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Oral pathology

The Oral Pathology course discussed several different diseases and conditions in relation to the oral cavity, facial structures, and teeth itself. Due to this, I found that there were just so many terms for me to learn the meaning and definitions of, as well as match up to the oral manifestations. Instead of being tested on each individual chapter, we were tested on multiple chapters at once. This caused my brain to be filled with several different terms, but barely grasping the descriptions, and which categories they fell under. However, some of the content that I did happen to remember involved immunity, and also the many variants of normal. I remember this content as immunity has come up in many other courses such as Anatomy and Physiology, Pathophysiology, Periodontology, and Principles. As for the many variants of normal, we had to complete a project and group presentation on this content, so that is why they just stuck with me. In this e-learning portfolio, two specific sections that are focused on are: the oral manifestations related to infectious diseases from Chapter 4: Infectious Diseases, and the different developmental abnormalities of teeth from Chapter 5: Developmental Disorders. Below are the study notes that I have created.

CHAPTER 4:

INFECTIOUS DISEASES

The different bacterial, fungal, and viral infectious diseases and their oral manifestations.

 

   Baterial Infections

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  • Impetigo – lesions affecting perioral skin, which may itch (pruritus); vesicles can rupture, resulting in thick, amber-coloured crusts, or be longer lasting bullae
    -May resemble recurrent herpes simplex infection oral manifestations

  • Tonsillitis – inflamed tonsils

  • Pharyngitis – inflamed pharyngeal mucosa

  • Tuberculosis – enlargement of submandibular and cervical lymph nodes; possible oral lesions appear mainly on tongue and palate, which appear as painful, nonhealing, slowly enlarging superficial or deep ulcers

  • Actinomycosis – abscesses in oral cavity, with bright yellow grains in the pus

  • Syphilis – primary stage: oral lesion, called a chancre; secondary stage: mucous patches on skin and mucous membranes of oral cavity appearing as multiple, painless, white plaques covering ulcerated mucosa; tertiary stage: localized lesion, called a gumma, occurring most commonly on tongue and palate, however, it is not infectious

  • Necrotizing Ulcerative Gingivitis (NUG) – painful erythematous gingivitis with necrosis of interdental papillae, accompanied by a foul odor and metallic taste

  • Pericoronitis – inflamed mucosa around crown of a partially erupted, impacted tooth

  • Acute Osteomyelitis – inflamed bone and bone marrow of the jaws

  • Chronic Osteomyelitis – inflamed bone of the jaws, that is long-term, painful and swollen
     

   Fungal Infections

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  • Candidiasis – also called candidosis, moniliasis, and thrush; fungal infection of the oral cavity; many different types of diseases are caused by candidiasis which have oral manifestations

    • Pseudomembranous Candidiasis – oral mucosa contains a white curd-like material, where underlying mucosa is erythematous, and may cause a burning sensation and metallic taste

    • Erythematous Candidiasis – oral mucosa is erythematous and often painful; potentially irregular, patchy depapillation of tongue

    • Denture Stomatitis – oral mucosa is erythematous where complete denture or partial denture sits; oral lesions vary from petechiae-like to more generalized and granular

    • Chronic Hyperplastic Candidiasis – oral mucosa contains white lesions that do not wipe off

    • Angular Cheilitis – labial commissures appear erythema or fissured

    • Chronic Mucocutaneous Candidiasis – oral lesions appearing as pseudomembranous, erythematous, or hyperplastic; angular cheilitis may appear too

    • Median Rhomboid Glossitis – midline of the posterior dorsal part of tongue appears as an erythematous rhombus-shaped, flat-to-raised area

  • Mucormycosis – proliferating or destructive mass involving the nasal cavity, maxillary sinus, and hard palate
     

    Viral Infections
 

  • Human Papillomavirus (HPV) – benign lesions in oral cavity; squamous cell carcinoma in oropharyngeal region may also occur; causes several other diseases which have oral manifestations

    • Verruca Vulgaris – white, papillary, exophytic (growing outwards) oral lesion, most commonly found on lips or tongue
      -Most commonly resembles and is related to the benign tumour of squamous epithelium, called the papilloma

    • Condyloma Acuminatum – oral lesions appearing as pink, papillary, bulbous masses, occurring on the tongue, buccal mucosa, palate gingiva, and alveolar ridge

    • Multifocal Epithelial Hyperplasia – multiple whitish to pale pink nodules distributed throughout the oral mucosa

  • Herpes Simplex – oral infections are generally caused by type 1

    • Primary Herpetic Gingivostomatitis (initial, primary form) – painful, erythematous, and swollen gingiva, as well as multiple tiny vesicles on the perioral skin, vermilion border of lips

    • Recurrent Herpes Simplex (secondary form) – recurrent oral herpetic lesions on vermilion border of lips, called herpes labialis; they also appear on keratinized mucosa that is fixed to bone, such as the hard palate and gingiva, appearing as painful clusters of tiny vesicles or ulcers that can join to form a single ulcer with an irregular border

  • Varcella-Zoster Virus (VZV) – causes both chickenpox and shingles that each have oral manifestations

    • Varcella (Chickenpox) – vesicular and pustular rashes on perioral skin and mucous membranes

    • Herpes Zoster (Shingles) – unilateral, painful outburst of vesicles occur orally when the maxillary and/or mandibular branches of the trigeminal nerve are affected
      -These oral lesions begin as vesicles that progress to ulcers

  • Epstein-Barr Virus (EBV) – causes several other diseases which have oral manifestations

    • Infectious Mononucleosis – early stage: palatal petechiae

    • Hairy Leukoplakia – irregular, corrugated white lesion most commonly on the lateral border of tongue

  • Coxsackievirus – causes several other diseases which have oral manifestations

    • Herpangina – vesicles on soft palate; erythematous pharyngitis is also present

    • Hand-Foot-and-Mouth Disease – oral lesions that consist of painful vesicles and ulcers

    • Acute Lymphonodular Pharyngitis – hyperplastic lymphoid tissue of soft palate or tonsillar pillars, appearing as yellowish or dark pink nodules

  • Paramyxovirus – causes several other diseases which have oral manifestations

    • Measles – early stage: small erythematous macules with white necrotic centres occur in the oral cavity, called Koplik spots

    • Mumps – painful swelling of salivary glands, most commonly bilateral swelling of parotid glands

  • Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) – many other diseases that have oral manifestations are also associated with HIV and AIDS:

-Oral Candidiasis

-Herpes Simplex Infection

-Herpes Zoster

-Hairy Leukoplakia

-HPV

-Gingival and Periodontal Disease: Linear Gingival Erythema and Necrotizing Ulcerative Periodontitis (NUP)

-Kaposi Sarcoma

-Non-Hodgkin Lymphoma

-Aphthous ulcers: minor and major

-Salivary Gland Disease

-Spontaneous gingival bleeding

-Xerostomia

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References

 

Ibsen, O. A. C., & Phelan, J. A. (2014). Oral Pathology for the Dental Hygienist (6th ed.).
         114-138. St. Louis, Missouri: Elsevier

CHAPTER 5:

DEVELOPMENTAL DISORDERS

The different developmental abnormalities of teeth.

 

    Abnormalities in the Number of Teeth

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  • Anodontia – congenital lack of teeth; total andontia = lack of all teeth
    -May affect deciduous or permanent teeth

  • Hypodontia – lack of one or more teeth; teeth are often missing bilaterally
    -May affect deciduous or permanent teeth
    -Most common: maxillary and mandibular third molars, maxillary lateral incisors, mandibular second premolars, and mandibular incisors (in deciduous dentition)

  • Oliodontia – subcategory in which six or more teeth are congenitally missing

  • Supernumerary Teeth – extra teeth found in either the maxillary arch or mandibular arch
    -From the formation of extra tooth buds in the dental lamina, or the separation of already existing tooth buds
    -Either in the deciduous or permanent dentition
    -Most often seen in the maxilla
    -May occur singly, in multiples, unilaterally, or bilaterally
    -Usually smaller than a normal-size tooth, and often does not erupt
    -Most common: located between the maxillary central incisors, called the mesiodens; maxillary fourth molar, called the distomolar

 

    Abnormalities in the Size of Teeth

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  • Microdontia – one or more teeth are smaller in size than normal
    -Most common: maxillary lateral incisors, called “peg laterals”, and maxillary third molars

  • Macrodontia – one or more teeth are larger than normal
    -Localized macrodontia affecting one side of the dental arches is referred to as facial hemihypertrophy

 

    Abnormalities in the Shape of Teeth

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  • Gemination – a single tooth germ attempt to divide, and results in the incomplete formation of two teeth
    -Seen more frequently in the deciduous dentition, but occasionally occurs in the permanent dentition
    -Most often affects anterior teeth
    -Most common: deciduous mandibular incisors, and permanent maxillary incisors

  • Fusion – union of two normally separated adjacent tooth germs
    -Can happen between two adjacent normal teeth, or between a normal tooth and a supernumerary tooth
    -Occurs more frequently to deciduous teeth than permanent teeth
    -Most often occurs in the anterior region
    -Most common: incisors

  • Concrescence – two adjacent teeth are united by cementum only
    -Most common: adjacent maxillary molars, and adjacent supernumerary teeth, with involvement of erupted, unerupted, or impacted teeth

  • Dilaceration – an abnormal curve or angle in the root, but can however happen in the crown of a tooth

  • Enamel Pearl / Enameloma – a small, spherical enamel projection located on a root surface
    -Attached to cementum near the root bifurcation or trifurcation area, or occasionally near the CEJ
    -May consist of enamel only, or enamel, dentin, and pulp
    -Clinically, may be mistaken for calculus
    -Most common: maxillary molars

  • Talon Cusp – an accessory cusp located in the area of the cingulum of a permanent maxillary or mandibular incisor

  • Taurodontism – teeth exhibit elongated, large pulp chambers, and short roots (“bull-like” teeth), called taurodont
    -Seen in both deciduous and permanent dentition
    -Affects a single molar, or several molars in the same quadrant
    -Occurs unilaterally or bilaterally

  • Dens in Dente / Dens Invaginatus – enamel organ invaginates into the crown of a tooth before mineralization (“a tooth within a tooth”)
    -Usually affects a single tooth
    -Anterior teeth, particularly maxillary and mandibular incisors, are more commonly affected than posterior teeth
    -Most common: maxillary lateral incisor

  • Dens Evaginatus – accessory enamel cusp found on the occlusal surface of a tooth
    -Most common: mandibular premolars, called tuberculated premolars

  • Supernumerary Roots – extra roots on any tooth
    Most common: maxillary and mandibular third molars (for multirooted teeth), and mandibular canines and premolars (for single-rooted teeth)

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    Abnormalities of Tooth Structure

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  • Enamel Hypoplasia – incomplete or defective formation of enamel, resulting in the alteration of tooth form or colour
    -Can affect the deciduous or permanent teeth
    -When it is inheritied, it is called amelogenesis imperfecta

  • Enamel Hypocalcification – disturbance of the maturation of the enamel matrix, appearing as a chalky white spot on the middle third of smooth crowns of teeth

  • Endogenous or Intrinsic Staining – result of the deposition of substances circulating systemically during tooth development

  • Regional Odontodysplasia – known as “ghost teeth”, in which one or several teeth in the same quadrant are malformed, and radiographically exhibit a marked reduction in radiodensity
    -Very thin enamel and dentin are present, and the pulp chambers are very large
    -Either the teeth do not erupt, or eruption is incomplete: teeth will be non-functional and malformed

 

    Abnormalities of Tooth Eruption

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  • Impacted Teeth – teeth that cannot erupt due to physical obstruction
    -Most common developmental defect
    -Most common: maxillary and mandibular third molars, maxillary canines, the maxillary and mandibular premolars, and supernumerary teeth

  • Embedded Teeth – teeth that do not erupt because of lack of eruptive forces

  • Ankylosed Teeth – (also known as submerged teeth ), deciduous teeth in which bone has fused to cementum and dentin, preventing exfoliation and eruption of the underlying permanent tooth
    -Most common: deciduous molars

 

References

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Ibsen, O. A. C., & Phelan, J. A. (2014). Oral Pathology for the Dental Hygienist (6th ed.).
         162-174. St. Louis, Missouri: Elsevier

As you can tell from my study notes on just small sections of those two individual chapters, there are many different terms, and a lot of content. I focused on the oral manifestations of infectious diseases because although I am familiar with each of the bacterial, fungal, and viral infectious diseases, I think it is very beneficial for an RDH to know all of the oral manifestations involved with each. I also focused on just the developmental abnormalities of teeth because I felt those are the most common developmental disorders that I will see and should have a good understanding of. This “study session” really did help me to fill in the gaps as I individually wrote and typed out each infectious disease with the associated oral manifestations, and developmental abnormalities of teeth: number, size, shape, structure, and eruption abnormalities. In the Niagara College Dental Clinic, we would have to fill out specific assessments before having a DDS exam where one part asks about tooth surface anomalies in the hard tissue assessments category. Due to this “study session” that I had, I was able to become familiar with what this section is referring to, and successfully complete it with all of my clients in the Niagara College Dental Clinic.

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