Autoimmune & Immune-related

SLE / Systemic Lupus Erythematosus

Autoimmune, >young adult females
Butterfly rash, photosensitivity
Diff Dx: Lichen Planus
Complications: Heart (endocarditis) & Kidney
(glomerulonephritis)

Sjogrens Syndrome
NOT infectious
>Elderly women
Dry eyes & dry mouth = sicca
Secondary to Lupus or RA

Recurrent Aphthous Stomatitis / Ulcers /
Canker Sores
Moveable mucosa (uvula, labial mucosa, buccal
mucosa, ventral tongue, FOM, soft palate)
Immune-mediated (CD4, CD8), HLA associated
NOT contagious
NOT preceded by vesicle (UNLIKE Herpes)
Herpetiform (rare, 50+ small painful lesions)
Tx: cauterize w/laser or acid, OraBase &
Kenalog (corticosteroid)
Minor (shallow, red halo) heal in 5-10 days
Major heal in weeks
H/O trauma, stress, UV exposure
Risk Factors: Behcets disease, Crohns, familial



Scarlet Fever
Strawberry tongue = swollen fungiform papilla
White Strawberry (1-2 days) = sloughs off
Often req AB prophylaxis for prevention
Group A, Beta-hemolytic Strep
Erythrogenic toxin affects bl vessels
Pastias Lines: red streaks on skin
Fever, Circumoral pallor, soft palate petechiae
Complications: Rheumatic fever, bacteremia,
glomerulonephritis, TSS, cellulitis

Benign Mucous Membrane Pemphigoid (BM)
Cicatricial (scars), Vesiculoerosive
>Mid-aged females
Skin, Eye, Oral (anywhere)
Subepithelial split (epithelial-CT separates from
lamina dura)
Starts as vesicle/bulla erosions & ulcers
Conjunctiva scarring / blindness, dry eyes
Autoimmune, AB against basement membrane
More common & Milder than Pemphigus
POS Nikolsky


Pemphigus Vulgaris (desmosome)
Vesiculoerosive, IgG immunofluorescence
>Lips, palate, gingiva
INTRAepithelial split/acantholysis
(SUPRAepithelial) epithelial cells dont bind
Autoimmune, AB against desmoglein
POS Nikolsky (blisters w/lateral pressure/air)
POS Direct + Indirect immunofluorescence
(UNIQUE), Tzanck cells (round epithel cells)
Tx: skin grafts


Pseudomembranous Candidiasis / Thrush
Common in elderly & infants, ABs & steroids
Anywhere (>B mucosa, palate, dorsal tongue)
Hyphae & Spores (Dx: cytology smear)
White patch, wipes off
>Buccal mucosa & Palate
Tx: Nystatin or Clotramizole (topical),
Fluconazole (systemic)


Chronic Erythematous Candidiasis
A) Median Rhomboid Glossitis
Red atrophy / bald tongue of filiform papilla (in
front of circumvallate)
Midline tongue, Jx of ant 2/3 & post 1/3 @
tuberculum impar
Tx: Nystatin, Clotramizole


B) Denture Stomatitis / Sore Mouth
Tx: rinse & soak denture in antifungal
Diff Dx: methylmethacrylate allergy (acrylic)
Dx with Cytology smear


Oral Hairy Leukoplakia (EBV)
Lateral tongue, white rough plaque
HIV+ pts progressing to AIDS
Epstein Barr Virus


Infections

Cavernous Sinus Thrombosis (cellulitis)
Abscess of upper lip or intrabony Ant Max tooth
10% from orofacial infx (>Max canine)
Valveless facial veins orbit
Proptosis, orbital edema, conjunctiva

Ludwigs Angina: (cellulitis)
Submandibular space infx (70% Mand infx)
Worst Complication = glottis edema
obstructs airway

Sarcoidosis
Bilateral hilar lymphadenopathy (chest xray)
Cutaneous lesions (violet)
Tx: corticosteroids

Actinomycosis
Soft granular / woody swelling
Multiple draining fistulas
Enlarged, red, inflamed
Sulfur granules (bacteria), neutrophils


Chronic Osteomyelitis
Best seen in LATERAL OBLIQUE xray view
Mixed radiolucent & radiopaque
Painful, swelling, fever, purulent
Etiology: dental infx, ANUG, NOMA,
Osteopetrosis & Florid Cemento-Osseous
Dysplasia


Necrotizing Sialometaplasia
Rapid onset
Deep ulcer of palate
Self-resolving


Infectious Diseases & STDs

Condyloma Acuminatum: Venereal wart
HPV>16, 18
>Females age 20-24
Labial mucosa, soft palate, lingual frenum
Causes 95% of cervical cancer (NOT oral)


Squamous Papilloma: HPV 6, 11
= gender, age 30-50
Rough cauliflower papule/nodule, >2cm
>Gingiva, Soft Palate, Tongue
NOT precancerous! NO Dysplasia
Histo: Epithelial proliferation (NOT CT)
Tx: Excision


Recurrent/Secondary Herpes Simplex: Type 1
80-85% of US ppl, CONTAGIOUS, NO fever
NON-movable mucosa (hard palate, gingiva)
Lip & vermillion
Vesicles rupture into ulcers
Tzanck Test: rupture a vesicle, look for MNGs
Mostly subclinical, Trigeminal ganglion
Prodrome: burning, tingling
H/O trauma, stress, UV exposure
Tx: heals in 7-10 days



Tuberculosis
INC incidence
Non-healing ulcers (like cancer)
Dx: chest xray
May spread by infected sputum to oral lesions
(ie. Ulcer mimicking cancer on tongue)


Varicella Zoster / Chickenpox
Trigeminal ganglion
Buccal mucosa, palate, gingiva
Dx: Cytopathologic effect in smear
Complications: Encephalitis


Herpes Zoster / Shingles
Dorsal root ganglion
Prodrome (fever, headache)
Vesicles painful ulcers
Unilateral skin & oral (palate, tongue)



Primary Herpes / Gingivostomatitis
Kids 6mo-5yrs, INFECTIOUS
Non-movable mucosa: hard palate, gingiva
Inflamed enlarged marginal gingiva, bleeding
Vesicles coalescing ulcers in mouth & lips
Low fever, malaise, sore throat,
lymphadenopathy
Tx: analgesics 1-2wks, Antiviral if <2 days S/S


Infectious Mononucleosis (EBV)
>Teens
Lateral neck swelling, Sore throat
POSITIVE Monospot test
Palatal petechiae

Erythema Multiforme
Young adult males
Sudden acute explosive onset
Causes: Viral, Herpes, Pneumonia, Allergy, med
Crusted bleeding vesicles & ulcers
>Lips, labial mucosa, hands & feet (bulls-
eye/target /iris), NOT on gingiva!
Supportive Tx (self-limiting in 2-6wks):
steroids, analgesics, ABs, electrolytes


Stevens Johnson Syndrome
Like Erythema Multiforme but WORSE
Oral (conjunctiva), Ocular, Genital
Toxic Epidermal Necrolysis/Lysells Disease

Developmental

Treacher Collins Syndrome /
Mandibulofacial Dystosis / Deficit
Mand retrognathism (lower 1/3 face deficit)
External ear changes, 30% cleft palate,
Hypoplastic or absent parotid gland
Downward slant of eyes / palpebral fissures
Outer canthus is lower than inner (reversed)
Autosom dom or spontaneous mutation (60%)
1
st
& 2
nd
branchial arches

Turner Tooth
Local trauma or infx in developing tooth bud
>Mand premolar = #1 affected tooth


Intrinsic Staining
Stained dentinal tubules
Causes: Tetracycline, A. Imperfecta, D.
Imperfeca, Fluorosis

Traumatic

Traumatic Neuroma
Transected nerve w/scar tissue
Painful or tender, firm nodule
Sites of chronic trauma (Mand alveolar ridge in
denture pts, near Mental N, tongue)
Diff Dx: Fibroma (no pain, >tongue)



Pyogenic Granuloma (Pregnancy Tumor)
Any age, >Females
Causes: local irritation (food trap, overhang)
Can be ANYWHERE, >Max anterior, buccal
>Gingiva (interdental papilla)
Bleeds, red, NOT painful, fast growth
Histo: granulation tissue, AICI, CICI
Tx: excision + eliminiate trigger


Peripheral Giant Cell Granuloma
Middle-aged
GINGIVA ONLY (>ant to 1
st
molar)
Purple/Liver (hemosiderin + RBCs)
Pressure resorption (cupping/saucer)
Histo: MNG cells (PDL osteoclasts),
hemosiderin, granulation, AICI, CICI
Tx: excision to periosteum + elim trigger


Peripheral Ossifying Fibroma
>Teenage females
GINGIVA ONLY, NOT in bone but makes osteoid
Reactive bone formation, PDL origin
Scattered light radiopacities
Histo: collagenous stroma w/osteoid,
granulation tissue, AICI, CICI
Tx: excision down to bone


Central Giant Cell Granuloma
>Young Females (<age30)
Intrabony (jaws), >Ant mandible (70%)
Asymptomatic expansion, >crosses midline
Complications: root resorption, move teeth
Chronic renal disease bone destruction
Same Histo as: brown tumor
(hyperparathyroid), Cherubism, PGCG


Salivary Gland Tumors

Salivary Glands
Parotid: serous
Submandibular: >serous, some mucous
Sublingual: mucous
Palate: MUCOUS
Labial mucosa: mucous + serous

Nicotine Stomtatitis / Leukokeratosis
Hard palate, Red inflamed MSGs
Due to HEAT (NOT precancer)
Histo: hyperkeratosis, keratin, squamous
metaplasia of MSG ducts

Salivary Neoplasms
>Parotid (major) & Palate (MSG)
Most common location = Hard Palate
Benign: >Pleomorphic Adenoma
Malignant: >Mucoepidermoid > Adenoid Cystic
Perineural invasion: Adenoic Cystic Carcinoma,
Polymorphous Low-Grade Adenocarcinoma

Pleomorphic Adenoma (Benign)
Most common salivary gland tumor
>Females ~age 30-40
>Parotid >Palate (jx of SP + HP)
Encapsulated
Histo: ductal, squamous, myxoid, chondroid


Monomorphic Adenoma (Benign)
#1 Benign MSG tumor in upper lip
>Females
Canalicular (upper lip), Basal (parotid)
NO H/O trauma or infx


Mucoepidermoid Carcinoma (MALIGNANT)
Most common salivary gland malignancy
>Females, Bimodal (30s & 60s)
>Parotid, Palate, Submandibular, B mucosa
Least common intraoral site: sublingual, FOM
Histo: mucocytes/goblet cells

Adenoid Cystic Carcinoma (MALIGNANT)
>Middle-aged Females
>Submandibular, MSGS (>palate)
Parotid: RARE, perineural invasion w/NO
upper lip paresthesia), BEST prognosis
Worst Px: MSG (lung & bone mets)

Cheilitis Glandularis
Mucous MSGs of lips are inflamed
Mucous secretions
Premalignant! SCC


Warthins Tumor / Papillary Cystadenoma
Lymphomatosum
> Parotid gland NOT in oral cavity!
>Males

Cheilitis Glandularis
Mucous MSGs inflamed on lower labial mucosa
NOT sun-induced
Premalignant SCC
Lip swelling, lip everts (can see labial mucosa)

Benign

Benign Migratory Glossitis / Geographic
Tongue / Erythema Migrans
Red & white serpentine/circinate (keratin)
Filiform papilla atrophy / depapillated
Sore, burning tongue, migrates daily
Tx: corticosteroid rinse (Dexamethasone)


Lichen Planus
>Buccal mucosa, bilateral, >Reticular
>Mid-aged women
Skin (purple polygonal prurititic papules)
Oral: Wickams stria (white coalescing papules)
Reticular: white NOT wipe off, asymptomatic
Erosive: tongue, painful, looks like geographic
Hyperplastic: plaque-like, NOT wipe off
Bullous: Skin, looks like Benign Pemphigoid
Diff Dx of Hyperplastic: Candida, Leukoplakia
Histo: hyperkeratosis, BM necrosis
(Colloid/Civatte bodies = degenerating
keratinocytes), saw tooth rete ridges
Tx: Steroids

Reticular
Hyperplastic
Erosive

Aspirin / Chemical Burn
White coagulative necrosis
Wipes off with difficulty (UNLIKE
hyperkeratosis which doesnt wipe off)


White Sponge Nevus
Bilateral buccal mucosa
Nasal, esophageal, laryngeal, anogenital
Autosomal dominant
Thick white folds, NO eye involvement
Does NOT dissipate when stretched
Histo: hyperkeratosis, acanthosis, perinuclear
eosinophilic condensation (fried egg)


HBID / Hereditary Benign Intraepithelial
Dysplasia
Auto dom
Oral & Ocular B&L mucosa, conjunctiva
Histo: dyskeratosis cell within a cell


Leukoedema
Bilateral buccal mucosa, >Afr Ams
Stretch buccal mucosa disappears
Histo: intraepithelial edema, acanthosis
Diff Dx: White sponge nevus, HBID (eyes)


Morsicatio Buccarum / Cheek Nibbling
> Buccal mucosa, lingual, lip, tongue
White rough tissue tags BELOW occlusal plane
Partially removable


Fordyce Granules: ectopic sebaceous glands
Yellow plaque/papules (sebum)
>Buccal mucosa (inner cheek) & >Labial
mucosa (inner lip), retromolar pads, genital
80% of adults


Physiologic / Racial Pigmentation
Lower lip, vermilion, attached gingiva, tongue,
buccal mucosa
Symmetrical brown macules

Acquired Melanocytic Nevus / Mole
Jx type: most likely malignant transformation
Intramucosal/Intradermal type
Compound type

Abrasion
Cervical mechanical wear
Exposed Roots


Malignancies

Kaposis Sarcoma
HIV+ pts progressing to AIDS
Etiology: Herpes virus type 8

Osteosarcoma
Rapid onset of localized pain & swelling
Tingling lower lip
Late 20s-early 30s
Most common primary malignancy of bone in
ppl <25yo
Early radiolucency later radiopacity
Symmetrical PDL widening, trabeculae changes


Malignant Melanoma
>Hard palate & gingiva

Multiple Myeloma
Elderly males
Bence-Jones proteinuria, Ig spike
Calvaria, spine, pelvic girdle, jaws
Punched out radiolucencies

(Black) Hairy Tongue
Keratin on filiform papilla
Smokers, ABs, poor hygiene, infx

Oral Hairy Leukoplakia
Lateral border of tongue
Epstein-Barr Virus
Uncontrolled HIV+ pts


Leukoplakia
MOST common premalignant lesion!
Precedes 85% of all oral cancers
20% are precancerous
White hyperkeratosis, does NOT wipe off
>Tongue (25% dysplastic)
Most Dysplasia: FOM (50% dysplastic)
Dx: biopsy (NOT cytology)



Erythroleukoplakia (speckled)
>Posterior lateral tongue, FOM, soft palate,
alveolar ridge
May be dysplasia or malignant carcinoma
Initial Tx: incisional biopsy of red component


SCC / Squamous Cell Carcinoma
95% of all oral cancers!
>Posterior 2/3 of lateral tongue
>Lower lip (Actinic Cheilitis)
LEAST common oral site: hard palate
Worst Prognosis: FOM Lung mets
Tongue lateral neck LNs
Palate preauricular LNs
Staging (spread) is more important than
Grading (differentiation)


Actinic Cheilitis
Lower lip vermilion sun damage
Premalignant Dysplasia SCC

Field Cancerization Theory of SCC
Oral cancer likely to spread throughout mouth
p53 tumor suppressor gene = most associated
Mets to jaw: >Posterior mandible

Keratocanthoma = BENIGN!
Looks like SCC of face & lip
Sun-exposure
Spontaneously resolves in 4months
Ulcer w/central keratin plug


Basal Cell Carcinoma (EXTRAORAL)
Painless ulcer of upper lip & sun-exposed areas
NOT intraoral!
Papule, telangiectasia
Rarely Mets


Metastatic Disease to the Jaws
>Posterior mandible
Radiolucency with NO sclerotic border
Most commonly mets from: lung, breast,
kidney, colon, prostate
Batsons/Paravertebral Venous Plexus: route
of mets of distant tumor emboli to H&N

Leukemia (malignant WBCs)
Red, swollen, hyperplastic, boggy gums
Spontaneous gingival bleeding (>interdental
papilla) w/ ulcers
Punched out oral ulcers, necrotic
Pallor, red skin macules & bruising (purpura)
Infx, malaise, anemia (DEC RBCs), DEC platelets
Green lesion (Chloroma/Granulocytic
Sarcoma): palatal necrosis

Verrucous Carcinoma
Well-diff SCC, >Smokeless tobacco
Large, papillary, exophytic
BEST prognosis of all oral cancers (NO mets!)
>Buccal vestibule, >Mand, palate
NO Dysplasia, NO pleomorphism



Bone Pathology

Lateral Periodontal Cyst
True cyst (epithelial lining)
>Mand premolars
Remnants of dental lamina
Pure Radiolucency btwn roots of adj Vital teeth
Histo: Zellerballen (thin epith, focal thickening)
Botryoid Odontogenic Cyst: multilocular



Ameloblastoma
Most common true odontogenic tumor
Avg age 34, high recurrence
>Post mand, >impacted tooth
Can be anywhere & cross midline, Multilocular
Dental lamina remnants
Asymptomatic swelling, B-L expansion
Complications: root resorption, displacement,
destroys bone, thinning of cortical plates
Histo: Reverse polarization of nuclei of
peripheral columnar cells
Tx: en bloc resection, curettage


Ameloblastic Fibroma
MISNOMER (NO Fibroma!)
Young males (age 10-13yo)
Slight pain, swelling, not aggressive
>Post Mand, Pure radiolucency, multiloc
Complications: transformation into
Ameloblastic Fibrosarcoma, delays eruption,
root resorption, displaces teeth


Ameloblastic Fibro-Odontoma
Radiolucency & Radiopacity (odontoma)
= gender, ~10yo
Cap Stage (highly diff)


Odontoma
Teens & 20yos
Radiopaque w/radiolucent rim ( = follicle)
Compound: >Ant maxilla, looks like a tooth
Complex: >Post jaws, unidentifiable mass
Contains enamel, dentin, cementum, pulp
DONT recur


Adenomatoid Odontogenic Tumor / AOT
Young females (kid or teen)
>Impacted tooth in Ant Maxilla, >Canine
Radiolucency w/snowflake calcifications
Expansile, painless
Histo: duct-like (UNIQUE), amyloid
Tx: simple enucleation (scoop it out)



Periapical Cemento-Osseous Dysplasia
Mid-aged black women
NO pain, NO expansion
Mand Anteriors, VITAL
Periapical radiolucencies mature & become
mixed lucent/opaque mostly opaque


Focal Cemento-Osseous Dyslasia
>Mid-aged white females
MOST common benign fibro-osseous lesion
>Posterior Mandible

Florid Cemento-Osseous Dysplasia
>Mid-aged black females
Multiquadrant, intrabony, avascular
>Posterior mandible
Complication: 2 Osteomyelitis
Radiolucent & Radiopaque
NO Tx req!


Proliferative Periostitis / Garres
Young pts, visible swelling
Inf border of Post Mand
Onion skin pattern


Osteopetrosis
Young pts & adults
Expansion
Over-prod of dense NON-vital bone in jaws
Complication: Osteomyelitis


Odontogenic Myxoma
Young adult onset
Looks like Ameloblastoma on xray
Multilocular radiolucency w/soap bubble


Genetic / Inherited

Amelogenesis Imperfecta
Yellow brown teeth, E
namel hypoplasia
Crowns look more bulbous bc narrower @ neck
Normal roots & pulp & crown
Crowns, veneers


Dentinogenesis Imperfecta
Blue/gray opalescent dentin
NO pulp chambers or root canals
Bell-shape crown w/constricted cervical region
Type 1 (Hereditary Opalescent Dentin): not
systemic
Type 2 (Osteogenesis Imperfecta): Blue
sclera, bone fractures, systemic
Tx: dentures or implants (NO Crowns bc would
fracture)



Dentinal Dysplasia
Draining fistulas, misshapen teeth
Type 1 / Radicular: Rootless, periapical
radiolucencies, short roots
Type 2 / Coronal: thistle/flame pulp,
interglobular dentin


Hypohydrotic Ectodermal Dysplasia
Hypodontia, anodontia
Lack skin appendages & hair
Heat intolerance
Diff Dx: White sponge, HBID, Morsicatio,
Leukoedema

Scleroderma / Progressive Systemic Sclerosis
Induration, no sweat glands, stiff soft tissue
Trismus, generalized widening of PDL space
Thickened CT



Cherubism
Young pts (3-7yo), Auto dom
Multilocular bilateral radiolucencies
Many unerupted teeth, displaces teeth
Facial disfiguration, BOTH jaws
Histo: MNG cells
Tx after puberty (expansion ceases)


Crohns Disease
Oral: cobblestone nodules, aphthous-like
ulcers, granulomatous gingivitis
Rectal bleeding (>small intestine skip lesions)
Histo: Langerhans giant cells
Tx: Sulpha drugs + Steroids


MEN / Multiple Endocrine Neoplasia IIB
Auto dom, 50% spontaneous dom
1
st
sign = oral mucosa neuromas
Marfan body type, thick lips / papules
Multiple mucosal neuromas (tongue)
Complications: 90% Medullary thyroid
carcinoma, 50% Adrenal pheochromocytoma


Peutz-Jeghers
Pigmented brown macules
Lips, tongue, buccal mucosa, vermilion
Intestinal polyposis


Cleidocranial Dysplasia
Many supernumerary unerupted teeth
Retention of primary teeth
No clavicles! Frontal bossing, large head

Neurofibromatosis Type 1 (von
Recklinghausen)
Multiple neurofibromas (nodules)
Skin & oral (especially tongue)
Caf au lait pigmentations (brown macules)


Calcifying Odontogenic Cyst / Gorlin Cyst
Ghost cells (no nuclei) calcify, amyloid

Melanotic Neuroectodermal Tumor of Infancy
Rapid onset, newborns
INC VMA (vanillylmandelic acid)
Ant maxilla, soft & hard tissue
Mobile teeth, tooth floating in air
Intrabony radiolucency, looks malignant
5% Malignant (brain, skull)


Fibrous Dysplasia
Young pts (10yo), Onset before puberty
>Maxilla
Ceases by age 20yo (Tx: bone shaving)
No pain, teeth do not fit
Unilateral expansion, 1 jaw, painless
Ground glass radiopacity

McCune Albrights Syndrome: Fibrous
Dysplasia + Caf au lait pigmentations +
Precocious puberty (ie. 4yo w/breasts & period)



Condensing / Sclerosing Osteitis
Young pts, reactive bone formation
NON-vital tooth, Pulpitis, deep caries
NOT connected to root you can trace PDL
Tx: RCT or extraction


Idiopathic Osteosclerosis
VITAL tooth, NO Tx bc benign
>Posterior mandible
NOT connected to root you can trace PDL
Radiopacity with NO radiolucent rim


Hypercementosis
VITAL Mand 1
st
molar
Generalized acromegaly
Sometimes seen in Pagets
Radiopacity w/intact PDL, attached to root


Cementoblastoma
PDL NOT intact



Traumatic / Hemorrhagic / Solitary /
Simple Bone Cyst / Idiopathic Bone Cavity
(Pseudocyst)
>Young males
>Mandible, NOT expansile, can cross midline
Radiolucency w/scalloped margins
NO root resorption, NO swelling, NO pain
No Tx: Spontaneously heals


Pagets Disease / Osteitis Deformans
Older white pts, CC: Dentures too small
Bilateral maxilla
Complications: Osteosarcoma, CHF, CN deficits
(if foramen compressed)
Elevated AP (extra bone growth)
NO hyperglobulinemia or premature exfoliation
of primary teeth
Xray: punched out radiolucencies, cotton wool,
50% hypercementosis
Histo: reversal lines (mosaic, jigsaw)
Tx: Calcitonin, Bisphosphonates, Aspirin


Gardner Syndrome
Colon polyps + Mutiple osteomas + skin nodules
Supernumerary/Hyperdontia, unerupted tooth
Osteomas @ angle of mandible
Complications: risk of colon carcinoma
(remove polyps by age 20 or will turn into
cancer)



Langerhans Cell Histiocytosis X / Eosinophilic
Granuloma
Young adults, solitary lesion
Bone destruction, reticuloendotheliosis
Xray: Punched out radiolucencies, tooth
floating in air (perio disease)
Histo: Langerhans cells / eosinophilic
granuloma (NOT histiocytes), Birbeck bodies
(cytoplasm)
*Hans-Schuller-Christian Triad =
Diabetes Insipidus + Exophthalmos + Bone
lesions (Langerhans cells)
*Letterer-Siwe: WORST, infants, organomegaly
Tx: radiation, chemotherapy





Cysts

Nasolabial Cyst (soft tissue)
Swelling adj to Max LI
Histo: PSSE lining (respiratory)
NOT on xray bc soft tissue only!

Lymphoepithelial Cyst (soft tissue)
>Ventral tongue / FOM
Pale yellow (lymph), compressible


Odontogenic Keratocyst / OKC / KOT /
Keratocystic Odontogenic Tumor
Any age, 10-15% of jaw cysts
>Post mand, intrabony, can be anywhere
Multilocular radiolucency, bilateral
NO B-L expansion! NO root resorption
High recurrence 30%
Histo: parakeratin
Multiple lesions: Gorlin/Nevoid basal cell
carcinoma
Tx: enucleate + curettage, cautery + osteotomy,
resection + bone graft


Nevoid Basal Cell Carcinoma / Basal Cell
Nevus / Gorlin Syndrome
Basal cell carcinomas + Multiple OKCs + Bifid
ribs + Calcified falx cerebri
Childhood onset
Genetic: Mutated PTCH gene, chromosome 9
Skin: basal cell carcinomas, epidermal cysts,
palmar/plantar pits



Dens-in-Dente / Dens Invaginatus
>Ant jaw (>Max lateral incisor)
Developmental pit in cingulum area
Tx: restore opening or may lose vitality


Dens Evaginatus
>Posterior mandible, bilateral
15% Asians
Cusp-like elevation of enamel on lingual ridge of
buccal cusp
Shovel-shaped incisors may req RCT
Tx: remove for occlusion

Soft Tissue

Traumatic Fibroma / Fibrous Nodule / Focal
Fibrous Hyperplasia
Most common CT tumor!
>Tongue (trauma)
Reactive Hyperplasia (not true tumor)
Firm smooth, pink, sessile (wider base)

Epulis Fissuratum
Hyperplastic CT (like fibroma)
Ill-fitting denture
NO ABs req


Dermoid Cyst (developmental)
Doughy / slightly compressible
Midline distrib
>Ant FOM or neck

Gingival Cyst of the Adult
Facial attached gingiva
>Ant mandible
Vesicle


Granular Cell Tumor
>Females, age 30-50
Origin: Schwann cells
>Dorsal tongue
Lysosomal granular cytoplasm
Smooth or papillated nodule
Histo: pseudoepitheliomatous hyperplasia
(resembles SCC)

>Dorsal tongue

Hemangioma
Hamartoma, red-blue, blanches
RBCs


Lymphangioma
Lymph-filled superficial vessels
Most common cause of macroglossia!


Dentigerous Cyst
Doughy / compressible
Midline distrib
Ie) Ant FOM


Mucocele / Mucous Retention/Extravasation
Kids & young adults, bite lip
>Lower lip, PSEUDOcyst
Trauma vesicle/bulla, bluish color, dome
Free Mucin extravasation from MSG, histiocytes
Tx: excision + severed duct/gland


Ranula
FOM Mucocele, frogs belly
Bluish, Recurrent, Viscous aspirate (mucous)
>sublingual gland
Histiocytes, granulation tissue, mucin


Mucous Retention Cyst
Sialolith or bacterial plug obstruction
True cyst (Lined by epithelium)
>FOM

Antral / Mucous Retention Pseudocyst
Asymptomatic, NO Tx req
Radiopaque dome-shaped
Max sinus floor



Sialolithiasis
80% submandibular (Whartons)

Sialadenitis
Inflamed salivary glands
Etiology: mumps, viral infx, bacterial (Staph
Aureus), xerostomia, Sjogren, Sarcoid

Dentigerous Cyst
>Post Mand, >impacted 3
rd
molars
Mand 3
rd
M > Max 3
rd
M > Can > Mand PM
Epithelial lining Ameloblastoma, SCC,
Mucoepidermoid carcinoma
Xray: Pericoronal radiolucency attached @ CEJ
of unerupted tooth


Incisive Canal / Nasopalatine Duct Cyst
Most common developmental non-odonto cyst
Vital teeth, Max midline btwn CIs
Bad taste, heart-shaped radiolucency


Varices
Tongue & Lip, >elderly
Dilated veins, bluish
Phlebolith: lip varices thrombose & calcify


Parulis / Gum Boil (fistula)
Incomplete RCT w/ sensitivity
Elevated yellow-red color, draining fistula


Allergic Mucositis
Due to toothpaste, candy, gum, cinnamon


Eagle Syndrome
Elongated calcified stylohyoid ligament
H&N pain when chewing, yawning, opening


Stafne Defect
Developmental, >Males
Asymptomatic, VITAL Teeth
Radiolucency near angle of Mand under Mand
canal


Nerve
Xray: enlarged mandibular canal & foramina



Neurofibroma (axons)
>Tongue & Buccal mucosa
No pain

Schwannoma / Neurilemoma (myelin)
Neoplasm, No pain, rarely in bone
>Tongue, gingiva, lips, mucosa
Histo: encapsulated, Antoni A, Verocay bodies

Bells Palsy (CN 7 unilateral facial paralysis)
Drooping corner of lip, cant close eye
Etiology: viral, lyme disease (Borrelia),
earache, infx, MS
Melkersson-Rosenthal / Orofacial
Granulomatosum: fissure tongue + facial N
paralysis + Cheilitis Granulomatosum
Self-limiting within 6 months

Trigeminal Neuralgia / Tic Douloureux
Onset >35yo
Highest suicide rate of any disease
>Mandibular branch, >Unilateral
Pain duration <60 secs
Triggers: touching nasolabial fold, vermilion,
periorbital, alveolar ridge
Tx: Phenytoin, Gabapentin, inject alcohol or
glycerin near Gasserian ganglion, Btx, Capsaicin
cream, Peripheral neurectomy, microvascular
decompression

Neuritis
Unilateral pain >1wk (forehead & eye)

Auriculotemporal / Frey Syndrome
CN 5
Often after parotid surgery
Unilateral face sweating after meal

NOTES
Causes of Desquamative Gingivitis
Erosive Lichen Planus
Benign Pemphigoid
Pemphigus Vulgaris

Erosion: MOST of epithelium is gone
Ulcer: ALL epithelium is gone

Cytology Smear is useful to Dx:
-Candidiasis
-Recurrent Herpes
-NOT if suspect precancer/Dysplasia

Caf Au Lait Pigmentations = McCune
Albrights Syndrome (fibrous Dysplasia) &
Neurofibromatosis / von recklinghausen
(papules/neurofibromas)

Extravasated Blood
Purpura = generalized
Petechiae = pinpoint
Ecchymosis = medium
Hematoma = large, elevated

Radiation Cervical caries due to xerostomia,
NOT pulp necrosis!

Internal root resorption pink tooth (if crown
involved)

Herpes = NON-movable mucosa (hard palate &
gingiva)
Aphthous Ulcers = MOVABLE mucosa (labial
mucosa, uvula)

Vit D deficiency / Scurvy = does NOT cause
xerostomia

Mand fracture Dx w/Pano & Occlusal xray

Condylar hyperplasia chin deviates AWAY
from affected side on closing


Radiology Facts
Xray & High voltage = shortest wavelength &
highest energy
Doubled mA = doubled intensity of xray beam
kVP determines penetration & controls contrast
Focal spot size influences resolution
Acute xray damage @ 4Gy = erythema
Nerve & Muscle = most radio-resistant
Hematopoetic stem cells = most radio-sensitive
Density of processed film is affected by
-INC mA, INC exposure time
-DEC object-thickness distance, DEC target-
object distance
-NOT by over-fixation
Intensifying screens: DEC exposure time & DEC
radiation exposure
8-bit digital image = 256 shades of gray
Coin tests: detect light leakage
Double distance from xray source = DEC
radiation by 4x (inverse square law)

Cleft Palate
Btwn LI & Canine

Globulomaxillary Cyst
Btwn LI & Canine

SCC: no sclerotic border bc cancer has a rapid
onset & spread