Diseases of the Oral Mucosa: Study Guide and Review

Foreword
Preface
Contents
About the Editor
1: Introduction
1.1 Introduction
1.2 Book Structure
1.3 Biopsy Sampling
1.4 Limitations
References
2: Anatomy of the Oral Mucosa
2.1 Macroscopy of the Oral Cavity
2.2 Functions of the Oral Mucosa
2.3 Histology of the Oral Mucosa
2.3.1 Masticatory Mucosa
2.3.1.1 Epithelium of Masticatory Mucosa
2.3.2 Lining Mucosa
2.3.2.1 Epithelium of Lining Mucosa
2.3.3 Specialized Mucosa
2.3.4 Protein Expression of Oral Epithelium
2.3.4.1 Renewal of the Oral Epithelium
2.3.4.2 Aging
2.3.4.3 Cell-Cell- and Cell-Matrix-Contacts
2.3.4.4 Composition of the Epithelial Permeability Barrier
2.3.5 Non-Keratinozytes in Oral Epithelium
2.3.5.1 Melanocytes
2.3.5.2 Langerhans Cells
2.3.5.3 Merkel Cells
2.3.6 The Basement Membrane: Epithelial-Connective Tissue Interface
2.3.7 Lamina Propria
2.3.8 Submucosa
2.3.9 Organization of Blood and Nerve Supply in Oral Mucosa
2.4 The Immune System of the Oral Mucosa
References
3: Medical History and Clinical Examination
3.1 Introduction
3.2 History Taking
3.3 Examination of the Oral Cavity
3.4 Examination of Extra Oral Sites
References
4: Normal Variations
4.1 Linea Alba (White Line)
4.2 Morsicatio
4.3 Imprints
4.4 Fordyce Granules
4.5 Leukoedema
4.6 Pigmentation
4.6.1 Physiological Pigmentation
4.6.2 Melanotic Macule
4.7 Torus (Exostosis)
4.8 Retrocuspid Papilla
4.9 Reactive Fibroma
4.10 Papilla of the Parotid Duct
4.11 Leukoplakia
4.12 Aphthae
4.13 Variations of the Tongue
4.13.1 Lingual Tonsils
4.13.2 Foliate and Vallate Papillae
4.13.3 Varices
References
5: Clinical Scores
5.1 Introduction
5.2 Clinician Reported Outcome Measures (CROM)
5.2.1 Methodologies for Use in Autoimmune Blistering Diseases
5.2.1.1 Generic
Autoimmune Bullous Skin Disorder Intensity Score (ABSIS)
Oral Disease Severity Score (ODSS) (Additionally Applicable to Oral Lichen Planus)
Physician’s Global Assessment (PGA)
5.2.1.2 Disease specific clinical outcome measures
Pemphigus Disease Area Index (PDAI)
Mucous Membrane Pemphigoid Disease Area Index (MMPDAI)
5.2.2 Methodologies Designed for Oral Lichen Planus (OLP)
5.2.2.1 Oral Disease Severity Score (ODSS)
5.2.2.2 Modified White-Erosive-Atrophic (WEA-MOD)
5.2.2.3 Reticular-Erythematous-Ulceration (REU)
5.2.3 Behçet Disease
5.2.4 Recurrent Aphthous Stomatitis
5.2.5 Orofacial Granulomatosis
5.2.6 Sjögren Syndrome
5.2.7 Summary of Clinician Reported Outcome Measures (CROM)
5.3 Patient-Reported Outcome Measures (PROM)
5.3.1 Generic-Oral
5.3.2 Discipline-Specific
5.3.3 Disease-Specific
5.3.4 Summary of Patient Reported Outcome Measures (PROM)
5.4 Clinical Pearls
References
6: Histopathology of Oral Hyperplastic and Neoplastic Lesions
6.1 Introduction
6.2 Oral Squamous Cell Carcinoma
6.2.1 Verrucous Carcinoma [9] (Table 6.4)
6.2.2 Basaloid Squamous Carcinoma [10] (Table 6.5)
6.2.3 Leukoplakia [7, 11] (Tables 6.6 and 6.7)
6.2.4 Precancerous Leukoplakia [13]
6.2.5 Morsicatio
6.2.6 Frictional Keratosis
6.2.7 Smoker’s Palate
6.2.8 Viral Papillomas [8]
6.2.9 Multifocal Epithelial Hyperplasia (Heck Disease) [8]
6.2.10 Verruciform Xanthoma
6.2.11 Candidiasis
6.2.12 Lingua/Stomatitis Geographica
6.2.13 Lichen Planus Mucosae
6.2.14 White Sponge Nevus
6.2.15 Reactive Hyperplastic Lesions [18, 19]
6.2.15.1 Epulis
6.2.16 Pigmented Lesions [20, 21] (Table 6.9)
6.2.17 Exogenous Pigmentation
6.2.18 Amalgam Tattoo
6.2.19 Melanotic Macule
6.2.20 Melanocytic Nevi
6.2.21 Oral Mucosal Melanoma [22–24] (Table 6.10)
References
7: Genodermatoses with Oral Manifestations
7.1 Introduction
7.2 Ehler-Danlos Syndrome
7.2.1 Clinical Features
7.2.1.1 Oral Cavity
7.2.1.2 Skin
7.2.1.3 Systemic Manifestations
7.2.2 Differential Diagnosis
7.2.3 Diagnosis
7.2.4 Management
7.3 Dyskeratosis Follicularis
7.3.1 Clinical Features
7.3.1.1 Oral Cavity
7.3.1.2 Skin
7.3.1.3 Systemic Manifestations
7.3.2 Differential Diagnosis
7.3.3 Diagnosis
7.3.4 Management
7.4 Nevoid Basal Cell Carcinoma Syndrome (Gorlin-Goltz Syndrome)
7.4.1 Clinical Features
7.4.1.1 Oral Cavity
7.4.1.2 Skin
7.4.1.3 Systemic Manifestations
7.4.2 Differential Diagnosis
7.4.3 Diagnosis
7.4.4 Management
7.5 Cowden Syndrome
7.5.1 Clinical Features
7.5.1.1 Mucocutaneous Manifestations
7.5.1.2 Systemic Manifestations
7.5.2 Differential Diagnosis
7.5.3 Diagnosis
7.5.4 Management
7.6 Hereditary Hemorrhagic Teleangiectasia
7.6.1 Clinical Features
7.6.1.1 Skin and Oral Cavity
7.6.1.2 Systemic Manifestations
7.6.2 Differential Diagnosis
7.6.3 Diagnosis
7.6.4 Management
7.7 Lipoid Proteinosis
7.7.1 Clinical Features
7.7.1.1 Oral Cavity
7.7.1.2 Skin
7.7.1.3 Systemic Manifestations
7.7.2 Differential Diagnosis
7.7.3 Diagnosis
7.7.4 Management
7.8 Hereditary Benign Intraepithelial Dyskeratosis
7.8.1 Clinical Features
7.8.2 Differential Diagnosis
7.8.3 Diagnosis
7.8.4 Management
7.9 White Sponge Nevus
7.9.1 Clinical Features
7.9.2 Differential Diagnosis
7.9.3 Diagnosis
7.9.4 Management
7.10 Hereditary Mucoepithelial Dysplasia
7.10.1 Clinical Features
7.10.2 Differential Diagnosis
7.10.3 Diagnosis
7.10.4 Management
7.11 Neurocutaneous Syndromes
References
8: Oral Manifestations in Inherited Epidermolysis Bullosa
8.1 Introduction
8.2 Epidemiology
8.3 Genetics and Risk Factors
8.4 Pathophysiology
8.5 Diagnosis and Differential Diagnoses
8.6 Clinical Features
8.6.1 Oral Manifestations of EB
8.6.1.1 Pathophysiology of Oral Disease
8.6.1.2 Epidermolysis Bullosa Simplex
8.6.1.3 Junctional Epidermolysis Bullosa
8.6.1.4 Dystrophic Epidermolysis Bullosa
Dominant Dystrophic EB
Recessive Dystrophic EB
Recessive Dystrophic EB Inversa
8.6.1.5 Kindler Epidermolysis Bullosa
8.6.2 Cutaneous Manifestations of EB
8.6.3 Gastrointestinal Manifestations
8.6.4 Genitourinary Manifestations
8.6.5 Respiratory Manifestations
8.6.6 Cardiac Manifestations
8.6.7 Systemic Manifestations of Severe EB
8.7 Management
8.7.1 General Management of EB
8.7.2 Management of Oral Disease in EB
8.7.2.1 Oral Blisters, Ulcers, and Erosions
8.7.2.2 Fibrotic Scarring Sequelae
Microstomia
Obliteration of the Oral Vestibule
References
9: Dyskeratosis Congenita
9.1 Introduction
9.2 Epidemiology
9.3 Genetics
9.4 Clinical Features
9.4.1 Oral Manifestations
9.4.2 Cutaneous Manifestations
9.4.3 Systemic Manifestations
9.5 Differential Diagnoses
9.6 Diagnosis
9.7 Pathophysiology
9.8 Management
9.9 Clinical Pearls
References
10: Pachyonychia Congenita
10.1 Introduction
10.2 Epidemiology
10.3 Genetics
10.4 Clinical Features
10.4.1 Oral Manifestations
10.4.2 Extraoral Manifestations
10.5 Differential Diagnoses
10.6 Diagnosis
10.7 Pathophysiology
10.8 Management
References
11: Oral Lichen Planus
11.1 Introduction
11.2 Epidemiology
11.3 Genetics and Risk Factors
11.3.1 Genetics
11.3.2 Autoimmune and Immune-Mediated Mechanisms
11.3.3 Drugs
11.3.4 Stress and Mood
11.3.5 Infection
11.4 Clinical Features
11.4.1 Reticular OLP
11.4.2 Atrophic
11.4.3 Plaque-Like
11.4.4 Erosive/Ulcerative
11.4.5 Papular
11.4.6 Bullous
11.4.7 Extra-Oral Manifestations of Lichen Planus
11.4.7.1 Skin
11.4.7.2 Nails
11.4.7.3 Scalp
11.4.7.4 Genital
11.5 Differential Diagnoses
11.5.1 Oral Lichenoid Reaction
11.5.2 Systemic Lupus Erythematosus
11.5.3 Discoid Lupus Erythematosus
11.5.4 Graft Versus Host Disease (GvHD)
11.6 Diagnosis
11.6.1 Histopathology
11.6.2 Immunofluorescence
11.6.3 Haematoserological Investigations
11.6.4 Patch Testing
11.7 Pathophysiology
11.8 Management
11.8.1 Asymptomatic Oral Lichen Planus: Non-Ulcerative
11.8.2 Non-ulcerative, Symptomatic Oral Lichen Planus
11.8.3 Ulcerative/Erosive/Atrophic Oral Lichen Planus
11.8.3.1 Intralesional Triamcinolone
11.8.4 Severe Ulcerative/Erosive/Atrophic Oral Lichen Planus
11.8.4.1 Systemic Corticosteroids
11.8.4.2 Hydroxychloroquine
11.8.4.3 Azathioprine
11.8.4.4 Mycophenolate Mofetil
11.8.4.5 Methotrexate
11.8.4.6 Systemic Retinoids
11.8.4.7 Biologics
11.8.4.8 Phototherapy
11.8.5 Non-pharmacological Treatment Modalities
11.8.5.1 Dental Hygiene Therapy
11.8.5.2 Dietary Avoidance
11.8.5.3 Laser Therapy
11.8.6 Malignant Potential
11.8.7 Monitoring of OLP
References
12: Recurrent Aphthous Stomatitis
12.1 Introduction
12.2 Epidemiology
12.3 Genetics and Risk Factors
12.4 Clinical Features
12.5 Differential Diagnosis
12.6 Diagnosis
12.7 Pathophysiology
12.8 Management
References
13: Behçet Disease
13.1 Introduction
13.2 Epidemiology
13.3 Genetics and Risk Factors
13.4 Clinical Features
13.4.1 Mucocutaneous Manifestations
13.4.1.1 Oral Ulcers
13.4.1.2 Genital Ulcers
13.4.1.3 Skin Lesions
13.4.1.4 Skin Pathergy Reaction
13.4.2 Musculoskeletal Involvement
13.4.3 Ocular Involvement
13.4.4 Neurologic Involvement
13.4.5 Vascular Involvement
13.4.5.1 Venous Involvement
13.4.5.2 Arterial Involvement
13.4.6 Gastrointestinal Involvement
13.5 Diagnosis
13.5.1 Diagnostic Criteria
13.5.2 Difficulties in Making Diagnosis
13.5.3 Diagnostic Process in Clinical Practice
13.6 Pathophysiology
13.7 Differential Diagnosis
13.8 Management
13.8.1 Mucocutaneous Involvement
13.8.2 Joint Involvement
13.8.3 Ocular Involvement
13.8.4 Neurologic Involvement
13.8.5 Venous Involvement
13.8.6 Arterial Involvement
13.8.7 Gastrointestinal Involvement
References
14: Chronic Ulcerative Stomatitis
14.1 Introduction
14.2 Epidemiology
14.3 Genetics and Risk Factors
14.4 Clinical Features
14.4.1 Differential Diagnosis
14.5 Diagnosis
14.5.1 Histopathologic Features
14.5.2 Immunofluorescence Studies
14.5.3 Pathophysiology
14.5.4 Management
References
15: Lichen Sclerosus of the Oral Mucosa
15.1 Introduction
15.2 Epidemiology
15.3 Genetics and Risk Factors
15.4 Clinical Features
15.5 Differential Diagnoses
15.6 Diagnosis
15.7 Pathophysiology
15.8 Management
References
16: Cheilitis Granulomatosa and Melkersson Rosenthal Syndrome
16.1 Introduction
16.2 Epidemiology
16.3 Genetics and Risk Factors
16.4 Clinical Features
16.5 Differential Diagnosis
16.6 Diagnosis
16.7 Pathophysiology
16.8 Management
References
17: Autoimmune Blistering Diseases: An Introduction
17.1 Introduction
17.2 Target Antigens
17.3 Diagnostic Principles
17.4 Oral Involvement
17.5 Pemphigoid Gestationis
17.6 Dermatitis Herpetiformis
References
18: Pemphigus Vulgaris
18.1 Introduction
18.2 Epidemiology
18.3 Genetics and Risk Factors
18.4 Clinical Features
18.5 Differential Diagnosis
18.6 Diagnosis
18.7 Pathophysiology
18.8 Management
References
19: Paraneoplastic Pemphigus
19.1 Introduction
19.2 Epidemiology
19.3 Genetics and Risk Factors
19.4 Clinical Features
19.5 Differential Diagnosis
19.6 Diagnosis
19.6.1 Histopathology
19.6.2 Direct Immunofluorescence Microscopy
19.6.3 Indirect Immunofluorescence Microscopy
19.6.4 Other Serological Assays
19.6.5 Diagnostic Criteria
19.7 Pathophysiology
19.8 Management
19.9 Prognosis
References
20: Mucous Membrane Pemphigoid
20.1 Introduction
20.2 Epidemiology
20.3 Clinical Features
20.3.1 Oral Involvement
20.3.2 Ocular Involvement
20.3.3 Laryngeal Involvement
20.3.4 Esophageal Involvement
20.3.5 Genital Involvement
20.4 MMP Subtypes Related to Target Antigens
20.4.1 Anti-Laminin 332 MMP
20.4.2 Anti-Type VII Collagen MMP
20.5 Diagnosis
20.5.1 Histopathology
20.5.2 Direct Immunofluorescence Microscopy
20.5.3 Serration Pattern Analysis
20.5.4 Serological Tests
20.5.4.1 Target Antigens
20.5.4.2 Indirect Immunofluorescence
20.5.4.3 ELISA and Immunoblot
20.6 Outcome Measurements
20.6.1 Patient Reported Outcome Measurements
20.7 Therapy
20.7.1 Mild to Moderate MMP
20.7.2 Severe MMP
References
21: Bullous Pemphigoid
21.1 Introduction
21.2 Epidemiology
21.3 Genetics and Risk Factors
21.3.1 Medications
21.4 Clinical Features
21.4.1 Initial Prodrome of BP and Non-bullous Presentations
21.4.2 Bullous Stage
21.4.3 Mucosal Involvement in Bullous Pemphigoid
21.4.4 Atypical Variants
21.4.5 Pediatric Bullous Pemphigoid
21.4.6 Neurological and Psychiatric Comorbidities
21.4.7 Other Comorbidities
21.5 Differential Diagnosis
21.6 Diagnosis
21.6.1 Histopathology
21.6.2 Direct Immunofluorescence Microscopy
21.6.3 Indirect Immunofluorescence Microscopy
21.6.4 Enzyme-linked Immunosorbent Assay
21.6.5 Other Diagnostic Modalities
21.7 Pathophysiology
21.7.1 Blister Formation
21.7.2 T Cells
21.7.3 Inflammatory Cells
21.7.4 Proteolytic Enzymes
21.8 Management
21.8.1 Mucosal Disease
21.8.2 Wound Care
21.8.3 Other Treatments and Clinical Trials
References
22: Anti-p200 Pemphigoid
22.1 Introduction
22.2 Epidemiology
22.3 Genetics and Risk Factors
22.4 Clinical Features
22.5 Differential Diagnosis
22.6 Diagnosis
22.7 Pathophysiology
22.8 Management
References
23: Linear IgA Disease
23.1 Introduction
23.2 Epidemiology
23.3 Genetics and Risk Factors
23.4 Clinical Features
23.5 Differential Diagnosis
23.6 Diagnosis
23.7 Pathophysiology
23.8 Management
References
24: Epidermolysis Bullosa Acquisita
24.1 Introduction
24.2 Epidemiology
24.3 Genetics and Risk Factors
24.4 Clinical Features
24.5 Differential Diagnosis
24.6 Diagnosis
24.7 Pathophysiology
24.7.1 Type VII Collagen is the Autoantigen in EBA
24.7.2 Loss of Tolerance and Autoantibody Production
24.7.3 Autoantibody-Induced Tissue Damage
24.7.4 Resolution
24.8 Management
References
25: Oral Lupus Erythematosus
25.1 Introduction
25.2 Epidemiology
25.3 Genetics and Risk Factors
25.4 Clinical Features
25.5 Differential Diagnosis
25.6 Diagnosis
25.7 Pathophysiology
25.8 Management
References
26: Systemic Sclerosis
26.1 Epidemiology
26.2 Genetics and Risk Factors
26.3 Clinical Features
26.3.1 Extraoral Manifestations
26.3.2 Oral and Perioral Manifestations
26.3.3 Radiological Findings
26.4 Differential Diagnosis
26.5 Diagnosis
26.6 Pathophysiology
26.7 Management
References
27: ANCA-Associated Vasculitis
27.1 Introduction
27.2 Granulomatosis with Polyangiitis
27.2.1 Epidemiology
27.2.2 Clinical Features of Systemic Involvement
27.2.3 Mucocutaneous Features
27.2.4 Histopathological Features
27.2.5 Direct Immunofluorescence Studies on Lesional Skin and/or Mucosa
27.3 Eosinophilic Granulomatosis with Polyangiitis
27.3.1 Epidemiology
27.3.2 Clinical Features of Systemic Involvement
27.3.3 Mucocutaneous Features
27.3.4 Histopathological Features
27.4 Microscopic Polyangiitis
27.4.1 Epidemiology
27.4.2 Clinical Features of Systemic Involvement
27.4.3 Mucocutaneous Features
27.4.4 Histopathological Features
27.4.5 Direct Immunofluorescence Studies on Lesional Skin and/or Mucosa
27.5 Diagnosis and Differential Diagnosis
27.6 Management
References
28: Viral Infections
28.1 Introduction
28.2 Herpes Virus Family
28.3 Herpes Simplex Virus Type 1
28.3.1 Epidemiology
28.3.2 Transmission and Replication
28.3.3 Primary Herpetic Gingivostomatitis
28.3.4 Herpes Recidivans
28.4 Herpes Simplex Virus Type 2
28.5 Varicella Zoster Virus
28.5.1 Varicella
28.5.2 Herpes Zoster
28.6 Epstein-Barr Virus
28.6.1 Infectious Mononucleosis
28.6.2 Oral Hairy Leukoplakia
28.6.3 EBV-Positive Mucocutaneous Ulcer
28.7 Cytomegalovirus
28.7.1 Mucocutaneous CMV Ulcer
28.8 Kaposi Sarcoma Herpesvirus
28.9 Human Papilloma Virus
28.9.1 Virus Characteristics
28.9.2 Transmission and Epidemiology
28.9.3 Oral Potentially Malignant Disorders
28.9.4 Oral Epithelial Dysplasia and Oral Intraepithelial Neoplasia
28.9.5 High-Risk HPV-Associated Oral Epithelial Dysplasia
28.9.6 Verruca Vulgaris
28.9.7 Condyloma Acuminatum
28.9.8 Immunodeficiency-Associated Oral Papillomatosis
28.9.9 Focal Epithelial Hyperplasia
28.10 Enteroviruses
28.10.1 Herpangina Zahorsky
28.10.2 Hand-Foot-Mouth Disease
28.11 Rubeola (Measles)
28.11.1 Clinical Features
28.11.2 Treatment and Prevention
28.12 Rubella (German Measles)
28.12.1 Forchheimer Spots
28.13 Arthropod-Born Viruses
28.13.1 Dengue
28.13.2 Chikungunya
28.13.3 Zika
28.13.4 West Nile Virus
28.14 SARS-CoV-2
References
29: Bacterial Infections of the Oral Mucosa
29.1 Introduction
29.2 Dental Caries
29.2.1 Introduction
29.2.2 Epidemiology
29.2.3 Clinical Features
29.2.4 Diagnosis and Pathophysiology
29.2.5 Management
29.3 Actinomycosis
29.3.1 Introduction
29.3.2 Epidemiology
29.3.3 Clinical Features
29.3.4 Diagnosis and Pathophysiology
29.3.5 Management
29.4 Tuberculosis
29.4.1 Introduction
29.4.2 Epidemiology
29.4.3 Clinical Features
29.4.4 Diagnosis and Pathophysiology
29.4.5 Management
29.5 Leprosy
29.5.1 Introduction
29.5.2 Epidemiology
29.5.3 Clinical Features
29.5.3.1 Oral Manifestations
29.5.3.2 Extraoral Manifestations
29.5.3.3 Leprosy Reactions
29.5.4 Diagnosis and Pathophysiology
29.5.5 Management
29.6 Other Bacterial Infections
29.6.1 Gram Positive Bacteria
29.6.2 Gram Negative Bacteria
29.7 Sexually Transmitted Infections (STI)
29.7.1 Syphilis
29.7.1.1 Introduction
29.7.1.2 Epidemiology
29.7.1.3 Clinical Features
Primary Stage
Secondary Stage
Latency
Tertiary Stage
Congenital Syphilis
29.7.1.4 Diagnosis
29.7.1.5 Pathophysiology
29.7.1.6 Management
29.7.2 Neisseria Gonorrhoea and Other Neisseria spp.
29.7.3 Chlamydia spp.
29.7.4 Mycoplasma spp.
References
30: Fungal Diseases of Oral Cavity
30.1 Introduction
30.2 Oral candidosis
30.2.1 Epidemiology
30.2.2 Genetics and Risk Factors
30.2.3 Pathophysiology
30.2.4 Clinical Features
30.2.4.1 Pseudomembranous Candidosis
30.2.4.2 Erythematous Candidosis
30.2.4.3 Hyperplastic Candidosis
30.2.4.4 Median Rhomboid Glossitis
30.2.4.5 Angular Cheilitis
30.2.4.6 Denture Stomatitis
30.2.4.7 Linear Gingival Erythema
30.2.4.8 Chronic Mucocutaneous Candidosis
30.2.5 Differential Diagnosis
30.2.6 Diagnosis
30.2.6.1 Direct Examination of Smears
30.2.6.2 Culture
30.2.6.3 Histological Examination
30.2.7 Management
30.3 Aspergillosis
30.3.1 Epidemiology
30.3.2 Genetics and Risk Factors
30.3.3 Pathophysiology
30.3.4 Clinical Features
30.3.5 Differential Diagnosis
30.3.6 Diagnosis
30.3.7 Management
30.4 Mucormycosis
30.4.1 Epidemiology
30.4.2 Genetics and Risk Factors
30.4.3 Pathophysiology
30.4.4 Clinical Features
30.4.5 Differential Diagnosis
30.4.6 Diagnosis
30.4.7 Management
30.5 Cryptococcosis
30.5.1 Epidemiology
30.5.2 Genetics and Risk Factors
30.5.3 Pathophysiology
30.5.4 Clinical Features
30.5.5 Differential Diagnosis
30.5.6 Diagnosis
30.5.7 Management
30.6 Histoplasmosis
30.6.1 Epidemiology
30.6.2 Genetics and Risk Factors
30.6.3 Pathophysiology
30.6.4 Clinical Features
30.6.5 Differential Diagnosis
30.6.6 Diagnosis
30.6.7 Management
30.7 Paracoccidioidomycosis
30.7.1 Epidemiology
30.7.2 Genetics and Risk Factors
30.7.3 Pathophysiology
30.7.4 Clinical Features
30.7.5 Differential Diagnosis
30.7.6 Diagnosis
30.7.7 Management
30.8 Geotrichosis
30.8.1 Epidemiology
30.8.2 Genetics and Risk Factors
30.8.3 Pathophysiology
30.8.4 Clinical Features
30.8.5 Differential Diagnosis
30.8.6 Diagnosis
30.8.7 Management
30.9 Conclusion
References
31: Benign Tumors and Hyperpigmentations of Oral Mucosa
31.1 Introduction
31.2 Lipomatous Tumor
31.2.1 Lipoma
31.3 Vascular Tumors
31.3.1 Pyogenic Granuloma
31.3.2 Hemangioma
31.3.3 Epithelioid Hemangioma and Kimura Disease
31.3.4 Bacillary Angiomatosis
31.3.5 Lymphangioma
31.4 Tumors of Nerve Sheet Origin
31.4.1 Neurofibroma
31.4.2 Schwannoma
31.4.3 Neuroma
31.5 Granular Cell Tumor
31.6 Reactive Fibroblastic Tumors
31.6.1 Peripheral Giant Cell Granuloma
31.6.2 Focal Fibrous Hyperplasia
31.6.3 Peripheral Ossifying Fibroma
31.7 Fibroblastic and Myoblastic Tumors
31.7.1 True Fibroma
31.7.2 Solitary Fibrous Tumor
31.7.3 Rhabdomyoma
31.8 Genetic Diseases with Benign Oral Tumors
31.9 Pigmented Lesions
31.9.1 Focal Lesions
31.9.1.1 Oral Melanotic Macules
31.9.1.2 Laugier-Hunziker Syndrome
31.9.1.3 Melanocytic Nevi
31.9.1.4 Oral Melanoacanthoma
31.9.1.5 Foreign Body Pigmentation
Amalgam, Graphite, and Carbon
31.9.2 Diffuse or multifocal lesions
31.9.2.1 Physiologic Pigmentation
31.9.2.2 Drug Induced Pigmentation
31.9.2.3 Smoker’s Melanosis
31.9.2.4 Heavy Metal Pigmentation
31.9.2.5 Post-Inflammatory Pigmentation
31.9.2.6 In Systemic Diseases
References
32: Leukoplakia and Squamous Cell Carcinoma
32.1 Introduction
32.2 Oral Premalignant Disorders and Oral Epithelial Dysplasia
32.2.1 Epidemiology
32.2.2 Clinical Features
32.2.3 Diagnosis
32.2.4 Histological Criteria
32.2.4.1 Cellular Changes in OPMD
32.2.4.2 Architectural Changes in OPMD
32.2.5 Differential Diagnosis
32.2.6 Pathophysiology and Risk Factors
32.2.7 Management
32.3 Squamous Cell Carcinoma of the Oral Mucosa
32.3.1 Epidemiology
32.3.2 Genetics and Risk Factors
32.3.3 Clinical Features
32.3.4 Differential Diagnosis
32.3.5 Histopathologic Diagnosis
32.3.6 Management
32.3.6.1 Staging
32.3.6.2 Radiology
32.3.6.3 Surgery
32.3.6.4 Postoperative Treatment
32.3.6.5 Alternative Treatment
References
33: Oral Submucous Fibrosis
33.1 Introduction
33.1.1 Definitions
33.2 Epidemiology
33.3 Etiology, Etiopathogenesis, and Malignant Transformation
33.4 Clinical Features
33.4.1 Clinical Presentation (Fig. 33.3)
33.4.2 Radiographic Presentation
33.4.3 Laboratory Findings
33.4.4 Histopathological Presentation
33.5 Diagnosis
33.6 Management
33.6.1 Management of Stage 1 OSMF
33.6.2 Management of Stage 2 OSMF
33.6.3 Management of Stage 3 OSMF
33.6.4 Management of Stage 4A OSMF
33.6.5 Management of stage 4B OSMF
33.7 Clinical Pearls
References
34: Melanoma of the Oral Cavity
34.1 Introduction
34.2 Epidemiology
34.3 Genetics and Risk Factors
34.4 Clinical Features
34.5 Differential Diagnosis
34.6 Diagnosis
34.7 Pathophysiology
34.8 Management
34.8.1 Immunotherapy
References
35: Lymphoma, Hematological Neoplasia, and Metastases of the Oral Cavity
35.1 Lymphoma
35.1.1 Non-Hodgkin Lymphoma
35.1.1.1 Epidemiology
35.1.1.2 Common Variants
35.1.1.3 Oral Lesions
35.1.1.4 Primary Cutaneous Lymphomas
35.1.1.5 EBV-Positive Mucocutaneous Ulcer
35.1.1.6 Diffuse Large B Cell Lymphoma
35.1.1.7 Diagnosis and Management
35.1.2 Hodgkin Lymphoma
35.2 Hematological Neoplasia
35.2.1 Leukemia
35.2.2 Langerhans Cell Histiocytosis
35.3 Sarcomas
35.3.1 Extramedullary Myeloid Sarcoma
35.3.2 Other Sarcomas
35.4 Metastatic Tumours
References
36: Oral Mucositis Following Cancer Therapy
36.1 Introduction
36.2 Epidemiology
36.2.1 Chemotherapy
36.2.2 Hematopoietic Stem Cell Transplantation
36.2.3 Head and Neck Radiation Therapy
36.2.4 Targeted Anti-cancer Therapy and Immunotherapy
36.3 Genetics and Risk Factors
36.3.1 Demographic/Lifestyle Factors
36.3.2 Genetic Factors
36.3.3 Systemic Factors
36.3.4 Tumor-related Variables
36.4 Pathobiology
36.4.1 The Five-stage Model
36.4.2 Oral Toxicity Associated with Targeted Therapies and Immunotherapy
36.5 Clinical Features
36.5.1 Oral Mucositis Induced by Chemotherapy- and Radiotherapy
36.5.2 Long-term Post-radiation Oral Mucosal Changes
36.5.3 Targeted Therapy-induced Oral Toxicity
36.6 Outcome Assessment Measures
36.6.1 Clinician Reported Outcome Measures
36.6.2 Patient Reported Outcome Measures
36.7 Outcomes and Economic Impact
36.8 Management
36.8.1 Preventive Measures
36.8.2 Therapeutic Measures
36.8.3 Nutritional Support
References
37: Erythema Multiforme
37.1 Introduction
37.2 Epidemiology
37.3 Pathogenesis, Genetics and Risk Factors
37.3.1 Herpes Simplex Virus Infection-related EM
37.3.2 Drug-related EM
37.4 Clinical Features
37.5 Differential Diagnosis
37.6 Diagnosis
37.6.1 Histopathology
37.7 Management
References
38: Epithelial Necrolysis
38.1 Introduction
38.2 Epidemiology
38.3 Genetics and Risk Factors
38.3.1 Risk Factors
38.3.2 Genetics
38.4 Clinical Features
38.5 Differential Diagnosis
38.6 Pathophysiology
38.7 Diagnosis
38.8 Management
38.8.1 Identification and Withdrawal of Potential Causes
38.8.2 Supportive Care and Topical Treatment
38.8.3 Immunomodulating Therapy
References
39: Allergic Contact Stomatitis
39.1 Introduction
39.2 Epidemiology
39.3 Genetics and Risk Factors
39.4 Clinical Features
39.4.1 Contact Urticaria and Oral Allergy Syndrome
39.4.2 Plasma Cell Gingivitis
39.5 Differential Diagnosis
39.6 Diagnosis
39.7 Pathophysiology
39.8 Management
References
40: Oral Allergy Syndrome
40.1 Introduction
40.2 Epidemiology
40.3 Genetics and Risk Factors
40.4 Clinical Features
40.4.1 Potential Symptoms Due to Bet v 1-associated IgE-cross-reactivity to Plant Foods [1]
40.4.1.1 Symptom Complex (Organ/Localization)
40.5 Differential Diagnosis
40.6 Diagnosis
40.7 Pathophysiology
40.7.1 Allergens: Single Allergenic Molecules
40.7.2 Allergen Nomenclature
40.7.3 Allergen Structure and its Effect on Function
40.7.3.1 Bet v 1-homologues
40.7.3.2 Profilins: Panallergens
40.7.3.3 Lipid Transfer Proteins
40.8 Management
40.8.1 Pharmaceutical Intervention
40.8.2 Allergen-specific Immunotherapy
References
41: Gingivitis and Periodontitis
41.1 Gingivitis
41.1.1 Plaque-induced Gingivitis
41.1.1.1 Epidemiology
41.1.1.2 Genetics and Risk Factors
41.1.1.3 Clinical Features
41.1.1.4 Differential Diagnosis
41.1.1.5 Diagnosis
41.1.1.6 Pathophysiology
41.1.1.7 Management
41.1.2 Non-plaque-induced Gingivitis
41.2 Periodontitis
41.2.1 Introduction
41.2.2 Periodontitis
41.2.2.1 Epidemiology
41.2.2.2 Genetics and Risk Factors
41.2.2.3 Clinical Features
41.2.2.4 Differential Diagnosis
41.2.2.5 Diagnosis
41.2.2.6 Pathophysiology
41.2.2.7 Management
41.2.3 Periodontitis as a Direct Manifestation of Systematic Diseases
41.2.4 Necrotizing Periodontitis
41.2.4.1 Introduction
41.2.4.2 Epidemiology
41.2.4.3 Genetics and Risk Factors
41.2.4.4 Clinical Features
41.2.4.5 Differential Diagnosis
41.2.4.6 Diagnosis
41.2.4.7 Pathophysiology
41.2.4.8 Management
References
42: Gingival Overgrowth
42.1 Introduction
42.2 Inflammatory Enlargement
42.3 Drug-induced Gingival Overgrowth
42.4 Gingival Enlargement Associated with Systemic Diseases
42.4.1 Leukemia
42.4.2 Crohn’s Disease
42.5 Idiopathic Gingival Enlargement
42.6 Gingival Enlargement Associated with Benign Tumours
References
43: Diseases of the Tongue
43.1 Introduction
43.2 Fissured Tongue
43.2.1 Clinical Features and Epidemiology
43.2.2 Diagnosis
43.2.3 Pathophysiology
43.2.4 Management
43.3 Median Rhomboid Glossitis
43.3.1 Clinical Features and Epidemiology
43.3.2 Diagnosis
43.3.3 Pathophysiology
43.3.4 Management
43.4 Geographic Tongue
43.4.1 Clinical Features and Epidemiology
43.4.2 Diagnosis
43.4.3 Pathophysiology
43.4.4 Management
43.5 Black Hairy Tongue (Lingua Villosa Nigra)
43.5.1 Clinical Features and Epidemiology
43.5.2 Diagnosis
43.5.3 Pathophysiology
43.5.4 Management
43.6 Macroglossia
43.6.1 Clinical Features and Epidemiology
43.6.2 Diagnosis
43.6.3 Pathophysiology
43.6.3.1 Congenital macroglossia
43.6.3.2 Acquired macroglossia
43.6.4 Management
43.7 Vascular Malformation
43.7.1 Clinical Features and Epidemiology
43.7.2 Diagnosis
43.7.3 Pathophysiology
43.7.4 Management
43.8 Sublingual Varices
43.8.1 Clinical Features and Epidemiology
43.8.2 Diagnosis
43.8.3 Pathophysiology
43.8.4 Management
43.9 Amyloidosis
43.9.1 Clinical Features and Epidemiology
43.9.2 Diagnosis
43.9.3 Pathophysiology
43.9.4 Management
43.10 Hunter Glossitis (Atrophic Glossitis)
43.10.1 Clinical Features and Epidemiology
43.10.2 Diagnosis
43.10.3 Pathophysiology
43.10.4 Management
43.11 Strawberry Tongue
43.11.1 Clinical Features and Epidemiology
43.11.2 Diagnosis
43.11.3 Pathophysiology
43.11.4 Management
43.12 Cowden Disease
43.12.1 Clinical Features and Epidemiology
43.13 Acanthosis Nigricans
43.13.1 Clinical Features and Epidemiology
43.13.2 Diagnosis
43.13.3 Pathophysiology
43.13.4 Management
43.14 Eosinophilic Granulomatosis with Polyangiitis
43.14.1 Clinical Features and Epidemiology
References
44: Diseases of the Oral Mucosa in Infants, Children and Adolescents
44.1 Introduction
44.2 Aphthous Disorders
44.2.1 Recurrent Aphthous Stomatitis
44.2.2 Bednar Aphthae in Neonates and Infants
44.3 Infections
44.3.1 Candida Infections
44.3.2 Gingivostomatitis Herpetica
44.3.3 Oral Lesions in Classical Exanthems, Other Viral Exanthems and Paraviral Exanthematous Diseases
44.3.4 Mucocutaneous Lesions in Coxsackieviruses
44.3.5 Papular Purpuric Gloves and Socks Syndrome
44.3.6 Focal Epithelial Hyperplasia
44.4 Immnune-mediated Reactions
44.4.1 Kawasaki Disease
44.4.2 Erythema Multiforme
44.4.3 Reactive Infectious Mucocutaneous Eruption
44.5 Genodermatoses
44.5.1 Down Syndrome
44.5.2 Cathepsin C Coding Gene-related Disorders
44.5.2.1 Papillon-Lefèvre Syndrome
44.5.2.2 Haim-Munk Syndrome
44.5.2.3 Prepubertal Periodontitis
44.5.3 Peutz-Jeghers Syndrome
References
45: Diseases of the Oral Mucosa in East Africa
45.1 Syphilis
45.1.1 Epidemiology
45.1.2 Clinical Features
45.1.3 Diagnosis
45.1.4 Management
45.2 Oral Candidiasis
45.2.1 Epidemiology
45.2.2 Clinical Features
45.2.3 Diagnosis
45.2.4 Management
45.3 Herpes Simplex Virus Infection
45.3.1 Clinical Features
45.3.2 Diagnosis
45.3.3 Management
45.4 Herpes Zoster
45.4.1 Epidemiology
45.4.2 Clinical Features
45.4.3 Diagnosis
45.4.4 Pathophysiology
45.4.5 Management
45.5 Erythema Multiforme
45.5.1 Clinical Features
45.5.2 Diagnosis
45.5.3 Management
45.6 Recurrent Aphthous Stomatitis
45.6.1 Clinical Features
45.6.2 Diagnosis
45.6.3 Management
45.7 Pemphigus Vegetans
45.7.1 Clinical Features
45.7.2 Diagnosis
45.7.3 Management
45.8 Oral Lichen Planus
45.8.1 Clinical Features
45.8.2 Diagnosis
45.8.3 Management
45.9 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
45.9.1 Epidemiology and Etiology
45.9.2 Clinical Features
45.9.3 Diagnosis
45.9.4 Management
45.10 Oral Hairy Leukoplakia
45.10.1 Etiology and Clinical Presentation
45.10.2 Differential Diagnosis
45.10.3 Diagnosis
45.10.4 Management
45.11 Kaposi Sarcoma
45.11.1 Epidemiology
45.11.2 Clinical Features
45.11.3 Differential Diagnosis
45.11.4 Diagnosis
45.11.5 Pathophysiology
45.11.6 Management
45.12 Other Sarcomas
45.13 Oral Malignant Melanoma
45.13.1 Epidemiology
45.13.2 Clinical Features
45.13.3 Diagnosis
45.13.4 Management
45.14 Impact of HIV Infection on Oral Disease
References
46: Nutrition-related Disorders
46.1 Introduction
46.2 Malnutrition and Undernutrition
46.3 Chronic Disease-related Malnutrition with Inflammation/Cachexia
46.4 Protein-energy Malnutrition
46.5 Noma
46.6 Malassimilation
46.7 Hematinic Nutrients
46.8 Vitamins
46.9 Minerals
46.10 Overnutrition and Oral Mucosa
46.11 Metabolic Syndrome
46.12 Conclusion
References
47: Xerostomia
47.1 Introduction
47.2 Epidemiology
47.3 Etiology
47.4 Clinical Features
47.4.1 Xerostomia Caused by Systemic Diseases
47.4.1.1 Sjögren Syndrome
47.4.1.2 Systemic Lupus Erythematosus
47.4.1.3 Rheumatoid Arthritis
47.4.1.4 Systemic Sclerosis
47.4.1.5 Diabetes Mellitus
47.4.1.6 Thyroid Diseases
47.4.1.7 Infectious Diseases
47.4.1.8 Graft-versus-host Disease
47.4.1.9 Other Systemic Diseases
47.4.2 Xerostomia Caused by Local or Alternative Factors
47.4.2.1 Medications
47.4.2.2 Head and Neck Radiation
47.4.2.3 Life Style
47.4.2.4 Aging
47.5 Diagnosis
47.6 Management
47.6.1 Topical Agents
47.6.2 Systemic Agents
References
48: Miscellaneous Disorders with Oral Manifestations
48.1 Introduction
48.2 Effect of Tobacco Usage
48.3 Salivary Gland Disorders
48.3.1 Mucocele and Ranula
48.3.2 Necrotizing Sialometaplasia
48.4 Gastrointestinal Disorders
48.4.1 Crohn’s Disease
48.4.2 Ulcerative Colitis
48.4.3 Coeliac Disease
48.5 Pyoderma Gangrenosum
48.6 Sarcoidosis
48.7 Reactive Arthritis
48.7.1 Oral Mucosa
48.7.2 Skin
48.7.3 Arthritis
48.7.4 Ocular Symptoms
48.7.5 Urogenital Symptoms
48.7.6 Gastrointestinal Symptoms
48.8 Immunosuppression-associated Oral Manifestations
48.9 Transplantation-related Oral Lesions
48.9.1 Mucositis
48.9.2 Infections
48.9.3 Graft-versus-host Disease
48.9.4 Squamous Cell Carcinoma
48.9.5 Neutropenic Ulcer
48.9.6 Ohers
48.10 Drug-induced Oral Lesions
48.10.1 Drug-induced Oral Lesions Detailed in Other Chapters
48.10.2 Lichenoid Lesions
48.10.3 Drugs Inducing Oral Ulcers
48.10.4 Fixed-drug Eruption
48.10.5 Angioedema
48.11 Burning Mouth Syndrome
48.12 Trauma
48.12.1 Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)
References
Index