Oral Pathology Review 1

Squamous Cell Carcinoma

The lesion is located on the posterior lateral surface of the tongue--a high risk area for oral cancer. It is large, red, ulcerated, and irregular. Lesions with this appearance must be considered to be oral cancer until proven otherwise.

Fissured and Geographic Tongue (Migratory Glossitis)

The grooves running laterally across the tongue are one obvious diagnosis (fissured tongue). The white areas suggest another diagnosis. Note that some of white areas form partial rings, a characteristic of geographic tongue. Usually the tongue looks red in the center of the rings; however, in this case the entire tongue looks red obscuring these features except at the tip where the typical appearance is preserved. The two vesicles on the near lateral surface are probably related to geographic tongue

Nicotine Stomatitis

The white color of this patient's hard palate and the white elevations with red centers are characteristic of nicotine stomatitis. The red dots are the orifices of minor salivary gland ducts the epithelium of which does not keratinize. This patient should be informed that the smoking habit has caused these changes and that a malignancy may develop here or elsewhere.

Mucocoele (Mucous Escape Reaction)

This photograph was taken before use of gloves was accepted practice. There is a dome-shaped raised lesion covered by normal mucosa in the lip. The most obvious diagnosis is mucocoele resulting from injury to minor salivary glands in the lip and spilling of saliva into the tissues. It must be kept in mind that minor salivary gland tumors can have a similar clinical appearance.

Aphthous Ulcer (Canker Sore, Aphthous Stomatitis)

The yellowish lesion surrounded by the red ring is characteristic of aphthous stomatitis. The yellow area is an ulcer and the red ring is surrounding inflammation. That the lesion was painful cinches the diagnosis

Suppurative Apical Periodontitis (Parulis)

The raised, red gingival lesion is probably associated with the carious mandibular first molar tooth. There probably is a periapical lesion at the molar apex that is draining onto the surface. If so, the lesion is located at the drainage site. While the lesion could be called a "pyogenic granuloma," it is commonly called a "parulis." One author calls this situation (a periapical lesion draining through a parulis) "suppurative apical periodontitis."

Radiation Caries

This patient is afficted with generalized caries around the necks of all teeth. This circumstance occasionally is seen in patient who receive head and neck radiotherapy. In such cases, the salivary glands are damaged or destroyed by radiation passing through them. It is diminished saliva flow that leads to the generalized caries seen here. The term "radiation caries" is used to describe this situation.

Epulis Fissuratum (Inflammatory Hyperplasia)

The extra tissue in the maxillary vestibule was caused by an ill-fitting maxillary denture. The term "epulis fissuratum" is commonly used for this circumstance. Since the extra tissue was produced by inflammation and subsequent scarring, the term "inflammatory hyperplasia" is a common synonym

Median Rhomboid Glossitis

The rough reddish area in the midline of the tongue is median rhomboid glossitis--few other diseases occur in this location. For years, it has been assumed that median rhomboid glossitis is cause by faulty tongue development; however, more recently, Candida infestation has been posed as its etiology.

Residual Cyst

There is an obvious radiolucency in the anterior maxilla. That it is not in the midline eliminates incisive canal and median palatal cysts from consideration. Note that the central incisor tooth near the lesion is missing (replaced by a bridge). Most likely, this tooth was extracted and an attached cyst inavertently left behind. Cysts left behind after tooth extraction are known as "residual cysts."

Ameloblastoma

There is a multilocular radiolucency extending from the first molar tooth to the coronoid notch. The lesion within the radiolucency has caused root resorption. The most obvious cause of a multiloculated radiolucency in the posterior mandible is an ameloblastoma, a benign but aggressive odontogenic neoplasm

Varicella Zoster

This young woman has obvious scabbing lesions on the upper right side of her face. If you look carefully at her forehead, however, you will see blistering (vesicular) lesions suggesting a varicella infection. This condition was once thought to be caused by the Herpes Zoster virus; now it is known be caused by the chicken pox varicella virus. Varicella zoster is a fairly common condition of the skin; the lesions usually occur along the distribution of a nerve (here it is the ophthalmic division of the trigeminal nerve).

Condensing Osteitis

There is a radiopaque area in the mandible between the molar teeth. The first molar has periapical radiolucencies around both roots; it also has extensive coronal caries that seems to extend into the pulp. Radiopacities associated with non-vital teeth are known as "condensing osteitis."

Supernumerary Teeth (Suggestive of cleidocranial dysostosis)

This patient obviously has many extra (supernumerary) teeth. Cleidocranial dysostosis is one condition in which supernumerary teeth occur. The diagnosis of "supernumerary teeth" would, hopefully, suffice.

Irritation Fibrosis (Fibroma)

This large raised lesion is covered with mucosa that is normal in texture and color. The fact that the lesion is not red suggests it is composed of fibrous connective tissue similar to that found in the lamina propria of oral mucous membrane. It seems to be slow-growing and is probably benign. Benign neoplasms of fibrous c.t. are "fibromas." Since these lesions may be produced by chronic cheek biting some use the terms "irritation fibroma" or "irritation fibrosis" instead.

Benign Keratosis (Hyperkeratosis)

This white lesion is located in a high risk area for the development of oral cancer; biopsy is required to determine its true nature. However, since the state board requires a "snap" diagnosis and since no redness or ulceration is evident, "benign keratosis" is the most likely bet.

Fordyce "Disease" (Ectopic Sebaceous Glands)

Sebaceous glands are most commonly associated with hair follicles; since the mouth is hairless, sebaceous glands are uncommon there. Sometimes, however, they appear in the mouth where they usually appear as yellowish flecks under the overlying mucosa. They are usually bilateral and do not wipe off; once correctly diagnosed, no treatment is necessary/

Dentinogenesis Imperfecta

This is obviously a child patient. All exposed teeth have a grayish opalescent appearance. The fact that all teeth are involved suggests a systemic, rather than local, condition. The enamel seems unaffected ruling out amelogenesis imperfecta. Ruling out an enamel condition leaves a condition of dentin; dentinogenesis imperfecta is the most likely diagnosis.

Actinic (Solar) Cheilitis

The lower lip in this male patient is thicker than normal; also, there are white discolorations of the vermilion surface. Chronic exposure to sunlight causes premalignant changes in the surface epithelium and reactive changes in the underlying connective tissue. The name given this condition is "actinic" (sunlight) "cheilitis" (inflammation of the lip).

Lichen Planus

The white intersecting lines affecting this patient's buccal mucosa is characteristic of lichen planus. This condition may occur on the skin, on the oral mucosa, or on both skin and mucosa. It is usually bilateral and may sometimes cause ulceration (erosion) of the mucous membrane. The red posterior area may be the beginning of such "erosive lichen planus."

Hemangioma

The large red mass within the tongue most likely represents a benign neoplasm of blood vessels--a "hemangioma." Hemorrhage is the most common complication of such lesions

Tori

Some patients inherit a tendency to form bony protuberances on their jaws. Here they extend from the lingual surface of the mandible; in this location they are known as "tori mandibularis." If they occur in the midline of the hard palate they are known as "tori palatini." In any other location they are known simply as "exostoses." Unless a denture is needed, no treatment is necessary.

Inflammatory Papillary Hyperplasia

This is the classic appearance of an inflammatory reaction to an ill-fitting maxillary denture. There are many red, soft, raised lesions extending from the mucosal surface. The term "inflammatory papillary hyperplasia" is commonly used for this condition