1
Table of Common Oral Conditions
Disease Etiology
Addison’s Idiopathic adrenal cortical
Disease insufficiency
The anterior pituitary is
stimulated to make more
adrenal stimulating hormone
due to the adrenal cortical
insufficiency, however, melanin
stimulating hormone (MSH)
production is also enhanced by
this process
Angular Multifactorial etiology
Cheilitis or The most common cause is a
Perleche reduction of the vertical height
which results in the
development of a skin furrow or
fold in the area. Subsequently,
saliva flows in the area that can
then be superimposed by
microorganism such as C.
albicans, streptococci,
staphylococci, and others.
Mechanical trauma has also a
role in the development of the
disorder.
Angular cheilitis is commonly
observed in iron deficiency
anemia, megaloblastic anemia,
Plummer-Vinson syndrome,
riboflavin deficiency, Crohn’s
disease, sarcoidosis, and HIV
infection
Black Hairy Elongation of filiform papillae –
Tongue related to smoking, medications,
bacteria
Clinical
Patients exhibit fatigue, weight In Addison’s disease there is
loss, and hypotension.
Skin and mucosa display
patchy pigmented macules
also known as ephelides or
freckles.
Patients often present with a
bronzed or tanned look.
Pigmentation are more
prominent in areas that are
often traumatized (elbows and
knees)
Intra-orally, the lesions are
macular, irregular in shape,
usually patchy, and can occur
in multiple areas
Characterized by erythema
and fissuring starting at the
corners of the mouth and then Staphylococcus or
extending in a radial pattern
beyond the mucocutaneous
border, toward the skin in
more severe cases.
Occasionally, crusts and white
plaques cover the fissures.
A burning sensation and
feeling of dryness may be
experienced that makes the
patient lick the affected areas
that in turn results in
perpetuating the situation.
Elongation of filiform papillae
with staining by food, tobacco,
or bacteria.
Histopathology
an increase of melanocyte
function thus an increase in
melanin production rather
than an increase in the
number of melanocytes.
An increase in the amount
of melanin produced and
deposited in the basal cell
layer is evident
Oral candidiasis and
secondary infection with
Streptococcus may be also
present.
Elongation and
hyperparakeratosis of the
filiform papillae.
Treatment/Prognosis
Corticosteroid replacement
therapy at normal
physiologic levels will
alleviate Addison;s disease
and minimize systemic
manifestations
Consist of treatment of
underlying cause such as
correction of the occlusal
vertical dimension, vitamin
administration, treatment
of underlying anemia, etc.
Topical treatments
including local steroids
along with antifungal or
antibiotic ointments.
Staining can be reduced by
meticulous hygiene
practices, including

Candidiasis or Suppression of the immune
Thrush response by HIV, enhances the
opportunistic Candida albicans
proliferation in the oral cavity
Cherubism It is a hereditary autosomal
Also known as dominant developmental jaw
Familial condition. It is characterized by
Fibrous bilateral painless swelling of the
Dysplasia mandible (and often the maxilla)
that causes fullness of the
cheeks.
Extensive maxillary involvement
causes stretching of the skin of
the upper face that produces a
slight upward turning of the eye.
This causes the children to
appear as though they are
gazing skywards, and thus
revealing an abnormal amount
of sclera.
Cleft lip Hereditary factors and
environmental factors
The most frequent intramural
infection in HIV positive
patients.
HIV positive patients usually
demonstrates the
pseudomembranous or
erythematous type of
candidiasis
Most common site is the
palate followed by the tongue
The lesions are characterized
by onset before the age 3 and
often present as a painless
bilateral expansion of the
posterior mandible.
Cherubism usually involves
the ramus, angle of the
mandible, mandibular trigone
area, and posterior maxilla. It
rarely involves all four
quadrants,
Intraorally, a hard swelling
can be palpated in the affected
area.
Developing teeth in the area of
the lesion are often displaced
and fail to erupt, therefore,
one should expect defects in
developing teeth.
These lesions will arrest
spontaneously by puberty.
And the involved bone will
remodel to normalcy by the
age 25-30 years old. Therefore,
no treatment is necessary.
The philtrum of the upper lip
develops from the fusion of the
Increase number of bacteria
may be present on the
epithelial surface
Candida albicans organisms
found with periodic acid-
Schiff (PAS) staining method
The microscopic
examination of cherubism
reveals a highly vascularized
fibrous stroma. Numerous
fibroblasts and
multinucleated giant cells
with prominent nucleoli are
noted.
In mature lesions, there are
large amount of fibrous
tissue and fewer giant cells.
Radiographs: The
characteristic radiographic
appearance of cherubism is
multiple, well-defined,
bilateral, multiloculated
radiolucencies in the
posterior mandible
None
2
brushing of the tongue
encourages desquamation.
Good prognosis, a benign
lesion with no sequelae
Chlortrimazole troches
that dissolves in the mouth
is the standard of
treatment
Fluconazole is also
prescribed for tenacious
infections
Poor response with
treatment and rapid
recurrence rates are
common in the HIV
positive patient
After a rapid pace of bone
expansion, the disease is
usually self-limiting and
regressive.
Surgical intervention must
be based on the need to
improve function, prevent
deliberation, and satisfy
esthetic considerations.
Cherubism arrests
spontaneously, Bone
remodels so that it appears
normal at around ages 25-
30.
Reconstructive surgery
closing the cleft through

Cleft palate Hereditary factors and
environmental factors
Cyanotic lips Most common causes of blue
lips are events that limit the
amount of oxygen that the lungs
take in, including:
- air passage blockage
- choking
- excessive coughing
- smoke inhalation
- exposure to cold air/water
In addition, blue lips may be
associated with the following
conditions:
- lung disease
- congenital heart abnormalities
- adult respiratory distress
syndrome
- aspiration pneumonia
- asthma
medial nasal process and the
lateral portion of the maxillary
process.
Failure to fuse at any point in
development will result in
some degree of clefting.
Cleft lips are generally
unilateral (80%). Most
common in males on left side.
Midline lip clefts are rare.
Occurs about 1 in 600 births
Failure to fuse at any point in
development of structures
responsible in forming the
primary and secondary palate
will result in some degree of
clefting.
Incidence of cleft with cleft
palate:
3.6 per 1,000 Native American
births
1.5 per 1,000 Asian births.
1.0 per 1,000 white births
0.4 per 1,000 black births
Bluish discoloration of the
skin of the lips
None
Radiographs: Missing bone
in area of cleft palate
Cyanosis may be evident,
indicating that the arterial
blood is not saturated with
oxygen
3
multiple step procedure is
required.
Oral surgeons, ear, nose,
and throat surgeons,
orthodontists, plastic
surgeons, and
pedodontists are some of
the expertise that are
required for successful
rehabilitation.
Good prognosis with
surgical intervention
Reconstructive surgery
closing the cleft. (similar to
cleft lip)
Prognosis with surgical
intervention is good
Involves identifying and
correcting the underlying
cause and restoring the
flow of oxygenated blood to
the lips.

- carbon monoxide poisoning
- cardiac tamponade
- chronic obstructive pulmonary
disease (COPD)
- emphysema
- pulmonary edema
- Raynaud’s phenomenon
Denture Etiologic factors are irritation
Stomatitis from ill-dentures and poor
denture hygiene.
Dermoid Cyst Multiple germ layer lay
involvement of the cystic wall.
May be caused by the
developmental inclusion of
pluripotential cells
Depapillated Unknown. A candida component
Tongue or has consistently been
Atrophic demonstrated.
Glossitis
Common disorder in people
who wear dentures
continuously for long periods
of time – 30-70% prevalence.
Lesion is confined to maxilla
and rarely occurs on the
mandibular-mucosal surface.
Mucosa beneath the denture
is edematous and
erythematous with or without
whitish spots.
The mucosal surface may be
smooth or granular or
nodular.
Most patient are
asymptomatic, but some
complain of a burning
sensation, irritation, or mild
pain.
The lesions are benign and
may be localized or
generalized.
Large midline cyst.
Usually found under the
tongue or peri-mylohyoid
muscle.
Can develop anywhere where
pluripotent cells are located.
Associated with sweat glands
and hair.
A condition where there is loss
of filiform papillae.
On histologic examination,
the epithelium is
hyperplastic. The mucosa is
irregular with multiple
papillary projections with or
without hyphae
presentation.
Microscopic examination of
cystic cavity of dermoid cyst
reveals a layer of stratified
squamous epithelium
supported by a fibrous
connective tissue wall.
Numerous ectodermal
derivatives can be seen such
as hair follicles, sebaceous
glands.
Candida albicans organisms
found with periodic acid-
Schiff (PAS) staining
method.
4
Improvement of denture fit,
oral hygiene, and
antifungal drugs
systemically, e.g.
fluconazole 100 mg/d or
itraconazole caps 100
mg/d for 6 to 7 days are
the first-time therapy.
In cases with extensive
papillary hyperplasia, the
lesions must be removed
by electrosurgery or CO2
laser and a new denture
should be constructed.
Surgical excision.
Prognosis is good with little
risk of recurrence post-
excision
Treatment includes
addressing the candidiasis
infection.
 5

Often associated Chlortrimazole troches

erythematous (atrophic) that dissolves in the mouth
candidiasis is the standard of
treatment.
Prognosis is poor. Tongue
may oscillate between a
papillated state and a
depapillated state.
Fissured Unknown but may be The tongue presents with deep None Brushing of the tongue
Tongue congenital, although occurs grooves and fissures. may diminish the bad taste
Also known as later in life. Some patients complain of bad and mal-odor.
furrowed Is associated with the taste or mal-odor due to No other treatment
tongue Melkenson-Rosenthal Syndrome presence of bacteria. indicated.
of Bell’s palsy and cheilitis This defect is usually
granulomatosum. asymptomatic, benign, but
worsen over time
Geographic Unknown, but stress has been There are patchy red zones Resembles psoriasis of the Treatment is not required.
tongue hypothesized as an etiological caused by atrophy of filiform skin Local or topical anesthetics
Also known as factor. papillae and often surrounded Atrophy of epithelium with can be prescribed in cases
benign Frequently (20-30%) coexists by a white edge of extension of rete ridges with sensitivity.
migratory with fissured tongue. desquamative papillae. The between which are well- Homemade mouth rinse
glossitis or May occur in association with zones change patterns and vascularized papillae with with chamomile and
erythema psoriasis and Reiter’s syndrome sometimes resembles chronic inflammatory cells avoidance of commercial
migrans geographic places. mouthwashes are
recommended.
Commonly seen in patients Lesions arise without
with fissured tongues. apparent cause.
Occurs mostly on the dorsum The erythematous areas
of the tongue, especially the heal within days. But
anterior 2/3, but may occur usually redevelop
on the ventral aspect. elsewhere
May occur on buccal mucosa
and floor of mouth in which
case it is called stomatitis
migrans. May present as a
burning tongue. Acid foods
can irritate it.
Hairy Tongue A relatively common benign, Usually develops in the Microscopically, nonspecific, Usually no treatment is
asymptomatic condition. midline of the dorsum of the mild inflammatory reaction required. However, in
The cause is not well tongue just anterior to the and loss of the lingual cases with C. albicans
understood, although several circumvallate papillae. papillae are seen. infection, systemic
predisposing factors have been It is characterized by Parakeratosis and itraconazole or fluconazole
implicated such as emotional hypertrophy and elongation of acanthosis with irregular 100 mg/d for 7 days

stress heavy smoking, use of
metronidazole and other
antibiotics, long time use of
mouthwashes, poor oral
hygiene, C. albicans,
radiotherapy of the head and
neck area, etc,
Leukoplakia Leukoplakia is a clinical term
defined by the World Health
Organization (WHO) as a clinical
patch/plaque on the oral
mucosa that cannot be removed
by scrapping and cannot be
classified clinically or
microscopically as another
disease entity.
It is the most common
premalignant lesion of the
mouth.
One study indicates that 20% of
leukoplakias that are biopsied
are dysplastic or malignant.
Therefore, it is absolutely
mandatory to biopsy
leukoplakia
Lichen Planus This is an eruptive disease
found commonly in the mouth,
but can also affect the skin. The
skin surfaces that are most
commonly affected are areas of
folded skin or areas commonly
rubbed/irritated, for example
the wrist, ankles, chest. The
the filiform papillae due to
accumulation of keratin and
resulting to a hair-like
appearance. The color of the
elongated is usually brown or
yellowish-white or even black
when pigment-producing
bacteria colonize the lesion.
Excessive length of the
papillae may cause
unpleasant feeling of gagging,
bad taste, discomfort, and
malodor
Leukoplakia is more common
in males than females
Leukoplakia is associated with
middle age and older
populations.
Most common intraoral site for
leukoplakia is the buccal
mucosa.
Leukoplakia lesions also have
a wide spectrum of clinical
presentations ranging from a
normal appearing tissue to
smooth slightly translucent
macular areas to thick,
leathery fissured, firm, raised
plaque.
Most common intraoral site is
the buccal mucosa (80%),
followed by the tongue (60%)
and the vermilion border and
the gingiva.
Common forms are:
Reticular/lace-like pattern
rete ridges may be present.
Hypha of C. albicans is a
common finding.
On histologic examination,
marked elongation with
hyperkeratosis and
parakeratosis of the filiform
papillae are present.
Colonization of the
epithelium by bacteria and
C. albicans hyphae is a
common finding.
Macroscopic evaluation of
leukoplakia presents with a
spectrum of changes that
can be found in the mucosal
epithelium ranging from
hyperkeratosis, acanthosis,
dysplasia, carcinoma in situ
to invasive carcinoma
White lesion
Rete ridges broad and flat
Hydropic degeneration of
the basal layer.
Accumulation of fluid
occurs where basal cells
used to be producing
vesicles that are
6
improve the subjective
symptoms.
Excellent oral hygiene,
brushing of the dorsum of
the tongue by a tongue
cleaner and elimination or
cessation of any
predisposing factors, is the
treatment of choice.
However, in cases of
extreme papillary
elongation, topical use of
keratolytic agents (e.eg.
trichloroacetic acid 30%,
podophyllin in alcohol,
salicylic acid) have been
used with success.
One study indicated that
20% of leukoplakias that
are biopsied are dysplastic
or malignant. Therefore, it
is absolutely mandatory to
biopsy leukoplakia,
The treatment of
leukoplakia is dependent
on the microscopic
findings
The treatment is through
supportive therapy. Severe
cases that are
accompanied with pain
and discomfort require the
administration of systemic
corticosteroids.

affected areas of the skin are
characterized by lines called
“Stria of Wickham”
The causes of LP are idiopathic,
but most cases arise from
psychosomatic causes.
Anecdotal evidence suggests
that emotional stress cause
eruption of LP. A small
percentage of cases result from
drug allergies (<10%). Certain
drugs can cause unique
reactions similar to LP, these
reactions are referred to as
lichenoid drug reactions, which
have microscopic and clinical
appearance as LP.
Ludwig”s Acute painful infection that is
Angina diffusely spread throughout the
tissue rather than localized as
in an abscess.
Cellulitis in the head and neck
region is most commonly the
result of extension of a
periapical abscess into the soft
tissue. However, cellulitis can
also occur from other causes as
well.
Median The etiology is not clear
Rhomboid although a developmental defect
Glossitis along with C. albicans infection
Also called is the most probable theory.
central
papillary
atrophy of the
tongue
Necrotizing The infection frequently occurs
Ulcerative in the presence of psychological
Gingivitis/ stress.
- Keratotic lines intersect
giving lacy pattern on
buccal mucosa
White plaque – or patch
common on dorsum of the
tongue
Annular multiple lesions that
are round. Erosive/ulcerated
lesions appear red and bleed
easily.
-
Bilateral infection of the
submandibular, sublingual
and submental spaces.
It is a rapidly spreading
cellulitis and commonly
spreads posteriorly.
There is always a severe
swelling with elevation and
displacement of the tongue
and a tense, hard induration
of the submandibular region.
Patient have trismus, drooling
of saliva, difficulty swallowing
and breathing.
The infection may spread with
Clinically appears as a flat or
slightly raised, red, diamond-
shaped patch, devoid of
filiform papillae usually
located in the posterior,
dorsal, midline of the tongue.
It does not migrate.
May cause a burning tongue.
Interdental papillae are highly
inflamed and edematous.
subepithelial thus
separating the epithelium
from the connective tissue
Inflammatory infiltrate
within the connective tissue
in the form of a band. The
band is primarily of
lymphocytes. Deeper layers
of connective tissue tend to
be free of inflammatory cells
None
Presence of Candida
albicans on the surface of
the epithelium and mild
chronic inflammation
None
7
Also, always advice the
patient of good oral
hygiene, and the use of
hydrogen peroxide rinses
twice a day, especially
before bed.
Medical evaluation of the
patient.
Administration of proper
antibiotics.
Surgical removal of the
source of infection as early
as possible.
Surgical drainage of the
infection.
Constant re-evaluation.
Antifungal medication
Reassurance of patient
Good prognosis as patients
with median rhomboid
glossitis will observe
regression with proper
hygiene.
The affected area is best
treated with debribment

Necrotizing In addition to stress other
Ulcerative factors have been related to an
Stomatitis or increased frequency of NUG
Trench Mouth - Smoking
- Local trauma
- Poor nutritional status
- Poor oral hygiene
In addition,
immunocompromised status,
especially that seen in
association with acquired
immunodeficiency syndrome
AIDS and infectious
mononucleosis, has been
related to the development of
NUG.
Nicotinic The lesion of nicotinic stomatitis
stomatitis is associated with pipe and cigar
smokers.
Some studies suggested that
heat is the etiological factor in
nicotinic stomatitis
Lesions of NS where present in
patients who do not smoke
cigars and pipes, but frequently
drink extremely hot liquids.
No conclusive evidence is
present regarding the etiology of
nicotinic stomatitis
Pachyderma Causes may include:
Oris / - Chronic irritation
Pachyderma - Low grade trauma
Oralis / Benign - Denture irritation
Hyperkeratosis - Frequent x-ray
/ Focal - Physical rubbing or injury
Keratosis / - Cheek biting
Leukokeratosis - Heavy smoking
Oris
Pericoronitis Continuous mechanical trauma
of the overlying mucosa and
8
The papillae are blunted and
demonstrate areas of
punched-out, crater like
necrosis, which are covered
with a gray pseudomembrane.
The buccal mucosa opposite
the third molar, is the most
commonly affected area.
A fetid odor, exquisite pain,
spontaneous hemorrhage, and
accumulations of necrotic
debris are common symptoms
The lesion of nicotinic Macroscopic appearance of No treatment is indicated.
stomatitis occurs in the palate nicotinic stomatitis is The lesions of nicotinic
The palatal mucosa in characterized by stomatitis usually resolve
patients with NS appears orthokeratinization, and after the cessation of cigar
whiter than normal, moderate levels of and pipe smoking
roughened, fissured, and acanthosis.
wrinkled. The minor salivary glands
Small circular papules are and the underlying
scattered throughout the connective tissue exhibit
palate. The red papules may chronic inflammation.
be surrounded with white
keratotic rings. It is believed
that the red papules are the
inflamed orifices of minor
salivary glands.
The lesions are asymptomatic
Asymptomatic white patch Thickening of the keratin Elimination of all possible
that does not rub off and and granular layers of factors of irritation
commonly seen on the epithelium Surgery
edentulous ridge, buccal No granular layers of Electrocautery
mucosa and tongue. epithelium Dessication
Mucosal lesion may be flat or No other epithelial changes
raised lasting for weeks to
months.
Usually affects adults
Redness and swelling of the Microscopically, the During the acute phase,
gingiva and the mucosal flap epithelium is hyperplastic local antiseptics,

gingiva surrounding an
impacted or partially erupted
tooth, usually the lower third
molar
Peutz-Jegher Is an autosomal dominant
hereditary hamartomatous
polyposis syndrome
accompanied by melanotic spots
on the lips, buccal mucosa, and
skin. Although the
hamartomatous polyps are
nonneoplastic, patients with
Peutz-Jeghers syndrome carry
an increased risk of both
intestinal and extraintestinal
malignancies.
Ranula Trauma is the most common
cause of ranula
Recurrent The underlying etiology remains
Aphthous unclear though a series of
Stomatitis factors are known to predispose
(RAS) to the appearance of oral
aphthae, including:
- genetic factors
(the operculum) overlying and
surrounding the semi-erupted
tooth.
Frequently, ulceration and
abscess formation may occur.
Usually accompanied by
intense pain, halitosis, low-
grade fever, malaise, and
regional lymphadenopathy.
Multiple melanotic macules on
the skin, lower lip and buccal
oral mucosa.
Systemic symptoms include
abdominal pain, rectal
bleeding, and diarrhea.
A mucus extravasation
condition of the sublingual
salivary gland or the minor
salivary glands in the floor of
the mouth.
Appears as a blue fluctuant
swelling.
Is characterized by the
appearance of initially necrotic
ulcers, with well defined limits
surrounded by an
erythematous halo.
while the connective tissue
exhibits dense inflammatory
infiltration by
polymorphonuclear
leukocytes, lymphocytes,
eosinophils and plasma cells
Microscopic examination
shows increased melanin in
the basal keratinocytes,
rather than an increased
number of melanocytes
Mucin within granulation
tissue containing foamy
histiocytes and neutrophils
Microscopic characteristics
are non-specific. The pre-
ulcerative lesion
demonstrates subepithelial
inflammatory mononuclear
cells with abundant mast
9
analgesics and good oral
hygiene are the
recommended measures.
In the presence of fever
and other systemic signs
and symptoms, systemic
use of antibiotics such as
metronidazole 250 -500 mg
three times a daily for 4 to
6 days or penicillin 1 to 2
MIU/d for 4 to 5 days is
recommended.
Surgical removal of the
overlying gingival flap or
extraction of the offending
tooth may be performed
after the acute phase to
avoid recurrence.
Treatment is not indicated
for the oral and extraoral
pigmented lesions.
Marsupialization is the
initial choice of treatment.
If the ranula recurs,
excision of affected gland
can be utilized
Treatment is multifocal
and varies according to the
predisposing factors. In all
cases management is
asymptomatic, and seeks
to reduce inflammation of

- food allergens
- local trauma
- endocrine alterations
(menstrual cycle)
- stress and anxiety
- smoking cessation
- certain chemical products
- immunologic
- microbial agents
Classified as:
- Minor
- Major, and
- Herpetiform
Recurrent Caused by Herpes Simplex
Herpes Labialis Virus (HSV) I and II.
Distinction between HSV I and
HSV II can only be made
immunologically
Both HSV types are known to
produce oral, genital, facial and
digital lesions.
Incubation period post-contact
is 2-20 days.
HSV may migrate to the
trigeminal ganglion where it
remains dormant.
Precipitating factors such as
fever, cold, upper respiratory
infection, exposure to the sun or
cold air, fatigue and psychic
stress may reactivate the virus.
Diminished host resistance is
the common precipitating factor
for the reactivation of HSV
Scalloped Scalloped tongue is a condition
Tongue secondary to macroglossia.
Macroglossia may be hereditary
or be associated with underlying
causes such as: vascular
The lesions are located on the
oral mucosa – usually non-
keratinized area, but are
infrequent on the gums.
The disease manifests in the
form of outbreaks, with a
chronic and self-limiting
course in most cases.
RAS is the most frequent
chronic disease of the oral
cavity, affecting 5-25% of the
population.
It is more common in patients
between 10-40 years of age,
and predominantly affects
women and individuals of
higher socioeconomic levels.
Occurring on dry surface of
skin and vermilion, these
crust after rupturing and
ulcerating.
Lesion of recurrent labialis
type often occur in cluster.
Some patients get an “Aura”
sensation; they are able to
sense that a lesion will soon
develop.
Recurrent form of herpes that
occurs on the mucosal surface
is called Recurrent Intraoral
Herpes
Lesions always start out as
vesicles and may be fleeting
vesicles.
Occurs particularly on the
bound down mucosa which is
attached to the periosteum
An abnormally large tongue
will fill the embrasures of the
lingual surfaces of teeth and
thus causing the tongue to
appear scalloped
cells, connective tissue
edema and lining of the
margins with neutrophils.
Damage to the epithelium
usually begins in the basal
layer and progresses
through the superficial
layers, leading eventually to
ulceration and surface
exudate.
There is an intraepithelial
vesicle just as with
pemphigus vulgaris.
Intracellular bridges can be
fine or falling apart due to
the virus.
Intraepithelial vesicles
contain many cells infected
with the virus, and many
inflammatory cells.
Epithelial cells may appear
multinucleated, changes in
the nuclei seen because of
the virus presence
Radiograph: N/A
In vascular tumors, an
increase in the number of
blood vessels is evident
histologically.
10
the aphthae and afford
pain relief by
administering topical or
systemic treatments.
Herpes disease is self-
limiting
Topical Acyclovir can be
prescribed; works best
when used as soon as
there is any suggestion of a
lesion occurring –
prodrome.
Acyclovir serves to shorten
the duration of the disease
by one or two days.
Prognosis is good
Usually heals in1-2 weeks.
Speech therapy may be
required for mild cases of
macroglossia.
In severe cases, underlying
causes should first be

tumors, acromegaly,
hypothyroidism, Down
syndrome, neurofibromatosis,
amyloidosis.
Sialolithiasis – Calcium salt formation around
also known as debris within the salivary ductal
salivary stone system
Squamous Cell Alcohol Consumption
Carcinoma
Smoking: The regular use of
tobacco products in its various
forms (cigarettes, cigars, pipes,
snuff, chewing tobacco) play an
important etiological factor in
SCC. 90% of all cancer cases are
found in smokers, especially
those who drink excessively.
Increased risk for oral cancer:
- cigar pipe 4.1 times
greater risk for oral cancer
- 10-19 cigarettes/day 3.2 times
greater risk for oral cancer
- Smokers and heavy drinkers
6-15 times greater risk for oral
cancer
Plummer-Vinson Syndrome:
This syndrome develops from an
iron deficiency, there is also a
defective upper respiratory tract,
and an inherent potential, which
Calcified matter that develops
in the salivary ductal system.
Most commonly found with
the submandibular duct
system along the floor of the
mouth.
Pain is a common symptom
especially at times when
patient is eating (increased
salivary flow).
Risk factors for development of
SCC include fair skin
complexion, increased
ultraviolet B exposure, and
decreased host immunity.
SCC typically presents as an
erythematous, scaly papule,
nodule, or plaque, and may
have central ulceration.
SCC on the lips:
- Occurs in patients in the
fifth and eighth decades.
- It is more common in males
than in females (6:1 male to
female ratio)
- Most lesions occur on the
vermillion border and may
appear as a chronic non-
healing ulcer.
- SCC of the lower lip are well
differentiated and slow to
metastasize.
In neurofibromatosis, an
increase in neural tissue is
evident histologically.
In Down syndrome, no
histopathological feature is
present.
In amyloidosis, an abnormal
(amyloid) protein is
deposited in the tongue.
Calcified mass surrounding
debris
Radiographs - radiolucent
stone best viewed on an
occlusal radiograph.
Radiolucency may also be
seen on periapical and
panoramic films
superimposed on the
mandible.
Microscopic examination of
SCC reveals the following:
Epithelia dysplasia with
evidence of invasion.
The microscopic features of
epithelial dysplasia include
- Prominent nucleoli
- Hyperchromatic nuclei
- Nuclear pleomorphism
- Altered nuclear to
cytoplasmic ratio.
- Abnormal mitotic figures.
- Increased mitotic activity
The basement membrane
tends to disappear and the
tumor appear as invading by
the extension of irregular
epithelial processes of cells
with ill-defined outlines, to
the underlying connective
tissue.
11
addressed; otherwise,
reduction glossectomy may
be indicated.
Scalloped tongue will
resolve when the
underlying cause of
macroglossia is addressed
Milking the stone to the
terminus of the duct will
often produce the stone
and remove the
obstruction.
Large stones need to be
removed surgically
Treatment for invasive SCC
includes excisional
surgery, cryosurgery,
topical chemotherapy, and
radiation therapy.
Radical neck dissection is
indicated in patients with
multiple lymph nodes
involvement.
Radiation therapy
administered by itself as
definitive treatment for less
advanced squamous cell
head and neck cancers, or
it may be delivered
preoperatively or
postoperatively.
Chemotherapy alone
cannot cure oral cancer.
The most active single
agents include cisplatin,
carboplatin, methotrexate,

renders the mucosa more
susceptible to carcinogens.
There are also possible viral
origins.
HPV (Human Papilloma Virus) –
is associated with
gastrointestinal and laryngeal,
and lower lip cancers.
EBV (Epstein Bar Virus) – is
associated with Burkitt’s
lymphoma and nasopharyngeal
carcinoma.
CMV (Cytomegalovirus) – is
associated with Kaposi sarcoma.
High Risk site for Squamous
Cell Carcinoma
- Lowe lip 35%
- Lateral/ventral tongue 25%
- Floor of the mouth 20%
- Soft palate 15%
Tonsillitis Most often caused by common
viruses, but bacterial infections
can also be the cause. The most
common bacterium causing
tonsillitis is Streptococcus
pyogenes (group A
streptococcus).
Non-contagious
Risk factors:
Young age – 5-15 of age
Frequent exposure to germs
- If metastasis did not occur
the lesions are 100%
curable.
SCC of the Tongue
- Is the most common
intraoral malignancy.
- Most lesions occur on the
lateral border (middle and
posterior thirds) and ventral
surface of the tongue:
- SCC of the tongue are
asymptomatic.
- Clinically the lesion appears
initially as an area of
leukoplakia and then
develop to an indurated,
non-healing ulcer with
elevated margins.
SCC of the floor of the mouth:
- Most lesions occur in the
anterior segment of the floor
of the mouth adjacent to the
opening of Wharton’s duct
- The lesions initially appear
as areas of erythroplakia
and then develops to an area
of painless, indurated, non-
healing ulcer.
Red, swollen tonsils.
White or yellow coating or
patches on the tonsils
Sore throat
Difficulty or painful
swallowing.
Fever, enlarged, tender glands
(lymph nodes) in the neck
Bad breath
Hoarse or no voice
Earache, malaise
12
bleomycin, 5-fluorouracil,
and paclitaxel.
Response rates depend on
tumor bulk, degree of
pretreatment, and the
drugs used.
The prognosis of SCC is
dependent on the clinical
staging of the tumor.
Overall, 5-year survival
rate of oral SCC is around
50%. Lower lip lesion, with
a high degree of
differentiation may have a
survival rate of 80-90%.
Invasion of the mucous Viral tonsillitis – this type
membrane by has to run its course and
microorganisms, usually antibiotics will not help
hemolytic streptococci or
viruses Bacterial tonsillitis –
antibiotics or sulfonamides
or both are prescribed in
severe infections to prevent
complications
Tonsillectomy in severe
tonsillitis that keeps
coming back

Torus Palatinus Unknown
Torus Unknown
Mandibularis
White hairy Isa benign condition with no
tongue serious sequelae
It is asymptomatic, but its
concern among patients is
aesthetic. There are certain
precipitating factors, but no
certain causes for white hairy
tongue. There are two factors
that relate to hairy tongue:
- Smoking is a major
precipitating factor for white
hairy tongue because it is a
chronic irritant. The filiform
Appears as a sessile.
Asymptomatic, bony, hard
mass that develops during
normal growth found
exclusively on the midline of
the hard palate and is covered
by thin normal mucosa.
May have varying number of
nodules.
Occasionally, the mucosa may
become ulcerated and painful
if traumatized
Can make taking radiographs
difficult because ideal seating
of the film may not be
achieved.
Presents as slow-growing
asymptomatic, hard bony
modules that may be single or
multiple, found exclusively on
the lingual of mandibular
premolar teeth, usually
bilateral.
Usually reach their final size
by the end of third decade of
life. Can make taking
radiographs difficult because
ideal seating of the film may
not be achieved.
White hairy tongue usually
affects the dorsum of the
tongue, anterior to the
circumvallate papillae, and
spreads out from the midline.
It is always found on a surface
where filiform papillae are
present.
Patients may complain of bad
taste because the long papillae
may entrap food, debris, and
organism
13
Appear as normal dense Do not necessarily require
bone. intervention as they are
Radiograph: May appear as benign lesions, but may be
radiopacity superimposed removed to reduce
on the roots of teeth and undercuts which may
alveolar bone. interfere with the seating
of a denture.
Demonstrates slow growth.
Patients will often be aware
of their presence due to the
slow nature of their
growth.
Appear as normal dense It is usually not required.
bone with no inflammation. In severe cases surgical
Radiographs: May appear as correction is needed
radiopacities superimposed particularly if a full or
on the mid-roots of teeth. partial denture has to be
constructed.
(similar to torus palatinus)
None It is generally
asymptomatic – no
treatment is indicated.
You can advise the patient
to brush their tongue
gently, this may improve
the aesthetic and the taste

papillae extend more than
usual, or fail to desquamate
- Poor oral hygiene
14
Individuals with hairy
tongues, DO NOT lose their
taste sensation
Diagnosis of hairy tongue is
purely clinical, and is
relatively common clinical
finding