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Pathology of the Oral Cavity

Pathology of the Oral Cavity. Diseases of the Oral Cavity. To learn: Disorders of the Oral Mucosa and Gingiva Disorders of the Salivary glands Disorders of the Teeth and Jaw bones Disorders due to the Systemic Diseases. Disorders of the Oral Mucosa and Gingiva.

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Pathology of the Oral Cavity

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  1. Pathology of the Oral Cavity

  2. Diseases of the Oral Cavity • To learn: • Disorders of the Oral Mucosa and Gingiva • Disorders of the Salivary glands • Disorders of the Teeth and Jaw bones • Disorders due to the Systemic Diseases

  3. Disorders of the Oral Mucosa and Gingiva • Ulcerative and inflammatory lesions • Aphtous ulcers • Herpes virus infections • Fungal infections • Hyperkeratotic lesions • Leukoplakia • Erythroplakia • Tumors • Benign tumors • Malignant tumors

  4. Ulcerative and inflammatory lesions Aphtous ulcers • Extremely common superficial ulcerations (erosions) of the oral mucosa • Painful • Single or multiple • Shallow • Hyperemic (erythematous) or yellowish-gray • Less than 5 mm in diameter • Covered by a thin exudate and rimmed by a narrow zone of erythema

  5. Location: • Soft palate • Buccolabial mucosa • Floor of the mouth • Lateral borders of the tongue

  6. Triggers or Etiology: • Inflammatory bowel diseases • Behçet’s disease • Hypersensitivity reactions • Emotional stress • Endocrine influences (pregnancy, menstruation) • Autoimmune reactions (involving both cellular and humoral mechanisms) • Infectious diseases

  7. Herpes virus infections • Orofacial herpetic infections are caused by HSV type 1 (HHV-1) • HHV-2 most often involves the genital tract • Most primary oral infections with HSV-1 are trivial “cold sores” • Adults harbor latent HHV-1: • upper respiratory tract infections • excessive exposure to cold, wind, or sunlight • allergic reactions

  8. Herpetic gingivostomatitis • Generally acute • Common in AIDS patients • In severe cases  • keratoconjunctivitis • encephalitis • Lesions: • the oral and pharyngeal mucosa • the tongue • the gingivae

  9. Herpes simplex Herpetic gingivostomatitis (HIV-positive patient)

  10. Fungal infections Candida albicans • Superficial, curdy, gray to white inflammatory membrane • Fibrinosuppurative exudate + C.albicanswith an underlying erythematous inflammatory base • Risk factors: • diabetes mellitus • neutropenia • immune deficiency syndromes • AIDS • antibiotic therapy

  11. Oral trush

  12. Candida albicans

  13. Hyperkeratotic lesions Leukoplakia(white plaque) • White plaque on the oral mucous membranes that cannot be removed by scraping • Precancerous lesion • Range from completely benign epithelial thickenings to highly atypical lesions with dysplastic changes that merge with carcinoma in situ (CIS) • Etiology: • Tobacco • smoking (cigar, cigarette, pipe) • Chewing tobaco • Alcohol • Chronic irritations (i.e. cheek bite)

  14. Leukoplakia

  15. Erythroplakia (dysplastic leukoplakia) • Red, velvety, possibly eroded area • Higher risk of malignant transformation • more than 50% • Etiology: • Tobacco (cigarettes, pipes, cigars, and particularly chewing tobacco ) • alcohol • Chronic exposure to persistent irritants • ill-fitting dentures • hot meals • HPV

  16. Erythroplakia

  17. Tumors Benign tumors and tumor-like conditions • Tumors • Papilloma (HPV serotypes 6 and 11) • Angioma (hemangioma & lymphangioma) • Tumor-like conditions • Fordyce spots (ectopic sebaceous glands) • Mucocele (minor salivary glands – destruction of ductus)

  18. Malignant tumors Squamous cell carcinoma: 95% of cancers of the oral cavity and the tongue • The small residual includes • adenocarcinoma (of salivary gland origin) • melanoma • various carcinomas

  19. Squamous cell carcinoma (Epidermoid carcinoma) • Location (most predicted): • Lower lip • Floor of the mouth • Tongue (lateral borders) • Etiology: • Leukoplakia and erythroplakia • Tobacco : alcohol&smoking, tobacco chewing • Ill-fitting dentures • Jagged teeth • HPV • Sunlight (lower lip) • Chronic infections

  20. Morphology • In the early stage: • Raised, firm, pearly plaques • irregular - roughened • verrucose areas of mucosal thickening • Differential diagnosis : leukoplakia & erythroplakia • As these lesions enlarge: • protruding masses • undergo central necrosis • irregular, shaggy ulcer rimmed by elevated, firm, rolled borders

  21. Microscopy • with leukoplakia and erythroplakia • well-differentiated keratinizing neoplasms • or anaplastic • or sometimes undifferentiated (sarcomatoid) tumors • Metastases: • regional and mediastinal lymph nodes • lungs • liver • bones

  22. Squamous cell carcinoma

  23. Disorders of the Salivary glands Inflammatory disorders • Sialadenitis • Sjögren syndrome • Mikulicz syndrome Tumors • Benign tumors • Plemorphic adenoma • Warthin tumor • Malignant tumors • Mucoepidermoid carcinoma • Adenoid cystic carcinoma

  24. Inflammatory Disorders of the Salivary glands • Viral (mumps) • Bacterial (complication of sialolithiasis) • Autoimmune origin • Sjögren’s syndrome: • involvement of the salivary glands  xerostomia (dry mouth) • involvement lacrimal glands  keratoconjunctivitis sicca (dry eyes) • Sarcoidosis : • bilateral sarcoidosis of the parotid, submaxillary, and sublingual glands • uvea involvement

  25. Sjögren’s syndrome Mikulicz syndrome

  26. Tumors of the Salivary glands Benign tumors Plemorphic adenoma • Mostly parotid gland • Painless swelling at the angle of the jaw • Excision; may recur (10%)

  27. Microscopy • Composed of epithelial elements and myoepithelial cells dispersed throughout a matrix of • mucoid, • myxoid, • chondroid tissue  a mixed tumor

  28. Warthin Tumor(Papillary Cystadenoma Lymphomatosum) • Almost always in the parotid gland • Small, round to oval, encapsulated mass • Excision; may recur (10%) • Microscopy: • (1) spaces are lined by a double layer of epithelial cells • (2) dense lymphoid stroma sometimes forming germinal centers

  29. Malignant tumors Mucoepidermoid carcinoma • Particularly the minor salivary glands • Radiation-induced neoplasm • Mixture of squamous cells, mucus-secreting cells • May recur ( 30%) • Disseminate to distant sites (30%) Adenoid cystic carcinoma • Particularly the minor salivary glands • Frank pain due to neural invasion • Microscopy: round-cystic spaces filled by mucus

  30. Tumors of the Salivary glands

  31. Disorders of the Teeth and Jaw bones • Teeth • Caries • Inflammation (pulpitis, apical granuloma & cyst) • Jaw bones • Fractures • Inflammation (osteomyelitis) • Cysts (odontogenic; non-odontogenic) • Tumors • Soft tissues • Bone & Cartilage • Odontogenic

  32. Odontogeic cysts & tumors

  33. Disorders due to the Systemic Diseases INFECTIOUS DISEASES • Measles: Koplik’s spots • Infectious mononucleosis: acute tonsillitis/pharyngitis, cervical lymphadenopathy • Diphtheria: pseudomembrane (tonsils/retropharynx) • AIDS: Herpesvirus infection (gingivostomatitis), Candida albicans, Kaposi sarcoma

  34. DERMATOLOGIC DISORDERS • Lichen planus: reticulate, white (keratotic) lesions • Pemphigus: vesicles and erosions • Bullous pemphigoid: bullae and erosions • Erythema multiforme (Stevens-Johnson syndrome): maculopapular-vesiculobullous lesions • follows an infection • drug • cancer • auto-immune disorder

  35. Pemphigus vulgaris

  36. HEMATOLOGIC DISORDERS • Pancytopenia and/or Leukemia • gingivitis • pharyngitis • tonsillitis • neck cellulitis (Ludwig’s angina) • Monocytic leukemia • gingival infiltration

  37. MISCELLANEOUS • Melanotic pigmentation: • Albright’s syndrome • Peutz-Jegher’s syndrome • Dilantin (phenytoin): gingival hyperplasia • Pregnancy: granuloma gravidarum • Other Syndromes: oral manifestations can be found in the hereditary or acquired syndromes • Teeth anomalies • Macroglossia • Bifid palate/tongue/lip • Hemangiomas, ect.

  38. Peutz-Jegher’s syndrome; Gingival hyperplasia

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