ESSAYS

PLEOMORPHIC ADENOMA:
 It is a benign neoplasm of salivary glands which consists of neoplastic cells exhibiting the
ability to differentiate into both epithelial and mesenchyme likes cells.
 It is also called as mixed tumor but is not true in sense as it is not a teratomatous in origin.
HISTOGENESIS:
 A neoplastically altered epithelial cell with the potential for multidirectional differentiation
may be histogenetically responsible for Pleomorphic adenoma.
 It is been stated that myoepithelial cells and a reserve cell in the intercalated duct are
responsible.
 The intercalated duct reserve cell can differentiate into ductal and myoepithelial cells and
the latter can undergo mesenchymal metaplasia.
CLINICAL FEATURES:
 AGE & SEX: Usually occurs in fourth to sixth decades of life and a slight female predilection is
seen (6:4)
 COMMON SITES: parotid gland (superficial lobe is most commonly involved, 10% of lesions
show deep lobe involvement), sub mandibular salivary gland and palatal minor salivary
glands.
 Patient present with small, painless, slow growing and firm mass.
 The lesions of major salivary glands doesn’t show fixation to the deeper and superficial
structures whereas intraoral minor salivary gland lesions especially palatal tumors appear to
be fixed but are not invasive.
 Pain is not a common symptom and facial nerve palsy is rare.
MACROSCOPIC CUT SECTION FEATURES:
a. Irregular to ovoid mass with well defined borders.
b. The encapsulation is incomplete especially in the minor salivary gland tumors.
c. Cut surface show rubbery, fleshy, mucoid or glistening with a homogenous tan or white
color.
MICROSCOPIC FEATURES:
 The tumor is composed of a mixture of glandular epithelium and myoepithelial cells with a
mesenchyme like background.
 The proportion between the epithelial component and mesenchyme component is highly
variable among individual tumors and hence categorized the tumor into following tumors:
a. Principally myxoid
b. Myxoid and cellular components present in equal proportion
c. Predominantly cellular
d. Extremely cellular.
 The epithelium often forms ducts and cystic structures or may occur as islands or sheets of
cells.
 Myoepithelial cells have a variable morphology, sometimes appearing angular or spindled.
 Some myoepithelial cells are rounded and demonstrate an eccentric nucleus and
eosinophilic hyalinized
cytoplasm, thus resembling plasma cells
 The characteristic stromal changes produced by the myoepithelial cells are resulted through
extensive accumulation of mucoid material between the tumors cells, resulting in a
myxomatous background.
 Vacuolar degeneration of cells in these areas can produce a chondroid appearance.
 At times, fat or osteoid also is seen.
TREATMENT AND PROGNOSIS:
 It is best treated by surgical excision
a. Tumors involving superficial lobe of parotid gland – superficial parotidectomy with facial
nerve conservation.
b. Tumors involving deep lobe of parotid gland – total parotidectomy with facial nerve
conservation.
c. Tumors involving sub mandibular gland – total gland removal along with the tumor.
 Local enucleation should be avoided as it results in seeding of the tumor bed.
 Prognosis is excellent.
 Malignant transformation leads to carcinoma ex Pleomorphic adenoma in 5% cases.

WARTHIN’S TUMOR:
SYNONYMS: papillary cystadenoma lymphomatosum, lymphadenoma
 It is the second commonest benign tumor of salivary glands and mostly affects the parotid
gland only.
HISTOGENESIS:
 The tumor arises itself in the salivary gland tissue entrapped within the paraparotid or
intraparotid lymph nodes during embryogenesis.
 It is a delayed hypersensitivity disease, the lymphocytes being an immune reaction to the
salivary ducts which undergo oncocytic damage.
 Strong association between cigar smoking and development of this tumor is documented.
CLINICAL FEATURES:
 AGE & SEX: Usually in the sixth and seventh decades with men predilection
 Commonly affects parotid tail and is presented as painless, nodular, firm swelling at the
angle of the mandible.
 It is usually superficial and lies beneath to the parotid capsule or protruding it.
 Unique feature is that it has tendency to occur bilaterally.
HISTOLOGIC FEATURES:
MACROSCOPIC FEATURES:
 Soft parotid mass with well encapsulation.
 Tumor contains numerous cysts that contain clear fluid.
MICROSCOPIC FEATURES:
 The tumor consists of two components
a. Epithelial
b. Lymphoid
 As the name would indicate, the tumor comprises of cysts lined by papillary projections into
the cystic lumen and the lining epithelium is supported by lymphoid stroma.
 The oncocytic lining epithelium is double layered. The outer layer cells are tall columnar
with hyperchromatic and centrally placed nuclei. The inner layer cells are cuboidal or
polygonal.
 The lymphoid component is may be the original lymphoid tissue of the lymph node in which
the tumor has developed or the reactive lymphoid cell infiltration as result of immune
mechanisms.
 The cystic lumen contains eosinophilic coagulum which appears as chocolate colored fluid in
gross specimen.
TREATMENT AND PROGNOSIS:
 The accepted treatment is surgical removal.
 It can be easily accomplished without facial nerve involvement as the lesion is superficial.
 Malignant transformation is rare.

SJOGREN’S SYNDROME:
 A group of autoimmune conditions with a marked predilection for women; it has an intense
T lymphocyte-mediated autoimmune process in the salivary and lacrimal glands as one of its
most prominent components.
ETIOLOGY:
 Auto immune process which results in immunologic reaction that occurs in the parenchymal
tissue of salivary and lacrimal glands with consequential acinar loss and lymphocytic
infiltration.
 HLA system is also associated
 Viral agents like cytomegalo virus, paramyxo virus, and EBV also been implicated in the
pathogenesis.
CLINICAL FEATURES:
 AGE & SEX: women are most affected with a female to male ratio of 10:1. It usually occurs
over 40 years of age.
 Two forms of the disease are recognized. They are:
a. Primary SS (sicca complex): disease affects only salivary and lacrimal glands without other
coexisting systemic autoimmune diseases
 The significant manifestations are xeropthalmia and xerostomia results in painful and
burning sensations of mucosa.
 The dry oral mucosa is very susceptible to secondary candidiasis and root surface caries.
b. Secondary SS: other signs or symptoms of autoimmune disease are present, the most
common being rheumatoid arthritis. Other diseases may occur including lupus
erythematosus, systemic sclerosis, dermatomyositis
 Other extra salivary and lacrimal diseases that have been identified in both primary and
secondary forms of SS include Raynaud disease, interstitial nephritis, interstitial
pneumonitis, purpura, and polymyopathy.
 The risk for the development of extra salivary malignant lymphoma is increased.
 Parotid enlargement is presented with discomfort.

HISTOLOGICAL FEATURES:

 Intense lymphocytic infiltration (mainly of T cells)of the gland replacing all acinar structures
although the lobular architecture is preserved
 Proliferation of ductal epithelium and myoepithelium to form epimyoepithelial islands in
stroma.
LABORATORY FINDINGS:
 Raised ESR
 Hyperglobulinemia, positive serological tests for rheumatoid factors, anti nuclear
antibodies, anti – SS- A and anti -SS- B.
 Biopsy of minor accessory salivary glands in lip mucosa for histopathological studies aid in
establishing the diagnosis of the disease as these glands exhibits alterations
characteristically similar to those in major salivary glands.
RADIOGRAPHICAL FINDINGS:
 Sialographs demonstrate the formation of punctate and cavitary defects which are filled
with radiopaque contrast media.
 These fillings have been said to produce a cherry blossom or branchless fruit- laden tree
effect radiographically.
TREATMENT:
 Patient is treated symptomatically
 Xerostomia is treated with salivary substitutes.
 Xeropthalmia is treated with ocular lubricant instillations like artificial tears containing
methylcellulose.
 Parotid gland surgical removal if it is causing discomfort.
 Fluoride application is indicated to reduce the incidence of the root surface caries.

MUCOEPIDERMOID CARCINOMA
 A malignant salivary gland tumor of varying degrees of aggressiveness composed of mucus-
secreting and stratified squamous (epidermoid) epithelial cells.
CLINICAL FEATURES:
 AGE & SEX: Usually occurs in all ages but primarily in adults between third to fifth decades
of life with female predilection. It is the most common malignant salivary gland tumor of
children
 COMMON SITES: parotid gland and palatal minor salivary glands.
 Based on its biologic behavior (aggressiveness) it is categorized into
a. Low grade mucoepidermoid carcinoma
b. High grade mucoepidermoid carcinoma
 Low grade tumors are painless, fluctuant, non-ulcerated, and composed of multiple cystic
structures containing mucin that may yield a bluish color to the overlying mucosa which can
be easily mistaken as Mucocele.
 High grade tumors are painful, fixed and indurated mass or an ulcer with frequent
presentation of facial nerve paralysis.
 Low grade tumors do not metastasize but high grade tumors do to regional lymph nodes.
 4% of lesions are presented intraosseously which often occur in mandible and diagnosed by
clinical evident bone enlargement or through routine dental radiographs where they are
presented as unilocular or multilocular radiolucencies mainly in the impacted third molar
regions.

HISTOPATHOLOGIC FEATURES:
 Mucoepidermoid carcinomas have three dominant cell types:
a. Mucous cells which are variously shaped with abundant, pale, foamy cytoplasm
b. Epidermoid cells show squamoid features with polygonal shape, intercellular bridges and
rarely keratinization.
c. Intermediate cells are larger than basal cells and smaller than squamous cells.
 These cellular elements are arranged in nests and diffuse sheets that may surround cystic
spaces.
 Mucoepidermoid carcinomas have been categorized into one of three histopathological
grades based on the following:
1. Amount of cyst formation
2. Degree of cytologic atypia
3. Relative numbers of mucous, epidermoid, and intermediate cells
A. LOW GRADE: tumor show prominent cyst formation, minimal cellular atypia, and a
relatively high proportion of mucous cells
B. HIGH GRADE: tumor consist of solid islands of squamous and intermediate cells, which
can demonstrate considerable pleomorphism and mitotic activity & mucus-producing
cells may be infrequent
C. INTERMEDIATE GRADE: tumor show cystic spaces which are less prominent than that
observed in low-grade tumors. All three major cell types are present, but the intermediate
cells are usually more. Cellular atypia may or may not be observed.

 The connective tissue is presented with inflammatory reaction when any rupture and
liberating of mucus from cystic spaces occur.
TREATEMENT AND PROGNOSIS:
 PAROTID TUMORS:
a. Early low grade tumors – subtotal parotidectomy with preservation of facial nerve.
b. High grade tumors – total removal of the gland with sacrifice of facial nerve.
 SUB MANDIBULAR GLAND tumors are treated by total removal of the gland.
 Minor salivary glands are treated by surgical excision
 Radical neck dissection is indicated in high grade tumors where metastasis is clinically
evident.
 Post operative radiation therapy is used for high grade tumors
 Good prognosis for low grade tumors whiles a fair prognosis for high grade tumors.

DENTIGEROUS CYST:

 An odontogenic cyst that surrounds the crown of an impacted tooth, caused by fluid
accumulation between reduced enamel epithelium and enamel surface, resulting in a cyst in
which the crown is located within the lumen and root/roots outside.
 It is a common developmental odontogenic cyst involving always a permanent tooth.

CLINICAL FEATURES:

 It is always associated with impacted, embedded or unerupted tooth and it is usually

solitary.
 The most common sites of occurrence are mandibular and maxillary third molar area and
maxillary cuspid area.
 It usually occurs in 2nd to 3rd decades of life with male predilection.
 It usually remains asymptomatic but produce swelling or pain if it is large or inflamed.
 It has potential to become into a aggressive lesion which shows:
 Bone expansion with subsequent facial asymmetry
 Displacement of teeth to extremities like mandibular third molar is displaced to inferior
border of mandible. When a maxillary cuspid is involved, it resembles acute sinusitis or
cellulitis.
 Severe root resorption of adjacent teeth.
 Pain

RADIOGRAPHIC FEATURES:

 Dentigerous cysts are commonly diagnosed by radiographic appearances

 Radiograph reveals a radiolucent area associated in some fashion with an unerupted tooth
crown.
 Three patterns are usually observed. They are :
 CENTRAL VARIETY:-
 The crown is enveloped symmetrically and hence when the pressure applied to the crown,
pushes it away from the direction of eruption.
 In mandibular third molar, it may be pushed into lower border of mandible or into
ascending ramus of the mandible.
 In maxillary cuspid, it may be forced into maxillary sinus till the floor of the orbit.
 LATERAL VARIETY:-
 It results when the dilatation of follicle is on one aspect of the crown.
 It is usually seen in impacted mandibular third molar which is partially erupted.
 CIRCUMFERENTIAL VARIETY:-
 It is resulted when the follicle expands to envelop entire tooth into the cyst.
 A thin sclerotic area surrounds the radiolucent area indicative of its slow and uniform
growth.

HISTOPATHOLOGICAL FEATURES:

 The cyst usually composed of thin connective tissue wall with a thin layer (2-10 cells) of
stratified squamous epithelium lining the lumen.
 The connective tissue wall is composed of loose fibrous connective tissue, inflammatory cell
infiltration and island of odontogenic epithelium.
 Epithelium shows Rushton bodies in case of inflammation.
 The cystic lumen contains thin, watery yellowish fluid occasionally blood tinged.

TREATMENT AND PROGNOSIS:

 Surgical enucleation.
 Mandibular 3rd molars are extracted at the time of cyst removal.
 Maxillary cuspids are treated orthodontically after the excision or marsupialization of cyst.
 Recurrence is uncommon.

POTENTIAL COMPLICATIONS:

 Ameloblastoma
 Mucoepidermoid carcinoma
 Squamous cell carcinoma.

ODONTOGENIC KERATOCYST
 A cyst derived from remnants of the dental lamina, with a biologic behavior similar to a
benign neoplasm, with a distinctive lining of six to ten cells in thickness, and that exhibits a
basal cell layer of palisaded cells and a surface of corrugated parakeratin.
 It is unique odontogenic lesion that have the potential to behave aggressively, that can
recur and can be associated with nevoid basal cell carcinoma syndrome.

CLINICAL FEATURES:

 It occurs over wide range of age i.e. 1st to 8th decades with peak incidence in 2nd and 3rd
decades.
 A slight male predilection is seen
 The common sites of occurrence are mandibular posterior body and ramus area, posterior
segment or in the cuspid – lateral incisor area in maxilla.
 It usually present as a single lesion, occasionally as multiple lesions as a component of
Nevoid Basal Cell Carcinoma Syndrome
 The other clinical manifestations are pain, soft tissue swelling and bone expansion,
paraesthesia of lip or teeth.
 Usually OKC’s are intra osseous in origin, but rarely it occurs entirely within the gingiva and
they have been termed as Peripheral OKC.

RADIOGRAPHIC FEATURES:

 It appears as well defined, solitary lesion with smooth or scalloped margin or as multilocular
polycystic radiolucency exhibiting a thin corticated margin.
 Multilocular radiolucencies represent a central cavity having satellite cysts within it.
 Multilocular OKC in mandibular 3rd molar is confused with Ameloblastoma.
 Root resorption and displacement of adjacent teeth is more common.

HISTOPATHOLOGICAL FEATURES:

 Microscopic findings of OKC are characteristic and distinctive.

 6 to 10 cells thick parakeratinized squamous epithelial lining
 A palisaded layer of columnar or cuboidal basal cell layer described as having “picket fence
or tombstone appearance”.
 Corrugated /rippled/ wrinkled layer of parakeratin on luminal surface.
 Lack of rete pegs.
 Focal separation of the epithelial lining from adjacent connective tissue.
 Lumen containing variable amounts of desquamated parakeratin, thin straw colored fluid,
thicker creamy material.
 Dental lamina rests, micro cysts, satellite cysts, epithelial budding from the basal layer are
occasionally present in the cyst wall.
 Generally it lack inflammation in capsule wall, but if present, epithelium looses it keratinized
surface and may thicken & develop rete pegs or may ulcerate.
 OKC lined by orthokeratinized squamous epithelium is rarely seen (orthokeratinized
odontogenic keratocyst).

TREATMENT AND PROGNOSIS

 Surgical excision.
 It has high recurrence rate of 13% to 60%
 RADICULAR CYST

 SYNONYMS: Apical periodontal cyst, periapical cyst, root end cyst.

 An odontogenic cyst derived from rests of malassez that proliferates in response to
inflammation.
 It is the most common odontogenic cyst of oral cavity.
ETIOLOGY:
 Infected carious teeth release toxins into the periapical area which cause inflammation.
 Other causes like events of pulp necrosis like tooth fracture, improper dental restorations.
PATHOGENESIS:

PULP NECROSIS

PERIAPICAL GRANULOMA

RESTS OF MALASSEZ IN PERIAPICAL GRANULOMA

PROLIFERATE INTO A LARGE MASS OF CELLS

DURING THE GROWTH OF EPITHELIAL MASS, THE INNER

CORE CELLS ARE DEPRIVED OF NOURISHMENT AND
UNDERGO ISHCEMIC LIQUEFACTION NECROSIS

FORMATION OF CAVITY IN THE GRANULOMA

RADICULAR CYST

BAY CYST:

 Islands of odontogenic squamous epithelium are present in the periapical granuloma

without cystic transformation. Such granulomas are called Bay cyst.

CLINICAL FEATURES:

 It can occur in the periapical area of any teeth at any age of permanent dentition. Rarely
seen in primary dentition.
 Usually asymptomatic.
 Rarely painful and sensitive to percussion.
 The size is variable and is measured less than one cm in size.
 It is a chronic inflammatory lesion and develops over a prolonged period of time.
 Acute exacerbation of this lesion causes periapical abscess that may proceed into cellulitis
or to form a draining fistula.
 RADIOGRAPHIC FEATURES:

 Radiograph reveals a peri or para apical round or oval radiolucency of variable size which is
generally well demarcated with a radiopaque rim.
 It is to be greater than 2 cm in size to establish the diagnosis for periapical radiolucency to a
periapical cyst or granuloma.
 Adjacent root resorption is rare.

HISTOPATHOLOGICAL FEATURES:

 The cystic wall is composed of mature collagenous stroma with abundant fibroblasts,
lymphocytic inflammatory infiltration, areas of hemorrhage, multinucleated giant cells, and
cholesterol crystals.
 The cystic lining is by stratified squamous epithelium and with respiratory lining epithelium
as the cyst is in close vicinity to the maxillary sinus. It is missing or discontinuous at many
times in the area of intense inflammation.
 Rushton bodies are seen intraepithelially which are linear/arc shaped eosinophilic bodies of
unknown nature, origin and significance.
 The lumen of cyst is filled with proteinaceous fluid and necrotic cellular debris.

TREATMENT:

 Extraction of involved tooth and careful curettage of periapical tissue.

 In some conditions, root canal therapy along with apicoectomy of cystic lesion.
 Do not recur if properly excised.
 A residual cyst may develop if the epithelial remnants left or if periapical granuloma is
incompletely removed.

LATERAL PERIODONTAL CYST

 A slow growing, non expansile developmental odontogenic cyst derived from one or more
rests of dental lamina exhibiting a lining of one or three cuboidal cells and distinctive focal
thickenings (plaques)
 As the name implies, it occurs on lateral periodontal location and is of developmental in
origin arising from proliferation and cystic transformation of rests of dental lamina.

CLINICAL FEATURES:

 It is uncommon.
 It shares morphological and histological similarities with gingival cyst of adult which led to
conclude that LPC is intraosseous manifestation of extraosseous gingival cyst.
 It is usually solitary.
 No signs and symptoms. It is discovered during radiographic routing examination.
 It occurs in aged people of 50 years old with slight male predilection.
 Common sites are mandibular premolar and maxillary cuspid region.
 RADIOGRAPHIC FEATURES:

 Radiograph reveals a radiolucent area present laterally to the root surface.

 Lesion is small, rarely over one cm in diameter, well defined, unilocular.
 Polycystic variety (Botryoid) is seen as multilocular radiolucency.

HISTOPATHOLOGICAL FEATURES:

 Cystic lining is composed of thin one to five cell layer thicknesses; non- keratinized with
multiple clear, vacuolated, glycogen rich cells.
 Focal thickening of lining cells (plaques) is seen.
 Connective tissue wall is fibrous and non-inflamed.

TREATMENT:

 Surgical enucleation.
 Recurrence is uncommon.

AMELOBLASTOMA
SYNONYMS: Adamantinoma, Adamantoblastoma.
 A locally aggressive neoplasm of odontogenic epithelium that has a wide spectrum of
histological patterns resembling early odontogenesis.

ETIOPATHOGENESIS:

 An Ameloblastoma can arise from various sources of odontogenic epithelium remnants like
 Rests of serre, rests of malassez, reduced enamel epithelium, basal cell layer of overlying
surface epithelium.
 Odontogenic cysts like dentigerous cysts.
 The stimulation for these epithelial cells is unknown.

CLINICAL FEATURES:

 It is a slow growing, locally aggressive, capable of large facial deformities.

 Three clinical subtypes are categorized for treatment purposes:
 Common/simple Ameloblastoma
 Unicystic Ameloblastoma
 Peripheral/extraosseous Ameloblastoma

COMMON AMELOBLASTOMA:

 It is also called simple or follicular Ameloblastoma.

 It usually occurs over 25 years of age with majority of cases between 20 to 40 years of age.
 No sex predilection is seen.
 It most commonly occurs in mandible with third molar and ascending ramus areas more
common. In maxilla, it occurs in molar area where it extends till maxillary sinus and floor of
the nose.
 DIAGNOSITC SIGN:
 This form of the lesion has a tendency to expand bony cortices as it grows slowly and allows
time for periosteum to produce a thin shell of bone ahead of the expanding lesion.
 This thinned outer shell of bone cracks easily when palpated – sign referred to as “Egg shell
cracking”.

UNICYSTIC AMELOBLASTOMA:

 It occurs in patients who are 16 to 20 years of age.

 This form is in close relationship with dentigerous cyst and is usually associated with
severely displaced third molar.
 Whether the lesion is derived from normal cystic lining of a dentigerous cyst or it arises de
novo form preexisting odontogenic epithelial remnants is not determined.
 They are more common in mandible than in maxilla.

PERIPHERAL AMELOBLASTOMA:

 This form is limited to the soft tissues of gingiva which histologically resemble common
Ameloblastoma.
 It usually appear as firm sessile nodules of gingiva with a range of size from 0.5 to 2 cm.
 It occurs in patients of 20 to 80 years of age with mandibular propensity.
 The surface is smooth and normal colored. It may be erythamatous and ulcerated if it is
developed from surface epithelium.

RADIOGRAPHIC FEATURES:
COMMON AMELOBLASTOMA:
 Multilocular cyst like radiolucent mass.
 Actual size is usually difficult to determine as they do not exhibit a distinct line of
demarcation with normal bone.
 Adjacent teeth root resorption is seen in rapidly growing lesions.
UNICYSTIC AMELOBLASTOMA:
 Unilocular radiolucency with well demarcated border.
 A tooth is often present in radiolucency
PERIPHERAL AMELOBLASTOMA:
 Bone changes are rare as it is extraosseous.
 Superficial saucerization of cortical plate is seen occasionally which appears as cup shaped
radiolucency beneath the nodule.
 Tooth separation may occur if it is located interdentally.

HISTOPATHOLOGY:
 The classic microscopic appearance of an ameloblastoma consists of an epithelium in which
the basal cell layer consists of columnar palisaded cells i.e.., the nucleus of the cell is placed
away from basement membrane and a clear cytoplasm seen adjacent to it.
 This change is reminiscent to the change that occurs in cells of inner enamel epithelium
before they undergo transition to presecretory ameloblasts.
 6 histological subtypes of ameloblastoma are recognized.
 FOLLICULAR
 ACANTHOMATOUS
 GRANULAR
 BASAL CELL
 DESMOPLASTIC
 PLEXIFORM
 SHORT ANSWER QUESTIONS
1. SCARLET FEVER OR SCARLATINA:
It is caused by the organism beta- hemolytic streptococci, streptococcus pyogenes. It produces
a pyrogenic exotoxin which is described as erythrogenic or scarlet fever toxin.
CLINICAL FEATURES: It is common in children.
After an incubating period of 3 to 5 days, it manifests severe pharyngitis, tonsillitis, headache,
fever, chills, abdominal pain and vomiting.
It is characterized by occurrence of diffuse bright scarlet skin rashes in areas of skin folds by the
second or third day of illness. Small papules of normal color erupt through these rashes and
give characteristic “sandpaper” feel to the skin.
ORAL MANIFESTATIONS: Red macules appear over hard palate, soft palate and uvula which are
called as Forchheimer spots. Tongue exhibits a white coating and the fungiform papillae appear
edematous and hyperemic projecting above from the surface. This is clinically referred to as
“strawberry tongue”. The white coating is soon lost and the tongue become deep red,
glistening and smooth except for the swollen hyperemic fungiform papillae. This is referred as
“raspberry tongue”.
TREATMENT: Administration of antibiotics like penicillin, dicloxacillin, cephalexin.
2. NOMA or CANCRUM ORIS or NECROTIZING/GANGRENOUS STOMATITIS or OROFACIAL
GANGRENE:
It is a rapid spreading gangrenous stomatitis that occurs usually in weakened or nutritionally
deficient persons associated with high morbidity and mortality. It is a secondary opportunistic
complication of systemic diseases like syphilis, TB, AIDS rather than as a primary disease.
The predisposing factors of this disease includes:
Poverty, Malnutrition, Poor oral hygiene, recent illness, Malignancy, AIDS
CLINICAL FEATURES: Infection begins as necrotizing ulcerative gingivitis (NUG) and extends
facially or lingually to involve adjacent soft tissue and form necrotizing ulcerative mucositis.
Odor arising from gangrenous tissues is extremely foul.
TREATMENT: Administration of antibiotics like penicillin and metronidazole. Treatment of any
existing malnutrition.
3. MARFAN SYNDROME
SYNONYMS: Marfan Acharad syndrome, arachnodactyly
It is a spectrum of disorders inherited by an autosomal dominant trait. The defective gene
FBN1 on chromosome 15 undergoes point mutations and cause defective formation of
connective tissue protein, fibrilin.
CLINICAL FEATURES:
Manifestations include:
Arachnodactyly- hands, fingers, feet and toes are long and slender like spider fingers.
Dolichostenomelia- long limbs relative to trunk length. Thoracolumbar scoliosis. Skull and face
are long and narrower. Kyphosis, flat feet. Hyperextensibility of joints. Cardiovascular
manifestations like aortic dilation, aortic regurgitation, and mitral valve prolapse, aneursyms.
Ocular manifestations like myopia, cataracts, retinal detachment and superior
Dislocation of lens.
ORAL MANIFESTATIONS:
High arched palatal vault. Bifid uvula. Malocclusion. Multiple Odontogenic cysts of maxilla.
Temporomandibular dysarthrosis.
RADIOGRAPHIC FEATURES:
High arched palate, increased skull height, enlarged frontal sinus.
TREATMENT AND PROGNOSIS:
No specific treatment. Management of cardiovascular manifestations led to decrease in
morbidity and mortality.
4. SYPHILIS or LUES:
It is a venereal disease caused by the bacterium treponema pallidum.It is characterized by
episodes of active disease interrupted by periods of latency. Besides sexual transmission that
causes acquired syphilis, transmission from infected mother to child also occurs which is called
as congenital syphilis.
ACQUIRED SYPHILIS: Acquired syphilis is manifested in three stages; primary, secondary and
tertiary stages.
PRIMARY STAGE: This stage is presented with the lesion CHANCRE. After the 3 to 90 days of
infection, this lesion occurs at the site of inoculation. The usual sites are penis in male, vulva or
cervix in females as the genitalia. This chancre is presented as solitary elevated ulcerated
nodule with local induration. Intra oral chancre is an ulcerated lesion covered by grayish- white
membrane and is painful. This lesion is highly infectious as it contains the bacterium. This
lesion heals spontaneously within 3 weeks to two months.
SECONDARY STAGE OR METASTATIC STAGE: It commences 6 months after the primary stage
as the infection disseminate. It is characterized by occurrence of small maculopapular
eruptions on the skin and mucous membranes. These are multiple, diffuse and painless and are
presented as grayish white plaques which are highly infectious. They occur on tongue, buccal
mucosa and gingiva. The lesions remit spontaneously
Between secondary and tertiary stage, there is a latent period of 1 to 30 years where there are
no lesions and symptoms.
TERTIARY STAGE: It is not infectious. It involves CVS, CNS, and other tissues. The characteristic
lesion is atrophic or interstitial glossitis. Another classic lesion is Gumma which consists of focal
granulomatous inflammatory process with central necrosis. Intra oral gumma occurs over
tongue and palate. Tongue shows deep painless ulcer. Palate shows necrosis which gets
sloughed and results in perforation.
CONGENITAL SYPHILIS: It is transmitted from infected mother to the child. It is manifested with
variety of lesions like Frontal bossae, Saddle nose, Mandibular prognathism, High arched
palate, Short maxilla,Mulberry molars. Hutchinson’s triad which has the components of A.
Hypoplasia of incisors and molar teeth B. Eighth cranial nerve deafness C. Interstitial keratitis.
TREATMENT: Antibiotic therapy with penicillin. Erythromycin and tetracycline for penicillin
allergic patients.

5. CHERUBISM
SYNONYMS: Familial fibrous dysplasia of jaws, disseminated juvenile fibrous dysplasia.
It is a non-neoplastic hereditary bone lesion that affects jaws of children bilaterally usually
Producing a cherubic look. It is a rare benign condition with autosomal dominant inheritance.
The jaw lesions of cherubism remit spontaneously when affected children reach puberty.
CLINICAL FEATURES: Clinically not evident until 14 months to 3 years of age. After puberty
lesion begin to regress and jaw remodeling continues. Jaw lesions are usually painless,
symmetric, and firm to palpation, non-tender and most commonly involve the molar to
coronoid regions, the condyles being spared associated with lympadenopathy. A rim of sclera
may be visible beneath the iris, giving the classic “eye to heaven” appearance.
ORAL MANIFESTATIONS: Agenesis of second and third mandibular molars. Displacement,
transpositions and rotation of teeth. Premature exfoliation of primary teeth and delayed
eruption of permanent teeth. In severe cases, tooth resorption occurs.
RADIOGRAPHIC FEATURES: Bilateral multilocular radiolucent cystic expansion of jaws.
Presence of numerous unerupted teeth and the destruction of the alveolar bone may displace
the teeth producing a radiographic appearance called FLOATING TOOTH SYNDROME.
6. CLEIDOCRANIAL DYSPLASIA:
It is a congenital disorder of the bone formation manifested with agenesis or hypoplasia of
clavicle and delayed ossification of skull bones and closing of sutures.
CLINICAL FEATURES:
Unilateral or bilateral absence of clavicle, abnormal development of clavicle is seen.
Frontal, parietal and occipital bossing gives the skull a large globular shape and small face. This
is referred as ARNOLD HEAD. Ocular hypertelorism, broad base of the nose and depressed
nasal bridge. Short lower facial height, acute gonial angle and mandibular prognathism.
ORAL MANIFESTATIONS:
High arched, narrow and cleft palate. Retained primary dentition with delayed eruption of
permanent teeth. Spacing in between mandibular incisors.
RADIOGRAPHICAL FINDINGS:
Anterior fontanale show delayed closure or remain open throughout the life. Sutures show
delayed closure or with wormian bones between them. Multiple unerupted permanent and
supernumerary teeth.
HISTOLOGIC FINDINGS:
Unerupted permanent teeth shows absence of secondary cementum which is related to the
failure of their eruption. The primary teeth also don’t show the secondary cementum.

7 .OSTEOPETROSIS:
SYNONYMS: Marble bone disease, Albers Schonberg disease.It is rare congenital bone
disorder characterized by increased bone mass due to failure in the osteoclast activity of bone
resorption. The bones thus formed are poor in mechanical properties and fragile.
ETIOLOGY:
Failure of osteoclast activity of bone resorption causing the sclerotic thickening of bone. The
poor mechanical properties and fragility is due to lack of collagen fibril augmentation in the
bone matrix and failure of transmission of woven bone into compact bone.
CLINICAL FEATURES:
Based on age and severity, it is divided into three different categories namely a) Infantile b)
Adult c) Intermediate
A. INFANTILE OSTEOPETROSIS:
It is also called as malignant osteopetrosis. It is usually diagnosed earlier in life and is
characterized by bone marrow failure, frequent fractures, and neural tissue compressions.
Bone marrow failure results in severe anemia due to pancytopenia, frequent infections due to
granulocytopenia, osteomyelitis. Hepatospleenomegaly due to extramedullary hematopoeisis.
Neural tissue compressions result in facial palsy, proptosis, and deafness. Broad face, snub
nose and frontal bossing is seen.
ADULT OSTEOPETROSIS:
It is also called as benign osteopetrosis. It is usually assympotmatic but may show various
symptoms that include: Bone fractures, neural tissue compressions, Osteomyelitis, Bone pain
and osteoarthritis.
ORAL MANIFESTATIONS:
Delayed dentition. Osteomyelitis as complication after tooth extraction. Fracture of jaw during
tooth extraction.
HISTOPATHOLOGIC FEATURES:
Abnormal endosteal bone production with lack of
physiologic bone resorption. Osteoblasts are prominent and osteoclasts are rare in number.
The marrow tissue is usually fibrous.
8. ATTRITION:
It is the physiologic wearing of tooth resulted as tooth to tooth contact during mastication. This
is a physiological phenomenon rather pathologic.
CLINICAL FEATURES:
This occurs only on occlusal, incisal, and proximal surfaces of a tooth. Appear as a small
polished facet on a cusp tip or ridge or a slight flattening of an incisal edge. It is associated with
aging process.
Men exhibit severe form rather woman as men have greater masticatory forces. As the
attrition continues, there is gradual reduction of cusp height and consequent flattening of
occlusal inclined planes. In advanced attrition, enamel has completely lost and a yellowish to
brown staining of the exposed dentin is seen. The exposed dentinal tubules are irritated and
results in the formation of secondary dentin pulpally to the primary dentin.
9. ODONTOGENIC KERATOCYST
A cyst derived from remnants of the dental lamina, with a biologic behavior similar to a benign
neoplasm, with a distinctive lining of six to ten cells in thickness, and that exhibits a basal cell
layer of palisaded cells and a surface of corrugated parakeratin. It is unique odontogenic lesion
that have the potential to behave aggressively, that can recur and can be associated with
nevoid basal cell carcinoma syndrome.
CLINICAL FEATURES:
The common sites of occurrence are mandibular posterior body and ramus area, posterior
segment or in the cuspid – lateral incisor area in maxilla.It usually present as a single lesion,
occasionally as multiple lesions as a component of Nevoid Basal Cell Carcinoma Syndrome. The
other clinical manifestations are pain, soft tissue swelling and bone expansion, paraesthesia of
lip or teeth.
Usually OKC’s are intra osseous in origin, but rarely it occurs entirely within the gingiva and
they have been termed as Peripheral OKC.
RADIOGRAPHIC FEATURES:
It appears as well defined, solitary lesion with smooth or scalloped margin or as multilocular
polycystic radiolucency exhibiting a thin corticated margin. Multilocular radiolucencies
represent a central cavity having satellite cysts within it.
Root resorption and displacement of adjacent teeth is more common.
HISTOPATHOLOGICAL FEATURES: DIAGRAM
Microscopic findings of OKC are characteristic: 6 to 10 cells thick parakeratinized squamous
epithelial lining. A palisaded layer of columnar or cuboidal basal cell layer described as having
“picket fence or tombstone appearance”. Corrugated /rippled/ wrinkled layer of parakeratin on
luminal surface. Lack of rete pegs. Focal separation of the epithelial lining from adjacent
connective tissue. Lumen containing variable amounts of desquamated parakeratin, thin straw
colored fluid, thicker creamy material. Dental lamina rests, micro cysts, satellite cysts, epithelial
budding from the basal layer are occasionally present in the cyst wall.
TREATMENT: Surgical excision.
10. MUCOCELE:
It is a lesion involving salivary glands & salivary ducts. ETIOLOGY: It is resulted from obstruction
of the duct of minor and accessory salivary glands which is caused most commonly during
biting of lips or cheek, pinching of lips. It is also resulted from a chronic obstruction of salivary
duct such as in the cases like sialolithiasis, intraductal calculus, and contraction of developing
scar connective tissue around a duct after a traumatic injury.
CLINICAL FEATURES: Occurs at any age group without gender predilection. Mostly occur on
lower lip, buccal mucosa and rarely on palate too. It is either a superficial lesion or deep lesion.
Superficial lesion is presented as raised circumscribed vesicle of few millimeters to centimeter
in diameter with bluish translucent appearance. Deep lesion is manifested as a swelling but
due to its deep placement in the connective tissue, it is of normal color and surface like oral
mucosa.
HISTOPATHOLOGY: DIAGRAM
A circumscribed cavity in the connective tissue without any epithelial lining but it is lined by
fibrous tissue and fibroblasts (granulation tissue)
The lumen of the cavity is filled with Eosinophillic coagulum along with numerous white blood
cells and phagocytes. Thinning of epithelium as it were stretched.
TREATMENT: Surgical excision. It is rapidly filled again if it simply incised.

11. RANULA:
ETIOLOGY:
It is resulted from obstruction of the duct of minor and accessory salivary glands which is
caused most commonly during biting of lips or cheek, pinching of lips. It is also resulted from a
chronic obstruction of salivary duct such as in the cases like sialolithiasis, intraductal calculus,
and contraction of developing scar connective tissue around a duct after a traumatic injury.
CLINICAL FEATURES:
It is a type of mucous retention phenomenon larger in size and mostly occurs in the one side of
the floor of the mouth. The tongue is usually elevated. It is of superficial or deep type.
Superficial lesion show bluish translucency, deep lesions appear alike to normal mucosa.
HISTOLOGICAL FEATURES:
A circumscribed cavity in the connective tissue a definite epithelium is sometimes seen lining
the cavity & sometimes lined by fibrous tissue and fibroblasts (granulation tissue). The lumen
of the cavity is filled with Eosinophillic coagulum along with numerous white blood cells and
phagocytes. Thinning of epithelium as it were stretched.
a definite epithelium is sometimes seen lining the cavity. TREATMENT: Marsupialization or
excision of the entire sublingual gland.
12. ACRODYNIA: (PINK DISEASE/ SWIFT DISEASE):
ETIOLOGY:
Mercury toxicity which is resulted from teething powder, ammoniated mercury ointment and
calomel lotions.
CLINICAL FEATURES:
Usually children of 2 years are affected.
Hands, feet, ear, nose and cheek become red and pink and have cool and clammy feeling &
resemble raw beef.
Profuse sweating, lacrimation, photophobia and maculopapular rashes often associated with
prupritis.
ORAL MANIFESTATIONS:
Profuse salivation with dribbling.
Ginigiva is sensitive and painful often shows ulceration.
Bruxism and loosening and premature exfoliation of teeth.
Children will extract loosened teeth with their fingers.
TREATMENT:
Immediate chelation therapy with dimercaprol, D- pencillamine or DSMA.

13.BRUXISM:
SYNONYMS: Night grinding, bruxomania.
Bruxism is a habitual grinding or clenching of the teeth during sleep or during a subconscious
state.
ETIOLOGY:This habit has various etiological factors likeLocal factors- mild occlusal disturbances
which cause a firm habit of patient to establish a greater number of teeth in contact. In
children it is a result of transition from primary dentition to secondary dentition. Systemic
factors- gastrointestinal disturbances, endocrine factors, allergy, and subclinical nutritional
deficiencies.
Psychological factors- high levels of anxiety, stress, emotions, and tensions will result a habitual
grinding of teeth. Occupational factors- persons like athletes engage in physical activities can
develop this habit. Voluntarily acquiring by chewing habits of chew gum, tobacco, pencils etc.
CLINCIAL FEATURES:
Grinding or clenching motions of teeth during sleep or subconscious state with a presentation
of grinding or grating sounds. occlusal and proximal wear of teeth with actual facets. Damage
to peridontium which further loosens and drift the tooth, gingival recession, destruction of the
alveolar bone.hypertrophy of masseter muscle which cause trismus. Effect on TMJ. Head and
facial pain
TREATMENT AND PROGNOSIS:
Correcting the nervous factor. Construction of removable splints worn during night to
immobilize the jaws. Butox injection to masseter muscle which cause reduced grinding and
clenching motions of teeth but don’t alter the facial and masticatory expressions.
14.ABRASION:
It is the pathologic wearing of tooth through some abnormal mechanical processes. It usually
occurs on the exposed root surfaces.
ETIOLOGY: The most common cause is the use of an abrasive dentifrice. Usage of dentifrice in
horizontal direction rather vertical direction.
Other common factors are habits and occupation related.
CLINICAL FEATURES: V-shaped or wedge shaped notch is created over the CEJ and extends
towards the root surface. The dentin appears to be highly polished. Abrasion is more on right
side in left handers and left side in right handers. Habitual opening of bobby pins creates a
notch in the maxillary incisal edges. Similar notches are seen in carpenters, tailors, shoemakers.
Pipe smokers may develop notch of a shape related to pipe stem. The exposure of dentinal
tubules produces secondary dentin in the pulpal surface of primary dentin.
15.CHRONIC FOCAL SCLEROSING OSTEOMYELITIS (Condensing osteitis )
The bone reacts to the carious lesion by focal proliferation rather than destruction as the
infection acts as stimulus rather than as an irritant. CLINICAL FEATURES: Commonly occur in
children and young adults. Mostly in mandibular first molar region. No signs and symptoms
other than mild pain associated with infected pulp.
RADIOGRAPHIC FEATURES: PATHOGNOMONIC: well circumscribed, radiopaue mass of sclerotic
bone surrounding and extending below the root apex. Root outline is clearly visible with intact
lamina dura & widened periodontal ligament space. The border is smooth and distinct and
appears to blend into the surrounding bone. HISTOLOGIC FEATURES: Dense mass of bony
trabaculae with little marrow in between. If present, the soft tissue is fibrotic and presented
with inflammatory cells. Osteoblastic activity is subsided. TREATMENT: Treated endodontically
or extraction is adviced. The sclerotic bone is not associated with the tooth and hence it is not
removed during extraction. Surgical removal is not indicated unless it is symptomatic.
16. GARRE’S OSTEOMYELITIS:
It is the periosteal osteosclerosis resulting from mild irritant or infection.
CLINICAL FEATURES: Usually in young adults < 25 years & frequently in anterior surface of tibia.
In oral cavity it occurs in mandiblular bicuspid and molar region. Patient complains of tooth
ache, pain in jaw and bony outgrowth in the jaw. It usually develops as a result of dental
infection of jaw that perforates outward and also as a result of overlying soft tissue infection.
RADIOGRAPHIC FEATURES: Often shows carious tooth opposite to the bony mass. Occlusal
radiograph shows focal overgrowth of bone on the outer surface of the cortex which is
described as duplication of the cortical layer. It is smooth and well calcified.
HISTOLOGICAL FEATURES: Shows new reactive bone and osteoid with osteoblasitc bordering
the trabaculae. The trabaculae are arranged perpendicular to the cortical layer and paralled to
each other or in a retiform pattern. The connective tissue is fibrous and shows lymphocytes
and plasma cells. TREATMENT: Endodontically treated or extracted. This usually resolves the
bony mass with gradual remodeling.
DIFFERENTIAL DIAGNOSIS: Caffey’s disease, Hypervitaminosis A, Syphilis, Leukemia, Ewing’s
sarcoma, Metastatic neuroblastoma.
17.PULP POLYP (CHRONIC HYPERPLASTIC PULPITIS):
The inflamed pulp reacts by excessive and exuberant proliferation. It occurs as a chronic lesion
or as a chronic stage of an acute pulpitis.
CLINICAL FEATURES: Usually occurs in children (they have high tissue resistance and reactivity),
deciduous molars and permanent first molar. It appears as pinkish red globule of tissue
protruding from the pulp chamber. It usually occurs in large, open carious lesions. HISTOLOGIC
FEATURES: It is basically a granulation tissue with numerous delicate connective tissue fibers
with chronic inflammatory cells like macrophages and plasma cells. The granulation tissue
commonly becomes epithelialized. TREATMENT: Condition is not reversible. Treated by
extraction or pulp extirpation.
18. ACUTE NECROTIZING ULCERATIVE GINGIVITIS:
It is type of gingivitis characterized by destructive inflammation. ETIOLOGY: Fusiform bacillus
and borrelia vincenti, the spirochetes are the causative organisms. Various predisposing factors
play an important role in the development. They are: Smoking, immunosupression, nutritional
deficiencies, poor oral hygiene, upper respiratory tract infections, local trauma, psychological
stress. CLINICAL FEATURES: It mainly involves free gingival margin, crest of the gingiva and the
interdental papillae. If it involves soft palate and tonsillar areas it is termed as Vincent’s angina.
It is characterized by painful, hyperemic gingiva & sharply punched out crater like erosion of
interdental papillae. Pain, interdental ulceration and gingival bleeding are the diagnostic triad.
The ulcerated area is covered by grayish green necrotic pseudo membrane. A fetid odor that is
extremely unpleasant is developed. Excessive salivation, regional lymphadenopathy and other
systemic manifestations like GIT disturbances, tachycardia is observed. HISTOLOGIC FEATURES:
Reveals an acute gingivitis with extensive necrosis. The surface epithelium of the gingiva is
ulcerated and replaced by a thick fibrinous exudate, or pseudo membrane containing
neutrophils & microorganisms. The connective tissue is infiltrated by dense neutrophils and
show intense hyperemia.
TREATMENT: Superficial cleansing of oral cavity with chlorhexidine, diluted hydrogen peroxide
and warm salt water, followed by scaling and polishing regress the disease without medication
in early acute stages. Antibiotics are also coupled with this local treatment.

19. PERIAPICAL GRANULOMA (CHRONIC APICAL PERIODONTITIS): It is a sequelae of pulpitis or

acute apical periodontitis. It is a localized mass of chronic granulation tissue formed in
response to the infection. CLINICAL FEATURES: The involved tooth is non vital and slightly
tender to percussion. The percussion may produce a dull sound because of the presence of the
granulation tissue around the tooth apex. It is usually asymptomatic unless an acute phase
undergoes. RADIOGRAPHIC FEATURES: A well circumscribed, radiolucent area of variable size
attached to the root apex & is well demarcated from the surrounding bone. Thickening of the
PDL at the root apex. In chronic lesions, a thin radiopaque line is seen outlining the lesion. In
acute phases a diffuse radiolucency is seen. HISTOLOGICAL FEATURES: Hyperemia and edema of
the PDL with chronic inflammatory cell infiltration. Resorption of the adjacent supporting bone.
It is a homogenous lesion composed of macrophages, lymphocytes and plasma cells.
Epithelium is present which may be originated from maxillary sinus or oral epithelium.Presence
of ring like structures called Rushton Bodies which are composed of eosionphilic material
resembling hyalinized collagen. TREATMENT: Extraction of involved teeth. Root canal therapy
with or without apicoectomy. If left untreated, it transforms into apical periodontal cyst.
20. SJOGREN’S SYNDROME:
A group of autoimmune conditions that has an intense T lymphocyte-mediated autoimmune
process in the salivary and lacrimal glands. ETIOLOGY: Auto immune process which results in
immunologic reaction that occurs in the parenchymal tissue of salivary and lacrimal glands with
consequential acinar loss and lymphocytic infiltration. Viral agents like cytomegalo virus,
paramyxo virus, and EBV also been implicated in the pathogenesis. CLINICAL FEATURES: AGE &
SEX: women are most affected with a female to male ratio of 10:1. It usually occurs over 40
years of age. Two forms of the disease are recognized. They are: Primary SS (sicca complex):
affects only salivary and lacrimal glands without other coexisting systemic autoimmune
diseases
The significant manifestations are xeropthalmia and xerostomia results in painful and burning
sensations of mucosa. The dry oral mucosa is very susceptible to secondary candidiasis and
root surface caries.Secondary SS: other signs or symptoms of autoimmune disease are present,
the most common being rheumatoid arthritis. Other diseases may occur including lupus
erythematosus, systemic sclerosis, dermatomyositis. Other extra salivary and lacrimal diseases
that have been identified in both primary and secondary forms of SS include Raynaud disease,
interstitial nephritis, interstitial pneumonitis, purpura, and polymyopathy.
Parotid enlargement is presented with discomfort.
HISTOLOGICAL FEATURES: Intense lymphocytic infiltration (mainly of T cells) of the gland
replacing all acinar structures although the lobular architecture is preserved. Proliferation of
ductal epithelium and myoepithelium to form epimyoepithelial islands in stroma.
LABORATORY FINDINGS: Raised ESR. Hyperglobulinemia, positive serological tests for
rheumatoid factors, anti nuclear antibodies, anti – SS- A and anti -SS- B. Biopsy of minor
accessory salivary glands in lip mucosa for histopathological studies aid in establishing the
diagnosis of the disease as these glands exhibits alterations characteristically similar to those in
major salivary glands.
RADIOGRAPHICAL FINDINGS:
Sialographs demonstrate the formation of punctate and cavitary defects which are filled with
radiopaque contrast media. These fillings have been said to produce a cherry blossom or
branchless fruit- laden tree effect radiographically. TREATMENT: Patient is treated
symptomatically. Xerostomia is treated with salivary substitutes. Xeropthalmia is treated with
ocular lubricant instillations like artificial tears containing methylcellulose. Parotid gland
surgical removal if it is causing discomfort. Fluoride application is indicated to reduce the
incidence of the root surface caries.
21. DRY SOCKET
DRY SOCKET OR ALVEOLAR OSTEITIS is inflammation of the alveolar bone. It occurs as a
postoperative complication of tooth extraction where the blood clot fails to form or is lost from
the socket. This leaves an empty socket where bone is exposed to the oral cavity, causing a
localized alveolar osteitis limited to the lamina dura.. The name dry socket is used because the
socket has a dry appearance once the blood clot is lost and debris is washed away. Causes: The
clot may fail to form because of poor blood supply (e.g., secondary to local factors such as
smoking, anatomical site, bone density and conditions which cause sclerotic bone to form). The
clot may be lost because of excessive mouth rinsing, or disintegrate prematurely due to
fibrinolysis. CLINICAL FEATURES: The most common location of dry socket: in the socket of an
extracted mandibular third molar. Sign: An empty socket, which is partially or totally devoid of
blood clot. Symptoms: Dull, aching, throbbing pain in the area of the socket,
intraoral halitosis (oral malodor), Bad taste in the mouth. Diagnosis: Dry socket typically causes
pain on the second to fourth day following a dental extraction. Examination typically involves
gentle irrigation with warm saline and probing of the socket to establish the diagnosis.
Treatment: It is usually symptomatic, (i.e., analgesic medications) and also the removal of
debris from the socket by irrigation with saline or local anesthetic. Medicated dressings are
also commonly placed in the socket. Examples of medicated dressings include antibacterials,
topical anesthetics and obtundants, or combinations of all three, e.g., zinc
oxide and eugenol impregnated cotton pellets, alvogyl (eugenol, iodoform and butamen),
dentalone, bismuthsubnitrate and iodoform paste (BIPP) on ribbon gauze
and metronidazole and lidocaine ointment.
22. DENTINOGENESIS IMPERFECTA
It is an autosomal dominant condition affecting both deciduous and permanent teeth.
ETIOLOGY: Dentin sialophosphoprotein is mutated and resulted in defective dentin formation.
CLINICAL FEATURES: A. DENTINOGENESIS IMPERFECTA I: dentinogenesis imperfecta without
osteogenesis imperfect (opalescent dentin).
The teeth are blue-gray or amber brown. Radiographs show teeth having bulbous crowns,
narrower roots, small pulp chambers and root canals & are obliterated. Enamel may split from
dentin under occulusal stresses. DENTINOGENESIS IMPERFECTA II: Brandywine type
dentinogenesis imperfecta. It is characterized by too little dentin formation. Hence Crowns of
deciduous & permanent teeth wear rapidly after eruption & multiple pulp exposures occur.
Radiographs show very large pulp chambers & root canals (shell teeth). Amber discoloration of
teeth.
TREATMENT: The treatment is primarily towards preventing the loss of enamel & subsequent
loss of dentin through attrition. Cast metal crowns on the posterior teeth & jacket crowns on
anterior teeth.

23. SUPERNUMERARY TEETH

A Supernumerary tooth is an additional entity to the normal series. The conditions commonly
associated with supernumerary teeth are cleft lip and palate, cleidocranial dysplasia, & gardner
syndrome. Classification: Four different morphological types are described. A. Conical: small
peg shaped conical teeth. Commonly seen in permanent dentition. B. Tuberculate: this type
have more than one cusp or tubercle. It is described as barrel-shaped. They are often paired &
commonly located on palatal aspect of central incisors. C. Supplemental: they refer to
duplication of teeth in the normal series & is found at the end of a tooth series. Common tooth
is permanent maxillary lateral incisor, premolars & molars. D. Odontome: described as
hamartomatous malformation. Two separate types are described. A. Complex composite
odontoma: diffuse mass of dental tissue which is totally disorganized. B. Compound composite
odontoma: malformation which bears some superficial anatomical similarity to a normal tooth.
24. LEUKOPLAKIA:
It is defined as a predominantly white lesion of the oral mucosa that cannot be characterized as
any other definable lesion, some oral leukoplakia will transform into cancer. It is the most
common potentially malignant lesion of the oral mucosa.
ETIOLOGY: Tobacco smoking, Candida albicans, Human papilloma virus 16, 18.
CLINCIAL CLASSIFICATION: A. HOMOGENOUS- Lesions that are uniformly white. They can be
subdivided into Smooth, Furrowed & ulcerated. B. NON HOMOGENOUS- Lesions in which part
of the lesion is white & rest appears reddened. It is again divided into non homogenous
nodulospeckled. CLINICAL FEATURES: Homogenous type is usually asymptomatic. Non
homogenous type has localized pain or discomfort. HISTOPATHOLOGY: DIAGRAM.
FEATURES: 1. Hyperkeratotic epithelium. 2. Acanthosis. 3. Dyplastic features- bulbous or drop
shaped rete ridges, basal cell hypeplasia, loss of polarity of basal cells, irregular epithelial
stratification, loss of intercellular adhesion, cellular pleomorphism, alteration in nuclear
cytoplasmic ratio, nuclear hyperchromatism, prominent nucleoli, increased mitoses.
TREATMENT: Surgical excision, cryosurgery, co2- laser surgery, retinoids & other drugs,
photodynamic therapy.

25. ERYTHROPLAKIA
A lesion that is analogous to leukoplakia that present as bright red velvety plaques which
cannot be characterized clinically or pathologically as any other condition. CLINICALFEATURES
Erythroplakia of the mouth is usually an asymptomatic lesion that occurs primarily in older
males who smoke cigarettes. It can be found on the floor of the mouth, lateral and ventral
surfaces of the tongue, soft palate, and buccal mucosa. The term speckled erythroplakia is
often used to describe a lesion that is primarily red but exhibits interspersed focal white
plaques.
HISTOPATHOLOGY: Three microscopic features of erythroplakia explain the deep-red
coloration of the lesions: First, erythroplakia lacks the surface layer of keratin that normally
diffuses the redness emanating from the underlying vasculature.
Second, the remaining epithelial layers that normally cover the connective tissue papillae
between the rete pegs are frequently reduced in thickness; therefore the blood vessels
normally present in the papillae are more visible from the surface than in normal mucosa.
Third, in most erythroplakias, the size and number of vascular structures increase in response
to the inflammation associated with the thinned and neoplastic epithelium.
26. ORAL SUBMUCOUS FIBROSIS (OSMF)
Diffuse firm whitish areas of submucosal scarring usually caused by frequent and prolonged
contact with betel nut quids, tobacco, or hot chili peppers.
ETIOLOGY: habitual chewing of arecanut.
CLINICAL FEATURES: Onset is insidious, over two to five years. Early OSMF: burning sensation.
Blisters especially on the palate, ulcerations. Excessive salivation. Defective gustatory
sensation. Petechiae. Pain in areas where submucosal fibrotic bands are developing. Advanced
OSMF: blanched and slightly opaque, and white fibrous bands appear on buccal mucosa and
faucial pillars. Fixation and shortening or even deviation of uvula and soft palate. Difficulty in
mouth opening. HISTOPATHOLOGY: diagram
IDENTIFICATION POINTS: 1. Atrophic epithelium. 2. Juxta- epithelial hyalinization. 3. Fibrosed
connective tissue. The epithelium is atrophic with short or flat rete ridges. Connective tissue
just beneath the epithelium shows juxta- epithelial hyalinization and exhibits fibrosis with
dense bundles of collagen fibers. Focal collections of chronic inflammatory cells are present. In
severe cases muscle undergoes degenerative changes.
MANAGEMENT: A. Nutritional support with Vitamin B complex and other vitamins. B.
Immunomodulatory drugs like glucocorticoids for local & systemic applications. C.
Physiotherapy such as forceful mouth opening & heat therapy. D. Local drug therapy with
corticosteroid injections.
E. Surgical measures like forcing the mouth open and cutting the fibrotic bands
27. BASAL CELL CARCINOMA
It is an epithelial malignancy that is slow growing and rarely metastasizes, but it can cause
significant local destruction. ETIOLOGY: Ultraviolet radiation. Chemical like arsenic. Syndromes
like xeroderma pigmentosum, nevoid bcc syndrome are characterized by multiple basal cell
carcinomas. CLINICAL FEATURES: Occurs in fourth decade of life. Disorder of white individuals
with very fair skin. Occurs in middle third of face & is never seen in oral cavity. Sub types of BCC
are: a. Nodular b. Pigmented C. cystic d. superficial e. micronodular f. morpheaform &
infiltrating. HISTOPAHTOLOGY: DIAGRAM
IDENTIFICATION POINTS: 1. Islands of epithelial cells invading connective tissue. 2. Cells
resemble basal cells 3. Peripheral cells having palisading arrangement of nuclei. BCC is
characterized by sheets, of epithelial cell in the connective tissue where the cells resemble
basal cells with deeply staining nuclei & variable number of mitotic figures. The peripheral cells
of the islands are distinct with palisading arrangement of nucleus.
TREATMENT: Surgical excision of the tumor or X-ray irradiation.
28. PERIPHERAL OSSIFYING FIBROMA
It is a relatively common gingival lesion characterized by a high degree of cellularity usually
exhibiting bone formation. CLINICAL FEATURES: It is a well demarcated focal mass of tissue on
the gingiva, with a sessile or pedunculated base with same color as normal mucosa. The
surface may be intact or ulcerated. It appears to originate from an interdental papilla.
RADIOGRAPHIC FEATURES: Rarely superficial erosion of underlying alveolar bone.
HISTOPATHOLOGY: DIAGRAM
IDENTIFICATIO POINTS: A. Highly cellular connective tissue. B. Presence of calcifications.
The lesional tissue comprises of dense fibrous connective tissue with few fibroblasts and
fibrocytes & scanty blood vessels associated with formation of mineralized product.
Mineralization may be osteoid bony trabeculae or cementum like material. Epithelium may be
intact or ulcerated.
TREATMENT: Surgical excision & submitted for microscopic examination for confirmation of
diagnosis.
29. PERIPHERAL GIANT CELL GRANULOMA
An extraosseous nodule composed of a proliferation of mononuclear and multinucleated giant
cells with an associated prominent vascularity found on the gingiva or alveolar ridge.
ETIOLOGY: Local irritation due to dental plaque or calculus, periodontal disease, poor dental
restorations, ill- fitting dental appliances. CLINICAL FEATURES: Seen in both dentulous and
edentulous patients. They are asymptomatic and grow rapidly. It occurs on the gingiva or
alveolar process. It is a pedunculated or sessile lesion that seems to be arising from deeper in
the tissue. It is often dark red, vascular or hemorrhagic in appearance. HISTOPATHOLOGY:
DIAGRAM
IDENTIFICATION POINTS: A. Highly cellular connective tissue stroma. B. presence of multiple
giant cells. C. Zone of connective tissue separating lesional tissue from epithelium.
RADIOGRAHIC FEATURES: In edentulous areas the lesion is characteristically exhibits
superficial erosion of the bone with pathognomonic peripheral cuffing of the bone.
TREATMENT: Conservative excision.
30. CENTRAL GIANT CELL GRANULOMA
An intraosseous destructive lesion of the anterior mandible and maxilla in which larger lesions
expand the cortical plates, cause movement of teeth, and produce root resorption; it is
composed of multinucleated giant cells in a background of mononuclear fibrohistiocytic cells
and red blood cells. CLINICAL FEATURES: No signs & symptoms. Cause expansion of the cortex
& perforation, mobility, displacement and root resorption of associated tooth. Two subtypes
are described: A. Non aggressive- slow growing, does not show root resorption or cortical
perforation. B. Aggressive- grows quickly, shows pain, cortical perforation, and root resorption.
RADIOGRAPHIC FEATURES: Radiolucent area with relatively smooth or a ragged border with
definite loculations. Displaced teeth. Thinned cortical plates. HISTOPATHOLOGY: DIAGRAM.
IDENTIFICATION POINTS: A. Highly cellular connective tissue stroma. B. Presence of multiple
giant cells. C. Giant cells arranged close to blood vessels.
31. HISTOPATHOLOGY OF ENAMEL CARIES
DIAGRAM:
ZONES OF ENAMEL CARIES:
TRANSLUCENT ZONE (TZ): First recognizable zone of alteration. Advancing front of the lesion. It
appears structureless. Pore volume- 1%. DARK ZONE: lies adjacent and superficial to the
translucent zone. Shows positive birefringence. Presence of small pores. Medium like water
can penetrate. Pore volume- 2-4%. BODY OF THE LESION: between unaffected surface and dark
zone. Area of greatest demineralization. Pore volume – 5% in periphery & 25% in center. Water
imbibition- positive birefringence compare to sound enamel. Striae of retzius are prominent.
SURFACE ZONE: partial demineralization- 1-10%. Pore volume- less thant 5% of spaces.
Negative birefringence- water imbibitions. Positive birefringence – porous subsurface.
32. HISTOPATHOLOGY OF DENTINAL CARIES: DIAGRAM:
ZONES OF DENTINAL CARIES:
EARLY DENTINAL CARIES:
A. Fatty degeneration of odontoblast process: disposition of fat globules – precedes early
sclerotic changes. B. Sclerotic dentin: Calcification of dentinal tubules. Seals off DT from further
penetration of microbes. Appear white in transmitted light. C. Decalcification of Dentinal
tubules: above dentinal sclerosis, presence of zone of decalcification. Occurs in advance of
bacterial invasion of DT. Pioneer bacteria. D. Zone of Microbial invasion: proteolytic organisms-
predominant in deeper layers. Acidogenic microorganisms- more in early caries. E. Zone of
decomposed dentin.
ADVANCED DENTINAL CARIES:
Decalcification of the walls of DT- confluence. Thickening of sheath of Neumann- along its
course. Increase in the diameter of DT- microorganisms. Liquefaction foci. Acidogenic
organisms- initial decalcification. Proteolytic organisms- matri destruction. Multiple areas of
destruction. Necrotic mass of dentin. Formation of transverse clefts.

33. INTERNAL RESORPTION:

A form of tooth loss that begins within the pulpal chambers of intact teeth, destroying dentin
as it extends outward in a uniform pattern toward the tooth surfaces. CLINICAL FEATURES
Most occurrences of internal resorption are within the crown of anterior incisors and are
idiopathic. The affected tooth is usually asymptomatic, with the lesion first detected by the
appearance of a pink spot beneath the enamel surface. At this time, extensive loss of tooth
structure has occurred, greatly weakening the tooth and predisposing it to fracture.
RADIOGRAPHIC APPEARANCE:
It usually consists of a fusiform enlargement of the pulpal chamber of one or more teeth that
appears in either the crown or root pulpal chambers.
TREATMENT: If internal resorption has not progressed to the point of making the tooth
structurally unsound, endodontic treatment can often halt the process.
34. DOWN SYNDROME
It is caused by trisomy of chromosome 21. Features of the syndrome include: Mental
retardation, Short stature, Brachycephaly
Short broad neck, flat facial profile
Flat occiput, Short broad hands, Thick short fingers, Single palmar crease, Small ears with
overhanging helices and small or absent
Earlobes, up slanting palpebral fissures
Epicanthic folds, flat nasal bridge, Hypermobility of joints, increased incidence of leukemia and
lymphoma. Oral findings include: broad lips, an open mouth with protruding tongue,
macroglossia, fissured tongue, fissured lips, narrow palate, dental malalignment and
malocclusion, congenitally missing teeth, and delayed eruption of both primary and permanent
teeth.
35. BIOPSY
Biopsy is the removal and examination of a part or the whole of a lesion. There are several
types of biopsy techniques namely:
Surgical biopsy (incisional or excisional)
Fixed specimen for paraffi n blocks
Frozen sections
Fine needle aspiration biopsy
Thick needle/core biopsy
Surgical biopsy: Incisional biopsy (removal of part of a lesion) is used to determine the
diagnosis before treatment. Excisional biopsy (removal of the whole lesion such as a mucocele)
is used to confirm a clinical diagnosis.
Fine needle aspiration (FNA) biopsy: A 21 gauge needle is inserted into the lesion and cells
aspirated and smeared on a slide.
Rapid and usually effective aid to diagnosis of swellings in lymph nodes and parotid tumors
especially. Cells can be fixed, stained and examined within minutes. Valuable when surgical
biopsy could spread tumor cells.
Needle/core biopsy: Needle up to 2 mm diameter used to remove a core of tissue. Specimen
processed as for a surgical biopsy. Larger sample than FNA, preserves tissue architecture in the
Specimen. Definitive diagnosis more likely than with FNA.

36. EXFOLIATIVE CYTOLOGY

Exfoliative cytology is examination of cells scraped from the surface of a lesion or occasionally
of material from aspirates of a cyst. Uses and limitations of exfoliative cytology: Quick, easy.
Local anaesthetic not required.
Special techniques, such as immune staining, can be applied. Most useful for detecting virally-
damaged cells, acantholytic cells of pemphigus or candidal hyphae. Unreliable for diagnosing
cancer. Frequent false-positive or false negative results.
37. BELL’S PALSY
Bell’s palsy is a self-limiting, unilateral facial paralysis. ETIOLOGY: familial occurrences,
reactivation of herpes simplex or zoster in the geniculate ganglion, nerve demyelination, nerve
edema or ischemia, autoimmune damage to nerves, and vasospasm of vessels associated with
nerves. CLINICAL FEATURES: The palsy is characterized by an abrupt loss of muscular control
on one side of the face, imparting a rigid masklike appearance and resulting in the inability to
smile, to close the eye, to wink, or to raise the eyebrow. The corner of the mouth usually
droops, causing saliva to drool onto the skin. Speech becomes slurred and taste may be
abnormal. Because the eyelid cannot close, conjunctival dryness or ulceration may occur.
TREATMENT: Histamine and other vasodilators may shorten the duration, as will systemic
corticosteroids and hyperbaric oxygen therapy. Surgical decompression of the intratemporal
facial nerve is used in select cases. Topical ocular antibiotics and artificial tears may be required
to prevent corneal ulceration, and the eyelid may have to be taped shut.
38. TRIGEMINAL NEURALGIA
The most serious and the most common of the facial neuralgias, is characterized by an
extremely severe electric shock like or lancinating (i.e., sharp, jabbing) pain limited to one or
more branches of the trigeminal nerve. In the majority of cases the pain is located in the
maxillary (V2) or the mandibular (V3) distribution of the nerve. CLINICAL FEATURES: Specific
and strict criteria must be met for an accurate diagnosis. They are: The onset of a pain “attack”
is abrupt, often initiated by a light touch to a specific and constant trigger point. The pain is
extreme, paroxysmal, and lancinating. The duration of a single pain “spasm” is less than 2
minutes, although the overall attack may consist of numerous repeating spasms of short
duration. For several minutes after an attack (the “refractory period”), touching the trigger
point usually cannot induce additional attacks. The pain must be limited to the known
distribution of one or more branches of the trigeminal nerve with no motor deficit in the
affected area. The pain is dramatically diminished, at least initially, with the use of
carbamazepine. Spontaneous remissions occur, often lasting more than 6 months, especially
during the early phase of the disease. TREATMENT: The initial treatment for trigeminal
neuralgia is medical. Topical capsaicin cream over the affected skin may be effective.
Anticonvulsant medications (phenytoin, carbamazepine, gabapentin) often are effective in pain
control. Various neurosurgical procedures such as Injection of caustic material near nerves
leaving or entering the gasserian ganglion (glycerol rhizotomy). Removal of skull base bony
irregularities impinging on trigeminal nerve (decompression). Repositioning of blood vessels
impinging on trigeminal nerve (microvascular decompression). Selective destruction of the
sensory fibers of the nerve by crushing or by the application of heat (percutaneous
radiofrequency rhizotomy). Severing the trigeminal sensory roots (neurectomy).
39. FREY SYNDROME
Frey syndrome is characterized by facial flushing and sweating along the distribution of the
auriculotemporal nerve. These signs occur in response to gustatory stimuli, and the syndrome
results from injury to the nerve. ETIOLOGY: This nerve, carries parasympathetic fibers to the
parotid gland and sympathetic vasomotor and Pseudomotor (sweat stimulating) fibers to
the preauricular skin. After parotid abscess, trauma, mandibular surgery, or parotidectomy,
the parasympathetic nerve fibers may become misdirected and regenerate along the
sympathetic nerve pathways, establishing communication with the sympathetic nerve fibers of
sweat glands and blood vessels of the facial skin. Subsequent to these aberrant neural
connections, when salivation is stimulated, local sweat glands are activated inadvertently and
the patient’s cheek becomes flushed and moist.
CLINICAL FEATURES: The presenting signs and symptoms of Frey syndrome include sweating,
flushing, warmth, and occasionally pain in the preauricular and temporal regions during
chewing. TREATMENT: Mostly not required. Atropine injections, botulinum toxin injections,
scopolamine creams, and the systemic use of oxybutynin chloride, an antimuscarinic agent are
beneficiary.
40. PERNICIOUS ANEMIA
Impaired red blood cell maturation secondary to insufficient vitamin B12as the result of a
defective intrinsic factor required for its absorption through the intestinal wall. The disease is a
megaloblastic anemia caused by poor absorption of cobalamin (vitamin B12, extrinsic factor).
Patients lack intrinsic factor because of an autoimmune destruction of the parietal cells of the
stomach, and this results in decreased absorption of cobalamin. CLINICAL FEATURES:
Depapillation of the tongue, a condition known as Hunter glossitis. The filiform papillae
undergo atrophy, and the tongue appears bald and smooth with an erythematous cast. The
oral mucosa in general may be atrophic and exhibit pallor. Angular cheilitis is also seen and is
usually associated with a chronic atrophic form of candidiasis. TREATMENT: Intramuscular
injections of vitamin B12.
41. PSORIASIS
It is a noncontagious skin disorder that appears as inflamed, edematous skin lesions covered
with a silvery white scale. ETIOLOGY: usually unknown but have a genetic predisposition.
Evident that it is an autoimmune disease. CLINICAL FEATURES: skin is characterized by small,
sharply delineated, dry papules, each covered by a delicate silvery scale. If the deep scales are
removed, one or more tiny bleeding points are disclosed, a characteristic feature termed
Auspitz’s sign. After removal of scale the surface of the skin is red and dusky in appearance.
The cutaneous lesions are painless & pruritic. This disease is more severe in winter & less
severe in summer. Oral lesions are rare. HISTOPATHOLOGY: Monro’s abscesses or intra
epithelial micro abscesses. TREATMENT: UV-A, PUVA, retinoids, cyclosporine and alefacept.

42. ERYTHEMA MULTIFORMAE

It is an acute self- limiting dermatitis characterized by a distinctive clinical eruption manifested
as iris or target lesion. ETIOLOGY: Drugs are prime cause. CLINICAL FEATURES: Occasionally
triggered by herpetic infection or drugs. Adolescents or young adults, particularly males, mainly
affected. Mild fever and systemic upset may be associated. Lips frequently grossly swollen,
split, crusted and bleeding. Widespread irregular fibrin-covered erosions and erythema in the
mouth. Conjunctivitis may be associated. Cutaneous lesions may consist of widespread
erythema alone or characteristic target lesions. Attacks may recur at intervals of several
months. Remittent but usually ultimately self-limiting.
TREATMENT: Systemic corticosteroids may give symptomatic relief.
43. RECURRENT APHTHOUS STOMATITIS
It is a common disease characterized by the development of painful, recurring solitary or
multiple ulcerations of the oral mucosa. ETIOLOGY: Bacterial infections with streptococcus
sanguis, immunologic abnormalities like autoimmune responses, iron, vit B12 & folic acid
deficiency, trauma, endocrine abnormalities, psychological stresses, allergic factors. CLINICAL
FEATURES: RAS has been categorized into 4 varieties namely A. Recurrent aphthous minor B.
Recurrent aphthous major. C. Recurrent herpetiform ulcerations. D. recurrent ulcers associated
with behcet’s syndrome.
The ulcers begin as a single or multiple superficial erosions covered by a gray membrane and
has a necrotic center with raised margins surrounded by an erythematous halo. The most
common sites of occurrence are the buccal & labial mucosa, buccal and lingual sulci, tongue,
soft palate, pharynx, and gingiva. The ulcers persist for 7 to 14 days and then heal gradually.
TREATMENT: tetracycline mouthwash used four times daily for 5 to 7 days. Analgesic topical
applications.
44. XEROSTOMIA
It is also called dry mouth.
ETIOLOGY: TEMPORARY CAUSES: A. Psychological- anxiety & depression. B. Duct calculi
blockage of major salivary gland. C. sialoadenitis D. Drug therapy- anticholinergic &
sympathomimetic agents and Zyban. PERMANENT CAUSES: A. salivary gland aplasia B.
sjogren’s syndrome
C. systemic disorders like Diabetes mellitus, Parkinson’s disease, cystic fibrosis and sarcoidosis.
D. Radiotherapy E. surgical desalivation.
CLINICAL FEATURES: dry or burning sensation. The mucosa will appear dry and atrophic, pale
and translucent. The tongue may manifest atrophy of papillae, inflammation, fissuring and
cracking. Chronic xerostomia predisposes to rampant dental caries and subsequent loss of
teeth. Difficulty in wearing artificial dentures.
TREATMENT: eliminate any etiological factors such as drugs, calculi and emotional problems.
Promote salivary stimulation by using sugar free chewing gum. Salivary substitutes can also be
given.

45. CANDIDIASIS
Candidiasis is a common opportunistic oral mycotic infection. Etiology: Candidiasis is caused by
Candida albicans. Predisposing factors: Immunodeficiency, Acquired immunosuppression
Endocrine disturbances, Diabetes mellitus Hypoparathyroidism, Pregnancy, Hypoadrenalism
Corticosteroid therapy, Systemic antibiotic therapy, Malignancies and their therapies
Xerostomia, Poor oral hygiene.
Classification:
ACUTE
Pseudomembranous (white colonies)
Erythematous (red mucosa)
CHRONIC
Erythematous (red mucosa)
Hyperplastic (white keratotic plaque)
MUCOCUTANEOUS
Localized (oral, face, scalp, nails)
Familial
Syndrome associated
CLINICAL FEATURES:
Acute candidiasis (thrush): Oral lesions are characteristically white, soft plaques that
sometimes grow centrifugally and merge. Wiping away the plaques or pseudomembranes with
a gauze sponge leaves a painful erythematous, eroded, or ulcerated surface.
Acute erythematous candidiasis: Persistence of acute pseudomembranous candidiasis may
eventually result in loss of pseudomembrane, with presentation as a more generalized red
lesion.
Chronic erythematous candidiasis: It is a commonly seen form, occurring in geriatric individuals
who wear complete maxillary dentures (denture sore mouth). Denture-related chronic atrophic
candidiasis is angular cheilitis.
Chronic hyperplastic candidiasis: Chronic candidal infections are capable of producing a
hyperplastic tissue response. When occurring in the retrocommissural area, the lesion
resembles speckled leukoplakia and is known as candidal leukoplakia. Hyperplastic candidiasis
may involve the dorsum of the tongue in a pattern referred to as median rhomboid glossitis.
TREATMENT: TOPICAL: Nystatin- oral suspension, powder and ointment for denture.
Clotrimazole- oral troches. SYSTEMIC: Fluconazole, ketoconazole

46. CELLULITIS
It is also called as phlegmon. It is a diffuse inflammation of soft tissues which is not
circumscribed or confined to one area, tends to spread through tissue spaces and along fascial
planes. ETIOLOGY: Infection by microorganisms that produce significant amounts of
streptokinase , hyaluronidase (the spreading factor) and fibrinolysins which act to breakdown
or dissolve hyaluronic acid, the intercellular cement substance and fibrin. CLINICAL FEATURES:
Dental infection of posterior teeth. Painful swelling of the soft tissues involved that are firm
and brawny. The skin is inflamed, has an orange peel appearance. Regional lymphadenitis is
seen.
Perforation of maxillary cortical bone above buccinator attachment cause swelling of upper
half of face and soon it reaches entire facial area and pose serious complication of cavernous
sinus thrombosis. When infection in the mandible, cortical plate is perforated below the
buccinator attachment. Hence the swelling occurs in the lower half of the face which further
spreads cervically. HISTOLOGY: Section shows diffuse exudation of PMN’s and occasional
lymphocytes with considerable serous fluid & fibrin. TREATMENT: Antibiotic administration.
Surgical intervention.
47. LUDWIG’S ANGINA
It is an acute potentially life threatening, toxic cellulitis, beginning usually in the submandibular
space and secondarily involving the sublingual and submental spaces as well. ETIOLOGY: It is
most commonly a disease of dental origin. The chief source of infection is involvement of a
mandibular 2nd and 3rd molars, either periapical ar periodontal.
CLINICAL FEATURES: Patient manifests a rapidly developing board like swelling of the floor of
the mouth and consequent elevation of the tongue. The swelling is firm, painful and diffuse,
showing no evidence of localization and paucity of pus. There is difficulty in eating and
swallowing as well as in breathing. As swelling spreads cervically, it carries serious complication
of suffocation.
TREATMENT: Early recognition of incipient cases. Maintenance of airway. Intense and
prolonged antibiotic therapy. Extraction of the affected tooth and surgical drainage.
48. AIDS
Oral lesions strongly associated with Hiv infection: Candidiasis: erythematous,
pseudomembranous, angular cheilitis. Hairy leukoplakia. Kaposi’s sarcoma (KS). Non-Hodgkin’s
lymphoma. Periodontal diseases: linear gingival erythema, necrotizing gingivitis, necrotizing
periodontitis
Oral lesions less commonly associated with
Hiv infection: Melanotic hyperpigmentation. Necrotizing ulcerative stomatitis. Salivary gland
disease: dry mouth, unilateral or bilateral swelling of major salivary glands. Thrombocytopenia
purpura. Oral ulcerations. Viral infections: HSV, HPV, varicella-zoster.
Oral lesions seen in hiv infection: Actinomycosis. Cat-scratch disease. Bacillary angiomatosis.
Drug reactions: ulcerative, erythema multiforme, Recurrent aphthous stomatitis. Viral
infections: cytomegalovirus, molluscum contagiosum.
 CLASSIFICATIONS

CYSTS OF ORAL CAVITY

A. ODONTOGENIC
B. NON- ODONTOGENIC
ODONTOGENIC CYSTS
BASED ON HISTOGENESIS:
CYSTS DERIVED FROM RESTS OF MALASSEZ
Periapical cyst
Residual cyst
CYSTS DERIVED FROM REDUCED ENAMEL
EPITHELIUM
Dentigerous cyst
Eruption cyst
Paradental cyst
CYSTS DERIVED FROM DENTAL LAMINA
(RESTS OF SERRES)
Odontogenic keratocyst (OKC)
Multiple
Lateral periodontal cyst
Polycystic (“botryoid”)
Gingival cyst of adult
Dental lamina cyst of newborn
Glandular odontogenic cyst
BASED ON ORIGIN:
DEVELOPMENTAL
Gingival cysts of infants (Epstein pearls)
Odontogenic keratocyst (‘primordial’ cyst)
Orthokeratinised odontogenic cyst
Dentigerous (follicular) cyst
Eruption cyst
Lateral periodontal cyst
Gingival cyst of adults
INFLAMMATORY
Radicular cyst
Residual cyst
Lateral cyst
Paradental cyst
 NON ODONTOGENIC CYSTS
CYSTS OF VESTIGIAL TRACT
Thyroglossal cyst
CYSTS OF VESTIGIAL DUCTS
Nasopalatine cyst
Nasolabial cyst
LYMPHOEPITHELIAL CYSTS
Oral lymphoepithelial cyst
Cervical lymphoepithelial cyst
CYSTS OF EMBRYONIC SKIN
Dermoid cyst
Epidermoid cyst
CYSTS OF MUCOSAL EPITHELIUM
Surgical ciliated cyst of maxilla

ODONTOGENIC TUMORS
Benign epithelial neoplasms
Ameloblastoma and its variants
Squamous odontogenic tumour
Calcifying epithelial odontogenic tumour
Adenomatoid odontogenic tumour
Calcifying cystic odontogenic tumour (calcifying odontogenic cyst)
Benign mixed epithelial and connective tissue neoplasms
Ameloblastic fibroma
Benign connective tissue neoplasms
Odontogenic fibroma
Odontogenic myxoma
Cementoblastoma
Malignant epithelial neoplasms
Odontogenic carcinomas
Clear cell odontogenic carcinoma
Malignant connective tissue neoplasms
Odontogenic sarcomas
Hamartomas
Odontomas
Dysplasias: Cemento-osseous dysplasia
 NON ODONTOGENIC TUMORS
Primary – benign
• Osteoma
• Osteochondroma
• Cemento-ossifying fi broma
• Central giant cell granuloma
• Haemangioma
• Melanotic neuroectodermal tumour
Primary – malignant
• Osteosarcoma
• Chondrosarcoma
• Ewing’s sarcoma
• Multifocal or potentially multifocal:
Myeloma
Langerhans cell histiocytosis
Metastatic
• Carcinoma

ORAL PRE MALIGNANT LESIONS

Dysplastic leukoplakia
Erythroplakia
Chronic candidiasis
Snuff dipper’s keratosis
Pipe smoker’s keratosis
ORAL PREMALIGNANT CONDITIONS
Tertiary syphilis
AIDS
Erosive lichen planus
Dyskeratosis congenital
Discoid lupus erythematosus
Oral submucous fibrosis

SALIVARY GLAND TUMORS

BENIGN
● Pleomorphic adenoma (mixed tumor)
● Myoepithelioma
● Basal cell adenoma
● Warthin tumor
● Oncocytoma
● Sebaceous adenoma
● Sebaceous lymphadenoma
● Ductal papillomas
● Sialadenoma papilliferum
● Intraductal papilloma
 ● Inverted ductal papilloma
● Papillary cystadenoma
● Sialoblastoma
MALIGNANT
● Malignant mixed tumors
● Carcinoma ex pleomorphic adenoma
● Carcinosarcoma
● Metastasizing mixed tumor
● Mucoepidermoid carcinoma
● Acinic cell adenocarcinoma
● Adenoid cys c carcinoma
● Polymorphous low-grade adenocarcinoma
● Basal cell adenocarcinoma
● Myoepithelial carcinoma
● Cystadenocarcinoma
● Clear cell adenocarcinoma

PULPITIS
A.REVERSIBLE PULPITIS
Symptomatic (ACUTE)
Asymptomatic (CHRONIC)
B.IRREVERSIBLE PULPITIS
ACUTE
Abnormally responsive to heat
abnormally responsive to cold
CHRONIC
Hyperplastic pulpitis
Internal resorption
Asymptomatic with pulp exposure

DENTAL CARIES
According to the anatomical site
Pit & fissure caries
Smooth surface caries
According to the rate of progression
Acute dental caries
Chronic dental caries
According to the nature of attack
Primary caries
Secondary caries
Based on chronology
Infancy caries
Adolescent caries
 VESICULO-BULLOUS LESIONS
VIRAL DISEASE
Herpes Simplex Infection
Varicella-Zoster Infection
Hand-Foot-and-Mouth Disease
Herpangina
Measles (Rubeola)
IMMUNOLOGIC DISEASE
Pemphigus Vulgaris
Mucous Membrane Pemphigoid
Bullous Pemphigoid
Dermatitis Herpetiformis
Linear Immunoglobulin A Disease (LAD)
HEREDITARY DISEASE
Epidermolysis Bullosa

FIBRO-OSSEOUS LESIONS
1. Bone dysplasias
a. Fibrous dysplasia
i. Monostotic
ii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv. Osteofibrous dysplasia
b. Osteitis deformans
c. Pagetoid heritable bone dysplasia of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia
b. Florid cemento-osseous dysplasia
3. Inflammatory/reactive processes
a. Focal sclerosing osteomyelitis
b. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibroma
b. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma
i. Trabecular type
ii. Psammomatoid type
 VERY SHORT ANSWER QUESTIONS
1.Abfraction:
A regressive alteration of tooth structure usually involving hard tissue of the permanent
dentition leading to loss of tooth surface at the cervical areas of teeth caused by tensile and
compressive forces during tooth flexure. Alternatively, Cervical erosive lesions that cannot be
attributed to any particular etiology.
2.Acantholysis:
A histopathological feature, characterized by loss of the intercellular bridges of the prickle cell
layer (spinous) of the epithelium usually caused by accumulation of fluid or edema in between
the keratinocytes. It is seen in Pemphigus vulgaris.
3.Acidogenic theory:
It states that dental caries is a chemico-parasitic process consisting of two stages- the
decalcification of enamel as a preliminary stage followed by dissolution of the softened
residue. The acid required for decalcification is synthesized by the fermentation of starch and
food residue by the bacteria’s. This theory was proposed by Miller.
4.Actinic chelitis:
A chronic inflammatory lesion caused by chronic exposure to actinic or sunlight manifesting in
skin of the middle and lower third of face and commonly in lower lips.
5.Actinic keratosis:
It is a common cutaneous premalignant lesion caused by exposure to ultraviolet radiation
exposure with microscopic changes in epithelium and connective tissues. It is also called as
solar keratosis. Individual lesions are irregular scaly plaques that peels off & palpation reveals a
“sandpaper,” roughened texture.
6.Addison´s disease
A rare hormonal disorder that occurs when the adrenal glands do not produce enough of the
hormone cortisol and less commonly aldosterone. The result is a severe disorder of electrolyte
and fluid balance and serious clinical effects like loss of weight, low blood pressure, and
abnormal oral and cutaneous pigmentations.
7.Aerodontolgia:
It is also called as barodontolgia. A condition similar to pulpitis experienced in deep fillings in
high altitudes is referred as aerodontalgia.
8.Agranulocytosis
Agranulocytosis is the term given to the clinical effects of severe neutropenia, fever,
prostration and mucosal ulceration, particularly of the gingivae and pharynx. Oral lesions are
common and include necrotizing, deep, punched-out ulcerations of the buccal mucosa, tongue,
and palate. The gingivae are especially susceptible to infection, often resembling the pattern of
necrotizing ulcerative gingivitis (NUG).
9.Amalgam tattoo:
It is also called as focal argyrosis. It is an iatrogenic lesion that follows traumatic soft tissue
implantation of amalgam particles or passive transfer by chronic friction of mucosa against an
amalgam restoration. It is the most common exogenous pigmentation of the oral cavity.
10.Anachoretic pulpitis:
It refers to the inflammation of pulp caused by agents reaching pulp through circulation. Most
commonly the agents are bacteria in the blood circulation reaching dental pulp through apical
foramen.
11.Anodontia
Total anodontia is a rare condition in which the patient has no deciduous and no permanent
teeth. It usually occurs in association with a generalized disorder such as hereditary ectodermal
dysplasia.
12.Anesthesia dolorosa:
It is an uncommon side-effect of surgical treatment of trigeminal neuralgia resulting in a
combination of anesthesia and spontaneous pain of the facial skin.
13.Aneurysmal bone cyst:
It is an uncommon pseudocystic lesion located primarily in the posterior mandible and maxilla
with clinical features similar to central giant cell lesion often containing many large blood-filled
spaces separated by connective tissue septa containing giant cell tissue and lined by
epithelium. It is a Pseudocyst because they appear radiographically as cystlike lesions but
microscopically exhibit no epithelial lining.
14.Angiomatosis:
The process of subcutaneous vascular proliferation is referred to as angiomatosis.
Ex: Encephalotrigeminal angiomatosis.
15.Anitschkow cell:
The cytologic smear of a recurrent apthous ulcer show a characteristic change in nucleus of
epithelium with elongated nuclei containing a linear bar of chromatin. Such a cell is termed as
Anitschkow cell.
16.Ankyloglssia:
A developmental anomaly of tongue characterized by an abnormal extensive adhesion of the
tongue to the floor of the mouth or the lingual aspect of the anterior portion of the mandible
caused by a short lingual frenum. It is also called as Tongue tie and is treated by frenectomy.
17.Arrested caries:
A dental caries that has become static and does not show any tendency for further
progression. After demineralization in a cavity, alteration occurs in the loss and redeposition of
mineralizing salts that is caused by fluctuationsin the pH in that particular location. In some
situations if the pH can be stabilized in its normal range, the whole process may stop or even
reverse, which is referred to as arrested caries.
18.Arnold head:
In Cleidocranial dysplasia, the fontanelles may remain open until adulthood, but the sutures
often close with interposition of wormian bones. Bosses of the frontal, parietal, and occipital
regions give the skull a large globular shape with small face. The characteristic skull
abnormalities are sometimes referred to as the "Arnold head".
19.Asteroid bodies:
The granulomatous inflammation of sarcoidosis contains epithelioid macrophages and
multinucleated giant cells, laminated stellate inclusions called as asteroid bodies.
20.Auspitz sign:
A Clinical sign in psoriasis. When the dry scales are removed forcefully reveals a one or more
tiny bleeding spots characteristic to psoriasis scales.
21.Bacillary angiomatosis:
It is a multifocal subcutaneous vascular proliferation associated with cat scratch disease and
often observed in patients with long standing HIV infection. They respond to erythromycin.
22.Ballooning degeneration:
The Herpes Simplex virus infected cell exhibit acantholysis, nuclear clearing and enlargement
and is called as the ballooning degeneration.
23.Bence jone’s proteins
They are the diagnostic proteins often associated with proteinuria in conditions like multiple
myeloma. Bence jones proteinuria confirms myeloma in 50% of cases.
24.Black hairy tongue:
It is a developmental defect of tongue, characterized by marked accumulation of keratin on the
filliform papillae of the dorsal aspect and associated with other conditions. The elongated
papillae are usually brown, yellow, or black as a result of growth of pigment-producing bacteria
or staining from tobacco and food.
25.Blue nevus:
A benign pigmented epithelial pathology that presents as a dark blue dome-shaped papule or
as a flat macule on the skin or mucosa. Made up of nevus cell and appears blue due to
tyndallization effect.
26.Blue sclera
The sclera appear blue tinged in osteogenesis imperfecta. It is due to the impaired collagen
maturation in sclera and underlying blue color of tissues is reflected outward.
27.Bohn’s nodules:
An uncommon superficial raised nodule scattered over the hard palate often near the border
with the soft palate in infants that resolve without treatment. They are derived from rests of
the dental lamina and consisting of keratin-producing epithelial lining.
28.Botryoid odontogenic cyst:
A slow-growing, non-expansile developmental odontogenic cyst derived from rests of the
dental lamina resembling a bunch of grapes. The cyst contains an embryonic lining of 1 to 3
cuboidal cells and distinctive focal thickenings (plaques).
29.Bulla (bullous/ bullae):
A circumscribed elevated blister like lesion that is more than 5 mm in diameter, usually
contains serous fluid.
30.Button-hole sign:
It is seen in neurofibromatosis. Invagination of a nodule when pressed with a finger, a
characteristic of neurofibromatosis
31.Bulimia:
A psychiatric compulsive eating disorder characterized by episodic eating of large volumes of
food, followed by purging behavior such as self-induced vomiting. This may cause erosion of
the lingual aspect of mandibular anterior teeth.
32.Bull’s teeth:
A developmental abnormality of a malformed multirooted tooth characterized by an altered
crown-to-root ratio, the crown being of normal length, the roots being abnormally short, and
the pulp chamber being abnormally large.
33.Bull’s eye lesion:
Skin or mucous membrane lesions which are concentric rings resembling a circle within a circle
with a slightly depressed, dusky purple center, an elevated, surrounding macular erythema
pale middle zone, and an erythematous border. They are usually associated with herpes
simplex or erythema multiforme or drug eruption or mycoplasma infection.
34.Cabots rings:
A red blood cell abnormal feature observed in peripheral smear of pernicious anemia. The rings
are thin, red-violet staining, threadlike strands in the shape of a loop or figure-8 in
erythrocytes.
35.Café au lait spots:
Hyperpigmented lesions that may vary in color from light brown to dark brown. The borders
may be smooth or irregular. Often found with fibrous dysplasia, neurofibromatosis and certain
endocrine abnormalities.
36.Capedont teeth:
It is a term given to teeth affected with dentinogenesis imperfecta.
37.Carotid artery syndrome:
It is an abnormal developmental defect caused by the elongation of styloid process and or
mineralization of stylohyoid ligament that leads to facial pain, dysphagia and transient
syncope. Also known as Eagle’s syndrome.
38.Carpet tack lesions:
In discoid lupus erythematosus, when the cutaneous scales are forcefully removed numerous
extensions that had dipped in to the enlarged pilosebaceous canals. Such a lesion is described
as carpet tack lesion.
39.Cementifying fibroma:
It is also known as ossifying fibroma, cemento –ossifying fibroma. It is a well demarcated,
osteogenic neoplasm that is composed of fibrous tissue that contain variable amount of
calcified structure- bone and cementum in varying proportion.
40.Cementoblastoma:
A benign, well-circumscribed neoplasm of cementum-like tissue growing in continuity with the
apical cemental layer of a tooth (often molar or premolar) that produce expansion of cortical
plates and pain.
41.Cementicle
It is a small, spherical or ovoid calcified mass embedded within or attached to
the cementum layer on the root surface of a tooth, or lying free within the periodontal
ligament. They are 3 kinds i.e free, attached and interstitial cementicles.
42.Chanchre:
It refers to the lesion of primary syphilis. It is single, indurated, nonpainful ulcer at site of
spirochete entry. It spontaneously heals in 4–6 week.
43.Chlorodontia
A type of intrinsic greenish discoloration of teeth caused by accumulation of bilirubin that
breaks in to biliverdin. This is formed during conditions like hyperbilirubinemia.
44.Chvosteks’s sign
It is an oral finding observed in hypoparathyroidism. It is characterized by a twitching of upper
lip when the facial nerve is tapped just below zygomatic process. It suggests a latent degree of
tetany.
45.Cherry blossom appearance
It is also called as branchless fruit laden tree appearance. It is seen radiographically in sjogren’s
syndrome.
46.Cobble stone appearance
Seen in Lymphangioma, Inflammatory papillary hyperplasia, Heck’s disease. The erythematous
densely compacted nodules near the midline
of the hard palate give the tissues a “cobblestone” appearance in inflammatory papillary
hyperplasia.
47.Codman’s triangle
The triangular elevation of periosteum in osteosarcoma radiographically is referred as
Codman's triangle.
48.Cotton wool appearance:
Radiopacties with poorly demarcated margins looking like cotton wool are seen in Paget’s
disease of bone, cemento osseous dysplasia, gardner syndrome and gigantiform cementoma.
49.Colley’s anemia
It is also known as thalassemia major. It has a defective hemoglobin synthesis inherited
through 2 defective genes for beta globin molecule causing microcytic, hypochromic anemia.
50.Compound nevus
The nevus characterized by a proliferation of nevus cells microscopically within the basal cell
layer of the surface epithelium and involving the underlying connective tissue.
51.Concrescence
A developmental anomaly or post inflammatory defect involving shape of teeth in which there
is union of two adjacent teeth by cementum alone without the confluence of dentin.
52.Corps ronds
It refers to the peculiar dyskeratotic cells observed in Darrier’s disease. They have small
pyknotic nuclei, a perinuclear clear halo and eosinophilic cytoplasm.
53.Denture sore mouth
It is also called as Denture stomatitis. It is an erythematous or better a chronic atrophic
candidiasis localized to denture bearing areas of maxillary denture. Treated with antifungal
drugs.
54.Dens evaginatus
It is also called as Leong’s premolar. It is a cusp like elevation of enamel located in the central
groove or lingual ridge of the buccal cusp of premolar or molar teeth. The accessory cusp
normally consists of enamel and dentin, with pulp.
55.Dilaceration
A developmental anomaly manifested as an abnormal bend or curve. More commonly
occurring in the root of a permanent tooth. The cause has been related to trauma during root
development. Movement of the crown or of the crown and part of the root from the remaining
developing root may result in sharp angulation after the tooth completes development.
56.Doorthy Reed cells
They are the characteristic typically binucleated (owl eye nuclei) or multinucletated (pennies
on plate) with prominent nucleoli in Hodgkins lymphoma.
57.Drug induced gingival hyperplasia
Increased amount of gingiva. Generalized increase in the fibrous component of the gingiva in
patients who have been taking long term doses of phenytoin, cyclosporine and nifedipine.
Persistent dental plaque, calculus (tartar) and gingival irritation increase the severity of the
hyperplasia.
58.Driven snow appearance
Multiple scattered calcifications in calcifying epithelial odontogenic tumor radiographically
appear as driven snow appearance.
59.Eagle syndrome
It is an abnormal developmental defect caused by the elongation of styloid process and or
mineralization of stylohyoid ligament that leads to facial pain, dysphagia and transient
syncope. Also known as carotid artery syndrome.
60.Ecchymosis
Large reddish-blue areas in skin or mucous membrane caused by the escape of blood into the
tissues, where it clots. It is commonly referred to as a bruise. Ecchymoses do not blanch on
diascopy.
61.Enamel pearl
Ectopic nodular deposits of enamel that primarily occur in the bifurcation or trifurcation areas
on the roots of molars. Maxillary molars are more commonly affected than mandibular molars.
62.Epstein’s pearls
They are uncommon superficial raised nodules (gingival cysts) on the midline of the hard palate
of infants that resolve without treatment. They are derived from rests of the dental lamina and
consisting of keratin-producing epithelial lining.
63.Epulis fissuratum
A reactive lesion resulting in proliferation of fibrous connective tissue with an associated
chronic inflammation in response to chronic injury such as an ill-fitting denture. It is a common
lesion that occurs in the vestibular mucosa and less commonly along the mandibular lingual
sulcus where the denture flange contacts tissue.
64.Eruption cyst
It is a soft tissue odontogenic cyst with the histologic features of a dentigerous cyst that
surrounds a tooth’s crown that has erupted through bone but not soft tissue and is clinically
visible as a soft fluctuant mass on the alveolar ridges. Also known as Eruption hematoma.
65.Erosion
The pathological wearing away of hard tissues of teeth through the action of chemical
substances. And also in histopathology refers to discontinuity or denudation of epithelium
above the basal cell layer.
66.Exostoses or Exostosis
An exophytic nodular benign growth of dense cortical bone commonly located on maxillary or
mandibular buccal alveolar bone, usually in the bicuspid/molar area. Treatment of tori and
exostoses is unnecessary unless it is required for prosthetic considerations.
67.Fibroma
A reactive hyperplasia of fibrous connective tissue that evolves in response to chronic irritation
in which there is extensive elaboration of collagen resembling scar tissue. Labial mucosa,
tongue, and gingiva also are common sites & the most common location is the buccal mucosa
along the bite line.
68.Fissural cysts
Originally believed to arise from cystic degeneration of epithelium remnants entrapped along
lines of fusion of embryonic growth processes. Ex: globulomaxillary cyst & median mandibular
cyst.
69.Fissure tongue
A developmental anomaly of tongue observed as deep grooves in dorsum of tongue which
cause no adverse consequences other than being a collection site for food debris and
colonization site for Candida albicans. It is caused by improper fusion of the lateral swellings.
70.Foam cells
They are lipid laden phagocytes that appear as empty in H&E section as lipids are lost during
processing. The presence of foam cell with macrophage and numerous inflammatory cells in
the vincity indicates that there is foreign body reaction present.
71.Follicular cyst
It is also known as dentigeous cyst. A common developmental type of odontogenic cyst
associated with unerupted teeth and is caused by fluid accumulation between the reduced
enamel epithelium and the enamel surface, resulting in a cyst in which the crown is located
within the lumen and root(s) outside.
72.Fordyces granules
They are collection of ectopic sebaceous glands that occur in various locations within the oral
cavity. They are most commonly seen bilaterally on the buccal mucosa and on the vermilion of
the upper lip. They appear as multiple small, milia-like yellowish maculopapular lesions.
73.Fusion
It is defined as a single enlarged tooth or a two joined teeth in which the tooth count reveals a
missing tooth when the anomalous tooth is counted as one.
74.Gardner syndrome
A rare autosomal dominant disease characterized by gastrointestinal adenomatous polyps,
multiple osteomas and soft tissue tumors such as cutaneous epidermoid cysts and fibromas &
supernumerary teeth.
75.Gemination
It is a single tooth germ splits completely or partially, forming two separate crowns. Also
defined as a single enlarged developmental anomalous tooth in which the tooth count is
normal when the anomalous tooth is counted as one. The tooth usually has a single root and
root canal. It is also called twinning.
76.Geographic tongue
It is also called as erythema migrans & benign migratory glossitis. It is a common anomaly of
tongue that presents as white annular lesions with atrophic red centers. Pattern migrates over
dorsum of tongue &may spontaneously disappear. Occasionally painful.
77.Ghost cells
They are the altered epithelial cells which are eosinophilic, with absence of nuclei but retaining
the basic cell outline within the epithelial component of calcifying odontogenic cyst.
78.Ghost teeth
A localized, nonhereditary, developmental anomaly affecting one or several adjacent teeth in
which the enamel and dentin are thin and irregular and fail to adequately mineralize. The
surrounding soft tissue is hyperplastic and contains focal accumulations of spherical
calcifications and odontogenic cell rests.
79.Gingival cyst of the adult
A small developmental odontogenic cyst of the gingival soft tissue derived from the rests of the
dental lamina, containing a lining of embryonic epithelium of cuboidal cells and distinctive focal
thickenings similar to the lateral periodontal cyst.
80.Gingival cyst of the newborn
Uncommon superficial raised nodules on edentulous alveolar ridges of infants that resolve
without treatment, derived from rests of the dental lamina and consisting of keratin-producing
epithelial lining.
81.Globulomaxillary cyst
A developmental fissural cyst that arises from epithelium entrapped during fusion of the
globular portion of medial nasal process with maxilla, commonly arising between maxillary
lateral incisor and the canine with inverted pear shaped radiolucency.
82.Glossopyrosis
It refers to a painful or tender or burning sensation of tongue with uncertain causes that
includes infections, malnutrition, deficiency status, underlying endocrine disturbances etc.
83.Gorlin cyst
A rare, well-circumscribed, solid or cystic lesion derived from odontogenic epithelium that
superficially resembles follicular ameloblastoma but contains "ghost cells" and spherical
calcifications.
84.Gumma
The scattered foci of granulomatous inflammation presenting as an indurated, nodular,
ulcerated lesion often associated with tissue destruction in tertiary syphilis is gumma. Intraoral
lesions usually affect the palate or tongue.
85.Ground glass appearance:
A characteristic radiographic feature of fibrous dysplasia.The radiopacity of poorly calcified
bone trabaculae arranged in disorganized pattern resembles ground glass. It is also seen in
hyperparathyroidism.
86.Grinspan syndrome
It is a syndrome characterized by presence of the triad: arterial hypertension, Diabetes mellitus
and oral lichen planus.
87.Hair on end appearance
It is the radiographic appearance seen in conditions like thalassemia, sickle cell anemia, severe
iron deficiency anemia in childhood, meningioma and hemangioma.
88.Hamartoma
It is a developmental tumor like but non neoplastic developmental malformation native with
that area of body in which it is formed.
Often present at birth, growth persists till physiologic growth stops and essentially benign.
89.Hemangioma
Hemangiomas are considered to be benign tumors of infancy that display a rapid growth phase
with endothelial cell proliferation, followed by gradual involution. The most common location
is the head and neck. Individual lesions having variable clinical courses.
90.Herpes labialis
The recurrent form of the herpes simplex virus 1 along the vermillion border and adjacent skin
of the lips. It is also known as cold sore or fever blister. Multiple small, erythematous papules
develop and form clusters of fluidfilled vesicles.
91.Honey comb appearance:
Multilocular radiolucenies seen in central hemangioma, aneurysmal bone cyst, resemble honey
comb pattern.
92.Hutchinson’s incisors
Central incisors seen in congenital syphilis. Crowns that are shaped like straight-edge
screwdrivers, with the greatest circumference present in the middle one third of the crown and
a constricted incisal edge. The middle portion of the incisal edge often demonstrates a central
hypoplastic notch.
93.Hunter’s glossitis
It is the condition of tongue seen in pernicious anemia. The tongue appears redder because of
atrophy of the papillae. The resultant smooth, red appearance has been referred to as
Hunter’s glossitis or Moeller’s glossitis.
94.Hutchinson's triad:
Congenital syphilis with Hypoplasia of incisor (Pegged laterals, screw driver shaped central
incisor and mulberry molars), Eighth nerve deafness and Interstitial keratitis.
95.Hypophosphatasia
An osteodystrophy with genetic metabolic disorder of bone mineralization caused by a
deficiency in alkaline phosphatase in serum and tissues. The condition is characterized by
skeletal defects resembling those of rickets.
96.Hypercementosis
Excessive deposit of cementum on root surface. The causes are ageing, periapical periodontitis,
paget’s disease, cementoblastoma, functionless teeth.
97.Idiopathic bone cavity
It is also called as simple bone cyst. It results due to a trauma to bone that is insufficient to
cause fracture resulting in an intraosseous haematoma which does not undergo organization
but liquefies to form a cyst.
98.Intradermal nevus
In latter stages of compound nevus, the nevus cells are restricted to underlying connective
tissue of skin after which the pigmentation is reduced, surface becoming papillomatous with
hairs appearing from centre of the lesion.
99.Iris lesion
A concentric circular erythematous rings resembling a targets or bull’s eye as observed in the
immunologically mediated erythema multiforme.
100.Jaffe-Lichtenstein syndrome
A syndrome characterized by polyostotic fibrous dysplasia of the skeletal system and cafe-au-
lait spots.
101.Junctional nevus
The pigmented acquired nevus that is characterized by a proliferation of nevus cells
microscopically within the basal cell layer of the surface epithelium, named because
microscopically appears at the junction of epithelium and connective tissues.
102.Keratoconjunctivitis sicca
The chronic, systemic autoimmune disorder that principally involves the salivary, lacrimal and
eyes is the Sjogren’s syndrome. The effect of such a condition on eye is keratoconjunctivitis
sicca.
103.Keratin pearls
They are the aberrant accumulations of keratin in the connective tissue stroma of squamous
cell carcinoma. They are produced by squamous cells capable of producing keratin. They are
characteristic histological features of squamous cell carcinoma.
104.Kissing lesion
The central papillary atrophy of tongue is a chronic low grade candidiasis, from which the
infection spreads to the palate when the tongue is at rest due to the intimate contact. Such
contact would produce a kissing lesion.
105.Koplik’s spot
The oral manifestation of measles occurring as multiple areas of mucosal erythema within
which are areas of numerous small bluish white macules are seen. These pathognomonic spots
represent foci of epithelial necrosis and have been described as “grains of salt” on a red
background.
106.Koebner phenomenon:
It is also called the "Koebner response" or the "isomorphic response", refers to skin lesions
appearing on lines of trauma. The Koebner phenomenon may result from either a linear
exposure or irritation. Causes of the Koebner phenomenon that are secondary to scratching
rather than an infective or chemical cause include vitiligo, psoriasis, lichen planus.
107.Leukodema
A common, bilateral developmental anomaly of buccal mucosa of unknown cause
characterized by a diffuse grayish white opalescent appearance of mucosa that disappears on
stretching with a striking intracellular edema of the spinous cell layer.
108.Leong’s premolar
It is also called as Dens evaginatus. It is a cusplike elevation of enamel located in the central
groove or lingual ridge of the buccal cusp of premolar or molar teeth. The accessory cusp
normally consists of enamel and dentin, with pulp.
109.Lead poisoning
It is also called plumbism. Oral manifestations include ulcerative stomatitis and a gingival lead
line (Burton’s line), Tremor of the tongue on thrusting, Advanced periodontal disease,
Excessive salivation, and Metallic taste.
110.Linea Alba
A soft linear streak of hyper keratinized reactive tissue on the buccal mucosa along the occlusal
line. The line may be formed by irritation from rough buccal cusps, bruxism or habitual
clenching of teeth.
111.Lipoma
A benign neoplasm of normal fat cells that appears as a soft, movable swelling, often with a
slight yellowish coloration. The buccal mucosa and buccal vestibule are the most common
intraoral sites.The tumor is usually well circumscribed and may demonstrate a thin fibrous
capsule. A number of microscopic variants like fibrolipoma, angiolipoma, intramuscular lipoma,
pleomorphic lipoma are present.
112.Lipschütz' bodies:
Histologically intra nuclear inclusions in a herpes simplex infected cell are termed as lipschutz
bodies.
113.Liesgang rings of calcification
Calcifications, which are a distinctive feature of calcifying epithelial odontogenic tumor,
develop within the amyloid-like material and form concentric rings (Liesegang ring
calcifications).These tend to fuse and form large, complex masses.
114.Macroglossia
A developmental or acquired disorder where the tongue is larger than normal. The most
frequent causes are vascular malformations and muscular hypertrophy.
115.McCune-Albright syndrome
A syndrome characterized by polyostotic fibrous dysplasia of the skeletal system, cafe-au-lait
spots, and endocrine dysfunction.
116.Median mandibular cyst
A developmental fissural cyst of questionable origin in the anterior midline of mandible arising
from epithelium entrapped within the mandible during its fusion in embryonic life.
117.Median rhomboid glossitis
It is also called as Central papillary atrophy of tongue.A form of erythematous candidal
infection in the central part of the dorsum of tongue. Presents as a well demarcated
erythematous zone that is often asymptomatic.
118.Melanoma
A common malignant neoplasm of melanocytes occurring on skin and mucosal surfaces. The
“ABCDE” Clinical Features of Melanoma are Asymmetry, Border irregularity, Color variation,
Diameter greater than 6 mm, Evolving.
119.Mesiodens
A supernumerary tooth located between the maxillary central incisors, usually termed a
mesiodens. It is conically shaped extra tooth present in the midline of the anterior palate.
120.Mikulicz’s disease
A bilateral painless swelling of the lacrimal and salivary glands with an intense lymphocytic
infiltrate, with destruction of acini and ductal cells becoming hyperplastic.
121.Mikulicz’s syndrome
The cases of parotid and lacrimal enlargement secondary to other diseases like tuberculosis,
sarcoidosis, and lymphoma is termed as Mikulicz syndrome.
122.Miller’s liquefaction foci
Foci are formed by focal coalescence and breakdown of few dentinal tubules in dental caries
and liquefaction focus is an ovoid area of destruction parallel to course of dentinal tubule filled
with necrotic debris that increases by expansion. This expansion compresses and distorts the
normal dentinal tubules.
123.Millian sign:
Erysipelas. Involvement of the ear (Milian's ear sign) is a distinguishing feature for erysipelas
since this region does not contain deeper dermis tissue.
124.Moeller’s glossitis
It is the condition of tongue seen in pernicious anemia. The tongue appears redder because of
atrophy of the papillae. The resultant smooth, red appearance has been referred to as
Moeller’s glossitis or Hunter’s glossitis.
125.Moth eaten appearance:
It is the radiographic appearance with irregular bony margins resembling moth eaten pattern.
It is seen in chondrosarcoma, multiple myeloma, and osteomyelitis.
126.Mulberry molars
Altered posterior teeth in congenital syphilis are termed mulberry molars and demonstrate
constricted occlusal tables with a disorganized surface anatomy that resembles the bumpy
surface of a mulberry.
127.Multiple myeloma
A relatively plasma cell malignancy with multiple bony lesions occurring often in old aged with
pathological fractures, radiographically punched out radiolucency and histopathologically as
sheet of round blue cell and amyloid deposits.
128.Mumps
An endemic paramyxovirus infection affecting bilateral, salivary glands, spreading through
respiratory droplets often in children occurring with fever and malaise. The complications
include
epididymo-orchitis and meningocephalitis.
129.Munro abscess
A collection of neutrophils inside the epithelium is called as Munro’s abscess and observed in
Psoriasis.
130.Myxoma
An aggressive intraosseous lesion derived from embryonic connective tissue associated with
odontogenesis and primarily consisting of a mucoid ground substance with widely scattered
undifferentiated spindled mesenchymal cells.
131.Nasolabial cyst
A developmental fissural cyst of the soft tissue of the anterior muco-buccal fold beneath the
ala of the nose or in the upper lip, most likely derived from remnants of the inferior portion of
the nasolacrimal duct.
132.Nasopalatine duct cyst
An intraosseous developmental fissural cyst of the midline of the anterior palate, derived from
the islands of epithelium remaining after closure of the embryonic nasopalatine duct. The
lesion presents as a heart shaped radiolucent area between maxillary central incisors in a
radiograph.
133.Neurofibroma
A common type of peripheral nerve neoplasm, occurring as demarcated or diffuse benign
proliferation of perineural fibroblasts that are oriented in either a random pattern with a
myxoid background or a nodular (plexiform) pattern.
134.Nevus
A benign, exophytic, usually pigmented, congenital lesion of the skin or mucosa composed of
focal collections of rounded melanocytes; a mole. It may be flat or elevated, pigmented or
nonpigmented, and may or may not contain hair.
135.Nikolsky's sign
A clinical sign observed some bullous diseases, such as pemphigus vulgaris and bullous
pemphigoid where the superficial epithelium separates easily from the basal layer on exertion
of firm sliding manual pressure.
136.Odontoma
They are common developmental hamartoms of odontogenic in origin. They are found in
children and young adult as painless swelling composed of multiple small tooth like structure
(compound) or conglomerate mass of enamel and dentin (Complex).
137.Oligodontia
Absence of six or more teeth than the normal number of teeth.
138.Onion skin appearance
The periosteal reaction in proliferative periostitis resembles the skin of onion radiographically.
Such an appearance is also evident in ewing’s sarcoma.
139.Ossifying fibroma
A well-demarcated fibro-osseous lesion, encapsulated, expansile intraosseous lesion of the
jaws composed of cellular fibrous tissue containing spherical calcifications and irregular,
randomly oriented bony structures.
140.Oil drop sign:
Psoriasis. A translucent discolouration in the nail bed that resembles a drop of oil beneath the
nail plate.
141.Osteoma
An exophytic nodular growth of dense cortical bone on or within the mandible or maxilla in
locations other than those occupied by tori or exostoses. Osteomas of the jaws may arise on
the surface of the bone, as a polypoid or sessile mass (periosteal, peripheral, orexophytic
osteoma), or they may be located in the medullary bone (endostealor central osteoma).
142.Papilloma
A benign exophytic papillary growth of stratified squamous epithelium. Most common
epithelial pathology. Often caused by Papilloma virus.
143.Papillon Lefevre syndrome
An autosomal recessive disorder characterized by severe destructive periodontal disease
affecting both the primary and permanent dentitions and hyperkeratosis of the palms of the
hands and soles of the feet due to an immune defect.
144.Pellagra
Niacin deficiency causes pellagra. The classic signs and symptoms include the triad of
dermatitis, dementia, and diarrhea.The oral manifestations have been described as stomatitis
and glossitis, with the tongue appearing red, smooth, and raw.
145.Port wine stain
A unique type of Hemangioma consisting of superficial and deep dilated capillaries in the skin
which produces reddish to purplish discoloration of the surface skin.
146.Plumbism
It is also called lead poisoning. Oral manifestations include ulcerative stomatitis and a gingival
lead line (Burton’s line), Tremor of the tongue on thrusting, Advanced periodontal disease,
Excessive salivation, and Metallic taste.
147.Plummer- Vinson syndrome
In addition to iron deficiency, the Plummer-Vinson
(Paterson-Kelly) syndrome includes dysphagia, atrophy of the upper alimentary tract, and a
predisposition to the development of oral cancer.
148.Proteolytic – chelation theory
It states that Dental caries is a simultaneous process of microbial degradation of organic
components and dissolution of minerals by chelation that is independent of pH.
149.Proteolytic theory
It states that dental caries initiates at the organic or protein elements through which bacteria
enters and cause the lyses of soft and hard tissues of teeth.
150.Pulp stones:
The pulp stones are again of two kinds, true and false.True denticles: they are the localized
mass of calcified material which resembles the secondary dentin in their microscopic tubular
structure. They commonly occur in pulp chamber. False denticles: they are the localized mass
of calcified material which is formed by concentric layers or lamellar type of deposition around
a central nidus. They usually differ from true denticles that they are larger than them and they
occupy entire pulp chamber.
151.Pyogenic granuloma
A benign reactive lesion restricted to gingiva characterized by a fast-growing proliferation of
endothelial cells and usually in response to chronic irritation.
152.Pyronine bodies
They are clusters of lightly basophilic particles in association with plasmacytic infiltrate in
periapical granuloma.
153.Ptyalism
It is also called as hypersalivation. The causes are oral infections like ANUG, oral wounds,
dental procedures, new dentures, nausea, acid regurgition (reflux esophagitis),Iodine & Heavy
metal poisoning.
154.Rampant Caries
A rapidly spreading type of caries commonly seen in bottle feeding children occurring in areas
that is less prone for caries. They are called early childhood caries. Common teeth being
affected are maxillary incisors.
155.Radiation caries
Radiation therapy induces dental caries. The cause is the shift of the pH of saliva into the acidic
range and reduction in its buffering capacity. Radiation caries occurs at CEJ of the buccolabial
surfaces, locations normally resistant to caries. This pattern of caries often leads to amputation
of the crowns.
156.Ramsay Hunt syndrome
It is a combination of cutaneous vesicular lesions of herpes zoster of external auditory canal
with involvement of ipsilateral facial paralysis and auditory nerves.
157.Raynaud’s phenomenon
A phenomenon exhibited by persons exhibited to cold. The initial clinical sign is a dramatic
blanching of the digits, which appear dead-white in color as a result of severe vasospasm. A
few minutes later, the affected extremity takes on a bluish color because of venous stasis. After
warming, increased blood flow results in a dusky-red hue with the return of hyperemic blood
flow. This may be accompanied by varying degrees of throbbing pain.
158.Reed- Sternberg cells
They are the characteristic typically binucleated (owl eye nuclei) or multinucletated (pennies
on plate) with prominent nucleoli in Hodgkins lymphoma.
159.Regional odontodysplasia
A developmental disturbance of several adjacent teeth in which the enamel and dentin are thin
and irregular and fail to adequately mineralize; surrounding soft tissue is hyperplastic and
contains focal accumulations of spherical calcifications and odontogenic rests.
160.Riga- Fede disease
A chronic type of traumatic ulceration that is histopathologically unique exhibiting a deep
pseudoinvasive inflammatory reaction with high number of eosinophilia.The Lesion is seen in
nursing babies when lower teeth erupt to cause ulcerations at the ventral surface of tongue
and rarely on dorsal surface by the maxillary incisors.
161.Rootless teeth
A hereditary defect in dentin formation in which the coronal dentin and tooth color is normal;
the root dentin is abnormal with a gnarled pattern and associated shortened and tapered
roots.
162.Russell bodies
They are scattered eosinophilic globules of gamma globulin secreted by numerous plasma cells
seen microscopically in periapical granuloma.
163.Rushton bodies
The lining epithelium of lateral radicular cyst may demonstrate linear or arch-shaped
calcifications known as Rushton bodies.
164.Schaumann bodies
The granulomatous inflammation of sarcoidosis contains a laminated basophilic calcifications
called as schaumann bodies. They are degenerated lysosomes.
165.Schwannoma
It is well-demarcated, benign neural lesion consisting of a fibroblastic proliferation of the nerve
sheath cell (Schwann cell) producing distinctive patterns referred to as Antoni A, Antoni B
tissue and Verocay bodies.
166.Scrofula
A form of tuberculosis spread through infected milk presenting as an enlargement of
oropharyngeal lymphoid tissue with cervical lymph node involvement.
167.Scurvy
It is the other name for vitamin C deficiency. The clinical signs of scurvy are typically related to
inadequate collagen synthesis. The oral manifestations include generalized gingival swelling
with spontaneous hemorrhage, ulceration, tooth mobility, and increased severity of
periodontitis and periodontal bone loss.
168.Scleroderma
A rare immunologically mediated dermatologic abnormality leading to Raynaud’s phenomenon
or CREST syndrome with skin developing a diffuse, hard texture with a smooth surface.
169.Shell teeth
In severe form of dentinogenesis imperfecta, due to pulpal enlargement, the dentin appears
thin and the pulp chambers and root canals extremely large, giving the appearance of thin
dentin shells—hence they are called shell teeth.
170.Sialolithiasis
It refers to calcified structures that develop within the salivary ductal system of major and
minor salivary glands, by deposition of calcium salts around a nidus of debris within the lumen.
The chief complaints are pain and swelling. Sialoliths can be removed by manual manipulation
of the stone through the major duct orifice. When manual maneuvers fail, a surgical cut-down
into the main duct is needed.
171.Sialadenitis
Refers to the inflammation of salivary glands that can arise from various infectious & non-
infectious cause. The most common cause being mumps. Others are mucocele & bacterial
infections.
172.Sphenopalatine neuralgia
It is a paroxysmal intense painful condition affecting the mid and upper face of unknown
etiology. The pain attacks over a period of few weeks followed by period of remission to recur.
173.Stafne cyst or Stafne defect
A developmental concavity of the lingual cortex of the angle of mandible, caused by
overextension of an accessory lateral lobe of the submandibular gland, and has the
radiographic appearance of a well-circumscribed cystic lesion within the bone, usually below
the inferior alveolar canal.
174.Stevens-Johnson syndrome
A severe form of erythema multiforme triggered by a drug reaction often involving the ocular,
genital mucosa in conjunction with oral and skin lesion.
175.Struge – Weber syndrome
A specific syndrome is sometimes identified with unilateral port-wine stains on the face when
the individuals also have intracranial hemangiomas and epilepsy. This istermed
encephalotrigeminal angiomatosis,also referred to as Sturge-Weber syndrome.
176.Starry sky appearance
A characteristic histological appearance of Burkett’s lymphoma. The presence of macrophages
in the tumor appear as stars against the deeply hyperchromatic neoplastic lymphoid cells.
177.Sun ray appearance
Radiographic appearance of osteosarcoma. The tumor shows sunburst kind of trabeculation of
tumor. It is also seen in intraosseous hemangioma.
178.Swiss cheese pattern
The histological appearance of tumor cells in adenoid cystic carcinoma resemble Swiss cheese
and hence it is termed as Swiss cheese patterned microscopic appearance.
179.Talon cusp
A developmental defect in the shape of teeth. It is a form of supernumerary cusp which arises
from the cingulum portion of the tooth and extends to the incisal edge as a prominent
projection of enamel that imparts a T shape, usually of incisors and canine.
180.Target lesion
A concentric circular erythematous rings resembling a targets or bull’s eye as observed in the
immunologically mediated erythema multiforme.
181.Taurodontism
A developmental abnormality of a malformed multirooted tooth characterized by an altered
crown-to-root ratio, the crown being of normal length, the roots being abnormally short, and
the pulp chamber being abnormally large.
182.Teratoma
A developmental tumor composed of tissue from all three germ layers and believed to arise
from germ cells or entrapped totipotent blastomeres.
183.Thistle tube appearance
The permanent teeth demonstrate normal clinical coloration; however, radiographically, the
pulp chambers exhibit significant enlargement and apical extension. This altered pulpal
anatomy has been described as thistle tube–shaped or flame-shaped.
184.Torus palatinus:
An exophytic nodular growth of dense cortical bone located on the midline of the hard palate.
Growths commonly consist of four evenly spaced lobes composed of dense bone with a thin
layer of mucosa tightly stretched over the surface. Larger tori interfere with speech, placement
of prosthetic appliances, and oral hygiene maintenance and may develop nonhealing ulcers
that progress to chronic osteomyelitis.
185.Torus mandibularis
An exophytic nodular growth of dense cortical bone located in the cuspid and premolar area of
the lingual mandible. It is commonly found bilaterally. Larger growths may interfere with
tongue movement, oral hygiene maintenance, and the ability to wear an intraoral prosthesis.
186.Traumatic bone cyst
It is an asymptomatic intraosseous empty cavity of young patients located primarily within the
jaw bone. It is lined by a thin loose connective tissue membrane and is adequately treated
when blood enters the space during an intraosseous biopsy.
187.Traumatic neuroma
A benign painful nodular proliferation of nerve and fibrous tissue of the nerve sheath resulting
from the futile attempt of nerve fibers to reunite with their severed distal portion due to a
trauma.
188.Turner’s hypoplasia or Turner’s tooth
Enamel hypoplasia of a single tooth, most commonly one of the permanent maxillary incisors
or a maxillary or mandibular premolar, resulting from local infection or trauma. Such tooth are
called turner’s tooth.
189.Tzanck cells
The acantholytic epithelial cell with nucleolar fragmentation with condensation of chromation
around the periphery of the nucleus. They are seen in viral infection like herpes and pemphigus
vulgaris.
190.Verocay bodies
In neurilemoma, the neural tissue is regularly arranged in streaming fascicles of schwan cells
which form a palisaded arrangement around central, acellular, eosinophilic areas called as
verocay bodies.
191.Verrucous hyperplasia
The papillary exophytic proliferation with increase in thickness of epithelium in a
hyperkeratotic whitish unscrappable patch is referred as verrucous hyperplasia.
192.Von Recklinghausen´s disease
An autosomal dominant hereditary condition with a mutation in 17q11.2 with an abnormal
neurofibrin, presenting as multiple neurofibromas of the skin and mucosa and associated café
au lait spots of the skin with the potential for producing disfigurement and malignant
transformation.
193.White sponge nevus
It is relatively rare autosomal dominant hereditary condition in which the oral mucosa has a
pearly white, thickened and folded appearance. White sponge nevus, also termed white-folded
gingivostomatitis, oral epithelial nevus, and Cannon disease.
194.Wickham’s striae
The most common type of Lichen planus is the reticular form, which is characterized by
numerous interlacing white keratotic lines or striae (so-called Wickham’s striae) that produce
an annular or lacy pattern.