Handbook of Oral Pathology and Oral Medicine

Handbook of Oral Pathology and Oral Medicine

S. R. Prabhu BDS; MDS (Oral Path); FFDRCS (Oral Med); FDSRCS(Edin); FDSRCPS (Glas); FDSRCS (Eng), FFGDPRCS(UK); MOMed RCS (Edin); FICD.

Honorary Associate ProfessorSchool of DentistryUniversity of QueenslandBrisbane, Australia

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Library of Congress Cataloging- in- Publication Data applied for[ISBN: 9781119781127]

Cover Design: WileyCover Images: Courtesy of S. R. Prabhu

Set in 9.5/12.5pt STIXTwoText by Straive, Pondicherry, India

10 9 8 7 6 5 4 3 2 1

To the victims of COVID- 19 infection and all those frontline healthcare workers who are engaged in the fight against the disease with utmost courage and dedication.

vii

Contents

Foreword xviiPreface xixAcknowledgements xxiAbout the Companion Website xxiiiNomenclature Used in The Study of Human Disease xxvStandard Abbreviations for Prescribers xxviii

Part I Pathology of Teeth and Supporting Structures 1

1 Disorders of Tooth Development and Eruption 31.1 Anodontia,HypodontiaandOligodontia 31.2 Hyperdontia(SupernumeraryTeeth) 51.3 Microdontiaand Macrodontia 61.4 Gemination,Fusionand Concrescence 71.5 Taurodontismand Dilaceration 91.6 AmelogenesisImperfecta 111.7 DentinogenesisImperfecta 131.8 DentinalDysplasia(DentinDysplasia) 141.9 RegionalOdontodysplasia(GhostTeeth) 161.10 DelayedToothEruption 171.11 ToothImpaction(ImpactedTeeth) 181.12 DensInvaginatusand DensEvaginatus 201.13 Fluorosis(MottledEnamel) 221.14 Tetracycline-InducedDiscolorationof Teeth:KeyFeatures 241.15 EnamelPearl:KeyFeatures 241.16 TalonCusp:KeyFeatures 251.17 Hutchinson’sIncisorsand MulberryMolars:KeyFeatures 261.18 ToothAnkylosis:KeyFeatures 261.19 SupernumeraryRoots:KeyFeatures 27

2 Dental caries 292.1 Definition/Description 292.2 Frequency 29

Contentsviii

2.3 Aetiology/RiskFactors/Pathogenesis 292.4 Classificationof Caries 302.5 ClinicalFeatures 302.6 DifferentialDiagnosis 332.7 Diagnosis 332.8 MicrosopicFeatures 332.9 Management 352.10 Prevention 36

3 Diseases of the Pulp and Apical Periodontal Tissues 373.1 ClassificationofDiseasesofthePulpandApicalPeriodontalTissues 373.2 Pulpitis 383.3 ApicalPeriodontitisand PeriapicalGranuloma 403.4 ApicalAbscess(DentoalveolarAbscess) 433.5 CondensingOsteitis 44

4 Tooth Wear, Pathological Resorption of Teeth, Hypercementosis and Cracked Tooth Syndrome 47

4.1 Toothwear:Attrition,Abrasion,Erosion,andAbfraction 474.2 PathologicalResorptionof Teeth 504.3 Hypercementosis 524.4 CrackedToothSyndrome 53

5 Gingival and Periodontal Diseases 575.1 ClassificationofGingivalandPeriodontalDiseases 585.2 ChronicGingivitis 585.3 NecrotizingPeriodontalDiseases 605.4 PlasmaCellGingivitis 635.5 ForeignBodyGingivitis 645.6 DesquamativeGingivitis 655.7 ChronicPeriodontitis 675.8 AggressivePeriodontitis 705.9 FibrousEpulis(PeripheralFibroma) 735.10 PeripheralOssifying/CementifyingFibroma 745.11 PeripheralGiantCellGranuloma(GiantCellEpulis) 765.12 Angiogranuloma(Pyogenicgranuloma/pregnancyepulis) 775.13 InflammatoryGingivalHyperplasia(InflammatoryGingivalEnlargement) 795.14 GeneralizedGingivalHyperplasiain Pregnancy 815.15 Drug-InducedGingivalHyperplasia 825.16 FamilialGingivalHyperplasia 845.17 Gingivaland PeriodontalAbscesses 865.18 Pericoronitis/PericoronalAbscess 895.19 GingivalEnlargementin Granulomatosiswith Polyangiitis(Wegener’s

granulomatosis) 915.20 GingivalEnlargementin Leukaemia 935.21 GingivalEnlargementin AscorbicAcidDeficiency 95

Contents ix

Part II Pathology of Jaw Bones 99

6 Infections and Necrosis of the Jaw 1016.1 AcuteSuppurativeOsteomyelitis 1016.2 ChronicSuppurativeOsteomyelitis 1046.3 SclerosingOsteomyelitis 1066.4 ProliferativePeriostitis(Garre’sOsteomyelitis) 1086.5 Actinomycosisof theJaw 1096.6 CervicofacialCellulitis(CervicofacialFascialSpaceInfection) 1116.7 Osteoradionecrosisof theJaw 1126.8 Medication-RelatedOsteonecrosisof theJaw 114

7 Cysts of the Jaw 1177.1 Radicular,LateralRadicular,and ResidualRadicularCysts 1177.2 DentigerousCyst 1207.3 EruptionCyst 1227.4 OdontogenicKeratocyst(KeratocysticOdontogenicTumour) 1237.5 LateralPeriodontalCyst 1267.6 CalcifyingOdontogenicCyst 1277.7 OrthokeratinizedOdontogenicCyst:KeyFeatures 1307.8 GlandularOdontogenicCyst:KeyFeatures 1307.9 NasopalatineDuctCyst(IncisiveCanalCyst) 1307.10 Pseudocystsof theJaw:SolitaryBoneCyst,Aneurysmal

BoneCystand Stafne’sboneCyst 1327.11 NasolabialCyst:KeyFeatures 135

8 Odontogenic Tumours 1378.1 WorldHealthOrganizationClassificationofOdontogenicTumours(2017) 1378.2 Ameloblastoma 1388.3 UnicysticAmeloblastoma 1418.4 SquamousOdontogenicTumour 1448.5 CalcifyingEpithelialOdontogenicTumour(PindborgTumour) 1458.6 AdenomatoidOdontogenicTumour 1478.7 AmeloblasticFibroma 1498.8 AmeloblasticFibrodentinomaand AmeloblasticFibro-Odontome 1518.9 Odontome(Odontoma) 1538.10 DentinogenicGhostCellTumour 1558.11 OdontogenicMyxoma 1578.12 OdontogenicFibroma(CentralOdontogenicFibroma) 1598.13 Cementoblastoma 161

9 Non- odontogenic Benign and Malignant Tumours of the Jaw 1659.1 Osteoma 1659.2 MultipleOsteomasin Gardner’sSyndrome 1679.3 CentralHaemangioma(IntraosseousHaemangioma) 1699.4 MelanoticNeuroectodermalTumourof Infancy 171

Contentsx

9.5 Osteosarcoma 1729.6 Chondrosarcoma:KeyFeatures 1749.7 Ewing’sSarcoma 1759.8 Myeloma(MultipleMyeloma) 1779.9 SolitaryPlasmacytoma 1799.10 Burkitt’sLymphoma 181

10 Fibro- Osseous and Related Lesions of the Jaw 18510.1 OssifyingFibroma/Cemento-OssifyingFibroma 18510.2 Cemento-OsseousDysplasias 18710.3 FamilialGigantiformCementoma:KeyFeatures 19010.4 CentralGiantCellGranuloma 191

11 Genetic, Metabolic, and Other Non- neoplastic Bone Diseases 19511.1 OsteogenesisImperfecta 19511.2 CleidocranialDysplasia 19711.3 Cherubism 19911.4 Gigantismand Acromegaly 20111.5 BrownTumourof Hyperparathyroidism 20311.6 Paget’sDiseaseof Bone(OsteitisDeformans) 20511.7 FibrousDysplasiaandMcCune–AlbrightSyndrome 20711.8 Mandibularand PalatineTori:KeyFeatures 21011.9 FocalOsteoporoticBoneMarrowDefect:KeyFeatures 210

Part III Pathology of the Oral Mucosa 213

12 Developmental Anomalies and Anatomical Variants of Oral Soft Tissues  21512.1 FordyceGranules:KeyFeatures 21512.2 DoubleLip:KeyFeatures 21512.3 Leukoedema:KeyFeatures 21612.4 Ankyloglossia:KeyFeatures 21612.5 GeographicTongue:KeyFeatures 21712.6 HairyTongue:KeyFeatures 21812.7 FissuredTongue:KeyFeatures 21812.8 LingualThyroid:KeyFeatures 21812.9 Microglossiaand Macroglossia:KeyFeatures 21912.10 BifidTongue:KeyFeatures 22012.11 BifidUvula:KeyFeatures 22012.12 CleftLip:KeyFeatures 22112.13 CalibrePersistentLabialArtery:KeyFeatures 22112.14 Epstein’sPearland Bohn’sNodules:KeyFeatures 22312.15 Dermoidand EpidermoidCysts:KeyFeatures 22312.16 OralVaricosities:KeyFeatures 22412.17 LymphoidAggregates:KeyFeatures 22412.18 ParotidPapilla:KeyFeatures 22512.19 CircumvallatePapillae:KeyFeatures 22612.20 PhysiologicalPigmentation:KeyFeatures 226

Contents xi

13 Bacterial Infections of the Oral Mucosa 22913.1 ScarletFever:KeyFeatures 22913.2 Syphilis 22913.3 Gonorrhoea:KeyFeatures 23213.4 Tuberculosis 233

14 Fungal Infections of the Oral Mucosa 23714.1 Candidosis(Candidiasis) 23714.2 Histoplasmosis 24414.3 Blastomycosis:KeyFeatures 246

15 Viral Infections of the Oral Mucosa 24715.1 PrimaryHerpeticGingivostomatitis(PrimaryHerpes) 24715.2 HerpesLabialis 25015.3 Varicella(Chickenpox) 25215.4 HerpesZoster(Shingles) 25315.5 InfectiousMononucleosis(GlandularFever) 25515.6 OralHairyLeukoplakia:KeyFeatures 25715.7 CytomegalovirusInfection:KeyFeatures 25815.8 Herpangina:KeyFeatures 25815.9 Hand,Foot,andMouthDisease 25815.10 SquamousPapilloma 26015.11 CondylomaAcuminatum:KeyFeatures 26115.12 MultifocalEpithelialHyperplasia:KeyFeatures 26215.13 VerrucaVulgaris:KeyFeatures 26215.14 Measles:KeyFeatures 263

16 Non- infective Inflammatory Disorders of the Oral Mucosa 26516.1 RecurrentAphthousStomatitis 26516.2 OralLichenPlanus 26916.3 OralLichenoidLesions 27216.4 PemphigusVulgaris 27316.5 MucousMembranePemphigoid 27616.6 ErythemaMultiforme 27916.7 LupusErythematosus:KeyFeatures 28116.8 TraumaticUlcer:KeyFeatures 28116.9 OralLesionsin Behcet’sDisease/Syndrome 28216.10 OralLesionsin Crohn’sDisease 28316.11 OralLesionsin ReactiveArthritis:KeyFeatures 28516.12 UremicStomatitis:KeyFeatures 28516.13 ChronicUlcerativeStomatitis:KeyFeatures 28516.14 Radiation-InducedMucositis:KeyFeatures 28616.15 Medication-InducedOralUlceration:KeyFeatures 28716.16 Stevens–JohnsonSyndromeandToxicEpidermalNecrolysis 287

17 Non- neoplastic Mucosal Swellings 29117.1 IrritationFibroma(TraumaticFibroma) 29117.2 Denture-InducedGranuloma(EpulisFissuratum) 293

Contentsxii

17.3 FibrousEpulis(PeripheralFibroma):keyfeatures 29417.4 PyogenicGranuloma:keyfeatures 29517.5 PeripheralGiantCellGranuloma:keyfeatures 29517.6 PeripheralOssifyingFibroma:keyfeatures 29517.7 TraumaticNeuroma 29517.8 SquamousPapilloma:KeyFeatures 29617.9 CongenitalEpulis:KeyFeatures 297

18 Benign Neoplasms of the Oral Mucosa 29918.1 Lipoma 29918.2 Schwannoma(Neurilemmoma) 30118.3 GranularCellTumour 30218.4 Haemangioma 30418.5 Lymphangioma 30618.6 Leiomyoma(VascularLeiomyomas):KeyFeatures 30718.7 Rhabdomyoma:KeyFeatures 307

19 Oral Potentially Malignant Disorders 30919.1 Erythroplakia 30919.2 Leukoplakia 31119.3 ChronicHyperplasticCandidosis(CandidalLeukoplakia) 31519.4 PalatalLesionsin ReverseSmokers 31719.5 OralLichenPlanus:KeyFeatures 31919.6 OralSubmucousFibrosis 32019.7 OralLichenoidLesion 32219.8 LupusErythematosus 32419.9 ActinicKeratosisof theLip(ActinicCheilitis) 32619.10 Graft-Versus-HostDisease 32819.11 DyskeratosisCongenita 33019.12 SublingualKeratosis:KeyFeatures 33119.13 SyphiliticLeukoplakia:KeyFeatures 33219.14 Darier’sDisease:KeyFeatures 332

20 Malignant Neoplasms of the Oral Mucosa 33520.1 SquamousCellCarcinomaand VerrucousCarcinoma 33520.2 Melanoma(MalignantMelanoma) 34020.3 Kaposi’sSarcoma 34220.4 Fibrosarcoma:KeyFeatures 34320.5 Rhabdomyosarcoma:KeyFeatures 34420.6 Leiomyosarcoma:KeyFeatures 344

Part IV Pathology of the Salivary Glands 347

21 Non- neoplastic Salivary Gland Diseases 34921.1 SalivaryCalculi:KeyFeatures 34921.2 Mucoceles(MucousExtravasationCysts,MucousRetention

Cystsand Ranula) 350

Contents xiii

21.3 Sjögren’sSyndrome 35221.4 Sialadenitis:KeyFeatures 35421.5 NecrotizingSialometaplasia:KeyFeatures 355

22 Salivary Gland Neoplasms 35722.1 WorldHealthOrganizationHistologicalClassificationof Salivary

Glandtumours(2017) 35722.2 PleomorphicAdenoma 35822.3 Warthin’sTumour(PapillaryCystadenomaLymphomatosum) 36022.4 MucoepidermoidCarcinoma 36222.5 AdenoidCysticCarcinoma 364

Part V Clinical Presentation of Mucosal Disease 367

23 White Lesions of the Oral Mucosa 36923.1 ActinicCheilitis:KeyFeatures 36923.2 ChemicalBurn:KeyFeatures 37023.3 ChronicHyperplasticCandidosis:KeyFeatures 37023.4 Darier’sDisease:KeyFeatures 37123.5 DyskeratosisCongenita:KeyFeatures 37123.6 Fordycegranules:KeyFeatures 37223.7 FrictionalKeratosis:KeyFeatures 37223.8 HereditaryBenignIntraepithelialDyskeratosis:KeyFeatures 37323.9 Leukoedema:KeyFeatures 37323.10 Leukoplakia:KeyFeatures 37323.11 OralHairyLeukoplakia:KeyFeatures 37423.12 OralLichenPlanus:KeyFeatures 37423.13 OralSquamousCellCarcinoma:KeyFeatures 37523.14 PseudomembranousCandidosis:KeyFeatures 37523.15 SmokelessTobacco-InducedKeratosis:KeyFeatures 37623.16 Smoker’sKeratosis:KeyFeatures 37623.17 SublingualKeratosis:KeyFeatures 37723.18 SyphiliticLeukoplakia:KeyFeatures 37723.19 VerrucousCarcinoma:KeyFeatures 37723.20 WhiteHairyTongue:KeyFeatures 37823.21 WhiteSpongeNevus:KeyFeatures 378

24 Red and Purple Lesions of the Oral Mucosa 38124.1 ContactStomatitis:KeyFeatures 38124.2 DesquamativeGingivitis:KeyFeatures 38224.3 ErythemaMigrans:keyfeatures 38224.4 ErythemaMultiforme:KeyFeatures 38224.5 ErythematousCandidosis:KeyFeatures 38324.6 Erythroplakia:KeyFeatures 38324.7 Haemangioma:KeyFeatures 38424.8 HereditaryHaemorrhagicTelangiectasia:KeyFeatures 38424.9 InfectiousMononucleosis:KeyFeatures 385

Contentsxiv

24.10 Kaposi’sSarcoma:KeyFeatures 38524.11 LinearGingivalErythema:KeyFeatures 38524.12 LupusErythematosus:KeyFeatures 38624.13 MedianRhomboidGlossitis:KeyFeatures 38624.14 MucosalEcchymosis,Haematoma,and Petechiae:KeyFeatures 38624.15 PlasmaCellGingivitis:KeyFeatures 38724.16 Port-WineNevus:KeyFeatures 38724.17 RadiationMucositis:KeyFeatures 38724.18 ThermalBurn:KeyFeatures 388

25 Blue, Black, and Brown Lesions of the Oral Mucosa 38925.1 Addison’sDisease:KeyFeatures 38925.2 AmalgamTattoo:KeyFeatures 38925.3 Black/BrownHairyTongue:KeyFeatures 39025.4 Drug-InducedPigmentation:KeyFeatures 39125.5 HeavyMetalPigmentation:KeyFeatures 39225.6 Laugier–HunzikerSyndrome:KeyFeatures 39225.7 Melanoma:KeyFeatures 39325.8 MelanoticMacule:KeyFeatures 39325.9 Peutz–JeghersSyndrome:KeyFeatures 39325.10 PhysiologicalPigmentation:KeyFeatures 39425.11 MucosalNevi:KeyFeatures 39425.12 Smoker’sMelanosis:KeyFeatures 395

26 Vesiculobullous Lesions of the Oral Mucosa 39726.1 AnginaBullosaHaemorrhagica:KeyFeatures 39726.2 BullousLichenPlanus:KeyFeatures 39726.3 DermatitisHerpetiformis:KeyFeatures 39826.4 ErythemaMultiforme:KeyFeatures 39826.5 Hand,Footand MouthDisease:KeyFeatures 39826.6 HerpesZoster(Shingles):KeyFeatures 39926.7 MucousMembranePemphigoid:KeyFeatures 39926.8 PemphigusVulgaris:KeyFeatures 40026.9 PrimaryHerpeticGingivostomatitis:KeyFeatures 40026.10 HerpesLabialis:KeyFeatures 400

27 Ulcerative Lesions of the Oral Mucosa 40327.1 OralUlcersin Agranulocytosis:KeyFeatures 40327.2 OralUlcersin Behçet’sDisease:KeyFeatures 40427.3 OralUlcersin CoeliacDisease:KeyFeatures 40427.4 ChronicUlcerativeStomatitis:KeyFeatures 40527.5 OralUlcersin Crohn’sDisease:KeyFeatures 40527.6 OralUlcersin CyclicNeutropenia:KeyFeatures 40627.7 CytomegalovirusUlcers:KeyFeatures 40627.8 EosinophilicUlcer:KeyFeatures 40627.9 GangrenousStomatitis:KeyFeatures 40627.10 NecrotizingSialometaplasia:KeyFeatures 407

Contents xv

27.11 NecrotizingUlcerativeGingivitis:KeyFeatures 40727.12 OralUlcersin ReactiveArthritis:KeyFeatures 40827.13 RecurrentAphthousUlcers:KeyFeatures 40827.14 SquamousCellCarcinomaPresentingas anUlcer:KeyFeatures 40927.15 SyphiliticUlcers:KeyFeatures 40927.16 TraumaticUlcer:KeyFeatures 41027.17 TuberculousUlcer:KeyFeatures 41027.18 OralUlcerin UlcerativeColitis:KeyFeatures 411

28 Papillary Lesions of the Oral Mucosa 41328.1 CondylomaAcuminatum:KeyFeatures 41328.2 MultifocalEpithelialHyperplasia(Heck’sDisease):KeyFeatures 41328.3 OralProliferativeVerrucousLeukoplakia:KeyFeatures 41428.4 SquamousPapilloma:KeyFeatures 41428.5 SquamousCellCarcinoma:KeyFeatures 41428.6 VerrucaVulgaris(OralWarts):KeyFeatures 41428.7 VerrucousCarcinoma:KeyFeatures 415

Part VI Orofacial Pain 417

29 Orofacial Pain 41929.1 OdontogenicOrofacialPain 41929.2 NeuropathicOrofacialPain 42129.3 OtherConditionswith OrofacialPain 423

Part VII Miscellaneous Topics of Clinical Relevance 427

30 Oral Manifestations of Systemic Disorders 42930.1 Gastrointestinaland LiverDisorders 42930.2 CardiovascularDisease 43130.3 RespiratoryDisease 43130.4 KidneyDiseases 43230.5 Endocrineand MetabolicDisorders 43430.6 NervousSystemDisorders 43530.7 HaematologicalDisorders 43730.8 ImmuneSystemDisorders 439

31 Systemic Diseases Associated with Periodontal Infections 44131.1 CardiovascularDisease 44131.2 CoronaryHeartDisease(Atherosclerosisand MyocardialInfarction) 44131.3 Stroke 44231.4 InfectiveEndocarditis 44231.5 BacterialPneumonia 44231.6 LowBirthWeight 44331.7 DiabetesMellitus 443

Contentsxvi

32 Other Signs and Symptoms Related to the Oral Environment 44532.1 Halitosis 44532.2 TasteDisorders 44632.3 DryMouth(Xerostomia) 44732.4 Sialorrhea 44832.5 Trismus 44932.6 COVID-19 Infection 449

33 Outline of Diagnostic Steps and Procedures Employed in Oral Pathology and Oral Medicine 453

33.1 History 45333.2 ClinicalExamination 45433.3 ClinicalDifferentialDiagnosis 45533.4 Diagnosis 456

Index 459

xvii

This is an amazing work. Professor SR Prabhu has touched constructively on almost every “issue”, every decision required, in the day-to-day practice of oral medicine and to a considerable extent, oral/maxillofacial pathology. He has laid out the material in a very logical set of chapters. The extensive illustrations are of uniformly high quality: many of these have been donated by col-leagues around the world and I join in thanking them for their generosity: many have become personal friends to us both.

I initially was hesitant to contribute this Foreword. As a quantitative scientist, I always wish to see the evidence base for every diagnosis, test and treatment presented. This is deliberately not the intention here - indeed it is the opposite of Prof Prabhu’s intent. As he put it in response to my challenge “My intention is not to compete with great authors of international repute. The material presented is truly a compilation of what is known in the scientific papers, books and case reports that are (I might interpolate with much hard work) available. This is a humble attempt to provide students and busy practitioners with a source that provides quick access to information”. I see the value of this: indeed, I wish my current undergraduate and postgraduate students came to clinics with a copy in their pockets!

Professor SR Prabhu is a remarkable professional in the autumn of a remarkable career. This has impacted the dental profession, and particularly dental students, across the globe, for decades, beginning with his first teaching appointment in India in 1971. We first met when he was Commonwealth Medical Scholar in my department in London in 1974. Chronologically since then he has taught and led teaching [including from positions as Head of Department or Dean in several institutions] in universities in India, Kenya, Sudan, Australia, Papua New Guinea, West Indies, Malaysia, Saudi Arabia, West Indies (again), United Arab Emirates, and several Australian univer-sities, again. His vast knowledge reflects this.

I have learned much from his global experience and it was particularly educative for me to work with him, as co-editor and co-author of his largest work Oral Diseases in the Tropics (Oxford University

Press 1992; Revised reprint, Jaypee Bros. 2017). Beyond that his bibliography is extensive.

We are fortunate that he has maintained the drive and passion to give us this valuable work at this time: one positive outcome of Covid-2019.

Newell W Johnson, CMG Emeritus Professor of Oral Health Sciences,

Kings’ College London, &Dean Emeritus and Honorary Professor of Dental Research,

Griffith University, Queensland, AustraliaBrisbane, June 2021

Foreword

xix

The Handbook of Oral Pathology and Oral Medicine is primarily targeted at undergraduate dental students and practitioners. Dental students find the available prescribed textbooks of oral pathol-ogy and oral medicine loaded with information and are not user friendly, particularly at the time of preparation for examinations. Teachers and students alike feel that there is a need for a book that offers information in a concise manner for quick reference. This handbook aims to fill this need by providing a highly illustrated succinct guide presented as bulleted lists for easy reference. Text style used in this handbook allows the reader to quickly gather essential information relevant to the disease without scanning through lengthy paragraphs. For further information, a recom-mended reading list is provided at the end of each chapter.

Topics included in this book are in accordance with the universally followed curricula in oral pathology and oral medicine. The text is divided in seven parts: pathology of teeth, pulp, and sup-porting structures, pathology of jawbones, pathology of the oral mucosa, pathology of the salivary glands, clinical presentation of mucosal disease, orofacial pain, and miscellaneous topics of clini-cal relevance. Many international clinicians and teachers have generously contributed clinical, radiographical and photomicrographic images to this handbook.

The author and the publishers feel that the format, design, style, and content of the text used in this handbook will assist dental students and clinicians in dentistry and other healthcare profes-sions. Accompanying this handbook is a website containing case scenarios and MCQs especially designed for dental students preparing for examinations.

S. R. PrabhuBrisbane

June 2021

Preface

xxi

I wish to thank Professor Newell Johnson for the Foreword and his inspirational role in shaping my academic career in oral pathology and oral medicine.

I also wish to express my grateful thanks to many colleagues who have shared their teaching material to this book. Every effort has been made to trace and acknowledge copyright material for the images used. If someone’s name has been inadvertently missed or infringement of copyright has occurred accidentally, I tender my sincere apologies.

My great appreciation goes to guidance provided by Associate Commissioning Editor for Veterinary and Dentistry books Miss Loan Nguyen and Managing Editor for Health and Life Sciences Miss Tanya McMullin of John Wiley & Sons (UK). Others at Wiley publishing who deserve my grateful thanks include Adalfin Jayasingh, Fathima Shaheen, and Susan Engelken.

Finally, I am indebted to my wife Uma Prabhu for her unconditional support during the COVID- 19 stay- at- home period when the preparation of manuscripts for this handbook was started and completed.

S. R. PrabhuBrisbane

June 2021

Acknowledgements

xxiii

Don’t forget to visit the companion web site for this book:

www.wiley.com/go/prabhu/oral_pathology 

There you will find valuable materials, including:

● 240 multiple choice questions ● 36 clinical case scenarios ● Images from the book as downloadable PowerPoint slides

Scan this QR code to visit the companion website

­About­the Companion­Website

xxv

Nomenclature of diseases:

● Disease: impairment of normal physiological function affecting all or part of an organism mani-fested by signs and symptoms.

● Disorder: deviation from the usual way the body functions. ● Condition: an abnormal state of health that interferes with the usual activities or feeling of

wellbeing. ● Risk factor: something that increases a person’s chances of developing a disease. ● Aetiology: the study of the underlying cause of the disease/disorder. ● Pathogenesis: the development and chain of events leading to a disease. ● Epidemiology: a branch of medical science that deals with the incidence, distribution, and

control of disease in a population. ● Incidence: the measure of the probability of occurrence of new cases of a disease over a cer-

tain period. ● Prevalence: total number of individuals in a population who have a disease or health condition

at a specific period, usually expressed as a percentage of the population. ● Prognosis: prediction of the likely course and outcome of a disease. ● Morbidity: the extent to which a patient’s overall health is affected by a disease. ● Mortality: the likelihood of death from a particular disease. ● Acute and chronic illnesses:

– Acute illnesses are of rapid onset. – Chronic conditions usually have a gradual onset and are more likely to have a pro-

longed course. ● Syndrome refers to a collection or set of signs and symptoms that characterize or suggest a par-

ticular disease.

Clinical nomenclature of oral mucosal lesions:

● Lesion: clinically detectable surface changes in the skin or mucous membranes can be termed ‘lesions’. They include the following:

– Macule: a macule is a change in surface colour, without elevation or depression and therefore nonpalpable, well- or ill- defined, but generally considered less than 1.5 cm in diameter at the widest point.

– Patch: a patch is a large macule equal to or greater than 1.5 cm across. Patches may have some subtle surface change, such as a fine scale or wrinkling but although the consistency of the surface is changed, the lesion itself is not palpable.

– Papule: a papule is a circumscribed, solid, palpable elevation of skin/mucous membrane with no visible fluid, varying in size from a pinhead to less than 1.5 cm in diameter at the wid-est point.

­Nomenclature­Used­in The­Study­of Human­Disease

­Nomenclatum Umed en Tm ateddy Non tole UmlUmxxvi

– Plaque: a plaque is a broad, flat- topped papule, or confluence of papules, equal to or greater than 1.5 cm in diameter, or alternatively as an elevated, plateau- like lesion that is often greater in its diameter than in its depth.

– Nodule: a nodule is morphologically similar to a papule and is a palpable spherical lesion in all three directions: length, width, and depth. A nodule is usually a solid lesion of 1.5 cm or less in diameter. It may be sessile (attached directly by the base) or pedunculated (attached by a peduncle – a stem).

– Tumour: similar to a nodule but larger than 1.5 cm in diameter. – Vesicle: a vesicle is a small blister; a circumscribed, fluid- filled, epithelial elevation generally

less than 1.5 cm in diameter at the widest point. The fluid is a clear serous fluid. – Bulla: a bulla is a large, rounded or irregularly shaped blister of the skin or mucous mem-

brane containing serous or seropurulent fluid. Bullae are greater than 1.5 cm in diameter. – Pustule: a pustule is a small elevation of the skin or mucous membrane containing cloudy or

purulent material (pus) usually consisting of necrotic inflammatory cells. When haemor-rhagic, the colour of the pustule may be red or blue.

– Cyst: a cyst is an epithelial- lined pathological cavity containing liquid, semisolid, or solid material.

– Pseudocyst: a cyst- like lesion that is not lined by epithelium. – Fissure: a fissure is a crack in the skin or mucous membrane that is usually narrow

and deep. – Erosion: an erosion is a lesion that lacks the full thickness of the overlying epithelium and is

moist, circumscribed, and usually depressed. – Ulcer: an ulcer is a discontinuity of the skin or mucous membrane exhibiting complete loss

of the epidermis or epithelium, with some amount of destruction of the subepithelial connec-tive tissue.

– Telangiectasia: a telangiectasia represents an enlargement of superficial blood vessels in the skin or mucous membrane to the point of being visible.

– Scale: a skin lesion that consists of dry or greasy laminated masses of keratin. – Crust: a skin lesion that is dried sebum, pus, or blood, usually mixed with epithelial and

sometimes bacterial debris. Can occur on the vermilion as well. – Lichenification: epidermal thickening of the skin characterized by visible and palpable

thickening with accentuated skin markings. – Excoriation: a punctate or linear abrasion of the skin produced by mechanical means (often

scratching), usually involving only the epidermis, but commonly reaching the papillary dermis. – Induration: dermal or mucosal thickening causing the cutaneous or mucosal surface to feel

thicker and firmer. – Atrophy: a loss of epithelial or submucous tissue. With epithelial atrophy, the mucous mem-

brane appears thin, translucent, and wrinkled. Atrophy should be differentiated from erosion. – Maceration: in maceration, the skin softens and turns white, due to being consistently wet. – Umbilication: formation of a depression at the top of a papule, vesicle, or pustule. – Rash: presence of multiple non- vesicular skin eruptions. – Sinus/fistula: a sinus or fistula is a tract connecting cavities to each other or to the surface. – Sessile lesion: a lesion attached to the underlying tissues with a broad base. – Pedunculated lesion: a lesion attached to the underlying tissues with a narrow base, such as

a stalk or pedicle. – Serpiginous lesion: a lesion with a wavy border. – Discoid lesion: a round or disc- shaped lesion. – Annular or circinate lesion: a ring- shaped lesion. – Herpetiform lesions: lesions resembling those of herpes.

­Nomenclatum Umed en Tm ateddy Non tole UmlUm xxvii

– Reticular or reticulated lesion: a lesion resembling a net or lace. – Verrucous lesion: a wart- like lesion. – Stellate lesion: a star- shaped lesion. – Target lesion or ‘bull’s eye lesion: named for its resemblance to the bullseye of a shooting

target. Also referred to as an ‘iris’ lesion. – Purpura: haemorrhage into the surface of the skin or mucous membrane. Purpura measure

3–10 mm whereas petechiae measure less than 3 mm, and ecchymoses greater than 10 mm. The appearance of an individual area of purpura varies with the duration of the lesions. Early purpura is red and becomes darker, purple, and brown, yellow as it fades. Purpuric spots do not blanch on pressure.

– Petechiae: petechiae are small sharply outlined and slightly elevated red- or purple- coloured purpuric macules of about 1–3 mm in diameter. They contain extravasated blood.

– Ecchymoses: ecchymoses are larger purpuric lesions that are macular and deeper in origin than petechiae. They are to be distinguished from hematoma caused by extravasation of blood.

– Hematoma: a localized swelling that is filled with blood caused by a break in the wall of a blood vessel.

– Hamartoma: a benign (non- neoplastic) tumour- like growth consisting of a disorganized mixture of cells and tissues normally found in the body where the growth occurs.

– Epulis: a nonspecific exophytic gingival mass.

Histological nomenclature of oral mucosal lesions:

● Hyperplasia: an increase in the amount of organic tissue that results from cell proliferation. ● Parakeratosis: a mode of keratinization characterized by the retention of nuclei in the stratum

corneum. ● Hyperkeratosis: thickening of the stratum corneum associated with the presence of an abnor-

mal quantity of keratin. ● Orthokeratosis: hyperkeratosis without parakeratosis. No nucleus is seen in the cells as in the

normal epidermis (skin) or epithelium (mucous membrane). ● Acanthosis: a benign abnormal thickening (hyperplasia) of the stratum spinosum, or prickle

cell layer of the epidermis (skin) or epithelium (mucous membrane). ● Acantholysis: the loss of intercellular connections (desmosomes), resulting in loss of cohesion

between keratinocytes in the skin or mucous membrane. ● Spongiosis: intercellular oedema (abnormal accumulation of fluid) in the epidermis in the skin

or the epithelium in the mucous membrane. ● Dyskeratosis: abnormal keratinization occurring prematurely within individual cells or groups

of cells below the stratum granulosum. ● Vacuolization: the formation of vacuoles within or adjacent to cells and often confined to the

basal cell- basement membrane zone area. ● Cellular or epithelial  dysplasia: an epithelial anomaly of growth and differentiation often

indicative of an early neoplastic process. ● Metaplasia: cells of one mature, differentiated type are replaced by cells of another mature,

differentiated type. ● Atypia: deviation from normal or a state of being not typical. Atypical cells are not necessarily

cancerous. ● Colloid bodies (also called Civatte bodies): these apoptotic keratinocytes are oval or round,

immediately above or below the epidermal or epithelial basement membrane. ● Hydropic  (liquefaction)  degeneration: basal cells become vacuolated, separated, and

disorganized. ● Hyaline  bodies: necrotic keratocytes; also termed colloid bodies, Civatte bodies, and apop-

totic bodies.

xxviii

ac (before meals)ad lib (as desired)ASAP (as soon as possible)bid (twice a day)btl (bottle)c (with)cap (capsule)crm (cream)disp (dispense on a prescription label)elix (elixir)g (gram)gtt (drop)h (hour)hs (at bedtime)iu (international units)IV (intravenous)l (litre)liq (liquid)loz (lozenge)mg (milligram)min (minute)

ml (millilitre)NaF (sodium fluoride)prn (as needed)q (every)q2h (every 2 hours)q4h (every 4 hours)q6h (every 6 hours)q8h (every 8 hours)q12h (every 12 hours)qam (every morning)qd (every day)qhs (every bedtime)qid (four times a day)qod (every other day)qpm (every evening)qsad (add a sufficient quantity to equal)qwk (every week)Rx (prescription)s (without)sig (patient dosing instructions on prescription label)sol (solution)stat (Immediately)

syr (syrup)tab (tablet)tbsp (ttablespoon)tid (three times a day)top (topical)tsp (teaspoon)oint (ointment)OTC (over the counter)oz (ounce)p (after)pc (after meals)PO (by mouth)U (unit)ut dict (as directed)visc (viscous)wk (week)yr (year)

­Standard­Abbreviations­for Prescribers