Ebook Cawson’s essentials of oral pathology and oral medicine (8/E): Part 2

(BQ) Part 2 book “Cawson’s essentials of oral pathology and oral medicine” has contents: Tongue disorders, benign chronic white mucosal lesions, oral premalignancy, common benign mucosal swellings, immunodefi ciencies and HIV disease,… and other contents.

SECTION SOFT TISSUE DISEASE 205 CHAPTER 12 Diseases of the oral mucosa: introduction and mucosal infections A few mucosal diseases, such as lupus erythematosus, are important indicators of severe underlying systemic disease and rare conditions, such as acanthosis nigricans, can be markers of internal malignancy Pemphigus vulgaris is potentially lethal, as is HIV infection – which can give rise to a variety of mucosal lesions Biopsy is mandatory, particularly in the bullous diseases as, in such cases, the diagnosis can only be confirmed by microscopy In other cases, microscopic findings can be less definite, but often (as in the case of major aphthae for example) serve to exclude more dangerous diseases Mucosal ulceration – a break in epithelial continuity – is a frequent feature of stomatitis Important causes are summarised in Table 12.1 However, ulceration is not a feature of all mucosal diseases as discussed below PRIMARY HERPETIC STOMATITIS ➔ Summary p 221 Primary infection is caused by Herpes simplex virus, usually type 1, which, in the non-immune, can cause an acute vesiculating stomatitis However, most primary infections are subclinical Thereafter, recurrent (reactivation) infections usually take the form of herpes labialis (cold sores or fever blisters) Transmission of herpes is by close contact and up to 90% of inhabitants of large, poor, urban communities, develop antibodies to herpes virus during early childhood In many British and US cities, by contrast, approximately 70% of 20-yearolds may be non-immune, because of lack of exposure to the virus In such countries, the incidence of herpetic stomatitis has declined and it is seen in adolescents or adults, rather than children It is more common in the immunocompromised, such as HIV infection, when it can be persistent or recurrent Clinical features The early lesions are vesicles which can affect any part of the oral mucosa, but the hard palate and dorsum of the tongue are favoured sites (Figs 12.1 and 12.2) The vesicles are domeshaped and usually 2–3 mm in diameter Rupture of vesicles leaves circular, sharply defined, shallow ulcers with yellowish or greyish floors and red margins The ulcers are painful and may interfere with eating The gingival margins are frequently swollen and red, particularly in children, and the regional lymph nodes are enlarged and tender There is often fever and systemic upset, sometimes severe, particularly in adults Table 12.1 Important causes of oral mucosal ulcers 206 Vesiculo-bullous diseases Ulceration without preceding vesiculation Infective Primary herpetic stomatitis Herpes labialis Herpes zoster and chickenpox Hand-foot-and-mouth disease Cytomegalovirus-associated ulceration Some acute specific fevers Tuberculosis Syphilis Non-infective Pemphigus vulgaris Mucous membrane pemphigoid Linear IgA disease Dermatitis herpetiformis Bullous erythema multiforme Traumatic Aphthous stomatitis Behỗets disease HIV-associated mucosal ulcers Lichen planus Lupus erythematosus Chronic ulcerative stomatitis Eosinophilic ulceration Wegener’s granulomatosis Some mucosal drug reactions Carcinoma (Ch 17) DISEASES OF THE ORAL MUCOSA: INTRODUCTION AND MUCOSAL INFECTIONS CHAPTER 12 Fig 12.1 Herpetic stomatitis Pale vesicles and ulcers are visible on the palate and gingivae, especially anteriorly, and the gingivae are erythematous and swollen Fig 12.3 Herpetic vesicle The vesicle is formed by accumulation of fluid within the prickle cell layer The virus-infected cells, identifiable by their enlarged nuclei, can be seen in the floor of the vesicle and a few are floating freely in the vesicle fluid Fig 12.2 Herpetic stomatitis A group of recently ruptured vesicles on the hard palate, a characteristic site The individual lesions are of remarkably uniform size but several have coalesced to form larger irregular ulcers Oral lesions usually resolve within a week to ten days, but malaise can persist so long that an adult may not recover fully for several weeks Pathology Vesicles are sharply defined and form in the upper epithelium (Fig 12.3) Virus-damaged epithelial cells with swollen nuclei and marginated chromatin (ballooning degeneration) are seen in the floor of the vesicle and in direct smears from early lesions (Fig 12.4) Incomplete division leads to formation of multinucleated cells Later, the full thickness of the epithelium is destroyed to produce a sharply defined ulcer (Fig 12.5) Diagnosis The clinical picture is usually distinctive (Box 12.1) A smear showing virus-damaged cells is additional diagnostic evidence A rising titre of antibodies reaching a peak after 2–3 weeks provides absolute but retrospective confirmation of the diagnosis Fig 12.4 A smear from a herpetic vesicle The distended degenerating nuclei of the epithelial cells cluster together to give the typical mulberry appearance Treatment Aciclovir is a potent antiherpetic drug and is life-saving for potentially lethal herpetic encephalitis or disseminated infection Aciclovir suspension used as a rinse and then swallowed should accelerate healing of severe herpetic stomatitis if used sufficiently early Bed rest, fluids and a soft diet may sometimes be required 207 SOFT TISSUE DISEASE CHAPTER 12 (A) Fig 12.5 Herpetic ulcer The vesicle has ruptured to form an ulcer (right) and the epithelium at the margin contains enlarged, darkly staining virusinfected cells liberating free virus into the saliva Box 12.1 Herpetic stomatitis: key features • • • • • • Usually caused by H simplex virus type Transmitted by close contact Vesicles, followed by ulcers, affect any part of the oral mucosa Gingivitis sometimes associated Lymphadenopathy and fever of variable severity Smears from vesicles show ballooning degeneration of viraldamaged cells • Rising titre of antibodies to HSV confirms the diagnosis • Aciclovir is the treatment of choice (B) In mild cases, topical tetracycline suspension, rinsed round the mouth several times a day, relieves soreness and may hasten healing by controlling secondary infection Unusually prolonged or severe infections or failure to respond to aciclovir (200–400 mg/day by mouth for days) suggest immunodeficiency and herpetic ulceration persisting for more than a month is an AIDS-defining illness HERPES LABIALIS ➔ Summary p 221 208 After the primary infection, the latent virus can be reactivated in 20–30% of patients to cause cold sores (fever blisters) Triggering factors include the common cold and other febrile infections, exposure to strong sunshine, menstruation or, occasionally, emotional upsets or local irritation, such as dental treatment Neutralising antibodies produced in response to the primary infection are not protective Clinically, changes follow a consistent course with prodromal paraesthesia or burning sensations, then erythema at the site of the attack Vesicles form after an hour or two, usually in clusters along the mucocutaneous junction of the lips, but can extend onto the adjacent skin (Fig 12.6) The vesicles enlarge, coalesce and weep exudate After or days they rupture and crust over but new vesicles frequently appear for a day or two only to scab over and finally heal, Fig 12.6 Herpes labialis (A) Typical vesicles (B) Crusted ulcers affecting the vermilion borders of the lips usually without scarring The whole cycle may take up to 10 days Secondary bacterial infection may induce an impetiginous lesion which sometimes leaves scars Treatment In view of the rapidity of the viral damage to the tissues, treatment must start as soon as the premonitory sensations are felt Aciclovir cream is available without prescription and may be effective if applied at this time This is possible because the course of the disease is consistent and patients can recognise the prodromal symptoms before tissue damage has started However, penciclovir applied 2-hourly is more effective Herpetic cross-infections Both primary and secondary herpetic infections are contagious Herpetic whitlow (Fig 12.7) is a recognised though surprisingly uncommon hazard to dental surgeons and their assistants Herpetic whitlows, in turn, can infect patients and have led to outbreaks of infection in hospitals and among patients in dental practices Now that gloves are universally worn when giving DISEASES OF THE ORAL MUCOSA: INTRODUCTION AND MUCOSAL INFECTIONS CHAPTER 12 Fig 12.8 Herpes zoster A severe attack in an older person shows confluent ulceration on the hard and soft palate on one side Fig 12.7 Herpetic whitlow This is a characteristic non-oral site for primary infection as a result of contact with infected vesicle fluid or saliva The vesiculation and crusting are identical to those seen in herpes labialis dental treatment, such cross-infections should no longer happen In immunodeficient patients, such infections can be dangerous, but aciclovir has dramatically improved the prognosis in such cases and may be given on suspicion Mothers applying antiherpetic drugs to children’s lesions should wear gloves HERPES ZOSTER OF THE TRIGEMINAL AREA ➔ Summary p 221 Zoster (shingles) is characterised by pain, a vesicular rash and stomatitis in the related dermatome The varicella-zoster virus (VZV) causes chickenpox in the non-immune (mainly children), while reactivation of the latent virus causes zoster, mainly in the elderly Unlike herpes labialis, repeated recurrences of zoster are very rare Occasionally, there is an underlying immunodeficiency Herpes zoster is a hazard in organ transplant patients and can be an early complication of some tumours, particularly Hodgkin’s disease, or, increasingly, of AIDS, where it is five times more common than in HIV-negative persons and potentially lethal Fig 12.9 Herpes zoster of the trigeminal nerve There are vesicles and ulcers on one side of the tongue and facial skin supplied by the first and second divisions The patient complained only of toothache irritation or tenderness in the dermatome corresponding to the affected ganglion Vesicles, often confluent, form on one side of the face and in the mouth up to the midline (Figs 12.8 and 12.9) The regional lymph nodes are enlarged and tender The acute phase usually lasts about a week Pain continues until the lesions crust over and start to heal, but secondary infection may cause suppuration and scarring of the skin Malaise and fever are usually associated Patients are sometimes unable to distinguish the pain of trigeminal zoster from severe toothache, as in the patient shown in Figure 12.9 This has sometimes led to a demand for a dental extraction Afterwards, the rash follows as a normal course of events and this has given rise to the myth that dental extractions can precipitate facial zoster Pathology Clinical features Herpes zoster usually affects adults of middle age or over but, occasionally, attacks even children The first signs are pain and The varicella-zoster virus produces similar epithelial lesions to those of herpes simplex, but also inflammation of the related posterior root ganglion 209 SOFT TISSUE DISEASE CHAPTER 12 Management Herpes zoster is an uncommon cause of stomatitis, but readily recognisable (Box 12.2) Box 12.2 Herpes zoster of the trigeminal area: key features • • • • • • • • Recurrence of VZV infection typically in the elderly Pain precedes the rash Facial rash accompanies the stomatitis Lesions localised to one side, within the distribution of any of the divisions of the trigeminal nerve Malaise can be severe Can be life-threatening in HIV disease Treat with systemic aciclovir, intravenously, if necessary Sometimes followed by post-herpetic neuralgia, particularly in the elderly According to the severity of the attack, oral aciclovir (800 mg five times daily, usually for days) should be given at the earliest possible moment, together with analgesics The addition of prednisolone may accelerate relief of pain and healing In immunodeficient patients, intravenous aciclovir is required and may also be justified for the elderly in whom this infection is debilitating Complications Post-herpetic neuralgia mainly affects the elderly and is difficult to relieve (Ch 34) 210 HAND-FOOT-AND-MOUTH DISEASE ➔ Summary p 221 This common, mild viral infection, which often causes minor epidemics among school children, is characterised by ulceration of the mouth and a vesicular rash on the extremities Hand-foot-and-mouth disease is usually caused by strains of Coxsackie A virus It is highly infectious, frequently spreads through a classroom in schools and may also infect a teacher or parent The incubation period is probably between and 10 days Foot-and-mouth disease of cattle is a quite different rhinovirus infection which rarely affects humans but can also cause a mild illness with vesiculating stomatitis Clinical features The small scattered oral ulcers usually cause little pain Intact vesicles are rarely seen and gingivitis is not a feature Regional lymph nodes are not usually enlarged and systemic upset is typically mild or absent The rash consists of vesicles, sometimes deep-seated, or occasionally bullae, mainly seen around the base of fingers or toes, but any part of the limbs may be affected (Fig 12.10) The rash is often the main feature and such patients are unlikely to be seen by dentists In some outbreaks, either the mouth or the extremities alone may be affected Serological confirmation of the diagnosis is possible but rarely necessary as the history, especially of other cases, and clinical features are usually adequate The disease typically resolves within a week No specific treatment is available or needed but myocarditis or encephalitis are rare complications Key features are summarised in Box 12.3 CYTOMEGALOVIRUS-ASSOCIATED ULCERATION THE ACUTE SPECIFIC FEVERS Cytomegalovirus (CMV) is a member of the herpes virus group Up to 80% of adults show serological evidence of CMV infection without clinical effects, but it is a common complication of immunodeficiency, particularly AIDS In the latter it can be life-threatening Oral ulcers in which CMV has been identified are sometimes clinically indistinguishable from recurrent aphthae, others have raised, minimally rolled borders Generally, the ulcers are large, shallow and single, and affect either the masticatory or non-masticatory mucosa Sometimes, oral ulcers are associated with disseminated CMV infection Microscopically, CMV-associated ulcers are non-specific, but cells with typical owl-eye intranuclear inclusions can be seen in the inflammatory infiltrate in the ulcer floor They are usually recognisable by light microscopy but their nature can be confirmed by immunocytochemistry (see Fig 1.8), in-situ hybridisation or electron microscopy The virus present in oral lesions may merely be a passenger, but their causative role is suggested by reports of response to ganciclovir Fevers which cause oral lesions are rarely seen in dentistry Those which cause vesicular rashes (smallpox and chickenpox) produce the same lesions in the mouth Fig 12.10 Hand-foot-and-mouth disease The rash consists of vesicles or bullae on the extremities; in this patient they are relatively inconspicuous DISEASES OF THE ORAL MUCOSA: INTRODUCTION AND MUCOSAL INFECTIONS Box 12.3 Hand-foot-and-mouth disease: key features • • • • • Caused mainly by Coxsackie A viruses Highly infectious School children predominantly affected Occasionally spreads to teacher or parent Typically mild vesiculating stomatitis and/or vesiculating rash on extremities • Rarely severe enough for dental opinion to be sought • Confirmation of diagnosis (if required) by serology • No specific treatment available or needed lymph nodes are usually unaffected Widespread ulcers in multiple oral sites have been reported in a patient with AIDS The diagnosis is rarely suspected until after biopsy CHAPTER 12 Pathology Typical tuberculous granulomas are seen in the floor of the ulcers (Fig 12.12) Mycobacteria are rarely identifiable in the oral lesion but can be demonstrated in the sputum Chest radiographs show advanced infection In the prodromal stage of measles, Koplik’s spots form on the buccal mucosa and soft palate and are pathognomonic Palatal petechiae or ulceration, involving the fauces especially, are seen in glandular fever and are accompanied by the characteristic, usually widespread lymphadenopathy KAWASAKI’S DISEASE (MUCOCUTANEOUS LYMPH NODE SYNDROME) Kawasaki’s disease is endemic in Japan but uncommon in Britain It is frequently unrecognised and has caused significant mortality Though its epidemiology suggests that it is an infection, this has not been established Clinical features Children are affected and have persistent fever, oral mucositis, ocular and cutaneous lesions and cervical lymphadenopathy (Ch 26) Oral lesions consist of widespread mucosal erythema with swelling of the lingual papillae (strawberry tongue), but are insignificant compared with the serious cardiac effects (Ch 27) Fig 12.11 A tuberculous ulcer of the tongue The rather angular shape and overhanging edges of the ulcer are typical The patient was a man of 56 with advanced but unrecognised pulmonary tuberculosis TUBERCULOSIS The recrudescence of tuberculosis in the West is partly a consequence of the AIDS epidemic Moreover, multiply-resistant mycobacteria are becoming widespread Oral tuberculosis is rare and a complication of pulmonary disease with infected sputum Those with HIV infection are an important group of victims, but oral tuberculosis is occasionally seen in immunocompetent persons who are usually elderly men with pulmonary infection and a chronic cough that has progressed unrecognised or who have neglected treatment The typical lesion is an ulcer on the mid-dorsum of the tongue; the lip or other parts of the mouth are infrequently affected The ulcer is typically angular or stellate, with overhanging edges and a pale floor, but can be ragged and irregular (Fig 12.11) It is painless in its early stages and regional Fig 12.12 Tuberculous ulcer At the margin, numerous granulomas are present in the ulcer bed The darkly stained multinucleate Langhans giant cells are visible even at this low power 211 SOFT TISSUE DISEASE CHAPTER 12 Tuberculosis or non-tuberculous mycobacterial infection must be considered in patients with AIDS who develop oral ulceration with histological granuloma formation Management Diagnosis is confirmed by biopsy, chest radiography and a specimen of sputum Mycobacterial infection is confirmed by culture or PCR Oral lesions clear up rapidly if vigorous multidrug chemotherapy is given for the pulmonary infection No local treatment is needed Tuberculous cervical lymphadenopathy Secondary syphilis See Chapter 26 The secondary stage develops 1–4 months after infection It typically causes mild fever with malaise, headache, sore throat and generalised lymphadenopathy, soon followed by a rash and stomatitis The rash is variable, but typically consists of asymptomatic pinkish (coppery) macules, symmetrically distributed and starting on the trunk It may last for a few hours or weeks and its presence or history is a useful aid to diagnosis Oral lesions, which rarely appear without the rash, mainly affect the tonsils, lateral borders of the tongue and lips They are usually flat ulcers covered by greyish membrane and may be irregularly linear (snail’s track ulcers) or coalesce to form well-defined rounded areas (mucous patches) Discharge from the ulcers contains many spirochaetes and saliva is highly infective Serological reactions (see below) are positive and diagnostic at this stage, but biopsy is unlikely to be informative SYPHILIS As a result of contact tracing and early treatment, fewer than 150 cases a year of primary or secondary syphilis were seen in England and Wales in the 1980s However, since the mid1990s, the prevalence has steadily risen This is a worldwide trend and the disease has, for example, become widespread in Eastern Europe Oral lesions in each stage of syphilis are clinically quite different from each other Oral lesions have recently been reported in Britain but some may pass unrecognised Primary syphilis 212 vary A chancre is typically painless but regional lymph nodes are enlarged, rubbery and discrete A biopsy may only show non-specific inflammation but sometimes there is conspicuous perivascular infiltration Serological reactions are negative at first Diagnosis therefore depends on finding Treponema pallidum by dark-ground illumination of a smear from the chancre, but they must be distinguished from other oral spirochaetes Clinical recognition of oral chancres is difficult but important They are highly infective, and treatment is most effective at this stage After or weeks the chancre heals, often without scarring An oral chancre appears 3–4 weeks after infection and may form on the lip, tip of the tongue or, rarely, other oral sites It consists initially of a firm nodule about a centimetre across (Fig 12.13) The surface breaks down after a few days, leaving a rounded ulcer with raised indurated edges This may resemble a carcinoma, particularly if on the lip However, the appearances Tertiary syphilis Fig 12.13 Primary chancre The lower lip is a typical site for extragenital Fig 12.14 Tertiary syphilis; gummas of the palate Necrosis in the centre of the palate has caused perforation of the bone and two typical round punched-out holes chancres but they are rarely seen Late-stage syphilis develops in many patients about or more years after infection The onset is insidious, and during DISEASES OF THE ORAL MUCOSA: INTRODUCTION AND MUCOSAL INFECTIONS Table 12.2 Interpretation of serological tests for syphilis VDRL FTA-ABS Usual interpretation ϩ ϩ Ϫ Ϫ ϩ ϩ False-positive Active syphilis Treated syphilis the latent period the patient may appear well A characteristic lesion is the gumma Clinically, a gumma, which may affect the palate, tongue or tonsils, can vary from a few to several centimetres in diameter It begins as a swelling, sometimes with a yellowish centre which undergoes necrosis, leaving a painless indolent deep ulcer The ulcer is rounded, with soft, punched-out edges The floor is depressed and pale (wash-leather) in appearance It eventually heals with severe scarring which may distort the soft palate or tongue, or perforate the hard palate (Fig 12.14) or destroy the uvula Microscopically, there may be no more than a predominance of plasma cells in the inflammatory infiltrate (a common finding in oral lesions) but associated with peri- or endarteritis Granuloma formation is rare Also rarely, there may be diffuse chronic inflammatory infiltration of the lingual muscles or coagulative necrosis mimicking caseation However, the appearances can be completely non-specific Diagnosis therefore depends on the serological findings Leukoplakia of the tongue may also develop during this late stage (Ch 16) and other effects of syphilis such as aortitis, tabes or general paralysis of the insane may be associated CAT-SCRATCH DISEASE See Chapter 26 12 CANDIDOSIS1 Candidal infection can cause a spectrum of lesions (Box 12.4) particularly thrush, chronic white plaques (chronic hyperplastic candidosis, ‘candidal leukoplakia’) or erythematous areas such as denture stomatitis Box 12.4 Spectrum of oral candidosis Acute candidosis • Thrush • Acute antibiotic stomatitis Chronic candidosis • Denture-induced stomatitis • Chronic hyperplastic candidosis (Ch 16) • Chronic mucocutaneous candidosis (Ch 15) • Erythematous candidosis Angular stomatitis (common to all types of oral candidosis) Thrush2 ➔ Summaries pp 220, 277 Thrush, a disease recognised in infants by Hippocrates, can also affect adults In the 19th century, Trousseau called thrush a ‘disease of the diseased’; this has been dramatically confirmed by its frequency in HIV disease Factors predisposing to candidal infection are shown in Box 12.5 Box 12.5 Oral candidosis: important predisposing factors Management Serological confirmation of the infection is essential (Table 12.2) Tests are either specific (such as the FTA-ABS) or nonspecific as in the VDRL The VDRL becomes positive 4–6 weeks after infection and becomes negative only after effective treatment, but false positives can result from several other causes The FTA-ABS acts as a check against false positive or negative results, but remains positive despite effective treatment for the life of the individual The Rapid Plasma Reagin (RPR) titre may also be high in active syphilis, but it is also a non-specific (lipoidal antigen) test Specific tests include the Treponema pallidum haemagglutination assay (THPA), the fluorescent treponemal antibody absorption test (FTA-abs test) and the treponemal enzymelinked immunosorbent assay (ELISA) Specific and nonspecific tests are used in combination to distinguish active syphilis from false positives Antibiotics, particularly penicillin, are the mainstay of treatment, but tetracycline and erythromycin are also effective Treatment should be by a specialist and must be continued until non-specific serological reactions (VDRL) are persistently negative CHAPTER • Immunodeficiency (diabetes mellitus or AIDS particularly) or immunosuppression (including steroid inhalers) • Anaemia • Suppression of the normal oral flora by antibacterial drugs • Xerostomia • Denture wearing • Smoking Neonatal thrush results from immaturity of the immune response and infection is probably acquired during passage through the birth canal Any adult male who develops thrush without apparent cause should be suspected of having HIV infection However, any form of candidosis can be secondary to HIV infection Clinical features Thrush forms soft, friable and creamy coloured plaques on the mucosa (Fig 12.15) The distinctive feature is that they can Candidosis not ‘candidiasis’ because it is a mycosis The ‘-iases’ are in general parasitic infections such as trypanosomiasis Thrush is not a mere nickname or household term but is of respectable antiquity though its origin is uncertain 213 SOFT TISSUE DISEASE CHAPTER 12 be easily wiped off to expose an erythematous mucosa Their extent varies from isolated small flecks to widespread confluent plaques Angular stomatitis is frequently associated, as it is with any form of intraoral candidosis Pathology A Gram-stained smear shows large masses of tangled hyphae, detached epithelial cells and leucocytes (Fig 12.16) Biopsy shows hyperplastic epithelium infiltrated by inflammatory oedema and cells, predominantly neutrophils Staining with PAS shows many candidal hyphae growing down through the epithelial cells to the junction of the plaque with the spinous cell layer (Fig 12.17) At this level there is a concentration of inflammatory exudate and inflammatory cells More deeply, the epithelium is hyperplastic but attenuated, with long slender processes extending down into the corium, surrounded by a light infiltrate predominantly lymphoplasmacytic The microscopic appearances explain both the friable nature of the plaques of thrush and their ready detachment Key features are summarised in Box 12.6 Box 12.6 Thrush: key features • • • • • • Acute candidosis Secondary to various predisposing factors (Box 12.5) Common in HIV infection and indicates low immunity Creamy soft patches, readily wiped off the mucosa Smear shows many Gram-positive hyphae Histology shows hyphae invading superficial epithelium with proliferative and inflammatory response • Responds to topical antifungals or itraconazole Management Control of any local cause such as topical antibiotic treatment may alone cause thrush to resolve If not, a course of nystatin or amphotericin lozenges should allow the oral microflora to return to normal Failure of resonse to topical antifungals such as nystatin suggests immune deficiency HIV infection should always be suspected when thrush is seen in an adult male in whom there is no other detectable cause In such patients, candidosis may respond to fluconazole or itraconazole, but is typically associated with a low CD4 count and indicates a poor prognosis Rarely, persistent thrush is an early sign of chronic mucocutaneous candidosis such as candida-endocrinopathy syndrome (Ch 15) A Fig 12.15 Thrush The lesions consist of soft, creamy patches or flecks lying superficially on an erythematous mucosa This soft palate distribution is particularly frequent in those using steroid inhalers B Fig 12.16 Direct smear from thrush The tangled mass of Gram-posi214 tive hyphae of Candida albicans is diagnostic A few yeast cells may be present as well, but it is the large number of hyphae that is diagnostic Fig 12.17 Thrush At high power the components of a plaque may be clearly seen The surface layers of the epithelium are separated by inflammatory oedema and are colonised by fungal hyphae (A) and infiltrated by neutrophils (B) SECTION Self-assessment questions and learning guides These self-assessment questions and learning guides are based on the material of the previous section, but may also link to material covered elsewhere They are not intended to be comprehensive, but give an indication of the understanding and problem solving abilities expected at an undergraduate level You will not find all the information you require to answer these questions in this textbook of essential facts Use these questions to guide your additional reading and learning CHAPTER 25 • How would you investigate and manage a patient with an enlarged upper lip? • Discuss non-infectious occupational risks of the practice of dentistry How may they be prevented? CHAPTER 26 CHAPTER 22 • How would you investigate a patient presenting with a sore uniformly-depapillated tongue? • How would you differentiate the various causes of anaemia using special investigations? • Which malignant neoplasms may present as gingival swellings or gingival enlargement? • How might a dentist notice the first signs of lymphoma or leukaemia? • What are the oral complications of chemotherapy for lymphoma and leukaemia? CHAPTER 23 • How would you manage a patient presenting with post-extraction haemorrhage? • How may post-extraction haemorrhage be prevented? 454 • Which features of an enlarged cervical lymph node would suggest malignancy? • Which features of an enlarged cervical lymph node would suggest a reactive cause? • How may tuberculosis present in the head and neck? • What investigations should be performed to aid diagnosis for a patient with a chronically enlarged cervical lymph node? What is the value of each test? CHAPTER 27 • Why has the recommended antibiotic prophylaxis for infective endocarditis in dental patients changed over the last few years? • What local measures should complement systemic antibiotic prophylaxis in the prevention of infective endocarditis in dentistry? • How and why has the prevalence of the different risk factors for infective endocarditis changed over the last decades? CHAPTER 24 CHAPTER 28 • What systemic complications of HIV infections may impact on the provision of routine dental care? • Which oral lesions might raise suspicion of immunodeficiency? • How the presentations of gingivitis and periodontitis in patients with immunodeficiency differ from those in normal patients? • When should antibiotics be prescribed for acute or chronic sinusitis? • How would you diagnose and treat an oroantral communication? • What are granulomas and why they form? • Is there a connection between granulomas, granulation tissue and pyogenic granuloma? SELF-ASSESSMENT QUESTIONS AND LEARNING GUIDES • Which diseases of the head and neck, excluding the oral mucosa, show granulomatous inflammation histologically? • Discuss the differential diagnosis for a patient with diffuse enlargement of the gingiva CHAPTER 29 • How may a patient with hepatitis B or C be identified and their infectivity assessed? • What are the causes of lip swelling? • What are the causes of granulomatous inflammation in the oral mucosa? CHAPTER 34 • How may dental causes for facial pain be identified? • What are the features of pain of vascular origin and how they differ from those of pain of neural origin? • How may depression present in a dental setting? • How would you decide whether or not to refer a patient with intractable pain to their medical practitioner? • For which types of facial pain might a computerised tomogram or magnetic resonance scan be indicated? • How may atypical facial pain be identified and how should it be treated? • What analgesics might be prescribed by a dentist to treat orofacial pain? SECTION CHAPTER 31 • How does diabetes mellitus affect the provision of dental treatment? • What are the causative connections between endocrine disease and gingival enlargement? • How might a dentist aid diagnosis of thyroid diseases, including neoplasms? CHAPTER 35 • Which drugs can cause lichen planus-like reactions? • Which drugs can cause symptoms of burning mouth? • Which drugs can cause oral or facial pigmentation? CHAPTER 36 CHAPTERS 32 AND 33 • What features of Down’s syndrome might affect provision of dental treatment? • How might a dentist aid the diagnosis of diseases common in the elderly? • In which conditions is there an increased risk of trauma to teeth and oral tissues? How may this be managed? • How may preventive regimens be adapted to suit patients with the conditions in these chapters? • How may consent for dental treatment be obtained in patients with learning difficulties or mental illness? • Why are patients with renal disease prone to latex allergy? • How would you differentiate the causes of loss of consciousness? • How would you treat each of the medical emergencies listed in this chapter? • In each case, which of the actions should be performed first? • What adverse effects might ensue if you inadvertently administered the wrong treatment for a medical emergency? • Where could you check the current Resuscitation Council UK guidelines for basic life support? • Are you able to use an automatic defibrillator? 455 This page intentionally left blank Index Abrasion gingival, 97 tooth, 75–6 Abscess brain, 111 lung, 111 periapical, 106 periodontal, 88, 89, 432 submasseteric, 192 Absence seizures, 423 Acanthomatous ameloblastoma, 138 Acesulfame K, 47 Achondroplasia, 174, 175 Aciclovir, 207–8 Acid bacterial, 40 production in plaque, 43–4 Acinar cells, 303 Acinic cell carcinoma, 303–4, 309 Acquired clotting defects, 348–9 Acquired immunodeficiency syndrome (AIDS), 352–5 aetiology, 352 clinical aspects, 353–4 diagnosis, 353 general management of, 354 highly active antiretroviral therapy, 325–6, 354–5, 359 immunology, 352–3 Kaposi’s sarcoma, 324–6 lymphadenopathy, 371 oral lesions in, 355–60 purpura associated with, 345 tuberculosis, 211 Acromegaly, 177, 406–7 Acrylic allergy, 237 Actinobacillus actinomycetemcomitans, 84, 89 Actinomyces spp., 42 A israelii, 109, 110 gingivitis, 79 Actinomycosis, 109–10 Addison’s disease, 331, 409–10 Adenocarcinomas, 305 basal cell, 309 mucinous, 309 Adenoid cystic carcinoma, 304, 309 Adenolymphoma, 302–3 Adenoma basal cell, 310 canicular, 310 pleomorphic, 10–11, 301–2, 306, 309 salivary gland, 303 sebaceous, 310 Adenomatoid odontogenic tumour, 141, 154 Adjuvant chemotherapy, 286 Adrenaline, 376, 450, 453 Adrenal medulla diseases, 411 Adrenocortical diseases, 409–11 Adults caries, 56–9 gingival cysts, 129 Agranulocytosis, 90, 342–3, 351 Albright’s syndrome, 184, 185 Alcian Blue, 12–13 Alcohol abuse, 446 oral cancer, 278 Alkaline phosphatase hypophosphatasia, 177 Paget’s disease, 182 skeletal serum, 16 Allergic stomatitis, 236–7 Allergy, 362–4 latex, 362–3 mercury, 363–4 metals, 363–4 nickel, 363 Alpha-thalassaemias, 338 Alveolar bone destruction of, 83 premature loss of, 83 resorption, 81 rhabdomyosarcoma, 324 Alveolar osteitis, 104–6 Alveolar ridge carcinoma, 282 Alveolus mucosa, 78 pain, 70 Alvogel, 106 Amalgam restorations, 363 Amalgam tattoo, 328 Amelanotic melanomas, 330, 331 Ameloblastic carcinoma, 140–1, 154 Ameloblastic fibro-dentinoma, 154 Ameloblastic fibroma, 144–5, 154 Ameloblastic fibro-odontoma, 145, 154 Ameloblastic sarcoma/fibrosarcoma, 145, 154 Ameloblastin, 137 Ameloblastoma, 136–41 cystic, 115 desmoplastic, 154 extraosseous/peripheral, 154 follicular, 137 genetic aspects, 137 key features, 136 management, 139 metastising, 140–1, 154 pathology, 137–9 patient explanation, solid/multicystic, 154 unicystic, 132, 137, 139–40, 154 Amelogenesis imperfecta, 24–7 Amphotericin, 111 Amylase, salivary, 48 Amyloid deposition, 164, 165 Amyloidosis, 164, 165, 250–1 Anaemia, 246, 336–7 aplastic, 336, 343 in leukaemia, 339 normocytic, 336, 337–8 pernicious, 336, 425 types of, 336 Anaerobic bacteria in fascial space infections, 107 suppurative parotitis, 294 Anaesthesia general, 337, 453 of the lip, 438–40 local, 376, 453 Anaphylactic reactions, 449–50 Aneurysmal bone cyst, 155, 159, 187–9 Angina acute, 375 chest pain, 451 Ludwig’s, 106–7, 108 Angiofollicular lymph node hyperplasia, 372–3 Angiomatosis, bacillary, 356 Angio-oedema, 362, 364, 446 Angiotensin converting enzyme (ACE), 16, 387 Angular stomatitis, 215, 217, 218, 337 Anhydrotic ectodermal dysplasia, 20–1 Ankylosing spondylitis, 197 Ankylosis temporomandibular joint (TMJ), 192, 194–5 tooth resorption, 70–1 Anodontia isolated, 20 with systemic defects, 20–1, 22 Anorexia nervosa, 405 Anterior pituitary hyperfunction, 406–7 Antibiotics dentally relevant adverse effects, 444 osteomyelitis, 100–1 prophylaxis see Prophylaxis sensitivity, 16 Antibiotic stomatitis, 216, 247 Antibodies immunostaining, 13, 14, 15 periodontitis, 84–5 Anticoagulants acquired clotting defects, 348–9 dentally relevant adverse effects, 444 Antidepressants, 444 Anti-epiligrin pemphigoid, 243 Antigen screen, 16 Antihistamines, 444 Antihypertensives, 444 Antineutrophil cytoplasmic antibodies (ANCA), 389 Antinuclear factors, 365 Anti-platelet drugs, 345 Anti-p105 pemphigoid, 243 Antipsychotics, 444 Antiretroviral drugs, 354–5 see also Highly active antiretroviral treatment (HAART) Antral polyp, 385 Antrum, maxillary see Maxillary antrum Anxiety disorders, 428 Apatite crystals, 49 Apex separation, 71 Aphthous stomatitis, 220–4 aetiology, 220–1 in anaemia, 337 clinical features, 221–2 diagnosis and management, 223–4 herpetiform, 222 in HIV/AIDS, 359 major form, 222, 224 minor form, 222 pathology, 222–3 in pregnancy, 413 treatment, 240–1 types of, 222 457 INDEX Apical periodontitis acute, 40, 65, 66–8 chronic, 68–70 Aplastic anaemia, 336, 343 Areca nut, 266, 268, 278 Arrested caries, 55–6 Arteritis, cranial, 195, 197–8, 433 Arthralgia, 195 Arthritis osteoarthritis, 196–7, 426 psoriatic, 197 rheumatoid, 195, 196, 365 suppurative, 192 temporomandibular joint, 195–7 Aspartame, 47 Aspergillosis, 111 Aspergillus spp., 384 Aspirin, 345, 444 Asthma, 362, 388 Ataxia, 422 Atherosclerosis, 87–8 Athetosis, 422 Atopic disease, 351, 362–4 Atrophic candidosis, 218 Attached gingiva, 77, 78 Attention deficit disorder, 421–2 Attrition, 74, 75 Atypical eosinophilic granuloma, 237–8 Atypical facial pain, 437 Atypical odontalgia, 438 Autism, 421 Autoantibodies, 16, 364 multiplicity of, 365 in Sjögren’s syndrome, 297 Autoimmune disease, 357, 364–6 458 Bacillary angiomatosis, 356 Bacillus intermedius, 84 Bacteraemias, 376 Bacteria anaerobic in fascial space infections, 107 antibiotics for plaque, 86 associated with periodontal disease, 81 mediators of tissue damage, 84 role of in destructive periodontitis, 83–4 systemic infection by oral, 111–12 Bacterial diagnosis of osteomyelitis, 100 Bacterial infections in HIV/AIDS, 356 Bacterial plaque see Plaque Bacterial polysaccharides, 41–2 Bacteroides, 99–100 Barbiturates, 444 Bartonella henselae, 370 Basal cell adenocarcinoma, 309 Basal cell adenoma, 310 Basal cell ameloblastoma, 138 Basal cell naevus syndrome, 127–9 Basic life support (BLS), 450 Behavioural disorders, 4212 Behỗets disease, 2245 Bells palsy, 437, 4401 Bence-Jones proteinuria, 164 Benign lymphoepithelial lesion, 299 Benzodiazepines, 444 Beta blockers, 453 Beta-thalassaemia, 336, 338 Betel quid, 266, 268, 278 Biofilms, 42 Biopsy, 10–12 brush, 12, 288–9 fine needle aspiration (FNA), 11 needle/core, 11 Bisphosphonate-induced osteonecrosis, 102–4, 164 Bisphosphonates dentally relevant adverse effects, 444 jaw necrosis, 102–4, 164 Paget’s disease, 183 Black tongue, 249 Bleeding excessive, 344, 349, 452–3 prolonged dental, 349 Bleeding time, 345 Blood blisters, ruptured, 238 Blood film, 16 Blood investigations see Haematology Blue naevus, 329 B lymphocytes, 342, 350, 352 Bohn’s nodules, 129 Bone cysts, 117, 155, 159 aneurysmal, 187–9 solitary, 186–7 dead, 100 destruction, 181 genetic diseases of, 172–8 haemangioma of, 159 malignant neoplasms of, 161–2 metabolic disease of, 178–81 non-odontogenic tumours of, 156–71 overgrowths, 156–7 resorbing factors, 84, 117 resorption, 81, 181 Bone islands, sclerotic, 106 Bone marrow depression of function, 443–4 osteoporotic defect, 187 transplantation, 351 Bone mineral density (BMD), 83 Borrelia burgdorferi, 370 Botryoid odontogenic cysts, 130 Brain abscess, 111 Brittle bone disease, 172 Brittle bone syndrome, 172–3 Bronchogenic carcinoma, 391 Bruising, 344–7 Brush biopsy, 12, 288–9 Bruxism, 74–5 Bulimia, 76, 393, 405 Bullous pemphigoid, 233, 243 Buried teeth, 24 Burkitt’s lymphoma, 341, 357 Burning mouth syndrome, 247, 437–8 Burns, chemical, 238, 443 Calcification pulp, 65 tooth, 24, 46–7 Calcific barriers, 62, 63 Calcifying cystic odontogenic tumour, 115, 132, 143–4, 155 Calcifying epithelial odontogenic tumour, 142, 154 Calcifying odontogenic cysts, 115, 132, 143–4, 155 Calcium hyperparathyroidism, 179 plaque minerals, 44 serum, 16 Calcium channel blocker antihypertensives, 444 Calculus pain from, 434 salivary, 291–2 subgingival gingivitis, 79–80 periodontitis, 81 Caldwell-Luc approach, 385 Cancellous osteoma, 156, 157 Cancer, oral, 277–89 aetiology, 277–80 alcohol, 278 candidosis, 279 detection aids, 288–9 epidemiology, 277 genetic factors, 280 incidence, 277 infections and immunological factors, 278–9 malnutrition, 279 management, 284 novel treatments, 286–7 oral sepsis, 279 palliative care, 286 pathology, 282–3 precancerous lesions, 280 preoperative assessment, 284–7 screening, 288–9 sites for, 280–2 spread of, 283–4 sunlight, 279 survival from, 287–8 syphilis, 279 TNM staging, 285 tobacco use, 277–8 treatment, 285–6 treatment failure, 286 verrucous carcinoma, 289 see also Carcinoma Cancrum oris, 108–9 Candida spp C albicans, 215, 216, 257, 267–8, 443 smear for, 16 Candidosis, 213–16 acute antibiotic stomatitis, 216 anaemia, 337 angular stomatitis, 215 chronic hyperplastic, 218, 267–8 chronic mucocutaneous syndromes, 256–8 denture-induced stomatitis, 215–16 erythematous, 216 HIV/AIDS, 355–6 malignant change, 261 management of types of, 218 oral cancer, 279 thrush, 213–14, 218, 254, 355–6 tongue, 247 treatment of, 217 Canicular adenoma, 310 Capnocytophaga ochraceus, 84 Carcinoma acinic cell, 303–4, 309 adenoid cystic, 304, 309 of the alveolar ridge, 282 ameloblastic, 140–1, 154 bronchogenic (lung), 391 of the cheek, 282 clear cell, 142–3, 154, 309 clear cell odontogenic, 142–3, 154 early, 270 epithelial-myoepithelial, 305, 309 ghost cell odontogenic, 154 large cell, 309 of the lip, 281 lymph node, 368 lymphoepithelial, 309 maxillary antrum, 390, 391 metastatic bronchogenic, 168 of the jaw, 168 of the mouth floor, 281–2 mucoepidermoid, 303, 304, 309 myoepithelial, 309 oncocytic, 309 INDEX of the palate, 282 polymorphous low-grade, 304, 309 primary intraosseous, 154 salivary duct, 305, 309 sebaceous, 309 small cell, 309 squamous cell, 280, 309 of the tongue, 281–2 undifferentiated, 305 verrucous, 289 Carcinoma-in-situ, 262 Carcinosarcoma, 309 Cardiac arrest, 450–1 Cardiac pacemakers, 379 Cardiovascular disease, 375–9 dental implications/side-effects of drugs used for, 375 in the elderly, 426 general aspects of management, 375–6 Caries, 40–59 adult, 56–9 aetiology, 40 arrested, 55–6 bacterial plaque, 42–4 childhood, 56–9 enamel mottling, 34 microbiology, 40–2 pathology of dentine caries, 53–9 of enamel caries, 49–52 prevalence of, 45–6 saliva and, 47–9 sucrose as a plaque substrate, 44–6 susceptibility of teeth to, 46–7 Cartilage-capped osteoma, 157 Castleman’s disease, 372–3 Cathepsin C gene, 90–1 Cat-scratch disease, 370 Cavernous sinus thrombosis, 108 CD4 cells, 325, 352 Cell-mediated immunity, 444 Cellulitis, 106–8, 192 Cementoblastoma, 146–7, 155 Cementoma, gigantiform, 151 Cemento-osseous dysplasias, 150–1, 185 Cemento-ossifying fibroma, 147–9, 157 Cementum, 54 excessive, 72–3 tumours and dysplasias of, 146–9 Central giant cell granuloma, 155 Cerebral palsy, 422 Cerebrovascular accidents, 441 Cervical lymphadenopathy, 367–73 investigation, 367–8 tuberculous, 368–9, 386 Cervicofacial cellulitis, 106–8 C1 esterase inhibitor deficiency, 351, 364 Cheek biting, 252–3 carcinoma, 282 swelling, 402 Chemical burns, 238, 443 Chemical dependence, 446–7 Chemistry, clinical, 14 Chemotherapy effect on tooth structure, 32 oral cancer, 286 Cherubism, 155, 159, 175–7 Chest pain, 451–2 Chewing tobacco, 266 Chicken tongue, 195 Children caries, 56–9 resuscitation of, 450 Chlorhexidine, 224 Cholesterol clefts in cysts, 118–19 Chondrocytes, 200 Chondroma, 162–3 Chondromatosis, synovial, 200 Chondrosarcoma, 162–3 Christmas disease, 347, 348 Chronic fatigue syndrome, 429 Chronic obstructive airways disease (COAD), 388 Cicatricial pemphigoid, 233 Ciclosporin dentally relevant adverse effects, 444 graft rejection, 415 Circulatory collapse, 449 Circumvallate papillae, Claudication, jaw, 197 Clavicles, absence of, 175 Clear cell carcinoma, 142–3, 154, 309 Clear cell odontogenic carcinoma, 142–3, 154 Clefts cysts, 118–19 lip and palate, 37–9 Cleidocranial dysplasia, 22, 23–4, 174–5 Clinical chemistry, 14 Closed questions, Clostridium difficile, 396 Clot formation, 113 Clotting disorders, 347–9 Cluster headache, 436 Codman’s triangles, 161 Coeliac disease, 393 Colds, 385 Cold sores, 208 COLIA1/2 genes, 172 Colitis pseudomembranous, 396 ulcerative, 393, 396 Collagen, 179 Collagen fibres, 146 Compact osteoma, 156, 157 Complement component level, 16 periodontitis, 85 Complex odontoma, 152, 154 Compound odontomas, 151, 154 Computerised tomography (CT), Concrescence, 73, 74 Condylar hyperplasia, 199 Condylar neck fracture, 193 Condyles, rheumatoid arthritis, 196 Cone beam CT, Congenital epulis, 322, 323 Connective tissue diseases, 365–6 Consciousness, sudden loss of, 448–51 Consent, 4–5 Consumption coagulopathy, 347 Contact dermatitis, 236, 362 Contrast studies, Convulsions, 452 Corticosteroids, 410–11 circulatory collapse, 449 dentally relevant adverse effects, 444 reactions and interactions, 453 recurrent aphthae, 223 Costen’s syndrome, 199 Coumarin anticoagulants, 348–9 Coxsackie A virus, 210 Cracked teeth, 60, 61 Cranial arteritis, 195, 197–8, 433 Cretinism, 408 Crohn’s disease, 393–5 Cryptococcosis, 110 Cultures, 16 Cushing’s disease, 411 CUSP, 231 Cyclamate, 47 Cyclic neutropenia, 343 Cystadenocarcinoma, 309 Cystadenoma, 310 Cystic ameloblastomas, 115 Cystic fibrosis, 390–1 Cystic neoplasms, 132 Cystic odontogenic tumours, 115 Cysts ameloblastoma, 137 bone see Bone, cysts calcifying odontogenic, 143–4 fluid, 116–17, 119 jaw see Jaw(s), cysts salivary gland, 292–3 Cytokines, 386 Cytology, exfoliative, 12 Cytomegalovirus (CMV) -associated ulceration, 210 in HIV/AIDS, 356 Cytotoxic drugs, 32, 444 Dane particle, 397 Darier’s disease, 238 Dead tracts, 55, 56 Debridement HIV-associated periodontitis, 93–4 osteomyelitis, 101 ulcerative gingivitis, 93 Decalcified sections, 13 Deciduous teeth defects of, 24 local factors affecting eruption of, 24 resorption, 70–1 Decortication, osteomyelitis, 101 Defibrination syndrome, 347 Delta agent, 399 Demographic details, Dens evaginatus, 35, 36 Dens in dente, 35 Dens invaginatus, 35, 36 Dental lamina cysts of the newborn, 129 Dental phobia, 428 Dental practice emergencies, 448–53 Denticles, 151 Dentigerous cysts, 121–3, 175 Dentinal dysplasia, 28, 29 Dentine caries, 53–9 protective reactions of, 53–4, 55 Dentinogenesis imperfecta, 27–8, 172, 173 Dentinogenic ghost cell tumour, 155 Dentinoma, 152 Dentists role in oral cancer, 287–8 Denture-induced granulomas, 314–15 Denture-induced stomatitis, 215–16, 218 Denture-wearers pain in, 432–3 problems affecting, 427 Depression, 428–9 Dermatitis, contact, 236, 362 Desalivation, 47 Desmoglein 3, 233 Desquamative gingivitis, 227, 233, 235 Development disorders, tooth, 20–39 Diabetes mellitus, 80, 412–13 Diagnosis differential, principles of, 2–17 Diffuse calcification, pulp, 65 Diffuse mucosal pigmentation, 331 Diffuse sclerosing osteomyelitis, 102 459 INDEX Diffuse type mucocutaneous candidosis, 257 Dilaceration, 34–5 Dilated odontoma, 152 Disability, intellectual and physical, 417–30 Disability Discrimination Act 2005, 418 Discoid lupus erythematosus, 230, 261, 366 Discrimination legislation, 418 Disinfection for viral hepatitis, 400 Dislocation of temporomandibular joint, 193–4 Disseminated intravascular coagulation, 347 Dorsal tongue fur, Down’s syndrome, 419–21 caries, 47 cleft lip and palate, 37 gingivitis, 80 hypodontia, 21 juvenile periodontitis, 90 Drug-induced hyperplasia, 95 Drug-induced leucopenia, 343 Drug(s) causing taste disturbance, 442 complications, 443–7 dependence, 446–7 effect on tooth structure, 31–2 impaired metabolism, 397 lichenoid reactions, 228–9 local reactions to, 443 lymphadenopathy, 373 management considerations, 446 oral reactions to, 238, 443 patient explanation, purpura associated with, 345–6 reaction and interactions, 453 side-effects of heart disease, 375 systemically mediated reactions, 443–6 temporomandibular joint trismus, 193 used for atopic disease, 362 Dry mouth, 294, 295, 359, 442, 446 Dry socket, 104–6 Ductal papillomas, 310 Dyskeratoma, warty, 238 Dyskeratosis, 262 Dyskeratosis congenita, 261, 270 Dyskinesia, tardive, 193 Dyspepsia, 393 Dysplasias cemento-osseous, 150–1, 185 of cementum, 146–9 cleidocranial, 174–5 dentinal, 28, 29 fibrous, 155, 159, 183–4 monostotic, 184–5 polyostotic, 185 florid cemento-osseous, 150 focal cemento-osseous, 150 malignant change, 261–2, 263 osseous, 150–1, 155 periapical cemental, 150 Dysplastic lesions management, 270–2 Dysplastic leukoplakia, 261 Dyspnoea, 452 Dysrhythmias, 376, 379 460 Ear disease, 196 Ecchymoses, 344–7 Ectodermal dysplasia, anhydrotic, 20–1 Eczema, 236 Edentulous patients see Denture-wearers Ehlers-Danlos syndromes, 30 pulp stones, 65 temporomandibular joint dislocation, 193, 194 type VIII, 91 Eikenella corrodens, 84 Elderly, 424–7 cardiovascular disease, 426 limitations on mobility, 425 oral disease, 426–7 systemic disease, 425–6 Electric pulp testing, 6–7 Electron microscopy, 17 ELISA (enzyme-linked immunosorbent assay), 17, 213 Embryonal rhabdomyosarcoma, 324 Emergencies in dental practice, 448–53 Enamel caries, 49–52 maturation, 48 mottled tooth, 32–4 zones, 50 Enamel pearls, 35–6, 37 Endocarditis, infective, 111, 376–9, 381–2 Endocrine disorders, 406–13 Endocrine mucocutaneous candidosis, 257 Endotoxins, 84 Enostoses, 106 Enucleation, cysts, 120 Enzyme linked immunosorbent assay (ELISA), 17, 213 Enzymes, 84 Eosin see Haematoxylin and eosin (H&E) Eosinophilic granuloma, 91, 166, 167 Eosinophilic ulcer, 237–8 Eosinophils normal values, 18 Epidermal growth factor receptor (EGFR), 286–7 Epidermolysis bullosa, 30, 235, 238 Epilepsy, 423, 452 Epinephrine, 376, 450, 453 Epithelial attachment, 77–8, 83 Epithelial dysplasia, 261–2 Epithelial lining, cysts, 117, 118 Epithelial-myoepithelial carcinoma, 305, 309 Epithelial proliferation, radicular cysts, 116 Epithelial rests of Malassez, 116, 117 Epithelial shedding, 235 Epithelium ameloblastic fibroma, 145 odontogenic, 146 squamous, 143 Epstein-Barr virus (EBV), 255 Burkitt’s lymphoma, 341 HIV/AIDS, 356 infectious mononucleosis, 370 Epulis, 314–15 congenital, 322, 323 differential diagnosis, 319 giant-cell, 317 pregnancy, 316, 413 Erosion, tooth, 76 Eruption cyst, 123 Erythema migrans linguae, 247–8 Erythema multiforme, 235–6, 390, 445 Erythematous candidosis, 216, 218 Erythrocyte sedimentation rate (ESR), 16, 18 Erythroplakia, 262–3 Erythroplasias see Red lesions Ewing’s sarcoma, 163 Examination clinical, 5–7 extraoral, 5–6 medical, 7–8 Excisional biopsy, 11 Exfoliative cytology, 12 Exophthalmos, 407 Exostoses, 156–7 External resorption, 71–2 Extraction socket dry socket, 104–6 normal healing of, 113–14 Extramedullary plasmacytoma, 164, 165 Extraoral disease, pain from, 434 Extraoral examination, 5–6 Exudate, gingival, 78 Facial pain, 437, 439 Facial palsy, 440–1 Facial swelling, 402 Factitious ulceration, 238, 438 Factor VIII, 346–7, 348 Fainting, 448 Familial adenomatous polyposis, 30 Familial hypophosphataemia, 178–9 Familial (limited) mucocutaneous candidosis, 257 Familial polyposis coli, 396 Fascial space infections, 106–8 Ferritin, 16, 247 Fetal alcohol syndrome, 35 Fever blisters, 208 Fevers, acute specific, 210–11 Fibrinolytic drugs, 345 Fibroblasts, 146 Fibro-dentinoma, ameloblastic, 154 Fibrolipoma, 321–2 Fibroma ameloblastic, 144–5, 154 cemento-ossifying, 147–9, 157 giant-cell, 315 juvenile ossifying, 149 leaf, 314, 315 odontogenic, 146, 155 ossifying, 147, 149, 155 psammomatoid ossifying, 149 Fibromatosis, hereditary gingival, 94, 95 Fibro-odontoma, ameloblastic, 145, 154 Fibro-osseous lesions, 183–9 Fibrosarcoma, 145, 154, 324 Fibrosis oral submucous, 194–5, 261, 268–9 progressive, 366 Fibrous ankylosis, 194 Fibrous dysplasia, 155, 159, 183–4 monostotic, 184–5 polyostotic, 185 Fibrous polyps, 314–15 Fine needle aspiration (FNA) biopsy, 11, 368 Fish mouth, 195 Fistula, oroantral, 385 Fits, 423 Fixation, 12 Fixed drug eruptions, 445–6 Floppy joint syndromes, 30, 65 Flora, microbial, 44–6, 443 Florid cemento-osseous dysplasia, 150 Fluorescent treponemal antibody absorption test (FTA-ABS), 213 Fluoride effects of on caries, 47 excess, 32–4, 178 plaque minerals, 44 Fluorosis, 32–4, 178 Focal cemento-osseous dysplasia, 150 Focal epithelial hyperplasia, 318 Focal sclerosing osteomyelitis, 102 Folate deficiency, 223, 336, 403, 404 red cell level, 16 serum, 247 Foliate papillae, 248 INDEX Follicular ameloblastoma, 137 Fordyce’s granules, 253 Fordyce’s spots, Fragile X syndrome, 419, 421 Free gingiva, 77 Frictional keratosis, 252–3 Frozen sections, 11 Fructans, 41 Fructose, 47 FTA-ABS test, 213 Full blood picture, 16 Fungal sinusitis, 384 Fungiform papillitis, 220 Furred tongue, 6, 249 Fusobacterium spp acute necrotising ulcerative gingivitis, 92 F necrophorum, 108–9 F nucleatum, 84 G1138A gene, 174 Galactose, 47 Gangrene, maxillofacial, 108–9 Gardner’s syndrome, 30, 157, 396 Garrè’s osteomyelitis, 102 Gastric regurgitation, 393 Gastrointestinal disease, 221, 393–6 Gastro-oesophageal reflux, 393 General anaesthesia, 337, 453 Generalised lymphadenopathy syndrome (GLS), 354 Genetic diseases of bone, 172–8 Geographical tongue, 247–8, 258 Germinated odontoma, 152 Germinated teeth, 35 Gestant odontoma, 152 Ghost cell cysts, 115, 143–4 Ghost cell odontogenic carcinoma, 154 Ghost teeth, 28–30 Giant-cell arteritis see Cranial arteritis Giant-cell epulis, 317 Giant-cell fibroma, 315 Giant-cell granuloma, 155, 157–9 Giant-cell tumour, 157, 159 Giant lymph node hyperplasia, 372–3 Gigantiform cementoma, 151 Gigantism, 177, 406–7 Gingiva abrasion, 96–7 attached, 77, 78 cysts, 129 enlargement, 94, 320 exudate, 78 free, 77 inflammatory swellings, 95–6 lichen planus, 227–8 normal, 77–8 recession, 96–7 swelling, 94, 314–20, 339 Gingival crevicular fluid, 78 Gingival fibres, 78 Gingival fibromatosis, hereditary, 94, 95 Gingival hyperplasia, 446 Gingivitis acute necrotising ulcerative, 92–3 chronic, 78–80 desquamative, 227, 233, 235 in HIV/AIDS, 93, 357–8 necrotising ulcerative, 432 pregnancy, 80 transition to periodontitis, 82 Gingivostomatitis, herpetic, 94 Glandular odontogenic cysts, 130 Globulomaxillary cysts, 132 Glossitis, 246–7 in anaemia, 337 median rhomboid, 218, 249–50 Glossopharyngeal neuralgia, 435 Glucans, 41–2 Glucose, 47 Glucose syrups, 47 GNAS1 gene, 183–4, 185 Goitre, 407 Gonorrhoea, 238 Gorlin-Goltz syndrome, 127–9 Gout, 197 Graft-versus-host disease (GVHD), 299, 351 Grand mild epilepsy, 423 Granular cell ameloblastoma, 138 Granular cell epulis, 322 Granular cell tumours, 322 Granuloma, 68, 69 atypical/traumatic eosinophilic, 237–8 central giant cell, 155 denture-induced, 314–15 eosinophilic, 91, 166, 167 giant-cell, 155, 157–9 multifocal eosinophilic, 167 pyogenic, 316 sarcoid, 95, 386–8 solitary eosinophilic, 166 Granuloma syndromes, 388–90 Granulomatosis orofacial, 95, 395–6 Wegener’s, 95, 238, 389–90 G380R gene, 174 Grinding of the teeth, 74–5 Ground sections, 13 Growth hormone, 177 Gutka, 266 Haemangioma, 310, 322–3 of bone, 159 parotid gland, 306, 307 Haemarthroses, 347 Haematocrit normal values, 18 Haematological deficiencies, 221, 247 Haematology, 14, 16, 18 Haematoxylin and eosin (H&E), 12 Haemoglobin (Hb) normal values, 18 sickle cell disease, 337–8 Haemophilia, 344 A, 347–8 B, 347, 348 Haemophilus influenzae, 383 Haemorrhage, 344, 349, 452–3 Haemorrhagic diseases, 344–9 Haemorrhagic fevers, 346 Haemorrhagic telangiectasia, 346 Haemosiderin, 158, 179 Hairy leukoplakia, 254–6, 356, 415 Hairy tongue, 248–9 Hamartomas, 151 Hand examination, 7–8 Hand-foot-and-mouth disease, 210, 211 Handicap, 417 Hand-Schuller-Christian triad, 167 Hashimoto thyroiditis, 341–2 Headache, cluster, 436 Healing stages, extraction socket, 113–14 Heart burn, 393 Heart disease see Cardiovascular disease Heart valve replacement, 376–8 Heberden’s nodes, 196 Heck’s disease, 318 Heerfordt’s syndrome, 388, 441 Helicobacter pylori, 341 Hemiplegia, 422 Heparin, 348–9 Hepatitis, 397–400 A, 397 B, 397–9, 400, 401 C, 399–400, 401 D, 399 E, 400 Hereditary prognathism, 37 Herpes labialis, 208–9 Herpes simplex virus herpetic stomatitis, 206 in HIV/AIDS, 356 Herpes zoster, 209–10, 440 Herpetic cross-infections, 208–9 Herpetic gingivostomatitis, 94 Herpetic stomatitis, 206–8 in HIV/AIDS, 356 primary, 206–8 recurrent, 206 tongue, 246 Herpetic whitlow, 208–9 Highly active antiretroviral treatment (HAART), 325–6, 354–5, 359 Histiocytes, 341 Histiocytosis, Langerhans’ cell, 91, 165–7, 237, 372 Histopathology, 10–12 Histoplasmosis, 111 History taking, 2–5 consent, 4–5 dental history, essential principles of, family and social history, medical history, 3–4 pain history, present complaint, HIV-associated gingivitis, 93, 357–8 HIV-associated periodontitis, 93–4, 357–8, 432 HIV (human immunodeficiency virus) aetiology, 352 assessment and staging, 354 general management of, 354 giant lymph node hypoplasia, 372–3 hairy leukoplakia, 254–6 Kaposi’s sarcoma, 324–6, 357 lymphadenopathy, 371 melanotic macules, 329 oral lesions in, 225, 355–60 recurrent aphthous stomatitis, 221 risk of transmission, 359–60 salivary gland disease, 299 test, 16, 353 tuberculosis, 211 HLA tissue types, 224 Hodgkin lymphoma, 310 Hodgkin’s disease, 341 Hormones, recurrent aphthous stomatitis, 221 Host defence mechanisms, 84 Human herpesvirus (HHV-8), 324–6, 357, 372 Human papilloma virus (HPV), 278–9, 317 Hutchinson’s incisors, 31 Hyaline bodies, 117, 118 Hydrocephalus, 421 Hydrogenated glucose, 47 Hydrogen ions, 51 Hydrostatic effects of cyst fluids, 116–17 Hyperactivity, 421–2 Hyperaemia, pulpal, 61 Hyperbaric oxygen therapy, 101 Hypercementosis, 72–3 Hyperchromatism, 282 461 INDEX Hyperdontia, 21–2 Hypergammaglobulinaemia, 164 Hyperparathyroidism, 159, 177, 179–81, 408–9, 415 Hyperparathyroidism-jaw tumour syndrome, 409 Hyperpigmentation, 359 Hyperplasia condylar, 199 drug-induced, 95 focal epithelial, 318 giant lymph node, 372–3 gingival, 446 Hyperplastic candidosis, chronic, 218, 267–8 Hyperplastic gingivitis, chronic, 78 Hypersalivation, 299 Hypertension, 376 Hyperthyroidism, 407–8 Hypnotics, 444 Hypocalcification, tooth, 24, 46–7 Hypocalcified amelogenesis imperfecta, 26–7 Hypodontia isolated, 20 other conditions associated with, 21 with systemic defects, 20–1 Hypofunction, 409–11 Hypoglycaemia, 449 Hypomaturation amelogenesis imperfecta, 25–6, 27 Hypoparathyroidism, 31, 32, 409 Hypophosphataemia, familial, 178–9 Hypophosphatasia, 31, 32, 91, 177 Hypoplasia focal epithelial, 318 gingival, 446 tooth, 24, 31 hereditary, 46–7 treatment of, 35 Hypoplastic amelogenesis imperfecta, 25, 26 Hypothyroidism, 408 Hysterical trismus, 193 462 Idiopathic hypoparathyroidism, 31, 32, 409 Idiopathic leukoplakia, 264 Idiopathic osteosclerosis, 106 Idiopathic resorption, 71–2, 73 Idiopathic thrombocytopenic purpura, 345 Imaging techniques, 9–10 see also specific technique Immunodeficiencies, 350–60 juvenile periodontitis, 90 oral manifestations of, 350 systemic infections by oral bacteria, 111–12 Immunofluorescent staining, 13, 14, 15 Immunoglobulin A (IgA), 48, 84 linear disease, 243 pemphigus, 242 selective deficiency, 350–1 Immunoglobulin G (IgG), 48, 231 Immunoglobulins light chain overproduction, 164, 165 myeloma, 163 Immunohistochemical staining, 13, 15, 330 Immunological processes in periodontal disease, 84–5 Immunosuppressive treatment/drugs, 351, 444 Impairment, 417 Implants, osseointegrated, 189–91 Incisional biopsy, 11 Incisors, Hutchinson’s, 31 Infection fascial space, 106–8 oral cancer, 278–9 purpura, 346 recurrent aphthous stomatitis, 221 susceptibility to oral, 351 systemic by oral bacteria, 111–12 temporomandibular joint pain, 195 temporomandibular joint (TMJ), 192–3 tooth, 30–1 see also specific infection Infectious mononucleosis, 370–1 Infective endocarditis, 111, 376–9, 381–2 Infective warts, 318 Inflammation gingival swellings, 95–6 periodontitis, 82 temporomandibular joint pain, 195 temporomandibular joint (TMJ), 192–3 Injuries factitious oral, 429 jaw, 193 recurrent aphthous stomatitis, 220 temporomandibular joint pain, 195 Instruments, aspiration of, 385 Insulin, 444 Insulin-dependent diabetes, 412 Intellectual disability, 417–30 Intensity modulated radiotherapy, 287 Interdental papillae, 81 Internal resorption, 71, 72 International Normalised Ratio (INR), 348 Intracapsular ankylosis, 192 Intracranial disorders, 434–8 Intracranial tumours, 436 Intraluminal unicystic ameloblastoma, 140 Intraosseous carcinoma, primary, 154 Intraosseous salivary gland tumours, 307 Invaginated odontoma, 152 Investigation plans, principles of, 2–17 special, 8–17 Iron deficiency, 246, 279, 336, 337 serum, 16, 247 Iron-deficiency anaemia, 246 Irradiation damage, salivary glands, 299 temporomandibular joint ankylosis, 194–5 Isomalt, 47 Jacobsen’s organ, 130 Jaundice, obstructive, 349 Jaw(s) acute osteomyelitis, 99–101 bisphosphonate necrosis of, 102–4, 164 claudication, 197 cysts, 115–32 cystic neoplasms, 132 dentigerous, 121–3, 175 eruption, 123 gingival, 129 globulomaxillary, 132 keratinising odontogenic, 123–4 lateral periodontal, 130 major factors in the pathogenesis of formation of, 116 multilocular radiolucency, 135 nasolabial, 132 nasopalatine duct, 130–1 neoplastic change within, 132 odontogenic keratocyst see Odontogenic keratocyst orthokeratinised odontogenic, 129 paradental, 120–1 radicular see Radicular cysts relative frequency of, 116 of the soft tissues, 132 typical features of, 115 well-defined monocular radiolucency, 134 in the elderly, 426 genetic disorders of the, 37 injuries, 193 non-odontogenic tumours of the, 156–71 odontogenic tumours of the, 136–52 osteonecrosis, 103, 164 painful diseases of the, 432 Jaw tumour syndrome, 177 Junctional epithelium, 77 Juvenile arthritides, 197 Juvenile onset diabetes, 412 Juvenile ossifying fibroma, 149 Juvenile periodontitis, 88–91 Kaposi’s sarcoma, 324–6, 357 Kawasaki’s disease, 211, 237, 371–2, 379 Keratin, 144, 282 Keratinising odontogenic cysts, 123–4 Keratocyst, odontogenic see Odontogenic keratocyst Keratocystic odontogenic tumours, 127, 154 Keratosis, 258 frictional, 252–3 oral of renal failure, 259 pipe smoker’s, 253–4, 261, 265 smokeless tobacco-induced, 265–7 sublingual, 265 Keratosis follicularis, 238 Khaini, 266 Koilocyte-like cells, 255 Koilocytes, 317–18 Koplik’s spots, 211 Laboratory procedures, 12–13, 344 see also specific procedure Lactic acid, 44 Lactitol, 47 Lactobacilli, 41–2, 53 Lactose, 47 Langerhans’ cell histiocytosis, 91, 165–7, 237, 372 Large cell carcinoma, 309 Late onset mucocutaneous candidosis, 257 Lateral periodontal cysts, 130 Lateral radicular cysts, 119–20 Latex allergy, 362–3 Leading questions, Leaf fibroma, 314, 315 Learning difficulty, 419–21 Learning guides, 202–4, 333–4, 454–5 Le Fort II/III fractures, 193 Left ventricular failure, 452 Leprosy, 238, 369 Leptotrichia buccalis, 111–12 Letterer-Siwe syndrome, 167 Leucopenia, 342–3, 351 Leukaemia, 336, 338–40 acute, 95, 96, 339–40 chronic, 340 juvenile periodontitis, 90 Leukoedema, 6, 252 Leukoplakia candidal, 267–8 dysplastic, 261 hairy, 254–6, 356, 415 idiopathic, 264 proliferative verrucous, 265 speckled, 261, 263–4 INDEX syphilitic, 270, 279 Lichenoid reactions, 228–9, 444–5 Lichen planus, 225–30 aetiology, 225 clinical features, 225–6 differential diagnosis, 230 distribution, 226 gingival, 227–8 lichenoid reactions, 228–9 malignant change in, 229, 261, 270 pigmented, 327 symptoms, 226 tongue, 247 Light chain overproduction, 164, 165 Limb defects, 424 Linear IgA disease, 243 Lingual papillitis, 220 Lingual thyroid, 408 Lingual tonsils, Lingual varicosities, 248 Lip carcinoma, 281 cleft, 37–9 paresthesia and anaesthesia of the, 438–40 swelling, 402 Lipoma, 321–2 Lipopolysaccharide, 84 Lipoteichoic acid (LTA), 84 Lithotripsy, 292 Liver disease, 349, 396–400 Local anaesthesia, 376, 453 Lockjaw, 193 Loose bodies in the temporomandibular joints, 199–200 Low grade cribriform cystadenocarcinoma, 309 Ludwig’s angina, 106–7, 108 Luminal unicystic ameloblastoma, 140 Lung abscess, 111 carcinoma, 391 Lupus erythematosus, 230–1, 261, 270 Lycasins, 47 Lyme disease, 197, 370, 441 Lymphadenocarcinoma, sebaceous, 309 Lymphadenoma, 310 Lymphadenopathy, 342 cervical see Cervical lymphadenopathy in HIV/AIDS, 357 in leukaemia, 339 tuberculosis, 386 Lymphangioma, 323–4 Lymph nodes carcinoma, 368 enlarged see Lymphadenopathy giant lymph node hyperplasia, 372–3 mucocutaneous lymph node syndrome, 211, 237, 371–2, 379 oral cancer spread to, 282 removal, 286 sentinel node biopsy, 286 Lymphoblastic leukaemia, acute, 339–40 Lymphocytes in AIDS, 352 in MALT lymphoma, 341 in non-Hodgkin lymphomas, 340 normal values, 18 in sarcoid granulomas, 386 Lymphoepithelial carcinoma, 309 Lymphoepithelial lesions, 342 Lymphoma, 167, 340–2 Burkitt’s, 341, 357 diffuse large B cell, 310 in HIV/AIDS, 357 Hodgkin, 310 Hodgkin’s disease, 341 immunostaining, 13 MALT, 310, 341–2 nasopharyngeal, 342, 390 non-Hodgkin, 340–1 plasmablastic, 354 salivary gland, 306–7 in Sjögren’s syndrome, 299 Macrocytosis, 223 Macroglossia, 250–1 Magnetic resonance imaging (MRI), Malabsorption syndromes, 396 Malignant melanoma, 329–31 Malnutrition, 279, 425 MALT lymphoma, 310, 341–2 Maltodextrins, 47 Mandibular block injections, 192 Mannitol, 47 Mantoux reaction, 387 Marble bone disease, 173–4 Marfan’s syndrome, 193 Marginal zone lymphocytes, 341 Marsupialisation, cysts, 120 Mastication, pain induced by, 433–4 Maturity onset diabetes, 412 Maxilla, 176 see also Jaw(s) Maxillary ameloblastoma, 139 Maxillary antrum carcinoma, 390, 391 displacement of a root or tooth into, 384–5 surgical damage to the, 384–5 Maxillary sinusitis, 383–4 Maxillofacial chondrosarcoma, 163 Maxillofacial gangrene, 108–9 Mealtime syndrome, 311 Mean corpuscular haemoglobin concentration (MCHC), 18 Mean corpuscular volume (MCV), 18, 223, 247 Measles-mumps-rubella (MMR) vaccine, 294 Median rhomboid glossitis, 218, 249–50 Melanin, 327, 331 Melanoma, malignant, 329–31 Melanotic macules, HIV-associated, 329 Melanotic naevi, 328–9 Melanotic neuroectodermal tumour of infancy, 155, 160–1, 331 Melkersson-Rosenthal syndrome, 441 Mental illness, 417–30 Mercury allergy, 363–4 Mesenchymal chondrosarcoma, 163 Mesenchymal neoplasms, 321–6 Mesenchyme, 145 Metabolic bone disease, 178–81 Metabolic disturbances, tooth structure, 31 Metal allergy, 363–4 Metastatic tumours bronchogenic carcinoma, 168 of the jaws, 167–9 oral carcinoma, 283–4 Metastising ameloblastoma, 140–1, 154 Methamphetamine, 446 Methyl mercury, 364 Metoclopramide, 193, 444 Microbiology, 14–17 Microcysts, 141 Microcytosis, 223 Microscopy, commons stains for, 12–13 Midline granuloma syndromes, 388–90 Migraine, 436 Migrainous neuralgia, 436 Mikulicz syndrome, 342, 388 Mitoses, 162 Mixed odontogenic tumours, 152 MMR (measles-mumps-rubella) vaccine, 294 Molars Moon’s, 31 mulberry, 31 Molecular biological tests, 13 Mona Lisa face, 195 Monoamine oxidase inhibitors (MAOIs), 444, 453 Monocytes, 18 Mononucleosis, infectious, 370–1 Monospot test, 16 Monostotic fibrous dysplasia, 184–5 Moon’s molars, 31 Morphoea, 366 Mouth floor carcinoma, 281–2 Mucinous adenocarcinoma, 309 Mucoceles, 292–3 Mucocutaneous candidosis syndromes, 256–8 Mucocutaneous lymph node syndrome, 211, 237, 371–2, 379 Mucoepidermoid carcinoma, 303, 304, 309 Mucormycosis, 111 Mucosa benign swellings, 314–20 diseases of the (see also specific diseases) in the elderly, 427 introduction and mucosal infections, 206–18 non-infective stomatitis, 220–45 examination of, painful lesions, 432 pemphigoid, 233–5 pigmentation, 327–31 swelling, 402 ulceration in leukaemia, 339 ulcers, 359 white lesions see White mucosal lesions Mucosa-associated lymphoid tissue (MALT) lymphoma, 310, 341–2 Mucous glands, 131 Mucoviscidosis, 390–1 Mulberry molars, 31 Multicentric Castleman’s disease, 372–3 Multifocal Castleman’s disease, 372–3 Multifocal eosinophilic granuloma, 167 Multimodality therapy, 285 Multinucleate giant cells, 176, 177 Multiple endocrine neoplasia (MEN) syndromes, 412 Multiple sclerosis, 422–3, 436 Mumps, 192, 294, 434 Munchausen’s syndrome, 430 Mural ameloblastoma, 140 Muscle spasm, temporomandibular joint pain, 195 Muscular dystrophies, 424 Myasthenia gravis, 424 Mycetoma formation, 384 Mycobacteria, 368 Mycoplasmal pneumonia, 390 Mycoses, systemic, 110–11, 357 Myelocytic leukaemia, 339 Myelogenous leukaemia, 340 Myeloid leukaemia, 339 Myeloma, 13, 163–5, 165 Myocardial infarction, 375, 434, 449, 451–2 Myoepithelial carcinoma, 309 Myoepithelial cells, 301 Myoepithelial islands, 297 Myoepithelioma, 301, 310 463 INDEX Myxofibroma, odontogenic, 155 Myxoma, odontogenic, 145–6, 155 Naevi blue, 329 oral melanotic, 328–9 white sponge, 256 Nasolabial cysts, 132 Nasopalatine duct cysts, 130–1 Nasopharyngeal lymphomas, 342, 390 Nass, 266 Natural killer cells, 342, 390 Neck dissection, 286 Necrotising fasciitis, 108 Necrotising sialometaplasia, 307 Necrotising ulcerative gingivitis, 92–3, 432 Necrotising ulcerative periodontitis (NUP), 357, 358 Needle/core biopsy, 11 Needle-stick injuries, 359–60 Neisseria gonorrhoeae, 84 Neoadjuvant chemotherapy, 286 Neoplasms see Tumours Neuralgia glossopharyngeal, 435 migrainous, 436 postherpetic, 435–6 trigeminal, 199, 434–5 Neurilemmomas, 321 Neurofibromas, 321 Neurological disease, 359 Neuromuscular dysfunction, 422 Neuropathy, trigeminal, 435 Neuropsychiatric disease in AIDS, 354 Neutropenia, cyclic, 343 Neutrophils, 18 Newborns, dental lamina cysts of, 129 Nickel allergy, 363 Nicorandil, 225 Nicotinamide, 403–4 Nicotinic acid deficiency, 247 Nikolsky’s sign, 232, 233 Noma, 108–9 Non-Hodgkin lymphomas, 340–1 Non-steroidal anti-inflammatory analgesics, 444 Noonan syndrome, 158 Noradrenaline, 453 Norepinephrine, 453 Normocytic anaemia, 336 Nucleoside reverse transcriptase inhibitors (nRTIs), 354 Nucleotide analogues, 354 Nutritional deficiencies, 403–5, 425 Nutritional disorders, 346 464 Obsessive compulsive disorder, 429 Obstructive jaundice, 349 Occlusion abnormalities, 198 Odontalgia, 438 Odontoameloblastoma, 154 Odontodysplasia, regional, 28–30 Odontogenesis imperfecta, 27–8 Odontogenic cysts, 115 botryoid, 130 calcifying, 115, 132, 143–4 glandular, 130 keratinising, 123–4 orthokeratinised, 129 Odontogenic fibroma, 146, 155 Odontogenic keratocyst, 124–9 basal cell naevus syndrome, 127–9 clinical features, 124 key features, 125 management, 127 neoplastic nature of, 126–7 orthokeratinised, 129 pathogenesis and histopathology, 124–6 radiography, 124 recurrence, 127 Odontogenic lesions, non-neoplastic, 149–52 Odontogenic myxofibroma, 155 Odontogenic myxoma, 145–6, 155 Odontogenic tumours adenomatoid, 141, 154 calcifying cystic, 155 calcifying epithelial, 142, 154 of the jaws, 136–52 keratocystic, 154 mixed, 152 squamous, 144, 154 WHO classification, 154–5 Odontomas, 35–6, 151–2 complex, 152, 154 compound, 151, 154 Oestrogen, 105 Oncocytic carcinoma, 309 Oncocytoma, 303, 310 Oncocytosis, 303 OncoVex, 287 Open questions, Oral contraceptives, 105 Oral examination, 6–7 Oral flora, 443 Oral keratosis of renal failure, 258, 259 Oral melanotic naevi, 328–9 Oral mucosa see Mucosa Oral purpura, localised, 346 Oral submucous fibrosis, 195, 268–9 Organ transplantation, 351–2 Oroantral fistula, 385 Orofacial granulomatosis, 95, 395–6 Orthokeratinised cysts, 123–4 Orthokeratinised odontogenic cysts, 129 Orthokeratinised odontogenic keratocyst, 129 Osseointegration, pathology of, 189–91 Osseous dysplasias, 150–1, 155 Ossifying fibroma, 147, 149, 155 Osteitis alveolar, 104–6 deformans see Paget’s disease of bone sclerosing, 102, 103 Osteitis fibrosa cystica, 179, 409 Osteoarthrectomy, 195 Osteoarthritis, 196–7, 426 Osteoblast-like cells, 147 Osteoblasts, 172, 185 Osteochondritis dissecans, 200 Osteochondroma, 157, 158, 199, 200 Osteoclastoma, 157 Osteoclasts, 100, 147, 158 hyperparathyroidism, 179 osteopetrosis, 173 Paget’s disease, 181 Osteodystrophy, renal, 415 Osteogenesis imperfecta, 172–3 Osteoid matrix, 179 Osteoma, 156–7 cancellous, 156, 157 cartilage-capped, 157 compact, 156, 157 Gardner’s syndrome, 30, 157, 396 Osteomyelitis, 150, 173, 192 acute of the jaws, 99–101 in anaemia, 337 chronic, 101–2 radiotherapy, 104 Osteonecrosis, 446 bisphosphonate-induced, 102–4, 183 jaw, 103, 164 Osteopetrosis, 173–4 Osteoporosis, 83 Osteoporotic bone marrow defect, 187 Osteoradionecrosis, 104, 285 Osteosarcoma, 161–2 Osteosclerosis, idiopathic, 106 Pacemakers, cardiac, 379 Packed cell volume (PCV), 18 Paget’s disease of bone, 180–3 hypercementosis in, 73 osteosarcoma, 161 Pain, 431–8 causes of, 431 chest, 451–2 from extraoral disease, 434 facial, 437, 439 history of, induced by mastication, 433–4 postoperative, 433 psychogenic dental, 438 psychogenic facial, 437 pulp, 60–1 temporomandibular joint, 195–200 tooth, 70 Pain dysfunction syndrome, 193, 198–9, 433 Palate carcinoma, 282 cleft, 37–9 papillary hyperplasia of the, 316 Papillae interdental, 81 parotid, 292 retrocuspid, Papillary hyperplasia of the palate, 316 Papillitis, lingual, 220 Papillomas, 310, 317–18 Papillomaviruses, 356 Papillon-Lefèvre syndrome, 90–1 Paradental cysts, 120–1 Parakeratin, 144 Paraneoplastic pemphigus, 242 Parathormone (PTH), 16, 179, 408–9 Parathyroid glands, 179–80, 408–9 Paresthesia of the lip, 438–40 Parkinson’s disease, 425–6 Parotid gland haemangioma, 306, 307 lump in, 312 oncocytosis, 303 pain, 434 papilla, 292 surgery, patient explanation, swelling, 313, 359, 388 tumour, 441 Parotitis, 192 in HIV/AIDS, 359 suppurative, 192, 294, 434 tuberculous, 386 Patau’s syndrome, 37 Paterson-Kelly syndrome, 279 Paul-Bunnell test, 16 Pellagra, 403–4 Pemphigoid immunostaining, 13, 14 mucous membrane, 233–5 subtypes of, 243 Pemphigus, 232–3 immunostaining, 13, 14, 15 variants, 242 Pemphigus foliaceus, 242 INDEX Pemphigus herpetiformis, 242 Pemphigus vulgaris, 232–3 Penicillin hypersensitivity, 445, 449 Periapical cemental dysplasia, 150 Periapical periodontitis, 65–6, 71 Periarticular tissues disorders, 192–200 Pericoronitis, 91–2, 192, 432 Peri-implantitis, 189, 190 Periodic acid-Schiff (PAS) stain, 12–13 Periodontal abscess, 88, 89, 432 Periodontal cysts, lateral, 130 Periodontal disease nomenclature and classification of, 78 types of, 79 see also Periodontitis; specific disease Periodontal fibres, 78, 83 Periodontal ligament, 78 Periodontal pain, 70 Periodontal surgery flap operations, 86 limitations of, 86 pocketing, 86 reattachment surgery, 86 Periodontal tissues in the elderly, 426 normal, 77–8 Periodontitis, 79 acute, 431 apical acute, 40, 65, 66–8 chronic, 68–70 chronic adult, 80–7 aetiology and pathology, 81–4 clinical features, 80–1 complications of, 87–8 general principles of management of, 85 immunological processes in, 84–5 pathological processes in, 81 pocketing, 82–3, 85–6 prognosis, 86–7 progress of, 85 radiography, 81 smoking, 84 treatment of advanced, 86 with gingival recession, 96–7 HIV-associated, 93–4, 357–8, 432 juvenile, 88–91 periapical, 65–6, 71 pre-pubertal, 90 transition from gingivitis, 82 Periostitis, proliferative, 102 Perivascular cuffing, 222 Permanent teeth defects of, 24 delayed eruption, 175 local factors affecting eruption of, 24 multiple malformed, 25 resorption, 71 Pernicious anaemia, 336, 425 Petit mal epilepsy, 423 Peutz-Jeghers syndrome, 328, 396 pH, oral, 44 Phaeochromocytoma, 411 Phenothiazine antipsychotics, 444 Phenothiazine neuroleptics, 193 Phenylbutazone, 345 Phenytoin, 95, 443 dentally relevant adverse effects, 444 lymphadenopathy, 373 Phobia, dental, 428 Phosphate, 16 Phosphorus, 44 Photodynamic therapy, 286 Photographs, 17 Physical disability, 417–30 Pigmentation oral, 359, 446 skin, 185 Pigmented lesions, 327–31 amalgam tattoo, 328 blue naevus, 329 common causes of, 332 oral melanotic macules, 329 oral melanotic naevi, 328–9 Peutz-Jeghers syndrome, 328 physiological and racial, 327 post-inflammatory, 327 Pindborg tumour, 142 Pink spot, 71, 72 Pipe smoker’s keratosis, 253–4, 261, 265 Pipe smoking, oral cancer and, 278 Plaque, 42–4 accumulation, 80 acid production in, 43–4 antibiotics for bacteria, 86 calcified see Calculus factors compromising removal of, 85 gingivitis, 79–80 minerals, 44 periodontitis, 81 polysaccharides, 41 stages of formation of, 43 sucrose as a substrate for, 44–6 Plasmablastic lymphoma, 354 Plasmacytoma, 164, 165 Plasmin, 105 Platelets disorders of, 344–6 normal values, 18 Pleomorphic adenoma, 10–11, 301–2, 306, 309 Plexiform ameloblastoma, 137, 138 Ploidy analysis, 272 Pneumocystis carinii, 354 Pneumonia mycoplasmal, 390 Pneumocystis carinii, 354 Pocketing, 82–3, 85–6 Polyglandular autoimmune disease, 411 Polyglandular autoimmune endocrinopathy syndromes, 411 Polymerase chain reaction (PCR), 13, 16 Polymorphous low-grade carcinoma, 304, 309 Polyostotic fibrous dysplasia, 185 Polyposis coli, 396 Polyps antral, 385 fibrous, 314–15 Polysaccharides, bacterial, 41–2, 44, 48 Porphyria, congenital, 24 Porphyromonas spp., 84, 99–100 Positron emission tomography (PET), Postherpetic neuralgia, 435–6 Postoperative pain, 433 Post-traumatic stress disorder, 429 Pregnancy, 413–14 epulis, 316 gingivitis, 80 Premalignancy, oral, 261–73 lesions and conditions, 262–70 management of dysplastic lesions, 270–2 at risk lesions, 261–2 smoking cessation, 272–3 Pre-pubertal periodontitis, 90 Prevotella spp., 84, 99–100, 109 Prickle cells, 255 Prilocaine, 376 Prognathism, hereditary, 37 Progonoma, 155, 160–1, 331 Progressive systemic sclerosis, 195 Proliferative periostitis, 102 Proliferative verrucous leukoplakia, 265 Prophylaxis infective endocarditis, 377, 378–9, 381–2 post-exposure to HIV, 360 Prosthetic joint replacements, 112 Protease inhibitors, 354 Proteinuria, Bence-Jones, 164 Prothrombin time, 348 Psammoma bodies, 149 Psammomatoid ossifying fibroma, 149 Pseudomembranous colitis, 396 Psoriasis, 258 Psoriatic arthritis, 197 Psychiatric disorders, 417–30 Psychogenic dental pain, 438 Psychogenic disorders, tongue signs, 247 Psychogenic facial pain, 437 Psychological disorders, 434–8 PTCH gene, 125, 128 Ptyalism, 299 Pulp calcifications, 65 capping, 62, 63 diffuse calcification, 65 pain, 60–1, 70 polyp, 63–4 protective reactions of, 53–4 Pulpal hyperaemia, 61 Pulpitis, 59, 60–4, 431 acute, 40, 60–1, 62 closed, 62 causes of, 60 chronic, 61 closed, 62–3 hyperplastic, 63–4 clinical features, 60–1 key features, 64 management, 64 open, 63 pathology, 62–4 treatment options, 64 Purpura, 344–7 AIDS-associated, 345 drug-associated, 345–6 idiopathic thrombocytopenic, 345 in leukaemia, 339 localised oral, 346 systemic, 345 Pus actinomycosis, 110 osteomyelitis, 100 Pyogenic granuloma, 316 Pyostomatitis gangrenosum, 396 Pyostomatitis vegetans, 238, 396 Quadriplegia, 422 Questions, types of, Radiation injury, 427 Radicular cysts, 115, 116–20 clinical features, 116 differential diagnosis, 119–20 pathogenesis, 116–17 pathology, 117–19 radiography, 119 residual and lateral, 119–20 treatment, 120 Radiography, conventional, 9–10 juvenile periodontitis, 89 odontogenic keratocyst, 124 periodontitis, 81, 89 radicular cysts, 119 465 INDEX Radiolucency differential diagnosis of sharply defined mixed, 155 mixed patchy, 188 multilocular, 134 well-defined monocular, 134 Radiopacity differential diagnosis of well-defined, 170 mixed patchy, 188 Radiotherapy intensity modulated, 287 oral cancer, 285–6 osteomyelitis, 104 Ramsay-Hunt syndrome, 441 RANK protein, 181 Ranula, 293–4 Rapid Plasma Reagin (RPR) titre, 213 Raynaud’s phenomenon, 195 Recurrent aphthae see Aphthous stomatitis Red cells depressed production, 443 folate level, 16 normal values, 18 Red lesions, 262–3 differential diagnosis, 274, 276 malignant change, 261 Regional odontodysplasia, 28–30 Regurgitation, 76 Reiter’s disease, 197, 237, 238 Remineralisation, 55–6 Renal disease, 415–16 Renal failure chronic, 415 oral keratosis of, 258, 259 Renal osteodystrophy, 415 Renal transplantation, 415–16 Residual radicular cysts, 119–20 Resorption bone, 81, 84, 117, 181 tooth, 70–2 Respiratory tract disease, 383–91 Resuscitation, 450 Retrocuspid papilla, Rhabdomyosarcoma, 324 Rheumatoid arthritis, 195, 196, 365 Riboflavin deficiency, 247, 403 Rickets, 31, 178–9 Risedronate, 183 Rootless teeth, 28, 29 Root planing, 85 Roots aspiration of, 385 displacement into the maxillary antrum, 384–5 fusion, 73, 74 Root surface caries, 54–5 Rothia gingivitis, 79 Routine blood test, 14 Rushton bodies, 117, 118 466 Saccharin, 47 Salicylates, 224 Saliva artificial, 298 and dental caries, 47–9 rate of flow and buffering power, 47–8 tests for oral cancer, 289 Salivary calculi, 291–2 Salivary duct carcinoma, 305, 309 strictures, 292 Salivary fistula, 292 Salivary function in the elderly, 426–7 Salivary gland disease, 291–313 HIV-associated, 299, 359 hypersalivation, 299 irradiation damage, 299 malignant tumours, 303–7 neoplasms, 300–3 obstruction, 291–4 pain, 434 sialadenitis, 294–5 sialadenosis, 307, 308 temporomandibular joint pain, 196 tumour-like salivary swellings, 307 WHO classification of tumours, 309–10 Salivary mucins, 12–13 Sarcoidosis, 95, 386–8 Sarcoma, 324–6 ameloblastic, 145 Ewing’s, 163 Kaposi’s, 324–6, 357 odontogenic, 154 Scaling, subgingival, 85 Schizophrenia, 429–30 Scintigraphy, Scleroderma, 195, 366 Sclerosing osteitis, 102, 103 Sclerosing osteomyelitis, 102 Sclerosis progressive systemic, 195 systemic, 195, 366 Sclerotic bone islands, 106 Scurvy, 96, 179, 346, 404 Sebaceous adenoma, 310 Sebaceous carcinoma, 309 Sebaceous glands, 253 Sebaceous lymphadenocarcinoma, 309 Sebaceous lymphadenoma, 310 Sedatives, 444 Segmental odontomaxillary dysplasia, 30 Seizures, 423 Selective IgA deficiency, 350–1 Selenomonas sputigena, 84 Self-assessment questions, 202–4, 333–4, 454–5 Self-inflicted oral lesions, 438 Self-inflicted oral lesions, 238 Sentinel node biopsy, 286 Sepsis, oral, 279 Septal defect, 376–8 Sequestra, 100, 101, 102 Seroconversion illness, 354 Serology, 14, 397–8 Seronegative arthropathy, 197, 237, 238 SH3BP2 gene, 175 Shell teeth, 28 Shingles, 209–10 Sialadenitis, 294–5 Sialadenosis, 307, 308 Sialoblastoma, 309 Sialometaplasia, necrotising, 307 Sialo-odontogenic cyst, 130 Sicca syndrome, 295 Sickle cell anaemia, 177 Sickle cell disease, 336, 337–8 Sickle cell trait, 336, 337–8 Silver staining, 13 Sinus, skin, 69 Sinusitis acute, 383, 434 chronic, 383–4 fungal, 384 Sjögren-like syndrome in graft-versus-host disease, 299 in HIV/AIDS, 359 Sjögren’s syndrome, 247, 294, 295–9 aetiology and pathology, 297 benign lymphoepithelial lesion, 299 clinical features, 295–7 diagnosis, 297–8 key features, 299 lymphadenopathy, 368 lymphoma in, 299 MALT lymphoma, 341–2 management, 298–9 ocular effects of, 297 oral effects of, 296 pain, 434 primary, 295 secondary, 295 Skin grafts, 259–60 pigmentation, 185 sinus, 69 Sleep apnoea syndrome, 391 Small cell carcinoma, 309 Smell disturbances, 441–2, 446 Smokeless tobacco, oral cancer, 278 Smokeless tobacco-induced keratoses, 265–7 Smoker’s cough, 386 Smoker’s palette, 253–4 Smoking cessation, 272–3 harm reduction, 267 oral cancer, 278 periodontitis, 84 recurrent aphthous stomatitis, 221 Snuff, 266 Snuff dippers’ keratosis, 261 Snus, 266, 267 Social phobia, 428 Soft tissues examination, Solitary bone cyst, 186–7 Solitary eosinophilic granuloma, 166 Solitary plasmacytoma, 164, 165 Sorbitol, 47 Spasticity, 422 Speckled leukoplakia, 261, 263–4 Spina bifida, 423–4 Spirochaetes, 84 acute necrotising ulcerative gingivitis, 92 noma, 109 Spitz-Holzer valve, 421 SQSTM1 gene, 181 Squamous cell carcinoma, 280, 309 Squamous cell papilloma, 317–18 Squamous epithelium, 143 Squamous odontogenic tumour, 144, 154 Stains used for microscopy, 12–13 Staphylococci Kawasaki’s disease, 237 osteomyelitis, 100 sinusitis, 383 suppurative parotitis, 294 Status asthmaticus, 388, 452 Status epilepticus, 452 Stephan curve, 43 Sterilisation for viral hepatitis, 400 Still’s disease, 197 Stomatitis, 215–16 allergic, 236–7 angular see Angular stomatitis antibiotic, 216, 247 chronic ulcerative, 231–2 denture-induced, 215–16, 218 herpetic see Herpetic stomatitis non-infective, 220–45 recurrent aphthous see Aphthous stomatitis tongue, 246 Stomatitis nicotina, 253–4 INDEX Stones, pulp, 65 Streptococci, 48 dental caries, 40–1 enamel caries, 53 gingivitis, 79 infective endocarditis, 377 Kawasaki’s disease, 237 sinusitis, 383 suppurative parotitis, 294 Stress, 221 Strokes, 451 Sturge Weber syndrome, 322 Sublingual dermoid cyst, 132 Sublingual keratosis, 265 Submasseteric abscess, 192 Submucous cleft palate, 39 Submucous fibrosis, oral, 195, 268–9 Sucrose acid production, 43 dietary intake, 40–1 effects on plaque polysaccharide production, 44 effects on the oral microbial flora, 44–6 nature and uses, 47 as a plaque substrate, 44–6 Sugars, 47 Sulcular epithelium, 77 Sulcus, gingival, 77 Sulphur granules, 110 Sunlight and oral cancer, 279 Supernumerary teeth, 22, 23 Supplemental teeth, 22, 23 Suppurative arthritis, 192 Suppurative parotitis, 192, 294, 434 Surgery oral cancer, 285–6 trigeminal neuralgia, 435 see also Periodontal surgery Surgical biopsy, 10–11 Sweeteners, non-sugar, 47 Synovial chondromatosis, 200 Syphilis, 212–13, 369 congenital, 30–1 malignant change, 261 oral cancer, 279 primary, 212 secondary, 212 serological test interpretation, 213 serology, 16 tertiary, 212–13 Syphilitic leukoplakia, 270, 279 Systemic lupus erythematosus (SLE), 230, 231, 365–6 Systemic mycoses, 110–11, 357 Systemic purpura, 345 Systemic sclerosis, 195, 366 Tardive dyskinesia, 193 Taste disturbances, 441–2, 446 Teeth additional, 21–2 aspiration of, 385 buried, 24 caries see Caries chronic (non-carious) injuries to, 74–6 cracked, 60, 61 deciduous see Deciduous teeth developmental disorders of the, 20–39 displacement into the maxillary antrum, 384–5 in the elderly, 426 eruption disorders, 23–4, 175 examination of, 6–7 ghost, 28–30 grinding, 74–5 hypoplasia, 24, 31, 35, 46–7 infection, 30–1 missing see Anodontia; Hypodontia multisystem disorders affecting the, 30 number abnormalities, 20–2 odontomas, 35–6 pain in, 70 permanent see Permanent teeth resorption of, 70–2 rootless, 28, 29 shell, 28 structural defects, 24–35 supernumerary, 22, 23 supplemental, 22, 23 testing vitality of, 6–7 trauma, 34–5 wisdom, 91–2 Telangiectasia, haemorrhagic, 346 Temperature, body, 17 Temporal arteritis, 195, 197–8, 433 Temporomandibular joint (TMJ) arthritis, 195–200 causes of pain in or around, 195–200 dislocation, 193–4 disorders, 192–200 in the elderly, 426 persistent limitation of movement, 194–5 temporary limitation of movement, 192–3 tumours, 199 Temporomandibular pain dysfunction syndrome, 193 Tetanus, 193 Tetany, 193, 409, 440 Tetracycline during dental development, 24 effect on tooth structure, 31–2 recurrent aphthae, 223–4 Thalassaemia, 336, 338 major, 177, 338 minor, 338 Thalidomide, 164 Th1 and Th2 cytokines, 386 Thaumatin, 47 T helper cells, 352 Thiamin deficiency, 403 Thiocyanates, 48 Thrombophlebitis, 224 Thrombosis, 108 Thrush, 213–14, 218, 254, 355–6 Thyroid disease, 407–8 Thyrotoxicosis, 407 Tissue processing, 12 T lymphocytes, 350 lymphomas, 342, 390 periodontitis, 85 see also T helper cells TNFRSF11A gene, 181 TNM staging, 285, 287 Tolonium chloride rinsing, 288 Toluidine blue rinsing, 288 Tongue amyloidosis, 250–1 black, 249 carcinoma, 281–2 disorders, 246–51 foliate papillae, 248 furred, 6, 249 geographical, 247–8, 258 hairy, 248–9 lingual varicosities, 248 macroglossia, 250–1 median rhomboid glossitis, 218, 249–50 sore, 246–8, 247 ulceration of the, 246 Tonsils, lingual, Toombak, 266 Toothache, 70 Tooth-wear, 74 Tori, Tori mandibularis, 156, 157 Torus palatinus, 156 Total iron binding capacity, 16 Toxic epidermal necrosis, 445 Toxins, 84 Toxoplasmosis, 371 Transient lingual papillitis, 220 Transplantation bone marrow, 351 organ, 351–2 renal, 415–16 Traumatic eosinophilic granuloma, 237–8 Traumatic ulcers, 220 Trench mouth, 93 Treponema pallidum, 31, 212, 369 Treponema pallidum haemagglutination assay (THPA), 213 Triamcinolone dental paste, 223 Tricyclic antidepressants, 444 Trigeminal neuralgia, 199, 434–5 Trigeminal neuropathy, 435 Trismus, temporomandibular joint (TMJ), 192–3 Trismus screw, 269 Tropical infections, 346 Tuberculosis, 211–12, 368–9, 386 Tuberculous cervical lymphadenopathy, 368–9 Tuberculous parotitis, 386 Tuberculous sialadenitis, 294 Tubular sclerosis, 55 Tumour-like lesions of the jaws, 136–52 Tumour-like salivary swellings, 307 Tumours benign mucosal, 318 of cementum, 146–9 cystic, 132 giant-cell, 157, 159 in HIV/AIDS, 357 intracranial, 436 of the jaws non-odontogenic, 156–71 odontogenic, 136–52 keratocystic odontogenic, 127, 154 malignant bone, 161–2 mesenchymal, 321–6 metastatic of the jaws, 167–9 odontogenic see Odontogenic tumours salivary gland, 300–3 malignant, 303–7 WHO classification, 309–10 temporomandibular joint, 199 see also specific tumour Tzanck cells, 233 UK Disability Discrimination Act 2005, 418 Ulcerative colitis, 393, 396 Ulcerative stomatitis, chronic, 231–2 Ulcers acute necrotising ulcerative gingivitis, 92–3 cytomegalovirus-associated, 210 drug effects, 446 factitious, 238, 438 HIV-associated oral, 225 miscellaneous mucosal, 237–9 mucosal, 359 Nicorandil induced oral, 225 467 INDEX Ulcers (Continued) oral mucosal, 206, 244–5 pain from, 432 tongue, 246 traumatic, 220 Ultrasound, Undecalcified sections, 13 Unicystic ameloblastoma, 132, 137, 139–40 Urine tests, 17 Valve defects, 376–8 Varicella-zoster virus, 209 Varicosities, lingual, 248 Vascular disorders, 195, 344, 346–7 Vasoconstrictors, 453 VDRL test, 213 Verruca vulgaris, 318 Verruciform xanthoma, 258–9 Verrucous carcinoma, 289 Vesiculo-bullous diseases, 206, 235 see also specific disease Video imaging, 17 Violence, 453 Vipeholm dental caries study, 46 Viral antibody titres, 16 Viral culture, 16 468 Viral infections, 15, 16–17, 356 see also specific infection Vitamin A deficiency, 403 Vitamin B12 blood test for, 16 deficiency, 223, 336, 403, 404 serum, 247 Vitamin B1 deficiency, 403 Vitamin B2 deficiency, 247, 403 Vitamin C deficiency, 179, 403, 404 Vitamin D deficiency, 403, 404 -resistant rickets, 178–9 Vitamin K deficiency, 348, 349 Von Willebrand’s disease, 346–7 Warthin’s tumour, 302–3, 310 Warts, infective, 318 Warty dyskeratoma, 238 Wegener’s granulomatosis, 95, 238, 389–90 White blood cells depressed production, 443 leukaemia see Leukaemia normal values, 18 White mucosal lesions, 252–60 cheek biting, 252–3 differential diagnosis, 274 Fordyce’s granules, 253 frictional keratosis, 252–3 HIV-associated hairy leukoplakia, 254–6 key features, 275 leukoedema, 6, 252 malignant change, 261 mucocutaneous candidosis syndromes, 256–8 oral keratosis of renal failure, 258, 259 pipe smokers keratosis, 253–4, 261, 265 psoriasis, 258 skin grafts, 259–60 thrush, 213–14, 218, 254, 355–6 verruciform xanthoma, 258–9 white sponge naevus, 256 see also Leukoplakia White sponge naevus, 256 Whitlow, herpetic, 208–9 Wisdom teeth, 91–2 Wolinella recta, 84 Xerostomia, 294, 295, 359, 442, 446 Xylitol, 47 Zoster, 209–10 ... affect any part of the oral mucosa, but the hard palate and dorsum of the tongue are favoured sites (Figs 12. 1 and 12. 2) The vesicles are domeshaped and usually 2 3 mm in diameter Rupture of vesicles... treatment SOFT TISSUE DISEASE Circumscribed dull red areas, particularly on the palate Cracking and reddening at the angles of the mouth CHAPTER 12 218 Candidal infection of oral mucosa and/ or lips... treatment of herpes zoster A randomized, placebocontrolled trial Ann Intern Med 125 :376–383 DISEASES OF THE ORAL MUCOSA: INTRODUCTION AND MUCOSAL INFECTIONS CHAPTER 12 Treatment of candidosis