• Calcifying Odontogenic Cyst (COC) / Gorlin Cyst: Characterized by Ghost Cells.

• Aneurysmal Bone Cyst (ABC): Associated with a "blood-soaked" appearance on gross examination.

• Radicular Cyst - Common Site: Maxillary anterior teeth (due to higher incidence of trauma).

• Odontogenic Keratocyst (OKC) / Keratocystic Odontogenic Tumor (KCOT):

  • Most common site: Posterior mandible (similar to ameloblastoma).

  • Expansion: Tends to expand antero-posteriorly; buccal and lingual expansion seen in late stages.

  • Basal layer histology: Tall columnar cells with palisaded nuclei – "row of tombstones" or "picket fence appearance."

  • Classification: Now considered a benign odontogenic neoplasm (KCOT) in recent WHO classifications.

• Retention Cyst of Maxillary Sinus: Characteristic X-ray feature is a dome-shaped/hemispherical radio-opacity in the antrum.

• Abfraction: Appears as a subgingival, deep, narrow "V" shaped notch in the cervical areas of teeth.

• Abrasion vs. Abfraction:

  • Abrasion: Commonly affects cuspids and bicuspids.

  • Abfraction: Affects only a single tooth (adjacent tooth is unaffected).

• Erosion (Gastric): Erosion due to gastric secretions is termed Perimolysis.

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

Macroglossia

• Feature: Crenated (scalloped) lateral tongue borders

Lymphangioma of Tongue

• Appearance: Tapioca pudding/Frog's egg

Geographic Tongue

• Associated With: Fissured tongue
• Histopathology: Similar to psoriasis
• Key Feature: Munro's abscesses

Median Rhomboid Glossitis

• Unique Sign: "Kissing lesion" on soft palate due to tongue contact

Hairy Tongue

• Misnomer: Elongated filiform papillae—not actual hair

Acute suppurative osteomyelitis

• Serious sequela of periapical infection.
• Leads to spread of pus through the medullary cavities of bone.
• Depending upon the main site of involvement of bone, can be of two types-

1. Acute intramedullary
2. Acute subperiosteal

Acute Intramedullary Osteomyelitis

CLINICAL FEATURES:

• Patient experiences dull , continuous pain , indurated swelling forms over the affected region of jaw involving the cheek , febrile.
• When mandible involved, loss of sensation occurs on lower lip on affected side due to involvement of inferior alveolar nerve.
• Teeth become loose later along with tender on percussion
• Pus discharge , trismus , foul smell , regional lymphadenopathy , weakness

RADIOGRAPHIC FEATURES

• Earliest radiographic change is that trabeculae in involved area are thin, of poor density & slightly blurred.
• Subsequently multiple radiolucencies appear which become apparent on radiograph.
• In some cases there is saucer shaped area of destruction with irregular margins.
• Loss of continuity of lamina dura, seen in more than one tooth.

HISTOLOGIC FEATURES:

• Dense infiltration of marrow by polymorphonuclear leukocytes.
• Bone trabeculae in involved site (sequestrum) are devoid of cells in the lacunae.
• separation of considerable portions of devitalized bone.

Acute Subperiosteal Osteomyelitis

CLINICAL FEATURES

• Pain , febrile condition , i/o and e/o swelling , parasthesia
• Bone involvement limited to localized areas of cortex.
• Pus ruptures rapidly through the overlying cortex, tracks along the surface of mandible under the periosteal sheath.
• Elevation of periosteum from cortex is followed eventually by minute cortical sequestration.

• Solitary Bone Cyst (Traumatic Bone Cyst): Usually situated above the inferior dental canal.

• Stafne's Bone Defect (Static Bone Cavity/Lingual Mandibular Bone Defect): Located below the inferior dental canal. (Note: Stafne's is a pseudocyst/developmental defect, not a true cyst).