribs---most common site 2\. Maxilla more often involved than mandible 3\. Can affect any bone; most common form **‣ Clinical features** 1\. Painless swelling; enlargement of the jaw or expansion of the buccal plate of maxilla or mandible 2\. Can cause malocclusion, tipping, or displacement of teeth 3\. In the maxilla, lesions are not clearly outlined because they extend into the sinus or the floor of the orbit **‣ Radiographic features** 1\. The lesion blends into surrounding bone 2\. Diffuse radiopacity; **"ground glass" appearance** 3\. Sometimes a radiolucency with areas of radiopacity (depending on the degree of calcification) Fibrous dysplasia \| Radiology Case \| Radiopaedia.org **Polyostotic Fibrous Dysplasia** ‣ Location 1\. Long bones (bowing); often unilateral 2\. Bones of the face and skull 3\. Clavicles 4\. Pelvic bones **‣ Clinical features (depend on the type of polyostotic fibrous dysplasia)** 1\. Systemic symptoms a\. **Café au lait spots**: irregular, light-brown macules on the skin b\. Painless enlargement of affected bone(s) c\. Bowing of long bones (pathologic fracture) d\. Females may reach premature puberty at age 2 or 3 years e\. Dysfunction of the **endocrine system**---pituitary, thyroid, and parathyroid glands 2\. Oral symptoms: a\. Expansion and deformity of the jaws; unilateral enlargement of maxilla or mandible b\. Disturbed eruption pattern caused by endocrine dysfunction **3. Types** a\. **Craniofacial fibrous dysplasia**---the maxilla is involved, and the lesion extends into the sinus and surrounding bones b\. **Jaffe-Lichtenstein type**---lesions arise in multiple bones; **café au lait skin lesions** appear over the involved bone c\. **McCune-Albright syndrome**---most severe form of polyostotic fibrous dysplasia \(1) Severe endocrine abnormalities \(a) **Premature puberty in females before age 2 years (precocious)** \(b) Stunted growth caused by early epiphyseal closure in both genders \(c) Café au lait skin lesions \(2) Other systemic complications (diabetes; hyperthyroidism) **‣ Radiographic appearance**---irregular bone trabeculae; expansion of cortical bone; sometimes a multi-locular cystic appearance with several radiopacities; **diffuse radiopacity resembling ground glass** **Paget's Disease (Osteitis Deformans)** **-** a progressive metabolic disturbance of different bones (skull, jaw, spine, femur), resulting in symmetrical enlargement with a cotton wool appearance **‣ Must know** similar to hyperparathyroidism, elevated alkaline phosphatase levels are observed due to increased breakdown of bone **-** Because of enlargement, dentures, or vent hats, become too tight (think ***p***inching ***P***aget's) **‣ Treatment:** bisphosphonates, calcitonin  **Thalassemia-** "salt and pepper effect" **Multiple Myeloma-** "Punched out" in bone marrow - **REACTIVE LESIONS IN ORAL SOFT TISSUE:** **Traumatic Ulcer** **‣ Etiology**---various types of trauma; history of lesion plays a significant role in the diagnosis 1\. Physical-biting the mucosa, denture irritation, toothbrush injury, sharp tooth, fractured filling 2\. Chemical---oral rinse, phenol, misuse of medication used to treat a toothache (e.g., misuse of aspirin causes an **aspirin burn**) 3\. Thermal---hot foods (e.g., soup), crack cocaine 4\. Electrical **‣ Age and gender related**---any age; no gender predilection **‣** Location---lateral border of the tongue, buccal mucosa, lips, palate (especially tori) **‣ Clinical features** 1\. Small, single, oval, round, or irregular shape 2\. Flat or slightly depressed 3\. Covered by necrotic membrane and surrounded by an erythematous halo 4\. Painful for 2 to 5 days 5\. Heals within 7 to 14 days **‣ Treatment and prognosis** 1\. Removal of the irritant or cause 2\. Application of benzocaine (Orabase with benzocaine) to relieve symptoms 3\. Corticosteroids (recommended by some, whereas others suggest corticosteroid medications can delay healing) 5\. In severe cases, systemic antibiotics are given to prevent secondary infection (these patients may also require surgical debridement depending on the extent of tissue damage) 6\. In patients with electrical burns, tetanus immunization is necessary 7\. Prognosis is good Figure, Aspirin induced chemical burn noted\...\] - StatPearls - NCBI Bookshelf Mucosal burns. **A,** Thermal burn of palate caused by contact with hot soup. **B,** Ulcer of midline of palate caused by heat generated during the use of crack cocaine **C** Aspirin Burn **Aphthous Ulcer** **-** the most common immunologic mucosal condition commonly known as a "canker sore\" **‣ Must know:** this condition impacts non-keratinized tissues (includes lining mucosa such as alveolar, buccal, labial mucosa; the soft palate; and ventral surface of the tongue) \- While this condition may superficially look similar to HSV, the two differ in that HSV impacts only keratinized tissues \- Can have two different types: minor ulcers, which heal without scarring, and major ulcers (Sutton Disease), that heal with scarring \- **Behcet's Syndrome** is a multi-system vasculitis condition that causes aphthous ulcers in the oral cavity and genitals, as well as inflammation of the eyes **‣ Treatment:** only necessary for serious cases; corticosteroids are perfect due to their anti-inflammatory properties. **Minor aphthous ulcers** **Recurrent Ulcerative Stomatitis (RUS); Recurrent Aphthous Stomatitis** **‣ Etiology** 1\. Autoimmune response of oral epithelium 2\. T cell--mediated immunologic response 3\. Decrease of mucosal tissue barrier 4\. Inherited predisposition 5\. Risk factors a.Hormonal imbalance---premenstrual (incidence increases), pregnancy (incidence decreases) b\. Psychological---anxiety, depression, acute emotional problems, stress c\. Allergy---asthma, hay fever, food, drug, gluten d\. Blood abnormalities e\. Trauma f\. Bacterial or viral agents (e.g., herpes simplex virus; cytomegalovirus) 6\. Systemic conditions associated with aphthous stomatitis: a\. Behçet syndrome b\. Crohn disease c\. Ulcerative colitis d\. Cyclic neutropenia e\. Sprue f\. Intestinal lymphoma **‣ Age and gender related**---childhood to adolescence and young adults; more common in females **‣ Location**---buccal and labial mucosa, soft palate, pharynx, tongue; more common in the anterior regions **‣ Clinical features** 1\. Ulcerations---oval or round in shape with distinct borders; the center of the ulcer has a yellowish white fibrous surface surrounded by an erythematous halo 2\. Range from 1 to 12 in number (3 to 10 most common) 3\. Size---3 to 10 mm 4\. Pain, tenderness, discomfort 5\. Interference with functions---speech, eating 6\. Prodromal period of 1 to 2 days; characterized by a tingling or burning sensation in the area where the ulcer will appear 7\. Associated systemic factors can include low-grade fever and localized lymphadenopathy **Major aphthous ulcers** **Recurrent Scarifying Ulcerative Stomatitis (RSUS); Periadenitis Mucosa Necrotica Recurrens; Mikulicz Aphthae; Sutton Disease** **‣ Etiology** 1\. Autoimmune response of oral epithelium 2\. T cell--mediated immunologic response 3\. Decrease of mucosal tissue barrier 4\. Inherited predisposition **‣ Age and gender related---**usually young adults, onset after puberty; more common in females **‣ Location**---labial mucosa, buccal mucosa, soft palate, posterior fauces **‣ Clinical features** 1\. **Multiple large** ulcers, 1 to 10 in number and 1 to 3 cm in diameter 2\. **Crater-like formations** with irregular shapes 3\. Lesions heal in 3 to 6 weeks, **producing scarring** 4\. Very painful 5\. Occur at frequent intervals; patient is rarely without an ulcer **‣ Treatment and prognosis** 1\. Corticosteroids a\. Systemic b\. Topical 2\. Inject the lesion with triamcinolone acetonide 3\. 0.05% Halobetasol propionate ointment 4\. Recurrence is common  **Fibroma** **-** a benign fibroid tumor caused by chronic trauma or irritation; are among the most common benign connect tissue tumors **‣ Must know:** also known as a hyperplastic scar, irritation fibroma, or traumatic fibroma **-** The tumor is specifically known as fibrous hyperplasia of oral mucosa Pathology Outlines - Irritation fibroma **Actinic Cheilitis (Solar Cheilitis)** **-** inflammation of lip due to prolonged sun exposure ‣ **Must know:** "actinic" = solar, "cheilitis" =reaction to long term sun damage caused primarily by UVB rays ‣ **Treatment:** surgical excision, or laser ablation for severe cases  **Pyogenic Granuloma (Pregnancy Tumor)** **-** hyperplasia of capillaries resulting in a bright red lesion **‣ Must know**: commonly found in gingiva of patients with elevated hormone levels --- pregnancy or puberty **‣ Etiology**---an exuberant tissue response to chronic irritants or trauma (i.e., plaque biofilm, calculus, poor restorative margins, hormonal levels) **‣ Age and gender related**---teenagers and young adults; more common in females (3:1), perhaps related to an increase in hormonal levels **‣ Location**---much more common on the maxillary labial gingiva than mandibular gingiva; can occur on the lips, tongue, and buccal mucosa ‣ **Clinical features** 1\. Protrusive mass; pedunculated, sessile, or lobulated base 2\. Deep-red to purple surface 3\. Soft and spongy; freely movable; ulcerated, bleeds easily 4\. Lesions are a few millimetres to several centimetres in size 5\. In pregnancy, these lesions were formerly called "**pregnancy tumors**" **‣ Treatment and prognosis** 1\. Removal of the irritant 2\. Surgical excision of the lesion 3\. These lesions can recur if the irritant remains (e.g., calculus) 4\. The lesions that occur during pregnancy may resolve spontaneously, and hormonal levels return to normal **Peripheral Giant Cell Granuloma** **‣ Etiology**---a reactive lesion caused by local irritants arising from the **periodontal ligament** **‣ Age and gender related**---40 to 60 years; more common in females (2:1) **‣ Location**---gingiva or alveolar mucosa, anterior to molars **‣ Clinical features** 1\. Exophytic lesion 0.5 to 2.0 cm in diameter 2\. Deep red 3\. Pedunculated or sessile base 4\. Arises from a deeper area in tissue than does pyogenic granuloma or fibroma **‣ Radiographic appearance**---peripheral giant cell granuloma 1\. May cause a superficial destruction of alveolar bone 2\. **Radiolucent "cuffing" or erosion of bone may appear in the Area** **‣ Treatment and prognosis** 1. Surgical removal of the entire base to eliminate recurrence **Central Giant Cell Granuloma** **‣ Etiology**---**occurs within bone**; trauma caused by a fall, blow, or tooth extraction **‣** Age and gender related---children and young adults; more common in females (2:1) age 10 to 30 years **‣ Location**---75% in the anterior segment of the mandible; also found in the maxilla **‣. Clinical features** 1\. Appears as a swelling or bulge resulting from the expansion of cortical plates 2\. No symptoms, so may be discovered on routine radiographs 3\. A similar lesion, often called **"brown tumor**," occurs in persons with **hyperparathyroidism**; resolves without treatment **‣** **Radiographic appearance** 1\. Usually a large radiolucent area with diffuse margins that are poorly defined with faint trabeculae 2\. Displacement of teeth; divergence of the roots of teeth adjacent to the lesion is a common feature 3\. Root resorption **‣ Treatment and prognosis** 1\. Curettage (perhaps more than one treatment) 2\. Surgical removal 3\. Radiotherapy is contraindicated 4\. Occasionally recurs 5\. In hyperparathyroid patients, the lesion is not removed because it resolves when hyperparathyroidism is treated **Lichen Planus** **-** a skin or oral mucosa inflammatory condition in which T lymphocytes target and destroy basal keratinocytes resulting in a burning or itching rash **‣ Must know**: secondary to the destruction of basal keratinocytes are basal zone vacuolization and sawtooth rete pegs, both of which are observed histologically \- Two forms of the condition: reticular and erosive ✦ Reticular: characterized by Wickhamstriae, lacy ribbon-like stripes onaffected area ✦ Erosive: also has Wickham striae, as well as red ulceration **‣ Treatment:** No treatment fo rasymptomatic reticular conditions; corticosteroids for symptomatic erosive conditions **Pemphigus Vulgaris** **‣ Etiology**---severe, progressive autoimmune disease that affects skin and mucous membranes **‣ Location**---anywhere on the oral mucosa; eyes, or skin **-Nikolsky sign** present---an intraoral bulla can form under light pressure from air syringe or tongue blade; same reaction can occur if pressure is applied to skin Pain may be severe, and the person is unable to eat Salivation is profuse; mouth odor Gingival desquamation **Mucous Membrane Pemphigoid** **-** an autoimmune disease characterized by blistering lesions on mucous membranes **Hematoma** \- mass of blood within tissue, often caused by trauma to oral mucosa \- dark color - **ORAL PATHOLOGY RELATED TO THE SALIVARY GLANDS:** **Ranula** **‣ Etiology** 1\. Blockage or obstruction by a salivary "stone" (sialolith) in the duct of a major salivary gland (sublingual or submandibular); unilateral 2\. Trauma to same area 3\. Term used for a mucocele that occurs in the floor of the mouth **‣ Age** and gender related---any age, but usually adults, no gender predilection **‣** Location---unilaterally on the floor of the mouth **‣ Clinical features** 1\. **Translucent, bluish, round, smooth-surfaced bulge 1 to 3 cm in diameter** 2\. Semi-firm, unilateral, fluctuant mass 3\. Increases in size between meals; decreases immediately after a meal 4\. **Located lateral to the midline (helpful to the differential diagnosis)** 5\. Small lesions can develop along the sublingual plica from the superficial ducts of Rivini **‣ Radiographic appearance**---radiopaque sialolith in the duct area if it is present **Mucocele (Mucus Extravasation)** **‣ Etiology** 1\. Trauma to a minor salivary gland duct; mucous secretion spills into connective tissue 2\. **Mechanical trauma to the salivary duct by lip biting or pinching** **‣** Age and gender related---all ages but most common in children and young adults, no gender predilection **‣ Location---the** most common site is the lower lip mucosa **‣Clinical features** 1\. Blister-like, raised, circumscribed vesicle; 1 to 4 mm in size; painless 2\. Bluish hue if the mucocele is near the surface 3\. Firm, movable on palpation **Sialolith=** Stone **Sjogren's Syndrome** **-** an autoimmune disease affecting salivary and tear glands, leading to dry mouth and dry eyes **‣ Must know:** this high-yield syndrome has two stages: **-** Primary: characterized by keratoconjunctivitis sick (dry eye) and xerostomia (dry mouth) **-** Secondary: same as primary, plus another autoimmune disease (usually rheumatoid arthritis, which typically involves TMJ disorders) **-** Antibodies common in Sjogren's syndrome patients include antinuclear antibody (ANA), rheumatoid factor (RF), Sjogren Syndrome A (SSA) and Sjogren Syndrome B (SSB) ***-** Think: ABCD (A = ANA, SSA; B = SSB; C = healthy Cells targeted; D = dry eye and mouth)* \- The most common complications of Sjogren\'s syndrome involve your eyes and mouth. - Dental caries. - Candida infections. - Vision problems. Dry eyes can lead to light sensitivity, blurred vision and corneal damage. - **ORAL PATHOLOGY OF THE TONGUE:** **Median rhomboid glossitis** loss of lingual papillae resulting in a "bald spot" on the tongue Pseudomembranous: a white plaque that *does* wipe off area is smooth because of the loss of filiform papilla May be associated with chronic fungal infection by candida albicans ‣ **Treatment:** An anti-fungal such as Clotrimazole or Nystatin Median Rhomboid Glossitis -- Exodontia **Geographic Tongue** \- aka erythema migrant, loss of papillae resulting in red patches that migrate over time, filiform papilla is lost **‣ Must know:** aka benign migratory glossitis and erythema migrant \- Look for a characteristic white ringed lesion surrounding the red patches **‣ Prevalence:** Very common **‣ Treatment:** None if asymptomatic, topical corticosteroid if symptomatic **Ankyloglossia (Tongue Tied)** Can cause problems with speech, gingival recession, and bone loss (if the frenum is attached too high on the lingual alveolar ridge) **Treatment:** Frenectomy -- surgical removal of a portion of the frenum  **Fissured Tongue** \- deep and prominent grooves and fissures across the tongue surface **‣ Must know**: benign condition, can be related to dry mouth \- **Melkersson-Rosenthal Syndrome (MRS)** is a rare neurological disorder that includes a fissured tongue, granulomatous cheilitis, and facial paralysis as main characteristics **‣ Prevalence:** Common **‣ Treatment:** None Fissured tongue - Wikipedia **Oral Hairy Leukoplakia** **-** a condition triggered by Epstein Barr Virus (EBV) causing white hairy-appearing patches on the sides of the tongue that do not wipe off ‣ **Must know**: This is an opportunistic infection associated with HIV  **Hairy Tongue** \- tongue appears dark and furry due to buildup of dead skin cells on filiform papillae ‣ **Must know:** poor oral hygiene, certain medications (corticosteroid) or antibiotics, tobacco use, or radiation treatment of head/neck are all potential causes of this condition BLACK HAIRY TONGUE?! How To Get Rid Of It 👅 - **ORAL PATHOLOGY RELATED TO HIV/AIDS:** **Candidiasis** a fungal infection caused by Candida ‣ **Must know:** Also known as thrush, this infection has several different types \- Angular cheilitis: inflammation of corners of the mouth \- Atrophic: a red plaque on oral mucosa that may form due to a poorly fitting denture or prosthetic device, or poorly cleaned prosthetic device \- Median rhomboid glossitis: loss of lingual papillae resulting in a "bald spot" on the tongue \- Pseudomembranous: a white plaque that *does* wipe off ‣ **Treatment:** An anti-fungal such as Clotrimazole or Nystatin  **Kaposi's Sarcoma** **-** malignant proliferation of endothelial cells **‣ Must know:** this condition is caused by HHV 8, and is usually a complication of AIDS **-** Unlike the other sarcomas that can vary in their oral appearances, Kaposi's Sarcoma has a very characteristic appearance: a purple lesion **Herpes** **Primary Herpetic Gingivostomatitis** **‣ Etiology** 1\. Virus---initial infection with herpes simplex virus (HSV) 2\. Member of the human herpesvirus (HHV) group 3\. Transmission---droplet infection; direct contact; highly contagious (the amount of virus is highest in the vesicle stage); patients can self-inoculate (especially the eyes) **‣ Age and gender related**---**ages 6 months to 6 years**; no gender predilection **‣ Location---**lips, gingiva, tongue, pharynx, floor of the mouth, buccal mucosa **‣ Clinical features** 1\. Systemic symptoms a\. Abrupt onset of fever b\. Headache, irritability c\. Pain on swallowing d\. Regional lymphadenopathy 2\. Oral symptoms a\. Hypertrophic gingivitis b\. Initially, tiny vesicles (pinhead size) that develop into ulcerations c\. Painful ulcers 1 to 3 mm in size; covered by a yellowish fibrinous surface d\. Shallow craters covered by white or yellow plaque; bright erythematous margins ("halo") e\. Most acute on days 3 to 7 **‣ Treatment and prognosis** 1\. Symptomatic therapy---bed rest, fluids 2\. Antiviral medications such as acyclovir ("swish and swallow") started within the first few days 3\. Ibuprofen to reduce pain and discomfort 4\. Self-limiting; healing in 7 to 14 days 5\. Recurrence most common in the form of herpes labialis **Herpes Labialis (Cold Sore, Fever Blister)** **‣ Etiology** 1\. Residual form of HSV type 1 2\. **Recurrence of HSV** from its latent stage 3\. Stimuli that can trigger the onset a\. Exposure to sunlight b\. Trauma c\. Menstruation d\. Emotional stress, anxiety, fatigue e\. Allergic reactions f\. Systemic diseases **‣Age and gender related**---adults; no gender predilection **‣ Location** 1\. Lips---most common (herpes labialis) 2\. Intraorally---**hard palate, attached gingiva (keratinized mucosa fixed to bone)** **‣ Clinical features** 1\. Prodromal period (any time up to 24 hours before the lesion erupts)---burning sensation, feeling of tightness, tingling, or soreness where the vesicle eventually appears 2\. Several fluid-filled papules may appear in clusters (most contagious state) 3\. Vesicles rupture, and crust forms on lips 4\. **Intraoral lesions can appear on keratinized mucosa** 5\. Do not confuse with angular cheilitis, a fungal infection **Herpes Zoster (Shingles)** **‣ Etiology** 1\. Reactivation of varicella-zoster virus (VZV, HHV-3) from its latent stage 2\. VZV also causes chickenpox, which is considered the primary infection with VZV 3\. Risk factors for reactivation of VZV a\. Systemic disease (malignancies, Hodgkin's disease, leukemia) b\. Drug toxicity, radiation, alcohol abuse c\. Advanced age d\. Extreme fatigue e\. Immunosupression 4\. Depression of cell-mediated immunity **‣ Age and gender related**---adults, usually **over 50 years;** no gender predilection **‣ Location**---skin or mucosa, supplied by the affected **sensory nerve**; any of the three branches of the trigeminal nerve **unilateral distribution** **‣ Clinical Features** 1\. Three phases---prodromal, acute, chronic 2\. Prodromal period of extreme pain 1 to 3 days before eruption of the unilateral rash, which can be accompanied by systemic features such as fever, severe headaches, lymphadenopathy, and overall weakness 3\. The erythematous rash develops into vesicles; the pain becomes more intense with a burning, tingling, or stabbing sensation 4\. Clusters of these vesicles develop along the pathway of a sensory nerve 5\. Intraoral lesions can appear as multiple vesicles with a white center, which eventually form shallow ulcerations; **these lesions are also unilateral and can be on movable or attached mucosa** 6\. After the skin vesicles heal, a postherpetic neuralgia occurs **Oral Lesions Associated with Human Immunodeficiency Virus (HIV) Infection** Candidiasis Herpes simplex infection Herpes zoster Hairy leukoplakia Human papillomavirus (HPV) lesions Atypical gingivitis and periodontitis **Other opportunistic infections reported** *Mycobacterium avium* Cytomegalovirus *Cryptococcus neoformans* *Klebsiella pneumoniae* *Enterobacter cloacae* *Histoplasm*a *capsulatum* **Kaposi's sarcoma** Non-Hodgkin's lymphoma Aphthous ulcers Mucosal pigmentation Bilateral salivary gland enlargement and xerostomia Spontaneous gingival bleeding resulting from thrombocytopenia - **ORAL PATHOLOGY RELATED TO TOBACCO USE AND ORAL APPLIANCES:** **Nicotine Stomatitis** **‣ Etiology**---heavy tobacco smoking using cigarettes, cigars, water pipe (hookah), or pipe; often associated with pipes ("pipe smoker's palate") **‣ Age and gender related**---most common in male smokers over 40 years **‣ Location**---posterior hard and soft palates 1\. Begins with erythema and inflammation of the palate; response to an irritant (heat) 2\. Over time, the palate becomes more keratinized and grayish white; thickened nodules surround the inflamed orifices of the minor salivary ducts 3\. Fissures or cracks around the nodules create an overall wrinkled appearance **Denture-Induced Fibrous Hyperplasia** -lesions that result due to a poorly fitting denture **‣ Must know:** there are two main types of this condition **- Epulis fissuratum:** occurs at the base of the vestibule **- Papillary hyperplasia:** occurs on palate; more likely due to poorly cleaned Dentures Mucogingival overgrowth in a geriatric patient  - **ORAL PATHOLOGY RELATED TO TEETH:** **Periapical Cyst (Radicular cyst)** **‣ Etiology** 1\. A true cyst; develops as an inflammatory response; associated with a nonvital tooth 2\. Factors could include dental caries, trauma, deep restorations causing pulpitis **‣ Age and gender related**---any age, but common ages 30 to 60 years; slight predilection for males **‣ Location**---apex of a tooth or lateral to the tooth root **‣ Clinical features** 1\. Nonvital tooth 2\. Usually asymptomatic **‣ Radiographic appearance** 1\. Round or ovoid, well-defined radiolucent area attached to the apex or lateral to the root **‣ Treatment -** 1\. Root canal therapy 2\. Extraction of the tooth and curettage of the socket and apical area to remove the cystic sac 3\. If radiolucency fails to resolve the condition, retreatment endodontically; apicoectomy may be required **Periapical Granuloma** **‣ Etiology**---dental caries or deep restorations; a response to injury **‣ Age and gender related**---any age; no gender predilection **‣ Location**---**apex of a nonvital tooth** **‣ Clinical features** 1\. **Nonvital tooth** 2\. Fistula or parulis may be present if the condition has been chronic 3\. The affected tooth can be sensitive to percussion 4\. Many times can be asymptomatic **‣ Radiographic appearance**---varies from a well-defined, circular, radiolucent lesion at the apex of the involved tooth to a diffuse radiolucency or thickening of the periodontal ligament space **‣ Treatment**---endodontic therapy or extraction of the affected Tooth **Focal Sclerosing Osteomyelitis (Condensing Osteitis)** **-** a periapical lesion resulting from low-grade inflammation such as chronic pulpitis **‣ Must know:** a wall of diffuse dense bone forms to "wall off" the infection **‣ Treatment:** none, other than addressing the cause of infection, such as performing a root canal Radiodontics \| Condensing Osteitis As the name suggests, condensing osteitis is a bony proliferation in response to inflammation and will therefore only... \| Instagram **Alveolar Osteitis** Also called \"dry socket.\" Post-operative complication of tooth extraction. Occurs when the blood clot breaks down and is lost before healing has taken place (clot is essential for healing). Patient complains of pain, bad odor, and taste. **Dentigerous Cyst (Follicular Cyst)** **‣Etiology**---from **reduced enamel epithelium after the crown of the tooth is completely formed (unerupted or impacted tooth);** **accumulation of fluid between the crown and reduced enamel epithelium;** cyst must be associated with a tooth; developmental or inflammatory origin **‣Age and gender related**---young adults 20 to 30 years; second most common odontogenic cyst; higher predilection for white males **‣ Location** 1\. **Mandibular third molar area**---around the crown of an unerupted third molar; often extending to the ramus 2\. **Maxillary canine region**---compromising the maxillary sinus **‣ Clinical features** 1\. Always associated with the crown of an unerupted tooth; **asymptomatic** 2\. Can be an aggressive lesion, causing expansion of bone and extreme displacement of teeth; fracture of the mandible **‣ Radiographic appearance** 1\. Smooth, unilocular radiolucency associated with the crown of an unerupted tooth 2\. At least 4 mm of radiolucency extending from the crown to the epithelium of the reduced enamel **Eruption Cyst**- blue/green layer **Primordial Cyst** **‣ Etiology**---neoplastic; arises from epithelium of the enamel organ or from primordial epithelium; history that a tooth was never present; **the cyst develops in place of the tooth;** sometimes histologically considered the same as an odontogenic keratocyst **‣ Age and gender related**---child to young adult; ages 10 to 40 years; slight male predilection **‣ Location**---posterior mandible; third molar area or posterior to an erupted third molar and up the ramus **‣ Clinical features**---no obvious clinical features; the affected person may be asymptomatic **‣ Radiographic appearance**---**well-defined radiolucent oval lesion; can be multi-locular** 1\. **Tooth never present in the space occupied by the cyst (this history is essential to the diagnosis)** 2\. An unerupted tooth can be involved in this cyst 3\. Size varies from a few millimeters to a centimeter 4\. Radiographic features not diagnostic  **Regional Odontodysplasia** Development anomaly impacting enamel, dentin, and cementum components of teeth **‣ Must know:** Termed *"ghost teeth"* this condition results in quadrants of teeth to exhibit short roots, enlarged pulp chambers, and open apical foramen \- The thin enamel and dentin layers result in a faint, fuzzy image of the teeth when x-rayed, hence the name "ghost teeth" ‣ **Inheritance pattern:** Unknown **‣ Treatment:** Extraction of affected teeth Regional odontodysplasia (ghost teeth \... **Odontogenic Keratocyst** **‣ Etiology**---odontogenic developmental cyst with unique histologic appearance and frequent recurrence **‣Age and gender related**---60% between 10 and 40 years of age; slight male predilection **‣ Location**---most often in posterior mandible **‣ Clinical features**---may be asymptomatic; does not expand bone **‣ Radiographic appearance**---well-defined, **multi-locular radiolucent lesion**; can be similar to that of an odontogenic tumor; lesion can move teeth and resorb tooth structure **‣ Treatment and prognosis** 1\. Aggressive surgical excision and osseous curettage 2\. High recurrence rate 3\. Close follow-up  **Lateral Periodontal Cyst (LPC)** **‣ Etiology**---developmental; odontogenic cyst; develops from the rests of the dental lamina **‣Age and gender related**---adults over 30 years; common ages 50 to 70 years; male predilection **‣Location**---most often lateral root surface of **mandibular canine or premolar teeth (occasionally seen in the maxilla in the same areas)** **‣ Clinical features** 1\. **Tooth or teeth involved are vital** 2\. **Asymptomatic**, no bulge **‣ Radiographic appearance** 1\. Small; less than 1 cm 2\. Well-defined ovoid or elliptically shaped radiolucent area found lateral to a tooth root 3\. The ***botryoid odontogenic cyst* (BOC)** is closely related to the LPC, and the diagnosis is used for multi-cystic or multi-locular variants; BOC is most common in the mandibular cuspid and premolar area **Odontoma** **‣ Etiology**---**most common odontogenic tumor**; composed of all tooth structure and pulp but not considered a neoplasm **‣Age and gender related**---usually seen in adolescents and **young adults**, mean age 14 years; no gender predilection **‣Location**---more frequently seen in the maxilla (especially anterior maxilla for the compound type) than in the mandible; usually between the roots of teeth or near apices; complex odontomas seen more often in posterior mandible **‣Clinical features** 1\. Failure of a permanent tooth to erupt 2\. Asymptomatic **‣ Radiographic appearance**---irregular mass of radiopacities ("tooth-like structures") surrounded by a narrow radiolucent halo 1\. Two types a\. Compound---tooth structures are identified radiographically (Common in ant maxilla) b\. Complex---appears as a radiopaque mass (can be confused with other lesions in bone) in post mandible Cyst involvement may occur with an odontoma **‣Treatment and prognosis** 1\. Complete surgical removal (both forms are well encapsulated) 2\. Prognosis is good - **PATHOLOGY SEEN IN UNUSUAL AREAS:** **Systemic Lupus Erythematosus (SLE)** **‣ Etiology**---acute and chronic inflammatory autoimmune disease involving several systems **‣Age and gender related**---much more common in females (8:1) during childbearing years; **African American females** more affected than white females (3:1); average age 31 years **‣ Location** 1\. Buccal mucosa, palate, gingiva (25% to 30% of persons with SLE) 2\. Skin---lesions occur in 85% of persons with SLE; a characteristic erythematous **butterfly-shaped rash on the face (malar areas) and nose;** chest, back, extremities; exposure to sunlight makes the rash worse **‣ Systemic characteristics** 1\. Fever, weight loss, arthritis, muscle pain 2\. **Raynaud phenomenon** is seen in up to 15% of persons with SLE 3\. CNS involvement, depression, and seizures 4\. Ocular involvement; retinal nerve damage 5\. Kidney involvement (complications can be fatal) 6\. Cardiac vegetations affecting heart valves (Libman-Sacks endocarditis) **Behcet's Syndrome** is a multi-system vasculitis condition that causes aphthous ulcers in the oral cavity and genitals, as well as inflammation of the eyes **‣ Treatment:** only necessary for serious cases; corticosteroids are perfect due totheir anti-inflammatory properties **Gardner Syndrome** involves multiple odontomas and intestinal polyps; patients diagnosed with this syndrome have a higher risk of early colorectal cancer *(think odonTOMATO* → *the* *opaque lesion is buried in tissues like a* *tomato in a GARDEN)* **Gingival Hyperplasia** **-** the enlargement of the gingiva **‣** Must know: this condition occurs as a side effect of *DCC: D*ilantin (anticonvulsant), *c*alcium channel blockers, and *c*yclosporine (an immunosuppressant) **-** This condition is very high yield for the INBDE! **‣** Treatment: gingivectomy; discontinued drug use, if possible - **ORAL PATHOLOGY OF INFECTIOUS ETIOLOGY:** **Impetigo** - Highly contagious superficial skin infection generally caused by one of two bacteria: Staphylococcus aureus or
Streptococcus pyogenes. - Characterized by vesicles or bullae resembling recurrent herpes virus that rupture and crust around the nose and mouth. - The condition is usually seen in young children, and the infection is transmitted from direct contact with the microorganism. - Systematic manifestations such as fever and malaise generally do not Skin Infection in Children \... **Strep Throat** - Bacterial infection caused by streptococcus pyogenes (Group A Streptococcus). - It is highly contagious and usually affects children from 5-15
years. - Symptoms include sore throat, fever, white patches on tonsils, red spots on palate, etc. Tonsillitis and pharyngitis describe the inflammation of the tonsils and pharynx. - Scarlet fever can occur and features bright red rash throughout the body. - Rheumatic fever: inflammatory disease following streptococcal infection that can cause permanent damage to the heart, joints, and central nervous system. - In addition, petechiae (small, round purplish-red spots on the soft palate), and strawberry tongue (red bumpy appearance) can appear. **Actinomycosis** **-**an infection caused by filamentous bacteria *Actinomyces israelii* ---do not confuse this with a fungal infection! ‣ Must know: This is an opportunistic, chronic, and granulomatous infection with two main types = periapical and cervicofacial \- Periapical: jaw infection \- Cervicofacial: head and neck infection \- The most common characteristic of actinomycosis is the presence of sulfur granules in the purulent exudate ‣ Treatment: Long-term high-dose penicillin  **Syphilis** **-** a bacterial infection caused by contact with *Treponema pallidum* (spirochete) and usually spread by sexual contact that starts as a painless sore on genitals, rectum, or mouth, but can become a systemic condition ‣ Must know: There are three different types of lesions = primary, secondary, and tertiary \- Primary lesion: chancre, a painless genital ulcer, forms \- Secondary lesion: oral mucous patch, condyloma latum, or maculopapular rash are observed \- Tertiary lesion: gumma, or a soft tumor- like growth, forms; CNS and cardiovascular systems become involved \- Congenital syphilis: a mother with syphilis can give birth to a baby with congenital syphilis, and the condition follows Hutchinson's triad pattern of presentation: ✦ Teeth abnormalities (notched incisors, mulberry molars), deafness, and ocular keratitis *(think: hear no evil* *= deafness, see no evil = ocular* *keratitis, speak no evil = teeth* *abnormalities)* **Condyloma Acuminatum** **-** papilloma caused by HPV infection, with strains 6 and 11 having the highest prevalence ‣ Must know: This condition may manifest as a genital or oral wart, usually as a result of having oral sex with someone with genital warts ‣ Treatment: Excision with high recurrence Genital Wart (Condyloma Acuminatum \... **Chickenpox and Shingles** - ****Varicella-zoster virus (VZV) causes both chickenpox (varicella) and shingles (herpes zoster). Vacci is available to prevent varicella-zoster infections. - Chickenpox occurs mostly in children and is highly contagious. Itchy lesions throughout the body and flu-like symptoms will appear. - Herpes zoster usually occurs with anyone who has had chickenpox. The virus remains inactive in the nerve cells near the spinal cord. - Characterized by unilateral, painful vesicles along t sensory nerves. Lesions can last for several weeks to several **Coxsackie Virus** **-** an enterovirus causing hand-foot-and-mouth diseases ‣ Must know: This virus can also cause herpangina, which results in small blister-like sores in the posterior oral cavity (soft palate, throat, and tonsils) - **ORAL PATHOLOGY MEDICAL CONDITIONS:** **Down Syndrome** - A genetic disorder caused by a third copy of chromosome 21.
Oral conditions include: - Prognathic mandible with Class Ill malocclusion, and open bite due to tongue-thrusting. - Fissured tongue, and cracked lips due to mouth-breathing habits (patients usually have small airways). - Macroglossia (true macroglossia is rare. The tongue appears larger because the mouth is small). - Microdontia with malformed teeth, anomalies in eruption and congenitally missing teeth. - Delayed exfoliation and tooth development. - Higher risk for periodontal disease because of poor oral hygiene, malocclusion, bruxism, conical-shaped roots, etc. - Lower risk for dental caries in children and young adults because of delayed primary/permanent tooth eruption, missing permanent teeth, small-sized teeth, wider interproximal spaces, etc. Higher risk for dental caries in adults because of poor oral hygiene and cariogenic food **Cyclic Neutropenia** - Inherited disorder with repeated decrease in the number of neutrophils for a short period (2-3 days). - Events usually occur in intervals of 21 to 27 days. - Periodontal disease is initiated and worsens during those periods.
When the neutrophil count returns to normal, the oral lesions tend to improve. Over time, episodes of neutropenia will lead to severe periodontal disease (inflamed gingiva, attachment loss, bone loss, tooth mobility, and tooth loss) and ulceration. - Treatment should be initiated when the circulating neutrophil count is normal and frequent appointments are recommended **Ellis-Van Creveld Syndrome** - An inherited disorder characterized by abnormal bone growth resulting in dwarfism. - Patients can be mildly mentally handicapped. - Characterized by polydactyly, hypoplastic fingernails, and toenails. - Fusion of the anterior portion of the maxillary gingiva to the upper lip from canine to canine (anterior maxillary vestibular sulcus is lacking). - Lack of central incisors on both the maxilla and mandible.
The area is replaced by a centrally located abnormal tooth. More than half of newborns with this syndrome have natal teeth - A genetic disorder that affects the development of the bones and teeth. - The cranium develops into a mushroom shape and the clavicles are underdeveloped. - Characterized by many supernumerary teeth, sometimes even simulating a third dentition. - Interference with the eruption of normal teeth results in pseudo anodontia. **Mandibulofacial Dysostosis** - Also called Treacher Collins Syndrome, it is a genetic disorder that affects the development of the facial structure. - Characterized by a fish-like mouth (high palate, downward sloping of the lip commissures, and an open-bite).
Deafness results from a lack of otic ossicles. **Nevoid Basal Cell Carcinoma Syndrome** - Also called Gorlin Syndrome, it is an inherited condition that causes abnormalities in the skin, nervous system, bones, etc. - Nevus (plural nevi): congenital lesion characterized by pale brown skin pigmentation. - Palms of hands and soles of feet show small dark pits that can easily get filled with dirt. - People with this syndrome are particularly prone to skin cancers. - Patients may have multiple cysts of the jaw that are odontogenic keratocysts.