Benign Migratory Glossitis

• Also called Erythema migrans, wandering rash, or geographic tongue.

• Associated with fissured tongue.

Fissured Tongue

• Seen in:

  • Melkersson-Rosenthal syndrome

  • Down syndrome

  • Benign migratory glossitis

Melkersson-Rosenthal Syndrome

• Triad:

  • Bell’s palsy

  • Cheilitis granulomatosa (lip/facial swelling)

  • Fissured tongue

Ankyloglossia

• Tongue-tie may cause speech defects.

• Affects articulation of: l, r, t, d, n, th, sh, z

Infective osteomyelitis

• Tuberculous osteomyelitis
• Syphilitic osteomyelitis
• Actinomycotic osteomyelitis

Tuberculous osteomyelitis

• Non healing sinus tract formation
• Age group affected is around 15 – 40 years.
• Commonly seen in phalanges and dorsal and lumbar vertebrae.
• Usually occurs secondary to tuberculosis of lungs.
• Cases have been reported where mandibular lesions were not associated with pulmonary disease.
• Another common entrance is through a carious tooth via open pulp.
• Usually affects long bones and rare in jaws.
• Results when blood borne bacilli lodge in cancellous bone. Usually in ramus , body of mandible. may mimic parotid swelling or submassetric abscess.

Syphilitic osteomyelitis

• Difficult to distinguish syphilitic osteomyelitis of the jaws from pyogenic osteomyelitis on clinical & radiographic examination.
• Main features are progressive course & failure to improve with usual treatment for pyogenic osteomyelitis.
• Massive sequestration may occur resulting in pathologic fracture.
• If unchecked, eventually causes perforation of the cortex.

Actinomycotic Osteomyelitis

• The organisms thrive in the oral cavity, especially tissues adjacent to mandible.
• May enter the bone through a fresh wound, carious tooth or a periodontal pocket at the gingival margin of erupting tooth.
• Soft or firm tissue masses on skin, which have purplish, dark red, oily areas with occasional zones of fluctuation.
• Spontaneous drainage of serous fluid containing granular material.
• Regional lymph nodes occasionally enlarged.
• Mimics parotitis / parotid tumors

Shape Recognition (Classic Boards Question)

• Heart/Oval Shape → Nasopalatine cyst
• Inverted Pear/Teardrop → Globulomaxillary cyst
• No Radiographic Feature → Nasolabial cyst

Location-Based Diagnosis

• Midline Maxilla (anterior) → Nasopalatine cyst
• Between maxillary lateral incisor & canine → Globulomaxillary cyst
• Midline Mandible → Median mandibular cyst
• Nasolabial fold → Nasolabial cyst

Clinical Correlations

• Spacing between centrals → Nasopalatine cyst
• Root divergence → Globulomaxillary cyst
• Nasal obstruction → Nasolabial cyst
• Usually asymptomatic → Median mandibular cyst

DIFFERENTIAL DIAGNOSIS PEARLS

For Midline Radiolucencies:

1. Nasopalatine cyst - Oval/heart shape, above centrals
2. Median palatine cyst - Posterior to nasopalatine
3. Central giant cell granuloma - More aggressive, may show septations

For Interradicular Radiolucencies:

1. Globulomaxillary cyst - Classic pear shape
2. Lateral periodontal cyst - More cervical location
3. Radicular cyst - Associated with non-vital tooth

• Actinomycosis (Sulfur Granules):

  • Yellow sulfur granules: Are actually bacterial colonies.

  • Histopathology: Colonies appear "cotton wool" shaped. (Note: "Cotton wool appearance" is seen radiographically in Paget's disease).

• Tuberculosis (TB):

  • Diagnosis (Gold Standard): Presence of acid-fast bacilli in sputum.

  • Staining Method: Ziehl-Neelsen staining method is used to identify acid-fast bacilli.

  • Scrofula: TB of cervical lymph nodes.

  • Lupus Vulgaris: TB of skin.

• Tongue & Gingival Appearance in Systemic Conditions:

  • Strawberry tongue and Raspberry tongue: Seen in stomatitis of Scarlet Fever.

  • Strawberry Gingivitis: Seen in Wegener's Granulomatosis.

• Stevens-Johnson Syndrome (SJS):

  • Characterized by ulcers with hemorrhagic crusts.

  • Typically has an acute onset following drug exposure (mainly sulfa group drugs).

• Biopsy for Vesiculobullous Pathology: Should be taken from the margin of the vesicle/bulla, including a significant amount of normal-appearing mucosa, to capture the pathological changes and adjacent healthy tissue for comparison.

• Linea Alba: A white, bilateral line on the buccal mucosa associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth.

• Morsicatio Buccarum: Chronic irritation seen on the buccal mucosa as a result of suction and glassblowers (chewing habits).

• Riga-Fede Disease: Sublingual ulcerations in infants resulting from chronic mucosal trauma from adjacent primary teeth (often natal/neonatal teeth).

Regional Odontodysplasia

• Key Feature: Widened pre-dentin layer
• Histology: Large areas of interglobular dentin

Supernumerary Roots

• Most Common: Mandibular canines and premolars

Congenitally Missing Teeth

Permanent Teeth (Descending Order):

1. Third molar
2. Mandibular 2nd premolar
3. Maxillary lateral incisor
4. Maxillary 2nd premolar

Deciduous Teeth: Maxillary and mandibular lateral incisors