General and Oral Pathology for the DENTAL HYGIENIST Third Edition 0003322846.INDD 1 11/1/2017 3:43:26 PM General and Oral Pathology DENTAL HYGIENIST Third Edition 0003322846.INDD 2 11/1/2017 3:43:31 PM General and Oral Pathology for the DENTAL HYGIENIST Third Edition Leslie DeLong, BS, MHA Associate Professor of Dental Hygiene (Retired) Lamar Institute of Technology Beaumont, Texas Nancy W. Burkhart, BSDH, MEd, EdD Adjunct Associate Professor Department of Periodontics College of Dentistry Texas A&M University Dallas,Texas 0003322846.INDD 3 11/1/2017 3:43:34 PM Acquisitions Editor: Jonathan Joyce Development Editor: Amy Millholen Editorial Coordinator: John Larkin Marketing Manager: Leah Thomson Production Project Manager: Barton Dudlick Design Coordinator: Holly McLaughlin Manufacturing Coordinator: Margie Orzech Prepress Vendor: SPi Global Third Edition Copyright © 2019 Wolters Kluwer Copyright © 2013, 2008 Wolters Kluwer Health/Lippincott Williams & Wilkins. All rights reserved. This book is protected by copy- right. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww. com, or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Names: DeLong, Leslie, author. | Burkhart, Nancy W., author. Title: General and oral pathology for the dental hygienist / Leslie DeLong, Nancy W. Burkhart. Description: Third edition. | Philadelphia : Wolters Kluwer, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017045001 | ISBN 9781496354525 Subjects: | MESH: Mouth Diseases | Mouth—pathology | Tooth Diseases | Tooth—pathology | Dental Hygienists Classification: LCC RK307 | NLM WU 140 | DDC 617.5/22—dc23 LC record available at https://lccn.loc.gov/2017045001 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to ac- curacy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and con- sideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diag- noses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare profes- sionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warn- ings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com 0003322846.INDD 4 11/1/2017 3:43:34 PM To my friend and coworker Patti Harrigan Parrott, Dental Hygiene Program Director at Lamar Institute of Technology, who lost her battle with cancer October 19, 2015. She taught and lead by example; her immense capacity for love and patience and her limitless faith in God and the goodness of mankind was reflected in her daily interactions with friends, coworkers, students, and everyone she came into contact with. She embraced every day and lived it to the fullest reminding all of us who knew her that life is fleeting and precious and we should treasure every day. I also dedicate this edition to all my past and present dental hygiene students. I am honored to have played a part in your education and have enjoyed watching you grow not only as adults but as professional dental hygienists. You have provided me with an education second to none and I thank you. And to my father and mother, Earl and Muriel Yarrington, who always told me I could do anything I put my mind to. I wish you could have seen the completed project. To my husband, Richard, and my son, Brian, you have been never ending sources of strength and encouragement and I thank you for having patience with me while I was working on this. Leslie DeLong To my husband, Alan, who continues to inspire me, and to my children, Anna, Michael, and Stephanie; thank you for reminding me of what is important in life. You are all truly amazing and motivating. Many individuals provided materials to our book through chapters, images, and text. Thank you all for the contributions and making this possible. Thank you to Dr. Terry Rees, Dr. John Jacoway, and Dr. Jeff Burkes. Your love for pathology and oral medicine was contagious. Thank you for mentoring me. Nancy W. Burkhart 0003322846.INDD 5 11/1/2017 3:43:34 PM ABOUT THE AUTHORS Leslie DeLong, Nancy W. Burkhart, BS, MHA BSDH, MEd, EdD Leslie DeLong received an Dr. Burkhart received a Associate of Science de- Bachelor of Science degree in gree in Dental Hygiene from dental hygiene from Fairleigh Middlesex Community Dickinson University School College, a Bachelor of of Dentistry, a Master of Science degree in Health Education degree from North Science from Northeastern Carolina State University University, and a Master of in Occupational Health Health Administration de- Education, and a Doctor gree from Clark University, of Education Degree from all in Massachusetts. Leslie recently retired from Lamar North Carolina State University in Adult Education/ Institute of Technology in Beaumont, Texas, where she was Interdisciplinary studies. Nancy conducted a 1-year post- an Associate Professor of Dental Hygiene. She was the First doctoral fellowship in the section of Oral Pathology at Year Clinic Coordinator for the Dental Hygiene Program the University of North Carolina School of Dentistry at Lamar for 22 years. Leslie taught Oral Pathology, Head in Chapel Hill. Her dissertation topic was “Oral Lichen and Neck Anatomy, and both clinical and didactic sections Planus Commonalities: Educational and Psychological of the Pre-Clinical Dental Hygiene and Introductory Clinic Implications.” Dr. Burkhart is an Adjunct Associate courses. Leslie can be reached at: [email protected] Professor in the Department of Periodontics/Stomatology at Texas A&M College of Dentistry, Dallas, Texas, where she has been a faculty member since 1997. She is founder and faculty co-host of the International Oral Lichen Planus Support Group established in 1997. Dr. Burkhart has presented papers both nationally and internationally on Oral Lichen Planus/Mucosal Diseases and has published articles in national dental journals. She was a 2006 recipient of the ADHA Crest Award through Proctor and Gamble and The Philips Consumer Lifestyle and PennWell Corporation “Mentor of Distinction Award” in 2012. She is an Academic Affiliate Fellow of The American Academy of the Oral Medicine Association– presented fellowship in 2016. Nancy is a 2017 recipient of the Award of Distinction through Sunstar and PennWell, Corporation and a 2017 “Dental Professional of the Year” given by The International Pemphigus and Pemphigoid Foundation. As a columnist for RDH since 2007, she writes a monthly column titled, “Oral Exams” for the PennWell publication that appears in both dental and dental hygiene literature. To date, she has written more than 120 columns for the publication on oral pathology/oral medicine topics. She is a reviewer for several national dental journals and a representative on the JCDE. Nancy can be reached at: [email protected]; https://dentistry.tamhsc.edu/olp/ vi 0003322846.INDD 6 11/1/2017 3:43:36 PM PREFACE General and Oral Pathology for the Dental Hygienist, The second part of the book focuses on oral pathology. Third Edition, is a comprehensive study of the general In accordance with ADEA Curriculum Guidelines, which concepts of pathophysiology as they relate to systemic and stress the recognition of oral disease based on clinical signs oral conditions. The material is organized to provide stu- and symptoms, the oral pathology section is uniquely or- dents and practicing clinicians with the information they ganized by distinct clinical/radiographic features of oral need in an easy to use format. lesions to help students evaluate and categorize lesions ac- Chapter 1 is an overview of the head and neck and in- cording to appearance,