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Oral Pathology

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

  • Gingivitis - Immune Cells: Neutrophils are the predominant immune cells present in the first stage of gingivitis.

  • Acute Necrotizing Ulcerative Gingivitis (ANUG): Involved papillae show punched out, crater-like necrotic areas covered by grayish pseudomembrane.

  • Drug-Induced Gingival Enlargement: Never seen in edentulous areas, as there is no plaque in these areas for the drug to interact with.

  • Papillon-Lefèvre Syndrome:

    • Cause: Mutation of the cathepsin C gene located on chromosome 11q14.

    • Result: Impaired chemotaxis and phagocytosis, leading to severe periodontitis and palmar/plantar hyperkeratosis.

  • 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).

Species Role
Streptococcus mutans Initiates caries; highly acidogenic/aciduric
Streptococcus sobrinus Similar to S. mutans, less adhesive
Lactobacillus spp. Progression in dentin; acid-loving
Actinomyces naeslundii/viscosus Linked with root surface caries
Veillonella spp. Lactate metabolizers in advanced lesions
Scardovia wiggsiae Emerging cause in early childhood caries
Propionibacterium, Bifidobacterium, Rothia Found in deep dentinal lesions

Miescher Cheilitis

  • Definition: Granulomatous inflammation confined to the lip

Melkersson–Rosenthal Syndrome

Triad:

  1. Facial palsy
  2. Cheilitis granulomatosa
  3. Fissured tongue

Ascher Syndrome

Triad:

  1. Double lip
  2. Blepharochalasis
  3. Nontoxic thyroid enlargement

Double Lip

  • Appearance: Cupid's bow

  • 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.

Intraepithelial Bulla

  • Location: Within the epithelium

  • Associated Conditions:

    • Herpes simplex

    • Herpes zoster

    • Chicken pox

    • Pemphigus

    • Hailey-Hailey disease (Familial benign pemphigus)

    • Epidermolysis bullosa (dystrophic recessive form)

    • Oral lesions of erythema multiforme

 Subepithelial Bulla

  • Location: Below the epithelium

  • Associated Conditions:

    • Pemphigoid

    • Bullous pemphigoid (most common subepithelial blistering disease)

    • Bullous lichen planus

    • Dermatitis herpetiformis

    • Epidermolysis bullosa

    • Skin lesions of erythema multiforme

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