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485 Pages·2010·56.94 MB·English
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CAWSON’S ESSENTIALS OF ORAL PATHOLOGY AND ORAL MEDICINE Professor Roderick A. Cawson BDS, FDSRCS, LMSSA, MB BS, MD, FRCPath 1921–2007 For Elsevier Commissioning Editor: Michael Parkinson/Alison Taylor Development Editor: Clive Hewat Project Manager: Kerrie-Anne Jarvis Design Direction: Erik Bigland Illustrator: David Gardner Illustrator Manager: Merlyn Harvey CCAWASWON’SS EOSSNENT’ISAL SE OFS SENTIALS OF ORAL PATHOLOGY ORAL PATHOLOGY EIGHTH AND ORAL MEDICINE EDITION AND ORAL MEDICINE R. A. Cawson MD FDSRCS FDSRCPS(Glas) FRCPath FAAOMP Emeritus Professor of Oral Medicine and Pathology, Guy’s, King’s and St Thomas’ Dental Institute, King’s College London Visiting Professor in Oral Pathology, Baylor College of Dentistry, Texas A & M University System, Dallas, Texas and 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 EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2008 Note Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or © Longman Group UK Limited 1991 appropriate. Readers are advised to check the most current informa- Assigned to Pearson Professional 1995 tion provided (i) on procedures featured or (ii) by the manufacturer of © Harcourt Brace and Company Limited 1998 each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindi- © 2008, Elsevier Limited. All rights reserved. cations. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to deter- No part of this publication may be reproduced, stored in a retrieval mine dosages and the best treatment for each individual patient, and system, or transmitted in any form or by any means, electronic, to take all appropriate safety precautions. To the fullest extent of the mechanical, photocopying, recording or otherwise, without the law, neither the Publisher nor the Authors assume any liability for any prior permission of the Publishers. Permissions may be sought injury and/or damage to persons or property arising out or related to directly from Elsevier’s Health Sciences Rights Department, 1600 any use of the material contained in this book. The Publisher John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: ((cid:2)1) 215 239 3804; fax: ((cid:2)1) 215 239 3805; or, e-mail:[email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier. com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. First edition 1962 Second edition 1968 Third edition 1978 Fourth edition 1984 Fifth edition 1991 Sixth edition 1998 Seventh edition 2002 ISBN: 978-0443-10125-0 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Printed in China Contents Preface xv Shell teeth (dentinogenesis imperfecta type III) 28 1. Principles of investigation and diagnosis 1 Dentinal dysplasia (‘rootless’ teeth) 28 Taking a history 1 Regional odontodysplasia (ghost teeth) 28 Demographic details 2 Segmental odontomaxillary dysplasia 30 History of the present complaint 2 Multisystem disorders affecting the teeth 30 The medical history 2 Epidermolysis bullosa 30 The dental history 3 Infection 30 The family and social history 3 Metabolic disturbances 31 Consent 3 Drugs 31 Clinical examination 4 Fluorosis 32 Extraoral 4 Other acquired developmental anomalies 34 Oral examination 5 Treatment of hypoplastic defects 35 Medical examination 6 Odontomas 35 Making a clinical differential diagnosis and investigation plan 7 Genetic disorders of the jaws 37 Special investigations 7 Hereditary prognathism 37 Imaging 8 Clefts of the lip and palate 37 Histopathology 9 Developmental disorders associated with clefting 37 Laboratory procedures 11 Submucous cleft palate 39 Molecular biological tests 12 Developmental defects of the oral soft tissues 39 Haematology, clinical chemistry and serology 13 Other genetic diseases relevant to dentistry 39 Microbiology 13 Other clinical tests 16 3. Dental caries 40 Interpreting special investigations and making a diagnosis Aetiology 40 and treatment plan 16 Microbiology 40 Normal haematological values 17 Bacterial polysaccharides 41 Bacterial plaque 42 Stages of formation of bacterial plaque 43 SECTION 1 Acid production in plaque 43 Plaque minerals 44 HARD TISSUE PATHOLOGY 19 Sucrose as a plaque substrate 44 2. Disorders of development of the teeth and related Effects of sucrose on plaque polysaccharide production 44 tissues 20 Effects of sucrose on the oral microbial fl ora 44 Abnormalities in the number of teeth 20 Experimental studies on humans 46 Isolated hypodontia or anodontia 20 Susceptibility of teeth to caries 46 Hypodontia or anodontia with systemic defects 20 Effects of fl uorides 47 Other conditions associated with hypodontia 21 Saliva and dental caries 47 Additional teeth: hyperdontia 21 Effects of desalivation 47 Syndromes associated with hyperdontia 22 Rate of fl ow and buffering power 47 Disorders of eruption 23 Other factors 48 Delayed eruption associated with skeletal disorders 23 Pathology of enamel caries 49 Local factors affecting eruption of deciduous teeth 24 The early lesion 49 Local factors affecting eruption of permanent teeth 24 Cavity formation 51 Changes affecting buried teeth 24 Pathology of dentine caries 53 Defects of structure: hypoplasia and hypocalcifi cation 24 Protective reactions of dentine and pulp under caries 53 Defects of deciduous teeth 24 Root surface caries 54 Defects of permanent teeth 24 Arrested caries and remineralisation 55 Amelogenesis imperfecta 24 Adult and childhood caries 56 Dentinogenesis (odontogenesis) imperfecta 27 Clinical aspects of reactions to caries 59 v CONTENTS 4. Pulpitis, apical periodontitis, resorption and Bisphosphonate-induced osteonecrosis 102 hypercementosis 60 Osteoradionecrosis 104 Pulpitis 60 Alveolar osteitis 104 Pulp calcifi cations 65 Sclerotic bone islands 106 Pulp stones 65 Fascial space infections (cervicofacial cellulitis) 106 Diffuse calcifi cation 65 Necrotising fasciitis 108 Periapical periodontitis 65 Cavernous sinus thrombosis 108 Acute apical periodontitis 66 Maxillofacial gangrene (noma, cancrum oris) 108 Chronic apical periodontitis 68 Actinomycosis 109 Resorption of teeth 70 The systemic mycoses 110 Resorption of deciduous teeth 70 Systemic infections by oral bacteria 111 Resorption of permanent teeth 71 Infective endocarditis 111 Idiopathic resorption 71 Lung and brain abscesses 111 Hypercementosis 72 Immunodefi ciency states 111 Concrescence 73 Normal healing of an extraction socket 113 Chronic (non-carious) injuries to teeth 74 Attrition 74 7. Cysts of the jaws 115 Bruxism 74 Typical features of jaw cysts 115 Abrasion 75 Other cystic or cyst-like lesions 115 Erosion 76 Radicular cysts 116 Residual and lateral radicular cysts 119 5. Gingivitis and periodontitis 77 Paradental cysts 120 The normal periodontal tissues 77 Dentigerous cysts 121 Gingival and periodontal fi bres 78 Eruption cyst 123 Gingival crevicular fl uid (exudate) 78 Keratinising odontogenic cysts 123 Nomenclature and classifi cation of periodontal disease 78 Odontogenic keratocyst 124 Chronic gingivitis 78 The basal cell naevus syndrome (Gorlin–Goltz syndrome) 127 Pregnancy gingivitis 80 Orthokeratinised odontogenic cyst (orthokeratinised Down’s syndrome 80 odontogenic keratocyst) 129 Diabetes mellitus 80 Gingival cysts 129 Chronic adult periodontitis 80 Dental lamina cysts of the newborn (Bohn’s nodules) 129 Complications of chronic periodontitis 87 Gingival cysts of adults 129 Periodontal (lateral) abscess 88 Lateral periodontal cysts 129 Juvenile periodontitis 88 Botryoid odontogenic cysts 130 Other causes of early-onset periodontal destruction 90 Glandular odontogenic cyst (sialo-odontogenic cyst) 130 Acute pericoronitis 91 Nasopalatine duct cysts 130 Acute necrotising ulcerative gingivitis 92 Nasolabial cysts 132 HIV-associated gingivitis 93 Cystic neoplasms 132 HIV-associated periodontitis 93 Unicystic ameloblastoma 132 Herpetic gingivostomatitis 94 Calcifying odontogenic cyst 132 Miscellaneous periodontal disorders 94 Neoplastic change within cysts 132 Gingival swelling 94 So-called globulomaxillary cysts 132 Hereditary gingival fi bromatosis 94 Cysts of the soft tissues 132 Drug-induced hyperplasia 95 Sublingual dermoid 132 Infl ammatory gingival swellings 95 Wegener’s granulomatosis 95 8. Odontogenic tumours and tumour-like lesions of the Sarcoidosis and orofacial granulomatosis 95 jaws 136 Acute leukaemia 95 Ameloblastomas 136 Scurvy 96 Unicystic ameloblastoma 139 Gingival recession 96 Metastasising ameloblastoma and ameloblastic Gingival abrasion 96 carcinoma 140 Adenomatoid odontogenic tumour 141 6. Major infections of the mouth, jaws and perioral tissues 99 Calcifying epithelial odontogenic tumour 142 Acute osteomyelitis of the jaws 99 Clear cell odontogenic carcinoma 142 vi Chronic osteomyelitis 101 Calcifying (ghost cell) odontogenic cyst 143 Chronic low-grade osteomyelitis and osteitis 102 Squamous odontogenic tumour 144 CONTENTS Ameloblastic fi broma 144 Hyperparathyroidism–jaw tumour syndrome 177 Ameloblastic sarcoma (ameloblastic fi brosarcoma) 145 Gigantism and acromegaly 177 Odontogenic myxoma 145 Fluorosis 178 Odontogenic fi broma 146 Metabolic bone disease 178 Tumours and dysplasias of cementum 146 Rickets 178 Cementoblastoma 146 Vitamin D-resistant rickets 178 Cemento-ossifying fi broma 147 Scurvy 179 Psammomatoid ossifying fi broma 149 Hyperparathyroidism 179 Juvenile ossifying fi broma 149 Other bone diseases 181 Non-neoplastic odontogenic lesions 149 Paget’s disease of bone (osteitis deformans) 181 Cemento-osseous dysplasias 150 Fibro-osseous lesions 183 Periapical cemental dysplasia 150 Fibrous dysplasia 183 Florid cemento-osseous dysplasia 150 Monostotic fi brous dysplasia 184 Focal cemento-osseous dysplasia 150 Polyostotic fi brous dysplasia 185 Gigantiform cementoma 151 Albright’s syndrome 185 Odontomas (odontomes) 151 Cemento-osseous dysplasias 185 Compound odontomas 151 Solitary bone ‘cyst’ (solitary bone cavity) 186 Complex odontoma 152 Osteoporotic bone marrow defect 187 Other types of odontomas 152 Aneurysmal bone ‘cyst’ (cavity) 187 WHO classifi cation of odontogenic tumours 2005 154 Pathology of osseointegration 189 11. Disorders of the temporomandibular joints and 9. Non-odontogenic tumours of the jaws 156 periarticular tissues 192 Osteoma and other bony overgrowths 156 Temporary limitation of movement (trismus) 192 Compact and cancellous osteoma 156 Infection and infl ammation in or near the joint 192 Gardner’s syndrome 157 Injuries 193 Osteochondroma (cartilage-capped osteoma) 157 Tetanus and tetany 193 Cemento-ossifying fi broma 157 Temporomandibular pain dysfunction syndrome 193 Giant cell granuloma 157 Hysterical trismus 193 Other giant cell lesions of the jaws 159 Drugs 193 Haemangioma of bone 159 Dislocation 193 Melanotic neuroectodermal tumour of infancy (progonoma) 160 Recurrent dislocation 193 Malignant neoplasms of bone 161 Ehlers–Danlos syndrome 194 Osteosarcoma 161 Persistent limitation of movement 194 Chondroma and chondrosarcoma 162 Irradiation 194 Chondrosarcoma 162 Oral submucous fi brosis 195 Ewing’s sarcoma 163 Progressive systemic sclerosis (scleroderma) 195 Myeloma 163 Arthritis and other causes of pain in or around the joint 195 Solitary (extramedullary) plasmacytoma 165 Rheumatoid arthritis 196 Amyloidosis 165 Osteoarthritis 196 Langerhans cell histiocytosis (histiocytosis X) 165 Other types of arthritis 197 Solitary eosinophilic granuloma 166 Cranial (giant cell) arteritis 197 Multifocal eosinophilic granuloma 167 Pain dysfunction syndrome 198 Letterer–Siwe syndrome 167 ‘Costen’s syndrome’ 199 Lymphomas 167 Condylar hyperplasia 199 Metastatic tumours 167 Neoplasms 199 Loose bodies in the temporomandibular joints 199 10. Genetic, metabolic and other non-neoplastic bone diseases 172 Self-assessment questions and learning guides 202 Genetic diseases of bone 172 Osteogenesis imperfecta (brittle bone syndrome) 172 Osteopetrosis – marble bone disease 173 SECTION 2 Achondroplasia 174 SOFT TISSUE DISEASE 205 Cleidocranial dysplasia 174 Cherubism 175 12. Diseases of the oral mucosa: introduction and mucosal vii Hypophosphatasia 177 infections 206 Sickle cell anaemia and thalassaemia major 177 Primary herpetic stomatitis 206 CONTENTS Herpes labialis 208 IgA pemphigus 242 Herpetic cross-infections 208 Pemphigus herpetiformis 242 Herpes zoster of the trigeminal area 209 Pemphigus foliaceus 242 Cytomegalovirus-associated ulceration 210 Subtypes of pemphigoid 243 Hand-foot-and-mouth disease 210 Linear IgA disease 243 The acute specifi c fevers 210 Bullous pemphigoid 243 Kawasaki’s disease (mucocutaneous lymph node Anti-epiligrin pemphigoid 243 syndrome) 211 Anti-p105 pemphigoid 243 Tuberculosis 211 Tuberculous cervical lymphadenopathy 212 14. Tongue disorders 246 Syphilis 212 The sore tongue 246 Primary syphilis 212 Ulceration of the tongue 246 Secondary syphilis 212 Glossitis 246 Tertiary syphilis 212 The sore, physically normal tongue 247 Cat-scratch disease 213 Geographical tongue (erythema migrans linguae) 247 Candidosis 213 The foliate papillae 248 Thrush 213 Lingual varicosities 248 Angular stomatitis 215 Hairy tongue 248 Denture-induced stomatitis 215 Black tongue 249 Acute antibiotic stomatitis 216 Furred tongue 249 Erythematous candidosis 216 Median rhomboid glossitis 249 Treatment of candidosis 217 Macroglossia 250 Amyloidosis 250 13. Diseases of the oral mucosa: non-infective stomatitis 220 Traumatic ulcers 220 15. Benign chronic white mucosal lesions 252 Lingual papillitis 220 Leukoedema 252 Recurrent aphthous stomatitis (recurrent aphthae) 220 Frictional keratosis and cheek biting 252 Behçet’s disease 224 Fordyce’s granules 253 Nicorandil-induced oral ulceration 225 Pipe smoker’s keratosis (‘stomatitis nicotina’) 253 HIV-associated oral ulceration 225 Thrush 254 Lichen planus 225 HIV-associated hairy leukoplakia 254 Gingival lichen planus 227 Hairy leukoplakia in the absence of HIV infection 256 Lichenoid reactions 228 White sponge naevus 256 Malignant change in lichen planus 229 Chronic mucocutaneous candidosis syndromes 256 Lupus erythematosus 230 Familial (limited) mucocutaneous candidosis 257 Chronic ulcerative stomatitis 231 Diffuse-type mucocutaneous candidosis 257 Pemphigus vulgaris 232 Endocrine candidosis syndrome 257 Mucous membrane pemphigoid 233 Late-onset mucocutaneous candidosis 257 ‘Desquamative gingivitis’ 235 Psoriasis 258 Other causes of epithelial shedding 235 Oral keratosis of renal failure 258 Erythema multiforme 235 Verruciform xanthoma 258 ‘Allergic’ stomatitis 236 Skin grafts 259 Reiter’s disease (seronegative arthropathy) 237 Mucocutaneous lymph node syndrome (Kawasaki’s disease) 237 16. Oral premalignancy 261 Miscellaneous mucosal ulcers 237 Premalignant lesions and conditions 262 Eosinophilic ulcer (atypical or traumatic eosinophilic Erythroplasia (‘erythroplakia’) 262 granuloma) 237 Speckled leukoplakia 263 Ruptured blood blisters (localised oral purpura) 238 Idiopathic leukoplakia 264 Wegener’s granulomatosis 238 Sublingual keratosis 265 Oral reactions to drugs 238 Proliferative verrucous leukoplakia 265 Some uncommon mucocutaneous diseases 238 Pipe smoker’s keratosis 265 Factitious ulceration (self-infl icted oral lesions) 238 Smokeless tobacco-induced keratoses 265 Treatment for aphthous stomatitis 240 Chronic hyperplastic candidosis (candidal leukoplakia) 267 Pemphigus variants 242 Oral submucous fi brosis 268 viii Paraneoplastic pemphigus 242 Lichen planus 270 CONTENTS Lupus erythematosus 270 Tuberculous sialadenitis 294 Dyskeratosis congenita 270 Chronic sialadenitis 294 Syphilitic leukoplakia 270 Dry mouth (xerostomia) 295 Early carcinoma 270 Sjögren’s syndrome 295 Management of dysplastic lesions 270 Lymphoma in Sjögren’s syndrome 299 Smoking cessation 272 Benign lymphoepithelial lesion 299 Irradiation damage 299 HIV-associated salivary gland disease 299 17. Oral cancer 277 Sjögren-like syndrome in graft-versus-host disease 299 Epidemiology 277 Hypersalivation (ptyalism) 299 Age and gender incidence 277 Salivary gland neoplasms 300 Aetiology 277 Pleomorphic adenoma 301 Tobacco use 277 Warthin’s tumour (adenolymphoma) 302 Alcohol 278 Oncocytoma 303 Infections and immunological factors 278 Other adenomas 303 Syphilis 279 Malignant salivary gland tumours 303 Chronic candidosis 279 Mucoepidermoid carcinoma 303 Malnutrition 279 Acinic cell carcinoma 303 Oral sepsis 279 Adenoid cystic carcinoma 304 Sunlight 279 Polymorphous low-grade adenocarcinoma 304 Genetic factors 280 Salivary duct carcinoma 305 Precancerous lesions 280 Epithelial-myoepithelial carcinoma 305 Early squamous cell carcinoma 280 Adenocarcinomas 305 Oral cancer sites 280 Undifferentiated carcinomas 305 Carcinoma of the lip 281 Malignant change in pleomorphic adenoma 306 Carcinoma of the tongue and fl oor of mouth 281 Secondary tumours 306 Carcinoma of the alveolar ridge, cheek and palate 282 Non-epithelial tumours 306 Pathology 282 Intraosseous salivary gland tumours 307 Spread of oral carcinoma 283 Tumour-like salivary swellings 307 Management 284 Necrotising sialometaplasia 307 Preoperative assessment 284 Sialadenosis 308 Treatment 285 WHO classifi cation of salivary gland tumours 2005 309 Treatment failure 286 Palliative care 286 19. Common benign mucosal swellings 314 Novel treatments 286 Fibrous polyps, epulides and denture-induced Survival from oral cancer 287 granulomas 314 Role of the dentist 287 Giant-cell fi broma 315 Oral cancer screening 288 Papillary hyperplasia of the palate 316 Screening and detection aids 288 Pyogenic granuloma and pregnancy epulis 316 Tolonium chloride (toluidine blue) rinsing 288 Giant-cell epulis 317 Brush biopsy 288 Papillomas 317 Saliva tests 289 Squamous cell papilloma 317 Verrucous carcinoma 289 Infective warts (verruca vulgaris) 318 Focal epithelial hyperplasia 318 18. Neoplastic and non-neoplastic diseases of salivary Other benign neoplasms 318 glands 291 Obstruction 291 20. Soft tissue (mesenchymal) neoplasms 321 Salivary calculi 291 Benign tumours 321 Parotid papilla and duct strictures 292 Neurofi bromas 321 Salivary fi stula 292 Neurilemmomas 321 Mucoceles and cysts 292 Lipoma and fi brolipoma 321 Ranula 293 Granular cell tumour 322 Sialadenitis 294 Congenital (granular cell) epulis 322 Mumps 294 Haemangiomas 322 ix Suppurative parotitis 294 Lymphangioma 323

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Making a clinical differential diagnosis and investigation plan 7. Special investigations 7. Imaging 8 . Sickle cell anaemia and thalassaemia major 177 lagen alpha helix, prevent polymerisation into normal type 1 collagen. Incomplete eruption of a wisdom tooth produces a large stagnation area
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