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Ninth Edition
Cawson’s Essentials of
Oral Pathology and Oral Medicine E.W. Odell FDSRCS MSc PhD FRCPath Professor of Oral Pathology and Medicine, King’s College London Honorary Consultant in Oral Pathology, Guy’s and St Thomas’ NHS Foundation Trust, London
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Contents Preface xv References xvii 1 Principles of investigation, diagnosis and treatment 1 Taking a history 1 Consent 5 Clinical examination 6 Medical examination 8 Clinical differential diagnosis 8 Investigations 9 Imaging 9 Histopathology 10 Laboratory procedures 14 Molecular biological tests 15 Haematology, clinical chemistry and serology 18 Microbiology 18 Other clinical tests 20 Interpreting investigations and making a diagnosis and treatment plan 20
SECTION 1: Hard tissue pathology
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2 Disorders of tooth development Abnormalities in the number of teeth Anodontia and oligodontia Additional teeth: hyperdontia Syndromes associated with hyperdontia Defective enamel formation Defects of deciduous teeth Defects of permanent teeth Amelogenesis imperfecta Chronological hypoplasia Molar-incisor hypomineralisation Defective dentine formation Osteogenesis imperfecta with opalescent teeth Dentinogenesis imperfecta Dentinal dysplasia (‘rootless’ teeth)
23 23 23 24 25 25 25 25 25 29 30 30 31 31 32
Defects of enamel and dentine Regional odontodysplasia (ghost teeth) Segmental odontomaxillary dysplasia Other systemic diseases affecting teeth Extrinsic agents affecting teeth Odontomes Disorders of eruption 3 Disorders of development Clefts of lip or palate Cleft lip and cleft palate Isolated cleft palate Syndromic cleft lip and palate Other facial clefts Stafne’s idiopathic bone cavity Hereditary prognathism Ankyloglossia Cowden’s syndrome Other craniofacial malformations 4 Dental caries Aetiology Bacterial plaque Microbiology Sucrose Susceptibility of teeth to caries Saliva and dental caries Pathology of enamel caries Pathology of dentine caries Clinical aspects of caries pathology Arrested caries and remineralisation Caries in deciduous teeth Hidden caries Root surface caries Clinical aspects of reactions to caries 5 Pulpitis and apical periodontitis Pulpitis Pulp calcifications Periapical periodontitis, abscess and granuloma Acute apical periodontitis Pathology and sequelae
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33 33 34 35 37 41 42 45 45 45 48 48 48 49 49 49 50 50 53 53 53 54 57 59 60 61 65 68 68 69 70 70 70 73 73 77 77 78 78
Contents vi
Acute apical (dentoalveolar) abscess Chronic apical periodontitis and periapical granuloma 6 Tooth wear, resorption, hypercementosis and osseointegration Tooth wear Attrition Abrasion Erosion Abfraction Bruxism Resorption of teeth Hypercementosis Pathology of osseointegration 7 Gingival and periodontal diseases The normal periodontal tissues Gingival and periodontal fibres Gingival crevicular fluid (exudate) Classification of periodontal diseases Chronic gingivitis Chronic periodontitis Pathology Systemic predisposing factors General principles of management of chronic periodontitis Complications of chronic periodontitis Gingival recession Aggressive periodontitis ‘Prepubertal’ periodontitis Periodontitis as a manifestation of systemic disease Down’s syndrome Papillon–lefèvre syndrome Periodontal (lateral) abscess Acute pericoronitis Acute necrotising ulcerative gingivitis HIV-associated periodontitis Gingival enlargement Hereditary gingival fibromatosis Drug-induced gingival overgrowth Localised juvenile spongiotic gingivitis Plasminogen deficiency gingivitis Other inflammatory gingival swellings
79 81 85 85 85 85 86 87 87 88 91 91 95 95 96 96 96 96 99 101 103 105 106 107 108 109 109 109 110 110 110 112 113 113 113 114 115 115 115
8 Infections of the jaws 117 Normal healing of an extraction socket 117 Alveolar osteitis 117 Osteomyelitis of the jaws 120 Acute osteomyelitis 120 Chronic osteomyelitis 122 Diffuse sclerosing osteomyelitis 123 Chronic low-grade focal osteomyelitis and sclerosing osteitis 124 Osteoradionecrosis 124 Proliferative periostitis 125 Medication-related osteonecrosis of the jaws (MRONJ) 125 Traumatic sequestrum 127 Sclerotic bone islands 128 9 Major infections of the mouth and face 129 Periapical (dentoalveolar) abscess 129 Collateral oedema 129 ‘Fascial’ or tissue space infections 129 Facial cellulitis 130 Facial abscess 132 Antibiotic abscess 133 Necrotising fasciitis 133 Cavernous sinus thrombosis 133 Noma (cancrum oris, necrotising stomatitis) 134 Actinomycosis 135 Other ‘actinomycoses’ 136 The systemic mycoses 136 Systemic infections by oral bacteria 137 10 Cysts in and around the jaws 139 Classification of cysts 139 Common features of jaw cysts 140 Treatment of jaw cysts 141 Treatment of soft tissue cysts 142 Odontogenic cysts 142 Radicular cyst 142 Lateral radicular cyst 146 Residual radicular cyst 146 Inflammatory collateral cysts 146 Dentigerous cysts 146 Eruption cyst 148 Odontogenic keratocyst 149 Basal cell naevus syndrome 153 Orthokeratinised odontogenic cyst 154
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155 155 156 156 157 157 158 158 158 160 160 161 161 162 162
11 Odontogenic tumours and related jaw lesions 165 Benign epithelial tumours 165 Ameloblastomas 165 Desmoplastic ameloblastoma 168 Metastasising ameloblastoma 169 Unicystic ameloblastoma 169 Squamous odontogenic tumour 170 Calcifying epithelial odontogenic tumour 170 Adenomatoid odontogenic tumour 172 Benign epithelial and mesenchymal tumours 172 Ameloblastic fibroma 172 Ameloblastic fibrodentinoma and fibro-odontome 173 Primordial odontogenic tumour 173 Odontomes (odontomas*) 173 Compound odontome 174 Complex odontome 174 Other types of odontome 175 Calcifying odontogenic cyst 176 Dentinogenic ghost cell tumour 176 Benign mesenchymal tumours 176 Odontogenic fibroma 177 Granular cell odontogenic tumour 177 Odontogenic myxoma 177 Normal dental follicle 178 Cementoblastoma 178 ‘Cementomas’ 179
Fibroosseous odontogenic lesions 179 Cemento-ossifying fibromas 180 Cemento-ossifying fibroma 180 Juvenile ossifying fibroma 181 Multiple and syndromic cemento-osseous fibromas 181 Cemento-osseous dysplasias 181 Periapical cemental dysplasia 181 Florid cemento-osseous dysplasia 182 Focal cemento-osseous dysplasia 182 Familial gigantiform cementoma 182 Malignant odontogenic tumours 183 12 Non-odontogenic tumours of the jaws 187 Exostoses and tori 187 Osteochondroma 187 Central giant cell granuloma 188 Noonan and other syndromes 190 Langerhans cell histiocytosis 190 Osteomas 192 Gardner’s syndrome 192 Ossifying fibromas 193 Psammomatoid ossifying fibroma 193 Haemangioma of bone 194 Melanotic neuroectodermal tumour of infancy 195 Malignant neoplasms of bone 196 Osteosarcoma 196 Chondrosarcoma 197 Ewing’s sarcoma 198 Myeloma 199 Amyloidosis 200 Solitary plasmacytoma 200 Lymphomas 200 Metastases to the jaws 200 13 Genetic, metabolic and other non-neoplastic bone diseases 205 Genetic diseases of bone 205 Osteogenesis imperfecta 205 Gnathodiaphyseal dysplasia 207 Osteopetrosis: marble bone disease 207 Achondroplasia 207 Cleidocranial dysplasia 208 Cherubism 208 Hypophosphatasia 209
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Contents
Lateral periodontal cysts Botryoid odontogenic cysts Glandular odontogenic cyst Calcifying odontogenic cyst Carcinoma arising in odontogenic cysts Gingival cyst of the newborn Gingival cyst of adults Non-odontogenic cysts Nasopalatine duct or incisive canal cyst Nasolabial cyst Sublingual dermoid cyst Thyroglossal duct cyst Branchial cyst Foregut cyst Other cysts in other chapters
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Contents
Sickle cell anaemia and thalassaemia Gigantism and acromegaly Metabolic bone disease Rickets Vitamin D–resistant rickets Hyperparathyroidism Other bone diseases Paget’s disease of bone Fibro-osseous lesions Fibrous dysplasia Monostotic fibrous dysplasia Polyostotic fibrous dysplasia Albright’s syndrome Osseous dysplasias Bone ‘cysts’ Solitary bone ‘cyst’ Aneurysmal bone ‘cyst’ Osteoporotic bone marrow defect 14 Disorders of the temporomandibular joints and trismus Temporary limitation of movement Infection and inflammation Injuries Drugs Persistent limitation of movement: extracapsular causes Irradiation Oral submucous fibrosis Systemic sclerosis and scleroderma CREST syndrome Morphoea Persistent limitation of movement: intracapsular causes Arthritis Rheumatoid arthritis Osteoarthritis Other types of arthritis Condylar hyperplasia Neoplasms Synovial chondromatosis and loose bodies in the temporomandibular joints Limitation of movement: muscle causes TMJ pain dysfunction ‘syndrome’
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210 211 211 211 211 211 213 213 216 216 216 218 218 218 218 218 220 221 223 223 223 223 224 224 224 224 224 225 225 226 226 226 227 228 228 229 229 229 229
Giant cell arteritis (temporal arteritis) Polymyalgia rheumatica Tetanus and tetany Pain referred to the joint Dislocation Ehlers–Danlos syndrome
SECTION 2: Soft tissue disease 15 Diseases of the oral mucosa: mucosal infections Ulcers Herpesvirus diseases Primary herpetic stomatitis Herpes labialis Herpetic whitlow Herpes zoster of the trigeminal nerve Ramsay Hunt syndrome Cytomegalovirus ulcers Hand-foot-and-mouth disease Herpangina Measles Chicken pox Tuberculosis Syphilis Candidosis Thrush Angular cheilitis Erythematous candidosis Acute antibiotic stomatitis Median rhomboid glossitis Denture-induced stomatitis Chronic hyperplastic candidosis Chronic mucocutaneous candidosis syndromes
231 232 232 232 232 233
235 235 235 235 235 238 239 239 240 240 240 241 241 241 242 242 244 244 246 246 246 247 248 249 250
16 Diseases of the oral mucosa: non-infective stomatitis 255 Ulcers 255 Traumatic ulcers 255 Eosinophilic ulcer (atypical or traumatic eosinophilic granuloma) 255 Factitious ulceration (self-inflicted oral ulcers) 255 Recurrent aphthous stomatitis 256
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259 261 261 261 262 262 267 267 268 268 268 269 269 270 271 271 273 273 275 277 277 277 277 278 279 279 279 279 283 283 283 283 283 283 284 284 285 285 287 287 287 289
18 Benign chronic white mucosal lesions Fordyce spots Leukoedema Frictional keratosis Cheek and tongue biting Stomatitis nicotina Oral hairy leukoplakia White sponge naevus Candidosis Oral keratosis of renal failure Skin grafts Psoriasis Other white lesions 19 Potentially malignant disorders Terminology Field change Erythroplakia Speckled leukoplakia Leukoplakia Proliferative verrucous leukoplakia Smokeless tobacco-induced keratoses Chronic hyperplastic candidosis Oral submucous fibrosis Lichen planus Lupus erythematosus Dyskeratosis congenita HPV-associated dysplasia Syphilitic leukoplakia Management of dysplastic lesions Smoking cessation 20 Oral cancer Epidemiology Aetiology ‘Early’ and ‘late’ oral carcinoma Oral cancer distribution Pathology Management Role of the dentist Oral cancer screening Screening and detection aids Verrucous carcinoma Diagnostic catches
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291 291 292 292 293 293 294 295 296 296 296 297 297 299 299 299 300 300 300 302
Contents
Behçet’s disease HIV-associated oral ulcers Nicorandil-induced ulcers Lichen planus and similar conditions ‘Desquamative gingivitis’ Lichen planus Vulvovaginal-gingival syndrome Malignant change in lichen planus Lichenoid reactions Lichenoid drug reactions Topical lichenoid reactions Graft-versus-host disease Lupus erythematosus Chronic ulcerative stomatitis Immunobullous disease Pemphigus vulgaris Paraneoplastic pemphigus Mucous membrane pemphigoid Erythema multiforme Stevens Johnson syndrome Toothpaste-induced epithelial peeling Other mucosal allergic responses Oral signs in reactive arthritis Mucocutaneous lymph node syndrome (Kawasaki’s disease) Miscellaneous mucosal ulcers Wegener’s granulomatosis Oral reactions to drugs Uncommon mucocutaneous diseases 17 Tongue disorders Normal structures Furred tongue Foliate papillae Lingual varicosities Erythema migrans Lingual papillitis Hairy tongue and black hairy tongue Glossitis Anaemic glossitis Glossodynia and the sore, physically normal tongue Macroglossia Amyloidosis Other diseases affecting the tongue
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