Atlas of Oral Diseases (eBook)

Isaäc van der Waal graduated from Dental School in 1968 at the University of Utrecht, the Netherlands, and completed his oral surgery training program in 1973. In the same year he defended his PhD thesis on "Carcinoma of the Tongue; a clinico‑pathologic study". From 1975 to 1976 he served a Fellowship in Oral Pathology at the Armed Forces Institute of Pathology in Washington D.C. In 1979 he was appointed full Professor in Oral Pathology at the Dental School of the Vrije Universiteit in Amsterdam. He served as President of the International Association of Oral Pathologists from 1986 to 1988 and as President of the European Association of Oral Medicine from 1998 to 2000. He has been a member of various EC committees for the dental profession in the campaign "Europe against Cancer" and the anti-tobacco program. Dr. van der Waal has been Editor-in-Chief of the Dutch Scientific Journal of Dentistry (1986–1996), Associate Editor of the Journal of Oral Pathology and Medicine, and a member of the editorial boards of various international journals. He is author or co-author of more than 400 papers in peer-reviewed scientific journals as well as various other publications. In 2006 he received a royal decoration in the Netherlands (Ridder in de Orde van de Nederlandse Leeuw). He has also received an honorary doctorate from Semmelweis University in Budapest (Hungary) and awards or honorary fellowships or memberships from various associations, such as the Royal College of Physicians and Surgeons of Glasgow, the American Academy of Oral Medicine, and the International Association of Oral Pathologists.

Preface 6
Acknowledgment of the Figures 8
Contents 10
1: Examination of the Oral Cavity, Referral to a Specialist, and the Biopsy Procedure 17
1.1 Examination of the Oral Cavity 17
1.1.1 Inspection 17
1.1.2 Palpation 18
1.1.3 Exfoliative Cytology 18
1.2 Referral to a Specialist 18
1.2.1 When to Refer? 18
1.2.2 To Whom to Refer? 18
1.2.3 What Information Should Be Given to the Patient? 18
1.2.4 Content of the Referral Letter 18
1.2.5 Timely Referral 19
1.2.6 Feedback from the Specialist 19
1.3 The Biopsy 19
1.3.1 When to Take a Biopsy? 19
1.3.2 Who Should Take the Biopsy? 19
1.3.3 The Importance of Proper Anesthesia 19
1.3.4 The Importance of Proper Tissue Handling 20
1.3.5 Excisional Versus Incisional Biopsy 20
1.3.6 Dimensions of the Biopsy Specimen Multiple Biopsies
1.3.7 Which Instruments to Use for a Biopsy? 20
1.3.8 Perilesional Biopsy in Case of a Clinical Diagnosis of Vesiculobullous Disease 21
1.3.9 Labial Biopsy in the Diagnostic Work-Up of the Diagnosis of Sjögren’s Syndrome 21
1.3.10 Biopsy of a Bony Lesion 22
2: Diseases of the Oral Mucosa and Soft Tissues: General Aspects 23
2.1 Introduction 23
2.2 Angioedema 23
2.3 Cysts in the Soft Tissues 24
2.3.1 (Epi)dermoid Cyst 24
2.3.2 Heterotopic Gastrointestinal Cyst 25
2.3.3 Lymphoepithelial Cyst (“Oral Tonsil”) 25
2.3.4 Nasolabial Cyst 26
2.3.5 Mucous Retention Phenomenon or Mucous Cyst (Mucocele, Ranula) 27
2.3.6 Thyroglossal Duct Cyst 27
2.4 Erythroplakia 28
2.5 Fibroma and Fibroma-Like Lesions 28
2.5.1 Fibroma 28
2.5.2 Lipoma 30
2.5.3 Mucinosis, Focal 31
2.5.4 Neurofibroma 32
2.5.5 Neurilemmoma (Schwannoma) 32
2.5.6 Neuroma 33
2.5.7 Pyogenic Granuloma (“Lobular Capillary Hemangioma”) 33
2.5.8 Mucosal Nodules in Sarcoidosis 34
2.5.9 Nodular Presentation of Sialoadenitis of Minor Salivary Glands 35
2.5.10 Fibroma-like Lesions or Nodules Caused by Salivary Gland Tumors of the Intraoral Glands 35
2.5.11 Fibroma-Like Swelling Caused by a Sialolith 36
2.6 Fordyce’s Spots 38
2.7 Fungal Diseases 38
2.7.1 Actinomycosis 38
2.7.2 Candidiasis 39
2.8 Hemangioma and Hemangioma-Like Lesions 40
2.8.1 Angina Hemorrhagica Bullosa 40
2.8.2 Phlebectasia (“Varicosity”) 41
2.8.3 Hemangioma and Arteriovenous Malformations 42
2.8.4 Kaposi Sarcoma, AIDS Related 43
2.9 Leukoplakia and Allied Lesions, Including Lichen Planus 45
2.9.1 Alveolar Ridge Keratosis 45
2.9.2 Aspirin Burn 45
2.9.3 Contact Lesion 46
2.9.4 Frictional Lesion (“Frictional Keratosis”) 47
2.9.5 Leukoedema 47
2.9.6 Leukoplakia 48
2.9.7 Lichen Planus and Lichenoid Lesions 52
2.9.8 Lichen Sclerosus 55
2.9.9 Linea Alba 55
2.9.10 Lupus Erythematodes, Discoid Type 56
2.9.11 Morsicatio 57
2.9.12 White Sponge Nevus 57
2.10 Lymphangioma 58
2.11 Metastases, Soft Tissues 60
2.12 Papillomatous Lesions 60
2.12.1 Multifocal Epithelial Hyperplasia 60
2.12.2 Papilloma (Squamous Papilloma) 61
2.12.3 Verruciform Xanthoma 61
2.13 Pigmented Lesions 62
2.13.1 Pigmentation Caused by Amalgam (Amalgam Tattoo) or Other Metals 62
2.13.2 Melanin Pigmentation 63
2.13.3 Nevus, Pigmented 65
2.13.4 Melanoacanthoma 66
2.13.5 Melanoma 67
2.14 Sarcomas of the Soft Tissues 68
2.15 Stomatitis 68
2.16 Submucous Fibrosis 70
2.17 Ulcers 70
2.17.1 Aphthous Ulcers 70
2.17.2 Ulcers in Viral Infections 71
2.17.2.1 Herpes Simplex 71
Primary Infection 71
Secondary or Recurrent Infection 72
2.17.2.2 Herpes Zoster (Shingles) 73
2.17.3 Ulcers in Mucocutaneous Diseases 73
2.17.3.1 Erythema Multiforme 73
2.17.3.2 Pemphigus Vulgaris 74
2.17.3.3 Mucous Membrane Pemphigoid 75
2.17.4 Ulcer in Squamous Cell Carcinoma 76
2.17.5 Traumatic Ulcer 79
2.17.6 Ulcers, Miscellaneous Etiologies 80
3: Diseases of the Lips 83
3.1 Introduction 83
3.2 Acanthosis Nigricans 83
3.3 Cheilitis 83
3.3.1 Cheilitis Actinica 83
3.3.2 Cheilitis Angularis 84
3.3.3 Cheilitis Exfoliativa 85
3.3.4 Cheilitis Fissurata (Fissured Lip) 85
3.3.5 Cheilitis Glandularis 86
3.3.6 Cheilitis Granulomatosa 86
3.4 Cleft Lip 87
3.5 Herpes Labialis 88
3.6 Keratoacanthoma 88
3.7 Mucocele 89
3.8 Other Lesions Occurring on the Lips 90
3.8.1 Arteriovenous Malformation (“Hemangioma”) 90
3.8.2 Double Lip 90
3.8.3 Granular Cell Tumor 90
3.8.4 Labial Pits 91
3.8.5 Leukoplakia and Erythroplakia 91
3.8.6 Lichen Planus 91
3.8.7 Lipoma 92
3.8.8 Malignancies Other Than Squamous Cell Carcinomas 92
3.8.9 Pyogenic Granuloma (“Lobular Capillary Hemangioma”) 92
3.8.10 Salivary Gland Tumors 93
3.8.11 Squamous Cell Carcinoma 93
3.8.12 Ulcers, Drug Related 94
3.8.13 Ulcer, Traumatic 94
4: Diseases of the Tongue 95
4.1 Introduction 95
4.2 Amyloidosis 95
4.3 Ankyloglossia (“Tongue Tie”) 96
4.4 Atrophy of the Mucosa of the Dorsum of the Tongue 96
4.5 Ectomesenchymal Chondromyxoid Tumor 97
4.6 Fissured Tongue (Lingua Fissurata) 97
4.7 Geographic Tongue (Lingua Geographica Migrating Glossitis)
4.8 Glossodynia and Burning Mouth Syndrome 99
4.9 Granular Cell Tumor 100
4.10 Hairy Leukoplakia 102
4.11 Hairy Tongue (Lingua Villosa Coated Tongue)
4.12 Lingual Thyroid 104
4.13 Lingual Tonsils 105
4.14 Macroglossia 106
4.15 Median Rhomboid Glossitis 106
4.16 Osteoma Osteochondroma
4.17 Papillae Foliatae and Foliate Papillitis 108
4.18 Thyroglossal Duct Cyst 108
4.19 Traumatic Eosinophilic Granuloma (Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)) 109
4.20 Varices and Phlebectasias 110
4.21 Other Lesions That May Occur on the Tongue 110
4.21.1 Aspirin Burn 110
4.21.2 Cowden’s Syndrome (Multiple Hamartoma Syndrome) 110
4.21.3 Erythroplakia 110
4.21.4 Fibroma 111
4.21.5 Kaposi Sarcoma 111
4.21.6 Leukoplakia 111
4.21.7 Lichen Planus 112
4.21.8 Lymphoepithelial Cyst 112
4.21.9 Morsicatio 113
4.21.10 Mucous Cyst 113
4.21.11 Multifocal Epithelial Hyperplasia 113
4.21.12 Papilloma 114
4.21.13 Pyogenic Granuloma 114
4.21.14 Recurrent Aphthous Ulcers 114
4.21.15 Salivary Gland Tumors 115
4.21.16 Squamous Cell Carcinoma 115
4.21.17 Syphilis 115
4.21.18 Tongue Piercing 115
4.21.19 Vascular Malformations 115
4.21.20 Vesiculobullous Diseases 116
5: Diseases of the Gingiva and the Alveolar Mucosa 117
5.1 Introduction 117
5.2 Cysts 117
5.2.1 Eruption Cyst 117
5.2.2 Gingival Cyst of the Adult 117
5.2.3 Gingival Cyst of the Newborn (“Dental Lamina Cyst of the Newborn”) 118
5.3 Epulis 118
5.4 Exostoses 121
5.5 Fibromatosis of the Gingiva 121
5.6 Gingivitis and Periodontitis 123
5.7 Pigmentations 126
5.7.1 Lead Line of the Gingiva (Burton’s Line) 126
5.7.2 Tattoos and Melanin Pigmentations 126
5.8 Lesions Arising from the Maxillary Sinus That May Extend into the Mouth 127
5.8.1 Chronic Oroantral Communication 127
5.8.2 Surgical Ciliated Cyst (Postoperative Maxillary Cyst) 127
5.8.3 Malignant Neoplasms Arising from the Maxillary Sinus That May Protrude into the Mouth 127
5.9 Some Other Lesions of the Gingiva and the Alveolar Ridges 128
5.9.1 Epulis of the Newborn 128
5.9.2 Leukoplakia and Leukoplakia Lesions and Erythroplakia 128
5.9.3 Lichen Planus 128
5.9.4 Melanoma 130
5.9.5 Melanotic Neuroectodermal Tumor of Infancy 130
5.9.6 Peripheral Giant Cell Lesion of the Edentulous Alveolar Ridge 131
5.9.7 Recurrent Aphthous Stomatitis 131
5.9.8 Squamous Cell Carcinoma 131
5.10 Some Syndromes with Gingival Involvement 132
5.10.1 Cowden Syndrome 132
5.10.2 Neurofibromatosis 132
5.10.3 Tuberous Sclerosis 132
6: Diseases of the Palate 133
6.1 Introduction 133
6.2 Angina Hemorrhagica Bullosa (Blood Blister) 133
6.3 Midline Granuloma 134
6.4 Mucormycosis 134
6.5 Nasopalatine Duct Cyst 135
6.6 Palatal Ulcer Due to the Use of Local Anesthetics 136
6.7 Papillomatosis of the Palate 136
6.8 Salivary Gland Tumors 137
6.9 Stomatitis Nicotina 138
6.10 Subacute Necrotizing Sialoadenitis (SANS) 138
6.11 Torus Palatinus 139
6.12 Some Other Lesions of the Palate 139
6.12.1 Candidiasis 139
6.12.2 Darier-White Disease 140
6.12.3 Fellatio 140
6.12.4 Langerhans Cell Histiocytosis 140
6.12.5 Leukoplakia and Erythroplakia 140
6.12.6 Lichen Planus 140
6.12.7 Metastases 141
6.12.8 Multiple Myelomas (Kahler’s Disease) 141
6.12.9 Nevus Pigmented 142
6.12.10 Non-Hodgkin Lymphoma (Incl. Lymphoid Hyperplasia) 143
6.12.11 Odontogenic Fistula 143
6.12.12 Palatal Perforation Due to Cocaine Abuse 143
6.12.13 Palatal Tooth Eruption 144
6.12.14 Pyogenic Granuloma 144
6.12.15 Reverse Smoking 144
6.12.16 Sarcoidosis 145
6.12.17 Squamous Cell Carcinoma 145
7: Diseases of the Jaw Bones 146
7.1 Introduction 146
7.2 Cysts of the Jaw Bones 146
7.2.1 Aneurysmal Bone Cyst 146
7.2.2 Simple Bone Cyst 147
7.2.3 Latent Bone Cyst (Stafne’s Bone Cyst) 147
7.3 Cysts and Tumors of Odontogenic Origin 148
7.3.1 Odontogenic Cysts 149
7.3.1.1 Developmental Odontogenic Cysts 149
Primordial Cyst 149
Follicular (Dentigerous) Cyst 149
Lateral Periodontal Cyst (Incl. Botryoid Odontogenic Cyst) 150
Keratinizing Odontogenic Cyst 151
Sialo-odontogenic Cyst 151
7.3.1.2 Inflammatory Odontogenic Cysts 152
Radicular Cyst 152
Residual (Radicular) Cyst 152
Paradental Cyst (Incl. Mandibular Buccal Infected Cyst) 153
7.3.2 Odontogenic Tumors 154
7.3.2.1 Ameloblastoma 155
7.3.2.2 Cementoblastoma 157
7.3.2.3 Keratocystic Odontogenic Tumor (“Keratocyst”) 158
7.3.2.4 Odontogenic Myxoma 160
7.3.2.5 Odontoma 161
7.4 Exostoses 162
7.5 Fibro-osseous Diseases 163
7.5.1 Fibrous Dysplasia 163
7.5.2 Osseous Dysplasia (Incl. Periapical Osseous Dysplasia) 166
7.5.3 Ossifying Fibroma 167
7.6 Focal Osteoporotic Bone Marrow Defect 169
7.7 Giant Cell Lesion, Central (Intraosseous) 169
7.8 Hemangioma (Arteriovenous Malformation), Central/Intraosseous 171
7.9 Langerhans Cell Histiocytosis (LCH) 171
7.10 Lymphoreticular Diseases 172
7.10.1 Hodgkin and Non-Hodgkin Lymphoma 172
7.10.2 Burkitt’s Lymphoma 175
7.10.3 Multiple Myeloma (Kahler’s Disease) 176
7.11 Metastases 177
7.12 Osteoma 178
7.13 Osteomyelitis and Allied Inflammatory Lesions and Disorders 178
7.13.1 Alveolitis 178
7.13.2 Lingual Sequestrum 179
7.13.3 Osteomyelitis (Incl. Periostitis, Osteoradionecrosis, and Medication-Related Osteonecrosis) 179
7.13.4 Periapical Granuloma 183
7.14 Sarcomas of the Bone 184
7.14.1 Chondrosarcoma 184
7.14.2 Ewing’s Sarcoma 185
7.14.3 Osteosarcoma 186
7.15 Some Uncommon Generalized Bone Diseases and Syndromes Involving the Jaw Bones 187
7.15.1 Cherubism 187
7.15.2 Cleidocranial Dysplasia 188
7.15.3 Cortical Hyperostosis (Van Buchem’s Disease) 188
7.15.4 Ectodermal Dysplasia 189
7.15.5 Gardner’s Syndrome 189
7.15.6 Hyperparathyroidism, Primary 189
7.15.7 Osteopetrosis 189
7.15.8 Paget’s Disease 190
7.15.9 Pseudohypoparathyroidism 190
7.15.10 Pycnodysostosis 191
7.15.11 Thalassemia 191
7.16 Overprojection of Opaque Structures in the Jaw Bones or the Oral and Perioral Soft Tissues 192
7.16.1 Calcifications of the Carotid Artery 192
7.16.2 Other Opacities Projected on a Radiograph 192
Index 194