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Shafer’s Textbook of Oral Pathology

NINTH EDITION

Adaptation Editor

B Sivapathasundharam, MDS

Professor and Head, Department of Oral Pathology, Meenakshi Ammal Dental College

Pro Vice Chancellor, MEENAKSHI ACADEMY OF HIGHER EDUCTION AND RESEARCH, Chennai

Table of Contents

Cover image

Title page

Copyright

Dedication

Contributors

Foreword 1

Foreword 2

Preface to the ninth edition

Preface to the first edition

Acknowledgements

Synopsis of oral lesions

1. Introduction

Health and disease

Pathology

Diagnosis

Etiopathogenesis

Genes and chromosomes

Gene inheritance pattern

Oral pathology

Stem cells

Forensic odontology

References

2. Developmental disturbances of oral and paraoral structures

Craniofacial anomalies

Congenital deformations of head and neck

Developmental disturbances of jaws

Abnormalities of dental arch relations

Developmental disturbances of lips and palate

Developmental disturbances of oral mucosa

Developmental disturbances of gingiva

Developmental disturbances of tongue

Developmental disturbances of oral lymphoid tissue

Developmental disturbances of salivary glands

Developmental disturbances in size of teeth

Developmental disturbances in shape of teeth

Developmental disturbances in number of teeth

Developmental disturbances in structure of teeth

Disturbances in eruption of teeth

References

3. Cysts of orofacial region

Odontogenic cysts

Nonodontogenic cysts

Miscellaneous cysts

References

4. Odontogenic tumors

Classification of odontogenic tumors

Tumors arising from odontogenic epithelium

Tumors arising from odontogenic epithelium with odontogenic ectomesenchyme

Tumors arising from odontogenic ectomesenchyme with or without included odontogenic epithelium

Malignant odontogenic tumors

Odontogenic carcinomas

Odontogenic sarcomas

References

5. Epithelial neoplasms of the oral cavity

Benign neoplasms of epithelial tissue origin

“Premalignant” lesions/conditions of epithelial tissue origin

Malignant tumors of the epithelial tissue origin

References

6. Nonepithelial tumors of the oral cavity

Benign tumors of connective tissue origin

Malignant tumors of connective tissue origin

Benign tumors of muscle tissue origin

Malignant tumors of muscle tissue origin

Benign tumors of nerve tissue origin

Malignant tumors of nerve tissue origin

References

7. Tumors of the salivary glands

Benign epithelial tumors of salivary glands

Malignant epithelial tumors of salivary glands

Nonepithelial tumors

Tumor-like lesions

References

8. Bacterial infections of the oral cavity

Tuberculosis

Leprosy (Hansen disease)

Actinomycosis

Tetanus (lock-jaw)

Syphilis (lues)

Gonorrhea

Granuloma inguinale (granuloma venereum, donovanosis)

Noma (cancrum oris, gangrenous stomatitis)

Scarlet fever (scarlatina)

Diphtheria

Botryomycosis (bacterial actinophytosis, actinobacillosis)

Tularemia (rabbit fever)

Rhinoscleroma (scleroma)

Cat-scratch disease (cat-scratch fever, benign lymphoreticulosis)

Pyostomatitis vegetans

References

9. Viral infections

Classification of major virus groups and viral diseases

Measles (rubeola, red spots, morbilli)

Mumps (epidemic parotitis)

Nonspecific “mumps”

Rubella (German measles)

Herpangina (aphthous pharyngitis, vesicular pharyngitis)

Acute lymphonodular pharyngitis

Hand-foot-and-mouth disease

Foot-and-mouth disease (aphthous fever, hoof-and-mouth disease, epizootic stomatitis)

Chikungunya

Herpes simplex (acute herpetic gingivostomatitis, herpes labialis, fever blisters, cold sores)

Chickenpox (varicella)

Herpes zoster (shingles, zona)

Cytomegalovirus inclusion disease (salivary gland virus disease)

Infectious mononucleosis (glandular fever, kissing disease)

Smallpox (variola)

Molluscum contagiosum

Condyloma acuminatum (verruca acuminata, venereal wart)

Acquired immunodeficiency syndrome (AIDS)

Coronavirus disease (COVID-19)

References

10. Mycotic infections

Fungal infections

Paracytic infections

References

11. Dental caries

Epidemiology of dental caries

Etiology of dental caries

Clinical aspects of dental caries

Histopathology of dental caries

Diagnosis of dental caries

References

12. Diseases of the pulp and periapical tissues

Diseases of dental pulp

Diseases of periapical tissues

References

13. Periodontal diseases

The healthy periodontium

Deposits on teeth

Classification of periodontal diseases and conditions

Gingival diseases

Periodontal diseases

Developmental or acquired deformities

Peri-implant diseases

References

14. Spread of oral infection

Osteomyelitis

Cellulitis (phlegmon)

Infections of specific tissue spaces

Manifestations of various space infections

Ludwig angina

Cavernous sinus thrombosis or thrombophlebitis

Maxillary sinusitis

Focal infection

References

15. Bone and joint diseases

Definitions

Diseases of the bone involving maxilla and mandible

Diseases of temporomandibular joint

References

16. Hematologic diseases

Diseases involving red blood cells

Diseases involving white blood cells

Diseases involving blood platelets

Diseases involving specific blood factors

References

17. Diseases of the skin

Ectodermal dysplasia (hereditary ectodermal dysplasia, ectodermal dysplasia syndrome)

White sponge nevus (familial white folded dysplasia of mucous

membrane, oral epithelial nevus, congenital leukokeratosis, Cannon disease)

Hereditary benign intraepithelial dyskeratosis

Dyskeratosis congenita (Zinsser–Cole–Engman syndrome, Hoyeraal-Hreidarsson syndrome)

Xeroderma pigmentosum

Ehlers–danlos syndrome (Tenascin-X deficiency syndrome, Lysyl hydroxylase deficiency syndrome, cutis hyperelastica)

Mucocutaneous lymph node syndrome (Kawasaki disease)

Focal dermal hypoplasia syndrome (Goltz–Gorlin syndrome)

Oral lichen planus (lichen ruber planus)

Lichenoid reaction (lichenoid mucositis, lichenoid drug reaction, oral drug-induced lichenoid eruptions)

Pemphigus

Cicatricial pemphigoid (benign mucous membrane pemphigoid, ocular pemphigus)

Bullous pemphigoid (parapemphigus)

Epidermolysis bullosa

Erythema multiforme (Stevens–Johnson syndrome, erythema multiforme major, erythema multiforme minor, herpes-associated erythema multiforme, drug-induced Stevens–Johnson syndrome)

Systemic lupus erythematosus

Systemic sclerosis (scleroderma, dermatosclerosis, hidebound

disease)

Psoriasis

Acanthosis nigricans

Pityriasis rosea (pityriasis circinata, roseola annulata, herpes tonsurans maculosus)

Dermatitis herpetiformis (Duhring–Brocq disease)

Solar elastosis (senile elastosis, actinic elastosis)

Graft-versus-host diseases

References

18. Diseases of the nerves and muscles

Diseases of the nerves

Diseases of the muscles

References

19. Allergic and immunologic diseases of the oral cavity

Recurrent aphthous stomatitis (aphthous ulcers, canker sores)

Behçet syndrome

Reiter syndrome

Sarcoidosis (boeck sarcoid, besnier–boeck–schaumann disease)

Uveoparotid fever (uveoparotitis, heerfordt syndrome)

Angioedema (angioneurotic edema, quincke edema, giant urticaria)

Drug allergy (drug idiosyncrasy, drug sensitivity, stomatitis medicamentosa)

Contact stomatitis and dermatitis (stomatitis and dermatitis venenata)

Contact stomatitis from cinnamon flavoring agent

Contact stomatitis from chronic oral mucosal contact with dental amalgam (silver amalgam)

Perioral dermatitis

Latex allergy

Midline lethal granuloma (midline lethal granulomatous ulcerations)

Wegener granulomatosis

Chronic granulomatous disease

References

20. Oral aspects of metabolic diseases

Disturbances in mineral metabolism

Disturbances in protein metabolism

Individual amino acids

Lysosomal storage diseases

Disturbances in carbohydrate metabolism

Disturbances in lipid metabolism

Avitaminoses

Fat-soluble vitamins

Water-soluble vitamins

Disturbances in hormone metabolism

References

21. Regressive alterations of the teeth

Attrition, abrasion, and erosion

Abfraction

Dentinal sclerosis (transparent dentin)

Dead tracts

Secondary dentin

Pulp calcification

Resorption of teeth

Hypercementosis (cementum hyperplasia)

Cementicles

References

22. Physical and chemical injuries of the oral cavity

Injuries of teeth associated with tooth preparation

Effect of restorative materials

Effect of cement bases, cavity liners, varnishes, and primers

Effect of cavity-sterilizing agents

Physical injuries of the teeth

Injuries to the supporting structures of the tooth

Physical injuries of the bone

Physical injuries of soft tissues

Radiation injuries

Electrical burns

Cervicofacial emphysema

Anesthetic necrosis

Human bite (morsus humanus)

Oral trauma related to sexual practices

Chemical injuries of oral cavity

Occupational injuries of the oral cavity

Occlusal trauma

References

23. Healing of oral wounds

Factors affecting healing of oral wounds

Complications of wound healing

Healing after pulpal diseases

Healing after periapical diseases

Biopsy and healing of biopsy wound

Exfoliative cytology

Healing of gingivectomy wound

Healing of extraction wound

Healing of bone fracture

Complications of fracture healing

Distraction osteogenesis (osteodistraction and callus distraction)

Replantation and transplantation of teeth

Implants

Stem cell therapy

References

24. Forensic odontology

Personal identification

Dental identification procedures

Identification in disasters

Identification from dental DNA

Palatal rugae in identification

Reconstructive dental identification

Dental profiling

Crime investigation

The dentist as an expert witness

Acknowledgments

References

25. Mucosal response to oral prostheses: Some pathological considerations

Denture in the oral environment

Direct sequelae caused by wearing dentures

Indirect sequelae

Oral reactions to orthodontic appliances

References

Diagrammatic representations of the histopathology of important oral lesions

Index

Copyright

RELX India Pvt. Ltd.

Registered Office: 818, 8th Floor, Indraprakash Building, 21, Barakhamba Road, New Delhi 110001

Corporate Office: 14th Floor, Building No. 10B, DLF Cyber City, Phase II, Gurgaon-122 002, Haryana, India

A Textbook of Oral Pathology, 4e, William G Shafer, Maynard K Hine and Barnet M Levy

Copyright © 1983, by Saunders, an imprint of Elsevier Inc. All rights reserved.

ISBN: 978-0-7216-8128-3

This adaptation of A Textbook of Oral Pathology, 4e, by William G Shafer, Maynard K Hine and Barnet M Levy is published by an arrangement with Elsevier Inc.

Shafer’s Textbook of Oral Pathology, 9e Adaptation editor: B Sivapathasundharam

Copyright © 2020, 2016, 2012, 2009, 2006 by RELX India Private

Limited

Adaptation ISBN: 978-81-312-5545-2

Adaptation e ISBN: 978-81-312-5546-9

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions .

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notice

The adaptation has been undertaken by RELX India Private Limited at its sole responsibility. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.

To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors in relation to the adaptation or for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

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Dedication

Dedicated to my wife Dr S Rohini

Contributors

Anita Krishnan Pandarathodiyil

Senior Lecturer, Department of Oral Pathology and Oral Biology Faculty of Dentistry, SEGi University & Colleges, Malaysia

Ashith B Acharya Professor and Head, Department of Forensic Odontology, SDM College of Dental Sciences and Hospital (A Constituent Unit of Shri Dharmasthala Manjunatheshwara University), Sattur, Dharwad

Burnice Nalina Kumari , Assistant Professor, Department of Periodontia, Meenakshi Ammal Dental College, Chennai

N. Gururaj , Professor and Head, Department of Oral Pathology, CSI Dental College, Madurai

Kavitha B , Professor, Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College, Chennai

Logeswari J , Associate Professor, Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College, Chennai

R Madhavan Nirmal , Professor and Head, Department of Oral Pathology, Raja Muthiah Dental College, Chidambaram

Mahesh C Verma , Vice Chancellor, Guru Gobind Singh Indraprastha University, New Delhi

Mandana Darafsh Donoghue , Director, OMFP Center, Belgaum

Manoj Prabhakar , Assistant Professor, Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College, Chennai

Preethi S , Chennai

Priya Kumar , Associate Professor, Maulana Azad Institute of Dental Sciences, New Delhi

Protyusha Guha Biswas , Assistant Professor, Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College, Chennai

Raghu A Radhakrishnan , Deputy Director, Research (Health Sciences), Manipal University, Professor Oral Pathology, MCODS, Manipal

K Ranganathan , Professor and Head, Department of Oral Pathology, Ragas Dental College, Chennai

R Sathish Muthukumar , Professor and Head, Department of Oral Pathology and Microbiology, Chettinad Dental College and Research Institute, Chennai

Uma Devi K Rao , Professor, Department of Oral Pathology, Ragas Dental College, Chennai

Vijay Wadhwan , Professor and Head, Department of Oral Pathology and Microbiology, Subarthi Dental College, Meerut

Foreword 1

Lakshman Perera Samaranayake, DSc, DDS (Glas), FRCPath, FHKCPath, FDSRCS (Edin), FRACDS, FDSRCPS

Professor and Vice-Dean, College of Dental Medicine, University of Sharjah, United Arab Emirates

Former Professor of Oral Microbiomics and Infection and Head of the School of Dentistry, University of Queensland, Australia

Immediate-past Dean of Dentistry, University of Hong Kong

A few years ago, in 2016, I wrote the foreword for the eighth edition of Shafer’s Textbook of Oral Pathology . Once again time has come for me to

pen a few words for the ninth edition of this excellent tome edited by the renowned don of Indian academia, Professor B. Sivapathasundharam. He has undertaken the onerous task of editing successive editions of this book over the last decades and accomplished this task sincerely, skillfully maintaining the generic format of the original text as envisioned by its founding father.

The fact that the book is now in its ninth edition is testimony to its extreme popularity. It is generally accepted in the Indian subcontinent and elsewhere that Shafer’s Textbook of Oral Pathology is the most venerated and the time-honored text in the discipline. I still recall my own student days in Sri Lanka where we had recourse to less than a handful of, rather pricey, American editions of the book, and that too only in our dental library. The publishers and the editors are to be congratulated once again for producing this affordable and easily accessible treatise that is updated in a timely and periodic manner for the South Asian region.

The current tome once again highlights the state-of-the-art oral pathology in all its shades and nuances. The presentation of the text, liberally interspersed with relevant illustrations and advanced and contemporary views in colored boxes and providing appropriate contextuality, is a joy to read. Indeed, the lucid, sequential, and logical presentation of the subject matter should help the reader to retain and recall the information well. I am also confident that clinicians will find the clear narrative, the colorful photomicrographs, and the life-like clinical pictures extremely valuable not only to refresh their memory but also to return to it from time to time when they encounter uncommon lesions that baffle them. The book, then, will be their silent guru. I wish to conclude by renewing my sincere congratulations to the editor, the contributors, and the publisher Elsevier India for a job extremely well done. This edition too as always will not disappoint the reader and will continue to remain at the helm as the textbook of Oral Pathology, particularly for the South Asian region. I wish it continued success!

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