PATHOLOGICAL ANALYSIS

1. Dentinogenesis imperfecta: Enamel is usually lost. At first they are almost translucent then
they become either grey or brown. Radiographically: they have a tulip shape, meaning the
crown is constricted in the cervical area.
2. Amelogenesis imperfecta: Color can go from chalky white to yellow to dark Brown. contact
points are usually open. occlusal and incisal edges are abraded. Sometimes they can look
normal except for a few grooves and wrinkles on its surface. “Snow-capped teeth” It has
near normal harness with white opaque flecks on the incisal margin.
3. Enamel hypoplasia: is a quantitative defect and occurs in the form of pits, grooves, or larger
areas of missing enamel.

• Turner’s hypoplasia: It’s caused by trauma to an associated primary tooth, primary

tooth with periapical inflammatory lesion. Usually affects premolar. Reduces the
thickness of tooth’s enamel, increasing tooth sensitivity and more susceptible to decay.
 Amelogenesis imperfecta is a generalised condition. Enamel hypoplasia is not, so not all
teeth will be affected. Early childhood caries starts from 2-4 years due to bottle feeding
habit, affecting maxillary incisors and molars, But in this picture, canines are also involved.

4. Tetracycline staining: The affected teeth vary from bright yellow to dark brown and in UV
light, showing a bright yellow fluorescence. After chronic exposure to ambient light, the
fluorescent yellow discoloration fades over months to years into a nonfluorescent brown
discoloration. Often the facial surfaces of the anterior teeth will darken while the posterior
dentition and lingual surfaces remain a fluorescent yellow.
5. FLUOROSIS: white opaque spots on smooth surface enamel that may turn Brown. Develop in
children during their first year of life which is why it will affect permanent incisors, canines,
and the first molar. premolars and 1st and 2nd molars are seldomly affected.
6. Dens in dente: Deep surface invagination of the crown or root that is lined by enamel.
7. FUSION VS GERMINATION

8. Fenestration vs Dehiscence:
9. Herpes simplex type I. Gingivostomatitis: Ulcers with yellow slough appear in the mouth.
Vesicles have the appearance of pinhead with two 2 three millimeters of diameter Can
appear in gingiva, hard palate, dorsum of tongue, lips, Vermilion, perioral skin, nasopharynx.
Reactivated HSV-1 will more commonly affect the Vermilion border of the lips causing a
lesion known as herpes labialis or cold sores.
10. Shingles (HSV-3): ): Distinguishably unilateral rarely crossing the midline, it's a cluster of
vesicles following nerves, more commonly in trigeminal, spinal and dorsal nerves. In the oral
mucosa you can see crateriform ulcers that heal without scars. can sometimes create
ophthalmic zoster in which the cornea ulcerates and needs treatment immediately

11. Fordyce spots: : Ectopic formation of numerous sebaceous glands. Bilateral and symmetrical
pattern. Found in upper lip, buccal mucosa, gingiva, anterior pillars of the fauces, and
occasionally over the tongue. they are small multiple discreet rice like yellowish white
bodies between 1 - 2 millimetres of diameter.
12. Traumatic ulcer: Mostly tender with yellow floor red margins and no induration, often seen
in buccal or lingual sulcus, lateral tongue. Look for a cause of trauma. Generally, appear as a
single entity. The periphery is whitish and highly keratinized.
13. Aphtous Stomatitis: Usually round or oval with a size of less than 1 centimeter if we are
talking about minor ulcers, with a crateriform margin surrounded by a halo. Usually
appearing multiple lesions, covered by a fibrous yellowish membrane. Attacks non-
keratinized mucosa so they are usually found in labial or buccal mucosa, floor of mouth,
ventral and lateral surface of tongue. The periphery is erythematous.
14. Scleroderma: Restrictive movements of the TMJ and trismus. the nostrils are pinched and
lips are pursed like blowing a whistle. difficult speech, stiffness of tongue, xerostomia and
telangiectasia. Radiographically it will show a thickening in the periodontal ligament
resorption in the areas of the condyle and in the mandibular angle.
15. Liquenoid reaction: White network of raised white lines can either be striae or papule
resembling leukoplakia. Unilateral. Associated with erosions, most common places are on
palate or tongue. They are in association with the introduction of a foreign material like
amalgam, gold and some drugs and vaccines. Examples like captropil, antimalarials and
methyldopa.

16. Traumatic keratosis: White lesion that is related to chronic rubbing or friction. They have a
rough and frayed surface clearly related to an identifiable source of mechanical irritation.
17. Lichen planus: Network of raised white lines often producing a lace like pattern against an
erythematous base. often called “Striae of Wickham”. Can also be erythematous. Always
bilateral. extra oral skin they percent as cluster or diffuse areas of raised, purplish or reddish
papules covered by a white glistening scale, often on flexor surfaces especially on the trunk.

18. Leukoplakia: White Patch that cannot be wiped off the mucosa or ascribe to any specific
disease process. Tough adherent plaques with a slightly raised irregular surface.
19. Leukoedema: Diffuse, white, translucent, greyish-white area with filmy appearance. Lesions
may be diffuse or patchy. Often bilateral, near the occlusal plane or lateral border of the
tongue and inner surface of the lips. Common in African Americans and it will disappear
when stretched

20. Spongy white nevus: Shaggy, spongy, foiled white lesions at several mucosal sites.
Asymptomatic diffuse bilateral lesions. Appears on early childhood. Symettrical, thickened,
white, corrugated or velverty plaques, affecting the mucosa. Bilaterally.
21. Radiation induced mucositis: Presents as redness and symptomatic erythema which
progresses to a white elevated desquamative patches that are slightly painful to contact
pressure. Affects non-keratinised mucosa the most.

22. Mucocele vs Ranula:

a. Mucocele: Usually on the lower lip but can also appear on palate, top of the tongue
or other areas of accessory gland ducts. Smaller under 1.5 cms. Slightly transparent
because it has fluid inside and dark colour.
b. Ranula: Ranula that causes large, bluish, fluctuant swelling in the floor of mouth.
Soft and movable. Dome-shaped. Developing on the lateral aspect of the midline.
23. Hutchinson teeth and mulberry molars:

24. Ectodermal dysplasia: hereditary condition derived from abnormalities of the ectodermal
structures. the hair may look thin or light there is a depressed nasal bridge, frontal bossing,
dry skin. Thick brittle fingernails. Anodontia, salivary gland aplasia, xerostomia, pyrexia,
defective enamel
25. Cleidocranial dysostosis/Dysplasia: failure of teeth erupting. Supernumeraries. Mandible is
prognathic, absence of cementum may be present in root, teeth may be impacted, short
middle phalanges, frontal eminence with bossing. the clavicles may be absent and shoulders
can bend to almost touching each other.
26. Erythoplakia: Bright velvet plaque an oral mucosa which cannot be characterized clinically or
pathologically as any other recognizable condition, commonly seen on the soft palate, floor
of mouth or oral mucosa. Associated with white patches they are termed speckled
leukoplakia. Seen most frequently on the floor of mouth and retromolar areas.
RADIOLUCENCIES

1. Periapical granuloma: Widening of the periodontal ligament space, producing a radiolucent

area that is well defined and varying in size in continuity with the root apex. May show
varying degrees of root resorption. Is a mass of granulation tissue around the tooth apex of a
non-vital tooth.
2. Periapical abscess: May appear as a minimum and limited thickening of the periodontal
ligament. But if we're talking about a chronic periodontal abscess it will reveal as a
radiolucent area at the root apex with poorly defined margins off a non-vital tooth.
3. Radicular cyst: It looks the same as a periapical granuloma, the difference is that radicular
cysts derived from the proliferation of the epithelial cells of Malassez at the apex of a non-
vital tooth. It is the most common odontogenic cyst.
4. Lateral Radicular cyst: Well circumscribed radiolucency located lateral to the root of a non-
vital tooth.
5. Lateral periodontal cyst: It's uncommon and develops immediate a lateral root surface of an
erupted vital tooth. Looks small, unilocular “teardrop shape” radiolucent area near the crest
of alveolar ridge surrounded by thin corticated margin at the periphery.
Rheumatoid Arthritis vs Osteoarthritis of the TMJ

Rheumatoid arthritis: Features inflammation in the joint lining tissue (synovium) which
leads to deformity and loosening of joint ligaments.
Osteoarthritis: Not a systemic or autoimmune disease, results as natural aging of the joint.
The water content of the aging increases and the protein makeup of the cartilage
degenerates. In advanced osteoarthritis, there is a total loss of the cartilage cushion
between the bones of the joint. It can cause joint pain and swelling. In osteoarthritis you will
see complete destruction of the TMJ structures.
Changes are usually more evident on the condylar side of the joint:
• flattening: common (in one series 27%)
• osteophytes: common (27%)
• erosions: 13%
• sclerosis: less common (9%)
• subchondral cysts

Imagenological characteristics of the temporomandibular joint affected with osteoarthritis.

(A) Sagittal CBCT images of a TMJ of a patient with DC/TMD diagnosis of osteoarthritis but
without bony osteoarthritic changes (erosions and osteophytes). (B) Sagittal CBCT images of
a TMJ of a patient with a DC/TMD diagnosis of osteoarthritis and with bony osteoarthritic
changes (erosions and osteophyte). CBCT: Cone beam computed tomography, TMJ:
temporomandibular joint, DC/TMD: diagnostic criteria for temporomandibular joint. White
arrow: osteophyte; black arrow: flattening; dot pattern arrow: erosion; asterisk: sclerosis.
 NERVE DAMAGE

1. Cranial nerve examination:

• I: olfactory. Sense of smell is rarely tested, although damage is quite

common following head &/or mid-face trauma.

• II: optic. Examine the pupils for both direct and consensual reflex; assess
the visual fields; check visual acuity and examine the fundus with an
ophthalmoscope.
 • III: oculomotor. The motor supply to the extra-ocular muscles except
lateral rectus and superior oblique. It supplies the ciliary muscle, the
constrictor of the pupil, and levator palpebrae superioris. A defect
therefore causes impairment of upward, downward, and inward
movement of the eye, leading to diplopia, drooping of the upper eyelid
(ptosis), and absent direct and consensual reflexes.
• IV: trochlear. Supplies superior oblique, paralysis of which causes
diplopia; worst on looking downward and inward.
• V: trigeminal. The major sensory nerve to the face, oral, nasal,
conjunctival, and sinus mucosa, and part of the tympanic membrane.
It is motor to the muscles of mastication. Sensory abnormalities are
mapped out using gentle touch and pin-prick. Motor weakness is best
assessed on jaw opening and excursion.
 • VI: abducens. Supplies lateral rectus. A defect causes paralysis of
abduction of the eye.

• VII: facial. Motor to the muscles of facial expression. Supplies taste

from the anterior two-thirds of tongue (via chorda tympani) and is
secretomotor to the lacrimal, sublingual, and submandibular glands.
It innervates the stapedius muscle in the middle ear. The lower face is
innervated by the contralateral motor cortex, whereas the upper face
has bilateral innervation. Assess by demonstrating facial movements.
• VIII: vestibulocochlear. Is sensory for balance and hearing. Deafness,
vertigo, and tinnitus are the main symptoms.

• IX: glossopharyngeal. Supplies sensation and taste from the posterior

one-third of the tongue, motor to stylopharyngeus, and secretomotor
to the parotid. Lesions impair the gag reflex in conjunction with X.
• X: vagus. Has a motor input to the palatal, pharyngeal, and laryngeal
muscles. Impaired gag reflex, hoarseness, and deviation of the soft
palate to the unaffected side are seen if damaged. The vagus has a huge
parasympathetic output to the viscera of the thorax and abdomen. Gag reflex damage is
caused mainly by this CN.
• XI: accessory. Is motor to sternomastoid and trapezius, causing
weakness on shoulder shrugging and on turning the head away from the
affected side.
• XII: hypoglossal. Motor supply to the tongue. Lesions cause dysarthria
(impaired speech) and deviation towards the affected side of protrusion.
 SIGNS ON THE HANDS

1. Koilonychia, also known as spoon nails, is a nail disease that can be a sign of hypochromic
anaemia, especially iron-deficiency anaemia or hemochromatosis, which is a liver disease.
It refers to abnormally thin nails (usually of the hand) which have lost their convexity,
becoming flat or even concave in shape.

2. Splinter haemorrhages: Splinter haemorrhages can occur with infection of the heart valves
(endocarditis). They may be caused by vessel damage from swelling of the blood vessels
(vasculitis) or tiny clots that damage the small capillaries (microemboli). The most common
cause of splinter haemorrhages is trauma, followed by psoriasis, onychomycosis, and
occasionally medications. Proximal splinters are rare and possible indicators of systemic
diseases, including endocarditis (infectious and marantic), vasculitis (including septic
vasculitis), trichinosis, and the antiphospholipid antibody syndrome. Hand sign of mitral
valve damage.
3. Ulnar deviation: Ulnar deviation is also known as ulnar drift. This hand condition occurs
when your knuckle bones, or metacarpophalangeal (MCP) joints, become swollen and cause
your fingers to bend abnormally toward your little finger. Ulnar deviation can occur due
to chronic inflammation from rheumatoid arthritis (RA). RA is a chronic inflammatory
disease in which the body's immune system attacks the soft tissue or synovium that lines the
surface of joints.

4. Palmar erythema: describes the redness of the skin of the palms (and, in this case, the
fingers) seen in chronic liver disease (‘liver palms’), rheumatoid arthritis, systemic lupus
erythematosus (SLE), bronchial carcinoma and in states of high cardiac output (e.g.
pregnancy or thyrotoxicosis).

5. Dupuytren's contracture (also called Dupuytren's disease) is an abnormal thickening of the

skin in the palm of your hand at the base of your fingers. This thickened area may develop
into a hard lump or thick band. Over time, it can cause one or more fingers to curl (contract),
or pull sideways or in toward your palm. Found in liver disease, alcoholism, pulmonary
tuberculosis or diabetes mellitus.
6. Gigantism vs acromegaly: Gigantism is characterized by tall stature and should be suspected
in children three standard deviations above the mean. Acromegaly is characterized by large
hands and feet, coarse facial features, broad nose, acne, hyperhidrosis, underbite, and teeth
separation.
7. Osteoarthritis vs Rheumatoid arthritis:

8. Rheumatoid arthritis:
9. Osteoarthritis:

10. Raynaud’s phenomenon: Can be defined as a health condition in which the blood vessels in
an individual get narrowed on experiencing changes in levels of cold and stress. This
narrowing obstructs blood supply to the skin surface leading to skin discolouration. At first,
skin turns white then slowly turns blue.
11. Infective endocarditis: Red spots on the soles of your feet or the palms of your
hands (Janeway lesions) Red, tender spots under the skin of your fingers or toes (Osler's
nodes) Tiny purple or red spots, called petechiae, on the skin, in the whites of your eyes or
inside your mouth.

12. Clubbing: is a bulbous uniform swelling of the soft tissue of the terminal phalanx of a digit,
with subsequent loss of the normal angle between the nail and nail bed. Lung cancer is the
most common cause of clubbing. Clubbing often occurs in heart and lung diseases that
reduce the amount of oxygen in the blood. These may include: Heart defects that are
present at birth (congenital)
13. Scleroderma:
14. Leukonychia: There are four types of Leukonychia defined by the clinical presentation:
(1) Leukonychia Totalis: which is characterized by whitening of the entire nail. It is often a
clinical sign of hypoalbuminemia as seen in the Nephrotic Syndrome, liver failure, protein
malabsorption, and protein-losing enteropathies. It is also observed as side-effects of
sulfonamides antibiotic treatment. (2) Leukonychia Partialis: shows whitening of parts of the
nail plate usually in form of small white dots. There are three different variations—punctate,
transverse, and longitudinal leukonychia. Some more serious variations of leukonychia
partialis may lead to leukonychia totalis. (3) Leukonychia Punctata: is also known as the
“true” leukonychia. It is the most frequent presentation of leukonychia in which small white
spots appear on the nails. Picking and biting of the nails are a prominent cause in young
children and nail biters. Besides parakeratosis, air that is trapped between the cells may also
cause this appearance. It is also caused by trauma and in most cases, the white spots appear
on a single or a couple of fingers or toes. The suggested mechanism of action is injury to the
matrix of the nail. In infancy, white spots disappear around 8 months of age that
corresponds to the time necessary for nails to regrow completely. The pattern and number
of spots may change as the nail grows. (4) Leukonychia Striata: also called transverse
leukonychia, or Mees’ lines, that is defined as whitening or discoloration of the nail in bands
or “stria” that run parallel from the lunula. This is commonly caused by physical injury or
disruption of the nail matrix. It is also reported as a result of heavy metal poisoning,
especially lead. It is also seen with chemotherapy and in patients affected with cirrhosis. This
is the only form that can be inherited as an autosomal dominant pattern.
15. Pitted fingernails: Nail psoriasis causes your nail plate to lose cells. This results in small pits
forming on your fingernails or toenails, which may look like your nails were hit with the tip
of a pen. The number of pits varies from person to person. Some people may have only a
single pit on each nail, while others have dozens of pits. Associated with psoriasis and lichen
planus.

16. Beau’s lines: Hypocalcaemia. The width of the grooves usually correlates with the duration
of the insult. Hypoparathyroidism and consequent underlying hypocalcemia are a cause of
Beau's lines affecting all the 20 nails of fingers and toes [
17. Herpetic whitlow: Herpetic whitlow is a viral condition where small blisters form on the
fingers and the fleshy area around the fingertips. These sores or blisters are often painful
and develop after direct contact with a contagious sore. The herpes simplex virus (HSV)
causes this condition.
CLEFT LIP AND PALATE