Oral Pathology for the Dental Hygienist 6th Edition Ibsen Test Bank

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Oral Pathology for the Dental Hygienist is your source for the most trusted content in oral pathology. With more than 50 years of combined real-world experience, Olga Ibsen and Joan Phelan have created a text that offers the ideal combination of clinical photographs, radiographs and discussion to help you identify, understand, evaluate, and document the appearance of normal and disease states. This user-friendly, atlas-style text features the learning tools and updated content you need to prepare for success on your exams and throughout your professional career.

 

Table of Content:

  1. Chapter 1 Introduction to Preliminary Diagnosis of Oral Lesions
  2. Objectives
  3. Vocabulary
  4. Clinical Appearance of Soft Tissue Lesions
  5. Soft Tissue Consistency
  6. Color of Lesion
  7. Size of Lesion
  8. FIGURE 1-1 Lobulated torus palatinus.
  9. FIGURE 1-2 Fibroma with a pedunculated base. Arrow points to the stemlike base.
  10. FIGURE 1-3 Fibroma with a sessile base.
  11. FIGURE 1-4 A ruler measuring centimeters is used to measure all specimens submitted for microscopic examination.
  12. Surface Texture
  13. Radiographic Terms Used to Describe Lesions in Bone
  14. FIGURE 1-5 A, Probe measuring the diameter of a fibroma with a sessile base. B, Gutta-percha point used to explore a radiographic defect. C, Periodontal probe placed before a radiograph.
  15. FIGURE 1-6 Squamous cell carcinoma involving the alveolar bone and hard palate showing diffuse borders.
  16. FIGURE 1-7 Odontogenic keratocyst (arrow), illustrating a multilocular lesion.
  17. FIGURE 1-8 Prominent pulp chambers, horns, and canals in mandibular molars.
  18. FIGURE 1-9 A, Stage I periapical cemento-osseous dysplasia (cementoma). B, Stage II periapical cemento-osseous dysplasia (cementoma).
  19. FIGURE 1-10 Amalgam restorations on the occlusal surfaces of the maxillary and mandibular molars.
  20. FIGURE 1-11 Resorption of the roots on maxillary anteriors as a result of rapid orthodontic movement.
  21. FIGURE 1-12 Traumatic bone cyst (arrows) around the roots.
  22. FIGURE 1-13 Radicular cyst (arrow) at the apex of the maxillary lateral incisor, illustrating a unilocular lesion.
  23. FIGURE 1-14 Well-circumscribed median palatal cyst (arrow).
  24. The Diagnostic Process
  25. Making A Diagnosis
  26. Clinical Diagnosis
  27. FIGURE 1-15 Fordyce granules.
  28. FIGURE 1-16 Lobulated torus palatinus.
  29. FIGURE 1-17 Arrows point to mandibular tori.
  30. FIGURE 1-18 Melanin pigmentation.
  31. FIGURE 1-19 Arrows point to the retrocuspid papillae on the gingival margin of the lingual aspect of the mandibular cuspids.
  32. FIGURE 1-20 Fissured tongue.
  33. FIGURE 1-21 Median rhomboid glossitis (top arrow) and geographic tongue (bottom arrows).
  34. FIGURE 1-22 Geographic tongue. Arrows point to areas of depapillation.
  35. Radiographic Diagnosis
  36. FIGURE 1-23 A, White hairy tongue. B, White hairy tongue showing a circumvallate papilla (arrow). C, Black hairy tongue.
  37. FIGURE 1-24 Arrow points to an amalgam tattoo at the apical area of the patient’s maxillary right central incisor. This patient had a root canal procedure on a deciduous tooth. No other amalgam restoration is in the area; therefore it was helpful to know the patient’s past dental history to confirm this diagnosis.
  38. FIGURE 1-25 A, Periapical pathosis (PAP); a radiolucency is seen at the apex of the mandibular second premolar (arrow). B, In another patient a fistula is seen on the maxillary lateral incisor. A fistula is usually an indication of PAP. When a fistula is observed clinically, a radiograph is necessary for diagnostic and treatment purposes.
  39. FIGURE 1-26 Arrow points to the area of internal resorption on the maxillary first molar.
  40. FIGURE 1-27 Arrow points to external resorption on a mandibular central incisor.
  41. FIGURE 1-28 Arrows point to heavy interproximal calculus.
  42. FIGURE 1-29 A, Dental caries. The reader should observe the interproximal radiolucencies. Clinical examination is necessary to confirm the involvement of some of the areas. B, Periapical radiograph showing a subtle carious area on the distal aspect of the mandibular second premolar. C, The patient in (B) was seen a year later. During the scaling procedure a defect on the distal aspect of the mandibular second premolar was detected. This vertical bitewing radiograph was taken. The reader should note the definite radiolucent, carious area on the distal aspect of the mandibular second premolar. This example emphasizes the need for careful clinical and radiographic evaluation.
  43. FIGURE 1-30 Arrow points to compound odontoma.
  44. FIGURE 1-31 A, Compound odontoma rather easily diagnosed from the radiograph alone. B, Complex odontoma (arrow) not diagnosed from the radiograph alone.
  45. FIGURE 1-32 A, Mesiodens (arrow). A supernumerary tooth is located between the maxillary central incisors. B, A radiograph showing a supernumerary mandibular premolar (arrow) surrounded by a radiolucent area diagnosed as a dentigerous cyst. Clinically this area was thought to be a mandibular torus (until the radiograph was taken).
  46. FIGURE 1-33 A, Impacted mandibular cuspid. B, Impacted maxillary cuspid.
  47. FIGURE 1-34 Calcified pulp in the mandibular first molar.
  48. Historical Diagnosis
  49. FIGURE 1-35 A, Nutrient canals in the anterior maxillary arch. B, Nutrient canals in the mandibular anterior area. C, The mixed dentition of a 5-year-old child is observed in this radiograph.
  50. FIGURE 1-36 A, Arrow points to a 7-carat cubic zirconia (a round stone) that was glued to this patient’s maxillary left central incisor. B, The radiopaque area on the distal aspect of the mandibular second premolar (arrow) is an amalgam fragment. There was a subtle clinical amalgam tattoo in the interproximal papilla that was not detected or charted on initial examination, which included a full-mouth series of radiographs and incomplete scaling. When the radiographs were viewed after the patient was dismissed, the radiopaque area was thought to be the tip of a broken instrument. Further evaluation of the instruments used at that appointment ruled out the possibility of a broken instrument. When the patient returned for an additional appointment 2 weeks later, another radiograph, using the same long cone and precision Rinn instruments, was taken of the area. The radiopaque fragment remained in the exact same place. Clinically, a very close look at the interproximal papilla in the area then revealed a subtle bluish-black area. The dentist surgically slit the papilla on the buccal aspect and revealed the amalgam particle. C, This patient wore wide-framed eyeglasses during the radiographic procedure. The arrow points to a U-shaped radiopacity from the eyeglass frame. D, This radiograph reveals an obvious radiopaque overhang from the amalgam restoration on the distal aspect of the mandibular first molar. E, Instruments from a root canal procedure were broken in these two maxillary lateral incisors (arrows). F, The broken tip of a curet (arrow) is observed as a radiopaque area on the distal aspect of the maxillary first premolar. G, Arrow points to a retained deciduous tooth with an amalgam restoration. H, Arrow points to a radiopaque area that identifies a retained shotgun pellet on the distal aspect of the mandibular third molar. I, Arrow points to a radiopaque circular area that is a nose ring. J, Periapical radiograph showing a radiopaque area at the apex of the mesial root of the mandibular second molar. This object was a retained piece of shrapnel. K, Panoramic radiograph of the same patient showing the same object (arrow). This radiograph gives a more accurate view of the location of the object. It was found to be in the soft tissue in the area and not within bone.
  51. FIGURE 1-37 A, One of the clinical appearances of amelogenesis imperfecta. B, The radiographic aspect of amelogenesis imperfecta.
  52. FIGURE 1-38 A, Clinical appearance of dentinogenesis imperfecta. B, Radiographic appearance of dentinogenesis imperfecta.
  53. Laboratory Diagnosis
  54. FIGURE 1-39 A, Oral ulcers on the soft palate associated with ulcerative colitis. B, Gingival enlargement seen in a patient taking nifedipine, a calcium channel blocker. C and D, Urticaria. D, Same patient as in C 8 hours later.
  55. FIGURE 1-40 Skin grafts performed to enhance the mandibular ridge in (A) a white patient and (B) a black patient. Without the patients’ past medical and dental histories, it would be difficult to diagnose this anomaly of melanosis accurately.
  56. FIGURE 1-41 Radiographic appearance of Paget disease, showing the traditional irregular radiopacities (“cotton-wool effect”) in bone characteristic of this disease.
  57. Microscopic Diagnosis
  58. FIGURE 1-42 A, A white lesion is seen on the anterior floor and ventral surface of the tongue. B, Microscopic examination of the white lesion showed a thickened keratin layer, called hyperkeratosis, and some atypical changes in the basal layer of the epithelium (mild epithelial dysplasia). C, Erythroplakia (arrow) in this case diagnosed microscopically as squamous cell carcinoma.
  59. Surgical Diagnosis
  60. Therapeutic Diagnosis
  61. Differential Diagnosis
  62. FIGURE 1-43 Traumatic bone cyst.
  63. FIGURE 1-44 Arrow points to a static (Stafne) bone cyst.
  64. FIGURE 1-45 Angular cheilitis.
  65. FIGURE 1-46 A, Necrotizing ulcerative gingivitis (NUG). B, Another example of NUG. The clinician should note the gingival contours and punched-out, blunted papillae.
  66. Box 1-1 Case Study
  67. FIGURE 1-47 Arrow points to a pyogenic granuloma between the patient’s right maxillary central and lateral incisors.
  68. Variants of Normal
  69. Fordyce Granules
  70. FIGURE 1-48 Fordyce granules on the buccal mucosa.
  71. FIGURE 1-49 A, Radiopaque appearance of torus palatinus (arrows). B, Clinical appearance of torus palatinus.
  72. Torus Palatinus
  73. Mandibular Tori
  74. Melanin Pigmentation
  75. FIGURE 1-50 A, Clinical appearance of lobulated mandibular tori. B, Radiopaque appearance of mandibular tori in same patient.
  76. FIGURE 1-51 Melanin pigmentation of the mandibular gingiva.
  77. Retrocuspid Papilla
  78. Lingual Varicosities
  79. Linea Alba
  80. FIGURE 1-52 Lingual varices.
  81. FIGURE 1-53 Arrow points to linea alba on the buccal mucosa.
  82. FIGURE 1-54 Leukoedema of the buccal mucosa, showing an opalescent, velvety texture.
  83. Leukoedema
  84. Benign Conditions of Unknown Cause
  85. Lingual Thyroid Nodule
  86. Median Rhomboid Glossitis
  87. Geographic Tongue
  88. FIGURE 1-55 Median rhomboid glossitis.
  89. FIGURE 1-56 A, Geographic tongue. B, Ectopic geographic tongue observed in the mandibular anterior mucosa.
  90. Fissured Tongue
  91. Hairy Tongue
  92. FIGURE 1-57 Fissured tongue and attrition.
  93. FIGURE 1-58 White hairy tongue.
  94. FIGURE 1-59 Black hairy tongue.
  95. Selected References
  96. Books
  97. Journal Articles
  98. Review Questions media
  99. CHAPTER 1 SynopsisView PDFmedia
  100. Pageburst Integrated Resource
  101. Activities
  102. Chapter 2 Inflammation and Repair
  103. Objectives
  104. Vocabulary
  105. Injury
  106. Innate Defenses
  107. Inflammation
  108. Microscopic Events of Inflammation and Clinical Signs
  109. TABLE 2-1 Local and Systemic Clinical Signs of Inflammation and Associated Microscopic Events
  110. Box 2-1 Inflammatory Response: Sequence of Events
  111. FIGURE 2-1 Microscopic events during inflammation.
  112. FIGURE 2-2 Microscopic view of a blood vessel showing margination and pavementing of neutrophils (N) at the periphery of a small blood vessel during inflammation.
  113. FIGURE 2-3 Swelling caused by increased local edema associated with a dental infection. The patient was hospitalized for treatment of the swelling.
  114. FIGURE 2-4 Fistulas formed from periapical abscesses. A, A fistula formed from an abscess associated with a mandibular first molar. B, The opening of a fistulous tract from a mandibular incisor is noted on the skin of the chin. C, A periapical radiolucency at the area of abscess causing the fistula to the skin in (B).
  115. FIGURE 2-5 An intraoral abscess has been incised, and a drain (arrow) placed to allow the escape of purulent exudate from the tissue.
  116. FIGURE 2-6 Phagocytosis of a foreign substance (bacterium) by a white blood cell. The foreign substance will later be destroyed by digestion within the cell by lysosomal enzymes that are contained within lysosomes.
  117. White Blood Cells in the Inflammatory Response
  118. Neutrophils
  119. FIGURE 2-7 Changes in the white blood cell population of injured tissue over time, starting with acute inflammation, continuing to chronic inflammation, and extending to the beginning of the immune response.
  120. FIGURE 2-8 Microscopic view of acute inflammation, showing an increase in the number of neutrophils. Macrophages are also present (medium magnification).
  121. FIGURE 2-9 Microscopic view of chronic inflammation and the beginning of the immune response, mainly showing macrophages, lymphocytes, and plasma cells (medium magnification).
  122. FIGURE 2-10 A neutrophil has a multilobed nucleus and granular cytoplasm.
  123. Macrophages
  124. FIGURE 2-11 Derivation of white blood cells from a stem cell in the bone marrow.
  125. FIGURE 2-12 A macrophage. This cell was a monocyte when circulating in the blood.
  126. Biochemical Mediators of Inflammation
  127. Kinin System
  128. Clotting Mechanism
  129. Complement System
  130. Other Biochemical Mediators of Inflammation
  131. Systemic Manifestations of Inflammation
  132. Fever
  133. Leukocytosis
  134. Lymphadenopathy
  135. FIGURE 2-13 Enlarged cervical lymph node.
  136. FIGURE 2-14 Location of lymph nodes in the neck.
  137. Elevated C-Reactive Protein
  138. Chronic Inflammation
  139. Antiinflammatory Drugs
  140. Reactive Tissue Responses
  141. FIGURE 2-15 Microscopic appearance of epithelial hyperplasia (low magnification). The epithelium (E) is thickened because of an increase in the number of cells in the spinous layer. CT, underlying connective tissue.
  142. Regeneration and Repair
  143. Microscopic Events during Repair
  144. Day of Injury
  145. FIGURE 2-16 Underlying microscopic events of the repair process from the day of injury to 2 weeks later.
  146. Day after Injury
  147. Two Days after Injury
  148. Seven Days after Injury
  149. FIGURE 2-17 Use of sutures to encourage healing by primary intention.
  150. Two Weeks after Injury
  151. Types of Repair
  152. Healing by Primary Intention
  153. Healing by Secondary Intention
  154. FIGURE 2-18 Healing by secondary intention (without the use of sutures) in a large injury.
  155. FIGURE 2-19 Example of keloid formation (excessive scar tissue formation) after an injury.
  156. Healing by Tertiary Intention
  157. Factors That Impair Healing
  158. Bone Tissue Repair
  159. Traumatic Injuries to Teeth
  160. Attrition
  161. FIGURE 2-20 A, Attrition of adult dentition. B, Attrition of adult dentition (incisal view).
  162. FIGURE 2-21 Attrition has caused the flattening of the cusps (wear facets) of both the maxillary and mandibular cuspid teeth.
  163. FIGURE 2-22 Attrition of the mandibular anterior teeth resulting from bruxism.
  164. Abrasion
  165. FIGURE 2-23 Abrasion at the cervical area of mandibular bicuspids caused by toothbrushing.
  166. Abfraction
  167. Erosion
  168. FIGURE 2-24 Abfraction.
  169. FIGURE 2-25 A, Erosion of buccal and labial surfaces of teeth that occurred as a result of accidental exposure to sulfuric acid. Erosion caused by bulimia: B, Decreased tooth size. C, Erosion of maxillary lingual surfaces.
  170. FIGURE 2-26 Extensive dental destruction related to methamphetamine abuse.
  171. Injuries to Oral Soft Tissues
  172. Oral Mucosal Burns
  173. Aspirin Burn
  174. Phenol and Other Chemical Burns
  175. FIGURE 2-27 A and B, Aspirin burns.
  176. Electric Burn
  177. Thermal Burns
  178. Lesions Associated with Cocaine Use
  179. FIGURE 2-28 Mucosal burns. A, Chemical burn caused by contact with caustic material during endodontic treatment. B, Thermal burn of palate caused by contact with hot soup. C, Ulcer of midline of palate caused by heat generated during the use of crack cocaine.
  180. Lesions From Self-Induced Injuries
  181. Hematoma
  182. Traumatic Ulcer
  183. FIGURE 2-29 Hematoma on the buccal mucosa.
  184. FIGURE 2-30 A, Traumatic ulceration caused by irritation of gingiva by fingernails. B, Traumatic ulcer caused by denture. C, Traumatic ulcer on lateral tongue caused by chronic trauma to tongue by teeth. D, Traumatic ulcer (traumatic granuloma) of buccal mucosa.
  185. FIGURE 2-31 Frictional keratosis (indicated by arrow) caused by an opposing third molar (A), and chronic tongue chewing (B). C, Microscopic appearance of hyperkeratosis (low magnification) showing an increase in surface keratin (K).
  186. Frictional Keratosis
  187. FIGURE 2-32 Linea alba.
  188. Linea Alba
  189. Nicotine Stomatitis
  190. FIGURE 2-33 Nicotine stomatitis.
  191. Smokeless Tobacco–associated Keratosis
  192. Traumatic Neuroma
  193. FIGURE 2-34 Smokeless tobacco–associated keratosis. Note the rough texture of the surface. A, Labial mucosa. B, Anterior buccal mucosa.
  194. Amalgam Tattoo
  195. FIGURE 2-35 A, This bluish-gray pigmentation of the gingiva is an amalgam tattoo. B, Periapical radiograph showing amalgam particles in the gingival tissue.
  196. Melanosis
  197. FIGURE 2-36 A, Posttraumatic melanin pigmentation: area of melanin pigmentation on the gingiva after healing of a traumatic injury. B, Oral melanotic macules on the buccal mucosa.
  198. Solar Cheilitis
  199. FIGURE 2-37 Solar cheilitis. The color of the vermilion appears mottled and the interface between the vermilion and skin is indistinct.
  200. Mucous Retention Lesions
  201. FIGURE 2-38 Mucocele of the lower lip. A, Fluid-filled lesion is seen on the lower lip. B, Microscopic appearance of a mucocele, showing a cystlike space lined by granulation tissue (low magnification).
  202. FIGURE 2-39 Ranula.
  203. FIGURE 2-40 Sialoliths.A, Sialolith (arrow) in a minor salivary gland on the floor of the mouth. B, Microscopic appearance of a sialolith, showing concentric rings.
  204. Sialolith
  205. FIGURE 2-41 A, Occlusal radiograph showing a sialolith (arrow) in Wharton’s duct. B, A panoramic radiograph showing a sialolith (arrow).
  206. FIGURE 2-42 Necrotizing sialometaplasia.
  207. Necrotizing Sialometaplasia
  208. Sialadenitis
  209. Reactive Connective Tissue Hyperplasia
  210. Pyogenic Granuloma
  211. FIGURE 2-43 Pyogenic granuloma.
  212. FIGURE 2-44 Pyogenic granuloma of pregnancy (pregnancy tumor).
  213. Peripheral Giant Cell Granuloma
  214. Irritation Fibroma, Focal Fibrous Hyperplasia
  215. FIGURE 2-45 A, Peripheral giant cell granuloma. B and C, Microscopic appearance of a peripheral giant cell granuloma. Low magnification (A) shows the surface epithelium. Higher magnification (C) shows multinucleated giant cells (M), capillaries, and fibroblasts.
  216. FIGURE 2-46 Irritation fibroma. A, Development of fibroma followed by the healing of a periodontal abscess. B, Irritation fibroma of the buccal mucosa. C, Microscopic appearance of a fibroma.
  217. FIGURE 2-47 Denture-induced fibrous hyperplasia (epulis fissuratum; arrows). A, With denture; B, without denture.
  218. Denture-Induced Fibrous Hyperplasia
  219. Inflammatory Papillary Hyperplasia of the Palate
  220. FIGURE 2-48 Papillary hyperplasia of the palate. A, Full denture. B, Partial denture.
  221. Gingival Enlargement
  222. FIGURE 2-49 Gingival enlargement. A, Fibrous. B, Inflamed.
  223. Chronic Hyperplastic Pulpitis
  224. FIGURE 2-50 Chronic hyperplastic pulpitis (pulp polyp) (arrow).
  225. Inflammatory Periapical Lesions
  226. Periapical Abscess
  227. Periapical Granuloma
  228. FIGURE 2-51 A, Radiograph of a periapical granuloma. B, Microscopic appearance of a periapical granuloma, showing a collection of inflammatory cells at the apex of a tooth (low magnification).
  229. Radicular Cyst (Periapical Cyst)
  230. Tooth Resorption
  231. FIGURE 2-52 Radicular cyst. A, Diagram of a radicular cyst located around the root of an erupted tooth. B, Radiograph showing a well-circumscribed radiolucency (arrow) around the root of a tooth. C, Microscopic features of a radicular cyst.
  232. Focal Sclerosing Osteomyelitis
  233. FIGURE 2-53 A, Diagram of a residual cyst. B, Radiograph of a residual cyst, showing radiolucency at the site of a previously extracted tooth.
  234. FIGURE 2-54 Tooth resorption. A, Root resorption of a mandibular anterior tooth associated with chronic inflammation. B, Resorption of tooth structure and bone because of chronic inflammation. C, Idiopathic resorption of an impacted tooth. D, Generalized root resorption associated with orthodontic tooth movement.
  235. Alveolar Osteitis
  236. FIGURE 2-55 Focal sclerosing osteomyelitis (condensing osteitis).
  237. Selected References
  238. Books
  239. Journal Articles
  240. Lesions from Physical and Chemical Injuries to the Oral Tissues
  241. Reactive Connective Tissue Hyperplasia
  242. Inflammatory Periapical Lesions
  243. Websites
  244. Review Questions media
  245. CHAPTER 2 SynopsisView PDFmedia
  246. Pageburst Integrated Resource
  247. Activities
  248. Chapter 3 Immunity and Immunologic Oral Lesions
  249. Objectives
  250. Vocabulary
  251. Acquired Immune Response
  252. Antigens
  253. Cellular Involvement in the Immune Response
  254. B-Cell Lymphocyte
  255. FIGURE 3-1 Primary cells of the immune response include the lymphocytes, both B-cell lymphocytes and T-cell lymphocytes. Lymphocytes, polymorphonuclear neutrophils (PMN) and, macrophages are derived from stem cells in the bone marrow.
  256. FIGURE 3-2 Antibody or immunoglobulin (Ig) basic structure, with four protein chains with two identical heavy polypeptide chains and two identical light chains, forming a Y-shape. The tips of the arms are called the variable region because they vary greatly, creating a pocket uniquely shaped to enfold or “bind” a specific antigen (Fab). The stem or base, called the constant region, is identical in all antibodies of the same class and serves to link the antibody to other cells and products in the immune response (Fc).
  257. TABLE 3-1 Immunoglobulins (Antibodies)
  258. FIGURE 3-3 Five general types of antibodies or immunoglobulins in serum include the same basic structure arranged differently. This variation in structure allows them to function differently.
  259. FIGURE 3-4 Various types of T-cell lymphocytes and their involvement in the immune response.
  260. T-Cell Lymphocyte
  261. Natural Killer Cell
  262. Macrophage
  263. Dendritic Cell
  264. TABLE 3-2 Cytokines
  265. Cytokines
  266. Major Divisions of the Immune Response
  267. Memory and Immunity
  268. Types of Immunity
  269. FIGURE 3-5 The two major divisions of the immune response: humoral immunity and cell-mediated immunity.
  270. Immunopathology
  271. Hypersensitivity
  272. Type I Hypersensitivity
  273. TABLE 3-3 Hypersensitivity Reactions
  274. Type II Hypersensitivity
  275. Type III Hypersensitivity
  276. Type IV Hypersensitivity
  277. Hypersensitivity to Drugs
  278. Autoimmune Diseases
  279. Immunodeficiency
  280. Oral Immunologic Lesions and Diseases
  281. Aphthous Ulcers, Recurrent Aphthous Ulcers
  282. Types of Aphthous Ulcers
  283. FIGURE 3-6 Minor aphthous ulcers. A, On the floor of the mouth. B, On the buccal mucosa, on the papilla of the Stenson duct.
  284. Diagnosis
  285. FIGURE 3-7 Major aphthous ulcers. A, On the labial mucosa. B, On the soft palate. C, On the buccal mucosa.
  286. FIGURE 3-8 Herpetiform aphthous ulcers on the palate. These are the smallest of the aphthous ulcers.
  287. Treatment and Prognosis
  288. FIGURE 3-9 A and B, Two examples of urticaria (hives).
  289. TABLE 3-4 Clinical Features of the Three Types of Recurrent Aphthous Ulcers
  290. Urticaria and Angioedema
  291. FIGURE 3-10 Angioedema.
  292. Diagnosis
  293. Treatment and Prognosis
  294. Contact Mucositis and Dermatitis
  295. Diagnosis
  296. Treatment and Prognosis
  297. Fixed Drug Eruptions
  298. FIGURE 3-11 A, Contact mucositis on the labial mucosa, from acrylic. B, Contact dermatitis on the skin between the thumb and index finger, from latex gloves.
  299. Erythema Multiforme
  300. FIGURE 3-12 Skin lesions of erythema multiforme. A, Target lesion (arrow). B, Bullae.
  301. Diagnosis
  302. Treatment and Prognosis
  303. Lichen Planus
  304. FIGURE 3-13 Oral lesions of erythema multiforme. A, Crusted lip lesions with edema, ulceration, and erythema. B, Erythematous and ulcerated lesions of the lips and buccal mucosa. C, Stevens-Johnson syndrome.
  305. FIGURE 3-14 A and B, Two examples of the oral lesions of lichen planus. C, The plaquelike lesions on the tongue of a patient with lichen planus.
  306. Types of Lichen Planus
  307. FIGURE 3-15 Erosive lichen planus on the buccal mucosa.
  308. Diagnosis
  309. FIGURE 3-16 Desquamative gingivitis seen in lichen planus.
  310. FIGURE 3-17 Skin lesions of lichen planus presenting as scaly purplish lesions.
  311. FIGURE 3-18 Microscopic appearance of lichen planus. Degeneration of the basal cell layer of the epithelium (B) and the bandlike infiltrate of lymphocytes (L).
  312. Treatment and Prognosis
  313. Reactive Arthritis (Reiter Syndrome)
  314. Diagnosis
  315. Treatment and Prognosis
  316. Langerhans Cell Histiocytosis (Langerhans Cell Disease)
  317. FIGURE 3-19 Reactive arthritis. A, Ulcerative lesions on the palate. B, Lesion on the tongue.
  318. FIGURE 3-20 Langerhans cell histiocytosis (Langerhans cell disease) microscopic appearance (high magnification) with a combination of Langerhans cells and eosinophils.
  319. FIGURE 3-21 Langerhans cell histiocytosis (Langerhans cell disease): chronic disseminated form also known as Hand-Schüller-Christian disease. A, Skull radiograph. B, Ulcerated lesion of the mandible.
  320. FIGURE 3-22 Langerhans cell histiocytosis (Langerhans cell disease) in the solitary or chronic localized form of an eosinophilic granuloma, showing a well-circumscribed radiolucency.
  321. Treatment and Prognosis
  322. Autoimmune Diseases with Oral Manifestations
  323. Sjögren Syndrome
  324. TABLE 3-5 Autoimmune Diseases with Oral Manifestations
  325. FIGURE 3-23 Sjögren syndrome with severe xerostomia and a lack of papillae on the dorsal tongue.
  326. FIGURE 3-24 Bilateral parotid gland enlargement seen in Sjögren syndrome.
  327. FIGURE 3-25 Microscopic appearance (high magnification) of a minor salivary gland in Sjögren syndrome, showing aggregates of lymphocytes surrounding the salivary gland ducts.
  328. Diagnosis
  329. Treatment and Prognosis
  330. FIGURE 3-26 Sialogram of the parotid gland in Sjögren syndrome.
  331. Systemic Lupus Erythematosus
  332. FIGURE 3-27 A and B, Skin lesions of lupus erythematosus.
  333. Diagnosis
  334. Treatment and Prognosis
  335. Pemphigus Vulgaris
  336. FIGURE 3-28 A and B, Oral lesions of lupus erythematosus.
  337. Diagnosis
  338. Treatment and Prognosis
  339. FIGURE 3-29 A-C, Oral lesions in pemphigus vulgaris.
  340. FIGURE 3-30 Microscopic appearance of pemphigus vulgaris (low magnification), showing acantholysis of the epithelium and the intact basal layer attached to the connective tissue.
  341. Mucous Membrane Pemphigoid
  342. Diagnosis
  343. FIGURE 3-31 Desquamative gingivitis in mucous membrane pemphigoid.
  344. Treatment and Prognosis
  345. Bullous Pemphigoid
  346. FIGURE 3-32 Microscopic appearance of mucous membrane pemphigoid (low magnification), showing a separation of the epithelium from the connective tissue at the basement membrane area.
  347. Diagnosis
  348. Treatment and Prognosis
  349. Behçet Syndrome
  350. FIGURE 3-33 Aphthous-like ulcer on the tongue in Behçet syndrome.
  351. Diagnosis
  352. Treatment and Prognosis
  353. Selected References
  354. Books
  355. Journal Articles
  356. Immunologic Oral Lesions
  357. Websites
  358. Review Questions media
  359. CHAPTER 3 SynopsisView PDFmedia
  360. Pageburst Integrated Resource
  361. Activities
  362. Chapter 4 Infectious Diseases
  363. Objectives
  364. Vocabulary
  365. Bacterial Infections
  366. Impetigo
  367. Tonsillitis and Pharyngitis
  368. Tuberculosis
  369. FIGURE 4-1 This ulcer on the tongue tested positive for tuberculosis organisms.
  370. Diagnosis
  371. Treatment and Prognosis
  372. Actinomycosis
  373. FIGURE 4-2 Actinomycosis. The skin lesion is over the mandible, and the incision and drainage site is seen below the lesion. “Sulfur granules” were noted in the exudate draining from the site, and the condition was treated with long-term antibiotic therapy.
  374. TABLE 4-1 Stages of Syphilis
  375. Syphilis
  376. Congenital Syphilis
  377. Diagnosis and Treatment
  378. FIGURE 4-3 A, Chancre on tongue seen in primary syphilis. B, Chancre on lip.
  379. Necrotizing Ulcerative Gingivitis
  380. Pericoronitis
  381. Diagnosis
  382. FIGURE 4-4 Necrotizing ulcerative gingivitis.
  383. FIGURE 4-5 Pericoronitis.
  384. Treatment and Prognosis
  385. Acute Osteomyelitis
  386. Diagnosis
  387. FIGURE 4-6 A, Low-power microscopy of acute osteomyelitis, showing nonviable bone. Bacterial colonies and inflammatory cells are seen between trabeculae of bone. B, Diffuse, irregular radiographic changes seen in chronic osteomyelitis.
  388. Treatment and Prognosis
  389. Chronic Osteomyelitis
  390. Diagnosis
  391. Treatment
  392. Fungal Infections
  393. Candidiasis
  394. Types of Oral Candidiasis
  395. FIGURE 4-7 Pseudomembranous candidiasis.
  396. FIGURE 4-8 Erythematous candidiasis. A, Recent-onset and erythematous lesions elsewhere in the oral cavity differentiate this from median rhomboid glossitis. B, Response to antifungal treatment confirmed the diagnosis of oral candidiasis in this patient.
  397. Box 4-1 Conditions Associated with Overgrowth of Candida albicans
  398. Pseudomembranous Candidiasis
  399. Erythematous Candidiasis
  400. FIGURE 4-9 Chronic atrophic candidiasis (denture stomatitis). A, Full denture. B, Partial denture.
  401. Denture Stomatitis
  402. Chronic Hyperplastic Candidiasis
  403. FIGURE 4-10 Chronic hyperplastic candidiasis. The white appearance of the tongue did not wipe off, and it disappeared with antifungal treatment.
  404. FIGURE 4-11 Angular cheilitis.
  405. Angular Cheilitis
  406. FIGURE 4-12 Median rhomboid glossitis.
  407. Chronic Mucocutaneous Candidiasis
  408. Median Rhomboid Glossitis (Central Papillary Atrophy)
  409. Diagnosis and Treatment
  410. FIGURE 4-13 Photomicrograph of a smear showing epithelial cells and Candida organisms.
  411. Deep Fungal Infections
  412. Diagnosis
  413. FIGURE 4-14 Oral lesions of histoplasmosis in this patient clinically resemble squamous cell carcinoma.
  414. Treatment
  415. Mucormycosis
  416. Viral Infections
  417. Human Papillomavirus Infection
  418. FIGURE 4-15 Koilocytes in oral epithelium indicate human papilloma virus infection.
  419. FIGURE 4-16 A and B, Verruca vulgaris on the tongue of a child with a similar lesion on the thumb.
  420. Verruca Vulgaris
  421. FIGURE 4-17 Verruca vulgaris on the lateral aspect of the tongue in an adult.
  422. FIGURE 4-18 Condyloma acuminatum. The presence of condyloma acuminatum in a child is strongly suggestive of sexual abuse.
  423. Diagnosis
  424. Treatment and Prognosis
  425. Condyloma Acuminatum
  426. FIGURE 4-19 Multifocal epithelial hyperplasia.
  427. Multifocal Epithelial Hyperplasia
  428. Herpes Simplex Infection
  429. Primary Herpetic Gingivostomatitis
  430. Recurrent Herpes Simplex Infection
  431. FIGURE 4-20 A, Primary herpetic gingivostomatitis in a child. B and C, Primary herpetic gingivostomatitis in an adolescent.
  432. FIGURE 4-21 Herpes labialis. A, Twelve hours after onset. B, Forty-eight hours after onset.
  433. FIGURE 4-22 A and B, Recurrent intraoral herpes simplex.
  434. Diagnosis
  435. FIGURE 4-23 A, Herpetic whitlow in a dental hygienist (initial lesion). B, Recurrent lesion occurred many, many years later.
  436. TABLE 4-2 Comparison of the Clinical Features of Recurrent Minor Aphthous Ulcers and Recurrent Herpes Ulceration
  437. Treatment
  438. FIGURE 4-24 Herpetic eye infection.
  439. FIGURE 4-25 Cytologic smear preparation showing a virally altered cell (Tzanck cell) resulting from herpes simplex infection.
  440. Varicella-Zoster Virus
  441. Chickenpox
  442. Herpes Zoster
  443. FIGURE 4-26 Chickenpox. A, Skin lesions. B, Gingival lesion.
  444. FIGURE 4-27 Herpes zoster. A, Unilateral distribution of vesicles along the distribution of a sensory nerve. B, Many vesicles coalesce to form large lesions.
  445. FIGURE 4-28 Diagram of the branches of the trigeminal nerve.
  446. Diagnosis
  447. Treatment
  448. Epstein-Barr Virus Infection
  449. FIGURE 4-29 Herpes zoster. A, Unilateral facial lesions occurring along the distribution of the maxillary branch of the trigeminal nerve. B, Intraoral lesions in the same patient illustrate the unilateral distribution of herpes zoster.
  450. Infectious Mononucleosis
  451. FIGURE 4-30 Hairy leukoplakia seen here in an HIV-infected patient is an oral epithelial lesion caused by the Epstein-Barr virus.
  452. Hairy Leukoplakia
  453. Coxsackievirus Infections
  454. Herpangina
  455. Hand-Foot-and-Mouth Disease
  456. FIGURE 4-31 Herpangina.
  457. Diagnosis
  458. Treatment
  459. Acute Lymphonodular Pharyngitis
  460. Other Viral Infections That May Have Oral Manifestations
  461. Measles
  462. Mumps
  463. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
  464. The Spectrum of Human Immunodeficiency Virus
  465. Diagnosing AIDS
  466. Box 4-2 Definition of Acquired Immunodeficiency Syndrome
  467. With Laboratory Evidence of Human Immunodeficiency Virus Infection
  468. Human Immunodeficiency Virus Laboratory Tests Not Performed or Results Inconclusive and the Patient Has No Other Cause of Immunodeficiency
  469. Human Immunodeficiency Virus Testing
  470. Clinical Manifestations
  471. FIGURE 4-32 Spectrum of human immunodeficiency virus (HIV) disease. AIDS, acquired immunodeficiency syndrome.
  472. Medical Management
  473. Oral Manifestations
  474. Oral Candidiasis
  475. Box 4-3 Oral Lesions Associated with Human Immunodeficiency Virus Infection
  476. Herpes Simplex Infection
  477. FIGURE 4-33 Candidiasis in a patient with human immunodeficiency virus infection. Removable white plaques are present on the mucosa of the soft palate.
  478. FIGURE 4-34 Herpes simplex ulceration of the hard palate in a patient with human immunodeficiency virus infection. Arrows point to the periphery of the ulcer.
  479. Herpes Zoster
  480. Hairy Leukoplakia
  481. FIGURE 4-35 Hairy leukoplakia.
  482. Human Papillomavirus Infections
  483. FIGURE 4-36 Papillary lesion of the upper lip caused by human papillomavirus in a patient with human immunodeficiency virus infection.
  484. Kaposi Sarcoma
  485. Lymphoma
  486. FIGURE 4-37 Kaposi sarcoma in a patient with acquired immunodeficiency syndrome. A, Skin. B, Gingiva.
  487. FIGURE 4-38 Intraoral lymphoma in a patient with acquired immunodeficiency syndrome.
  488. Gingival and Periodontal Disease
  489. FIGURE 4-39 Atypical periodontal disease in a patient with human immunodeficiency virus infection.
  490. FIGURE 4-40 Persistent, nonspecific (major aphthous-like) ulcers in a patient with human immunodeficiency virus infection.
  491. Spontaneous Gingival Bleeding
  492. Aphthous Ulcers
  493. FIGURE 4-41 Salivary gland enlargement was bilateral in this patient with human immunodeficiency virus infection.
  494. Salivary Gland Disease
  495. Selected References
  496. Books
  497. Journal Articles
  498. Website
  499. Review Questions media
  500. CHAPTER 4 SynopsisView PDFmedia
  501. Pageburst Integrated Resource
  502. Activities
  503. Chapter 5 Developmental Disorders
  504. Objectives
  505. Vocabulary
  506. Embryonic Development of the Face, Oral Cavity, and Teeth
  507. Face
  508. FIGURE 5-1 In the third week of embryonic life an invagination, or infolding, of the ectoderm forms the primitive oral cavity, called the stomodeum. A and B, As facial development continues, the first branchial arch divides into two maxillary processes. C, The fourth week of development.
  509. FIGURE 5-2 The right and left palatine processes fuse to form the maxilla and premaxilla. A Y-shaped pattern results.
  510. Oral and Nasal Cavities
  511. Teeth
  512. FIGURE 5-3 Development of a tooth germ, showing initiation of dental lamina (A), proliferation of dental lamina (B), and differentiation of the components of the tooth germ (C).
  513. FIGURE 5-4 Deposition of enamel and dentin.
  514. Developmental Soft Tissue Abnormalities
  515. Ankyloglossia
  516. Commissural Lip Pits
  517. Lingual Thyroid
  518. FIGURE 5-5 Ankyloglossia. The short lingual frenum is attached near the tip of the tongue.
  519. FIGURE 5-6 Commissural lip pit. A deep depression is seen at the labial commissure.
  520. Developmental Cysts
  521. TABLE 5-1 Classification of Developmental Cysts
  522. Odontogenic Cysts
  523. Dentigerous Cyst
  524. FIGURE 5-7 Schematic of a dentigerous cyst located around the crown of an unerupted or impacted tooth.
  525. Eruption Cyst
  526. Primordial Cyst
  527. FIGURE 5-8 Radiographs of dentigerous cysts around the crown of an unerupted bicuspid (A) and an impacted third molar (B). C, Microscopic appearance of a dentigerous cyst.
  528. FIGURE 5-9 Primordial cyst occurring in place of a tooth: the third molar, in this instance.
  529. Odontogenic Keratocyst (Keratocystic Odontogenic Tumor)
  530. Calcifying Odontogenic Cyst
  531. Lateral Periodontal Cyst, Gingival Cyst, and Botryoid Odontogenic Cyst
  532. Glandular Odontogenic Cyst
  533. FIGURE 5-10 A, Microscopic appearance of an odontogenic keratocyst (OKC), showing a thin uniform epithelial lining (low power). Lu, Lumen; E, epithelium; CT, connective tissue. B, Microscopic appearance of an OKC, showing a corrugated parakeratotic surface (P) and a prominent basal cell layer (B) (high power). C, Radiograph of an OKC, showing a multilocular radiolucency. D, Radiograph of an OKC extending to the third molar. E, Same patient in (D), 2 years later, showing recurrence of OKC. The reader should note that the third molar has been removed.
  534. Nonodontogenic Cysts
  535. Nasopalatine Canal Cyst
  536. FIGURE 5-11 A, Radiograph of a lateral periodontal cyst. This well-defined radiolucency is located lateral to the tooth root. B, Radiograph of a botryoid cyst showing the biloculated radiolucency lateral to the tooth root. C, Microscopic appearance of a lateral periodontal cyst, showing a thin epithelial lining with focal epithelial thickenings. D, Gingival cyst.
  537. Median Palatine Cyst
  538. Globulomaxillary Cyst
  539. FIGURE 5-12 A, An incisive canal cyst may be located in the anterior maxilla in either bone or soft tissue or both. This radiograph of an incisive canal cyst shows a well-circumscribed radiolucency between the maxillary central incisors. B, Microscopic appearance of an incisive canal cyst, showing a pseudostratified, ciliated, columnar epithelial lining.
  540. FIGURE 5-13 Radiograph of a median palatine cyst, showing a well-defined radiolucency located in the midline of the maxilla.
  541. FIGURE 5-14 Radiograph of a globulomaxillary cyst, showing the characteristic pear-shaped radiolucency (arrow) between the roots of the maxillary lateral incisor and cuspid.
  542. Median Mandibular Cyst
  543. Nasolabial Cyst
  544. FIGURE 5-15 Nasolabial cyst causing a swelling in the nasolabial fold area.
  545. Lymphoepithelial Cyst
  546. Epidermal Cyst
  547. FIGURE 5-16 A, Clinical lymphoepithelial cyst. B, Microscopic appearance of a lymphoepithelial cyst, showing the lumen (Lu), epithelial lining (E), surrounding lymphocytes (L), and connective tissue (CT) (low power).
  548. Dermoid Cyst and Benign Cystic Teratoma
  549. Thyroglossal Tract Cyst
  550. Pseudocysts
  551. Static Bone Cyst
  552. FIGURE 5-17 A, The thyroglossal tract extends from the area of the foramen cecum on the tongue to the lower part of the neck. B, A thyroglossal tract cyst is the cause of this enlargement at the midline of the neck.
  553. Simple Bone Cyst
  554. FIGURE 5-18 A, Panoramic radiograph of a lingual mandibular bone concavity (Stafne bone cyst). Arrow points to a well-circumscribed radiolucency inferior to the mandibular canal. B, Axial computerized tomography (CT) image showing a depression in the bone of the left mandible (arrow). This results in a well-circumscribed radiolucency on a panoramic radiograph that is called a Stafne (static) bone cyst.
  555. Aneurysmal Bone Cyst
  556. FIGURE 5-19 Extraoral radiograph showing a simple (traumatic) bone cyst in the mandible with its unique radiolucent characteristic, scalloping around the roots.
  557. Developmental Abnormalities of Teeth
  558. Abnormalities in the Number of Teeth
  559. Anodontia
  560. Hypodontia
  561. FIGURE 5-20 A and B, Hypodontia. Teeth that are missing were not extracted; they never developed.
  562. Supernumerary Teeth
  563. FIGURE 5-21 A, Supernumerary teeth. This patient has four maxillary lateral incisors. B, Radiograph showing unerupted supernumerary teeth. C, Supernumerary mandibular incisor.
  564. FIGURE 5-22 A, Mesiodens seen between the maxillary central incisors. B, Radiograph of an erupted mesiodens. C, Radiograph showing a pair of inverted impacted mesiodens.
  565. Abnormalities in the Size of Teeth
  566. Microdontia
  567. FIGURE 5-23 A, Small erupted microdont distal to the maxillary second molar. B, Radiograph of a third molar microdont and distomolar.
  568. FIGURE 5-24 Peg-shaped lateral incisor.
  569. Macrodontia
  570. Abnormalities in the Shape of Teeth
  571. Gemination
  572. Fusion
  573. FIGURE 5-25 A, Clinical picture of gemination in a mandibular cuspid. B, Gemination seen in a maxillary central incisor. C, Radiograph of the same maxillary central incisor.
  574. Concrescence
  575. FIGURE 5-26 A, Clinical picture of fusion involving a permanent mandibular lateral incisor. B, Fusion of mandibular molars.
  576. FIGURE 5-27 Concrescence illustrated in a photograph (A) of extracted teeth and in a corresponding radiograph (B).
  577. Dilaceration
  578. Enamel Pearl
  579. FIGURE 5-28 A, Dilaceration on the distal root of an extracted tooth. B, Mesial root dilaceration on a mandibular second molar. C, Radiograph of root dilaceration in maxillary lateral incisor and cuspid.
  580. Talon Cusp
  581. FIGURE 5-29 Enamel pearl in the furcation area.
  582. FIGURE 5-30 Talon cusp on the lingual aspect of the maxillary right lateral permanent incisor.
  583. Taurodontism
  584. FIGURE 5-31 A, Taurodont in the mandibular third molar. B, Taurodont in the mandibular second molar.
  585. Dens in Dente
  586. FIGURE 5-32 A, Clinical illustration of dens in dente in maxillary lateral incisor. B, Radiograph of dens in dente in maxillary lateral incisor.
  587. FIGURE 5-33 Dens evaginatus of maxillary premolar.
  588. Dens Evaginatus
  589. Supernumerary Roots
  590. FIGURE 5-34 Supernumerary roots in mandibular premolars.
  591. Box 5-1 Factors That Can Cause Enamel Hypoplasia
  592. Abnormalities of Tooth Structure
  593. Enamel Hypoplasia
  594. FIGURE 5-35 Enamel hypoplasia. In this patient the enamel hypoplasia follows a pattern that is suggestive of a systemic problem such as a high fever.
  595. Enamel Hypoplasia Caused by Febrile Illness or Vitamin Deficiency
  596. Enamel Hypoplasia Resulting from Local Infection or Trauma
  597. FIGURE 5-36 Mottled enamel. The discoloration of the enamel in this patient occurred as a result of high fluoride intake.
  598. Enamel Hypoplasia Resulting from Fluoride Ingestion
  599. Enamel Hypoplasia Resulting from Congenital Syphilis
  600. FIGURE 5-37 A, Hutchinson incisors. B, Mulberry molars.
  601. Enamel Hypoplasia Resulting from Birth Injury, Premature Birth, or Idiopathic Factors
  602. FIGURE 5-38 Regional odontodysplasia.
  603. Enamel Hypocalcification
  604. Endogenous Staining of Teeth
  605. Regional Odontodysplasia
  606. FIGURE 5-39 A, Horizontal impaction of the third molar. B, Mesioangular impaction of the third molar.
  607. Abnormalities of Tooth Eruption
  608. Impacted and Embedded Teeth
  609. FIGURE 5-40 Ankylosis of deciduous molar.
  610. Ankylosed Teeth
  611. Selected References
  612. Books
  613. Journal Articles
  614. Review Questions media
  615. CHAPTER 5 SynopsisView PDFmedia
  616. Pageburst Integrated Resource
  617. Activities
  618. Chapter 6 Genetics
  619. Objectives
  620. Vocabulary
  621. Chromosomes
  622. FIGURE 6-1 High-power photomicrograph shows several dividing cells with visible chromosomes and also nuclei of cells with scattered chromatin.
  623. Normal Cell Division
  624. Mitosis
  625. Stages of Mitosis
  626. FIGURE 6-2 Schematic representation of the mitotic cycle shows the end of mitosis, followed by the G1, S, and G2 phases and the next mitosis.
  627. FIGURE 6-3 Autosomal chromosome at metaphase shows (1) short arm, (2) centromere, (3) long arm, and (4) chromatid.
  628. Meiosis
  629. FIGURE 6-4 Pair of autosomal chromosomes at metaphase. Each chromatid represents 1n DNA.
  630. First Meiosis
  631. FIGURE 6-5 Homologous autosomal chromosomes line up in first meiosis (A), cross over during metaphase of first meiosis (B), and exchange segments after crossing over (C).
  632. Second Meiosis
  633. FIGURE 6-6 Two haploid cells after second meiosis, each having 1n DNA.
  634. FIGURE 6-7 Cytologic preparation from the buccal mucosa shows the Barr body (the small dark dot on the nuclear membrane [arrow]) at the periphery of the nucleus of a desquamated epithelial cell from a woman’s buccal mucosa.
  635. Lyon Hypothesis
  636. Molecular Composition of Chromosomes
  637. Deoxyribonucleic Acid
  638. FIGURE 6-8 Schematic representation of the DNA double helix.
  639. Ribonucleic Acid
  640. Types of Ribonucleic Acid
  641. Genes and Chromosomes
  642. FIGURE 6-9 Production (synthesis) of protein from DNA.
  643. Chromosomal Abnormalities
  644. Gross Chromosomal Abnormalities
  645. Alterations in Number and Structure of Chromosomes
  646. Clinical Syndromes Resulting From Gross Chromosomal Abnormalities
  647. Trisomy 21
  648. Trisomy 13
  649. FIGURE 6-10 Karyotype from a female shows the 22 pairs of autosomal chromosomes and the pair of X chromosomes.
  650. FIGURE 6-11 Karyotype from a male shows the 22 pairs of autosomal chromosomes and the X and Y chromosomes.
  651. FIGURE 6-12 Newborn with trisomy 13. Cleft lip, frontal hemangioma, and abnormal position of fingers should be noted.
  652. Turner Syndrome
  653. Klinefelter Syndrome
  654. FIGURE 6-13 Patient with Turner syndrome. Note the webbing of the neck.
  655. Cri du Chat (Cat Cry) Syndrome and Wolf-Hirschhorn Syndrome
  656. Patterns of Inheritance
  657. Autosomal-Dominant Inheritance
  658. Autosomal-Recessive Inheritance
  659. X-Linked Inheritance
  660. Lyon Hypothesis and X-linked Recessive Traits
  661. Genetic Heterogeneity
  662. Multifactorial Inheritance
  663. Examples of Inherited Disorders
  664. Inherited Disorders Affecting the Gingiva and Periodontium
  665. Cyclic Neutropenia.
  666. FIGURE 6-14 Hypertrophic gingivitis with areas of gingival recession is exhibited in a patient with cyclic neutropenia.
  667. Papillon-Lefèvre Syndrome.
  668. FIGURE 6-15 Areas of hyperkeratinization of the palms are exhibited in a patient with Papillon-Lefèvre syndrome.
  669. Focal Palmoplantar and Gingival Hyperkeratosis.
  670. Gingival Fibromatosis.
  671. FIGURE 6-16 Panoramic radiograph shows marked periodontal destruction with alveolar bone resorption in the patient in Figure 6-15.
  672. FIGURE 6-17 Marked hyperkeratosis follows the normal contour of the gingiva in focal palmoplantar and gingival hyperkeratosis.
  673. FIGURE 6-18 Gingival hypertrophy is shown in a patient with isolated gingival fibromatosis.
  674. Laband Syndrome.
  675. Gingival Fibromatosis with Hypertrichosis, Epilepsy, and Mental Retardation Syndrome.
  676. Gingival Fibromatosis with Multiple Hyaline Fibromas.
  677. Inherited Disorders Affecting the Jaw Bones and Facies
  678. Cherubism.
  679. FIGURE 6-19 Panoramic radiograph of the jaws shows typical bilateral soap-bubble image in a patient with cherubism.
  680. Ellis–van Creveld Syndrome.
  681. FIGURE 6-20 Infant with Ellis–van Creveld syndrome (chondroectodermal dysplasia). The anterior maxillary vestibular sulcus is absent.
  682. Cleidocranial Dysplasia.
  683. Gardner Syndrome.
  684. FIGURE 6-21 Multiple extracted supernumerary teeth from a patient with cleidocranial dysplasia.
  685. Mandibulofacial Dysostosis.
  686. Nevoid Basal Cell Carcinoma Syndrome.
  687. FIGURE 6-22 Panoramic radiograph of a patient with Gardner syndrome shows multiple osteomas and odontomas.
  688. FIGURE 6-23 Markedly high-arched palate and malpositioned teeth in a patient with mandibulofacial dysostosis.
  689. Osteogenesis Imperfecta.
  690. Torus Mandibularis.
  691. FIGURE 6-24 Multiple mandibular radiolucencies in a patient with nevoid basal cell carcinoma syndrome. These lesions are odontogenic keratocysts
  692. FIGURE 6-25 Patient with osteogenesis imperfecta. Teeth are yellowish with chipped enamel.
  693. Torus Palatinus.
  694. FIGURE 6-26 Bilateral lobulated mandibular tori.
  695. FIGURE 6-27 Torus palatinus.
  696. Maxillary Exostosis.
  697. Inherited Disorders Affecting the Oral Mucosa
  698. Isolated Cleft Palate and Cleft Lip with or without Cleft Palate.
  699. FIGURE 6-28 Maxillary exostoses are inherited as autosomal-dominant.
  700. FIGURE 6-29 Paramedial pits in the lower lip. Note the scar of the repaired cleft of the left upper lip.
  701. FIGURE 6-30 Multiple telangiectases of lips and tongue in a patient with hereditary hemorrhagic telangiectasia. Gingival bleeding can be profuse in cases like this.
  702. Hereditary Hemorrhagic Telangiectasia.
  703. Multiple Mucosal Neuroma Syndrome.
  704. FIGURE 6-31 Patient with multiple endocrine neoplasia, type 2B (MEN 2B) syndrome with multiple mucosal neuromas on the tip of the tongue and upper lip.
  705. FIGURE 6-32 Multiple neurofibromas of the maxillary gingiva and palate in a patient with neurofibromatosis of von Recklinghausen.
  706. Neurofibromatosis of von Recklinghausen.
  707. FIGURE 6-33 Multiple small- to medium-size pigmented macules on the labial mucosa of a patient with Peutz-Jeghers syndrome.
  708. Peutz-Jeghers Syndrome.
  709. White Sponge Nevus.
  710. Inherited Disorders Affecting the Teeth
  711. Amelogenesis Imperfecta.
  712. FIGURE 6-34 Pitted autosomal-dominant amelogenesis imperfecta. Multiple pits on the labial surface of the teeth should be noted. Some of the pits have been filled with composite.
  713. FIGURE 6-35 Loss of enamel is exhibited in the teeth of a patient with hypocalcified amelogenesis imperfecta.
  714. Dentinogenesis Imperfecta.
  715. FIGURE 6-36 Uniform whitening of incisal edges and occlusal cusps is exhibited in a case of snow-capped amelogenesis imperfecta.
  716. FIGURE 6-37 Opalescent bluish hue in the anterior teeth typical of dentinogenesis imperfecta. The yellow color seen in the molars is from exposed abnormal dentin due to loss of enamel.
  717. FIGURE 6-38 Panoramic radiograph of a patient with dentinogenesis imperfecta shows markedly short roots and almost complete lack of pulp chambers.
  718. Dentin Dysplasia.
  719. Radicular Dentin Dysplasia.
  720. Coronal Dentin Dysplasia.
  721. FIGURE 6-39 Radiographs of a patient with radicular dentin dysplasia shows blunted and short tooth roots. The few remaining pulp chambers have a half-moon appearance.
  722. Hypohidrotic Ectodermal Dysplasia.
  723. Hypophosphatasia.
  724. FIGURE 6-40 Obliteration and partial lack of coronal pulp chambers and small root canals can be seen in teeth of a patient affected with coronal dentin dysplasia.
  725. FIGURE 6-41 Patient with hypohidrotic ectodermal dysplasia has only three, abnormally shaped teeth.
  726. FIGURE 6-42 Histologic section of a tooth from a patient with hypophosphatasia shows only dentin. Cementum is entirely lacking.
  727. Hypophosphatemic Vitamin D–resistant Rickets.
  728. FIGURE 6-43 Pegged maxillary lateral incisors. The conical shape should be noted.
  729. Pegged or Absent Maxillary Lateral Incisors.
  730. Taurodontism.
  731. FIGURE 6-44 Intraoral radiograph of taurodontic teeth shows large pulp chambers and low bifurcation of the roots in this pyramid-shaped molar.
  732. Selected References
  733. Books
  734. Journal Articles
  735. Review Questions media
  736. CHAPTER 6 SynopsisView PDFmedia
  737. Pageburst Integrated Resource
  738. Activities
  739. Chapter 7 Neoplasia
  740. Objectives
  741. Vocabulary
  742. Description of Neoplasia
  743. Causes of Neoplasia
  744. Classification of Tumors
  745. Names of Tumors
  746. FIGURE 7-1 Photomicrographs of malignant tumors show pleomorphic (P) and hyperchromatic (H) nuclei and mitotic figures (MI). A, Squamous cell carcinoma. B, Osteosarcoma.
  747. TABLE 7-1 Comparison of Benign and Malignant Tumors
  748. TABLE 7-2 Names of Tumors
  749. Treatment of Tumors
  750. Epithelial Tumors
  751. Tumors of Squamous Epithelium
  752. Papilloma
  753. FIGURE 7-2 A, Clinical appearance of a papilloma of the oral mucosa shows a cauliflower-like appearance and rough surface resulting from finger-like projections. B, Microscopic appearance of a papilloma shows fingerlike projections surfaced by squamous epithelium and supported by thin cores of fibrous connective tissue.
  754. Premalignant Lesions
  755. Leukoplakia
  756. FIGURE 7-3 Clinical appearance of leukoplakia. A, Floor of the mouth. B, Maxillary alveolar mucosa and palate. The cause of these lesions could not be identified. C, Erythroplakia in this case diagnosed microscopically as squamous cell carcinoma.
  757. FIGURE 7-4 Clinical appearance of a white lesion that was associated with smokeless tobacco (smokeless tobacco–associated keratosis). This lesion developed on the lower labial mucosa at the site where the tobacco was held.
  758. Erythroplakia
  759. Epithelial Dysplasia
  760. FIGURE 7-5 Microscopic appearance of epithelial dysplasia. Loss of the normal stratification of the epithelium, hyperplasia of the basal cells, and enlarged, hyperchromatic nuclei are seen.
  761. Squamous Cell Carcinoma
  762. FIGURE 7-6 A, Clinical appearance of a squamous cell carcinoma of the posterolateral tongue shows an exophytic, ulcerated mass. B, Clinical appearance of a squamous cell carcinoma on the left side of the soft palate and fauces. C, Clinical appearance of a squamous cell carcinoma on the floor of the mouth. D, Left side of a panoramic radiograph shows destruction of the mandible by a squamous cell carcinoma.
  763. FIGURE 7-7 A, Microscopic appearance (low power) of a squamous cell carcinoma shows infiltration of the tumor into the connective tissue. B, High-power photomicrograph shows abnormal keratinization and keratin pearls (K).
  764. Risk Factors
  765. Treatment and Prognosis
  766. FIGURE 7-8 A and B, Clinical appearance of squamous cell carcinoma of the lower lip. Squamous cell carcinoma (arrow) is seen with actinic (solar) cheilitis in (A).
  767. TABLE 7-3 TNM Staging System
  768. Box 7-1 TNM Staging System for Oral Squamous Cell Carcinoma
  769. T: Tumor
  770. N: Node
  771. M: Metastasis
  772. Verrucous Carcinoma
  773. FIGURE 7-9 A, Clinical appearance of a verrucous carcinoma occurring on the commissure and anterior buccal mucosa. B, Maxillary alveolar ridge.
  774. Basal Cell Carcinoma
  775. FIGURE 7-10 Clinical appearance of a basal cell carcinoma (arrow), illustrating the characteristic “rolled” borders.
  776. FIGURE 7-11 A, Benign salivary gland tumor of the palate (pleomorphic adenoma). B, Malignant salivary gland tumor of the palate (adenoid cystic carcinoma). Biopsy site should be noted. C, Benign salivary gland tumor of the upper lip (pleomorphic adenoma). D, Malignant salivary gland tumor of the buccal mucosa (mucoepidermoid carcinoma). E, Malignant salivary gland tumor of the tongue (adenoid cystic carcinoma).
  777. Salivary Gland Tumors
  778. Pleomorphic Adenoma (Benign Mixed Tumor)
  779. FIGURE 7-12 Microscopic appearance of a pleomorphic adenoma. A, Low-power photomicrograph shows a capsule (C). B, High-power photomicrograph shows a mixture of epithelium (E) and connective tissue (CT).
  780. FIGURE 7-13 Microscopic appearance (low power) of a portion of a monomorphic adenoma shows a capsule and a uniform pattern of epithelial cells.
  781. Monomorphic Adenomas
  782. FIGURE 7-14 Microscopic appearance of a portion of a papillary cystadenoma lymphomatosum (Warthin tumor) shows spaces lined by epithelium and surrounded by sheets of lymphocytes.
  783. FIGURE 7-15 A, Microscopic appearance (low power) of a mucoepidermoid carcinoma shows cystic structures, mucous cells, and epidermoid cells. B, Radiograph of a central mucoepidermoid carcinoma shows a multilocular radiolucency.
  784. Mucoepidermoid Carcinoma
  785. Adenoid Cystic Carcinoma (Cylindroma)
  786. FIGURE 7-16 Microscopic appearance of an adenoid cystic carcinoma shows perforated islands of uniform cells. Tumor (T) is seen infiltrating the adjacent adipose tissue.
  787. TABLE 7-4 Classification of Central Odontogenic Tumors
  788. Other Malignant Salivary Gland Tumors
  789. Odontogenic Tumors
  790. Epithelial Odontogenic Tumors
  791. Ameloblastoma
  792. FIGURE 7-17 Microscopic appearance (low power) of a follicular ameloblastoma shows dental follicle–like islands composed of epithelial cells consisting of peripheral ameloblast-like cells (A) and stellate reticulum–like areas (S).
  793. FIGURE 7-18 A and B, Radiographs of ameloblastomas showing multilocular radiolucencies in the molar area of the mandible. C, Radiograph of an ameloblastoma shows a small but multilocular radiolucency in the mandibular cuspid and bicuspid region.
  794. Calcifying Epithelial Odontogenic Tumor
  795. FIGURE 7-19 Radiograph of an ameloblastoma that formed in association with an impacted tooth and dentigerous cyst.
  796. FIGURE 7-20 Calcifying epithelial odontogenic tumor. A, Microscopic appearance (low power) of a calcifying epithelial odontogenic tumor shows sheets of epithelial cells (E), amorphous material (A), and calcifications (C). B, Radiograph of a calcifying epithelial odontogenic tumor shows a multilocular radiolucency.
  797. Adenomatoid Odontogenic Tumor
  798. FIGURE 7-21 Adenomatoid odontogenic tumor. A, Microscopic appearance of a portion of an adenomatoid odontogenic tumor shows the capsule (C), epithelial cells, and ductlike structures (D). B, Radiograph of an adenomatoid odontogenic tumor shows a unilocular radiolucency surrounding the crown of an unerupted maxillary cuspid.
  799. FIGURE 7-22 Calcifying odontogenic cyst. A, Microscopic appearance of a calcifying odontogenic cyst shows a cystic structure lined by odontogenic epithelium (E) with associated ghost cells (G). B, Radiograph of a calcifying odontogenic cyst shows a unilocular radiolucency of the mandible.
  800. Calcifying Odontogenic Cyst
  801. Mesenchymal Odontogenic Tumors
  802. Odontogenic Myxoma
  803. FIGURE 7-23 A, Photomicrograph of an odontogenic myxoma shows background substance containing widely dispersed cells with long cytoplasmic processes. B, Radiograph of an odontogenic myxoma shows a multilocular, honeycombed radiolucency.
  804. Central Cementifying and Central Ossifying Fibromas
  805. Benign Cementoblastoma
  806. FIGURE 7-24 A, Photomicrograph of a central cementifying fibroma shows rounded, globular calcifications (GC) and cellular fibrous connective tissue (FCT). B, Radiograph of a central cementifying fibroma shows a radiolucent and radiopaque lesion. C, Radiograph of a central cementifying fibroma shows a well-circumscribed radiolucent lesion.
  807. FIGURE 7-25 Radiograph of a benign cementoblastoma shows a well-circumscribed radiopaque mass surrounded by a radiolucent halo and attached to the roots of a mandibular first molar.
  808. Mixed Odontogenic Tumors
  809. Ameloblastic Fibroma
  810. FIGURE 7-26 A, Microscopic appearance of an ameloblastic fibroma shows a combination of odontogenic epithelium (E) and mesenchymal tissue (M). B, Radiograph of an ameloblastic fibroma shows a poorly defined unilocular radiolucency.
  811. Odontoma
  812. FIGURE 7-27 Radiograph of a compound odontoma shows a collection of numerous, small, toothlike radiopacities surrounded by a radiolucent halo.
  813. Ameloblastic Fibro-Odontoma
  814. FIGURE 7-28 Radiograph of a complex odontoma shows a radiopaque mass surrounded by a radiolucent halo.
  815. FIGURE 7-29 A, Clinical appearance of a peripheral ossifying fibroma shows an exophytic lesion involving the palatal gingiva of the maxillary anterior teeth. B, Photomicrograph of a peripheral ossifying fibroma shows bonelike calcifications (B) in cellular fibrous connective tissue (CT). A small amount of surface epithelium (E) is also visible.
  816. Peripheral Odontogenic Tumors
  817. Peripheral Ossifying Fibroma
  818. Other Peripheral Odontogenic Tumors
  819. Tumors of Soft Tissue
  820. Lipoma
  821. Tumors of Nerve Tissue
  822. Neurofibroma and Schwannoma
  823. FIGURE 7-30 A, Clinical appearance of a lipoma. B, Photomicrograph of a lipoma shows mature fat cells.
  824. FIGURE 7-31 A, Clinical appearance of a neurofibroma shows a nonulcerated mass on the lateral border of the tongue. B, Photomicrograph of a neurofibroma.
  825. Granular Cell Tumor
  826. FIGURE 7-32 A, Clinical appearance of a granular cell tumor of the tongue shows a nonulcerated mass. B, Photomicrograph of a granular cell tumor showing granular cell(s) (G) between striated muscle fiber(s) (M). C, Photomicrograph of a granular cell tumor, showing overlying pseudoepitheliomatous hyperplasia.
  827. Congenital Epulis
  828. Tumors of Muscle
  829. Vascular Tumors
  830. Hemangioma
  831. FIGURE 7-33 Clinical appearance of a hemangioma of the lower lip (A) and of the buccal mucosa (B). C, Microscopic appearance of a cavernous hemangioma showing large dilated blood vessels (B) filled with red blood cells (RBC).
  832. Lymphangioma
  833. Malignant Vascular Tumors
  834. Tumors of Melanin-Producing Cells
  835. Melanocytic Nevi
  836. Malignant Melanoma
  837. FIGURE 7-34 Clinical appearance of a melanocytic nevus shows a well-defined pigmented lesion on the labial mucosa.
  838. FIGURE 7-35 Clinical appearance of a malignant melanoma shows a darkly pigmented lesion in the area of the fauces.
  839. Tumors of Bone and Cartilage
  840. Torus
  841. Exostosis
  842. FIGURE 7-36 A, Clinical appearance of bilateral lobulated mandibular tori. B, Clinical appearance of a lobulated torus palatinus.
  843. FIGURE 7-37 Clinical appearance of exostoses on the labial and buccal aspect of the maxilla. Less prominent exostoses are noted on the labial and buccal aspect of the mandible.
  844. Osteoma
  845. FIGURE 7-38 Radiograph of an osteoma shows a radiopacity of the posterior mandible.
  846. FIGURE 7-39 A, Clinical appearance of an osteogenic sarcoma shows swelling. B, Radiograph of an osteogenic sarcoma in the left molar area shows a poorly defined radiopaque lesion. C, Microscopic appearance of an osteogenic sarcoma shows pleomorphic (P) and hyperchromatic cells, abnormal cartilage (C), and bone formation (B).
  847. Osteosarcoma
  848. FIGURE 7-40 Clinical appearance of a chondrosarcoma shows an exophytic mass in the anterior mandible.
  849. Tumors of Cartilage
  850. Tumors of Blood-Forming Tissues
  851. Leukemia
  852. FIGURE 7-41 Clinical appearance of a patient with leukemic infiltration of the gingiva, resulting in diffuse enlargement.
  853. Lymphoma (Non-Hodgkin Lymphoma)
  854. Multiple Myeloma
  855. FIGURE 7-42 Multiple myeloma. A, Microscopic appearance of multiple myeloma shows a proliferation of plasma cells. B, Radiograph shows multiple radiolucent lesions of the mandible in a patient with multiple myeloma.
  856. Metastatic Tumors of the Jaws
  857. FIGURE 7-43 Radiograph shows diffuse radiolucent and radiopaque changes resulting from metastatic carcinoma of the prostate gland.
  858. Selected References
  859. Books
  860. Journal Articles
  861. Leukoplakia and Erythroplakia
  862. Salivary Gland Tumors
  863. Odontogenic Tumors
  864. Lipoma
  865. Neurogenic Tumors
  866. Vascular Tumors
  867. Tumors of Melanin-producing Cells
  868. Tumors of Bone
  869. Tumors of Blood-forming Tissues
  870. Metastatic Tumors
  871. Review Questions media
  872. CHAPTER 7 SynopsisView PDFmedia
  873. Pageburst Integrated Resource
  874. Activities
  875. Chapter 8 Nonneoplastic Diseases of Bone
  876. Objectives
  877. Vocabulary
  878. Benign Fibro-Osseous Lesions
  879. FIGURE 8-1 A and B, Radiographs of periapical cemento-osseous dysplasia. C, Microscopic appearance of periapical cemento-osseous dysplasia shows a combination of cellular fibrous connective tissue (F) and calcified tissue (C).
  880. Periapical Cemento-Osseous Dysplasia
  881. FIGURE 8-2 Florid cemento-osseous dysplasia. Pantomographic radiograph shows irregular radiopaque masses in both the left and right mandible.
  882. Box 8-1 Benign Fibro-osseous Lesions of the Jaws
  883. Florid Cemento-Osseous Dysplasia
  884. Focal Cemento-Osseous Dysplasia
  885. Fibrous Dysplasia
  886. Types of Fibrous Dysplasia
  887. Monostotic Fibrous Dysplasia
  888. Polyostotic Fibrous Dysplasia
  889. Paget Disease of Bone
  890. FIGURE 8-3 Fibrous dysplasia. A, Radiograph of fibrous dysplasia demonstrating indistinct borders that blend into the adjacent normal bone. B, Microscopic appearance (high power) of fibrous dysplasia shows cellular fibrous connective tissue (F) and irregular trabeculae of bone (B).
  891. FIGURE 8-4 Paget disease. A, Enlargement of the maxilla with spaces between the teeth. B, Radiograph demonstrating irregular opacification that is also referred to as a “cotton-wool” appearance. In areas, the lamina dura is obliterated. C, Microscopic appearance of Paget disease shows bone trabeculae surfaced by numerous osteoclasts and osteoblasts. The prominent reversal lines (arrows) seen here characterize the mosaic pattern of bone.
  892. Central Giant Cell Granuloma (Central Giant Cell Lesion)
  893. Aneurysmal Bone Cyst
  894. FIGURE 8-5 Radiographs of central giant cell granulomas showing multilocular radiolucencies in the mandible (A) and maxilla (B). C, Microscopic appearance of a central giant cell granuloma showing the same features as a peripheral giant cell granuloma except for the absence of surface mucosa.
  895. Osteomalacia
  896. Selected References
  897. Books
  898. Journal Articles
  899. Review Questions media
  900. CHAPTER 8 SynopsisView PDFmedia
  901. Pageburst Integrated Resource
  902. Activities
  903. Chapter 9 Oral Manifestations of Systemic Diseases
  904. Objectives
  905. Vocabulary
  906. Endocrine Disorders
  907. Hyperpituitarism
  908. Clinical Features and Oral Manifestations
  909. FIGURE 9-1 Enlarged tongue (macroglossia) in a patient with acromegaly.
  910. Diagnosis and Treatment
  911. Hyperthyroidism (Thyrotoxicosis, Graves Disease)
  912. Clinical Features
  913. Oral Manifestations
  914. Treatment
  915. Hypothyroidism (Cretinism; Myxedema)
  916. Hyperparathyroidism
  917. Clinical Features
  918. Oral Manifestations
  919. Diagnosis and Treatment
  920. Diabetes Mellitus
  921. FIGURE 9-2 A, Radiograph of a mandibular lesion in a patient with hyperparathyroidism. B, Microscopic appearance of a jaw lesion occurring in a patient with hyperparathyroidism. The histologic appearance is identical to that of a central giant cell granuloma. C, This periapical radiograph reveals the “ground-glass” appearance of the trabeculae and loss of lamina dura in a patient with secondary hyperparathyroidism.
  922. Types of Diabetes
  923. Insulin-dependent Diabetes Mellitus, Pathology, and Clinical Management
  924. The Insulin Pump
  925. Non–insulin-dependent Diabetes Mellitus
  926. Gestational Diabetes
  927. Clinical Features of Diabetes
  928. Oral Complications
  929. FIGURE 9-3 A, Acanthosis nigricans affecting the back of the neck. B, Acanthosis nigricans affecting the hand.
  930. Addison Disease
  931. FIGURE 9-4 Periapical radiograph of a patient with diabetes mellitus shows severe alveolar bone loss.
  932. Blood Disorders
  933. Disorders of Red Blood Cells and Hemoglobin
  934. Anemia
  935. Box 9-1 Complete Blood Count: Normal Adult Values
  936. Red Blood Cells
  937. Indices
  938. White Blood Cells (WBC)
  939. Iron Deficiency Anemia
  940. Clinical Features and Oral Manifestations
  941. Diagnosis and Treatment
  942. FIGURE 9-5 Iron deficiency anemia. The tongue is devoid of filiform papillae. Angular cheilitis was also present in this patient.
  943. Pernicious Anemia
  944. Clinical Features and Oral Manifestations
  945. Diagnosis and Treatment
  946. Folic Acid and Vitamin B12 Deficiency Anemia
  947. Oral Manifestations
  948. Diagnosis and Treatment
  949. FIGURE 9-6 Pernicious anemia. A, Angular cheilitis and depapillation of the tongue in a patient with pernicious anemia. B, The mucosa becomes atrophic in pernicious anemia and easily ulcerated. Note ulcer on left lateral aspect of tongue.
  950. Thalassemia
  951. Clinical Features and Oral Manifestations
  952. Treatment
  953. Sickle Cell Anemia
  954. FIGURE 9-7 Sickle cell anemia. Radiograph shows abnormal trabeculation.
  955. Clinical Features and Oral Manifestations
  956. Diagnosis and Treatment
  957. Aplastic Anemia
  958. FIGURE 9-8 Sickled red blood cells compared with normal red blood cells.
  959. FIGURE 9-9 Blood cells are derived from stem cells in the bone marrow.
  960. Systemic and Oral Manifestations
  961. Diagnosis and Treatment
  962. FIGURE 9-10 Aplastic anemia. Severe oral infection occurred after extraction of teeth in this patient with aplastic anemia.
  963. Polycythemia
  964. Types of Polycythemia
  965. Polycythemia Vera (Primary Polycythemia).
  966. Secondary Polycythemia.
  967. Relative Polycythemia.
  968. Oral Manifestations
  969. Diagnosis and Treatment
  970. Disorders of White Blood Cells
  971. Agranulocytosis
  972. Clinical Features and Oral Manifestations
  973. Diagnosis and Treatment
  974. Cyclic Neutropenia
  975. Leukemia
  976. Box 9-2 Classification of Leukemias
  977. Acute Leukemias
  978. Chronic Leukemias
  979. Acute Leukemias
  980. Clinical Features.
  981. Oral Manifestations.
  982. Diagnosis and Treatment.
  983. Chronic Leukemias
  984. FIGURE 9-11 Generalized gingival hyperplasia in a patient with leukemia.
  985. Clinical Features and Oral Manifestations.
  986. Diagnosis and Treatment.
  987. Celiac Disease
  988. Clinical Features and Oral Manifestations
  989. Diagnosis and Treatment
  990. Bleeding Disorders
  991. Hemostasis
  992. Platelet Count
  993. TABLE 9-1 Factors Involved in Coagulation*
  994. Bleeding Time
  995. FIGURE 9-12 Hemostasis.
  996. TABLE 9-2 Laboratory Tests for Hemostasis
  997. Prothrombin Time
  998. Partial Thromboplastin Time
  999. FIGURE 9-13 Coagulation cascade. Coagulation factors remain inactive until needed. As each coagulation factor becomes activated (a), it is responsible for the activation of another factor until all have been activated and the final clot is formed. The two pathways by which this cascade is activated are the intrinsic and extrinsic pathways.
  1000. Purpura
  1001. Thrombocytopenic Purpura
  1002. Clinical and Oral Manifestations.
  1003. Diagnosis and Treatment.
  1004. Nonthrombocytopenic Purpura
  1005. Oral Manifestations.
  1006. Diagnosis and Treatment.
  1007. Hemophilia
  1008. Types of Hemophilia
  1009. Oral Manifestations
  1010. Diagnosis and Treatment
  1011. Immunodeficiency
  1012. Primary Immunodeficiencies
  1013. TABLE 9-3 Examples of Drugs That Can Cause Immunosuppression
  1014. Secondary Immunodeficiencies
  1015. Oral Manifestations of Therapy for Oral Cancer
  1016. Radiation Therapy
  1017. Chemotherapy
  1018. FIGURE 9-14 A and B, Radiation mucositis. C, Postradiation xerostomia.
  1019. FIGURE 9-15 Clinical appearance of radiation caries.
  1020. FIGURE 9-16 Xerostomia caused by chlorpromazine (Thorazine) administration.
  1021. Effects of Drugs on the Oral Cavity
  1022. FIGURE 9-17 Candidiasis in a patient taking prednisone for rheumatoid arthritis.
  1023. FIGURE 9-18 Discoloration of teeth caused by tetracycline ingestion.
  1024. FIGURE 9-19 Drug-induced gingival hyperplasia. A, Gingival enlargement caused by phenytoin (Dilantin). B and C, Gingival hyperplasia caused by nifedipine (Procardia).
  1025. FIGURE 9-20 Osteonecrosis associated with bisphosphonate therapy involving the mandible.
  1026. Selected References
  1027. Books
  1028. Journal Articles
  1029. Newspaper Articles
  1030. Websites
  1031. Review Questions media
  1032. CHAPTER 9 SynopsisView PDFmedia
  1033. Pageburst Integrated Resource
  1034. Activities
  1035. Chapter 10 Diseases Affecting the Temporomandibular Joint
  1036. Objectives
  1037. Vocabulary
  1038. Anatomy of the Temporomandibular Joint
  1039. FIGURE 10-1 Lateral views of the temporomandibular joint. A, Jaw closed. B, Jaw open.
  1040. Box 10-1 Commonly Used Abbreviations
  1041. FIGURE 10-2 Muscles of mastication: the temporalis, lateral pterygoid, masseter, and suprahyoid.
  1042. Normal Joint Function
  1043. FIGURE 10-3 Muscles of mastication. The two distinct heads of the lateral pterygoid muscle are illustrated.
  1044. FIGURE 10-4 Muscles of mastication. Illustrated are the four paired muscles of mastication: the masseter, temporalis, medial pterygoid, and lateral pterygoid.
  1045. Temporomandibular Disorders
  1046. Epidemiology
  1047. Pathophysiology
  1048. Patient Evaluation
  1049. History
  1050. Clinical Examination
  1051. FIGURE 10-5 Panoramic radiograph of a patient with temporomandibular dysfunction and normal anatomy of the mandibular condyles.
  1052. Imaging
  1053. Types of Temporomandibular Disorders
  1054. Myofascial Pain and Dysfunction
  1055. FIGURE 10-6 Panoramic radiograph shows resorption of both the right and the left condyles. In this patient degenerative arthritis followed bilateral surgery of the temporomandibular joint. The left coronoid process was removed during surgery.
  1056. Box 10-2 TMD Classification
  1057. Internal Derangement
  1058. FIGURE 10-7 A and B, Cone-beam computed tomography illustrating degenerative joint changes in the right temporomandibular joint (TMJ) and normal left TMJ anatomy. There is flattening of the right condyle and erosive changes in the glenoid fossa (arrows). C, Malocclusion consisting of a prematurity of the right maxillary and mandibular second molars due to reduced vertical dimension of the right condyle and glenoid fossa.
  1059. FIGURE 10-8 A, Magnetic resonance imaging (MRI) scan of the right temporomandibular joint shows the normal position of the disk. Arrows point to the disk. B, MRI scan of the left temporomandibular joint in the same patient shows displacement of the disk. C, Condyle.
  1060. TABLE 10-1 Wilkes Classification
  1061. Arthritis
  1062. Hypermobility Disorders
  1063. FIGURE 10-9 Panoramic radiograph of an osteochondroma of the mandibular condyle.
  1064. Ankylosis
  1065. Neoplasia
  1066. Treatment of Temporomandibular Joint Disorders
  1067. Nonsurgical Treatment
  1068. Surgical Treatment
  1069. Multidisciplinary Management
  1070. Selected References
  1071. Books
  1072. Journal Articles
  1073. Review Questions media
  1074. Pageburst Integrated Resource
  1075. Activities
  1076. Answer Key
  1077. Chapter 1
  1078. Chapter 2
  1079. Chapter 3
  1080. Chapter 4
  1081. Chapter 5
  1082. Chapter 6
  1083. Chapter 7
  1084. Chapter 8
  1085. Chapter 9
  1086. Chapter 10
  1087. Case Studies
  1088. Glossary

 

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