Cawson's Essentials of Oral Pathology and Oral Medicine E-Book

485 Pages·2010·56.94 MB·English

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
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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
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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