BENIGN CONDITIONS ORAL PATHOLOGY CONSIDERED NORMAL CONDITION IMAGE KEY POINTS WMT (WAKE UP MEMORY TECHNIQUE) Fordyce granule ○ Clusters of ectopic sebaceous (oil) glands. (Ectopic: occurring in an abnormal position or pattern.) ○ Most commonly observed on the lips and buccal mucosa. Clinically appear as clusters of tiny yellow lobules. ○ Over 80% of adults have fordyce granules. Lingual varicosity ○ Purple/blue enlarged vessels observed on the ventral and lateral surfaces of the tongue. ○ Usually seen in elderly patients. Linea alba ○ White line of hyperkeratosis (thickening of the corneum, outermost layer of the epidermis) that extends horizontally on the buccal mucosa along the occlusal plane. ○ More prominent in patients with clenching, bruxing, or grinding habits. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG Leukoedema ○ Generalized gray opalescence on the oral tissues, especially the buccal mucosa. Cannot be rubbed off but disappears when the tissue is stretched. ○ Most commonly observed in black adults and smokers. Lingual thyroid ○ When the thyroid gland descends to its nodule normal location in the neck, the tissues can become entrapped in the tongue. ○ Appears as a mass in the midline of the dorsal surface of the tongue, posterior to the circumvallate papillae in the area of the foramen cecum. Amalgam tattoo ○ Flat, blue/gray lesion that results from amalgam particles being left in the tissues. It is sometimes possible to see the radiopaque amalgam particles in radiographs. ○ Most common pigmentation in the oral cavity. Exostosis ○ Overgrowth of normal compact bone on the buccal aspect of the maxilla or mandible. ○ Asymptomatic. No treatment is indicated unless it interferes with a prosthetic appliance. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG TUMORS AND CANCERS DEFINITIONS ○ Tumor: swelling, common synonym for neoplasia. The suffix “-oma” is used to indicate a tumor. ○ Benign tumor of fat = lipoma. ○ Benign tumor of salivary glands = adenoma. ○ Benign tumor of bones = osteoma. ○ Benign tumor of muscles = rhabdomyoma. ○ Benign tumor of squamous epithelium = papilloma. ○ Malignant tumor of epithelium = carcinoma. ○ Malignant tumor of connective tissue = sarcoma. ○ Malignant tumor of melanocytes = melanoma. ○ Benign tumor: remains localized and does not spread to distant sites. ○ Malignant tumor: invades and destroys surrounding tissues. Can spread throughout the body. ○ Cancer is synonymous with malignancy. Levels of tumors are classified according to the malignancy (harm potential) using the TNM stating system. The higher the stage, the worse the prognosis. CARCINOMA Squamous cell ○ Malignant tumor of the squamous cells. carcinoma ○ Squamous cells compose most of the epidermis (skin’s upper layer). ○ Most common primary malignancy of the oral cavity. ○ Can infiltrate adjacent tissues and metastasize (spread) to distant sites. ○ Early tumors can present as leukoplakia, erythroplakia, or speckled (white and red). Most tumors arise on the ventrolateral tongue, floor of the mouth, soft palate, tonsillar pillar, and retromolar areas. ○ Alcohol consumption, combined with tobacco use, increases the risk for cancer greatly. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG Verrucous ○ Low-grade squamous cell carcinoma. carcinoma ○ Has a much better prognosis than squamous cell carcinomas and represents about 5% of oral cancers. ○ Presents as a slow-growing exophytic tumor with a pebbly white/red surface or cauliflower-like papillary form. ○ Risk factors include irritation, human papilloma virus (HPV) infection, and smoking. Basal cell ○ Malignancy of the basal cells (deepest layer of the carcinoma epidermis; melanocytes are found in this layer). ○ Associated with excessive sun exposure. Most common type of skin cancer. Does not occur in the oral cavity. ○ Characterized by non-healing ulcers with rolled borders. OTHER MALIGNANT TUMORS Melanoma ○ Malignant tumor that develops in the melanocytes (in the basal layer of the epidermis, produces melanin to give color to the skin). Presents as a rapidly enlarging blue-to-black asymmetrical lesion with irregular borders. ○ Most serious type of skin cancer. Condition is strongly related to ultraviolet (UV) radiation exposure from sunlight. Osteosarcoma ○ Malignant tumor of the bone-forming tissue. ○ Some patients initially present with a toothache or exhibit tooth mobility. Sunburst pattern may be seen radiographically. ○ Teenagers and elderly patients are more commonly affected by this condition. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG Leukoplakia ○ Leukoplakia: white plaque-like (flat) lesion of the oral mucosa that cannot be diagnosed with a specific disease microscopically. Can range from hyperkeratosis to squamous cell carcinoma. ○ Leukoplakia found on the floor of the mouth, ventrolateral tongue, and lips have a higher potential to be squamous cell carcinoma than leukoplakia occurring in other areas of the oral cavity. BENIGN TUMORS Papilloma Ameloblastoma Lipoma BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG Neurofibroma and schwannoma Melanocytic nevus BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG ORAL PATHOLOGY IN BONES CYST IN BONES Nasopalatine ○ Located within the nasopalatine canal (contains canal cyst nerves and blood vessels) or the incisive papilla. ○ Appears as a radiolucent heart-shaped lesion. ○ 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. Median palatine ○ Located in the midline of the hard palate, more cyst posterior than the nasopalatine canal cyst. ○ Appears as a well-defined unilocular radiolucency. Globulomaxillary ○ Located between the roots of the maxillary lateral cyst incisor and canine. ○ Appears as a well-defined, pear-shaped radiolucency. ○ When the cyst is large enough, the roots can diverge. Static bone cyst ○ Also called stafne defect, it is a pseudocyst with no (stafne defect) epithelial lining. (Cyst is a pocket-like, closed structure filled with a substance.) ○ Appears as a well-defined radiolucency in the posterior region of the mandible, inferior to the mandibular canal. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG Simple bone cyst ○ Also called traumatic bone cyst, it is commonly (traumatic bone related to trauma. ○ Appears as a well-defined radiolucent lesion cyst) characterized by scalloping around the roots. MEDICAL CONDITIONS AFFECTING THE BONE Cherubism Fibrous dysplasia BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG (Osteitis deformans) Multiple myeloma BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG REACTIVE LESIONS ASPIRIN BURN, ULCER, KERATOSIS, FIBROMA Aspirin burn ○ Caused by an aspirin tablet placed directly on the pain area instead of being swallowed. ○ Affected tissues appear white with necrotic tissue that may slough off. ○ The lesion is painful and usually heals spontaneously in 7 to 21 days. Aphthous ulcers ○ Painful oral ulcers also known as canker sores or traumatic ulcers. ○ Only seen in movable parts of the oral cavity (labial and buccal mucosa, maxillary and mandibular vestibular mucosa, ventral and lateral borders of the tongue, soft palate, and nasopharynx). ○ Recur in episodes. Affect largely professional population or individual with high level of stress. ○ Ulcers resulting from various stimuli (e.g., biting the cheek, ill-fitting dentures, sharp edges of food etc.) ○ Can occur after dental procedures (e.g., in the area of the film placement or at the site of local anesthetic injection). ○ Minor aphthous ulcers: most common type, comprise 70-90% off aphthous ulcers. Less than 1 cm in diameter. ○ Exhibit a yellowish-white surface surrounded by a red halo. ○ Only present on movable parts of the oral cavity and occasionally extend onto the gingiva. ○ Prodromal period of 1 to 2 days precedes the appearance of ulcers. ○ Heal spontaneously in 7 to 10 days. ○ Major aphthous ulcers: larger than 1 cm in diameter and last longer than minor aphthous ulcers. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG ○ Can take several weeks to heal and frequently result in scarring. ○ Occur more commonly with immunodeficient conditions such as HIV. ○ Herpetiform aphthous ulcers: tiny (1 to 2 mm) in size and resemble clusters of herpes vesicles. ○ Unlike true herpes vesicles, aphthous ulcers respond to topical application of liquid tetracycline. May develop anywhere in the oral cavity. Frictional ○ Hyperkeratosis, a thickening of the keratin on the keratosis surface of the epithelium caused by friction against tissues. ○ Appears white and is not associated with malignancy. Irritation fibroma ○ Scar tissue from localized irritation and trauma. Appears as a small, elevated lesion of light color. ○ Most frequently appears on the buccal mucosa because of cheek biting. BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG CHEILITIS, GRANULOMA, ETC. Solar cheilitis (actinic cheilitis) Pyogenic granuloma Peripheral and central giant cell granuloma Erythema multiforme BY CLAIRE JEONG, RDH, MS – FOUNDER OF STUDENTRDH.COM, DENTALTOASTER.COM CLAIRE JEONG Lichen planus Pemphigus vulgarism Hematoma BY CLAIRE