1. 26
Oral Pathology

2. Introduction Antigenic Palpate Capable of causing antibody production
Feel with fingers
Oral pathology is defined as the study of oral diseases, their causes (if known), and their effects on the body.
Dental assistants do not diagnose oral pathological diseases, but may alert the dentist to abnormal conditions in the mouth.

3. Introduction Biopsy Etiology Surgical removal of tissue
Cause of the disease

4. Inflammation Redness Heat Swelling Pain
The body responds to disease and injury with a process known as inflammation.
White blood vessels are attracted to the chemicals of inflammation.
Histamine brings about the inflammation process by increasing blood flow to the involved area.

5. Diagnosing Oral Pathology
Radiographs
Examination
Genetic history
Surgical procedures
Microscopic examinations (biopsy)
Lab, differential, and therapeutic diagnoses
The dentist will often examine radiographs and do a physical examination of the area of concern.
The patient’s genetic and medical histories are reviewed to determine if there is a risk for a specific type of disease based upon past medical conditions or family predisposition.
The dentist may choose to biopsy the tissues to conduct further examinations of the problem areas.
All data is analyzed and then a diagnosis is presented to the patient with a treatment plan.
The dentist will then evaluate the treatment actions to determine if the diagnosis is accurate and is being impacted by the treatment.
If not, a new course of action can be planned.

6. Oral Lesions Four classifications Above surface of oral mucosa
Below surface of oral mucosa
Even or flat with surface of oral mucosa
Flat or above surface of oral mucosa
Abnormal tissues in the oral cavity, called lesions, are further classified according to their placement in the surface of the mucosa.

7. Lesions Above the Surface
Blister
Bulla
Hematoma
Papule
Plaque
Pustule
Vesicles
Blister is a raised area, usually oval or circular in shape, that is fluid filled.
Fluid leaks from the blood vessels to underlying layers of skin following some type of trauma such as burn, friction, or disease.
Fluid also protects the damaged tissue.
Bulla is a large (greater than one-half inch in diameter), fluid-filled blister.
Hematoma is a lesion caused by bleeding from a ruptured blood vessel, which appears as a raised bruised area due to the collection of localized, clotted blood.
Dental assistants should watch for a hematoma after oral anesthetic.
Even the best clinicians may nick a blood vessel during an injection, resulting in hematoma.
The dental assistant alerts the dentist about the condition and then applies pressure to the area to disperse the blood in the tissue, which alleviates the pressure.
Papule is a small (less than one-half inch in diameter), solid, raised area of skin.
The surface of the papule may be pigmented in color and either smooth or bumpy in texture.
Plaque is any raised or flat patch in the oral mucosa. This term is not to be confused with dental plaque.
Pustule is a small, pus-containing blister.
A person may see a pustule during noninfective acne.
A pustule at the end of an eyelash follicle is a stye.
Vesicles are small, fluid-filled blisters.

8. Lesions Below the Surface
Abscess
Cyst
Erosion
Ulcer
Abscess is a concentrated area of pus formed as a result of infection by microorganisms.
Dental abscesses are periapical (at the end of the tooth) or periodontal, caused by microorganisms invading the membrane of the tooth.
Cyst is a fluid or semisolid fluid-filled sac. The causes of cysts are numerous.
In dentistry, cysts normally occur as a result of a duct leading from a fluid-forming gland becoming blocked.
Cysts can develop around the crown of an undeveloped tooth prior to eruption.
Erosion is the defect left from a trauma or an injury.
It may arise from a person biting the cheek.
The margins of the cheek erosion are red and painful.
Ulcer is due to destruction of the mucous membrane and appears as an open sore on the tissue.
The ulcer may appear shallow or crated deeply and is normally inflamed and painful.

9. Lesions Even or Flat with the Surface
Ecchymosis
Macule
Patch
Petechiae
Purpura
Ecchymosis is a medical term for bruising of the tissue.
Macule is a spot of different texture or color on the skin.
Patch is an area of skin that appears differently either in color or texture.
Petechiae are small spots, red or purple in color, that occur in the skin or mucosa tissue.
Also caused by localized hemorrhage.
Purpura is caused by bleeding within underlying tissues.
These purplish or reddish brown areas or spots of discoloration can range in size from the diameter of a pinhead up to one inch.
Small purpura normally are referred to as petechiae, and the larger ones are called ecchymoses, or bruises.

10. Lesions Flat with or Above the Surface
Granuloma
Neoplasm
Nodule
Granuloma is associated with chronic inflammation and appears as a neoplasm or tumor that is filled with granulation tissue.
The suffix -oma refers to neoplasms or tumors.
Neoplasm is the medical term for tumor.
This new, abnormal growth that serves no usefulness can be either malignant (life threatening) or benign (non–life threatening).
Nodule is a small lump of tissue, either hard or soft, that is usually more than one-quarter inch in diameter.
May either protrude from the tissue or form beneath the surface of the tissue.

11. Biological Agents Actinomycosis Infection caused by bacterium
Painful swelling, pus, and discharge
Poor oral hygiene
Actinomycosis is microorganisms obtaining access to the bone through the dental socket after a tooth removal is thought to be contributing factors.

12. Biological Agents Herpes Simplex Cold sores Genital herpes
Herpetic whitlow
Herpes Simplex
Type I (above the waist) usually in the form of a cold sore; called herpes labialis
Type II (below the waist) commonly called genital herpes
Herpetic whitlow is a crusting ulceration on the fingers or hands that is extremely painful.
**Dental assistants must exert extreme care while working with patients who have herpes**

13. Biological Agents Aphthous ulcers Herpes Zoster Syphilis Thrush
Canker sores
Herpes Zoster
Syphilis
Three stages
Thrush
Aphthous ulcers are common ulcerations that reoccur in the oral cavity.
Appear circular with yellow centers and erythematous (red) halos surrounding lesions.
Patients refer to them as canker sores.
Herpes Zoster appears as unilateral, painful lesions that can last up to five weeks.
Causes varicella in children; may lie latent and then activate at a time when the person is immunodeficient.
Human immunodeficient virus (HIV) and advanced cancer patients are predisposed to herpes zoster.
Syphilis the venereal disease caused by bacteria that may be treated with antibiotics, has three primary stages.
First stage shows with a primary lesion about one-half inch in diameter that is hard and raised.
Second stage begins with flu-like symptoms, followed by one of two types of lesions that are extremely infectious.
Third stage: a gummy or localized lesion appears (may occur many years after nontreatment).
Destroys bone and cartilage. Children who are born to mothers with syphilis may have Hutchinson’s incisors and mulberry molars.
Thrush is the common name for the fungal infection of candidiasis in children.
It appears as a white, thick covering over the oral mucous membranes.
Often originates as the newborn travels through the birth canal.
Treatment is to wipe the involved area and apply topical antifungal drugs to the area.

14. Physical Agents Denture irritation causing hyperplasia Amalgam tattoo
Radiation overdose
Under-developed teeth
Pigmented tissue
Spider-like vessels
Oral piercing and tongue splitting
Denture irritation causing hyperplasia.
An ill-fitting denture can cause small ulcers that, after continued irritation, become folds of excess tissue called hyperplasia.
Amalgam tattoo can occur when amalgam particles become trapped in the tissue, either during oral surgery, an amalgam application, or crown preparation procedure.
Radiation injury is when a patient receives too much radiation.
Teeth may be malformed, dwarfed, or without roots, depending on the stage of development.
Tissue within the area may appear pigmented.
Spider-like vessels may appear in skin that appears to be atrophied.
Self expression.
Oral piercing often leads to tongue swelling and sometimes can become infected or cause teeth and tissue damage.
Metal hypersensitive, scar tissue development and problems with chewing is common.
Speech can also suffer.
Tongue splitting gives a person’s tongue a reptile appearance and can make swallowing more difficult.

15. Chemical Agents Aspirin burns Nicotine stomatitis
Hyperkeratinized tissue
Appears as wrinkled, white, thickened tissue
Hairy tongue
Gingival hyperplasia
“Meth” Mouth
Aspirin burns occur when people place an aspirin over the root area of the tooth to alleviate pain prior to seeking dental care.
Nicotine stomatitis is where chemicals from tobacco and heat affect tissues inside the mouth (usually pipe smokers).
Hyperkeratinized tissue.
- Chewing tobacco (snuff) lesion appears in the oral vestibule (normally the lower anterior area between lip and teeth).
Hairy tongue is a condition where the filiform papillae of the tongue become elongated and appear like hairs.
Gingival hyperplasia occurs when the connective tissue grows over the teeth.
Methamphetamine is more common than ever in today’s society.
This drug can devastate the oral cavity.
The acid of the drug causes cravings for high calorie carbonated drinks leading to tremendous decay.

16. Hormonal Disturbances
Pregnancy Gingivitis
Inflamed gum tissues
Pyogenic Granuloma
Pregnancy tumor
Found in others as well
Puberty Gingival Enlargement
Pregnancy gingivitis is where the gingival tissues appear enlarged and inflamed.
- This occurs in about 5 percent of pregnant women.
Pyogenic Granuloma can be found in anyone, although it is commonly referred to as pregnancy tumors.
- This overgrowth of granulation tissue is caused by hormonal disturbances.
Puberty gingival enlargement is where adolescents may develop swollen gingival tissues (like pregnancy gingivitis) that will disappear after time.
All of these are temporary and clear up after hormonal balance returns to normal.

17. Tooth Development Disturbances
Amelogenesis Imperfecta
Discolored enamel, thin or partially missing
Ankylosis
Tooth, cementum, dentin fuses with bone
Amelogenesis Imperfecta is a genetic condition of the teeth in which the enamel is discolored, partially missing, or very thin.
Ankylosis is a condition in which the tooth, cementum, or dentin fuses with the alveolar bone, restricting movement of the tooth, as well as eruption.
- Dentists may have to use a hand-piece and a bur to separate the tooth from the bone to remove it from the socket.

18. Tooth Development Disturbances
Anodontia
Congenitally missing teeth
Dentinogenesis Imperfecta
Opalescent enamel and chips away
Anodontia occurs when teeth are congenitally missing altogether.
Dentinogenesis Imperfecta is a condition in which the enamel appears to be opalescent and chips away from the dentin soon after eruption of the tooth.

19. Tooth Development Disturbances
Fusion
Teeth joined together
Gemination
Tooth bud attempts to divide
Fusion is a condition in which the enamel and dentin of two or more individual teeth join together.
Gemination may appear much like a fusion, but in this case a single tooth bud attempts to divide.

20. Tooth Development Disturbances
Macrodontia
Abnormally large teeth
Microdontia
Abnormally small teeth
Macrodontia teeth are abnormally large.
Microdontia teeth are abnormally small.

21. Tooth Development Disturbances
Neonatal Teeth
Present at time of birth
Supernumerary Teeth
Extra teeth
Twinning
Two separate teeth from one bud
Neonatal teeth are present at the time of birth or within the first month after birth. These teeth shed quickly because roots have not yet formed.
Supernumerary teeth are extra teeth that appear dwarfed in size and shape but normal in all other aspects.
Twinning is a condition in which the gemination process has been successful and two separate teeth are made from one tooth bud. They appear as a clone of the original tooth in both shape and size.

22. Developmental Disturbances
Oral Tori
Boney outgrowths of tissue
20 percent of population
Exostoses
Enlargement or nodular outgrowth
Oral Tori are boney outgrowths of tissue in the oral cavity that are benign in nature.
Exostoses is an enlargement or a nodular outgrowth of dense lamella bone that appears on the facial surfaces of the mandibular and maxillary palates.

23. Developmental Disturbances
Fordyce spots
Granules in the oral cavity
80 percent of population
Fordyce spots (granules) are numerous light-yellow spots in the oral cavity.

24. Developmental Disturbances
Fissured tongue
Bifid tongue
Extra tag of muscle
Ankyloglossia, or “tongue-tied”
Fissured Tongue has a wrinkled, deeply grooved surface.
Bifid Tongue is where the two lateral halves of the anterior two-thirds of the tongue fail to fuse completely (extra tag of muscle at the end of the tongue).
Ankyloglossia is where the tongue is literally tied and the patient is unable to lift completely.

25. Nutritional Disturbances
Angular Cheilitis
Deficiency of vitamin B
Lesions in the corners of mouth
Glossitis
Inflammation of the tongue
Angular Cheilitis involves both the mucous membrane and skin.
May occur in patients who constantly lick the corners of the mouth or if the patient loses vertical dimension of the face.
This condition can lead to more complications because it allows microorganisms to grow in an opportune environment.
Glossitis creates a bald tongue appearance and may be painful to the patient.

26. Neoplasms Neoplasms is the medical term for tumor
Benign tumors
Malignant tumors
Great potential to become malignant
Inform dentist
Without alarming patient
Dental assistants should be knowledgeable and act on recognition; could save a patient’s life if detected early.

27. Oral Cancer Warning Signs
Sores
Lumps and swelling
White or rough lesions
Dryness in the mouth
Sore inside mouth that does not heal in a month.
Lumps/swelling in the mouth, on lips, or at neck.
White or rough lesions in the mouth or lips.
Dryness in the mouth for no apparent reason.

28. Oral Cancer Warning Signs
Numbness
Burning sensation
Difficulty speaking, chewing, swallowing
Repeated bleeding in the same area
Numbness in or around the mouth.
Soreness or burning sensation in/on mouth.
Difficulty speaking, chewing, or swallowing.
Repeated bleeding in a specific area of the mouth for no apparent reason.

29. Types of Neoplasms Leukoplakia
White, leathery patch that cannot be identified as any other white lesion
Biopsy required for further identification
Leukoplakia
Usually, results show hyperkeratinization.
Could also show dysplasic cells.
Controversy over whether this is a premalignant condition and should be examined periodically for any changes.

30. Types of Neoplasms Lichen Planus
Initially appear on lower leg or ankle
Oral lesions begin as small, white papules that group and form interlacing white lines known as Wickham’s striae.
Lichen Planus
Lesion on the leg are flat and dark violet normally.
Fairly common.
Treatment is topical steroid therapy.
Controversy over whether this is a premalignant condition and should be examined periodically for any changes.

31. Types of Neoplasms Erythroplakia Squamous Cell Carcinoma
Red patch of tissue, very dangerous
Squamous Cell Carcinoma
Cancer of the squamous epithelium
Benign form called Papilloma
Erythroplakia is any red patch of tissue in the oral cavity that cannot be associated with inflammation; very dangerous lesion.
Most commonly seen on the soft palate, retro-molar pad area, or the floor of the mouth.
Usually seen with patients over sixty who have used tobacco an alcoholic beverages chronically.
Squamous cell carcinoma is a cancer of the squamous epithelium.

32. Types of Neoplasms Basal Cell Carcinoma Papilloma Fibroma
Most common form of skin cancer
Papilloma
Benign lesion of the squamous epithelium
Fibroma
Benign tumor of connective tissue cells
Basal cell carcinoma is the most common form of skin cancer.
Normally appears on the neck, ear, face, lip, and head due to exposure to sun rays.

33. Oral Lesions Related to AIDS and HIV
Hairy leukoplakia
Raised, white-patch lesion
Candida Albicans
Fungal Infection
Kaposi’s Sarcoma
Vascular tumor
Blue-purple lesions
Hairy leukoplakia appears like candidosis, but cannot be removed by wiping with gauze. Not painful, no treatment available.
Candida Albicans can be found in people who have AIDS or have had prior cancer treatment. Patients often report a burning sensation in the infected area.
Kaposi’s Sarcoma is found in AIDS patients. Not common until the 1980s. Spreads rapidly. Treatment is low-doses radiation and/or chemotherapeutic drugs.

34. Miscellaneous Disorders
Acute Necrotizing Ulcerative Gingivitis
Tissues bleed, are infected, painful, foul odor
Mucocele
Trauma occurs to a minor salivary gland
Acute necrotizing ulcerative gingivitis (ANUG) is a condition seen in young adults and teens.
Mucocele usually found on the mandibular anterior lip.

35. Miscellaneous Disorders
Varix
Weakened blood vessels
Geographical Tongue
Inflammatory patches on the tongue
Resembles a map of the world
Varix is a condition primarily seen in the elderly. The normal blood vessels become weakened and extended.
Geographical Tongue found in less than two percent of the population.

36. Miscellaneous Disorders
Anorexia/Bulimia
Decalcified teeth
Eroded enamel
Deterioration of existing restorations
Rampant caries
Enlargement of parotid glands
Bell’s Palsy
Temporary paralysis on one side of the face
Anorexia is a disease where loss of 15 percent of body weight occurs, and there is an intense fear of being fat.
Bulimia is out-of-control eating followed by vomiting.
Bell’s Palsy is a temporary paralysis of the muscles on one side of the face. Cause is unknown, although relations to Shingles have been found.