THIRD KDITION Textbook of ORAL MEDICINE Pramod John R Foreword MS Valiathan :> Textbook of Oral Medicine www.pdflobby.com Prilims .indd 11-11-2013 17:27:02 www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 Textbook of Oral Medicine Third Edition Pramod John R BSc BDS MDS Professor and Head Department of Oral Medicine and Radiology Amrita College of Dentistry Amrita Institute of Medical Sciences and Research Kochi, Kerala, India Formerly Associate Professor Department of Oral Medicine and Radiology College of Dental Surgery, Kasturba Medical College Mangalore, Karnataka, India Professor and Head Department of Oral Medicine and Radiology Mahatma Gandhi Postgraduate Institute of Dental Sciences Indira Nagar Complex, Puducherry, India Foreword MS Valiathan Jaypee Brothers Medical Publishers (P) Ltd New Delhi • London • Philadelphia • Panama www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 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Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and not necessarily represent those of editor(s) of the book All rights reserved No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book This book is sold on the understanding that the publisher is not engaged in providing professional medical services If such advice or services are required, the services of a competent medical professional should be sought Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com Textbook of Oral Medicine First Edition: 1998 Second Edition: 2005 Third Edition: 2014 ISBN 978-93-5090-850-1 Printed at www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 Dedicated to My Students, Past, Present, and Future www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” —Sir William Osler (1849–1919) www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 Foreword Our country has over 100 Dental Colleges which graduate 5,000 dentists every year, not to speak of specialists in dental disciplines These numbers are bound to grow in the face of everincreasing demand from our population The pressure for expansion will strain the resources of dental education, which would be obliged to expand without detriment to quality The publication of textbooks is an essential component of a strategy to meet the twin challenge It not only spares the student from buying high-priced and over-priced books from abroad but also promotes the writing of textbooks for which abundant talent in terms of authorship and publishing exists Dr Pramod John R has made excellent use of his clinical and teaching experience in the Department of Oral Medicine and Radiology to write the Textbook of Oral Medicine, which seeks to answer the requirements of the syllabi of various Indian universities as well as those universities abroad In the comprehensive textbook style, the book covers the clinical examination, pathology, investigation, and therapy of oral diseases and the oral manifestations of systemic diseases The author needs to be complimented on making a special effort to address the examination needs of the undergraduates and postgraduates who, I hope, will welcome this publication MS Valiathan ChM FRCS FRCS(C) Formerly Director Sri Chitra Institute of Medical Sciences and Research Vice-Chancellor Manipal Academy of Higher Education Manipal, Karnataka, India www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 Preface to the Third Edition When the first edition of the book Handbook of Oral Medicine, was released there was no Indian book available in the subject area, which basically covers the Indian syllabus Now the market is flooded with many Indian and imported books Most of the international publishers market their books in India that lack conformity with the curriculum prescribed by most of the Indian universities The students are confused about choosing the correct book Though all the books give adequate information about the subject and the students must study from multiple books, it is a sad fact that just before the examination, it is not possible to go through voluminous study material This book titled, Textbook of Oral Medicine, has been written by keeping the needs of the undergraduate and postgraduate students in mind Compared to the second edition, the third edition has been thoroughly rewritten and all the latest information has been provided so that the book is up-to-date in all respects More clinical photographs have been added so that the students will be able to appreciate the clinical picture of the oral diseases Newer and scientifically accepted classifications have been used in the book At the same time, unnecessary details regarding various studies and researches are avoided for the ease of understanding the subject It is my sincere hope that this book will be accepted by the undergraduate and postgraduate student community I request the readers to communicate their valuable opinions, suggestions, and constructive criticisms to improve the future editions of the book Pramod John R www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 ... xviii Textbook of Oral Medicine Chapter 20: Oral Cancer and Principles of Radiotherapy 249 Etiology of Oral Cancer 250 Mechanism of Carcinogenesis 250 Tnm Classification and Staging of Oral. . .Textbook of Oral Medicine www.pdflobby.com Prilims .indd 11-11-2013 17:27:02 www.pdflobby.com Prilims .indd 11-11-2013 17:27:03 Textbook of Oral Medicine Third Edition Pramod John... effective treatment Oral medicine was earlier termed as stomatology In some of the universities, the subject area is also termed as oral medicine and oral diagnosis In oral medicine or oral diagnostic