mebooksfree.com Cawson’s Essentials of Oral Pathology and Oral Medicine mebooksfree.com Professor Roderick A. Cawson BDS, FDSRCS, LMSSA, MB BS, MD, FRCPath 1921–2007 For Elsevier Commissioning Editor: Alison Taylor Development Editor: Veronika Watkins/Katie Golsby Project Manager: Andrew Riley Designer: Christian Bilbow Illustrator Manager: Karen Giacomucci mebooksfree.com Ninth Edition Cawson’s Essentials of Oral Pathology and Oral Medicine E.W. Odell FDSRCS MSc PhD FRCPath Professor of Oral Pathology and Medicine, King’s College London Honorary Consultant in Oral Pathology, Guy’s and St Thomas’ NHS Foundation Trust, London mebooksfree.com © 2017 Elsevier Ltd. All rights reserved. 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The publisher’s policy is to use paper manufactured from sustainable forests Printed in China mebooksfree.com Contents Preface xv Defects of enamel and dentine 33 References xvii Regional odontodysplasia (ghost teeth) 33 Segmental odontomaxillary dysplasia 34 1 Principles of investigation, diagnosis and Other systemic diseases affecting teeth 35 treatment 1 Extrinsic agents affecting teeth 37 Taking a history 1 Odontomes 41 Consent 5 Disorders of eruption 42 Clinical examination 6 Medical examination 8 3 Disorders of development 45 Clinical differential diagnosis 8 Clefts of lip or palate 45 Investigations 9 Cleft lip and cleft palate 45 Imaging 9 Isolated cleft palate 48 Histopathology 10 Syndromic cleft lip and palate 48 Laboratory procedures 14 Other facial clefts 48 Molecular biological tests 15 Stafne’s idiopathic bone cavity 49 Haematology, clinical chemistry and Hereditary prognathism 49 serology 18 Ankyloglossia 49 Microbiology 18 Cowden’s syndrome 50 Other clinical tests 20 Other craniofacial malformations 50 Interpreting investigations and making a 4 Dental caries 53 diagnosis and treatment plan 20 Aetiology 53 Bacterial plaque 53 Microbiology 54 SECTION 1: Hard tissue pathology 23 Sucrose 57 2 Disorders of tooth development 23 Susceptibility of teeth to caries 59 Abnormalities in the number of teeth 23 Saliva and dental caries 60 Anodontia and oligodontia 23 Pathology of enamel caries 61 Additional teeth: hyperdontia 24 Pathology of dentine caries 65 Syndromes associated with Clinical aspects of caries pathology 68 hyperdontia 25 Arrested caries and remineralisation 68 Defective enamel formation 25 Caries in deciduous teeth 69 Defects of deciduous teeth 25 Hidden caries 70 Defects of permanent teeth 25 Root surface caries 70 Amelogenesis imperfecta 25 Clinical aspects of reactions to caries 70 Chronological hypoplasia 29 5 Pulpitis and apical periodontitis 73 Molar-incisor hypomineralisation 30 Pulpitis 73 Defective dentine formation 30 Pulp calcifications 77 Osteogenesis imperfecta with opalescent Periapical periodontitis, abscess and teeth 31 granuloma 77 Dentinogenesis imperfecta 31 Acute apical periodontitis 78 Dentinal dysplasia (‘rootless’ teeth) 32 Pathology and sequelae 78 mebooksfree.com Acute apical (dentoalveolar) abscess 79 8 Infections of the jaws 117 s t Chronic apical periodontitis and periapical Normal healing of an extraction socket 117 n e t n granuloma 81 Alveolar osteitis 117 o C 6 Tooth wear, resorption, hypercementosis Osteomyelitis of the jaws 120 and osseointegration 85 Acute osteomyelitis 120 Tooth wear 85 Chronic osteomyelitis 122 Attrition 85 Diffuse sclerosing osteomyelitis 123 Abrasion 85 Chronic low-grade focal osteomyelitis and Erosion 86 sclerosing osteitis 124 Abfraction 87 Osteoradionecrosis 124 Bruxism 87 Proliferative periostitis 125 Resorption of teeth 88 Medication-related osteonecrosis of the jaws Hypercementosis 91 (MRONJ) 125 Pathology of osseointegration 91 Traumatic sequestrum 127 Sclerotic bone islands 128 7 Gingival and periodontal diseases 95 The normal periodontal tissues 95 9 Major infections of the mouth and face 129 Gingival and periodontal fibres 96 Periapical (dentoalveolar) abscess 129 Gingival crevicular fluid (exudate) 96 Collateral oedema 129 Classification of periodontal diseases 96 ‘Fascial’ or tissue space infections 129 Chronic gingivitis 96 Facial cellulitis 130 Chronic periodontitis 99 Facial abscess 132 Pathology 101 Antibiotic abscess 133 Systemic predisposing factors 103 Necrotising fasciitis 133 General principles of management Cavernous sinus thrombosis 133 of chronic periodontitis 105 Noma (cancrum oris, necrotising stomatitis) 134 Complications of chronic Actinomycosis 135 periodontitis 106 Other ‘actinomycoses’ 136 Gingival recession 107 The systemic mycoses 136 Aggressive periodontitis 108 Systemic infections by oral bacteria 137 ‘Prepubertal’ periodontitis 109 10 Cysts in and around the jaws 139 Periodontitis as a manifestation of Classification of cysts 139 systemic disease 109 Common features of jaw cysts 140 Down’s syndrome 109 Treatment of jaw cysts 141 Papillon–lefèvre syndrome 110 Treatment of soft tissue cysts 142 Periodontal (lateral) abscess 110 Odontogenic cysts 142 Acute pericoronitis 110 Radicular cyst 142 Acute necrotising ulcerative gingivitis 112 Lateral radicular cyst 146 HIV-associated periodontitis 113 Residual radicular cyst 146 Gingival enlargement 113 Inflammatory collateral cysts 146 Hereditary gingival fibromatosis 113 Dentigerous cysts 146 Drug-induced gingival overgrowth 114 Eruption cyst 148 Localised juvenile spongiotic gingivitis 115 Odontogenic keratocyst 149 Plasminogen deficiency gingivitis 115 Basal cell naevus syndrome 153 Other inflammatory gingival swellings 115 Orthokeratinised odontogenic cyst 154 vi mebooksfree.com Lateral periodontal cysts 155 Fibroosseous odontogenic lesions 179 s Botryoid odontogenic cysts 155 Cemento-ossifying fibromas 180 t n e t Glandular odontogenic cyst 156 Cemento-ossifying fibroma 180 n o C Calcifying odontogenic cyst 156 Juvenile ossifying fibroma 181 Carcinoma arising in odontogenic cysts 157 Multiple and syndromic cemento-osseous Gingival cyst of the newborn 157 fibromas 181 Gingival cyst of adults 158 Cemento-osseous dysplasias 181 Non-odontogenic cysts 158 Periapical cemental dysplasia 181 Nasopalatine duct or incisive canal cyst 158 Florid cemento-osseous dysplasia 182 Nasolabial cyst 160 Focal cemento-osseous dysplasia 182 Sublingual dermoid cyst 160 Familial gigantiform cementoma 182 Thyroglossal duct cyst 161 Malignant odontogenic tumours 183 Branchial cyst 161 12 Non-odontogenic tumours of the jaws 187 Foregut cyst 162 Exostoses and tori 187 Other cysts in other chapters 162 Osteochondroma 187 11 Odontogenic tumours and related Central giant cell granuloma 188 jaw lesions 165 Noonan and other syndromes 190 Benign epithelial tumours 165 Langerhans cell histiocytosis 190 Ameloblastomas 165 Osteomas 192 Desmoplastic ameloblastoma 168 Gardner’s syndrome 192 Metastasising ameloblastoma 169 Ossifying fibromas 193 Unicystic ameloblastoma 169 Psammomatoid ossifying fibroma 193 Squamous odontogenic tumour 170 Haemangioma of bone 194 Calcifying epithelial odontogenic Melanotic neuroectodermal tumour of tumour 170 infancy 195 Adenomatoid odontogenic tumour 172 Malignant neoplasms of bone 196 Benign epithelial and mesenchymal tumours 172 Osteosarcoma 196 Ameloblastic fibroma 172 Chondrosarcoma 197 Ameloblastic fibrodentinoma and Ewing’s sarcoma 198 fibro-odontome 173 Myeloma 199 Primordial odontogenic tumour 173 Amyloidosis 200 Odontomes (odontomas*) 173 Solitary plasmacytoma 200 Compound odontome 174 Lymphomas 200 Complex odontome 174 Metastases to the jaws 200 Other types of odontome 175 13 Genetic, metabolic and other Calcifying odontogenic cyst 176 non-neoplastic bone diseases 205 Dentinogenic ghost cell tumour 176 Genetic diseases of bone 205 Benign mesenchymal tumours 176 Osteogenesis imperfecta 205 Odontogenic fibroma 177 Gnathodiaphyseal dysplasia 207 Granular cell odontogenic tumour 177 Osteopetrosis: marble bone disease 207 Odontogenic myxoma 177 Achondroplasia 207 Normal dental follicle 178 Cleidocranial dysplasia 208 Cementoblastoma 178 Cherubism 208 ‘Cementomas’ 179 Hypophosphatasia 209 mebooksfree.com vii Sickle cell anaemia and thalassaemia 210 Giant cell arteritis (temporal arteritis) 231 s t Gigantism and acromegaly 211 Polymyalgia rheumatica 232 n e t n Metabolic bone disease 211 Tetanus and tetany 232 o C Rickets 211 Pain referred to the joint 232 Vitamin D–resistant rickets 211 Dislocation 232 Hyperparathyroidism 211 Ehlers–Danlos syndrome 233 Other bone diseases 213 Paget’s disease of bone 213 SECTION 2: Soft tissue disease 235 Fibro-osseous lesions 216 Fibrous dysplasia 216 15 Diseases of the oral mucosa: Monostotic fibrous dysplasia 216 mucosal infections 235 Polyostotic fibrous dysplasia 218 Ulcers 235 Albright’s syndrome 218 Herpesvirus diseases 235 Osseous dysplasias 218 Primary herpetic stomatitis 235 Bone ‘cysts’ 218 Herpes labialis 238 Solitary bone ‘cyst’ 218 Herpetic whitlow 239 Aneurysmal bone ‘cyst’ 220 Herpes zoster of the trigeminal nerve 239 Osteoporotic bone marrow defect 221 Ramsay Hunt syndrome 240 Cytomegalovirus ulcers 240 14 Disorders of the temporomandibular Hand-foot-and-mouth disease 240 joints and trismus 223 Herpangina 241 Temporary limitation of movement 223 Measles 241 Infection and inflammation 223 Chicken pox 241 Injuries 223 Tuberculosis 242 Drugs 224 Syphilis 242 Persistent limitation of movement: Candidosis 244 extracapsular causes 224 Thrush 244 Irradiation 224 Angular cheilitis 246 Oral submucous fibrosis 224 Erythematous candidosis 246 Systemic sclerosis and scleroderma 224 Acute antibiotic stomatitis 246 CREST syndrome 225 Median rhomboid glossitis 247 Morphoea 225 Denture-induced stomatitis 248 Persistent limitation of movement: Chronic hyperplastic candidosis 249 intracapsular causes 226 Chronic mucocutaneous candidosis Arthritis 226 syndromes 250 Rheumatoid arthritis 226 Osteoarthritis 227 16 Diseases of the oral mucosa: non-infective Other types of arthritis 228 stomatitis 255 Condylar hyperplasia 228 Ulcers 255 Neoplasms 229 Traumatic ulcers 255 Synovial chondromatosis and loose Eosinophilic ulcer (atypical or traumatic bodies in the temporomandibular eosinophilic granuloma) 255 joints 229 Factitious ulceration (self-inflicted Limitation of movement: muscle causes 229 oral ulcers) 255 TMJ pain dysfunction ‘syndrome’ 229 Recurrent aphthous stomatitis 256 viii mebooksfree.com Behçet’s disease 259 18 Benign chronic white mucosal s HIV-associated oral ulcers 261 lesions 291 t n e t Nicorandil-induced ulcers 261 Fordyce spots 291 n o C Lichen planus and similar conditions 261 Leukoedema 292 ‘Desquamative gingivitis’ 262 Frictional keratosis 292 Lichen planus 262 Cheek and tongue biting 293 Vulvovaginal-gingival syndrome 267 Stomatitis nicotina 293 Malignant change in lichen planus 267 Oral hairy leukoplakia 294 Lichenoid reactions 268 White sponge naevus 295 Lichenoid drug reactions 268 Candidosis 296 Topical lichenoid reactions 268 Oral keratosis of renal failure 296 Graft-versus-host disease 269 Skin grafts 296 Lupus erythematosus 269 Psoriasis 297 Chronic ulcerative stomatitis 270 Other white lesions 297 Immunobullous disease 271 19 Potentially malignant disorders 299 Pemphigus vulgaris 271 Terminology 299 Paraneoplastic pemphigus 273 Field change 299 Mucous membrane pemphigoid 273 Erythroplakia 300 Erythema multiforme 275 Speckled leukoplakia 300 Stevens Johnson syndrome 277 Leukoplakia 300 Toothpaste-induced epithelial peeling 277 Proliferative verrucous leukoplakia 302 Other mucosal allergic responses 277 Smokeless tobacco-induced Oral signs in reactive arthritis 277 keratoses 302 Mucocutaneous lymph node syndrome Chronic hyperplastic candidosis 304 (Kawasaki’s disease) 278 Oral submucous fibrosis 304 Miscellaneous mucosal ulcers 279 Lichen planus 305 Wegener’s granulomatosis 279 Lupus erythematosus 306 Oral reactions to drugs 279 Dyskeratosis congenita 306 Uncommon mucocutaneous diseases 279 HPV-associated dysplasia 306 17 Tongue disorders 283 Syphilitic leukoplakia 306 Normal structures 283 Management of dysplastic lesions 307 Furred tongue 283 Smoking cessation 312 Foliate papillae 283 20 Oral cancer 317 Lingual varicosities 283 Epidemiology 317 Erythema migrans 283 Aetiology 318 Lingual papillitis 284 ‘Early’ and ‘late’ oral carcinoma 321 Hairy tongue and black hairy tongue 284 Oral cancer distribution 322 Glossitis 285 Pathology 322 Anaemic glossitis 285 Management 326 Glossodynia and the sore, physically Role of the dentist 331 normal tongue 287 Oral cancer screening 332 Macroglossia 287 Screening and detection aids 333 Amyloidosis 287 Verrucous carcinoma 333 Other diseases affecting the tongue 289 Diagnostic catches 334 mebooksfree.com ix