(BQ) Part 1 book Shafer''s textbook of oral pathology presentation of content: Developmental disturbances of oral and paraoral structures, benign and malignant tumors of the oral cavity, tumors of the salivary glands, cysts and tumors of odontogenic origin, bacterial infections of the oral cavity, viral infections of the oral cavity,... and other contents.
Shafer • Hine • Levy Shafer’s Textbook of Oral Pathology Seventh Edition R Rajendran, MDS, PhD, FRCPath Professor and Consultant, Division of Oral Pathology, College of Dentistry, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia Formerly Professor and Head, Department of Oral Pathology and Microbiology, Government Dental College, Trivandrum, INDIA B Sivapathasundharam, MDS Professor and Head, Department of Oral Pathology, Meenakshi Ammal Dental College, Chennai, INDIA Table of Contents Cover image Title page Copyright Dedication Foreword Preface to the Seventh Edition Preface to the First Edition Contributors Acknowledgements Section I: Disturbances of Development and Growth Chapter 1: Developmental Disturbances of Oral and Paraoral Structures Craniofacial Anomalies Developmental Disturbances of Jaws Abnormalities of Dental Arch Relations Developmental Disturbances of Lips And Palate Hereditary Intestinal Polyposis Syndromen Developmental Disturbances of Oral Mucosa Developmental Disturbances of Gingiva Developmental Disturbances of Tongue Developmental Disturbances of Oral Lymphoid Tissue Developmental Disturbances of Salivary Glands Developmental Disturbances in Size of Teeth Developmental Disturbances in Shape of Teeth Developmental Disturbances in Number of Teeth Developmental Disturbances in Structure of Teeth Disturbances of Growth (Eruption) of Teeth Fissural (Inclusion, Developmental) Cysts of Oral Region Chapter 2: Benign and Malignant Tumors of the Oral Cavity Benign Tumors of Epithelial Tissue Origin ‘Premalignant’ Lesions/Conditions of Epithelial Tissue Origin Malignant Tumors of the Epithelial Tissue Origin Benign Tumors of Connective Tissue Origin Malignant Tumors of Connective Tissue Origin Benign Tumors of Muscle Tissue Origin Malignant Tumors of Muscle Tissue Origin Benign Tumors of Nerve Tissue Origin Malignant Tumors of Nerve Tissue Origin Chapter 3: Tumors of the Salivary Glands Benign Tumors of the Salivary Glands Malignant Tumors of the Salivary Glands Other Carcinomas Chapter 4: Cysts and Tumors of Odontogenic Origin Inflammatory Cysts Tumors of odontogenic origin Odontogenic epithelium with odontogenic ectomesenchyme with or without hard tissue formation Odontogenic ectomesenchyme with or without included odontogenic epithelium Malignant odontogenic tumors Odontogenic Carcinomas Section II: Diseases of Microbial Origin Chapter 5: Bacterial Infections of the Oral Cavity Chapter 6: Viral Infections of the Oral Cavity Oral Manifestations of Hiv Infection Human Immunodeficiency Virus Chapter 7: Mycotic Infections of the Oral Cavity Chapter 8: Diseases of the Periodontium The Healthy Periodontium Classification of Periodontal Disease Gingival Diseases Enlargement Associated with Systemic Factors Periodontitis Peri-Implantitis Chapter 9: Dental Caries Etiology of Dental Ca ries Clinical Aspects of Dental Caries Histopathology of Dental Caries Diagnosis of Dental Caries Methods of Caries Control Chapter 10: Diseases of the Pulp and Periapical Tissues Diseases of Dental Pulp Classification of Pulpitis Diseases of Periapical Tissues Osteomyelitis Chapter 11: Spread of Oral Infection Infections of Specific Tissue Spaces Ludwig’s Angina Maxillary Sinusitis Focal Infection Section III: Injuries and Repair Chapter 12: Physical and Chemical Injuries of the Oral Cavity Injuries of Teeth Associated with Tooth Preparation Effect of Heat Effect of Restorative Materials Physical Injuries of the Teeth Physical Injuries of the Bone Occupational Injuries of the Oral Cavity Occlusal Trauma Chapter 13: Regressive Alterations of the Teeth Attrition, Abrasion and Erosion Abfraction Dentinal Sclerosis: (Transparent Dentin) Dead Tracts Secondary Dentin Reticular Atrophy of Pulp Pulp Calcification Resorption of Teeth Hypercementosis: (Cementum Hyperplasia) Cementicles Chapter 14: Healing of Oral Wounds Factors Affecting Healing of Oral Wounds Complications of Wound Healing Biopsy and Healing of Biopsy Wound Exfoliative Cytology Healing of Extraction Wound Complications in Healing of Extraction Wounds Healing of Fracture Complications of Fracture Healing Replantation and Transplantation of Teeth Implants Section IV: Disturbances Immunologic Diseases of the Metabolism Chapter 15: Oral Aspects of Metabolic Diseases Disturbances in Mineral Metabolism Disturbances in Protein Metabolism Individual Amino Acids Lysosomal Storage Diseases Disturbances in Carbohydrate Metabolism and Hurler Syndrome: (Mucopolysaccharidosis I, MPS IH, gargoylism) Disturbances in Lipid Metabolism Avitaminoses Disturbances in Hormone Metabolism Chapter 16: Allergic and Immunologic Diseases of the Oral Cavity Recurrent Aphthous Stomatitis: (Aphthous ulcers, aphthae, canker sores) Behỗets Syndrome Reiter’s Syndrome Sarcoidosis: (Boeck’s sarcoid, Besnier-Boeck-Schaumann disease) Uveoparotid Fever: (Uveoparotitis, Heerfordt’s syndrome) Midline Lethal Granuloma: (Malignant granuloma, lethal granuloma, midline lethal granulomatous ulceration) Wegener’s Granulomatosis Chronic Granulomatous Disease Angioedema: (Angioneurotic edema, Quincke’s edema, giant urticaria) 10 mouth The Ninth Rheumatism Review (Hench) emphasized several points in favor of the septic foci theory of the etiology of rheumatoid arthritis These include the following: Streptococcal infections of the throat, tonsils, or nasal sinuses may precede the initial or recurrent attacks Removal of a septic focus show dramatic improvement sometimes The pathologic and anatomic features of lymphoid tissue in tonsillar infection, sinus infection, and root abscesses suggest that toxic products can be absorbed into the circulation A temporary bacteremia may occur immediately after tonsillectomy or tooth extraction or after vigorous massage of the gums The following points; however, are against this theory: Often no infectious focus can be found No dramatic results are produced when a focus has been extirpated 2067 Many persons who are in good health or are suffering from a disease other than rheumatoid arthritis may have septic foci in the same situations and of the same magnitude as patients who are suffering from rheumatoid arthritis Sulfonamides, antibiotics, and vaccines fail to produce beneficial effects The failure of removal of oral foci to result in improvement of rheumatoid arthritis has proved the wisdom of the advice of Freyberg, who stated that two conditions should govern the management of foci of infection: • Just like when a patient without rheumatic disease should have abscessed teeth or infected tonsils removed, so should the patient with rheumatoid arthritis • By removal of such infected tissues, the patient’s general health might be improved, and thereby his/her ability to combat the arthritis might be indirectly facilitated He stressed that the patient should be warned that removal of such foci might not be of direct value as treatment for his/ her arthritic disease Subacute bacterial endocarditis (or infective endocarditis) can without doubt be related to oral infection, since: • 2068 There is a close similarity in most instances between the etiologic agent of the disease and the microorganisms in the oral cavity, in the dental pulp, and in periapical lesions • Symptoms of subacute bacterial endocarditis have been observed in some instances shortly after extraction of teeth • Transient bacteremia frequently follows tooth extraction This disease is generally recognized as being due to the accretion of bacterial vegetation on heart valves that are predisposed to the development of the condition, usually by rheumatic fever or congenital heart disease Although streptococci of the viridans type once caused the majority of the subacute cases of bacterial endocarditis, the advent of the antibiotics has resulted in the drug-resistant microorganisms assuming a more important role Numerous studies have already been cited indicating that tooth extraction is often followed by a streptococcal bacteremia of the type usually associated with subacute bacterial endocarditis In addition, many reports have indicated that the appearance of this form of endocarditis is sometimes preceded by tooth extraction Elliott, for example, reported that 13 of 56 patients, or 23%, gave a history of recent dental operations preceding the occurrence of infective endocarditis Geiger noted that beginning of subacute bacterial endocarditis among 50 patients was specifically related to tooth extraction in 12 cases Bay reported that in a series of 26 cases of subacute bacterial endocarditis, six patients had had dental extraction, while Barnfield reported 2069 six of 92 cases to be associated with tooth extraction In a series of 250 cases reported by Kelson and White, the predisposing cause in one of each four cases of bacterial endocarditis was found to be some dental procedure, usually tooth extraction The majority of cases of subacute bacterial endocarditis reported in the literature as following tooth extraction have occurred within a few weeks to a few months after the dental procedure Premedication of patients with various antibiotics is usually prescribed to prevent the transient bacteremias that follow dental manipulations, and this prophylactic measure is considered to be an absolute necessity in patients who have a past history of rheumatic fever or other evidence of known valvular damage In contrast, BL Strom, and his associates noted in their study of patients with endocarditis who either did or did not have dental treatment at a reasonable interval before the onset of the disease concluded that there was no relationship between dental treatment and bacterial endocarditis (although the study did demonstrate a strong relation between cardiac valve pathology and endocarditis) Studies by van der Meer JT, Thompson J and associates (1992) and B Hoen, F Lacassin, and associates (1995) have also supported a very low risk rate for endocarditis with dental treatment The most recent American Heart Association guidelines for the prevention of endocarditis clearly state that the vast majority of endocarditis due to oral organisms is not related to dental treatment procedures Gastrointestinal diseases have been periodically related to oral foci of infection Gastric and duodenal ulcers have reportedly been produced experimentally by the injection of streptococci Some workers have proposed that the constant 2070 swallowing of microorganisms might lead to a variety of gastrointestinal diseases In most instances; however, the low pH of the gastric secretions is an adequate defense against such infection The lack of either clinical or experimental evidence of a relation between oral foci of infection and gastrointestinal diseases suggests that such a relation is highly questionable Ocular diseases have often been attributed in the ophthalmologic literature to primary foci of infection such as those associated with the teeth, tonsils, sinuses, genitourinary tract, and so forth Guyton and Woods carried out a study on 562 patients hospitalized with iritis, cyclitis, choroiditis, and generalized uveitis Definite evidence of foci of infection as the etiologic factor was found in 31, or 5.5% of the patients, and presumptive evidence of the same etiologic factor in 116, or 20.6% of the patients But when this group of patients was compared with a control group of 517 persons without uveitis, the percentages of foci of infection were almost identical This would indicate that the role of foci of infection in this situation is questionable at the very least Woods evaluated the role of foci of infection in ocular disease, and as pointed out by Easlick, listed the factors supporting the hypothesis as follows: Many ocular diseases occur in which no systemic cause other than the presence of remote foci of infection can be demonstrated 2071 Numerous instances of prompt and dramatic healing of ocular diseases are reported to have followed the removal of these foci Sudden transient exacerbations occasionally are observed after the removal of teeth or tonsils and often are accepted as an indication of a relationship Some reports indicate the presence of blood stream infection in the early stages of ocular disease Iritis may be produced in animal experiments by the intravenous injection of microorganisms, especially streptococci Very little evidence is to support that some microorganisms may have a special predilection for ocular tissue There are objections to these points; however, and they may be listed as follows: Many, otherwise healthy people, can be found to have focal infection, but no ocular disease Spontaneous cures frequently occur if nothing is done 2072 The exacerbations following surgery may also be explained as simple examples of the Shwartzman phenomenon, the flaring of an inflammatory focus through absorption of nonspecific protein, or on the basis of allergic shock to specifically sensitized tissue Positive blood cultures and cultures of the aqueous humor are rare in cases of acute iritis, and few secondary infections of the uveal tract follow the common transient streptococcal or staphylococcal bacteremia in patients Although lesions occur in the eyes of laboratory animals after intravenous injection of microorganisms, they also occur with equal frequency in other organs, and the eye lesions are usually purulent, which occasionally simulates the clinical lesions of the iris and uveal tract Scientific proof that ocular disease of unclear etiology may be caused by bacteria from remote foci of infection appears to be missing, and the acceptance of the conclusion must be based largely on faith; however, there exists a strong possibility (on research, not clinical basis) that sensitization to secondary metastatic products from a focus may be related to ocular disease Studies with ACTH and cortisone in ocular disease suggest that, in many such cases, the ophthalmologist may be dealing with an abnormal metabolism rather than with a reaction to a focus of infection Scientific evidence establishing dental foci of infection as the etiologic agent in ophthalmic disease is 2073 scanty If such a relationship does exist, the most probable mechanism is sensitization Skin diseases have been suggested by some dermatologists to be related to foci of infection in occasional instances Fox and Shields discussed dermatologic lesions and stated that the 10 most common skin diseases are: (1) acne, (2) seborrhea dermatitis, (3) tinea (fungus infection of the scalp, body, groin, hands, feet, nails), (4) eczema (eczematous dermatitis, nummular eczema, infectious eczematoid dermatitis, and atopic dermatitis), (5) dermatitis venenata (eczematous contact type dermatitis, occupational dermatitis), (6) impetigo, (7) scabies, (8) urticaria, (9) psoriasis, and (10) pityriasis rosea Of these diseases, only some forms of eczema and possibly urticaria can conceivably be related to oral foci of infection A few other dermatoses have been related to focus of infection, although there is little scientific proof of this association These diseases include erythema multiforme, pustular dermatitis, lupus erythematosus, lichen planus, and pustular acrodermatitis If such a relationship does exist, the mechanism is probably sensitization rather than metastatic spread of microorganisms Renal diseases of certain types are sometimes attributed to foci of infection The type of microorganism most commonly involved in urinary infections is Escherichia coli, although other staphylococci and streptococci also may be cultured Of the streptococci, Streptococcus hemolyticus seems to be the most common This Streptococcus is an uncommon inhabitant of dental root canals or periapical and gingival areas Since the 2074 microorganisms commonly involved in oral infection are only infrequently involved in renal infections, it appears that there is little relation between the two and that oral foci of infection play a small role even when the possibility of superimposition on a damaged urinary tract exists The present evidence for the relationship of oral microorganisms and systemic disease particularly that involving the coronary arteries, is very limited Occurrence of metastatic infections from the mouth to distant bodily sites is also not very common References Barnfield, W.F Subacute bacterial endocarditis and dental procedures Am J Orthod Oral Surg 1945; 31:55 Bauer, W.H Maxillary sinusitis of dental origin Am J Orthod 1943; 29:133 Bay, E.B Teeth as a portal of entry for systemic disease, especially subacute bacterial endocarditis Ann Dent 1944; 3:64 Bender, I.B., Pressman, R.S Factors in dental bacteremia J Am Dent Assoc 1945; 32:836 Berger, A Pterygomandibular abscess Dent Items Interest 1952; 74:722 Bransby-Zachary, G.M The submasseteric space Br Dent J 1948; 84:10 2075 Cobe, H.M Transitory bacteremia Oral Surg 1954; 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1937; 23:173 2076 Fish, E.W., MacLean, I The distribution of oral streptococci in the tissues Br Dent J 1936; 61:336 Fox, E.C., Shields, T.L Résumé of skin diseases most commonly seen in general practice J Am Med Assoc 1949; 140:763 Fox, S.L., West, G.B Thrombosis of the cavernous sinus J Am Med Assoc 1947; 134:1452 Frankl, Z The submandibular and parapharyngeal spaces: their topography and importance in oral surgery Oral Surg 1949; 2:1131 [1270] Freyberg, R.H ‘Focal infection’ in relation to rheumatic disease: a critical appraisal J Am Dent Assoc 1946; 33:1101 Geiger, A.J Relation of fatal subacute bacterial endocarditis to tooth extraction J Am Dent Assoc 1942; 29:1022 Gerrie, J.W The floor of the maxillary antrum J Am Dent Assoc 1935; 22:731 Gregory, G.T Infections in infratemporal fossa J Oral Surg 1944; 2:19 Grodinsky, M Ludwig’s angina Surgery 1939; 5:678 Grodinsky, M., Holyoke, E.A The fascia and fascial spaces of the head, neck, and adjacent regions Am J Anat 1938; 63:367 2077 Guyton, J.S., Woods, A.C Etiology of uveitis: a clinical study of 562 cases Arch Ophthalmol 1941; 26:983 Haymaker, W Fatal infections of the central nervous system and meninges after tooth extraction Am J Orthod Oral Surg 1945; 31:117 Hench, P.S Rheumatism and arthritis: review of American and English literature of recent years (ninth rheumatism review Ann Intern Med 1948; 28:66 [309] Herd, R.H., Hall, J.F Ludwig’s syndrome Oral Surg 1951; 4:1523 Job, T.T., Fouser, R.H Relationship of the teeth to the mandibular canal and the maxillary sinus J Am Dent Assoc 1927; 14:1072 Jones, I.H Anatomy and pathology of the spread of infection from dental foci Dent Gazette 1942; 9:106 Kay, L.W Investigations into the nature of pericoronitis I, II Br J Oral Surg 1966; 4:52 [3: 188] Kelson, S.R., White, P.D Notes on 250 cases of subacute bacterial (streptococcal) endocarditis, studied and treated between 1927 and 1939 Ann Intern Med 1945; 22:40 Kent, H.A Cellulitis Am J Orthod Oral Surg 1939; 25:172 Koenig, L.M., Carnes, M Body piercing medical concerns with cutting edge fashion J Gen Intern Med 1999; 14(6):379–385 2078 Krogh, H.W Extraction of teeth in the presence of acute infections J Oral Surg 1951; 9:136 Lacassin, F., Hoen, B., et al Procedures associated with infective endocarditis in adults: a case-control study Eur Heart J 1995; 16(12):1968–1974 Lazansky, J.P., Robinson, L., Rodofsky, L Factors influencing the incidence of bacteremias following surgical procedures in the oral cavity J Dent Res 1949; 28:533 Lederer, F.L., Fishman, L.Z Phlegmons, including fascial sheath infections of the face and neck of dental origin J Am Dent Assoc 1940; 27:1439 Mazzeo, V.A Cavernous sinus thrombosis J Oral Med 1974; 29:53 Mustian, W.F The floor of the maxillary sinus and its dental, oral and nasal relations J Am Dent Assoc 1933; 20:2175 O’Brien, G.R., Rubin, L.B One hundred and one cases of infections of the face and neck following oral pathology Am J Surg 1942; 55:102 Okell, C.C., 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Institutes of Health, Bethesda, Maryland, USA A.R Raghu, Professor and Head, Department of Oral Pathology, Manipal College of Dental Sciences, Manipal K Ranganathan, Professor and Head, Department of Oral. .. Allen, DDS, MSD Professor and Director, Oral and Maxillofacial Pathology, College of Dentistry, The Ohio State University, Columbus, Ohio Professor, Department of Pathology, College of Medicine and...Shafer • Hine • Levy Shafer’s Textbook of Oral Pathology Seventh Edition R Rajendran, MDS, PhD, FRCPath Professor and Consultant, Division of Oral Pathology, College of Dentistry, King Saud Bin