Contents

1. Microscope 1Shubhangi Mhaske (Jedhe)

Definition of Microscope 1; History of Microscope 1; Simple Microscope 3;Compound Microscope 3; Parts of Microscope 3; Image Formation in Microscope 10; Specialized Microscopy Techniques 11; Maintenance of Laboratory Microscope 19

2. Tissue processing MeThods 22Shubhangi Mhaske (Jedhe), Avadhoot Avadhani

Introduction and Terminology 22; Gross Examination 22; Preparation of Tissue Specimen for Histological Staining 23; Routine Method for Histological Study 25; Study of Hard Tissues 30; Frozen Sections 32; Staining of Cut Sections 32; Mounting 33; Artifacts in Histological Sections 33

3. hisTological sTaining MeThods 36Shubhangi Mhaske (Jedhe), Amol Gadbail

Chemistry of Stains 36; Classification of Stains 37; Theories of Staining 38; Vital Staining 39; Factors Affecting Staining 39; Staining Procedure 40; Hematoxylin and Eosin Stains 40; Special Stains 42; Gordon and Sweets’ Method for Reticulin Fibers 43

4. diagnosTic paThology 47Shubhangi Mhaske (Jedhe), Pradnya Lele

Biopsy 47; Types of Biopsy Procedures 48; Exfoliative Cytology 51; Oral Mucosal Brush Biopsy 54; Liquid Based Cytology 55; Fine Needle Aspiration Cytology 55; Frozen Section Biopsy 56

5. advanced diagnosTic Techniques 57Shubhangi Mhaske (Jedhe), Monal Yuwanati

Histochemical Techniques 57; Fixation in Histochemistry 57; Enzyme Histochemistry 58;Immunohistochemical Methods 58; Immunofluorescent Techniques 59;Flow Cytometry 61; Polymerase Chain Reaction 61; Hybridization Methods 62;Laser Captures Microdissection 63; Proteomics 63; Cytogenetics 64

6. healing of Wound 68Shubhangi Mhaske (Jedhe)

Factors Affecting the Wound Healing 68; Cascade of Wound Healing 72;Healing of Biopsy Wounds 74; Healing of Extraction Wounds 74; Healing of

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Fractures 75; Healing of Osseointegrated Implants 76; Healing of Pulp 76;Cementum 77; Dentin 77; Enamel 77; Skin Healing and Oral Mucosal Wound Healing 77; A Clinical Approach to Optimizing Wound Healing 79

7. hyperplasia, haMarToMa and neoplasM 82Shubhangi Mhaske (Jedhe)

Dysplasia 82; Metaplasia 82; Hyperplasia 82; Hamartoma 83; Choriostoma 84;Neoplasm 85; Carcinogenesis 87; Chemical Carcinogenesis 87; Physical Carcinogenesis 88; Hormonal Carcinogenesis 89; Biologic Carcinogenesis 89;Metastasis 92; Grading and Staging of Tumors 93

8. TeeTh anoMalies 97Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe), Savita Ghom

Disorders of Development of Teeth 97; Scale of Human Tooth Development 98; Disorders of Size of Teeth 98; Disturbances in Shape of Teeth 99; Disorders of Number of Teeth 109; Structure of Teeth 111

9. craniofacial anoMalies 127Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Developmental Anomalies of Jaws 128; Developmental Disorders of Oral Mucosa 138

10. denTal caries 144Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Theories of Cariogenesis 145; Secondary Contributing Factors in Dental Caries 150;Classification 152; Smooth Surface Caries 153; Pit and Fissure Caries 156; Root Caries 158; Recurrent Caries 160; Chemical Measures of Caries Control 164

11. Benign TuMors 167Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Characteristics of Benign Tumor 168; Classification of Benign Tumor 168; Epithelial Origin 168; Fibrous Connective Tissue 178; Cartilage 184; Adipose Tissue 186;Bone 189; Vascular Tissue 196; Neural Tissue 203; Muscle 211; Giant Cell Lesion 213

12. preMalignanT lesions and condiTions 219Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Concept of Precancer 219; Terminology and Definitions 219; Leukoplakia 220;Erythroplakia 229; Carcinoma in situ 231; Oral Lesion Associated with use of Tobacco 233; Lichen Planus 235; Oral Submucous Fibrosis 243; Dyskeratosis Congenita 249; Lupus Erythematosus 250

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13. MalignanT TuMors 255Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe), Ashok Mhaske

Classification 256; Etiology and Risk Factors for Oral Cancer 256; Risk Factors 258;Epithelial Tumors 258; Metastatic Carcinoma 266; Basal Cell Carcinoma 267;Adenosquamous Carcinoma 269; Basaloid Squamous Carcinoma 269; Sinonasal Undifferentiated Carcinoma 270; Verrucous Carcinoma 271; Transitional Cell Carcinoma 273; Malignant Melanoma 273; Spindle Cell Carcinoma 277;Adenoid Squamous Cell Carcinoma 277; Nasopharyngeal Carcinoma 278; Merkel Cell Carcinoma 279; Fibrous Connective Tissue 279; Malignant Fibrous Histiocytoma 282;Synovial Sarcoma 282; Adipose Tissue 283; Cartilage 284; Mesenchymal Chondrosarcoma 287; Bone 287; Ewing’s Sarcoma 289; Vascular 291; Neural Tissue 292; Muscle 294

14. odonTogenic TuMors 299Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Classification of Odontogenic Tumors 299; Development of Tooth 301; Stages of Tooth Development 301; Ameloblastoma 303; Variant of Ameloblastoma 313;Squamous Odontogenic Tumor 317; Calcifying Epithelial Odontogenic Tumor 318;Adenomatoid Odontogenic Tumor or Cyst 321; Mixed Odontogenic Tumors 325;Continuum Concept (Cahn and Blum) 325; Ameloblastic Fibroma 326;Ameloblastic Fibrodentinoma 328; Ameloblastic Fibro-odontoma 328; Odontoma 329;Odontoameloblastoma 331; Odontogenic Fibroma 332; Granular Cell Odontogenic Tumor 333; Odontogenic Myxoma 333; Malignant Tumors 335

15. cysT of orofacial region 342Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Classification 343; Theories of Cyst Enlargement 343; Dentigerous Cyst 345;Eruption Cyst 349; Odontogenic Keratocyst 350; Primordial Cyst 355; Gingival Cyst of Newborn 355; Gingival Cyst of Adult 356; Lateral Periodontal Cyst 357; Glandular Odontogenic Cyst 358; Calcifying Epithelial Odontogenic Cyst 359; Inflammatory Radicular Cyst 361; Residual Cyst 364; Inflammatory Collateral Cyst 365; Paradental Cyst 365; Mandibular Buccal Infected Cyst 366; Suppurating Cyst 366; Healing Cyst 366; Nonodontogenic Cysts 366; Median Palatine Cyst 368; Nasoalveolar Cyst 369; Median Mandibular Cyst 370; Globulomaxillary Cyst 370; Nonepithelial Cysts 370; Aneurysmal Bone Cyst 371; Cysts of the Maxillary Sinus 372; Antral Pseudocyst 374; Retention Cyst 374; Soft Tissue Cyst 374; Branchial Cleft Cyst 376; Oral Lymphoepithelial Cyst 376; Thyroglossal Duct Cyst 377; Anterior Median Lingual Cyst 377; Oral Cyst with Gastric or Intestinal Epithelium 377; Cystic Hygroma 377; Follicular Cysts of the Skin 378; Nasopharyngeal Cyst 378; Thymic Cyst 378; Cysts of Salivary Glands 378; Parasitic Cyst 378; Cysticercosis Cellulose 379; Syndromes Associated with Odontogenic Cysts 380; Treatment of Cysts 381

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16. periodonTal paThology 386Vivek Thombre, Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Fibromatosis Gingiva 386; Retrocuspid Papilla 388; Gingival Inflammation or Gingivitis 388; Necrotizing Ulcerative Gingivitis 391; Desquamative Gingivitis 392;Plasma Cell Gingivitis 393; Granulomatous Gingivitis 394; Gingival Abscess 394;Pericoronal Abscess 395; Chronic Inflammatory Enlargement 396; Gingival Enlargement due to Drugs 397; Pregnancy Tumor 398; Granuloma Pyogenicum 399;Periodontal Pockets 401; Adult Periodontitis 402; Rapidly Progressive Periodontitis 402;Aggressive Periodontitis/Juvenile Periodontitis 403; Papillon-Lefevre Syndrome 405;Haim-Munk Syndrome 406

17. salivary gland paThology 409Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Classification of Salivary Gland Disorders 410; Development of Salivary Gland 410; Major Salivary Glands 411; Aberrancy 412; Aplasia and Hypoplasia 412; Hyperplasia of Salivary Gland 413; Atresia 413; Accessory Duct 414; Diverticuli 414; Sialorrhea 414; Xerostomia 414; Sialolithiasis 415;Strictures and Stenosis 417; Mucocele (Mucous Extravasation Phenomenon) 417; Salivary Duct Cyst or Mucus Retention Cyst 419; Ranula 419; Sialosis (Sialadenosis) 420;Allergic Sialadenitis 421; Mumps 421; Cytomegalovirus Inclusion Disease 422;Bacterial Sialadenitis 422; Sjögren’s Syndrome 424; Mikulicz’s Disease or Benign Lymphoepithelial Lesion 427; Uveoparotid Fever 428; Tumors of Salivary Glands 428; Histogenesis 428; Theories of Salivary Gland Tumor Histogenesis 429; General Features of Salivary Gland Tumors 429;Clinical Staging of Salivary Gland Tumors 429; Pleomorphic Adenoma 430;Basal Cell Adenoma 433; Canalicular Adenoma 434; Warthin’s Tumor 435;Oncocytoma 437; Myoepithelioma 438; Ductal Papillomas 438; Mucoepidermoid Carcinoma 440; Central Mucoepidermoid Carcinoma 444; Acinic Cell Adenocarcinoma 444; Adenoid Cystic Carcinoma 445; Polymorphous Low-Grade Adenocarcinoma 447; Malignant Mixed Tumor 448; Connective Tissue Tumors 449; Necrotizing Sialometaplasia 450

18. BacTerial infecTion 453Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Impetigo 453; Erysipelas 454; Syphilis 455; Gonorrhea 460; Leprosy (Hansen Disease) 462; Tuberculosis 465; Actinomycosis 468; Noma 471; Scarlet Fever 472;Diphtheria 473; Tularemia 474; Rhinoscleroma 474; Granuloma Inguinale 475; Oral Manifestations 475; Streptococcal Tonsillitis and Pharyngitis 476; Tonsillar Concretion and Tonsillolithiasis 476; Lymphogranuloma Venereum 476; Myiasis 477; Cat Scratch Disease 478; Pyostomatitis Vegetans 479; Sinusitis 479

19. fungal or MyocoTic infecTion 484Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Candidiasis 484; Oral Candidiasis 486; Chronic Mucocutaneous Candidiasis 491;Forms of Candidiasis 491; Histoplasmosis 492; Blastomycosis 493; Mucormycosis 495;

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Cryptococcosis 496; Coccidioidomycosis 497; Geotrichosis 498; Sporotrichosis 498;Rhinosporidiosis 499; Aspergillosis 500; Paracoccidioidomycosis 501;Toxoplasmosis 502; Leishmaniasis 502; Trichinosis 503

20. viral infecTion 505Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Human Herpes Virus 505; Herpes Simplex Infection 505; Measles 509; Varicella Zoster Infection 510; Herpes Zoster 512; James Ramsey Hunt Syndrome 514; Rubella 514;Enteroviruses 514; Foot and Mouth Disease 516; Condyloma Acuminatum 517;Verruca Vulgaris 518; Focal Epithelial Hyperplasia 518; Molluscum Contagiosum Infection 519; Cytomegalovirus Infection 520; Infectious Mononucleosis 521

21. acquired iMMunodeficiency syndroMe 524Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Classification 525; AIDS Related Complex 526; Prevalence 526; Characteristic of HIV Virus 527; Clinical Features 527; Oral Manifestations 528; Uncommon Oral Manifestation of HIV 534; Diagnostic Tests 536; Screening Test for AIDS 536;Management 537; Prevention 538

22. odonTogenic infecTion and pulp paThology 540Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe), Seema Vaidya

Effect of Infection on Host 541; Pathophysiology of Infection 541; Pulp 542;Classification of Pulpitis 542; Pulpitis 542; Pulp Degeneration 545; Pulp Calcifications 546; Necrosis of Pulp 548; Cracked Tooth Syndrome 549; Periapical Abscess 549; Periodontal Abscess 551; Acute Exacerbation of a Chronic Lesion 552;Periapical Granuloma 553; Osteomyelitis 555; Acute Suppurative Osteomyelitis 557;Chronic Suppurative Osteomyelitis 559; Infantile Osteomyelitis 560; Synovitis, Acne, Pustulosis, Hyperostosis and Osteomyelitis Syndrome 562; Chronic Recurrent Multifocal Osteomyelitis 563; Cellulitis 565; Ludwig’s Angina 566; Fatal Complications of Oral Infection 568; Oral Foci of Infections 571; Dry Socket 573

23. Bone disease ManifesTed in JaW 576Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe), Pranoti Pradhan

Fibro-osseous Lesions 576; Classification 576; Fibrous Dysplasia 577; Cherubism 580;Central Giant Cell Granuloma 582; Paget’s Disease 584; Familial Gigantiform Cementoma 587; Ossifying Fibroma, Cementifying Fibroma and Cemento-ossifying Fibroma 588; Juvenile Ossifying Fibroma 590; Osteoporosis 591; Infantile Cortical Hyperostosis 593; Osteopetrosis 594; Osteogenesis Imperfecta 596; Pierre Robin Syndrome 597; Marfan’s Syndrome 597; Down’s Syndrome 598; Achondroplasia 599;Osteosclerosis 600; Massive Osteolysis 600; Gardner’s Syndrome 601

24. diseases of lip 604Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Classification of Lip Disorders 604; Anatomy 604; Developmental Disturbance of Lip 605; Cheilitis 610; Etiology 610; Miscellaneous 617

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25. Tongue disorders 619Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Embryology of Tongue 619; Anatomy of Tongue 620; Papillae 620; Muscle 621;Arterial Supply 621; Venous Drainage 621; Nerve Supply 621;Lymphatic Drainage 622; Functions of Tongue 622; Classification of Tongue Disorders 623; Aglossia and Microglossia 623; Macroglossia 624;Ankyloglossia 625; Cleft Tongue 626; Ankyloglossum Superius Syndrome 626; Lingual Varicosities 627; Lingual Thyroid Nodule 627; Variations in Tongue Movement 628;Patent Thyroglossal Duct Cyst 628; Lingual Polyp 629; Lingual Cyst 629; Fissured Tongue 629; Median Rhomboid Glossitis 630; Benign Migratory Glossitis 631; Hairy Tongue 633; Crenated Tongue 634; Foliate Papillitis 634; Leukokeratosis Nicotina Glossi 634; Depapillation of the Tongue 635; Dysgeusia and Hypogeusia 637;Dyskinesia 638; Paralysis of Tongue 638; Squamous Cell Carcinoma 639;Pigmentation of Tongue 640

26. TeMporoMandiBular JoinT paThology 643Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Coronoid Hyperplasia 643; Condylar Hyperplasia 643; Condylar Hypoplasia 644;Bifid Condyle 645; Osteoarthritis 645; Rheumatoid Arthritis 646;Ankylosis 648; Subluxation (Hypermobility) 650; Gout 651; Synovial Chondromatosis 652; Temporomandibular Joint Dysfunction 652

27. cheMical and physical inJuries 655Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Linea Alba 655; Habitual Cheek or Lip Biting 656; Traumatic Ulcer 657; Electrical and Thermal Burns 658; Anesthetic Necrosis 659; Chemical Burns 659; Smoker Melanosis 661; Drug Induced Discoloration of Oral Mucosa 661; Cutright Lesion 662; Traumatic Sequestration 662; Methamphetamine Abuse Lesion 663; Submucosal Hemorrhage 663; Oral Lesion as Complication to Anti-Neoplastic Therapy (Non-Infectious) 664; Cervicofacial Emphysema 665;Myospherulosis 666; Attrition 666; Abrasion 668; Erosion 669; Abfraction 670;Dentinal Sclerosis 671; Secondary and Tertiary Dentin 671; Resorption of Teeth 672;Hypercementosis 675; Cementicles 676; Bruxism 676; Traumatic Lesion Due Sexual Habit 678; Oral Piercing and other Body Modification 679;Fracture of Teeth 680; Amalgam Tattoo 681; Bismuthism 681; Plumbism 682;Mercurialism 683; Argyria 684; Arsenism 685 Auric Stomatitis 685; Inflammatory Fibrous Hyperplasia 685; Inflammatory Papillary Hyperplasia 686; Epulis Granulomatosum 687; Nodular Fasciitis 688; Uremic Stomatitis 688; Traumatic Keratosis 689; Bisphosphonates Associated Osteonecrosis 689

28. Blood paThology 693Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Disease of Lymph Tissue 693; Disease of Red Blood Cells 694; White Blood Cell Disorders 705; Disease of Platelet 708; Disease due to Clotting Defect 710; Dysfibrinogenemia 713; Macroglobulinemia 714; Malignancy Involving

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Blood Tissue 714; Primary Reticular Cell Sarcoma 717; Mycosis Fungoides 718;Burkitt’s Lymphoma 718; Chronic Myeloid Leukemia 723; Chronic Lymphatic Leukemia 724; Multiple Myeloma 725; Plasmacytoma 727; Extranodal NK/T-Cell Lymphoma 728

29. skin disorders 731Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Erythema Multiforme 731; Pemphigus 734; Paraneoplastic Pemphigus 737;Bullous Pemphigoid 737; Benign Mucous Membrane Pemphigoid 738; Familial Benign Chronic Pemphigus 740; Dermatitis Herpetiformis 742; Pityriasis Rosea 743; Incontinentia Pigmenti 743; Acanthosis Nigricans 744; Ehlers Danlos Syndrome 745; Psoriasis 746; Pachyonychia Congenita 747; Porokeratosis 748;Keratosis Follicularis 749; Warty Dyskeratoma 750; Seborrheic Keratosis 750;Hereditary Mucoepithelial Dysplasia 751; Pseudoxanthoma Elasticum 751; Hyalinosis Cutis Et Mucosa Oris 752; White Sponge Nevus 753; Hereditary Benign Intraepithelial Dyskeratosis 754; Hereditary Hemorrhagic Telangiectasia 754; Peutz-Jeghers Syndrome 755; Ephelis 755; Actinic Lentigo 756; Lentigo Simplex 756; Sebaceous Hyperplasia 756; Xeroderma Pigmentosum 757; Tuberous Sclerosis 757; Ectodermal Dysplasia 758; Cowden Syndrome 760; Graft versus Host Resistance 760; Crest Syndrome 761; Scleroderma 761; Kawasaki Disease 763

30. allergic and iMMunologic diseases of oral caviTy 766Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Introduction/Overview 766; Hypersensitivity Reaction 766; Wegner’s Granulomatosis 767; Sarcoidosis 769; Drug Allergy 770; Allergic Contact Stomatitis 771; Secondary Vaccinia 772; Angioedema 773; Aphthous Stomatitis (Recurrent Aphthous Ulcers (RAUs) or Canker Sores) 774; Behçet’s Syndrome 776;Transient Lingual Papillitis 777; Perioral Dermatitis 778; Reiter’s Syndrome 778;Lichenoid Contact Stomatitis/Lichenoid Tissue Reaction 779; Chronic Ulcerative Stomatitis 781; Crohn’s Disease 782

31. endocrine disorders 784Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Anatomy and Physiology 784; Diseases of Pituitary Gland 785; Progeria 788;Hyperthyroidism 788; Hypothyroidism 790; Hyperparathyroidism 791;Hypoparathyroidism 793; Pseudohypoparathyroidism 793; Diabetes Mellitus 794;Addison’s Disease 796; Adrenogenital Syndrome 797; Melasma 797; Cushing’s Syndrome 797

32. nuTriTion and oral caviTy 800Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Disturbances in Protein Metabolism 800; Disturbances in Lipid Metabolism 804; Disturbances in Carbohydrate Metabolism 807; Disturbances in Mineral Metabolism 809; Miscellaneous Disorders 811; Fat Soluble Vitamins 821;Disorders of Bilirubin 825

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33. neuroMuscular disorders and orofacial pain 830Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe)

Muscle Disorders 830; Neuromuscular Disorders 834; Facial Pain 839

34. forensic odonTology 849Anil Govindrao Ghom, Savita Ghom

Record Management 849; Identification 850; Dental Evaluation 850; Personal Recognition 853; Fingerprinting 853; Physical Anthropologic Examination of Bones and Teeth 853; Postmortem Serology and DNA Profiling 854; Bite Marks 854; Human Abuse 858; Dentist as Expert Witness 859

35. syndroMes of The orofacial region 860Shubhangi Mhaske (Jedhe)

Syndromes Associated with Craniofacial Anomalies of Genetic Origin 862; Syndromes Associated with Skin and Pigmentation 868; Broad Groups of Pigmentary Disorders 871;Syndromes Associated with Salivary and Lacrimal Glands 872; Syndromes Affecting Teeth 873; Syndromes Associated with Lips and Cheek 875; Syndromes Associated with Tongue 876; Syndromes Associated with Gingiva 877; Syndromes Associated with Nerves 878; Syndromes Associated with Blood 880; Syndromes Associated with Vascular Malformations 882; Syndromes Associated with Immunodeficiency 882; Syndromes Associated with Hormonal Disturbances 883; Syndromes with Benign Oral Neoplastic or Hamartomatous Components 884

appendices 889Appendix I: Differential Diagnosis of Most Common Lesions of Oral Cavity 890Aparna Thombre

Appendix II: Glossary 938Rashmi Ekka

Appendix III: Normal Values of Various Laboratory Parameters 951Smruti Nanda

Appendix IV: Classification Systems of Odontogenic Tumor 953Satish Chhugani

Appendix V: Histology Diagrams of Oral Tissues 978Sangamesh Halawar

Index 1005