Differential Diagnosis

Descriptive Terminology
 White Flat
• Cheek chewing (morsicatio)
• Mouthwash induced
• Linea alba
• Leukodema
• Leukoplakia
• Tobacco keratosis
• Actinic keratosis-lips
• Lichen planus
• Nicotine stomatitis
• Hairy leukoplakia
• Candidiasis
• Lupus erythematosus
• Skin graft
• Submucous fibrosis
• White sponge nevus
• Hereditary benign intraepithelial dyskeratosis (HBID)
• Uremic stomatitis
• Post-inflammatory hypopigmentation
 White Raised
• Verruca Vulgaris
• Papilloma
• Condyloma acuminatum
• Infected Burn
• Viral vesicles with secondary bacterial infection
• Fixed drug eruption
• Hyperplastic candidiasis
• Disseminated deep fungal infection
 White Diffuse
• Tongue/Cheek/lip chewing (morsicatio)
• Thermal burn
• Chemical burn i.e. aspirin
• Leukodema
• Tobacco keratosis
• Candidiasis, hyperplastic
• Lichen planus
• Proliferative verrucous leukoplakia
• Verrucous carcinoma
• Field cancerization
• White sponge nevus
• Submucous fibrosis
• Hereditary benign intraepithelial dyskeratosis (HBID)
 Red Flat
• Pharyngitis
• Trauma (hematoma)
• Denture sore mouth
• Contact hypersensitivity
• Atrophic, erythematous candidiasis
• Kaposi sarcoma
• Erythema migrans
• Angular cheilitis
• Thermal & chemical burns
• Erythroplakia
• Anemia
• Thrombocytopenia
• Hemangioma
• Lupus erythematosus
• Scarlet fever
• Plasma cell gingivitis
• Radiation mucositis
• Infectious mononucleosis
• Fellatio
• Leukemia
• Hereditary hemorrhagic telangiectasia
 Red Raised
• PG
• PGCG
• Kaposi sarcoma
• Hematoma/bruising
• Thrombocytopenia
• Idiopathic thrombocytopenic purpura
• Leukemia
• Hemophilia
 Red Multiple
• Multiple hemangiomas i.e. Maffucci syndrome
• Petechiae
• Bruising/hematoma
• Infectious mononucleosis
• Fellatio
• Hemophilia
• Thrombocytopenia
• Leukemia
• Idiopathic thrombocytopenic purpura
• Disseminated intravascular coagulation
 Red Marginal Gingiva
• Non-specific gingivitis
• Erythematous candidiasis
• Infectious mononucleosis
• HIV gingivitis
 Speckled Red & White
• Erythema migrans
• Candidiasis
• Lichen planus
• Burn
• Actinic keratosis
• Nicotine stomatitis
• Speckled erythroleukoplakia
• Cinnamon aldehyde-induced
• Lupus erythematosus
• Scarlet fever
 Yellow Flat
• Fordyce granules
• Discoloration due to exogenous material i.e.
food coloration
• Orange dental plaque described in children
• Discoloration due to ingested chemical i.e.
excessive carotene
 Yellow Raised
• Fordyce granules (sebaceous glands hyperplasia)
• Superficial abscess
• Accessory lymphoid aggregate
• Lymphoepithelial cyst
• Lipoma
• Verruciform xanthoma
• Pyostomatitis vegetans
• Juvenile xanthogranuloma
 Yellow Multiple
• Fordyce granules
• Superficial abscess
• Accessory lymphoid aggregate
• Lipomas, can be multiple
• Verruciform xanthoma, can be multiple
• Pyostomatitis vegetans-usually multiple
• Sebaceous gland hyperplasia
• Juvenile xanthogranuloma-usually multiple
 Brown Flat
• Racial pigmentation
• Amalgam tattoo-very rarely brown (usually blue, grey and black)
• Black/brown hairy tongue
• Melanotic macule
• Smoker’s melanosis
• Other tattoos
• Junctional nevus
• Malignant melanoma
• Drug induced melanosis
• Peutz-Jegher’s syndrome
• Addison’s disease
• Neurofibromatosis-Café au lait spot
• Albright syndrome-Café au lait spot
• MEN 2b-mlanotic macules
• Heavy metal poisoning-usually dark blue or black
• Melanotic neuroectodermal tumor of infancy
• Lentigo maligna
• Post-inflammatory hyperpigmentation
• Diffuse endocrine hyperpigmentation
• Incontinentia pigmenti
 Brown Raised
• Intradermal, compound & blue nevus
• Juvenile xanthogranuloma
• Malignant melanoma
• Lentigo maligna-usually flat but can be raised
• Pyogenic granuloma-usually red
• Hemangioma
 Black Flat
• Racial pigmentation
• Amalgam tattoo
• Heavy metal poisoning
• Melanotic macule
• Smoker’s melanosis
• Non-amalgam tattoo
• Drug induced melanosis
• Peutz-Jegher’s syndrome
• Addison’s disease
• Neurofibromatosis-café au lait spots
• McCune-Albright syndrome-café au lait spots
• MEN 2b-melanotic macules
 Black Raised
• Black/brown hairy tongue
• Amalgam tattoo (rare)
• Melanocytic nevi
• Malignant melanoma
• Melanotic neuroectodermal tumor of infancy
 Blue/Purple Flat
• Submucosal hemorrhage/bruise/hematoma
• Amalgam tattoo
• Heavy metal poisoning
• Portwine hemangioma
• Kaposi sarcoma
• Blue nevus
• Malignant melanoma
• Upper respiratory infections
• Infectious mononucleosis
• Trauma from fellatio
• Hemophilia
• Leukemia
• Hereditary hemorrhagic telangiectasia
 Blue/Purple Raised
• Hematoma
• Idiopathic thrombocytopenic purpura
• Hemophilia
• Leukemia
• Varicosities
• Mucocele
• Eruption cyst (hematoma)
• Salivary duct cyst
• Hemangioma
• Ranula
• Kaposi’s sarcoma
• Salivary gland tumors
• Gingival cyst of the adult
• Blue nevus
• Malignant melanoma
• Leukemia
 Papillary Single Raised
• Verruca Vulgaris
• Papilloma
• Condyloma acuminatum
• Verrucous carcinoma
 Papillary Diffuse Raised
• Hairy tongue
• Inflammatory papillary hyperplasia
• Squamous cell carcinoma
• Proliferative verrucous leukoplakia
• Hairy leukoplakia
• Verruciform xanthoma
• Verrucous carcinoma
• Chronic granulomatous inflammation
• Focal epithelial hyperplasia-cobble stone
 Papillary/Rough surface Multiple
• Verruca Vulgaris
• Papilloma (syndrome)
• Condyloma acuminatum
• Chronic granulomatous inflammation
• Proliferative verrucous leukoplakia
Annular/ring-like/Circular Multiple
• Erythema migrans (geographic tongue)
• Allergy
• Mucous patch
• Lichen planus
• Reiter’s syndrome
• Erythema multiforme (target lesions)
 Solid/Smooth surface Nodule-Multiple
• Lipoma
• Exostosis
• Adnexal tumors
• Basal cell carcinoma
• Neurofibroma
• Angiomyoma
• Irritation fibroma
• Other mesenchymal tumors
• Salivary gland tumors
• Keratoacanthoma
• Squamous cell carcinoma
• Sialolith
• Hyperplastic lymph node
• Epulis fissuratum/inflammatory fibrous hyperplasia
• Pyogenic granuloma
• Peripheral ossifying fibroma
• Peripheral giant cell granuloma
• Metastatic tumors
• Traumatic neuroma
• Kaposi’s sarcoma
• Peripheral odontogenic tumors
• Congenital epulis of the newborn
• Melanotic neuroectodermal tumor of infancy
• Granular cell tumor
• Lingual thyroid
• Melanocytic nevi/melanoma
• Focal epithelial hyperplasia
• Amyloidosis
• Thyroid gland enlargement
• Thyroglossal duct cyst
• Reactive lymphadenopathy
• Infectious mononucleosis
• Lymphoma
• Major salivary gland sialadenitis or sialadenosis
• Branchial cleft cyst
• Scrofula
• Cat-scratch disease
 Solid/Diffuse Single Nodule
• Trauma
• Cheilitis granulomatosa
• Angioedema
• Double lip
• Neurofibroma
• Nasolabial cyst
• Lipoma
• Epulis fissuratum
• Kaposi’s sarcoma
• Melanotic neuroectodermal tumor of infancy
• Plunging ranula
• Sarcoidosis
• Chronic granulomatous infectious disease
• Scrofula
• Cat-scratch disease
 Solid/Smooth Surface Multiple
• Focal epithelial hyperplasia-usually smooth surfaced
• Condyloma accuminatum-can be smooth surfaced
• Mucocele-rare to be multiple
• Reactive or infectious lymphoid nodules
• Basal cell carcinomas-rarely in nodules or multiple but
can be in Gorlin syndrome
• Neurofibromatosis
• MEN 2b syndrome
• Angiolipoma
• Exostosis
• Torus mandibularis
 Fluid Filled Single Nodule
• Burn blister
• Sucking-induced blister
• Friction-induced blister
• Hypersensitivity-induced blister
• Lymphangioma of infants
• Fixed drug eruption blister-rare single
• Diabetic bulla
• Mucocele/Ranula
• Nasolabial cyst
• Parulis
• Gingival cyst of the adult
• Lymphoepithelial cyst
• Epidermal/epidermoid cyst
• Dermoid cyst
• Plunging ranula
• Branchial cleft cyst
 Fluid Filled Multiple Nodules
• Burns blister
• Sucking blisters
• Friction blisters
• Hypersensitivity-induced blisters
• Epidermolysis bullosa
• Lymphangioma
• Viral blisters i.e. HSV, VZ, others
• Scalded skin syndrome
• Erythema multiforme (Stevens-Johnson syndrome ; TEN)
• Linear IgA dermatosis
• Bullous pemphigoid
• Pemphigus vulgaris
• Diabetic bulla
• Bullous lichen planus
 Pus Filled Single Nodule
• Infected Burn blister
• Viral blister
• Parulis (sinus tract)
• Soft tissue abscess
• Mucocele with abscess
 Pus Filled Multiple Nodules
• Infected Burn blisters
• Viral vesicles/secondary bacterial infection
• Fixed drug eruption
• Pyostomatitis vegetans
• Pemphigus vegetans-infected
• Bullous pemphigoid-infected
 Sinus Tract
• Infected cyst
• Infected lymph node
• Necrotizing granulomatous inflammation
– Actinomycosis
– Cat-scratch disease
– Scrofula
– Others i.e. fungal infections
• Necrotic malignant neoplasm
 Fissures/Grooves Tongue
• Fissured tongue
• Scarring
• Tertiary syphilis
• Xerostomia
 Fissures/Grooves Lip
• Aging
• Congenital syphilis
• Excessive sun exposure
• Ill-fitting denture
 Holes-Mouth
• Paramedial pits
• Van der Woude’s syndrome
• Commissural pits
• Gumma, tertiary syphilis
• Midline lethal granuloma
• Lymphoma/other malignant neoplasms
• Deep fungal infections-i.e. Mucormycosis &
Aspergillosis
 Necrotic/Fungating
• Midline lethal granuloma
• SCC
• Lymphoma and other primary malignancies
• Deep fungal infections-i.e. Mucormycosis &
Aspergillosis
• Metastatic malignancy
• Metal Poisoning
 Single Ulcer Deep
• Traumatic ulcer
• Major aphthous ulcers
• Mucosal burns
• Necrotizing sialometaplasia
• Anesthetic necrosis
• Primary syphilis
• Squamous cell carcinoma & other malignancies
• Basal cell carcinoma (only skin-more on upper lip)
 Multiple Ulcers Deep Mouth
• Major Aphthous ulcers
• Electrical burn
• Chemotherapy
• Squamous cell carcinoma-usually single
• Traumatic ulcerative granuloma with stromal eosinophilia
(TUGSE)-usually single
• Deep fungal infections
• Tuberculosis
• Sarcoidosis
• Midline lethal granuloma
• Noma
• Tertiary syphilis
 Single Ulcer Superficial
• Minor aphthous ulcers-usually multiples
• Mucosal burns
• Mucosal allergic reaction
• Geographic tongue-usually multiple
• Chemical or temperature burn
• Bullous Pemphigoid-usually multiple
• Pemphigus vulgaris-usually multiple
• Erosive lichen planus/lichenoid
• Cicatricial (mucous membrane) pemphigoid
• Lupus erythematosus
• Oral Manifestation of Crohn’s and Behcet-usually multiple
 Multiple Ulcers Superficial
• Minor and Herpetiform Aphthous ulcers
• Herpes simplex-primary and recurrent
• Varicella (chickenpox)
• Acute necrotizing ulcerative gingivitis (ANUG)
• Mucosal burns
• Allergic reaction
• Erythema multiforme
• Herpangina
• Herpes zoster
• Hand-foot-and-mouth disease
• Primary and secondary syphilis
• Behçet’s syndrome
• Crohn’s disease
• Celiac disease
• Epidermolysis bullosa
• Candidiasis
• Congenital syphilis
• Geographic tongue
• Chemical burn
• Bullous Pemphigoid
• Pemphigus vulgaris
• Chemotherapy
• Leukopenia
• Cyclic neutropenia
• Leukemia
• Vitamin B and iron deficiency
• Erosive lichen planus/lichenoid mucositis
• Cicatricial (mucous membrane) pemphigoid
• Lupus erythematosus
• Pyostomatitis vegetans
 Surface Sloughing Generalized
• Mucosal burn (temp & chemical)
• Allergic reaction
• Erythema multiforme
• Celiac disease
• Epidermolysis bullosa
• Bullous Pemphigoid
• Pemphigus vulgaris
• Erosive lichen planus/Lichenoid mucositis
 Surface Sloughing Gingiva
(Desquamative Gingivitis)
• Mucosal burn
• Allergic reaction
• Erythema multiforme
• Bullous Pemphigoid
• Mucous membrane pemphigoid
• Pemphigus vulgaris
• Erosive lichen planus/Lichenoid mucositis
 Surface Atrophy Mouth
• Xerostomia
• Mucosal burn (temp & chemical)
• Allergic reaction
• Epidermolysis bullosa
• Candidiasis
• Geographic tongue
• Erosive lichen planus/lichenoid mucositis
• Mucous membrane pemphigoid
• Lupus erythematosus
 Surface Atrophy Tongue
• Xerostomia
• Allergic reaction
• Erosive lichen planus/Lichenoid mucositis
• Mucous membrane pemphigoid
• Lupus erythematosus
• Atrophic candidiasis
• Anemia, iron, B12 & others
 Gingival Swelling Single
• Parulis
• Epulis fissuratum
• Pyogenic granuloma/Fibrous hyperplasia
• Peripheral ossifying fibroma
• Peripheral giant cell granuloma
• Giant cell fibroma
• Squamous cell carcinoma
• Metastatic disease
• Gingival cyst of the adult
• Traumatic neuroma
• Kaposi’s sarcoma
• Peripheral odontogenic neoplasms
• Congenital epulis
• Exostosis
• Mesenchymal (soft tissue) neoplasms
 Gingival Swellings Multiple
• Hyperplastic gingivitis-plaque induced
• Drug-related gingival hyperplasia
• Leukemic or lymphoma infiltrate
• Wegener’s granulomatosis
• Scurvy
• Exostoses
• Mandibular tori
 Gingival Swelling Generalized
• Hyperplastic gingivitis/periodontitis
• Drug-related gingival hyperplasia
• Fibromatosis gingivae
• Aggressive fibromatosis
• Leukemic or lymphoma infiltrate
• Wegener’s granulomatosis
• Scurvy
 Tongue Swelling Single
• Irritation fibroma
• Squamous cell carcinoma
• Mucocele
• Granular cell tumor
• Mesenchymal neoplasms
• Pyogenic granuloma
• Salivary gland neoplasms
• Lingual thyroid
• Median Rhomboid glossitis
 Tongue Swelling Generalized
• Congenital hypothyroidism
• Down syndrome
• Lymphangioma
• Hemangioma
• NF
• Angioedema
• Trauma
 Lower Lip Swelling Single
• Mucocele
• Irritation fibroma
• Pyogenic granuloma
• Squamous cell carcinoma
• Mesenchymal neoplasms
• Chronic granulomatous lesion-several conditions
• Salivary gland conditions
• Keratoacanthoma
 Lower Lip Swelling Generalized
• Trauma
• Angioedema
• Other Hypersensitivity
• Lymphangioma
• Hemangioma
• Other ST neoplasms i.e. NF
• Rhabdomyosarcoma
 Upper Lip Swelling Single
• Chronic granulomatous lesion-several conditions
• Irritation fibroma
• Pyogenic granuloma
• Salivary gland conditions
• Minor salivary gland Sialolith
• Mesenchymal (soft tissue) neoplasms
• Nasolabial cyst & other cysts
• Sialolith with abscess
 Upper Lip Swelling Generalized
• Trauma
• Angioedema
• Other Hypersensitivity
• Lymphangioma
• Hemangioma
• Other ST neoplasms i.e. NF
• Rhabdomyosarcoma
 Buccal Mucosa Swellings
• Irritation fibroma
• Mucocele
• Hyperplastic lymph node
• Mesenchymal (soft tissue) neoplasms
• Soft tissue abscess
• Cysts i.e. epidermal and others
• Squamous cell carcinoma
• Salivary gland neoplasms
 FOM Swellings
• Ranula/mucocele
• Sialolith
• Squamous cell carcinoma
• Lymphoepithelial cyst
• Epidermoid or dermoid cysts
• Salivary gland neoplasms
• Mesenchymal (soft tissue) neoplasms
 Palatal Swellings
• Torus palatinus
• Palatal abscess
• Leaf-like denture fibroma
• Salivary gland neoplasms
• Kaposi’s sarcoma
• Nasopalatine duct cyst
• Other mesenchymal neoplasms
• Squamous cell carcinoma
• Mucocele/salivary duct cyst
• Lymphoma
• Necrotizing sialometaplasia
• Adenomatoid hyperplasia
 Midline Neck Swellings
• Goiter
• Thyroid neoplasms & Reactive lesions
• Parathyroid neoplasms and Reactive lesions
• Thyroglossal duct cyst
• Dermoid cyst
• Plunging ranula
• Mesenchymal (soft tissue) neoplasms
 Lateral Neck Swellings
• Reactive lymphadenopathy
• Malignant lymphoma & HL
• Epidermoid cyst
• Infectious mononucleosis
• Metastatic carcinoma
• Salivary gland neoplasms
• Submandibular sialadenitis
• Cervical lymphoepithelial cyst
• Granulomatous diseases
• Cat-scratch disease
• Cystic hygroma
• Mesenchymal (soft tissue) neoplasms
 Lateral Face Swellings
• Infection: Viral & Bacterial
• Primary malignancy, sarcoma, lymphoma
• Metastatic malignancy to the parotid
• Odontogenic neoplasms & Cysts
• Salivary gland neoplasms
• Sialadenosis
• Sjogren’s Syndrome
• Lymphoepithelial cyst
• Mesenchymal neoplasms
 Radiolucent (RL) Unilocular
• Dental follicle/Dentigerous cyst/Eruption cyst
• Odontogenic keratocyst
• Ameloblastic fibroma/SOT
• Adenomatoid odontogenic tumor-usually radiolucent but can be mixed
• Other odontogenic neoplasms i.e. ameloblastoma, myxoma,
• Periapical granuloma/Periapical cyst/Periapical scar/Lateral radicular cyst
• Nasopalatine duct cyst
• Lateral periodontal cyst
• Residual (periapical) cyst
• Central giant cell granuloma/ABC/Cherubism
• Stafne’s bone defect
• Melanotic neuroectodermal tumor of infancy
• Median palatal cyst-some believe it is nasopalatine duct cyst
• Intra-osseous neurilemmoma/neurofibroma
• Intra-osseous hemangioma
• Intra-osseous SCC and ameloblastic carcinoma
• Metastatic breast and other metastatic epithelial cancers-NOT prostate
• Intra-osseous mucoepidermoid carcinoma
 RL Unilocular Pericoronal
• Dental follicle/Dentigerous cyst/Eruption cyst
• Odontogenic keratocyst
• Ameloblastoma/ myxoma/Pindborg/central
odontogenic fibroma
• Ameloblastic fibroma
• Ameloblastic fibro-odontoma-early stage
• Adenomatoid odontogenic tumor
• Calcifying odontogenic cyst-early stage
• Intraosseous mucoepidermoid carcinoma
 RL Unilocular Periapical
• Periapical (PA) granuloma/PA cyst/PA scar
• Odontogenic keratocyst
• Periapical cemental dysplasia (early)
• Traumatic bone cavity
• Metastatic neoplasms
• Intra-osseous benign soft tissue neoplasms i.e.
NF, hemangioma, schwannoma, myofibroma
 RL Unilocular Between Teeth
• Developing tooth bud-early stage
• Lateral radicular cyst
• Residual (periapical cyst)
• Lateral periodontal cyst/Botryoid odontogenic
• Odontogenic keratocyst
• Glandular odontogenic cyst
• Central giant cell granuloma
• Cemento-osseous dysplasia-early stage
• Central ossifying fibroma-early stage
• Ameloblastoma/myxoma/SOT/AOT
• Traumatic bone cavity
 RL Unilocular Ant Maxilla
• Nasopalatine duct cyst
• Apical periodontal
cyst/granuloma/scar/residual/lateral radicular
• Lateral periodontal cyst
• Globulomaxillary cyst
• Odontogenic keratocyst
• Melanotic neuroectodermal tumor of infancy
• Median palatal cyst
• Odontogenic myxoma & central O fibroma
 RL Unilocular Ant Mandible
• Apical periodontal
cyst/granuloma/scar/residual/lateral radicular
• Lateral periodontal cyst
• Glandular odontogenic cyst
• Odontogenic keratocyst
• Central giant cell granuloma
• Traumatic bone cavity
• Periapical cemental dysplasia-early stage
 RL Unilocular Area Missing Teeth
• Odontogenic keratocyst
• Residual periapical cyst/granuloma
• Fibrous healing/connective tissue scarring
• Central giant cell granuloma
• Central ossifying fibroma
• Ameloblastoma and other odontogenic
neoplasms & cysts
RL Unilocular Below Alveolar Canal
• Stafne bone defect
• Central hemangioma
• Central giant cell granuloma
• Central neurilemmoma/neurofibroma
• Intra-osseous benign soft tissue neoplasms
RL Unilocular Within Alveolar Canal
• Intra-osseous neurilemmoma/neurofibroma
• Intra-osseous hemangioma
 RL Scalloped Border
• Odontogenic keratocyst
• Botryoid odontogenic cyst
• Intra-osseous mucoepidermoid carcinoma
• Traumatic bone cavity
• Odontogenic Myxoma
• Ameloblastoma-solid
 Radiolucent Bilateral
• Cherubism
• Odontogenic keratocyst
• Globulomaxillary cyst
• Salivary gland depression
• Traumatic bone cavity
 Radiolucent Multilocular
• Ameloblastoma-solid
• Central giant cell granuloma
• Odontogenic myxoma
• Pindborg tumor-early stage
• Central odontogenic fibroma
• Botryoid odontogenic cyst
• Calcifying odontogenic cyst-early stage
• Central hemangioma/arteriovenous malformation
• Aneurysmal bone cyst
• Cherubism
• Hyperparathyroidism (brown tumor)
• Intraosseous mucoepidermoid carcinoma
• Fibrous dysplasia
• Dentigerous cyst
• Odontogenic keratocyst
 Radiolucent Multiple
• Multiple myeloma
• Langerhans Cell Histiocytosis
• Cherubism
• Brown tumor of hyperparathyroidism
• Fibrous dysplasia-Albright and Jaffe
• Cemento-osseous dysplasia i.e. PCD or florid COD
• Squamous odontogenic tumors
• Odontomas-early stage
• Dentigerous cyst
• Odontogenic keratocyst
• Globulomaxillary cyst
• Salivary gland depression
• Traumatic bone cavity
 RL Single Ill-Defined
• Osteoporotic bone marrow defect
• Osteomyelitis
• Eosinophilic granuloma
• Traumatic bone cyst-inferior border only
• Metastatic tumors
• Osteoradionecrosis
• Multiple myeloma
• Lymphoma
• Primary intraosseous carcinomas
• Osteosarcoma-early stage
• Chondrosarcoma
• Ewing’s sarcoma
• Other primary bone malignancies
• Desmoplastic fibroma of bone
 RL Single Well-Defined
• Dental follicle
• Dentigerous cyst
• Odontogenic keratocyst
• Ameloblastic fibroma
• Ameloblastic fibro-odontoma-early stage
• Adenomatoid odontogenic tumor
• Calcifying odontogenic cyst-early stage
• Other odontogenic neoplasms
• Periapical granuloma/Periapical cyst/Periapical scar/Lateral radicular cyst
• Residual (periapical) cyst
• Developing tooth bud-early stage
• Nasopalatine duct cyst
• Lateral periodontal cyst
• Central giant cell granuloma
• Aneurysmal bone cyst
• Stafne bone defect
• Central ossifying fibroma-early stage
• Ameloblastoma/Odontogenic myxoma
• Melanotic neuroectodermal tumor of infancy
 RL Generalized/Diffuse
• Generalized periodontitis-plaque induced
• Generalized periodontitis-oral manifestation
systemic disease i.e. diabetes, leukopenia,
cyclic neutropenia, leukemia, multiple
myeloma, Langerhans cell Histiocytosis/others
• Florid cemento-osseous dysplasia
• Phantom bone disease
 Radiopaque (RO) Single
• Torus or exostosis
• Retained root tip
• Condensing osteitis/Idiopathic osteosclerosis
• Psuedocyst of the maxillary sinus/Antral
mucocele
• Soft tissue radiopacity superimposed on bone i.e.
Choristoma, calcified LN
• Intraosseous foreign body
• Osteoma
• Enamel pearl
 Radiopaque Bilateral
• Torus mandibularis or exostoses
• Condensing osteitis/Idiopathic osteosclerosis
• Psuedocyst of the maxillary sinus/Antral
mucoceles
• Intraosseous foreign body
• Osteomas (Gardner’s syndrome)
 Radiopaque Multiple
• Tori and Exostoses
• Idiopathic osteosclerosis/condensing osteitis
• Multiple osteomas (Gardner syndrome)
• Osteopetrosis
• Intraosseous foreign body
 Radiopaque Periapical
• Torus or exostosis
• Retained root tip
• Condensing osteitis/Idiopathic osteosclerosis
• Soft tissue radiopacity superimposed on bone
• Intraosseous foreign body
• Osteoma
 Radiopaque Pericoronal
• Idiopathic osteosclerosis
• Osteosarcoma
 Radiopaque Between Teeth
• Exostosis
• Retained root tip
• Condensing osteitis/Idiopathic osteosclerosis
• Soft tissue radiopacity superimposed on bone
i.e. calcified LN
• Intraosseous foreign body
• Osteoma
 Radiopaque Below Alveolar Canal
• Torus or exostosis
• Idiopathic osteosclerosis/condensing osteitis
• Soft tissue radiopacity superimposed on bone
i.e. calcified LN
• Intraosseous foreign body
• Osteoma
 Radiopaque Ill-Defined
• Condensing osteitis/Idiopathic osteosclerosis
• Osteopetrosis
• Sclerosing Osteomyelitis
• Osteosarcoma-are usually mixed but can
rarely be RO
• Chondrosarcoma- are usually mixed but can
rarely be only RO
 Radiopaque Well-Defined
• Torus or exostosis
• Retained root tip
• Psuedocyst of the maxillary sinus/Antral
mucocele
• Soft tissue radiopacity superimposed on bone i.e.
calcified LN
• Intraosseous foreign body
• Osteoma
• Enamel pearl
 Mixed RL/RO Single
• Developing tooth
• Periapical cyst/granuloma with retained root tip
• Cemento-osseous dysplasia-all three types
• Odontoma
• Central ossifying fibroma/juvenile ossifying fibroma
• Ameloblastic fibro-odontoma
• Adenomatoid odontogenic tumor-can
• Calcifying epithelial odontogenic tumor
• Calcifying odontogenic cyst
• Osteoblastoma/osteoid osteoma
• Cementoblastoma
• Osteosarcoma/chondrosarcoma
• Fibrous dysplasia
 Mixed RL/RO Bilateral
• Developing teeth (especially 3rd molars)
• Florid cemento-osseous dysplasia
• Bilateral odontomas (Gardner’s syndrome)
• Bilateral central ossifying fibromas-rare
 Mixed RL/RO Multiple
• Florid cemento-osseous dysplasia
• Paget’s disease of bone
• Multiple odontomas (Gardner’s syndrome)
• Multiple fibrous dysplasias
• Hyperparathyroidism
 Mixed RL/RO Well-Defined
• Developing tooth
• Cemento-osseous dysplasia
• Odontoma
• Central ossifying fibroma
• Ameloblastic fibro-odontoma
• Adenomatoid odontogenic tumor
• Calcifying epithelial odontogenic tumor
• Calcifying odontogenic cyst
• Osteoblastoma/osteoid osteoma
• Cementoblastoma
 Mixed RL/RO Ill-Defined
• Osteomyelitis
• Metastatic carcinoma
• Osteosarcoma/chondrosarcoma
 Mixed RL/RO Between Teeth/Lateral
• Developing tooth
• Periapical cyst/granuloma with retained root tip
• Cemento-osseous dysplasia
• Odontoma
• Central ossifying fibroma
• Calcifying epithelial odontogenic tumor
• Calcifying odontogenic cyst
• Osteoblastoma/osteoid osteoma
 Mixed RL/RO Periapical
• Periapical cyst/granuloma W retained root tip
• Cemento-osseous dysplasia
• Periapical cemental dysplasia
• Central ossifying fibroma
• Osteoblastoma/osteoid osteoma
• Cementoblastoma
 Mixed RL/RO Pericoronal
• Developing tooth
• Odontoma
• Ameloblastic fibro-odontoma
• Adenomatoid odontogenic tumor
• Calcifying epithelial odontogenic tumor
• Calcifying odontogenic cyst
 Ballooning RL
• Aneurysmal bone cyst
• Central giant cell granuloma
• Dentigerous cyst
• Cystic ameloblastoma
• Other odontogenic neoplasms i.e. solid
ameloblastoma & odontogenic myxoma
 Ground Glass Radiopacity
• Fibrous dysplasia
• Hyperparathyroidism
• Marble bone disease
• Paget’s disease
 Orange Peel Radiopacity
• Fibrous Dysplasia
• Hyperparathyroidism
 Salt & Pepper RL/RO
• Fibrous dysplasia
• Hyperparathyroidism
• Pindborg tumor
 Cotton Wool Radiopacity
• Florid cemento-osseous dysplasia
• Chronic sclerosing osteomyelitis
• Fibrous dysplasia
• Paget’s disease of bone
• Gardner syndrome
• Gigantiform cementoma
 Mottled Radiolucency
• Osteomyelitis
• Primary malignancy, osteosarcoma,
chondrosarcoma
• Metastatic malignancy i.e. prostate cancer
• Eosinophilic granuloma
• Chondroma
 Punched-Out Radiolucency
• Multiple myeloma
• Primary malignancy
• Metastatic malignancy
• Langerhans cell Histiocytosis (Eosinophilic
Granuloma)
 Stepladder Radiolucency
• Normal anatomy
• Sickle cell anemia
• Thalassemia
 Hair-on-End Effect RO
• Sickle Cell Anemia
• Thalassemia
 Teeth Floating In Space RL
• Severe periodontitis
• Periodontitis result of systemic disease
• Primary malignant neoplasm
• Metastatic malignant neoplasm
• Langerhans cell Histiocytosis/Eosinophilic
granuloma
 Sunburst Radiopacity
• Osteosarcoma
• Other sarcomas i.e. chondrosarcoma
• Intraosseous hemangioma
• Odontogenic myxoma
 Onion-Skin Radiopacity
• Proliferative periostitis
• Ewing’s sarcoma
• Eosinophilic granuloma
• Garre’s osteomyelitis
 Soap Bubble Radioluceny
• Solid ameloblastoma
• Odontogenic myxoma
• Pindborg tumor
• Intraosseous (central) hemangioma
• Central Giant Cell Granuloma
• Aneurysmal bone cyst
• Brown tumor of hyperparathyroidism
• Intraosseous MEC
 Honeycomb Radiolucency
• Solid ameloblastoma
• Pindborg Tumor
• Odontogenic myxoma
• Aneurysmal Bone Cyst
• Central giant cell granuloma
• Brown tumor of hyperparathyroidism
• Intraosseous (central) hemangioma
• Intraosseous MEC
 Tennis Racket Radiolucency
• Odontogenic Myxoma
 Corticated Unilocular RL
• Odontogenic cysts
• Non-odontogenic cysts
• Salivary gland depression
• Benign odontogenic neoplasms
• Central ossifying fibroma
• Focal cemento-osseous dysplasia
 Driven Snow RL/RO
• Pindborg Tumor (Calcifying Epithelial
Odontogenic Tumor
 Snowflake Radiopacity
• Chondrosarcoma
• Adenomatoid Odontogenic Tumor
 Punctate Calcifications
• Chondrosarcoma
• Chondroma
 Moth-Eaten RL/RO
• Multiple Myeloma
• Intraosseous lymphoma or other primary
malignancy
• Metastatic malignancy-prostate
• Langerhans cell Histiocytosis (eosinophilic
granuloma)
• Chronic osteomyelitis
• Acute osteomyelitis
 Confetti Radiopacity
• Osteoblastoma
• Osteosarcoma
• Chondrosarcoma
 Loss of Lamina Dura
• Hyperparathyroidism
• Osteomalacia
• Paget’s disease of bone
• Fibrous dysplasia
 Widened/Thickened PDL
• Periapical abscess
• Current orthodontic therapy
• Increased occlusal function
• Systemic sclerosis (scleroderma)
• Sarcoma or carcinoma infiltration the
periodontal ligament space
 Wispy Septa
• Central Giant Cell Granuloma
• Odontogenic myxoma
• Central hemangioma
 Soft Tissue Calcifications
• Amalgam tattoo
• Other foreign body
• Sialolith
• Calcified lymph nodes
• Phlebolith
• Tonsillar lith
• Soft tissue osteoma/Chondroma (Choristoma)
• Calcinosis cutis
• Myositis ossificans
 Expansile Radiolucency
• Ameloblastoma & all odontogenic neoplasms
• All odontogenic and non-odontogenic cysts
except OKC, traumatic bone cavity & Stafne’s
defect
• Aneurysmal Bone Cyst/Central giant cell
granuloma/brown tumor of
hyperparathyroidism
• All benign and malignant neoplasms including
metastatic