Oral Disease: Case Studies of Difficult Diagnoses

Dr. Carl M. Allen is Emeritus Professor of the Ohio State University, College of Dentistry, retiring after 36 years of teaching. Following retirement, he practiced with a dermatology group, followed by an otolaryngology group. Two of his former residents took over the practice, and Carl finally retired. Dr. Allen received his DDS from Ohio State in 1975 and trained in oral and maxillofacial pathology at Indiana University from 1978 to 1980. Throughout his career, he has been active in seeing patients clinically who were referred for evaluation of oral disease. He has also actively participated in affiliated oral and maxillofacial biopsy services, allowing him to examine microscopically the tissue sections obtained from the patients he had seen. He has been a Diplomate of the American Board of Oral and Maxillofacial Pathology since 1983 and completed a six-year term (1994-2000) as Editor of the American Academy of Oral and Maxillofacial Pathology. He was President of the AAOMP in 2004 and was a Director of the American Board of Oral and Maxillofacial Pathology from 2005 to 2013. Carl has published over 125 refereed articles in dental and medical journals and has written chapters dealing with oral disease for texts in the fields of otolaryngology, microbiology, dermatology and surgical pathology. Three significant contributions, however, were as a co-editor of the textbook, Oral and Maxillofacial Pathology by Neville, Damm, Allen and Chi, which is in its fifth edition; the Color Atlas of Oral and Maxillofacial Diseases, by the same authors, published in 2019; and author of Oral Disease: Case Studies of Difficult Diagnoses, published in 2026.

• Section 1: Developmental Conditions/Syndromes1. Acro-osteolysis syndrome2. Gardner syndrome3. Oligodontia misdiagnosed as ectodermal dysplasia4. Plasminogen deficiency5. White sponge nevusSection 2: Dental Conditions6. Fluorosis7. Erosion secondary to bulimiaSection 3: Environmental and Trauma-Related Conditions8. Toothbrush trauma9. Petechial hemorrhage caused by fellatio10. Oxycontin insufflation injury11. Abrading the fibrin covering a non-specific ulcer12. Traumatic ulcers related to xerostomia and candida13. Burn caused by inhaling hashish ember14. Graphite tattoo15. Factitial oro-antral fistula16. Lip burns caused by crack pipe17. Mucosal sloughing caused by tartar-control toothpasteSection 4: Salivary Gland - Reactive18. Necrotizing sialometaplasiaSection 5: Infections - Bacterial19. Syphilis - secondary, presenting as lymphadenopathy20. Syphilis - secondary, presenting as leukoplakiaSection 6: Infections - Fungal21. Candidiasis - mucosal presentations and their management22. Candidiasis - severe cheilitis/lip balms23. Candidiasis - perioral, due to petroleum jelly application24. Candidiasis - invasive in uncontrolled diabetic with oral ulcer25. Aspergillosis - patient being treated for leukemiaSection 7: Infections - Viral26. Hand, foot and mouth disease mistaken for erythema multiforme27. Oral HSV-1 in a leukemia patient28. Oral primary herpes affecting a teenager29. Herpes - recurrent intraoral infectionSection 8: Oral Manifestations of HIV Infection30. Oral Kaposi sarcoma mistaken for Crohn disease31. Recurrent candidiasis and Kaposi sarcoma in a previously undiagnosed HIV patient32. HSV causing a persistent tongue ulcer33. Oral lymphoma mimicking a pyogenic granuloma34. Oral aphthous ulcers in HIV-positive patients35. Oral histoplasmosis in AIDS patients36. HIV-positive man with squamous cell carcinoma37. Behcet syndrome in an HIV-positive man38. HIV-positive man with gingival ulceration39. HIV-positive man with a vascular anomaly of his lipSection 9: Oral Precancerous Conditions - Leukoplakia and Erythroplaki40. Precancerous oral lesions - three different presentations41. Erythroplakia of the floor of the mouth, treated with radiation42. Erythro-leukoplakia of young man’s tongueSection 10: Oral Precancerous Conditions - Proliferative Verrucous Leukoplaki43. A woman with palatal erythroplakia and pharyngeal “polyps”44. PVL of the mandibular ridge45. PVL of a young woman’s tongue46. PVL of the lateral tongue of a nurse, treated as lichen planus47. PVL, lichenoid, in a middle-aged man48. PVL, slowly progressive in an older man49. PVL, erosive, but eventually leukoplakia and carcinoma50. PVL, young woman with lichenoid tongue lesions51. PVL eventually transforming to verrucous carcinomaSection 11: Oral Squamous Cell Carcinoma (SCCa)52. Poorly differentiated Ca of buccal mucosa in a young woman53. SCCa of tongue treated as denture sore54. SCCa of gingiva arising in “lichen planus”55. SCCa of gingiva mistaken for cyclosporine hyperplasia56. SCCa of the lower lip in BMT patient, treated as infection57. SCCa of dorsal tongue, treated as candidiasis58. SCCa, large and destructive of the buccal mucosa59. SCCa, due to betel quid and cigarette use in an Indian man60. SCCa of the dorsal tongue. Mild dysplasia 10 years earlier.61. SCCa of the tongue treated as infection over several months62. SCCa of tongue thought to be due to a foreign body63. SCCa, massive lesion of the lower lip. Non-treatable.64. SCCa of the gingiva. Prior biopsy suggested dysplasia.65. SCCa of tongue in a 36-year-old woman66. SCCa mistaken for abscess in a 19-year-old male67. SCCa of the cheek in a man who used alternative treatments68. Verrucous Ca is managed with radiation in an older man69. Verrucous Ca is seen in the initial incisional biopsy…Section 12: Melanoma70. Oral melanoma in an edentulous manSection 13: Malignancies of Osseous Differentiation71. Osteosarcoma affecting a woman with Turner syndrome72. Osteosarcoma, massive, of a woman’s mandible73. Osteosarcoma, referred by the woman’s dentistSection 14: Hematopoietic Malignancies74. Lymphoma causing palatal swelling75. Lymphoma causing a posterior maxillary mass76. Granulocytic sarcoma in an older man and a teenager77. Multiple myeloma - presenting as tongue and eyelid nodules of amyloid78. Multiple myeloma in a man with tongue and neck swellingSection 15: Other Mesenchymal Malignancies79. Synovial sarcoma in a woman treated as TMJ dysfunctionSection 16: Salivary Gland Malignancies80. Mucoepidermoid carcinoma misdiagnosed as a tattoo81. Mucoepidermoid carcinoma presenting as a tongue nodule82. Secretory carcinoma seen as a nodule in the buccal vestibuleSection 17: Metastatic Disease83. Metastatic adenocarcinoma of the colon in a denture patient84. Metastatic lung carcinoma presenting as a tongue nodule85. Metastatic nasopharyngeal Ca involving the brain and gingiva86. Metastatic prostate carcinoma treated endodontically87. Metastatic renal cell Ca presenting as a large jaw swelling88. Metastatic malignant peripheral nerve sheath tumor in a boySection 18: Vesiculobullous Disease89. Pemphigus vulgaris affecting a 15-year-old boy90. Mucous membrane pemphigoid leading to blindness91. Paraneoplastic pemphigoid caused by burn pit exposure92. Paraneoplastic pemphigus affecting a man with lymphomaSection 19: Immune-Mediated Disease93. Geographic tongue affecting a young woman94. Herpetiform aphthae and coated tongue in a young woman95. Lichenoid and granulomatous stomatitis in an elderly man96. Behcet syndrome in a woman with oral sores for months97. Pyostomatitis vegetans presenting as painful gingival lesions98. Crohn disease in a man with gingival swelling99. Crohn disease in a young woman with gingival swelling100. Cheilitis granulomatosa for years in a young woman101. Cinnamon reaction of the tongue noted for months102. Toothpaste reaction on both sides of the tongue103. Drug reaction causing diffuse oral ulcers for several years104. Erythema multiforme treated as oral candidiasis105. Wegener granulomatosis with palatal and gingival lesionsSection 20: Oral Manifestations of Systemic Disease106. Brown tumor presenting as an enlarging mandibular mass107. Hypothyroidism in a girl whose teeth were not erupting108. Burning mouth syndrome in a middle-aged womanSection 21: Coincidental Cutaneous Lesions109. Cutaneous sinus of dental origin on the facial skin110. Recurrent basal cell carcinoma of the forehead111. Basal cell carcinoma involving the forehead of a student112. Pigmented basal cell carcinoma of the neck113. Superficial basal cell carcinoma behind the ear114. Basal cell carcinoma of the upper lip115. Recurrent basal cell carcinoma of the nasal ala116. Melanoma arising in a congenital melanocytic nevus