• Pioneer bacteria invade dentinal tubules before clinical signs
• Tubules contain pure forms:
  • One tubule → cocci
  • Adjacent tubule → bacilli or threads
• No mixed forms within a single tubule

Smoker's Palate & Melanosis

• Status: NOT premalignant
• Exception: Reverse smoking palatal changes ARE premalignant

Oral Submucous Fibrosis (OSMF)

Initial Stage:

• Vesicles may be present
• Dilated capillaries

Advanced Stage:

• Compressed capillaries due to fibrosis

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.

 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

• Pemphigus → Granular IgG intercellular
• Lichen Planus → Linear anti-fibrinogen at BM, with lamina propria extensions
• Cicatricial Pemphigoid → Patchy linear IgG/C3 at BM
• Bullous Pemphigoid → Patchy linear IgG at BMZ
• Erythema Multiforme → Patchy linear fluorescence
• Discoid Lupus (Lesional mucosa) → Speckled pattern (IgG, IgM, IgA, C3, fibrinogen)