chapter 17 oral pathology copyright 2003, elsevier science (usa). all rights reserved. no part of...

Chapter 17Oral Pathology

Chapter 17Oral Pathology

Copyright 2003, Elsevier Science (USA).

All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.

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Produced in the United States of America

ISBN 0-7216-9770-4

Copyright 2003, Elsevier Science (USA). All rights reserved.

IntroductionIntroduction

Pathology is the study of disease. Oral pathology is the study of diseases in the oral cavity.

Many systemic diseases as well as infectious diseases have oral manifestations.

Pathology is the study of disease. Oral pathology is the study of diseases in the oral cavity.

Many systemic diseases as well as infectious diseases have oral manifestations.


Terminology Used to Describe Oral LesionsTerminology Used to Describe Oral Lesions Lesion is a broad term for abnormal tissues in the

oral cavity that includes wounds, sores, and any other tissue damage caused by injury or disease.

Determining the type of lesion in a disease is one of the earliest steps in formulating a differential diagnosis.

Types of lesions of the oral mucosa are classified as to whether they:

• Extend below or extend above the surface.

• Are flat or even with the surface.

Lesion is a broad term for abnormal tissues in the oral cavity that includes wounds, sores, and any other tissue damage caused by injury or disease.

Determining the type of lesion in a disease is one of the earliest steps in formulating a differential diagnosis.

Types of lesions of the oral mucosa are classified as to whether they:

• Extend below or extend above the surface.

• Are flat or even with the surface.


Lesions Extending Below the SurfaceLesions Extending Below the Surface

Ulcer: A defect or break in continuity of the mucosa that creates a punched-out area similar to a crater.

Erosion of the soft tissue: A shallow defect in the mucosa caused by mechanical trauma.

Abscess: A localized collection of pus in a circumscribed area.

Cyst: A closed sac or pouch that is lined with epithelium and contains fluid or semisolid material.

Ulcer: A defect or break in continuity of the mucosa that creates a punched-out area similar to a crater.

Erosion of the soft tissue: A shallow defect in the mucosa caused by mechanical trauma.

Abscess: A localized collection of pus in a circumscribed area.

Cyst: A closed sac or pouch that is lined with epithelium and contains fluid or semisolid material.


Lesions Extending Above the SurfaceLesions Extending Above the Surface

Blisters: Also known as vesicles, lesions filled with a watery fluid.

Pustule: Similar in appearance to a blister, but it contains pus.

Hematoma: Also similar to a blister, but it contains blood.

Plaque: Any patch or flat area that is slightly raised from the surface.

Blisters: Also known as vesicles, lesions filled with a watery fluid.

Pustule: Similar in appearance to a blister, but it contains pus.

Hematoma: Also similar to a blister, but it contains blood.

Plaque: Any patch or flat area that is slightly raised from the surface.


Diseases of the Oral Soft Tissues

Diseases of the Oral Soft Tissues


LeukoplakiaLeukoplakia

Leukoplakia means white patch.

Lesions vary in appearance and texture from a fine white transparency to a heavy, thick, warty plaque.

The cause is unknown but is commonly linked to chronic irritation or trauma.

Leukoplakia very often precedes the development of a malignant tumor.

Leukoplakia means white patch.

Lesions vary in appearance and texture from a fine white transparency to a heavy, thick, warty plaque.

The cause is unknown but is commonly linked to chronic irritation or trauma.

Leukoplakia very often precedes the development of a malignant tumor.


Fig. 17-2 Leukoplakia.Fig. 17-2 Leukoplakia.

Fig. 17-2Fig. 17-2


Lichen PlanusLichen Planus A benign, chronic disease affecting the skin

and oral mucosa.

Many factors have been implicated in lichen planus; however, the cause remains unknown.

On the oral mucosa, the patchy white lesions have a characteristic pattern of circles and interconnecting lines called Wickham's striae.

A benign, chronic disease affecting the skin and oral mucosa.

Many factors have been implicated in lichen planus; however, the cause remains unknown.

On the oral mucosa, the patchy white lesions have a characteristic pattern of circles and interconnecting lines called Wickham's striae.


Fig. 17-3 Lichen planus.Fig. 17-3 Lichen planus.

Fig. 17-3Fig. 17-3


CandidiasisCandidiasis A superficial infection caused by the yeastlike

fungus, Candida albicans. Candidiasis does occur under conditions such as

antibiotic therapy, diabetes, xerostomia (dry mouth), and weakened immunologic reactions.

It can be the initial clinical manifestation for patients with acquired immunodeficiency syndrome (AIDS).

Diaper rash, vaginitis, and thrush are also common types of candidiasis.

A superficial infection caused by the yeastlike fungus, Candida albicans.

Candidiasis does occur under conditions such as antibiotic therapy, diabetes, xerostomia (dry mouth), and weakened immunologic reactions.

It can be the initial clinical manifestation for patients with acquired immunodeficiency syndrome (AIDS).

Diaper rash, vaginitis, and thrush are also common types of candidiasis.


Types of CandidiasisTypes of Candidiasis

Pseudomembranous candidiasis Thrush

Hyperplastic candidiasis

Atrophic candidiasis

Pseudomembranous candidiasis Thrush

Hyperplastic candidiasis

Atrophic candidiasis


Fig. 17-4 Erythematous candidiasis.Fig. 17-4 Erythematous candidiasis.

Fig. 17-4Fig. 17-4


Aphthous UlcersAphthous Ulcers Aphthous ulcers are also known as aphthous

stomatitis or canker sores.

Recurrent aphthous ulcers (RAU) is a disease that causes recurring outbreaks of blisterlike sores inside the mouth and on the lips.

– Minor RAU: Episodes fewer than 6 times a year; lesions usually heal within 7 to 10 days.

– Major RAU: Outbreaks of larger, deeper ulcers that take longer to heal.

Aphthous ulcers are also known as aphthous stomatitis or canker sores.

Recurrent aphthous ulcers (RAU) is a disease that causes recurring outbreaks of blisterlike sores inside the mouth and on the lips.

– Minor RAU: Episodes fewer than 6 times a year; lesions usually heal within 7 to 10 days.

– Major RAU: Outbreaks of larger, deeper ulcers that take longer to heal.


Fig. 17-7 Minor aphthous ulcer.Fig. 17-7 Minor aphthous ulcer.

Fig. 17-7Fig. 17-7


CellulitisCellulitis

Inflammation spreads through the soft tissue or organ.

Swelling develops rapidly, with a high fever.

The skin becomes very red, and there is severe throbbing pain as the inflammation localizes.

Cellulitis associated with oral infections is potentially dangerous because it can travel quickly to sensitive tissues such as the eye or brain.

Inflammation spreads through the soft tissue or organ.

Swelling develops rapidly, with a high fever.

The skin becomes very red, and there is severe throbbing pain as the inflammation localizes.

Cellulitis associated with oral infections is potentially dangerous because it can travel quickly to sensitive tissues such as the eye or brain.


Fig. 17-8 Cellulitis.Fig. 17-8 Cellulitis.

Fig. 17-8Fig. 17-8


Conditions of the Tongue

Conditions of the Tongue


GlossitisGlossitis Glossitis is the general term used to

describe inflammation and changes in the topography of the tongue.

Glossitis is the general term used to describe inflammation and changes in the topography of the tongue.


Black Hairy TongueBlack Hairy Tongue Black hairy tongue may be caused by the

oral flora imbalance after the administration of antibiotics.

The filiform papillae are so greatly elongated that they resemble hairs.

These elongated papillae become stained by food and tobacco, producing the name black hairy tongue.

Black hairy tongue may be caused by the oral flora imbalance after the administration of antibiotics.

The filiform papillae are so greatly elongated that they resemble hairs.

These elongated papillae become stained by food and tobacco, producing the name black hairy tongue.


Fig. 17-9 Black hairy tongue.Fig. 17-9 Black hairy tongue.

Fig. 17-9Fig. 17-9


Geographic Tongue Geographic Tongue The tongue develops multiple areas of

desquamation (loss) of the filiform papillae in several irregularly shaped but well-demarcated areas.

The smooth areas resemble a map, thus the name geographic tongue.

Over a period of days or weeks, the smooth areas and the whitish margins seem to migrate across the surface of the tongue by healing on one border and extending on another.

The tongue develops multiple areas of desquamation (loss) of the filiform papillae in several irregularly shaped but well-demarcated areas.

The smooth areas resemble a map, thus the name geographic tongue.

Over a period of days or weeks, the smooth areas and the whitish margins seem to migrate across the surface of the tongue by healing on one border and extending on another.


Fig. 17-10 Geographic tongue.Fig. 17-10 Geographic tongue.

Fig. 17-10Fig. 17-10


Fissured TongueFissured Tongue A variant of normal; its cause is unknown.

Some theories include a vitamin deficiency or chronic trauma over a long period.

The dorsal surface (top) of the tongue appears to have deep fissures or grooves that become irritated if food debris collects in them.

The patient with a fissured tongue is advised to brush the tongue gently with a soft toothbrush to keep the fissures clean of debris and irritants.

A variant of normal; its cause is unknown.

Some theories include a vitamin deficiency or chronic trauma over a long period.

The dorsal surface (top) of the tongue appears to have deep fissures or grooves that become irritated if food debris collects in them.

The patient with a fissured tongue is advised to brush the tongue gently with a soft toothbrush to keep the fissures clean of debris and irritants.


Fig. 17-11 Fissured tongue.Fig. 17-11 Fissured tongue.

Fig. 17-11Fig. 17-11


Pernicious AnemiaPernicious Anemia Pernicious anemia is a condition in which the body

does not absorb vitamin B12.

People who have this condition show signs of anemia, weakness, pallor, and fatigue on exertion.

Other signs can include nausea, diarrhea, abdominal pain, and loss of appetite.

The oral manifestations of pernicious anemia include angular cheilitis (ulceration and redness at the corners of the lips), mucosal ulceration, loss of papillae on the tongue, and a burning and painful tongue.

Pernicious anemia is a condition in which the body does not absorb vitamin B12.

People who have this condition show signs of anemia, weakness, pallor, and fatigue on exertion.

Other signs can include nausea, diarrhea, abdominal pain, and loss of appetite.

The oral manifestations of pernicious anemia include angular cheilitis (ulceration and redness at the corners of the lips), mucosal ulceration, loss of papillae on the tongue, and a burning and painful tongue.


Fig. 17-12 Iron deficiency. The tongue is devoid of filiform papillae. Angular cheilitis was also present in this patient. Fig. 17-12 Iron deficiency. The tongue is devoid of filiform papillae. Angular cheilitis was also present in this patient.

Fig. 17-12Fig. 17-12


Oral CancerOral Cancer


Oral CancerOral Cancer Oral cancer is one of the 10 most frequently

occurring cancers in the world. The incidence, as well as the site, of the

cancer varies greatly from country to country. In the Western countries, the site most often affected is the vermilion border of the lip.

Most oral cancers do not cause pain in the early stages, and the thorough dentist is most likely to be the first to detect them. These cancers are fatal if not detected early enough or if left untreated.

Oral cancer is one of the 10 most frequently occurring cancers in the world.

The incidence, as well as the site, of the cancer varies greatly from country to country. In the Western countries, the site most often affected is the vermilion border of the lip.

Most oral cancers do not cause pain in the early stages, and the thorough dentist is most likely to be the first to detect them. These cancers are fatal if not detected early enough or if left untreated.


Fig. 17-13 Squamous cell carcinoma of the lower lip.Fig. 17-13 Squamous cell carcinoma of the lower lip.

Fig. 17-13Fig. 17-13


Types of Oral CancerTypes of Oral Cancer A carcinoma is a malignant neoplasm (growth) of the

epithelium (tissue lining the mouth).

An adenocarcinoma is a malignant tumor that arises from the submucous glands underlying the oral mucosa.

A sarcoma is a malignant neoplasm arising from supportive and connective tissue.

An osteosarcoma is a malignant tumor involving the bone. In the mouth, the affected bones are the bones of the jaws. Although the cancer may start in the bone, it often spreads and involves the surrounding soft tissues.

A carcinoma is a malignant neoplasm (growth) of the epithelium (tissue lining the mouth).

An adenocarcinoma is a malignant tumor that arises from the submucous glands underlying the oral mucosa.

A sarcoma is a malignant neoplasm arising from supportive and connective tissue.

An osteosarcoma is a malignant tumor involving the bone. In the mouth, the affected bones are the bones of the jaws. Although the cancer may start in the bone, it often spreads and involves the surrounding soft tissues.


Fig. 17-14 Panoramic radiograph showing destruction of the mandible by squamous cell carcinoma.Fig. 17-14 Panoramic radiograph showing destruction of the mandible by squamous cell carcinoma.

Fig. 17-14Fig. 17-14


LeukemiaLeukemia A cancer of the blood-forming organs that is

characterized by rapid growth of immature white blood cells.

Oral symptoms of leukemia may be some of the first indications of the disease.

Symptoms in the gingival tissues include hemorrhage, ulceration, enlargement, spongy texture, and magenta coloration of the gingiva.

Enlargement of lymph nodes, symptoms of anemia, and general bleeding tendencies are typical.

A cancer of the blood-forming organs that is characterized by rapid growth of immature white blood cells.

Oral symptoms of leukemia may be some of the first indications of the disease.

Symptoms in the gingival tissues include hemorrhage, ulceration, enlargement, spongy texture, and magenta coloration of the gingiva.

Enlargement of lymph nodes, symptoms of anemia, and general bleeding tendencies are typical.


Fig. 17-15 Leukemia.Fig. 17-15 Leukemia.

Fig. 17-15Fig. 17-15


Smokeless Tobacco Smokeless Tobacco Chewing tobacco or snuff presents a serious

health hazard.

It is a major concern because of the high rates of precancerous leukoplakia and oral cancer occurring among users of smokeless tobacco.

Cancers of the pharynx, larynx, and esophagus occur 400 to 500 times more frequently.

Smokeless tobacco is also linked to an increased incidence of tooth loss from periodontal disease.

Chewing tobacco or snuff presents a serious health hazard.

It is a major concern because of the high rates of precancerous leukoplakia and oral cancer occurring among users of smokeless tobacco.

Cancers of the pharynx, larynx, and esophagus occur 400 to 500 times more frequently.

Smokeless tobacco is also linked to an increased incidence of tooth loss from periodontal disease.


Fig. 17-16 A, Rough texture on the labial mucosa.Fig. 17-16 A, Rough texture on the labial mucosa.

Fig. 17-16 AFig. 17-16 A


Fig. 17-16 B, Rough surface on the anterior buccal mucosa.Fig. 17-16 B, Rough surface on the anterior buccal mucosa.

Fig. 17-16 BFig. 17-16 B


Dental Implications of Radiation TherapyDental Implications of Radiation Therapy

Xerostomia: Lack of adequate saliva and the reduced blood supply can cause oral infections, delay healing, and make it very difficult to wear dentures.

Radiation caries: Caused by the lack of saliva, usually appear first in the cervical areas of the teeth. The teeth also may become extremely sensitive to hot and cold stimuli.

Osteoradionecrosis: Necrosis (death) of bone after radiation treatment.

Xerostomia: Lack of adequate saliva and the reduced blood supply can cause oral infections, delay healing, and make it very difficult to wear dentures.

Radiation caries: Caused by the lack of saliva, usually appear first in the cervical areas of the teeth. The teeth also may become extremely sensitive to hot and cold stimuli.

Osteoradionecrosis: Necrosis (death) of bone after radiation treatment.


Acquired Immunodeficiency Syndrome (AIDS)Acquired Immunodeficiency Syndrome (AIDS)

Oral lesions are prominent features of AIDS and HIV infection.Oral lesions develop because of the breakdown of the immune system that occurs when the T-helper cells become depleted because of the disease.

Oral lesions are prominent features of AIDS and HIV infection.Oral lesions develop because of the breakdown of the immune system that occurs when the T-helper cells become depleted because of the disease.


HIV-Associated GingivitisHIV-Associated Gingivitis

There is often a bright red line along the border of the free gingival margin.

Also known as atypical gingivitis (ATYP).

In some cases, there may be progression of the bright red line from the free gingival margin over the attached gingival and alveolar mucosa.

There is often a bright red line along the border of the free gingival margin.

Also known as atypical gingivitis (ATYP).

In some cases, there may be progression of the bright red line from the free gingival margin over the attached gingival and alveolar mucosa.


HIV-Associated PeriodontitisHIV-Associated Periodontitis HIV-associated periodontis resembles acute necrotizing

ulcerative gingivitis superimposed on rapidly progressive periodontitis.

Other symptoms include:

• Interproximal necrosis and cratering

• Marked swelling

• Intense erythema over the free and attached gingiva

• Intense pain

• Spontaneous bleeding and bad breath

HIV-associated periodontis resembles acute necrotizing ulcerative gingivitis superimposed on rapidly progressive periodontitis.

Other symptoms include:

• Interproximal necrosis and cratering

• Marked swelling

• Intense erythema over the free and attached gingiva

• Intense pain

• Spontaneous bleeding and bad breath


Fig. 17-18, Atypical periodontal disease in a patient with HIV infection.Fig. 17-18, Atypical periodontal disease in a patient with HIV infection.

Fig. 17-18 A & BFig. 17-18 A & B


HIV Cervical Lymphadenopathy HIV Cervical Lymphadenopathy

Enlargement of the cervical (neck) nodes.

Lymphadenopathy is frequently seen in association with AIDS.

Enlargement of the cervical (neck) nodes.

Lymphadenopathy is frequently seen in association with AIDS.


Fig. 17-19 HIV cervical lymphadenopathy. Fig. 17-19 HIV cervical lymphadenopathy.

Fig. 17-19Fig. 17-19


HIV LymphomaHIV Lymphoma HIV lymphoma is the general term used to

describe malignant disorders of the lymphoid tissue.

In the immunocompromised individual, it may occur as a solitary lump or nodule, a swelling, or a nonhealing ulcer that occurs anywhere in the oral cavity.

The swelling may be ulcerated or may be covered with intact, normal-appearing mucosa.

Usually painful, the lesion grows rapidly in size and may be the first evidence of lymphoma.

HIV lymphoma is the general term used to describe malignant disorders of the lymphoid tissue.

In the immunocompromised individual, it may occur as a solitary lump or nodule, a swelling, or a nonhealing ulcer that occurs anywhere in the oral cavity.

The swelling may be ulcerated or may be covered with intact, normal-appearing mucosa.

Usually painful, the lesion grows rapidly in size and may be the first evidence of lymphoma.


Fig. 17-21 HIV lymphoma.Fig. 17-21 HIV lymphoma.

Fig. 17-21Fig. 17-21


Hairy LeukoplakiaHairy Leukoplakia Hairy leukoplakia can be an important early

manifestation of AIDS status.

It is a filamentous white plaque usually found unilaterally or bilaterally on the lateral borders (sides) in the anterior portion of the tongue.

It may spread to cover the entire dorsal surface of the tongue. It can also appear on the buccal mucosa, where it generally has a flat appearance.

Hairy leukoplakia can be an important early manifestation of AIDS status.

It is a filamentous white plaque usually found unilaterally or bilaterally on the lateral borders (sides) in the anterior portion of the tongue.

It may spread to cover the entire dorsal surface of the tongue. It can also appear on the buccal mucosa, where it generally has a flat appearance.


Fig. 17-22 Hairy leukoplakia.Fig. 17-22 Hairy leukoplakia.

Fig. 17-22Fig. 17-22


Kaposi's SarcomaKaposi's Sarcoma Kaposi's sarcoma is one of the opportunistic

infections that occur in patients with HIV infection.

Kaposi's sarcoma lesions may appear as multiple bluish, blackish, or reddish blotches that are usually flat in the early stages.

At present, there is no effective treatment for Kaposi’s sarcoma.

Kaposi’s sarcoma is one of the intraoral lesions that is used to diagnose AIDS.

Kaposi's sarcoma is one of the opportunistic infections that occur in patients with HIV infection.

Kaposi's sarcoma lesions may appear as multiple bluish, blackish, or reddish blotches that are usually flat in the early stages.

At present, there is no effective treatment for Kaposi’s sarcoma.

Kaposi’s sarcoma is one of the intraoral lesions that is used to diagnose AIDS.


Fig. 17-23 Kaposi’s sarcoma in a patient with AIDS. A, Skin. B, Gingivae. (From Ibsen O, PhelanJ: Oral pathology for the dental hygienist, ed 3, 2000, Saunders.)Fig. 17-23 Kaposi’s sarcoma in a patient with AIDS. A, Skin. B, Gingivae. (From Ibsen O, PhelanJ: Oral pathology for the dental hygienist, ed 3, 2000, Saunders.)

Fig. 17-23Fig. 17-23


Herpes SimplexHerpes Simplex

Herpes simplex lesions usually occur on the lip.

In immunocompromised patients, the lesions may occur throughout the mouth.

An ulcer caused by the herpes virus that persists for longer than 1 month could be an indicator of AIDS.

Patients that do not have HIV or AIDs may also suffer from herpes.

Herpes simplex lesions usually occur on the lip.

In immunocompromised patients, the lesions may occur throughout the mouth.

An ulcer caused by the herpes virus that persists for longer than 1 month could be an indicator of AIDS.

Patients that do not have HIV or AIDs may also suffer from herpes.


Fig. 17-24 Herpes simplex on the hard palate of a patient with HIV infection.Fig. 17-24 Herpes simplex on the hard palate of a patient with HIV infection.

Fig. 17-24Fig. 17-24


Human Papilloma VirusesHuman Papilloma Viruses Human papilloma viruses appear most

commonly in immunocompromised individuals.

Diagnosis is made based on history, clinical appearance, and biopsy.

They are a common finding in patients with early HIV infection.

These warts appear spiky, and some have a raised, cauliflower-like appearance.

Human papilloma viruses appear most commonly in immunocompromised individuals.

Diagnosis is made based on history, clinical appearance, and biopsy.

They are a common finding in patients with early HIV infection.

These warts appear spiky, and some have a raised, cauliflower-like appearance.


Fig. 17-25 Human papillomaavirus on the lip of a patient with AIDS.Fig. 17-25 Human papillomaavirus on the lip of a patient with AIDS.

Fig. 17-25Fig. 17-25


Developmental Disorders

Developmental Disorders

Can result when there is a disturbance of the cells during the period when the cells divide. The result is usually a deformity of part of the body.

Can result when there is a disturbance of the cells during the period when the cells divide. The result is usually a deformity of part of the body.


Types of Developmental DisordersTypes of Developmental Disorders Inherited disorders: Different from

developmental disorders because they are caused by an abnormal gene.

A congenital disorder: One that is present at birth. It can be either inherited or developmental; however, the exact cause of most congenital abnormalities is unknown.

Genetic factors: Malformations often due to genetic factors such as chromosome abnormalities.

Environmental factors: Called teratogens and can include infections, drugs, and exposure to radiation.

Inherited disorders: Different from developmental disorders because they are caused by an abnormal gene.

A congenital disorder: One that is present at birth. It can be either inherited or developmental; however, the exact cause of most congenital abnormalities is unknown.

Genetic factors: Malformations often due to genetic factors such as chromosome abnormalities.

Environmental factors: Called teratogens and can include infections, drugs, and exposure to radiation.


ExostosesExostoses

Exostosis is a benign bony growth projecting outward from the surface of a bone.

An exostosis also may be referred to as a torus. (A torus is a bulging projection. The plural is tori.)

Exostosis is a benign bony growth projecting outward from the surface of a bone.

An exostosis also may be referred to as a torus. (A torus is a bulging projection. The plural is tori.)


Fig. 17-27 Torus palatinus.Fig. 17-27 Torus palatinus.

Fig. 17-27Fig. 17-27


Fig. 17-28 Torus mandibularis. Fig. 17-28 Torus mandibularis.

Fig. 17-28Fig. 17-28


Disturbances in the Development of the Jaw, Lips,

Palate, and Tongue

Disturbances in the Development of the Jaw, Lips,

Palate, and Tongue


Types of Developmental Disturbances of the Jaw, Lips, Palate, and TongueTypes of Developmental Disturbances of the Jaw, Lips, Palate, and Tongue Cleft lip: Results when the maxillary and

medial nasal processes fail to fuse. Cleft palate: Results when the palatal

shelves fail to fuse with the primary palate. Cleft uvula: The mildest form of cleft

palate. Cleft palate, with or without cleft lip, occurs once in 2500 live births.

Ankyloglossia: Often called "tongue-tied," results in a short lingual frenum that extends to the apex of the tongue.

Cleft lip: Results when the maxillary and medial nasal processes fail to fuse.

Cleft palate: Results when the palatal shelves fail to fuse with the primary palate.

Cleft uvula: The mildest form of cleft palate. Cleft palate, with or without cleft lip, occurs once in 2500 live births.

Ankyloglossia: Often called "tongue-tied," results in a short lingual frenum that extends to the apex of the tongue.


Fig. 17-29 Cleft lip.Fig. 17-29 Cleft lip.

Fig. 17-29Fig. 17-29


Fig. 17-30 Ankyloglossia. Fig. 17-30 Ankyloglossia.

Fig. 17-30Fig. 17-30


Disturbances in Tooth Development and Eruption

Disturbances in Tooth Development and Eruption


Disturbances in Tooth DevelopmentDisturbances in Tooth Development Ameloblastoma is a tumor composed of remnants

of the dental lamina. Anodontia is the congenital absence of teeth. Supernumerary teeth are teeth in excess of the

32 normal permanent teeth. Macrodontia is abnormally large teeth. Microdontia is abnormally small teeth. Dens in dente (tooth within a tooth) results in the

formation of a small toothlike mass of enamel and dentin within the pulp.

Ameloblastoma is a tumor composed of remnants of the dental lamina.

Anodontia is the congenital absence of teeth. Supernumerary teeth are teeth in excess of the

32 normal permanent teeth. Macrodontia is abnormally large teeth. Microdontia is abnormally small teeth. Dens in dente (tooth within a tooth) results in the

formation of a small toothlike mass of enamel and dentin within the pulp.


Fig. 17-31 Partial anodontia.Fig. 17-31 Partial anodontia.

Fig. 17-31Fig. 17-31


Fig. 17-32 Radiograph showing two supernumery teeth in region of the permanent premolars.Fig. 17-32 Radiograph showing two supernumery teeth in region of the permanent premolars.

Fig. 17-32Fig. 17-32


Disturbances in Enamel FormationDisturbances in Enamel Formation

Amelogenesis imperfecta is a hereditary abnormality in which there are hypoplasia‑type defects in the enamel formation.

Hypocalcification is the incomplete calcification or hardening of the enamel.

Hereditary enamel hypoplasia is a type of amelogenesis imperfecta that is characterized by teeth with crowns that are hard and glossy, yellow, and cone shaped or cylindrical.

Amelogenesis imperfecta is a hereditary abnormality in which there are hypoplasia‑type defects in the enamel formation.

Hypocalcification is the incomplete calcification or hardening of the enamel.

Hereditary enamel hypoplasia is a type of amelogenesis imperfecta that is characterized by teeth with crowns that are hard and glossy, yellow, and cone shaped or cylindrical.


Abnormal Eruption of the TeethAbnormal Eruption of the Teeth

Premature Eruption is natal teeth present at birth.

Neonatal teeth are those that erupt within the first 30 days of life.

Ankylosis is deciduous teeth in which bone has fused to cementum and dentin, preventing exfoliation.

Impaction occurs when any tooth remains unerupted in the jaws beyond the time at which it should normally erupt.

Premature Eruption is natal teeth present at birth.

Neonatal teeth are those that erupt within the first 30 days of life.

Ankylosis is deciduous teeth in which bone has fused to cementum and dentin, preventing exfoliation.

Impaction occurs when any tooth remains unerupted in the jaws beyond the time at which it should normally erupt.


Additional Disturbances in Tooth Development and EruptionAdditional Disturbances in Tooth Development and Eruption

Variation in form includes extra, missing, or fused cusps or anomalies of roots; however, the most common variations are peg-shaped teeth.

Hutchinson's incisors are a variety of peg-shaped teeth, usually associated with maternal syphilis.

Fusion is the joining together of the dentin and enamel of two or more separate developing teeth.

Gemination is an attempt by the tooth bud to divide. When this attempt is not successful, an incisal notch indicates it.

Variation in form includes extra, missing, or fused cusps or anomalies of roots; however, the most common variations are peg-shaped teeth.

Hutchinson's incisors are a variety of peg-shaped teeth, usually associated with maternal syphilis.

Fusion is the joining together of the dentin and enamel of two or more separate developing teeth.

Gemination is an attempt by the tooth bud to divide. When this attempt is not successful, an incisal notch indicates it.


Miscellaneous DisordersMiscellaneous Disorders Abrasion is the abnormal wearing away of

tooth structure that is caused by a repetitive mechanical habit such as improper toothbrushing.

Attrition is the normal wearing away of tooth structure during mastication (chewing).

Bruxism is an oral habit consisting of involuntary gnashing, grinding, and clenching of the teeth in movements other than chewing. It is usually performed during sleep and is commonly associated with stress or tension.

Abrasion is the abnormal wearing away of tooth structure that is caused by a repetitive mechanical habit such as improper toothbrushing.

Attrition is the normal wearing away of tooth structure during mastication (chewing).

Bruxism is an oral habit consisting of involuntary gnashing, grinding, and clenching of the teeth in movements other than chewing. It is usually performed during sleep and is commonly associated with stress or tension.


Miscellaneous Disorderscont’dMiscellaneous Disorderscont’d

Bulimia is an eating disorder characterized by food binges and followed by self-induced vomiting.

The dental professional is often the first health care professional to identify a patient with bulimia.

Bulimia is an eating disorder characterized by food binges and followed by self-induced vomiting.

The dental professional is often the first health care professional to identify a patient with bulimia.


Fig. 17-39 Improper toothbrushing can cause abrasion.Fig. 17-39 Improper toothbrushing can cause abrasion.

Fig. 17-39Fig. 17-39


Fig. 17-40 A and B, Attrition of adult dentition.Fig. 17-40 A and B, Attrition of adult dentition.

Fig. 17-40Fig. 17-40


Fig. 17-41 Bruxism caused attrition of the mandibular anterior teeth. Fig. 17-41 Bruxism caused attrition of the mandibular anterior teeth.

Fig. 17-41Fig. 17-41


Fig. 17-42 A and B, Erosion caused by bulimia.Fig. 17-42 A and B, Erosion caused by bulimia.

Fig. 17-42 A & BFig. 17-42 A & B

chapter 17 oral pathology copyright 2003, elsevier science (usa). all rights reserved. no part of...

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oral lesions n lesion

n cyst

n abscess

n erosion

n plaque

n pustule

n hematoma

surface n blisters