Oral Medicine
(5th year material)
Done by: Abeer Khasawneh
Topic #1: Pigmentations of Oral and
Peri-oral Tissues
Extrinsic stain or die
Melanocytes
Nevus cells
Freckles
Myxoma syndrome
(Carneys syndrome)
Lentigo
Melanotic macule
Melanotic macule
Melanotic macule
Increased melanin pigmentation
within the basal cell layer with
melanin incontinence.
Melanotic macule
Melanoacanthoma
Dendritic-shaped, pigmented melanocytes (arrows) are noted
throughout the full thickness of a spongiotic and acanthotic
epithelium.
Congenital Nevi (moles)
Classification
Intramucosal nevus
Intramucosal nevus
The nevus cells are located within
the submucosal tissue, with no
evidence of any junctional component.
The superficial melanocytes are heavily
pigmented. Melanin is less evident in
the remaining cells.
Intramucosal nevus
Compound nevus
Nevus cells are located at the
junction of the epithelium and
connective tissue and within the
submucosal tissue.
The cells are variably pigmented.
Compound nevus
Junctional nevus
Blue nevus
Skin Melanoma
Skin Melanoma
Malignant Oral Melanoma
Malignant Oral Melanoma
Macular but diffuse involvement of the maxillary gingiva.
Malignant Oral Melanoma
One portion of the tumor is
heavily pigmented (arrow),
whereas the opposite side is
relatively amelanotic.
Malignant Oral Melanoma
Melanoma of the upper lip
presenting as an ulcerated mass
with multifocal areas of
pigmentation.
Oral Melanoma
Nests of melanoma cells demonstrating nuclear pleomorphism
and hyperchromatism and deposits of melanin pigment.
Oral Melanoma
Heavily pigmented melanoma
exhibiting primarily a radial
growth phase with pagetoid
spread of tumor cells
(hematoxylineosin stain).
Oral Melanoma
Neuroectodermal tumor of infancy
Physiologic pigmentation
Note the patchy distribution of the
pigment.
Physiologic pigmentation
Physiologic pigmentation
Melanin in a
macrophage
Smoking-associated melanosis
Post-inflammatory pigmentations
Lichen planusassociated
pigment. Classic-appearing
Wickhams striae and
surrounding pigmentation
(arrows) are seen in this
Caucasian patient with biopsy-
proven lichen planus.
Post-inflammatory pigmentations
Melasma
Pigmentation (arrows)
developed on the forehead
of this female during the second
trimester of pregnancy.
Melasma
Endocrinopathic pigmentations
Addisons disease
Addisons disease
Adrenocortical hyperfunction
Cushings disease (syndrome)
Peutz-Jeghers syndrome
Multiple small macules on the
fingertips (arrows).
Peutz-Jeghers syndrome
Skin pigmentations Oral / perioral pigmentations Intestinal polyps
Cutaneous menlanotic spots (Caf-au-Lait)
HIV-Associated melanosis
Laugier-Hunziker syndrome
Segmental vitiligo
Vitiligo
Ecchymosis-Haematoma
Diascopy
Haemochromatosis
Amalgam Tattoo
Amalgam Tattoo
Amalgam tattoo of the maxillary
alveolar mucosa. The pigment was
associated with a retrograde
amalgam restoration.
Amalgam Tattoo
Amalgam Tattoo
Amalgam particles are
dispersed throughout the
submucosal tissue.
Heavy metal pigmentations
Discoloration of the alveolar
mucosa associated with extensive
crown and bridge restoration.
Heavy metal pigmentations
Gingival staining due to poor quality
metals.
Heavy metal pigmentations
Generalized pigmentation due
to lead poisoning. The gingival
margin is pigmented.
Drug-induced pigmentations
Quinidine
Chlorpromazine
Drug-induced pigmentations
Chlorquine Hydroxyclorquine
Hairy tongue
Topic #2: Potentially malignant lesions
and conditions
Leukoplakia
Etiologic factors
Leukoplakia
Etiologic factors
Infiltration of the pseudohyphal form of
Candida into the epithelium of oral
leukoplakia.
Hairy Leukoplakia
Homogenous Leukoplakia
Non-Homogenous Leukoplakia
Verrucous Leukoplakia
Non-Homogenous Leukoplakia
Speckeled Leukoplakia
Leukoplakia
Leukoplakia
Leukoplakia
Leukoplakia
Leukoplakia
Leukoplakia
Leukoplakia
Leukoplakia
Erythroplakia
Speckeled Leukoplakia
Candidal Leukoplakia
Candidal Leukoplakia
Malignant transformation of potentially
malignant lesions
Potentially
Normal malignant Cancer
lesion
Computer-assessd oral brush biopsy
Toluidine Blue Staining
VELscope
Oral Submucous Fibrosis
Oral Submucous Fibrosis
Oral Submucous Fibrosis
Lichen Planus
Topic #3: Oral Cancer
Etiologic Factors
Progression of Cancer
Oral Squamous Cell Carcinoma
Lip Carcinoma
Carcinoma of the Palate
Oral Squamous Cell Carcinoma
Leukoplakia Proliferative mass
Oral Squamous Cell Carcinoma
Erythroplakia
Ulcer
Oral Squamous Cell Carcinoma
Oral Squamous Cell Carcinoma
Oral Squamous Cell Carcinoma
Complications of Radiotherapy
Early Onset: Direct Late Onset: Direct
damage of the ionizing damage to the mucosa &
radiation to the cells end-arteritis obliterans
Complications of Radiotherapy
Complications of Radiotherapy
Osteoradionecrosis
End-arteritis obliterans
Osteoradionecrosis
Hyperbaric Oxygen Therapy
Topic #4: Blood Disorders & Nutrition
Deficiency
Oral signs and symptoms in anaemias
Oral signs and symptoms in anaemias
Oral manifestations of leukaemia
Oral manifestations of leukaemia
Peticheal haemorrhage
Oral manifestations of leukaemia
Oral Candidosis
Oral manifestations of leukaemia
Herpetic Infections
Oral manifestations of leukaemia
Scurvy
Folate deficiency
Vitamin B12 deficiency
Beefy sore tongue Atrophic tongue
RAS
Angular cheilitis
Topic #5: Endocrine Disturbances &
Renal Disease
Endocrine Glands
Pregnancy (Gingivitis)
Bleeding & Halitosis
Pregnancy (Epulis)
Pregnancy (RAS)
Decreases in pregnancy
Addisons disease
Oral pigmentations & Oral candidosis
Cushings Syndrome
Phaeochromocytoma
Congenital Hypothyroidism (Cretinism)
Tetany
Chronic Renal Failure
Acute bacterial sialadenitis
Chronic Renal Failure
Mucosal ulceration (ulcerative
uraemic stomatitis)
Chronic Renal Failure
White plaques (uraemic
stomatitis)
Chronic Renal Failure
Chronic Renal Failure
Oral purpura due to platelets deficiency
Renal Transplant Patients
Drug-induced gingival overgrowth
Topic #6: Diseases of Lips and Tongue
Racial variations in lips size
Localized swellings
Mucocele Abscess
Localized swellings
Basal cell carcinoma Squamous cell carcinoma
Localized swellings
Haematoma Salivary tumour
Diffuse lip swellings
Angioedema Edema
Diffuse lip swellings
Oro-facial granulomatosis (Oral Crhons) Crhons disease
Localized / Diffuse
Lymphangioma
Haemangioma
Angular cheilitis
Lip fissures
Allergic cheilitis
Actinic cheilitis (solar keratosis)
Exfoliative cheilitis
Perioral dermatitis
Lick eczema
Cheilocandidosis
Developmental diseases of the tongue
Microglossia
Ankyloglossia
Macroglossia
Fissured tongue
Crenated tongue
Coated tongue
Hairy tongue
Foliate papillitis
Lingual tonsils
Atrophy of the lingual epithelium
Geographic tongue
Traumatic irritation of the tongue
Median rhomboid glossitis
Topic #7: Disorders of Teeth and Bone
Hypodontia
Supernumerary teeth
Supernumerary teeth
Neonatal teeth
Delayed eruption
Variations in size
Microdontia Macrodontia
Peg-shaped lateral incisor
Attrition
Abrasion
Abfraction
Erosion
Porphyria
Infantile jaundice
Tetracycline Staining
Tetracycline Staining
Localized causes of enamel hypoplasia
Infection Turner tooth
Generalized enamel hypoplasia
Generalized enamel hypoplasia
Enamel Opacities
Congenital syphilis
Dental fluorosis
Dental fluorosis
Amelogenesis imperfecta
Amelogenesis imperfecta
Dentinogenesis imperfecta
Cleidocranial dysplasia (dysostosis)
Fibrous dysplasia
Gigantism
Acromegaly
Acromegaly
Browns Tumor
Loss of lamina dura
Osteoporosis
Reduction in bone mass
per unit volume
Rickets
Pagets disease of bone
(osteitis deformans)
Cotton wool
appearance
THE END
