www.ajlobby.com POCKETBOOK of ORAL DISEASE www.ajlobby.com for Elsevier: Commissioning Editor: Alison Taylor Development Editor: Lynn Watt Project Manager: Andrew Riley Designer/Design Direction: Stewart Larking www.ajlobby.com POCKETBOOK of ORAL DISEASE Crispian Scully CBE MD PhD MDS MRCS BSc FDSRCS FDSRCPS FFDRCSI FDSRCSE FRCPath FMedSci FHEA FUCL DSc DChD DMed[HC] DrHC Emiritus Professor, University College London, UK Jose V Bagan MD DDS PhD Professor of Oral Medicine, Valencia University and Hospital General Universitario de Valencia, Valencia, Spain Marco Carrozzo MD DSM Professor of Oral Medicine, Newcastle University, Honorary Consultant, Royal Victoria Infirmary Hospital, Newcastle upon Tyne, UK Catherine M Flaitz DDS MS Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, The University of Texas School of Dentistry at Houston; Associate Faculty, McGovern Center for Humanities and Ethics, The University of Texas Medical School at Houston; and Associate Staff, Texas Children’s Hospital, Baylor College of Medicine, Texas, USA Sergio Gandolfo MD DDS Professor, Head of the Oral Medicine and Oral Oncology Section, Department of Oncology, University of Turin, Orbassano (Turin), Italy Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 www.ajlobby.com www.ajlobby.com CONTENTS Preface ix Introduction Dangerous conditions History Examination Anatomical features or developmental anomalies 18 Lesion descriptors 31 Differential diagnosis by signs and symptoms 33 Bleeding 34 Burning mouth 37 Desquamative gingivitis 41 Dry mouth (hyposalivation and xerostomia) 42 Halitosis (oral malodour) 47 Mucosal blisters 51 Mucosal brown and black lesions 53 Mucosal erosions 60 Mucosal fissures or cracks 62 Mucosal purpura 68 Mucosal red lesions 70 Mucosal ulceration or soreness 74 Mucosal white lesions 81 Pain (orofacial) 89 Palsy (orofacial) 92 Sensory changes (orofacial) 96 Sialorrhoea (hypersalivation and drooling) 101 Swellings in the lips or face 103 Swellings in the mouth 107 Swellings in the neck 116 Swellings of the jaws 119 v www.ajlobby.com Pocketbook of Oral Disease Swelling of the salivary glands 120 Taste disturbance 127 Tongue: furred 131 Tongue: smooth (glossitis) 134 Tongue swelling 136 Tooth abrasion 137 Tooth attrition 138 Tooth discolouration 139 Tooth erosion 143 Tooth hypoplasia 144 Tooth mobility or premature loss 147 Tooth number anomalies 148 Tooth shape anomalies 150 Trismus 152 Differential diagnosis by site 157 Cervical lymph node disease 158 Salivary gland disease 161 Lip lesions 179 Intraoral lesions 200 Coloured lesions: red 202 Coloured lesions: brown 207 Soreness/ulcers 211 White lesions 243 Intraoral soft tissue lumps and swellings 259 Tongue lesions 265 Palatal lesions 283 Gingival lesions 291 Jaw and musculoskeletal conditions 302 Neurological and pain disorders 318 Teeth-specific disorders 324 Iatrogenic conditions 329 Immunosuppressive therapy 329 Radiotherapy 332 Chemotherapy 334 Organ transplantation 335 vi www.ajlobby.com Contents Haematopoietic stem cell transplantation 335 Drugs 337 Other iatrogenic conditions 337 Immune defects and haematological defects and malignancies 351 Human immunodeficiency virus (HIV) disease 351 Leukopenia and neutropenia 356 Leukaemias 358 Lymphomas 360 Diagnosis 363 Diagnosis of mucosal disorders 363 Diagnosis of salivary disease 364 Diagnosis of jaw disorders 365 Diagnosis of dental disorders 366 Diagnosis of pain and neurological disorders 366 Investigations 371 Blood tests 371 Microbiological tests 371 Salivary flow determination 371 Biopsy 372 Imaging 384 Adjunctive screening tests 385 Management protocols for patients with oral diseases treated in primary care settings 387 Referral for specialist advice 395 10 Further information 397 Glossary of eponymous diseases and syndromes 397 Glossary of abbreviations 408 Further reading 412 Index 413 vii www.ajlobby.com This page intentionally left blank www.ajlobby.com Index examination 12–13 fissures/cracks in 66, 67f, 104f lesions see Lip lesions racial pigmentation 28f–30f swelling 103–106, 104f–105f, 189f tightening, in scleroderma 206f Lobulated tongue following hyposalivation 45f Sjögren syndrome with 174f Loss of taste 128 Lower motor neurone (LMN) lesions 11 Lupus erythematosus (LE) 230, 231f see also Discoid lupus erythematosus (DLE) Lymphadenopathy 158–159 Lymphangioma 105f, 113f, 262, 263f Lymphoid tissue, tongue 13–14 Lymphoma 159f, 176, 361f, 361t non-Hodgkin 234–236 M Macrocheilia 262 Macroglossia (enlarged tongue) 114, 136f, 267f Macules, melanotic 53, 194–196, 195f Maffucci syndrome 184 Magnetic resonance imaging (MRI) 312, 384–385 Malignant disease carcinoma see Carcinoma 269 cervical lymph node disease 160 chemotherapy 114, 334, 334t leukaemia see Leukaemia mortality rate 1–2 mucosal ulceration 77 multiple myeloma 97f potentially malignant 1–2, 382f sensory changes, orofacial 96 signs and symptoms, oral skin disorders 236 see also Malignant melanoma sublingual gland 168, 169f white lesions 243–259 Malignant melanoma 54, 208–210, 209f Management protocols, primary care settings 387 Mandibular dysfunction/stress syndrome 315–316, 317f Mapping incisional biopsy 376f Masseteric hypertrophy 306–307 Masticatory mucosa, examination 13 Measles 256, 257f Median rhomboid glossitis 280, 281f Melanocytes 12–13 Melanotic macules 53, 195f Melkersson–Rosenthal syndrome 23, 196, 278 Melphalan 334 Metastatic carcinoma 115f Methotrexate use 78, 172, 346f Metronidazole 294 Michels solution 382 Miconazole 64, 244–245 Microbiological tests 371 Middle ear disease 93 Miescher cheilitis 196 Migrainous neuralgia 89 Mikulicz disease (bilateral parotid inflammation) 122f, 178–179 427 Index Milk teeth, development 16 Minocycline pigmentation 55f, 344f MMR (measles, mumps and rubella) vaccine 164–166 Molar teeth, development 16 Moon/mulberry molars 146 Morsicatio buccarum (cheek biting) 87f, 246, 247f Mortality rate, high 1–2 Motor functions, trigeminal Mouth burning 37–41, 37f, 40f dry 42–45, 45f–46f, 173–176, 173f–174f, 206f floor of 13–14, 165f mucocele in floor of 165f swollen see Intraoral swelling see also Lip lesions; Lips; Teeth; Tongue; Tongue lesions Mucoceles, salivary gland 52, 120–124, 125f, 164, 165f in floor of mouth 165f lip lesions 197f superficial 164 Mucoepidermoid carcinoma 168 Mucosal barrier injury see Mucositis Mucosal conditions black and brown lesions 53–58, 57t, 59f blisters 51–52 diagnosis 363–364 erosions 60, 61f fissures/cracks 62–66, 63f, 65f, 67f history intraoral examination 11–12 neuromas 268 428 purpura 68, 69f, 71, 74 red lesions 70–74, 72f ulceration/soreness 74–78, 74f–76f, 79f–81f white lesions 81–87, 82f–88f Mucosal tags, Crohn disease 225f Mucosa-sparing blocks 332 Mucositis 60, 78, 333f, 334 Multifocal epithelial hyperplasia 262 Multiple myeloma 97f Mumps (acute viral sialadenitis) 120–121, 164–166, 167f Mycophenolate mofetil 236 Myofascial pain dysfunction (MFD) 315–316, 317f N Naevus brown lesions 210–211, 210f hyperpigmentation 53f white sponge 82f, 247f, 258–259, 258f Nasopharyngeal disease 48 Neck actinomycosis, showing purple swelling 159f examination lymphoma presenting as upper cervical lymph node enlargement 159f swollen 116–117 actinomycosis 159f midline of neck 117 side of neck 117 Necrotizing sialometaplasia 289, 289f Index Necrotizing ulcerative gingivitis (NUG) 75f, 292–294, 294f–295f in HIV/AIDS 355f in leukaemia 359f Neoplasms in left mandibular ramus (multiple myloma) 97f salivary glands 111f, 123f, 166–170, 167f, 169f, 171f intraoral (minor) 168–170 major glands 168 palatal minor glands 169f sublingual gland 169f Nerve, tooth 16 Neurilemmoma (benign nerve sheath tumour) 268 Neuroectoderm, teeth developed from 16 Neurofibroma 115f, 268 Neurofibromatosis 268, 269f Neurological conditions see Pain/ neurological conditions Neurological system, examination 8–11 Neuropraxia (crushed nerve) 98 Neurotmesis (cut nerve) 98 Neutropenia 356 Nicorandil use 346f Nicotine stomatitis (smoker’s keratosis) 87f, 290–291, 290f Nifedipine, gingival swelling 343f Nikolsky sign, pemphigoid 233f, 234 Nontropical sprue (coeliac disease) 209f, 223–224 Numb chin syndrome (NCS) 96, 97f, 99 Nystatin 64, 244–245 O Obstruction parotid duct 121f salivary gland 121–122, 124–125, 125f Odontogenic cysts and tumours 303f, 308, 309f–310f Odontome, complex 309f Oesophageal disease 48 Opitz syndrome 266 Opportunistic infections 329 Oral disease, predisposing factors Oral hygiene, poor: tooth discolouration 139f, 346f Oral lichen planus biopsy 375, 382f Oral malodour 47–49, 49f–50f Oral submucous fibrosis (OSMF) 153f, 256–258, 257f Oral tongue 13 Orbicularis oris muscle, lips 12 Organ transplantation 335, 335t Oroantral fistula, traumatic 349f Orofacial granulomatosis (OFG) 196–198 see also Crohn disease Orofacial pain see Pain/neurological conditions Orofacial palsy 92–94, 94f–95f Oropharynx 14–15 Orthopantomography (OPTG) 384 Osler–Rendu–Weber syndrome (hereditary haemorrhagic telangiectasia) 35f, 205–206, 205f Osteitis 311 Osteomyelitis 96, 311–312 Osteonecrosis 78, 302, 312–314, 345f Osteoradionecrosis (ORN) 313–314 429 Index P Paediatric patients, dental caries in Paget disease 314 Pain/neurological conditions 318–322, 319f benign trigeminal neuropathy 99 diagnosis 366–369 drug-induced 91 giant cell arteritis 320, 321f history 5–6 idiopathic facial pain 320–321 local diseases 90–91 myofascial pain dysfunction 315– 316, 317f orofacial pain 89–91, 92f psychogenic pain 89, 91 referred pain 91 salivary gland conditions 161–162 scans for 323f temporomandibular pain– dysfunction syndrome 315–316, 317f trigeminal neuralgia 322, 323f vascular disorders 91 Palatal lesions 283–291, 285f–290f angina bullosa haemorrhagica 284, 285f denture-related stomatitis 72f, 284–287, 285f–286f Kaposi sarcoma 287–288, 287f–288f necrotizing sialometaplasia 289, 289f papillary hyperplasia 286f Peutz–Jegher syndrome 199f red 283 smoker’s keratosis (stomatitis nicotina) 87f, 290–291, 290f 430 Palatal petechiae, with glandular fever 219f Palatal pigmentation, drug-induced 343f–344f Palate candidosis in HIV/AIDS 72f examination 14–15 see also Palatal lesions; Palatal petechiae; Palatal pigmentation, drug-induced Palsy 1–2, 92–94, 94f–95f, 319f Bell 92–93, 94f, 318, 319f glossopharyngeal 15 orofacial 319f Papillae circumvallate 13, 27f filiform and fungiform 13, 27f foliate 13 interdental 342f parotid see Stensen ducts Papillary hyperplasia 286f Papilloma in HPV 262 mucosal white lesions 83f swollen mouth 109f Paraneoplastic pemphigus 234–236 Parotid duct obstruction 121f Parotid gland enlargement 16–18, 163f left enlarged 163f lesions 93 pleomorphic adenoma in tail 167f swelling, in sarcoidosis 171f Parotid papillae see Stensen ducts Parotitis 123f, 163f Paul–Bunnell test 218 Peg-shaped lateral incisor 151f Index Pemphigoid 230–234, 232f–233f blistering in 51f, 233f conjunctival 232f desquamative gingivitis 41, 43f, 233f morbidity 1–2 ulceration 232f Pemphigus 1–2, 51, 234–236, 235f Nikolsky sign 233f, 234 Penciclovir cream 194 Pencillamine, reaction to 242f Periapical abscess 107f Periodic acid Schiff (PAS) 244 Periodontal ligament 15 Periodontitis 49f, 147, 292 Perleche 64 Permanent teeth, development 16 Personality disorder 190 Petechia 68, 219f Peutz–Jegher syndrome 196, 198–200, 199f Pharyngeal disease 49 Pharyngeal tongue 13 Phenytoin, gingival swelling 342f Philtrum, upper lip 12 Phosphate buffered saline (PBS) 382 Photodynamic therapy 272 Pigmentary incontinence 53 Pilocarpine 162 Pink stain 142 Plaque accumulation 147 Pleomorphic adenoma 123f, 167f, 170 pleomorphic salivary adenoma (PSA) 168 Polyp, fibroepithelial 108f, 260, 261f Posterior lingual papillary atrophy 280, 281f Posterior midline atrophic candidosis 280, 281f Pregnancy epulis 300–301, 301f Pregnancy gingivitis 300, 301f Pregnancy tumour 107f Primary herpes simplex stomatitis 293f Primary syphilis 220, 220f Primary teeth, development 16 Propionibacterium propionicus 302 Psychogenic pain (oral dysaesthesia) 89, 91 Pterygoid hamulus 18 Pulp, tooth 16 exposure, avoiding by secondary dentine deposition 138f Pupil size, extraoral examination Purpura blood blisters in 51f with leukaemia 360f mucosal 68, 69f, 71, 74 oral localized 284, 285f Pyogenic granuloma 200, 201f Pyostomatitis vegetans, in ulcerative colitis 227f R Racial pigmentation lips 28f–30f Radicular cyst, jaw 310f Radiotherapy 332, 332t, 333f Ramsay–Hunt syndrome 216 Ranula (mucocele, in floor of mouth) 164, 165f Raynaud syndrome 230 431 Index Recreational drugs 368 Recurrent aphthous stomatitis (RAS) 75f–76f, 78, 236–238 see also Aphthae Red lesions 202–207, 202f–206f angioma (haemangioma) 71f candidosis 70f, 72f, 202f see also Erythematous candidosis carcinoma, presenting as 72f diagnosis 73f erythematous candidosis 202– 207, 202f erythroplakia 72f, 203–205, 203f–204f hereditary haemorrhagic telangiectasia 35f, 205–206, 205f incisional biopsy 376f–377f mucosal see Red lesions, mucosal in palate 283 pemphigus ulceration 235f scleroderma 135f, 206–207, 206f Red lesions, mucosal 70–74, 72f see also White lesions, mucosal Redness generalized 70 localized red patches 71 Referral for specialist opinion 395–396 Referred pain 91 Relevant Medical History (RMH) Renal failure, leukoplakia 250 Rheumatoid arthritis 177f Riga–Fede disease 282 Rituximab 179, 236 Ro (SS-A) antibody 178 Root, dentine 16 432 S Saliva frothy 45f, 173–176 reduced 42 see also Dry mouth Saliva pH test 385–386 Saliva stimulants 162 Salivary flow determination 371, 372t Salivary gland conditions 161–179, 163f, 165f, 167f, 169f, 171f, 173f–175f, 177f acute bacterial sialadenitis 162 diagnosis 364–365 history 4–5 in HIV/AIDS 355f inflammation 161 investigations 371, 372t mucoceles see Mucoceles, salivary gland mumps (acute viral sialadenitis) 120–121, 164–166, 167f necrotizing sialometaplasia 289, 289f neoplasms see under Neoplasms obstruction 121–122, 124–125, 125f pain 161–162 parotitis 163f sarcoidosis 170–172, 171f sialosis 172–173, 173f Sjögren syndrome see Sjögren syndrome sublingual gland, malignant tumour 169f submandibular salivary calculus 121f Index swollen glands see under Salivary glands Salivary glands examination 12–13, 16–18 radiation effects 333f swelling 116, 120–125, 121f– 123f, 125f–126f, 161, 177f Salt-split skin indirect immunofluorescence 234 Sarcoidosis 170–172, 171f Scanning 323f, 385 Scarring, epidermolysis bullosa 229f Schwannoma 268 Scintigraphy 178 Scleroderma 135f, 206–207, 206f Screening tests, adjunctive 385–386 Sebaceous glands 12–13 Secondary syphilis 220–221, 220f Sensory changes, orofacial 96–99, 97f, 100f congenital causes 99 psychogenic causes 99 Sepsis, oral 48 Serum angiotensin converting enzyme (SACE) 172, 318 Serum antibody screening 224 Shingles (herpes zoster) 194, 195f, 216–217, 330f Sialadenitis, acute 122f bacterial 162 bilateral 167f viral 120–121, 164–166, 167f Sialogogues 162 Sialography 178 Sialorrhoea (hypersalivation) 101– 102, 103f Sialosis 172–173, 173f Sinuses, extraoral examination Sinusitis 315 Sjögren syndrome 173–178, 173f–175f, 177f candidosis 175f caries 175f dry mouth 173f–174f, 206f fissured tongue 23 glossitis 135f keratoconjunctivitis sicca with 177f lobulated tongue 174f lupus erythematosus with 230 swelling of salivary glands with 177f Skin disorders blisters 52 epidermolysis bullosa 228, 229f leukopenia 357f lichen planus see Lichen planus lupus erythematosus 230, 231f pemphigoid see Pemphigoid pemphigus 234–236, 235f swelling 116 ulceration 228–236, 229f, 231f–233f, 235f SLE see Systemic lupus erythematosus (SLE) Slough, fibrinous (erosions showing) 61f Smoking smoker’s keratosis (stomatitis nicotina) 87f, 250, 290–291, 290f tooth discolouration 139f, 290f, 346f Snuff-dipping 248 Social History (SH) Soft palate 14 Soreness see under Pain; Ulceration 433 Index Specialist opinion, referral for 395–396 Stafne cavity, in mandible 30f Stensen ducts examination 15–18 purulent discharge from 163f Stevens–Johnson syndrome 188 Stomatitis acute herpetic 131f angular 64, 65f denture-related 72f, 284–287, 285f–286f, 349f herpetic 213–215, 213f–215f primary herpes simplex 293f recurrent aphthous stomatitis 75f– 76f, 78 see also Aphthae Stomatitis nicotina (smoker’s keratosis) 87f, 250, 290–291, 290f Stratified squamous epithelium, lichen planus affecting 250–255 Stress crenated tongue 275f white lesions from 247f Striae, biopsy of 382f Sturge–Weber syndrome 182 Sub-epithelial split 51 Sublingual gland malignant tumour 168, 169f mucocele 164 Sublingual keratosis 249f, 250 Sublingual varices 26f Submandibular duct 18 Submandibular gland 18 Submandibular obstruction 125f Submandibular salivary calculus 121f Submucous fibrosis 1–2 Sulcus terminalis, tongue 13–14 434 Sulphasalazine 227 Superficial lesions, excisional biopsy 372, 373f Supernumerary teeth 149 Suture, excisional biopsy 375f Swelling drug-induced 296–298, 297f, 342f–343f gingival see Gingival swelling jaw 119–120, 120f in lips or face 7, 103–106, 104f–105f, 189f lymphoma 361f in mouth see Intraoral swelling neck 116–117, 159f salivary glands 116, 120–125, 121f–123f, 125f–126f, 161, 177f tongue 136, 269f see also Macroglossia (enlarged tongue) Swollen glands see under Swelling Symblepharon, with conjunctival pemphigoid 232f Syphilis 1–2, 218–221, 220f–221f Syphilitic leukoplakia 250 Systemic lupus erythematosus (SLE) 186, 230 T T lymphocyte function, immunosuppressive therapy 329, 335 Tacrolimus 187 Tar-stained teeth 290f Taste buds 13 Taste disturbance 127–130, 130f Index Taste sensation 14 Tattoo, amalgam 54f–55f, 200, 208, 209f, 347f Teeth development 16 examination 16 surface loss 143f unerupted 22, 283 see also Tooth abrasion; Tooth anomalies; Tooth attrition; Tooth discolouration; Tooth erosion; Tooth hypoplasia; Tooth mobility Telangiectases 74 Telangiectasia multiple 205f see also Hereditary haemorrhagic telangiectasia (HHT) Temporomandibular pain–dysfunction syndrome (TMPD) 315–316, 317f Temporal arteritis see Giant cell arteritis Temporomandibular joint (TMJ) 5, Tertiary syphilis 221, 221f Tetracycline 238, 328 Thrombocytopenia 34 Thrush (acute pseudomembranous candidosis) 243–244, 243f Thyroid gland swellings 116 Tissue removal, excisional biopsy 374f Toluidine blue staining 11–12, 363, 377f Tongue black hairy 58 brown hairy 58, 132f candidosis on 202f circumvallate papillae 13, 27f coated acute herpetic stomatitis 131f betel use 133f brown hairy tongue 132f chlorhexidine mouthwash use 133f no apparent reason 131f crenated 274, 275f enlargement see Macroglossia (enlarged tongue) examination 13–14 filiform and fungiform papillae 13, 27f fissured 23, 23f, 63f, 278, 279f furred 39f, 131–132, 132f–133f lesions see Tongue lesions lobulated 45f, 174f oral 13 pharyngeal 13 posterior 13–15 smooth (glossitis) see Glossitis (smooth tongue) swollen 136, 269f see also Macroglossia (enlarged tongue) taste buds 13 ulceration 131f Tongue dorsum 13–14 Tongue lesions 265–291, 267f, 269f–271f, 273f, 275f–277f, 279f, 281f amyloidosis 266–268, 267f ankyloglossia 266 benign nerve sheath tumour 268 candidal glossitis 70f, 134f–135f, 272–273, 273f 435 Index carcinoma 269–272, 270f–271f erythema migrans 274–277, 275f–277f foliate papillitis 278 hyposalivation 279f median rhomboid glossitis 280, 281f neurofibromatosis 269f traumatic ulcerative granuloma 282–283, 282f Tonsils 14–15 Tooth abrasion 137 Tooth anomalies number 148–150 shape 150–152 Tooth attrition 138–139 Tooth decay see Caries Tooth discolouration 139–142 Tooth erosion 143–144 Tooth eruption times 17t Tooth hypoplasia 144–146, 145f, 147f Tooth mobility 147, 292 Tooth staining black stain 142 blue stain 142 brown stain 142 drug-induced 345f–346f green stain 142 pink stain 142 smoking 139f, 290f, 346f white stain 142 yellow stain 142 see also Discolouration, tooth Tooth structure 16 Tooth-brushing friction, white lesions of keratosis from 249f Tooth-specific disorders 436 amelogenesis imperfecta 324– 328, 325f dentinogenesis imperfecta 326, 327f fluorosis 326–328, 327f tetracycline staining 328 Torus mandibularis 20, 20f–21f, 22 Torus palatinus 22f, 283 Total body irradiation (TBI) 335 Toxic epidermal necrolysis 188 Transglutaminase 224 Transplantation haematopoietic stem cell 60, 335, 336t, 337f organ 335, 335t Trauma jaw examination occlusal frictional 246f purpura in 68 sensory changes 98 tooth discolouration 141f tooth loss 147, 292 ulceration 236, 237f Traumatic oroantral fistula 349f Traumatic ulcerative granuloma (TUG) 282–283, 282f Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) 282– 283, 282f Triamcinolone 64 Trigeminal (V) nerve, examination 10 Trigeminal nerve mandibular division, trauma to 98 maxillary division, damage to 98 shingles 330f Trigeminal neuralgia 1–2, 89, 322, 323f Index Trigeminal sensory loss diagnosis 100f Trismus 152–154, 153f Tuberculosis (TB) 1–2, 222–223, 222f Tumours benign nerve sheath 268 jaw 302 Kuttner tumour (Mikulicz disease) 178–179 odontogenic 1, 303f, 308, 309f–310f pregnancy 107f sublingual gland 169f see also Cysts; Malignant disease Turner tooth 144–146, 145f U Ulceration acute ulcerative gingivitis 292– 294, 294f–295f aphthae 236–238 aphthous-like 74, 238, 240 Behỗet disease 241f in coeliac disease 223f vitamin deficiency 241f Behỗet disease 76f, 240242 blood disorders 211 and Crohn disease 112f denture flange, over-extended 237f drug-induced 78, 242, 242f, 346f duration of single ulcers 74 gastrointestinal disorders 223– 227, 223f, 225f–227f gingiva/gingival margin 292, 357f glandular fever (infectious mononucleosis) 219f hand, foot and mouth disease 211f herpangina 212f herpes simplex, in HIV/AIDS 352f herpetic stomatitis 213f–215f herpetiform 239f infectious causes 211–223 leukaemia 359f–360f leukopenia 357f local causes 236–242, 237f, 239f, 241f lymphoma 361f mucosal see Ulceration, mucosal mucositis 60, 333f in palate 283 pemphigoid 232f primary herpes simplex stomatitis 293f recurrent herpes 214f skin disorders 228–236, 229f, 231f–233f, 235f syphilis 220f–221f systemic causes 211 tongue 131f trauma 236, 237f tuberculosis 222f varicella-zoster virus 217f see also Pain Ulceration, mucosal 74–78, 74f–76f, 79f acute ulceration 79f BIGS acronym 77 diagnostic algorithms 79f–81f local causes 78 malignant disease 77 437 Index multiple ulcers 80f–81f persistent 79f–80f recurrent 80f–81f single ulcer 79f So Many Laws and Directives acronym 77 systemic disease 77 see also Erosions, mucosal Ulcerative colitis (UC) 223, 227, 227f Ultrasound scanning (US) 385 Ultrasound-guided fine needle aspiration biopsy 186, 272, 385 Unerupted teeth 22, 283 Upper motor neurone (UMN) lesions 11 V Valacyclovir 194, 217 Varicella 216, 217f Vascular disorders, orofacial pain 91 Vermilion, lip 12–13 Verrucous carcinoma 85f Verrucous leukoplakia, proliferative 86f, 292 Visualization aids 385–386 Vitamin deficiency aphthae 236–238 aphthous-like ulceration 241f glossitis 134f, 135 Von Recklinghausen neurofibromatosis 268 W Waldeyer ring of lymphoid tissue, tongue 13–14 Wegener granulomatosis 114 438 Wharton duct 18 White lesions candidosis 200, 243–245, 243f, 245f, 354f carcinoma 74f, 110f–111f cheek biting (morsicatio buccarum) 87f, 246, 247f keratosis 249f Koplik spots, in measles prodome 257f leukoplakia see Leukoplakia lichen planus see Lichen planus linea alba 255–256 lupus erythematosus 231f malignant disease 243–259 measles 256 mucosal see White lesions, mucosal occlusal frictional trauma 246f oral submucous fibrosis 153f, 256–258, 257f stress 247f sublingual keratosis 249f ulcerated, carcinoma presenting as 74f White lesions, mucosal 81–87, 82f–88f acquired causes 82–87 carcinoma 84f–85f diagnostic algorithm 88f hereditary causes 82, 82f infective 83f lichen planus 84f papilloma 83f proliferative verrucous leukoplakia 86f, 292 stomatitis nicotina 87f see also Red lesions, mucosal Index White sponge naevus 82f, 247f, 258–259, 258f White stain, tooth discolouration 142 Wisdom teeth, development 16 X Xerostomia 42–45 Y Yellow stain, tooth discolouration 142 Z Z-plasty 66 439 This page intentionally left blank ABOUT THE AUTHORS Crispian Scully CBE MD PhD MDS MRCS BSc FDSRCS FDSRCPS FFDRCSI FDSRCSE FRCPath FMedSci FHEA FUCL DSc DChD DMed[HC] DrHC Crispian Scully is President of the International Academy of Oral Oncology and President-Elect of the British Society for Oral Medicine He has written and edited over 40 books, written over 150 book chapters and has over 900 papers cited on MEDLINE plus over 300 others He is Co-Editor of Oral Diseases, Medicina Oral, and Associate Editor of the Journal of Investigative and Clinical Dentistry He has received the CBE, University of Helsinki Medal of Honour, University of Santiago de Compostela Medal, University of Granada Medal, Fellowship of UCL, and honorary degrees from the Universities of Athens, Granada, Helsinki and Pretoria He has received the UK Dental Award for the Most Outstanding Achievements in Dentistry, the Award of the Spanish Society for Oral Medicine and the Hellenic Society for Oral Medicine Jose Vicente Bagan MD DDS PhD Jose Bagan graduated in Medicine and Surgery at Valencia University, Spain, and then gained his PhD at Valencia University He directs the Service of Stomatology at Valencia University General Hospital and is Full Professor of Oral Medicine at Valencia University Jose is President of the European Association of Oral Medicine and President of the Research Commission, Valencia University General Hospital He is Director of the journal Medicina Oral, Patología Oral y Cirugía Bucal, and Associate Editor of the journal Oral Diseases as well as being on several other Editorial Boards Jose is the author of 10 books, 33 book chapters, and over 310 published papers in oral medicine He has been awarded 20 prizes in odontostomatology Marco Carrozzo MD DDS Marco Carrozzo is Professor of Oral Medicine, School of Dental Sciences and Honorary Consultant in Oral Medicine, RVI Hospital, Newcastle upon Tyne, UK Marco graduated in Medicine and Surgery at the University of Turin, Italy, and specialized in odontostomatology, becoming researcher and Consultant in Oral Medicine at the University of Turin He is author and co-author of over 180 scientific publications including several papers on oral cancer and potentially 441 ... PREFACE This Pocketbook of Oral Disease is aimed at graduating dental care students and, as such, assumes knowledge of basic sciences and human diseases and offers the basics of oral diseases The... such Pocketbook of Oral Disease as HIV/AIDS, tuberculosis or syphilis (all of which may be lethal) Other conditions have a high morbidity (incidence of ill health), and these include temporal... at least (Box 1.1): • date of onset of symptoms • symptom details, such as duration and character, referred pain Pocketbook of Oral Disease Box 1.1 Characteristics of pain (SOCRATES) Site Onset