DISEASES OF ORAL CAVITY

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 Introduction
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 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:
• Flat, Extend below or extend above the surface.
Lesions 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.
Lesions 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.
 Vesiculo-Bullous Diseases
Associated with viral infection
• Herpes simplex infection (Herpetic gingivostomatitis)
• Caused by Herpes simplex virus type I (occasionally type II)
• Multiple painful oral ulcers preceded by vesicles.
• Usually affect children under 5 years
• Self-limiting
• Varicella
• Painful pruritic vesicles and ulcers
• Distributed on trunk, face and few oral lesions
• Common in children
• Caused by varicella-zoster virus
• Self limiting condition

• Hand-foot-and-mouth
• Painful ulcers preceded by vesicles on hands, feet and oral mucosa
• Usually seen in children
• Very rare
• Self-limiting in few weeks
• Caused by Coxackie virus
• Measles
• Oral Koplik’s spots
• Maculopapular skin rash
• Fever, malaise
• Affects children
• Self-limiting in few weeks
• Caused by measles virus
 Vesiculo-Bullous Diseases
Associated with Immunological Defects
• Pemphigous Vulgaris
• Bullous Pemphigoid
• Dermatitis Herpetiformis
 Ulcerative conditions

• Reactive Lesions (Bacterial Conditions)

• Syphilis (chancre) Primary
• Indurated non painful ulcer
• Occurs at the site of spirochete entry
• Heals spontaneous within 4-6 weeks
• Caused by Treponema pallidum
• Highly infectious
• Secondary syphilis
• Maculopapular rash on skin,
• Ulcers on mucous membranes (in oral cavity)
• Tertiary Syphilis
• Gumas, cvs and CNS
Leukoplakia
• Leukoplakia means white patch or white lesions.
• 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 may precedes the development of a malignant tumor.
White lesions of the oral cavity

• Hereditary conditions
• Leukodema
• White sponge nevi
• Hereditary Benign intraepithelial Dyskeratosis
• Follicular keratosis
• Reactive Conditions
• Focal (frictional) hyperkeratosis
• Nicotine stomatitis
• Solar chilitis
• Other white lesions
• Iodiopathic Leukoplakia
• Hairy tongue
• Lichen Planus
• Nonepithelial White-Yellow Lesions
• Candidiasis
• Mucosal Burns
• Submucosal fibrosis
• Ectopic lymphoid tissue
• Gingival cysts
• lipoma
 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 Candidiasis
• Pseudomembranous candidiasis - Thrush
• Hyperplastic candidiasis
• Atrophic candidiasis
 Aphthous 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
Cellulitis
• 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
Conditions affecting
the Tongue
Glossitis
 Glossitis is the general term used to describe inflammation and
changes in the topography of the tongue.
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.
A black, hairy-looking tongue typically is caused by an overgrowth of
bacteria and sometimes yeast in the mouth. Although unattractive, it's
usually a temporary
harmless condition.
hairy tongue (lingua villosa) is a temporary (thank God!) and harmless problem
resulting from an overgrowth of bacteria and yeast in the mouth. These
organisms accumulate on the tiny projections of the tongue (called papillae) and
cause the discoloration, which can be black, brown
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.
Geographical tongue
Geographical tongue
Fissured 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.
Fig. 17-11 Fissured tongue.
Pernicious 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.
Iron deficiency. The tongue is devoid of filiform papillae. Angular
cheilitis was also present in this patient.
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.
HIV-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.
HIV-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
Atypical periodontal disease in a patient with HIV
infection.
HIV Cervical Lymphadenopathy

• Enlargement of the cervical (neck) nodes.

• Lymphadenopathy is frequently seen in association with AIDS.
HIV cervical lymphadenopathy.

Fig. 17-19
HIV 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.
Hairy 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.

Fig. 17-22
Kaposi'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 in a patient with AIDS. A,
Skin. B, Gingivae.

Fig. 17-23
Herpes 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 on the hard palate of a patient
with HIV infection.
Human 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 papillomaavirus on the
lip of a patient with AIDS.
 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.
Types 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.
Exostoses
• 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.)
Torus palatinus.

Fig. 17-27
Torus mandibularis.

Fig. 17-28
 Disturbances in the
Development of the Jaw, Lips,
Palate, and Tongue
Types 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.

Fig. 17-29
Ankyloglossia.
Salivary Glands
• Major Salivary Glands:
► Parotid gland
► Submandibular gland
► Sublingual gland
• Minor Salivary Glands:
►Labial
►Buccal
►Palatal
►Lingual

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Major Salivary Glands

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Salivary Glands Tumors

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Salivary Glands Tumors

• Uncommon and represent 2-4% of head and neck

neoplasms.
• Salivary gland tumors:
●70% originate in the parotid gland.
● 10-15% originate in the Submandibular
glands.
● the rest in the sublingual and minor
glands.
• 80% of Parotid tumors are benign.
• 50% of Submandibular tumors and 80% of minor salivary
glands are malignant.
• As the size of the gland decreases, the incidence of
malignancy of a tumor in the gland increases
Salivary Glands Tumors
• Divided into:
MALIGNANT:
►Epithelial Tumors:

BENIGN:
□MUCOEPIDERMOID

□ADENOMAS:
●Pleomorphic adenoma □ACINIC CELL TUMOR.
●Monomorphic adenoma:
oncocytoma
adenolymphoma
Basal cell adenoma
□CARCINOMA.
● Adenoid cystic
►Non-Epithelial Tumors:
□Hemangioma
carcinoma
□Lipoma
Salivary Glands Tumors Theories

• The etiology of salivary gland neoplasms is not fully

understood. Two theories predominate:
• Bicellular stem cell theory:
Tumors arise from 1 of 2 undifferentiated stem
cells:
The excretory duct reserve cell or
 the intercalated duct reserve cell.

● Excretory duct → squamous cell and mucoepidermoid

carcinomas
● Intercalated duct →pleomorphic adenomas,
oncocytomas,
adenoid cystic carcinomas, adenocarcinomas,
and acinic cell carcinomas.
 Salivary Glands Tumors Theories

Multicellular theory:
Each tumor type is associated with a specific
differentiated cell of origin within the salivary gland
unit.
● Excretory duct cells → Squamous cell carcinomas.
● Intercalated duct cells → Pleomorphic adenomas.
● Striated duct cells → Oncocytomas.
● Acinar cells → acinic cell carcinomas.
Risk factors to develop tumors

• Radiation therapy

• Smoking

• Alcohol (?)

• Genetic factors.

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Presentation of Salivary Glands Tumors
• History:
►slowly enlarging painless mass.
►airway obstruction, dysphagia, or hoarseness.
►Facial paralysis.( 80% of patients with facial nerve
paralysis have nodal metastasis at the
time of diagnosis)
► Pain
►History of the lump ( duration)
►History of previous parotid tumors.
► Trismus
► Ear pain
►Numbness in the distribution of the second or
third divisions of the trigeminal nerve often
indicates neural invasion.
Benign Epithelial Tumors
Pleomorphic adenoma (mixed benign tumor)

• The most common tumors of the salivary gland.

• 70% of parotid gland tumors, and 50% of submandibular gland
tumors.
• Usually in middle-aged women.(♀ > ♂)
• Slowly growing tumors
• Most often located in the parotid gland tail and in the minor
salivary glands mostly located on the hard palate.
• Termed pleomorphic because of the epithelial and connective
tissue components that compose them.
• Thin, delicate, incomplete capsule may have projections into
the surrounding parotid tissue.
(these projections limit its treatment by enaculation)

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Pleomorphic adenoma (mixed benign tumor)

• HISTORY:
-Painless swelling in the side of
their face.
-slowly growing
-has been there for months or
years.
• Examination:
-Round mass, with defined edges
-facial nerve examination (should be
normal)
-cervical lymph glands examination
(should be normal)
mobile, and skin moves freely.
Pleomorphic adenoma (mixed benign tumor)

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pleomorphic adenoma- salivary gland
pleomorphic adenoma ...
Warthin tumor ( papillary cystadenoma
lymphomatosum)
• Other terms: (cystic papillary adenoma, adenolymphoma)
• Benign tumor, May occur as multiple lesions

• Second most common benign parotid tumor.

• Has a heavy lymphoid stroma and aciniform epithelial cells that line the
cystic areas with papillary projections, Has a variable number of cysts
that exude a clear fluid.

• Tends to be bilateral (10% of cases) and is usually found in the major

glands, as are most other types.
• More common in older white men
• Malignant transformation has not been observed

• Treated by superficial parotidectomy

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Oncocytoma (Oxyphil adenoma)

• Rare
• Accounts for 1% of salivary gland tumors
• Benign tumor
• Composed of oncocytes
• Common in parotid gland
• More common in old age (>50)
• Small, firm, slow-growing, spherical masses.

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Oncocytoma (Oxyphil adenoma)
Oncocytoma (Oxyphil adenoma)
Basal cell adenoma

• Neoplasm of a uniform population of basaloid

epithelial cells.
• Common sites are parotid, submandibular gland, can
occur intaoral (lips).

• More common in women than in men (2:1).

• Single well defined nodule.

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Malignant Epithelial Tumors

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Mucoepidermoid Tumor

• Characterized by acini with mucus-producing cells and by

the presence of malignant squamous elements
• The Most common malignant salivary gland tumor, and The
most common malignant tumor of the parotid gland,
accounting for 30% of parotid malignancies.
• Most mucoepidermoid tumors are low-grade lesions readily
cured by adequate excision, the 5-year survival approaches
75%.
• If high-grade, they behave aggressively, widely infiltrating
the salivary gland and producing lymph
node and distant metastases, the 5-year survival approaches 5%.

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Mucoepidermoid Tumor
Adenoid cystic carcinoma

• characterized by its unpredictable behavior.

• Metastasis is more common to distant sites than to
regional nodes, with lung metastases being most
frequent .
• It has the highest incidence of distant metastasis,
occurring in 30-50% of patients.
• This tumor requires aggressive initial resection.
• Overall 5-year survival is 35%.

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Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma
Acinic cell tumor

• Intermediate-grade malignancy .

• usually solid, rarely cystic.

• This tumor rarely metastasizes.

• Overall 5-year survival is 82%

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• Acinic cell
carcinoma

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Thank you

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