Oral Pathology

Heather Wilhelmi
Kirkwood Dental Hygiene Program
April 2015

Introduction
Oral pathology studies the cause and effects of diseases that affect the oral
cavity to help with diagnosis, prevention and treatments.
There are multiple causes of the many oral pathologies. Bacteria, viruses,
trauma, chemicals, hormones, nutrition, and genetics are commonly a part of
the cause. In some cases the cause isnt identified meaning it is idiopathic.
The dental hygienist is at the front lines, playing a main role in recognizing
conditions. The dentist is ultimately responsible for diagnosing a pathology. The
RDH must be able to identify and describe lesions including the size, color,
shape, consistency, location, and duration or pain expressed by the patient.
Early detection can help save a life!

VARIANT OF NORMAL
(Different than the standard)
1. Exostosis
2. Commissural Lip Pits
3. Fordyce Granules
4. Hairy Tongue
5. Ankyloglossia
6. Physiologic Pigmentation

s
Overgrowth
of
Bone
Description: Extra bone growth on the outer (facial) surfaces of the mandible or
maxilla.
These small hard nodules can appear in one or more places.
Symptoms: Benign and not normally painful.
Etiology: Many possible causes.
Eg. Stress on teeth due to clenching or malocclusion (bite). The body responds
by growing
extra bone to support the teeth. Could also be genetic, environmental or
nutritional.
Photo resource: https://www.google.com/?gws_rd=ssl#q=buccal+exostosis+pictures

Commiss
ural Lip
Small
Pits holes
Description: Small pits or holes in the corner of lips.
Sizes range from 1-4 mm in depth.
Symptoms: None.
Etiology: Defect in development of lips.
Treatment:

No treatment necessary.

*Good oral hygiene important to keep bacteria removed from pits.

Photo resource: https://www.google.com/search?
q=lip+pits+corner+of+mouth&biw=1093&bih=493&tbm=isch&tbo=u&source=univ&sa=X&ei=l1gxVfDzDsLqoASxIGoBg&ved=0CDIQsAQ&dpr=1.25

Fordyce
Trapped oil
Granules
glands
Description: Small, raised bumps ranging from white to yellow color, pimples.
Appear on the lip or inside of the cheek and anywhere there are oil glands.
Symptoms: None.
Etiology: Blocked oil glands.
Treatment:

No treatment necessary.

Photo resource: https://www.google.com/search?

q=fordyce+granules&biw=1093&bih=493&tbm=isch&tbo=u&source=univ&sa=X&ei=q2IxVbfBFYb2yQS8x4DwAQ&sqi=2&ved=0CCoQsAQ&dpr=
1.25#imgrc=hXJD5VekqNk46M%253A%3BDNCKF4LW6u2WM%3Bhttp%253A%252F%252Fdoctorspiller.com%252Fimages%252FOralAnatomy
%252FFordyce.jpg%3Bhttp%253A%252F%252Fdoctorspiller.com%252Ffordyce_granules.htm%3B384%3B256

Hairy
Elongated
Tongue
Papilla
Description: The bumps on the surface of the tongue are longer than normal due to
not being
exfoliated. This coats the tongue and can have a hair-like appearance, picking
up stains.
Symptoms: None.
Etiology: Inadequate shedding or exfoliation of papilla on tongue and staining.
Treatment: Brush and clean tongue thoroughly each day to exfoliate and remove
stains caused by
foods, drinks, medicines, and smoking.

Photo resource: https://www.google.com/search?

q=hairy+tongue+images&biw=1093&bih=493&source=lnms&tbm=isch&sa=X&ei=EGwxVZ66NM-nyASj54HgDw&sqi=2&ved=0CAYQ_AUoAQ

Ankyloglos
sia Tongue
Tied

Description: Tongue is attached too tightly to the floor of the mouth by tissue, frenum.
Symptoms: Tongue movement is restricted. Depending on severity it can affect
speech
swallowing.
Etiology: Defect in development.
Treatment: Not always necessary. In more severe cases a frenectomy will release
the tongue by
Photo resource: http://search.tb.ask.com/search/GGmain.jhtml?
p2=^XP^xdm307^S11664^us&si=CMWW0KqJx8ICFatcMgodYU4Ahw&ptb=15467C17-F2BB-4E9E-9D6C774C5B7968F9&ind=2014121422&st=bar&n=780d0dce&searchfor=ankyloglossia+images

surgically cutting the tight frenum.

Physiologi
c
Pigmentati
on Melanin
Description: Darker pigmentation of oral tissues due to persons ethnicity. Can
appear anywhere in oral
cavity.
Symptoms: Color is darker than pink. No pain.
Etiology: Skin pigmentation, genetics.
Treatment:

Not necessary.

Photo resource: http://search.tb.ask.com/search/AJimage.jhtml?searchfor=physiology+pigmentation+images&p2=%5EXP

%5Exdm307%5ES11664%5Eus&n=780d0dce&ss=sub&st=bar&ptb=15467C17-F2BB-4E9E-9D6C774C5B7968F9&si=CMWW0KqJx8ICFatcMgodYU4Ahw&tpr=sbt&ts=1429304446706

ABNORMAL ORAL PATHOLOGIES

(Change due to trauma or disease causing a lesion)
1. Aphthous Ulcer
2.
3.
4.
5.
6.

Psuedomembranous Candidiasis
Verruca Vulgaris
Reticular/Papular Lichen Planus
Oral Squamous Cell Carcinoma
Monomorphic Adenoma
10

Ulcer
Canker
Sore
Description: Crater like break in tissue. Appears anywhere in the mouth or on the
lips.
*If appears in mouth it is most likely in other places (Eg. Stomach, intestines,
throat).
Symptoms: Painful, yellow tinted middle with red halo border.
Etiology: Many possible causes.
Eg. Hormonal imbalance, nutritional deficiencies, allergies, emotional or physical
stress.
Photo resource: https://www.google.com/search?q=aphthous+ulcers&biw=1093&bih=493&source=lnms&tbm=isch&sa=X&ei=RIExVerBpDsoASZooGYCA&ved=0CAYQ_AUoAQ

Treatment:

Difficult to treat due to the multiple possible causes.

Psuedomembr
anous
Candidiasis
Thrush
Description: Fungal infection that is a white plaque (cottage cheese appearance).
When wiped off
tissue underneath is irritated/red. Often seen on the tongue, cheek, or roof of
mouth.
Symptoms: Burning and bad taste. In more severe cases difficulty swallowing and
fever.
Could also be painless with no symptoms.
Etiology: Fungal infection caused by microorganisms.
Often occurs in people with weak immune systems, have dry mouth, smoke,
wear dentures
Photo resource: https://www.google.com/search?
q=thrush+pictures&biw=1093&bih=493&source=lnms&tbm=isch&sa=X&ei=07oxVYjWOMHboATsuICYDg&ved=0CAYQ_AUoAQ

or infants. The use of antibiotics, corticosteroids, and birth control pills can also

Verruca
Comm
Vulgaris
on
Wart

Description: A small bump that has a rough surface or white projections (Cauliflower
appearance).
Normally seen on the tongue, inside or outside of the lip.
*Commonly on the hands and spread to the mouth.
Symptoms: No pain, but can be uncomfortable depending on location and size.
Etiology: HPV-2, HPV-4, HPV-40 (Form of the Human Papillomavirus).
Treatment:

Surgically removed.

Outside of the oral cavity topical agents can be applied that cannot be used in
the mouth.

Photo resource: https://www.google.com/search?

q=verruca+vulgaris+in+oral+cavity+pdf&biw=1093&bih=493&source=lnms&tbm=isch&sa=X&ei=68ExVeixEI2rogS3o4CYAw&ved=0CAYQ_AUoA
Q&dpr=1.25#imgrc=lAmCVzSb3Ob_IM%253A%3B1BJ9zOyp8EK0NM%3Bhttp%253A%252F%252Fwww.intechopen.com%252Fsource%252Fhtml
%252F46324%252Fmedia%252Fimage2.png%3Bhttp%253A%252F%252Fwww.intechopen.com%252Fbooks%252Ftrends-in-infectious-diseases
%252Foral-hpv-related-diseases-a-review-and-an-update%3B1206%3B1045

Reticular/Pap
ular Lichen
Wickham
Planus
Striae
Description: Plaque with fine white lines resembling a spider web. Commonly found
on the inside of
the cheeks, gums, or side of the tongue.
*Can also appear outside of the oral cavity in a purple color, rather than white.
Symptoms: Some patients can experience sensitivity or pain, ranging from discomfort
to more
severe pain and lesions. Other patients do not experience these symptoms.
Etiology: Idiopathic, under investigation.

Photo resource: https://www.google.com/search?q=oral+lichen+planus+photos&biw=1093&bih=493&source=lnms&tbm=isch&sa=X&ei=otIxVf_J4HloAT-xIC4AQ&ved=0CAYQ_AUoAQ#imgrc=xepEKkYddtmwBM%253A%3B2ZNMulZHd3i1FM%3Bhttp%253A%252F%252Friversideonline.com

%252Fsource%252Fimages%252Fimage_popup%252Fsn7_orallichenplanus.jpg%3Bhttp%253A%252F%252Friversideonline.com
%252Fhealth_reference%252Fdental-care%252Fds00784.cfm%3B400%3B400

Treatment:

After diagnosing by biopsy managed through observation for any changes

Squamous
SCC
Cell
Carcinoma

90% of oral
cancers

Description: Red or white outward ulcerated growth. Often found on the tongue, floor
of mouth,
and lower lip.
*Most common oral cancer.
Symptoms: None initially. Eventually, a sore that doesnt heal, loose teeth and
bleeding gums.
When size increases pain, difficulty swallowing and speaking.
Etiology: Multiple contributors ranging from tobacco and alcohol to tissue irritation.
Treatment:

After biopsy diagnosis surgical removal, chemotherapy and radiation.

Photo Resource: https://www.google.com/search?

tbm=isch&q=oral+squamous+cell+carcinoma+pictures&ei=AtoxVYHIONfqoASn6YHQCg#imgrc=G2npK9J_6D7JAM%253A%3BiO_w6Hn2WrJaQM
%3Bhttp%253A%252F%252Fwww.merckmanuals.com%252Fmedia%252Fprofessional%252Fthumbnails%252Ftn_erythroplakia.jpg%3Bhttp%253A
%252F%252Fwww.merckmanuals.com%252Fprofessional%252Fear_nose_and_throat_disorders%252Ftumors_of_the_head_and_neck
%252Foral_squamous_cell_carcinoma.html%3B149%3B78

*Early diagnosis is critical to allow treat before it spreads.

Monomorphi
c Adenoma
Warthin
s Tumor

Description: A growth on the parotid salivary glands in the cheek region. Most often
benign fibroma.
Usually appears as large soft lumps on both sides of the face.
Symptoms: No pain, but can be uncomfortable and disfiguring as size increases.
Etiology: Unknown.
Thought to be associated with smoking.
Treatment:

Surgically removed.

Photo resource: https://www.google.com/search?q=warthin's+tumor+pictures&biw=1093&bih=493&source=lnms&tbm=isch&sa=X&ei=3d4xVbuOMiZyATdqwE&sqi=2&ved=0CAYQ_AUoAQ#imgdii=rbkRmNK3RJIrBM%3A%3BrbkRmNK3RJIrBM%3A%3BsPfdGMDO4k9ObM

%3A&imgrc=rbkRmNK3RJIrBM%253A%3BWYBLMlUcRgsApM%3Bhttp%253A%252F%252Fwww.ghorayeb.com%252Ffiles
%252FACinic_Cell_Carcinoma_Combo.jpg%3Bhttp%253A%252F%252Fwww.ghorayeb.com%252FParotidSqCCA.html%3B566%3B408