Oral pathology



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ORAL PATHOLOGY


  1. Types of Leukemia?

Neoplastic proliferation of white cells.

Types: Acute lymphoblastic most common in children (3-5 years), gingival hypertrophy and bleeding.

Acute myeloblastic, most common in adults.

Chronic lymphocytic is the commonest and has a 5 years survival of > 50%. Chronic myeloid characterized by presence of Philadelphia chromosome, over 40 years.




  1. White lesions of the tongue? Differential diagnosis.

Liquen planus, median rhomboid glossitis, hairy leukoplakia, geographic tongue.


  1. Acute necrotizing gingivitis? Diagnosis- treatment

Characterized by painful cratered ulcers starting at the tips of the interdental papillae which bleed easily, Ulcers are defined by erythema and covered by greyish or yellowish slough. No fever or systemic upset, no significant lymphadenopathy, metallic taste. Associated with smoking, stress and poor oral hygiene.

Differential diagnosis: primary herpetic gingivostomatitis, HIV associated acute ulcerative gingivitis, gingival ulceration in acute leukaemia or aplastic anaemia.

Treatment: Oral hygiene, metronidazole 200 mg after food 3 times a day for 3 days.


  1. Pregnancy epulis? Diferencial diagnosis- treatment.

An increased inflammatory response to plaque during pregnancy causes a lesion very hard to distinguish for a pyogenic granuloma. Onset usually in 3rd month. Treatment, only oral hygiene as it regresses after delivery. If very troublesome, simple excision, but it may recur.


  1. Ulcer in lateral border of the tongue? Differential diagnosis- treatment.

Squamous cell carcinoma, eosinophilic ulcer (heals spontaneously within 3 weeks), herpetiforme ulcers (chrolhexidine mouthwash and relieve pain, topical tetracycline and steroid preparations), apthous ulcers (same as herpetiforme ulcers).


  1. Hairy leukoplaquia, diagnosis, what else is expected in patient with this?

Usually has a vertically corrugated or shaggy surface. The plaque is soft, usually painless and most frequently affects the lateral borders of the tongue. Commonest in homosexual men.

Biopsy to confirm diagnosis. It doesn’t need treatment, it regresses spontaneously. Caused by Epstein bar-virus.

Indicates advance immunodeficiency, usually a sing of HIV infection.


  1. List white lesions of the oral mucosa

Liquen planus, lupus erythematosus, candidosis, chronic mucocutaneous candidosis syndromes, White sponge naevus, verruciform Xanthoma, skin grafts, verrucous carcinoma.


  1. If the patient comes with white lesions, resembling lines in the buccal mucosa, what questions would you ask him? How long, smoking, drinking important? Presumptive diagnosis, what is leukoplakia? Oclusal line. Types of liquen planus

A leukoplakia is defined as a white patch which cannot be whipped off the mucosa or ascribed to any specific disease process.

Smoking is the major etiological factor, in association with alcohol of oral cancer.

See in summary.


  1. Slide showing draining sinus on alveolar mucosa associated to 36. What is what you see? What test would you perform? Possible diagnosis and management.

  2. Suppurating lump on lower buccal sulcus. Differential diagnosis, special investigation.

Inspection of gingival and mucosal tissues, periodontal probing, palpation, percussion, mobility testing, pulp sensibility test, occlusion and radiograph examination.

Primary endodontic lesion with drainage through the periodontal ligament: originates from an infected root canal system.

Primary periodontal lesion: pulp may be vital, may change over time.

Combined endodontic periodontic lesion: tooth pulp-less, infected root canal system and periodontal defect.

Identify the primary cause if possible, treat both tissues: routine scaling, root planing, oral hygiene instruction and follow up maintenance therapy, surgery if necessary. Infected root canals should be treated by cleaning, shaping, medicating and filling of the root canal system



  1. Differential diagnosis internal resorption?

Internal resorption (pink spot) is an uncommon condition in which dentine is resorbed from within the pulp. Localised, well defined, radiolucency in the crown. Due possibly to a late result of damage to the blood supply of the pulp to a blow. Endodontic treatment before the pulp chamber becomes exposed. Differential diagnosis: can look like external cervical invasive resorption.


  1. Patient comes with painless ulcer that has been there for about one month. What questions do you ask? Management and possible diagnosis.

How long has it been like that? Is it painful? Any change in size and colour, do you smoke, drink alcohol? Try to find the underlying causes, review in 2 weeks time, Incisional biopsy. Exclude emotional disturbances…If more than 3 weeks, refer.


  1. What are S4 and S8 drugs? Give 3 examples of each.

S4 are restricted substances, not available without prescription from pharmacies.

S8 are drugs of addiction and dangerous drugs, not available without prescription.

S4 are antibiotics, corticosteroids, tranquilizers and sedatives eg. Diazepam, anti-inflammatory and analgesics eg. Mefenamic acid (ponstan), some codeine preparations eg. Codral forte, barbiturates for IV, local anaesthetics.

S8 are Narcotics eg. Codeine in concentration greater then permitted schedule, morphine, oral barbiturates.





  1. Vesicles on lips, differential diagnosis, treatment herpes labialis, herpes zoster, impetigo contagiosa.

See in summary


  1. Photo: patient smiling, wrinkling brows (unilateral only). Dx, etiology, Px, Tx.

Bell’s Palsy, common cause of facial paralysis. Compression of the facial nerve in its canal as a result of inflammation and swelling. Cause by viral infection (herpes simplex), cerebrovascular accidents. Diagnosed by asking the patient to perform facial movements. Trying to shut eyes, trying to smile. Majority of patients recover fully or partially without treatment. Prednisolone 5 -10 days + acyclovir.


  1. Patient had white patches under tongue for 7 years. Photo provided.

Liquen planus, can last 10 or more years. Or oral keratosis of renal failure: soft plaques, crenated surface, symmetrically distributed, appearance similar of hairy leukoplakia (Epstein bar virus is absent), Treatment, effective dialysis or renal transplantation.


  1. Patient with lateral patches on lateral tongue and buccal mucosa. Sequence of photographs showing progression of lesions. As above.




  1. Patient with fluctuant lump on palate.

Median palatal cyst, uncommon jaw cyst. The cyst does not have to be very large to raise the palatal mucosa causing an intraoral swelling. The absence of disease tooth, pain, redness, fever will confirm that the swelling is not a palatal abscess.


  1. Patient with exophytic and ulcerated mass on attached gingival of upper incisors.

Fibrous epulis or giant cell lesion, pyogenic granuloma.



  1. Cavernous sinus thrombosis.

Uncommon life threatening complication as a result of superior spread odontogenic infection. Blindness or death can result. Edema of eyelids, pulsative exophthalmos, cyanosis, fever, deteriorating sight. Early recognition, antibiotics, drainage, possibly anticoagulant therapy.


  1. OPG of an edentulous patient who wants their dentures done. There was a cyst in the upper incisor region. Treatment. What happens if it is not removed?

Nasopalatine duct cyst (so-called palatine papilla cyst) may cause a swelling in the midline of the anterior part of the palate. Which will cause the denture not to fit properly.

Treatment is enucleation, recurrence unlikely.




  1. Causes of xerostomia? How is sjogren’s syndrome diagnosed? (dry eyes, dry mouth and rheumatoid arthritis).

Causes: autoimmune, irradiation of the head and neck, drugs? Anxiety stages and sjogren syndrome, mumps, HIV infection, dehydration.

Sjogren syndrome is diagnosed by diminished mixed salivary flow rate (normal salivary flow is 1- 2 ml/min, reduced to 0.5 ml/min or less. Pathological changes in labial salivary glands. Snow storm appearance (sialectasis) on sialography. Antibody screen, rheumatoid factor and SS-A and SS-B, diminished tear secretion.

Management of xerostmia: non alcohol mouth rinses and oral hygiene, use of salivary substitute, frequent intake of liquids. Neutral fluoride application.


  1. Patient has had hepatitis many years ago. What type of hepatitis provided that he was coming from Asia? Is that a risk for dental treatment? Mode of transmission? Carrier?

Hepatitis A is frequently acquired from contaminated food during a holiday. There is little evidence that hepatitis A is transmitted during dentistry.

Hepatitis B carriage rate in hot climates is higher and dental staff is at high risk. Hazard of infection higher in inner urban areas and for surgeons and periodontists.

Transmission: blood and blood products, needle stick injuries, injections, blood transfusions. Saliva, heterosexually.

Hepatitis C most common cause post transfusion, transmitted as Hep B. No vaccine.

Hepatitis C, % of asymptomatic? Who develop chronic disease, why do they seem to have higher index of caries? Before when donors were not screened for Hep B and C, almost 100% of haemophiliacs became infected and remain carriers. Infection persists in 80% of individuals.


  1. Why hepatitis B is the greatest infective hazard to dental staff?

It is widespread, a chronic infective carrier state is common, minutes traces of blood fluids can transmit infection, the virus survives well outside the body and is relatively resistant to disinfection, infection can lead to serious complications (chronic active hepatitis, cirrhosis and death from liver failure or liver cancer), and there is not reliable effective treatment.


  1. Lesion/swelling in lips, causes?

Latex allergy, chron’s disease, sarcoidiosis, erythema multiforme.


  1. Patient has a lesion like papilloma and refuses treatment. What do you advice?

Cauliflower like or branched structure of finger like processes. Oral papillomas appear to have no potential malignant change and respond to local excision.


  1. Honey comb appareance on anterior mandible?

Characteristic of ameloblastoma, although most common in posterior mandible.

Odontogenic keratosis.




  1. Mouth breathing/ bad taste, how do you manage?

I would say the patient has a respiratory problem, like sinusitis or deviation of nasal septum; I would give decongestant, treat the sinusitis, and would advice sugar free chewing gum to increase the salivary flow. I would encourage better oral hygiene, including brushing of the tongue. It can also be to a severe class II malocclusion, I would refer to orthodontist.


  1. Patient is taking or finished chemotherapy and radiotherapy, how to treat?

These patients are usually edentulous or with unhealthy teeth.

Procedure before irradiation: assessment of the teeth to determine preservation of teeth and lesions in soft tissue, radiographic examination, extractions, periodontal treatment.

Post irradiation management: Mouth and neck examined for recurrent, regular dental prophylaxis and preventative measures (oral hygiene, fluoride rinses, dietary advice, post irradiation xerostomia, diagnostic radiographic).

Osteomyelitis is a complication, avoid lower denture (trauma).




  1. Mucocele?

Most common type of salivary and soft tissue cyst. On lower lip, caused by damage to duct and extravasations of saliva. Excision with underlying gland.

Ranula is a mucous cyst of the floor of the mouth caused by damage to the duct of either the sublingual or submandibular glands. Soft, bluish swelling on one side of the floor of the mouth. Surgical excision.




  1. White opaque areas on the tooth surface

Fluorosis: mottled enamel sign of excess fluoride in drinking water (more than 2 ppm). It can also be amelogenesis imperfecta hypomaduration type; the teeth are soft and vulnerable to attrition.


  1. Angular cheilitis? See in summary.




  1. Prescription

Name and address of dentist.

Date


Name and address of patient.

Superincription Rx.

Incription: details of ingredients.

Subscription:direction to dispenser (commonly mitte-send)

Signature preceeded by sig., sets out directions for patient.

Prescriber Signature

The words FOR DENTAL USE ONLY


  1. 25 PA and left molar BW from the same patient, which showed caries in several teeth, absence of 36, how would you treat those carious lesions? (restorative, fluoride) and 35 with widened pulp chamber and canal spaces, why? Internal resorption? Causes? See Q 11. Dental caries on the buccal and lingual surface and external resorption. What is the level of caries risk of this patient? High. How do you asses the level of caries risk? By the amount of caries in the whole mouth. How would you manage this patient? Diet, restorative, preventive, oral hygiene, regular check ups. What advice do you give to the patient? Avoid sugar, carbohydrates, and clean teeth after eating and before bed, chewing gum without sucrose. What other factors could be increasing the level of caries risk of this patient? Xerostomia due to drugs. Caused by atropine, tricyclic and some other antidepressants, antihistamines, neuroleptics, antihypertensive, decongestants, bronchodilators, appetite suppressants.

ESSENTIALS OF ORAL PATHOLOGY AND ORAL MEDICINE. R.A. CAWSON

Summary

Diseases of the oral mucosa



Infective stomatitis

Viral infections

Primary herpectic stomatitis

Cause is herpes simplex virus type 1.Primary infection in childhood. Painful ulcers preceded by vesicles. Recurrent forms take the form of herpes labialis. Vesicles are on any part of the mouth, hard palate and dorsum of the tongue are characteristic sites. Gingival margin swollen. Regional lymph nodes are enlarged and tender, fever and systemic upset. Lesions clear up within 10 days, malaise continues for longer. Contagious.

Differential diagnosis: teething, ulcerative gingivitis (not in children), herpes zoster, recurrent aphthae (no systemic upset, no vesicles), Hand, foot and mouth disease (no vesicles, no large lymph nodes, lesion on extremities).

Treatment: Systemic (AIDS) or suspension Aciclovir.


Herpes Labialis (cold sore)

Virus persists in latent form in trigeminal ganglia. Burning sensation, which becomes red, followed by vesicles that rupture after 2 -3 days. The vesicles scab over and heal without scarring. Cycle 10 days.

Treatment: acyclovir cream.
Hand, foot and mouth disease

Ulceration of the mouth (palate, pillars of the fauces and pharynx) and vesicular rash on the extremities. Coxsackie A virus. Ulcers not in gingival, less painful than herpes simplex. Regional lymph nodes rarely enlarged and systemic upset is mild or absent. Diagnosis by serology. Clear up in a week, no treatment needed.


Herpes zoster of the trigeminal nerve (shingles)

Recurrence of varicella zoster. Pain precedes facial vesicular rash and stomatitis in the area of distribution of a sensory nerve. Indication of underlying immunologic defect, early manifestation HIV, Hodgkin’s disease. Lesions localised on one side. Malaise and fever, severe pain. Regional lymph nodes enlarged and tender. Acute phase 1 week.

Treatment: acyclovir 200 mg, 8 times daily for 5 days. Analgesics. IV acyclovir in severe cases.
Infectious mononucleosis

Epstein-Bar virus, adolescents and young adults. Malaise, fever, acute pharyngitis. In children, ulcers and petechiae in posterior pharynx and soft palate. Self limiting.


Bacterial and mycotic infections, Candidosis can cause thrush, chronic white plaques or erythrmatous areas such as denture stomatitis.
Thrush

Acute infection by candida albicans. Soft creamy yellow patches on the surface of the oral membrane. Buccal mucosa, soft palate. Can be rubbed off leaving red area of mucosa. Early manifestations of AIDS. Diagnosis confirmed by smear.

Treatment: exclude immunodeficiency, haematological investigation (iron deficiency). Nystatin or amphotericin lozenges.
Q. 33 Angular stomatitis

Cause by leakage of candida infected saliva at the angles of the mouth. Iron deficiency, can be due to staphylococci in healthy mouths. Common in older patients with dentures.

Treatment : bacteriological investigation. In staphylococcal infections fucidin ointment. When mixed staphylococcal and candidal infection miconazole. Correct vertical dimensions of dentures. Riboflavin deficiency, give vitamin B.
Denture induced stomatitis

Iatrogenic disease, symptomless, area of bright, uniform erythema corresponding the upper denture bearing area, angular stomatitis associated, can also be due to denture trauma or hypersensitivity to denture base material.

Treatment: antifungal treatment, stop wearing denture while treatment (especially at night), nystatin lozenges, miconazole gel on the denture. Clean denture with hard brush and soap, keep it in antiseptic (1% sodium hypochloride).
Non-infective stomatitis

Traumatic ulcers: tender, yellowish floor, red margins, no induration. Tongue, buccal mucosa. Heal a few days after elimination of the cause.


Recurrent aphthae (aphthous stomatitis)

Cause by trauma, infections, genetic predisposition, immunological abnormalities, gastrointestinal disorders, hormonal disturbances, haematological deficiencies (iron, folate), stress. Types: Minor, major, and herpetiform. Onset in childhood, attacks variable, healthy patients, self limiting eventually. History of recurrences of self healing ulcers at regular intervals. Treatment palliative (chlorhexidine mouthwash and relieve pain, topical tetracycline and steroids preparations).


Q. 8 Liquen planus

Chronic inflammatory disease of skin and mucous membranes. Middle age or over. Untreated persist for 10 or more years. Lesions comprise: Striae, atrophic areas, erosions, plaques. Common site, buccal mucosa, dorsum of tongue, gingivae. Lesions usually bilateral and symmetrical, good response to corticosteroids. Affects females at a ratio 3:2. Skin lesions may be seen on the wrists.

Types: Reticular or striae: most common lacy network of white striae on buccal mucosa.

Atrophic: shallow irregular red areas of mucosal thinning surrounded by white striae.

Erosive: shallow irregular areas of epithelial destruction, covered by smooth, raised yellowish layer of fibrin. Margins depressed due to fibrosis and gradual healing at the periphery. Striae may radiate from the margins of these erosions.

Plaque like pattern: in early stages, dorsum of the tongue.

Gingival liquen planus: lesions atrophic, gingival shiny, inflamed and smooth (desquamative gingivitis)

Diagnosis by biopsy. Treatment topical application of potent anti-inflammatory corticosteroid.


Lupus erythematosus

Connective tissue disease. Lesions similar to liquen planus. Lesion are white, often striate, irregular atrophic areas or shallow erosions. Patchy, unilateral. Palate. Diagnosis: antinuclear antibodies. Palliative treatment.


Phemphigus vulgaris

Uncommon autoimmune disease, vesicles or bullae on skin and mucous membrane. Females 40-60 years old. Lesions first in the mouth but spread widely on the skin. Vesicles fragile unlikely to be seen intact in the mouth. Nikolsky sign positive (gently stroking the mucosa can cause a vesicle or bullae to appear).

Biopsy and immunofluoresce microscopy (autoantibody bound to the epithelial pickle cells, suprabasal). Immunosuppressive treatment (prednisolone).
Mucous membrane pemphigoid

Uncommon chronic disease causing bullae, painful erosions and mucosal scaring. Involvement of other mucosae, eyes, may cause blindness. Skin involvement absent. Oral bullae are subepithelial and seen intact. Desquamative gingivitis as a result. Biopsy and immunofluorescence microscopy (Autoantibody bound to the basement membrane). Coritcosteroids.


Bullous erythema multiforme

Mucocutaneous disease, triggered by herpetic infections and drugs, mild fever, systemic upset, lips grossly swollen, split, crusted and bleeding, widespread irregular fibrin-covered erosions and erythema in the mouth, conjunctivitis may be associated, attacks may recur at intervals of several months, usually self limiting (3-4 weeks). Target lesions are red macules a cm or more in diameter with bluish cyanotic centre. Corticosteroids and antibiotics.


Tongue disorders

Glossitis: anaemia, vitamin B deficiencies, candidosis.

Burning mouth syndrome: psychogenic disorder, antidepressives.

Geographical tongue (erythema migrans): recurrent appearance and disappearance of red areas on the tongue, sharply defined edges, where the filiform papillae stop short. Cause unknown. Associated with psoriasis.


Hairy tongue

The filiform papillae can become elongated and hairlike (half cm), forming a thick fur on the dorsum of the tongue. Cause unknown, heavy smoking, excessive use of antiseptic mouthwashes and defective diet. Pigmentation caused by bacteria and fungi. Treatment difficult, cleanse with firm toothbrush.


Mediam rhomboid glossitis

Abnormality in the midline of the dorsum of the tongue at the junction of the anterior two thirds with the posterior third. No longer accepted that it results from persistence of the tuberculum impar. Uncommon lesion of candidosis in response to broad spectrum antibiotics. In adults, symptomless, red or pink area of depapillation, it may be white. Treatment reassurance, as for candidosis.


Benign chronic with mucosal lesions

Leukoedema: bilateral, diffuse, translucent, greyish thickening of the buccal mucosa. Variation of normal, reassurance.


Frictional keratosis and cheek biting

White patches caused by mild abrasion by irritants. Remove irritant.


Fordyce’s granules

Sebaceous glands in the oral mucosa. They grow in size with age, soft, symmetrically distributed creamy spots.


Stomatitis nicotinic (smoker’s keratosis)

Seen among heavy, long term pipe smokers and some cigar smokers. Affects palate and areas protected by denture unaffected, hyperkeratosis and inflammatory swelling of minor mucous glands with red centres, Responds rapidly to abstinence from pipe smoking, risk oral cancer, but not in the hyperkeratinised area.


Q. 6 HIV associated hairy leukoplakia

Sing of HIV infection in male homosexuals. Forms soft, corrugated, painless plaques on lateral borders of the tongue. Dx by biopsy. Epstein bar virus, indicates advanced immunodeficiency, poor prognosis, not premaligant, treatment not justified in the absence of symptoms.


White sponge naevus

Genetic developmental anomaly. Affected mucosa is white, soft and irregularly thickened, usually bilateral and involves the whole oral mucosa. There are no evident borders. Histologically epithelial hyperplasia with basket weave appearance, no dysplasia or inflammation, no treatment.


Chronic mucocutaneous candidosis syndromes

Rare, difficult to manage. Leukoplakia like lesions.


Verruciform Xanthoma

Rare proliferation, white surface, any site of the mouth, sessile or pedunculated, have a warty surface and range in size from one to several cm across.. Excision.


Squamous cell carcinoma

In the early stages painless red, specked or white patches and only a minority are ulcerated. As it enlarges it may develop into a raised nodule or become ulcerated. Indurations results from inflammation and fibrosis and infiltration of the tissues. Indurated ulcer with the typical rolled border, poor prognosis at this stage. Soreness and bleeding as late feature. 70% form on lateral borders of the tongue and adjacent alveolar ridge and floor of mouth. Radiotherapy, surgery when cancer has invaded bone.


Lesions of vascular origin

Haemangioma

Endothelial hamartomas, at birth, regress with time, disappear by adolescence, no treatment.
Lymphangioma

Lymph vessel abnormalities. Surgical excision if functional or aesthetic concern.


Cyst of the jaws

Cysts are pathological fluid-filled cavities lined with epithelium. Form sharply defined radiolucencies with smooth borders, may be aspirate and thin walled cysts may be transilluminated. Grow slowly, displacing rather than resorbing teeth. Symptomless unless infected, rarely large enough to cause pathological fracture, form compressive and fluctuant swellings if extended into soft tissues, appear bluish when close to the mucosal surface.


Radicular cysts: form in bone in relation to the root of a non vital tooth, arise by epithelial proliferation in an apical granuloma, are usually asymptomatic unless infected, Dx by x ray, non vital tooth and histological appearance, do not recur after enucleation, residual cyst can remain after the causative tooth has been extracted.
Dentigerous cysts: arise in bone and contain the crown of an unerupted tooth which is usually displaced, are most frequently associated with unerupted third molars and canines, confirmation of dx is histological, may be mistaken radiographically for and odontogenic keratocyst or ameloblastoma, respond to enucleation or marsupialisation and do not recur after treatment.
Eruption cyst: forms over a tooth about to erupt, arises from enamel organ epithelium after enamel formation is completed and it is, in effect, a superficial dentigerous teeth, superficial in the gingival overlying the unerupted tooth, soft, rounded, bluish swelling. May be removed to allow eruption, may burst spontaneously.
Odontogenic keratocysts: multilocular, form intraosseously, most frequently in the posterior alveolar ridge or angle of mandible, may grow around a tooth, spread extensively along marrow spaces before expanding the jaw, may recur after enucleation, do not respond to marsupialisation, dx confirmed by histopathology, confused with ameloblastoma or dentigerous cysts, may be part of the jaw cyst/basal naevus syndrome.
Gingival cysts: dental lamina cyst of the new born (bohn’s nodules), in adults rare, enucleation.
Lateral periodontal cysts: intraosseous, beside a vital tooth, near the crest of the ridge, no symptoms, enucleation.
Nasopalatine duct cysts: uncommon, midline anterior maxilla, incisive canal region, asymptomatic, recognised radigraphically, dx histological, enucleation.
Cysts of soft tissue: most common are mucoceles, and ranula, but the sublingual dermoid is a developmental anomaly. Develop between the hyoid and jaw or beneath the tongue, not symptoms, interfere with speech or eating, should be dissected out.
Odontogenic tumours and tumour like lesions of the jaws

Ameloblastoma: most common neoplasm of the jaws, of odontogenic epithelium, between 30 and 50 years old, invasive but does not metastasise, multilocular cyst in radiographs, most common in posterior mandible, treated by excision with a margin of normal tissue.


Calcifying odontogenic cyst (ghost cells): rare, unilocular, usually posterior jaw, enucleation.
Ameloblastic fibroma: rare, neoplasm of epithelium and mesenchyme, children and young adults, unilocular or multilocular radiolucency, excision with margin.
Odontogenic myxoma: rare, neoplasm of odontogenic mesenchyme, young adults, prone to recurrence, multilocular soap bubble radiolucency, posterior mandible, excision.
Cementoblastoma: only neoplasm of cemetum, usually seen in young adults, benign, irregular or rounded radiopaque mass attached to the root of a tooth, mandibular first molar, thin radiolucent margin, resorption of related roots is common, enucleation and tooth extraction.
Odontomas: Lesions occur because disordered differentiation. Hamartomas of odontogenic epithelium and mesenchyme, between 10 and 20 years, benign, develop in sequence, like surrounding teeth, with initial (crypt like) radilucent phase, intermediate stage of mixed radilucency, finally densely radiopaque, may be compound (many small teeth, failure of eruption of a permanent tooth) or complex (disordered mass of dental hard tissue), anterior maxilla and posterior mandible, enucleation.
Non odontogenic tumours of the jaws

Osteoma and other bony overgrowths: torus palatinus, tori mandibularis.


Cemento-ossifying fibroma: premolar/ molar region of the mandible, females affected twice as frequently as males, slow growing, and well circumscribed, sometimes encapsulated, roots may be displaced or resorbed, enucleation.
Giant cell (reparative) granuloma: benign hyperplastic lesion of unknown aetiology, young females, very expansile and may be destructive, solid but appears as unilocular or multilocular cyst like radiolucency, in alveolar ridge, mandible most frequent, curettage, second operation may be required.
Malignant neoplasm of bone

Osteosarcoma: rare, 35 years, occasionally follows irradiation, usually affects the mandible, radiographically bone formation is seen in a soft tissue mass, radical surgery, sometimes with chemotherapy.


Chondroma: rare, excision with wide margin of normal tissue.

Chondrosarcoma: 45 years, anterior maxilla 60%, pain, swelling, loosening of teeth associated with a radiolucent area, may appear multilocular, aggressive, excision.


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