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Textbook of Oral Pathology

© 2006, Sanjay Saraf
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system,
or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the editor and the publisher.

This book has been published in good faith that the material provided by editor is original. Every
effort is made to ensure accuracy of material, but the publisher, printer and editor will not be
held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be
settled under Delhi jurisdiction only.

First Edition : 2006

ISBN 81-8061-655-X
Typeset at JPBMP typesetting unit
Printed at Gopson Papers Ltd, A-14, Section 60, Noida
 dedicated
to
my family members who always stood by my side and
helped me in proofreading with lots of enthusiasm and fervour
 Contributors
Ranjana Gondal Pankaj Goel
Professor Department of Community Dentistry
Department of Pathology Assistant Professor
GB Pant Hospital Maulana Azad Dental College and Hospital
New Delhi New Delhi

Kanwarjit Singh Sujata Mohanty

Assistant Professor Assistant Professor
Department of Periodontics Department of Oral and Maxillofacial Surgery
Maulana Azad Dental College and Hospital Maulana Azad Dental College and Hospital
New Delhi New Delhi
Dr
Dr.. (Mrs.) Alka D. K ale
Kale Professor & Head,
Dept. of Oral Pathology & Microbiology
Oral Pathologist M.D.S. K.L.E. Institute of Dental Sciences,
Nehru Nagar, Belguam - 590 010,
: (0831) 470034, 470540


Foreword
The Textbook of Oral Pathology is concerned with the science of Oral Pathology. Most dental students are not
going to become Oral Pathologists. It is nevertheless essential that the dental school curriculum should
include a course of Oral Pathology, which provides a clear account of the causes, where these are known,
and of pathological changes of the more important diseases. Thus, appreciation of pathological processes of
disease aids in correct interpretation, diagnosis, research and treatment planning.
Progress in biological sciences necessitates newer books and changes in the existing text. This book has
been designed for the undergraduates, the beginner, who is apt to be borne down by the erudition of the
real expert.
In the practice of medicine we are concerned with three main questions: what is wrong? (Diagnosis);
what is going to happen? (Prognosis); what can be done? (Treatment); To this one more should be added:
why did this happen? (Pathogenesis).
The objective of the book has been to present an appropriate in-depth knowledge of the disease process.
Special emphasis has been made on pathogenesis and diagnostic pathology so that the integration and
factual coordination makes clinical application possible.
This textbook has 21 chapters which are provided with appropriate schematic diagrams and
photomicrographs. The illustrations and photographs are from personal collection depicting disease processes
of common occurrence in India.
Pathogenesis of each disease has been described in detail. Chapter on forensic dentistry has been included.
There are auxiliary chapters consisting of glossary of difficult words, list of syndromes, references for
suggested reading and classification. Disease can be classified in different ways. Making it available in the
textbook makes the understanding and grouping of disease easier.
It has been said that an educated man is one who knows how to use a library. Education is a process
whereby a pupil who must be taught, is transformed into a student who teaches himself. A student should
be provided with a stream of knowledge not a stagnant pool from which to drink. This has been the main
goal of Textbook of Oral Pathology.

Dr Alka D Kale
Professor and Head
Department of Oral Pathology
and Microbiology
KLE Institute of Dental Sciences
Belgaum
India
 Preface
The subject of Oral and Maxillofacial Pathology is a branch of Dentistry and Pathology that deals with
identification of diseases of oral and maxillofacial region. It constitutes the basic step and a necessary
adjunct (along with other diagnostic means) towards a correct diagnosis of a disease or pathology. The
study of this subject at the outset involves the study of etiology of a disease; its nature; course; mode of
progression and adverse impact on the morphology and normal functioning of human body. The essence of
this science lies in unraveling the ugly marks of a disease at macroscopic and microscopic levels. A correct
identification and diagnosis of a disease at cellular level along with clinical, radiological, and biochemical
analysis will contribute to correct management of a disease.
The subject of Oral and Maxillofacial Pathology is an important subject for a student pursuing Dentistry.
An understanding of this subject for the undergraduate students is necessary because it widens the mental
comprehension and strengthens the basic precepts of oral diseases. The learning of this subject is interrelated
because its basic understanding can give a clear picture of other dental subjects to the students.
An attempt has been made in this book to provide the basic understanding of a disease process. Oral
disorders occurring either primarily or as manifestation of systemic disorders have been described with
special emphasis on pathogenesis of disease. The students should find the chapters titled diagnostic pathology
and forensic dentistry useful. A list of syndromes, glossary of difficult terms and classifications of oral
disorders will help the students to augment the understanding of this subject.
The study of differential and clinical diagnosis as well as management of a disease has to be studied once
a student understands basic pathology. Therefore, the epidemiology, treatment and prognosis have not
been emphasized much in this textbook. Students should refer to pertinent texts for the same. This book has
been written in a clear and lucid language that can help the student to grasp this subject.
In no way does this book challenge or refute individual hypothesis or theories. Rather, it reflects the
widely accepted facts and suggestions. Critical appraisal or new suggested facts and research work to
improve the contents of this book are always welcome because it would largely facilitate learning process
instead of tethering it to one point.

Sanjay Saraf
 Acknowledgements

I am extremely thankful to the contributors of this textbook for the efforts put in by them, viz. Dr Ranjana
Gondal (Professor of Pathology, GB Pant Hospital, New Delhi), Dr Kanwarjit Singh (Assistant Professor of
Periodontics, MADC and H, New Delhi), Dr Pankaj Goel (Assistant Professor of Community Dentistry,
MADC and H, New Delhi), and Dr Sujata Mohanty (Assistant Professor of Oral and Maxillofacial Surgery,
MADC and H, New Delhi). I am also indebted to the following people for their timely and much needed
help in writing this textbook, viz. Dr SC Mittal (Deputy Director, Central Forensic Science Laboratory, New
Delhi), Dr (Mrs) Alka Kale (Vice Principal, KLE Institute of Dental Sciences, Belgaum) and Dr Seema H,
(Associate Professor of Oral Pathology, KLE Institute of Dental Sciences, Belgaum). I also express my sincere
thanks to Dr Sushmita Saxena (Professor of Oral Pathology, Subharti Dental College and Hospital, Meerut),
Dr Keya Sircar (Professor and Head, DJs College of Dental Science and Hospital, Modinagar), and Dr Meera
Chaudhary (Lecturer, MADC and H, New Delhi) for proofreading the text. This textbook would not have
been accomplished if much needed help would not have come from Dr Passi, Dr Sahoo, Dr Alok, Dr Panki
Datta, Dr Vikas Malhotra and Dr Aditi. I acknowledge all the help provided by interns and junior residents
of MADC and H, New Delhi towards proofreading of the text. I also thank Mr Pratap for providing me the
journals and books in National Medical Library, New Delhi.
The endeavor of typing, checking the proofs, drawing the schematic diagrams, etc. goes to M/s Jaypee
Brothers Medical Publishers (P) Ltd., New Delhi.
 Contents
1. Physical and Chemical Injuries ........................................................................................................................ 1

2. Healing and Repair ............................................................................................................................................ 21

3. Developmental Disorders of Oral and Paraoral Structures ...................................................................... 31

4. Bacterial, Viral, Mycotic and Protozoal Disorders ...................................................................................... 77

5. Oral Manifestations of Systemic Disorders ................................................................................................ 121

6. Allergic and Immunological Disorders ....................................................................................................... 145

7. Dental Caries ..................................................................................................................................................... 159

8. Pulp and Periapical Disorders ...................................................................................................................... 175

9. Spread of Oral Infections ............................................................................................................................... 187

Sujata Mohanty

10. Cysts of Oral and Paraoral Structures .......................................................................................................... 205

11. Neoplasms of Oral Cavity .............................................................................................................................. 221

• Benign Neoplasms of Epithelial Tissue Origin ........................................................................................ 222
• Malignant Neoplasms of Epithelial Tissue Origin ................................................................................. 245
• Neoplasms of Odontogenic Tissue Origin ................................................................................................. 267
• Benign Soft Tissue Neoplasms of Mesenchymal Origin ......................................................................... 285
• Malignant Soft Tissue Neoplasms of Mesenchymal Origin ................................................................... 313

12. Disorders of Periodontium ............................................................................................................................. 323

Kanwarjit Singh

13. Disorders of Salivary Glands ........................................................................................................................ 345

14. Hematological Disorders ................................................................................................................................ 375

15. Dermatological Disorders ............................................................................................................................... 411

16. Disorders of Bone and Joints of Oral and Maxillofacial Regions ......................................................... 443

17. Disorders of Nervous System ........................................................................................................................ 483

18. Regressive Alterations of the Teeth ............................................................................................................. 493

19. Biopsy and Exfoliative Cytology .................................................................................................................. 503

xvi Textbook of Oral Pathology

20. Diagnostic Pathology ...................................................................................................................................... 511

Ranjana Gondal

21 Forensic Odontology ....................................................................................................................................... 517

Pankaj Goel

Glossary .............................................................................................................................................................. 539

Features of Syndromes and Conditions Affecting Oral and Extra Oral Structures ............................... 547

Histological Typing of Oral and Paraoral Lesions .................................................................................... 555

Bibliography and Suggested Reading ............................................................................................................ 559

Index ..................................................................................................................................................................... 589