Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment, 2e

407 Pages·2008·17.43 MB·English

by  Crispian Scully

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Oral and
MaxillOfacial
Medicine
The Basis of diagnosis and Treatment
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This ebook is uploaded by dentalebooks.com
Commissioning Editor: Michael Parkinson
Development Editor: Hannah Kenner
Project Manager: frances affleck
Design Direction: George ajayi
Illustrator: dartmouth inc.
Illustration Manager: Gillian richards
Oral and
MaxillOfacial
M e d i c i n e
Second Edition
The Basis of diagnosis and Treatment
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crispian Scully
cBe Md Phd MdS MrcS fdSrcS fdSrcPS ffdrcSi fdSrcSe frcPath fmedSci
fHea dSc
Dean and Director of Studies and Research, and Professor of Oral Medicine,
Pathology and Microbiology, University of London, UK

Eastman Dental Institute, and WHO Collaborating Centre for Disability, Culture
and Oral Health, University College London, UK

Visiting Professor at Universities of Edinburgh, Helsinki, Middlesex and West of
England; Honorary Consultant at University College Hospitals, London, UK;
Great Ormond Street Hospital, London;
and European Institute for Oncology, Milan, Italy
edinburgh london new York Oxford Philadelphia St louis Sydney Toronto 2008
© 2008, elsevier limited. all rights reserved.
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first edition 2004
Second edition 2008
iSBn-13: 9780443068188
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
Note
Knowledge and best practice in this field are constantly changing. as new research
and experience broaden our knowledge, changes in practice, treatment and drug
therapy may become necessary or appropriate. readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications.
it is the responsibility of the practitioner, relying on their own experience and
knowledge of the patient, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the author assume any
liability for any injury and/or damage to persons or property arising out or related
to any use of the material contained in this book.
The Publisher
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Printed in china
Contents
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Preface ii 25 Erythema migrans 205
Intended outcomes xi 26 Erythema multiforme 207
27 Erythroplakia, leukoplakia, keratosis and other
potentially malignant lesions 211
28 Fordyce spots 225
Section 1 FUNDAMENTAL PRINCIPLES 29 Gingial drug-induced swelling 227
30 Granulomatous cheilitis 229
OF PATIENT MANAGEMENT
31 Herpesirus infections 233
32 Lichen planus 241
1 Diagnosis: history 3
33 Odontogenic cysts and tumours 249
2 Diagnosis: examination 9
34 Pemphigoid 261
3 Diagnosis: inestigations 21
35 Pemphigus 267
4 Treatment 39
36 Saliary neoplasms 273
5 Agents used in the treatment of patients with oral
37 Sjögren syndrome 279
disease 49
38 Temporomandibular joint pain–dysfunction
syndrome 291
39 Trigeminal and other neuralgias 297
Section 2 COMMON COMPLAINTS
6 Cerical lymphadenopathy 69 Section 4 RELEVANT AND OTHER
7 Drooling and sialorrhoea 75
SYSTEMIC DISORDERS
8 Dry mouth (xerostomia) 79
9 Halitosis (oral malodour) 87
10 Lumps and swellings 93
40 Human immunodeficiency irus infection 305
11 Pain 97
41 Iatrogenic disease 315
12 Red, white and pigmented lesions 109
42 Oral manifestations of disorders of specific
13 Sensory and motor changes and taste
systems 325
abnormalities 119
14 Soreness and ulcers 131
Section 5 EPONYMOUS AND OTHER
CONDITIONS
Section 3 COMMON AND IMPORTANT
ORAL CONDITIONS
43 Eponymous conditions 337
15 Angioedema (angioneurotic oedema) 143 44 Other conditions 347
16 Angular cheilitis (angular stomatitis) 147
17 Aphthae (recurrent aphthous stomatitis) 151
18 Atypical facial pain 159
19 Behçet syndrome 163 Section 6 ADVERSE DRUG REACTIONS
20 Bell’s palsy 167
21 Burning mouth syndrome (oral dysaesthesia) 171
45 Aderse drug reactions 375
22 Cancer 177
23 Candidiasis (candidosis) 191
Index 383
24 Denture-related stomatitis 201

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Preface to second edition
i am pleased to say that the first edition was very well comments overall, to dr Mohamed el-Maaytah and
received and proved popular. indeed, the book was dr navdeep Kumar for providing a few figures, to
awarded the first Prize of the royal Society of Medicine Professor John eveson for kind permission to use
and Society of authors, for a new authored book. histopathology from our book eveson, J.W. and Scully
nevertheless, i have taken the opportunity to re- c. colour Atlas of Oral Pathology (1995). Mosby-Wolfe
structure; to thoroughly revise and update the text; (london) and to Peter reichart, david Sidransky and
to reformat where this could enhance clarity; to add dr l. Barner for permission to reproduce their WHO
new material and clinical pictures and some basic his- classifications from Pathology and Genetics of Tumours
topathology, tables, boxes and algorithms; to add new of the Head and neck (2005) and to Professor Mervyn
chapters on sialorrhoea and drooling, other conditions, Shear for commenting on the chapter on Odontogenic
and adverse drug reactions; and to update further cysts and Tumours.
reading. CS
My additional thanks are to John Huw evans for 2007
his technical assistance, to dr Stefano fedele for his
The wise should consider that health is the greatest of human blessings.
Hippocrates
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ii
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Preface to first edition
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Oral medicine is that area of special competence in Clinical Drug Use in Dentistry (cawson, Spector and
dentistry concerned mainly with diseases involving the Skelly: churchill livingstone, edinburgh, 1995).
oral and perioral structures, especially the oral mucosa, an attempt has been made to present the material
and the oral manifestations of systemic diseases. The in such a way as to highlight the more important
specialty, in some countries termed ‘stomatology’, deals conditions – important because of frequency or
not only with oral disease but also with perioral lesions, seriousness – and to guide the reader through didactic
and is increasingly known as ‘oral and maxillofacial and problem-oriented approaches. However, it is
medicine’. furthermore, apart from the obvious close impossible to position every subject in a perfect location,
relationships with oral pathology (oral and maxillo- not least because few conditions affect only one site (e.g.
facial pathology) and with oral surgery (oral and even erythema migrans can have lesions in sites other
maxillofacial surgery), there is a close relationship with than on the tongue), some affect even more than one
special care dentistry and hospital dentistry. tissue (e.g. ectodermal dysplasia affects skin, salivary
This book attempts to present for those interested glands and teeth) and several have a range of clinical
in oral medicine and hospital dentistry, the basics of presentations (e.g. lichen planus and cancer can both
the specialty of oral medicine in a useful and digestible present with white, red or ulcerative lesions, and can
format; by offering the information in a range of modes be symptomless or cause extreme discomfort). cross-
and levels of detail and offering practical guidance referring between sections will help the user get full
to diagnosis, therapy and sources of information value from the content.
for patient and clinician, both on the internet and The book is not intended to give all the details of the
elsewhere. various investigative and therapeutic modalities, since
The first section reviews the fundamental principles these are covered in other texts by the author, or in
of the history, examination and investigations and pharmacopoeias. The book offers illustrative examples
principles of management. in the absence of randomized of the more common and important conditions, but
controlled trials, many of the therapies suggested are cannot provide the more comprehensive selection of
unable to be thoroughly evidence based. Hopefully, illustrations such as can be found in atlases such as
future multicentre studies will rectify this deficiency. Oral Diseases (Scully, flint, Porter and Moos: dunitz,
The second section discusses the more common london, 2004).
symptoms and signs in oral medicine. i thank my patients and nurses who have taught
The third section covers in some detail the most me so much over the years, and continue so to do,
common and important conditions seen in oral and all those students and colleagues with whom i
medicine. This section also includes synopses of a have worked and interacted, who may have shared
number of eponymous and other conditions relevant to the clinical care of some patients, and/or may have
oral medicine; if a specific condition is not found there, knowingly or otherwise contributed ideas or content.
the reader is referred to the index, since it may well be in this respect i thank especially Professors Oslei almeida
located elsewhere in the book. (Brazil), Jose-Vicente Sebastian-Bagan (Spain), Johann
The fourth section is a discussion of the important Beck-Managetta (austria), roman carlos (Guatemala),
areas of HiV infection and iatrogenic diseases. Marco carrozzo (italy), roderick cawson (UK), Pedro
The other relevant oral manifestations of systemic diz dios (Spain), drore eisen (USa), Joel epstein
disorders are tabulated in appendix 1: further detail (canada), Sergio Gandolfo (italy), George laskaris
can be found in Medical Problems in Dentistry (Scully and (Greece), Jens Pindborg (denmark; deceased), Stephen
cawson: elsevier, edinburgh, 2004). Porter (UK), Peter reichart (Germany), Pierre-luigi
agents used in the treatment of patients with oral Sapelli (italy), Sol 'Bud' Silverman (USa) and isaac Van
diseases are outlined in appendix 2. Only a limited der Waal (The netherlands).
number of these are prescribed by dental practitioners, Thanks are also due to: alan drinnan (USa) for
but practitioners may have to cope with questions his innovative introduction of the Bulletin Board in
from patients about their treatment, or to recognize or Oral Pathology (BBOP), a useful world forum for
deal with treatment complications. further details can oral medicine and pathology; to Miguel lucas-Tomas
be found in textbooks such as Basic Pharmacology and (Spain), who founded the european association for
ix