Handbook of Oral Pathology and Oral Medicine

S.R. PRABHU is Honorary Associate Professor of Oral Medicine at the School of Dentistry at the University of Queensland in Brisbane, Australia. He is a Fellow of Dental Faculty of all four United Kingdom and Ireland based Royal Surgical Colleges. He has taught oral pathology and oral medicine in a number of dental schools internationally, and has authored numerous book chapters, papers and reviews, and edited books.

• ForewordPrefaceAcknowledgementsStandard AbbreviationsTerminology used in oral pathology and oral medicine  PART 1. PATHOLOGY OF TEETH AND SUPPORTING STRUCTURES  1. Disorders of tooth development and eruption1. 1. Anodontia, hypodontia and oligodontia1. 2. Hyperdontia (supernumerary teeth)1.3. Microdontia and macrodontia1.4. Gemination, fusion and concrescence1.5. Taurodontism and dilaceration1.6. Amelogenesis imperfecta1.7. Dentinogenesis imperfecta1.8. Dentinal dysplasia1.9. Regional odontodysplasia1.10. Delayed tooth eruption1.11. Tooth impaction1.12. Dens invaginatus and dens evaginatus1.13. Fluorosis1.14. Tetracycline induced discolouration of teeth1.15. Enamel pearl,1.16. Talon cusp1.17. Hutchinson’s incisors and mulberry molars1.18. Tooth ankylosis1.19. Supernumerary roots  2. Dental caries2.1. Definition/description2.2. Incidence/prevalence2.3. Aetiology/risk factors/pathogenesis2.4. Classification of caries2.5. Clinical features2.5.1.      Primary caries2.5.2.      Secondary caries2.5.3.      Arrested caries2.5.4.      Rampant caries2.5.5.      Early childhood caries2.5.6.      Methamphetamine-induced caries (MIC)2.5.7.      Radiation caries2.6. Differential diagnosis2.7. Diagnosis2.8. Microscopic features of enamel caries2.9. Microscopic features of dentinal carries2.10.        Management2.11.        Prevention   3.      Diseases of the pulp and apical periodontal tissuesClassification of diseases of the pulp and apical periodontal tissues3.1. Pulpitis3.2. Apical periodontitis and periapical granuloma3.3. Apical Abscess3.4. Condensing osteitis4. Tooth wear, pathological resorption of teeth, hypercementosis and cracked tooth syndrome4.1.   Tooth wear: Attrition, Abrasion, Erosion and Abfraction4.2.   Pathological resorption of teeth4.3.   Hypercementosis4.4.   Cracked tooth syndrome  5. Gingival and periodontal diseases.Classification of gingival and periodontal diseases5.1. Gingivitis: Chronic gingivitis5.2. Necrotizing periodontal diseases5.3. Plasma cell gingivitis5.4. Foreign body gingivitis5.5. Desquamative gingivitis5.6. Chronic periodontitis5.7. Aggressive periodontitis5.8. Fibrous epulis5.9. Peripheral ossifying/cementifying fibroma5.10. Peripheral giant cell granuloma5.11. Angiogranuloma: Pyogenic granuloma and pregnancy epulis5.12. Inflammatory gingival hyperplasia5.13. Generalized gingival hyperplasia in pregnancy5.14. Drug-induced gingival hyperplasia5.15. Familial gingival hyperplasia5.16. Gingival and periodontal abscesses5.17. Pericoronitis/pericoronal abscess5.18. Gingival enlargement in granulomatosis with polyangiitis (Wegener’s granulomatosis)5.19. Gingival enlargement in leukaemia5.20. Gingival enlargement in ascorbic acid deficiency  PART 2. PATHOLOGY OF JAW BONES  6. Infections and necrosis of the jaws6.1. Acute suppurative osteomyelitis6.2. Chronic suppurative osteomyelitis6.3. Sclerosing osteomyelitis6.4. Proliferative periosteitis (Garre’s osteomyelitis)6.5. Actinomycosis6.6. 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 jaws7.1. Radicular cyst, Lateral radicular cyst, and Residual radicular cyst7.2. Dentigerous cyst7.3. Eruption cyst7.4. Odontogenic keratocyst7.5. Lateral periodontal cyst7.6. Calcifying odontogenic cyst7.7. Orthokeratinized odontogenic cyst7.8. Glandular odontogenic cyst7.9. Nasopalatine duct cyst7.10. Pseudocysts of the jaws: Solitary bone cyst, Aneurysmal bone cyst, and Stafne’s bone cyst7.11. Nasolabial cyst  8. Odontogenic tumours of the jawsClassification of odontogenic tumours8.1. Ameloblastoma8.2. Unicystic ameloblastoma8.3. Squamous odontogenic tumour8.4. Calcifying epithelial odontogenic tumour8.5. Adenomatoid odontogenic tumour8.6. Ameloblastic fibroma8.7. Ameloblastic fibrodentinoma and ameloblastic fibro-odontome8.8. Odontome (Odontoma)8.9. Dentinogenic ghost cell tumour8.10. Odontogenic myxoma8.11. Odontogenic fibroma8.12. Cementoblastoma  9. Non-odontogenic benign and malignant tumours of the jaws9.1. Osteoma9.2. Multiple osteomas in Gardner’s syndrome9.3. Central haemangioma9.4. Melanotic neuroectodermal tumour of infancy9.5. Osteosarcoma9.6. Chondrosarcoma9.7. Ewing’s sarcoma9.8. Multiple myeloma9.9. Solitary plasmacytoma9.10. Burkitt’s lymphoma  10. Fibro-osseous and related lesions of the jaws10.1. Ossifying fibroma/Cemento-ossifying fibroma10.2 Cemento-osseous dysplasias:10.2.1. Periapical cemento-osseous dysplasia10.2.2. Focal cemento-osseous dysplasia10.2.3. Florid cemento-osseous dysplasia10.2.4. Familial gigantiform cementoma10.3. Central giant cell granuloma  11. Genetic, metabolic, and other non-neoplastic bone diseases11.1. Osteogenesis imperfecta11.2. Cleidocranial dysplasia11.3. Cherubism11.4. Gigantism and acromegaly11.5. Hyperparathyroidism (Brown tumour)11.6. Paget’s disease of bone11.7. Fibrous dysplasia and McCune Albright syndrome11.8. Mandibular and palatine tori11.9. Focal osteoporotic bone marrow defect (FOBMD)  PART 3. PATHOLOGY OF THE ORAL MUCOSA  12. Developmental anomalies and anatomical variants of oral soft tissues12.1. Fordyce granules12.2. Double lip12.3. Leukoedema12.4. Ankyloglossia12.5. Geographic tongue12.6. Hairy tongue12.7. Fissured tongue12.8. Lingual thyroid12.9. Microglossia and macroglossia12.10. Bifid tongue12.11. Bifid uvula12.12. Cleft lip12.13. Caliber persistent artery12.14. Epstein pearls and Bohn’s nodules12.15. Dermoid and Epidermoid cysts12.16. Oral varicosities12.17. Lymphoid aggregates12.18. Parotid papilla12.19. Circumvallate papillae12.20. Physiological pigmentation  13 Bacterial infections of the oral mucosa13.1. Scarlet fever13.2. Syphilis13.3. Gonorrhoea13.4. Tuberculosis  14. Fungal infections of the oral mucosa14.1. Candidosis:14.1.1. Pseudomembranous candidosis14.1.2. Erythematous candidosis14.1.3. Angular cheilitis14.1.4. Denture stomatitis14.1.5. Chronic hyperplastic candidosis (Candida leukoplakia)14.1.6. Median rhomboid glossitis14.2. Histoplasmosis14.3. Blastomycosis  15. Viral infections of the oral mucosa15.1. Primary herpetic gingivostomatitis15.2. Herpes labialis (Secondary herpes infection)15.3. Varicella (Chicken pox)15.4. Herpes zoster (Shingles)15.5. Infectious mononucleosis15.6. Oral hairy leukoplakia15.7. Cytomegalovirus infection15.8. Herpangina15.9. Hand-foot and mouth disease15.10. Squamous papilloma15.11. Condyloma acuminatum 15.12. Multifocal epithelial hyperplasia15.13. Verruca vulgaris15.14. Measles  16. Non-infective inflammatory disorders of the oral mucosa16.1. Recurrent aphthous ulcers (Recurrent aphthous stomatitis)16.2. Oral lichen planus16.3. Oral lichenoid reactions16.4. Pemphigus vulgaris16.5. Mucous membrane pemphigoid16.6. Erythema multiforme16.7. Lupus erythematosus16.8. Traumatic ulcer16.9. Oral lesions in Behcet’s disease16.10. Oral lesions in Crohn’s disease16.11. Oral lesions in reactive arthritis (Reiter’s disease)16.12. Uremic stomatitis16.13. Chronic ulcerative stomatitis16.14. Radiation-induced mucositis16.15. Medication-induced oral ulceration16.16. Stevens-Johnson syndrome and Toxic Epidermal Necrolysis  17. Non- neoplastic mucosal swellings17.1. Irritation fibroma17.2. Denture induced granuloma17.3. Fibrous epulis/ peripheral fibroma/ fibrous polyp17.4. Pyogenic granuloma17.5. Peripheral giant cell granuloma17.6. Peripheral ossifying fibroma17.7. Traumatic neuroma17.8. Squamous papilloma17.9. Congenital epulis  18. Benign neoplasms of the oral mucosa18.1. Lipoma     18.2. Schwannoma (Neurilemmoma)18.3. Granular cell tumour18.4. Haemangioma18.5. Lymphangioma18.6. Leiomyoma18.7. Rhabdomyoma  19. Oral potentially malignant disorders 19.1. Erythroplakia19.2. Leukoplakia19.3. Chronic hyperplastic candidosis19.4. Palatal lesions in reverse smokers19.5. Oral lichen planus19.6. Oral submucous fibrosis19.7. Oral lichenoid lesion19.8. Discoid Lupus erythematosus19.9. Actinic keratosis19.10. Graft versus host disease19.11. Dyskeratosis congenita!9.12. Sublingual keratosis19.13. Syphilitic leukoplakia19.14. Darrier’s disease  20. Malignant neoplasms of the oral mucosa20.1. Squamous cell carcinoma and verrucous carcinoma20.2. Melanoma20.3. Kaposi’s sarcoma20.4. Fibrosarcoma20.5. Rhabdomyosarcoma20.6. Leiomyosarcoma  PART 4. PATHOLOGY OF THE SALIVARY GLANDS  21. Non-neoplastic salivary gland diseases21.1. Salivary calculi21.2. Mucoceles21.3. Sjögren’s syndrome21.4. Sialadenitis21.5. Necrotizing sialometaplasia  22. Salivary gland neoplasmsWHO classification of Salivary Gland Tumours22.1. Pleomorphic adenoma22.2. Warthin’s tumour23.3. Mucoepidermoid carcinoma23.4. Adenoid cystic carcinoma  PART 5. CLINICAL PRESENTATION OF MUCOSAL DISEASE  23. White lesions of the oral mucosa23.1. Actinic cheilitis23.2. Chemical burn23.3. Chronic hyperplastic candidosis23.4. Darier’s disease (Darier-White disease)23.5. Dyskeratosis congenita23.6. Fordyce spots23.7. Frictional keratosis23.8. Hereditary benign intraepithelial dyskeratosis23.9. Leukoedema23.10. Leukoplakia23.11. Oral hairy leukoplakia23.12. Oral lichen planus23.13. Oral squamous cell carcinoma23.14. Pseudomembranous candidosis23.15. Smokeless tobacco induced keratosis23.16. Smoker’s keratosis23.17. Sublingual keratosis23.18. Syphilitic leukoplakia23.19. Verrucous carcinoma23.20. White hairy tongue23.21. White sponge nevus  24. Red and purple lesions of the oral mucosa24.1. Contact stomatitis24.2. Desquamative gingivitis24.3. Erythema migrans24.4. Erythema multiforme24.5. Erythematous candidosis24.6. Erythroplakia24.7. Haemangioma24.8. Hereditary haemorrhagic telangiectasia24.9. Infectious mononucleosis24.10. Kaposi’s sarcoma24.11. Linear gingival erythema24.12. Lupus erythematosus24.13. Median rhomboid glossitis24.14. Mucosal ecchymosis, haematoma and petechiae24.15. Plasma cell gingivitis24.16. Port wine nevus24.17. Radiation mucositis24.18. Thermal erythema  25. Blue, black, and brown lesions of the oral mucosa25.1. Addison’s disease25.2. Amalgam tattoo25.3. Black and brown hairy tongue25.4. Drug induced pigmentation25.5. Heavy metal pigmentation25.6. Laugier-Hunziker syndrome25.7. Melanoma25.8. Melanotic macule25.9. Peutz-Jeghers syndrome25.10. Physiologic pigmentation25.11. Pigmented nevi25.12. Smoker’s melanosis  26. Vesiculobullous lesions of the oral mucosa26.1. Angina bullosa haemorrhagica26.2. Bullous lichen planus26.3. Dermatitis herpetiformis26.4. Epidermolysis bullosa26.5. Hand-Foot and Mouth disease26.6. Herpes zoster26.7. Mucous membrane pemphigoid26.8. Pemphigus vulgaris26.9. Primary herpetic stomatitis26.10. Secondary (recurrent) herpetic stomatitis (Herpes labialis)  27. Ulcerative lesions of the oral mucosa27.1. Oral ulceration in agranulocytosis27.2. Oral ulceration in Behcet’s disease27.3. Oral ulceration in celiac disease27.4. Chronic ulcerative stomatitis27.5. Oral ulceration in Crohn’s disease27.6. Oral ulceration in cyclic neutropenia27.7. Cytomegalovirus ulcers27.8. Eosinophilic ulcer27.9. Gangrenous stomatitis27.10. Necrotizing sialometaplasia27.11. Necrotizing ulcerative gingivitis27.12. Reactive arthritis27.13. Recurrent aphthous ulcers27.14. Squamous cell carcinoma presenting as an ulcer27.15. Syphilitic ulcers27.16. Traumatic ulcer27.17. Tuberculous ulcer27.18. Oral ulceration in ulcerative colitis  28. Papillary lesions of the oral mucosa28.1. Condyloma acuminatum28.2. Multifocal epithelial hyperplasia (Heck’s disease)28.3. Oral proliferative verrucous leukoplakia28.4. Squamous papilloma28.5. Squamous cell carcinoma28.6. Verruca vulgaris (oral warts)28.7. Verrucous Carcinoma  PART 6. OROFACIAL PAIN  29. Orofacial pain29.1. Odontogenic orofacial pain29.1.1. Pain of reversible pulpitis and dentine hypersensitivity29.1.2. Pain of irreversible pulpitis29.1. 3. Pain of periodontitis or infected root canals29.1.4. Pain of fractured or cracked tooth29.1.5. Pain of spreading odontogenic infection without severe or systemic features29.1.6. Cellulitis/Ludwig’s angina with systemic features29.1.7. Pain of dry socket  29.2. Neuropathic orofacial pain29.2.1. Trigeminal neuralgia29.2.2. Glossopharyngeal neuralgia29.2.3. Postherpetic neuralgia29.2.4. Burning mouth syndrome  29.3. Other conditions with orofacial pain29.3.1. Acute necrotizing ulcerative gingivitis29.3.2. Temporomandibular joint disorders29.3. 3. Atypical facial pain29.3. 4. Migraine29. 3.5. Sinusitis29.3. 6. Temporal arteritis29.3. 7. Cardiogenic jaw pain29.3. 8. Pain of sialolithiasis  PART 7. MISCELLANEOUS TOPICS OF CLINICAL RELEVANCE  30. Oral manifestations of systemic disorders30.1. Oral manifestations of gastrointestinal and liver disorders30.1.1 Gastroesophageal reflux disease30.1. 2. Bulimia and nervosa30.1. 3. Crohn’s disease30.1.4. Ulcerative colitis30.1.5. Celiac disease30.1.6. Irritable bowel syndrome30.1.7. Alcoholic liver disease30.1.8. Liver cirrhosis30.2. Oral manifestations of cardiovascular disease30.2.1. Angina pectoris and myocardial infarction30.2.2. Congenital heart disease30.2.3. Rheumatic fever and infective endocarditis30.2.4. Hypertension30.3. Oral manifestations of respiratory disease30.3.1. Chronic obstructive pulmonary disease30.3.2 Lung abscess and bronchiectasis30.3.3. Pulmonary tuberculosis30.3.4. Cystic fibrosis30.4. Oral Manifestations of Kidney diseases30.4.1. Chronic renal failure30.4.2. Nephrotic syndrome30.4.3. Patients on kidney dialysis: Dental considerations30.5. Oral Manifestations of endocrine and metabolic disorders30.5.1. Hyperthyroidism30.5.2. Hypothyroidism30.5.3. Hyperpituitarism30.5.4. Hypopituitarism30.5.5. Diabetes insipidus30.5.6. Addison’s disease30.5.7. Cushing syndrome30.5.8. Diabetes mellitus30.5.9. Hypocalcaemia30.5.10. Hypercalcaemia30.6. Oral Manifestations of nervous system disorders30.6.1. Stroke30.6.2. Epilepsy30.6.3. Parkinson’s disease30.6.4. Multiple sclerosis30.6.5. Myasthenia gravis30.6.6. Bell’s palsy30.7. Oral manifestations of hematologic disorders30.7.1. Anaemia30.7.2. Thrombocytopenia30.7.3. Haemophilia30.7.4. Multiple myeloma30.7.5. Non-Hodgkin’s lymphoma30.7.6. Burkitt’s lymphoma36.7.7. Leukaemia30.8. Oral manifestations of immune system disorders30.8.1. Allergic mucositis30.8.2. Angioedema30.8.3. Sjogren’s syndrome30.8.4. Temporal arteritis30.8.5. Granulomatosis with polyangiitis (Wegener’s granulomatosis)30.8.6. Behcet’s disease  31. Systemic diseases associated with periodontal infections31.1. Cardiovascular disease31.2. Coronary heart disease31.3. Infective endocarditis31.4. Bacterial pneumonia31.5. Low birth weight31.6. Diabetes mellitus  32. Other signs and symptoms related to the oral environment32.1. Halitosis32.2. Taste disturbances32.3. Dry mouth (Xerostomia)Trismus32.4. Sialorrhea32.5. Trismus32.8. Basic facts and oral manifestations associated with Covid-19 infection  33. Outline of diagnostic procedures employed in oral pathology and oral medicine33.1. History33.2. Clinical examination33.3. Clinical differential diagnosis33.4. Biopsy: Histopathology, immunofluorescence, and immunohistochemistry33.5. Special tests: Polymerase chain reaction and In situ hybridization33.6. Microbiology: Smears, swabs, oral rinse, culture tests and antibiotic sensitivity tests33.7. Molecular biological investigations33.8. 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