Autoimmune & Immune-related Skin, Eye, Oral (anywhere)

Subepithelial split (epithelial-CT separates from

SLE / Systemic Lupus Erythematosus
Autoimmune, >young adult females
Butterfly rash, photosensitivity
Diff Dx: Lichen Planus
Complications: Heart (endocarditis) & Kidney
(glomerulonephritis)
lamina dura)
Starts as vesicle/bulla erosions & ulcers
Conjunctiva scarring / blindness, dry eyes
Autoimmune, AB against basement membrane
More common & Milder than Pemphigus
POS Nikolsky

Sjogrens Syndrome
NOT infectious
>Elderly women
Dry eyes & dry mouth = sicca
Secondary to Lupus or RA

Recurrent Aphthous Stomatitis / Ulcers / Pemphigus Vulgaris (desmosome)

Canker Sores
Moveable mucosa (uvula, labial mucosa, buccal
mucosa, ventral tongue, FOM, soft palate)
Immune-mediated (CD4, CD8), HLA associated
NOT contagious
NOT preceded by vesicle (UNLIKE Herpes)
Herpetiform (rare, 50+ small painful lesions)
Tx: cauterize w/laser or acid, OraBase &
Kenalog (corticosteroid)
Minor (shallow, red halo) heal in 5-10 days
Major heal in weeks
H/O trauma, stress, UV exposure
Risk Factors: Behcets disease, Crohns, familial
Vesiculoerosive, IgG immunofluorescence
>Lips, palate, gingiva
INTRAepithelial split/acantholysis
(SUPRAepithelial) epithelial cells dont bind
Autoimmune, AB against desmoglein
POS Nikolsky (blisters w/lateral pressure/air)
POS Direct + Indirect immunofluorescence
(UNIQUE), Tzanck cells (round epithel cells)
Tx: skin grafts

Pseudomembranous Candidiasis / Thrush

Common in elderly & infants, ABs & steroids
Anywhere (>B mucosa, palate, dorsal tongue)
Hyphae & Spores (Dx: cytology smear)
White patch, wipes off
>Buccal mucosa & Palate
Scarlet Fever
Tx: Nystatin or Clotramizole (topical),
Strawberry tongue = swollen fungiform papilla
Fluconazole (systemic)
White Strawberry (1-2 days) = sloughs off
Often req AB prophylaxis for prevention
Group A, Beta-hemolytic Strep
Erythrogenic toxin affects bl vessels
Pastias Lines: red streaks on skin
Fever, Circumoral pallor, soft palate petechiae
Complications: Rheumatic fever, bacteremia,
glomerulonephritis, TSS, cellulitis
Chronic Erythematous Candidiasis
Benign Mucous Membrane Pemphigoid (BM) A) Median Rhomboid Glossitis
Cicatricial (scars), Vesiculoerosive
>Mid-aged females
Red atrophy / bald tongue of filiform papilla (in
front of circumvallate)
Midline tongue, Jx of ant 2/3 & post 1/3 @
tuberculum impar
Tx: Nystatin, Clotramizole
B) Denture Stomatitis / Sore Mouth
Tx: rinse & soak denture in antifungal
Diff Dx: methylmethacrylate allergy (acrylic)
Dx with Cytology smear
Oral Hairy Leukoplakia (EBV)
Lateral tongue, white rough plaque
HIV+ pts progressing to AIDS
Epstein Barr Virus
Infections
Cavernous Sinus Thrombosis (cellulitis)
Abscess of upper lip or intrabony Ant Max tooth
10% from orofacial infx (>Max canine)
Valveless facial veins orbit
Proptosis, orbital edema, conjunctiva
Ludwigs Angina: (cellulitis)
Submandibular space infx (70% Mand infx)
Worst Complication = glottis edema
obstructs airway
Sarcoidosis
Bilateral hilar lymphadenopathy (chest xray)
Cutaneous lesions (violet)
Tx: corticosteroids
Actinomycosis
Soft granular / woody swelling
Multiple draining fistulas
Enlarged, red, inflamed
Sulfur granules (bacteria), neutrophils
Chronic Osteomyelitis
Best seen in LATERAL OBLIQUE xray view
Mixed radiolucent & radiopaque
Painful, swelling, fever, purulent
Etiology: dental infx, ANUG, NOMA,
Osteopetrosis & Florid Cemento-Osseous
Dysplasia
Necrotizing Sialometaplasia
Rapid onset
Deep ulcer of palate
Self-resolving
Infectious Diseases & STDs
Condyloma Acuminatum: Venereal wart
HPV>16, 18
>Females age 20-24
Labial mucosa, soft palate, lingual frenum
Causes 95% of cervical cancer (NOT oral)
Squamous Papilloma: HPV 6, 11
 = gender, age 30-50
Rough cauliflower papule/nodule, >2cm
>Gingiva, Soft Palate, Tongue
NOT precancerous! NO Dysplasia
Histo: Epithelial proliferation (NOT CT)
Tx: Excision
Herpes Zoster / Shingles
Dorsal root ganglion
Prodrome (fever, headache)
Vesicles painful ulcers
Unilateral skin & oral (palate, tongue)
Recurrent/Secondary Herpes Simplex: Type 1
80-85% of US ppl, CONTAGIOUS, NO fever
NON-movable mucosa (hard palate, gingiva)
Lip & vermillion
Vesicles rupture into ulcers
Tzanck Test: rupture a vesicle, look for MNGs
Mostly subclinical, Trigeminal ganglion
Prodrome: burning, tingling
H/O trauma, stress, UV exposure
Tx: heals in 7-10 days

Primary Herpes / Gingivostomatitis

Kids 6mo-5yrs, INFECTIOUS
Non-movable mucosa: hard palate, gingiva
Inflamed enlarged marginal gingiva, bleeding
Vesicles coalescing ulcers in mouth & lips
Low fever, malaise, sore throat,
Tuberculosis lymphadenopathy
INC incidence Tx: analgesics 1-2wks, Antiviral if <2 days S/S
Non-healing ulcers (like cancer)
Dx: chest xray
May spread by infected sputum to oral lesions
(ie. Ulcer mimicking cancer on tongue)

Varicella Zoster / Chickenpox

Trigeminal ganglion Infectious Mononucleosis (EBV)
Buccal mucosa, palate, gingiva >Teens
Dx: Cytopathologic effect in smear Lateral neck swelling, Sore throat
Complications: Encephalitis POSITIVE Monospot test
Palatal petechiae
 Transected nerve w/scar tissue
Erythema Multiforme Painful or tender, firm nodule
Young adult males Sites of chronic trauma (Mand alveolar ridge in
Sudden acute explosive onset denture pts, near Mental N, tongue)
Causes: Viral, Herpes, Pneumonia, Allergy, med Diff Dx: Fibroma (no pain, >tongue)
Crusted bleeding vesicles & ulcers
>Lips, labial mucosa, hands & feet (bulls-
eye/target /iris), NOT on gingiva!
Supportive Tx (self-limiting in 2-6wks):
steroids, analgesics, ABs, electrolytes

Pyogenic Granuloma (Pregnancy Tumor)

Stevens Johnson Syndrome
Like Erythema Multiforme but WORSE
Oral (conjunctiva), Ocular, Genital
Toxic Epidermal Necrolysis/Lysells Disease
Any age, >Females
Causes: local irritation (food trap, overhang)
Can be ANYWHERE, >Max anterior, buccal
>Gingiva (interdental papilla)
Bleeds, red, NOT painful, fast growth
Histo: granulation tissue, AICI, CICI
Tx: excision + eliminiate trigger

Developmental

Treacher Collins Syndrome /

Mandibulofacial Dystosis / Deficit
Mand retrognathism (lower 1/3 face deficit)
External ear changes, 30% cleft palate, Peripheral Giant Cell Granuloma
Hypoplastic or absent parotid gland
Middle-aged
Downward slant of eyes / palpebral fissures
GINGIVA ONLY (>ant to 1st molar)
Outer canthus is lower than inner (reversed) Purple/Liver (hemosiderin + RBCs)
Autosom dom or spontaneous mutation (60%) Pressure resorption (cupping/saucer)
1st & 2nd branchial arches
Histo: MNG cells (PDL osteoclasts),
hemosiderin, granulation, AICI, CICI
Turner Tooth Tx: excision to periosteum + elim trigger
Local trauma or infx in developing tooth bud
>Mand premolar = #1 affected tooth

Peripheral Ossifying Fibroma

Intrinsic Staining
>Teenage females
Stained dentinal tubules
GINGIVA ONLY, NOT in bone but makes osteoid
Causes: Tetracycline, A. Imperfecta, D.
Reactive bone formation, PDL origin
Imperfeca, Fluorosis
Scattered light radiopacities
Histo: collagenous stroma w/osteoid,
Traumatic
granulation tissue, AICI, CICI
Tx: excision down to bone
Traumatic Neuroma

Central Giant Cell Granuloma
>Young Females (<age30)
Intrabony (jaws), >Ant mandible (70%)
Asymptomatic expansion, >crosses midline
Complications: root resorption, move teeth
Chronic renal disease bone destruction
Same Histo as: brown tumor
(hyperparathyroid), Cherubism, PGCG
Salivary Gland Tumors
Salivary Glands
Parotid: serous
Submandibular: >serous, some mucous
Sublingual: mucous
Palate: MUCOUS
Labial mucosa: mucous + serous
Nicotine Stomtatitis / Leukokeratosis
Hard palate, Red inflamed MSGs
Due to HEAT (NOT precancer)
Histo: hyperkeratosis, keratin, squamous
metaplasia of MSG ducts
Salivary Neoplasms
>Parotid (major) & Palate (MSG)
Most common location = Hard Palate
Benign: >Pleomorphic Adenoma
Malignant: >Mucoepidermoid > Adenoid Cystic
Perineural invasion: Adenoic Cystic Carcinoma,
Polymorphous Low-Grade Adenocarcinoma
Pleomorphic Adenoma (Benign)
Most common salivary gland tumor
>Females ~age 30-40
>Parotid >Palate (jx of SP + HP)
Encapsulated
Histo: ductal, squamous, myxoid, chondroid
Monomorphic Adenoma (Benign)
#1 Benign MSG tumor in upper lip
>Females
Canalicular (upper lip), Basal (parotid)
NO H/O trauma or infx
Mucoepidermoid Carcinoma (MALIGNANT)
Most common salivary gland malignancy
>Females, Bimodal (30s & 60s)
>Parotid, Palate, Submandibular, B mucosa
Least common intraoral site: sublingual, FOM
Histo: mucocytes/goblet cells
Adenoid Cystic Carcinoma (MALIGNANT)
>Middle-aged Females
>Submandibular, MSGS (>palate)
Parotid: RARE, perineural invasion w/NO
upper lip paresthesia), BEST prognosis
Worst Px: MSG (lung & bone mets)
Cheilitis Glandularis
Mucous MSGs of lips are inflamed
Mucous secretions
Premalignant! SCC
Warthins Tumor / Papillary Cystadenoma
Lymphomatosum
> Parotid gland NOT in oral cavity!
>Males
Cheilitis Glandularis
Mucous MSGs inflamed on lower labial mucosa
NOT sun-induced
Premalignant SCC
Lip swelling, lip everts (can see labial mucosa)
Erosive
Benign
Aspirin / Chemical Burn
Benign Migratory Glossitis / Geographic White coagulative necrosis
Tongue / Erythema Migrans Wipes off with difficulty (UNLIKE
Red & white serpentine/circinate (keratin) hyperkeratosis which doesnt wipe off)
Filiform papilla atrophy / depapillated
Sore, burning tongue, migrates daily
Tx: corticosteroid rinse (Dexamethasone)

White Sponge Nevus

Lichen Planus
>Buccal mucosa, bilateral, >Reticular
>Mid-aged women
Skin (purple polygonal prurititic papules)
Oral: Wickams stria (white coalescing papules)
Reticular: white NOT wipe off, asymptomatic
Erosive: tongue, painful, looks like geographic
Hyperplastic: plaque-like, NOT wipe off
Bullous: Skin, looks like Benign Pemphigoid
Diff Dx of Hyperplastic: Candida, Leukoplakia
Histo: hyperkeratosis, BM necrosis
(Colloid/Civatte bodies = degenerating
keratinocytes), saw tooth rete ridges
Tx: Steroids
Bilateral buccal mucosa
Nasal, esophageal, laryngeal, anogenital
Autosomal dominant
Thick white folds, NO eye involvement
Does NOT dissipate when stretched
Histo: hyperkeratosis, acanthosis, perinuclear
eosinophilic condensation (fried egg)
HBID / Hereditary Benign Intraepithelial
Dysplasia
Auto dom
Oral & Ocular B&L mucosa, conjunctiva
Histo: dyskeratosis cell within a cell

Reticular

Hyperplastic

Leukoedema
Bilateral buccal mucosa, >Afr Ams
Stretch buccal mucosa disappears
Histo: intraepithelial edema, acanthosis
Diff Dx: White sponge nevus, HBID (eyes)
Malignancies

Kaposis Sarcoma
HIV+ pts progressing to AIDS
Etiology: Herpes virus type 8

Morsicatio Buccarum / Cheek Nibbling
> Buccal mucosa, lingual, lip, tongue
White rough tissue tags BELOW occlusal plane
Partially removable
Osteosarcoma
Rapid onset of localized pain & swelling
Tingling lower lip
Late 20s-early 30s
Most common primary malignancy of bone in
ppl <25yo
Early radiolucency later radiopacity
Symmetrical PDL widening, trabeculae changes

Fordyce Granules: ectopic sebaceous glands

Yellow plaque/papules (sebum) Malignant Melanoma
>Buccal mucosa (inner cheek) & >Labial >Hard palate & gingiva
mucosa (inner lip), retromolar pads, genital
80% of adults Multiple Myeloma
Elderly males
Bence-Jones proteinuria, Ig spike
Calvaria, spine, pelvic girdle, jaws
Punched out radiolucencies

(Black) Hairy Tongue

Keratin on filiform papilla
Physiologic / Racial Pigmentation Smokers, ABs, poor hygiene, infx
Lower lip, vermilion, attached gingiva, tongue,
buccal mucosa Oral Hairy Leukoplakia
Symmetrical brown macules Lateral border of tongue
Epstein-Barr Virus
Acquired Melanocytic Nevus / Mole Uncontrolled HIV+ pts
Jx type: most likely malignant transformation
Intramucosal/Intradermal type
Compound type

Abrasion
Cervical mechanical wear
Exposed Roots Leukoplakia
MOST common premalignant lesion!
Precedes 85% of all oral cancers
20% are precancerous
White hyperkeratosis, does NOT wipe off
>Tongue (25% dysplastic)
Most Dysplasia: FOM (50% dysplastic)
Dx: biopsy (NOT cytology)

Basal Cell Carcinoma (EXTRAORAL)

Painless ulcer of upper lip & sun-exposed areas
Erythroleukoplakia (speckled) NOT intraoral!
>Posterior lateral tongue, FOM, soft palate, Papule, telangiectasia
alveolar ridge Rarely Mets
May be dysplasia or malignant carcinoma
Initial Tx: incisional biopsy of red component

Metastatic Disease to the Jaws

>Posterior mandible
Radiolucency with NO sclerotic border
SCC / Squamous Cell Carcinoma
Most commonly mets from: lung, breast,
95% of all oral cancers!
kidney, colon, prostate
>Posterior 2/3 of lateral tongue
Batsons/Paravertebral Venous Plexus: route
>Lower lip (Actinic Cheilitis)
of mets of distant tumor emboli to H&N
LEAST common oral site: hard palate
Worst Prognosis: FOM Lung mets
Leukemia (malignant WBCs)
Tongue lateral neck LNs
Red, swollen, hyperplastic, boggy gums
Palate preauricular LNs
Spontaneous gingival bleeding (>interdental
Staging (spread) is more important than
papilla) w/ ulcers
Grading (differentiation)
Punched out oral ulcers, necrotic
Pallor, red skin macules & bruising (purpura)
Infx, malaise, anemia (DEC RBCs), DEC platelets
Green lesion (Chloroma/Granulocytic
Sarcoma): palatal necrosis

Actinic Cheilitis
Lower lip vermilion sun damage
Premalignant Dysplasia SCC
Field Cancerization Theory of SCC
Oral cancer likely to spread throughout mouth
p53 tumor suppressor gene = most associated
Mets to jaw: >Posterior mandible
Verrucous Carcinoma
Well-diff SCC, >Smokeless tobacco
Large, papillary, exophytic
BEST prognosis of all oral cancers (NO mets!)
>Buccal vestibule, >Mand, palate
NO Dysplasia, NO pleomorphism

Keratocanthoma = BENIGN!
Looks like SCC of face & lip
Sun-exposure
Spontaneously resolves in 4months Bone Pathology
Ulcer w/central keratin plug
Lateral Periodontal Cyst
True cyst (epithelial lining)
>Mand premolars
Remnants of dental lamina
Pure Radiolucency btwn roots of adj Vital teeth
Histo: Zellerballen (thin epith, focal thickening)
Botryoid Odontogenic Cyst: multilocular

Ameloblastic Fibro-Odontoma
Radiolucency & Radiopacity (odontoma)
= gender, ~10yo
Cap Stage (highly diff)

Ameloblastoma
Most common true odontogenic tumor
Avg age 34, high recurrence
>Post mand, >impacted tooth
Can be anywhere & cross midline, Multilocular
Dental lamina remnants
Asymptomatic swelling, B-L expansion Odontoma
Complications: root resorption, displacement, Teens & 20yos
destroys bone, thinning of cortical plates Radiopaque w/radiolucent rim ( = follicle)
Histo: Reverse polarization of nuclei of Compound: >Ant maxilla, looks like a tooth
peripheral columnar cells Complex: >Post jaws, unidentifiable mass
Tx: en bloc resection, curettage Contains enamel, dentin, cementum, pulp
DONT recur

Ameloblastic Fibroma
MISNOMER (NO Fibroma!)
Young males (age 10-13yo)
Slight pain, swelling, not aggressive
>Post Mand, Pure radiolucency, multiloc
Complications: transformation into
Ameloblastic Fibrosarcoma, delays eruption,
root resorption, displaces teeth
Adenomatoid Odontogenic Tumor / AOT
Young females (kid or teen)
>Impacted tooth in Ant Maxilla, >Canine
Radiolucency w/snowflake calcifications
Expansile, painless
Histo: duct-like (UNIQUE), amyloid
Tx: simple enucleation (scoop it out)

Periapical Cemento-Osseous Dysplasia
Mid-aged black women
NO pain, NO expansion
Mand Anteriors, VITAL
Periapical radiolucencies mature & become
mixed lucent/opaque mostly opaque
Focal Cemento-Osseous Dyslasia
>Mid-aged white females
MOST common benign fibro-osseous lesion
>Posterior Mandible
Florid Cemento-Osseous Dysplasia
>Mid-aged black females
Multiquadrant, intrabony, avascular
>Posterior mandible
Complication: 2 Osteomyelitis
Radiolucent & Radiopaque
NO Tx req!
Proliferative Periostitis / Garres
Young pts, visible swelling
Inf border of Post Mand
Onion skin pattern
Osteopetrosis
Young pts & adults
Expansion
Over-prod of dense NON-vital bone in jaws
Complication: Osteomyelitis
Odontogenic Myxoma
Young adult onset
Looks like Ameloblastoma on xray
Multilocular radiolucency w/soap bubble
Genetic / Inherited
Amelogenesis Imperfecta
Yellow brown teeth, E
namel hypoplasia
Crowns look more bulbous bc narrower @ neck
Normal roots & pulp & crown
Crowns, veneers
Dentinogenesis Imperfecta
Blue/gray opalescent dentin
NO pulp chambers or root canals
Bell-shape crown w/constricted cervical region
Type 1 (Hereditary Opalescent Dentin): not
systemic
Type 2 (Osteogenesis Imperfecta): Blue
sclera, bone fractures, systemic
Tx: dentures or implants (NO Crowns bc would
fracture)
Dentinal Dysplasia
Draining fistulas, misshapen teeth
Type 1 / Radicular: Rootless, periapical
radiolucencies, short roots
Type 2 / Coronal: thistle/flame pulp,
interglobular dentin
Hypohydrotic Ectodermal Dysplasia
Hypodontia, anodontia
Lack skin appendages & hair
Heat intolerance
Diff Dx: White sponge, HBID, Morsicatio,
Leukoedema
Scleroderma / Progressive Systemic Sclerosis
Induration, no sweat glands, stiff soft tissue
Trismus, generalized widening of PDL space
Thickened CT
Cherubism
Young pts (3-7yo), Auto dom
Multilocular bilateral radiolucencies
Many unerupted teeth, displaces teeth
Facial disfiguration, BOTH jaws
Histo: MNG cells
Tx after puberty (expansion ceases)
Crohns Disease
Oral: cobblestone nodules, aphthous-like
ulcers, granulomatous gingivitis
Rectal bleeding (>small intestine skip lesions)
Histo: Langerhans giant cells
Tx: Sulpha drugs + Steroids
MEN / Multiple Endocrine Neoplasia IIB
Auto dom, 50% spontaneous dom
1st sign = oral mucosa neuromas
Marfan body type, thick lips / papules
Multiple mucosal neuromas (tongue)
Complications: 90% Medullary thyroid
carcinoma, 50% Adrenal pheochromocytoma
Peutz-Jeghers
Pigmented brown macules
Lips, tongue, buccal mucosa, vermilion
Intestinal polyposis
Cleidocranial Dysplasia
Many supernumerary unerupted teeth Condensing / Sclerosing Osteitis
Retention of primary teeth Young pts, reactive bone formation
No clavicles! Frontal bossing, large head NON-vital tooth, Pulpitis, deep caries
NOT connected to root you can trace PDL
Neurofibromatosis Type 1 (von Tx: RCT or extraction
Recklinghausen)
Multiple neurofibromas (nodules)
Skin & oral (especially tongue)
Caf au lait pigmentations (brown macules)

Calcifying Odontogenic Cyst / Gorlin Cyst
Ghost cells (no nuclei) calcify, amyloid
Idiopathic Osteosclerosis
VITAL tooth, NO Tx bc benign
>Posterior mandible
NOT connected to root you can trace PDL
Radiopacity with NO radiolucent rim

Melanotic Neuroectodermal Tumor of Infancy

Rapid onset, newborns
INC VMA (vanillylmandelic acid)
Ant maxilla, soft & hard tissue
Mobile teeth, tooth floating in air
Intrabony radiolucency, looks malignant
5% Malignant (brain, skull) Hypercementosis
VITAL Mand 1st molar
Generalized acromegaly
Sometimes seen in Pagets
Radiopacity w/intact PDL, attached to root

Fibrous Dysplasia
Young pts (10yo), Onset before puberty
>Maxilla
Ceases by age 20yo (Tx: bone shaving) Cementoblastoma
No pain, teeth do not fit PDL NOT intact
Unilateral expansion, 1 jaw, painless
Ground glass radiopacity

McCune Albrights Syndrome: Fibrous

Dysplasia + Caf au lait pigmentations +
Precocious puberty (ie. 4yo w/breasts & period)
Traumatic / Hemorrhagic / Solitary /
Simple Bone Cyst / Idiopathic Bone Cavity
(Pseudocyst)
>Young males
>Mandible, NOT expansile, can cross midline
Radiolucency w/scalloped margins
NO root resorption, NO swelling, NO pain
No Tx: Spontaneously heals

Langerhans Cell Histiocytosis X / Eosinophilic

Pagets Disease / Osteitis Deformans
Older white pts, CC: Dentures too small
Bilateral maxilla
Complications: Osteosarcoma, CHF, CN deficits
(if foramen compressed)
Elevated AP (extra bone growth)
NO hyperglobulinemia or premature exfoliation
of primary teeth
Xray: punched out radiolucencies, cotton wool,
50% hypercementosis
Histo: reversal lines (mosaic, jigsaw)
Tx: Calcitonin, Bisphosphonates, Aspirin
Granuloma
Young adults, solitary lesion
Bone destruction, reticuloendotheliosis
Xray: Punched out radiolucencies, tooth
floating in air (perio disease)
Histo: Langerhans cells / eosinophilic
granuloma (NOT histiocytes), Birbeck bodies
(cytoplasm)
*Hans-Schuller-Christian Triad =
Diabetes Insipidus + Exophthalmos + Bone
lesions (Langerhans cells)
*Letterer-Siwe: WORST, infants, organomegaly
Tx: radiation, chemotherapy

Gardner Syndrome
Colon polyps + Mutiple osteomas + skin nodules
Supernumerary/Hyperdontia, unerupted tooth
Osteomas @ angle of mandible
Complications: risk of colon carcinoma
(remove polyps by age 20 or will turn into
cancer) Cysts

Nasolabial Cyst (soft tissue)

Swelling adj to Max LI
Histo: PSSE lining (respiratory)
NOT on xray bc soft tissue only!

Lymphoepithelial Cyst (soft tissue)

 >Ventral tongue / FOM
Pale yellow (lymph), compressible
Odontogenic Keratocyst / OKC / KOT /
Keratocystic Odontogenic Tumor
Any age, 10-15% of jaw cysts
>Post mand, intrabony, can be anywhere
Multilocular radiolucency, bilateral
NO B-L expansion! NO root resorption
High recurrence 30%
Histo: parakeratin
Multiple lesions: Gorlin/Nevoid basal cell
carcinoma
Tx: enucleate + curettage, cautery + osteotomy,
resection + bone graft
Nevoid Basal Cell Carcinoma / Basal Cell
Nevus / Gorlin Syndrome
Basal cell carcinomas + Multiple OKCs + Bifid
ribs + Calcified falx cerebri
Childhood onset
Genetic: Mutated PTCH gene, chromosome 9
Skin: basal cell carcinomas, epidermal cysts,
palmar/plantar pits
Dens-in-Dente / Dens Invaginatus
>Ant jaw (>Max lateral incisor)
Developmental pit in cingulum area
Tx: restore opening or may lose vitality
Dens Evaginatus
>Posterior mandible, bilateral
15% Asians
Cusp-like elevation of enamel on lingual ridge of
buccal cusp
Shovel-shaped incisors may req RCT
Tx: remove for occlusion
Soft Tissue
Traumatic Fibroma / Fibrous Nodule / Focal
Fibrous Hyperplasia
Most common CT tumor!
>Tongue (trauma)
Reactive Hyperplasia (not true tumor)
Firm smooth, pink, sessile (wider base)
Epulis Fissuratum
Hyperplastic CT (like fibroma)
Ill-fitting denture
NO ABs req
Dermoid Cyst (developmental)
Doughy / slightly compressible
Midline distrib Ie) Ant FOM
>Ant FOM or neck

Gingival Cyst of the Adult

Facial attached gingiva
>Ant mandible
Vesicle

Mucocele / Mucous Retention/Extravasation

Kids & young adults, bite lip
>Lower lip, PSEUDOcyst
Trauma vesicle/bulla, bluish color, dome
Free Mucin extravasation from MSG, histiocytes
Tx: excision + severed duct/gland
Granular Cell Tumor
>Females, age 30-50
Origin: Schwann cells
>Dorsal tongue
Lysosomal granular cytoplasm
Smooth or papillated nodule
Histo: pseudoepitheliomatous hyperplasia Ranula
(resembles SCC) FOM Mucocele, frogs belly
Bluish, Recurrent, Viscous aspirate (mucous)
>sublingual gland
Histiocytes, granulation tissue, mucin

>Dorsal tongue

Hemangioma
Hamartoma, red-blue, blanches
RBCs

Mucous Retention Cyst

Lymphangioma
Lymph-filled superficial vessels
Most common cause of macroglossia!
Sialolith or bacterial plug obstruction
True cyst (Lined by epithelium)
>FOM
Antral / Mucous Retention Pseudocyst
Asymptomatic, NO Tx req
Radiopaque dome-shaped
Max sinus floor

Dentigerous Cyst
Doughy / compressible
Midline distrib
Sialolithiasis
80% submandibular (Whartons)

Sialadenitis
Inflamed salivary glands
Etiology: mumps, viral infx, bacterial (Staph
Aureus), xerostomia, Sjogren, Sarcoid

Dentigerous Cyst
>Post Mand, >impacted 3rd molars
Mand 3rd M > Max 3rd M > Can > Mand PM Allergic Mucositis
Epithelial lining Ameloblastoma, SCC, Due to toothpaste, candy, gum, cinnamon
Mucoepidermoid carcinoma
Xray: Pericoronal radiolucency attached @ CEJ
of unerupted tooth

Eagle Syndrome
Elongated calcified stylohyoid ligament
H&N pain when chewing, yawning, opening

Incisive Canal / Nasopalatine Duct Cyst

Most common developmental non-odonto cyst
Vital teeth, Max midline btwn CIs
Bad taste, heart-shaped radiolucency

Stafne Defect
Developmental, >Males
Asymptomatic, VITAL Teeth
Radiolucency near angle of Mand under Mand
Varices
canal
Tongue & Lip, >elderly
Dilated veins, bluish
Phlebolith: lip varices thrombose & calcify

Nerve
Xray: enlarged mandibular canal & foramina

Parulis / Gum Boil (fistula)

Incomplete RCT w/ sensitivity
Elevated yellow-red color, draining fistula

Neurofibroma (axons)
>Tongue & Buccal mucosa
No pain
Schwannoma / Neurilemoma (myelin)
Neoplasm, No pain, rarely in bone
>Tongue, gingiva, lips, mucosa
Histo: encapsulated, Antoni A, Verocay bodies
Bells Palsy (CN 7 unilateral facial paralysis)
Drooping corner of lip, cant close eye
Etiology: viral, lyme disease (Borrelia),
earache, infx, MS
Melkersson-Rosenthal / Orofacial
Granulomatosum: fissure tongue + facial N
paralysis + Cheilitis Granulomatosum
Self-limiting within 6 months
Trigeminal Neuralgia / Tic Douloureux
Onset >35yo
Highest suicide rate of any disease
>Mandibular branch, >Unilateral
Pain duration <60 secs
Triggers: touching nasolabial fold, vermilion,
periorbital, alveolar ridge
Tx: Phenytoin, Gabapentin, inject alcohol or
glycerin near Gasserian ganglion, Btx, Capsaicin
cream, Peripheral neurectomy, microvascular
decompression
Neuritis
Unilateral pain >1wk (forehead & eye)
Auriculotemporal / Frey Syndrome
CN 5
Often after parotid surgery
Unilateral face sweating after meal
NOTES
Causes of Desquamative Gingivitis
Erosive Lichen Planus
Benign Pemphigoid
Pemphigus Vulgaris
Erosion: MOST of epithelium is gone
Ulcer: ALL epithelium is gone
Cytology Smear is useful to Dx:
-Candidiasis
-Recurrent Herpes
-NOT if suspect precancer/Dysplasia
Caf Au Lait Pigmentations = McCune
Albrights Syndrome (fibrous Dysplasia) &
Neurofibromatosis / von recklinghausen
(papules/neurofibromas)
Extravasated Blood
Purpura = generalized
Petechiae = pinpoint
Ecchymosis = medium
Hematoma = large, elevated
Radiation Cervical caries due to xerostomia,
NOT pulp necrosis!
Internal root resorption pink tooth (if crown
involved)
Herpes = NON-movable mucosa (hard palate &
gingiva)
Aphthous Ulcers = MOVABLE mucosa (labial
mucosa, uvula)
Vit D deficiency / Scurvy = does NOT cause
xerostomia
Mand fracture Dx w/Pano & Occlusal xray
Condylar hyperplasia chin deviates AWAY
from affected side on closing
Radiology Facts
Xray & High voltage = shortest wavelength &
highest energy
Doubled mA = doubled intensity of xray beam
kVP determines penetration & controls contrast
Focal spot size influences resolution
Acute xray damage @ 4Gy = erythema
Nerve & Muscle = most radio-resistant
Hematopoetic stem cells = most radio-sensitive
Density of processed film is affected by
-INC mA, INC exposure time
-DEC object-thickness distance, DEC target-
object distance
-NOT by over-fixation
Intensifying screens: DEC exposure time & DEC
radiation exposure
8-bit digital image = 256 shades of gray
Coin tests: detect light leakage
Double distance from xray source = DEC
radiation by 4x (inverse square law)

Cleft Palate
Btwn LI & Canine

Globulomaxillary Cyst
Btwn LI & Canine

SCC: no sclerotic border bc cancer has a rapid

onset & spread