Ebook Textbook of oral pathology (2/E): Part 2

(BQ) Part 2 book “Textbook of oral pathology” has contents: Acquired immunodeficiency syndrome, odontogenic infection and pulp pathology, tongue disorders, temporomandibular joint pathology, chemical and physical injuries, blood pathology, skin disorders,… and other contents.

21 Acquired Immunodeficiency Syndrome Anil Govindrao Ghom, Shubhangi Mhaske (Jedhe) Chapter Outline                 Definition AIDS related complex Prevalence Etiology Characteristic of HIV virus Mechanism of action Transmission Clinical features Oral manifestations Candidiasis Kaposi’s sarcoma Hairy leukoplakia Periodontal disease associated with HIV Non-Hodgkin lymphoma Recurrent herpes labialis Oral human papilloma virus lesions Acquired immunodeficiency syndrome (AIDS) is a devastating fatal disease, which is in epidemic form throughout the world It is an incurable viral STD caused by human immunodeficiency virus (HIV) It stands for: ∙ A: Acquired, i.e contagious not inherited ∙ I: Immune, i.e power to receive disease ∙ D: Deficiency ∙ S: Syndrome, i.e number of signs and complains indicative of particular disease Four identified etiological agents are of substantially lenti virus (HIV-I an HIV-II) that cause slow infection in which sign and symptoms only appear after many months or years of infection and two member of oncovirus (HTLV-I                 Herpes zoster HIV associated salivary gland diseases Idiopathic thrombocytopenic purpura Mycobacterium infection Hyperpigmentation Histoplasmosis Recurrent aphthous stomatitis Molluscum contagiosum Oral squamous cell carcinoma Diagnostic tests Screening test for AIDS Enzyme-linked immunosorbant assay The Western Blot method Viral culture and polymerase chain reaction Surrogate marker for progression of HIV-I infection Management and HTLV-II) that are capable of oncogenic transformation and are usually associated with leukemia or lymphoma The case of AIDS was detected in June 1981 when young homosexuals men came with the suffering from rare lung infection due to microorganism called Pneumocystis carinii In India, the first description of AIDS came in Madras where women out of 125 who were screened were HIV positive in high-risk group of prostitutes The AIDS appear to be endemic in central and equatorial Africa and it may be old disease of Africa that has gone unrecognized The HIV-1 infection has also become the primary emphasis of effort at controlling Acquired Immunodeficiency Syndrome sexually transmitted diseases (STDs) Moreover, the knowledge gain about sexual and other behavior associated with transmission of HIV, as well as strategies that have been effective in modifying those behaviors, is transferable to other sexually transmittable and bloodborne infections and has revolutionized standard approaches to the control of these infections Oral and perioral lesions are common presenting features in patient with human immunodeficiency virus and may have deterioration of general health and a poor prognosis DEFINITION World Health Organization (WHO) has given following definition of AIDS: One or more opportunistic infections listed in clinical features that are at least moderately indicative of underlying cellular immune deficiency Absence of all known underlying causes of cellular immune deficiency (other than HIV infection) and absence of all other causes of reduced resistance reported to be associated with at least one of those opportunistic diseases CLASSIFICATION 1st Classification (given in 1993) by Center for Disease Control (CDC) CD4 + T-cell categories A Asymptomatic, acute HIV and PGL B Symptomatic, not A or C conditions C AIDS indicator condition More 500/µL A1 B1 C1 200 to 499/µL A2 B2 C2 Less than 200/µL AIDS indicator T-cell count A3 B3 C3 Category A: In adolescent less than 13 years with documented HIV infection: ∙ Persistence generalized lymphadenopathy ∙ Active condition ∙ ∙ Category B: Condition is attributed to HIV infection or indicative of defect in the cell-mediated immunity ∙ Bacillary angiomatosis ∙ Oropharyngeal and vulvovaginal candidiasis ∙ Cervical carcinoma in situ ∙ Constitutional symptoms like fever (38.5˚C) and diarrhea ∙ Oral hairy leukoplakia and herpes zoster ∙ Idiopathic thrombocytopenic purpura ∙ ∙ ∙ ∙ Category C: AIDS indicative condition ∙ Candidiasis of bronchi, trachea or lung and esophageal candidiasis ∙ ∙ ∙ Invasive cervical cancer Disseminated or extrapulmonary coccidioidomycosis, extrapulmonary cryptococcosis Chronic intestinal cryptosporidiosis more than month duration Cytomegalovirus retinitis with loss of vision HIV related encephalopathy Herpes simplex bronchitis, pneumonitis and esophagitis Kaposi sarcoma, Burkitt’s lymphoma and immunoblastic lymphoma Mycobacterium tuberculosis infection at any pulmonary or extrapulmonary sites Pneumocystic carinii pneumonia and recurrent pneumonia Progressive multifocal leukoencephalopathy Toxoplasmosis of brain and wasting syndrome Recurrent Salmonella septicemia ∙ ∙ ∙ 525 Textbook of Oral Pathology 2nd Classification by USPHS-CDC 526 ∙ ∙ ∙ ∙ Group I: Acute infection Group II: Asymptomatic infection Group III: Persistence generalized lymphadenopathy Group IV: Other disease – Subgroup A: Constitutional diseases – Subgroup B: Neurological diseases – Subgroup C: Secondary infectious diseases - - C1: Specified secondary infectious diseases listed in CDC surveillance definition for AIDS C2: Other specified secondary infectious stages – Subgroup D: Secondary cancer – Subgroup E: Other conditions AIDS RELATED COMPLEX For clinical and research studies, persons exhibiting complex clinical problems and immunological or hematological abnormalities on the laboratory tests, have been classified as having AIDS related complex (ARC) The ARC requires any two or more symptoms and two or more abnormal laboratory findings It must be present for at least months Symptoms Laboratory findings • Lymphadenopathy • Weight loss of 15 lbs or 10% of body weight • Fever of 38.5˚C which is intermittent or continuous • Diarrhea, fatigue and malaise • Night sweats • • • • • • • Decreased number of T helper cell Decreased ratio of T helper cells to T suppressor cells Anemia or leukopenia or thrombocytopenia or lymphopenia Increased serum globulin level Decreased blastogenic response of lymphocytes to mitogen Increased level of circulating immune complex Cutaneous anergy to multiple the skin test antigens PREVALENCE It is more common in Western countries particularly in the United State Largest population of AIDS is in homosexuals, intravenous drug users and, heterosexuals with sexual contact with AIDS patient Patients who received transfusion of blood or blood pigments donated by the person with risk factors Ninety-two percent of victims are males, 6.5 percent female with percent children It is common at the age of 25 to 49 years Etiology T lymphocytes: There is quantitative and qualitative deficiency of T4 helper cells in AIDS patients, which lead to certain investigators to focus their efforts on determining if etiologic agent was a virus that manifested a particular tropism for T4 helper lymphocytes HTLV-III virus: Dr Robent C Galleo determined that type C retrovirus was tropic for T4 lymphocytes in adult T-cell leukemia/lymphoma He named the virus, Humans T-cell leukemia/lymphoma virus (HTLV–I) So it is considered to be etiological agent for AIDS But as it causes lymphoproliferation in T-cell leukemia, where as AIDS is a disease of lymphodepletion The answer came in the discovery of type D retrovirus of HTLV family that has been termed as HTLV-III LAV virus: On the other hand, virus called lymphadenopathy associated virus (LAV), was being isolated from the AIDS patient in Europe HTLV-III and LAV is closely related members of same class of virus Finally, it is proved that HTLV and LAV are cytopathic human T–lymphocytotropic viruses that manifested selective infectivity for the helper/inducer subset of T-cells that as phenotypically designated reactivity with monoclonal antibody T4 or Leu3 HIV: In order to avoid different nomenclatures retrovirus responsible for the AIDS are named ‘Human immunodeficiency virus’ which belong to family of retroviruses Risk person: Six groups are at risk of developing AIDS These are homosexuals or bisexuals—71.4 percent, intravenous drug users—18.4 percent, hemophilia, recipient of multiple blood transfusion, infant born of parents belonging to first three high-risk groups and heterosexual contacts of high-risk group Acquired Immunodeficiency Syndrome CHARACTERISTIC OF HIV VIRUS The HIV is a spherical enveloped virus, about 90 to 120 nm in size (Fig 21.1) The nucleocapsid has an outer icosahedral shell and inner cone shaped core, enclosing the ribonucleoproteins The genome is diploid, composed of two identical single stranded, positive sense RNA copies Inside the envelope is a protein core, which contain enzymes reverse transcriptase, intregrase, protease, etc all essential for viral replication and maturation When the virus infects a cell, the viral RNA is transcribed by the enzymes, first into single stranded DNA and then to double stranded DNA (provirus), which is integrated into the host cell chromosomes The virus is extremely sensitive to heat, thus boiling and autoclaving are very effective measure of inactivating the virus Mechanism of Action The HIV attacks the immune system of the body Due to that an individual is not able to protect himself from potentially harmful organism Normal mechanism: Pathogenic viruses → identified by macrophage → it activates T lymphocytes → it get differentiated into effecter cell like T helper cell or T4 and T suppresser cell or T8 → T4 cells secrete various lymphokines which induce lymphocyte to differentiated into plasma cell → it secrete specific antibodies against viral antigen → it destroy the virus Mechanism in AIDS: HIV virus is lymphotropic virus → its primary target is T4 cell → when the virus enters the bloodstream, it integrates into gene into DNA of some primary T4 lymphocyte → this viral DNA then becomes integrated into the host chromosomes → the chromosomal integration is prerequisite for replication of retroviruses, but also for the latency → once the viral genes are integrated into cells of own DNA, they can apparently remain dormant for an indefinite period of time, without causing its affects This is called ‘incubation period’ → once the viral gene is activated, virus particles convert T4 lymphocytes into AIDS virus factory → when the number of T4 lymphocyte is severely depleted, the immune system collapses and variety of infections occur → at this stage patient is said to have AIDS Transmission Repeated intimate contact: It is in 90 percent of cases It depends upon number of sexual partners, receptive anal intercourse and presence of other STDs All these are in high-risk group Prostitution is a major heterosexual factor associated with AIDS Use of contaminated blood products: Intravenous drug users, HIV contaminated blood transfusion, blood clotting concentrate and organ transplantation Perinatal transmission: It occurs in 13 percent among children born to HIV seropositive mother Other nosocomial routes: Transmission from patient to patient due to reuse of contaminated and shared needles Professional hazards: The risk of transmission from HIV infected patient to health care workers is more than health care workers to patient CLINICAL FEATURES (FIG 21.2) Protozoan and helminthes infection: Cryptosporidiosis (intestinal) causing diarrhea for over one month The most common opportunistic infection is by Pneumocystis carinii which causes pneumonia CNS infection or other disseminated infections and toxoplasmosis Fungal infection: Candidiasis causing esophagitis, cryptococcosis causing CNS infection, disseminated histoplasmosis and bronchial or pulmonary candidiasis Bacterial infections: Mycobacterium avium intracellulare causing infection disseminated beyond lung and lymph node Mycobacterium tuberculosis will cause tuberculosis Figure 21.1 HIV virus Viral infections: Cytomegalovirus causing infection in the internal organs other than liver, spleen and lymph nodes Herpes simplex virus, causing chronic mucocutaneous infection with ulcers persisting more than one month 527 Textbook of Oral Pathology 528 Figure 21.2 Features of HIV infection Malignancy: Kaposi’s sarcoma and squamous cell carcinoma Lymphoma limited to bronchi and nonHodgkin’s lymphoma AIDS dementia complex: This occur in patient with HIV infection and causes progressive encephalopathy ORAL MANIFESTATIONS Oral manifestations of HIV disease are common and include oral lesions and novel presentations of previously known opportunistic diseases Careful history taking and detailed examination of the patient’s oral cavity are important parts of the physical examination and diagnosis requires appropriate investigative techniques Early recognition, diagnosis and treatment of HIVassociated oral lesions may reduce morbidity The presence of these lesions may be an early diagnostic indicator of immunodeficiency and HIV infection may change the classification of the stage of HIV infection and is a predictor of the progression of HIV disease Around 95 percent of AIDS patients have head and neck lesions and about 55 percent have important oral manifestation They are described below Oral Disorders in HIV Disease ∙ Fungal More common – Candidiasis Less common – Aspergillosis – Histoplasmosis – Cryptococcus neoformans – Geotrichosis ∙ Bacterial More common – HIV gingivitis – HIV periodontitis – Necrotizing gingivitis Less common – Mycobacterium avium intracellulare – Klebsiella pneumoniae – Enterobacter cloacae – E coli – Salmonella enteritidis – Sinusitis – Exacerbation of apical periodontitis – Submandibular cellulitis Acquired Immunodeficiency Syndrome ∙ ∙ ∙ ∙ ∙ Viral More common – Herpes simplex – Varicella zoster – Epstein-Barr virus including hairy leukoplakia Less common – HPV virus – CMV virus Neoplasm More common – Kaposi’s sarcoma Less common – Non-Hodgkin lymphoma – Squamous cell carcinoma Lymphadenopathy Neurologic disorders Less common – Paresthesia – Facial palsy – Hyperesthesia – Dysphagia Miscellaneous Less common – Recurrent apthous ulceration – Progressive necrotizing ulceration – Toxic epidermolysis – Delayed wound healing – Thrombocytopenia – Xerostomia and sicca type syndrome – HIV embryopathy – Hyperpigmentation – Granuloma annulare – Exfoliative cheilitis – Lichenoid and other drug reaction EC-Clearinghouse Classification of Oral Manifestation of HIV Group I—strongly associated with HIV infection ∙ Candidiasis ∙ Hairy leukoplakia ∙ Kaposi’s sarcoma ∙ Non-Hodgkin’s lymphoma ∙ Periodontal disease (linear gingival erythema, necrotizing gingivitis and necrotizing periodontitis) Group II—less commonly associated with HIV infection ∙ Bacterial infection (Mycobacterium) ∙ Melanotic hyperpigmentation ∙ Necrotizing ulcerative stomatitis ∙ Salivary gland disease ∙ Thrombocytopenia purpura ∙ Oral ulceration NOS (not otherwise specified) ∙ Viral infections like herpes simplex, zoster, papillomavirus Group III—seen in HIV infection ∙ Bacterial infection (Actinomyces israelii, E coli, Klebsiella pneumonia) ∙ Cat scratch disease ∙ Epithelioid angiomatosis ∙ Drug reaction ∙ Fungal infection other than candidiasis ∙ Neurologic disturbance ∙ Recurrent aphthous stomatitis ∙ Viral infection like cytomegalovirus, molluscum contagiosum Candidiasis Oral candidiasis is most commonly associated with Candida albicans, although other species, such as C glabrata and C tropicalis, are frequently part of the normal oral flora A number of factors predispose patients to develop candidiasis: infancy, old age, antibiotic therapy, steroid and other immunosuppressive drugs, xerostomia, anemia, endocrine disorders and primary and acquired immunodeficiency Candidiasis is a common finding in people with HIV infection Reports describe oral candidiasis during the acute stage of HIV infection, but it occurs most commonly with falling CD4+ T-cell count in middle and late stages of HIV disease Several reports indicate that most persons with HIV infection carry a single strain of Candida during clinically apparent candidiasis and when candidiasis is quiescent Clinical Features Location: Patient with a HIV usually has lesion of hard palate and soft palate Appearance: The clinical appearances of oral candidiasis vary The most common presentations include 529 Textbook of Oral Pathology clinical lesions are examined using potassium hydroxide (KOH), PAS, or Gram’s stain Smear shows candidal organism embedded in superficial keratin 530 Management Topical clotrimazole is treatment option in case of candidiasis associated with HIV infection Systemic fluconazole is given if the CD4+ count is below 50 cell/mm3 In some patient itraconazole and intravenous amphotorecin B are given to combat severe infection Points to Remember Figure 21.3 Candidiasis in AIDS patient pseudomembranous, hyperplastic, angular, and erythematous candidiasis, which are equally predictive of the development of AIDS and angular cheilitis (Fig 21.3) Symptoms: These lesions may be associated with a variety of symptoms, including a burning mouth, problems in eating spicy food and changes in taste All three of these common forms may appear in one individual Pseudomembranous candidiasis (Thrush): Characteristic creamy white, removable plaques on the oral mucosa are caused by overgrowth of fungal hyphae mixed with desquamated epithelium and inflammatory cells The mucosa may appear red when the plaque is removed This type of candidiasis may involve any part of the mouth or pharynx Erythematous candidiasis: Erythematous candidiasis appears as flat, red patches of varying size It commonly occurs on the palate and the dorsal surface of the tongue Erythematous candidiasis is frequently subtle in appearance and clinicians may easily overlook lesions, which may persist for several weeks if untreated Angular cheilitis: Angular cheilitis appears clinically as redness, ulceration and fissuring, either unilaterally or bilaterally at the corners of the mouth It can appear alone or in conjunction with another form of candidiasis Histopathological Features Candida is a commensal organism in the oral cavity Candidiasis is diagnosed by its clinical appearance and by detection of organisms on smears Smears taken from C glabrata and C tropicalis, falling CD4+ T-cell count, pseudomembranous, hyperplastic, angular, and erythematous candidiasis, burning mouth, smears, embedded in superficial keratin, topical clotrimazole, systemic fluconazole, itraconazole and intravenous amphotorecin B Kaposi’s Sarcoma It is also called angioreticulo-endothelioma It is the most common tumor associated with AIDS and occurs in 1/3rd of AIDS patients Etiology There is higher incidence of Kaposi’s sarcoma is in homosexual men with AIDS as compared to heterosexuals with AIDS It has been suggested that there is transmissible agent prevalence in homosexual population, which stimulate certain factor such as angiogenesis protein that may be critical in the pathogenesis of neoplasm The patient with AIDS often shows clustered lesion in the oral cavity, which suggests direct inoculation of mucosa with sexually transmitted agent Some theories suggests role of cytomegalovirus in the pathogenesis of Kaposi’s sarcoma, but studies on prevalence of antibodies to cytomegalovirus in patient with classic and epidemic Kaposi’s sarcoma have failed to demonstrate role of cytomegalovirus Nowadays, it has been stated that Kaposi’s sarcoma is associated with human herpes virus (HHV 8) The HHV is detected in oral epithelial cells and in oropharynx Types • • • • Classic African (cutaneous variant) African (lymphadenopathy variant) Kaposi’s sarcoma associated with AIDS Acquired Immunodeficiency Syndrome Epidemiology and Form Kaposi’s sarcoma appears in various forms like classic, African (cutaneous variant), African (lymphadenopathy variant) and Kaposi’s sarcoma associated with AIDS Classic type is a rare neoplasm and occurs in the older man Usually, it appears as blue-black macule on the lower extremities It is slow growing and rarely involves the lymph nodes and visceral organs African Kaposi’s sarcoma is considered an endemic disease and affects children, 10-year-old or younger patients, more common in men than women It appears as exophytic growth located in legs and arms This form is locally aggressive and lymph nodes involvement is rare The lymphadenopathic form occurs in children of 10 years age and younger with same frequency in men and women The visceral and massive nodal involvement is common Kaposi’s sarcoma is observed in patients with kidney transplantation and in patients who receive the immunosuppressive drugs for variety of diseases Drugs such as prednisolone, cyclosporine and cyclophosphamide have been associated with development of Kaposi’s sarcoma It usually affects legs, arms, lymph nodes and visceral organs Clinical Features Age and sex distribution: It is more common in male as compared to female in ratio of 20:1 It can occur at any age but most common in 5th, 6th, 7th decade except in Africa where it more common in children on any part of the oral mucosa including the gingiva, soft palate, buccal mucosa and in the oropharynx It can involve either alone or in association with skin and disseminated lesions It may be the first symptom of AIDS Appearance: It can appear as a red, blue, or purplish lesion It may be flat or raised solitary or multiple Occasionally, yellowish mucosa surrounds the lesion The lesions may enlarge, ulcerate and become infected Good oral hygiene is essential to minimize these complications Sign: It may vary in size from few millimeter to a centimeter or more in diameter and are tender and painful Histopathological Features It consists of interweaving band of spindle shaped and or plump endothelial cell and atypical vascular channels, enmeshed in reticular or collagen fibers It consists of numerous, small capillary type blood vessels, which may or may not contain blood Inflammatory cell infiltration is common (Fig 21.4) In late stage, lesion consists of well defined nodules or lesions with diffuse involvement of the lamina propria Histopathological Stages • P atch stage (macular): In this proliferation of miniature vessels • Plaque stage: It shows further proliferation of vascular channels with development of spindle cells • Nodular stage: Spindle cell increase to form nodular tumor like mass Site: Commonly affects skin, oral and visceral organs It occurs commonly in head and neck region Tip of nose is peculiar and frequent location of it It can involve lymph nodes, soft tissue, extremities, GIT, lung, liver, pancreas, spleen and adrenal gland Appearance: It begins as multinucleated neoplastic process that manifests as multiple red or purple macules and in more advanced stage, a nodule occurring on the skin or mucosal surface Sign: Size of it ranges from a few millimeters to a centimeter or more in diameter and are usually tender on palpation It is slow growing but can behave as a very aggressive lesion with rapid visceral involvement Oral Manifestations Location: It has tendency to involve the oral cavity, with hard palate as the most common site But lesions may occur Figure 21.4 Capillary blood cell seen in Kaposi’s sarcoma 531 Textbook of Oral Pathology 532 Management Clinical Features Treatment is determined on the basis of the number, size and location of the oral lesions The choice of therapy depends on the effect of treatment on the adjacent mucosa, pain associated with treatment, interference with eating and speaking and the patient’s preference It is important to perform thorough dental prophylaxis before initiating therapy for lesions involving the gingiva Response to therapy is improved if all local plaque and calculus are removed Local application of sclerosing agents may reduce the size of oral lesions Local treatment is appropriate for large oral lesions that interfere with eating and talking Oral lesion can be treated surgically or with localized intralesional chemotherapy Intralesional vinblastine, radiation therapy, intravenously interferon alpha and sclerotherapy with percent sodium tetradecyl sulfate Location: It is unique and significant lesion which primarily occurs unilaterally or bilaterally on the lateral border of tongue It can also occur on dorsum of the tongue, buccal mucosa, floor of mouth, retromolar area and soft palate Many time lesion start on lateral border and spread to entire dorsum of tongue Points to Remember Angioreticulo-endothelioma, affects skin, multinucleated neoplastic process that manifests as multiple red or purple macules, hard palate, most common site, red, blue, or purplish lesion, yellowish mucosa surrounds the lesion, spindle shaped and or plump endothelial cell, numerous, small capillary type blood vessels, Inflammatory cell infiltration, thorough dental prophylaxis, intralesional vinblastine, radiation therapy, intravenously Hairy Leukoplakia Oral hairy leukoplakia, which presents as a non-movable, corrugated or “hairy” white lesion on the lateral margins of the tongue occurs in all risk groups for HIV infections, although less commonly in children than in adults It occurs in about 20 percent of persons with asymptomatic HIV infection and becomes more common as the CD4+ T-cell count falls Appearance: There is characteristic corrugated and white appearance It does not rub off and may resemble the keratotic lesion The surface is irregular and may have prominent folds or projections, sometimes markedly resembling hairs Occasionally, however, some areas may be smooth and flat (Fig 21.5) Pseudo hairy leukoplakia: Sometimes, the white lesion satisfies many criteria for diagnosis of hairy leukoplakia, but if EBV not present this is called ‘pseudo hairy leukoplakia’ Presence of hairy leukoplakia is fairly indicator of HIV pro-sensitivity and is predictor of deficiency immunocompetence Histopathological Features Histologically lesion shows hyperkeratosis, acanthosis, contain Epstein-Barr virus and no or minimum inflammation Balloon cells: The epithelial exhibits band-like zone of lightly stained cells with abundant cytoplasm in the upper spinous layer Nuclear beading: There is presence of scattered cells with nuclear clearing with pattern of peripheral margination of Etiology Exact etiology is not known but Epstein-Barr virus has identified in these lesions One hypothesis is that basal epithelial cells of lateral margin of tongue normally harbors EBV in majority of adult population, who are EBV sero-positive and carrier of that disease It is found primarily in homosexual male Direct infection of Langerhans cell due to HIV induced loss of factor essential for their integrity and function, permit reactivation of EBV with frequent epithelial hyperplasia Figure 21.5 Hairy leukoplakia showing characteristic corrugated appearance Acquired Immunodeficiency Syndrome chromatin on superficial epithelium This is called nuclear beading Immunochemistry tissue in situ hybridization, noninvasive tissue in situ hybridization, or electron microscopy does demonstrate of Epstein-Barr virus The lesion of leukoplakia consists of Langerhans cells Management Hairy leukoplakia usually is asymptomatic and does not require treatment Hairy leukoplakia is almost always a manifestation of HIV infection and clinicians should arrange evaluation of HIV disease and appropriate treatment for patients with hairy leukoplakia Hairy leukoplakia has disappeared in patients receiving high-dose acyclovir for herpes zoster, presumably because of the anti-EBV activity of acyclovir Doses of acyclovir (2.5–3 mg per day for 2–3 weeks) usually eliminate HL, but the lesion usually recurs with cessation of treatment Elimination or almost complete clinical resolution of the lesion has occurred in patients treated with agents such as desciclovir (an analog of acyclovir), phosphonoformate, Retin A and podophyllin resin, although lesions tend to recur within few months Occasionally, Candida albicans may be found in HL lesions Antifungal medications like topical clotrimazole, topical nystatin 10000 unit/g times a day can be given Systemic agent like ketoconazole 200 mg BD a day, acyclovir, azidothymidine and retinoid acid podophyllin resin can also be given Points to Remember Clinical Features Site: It often occur in clean mouths, where there is very little plaque or calculus to account for the gingivitis Sign: The onset is often sudden, with rapid loss of bone and soft tissue Patients sometimes complain of spontaneous bleeding Linear gingival erythema: In this condition gingiva may be reddened involving the free gingival margin There is linear band of erythema which can extend mm apically The diagnosis of this should be done if gingivitis does not respond to improved plaque control (Fig 21.6) Necrotizing ulcerative gingivitis: In these ulcers occurs at the tips of the interdental papilla and along the gingival margins and often elicits complaints of severe pain The ulcers heal, leaving the gingival papillae with a characteristic cratered appearance Necrotizing ulcerative periodontitis may present as rapid loss of supporting bone and soft tissue Typically, these losses occur simultaneously with no formation of gingival pockets, sometimes involving only isolated areas of the mouth Teeth may loosen and eventually fall out, but uninvolved sites can appear healthy There is loss of more than mm attachment Necrotizing stomatitis may develop and areas of necrotic bone may appear along the gingival margin The bone may eventually sequestrate Patients with necrotizing ulcerative periodontitis and necrotizing stomatitis frequently complain of extreme pain and spontaneous bleeding Nonmovable, corrugated or hairy white lesion on the lateral margins of the tongue, Epstein-Barr virus, does not rub off, pseudo hairy leukoplakia, hyperkeratosis, acanthosis, balloon cells, nuclear beading, demonstrate of Epstein-Barr virus, Langerhans cells, high-dose acyclovir, desciclovir, phosphonoformate, Retin A, podophyllin resin, antifungal medications like topical clotrimazole, topical nystatin 10000 Periodontal Disease Associated with HIV Periodontal disease is a fairly common problem in both asymptomatic and symptomatic HIV-infected patients Form • • • Linear gingival erythema Necrotizing ulcerative gingivitis Necrotizing ulcerative periodontitis Figure 21.6 Linear gingival erythema 533 Index E Eagle’s talon 102 Early syphilis 456 Earthy tongue 634 Ebbing tide 223, 234 Ebnuration of dentin 161 Ecchondroma 184 Ecchymosis 663 Echinococcosis 378 Ecological plaque hypothesis 149 Ectodermal dysplasia 758, 759 Ectopic enamel 108 Ectopic eruption 124 Ectopic geographic tongue 633 Ectopic salivary gland 412 Eczema herpeticum 508 Eczematous cheilitis 612 Edward syndrome 864 Egg shell crackling 214, 307 Ehlers Danlos syndrome 351, 745, 867 Electrical burns 658 Electron gun 18 Electron lenses 18 Electron microscope 3, 17 Elephantiasis gingiva 386 Elephantiasis neuromatosa 206 ELISA 536 Elliptical rima oris 246 Ellis Van Creveld syndrome 121, 136, 864 Ely cyst 646 Embedded cementicles 676 Embedded teeth 122 Embedding 26 Embedding center 26 Embryonal rhabdomyosarcoma 295 En coupe de sabre 131 Enamel 77 Enamel agenesis 115 Enamel hypoplasia 111 Enamel pearl 108 Encapsulated lipoma 186 Encephalofacial angiomatosis 882 Enchondroma 184 Enclavoma 430 Encrusted tongue 634 Endemic Burkitt’s lymphoma 719 Endemic parotitis 421 Endochondroma 430 Endosteal osteoma 189 Endothelial myeloma 289 Endothelioma 430 Enostosis 600 Enterocystoma 629 Enterovirus 514 Enucleation 382 Environmental enamel hypoplasia 111 Enzyme histochemistry 58 Eosin 42 Eosinophilic granuloma 805 Eosinophilic granuloma of bone 804 Eosinophilic ulceration 658 Eosinophilic granuloma of tongue 635 Ephelis 755 Epidermolysis bullosa 740 Epidermolysis bullosa acquista (acquired) 740 Epidermolysis bullosa dystrophic dominant 740, 741 Epidermolysis bullosa dystrophic recessive 740, 741 Epidermolysis bullosa latalis 740 Epidermolysis bullosa simplex 740, 741 Epididymo-orchitis 421 Epigenetic theory 91 Epithelial dysplasia 226 Epithelial odontome 303 Epitheloid cell nevus 175 Epitheloid leiomyoma 211 Eponyms 861 Epstein’s pearls 359 Epulis fissuratum 685 Epulis granulomatosum 687 Erosion 669 Erosion interdigitalis 491 Erosive lichen planus 242 Eruption cyst 349 Eruption hematoma 349 Eruption of teeth 120 Eruption sequestrum 124 Erysipelas 454 Erythema areata migrans 631 Erythema circinate migrans 632 Erythema migrans 631 Erythema multiforme 731 Erythema multiforme major 732 Erythema multiforme minor 731 Erythema nodosum leprosum 463 Erythema nodosum 769 Erythematous candidiasis 488,530 Erythremia 704 Erythroblastic anemia 696 Erythroblastosis fetalis 699 Erythrodermic psoriasis 746 Erythrodontia 700 Erythroleukoplakia 221, 230 Erythroplakia 229 Erythroplasia 230 Erythroplasia of queyrat 229 Erythropoietic porphyria 700 Esophageal candidiasis 492 Esophageal dysmotility 761 Esthesioneuroblastoma 293 Estrogen 89 Etiology of oral cancer 85 Evaginated odontome 105 Ewing’s sarcoma 289, 290 Excisional biopsy 50 Exciter filter 16 Excrescences 233 Exfoliative cheilitis 615 Exfoliative cytology 51 Exocrine glands 410 Exophytic growth 264 Exophytic osteoma 189 Exostosis 195 Exostosis of root 675 External callus 76 External resorption 672 Extrafollicular AOT 322 Extranodal NK/T-cell lymphoma 728 Extraosseous ameloblastoma 314 Extraosseous osteosarcoma 287 Extravasation cyst 370 Extrinsic factor of castle 807 Extropia 133 Eye raised to heaven 581 Eyepiece 16 Eyepieces F Facial hemiatrophy 130, 635 Facial hemihypertrophy 129 Facial pain 839 Facial paralysis 835 Facies leprosa 464 Factor V deficiency 713 Factors affecting fixation 25 Factors affecting staining 39 Factors affecting the wound healing 68 False gemination 101 False pocket 401 Familial benign chronic pemphigus 740 Familial fibrous dysplasia of the jaws 580 Familial gigantiform cementoma 587 1011 Textbook of Oral Pathology 1012 Familial hypophosphatemia 823 Familial multilocular cystic disease of the jaws 580 Familial neutropenia 707 Familial or heredofamilial amyloidosis 802 Familial osteodysplasia 865 Familial pancytopenia 874 Familial panmyelophthisis 874 Familial thrombasthenia 710 Fanconi’s anemia 698 Fanconi’s syndrome 874 Farmer’s lip 613 Fat soluble vitamins 821 Fetal deciduous teeth 121 Fetal rhabdomyoma 212 Fever blister 507 Fibrinolytic alveolitis 573 Fibroadamanblastoma 326 Fibrolipoma 189 Fibroma 178, 181 Fibroma molluscum 206 Fibromatosis 180 Fibromatosis gingiva 386 Fibromyxomas 334 Fibro-osseous lesions classification 576 Fibrosarcoma 279 Fibrosarcoma variants 282 Fibrous adamantinoma 326 Fibrous degeneration 546 Fibrous dysplasia 577 Fibrous dysplasia of dentin 119 Fibrous histiocytoma 179 Fibrous nodule 178 Fibroxanthoma 179 Field cancerization 220 Fiery red tongue 703 Filiform papillae 620 Filter 15 Fimbriated fold 620 Fine needle aspiration cytology 55 Fingerprinting 853 First week wound 75 Fissured tongue 629 Fixation 25, 29 Fixation in histochemistry 57 Flashlamp pulsed dye laser 199 Flat torus 194 Florid cement-osseous dysplasia 586 Flow cytometry 61 Fluctuation test 375 Fluorescence microscopy 15 Fluorescent in situ hybridization (FISH) 63 Fluorescent microscope Fluorine 164 Fluorite Flushing 834 Fly-catcher’s sign 638 Foam cells 172 Focal cement-osseous dysplasia 586 Focal dermal hypoplasia syndrome 169 Focal epithelial hyperplasia 518 Focal fibrous hyperplasia 178 Focal length Focal melanosis 138 Focal osteoporosis bone marrow defect 135 Focal periapical osteosclerosis 600 Focal point 11 Focal sclerosing osteomyelitis 563 Folacin 817 Folate 817 Foliate papillae 620 Foliate papillitis 634 Folic acid 817 Folic acid deficiency 636 Follicular ameloblastoma 308 Follicular AOT 321 Follicular cyst 345 Follicular cysts of the skin 378 Follicular lichen planus 239 Folliculosis 819 Foot and mouth disease 516 Forchheimer sign 514 Fordyce granule 138 Fordyce’s granules 84 Foreign bodies 69 Foreign body gingivitis 394 Forensic odontology 849 Forked tongue 679 Formaldehyde fixed tissue 29 Formication 663 Fosdick calcium dissolution test 163 Fothergill’s disease 839 Fournier’s molar 112 Fourth week wound 75 Fracture of teeth 680 Franceschetti syndrome 134 Freckle 755 Free cementicles 676 Frenal tag 179 Frey’s syndrome 834, 878 Friedreich’s disease 129 Frontonasal dysplasia syndrome 865 Frozen section 32 Frozen section biopsy 56 Functions of tongue 622 Fungiform papillae 620 Fungiform papilloma 170, 171 Fusion 100 Fusospirochetal gingivitis 391 G G banding 64 Galvanism 222 Ganglioneuroma 208 Gangrenous stomatitis 471 GAPO 870 Gardener’s syndrome 601, 111, 180, 190, 873 Gastric cyst 629 Gaucher’s disease 804 , 806 Gemination 99 General adaptation syndrome 884 Generalized aggressive periodontitis 404 Generalized neurological disease 638 Genetic factors 862 Genetic theory 91 Geniculate neuralgia 841 Genital wart 517 Geographic tongue 631 Geotrichosis 498 German measles 514 Gestant odontome 103 Ghost cells 360 Ghost teeth 118 Giant cell arteritis 844 Giant cell epulis 214 Giant cell fibroma 180, 181 Giant cell lesion 213 Giant cell tumors 213 Giant cells 181 Giant hairy nevus 174 Giant osteoid osteoma 190 Giant urticaria 773 Giemsa stain 46 Gigantism 786 Gilbert syndrome 825 Gilles de la tourette’s syndrome 638 Gingival abscess 394 Gingival cyst of adults 356 Gingival cyst of newborn 355 Gingival enlargement due to drugs 397 Gingival inflammation 388 Gingival pocket 401 Index Gingival salivary gland choristoma 412 Gingivitis 388 Glandular cheilitis 610 Glandular fever 521 Glandular odontogenic cyst 358 Glanzmann’s disease 710 Glassblower’s white patch 689 Globodontia 108 Globulomaxillary cyst 370 Glomangioma 201 Glomus jugulare tumor 206 Glomus tumor 201 Glomus tympanicum tumor 206 Glossitis areata exfoliativa 631 Glossopharyngeal neuralgia 840 Glossoplegia 638 Glossopyrosis 845 Goblet cells 171 Gonococcal ophthalmia neonatorum 461 Gonococcal stomatitis 461 Gonorrhea 460 Gonzalez-Crussi grading of teratoma 84 Gordon and Sweet’s method for reticulin fiber 43 Gorham syndrome 600 Gorlin-Goltz syndrome 351, 380, 874, 885 Gorlin cyst 360 Gorlin sign 628, 745 Gougerat-Sjögren’s syndrome 872 Gout 651 Grading and staging of tumors 93 Grading of dysplasia 228 Grading of malignant melanoma 276 Graft versus host disease 243 Graft versus host resistance 760 Graham little syndrome 237, 239 Granular cell ameloblastoma 310 Granular cell myoblastoma 212 Granular cell neural fibroma 21 Granular cell odontogenic fibroma 333 Granular cell odontogenic tumor 333 Granular cell Schwannoma 212 Granular cell tumor 212 Granular erythroplakia 230 Granulation 73 Granulation tissue 74 Granulocytopenia 705 Granuloma gravidarum 398 Granuloma inguinale 475 Granuloma pyogenicum 399 Granuloma venereum 475 Granulomatous cheilitis 611 Granulomatous gingivitis 394 Groove sign 477 Ground glass appearance 578, 792 Ground section 30 Gubernacular dentis 302 Gum boil 550 Gumma 458 Gummy smile 129 Gustatory sweating 834, 878 Guttate lichen planus 239 Guttate psoriasis 746 H Habitual abrasion 668 Habitual cheek biting 656 Habitual lip biting 656 Hailey-Hailey disease 740 Haim-Munk syndrome 406 Hairy leukemia 725 Hairy leukoplakia 532 Hairy tongue 633 Hajadu-Cheney syndrome 865, 876 Hallmarks of cancer 87 Hallopeau type pemphigus 735 Halo nevus 175, 177 Hamartoma 83, 168 Hamman’s crunch 666 Hand foot mouth disease 516 Hand-Schuller-Christian disease 804 Hansen disease 462 Haptens 91 Hard fibroma 179 Hard tissue microtome 31 Harrison grooves 823 Healing cyst 366 Healing of biopsy wounds 74 Healing of extraction wounds 74 Healing of fractures 75 Healing of osseointegrated implants 76 Healing of pulp 76 Healing of skin 77 Healing of wound of oral mucosa 77 Healing response in oral mucosa 78 Hebra nose 474 Heck disease 518 Heerfordt’s syndrome 428, 769, 873 Heliotrope 833 Hemangioendothelial sarcoma 291 Hemangio-lymphangioma 201 Hemangioma 196 Hemangioma of infancy 196 Hemangiopericytoma 202 Hemarthrosis 711 Hematoma 663 Hematoxylin stain 40 Hemidesmosomal 740 Hemifacial hyperplasia 129 Hemifacial microstomia 130 Hemihyperplasia 129 Hemimaxillofacial dysplasia 131 Hemodialysis associated amyloidosis 802 Hemoglobin Bart disease 696 Hemoglobin H disease 696 Hemophilia 710 Hemophilia A 710 Hemophilia B 710 Hemophilia C 711 Hemorrhagic bone cyst 370 Hemostasis 72 Henderson-Paterson inclusion 519 Hepadnavirus 90 Hereditary benign intraepithelial dyskeratosis 754 Hereditary brown enamel 114 Hereditary brown opalescent teeth 114 Hereditary disease of newborn 699 Hereditary ectodermal dysplasia 868 Hereditary elliptocytosis 699 Hereditary enamel dysplasia 114 Hereditary fibrous dysplasia of the jaws 580 Hereditary hemorrhagic telangiectasia 754, 875 Hereditary hypohidrotic (anhidrotic) ectodermal dysplasia 758 Hereditary hypohydrotic ectodermal dysplasia 870 Hereditary mucoepithelial dysplasia 751 Hereditary multiple exostosis 193 Hereditary opalescent dentin 117 Hereditary spherocytosis 699 Herlitz’s disease 740 Herpangina 515 Herpes associated erythema multiforme 732 Herpes barbae 508 Herpes gladiatorum 508 Herpes simplex infection 505 Herpes zoster 512, 535 Herpes zoster ophthalmicus 513 Herpetic paronychia 508 Herpetic whitlow 508 1013 Textbook of Oral Pathology 1014 Herpetiform ulcers 774 Herring bone 180 Herring bone pattern 207, 280 Heterotrophic gastrointestinal cyst 84 Hibernoma 187 Hidebound disease 761 Higoumenakis’s sign 459 Histiocytosis X 804 Histiocytosis Y 171 Histochemical stain 38 Histology 22 Histopathology 22 Histoplasmosis 492, 536 History of microscope Histotechnique 22 HIV 524 HIV associated salivary gland disease 535 HIV virus 526, 527 HME 193 Hodgkin’s lymphoma 714 Homogenous erythroplakia 230 Homogenous leukoplakia 224 Homozygous β-thalassemia 696 Honeycomb appearance 196, 308 Hormonal carcinogenesis 89 Hormone dependant tumors 89 Hormone related amyloid 802 Hormones 222 Horn cyst 751 Horner’s syndrome 880 Horton’s syndrome 842, 879 Host defense 541 Hot start PCR 62 Hound dog appearance 752 Hour-glass manner 215 Howell-Jolly bodies 704 HTLV-III virus 526 Human abuse 858 Human herpes virus 505 Human T-cell lymphotropic virus 89 Humoral theory 145 Hunter’s glossitis 818 Huntington’s chorea 638 Hurler syndrome 807, 876 Hutchinson-Gilford syndrome 884 Hutchinson’s freckles 274 Hutchinson’s incisor 109, 112 Hutchinson’s triad 459 Hutchinson’s sign 513 Huygenian eyepieces Hyaline cartilage 184 Hyalinosis cutis et mucosa oris 752 Hybridization method 62 Hybridoma technique 58 Hydatid cyst 378 Hydatid disease 378 Hydration 40 Hyperbaric oxygen therapy 560 Hypercementosis 675 Hypercortisolism 797 Hyperdontia 110 Hypermobility 650 Hyperorthokeratinization 225 Hyperostosis 195 Hyperparakeratinization 225 Hyperparathyroidism 791 Hyperpigmentation 536 Hyperpituitarism 785 Hyperplasia 82, 168, 194 Hyperplasia of salivary gland 413 Hyperplastic neutropenia 707 Hypersensitivity reaction 766 Hypertaurodont 106 Hypertelorism 133 Hyperthyroidism 788 Hypertrophic lichen planus form 238, 239 Hypertrophy 168 Hypervitaminosis A 822 Hypoadrenocorticism 796 Hypodontia 109 Hypofibrinogenemia 713 Hypogeusia 637 Hypoglycemia 809 Hypognathous 128 Hypoparathyroidism 793 Hypophosphatasia 810 Hypopituitarism 787 Hypoplasia of gland 412 Hypoplasminogenemia 712 Hypotaurodont 106 Hypotelorism 136 Hypothyroidism 790 I Iceberg tumor 430 Id reaction 489 Identification 850 Idiopathic bone cavity 370 Idiopathic histocytosis 804 Idiopathic leukoplakia 223 Idiopathic midline destructive disease 728 Idiopathic osteosclerosis 600 Idiopathic steatorrhea 811 Idiopathic thrombocytopenic purpura (ITP) 535, 708 Illumination Image formation in microscope 10 Immediate hypersensitivity 766 Immune reactions 766 Immune surveillance theory 91 Immunodeficiency 236 Immunodeficiency associated Burkitt’s lymphoma 719 Immunofluorescent study 241 Immunofluorescent technique 59 Immunofluorescent test 736 Impacted teeth 122 Impaired glucose tolerance 794 Impetiginized dermatitis 454 Impetigo 453 Impetigo vulgaris 453 In situ hybridization 63 Incipient carcinoma 230 Incisional biopsy 48, 231 Incisive canal cyst 366 Incontinentia pigmenti 743, 871 Indication of biopsy 47 Indirect Immunofluorescent technique 60 Indirect staining 39 Indirect-acting carcinogens 87 Infantile osteopetrosis 594 Infantile cortical hyperostosis 593, 865 Infantile osteomyelitis 560 Infantile scurvy 819 Infected periapical lesion 571 Infected ulcer 658 Infectious mononucleosis 521 Infinity corrected optics Inflammation 73 Inflammatory collateral cyst 365 Inflammatory fibrous hyperplasia 685 Inflammatory papillary hyperplasia 686 Inflammatory radicular cyst 361 Infrabony pocket 401 Infravital staining 39 Inositol 820 Integration 90 Interdigital candidiasis 491 Interface dentin 671 Interferon 537 Intermediate osteopetrosis 594 Internal callus 76 Internal resorption 673 Index Interproximal caries 153 Intertriginous candidiasis Intra-alveolar cyst 370 Intra-alveolar pocket 401 Intrabony pocket 401 Intradermal nevi 175, 176, 177 Intraductal papilloma 438, 439 Intraepidermoid carcinoma 232 Intraepithelial carcinoma 231 Intraepithelial edema 226 Intralingual cyst of foregut origin 377 Intramuscular lipoma 189 Intra-nuclear inclusions 508 Intraosseous mucoepidermoid carcinoma 444 Inversion 65 Inverted ductal papilloma 438, 439 Inverted follicular keratosis Helwig 751 Inverted papilloma 170, 171 Inverted schneiderian papilloma 170 Inverted tear drop 367 Investigation of bite mark 857 Involucrum 556 Iris lesion 732 Iron deficiency anemia 636, 700, 880 Iron hematoxylin 41 Irregular dentin 671 Irreversible pulpitis 543 Irritation fibroma 178 Ischemic myelofibrosis 842 Isolated darier’s disease 750 Isotropic specimen 15 Ivory osteoma 189 J Jadassohn-Lewandowsky syndrome 747 Jadassohn-Tieche nevus 175 Jaffe’s fibrous dysplasia 578 Jaffe-Lichtenstein syndrome 577 James Ramsay Hunt syndrome 510, 514 Jarisch-Herxheimer reaction 460 Jaundice 825 Jaw Winking syndrome 880 Jaw cyst-basal cell nevus-bifid rib syndrome 380 Johanson-Blizzard syndrome 870, 874 Junctional bullous epidermatosis 740 Junctional epidermolysis bullosa 740, 741 Junctional nevi 177 Junctional nevus 175 Juvenile aggressive fibromatosis 180 Juvenile melanoma 175 Juvenile myxedema 790 Juvenile ossifying fibroma 590 Juvenile periodontitis 403 K Kaposi’s sarcoma 530 Kaposi’s varicelliform eruption 508 Karyogram 65 Karyotype analysis 65 Karyotyping 64 Kawasaki syndrome 763, 871 Keloid 74 Keratin horn 168, 518 Keratin pearl 260 Keratin pit 173 Keratinizing and calcifying odontogenic cyst 359 Keratinizing metaplasia 821 Keratoacanthoma 173 Keratoameloblastoma 311, 312 Keratocarcinoma 173 Keratoconjunctivitis sicca 426 Keratocyst radiological types 352 Keratosis 225 Keratosis follicularis 749 Keratotic basal cell carcinoma 268 Kernicterus 700 Kernig’s sign 568 Kinetics of tumor cell growth 90 Kissing disease 521 Kissing lesion 631 Klestadt’s cyst 369 Klinefelter syndrome 107 Klippel-Trenaunay syndrome 886 Klippel-Trenaunay-Weber syndrome (KTW) 878 Koebner phenomenon 237 Kohler illumination Koilocytes virus 169 Koilocytosis 534 Koilonychias 701 Koplik spots 510 Korsakoff’s psychosis 813 Kuttner’s disease 423 Kveim-Siltzbach test 769 Kwashiorkor disease 800 L Laband syndrome 878 Labial melanotic macule 138 Labret 679 Lacrimo-auriculo-dento-digital syndrome 413, 874 Lactobacillus count test 162 Lacy white pattern 243 LADD 413 Lane tumor 277 Langerhans cell disease 804 Laser ablation 614 Laser capture microdissection 63 Laser-Trelat sign 751 Late syphilis 456 Latent bone cyst 137 Lateral facial cleft Lateral periodontal cyst 357 Lateral radicular cyst 362 Lateral soft tissue fistulas 141 LAV virus 526 Lazy leukocyte syndrome 706, 881 Leaf like denture fibroma 686 Legend of worm 145 Leiomyofibrillogenic capacity 212 Leiomyoma 211 Leiomyosarcoma 294 Leishmaniasis 502 Lemmoma 204 Lens Lentigo maligna melanoma 274 Lentigo melanoma 276 Lentigo simplex 756 Lentigo solaris 756 Leong’s premolar 105 Leonine facies 463 Leontiasis ossea 584 LEOPARD syndrome 870 Leporma 463 Lepromatous leprosy 462 Lepromin test 464 Leprosy 462 Leptomeningeal angiomatosis 200 Letterer-Siwe disease 804, 806 Leukemia 427, 720 Leukemia classification 720 Leukemia types 720 Leukemoid reaction 720 Leukoedema 140 Leukokeratosis nicotina glossi 634 Leukoplakia 220 Leukoplakia erosiva 221, 224 Leukoplakia simplex 221, 224 Leukoplakia verrucosa 221, 224 Leutic glossitis 458 Libman-Sacks endocarditis 251 1015 Textbook of Oral Pathology 1016 Lichen planopilaris 239 Lichen planus 60, 235 Lichen planus pemphigoides 239 Lichen planus pigmentosus 239 Lichen planus types 236 Lichen planus-lupus erythematosus overlap 240 Lichenoid contact dermatitis 240 Lichenoid contact stomatitis 779, 780 Lichenoid tissue reaction 779 Lie bump 777 Liesegang rings 319 Light microscope Light source 15 Ligneous conjunctivitis 712 Limb defect 137 Linea alba 655 Linear gingival erythema 533 Linear lichen planus 239 Lingua dissecta 629 Lingua villosa 633 Lingual caries 153 Lingual cortical mandibular defect 137 Lingual cyst 629 Lingual mandibular salivary gland depression 137 Lingual polyp 629 Lingual thyroid nodule 84, 627 Lingual tonsil 694 Lingual varicosities 627 Lip disorders classification 604 Lip ulcers due to caliber persistent artery 617 Lipid metabolism 804 Lipid proteinosis 808 Lipid reticuloendothelioses 804 Lipoblastoma 187 Lipoblastomatosis 187 Lipoid proteinosis 752 Lipoma 186 Lipomatosis 186 Liposarcoma 283 Lipschutz bodies 508 Liquefaction foci 156 Liquefaction necrosis 548 Liquid base cytology 55 Lisch bodies 207 Liver spot 756 Ljubljana classification system 228 Lobular carcinoma 447 Lobular pattern 188 Lobular torus 194 Local infection 69 Localized aggressive periodontitis 404 Localized myositis ossificans 838 Localized or organ limited amyloidosis 802 Location of wound 69 Lofgren’s syndrome 769 Loose bodies 652 Loss of polarity 227 Lou Gehrig disease 836 Love bites 857 Low grade fibrosarcoma 281 Ludwig’s angina 566 Lues 455 Lues maligna 457 Lumber lordosis 823 Lupus cheilitis 252 Lupus erythematosus 61, 250 Lupus pernio 769 Lupus vulgaris 466 Lyell’s disease 733 Lymph nodes 259 Lymphangioma 200 Lymphangioma simplex 200 Lymphogranuloma venereum 476 Lymphoid hyperplasia 693 Lymphokines 538 Lympho-proliferative malignancy 425 Lymphosarcoma 716 M Macrodontia 99 Macroglobulinemia 714 Macroglossia 200, 624 Macrognathia 129 Maffucci’s syndrome 882 Magical charm 679 Magnification of microscope Main’s theory 345 Maintenance of laboratory microscope 19 Major aphthae 774 Major salivary gland 410 Malabsorption syndrome 811 Malignancy 71 Malignant ameloblastoma 335 Malignant fibrous histiocytoma 282 Malignant fibroxanthoman 282 Malignant granular cell myoblastoma 296 Malignant hemangioendothelioma 291 Malignant hemangiopericytoma 291 Malignant melanoma 273 Malignant mixed tumor 448 Malignant odontoma 318 Malignant osteopetrosis 595 Malignant peripheral nerve sheath tumors 293 Malignant Schwannoma 293 Mallory’s phosphotungstic acid hematoxylin for muscle striation 43 Mandibular buccal infected cyst 366 Mandibular tori 195 Mandibulofacial dysostosis 134, 866 Maran-Achard syndrome 597 Marasmus 800 Marble bone disease 594 Marcus gun phenomenon 880 Marfan’s syndrome 351, 597, 867 Marginal acute gingivitis 507 Marie and Sainton disease 132 Marsupilization 381 Mask of pregnancy 797 Mass fatality index (MFI) 852 Massive osteolysis 600 Masson trichrome 43 Mast cells 240 Maxillary sinusitis 479 McCune-Albright’s syndrome 577 Measles 509 Mechanical measure for caries control 164 Mechanical stress 70 Mechanical tube Mechanical tube length Mechanism of action of chemical carcinogen 88 Mechanism of distant metastases 90 Mechanism of DNA viral oncogenesis 90 Mechanism of local invasion 90 Mechanism of RNA viral oncogenesis 89 Mechanistic theory 92 Meckel’s cartilage 184 Median anterior maxillary cyst 366 Median cleft face syndrome 865 Median cleft of lip 608 Median mandibular cyst 370 Median palatine cyst 368 Median rhomboid glossitis 489, 630, 796 Mediastinitis 570 Mediterranean anemia 696 Megadontia 99 Megagnathia 129 Index Melanin incontinence 138, 756 Melanoameloblastoma 209 Melanocytic nevus 174 Melanotic ameloblastoma 209 Melanotic neuroectodermal tumor of infancy 209 Melanotic progonoma 209 Melasma 797 Melkerson Rosenthal syndrome 413, 630, 875 Melnick Needles syndrome 866 Membranous basal cell adenoma 433 MEN syndrome 205, 885 Mercurialism 683 Merkel cell carcinoma 279 Merkel cell tumor 279 Mesenchymal chondrosarcoma 287 Mesiodens 110 Mesocrine glands 410 Mesomelic 136 Mesotaurodont 106 Metachromatic stain 38 Metachromatic staining 39 Metallic impregnation 39 Metaplasia 82 Metastasis 92 Metastasizing mixed tumor 449 Metastatic 263 Metastatic carcinoma 266 Meth sores 663 Methamphetamine abuse lesion 663 Mibelli’s disease 748 Mickey mouse ears 501 Mikulicz’s aphthae 774 Microbial homeostasis 149 Microcyst 441 Microdontia 98 Microglossia 623 Micrognathia 128 Micrometry Microstomia 135 Microtophi 652 Microwave biopsy 29 Microwave oven 28 Microwave stimulated processing 28 Microwave tissue processing 28 Midline lethal granuloma 728 Midline malignant reticulosis 728 Miescher’s syndrome 611, 875 Migraine 843, 879 Migraine syndrome 879 Migrainous neuralgia 842 Mikulicz’s disease 427 Mikulicz’s disease proper 427 Mild neutropenia 705 Mild periodontitis 402 Mild restricted muscular dystrophy 831 Miliary tuberculosis 465 Miliary tubercle 467 Miller’s acidogenic theory145 Minor aphthae 774 Minor salivary gland 410 Minor starch-iodine test 835 Mixed odontogenic tumors 325 Mixed tumor 430 Mobius syndrome 877 Moderate neutropenia 705 Moderate periodontitis 402 Moderately differentiated SCC 260 Mohr syndrome 866 Mohs micrognathic surgery 268 Molar incisor hypomineralization 114 Molluscum contagiosum 536 Molluscum contagiosum infection 519 Molluscum sebaceum 173 Mongolism 598 Mongoloid appearance 697 Mono 521 Monoclonal antibodies therapy 538 Monoclonal hypothesis 91 Monomelic fibrous dysplasia 577 Monosomic 65 Monostotic fibrous dysplasia 577 Moon molars 460 Moon’s molar 109, 112 Morbilli 509 Mordant 41 Morphea 762 Morsicatio buccarum 656 Morsicatio labiorum 656 Morsicatio lingurum 657 Moth eaten appearance 262, 290 Mother of pearl appearance 140 Motor neuron disease 836 Mottled enamel 113 Mounting 33 Mouse species 762 Muciphage 418 Mucocele 373, 417 Mucocutaneous leishmaniasis 502 Mucocutaneous lymph node syndrome 763, 871 Mucoepidermoid carcinoma 440 Mucoepidermoid cyst 358 Mucopolysaccharidosis 809, 876 Mucormycosis 495 Mucositis 664 Mucous membrane pemphigoid 60 Mucous patches 457 Mucous salivary gland 410 Mucus duct cyst 419 Mucus escape phenomenon 417 Mucus extravasation phenomenon 417 Mucus retention cyst 419 Muir-Torre syndrome 173 Mulberry molar 108, 112 Multifactorial inheritance 863 Multifocal eosinophilic granuloma 804 Multifocal epithelial hyperplasia 518 Multifocal papilloma virus epithelial hyperplasia 518 Multihead demonstration eyepiece Multilocular cyst 303 Multinucleated giant cells 185, 215 Multiple angiofibroma 758 Multiple carcinomas 265 Multiple endocrine neoplasia syndromes 885 Multiple hamartoma syndrome 386, 760, 875 Multiple myeloma 725 Multiple PCR 62 Multiple sclerosis 837 Multistep theory 92 Mumps 421 Murray-Puretic-Drescher syndrome 386 Muscles of tongue 621 Muscular dystrophy 830 Myasthenia gravis 832 Mycobacterium infection 535 Mycosis fungoides 718 Myeloid leukemia 720 Myelomatosis 725 Myiasis 477 Myoblastic myoma 212 Myoepithelioma 432, 438 Myopathic facies 831 Myositis ossificans 837 Myospherulosis 666 Myotonias 831 Myotonic dystrophy 831 Myxadenitis labialis 610 Myxedema 790 Myxofibroma 183, 333 Myxoid chondrosarcoma 286 Myxoma 182 1017 Textbook of Oral Pathology N 1018 Naegeli-Franceschetti-Jadassohn syndrome 874 Nasoalveolar cyst 369 Nasolabial cyst 369 Nasopalatine cyst 366 Nasopalatine duct cyst 366 Nasopharyngeal angiofibroma 203 Nasopharyngeal carcinoma 278 Nasopharyngeal cyst 378 Natal teeth 121 Natural oxidation 41 Necrosis of pulp 548 Necrotizing fasciitis 571 Necrotizing sialometaplasia 450 Necrotizing stomatitis 391, 471, 533 Necrotizing ulcerative gingivitis 391, 533 Necrotizing ulcerative mucositis 391, 471 Necrotizing ulcerative periodontitis 391, 533 Neonatal teeth 121 Neoplasm 85, 168 Nerve sheath myxoma 183 Nested PCR 62 Neumann type pemphigus 735 Neumann’s tumor 208 Neuralgia inducing cavitational osteonecrosis 841 Neurilemmoma 204 Neurinoma 204 Neuroblastoma 292, 293 Neuroendocrine carcinoma of skin 279 Neurofibromatosis 884 Neurofibromatosis 884 Neurofibromatosis 206 Neurofibrosarcoma 293, 294 Neurogenic sarcoma 293 Neuroma 203 Neurosarcomas 293 Neurosyphilis 458 Neutrons-tropic ulcer 657 Nevoid basal cell carcinoma 380 Nevoid basal cell carcinoma syndrome 874, 885 Nevus flammeus 200 Nevus unius lateris 169 Niacin 814, 827 Niacin deficiency 636 NICO 841 Nicotine palatinus 233 Niemann-Pick disease 804, 807 Nikolsky’s phenomenon 734 Nikolsky’s sign 734, 740 Nitrofurans 165 Nodular elastoidosis 617 Nodular fasciitis 688 Nodular leukoplakia 224 Nodular melanoma 274, 276 Nodular oncocytic hyperplasia 437 Nodular subepidermal fibrosis 179 Nodular torus 194 Noma 471 Noma neonatorum 471 Nonodontogenic hamartoma 83 Nonspecific plaque hypothesis 149 Non-bullous impetigo 454 Nondisjunction 65 Non-Hodgkin lymphoma 534, 716 Non-lipid reticuloendothelioses 804 Nonradiation carcinogenesis 88 Noonan’s syndrome 351 Normal cell cycle 85 Northern blot technique 62 Nosepiece Nuclear beading 532 Nuclear staining 40 Numb chin syndrome 267 Numerical aperture Nursing bottle caries 160 Nutritional deficiency 222 Nutritional measure of caries control 164 O Object stage Objective 13, 16, 20 Objective of microscope Obligatory myiasis 477 Oblique facial cleft 608 Occlusal caries 156 Occlusal enamel pearl 105 Occupational abrasion 668 Oculodentodigital dysplasia 874 Oculoglandular syndrome of parinuad 478 Odontoameloblastoma 331 Odontogenesis 301 Odontogenesis imperfecta 117 Odontogenic dysplasia 118 Odontogenic fibroma 332 Odontogenic fibromyxoma 333 Odontogenic fibrosarcoma 339 Odontogenic hamartoma 83 Odontogenic infection of orbit 570 Odontogenic keratocyst 350 Odontogenic myxoma 333 Odontogenic tumors classification 300 Odontogram 852 Odontoma 329 OFD II 866 OFD orofacial digital syndrome II 866 Oil red O stain 44 Olfactory neuroblastoma 293 Oligodontia 109 Ollier’s syndrome 184 OLP staging 225 Oncocytic schneiderian papilloma 170 Oncocytoma 437 Oncocytosis 437 Oncogenes 91, 304 Optical aberrations Optical maintenance 19 Oral alimentary tract cyst 377 Oral amyloidosis 726 Oral cancer 255 Oral cancer classification 256 Oral cancer etiology 256 Oral cancer risk factors 258 Oral candidiasis 486 Oral cyst with gastric epithelium 377 Oral cyst with intestinal epithelium 377 Oral disorders in HIV disease 528, 529 Oral epithelial nevi 753 Oral florid papillomatosis 225 Oral focal mucinosis 182 Oral foci of infection 571 Oral human papilloma virus lesions 534 Oral lesion as complication to anti-neoplastic therapy 664 Oral lymphoepithelial cyst 376 Oral melanoacanthoma 174 Oral mucosal brush biopsy 54 Oral physiotherapy 249 Oral piercing 679 Oral sebaceous hyperplasia 757 Oral squamous cell carcinoma 258 Oral submucous fibrosis 243 Oral ulceration with bone sequestration 662 Oral-facial-digital syndrome 626, 876 Orofacial gangrene 471 Oropharyngeal aspergillosis 500 Orthochromatic stain 38 Osler’s disease 704, 875 Index Osler-Rendu-Weber syndrome 754, 875 OSMF clinical staging 248 OSMF functional staging 248 OSMF grading 248 OSMF malignant potential 249 OSMF management 249 OSMF pathogenesis 245, 246 Osseous metaplasia 686 Ossifying fibroma 588, 589 Ossifying fibrous epulis 182 Osteitis deformans 584 Osteitis fibrosa cystic 792 Osteoarthritis 645 Osteoarthrosis 645 Osteoblastoma 190, 192 Osteochondroma 192, 194 Osteoclastoma 214 Osteodysplasty 866 Osteogenesis imperfecta 596 Osteogenesis imperfecta types 596 Osteogenic sarcoma 287 Osteoid osteoma 191, 192 Osteoma 189 Osteoma cutis 189 Osteomalacia 823 Osteomatosis 190 Osteomyelitis 555 Osteomyelitis classification 557 Osteomyelitis with proliferative periostitis 563 Osteopetrosis 594 Osteophytes 646 Osteophytic lipping 646 Osteoporosis 591 Osteoporosis circumscripta 584 Osteoradionecrosis 665 Osteosarcoma 287 Osteosclerosis 600 Osteosclerosis fragilis generalisata 594 Otodental dysplasia 111, 870 Oxidative mechanism of carcinogenesis 90 Oxygenation 69 Oxyphilic adenoma 437 P p53 tumor 350 Pachyderma oralis 753 Pachyonychia congenita 747 Paget’s disease 584, 585 Palatal caries 153 Palatal cyst of newborn 359 Palatal epithelial hyperplasia 686 Palatal fauces 247 Palatal papillomatosis 686 Palatal tubercle 195 Palatine torus 194 Pallor 701 Palmoplanter keratosis 760 Panhypopituitarism 787 Pansinusitis 479 Pantothenic acid 816 Paper test 682 Papillae 620 Papillae simplices 620 Papillary cystadenoma lymphomatosum 435 Papillon-Lefevre syndrome 405, 878 Papovavirus 90 Papular lichen planus 241 Papyraceous scarring 745 Para pemphigus 737 Paraboloid condenser 12 Paracoccidioidomycosis 501 Paradental cyst 365 Paraganglioma 206 Parahemophilia 713 Parakeratin plugging 172, 272 Paralysis of tongue 638 Paramedian lip pits 605 Paramolar 110 Paraneoplastic pemphigus 737 Parasitic cyst 378 Parasitosis 663 Parathyroid gland 785 Paratrigeminal syndrome 879 Parkes-Weber syndrome 886 Parosteal osteosarcoma 287, 289 Parotid gland 410 Paroxysmal hemicranias 843 Parrot beak 134 Parry Romberg syndrome 130 Partsch’s operation 381 Parulis 550 PAS 42 Pastia’s line 472 Patau syndrome 865 Patent thyroglossal duct cyst 628 Paterson-Brown-Kelly syndrome 702 Pathergy test 777 Pathologic hyperplasia 82 Pathological attrition 666 Pathophysiology of infection 541 Pathothenic acid 807 Pattern of metastatic speed 92 PCNA 351 Pellagra 815 Pelvic inflammatory disease 461 Pemphigus 734 Pemphigus erythematosus 735 Pemphigus foliaceus 735 Pemphigus vegetans 735 Pemphigus vulgaris 60, 734 Penicillin 165 Peri-adenitis mucosa necrotica recurrent 774 Periapical abscess 549 Periapical cement-osseous dysplasia 586 Periapical cyst 361 Periapical granuloma 553 Periapical pocket cyst 362 Periapical scar 554 Periapical true cyst 362 Pericoronal abscess 395 Pericoronal cyst 345 Pericoronitis 395 Peridens 110 Perimolysis 670 Perineural fibroblastoma 204 Periodic acid Schiff method 42 Periodic migrainous neuralgia 879 Periodic neutropenia 706 Periodontal abscess 551 Periodontal disease associated with HIV 533 Periodontal ligament traction theory 121 Periodontal pocket 401 Periodontosis 403 Perioral dermatitis 778 Periorificial lentiginosis 755, 871 Periosteal chondroma 184 Periosteal osteoma 189 Periosteal osteosarcoma 287, 289 Periostitis ossificans 563 Peripheral AOT 322 Peripheral fibroma with calcification 182 Peripheral giant cell granuloma 214 Peripheral giant cell reparative granuloma 214 Peripheral giant cell tumor 214 Peripheral neuroblastic tumors (PNTs) 292 Peripheral ossifying fibroma 182 Peripheral osteochondroma 193 Peripheral osteoma 189 1019 Textbook of Oral Pathology 1020 Peripheral osteosarcoma 289 Peripheral vascular disease 636 Periungual fibromas 758 Perl’s Prussian blue reaction 45 Perleche 612 Pernicious anemia 636, 702 Persistent ulcer 658 Petechiae 663 Petrified man 838 Peutz-Jeghers syndrome 755, 871 PHACE(S) syndrome 197 Phantom bone 600 Phantom taste 637 Pharyngeal gonorrhea 461 Pharyngotonsillitis 507 Phase contrast microscopy 13 Phase shifting ring 14 Phleboliths 199 Phlegmon 565 Phoenix abscess 552 Phosphotungstic acid hematoxylin 41 Phycomycosis 495 Phylloquinone 825 Physical carcinogen 88 Physical stain 38 Physical theory 38 Physiologic hyperplasia 82 Physiological attrition 666 Picket fence 355 Picking the section 27 Picric acid 29 Pierre-Robin syndrome 597, 866 Pigeon breast 823 Pigeon chest 792 Pigmentation of tongue 640 Pigmented ameloblastoma 209 Pigmented mole 174 Pindborg tumor 318 Pingueculae 806 Pink disease 683 Pink tooth mummery 674 Pit and fissure caries 156 Pit and fissure sealant 164 Pituitary ameloblastoma 314 Pituitary dwarfism 787 Pituitary gland 784 Pityriasis rosea 743 Pizza burns 659 Placental extract 249 Plan achromat Plaque lichen planus 237, 241 Plasma cell cheilitis 615 Plasma cell gingivitis 393, 772 Plasma cell myeloma 727 Plasmacytoma 727 Plasminogen deficiency 712 Pleomorphic adenoma 430 Pleomorphic lipomas 189 Pleomorphic rhabdomyosarcoma 295 Plexiform ameloblastoma 309 Plexiform neuroma 207 Plica fimbriata 620 Plicated tongue 629 Plumbism 682 Plummer-Vinson syndrome 636, 702, 880 Plump cells 179 Plump nuclei 197 Plunging ranula 420 Pneumoparotid 666 Pointer eyepiece Polarized light microscopy 14 Polarizers 14 Polychromatic stain 38 Polycyclic aromatic hydrocarbons 87 Polycythemia rubra vera 704 Polymerase chain reaction 61, 537 Polymorphic reticulosis 728 Polymorphous low grade adenocarcinoma 447 Polymyalgia rheumatica 844 Polymyositis 833 Polyostotic fibrous dysplasia (Jaffe’s type) 577 Polypoid squamous cell carcinoma 277 Polystotic fibrous dysplasia 579 Poor circulation 69 Poorly differentiated SCC 260 Popcorn cells 715 Popliteal pterygium syndrome 605 Popular lichen planus 237 Porokeratosis 748 Porphyria 803 Port-wine stain 198, 200 Post axial polydactyly 136 Post-herpetic neuralgia 513 Postmortem examination 851 Postmortem serology 854 Postoperative maxillary cyst 373 Postpermanent dentition 125 Postradiation osteosarcoma 287 Postrhagadic scarring 459 Post-traumatic myositis ossificans 838 Potassium ferrocyanide 165 Pott’s disease 465 Poxvirus 90 Pre-eruptive caries 161 Precancerous condition 220 Precancerous lesion 220 Predeciduous dentition 121 Pregnancy gingivitis 389 Pregnancy tumor 398 Preheadache phenomenon 844 Pre-leukoplakia 223 Premature exfoliation 125 Preparation of tissue specimen 23 Pretrigeminal neuralgia 839 Primary acquired erythrocytosis 704 Primary agranulocytosis 705 Primary amyloidosis 802 Primary anemia 702 Primary chronic osteomyelitis 561 Primary cutaneous coccidioidomycosis 497 Primary epithelial tumor of the jaw 336 Primary healing 74 Primary herpes simplex infection 506 Primary intra-alveolar epidermoid carcinoma 336 Primary intraosseous carcinoma 336 Primary lymphoma of bone 717 Primary pulmonary blastomycosis 494 Primary pulmonary coccidioidomycosis 497 Primary reticular cell sarcoma 717 Primary Sjögren’s syndrome 424, 427 Primary syphilis 456 Primary thrombocytopenic purpura 708 Primary tuberculosis 466 Primordial cyst 350, 355 Principal focus 11 Principle of PAP smear 51 Principle of phase contrast microscope 13 Principle of polarized light microscopy 14 Pringle-Bourneville syndrome 757, 885 Procarcinogens 87 Progeria 788, 884 Progressive bulbar palsy 836 Progressive disseminated coccidioidomycosis 497 Progressive disseminated histoplasmosis 492 Progressive facial hemiatrophy 130 Progressive muscular atrophy 836 Index Progressive myositis ossificans 838 Progressive osteolysis 600 Progressive staining 39 Progressive systemic sclerosis 761 Proliferation 73 Prolymphocytic leukemia 725 Promoters of carcinogenesis 88 Proptosis 133 Protein deficiency 800, 801 Proteolysis chelation theory 150 Proteolysis theory 149 Proteomics 63 Provitamins 811 Prussian blue 45 Pseudocarcinoma 173 Pseudo hairy leukoplakia 532 Pseudo hemophilia 712 Pseudo horn cyst 751 Pseudo lymphoma 425 Pseudoacanthosis nigricans 744 Pseudoallergic reactions 770 Pseudoepitheliomatous hyperplasia 174 Pseudohypoparathyroidism 793 Pseudoleukemia 427 Pseudolipoma 186 Pseudomembranous candidiasis 486, 530 Pseudosarcomatous fasciitis 688 Pseudotumor of hemophilia 711 Pseudoxanthoma elasticum 751 Psoriasiform hyperplasia 393 Psoriasis 746 Psychotherapy 242 PTAH stain 43 Pterygoid-Levators synkinesis 880 PTN hamartoma tumor syndrome 760 Puberty gingivitis 390 Pulmonary sporotrichosis 499 Pulmonary tuberculosis 466 Pulp 542 Pulp artifacts 546 Pulp calcifications 546 Pulp degeneration 545 Pulp hyperemia 543 Pulp polyps 543 Pulp stone 546 Pulpitis 542 Pumice appearance 233 Pumping tooth syndrome 196 Punch biopsy 49 Purpura 663 Purpura hemorrhagic 708 Pushing margin 272 Pustular psoriasis 746 PUVA therapy 242 Pyogenic granuloma 399 Pyostomatitis vegetans 479 Pyridoxine 807, 816 Q Q banding 64 Quantitative PCR 62 Quaternary syphilis 456 Quincke’s edema 773 R Rabbit syndrome 638 Rachitic metaphysic 824 Radiation burns 658 Radiation carcinogenesis 88 Radiation osteomyelitis 564 Radicular dens invaginatus 104 Radicular dentin dysplasia 118 Radioactive iodine 789 Ramon syndrome 878 Rampant caries 161 Rampant dental caries 663 Ramsden eyepiece Ranula 419 Rapidly progressive periodontitis 402 Rathke’s pouch tumor 314 Raw beef appearance 684 Ray fungus appearance 469 Reynaud’s phenomenon 761 Reactionary dentin 77, 671, 778 Reactive lymphoid hyperplasia 693 Reactive osseous metaplasia 662 Reactive proliferation 167 Reactive subpontic exostosis 195 Reader’s syndrome 879 Real image 10 Record management 949 Recovery of dental structure 851 Recrudescent herpetic infection 507 Recurrent aphthous stomatitis 536 Recurrent aphthous ulcer 774 Recurrent caries 160 Recurrent herpes labialis 507, 534 Recurrent herpetic infection 507 Recurrent intra oral herpes infection 507 Red raspberry tongue 472 Reductase test 163 Refractory rickets 823 Regional enteritis 782 Regional ileitis 782 Regional odontodysplasia 118 Regressive staining 39 Reiter’s syndrome 778, 883 Relative macroglossia 624 Relative pocket 401 Remodeling 73 Reparative dentin 77, 671 Replication 90 Requirement of biopsy tissue 48 Residual cyst 364 Resolution Resorption of teeth 672 Respiratory disease 71 Retention cyst 374 Reticular lichen planus 237, 241 Retinal anlage tumor 209 Retinol 821 Retrocuspid papilla 388 Reverse smoker’s palate 233 Reversible pulpitis 543 Rhabdomyoma 212 Rhabdomyosarcoma 294 Rheumatoid arthritis 646, 647 Rheumatoid sialadenitis 872 Rhinoscleroma 474 Rhinosporidiosis 499 Riboflavin 807, 813 Rice bodies 648 Rickety rosary 823 Riga-Fede disease 122 Riley-Day syndrome 873 Ripening of staining solution 40 Risk factors of oral cancer 86 Risky epithelium 228 Ritual abrasion 668 RNA oncogenic viruses 89 Robin anomalad Pierre Robin sequence 597 Rodent facies 697 Rodent ulcer 267, 268 Role of forensic odontology 849 Romberg hemifacial atrophy 130 Root caries 158 Root growth theory 120 Rose Bengal staining test 426 Rose gardener’s disease 498 Rose Waller test 648 Rosette pattern 324 Rothmund-Thomson syndrome 111 1021 Textbook of Oral Pathology 1022 Round cell carcinoma 289 Routes of metastasis 92 RT PCR 62 Rubber man 745 Rubella 514 Rubeola 509 Rubinstein Taybi syndrome 102 Rudimentary supernumerary teeth 110 Rushton bodies 348, 363 Russell’s bodies 554 Rutherford syndrome 386, 878 S Safranin O 45 Sailor’s lip 613 Saint Anthony’s fire 455 Saliva 70, 150 Salivary duct cyst 419 Salivary gland calculus 415 Salivary gland stone 415 Salmon patch 198 Sanguinaire 222 SAPHO syndrome 562 Sarcoidosis 769 Sarcoside 165 Satellite cyst 351 Saucerization 560 Saw microtome 31 Saw tooth appearance 240 Scale of development of teeth 98 Scaly gray dermatitis 814 Scanning electron microscope 19 Scaphocephaly 133 Scarlatina 472 Scarlet fever 472 Schirmer test 426 Schwann cells 203 Schwannoma 204 Sclerodactyly 761 Scleroderma 761 Sclerosing hemangioma 179, 199 Sclerosing technique 199 Sclerotic dentin 77 Scrofula 466 Scrotal tongue 629 Scrumpox 508 Scurvy 819 Sebaceous hyperplasia 756 Seborrheic keratosis 750 Seborrheic wart 168 Second week wound 75 Secondary agranulocytosis 705 Secondary amyloidosis 802 Secondary carcinoma 266 Secondary dentin 671 Secondary healing 74 Secondary herpetic infection 507 Secondary Sjögren’s syndrome 424, 427 Secondary syphilis 456, 457 Secondary tuberculosis 466 Secondary vaccinia 772 Sectioning with microtome 27 Seed and soil hypothesis 92 Segmental odontomaxillary dysplasia 131 Self-healing carcinoma 173 Self-inflicted bites 855 Senear-Usher syndrome 735 Senile lentigo 756 Senile osteoporosis 592 Sentinal tubercle 466 Septal squamous exophytic papilloma 170 Sequestra 556 Sequestrectomy 560 Seromucous salivary gland 410 Serous cell adenoma 444 Serous salivary gland 410 Sessile cementicles 676 Severe generalized muscular dystrophy 830 Severe neutropenia 705 Severe periodontitis 402 Sex-linked inheritance 863 Shagreen patch 757 Sharp’s staging 224 Sheehan’s syndrome 787 Shell teeth appearance 117 Shield type I 117 Shield type II 117 Shield type III 117 Shingles 510, 512 Shovel shaped incisor 109 Sialadenoma papilliferum 438, 439 Sialadenosis 420 Sialo odontogenic cyst 358 Sialochemistry 426 Sialocyst 419 Sialolithiasis 415 Sialometry 426 Sialorrhea 414 Sialosis 420 Sicca syndrome 424, 872 Sickle cell anemia 695 Sickle cell crisis 695 Sickle cell disease 695 Sickle cell trait 695 Sideropenic anemia 222 Sideropenic dysphagia 702 Silver nitrate 165 Simmond’s disease 787 Simple aphthous 774 Simple bone cyst 370 Simple hemihyperplasia 129 Simple microscope Simple odontogenic fibroma 332 Single gene disorders 862 Single refractive specimen 15 Sinonasal papilloma 170 Sinonasal undifferentiated carcinoma 270 Sinus mucocele 372 Sinusitis 479 Sipple syndrome 205, 885 Sistrunk operation 629 Six P of lichen planus 237 Sjögren’s syndrome 424, 872 Skin sporotrichosis 498 Slip signs 187 Slow transforming tumor viruses 89 Slowly progressive periodontitis 402 Small cell carcinoma of skin 279 Smokeless tobacco forms 257 Smokeless tobacco keratosis 234 Smoker’s melanosis 661 Smoker’s palate 233 Smoker’s tongue 634 Smoking 257 Smooth erythroplakia 230 Smooth surface caries 153 Snail track ulcers 457 Snow burns 659 Snow capped teeth 116 Snuff dipper lesion 234 Snuff dipper’s cancer 271 Snuff pouch 234 Snyder test 162 Soap bubble appearance 196, 308, 333 Soft fibroma 179 Soft mixed odontoma 326 Soft odontoma 326 Soft papilloma 168 Solar cheilosis 613 Solar elastosis or senile elastosis 617 Solar lentigo 756 Solid leiomyoma 211 Index Solid or primordial basal cell carcinoma 268 Solitary bone cyst 370 Solitary labial lentigo 138 Solitary myositis 838 Sorrowful appearance 833 South American blastomycosis 501 Southern blot technique 62 Specific plaque hypothesis 149 Specimen accessioning 22 Specimen submission 48 Speckled leukoplakia 224 Speed bumps 663 Sphenopalatine neuralgia 842, 879 Spherical aberration Sphingomyelin lipidosis 807 Spider finger 598 Spider web appearance 212 Spike formation of cementum 676 Spindle cell carcinoma 277 Spindle cell lipomas 189 Spindle cell nevus 175, 176 Spindle cells 277 Spindle torus 194 Spit tobacco keratosis 234 Spitz nevus 175, 177 Splints 678 Split papule 457 Spontaneous dyskinesia 638 Spontaneous sequestration 662 Sporotrichosis 498 Sprue 811 Squamous acanthoma 174 Squamous cell carcinoma 639 Squamous eddies 751 Squamous odontogenic tumor 317 Squamous papilloma 168 Stable plaque psoriasis 746 Stafne bone cyst 137 Stafne defect 137 Stafne’s cyst 412 Stage of chemical carcinogen 88 Staghorn appearance 202 Staging of leukoplakia 225 Staining of chemical production 39 Staining of cut section 32 Staining of selective solubility 39 Staining procedure 40 Starch-iodine test 835 Starry-sky appearance 719 Static bone cyst 137 Stellate cells 182 Stem cell leukemia 720 Stenosis 417 Stensen’s duct 411 Steps of metastasis 92 Steps of processing 25 Steps of staining procedure 40 Stereomicroscopy 11 Stevens Johnson syndrome 733, 870 Stiff joint 648 STNMP staging system 95 Stomatitis areata migrans 631 Stomatitis medicamentosa 770 Stomatitis nicotina 233 Stomatitis venenata 771 Stomatodynia 845 Stomatopyrisis 245 Stomatopyrosis 845 Storiform pattern 180, 207 Strabismus 133 Stratum intermedium 301 Straw mat appearance 180 Strawberry gingivitis 768 Strawberry hemangioma 197 Streptococcal pharyngitis 476 Streptococcal tonsillitis 476 Streptococcus mutans level in saliva 163 Stress lesion 670 Strictures 417 Sturge-Weber angiomatosis 199 Sturge-Weber syndrome 199, 882 Study of hard tissue 30 Subacute cutaneous erythematosus 250 Subacute necrotizing sialadenitis 424 Subchondral cyst 646 Subclinical fibrous dysplasia 577 Subcrestal pocket 401 Subcutaneous nodules 647 Subleukemia 720 Sublingual gland 410 Sublingual keratosis 223 Subluxation 650 Submandibular gland 410 Submerged teeth 123 Submucosal hemorrhage 663 Submucous palatal cleft 609 Sucrose chelation theory 150 Sudan black B 44 Sulphur granule 469 Sun ray appearance 288 Sunburst appearance 196 Sunshine vitamin 822 Superficial hemangioma 196 Superficial lipoma 189 Superficial lymphangioma 200 Superficial ranula 420 Superficial vacuolated cells 169 Supernumerary roots 107 Supernumerary teeth 110 Supplemental supernumerary teeth 110 Suppurating cyst 366 Suppurative parotitis 422 Supra vital stain 38 Supra-alveolar pocket 401 Suprabony pocket 401 Supracrestal pocket 401 Supravital staining 39 Surgical ciliated cyst 373 Susuk 679 Sutton’s disease 774 Swab test 163 Swan neck 831 Sweet’s syndrome 881 Swift’s disease 683 Swiss cheese pattern 279, 446 Sympathetic ophthalmoplegia 880 Synodontia 100 Synovial chondromatosis 652 Synovial sarcoma 282 Syphilis 222 Syphilis 455, 636 Syphilitic rhagades 459 Systemic blastomycosis 494 Systemic lupus erythematosus 250, 251 Systemic sclerosis 761 T T lymphocytes 526 Tabes dorsalis 458 Talisman 679 Talon’s cusp 102 Tardive dyskinesia 638 Target lesion 732 Taste buds 620 Taurodontism 106 Tay Sachs disease 804, 807 T-cell lymphoma 728 Teeth specimen 48 Telangiectasia 197, 761 Temporal arteritis 844 Temporomandibular joint dysfunction 652 Tennis racket appearance 333 Teratoma 84 Teratoma of tongue 84 1023 Textbook of Oral Pathology 1024 Terminal duct carcinoma 447 Tertiary dentin 671 Tertiary syphilis 456 Test tube appearance 747 Tetany 793 Thalassemia 696 Thalassemia intermedia 696 Thalassemia major 696 Thalassemia minor 696 Thalassemia trait 696 Theories of carcinogenesis 91 Theories of cariogenesis 145 Theories of cyst enlargement 343 Theories of salivary gland tumor histogenesis 429 Theories of staining 38 Theories of tooth eruption 120 Theques 175 Thermal burns 658 Thiamine 812 Third week wound 75 Thistle tube appearance 118 Thomson’s disease 832 Thrombocythemia 710 Thrombocytosis 710 Thrombotic thrombocytopenic purpura 709 Thrush 486, 530 Thymic cyst 378 Thymic replacement therapy 537 Thyroglossal duct cyst 377, 628 Thyroid crisis 788 Thyroid gland 785 Thyroid storm 788 Thyrotoxic osteoporosis 592 Thyrotoxicosis 788, 789 Tic douloureux 839 Tingible bodies 694 TNM staging 93 TNM staging of melanoma 276 Tobacco 221 Tobacco pouch keratosis 234 Tobacco pouch mouth 762 Tocopherol 824 Toluidine stain 45 Tombstone appearance 355 Tongue anatomy 620 Tongue arterial supply 621 Tongue disorders classification 623 Tongue embryology 619 Tongue lymphatic drainage 622 Tongue nerve supply 621 Tongue tie 625 Tongue torches 777 Tongue venous damage 621 Tonsillar hyperplasia 469 Tonsillar concretion 476 Tonsillolithiasis 476 Tooth brush injury 668 Tooth germ 302 Tooth march 854 Tooth pick injury 669 Tophi 651 Torulosis 496 Torus mandibularis 195 Torus palatinus 194 Toxic epidermal necrolysis 733 Toxoplasmosis 502 Trabecular carcinoma of skin 279 Trans illumination test 187 Transformation 90 Transient lingual papillitis 777 Transient osteopetrosis 594 Transitional cell carcinoma 273 Translocation 65 Transmission electron microscope 18 Transparent dentin 671 Transposition 124 Trapezoid lip 137 Traumatic bone cyst 370 Traumatic ciliated cyst 373 Traumatic fibroma 178 Traumatic keratosis 689 Traumatic lesion due to sexual habit 679 Traumatic neuroma 203 Traumatic sequestration 662 Traumatic ulcer 657 Treacher Collins syndrome 134, 866 Trefoil tongue 628 Triangular frontal defect 134 Trichinosis 503 Tricho-dento-osseous syndrome 107, 870, 874 Tricho-onychodental syndrome 870 Trichrome stain 42 Trifacial neuralgia 839 Trigeminal neuralgia 839 Trigeminal neuropathic pain 841 Trigger zones 839, 840 Trigonocephaly 133 Trisomy 65 Trisomy 13 syndrome 864, 865 Trisomy 18 syndrome 864 Trisomy 21 syndrome 598, 864 Trisomy syndrome 864 Tropic ulcer 657 Trousseau’s sign 793 True cementoma 334 True micrognathia 128 True pocket 401 Tubercular ulcer 466 Tuberculin skin test 467 Tuberculoid leprosy 462 Tuberculosis 465, 637 Tuberous sclerosis 757, 877, 885 Tularemia 474 Tumor droplets 324 Tumor metastasis 546 Tumorigenesis 304, 305 Turner’s hypoplasia 113 Turner’s tooth 113 Twining 100 Types of carcinogenesis 87 Types of objective Tzanck smear 736 U Ulcerated leukoplakia 224 Ulcerative lichen planus 239 Uncomplicated fracture 680 Ungual fibroma 758 Unicameral cyst 370 Unicystic ameloblastoma 315, 316 Unifocal eosinophilic granuloma 805 Urbach-Wiethe syndrome 752 Urea 165 Uremic stomatitis 688 Uveitis 428 Uveoparotid fever 428 Uveoparotid syndrome 873 V Vaccinia autonoculata 772 Vacuolar degeneration 226 Vaginogingival syndrome 237 Vagoglossopharyngeal neuralgia 840 Valley fever 497 Van der Woude’s syndrome 605, 875 van Gieson’s method 43 Vanishing bone disease 600 Vaquez’s disease 704 Varicella 510 Varicella zoster infection 510 Index Varicose aneurysm 199 Varicosity 627 Varix 627 Vascular hemophilia 712 Vascular leiomyoma 211 Vascular malformation 196, 198 Vascular nevi 196 Vascular pressure theory 120 Vascular purpura 712 Venereal wart 517 Venous malformation 198 Vermilion zone 605 Vermilionectomy 611 Verocay body 205 Verruca acuminate 517 Verruca vulgaris 518 Verruciform xanthoma 171 Verrucous carcinoma 271 Verrucous leukoplakia 224 Vertical root fracture 680 Vesicular pharyngitis 515 Vestigial cyst 366 Vichow’s physeal theory 193 Vincent’s infection 391 Virtual image 10 Virus theory 91 Visceral leishmaniasis 502 Vital stain 38 Vital staining 39 Vital theory 145 Vitamin A 821, 826 Vitamin A palmitate 229 Vitamin B1 812, 826 Vitamin B12 827, Vitamin B2 813, 827 Vitamin B3 814 Vitamin B5 816 Vitamin B5 827 Vitamin B6 816 Vitamin B6 827 Vitamin B7 807 Vitamin B8 816 Vitamin B9 817 Vitamin C 819, 826 Vitamin D 826 Vitamin D deficient rickets 822 Vitamin D resistance rickets 823 Vitamin E 824, 826 Vitamin H 807 Vitamin K 165, 825, 826 Vitamin therapy 229 volkman’s cheilitis 610 von Hippel-Lindau syndrome 886 von Recklinghausen’s disease of skin 206 von Recklinghausen’s neurofibromatosis 884 von Willebrand’s disease 712 W Waardenburg’s syndrome 870 Waddling gait 830 Wakeful EMG feedback 678 Waldeyer’s ring 278 Wandering rash 631 Warthin’s tumor 435 Warty dyskeratoma 750 Waterhouse-Friderichsen syndrome 884 Water soluble vitamins 812 Wax infiltration 26 Weber-Cockayne syndrome 740 Wegner’s granulomatosis 767, 768 Well differentiated SCC 259 Werlhof’s disease 708 Wernicke’s encephalopathy 813 Western blot method 537 Western blot technique 63 Wet beriberi 813 Wharton’s duct 411 White folded gingivostomatitis 753 White sponge nevus 753 White strawberry tongue 472 WHO dysplasia system 228 WHO type odontogenic fibroma 332 Whorl pattern 180 Wickham’s striae 237, 240 Winchester syndrome 876 Wire loop 251 Wiskott-Aldrich syndrome 709 Witkop-Von-Sallman syndrome 754 Woody tongue 567 Wound fibroblast 73 Wound temperature 69 Woven bone 191 X Xanthoma cells 172 Xanthomatosis 804 Xeroderma pigmentosum 757 Xerostomia 414, 665 X-linked inheritance 127 X-linked recessive 128 Z Zellballen 206 Zellweger syndrome 876 Zimmerman Laband syndrome 386, 878 Zinc chloride 165 Zinc deficiency 809 Zinsser-Engman-Cole syndrome 249, 875 Zona 510, 512 Zoster-Infection 637 Zoster sine herpete 513 Zycomycosis 495 Zymogen granules 421 1025 ... mucocutaneous infection with ulcers persisting more than one month 527 Textbook of Oral Pathology 528 Figure 21 .2 Features of HIV infection Malignancy: Kaposi’s sarcoma and squamous cell carcinoma... Kaposi’s sarcoma 531 Textbook of Oral Pathology 5 32 Management Clinical Features Treatment is determined on the basis of the number, size and location of the oral lesions The choice of therapy depends... predictor of HAAAT failure in Brazilian HIV infected patients Oral Dis 20 06; 12: 4 02- 7 Neville BW, Damm DD, Allen CM, Bouquot JE Oral and maxillofacial pathology, 3rd edn, Saunder Elsevier; 20 09 10