Ebook Textbook of oral pathology (2/E): Part 1

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Textbook of

ORAL

PATHOLOGY
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Editors

ANIL GOVINDRAO GIIOM
SHUBHANGI MHASKE ( lEDHE)

JAYPEE


Textbook of

ORAL PATHOLOGY



Textbook of

ORAL PATHOLOGY
Second Edition

Editors
Anil Govindrao Ghom

Shubhangi Mhaske ( Jedhe )

MDS ( Oral Medicine and Radiology )

MDS (Oral Pathology )

Professor and Head
Department of Oral Medicine and Radiology
Chhattisgarh Dental College and Research Center
Sundra, Rajnandgaon, Chhattisgarh , India

Professor and Head
Department of Oral Pathology
People’s Dental Academy
Bhopal, Madhya Pradesh, India

Forewords
Manisha Sanjay Tijare
Jagdish V Tupkari

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Textbook of Oral Pathology

First Edition: 2009
Second Edition: 2013
ISBN 978-93-5090-171-7
Printed at


Contributors
Amol Gadbail 
MDS (Oral Pathology)

Lecturer
Department of Oral Pathology and
Microbiology
Sharad Pawar Dental College
Sawangi, Wardha, Maharashtra, India

Monal Yuwanati 
MDS (Oral Pathology)

Assistant Professor
Department of Oral Pathology and
Microbiology
People’s College of Dental Academy
Bhopal, Madhya Pradesh, India

Anil Govindrao Ghom

Pradnya Lele 

MDS (Oral Medicine and Radiology)

MDS (Oral Pathology)

Professor and Head
Department of Oral Medicine and
Radiology
Chhattisgarh Dental College and
Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India

Lecturer
Department of Oral Pathology and
Microbiology
Government Dental College and
Hospital, Mumbai, Maharashtra, India

Aparna Thombre 

MDS (Oral Medicine and Radiology)

Pranoti Pradhan

MDS (Oral Pathology)

Professor
Department of Oral Medicine and
Radiology
Maitri Dental College and Research
Centre, Durg, Chhattisgarh, India

Ashok Mhaske 

MDS (Oral Medicine and Radiology)

Reader
Department of Oral Pathology and
Microbiology
VSPM Dental College and Research
Institute, Nagpur, Maharashtra, India

Rashmi Ekka
MS (General Surgery)

Vice Dean, Professor and Head
Department of Surgery
People’s College of Medical Sciences
and Research Centre
Bhopal, Madhya Pradesh, India

Avadhoot Avadhani
MDS (Oral Pathology)

Faculty of Dentistry
Sir John Walsh Research Institute
University of Otago
Dunedin, New Zealand

Lecturer
Department of Oral Medicine and
Radiology

Chhattisgarh Dental College and
Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India

Sangamesh Halawar
MDS (Oral Pathology)

Reader
Department of Oral Pathology
Vasantdada Patil Dental College and
Hospital
Kavalapur, Sangli, Maharashtra, India


Textbook of Oral Pathology

vi

Satish Chhugani

Shubhangi Mhaske (Jedhe)

MDS (Oral Medicine and Radiology)

MDS (Oral Pathology)

Postgraduate Student
Department of Oral Medicine and
Radiology
Chhattisgarh Dental College and

Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India

Savita Ghom
MDS (Oral Medicine and Radiology)

Lecturer
Department of Oral Medicine and
Radiology
Chhattisgarh Dental College and
Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India

Professor and Head
Department of Oral Pathology
People’s Dental Academy, Bhopal,
Madhya Pradesh, India

Smruti Nanda  BDS
Lecturer
Department of Oral Medicine and
Radiology
Chhattisgarh Dental College and
Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India

Seema Vaidya

Vivek Thombre 

MDS (Oral Medicine and Radiology)

MDS (Periodontology)

Lecturer
Department of Oral Medicine and
Radiology
Chhattisgarh Dental College and
Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India

Reader
Department of Periodontology
Chhattisgarh Dental College and
Research Institute
Sundra, Rajnandgaon, Chhattisgarh, India


Foreword to the Second Edition
It is at once a great privilege and pleasure to write a foreword for the invaluable compilation
of 2nd edition of Textbook of Oral Pathology by Dr Anil Govindrao Ghom and Dr Shubhangi
Mhaske (Jedhe). The authors have taken extraordinary pains and care in putting together
meticulously the data collected over many years. This has resulted in production of superb new
edition. The excellent features of this edition are that the authors covered all the topics according
to new syllabus of almost all universities. Special attraction, which I found in the book, is the
multiple choice questions at the end of each chapter and the points to remember.
An attempt has been made in the book, to simplify and make it easy to remember the subject.
The book will help the undergraduate and postgraduate students to get a bird’s eye view of the
entire topics.
I would like to congratulate the efforts of editors for designing 2nd edition of Textbook of Oral Pathology. I am sure

that the book will rapidly find a place in most progressive libraries the world over.

Manisha Sanjay Tijare  MDS (Oral Pathology)

Professor and Head
Department of Oral Pathology and Microbiology
People’s College of Dental Sciences and
Research Centre
Bhopal, Madhya Pradesh, India
Dean, Faculty of Dentistry
Barkatullah University, Bhopal, Madhya Pradesh, India
PhD Guide
Barkatullah University, Bhopal, Madhya Pradesh, India
Executive Committee Member
Indian Association of Oral and Maxillofacial Pathologists (IAOMP)



Foreword to the First Edition
It gives me immense pleasure to write a few words about the Textbook of Oral Pathology.
This book is the outcome of combined efforts of Dr Anil Govindrao Ghom, Professor of Oral Medicine and Radiology
and Dr (Mrs) Shubhangi Mhaske (Jedhe), Associate Professor of Oral Pathology and Microbiology. I know Dr Shubhangi
as undergraduate as well as postgraduate student. I feel her sincerity coupled with hard work and humanly approach
toward the patients during her postgraduate studies contributed in making the textbook.
My heartiest congratulations to Professor (Dr) Anil Govindrao Ghom and Dr (Mrs) Shubhangi Mhaske (Jedhe) for
their great endeavor in bringing out the book. The book contains six sections which are divided into 37 chapters related
to oral lesions/diseases inclusive of basic topics of oral pathology. The topics like microscopy, stains and routine as well
as special investigations are noteworthy. The lots of updated information in the book will be helpful to undergraduates,
postgraduates and also for practising dental fraternity.
The total of over 600 clinical photographs, microphotographs and line diagrams incorporated in the book are definitely

useful for in-depth understanding of the subject. The textbooks available on these subjects are many, but only a few ones
cover both the subjects: oral medicine and radiology as well as oral pathology. Contribution of Indian authors toward
the books in dentistry is less as compared to the foreign authors. Therefore, Mrs Mhaske (Jedhe) deserves a word of
appreciation for her sincere and painstaking efforts.
The book is an excellent contribution to a scientific literature in Indian scenario and thereby facilitating our students
to understand various diseases.


With regards and best wishes

Jagdish V Tupkari

Professor and Head
Department of Oral Pathology and Microbiology
Government Dental College and Hospital
Mumbai, Maharashtra, India



Preface to the Second Edition
I may not have gone where I intended to go, but I think I have ended up where I needed to be.
― Douglas Adams
In the study of oral and dental sciences, oral pathology is the subject that concentrates on the mechanisms of the disease
process and the morphologic changes in tissue that it causes. Everyday, there are new additions to the knowledge of the
subject and we have to keep pace with it to update our students about it. That is the reason, we are here with the 2nd
edition of Textbook of Oral Pathology.
In our first edition, there is a lot of feedback which has come to improve the quality of the book. We tried to incorporate
all the feedback in the book. As due to new Dental Council of India (DCI) guidelines, multiple choice questions (MCQs)
are part and parcel of examination pattern of the Bachelor of Dental Surgery (BDS) curriculum. We have incorporated
MCQs at the end of every chapter so that students can practice it and have some insight into what type MCQs can be there

in the examination. Also, we have included ‘points to remember’ in every disease so that with respect to time, students
can revise it fast. There are also many new additions of photographs—clinical, histopathological as well as radiological
in this edition.
In spite of an essential sincere efforts, elements of human error or shortcomings are likely; the readers are welcome to
point out all such mistakes and render valuable suggestions for further improvements and shall be greatly acknowledged.

Anil Govindrao Ghom
Shubhangi Mhaske (Jedhe)



Preface to the First Edition
In the study of oral and dental sciences, oral pathology is the subject that concentrates on the morphologic changes in oral
tissues which cause diseases and the mechanisms of the disease process. Most recently published works on the subject
are the product of eminent authorities with multiple authorship with current research advances. ‘Why another book in oral
pathology’? This question can probably be answered by the phrase,
Nothing can be changed by changing the face
But many things can be changed by facing the change.
The purpose of the book is mainly to provide the undergraduate and postgraduate students, an easy way of reference
for covering a broad-spectrum of oral pathology in lucid and simple language. In support of all the composite works, it
can be stated that the progress of oral and maxillofacial pathology in its many varied specialties coming up has made the
subject too vast to be covered adequately by a single author. Also, a balance between the advances and the basic essentials
is need of the hour. With this balanced perspective and from the viewpoint of the graduate and postgraduate students under
training, the authors have endeavored to compile the oral and maxillofacial pathology with respect to the related essential
clinical oral medicine and radiology. The book gives an extensive coverage and emphasizes on detailed description,
adequate well-labeled illustrations, flow charts, recent developments and molecular aspects. Aside from oral pathology
in general, the initial phase of the book includes the basics of the embryology, anatomy and pathology. The study of
microscope, tissue processing, diagnostic tests and advanced techniques are also included. The photomicrographs and the
clinical photographs in the book signify the adage: “A picture is worth a thousand words”; as the reader is encouraged to
study the details and to clarify the confusion of the topics.

In spite of sincere efforts, elements of human error or shortcomings are likely; the readers are welcome to point out
all such mistakes and render valuable suggestions for further improvements and shall be greatly acknowledged.

Anil Govindrao Ghom
Shubhangi Mhaske (Jedhe)



Acknowledgments
This book could not have been written without the encouragement and motivation of my teachers and students. I would
also like to express my gratitude for my contributors Drs Sangamesh Halawar, Pranoti Pradhan, Monal Yuwanati,
Pradnya Lele, Aparna Thombre, Avadhoot Avadhani, Vivek Thombre, Amol Gadbail, Rashmi Ekka, Seema Vaidya,
Smruti Nanda, Savita Ghom, Satish Chhugani, without whose help and cooperation writing the book would have been
an uphill task.
I would like to acknowledge the efforts of my Postgraduate students Satish, Manjari, Mansi and Bharani. I am also
thankful to Drs Swati Arora and Varun Rastogi, Senior Lecturers, Department of Oral and Maxillofacial Pathology, Kalka
Dental College, Meerut, Uttar Pradesh, India, for their contribution of different classification systems of odontogenic
tumors.
Last but not least, my dear wife, “As fish is without water, so is me without my wife Savita.” Her contribution to my
life is beyond what I can express in words. I am also thankful to my daughter Milini and son Sanvil for their love and
affection.
Finally, I am indebted to the almighty for presenting me with such wonderful opportunities and people in this life.

Anil Govindrao Ghom
I dedicate my work to my caring devoted mother, Late Mrs Sulochana Jedhe to whom I owe special idiosyncratic
gratitude throughout my life. I express my profound thankfulness to my enthusiastic, dynamic and empathetic husband
Dr Ashok Mhaske (Vice Dean, Professor and Head, Department of Surgery, People’s College of Medical Sciences and
Research Centre); my compassionate son Sumedh; benevolent father Shri Shrikant Jedhe (Retd), Additional Registrar,
Cooperative Societies, Maharashtra Government; munificent parents-in-laws Anna and Aai (Shri NS Mhaske and
Mrs Rukhmini Mhaske); knit family ties Niket, Samir (Engineer), Sharayu Tayade (Engineer), Shirin, Dr Mandakini,

Dr Maya and Advocate Dharmanand.
I extend my indebted thankfulness to all who contributed especially my colleagues, relatives, friends, and dear
students. Each one provided extremely and distinctly valuable support for the completion of this work. My special thanks
to Honorable Suresh Vijaywargiya, Chairman, People’s Group, Bhopal; Ms Megha Vijaywargiya, Director (Human
Resource), People’s Group, Bhopal, Madhya Pradesh, India, for the inestimable support and my colossal inspiration;
Dr Jagdish V Tupkari, Professor and Head, Department of Oral Pathology and Microbiology, Government Dental College
and Hospital, Mumbai, Maharashtra, India; Dr Suresh Barpande, Dean, Government Dental College and Hospital,
Aurangabad; Dr Vinay Hazare, Dean, Government Dental College and Hospital, Nagpur, Maharashtra, India; Dr MK
Gupta, Dean, People’s Dental Academy, Bhopal, Madhya Pradesh, India; Dr Alka Kale, Dean, KLE Institute of Dental
Sciences, Belgaum, Karnataka, India; Dr PV Wanjari and Dr Sangeeta Wanjari, Professor and Head, Department of Oral
Pathology, Modern Dental College, Indore, Madhya Pradesh, India.


Shubhangi Mhaske (Jedhe)



Contents
1. MICROSCOPE

1

Shubhangi Mhaske (Jedhe )

Definition of Microscope 1 ; History of Microscope 1 ; Simple Microscope 3;
Compound Microscope 3; Parts of Microscope 3; Image Formation in
Microscope 10 ; Specialized Microscopy Techniques 11 ; Maintenance of Laboratory
Microscope 19

2. TISSUE PROCESSING METHODS

22

Shubhangi Mhaske ( Jedhe ) , Avadhoot Avadhani
Introduction and Terminology 22 ; Gross Examination 22; Preparation of Tissue Specimen
for Histological Staining 23; Routine Method for Histological Study 25; Study ofHard
Tissues 30 ; Frozen Sections 32; Staining of Cut Sections 32; Mounting 33; Artifacts
in Histological Sections 33

3. HISTOLOGICAL STAINING METHODS

36

Shubhangi Mhaske ( Jedhe ) , Amol Gadbail

Chemistry of Stains 36 ; Classification of Stains 37 ; Theories of Staining 38 ; Vital
Staining 39 ; Factors Affecting Staining 39 ; Staining Procedure 40 ; Hematoxylin and
Eosin Stains 40 ; Special Stains 42 ; Gordon and Sweets ' Methodfor Reticulin Fibers 43

4. DIAGNOSTIC PATHOLOGY

47

Shubhangi Mhaske ( Jedhe ) , Pradnya Lele

Biopsy 47; Types of Biopsy Procedures 48 ; Exfoliative Cytology 51 ; Oral
Mucosal Brush Biopsy 54 ; Liquid Based Cytology 55 ; Fine Needle Aspiration
Cytology 55 ; Frozen Section Biopsy 56

5. ADVANCED DIAGNOSTIC TECHNIQUES

57

Shubhangi Mhaske (Jedhe ) , Monal Yuwanati

Hi stoche mi cal Techniques 57 ; Fixation in Histochemistry 57 ; Enzyme Histochemistry 58 ;
Immunohistochemical Methods 58 ; Immunofluorescent Techniques 59 ;
Flow Cytometry 61 ; Polymerase Chain Reaction 61 ; Hybridization Methods 62;
Laser Captures Microdissection 63; Proteomics 63; Cytogenetics 64

6. HEALING OF WOUND
Shubhangi Mhaske ( Jedhe )

Factors Affecting the Wound Healing 68; Cascade of Wound Healing 72;
Healing of Biopsy Wounds 74 ; Healing of Extraction Wounds 74; Healing of

68


Textbook of Oral Pathology

Fractures 75; Healing of Osseointegrated Implants 76 ; Healing of Pulp 76 ;
Cementum 77 ; Dentin 77; Enamel 77; Skin Healing and Oral Mucosal Wound
Healing 77 ; A Clinical Approach to Optimizing Wound Healing 79

7. HYPERPLASIA , HAMARTOMA AND NEOPLASM

82

Shubhangi Mhaske ( Jedhe )

Dysplasia 82;
Neoplasm 85 ;
Carcinogenesis
Metastasis 92 ;

Metaplasia 82; Hyperplasia 82; Hamartoma 83; Choriostoma 84 ;
Carcinogenesis 87; Chemical Carcinogenesis 87 ; Physical
88 ; Hormonal Carcinogenesis 89 ; Biologic Carcinogenesis 89 ;
Grading and Staging of Tumors 93

8. TEETH ANOMALIES

97

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe ) , Savita Ghom
Disorders of Development of Teeth 97 ; Scale of Human Tooth Development 98 ; Disorders
of Size of Teeth 98 ; Disturbances in Shape of Teeth 99 ; Disorders of Number of
Teeth 109 ; Structure of Teeth 111

9. CRANIOFACIAL ANOMALIES

111

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Developmental Anomalies of Jaws 128 ;

Developmental Disorders of Oral Mucosa 138

10. DENTAL CARIES

144

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Theories of Cariogenesis 145 ; Secondary Contributing Factors in Dental Caries 150 ;
Classification 152; Smooth Surface Caries 153 ; Pit and Fissure Caries 156 ; Root
Caries 158 ; Recurrent Caries 160 ; Chemical Measures of Caries Control 164

11. BENIGN TUMORS

167

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Characteristics of Benign Tumor 168 ; Classification of Benign Tumor 168 ; Epithelial
Origin 168 ; Fibrous Connective Tissue 178 ; Cartilage 184 ; Adipose Tissue 186 ;
Bone 189; Vascular Tissue 196 ; Neural Tissue 203; Muscle 211 ; Giant Cell
Lesion 213

12. PREMALIGNANT LESIONS AND CONDITIONS
Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Concept of Precancer 219 ; Terminology and Definitions 219 ; Leukoplakia 220 ;
Erythroplakia 229 ; Carcinoma in situ 231 ; Oral Lesion Associated with use of
Tobacco 233; Lichen Planus 235; Oral Submucous Fibrosis 243 ; Dyskeratosis
Congenita 249 ; Lupus Erythematosus 250

219


Contents

13. MALIGNANT TUMORS

255

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe ) , Ashok Mhaske

Classification 256 ; Etiology and Risk Factors for Oral Cancer 256 ; Risk Factors 258 ;
Epithelial Tumors 258 ; Metastatic Carcinoma 266 ; Basal Cell Carcinoma 267;
Adenosquamous Carcinoma 269 ; Basaloid Squamous Carcinoma 269 ; Sinonasal
Undifferentiated Carcinoma 270 ; Verrucous Carcinoma 271 ; Transitional Cell
Carcinoma 273; Malignant Melanoma 273; Spindle Cell Carcinoma 277;
Adenoid Squamous Cell Carcinoma 277 ; Nasopharyngeal Carcinoma 278 ; Merkel Cell
Carcinoma 279 ; Fibrous Connective Tissue 279 ; Malignant Fibrous Histiocytoma 282;
Synovial Sarcoma 282; Adipose Tissue 283; Cartilage 284 ; Mesenchymal
Chondrosarcoma 287; Bone 287; Ewing 's Sarcoma 289 ; Vascular 291 ; Neural
Tissue 292; Muscle 294

14. ODONTOGENIC TUMORS

299

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Classification of Odontogenic Tumors 299 ; Development of Tooth 301 ; Stages of Tooth
Development 301 ; Ameloblastoma 303; Variant of Ameloblastoma 313;
Squamous Odontogenic Tumor 317 ; Calcifying Epithelial Odontogenic Tumor 318 ;
Adenomatoid Odontogenic Tumor or Cyst 321 ; Mixed Odontogenic Tumors 325 ;
Continuum Concept (Cahn and Blum) 325; Ameloblastic Fibroma 326 ;
Ameloblastic Fibrodentinoma 328 ; Ameloblastic Fibro-odontoma 328 ; Odontoma 329 ;
Odontoameloblastoma 331 ; Odontogenic Fibroma 332; Granular Cell Odontogenic
Tumor 333; Odontogenic Myxoma 333; Malignant Tumors 335

15. CYST OF OROFACIAL REGION
Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Classification 343; Theories of Cyst Enlargement 343; Dentigerous Cyst 345;
Eruption Cyst 349 ; Odontogenic Keratocyst 350 ; Primordial Cyst 355 ; Gingival Cyst
of Newborn 355 ; Gingival Cyst of Adult 356 ; Lateral Periodontal Cyst 357; Glandular
Odontogenic Cyst 358 ; Calcifying Epithelial Odontogenic Cyst 359 ; Inflammatory
Radicular Cyst 361 ; Residual Cyst 364 ; Inflammatory Collateral Cyst 365 ; Paradental
Cyst 365; Mandibular Buccal Infected Cyst 366 ; Suppurating Cyst 366 ; Healing
Cyst 366 ; Nonodontogenic Cysts 366 ; Median Palatine Cyst 368 ; Nasoalveolar
Cyst 369 ; Median Mandibular Cyst 370 ; Globulomaxillary Cyst 370 ; Nonepithelial
Cysts 370 ; Aneurysmal Bone Cyst 371 ; Cysts of the Maxillary Sinus 372; Antral
Pseudocyst 374 ; Retention Cyst 374 ; Soft Tissue Cyst 374 ; Branchial Cleft
Cyst 376 ; Oral Lymphoepithelial Cyst 376 ; Thyroglossal Duct Cyst 377; Anterior
Median Lingual Cyst 377 ; Oral Cyst with Gastric or Intestinal Epithelium 377 ; Cystic
Hygroma 377; Follicular Cysts of the Skin 378 ; Nasopharyngeal Cyst 378 ; Thymic
Cyst 378 ; Cysts of Salivary Glands 378 ; Parasitic Cyst 378 ; Cysticercosis
Cellulose 379 ; Syndromes Associated with Odontogenic Cysts 380 ; Treatment of
Cysts 381

342


Textbook of Oral Pathology

16. PERIODONTAL PATHOLOGY

386

Vivek Thombre , Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )

Fibromatosis Gingiva 386 ; Retrocuspid Papilla 388 ; Gingival Inflammation or
Gingivitis 388 ; Necrotizing Ulcerative Gingivitis 391 ; Desquamative Gingivitis 392 ;
Plasma Cell Gingivitis 393; Granulomatous Gingivitis 394 ; Gingival Abscess 394 ;
Pericoronal Abscess 395; Chronic Inflammatory Enlargement 396 ; Gingival Enlargement
due to Drugs 397 ; Pregnancy Tumor 398 ; Granuloma Pyogenicum 399 ;
Periodontal Pockets 401 ; Adult Periodontitis 402; Rapidly Progressive Periodontitis 402 ;
Aggressive Periodontitis/Juvenile Periodontitis 403; Papillon-Lefevre Syndrome 405 ;
Haim-Munk Syndrome 406

17. SALIVARY GLAND PATHOLOGY

409

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )

Classification of Salivary Gland Disorders 410 ; Development of Salivary
Gland 410 ; Major Salivary Glands 411 ; Aberrancy 412 ; Aplasia and
Hypoplasia 412; Hyperplasia of Salivary Gland 413 ; Atresia 413; Accessory
Duct 414 ; Diverticuli 414 ; Sialorrhea 414 ; Xerostomia 414 ; Sialolithiasis 415;
Strictures and Stenosis 417 ; Mucocele (Mucous Extravasation Phenomenon) 417; Salivary
Duct Cyst or Mucus Retention Cyst 419 ; Ranula 419 ; Sialosis (Sialadenosis) 420 ;
Allergic Sialadenitis 421 ; Mumps 421 ; Cytomegalovirus Inclusion Disease 422 ;
Bacterial Sialadenitis 422; Sjogren s Syndrome 424 ; Mikulicz s Disease or
Benign Lymphoepithelial Lesion 427; Uveoparotid Fever 428 ; Tumors of
Salivary Glands 428 ; Histogenesis 428 ; Theories of Salivary Gland Tumor
Histogenesis 429; General Features of Salivary Gland Tumors 429 ;
Clinical Staging of Salivary Gland Tumors 429 ; Pleomorphic Adenoma 430 ;
Basal Cell Adenoma 433; Canalicular Adenoma 434 ; Warthin 's Tumor 435 ;
Oncocytoma 437; Myoepithelioma 438 ; Ductal Papillomas 438 ; Mucoepidermoid
Carcinoma 440 ; Central Mucoepidermoid Carcinoma 444 ; Acinic Cell

Adenocarcinoma 444 ; Adenoid Cystic Carcinoma 445 ; Polymorphous Low Grade Adenocarcinoma 447 ; Malignant Mixed Tumor 448 ; Connective Tissue
Tumors 449 ; Necrotizing Sialometaplasia 450

18. BACTERIAL INFECTION

453

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Impetigo 453; Erysipelas 454 ; Syphilis 455 ; Gonorrhea 460 ; Leprosy (Hansen
Disease ) 462; Tuberculosis 465; Actinomycosis 468 ; Noma 471 ; Scarlet Fever 472;
Diphtheria 473 ; Tularemia 474 ; Rhinoscleroma 474 ; Granuloma Inguinale 475; Oral
Manifestations 475 ; Streptococcal Tonsillitis and Pharyngitis 476 ; Tonsillar Concretion
and Tonsillolithiasis 476 ; Lymphogranuloma Venereum 476 ; Myiasis 477 ; Cat Scratch
Disease 478 ; Pyostomatitis Vegetans 479 ; Sinusitis 479

19. FUNGAL OR MYOCOTIC INFECTION
Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Candidiasis 484 ; Oral Candidiasis 486 ; Chronic Mucocutaneous Candidiasis 491 ;
Forms ofCandidiasis 491 ; Histoplasmosis 492; Blastomycosis 493; Mucormycosis 495;

484


Contents

Cryptococcosis 496 ; Coccidioidomycosis 497; Geotrichosis 498 ; Sporotrichosis 498 ;
Rhinosporidiosis 499 ; Aspergillosis 500 ; Paracoccidioidomycosis 501 ;
Toxoplasmosis 502; Leishmaniasis 502; Trichinosis 503

20. VIRAL INFECTION

505

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )

Human Herpes Virus 505 ; Herpes Simplex Infection 505 ; Measles 509 ; Varicella Zoster
Infection 510 ; Herpes Zoster 512; James Ramsey Hunt Syndrome 514 ; Rubella 514 ;
Enteroviruses 514 ; Foot and Mouth Disease 516 ; Condyloma Acuminatum 517 ;
Verruca Vulgaris 518 ; Focal Epithelial Hyperplasia 518 ; Molluscum Contagiosum
Infection 519 ; Cytomegalovirus Infection 520 ; Infectious Mononucleosis 521

21. ACQUIRED IMMUNODEFICIENCY SYNDROME

524

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )

Classification 525 ; AIDS Related Complex 526 ; Prevalence 526 ; Characteristic of
HIV Virus 527; Clinical Features 527 ; Oral Manifestations 528 ; Uncommon Oral
Manifestation of HIV 534 ; Diagnostic Tests 536 ; Screening Test for AIDS 536 ;
Management 537 ; Prevention 538

22. ODONTOGENIC INFECTION AND PULP PATHOLOGY

540

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe ) , Seema Vaidya
Effect of Infection on Host 541 ; Pathophysiology of Infection 541 ; Pulp 542;
Classification of Pulpitis 542; Pulpitis 542; Pulp Degeneration 545 ; Pulp
Calcifications 546 ; Necrosis of Pulp 548 ; Cracked Tooth Syndrome 549 ; Periapical

Abscess 549 ; Periodontal Abscess 551 ; Acute Exacerbation of a Chronic Lesion 552;
Periapical Granuloma 553; Osteomyelitis 555; Acute Suppurative Osteomyelitis 557 ;
Chronic Suppurative Osteomyelitis 559 ; Infantile Osteomyelitis 560 ; Synovitis, Acne ,
Pustulosis, Hyperostosis and Osteomyelitis Syndrome 562; Chronic Recurrent Multifocal
Osteomyelitis 563; Cellulitis 565; Ludwig 's Angina 566 ; Fatal Complications of Oral
Infection 568 ; Oral Foci of Infections 571 ; Dry Socket 573

23. BONE DISEASE MANIFESTED IN JAW

576

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe ) , Pranoti Pradhan
Fibro-osseous Lesions 576 ; Classification 576 ; Fibrous Dysplasia 577 ; Cherubism 580 ;
Central Giant Cell Granuloma 582; Paget 's Disease 584 ; Familial Gigantiform
Cementoma 587 ; Ossifying Fibroma, Cementifying Fibroma and Cemento-ossifying
Fibroma 588 ; Juvenile Ossifying Fibroma 590 ; Osteoporosis 591 ; Infantile Cortical
Hyperostosis 593; Osteopetrosis 594 ; Osteogenesis Imperfecta 596; Pierre Robin
Syndrome 597 ; Marfan 's Syndrome 597 ; Down 's Syndrome 598 ; Achondroplasia 599;
Osteosclerosis 600 ; Massive Osteolysis 600 ; Gardner ' s Syndrome 601

24. DISEASES OF LIP
Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Classification of Lip Disorders 604 ; Anatomy 604 ; Developmental Disturbance of
Lip 605 ; Cheilitis 610 ; Etiology 610 ; Miscellaneous 617

604


Textbook of Oral Pathology

25. TONGUE DISORDERS

619

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Embryology of Tongue 619 ; Anatomy of Tongue 620 ; Papillae 620 ; Muscle 621 ;
Arterial Supply 621 ; Venous Drainage 621 ; Nerve Supply 621 ;
Lymphatic Drainage 622; Functions of Tongue 622 ; Classification of Tongue
Disorders 623; Aglossia and Microglossia 623; Macroglossia 624 ;
Ankyloglossia 625 ; Cleft Tongue 626 ; Ankyloglossum Superius Syndrome 626 ; Lingual
Varicosities 627; Lingual Thyroid Nodule 627; Variations in Tongue Movement 628 ;
Patent Thyroglossal Duct Cyst 628 ; Lingual Polyp 629 ; Lingual Cyst 629 ; Fissured
Tongue 629 ; Median Rhomboid Glossitis 630 ; Benign Migratory Glossitis 631 ; Hairy
Tongue 633; Crenated Tongue 634 ; Foliate Papillitis 634 ; Leukokeratosis Nicotina
Glossi 634 ; Depapillation of the Tongue 635; Dysgeusia and Hypogeusia 637;
Dyskinesia 638 ; Paralysis of Tongue 638 ; Squamous Cell Carcinoma 639 ;
Pigmentation of Tongue 640

26. TEMPOROMANDIBULAR JOINT PATHOLOGY

643

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Coronoid Hyperplasia 643; Condylar Hyperplasia 643; Condylar Hypoplasia 644 ;
Bifid Condyle 645; Osteoarthritis 645 ; Rheumatoid Arthritis 646 ;
Ankylosis 648 ; Subluxation (Hypermobility) 650 ; Gout 651 ; Synovial
Chondromatosis 652; Temporomandibular Joint Dysfunction 652

27. CHEMICAL AND PHYSICAL INJURIES

655

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
LineaAlba 655 ; Habitual Cheek or Lip Biting 656 ; Traumatic Ulcer 657 ; Electrical
and Thermal Burns 658 ; Anesthetic Necrosis 659 ; Chemical Burns 659 ; Smoker
Melanosis 661 ; Drug Induced Discoloration of Oral Mucosa 661 ; Outright
Lesion 662; Traumatic Sequestration 662; Methamphetamine Abuse
Lesion 663; Submucosal Hemorrhage 663; Oral Lesion as Complication to AntiNeoplastic Therapy (Non-Infectious) 664 ; Cervicofacial Emphysema 665;
Myospherulosis 666 ; Attrition 666 ; Abrasion 668 ; Erosion 669 ; Abfraction 670 ;
Dentinal Sclerosis 671 ; Secondary and Tertiary Dentin 671 ; Resorption of Teeth 672;
Hypercementosis 675; Cementicles 676 ; Bruxism 676 ; Traumatic Lesion
Due Sexual Habit 678 ; Oral Piercing and other Body Modification 679 ;
Fracture of Teeth 680 ; Amalgam Tattoo 681 ; Bismuthism 681 ; Plumbism 682;
Mercurialism 683; Argyria 684 ; Arsenism 685 Auric Stomatitis 685 ; Inflammatory
Fibrous Hyperplasia 685; Inflammatory Papillary Hyperplasia 686 ; Epulis
Granulomatosum 687 ; Nodular Fasciitis 688 ; Uremic Stomatitis 688 ; Traumatic
Keratosis 689 ; Bisphosphonates Associated Osteonecrosis 689

28. BLOOD PATHOLOGY
Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )

Disease of Lymph Tissue 693 ; Disease of Red Blood Cells 694 ; White
Blood Cell Disorders 705; Disease of Platelet 708 ; Disease due to Clotting
Defect 710 ; Dysfibrinogenemia 713 ; Macroglobulinemia 714 ; Malignancy Involving

693


Contents

Blood Tissue 714 ; Primary Reticular Cell Sarcoma 717 ; Mycosis Fungoides 718 ;
Burkitt ’s Lymphoma 718 ; Chronic Myeloid Leukemia 723; Chronic Lymphatic
Leukemia 724 ; Multiple Myeloma 725 ; Plasmacytoma 727 ; Extranodal NK/T-Cell
Lymphoma 728

29. SKIN DISORDERS

731

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Erythema Multiforme 731 ; Pemphigus 734 ; Paraneoplastic Pemphigus 737 ;
Bullous Pemphigoid 737 ; Benign Mucous Membrane Pemphigoid 738 ; Familial
Benign Chronic Pemphigus 740 ; Dermatitis Herpetiformis 742; Pityriasis
Rosea 743; Incontinentia Pigmenti 743; Acanthosis Nigricans 744 ; Ehlers Danlos
Syndrome 745 ; Psoriasis 746 ; Pachyonychia Congenita 747 ; Porokeratosis 748 ;
Keratosis Follicularis 749 ; Warty Dyskeratoma 750 ; Seborrheic Keratosis 750 ;
Hereditary Mucoepithelial Dysplasia 751 ; Pseudoxanthoma Elasticum 751 ; Hyalinosis
Cutis Et Mucosa Oris 752; White Sponge Nevus 753; Hereditary Benign Intraepithelial
Dyskeratosis 754 ; Hereditary Hemorrhagic Telangiectasia 754 ; Peutz-Jeghers
Syndrome 755; Ephelis 755 ; Actinic Lentigo 756 ; Lentigo Simplex 756 ; Sebaceous
Hyperplasia 756 ; Xeroderma Pigmentosum 757 ; Tuberous Sclerosis 757 ; Ectodermal
Dysplasia 758 ; Cow den Syndrome 760 ; Graft versus Host Resistance 760 ; Crest
Syndrome 761 ; Scleroderma 761 ; Kawasaki Disease 763

30. ALLERGIC AND IMMUNOLOGIC DISEASES OF ORAL CAVITY

766

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Introduction/Overview 766 ; Hypersensitivity Reaction 766 ; Wegner ’ s

Granulomatosis 767; Sarcoidosis 769 ; Drug Allergy 770 ; Allergic Contact
Stomatitis 771 ; Secondary Vaccinia 772; Angioedema 773; Aphthous Stomatitis
(Recurrent Aphthous Ulcers (RAUs) or Canker Sores) 774 ; Behqet ’s Syndrome 776 ;
Transient Lingual Papillitis 777 ; Perioral Dermatitis 778 ; Reiter ’ s Syndrome 778 ;
Lichenoid Contact Stomatitis/Lichenoid Tissue Reaction 779 ; Chronic Ulcerative
Stomatitis 781 ; Crohn ’s Disease 782

31. ENDOCRINE DISORDERS

784

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Anatomy and Physiology 784 ; Diseases of Pituitary Gland 785; Progeria 788 ;
Hyperthyroidism 788 ; Hypothyroidism 790 ; Hyperparathyroidism 791 ;
Hypoparathyroidism 793 ; Pseudohypoparathyroidism 793; Diabetes Mellitus 794 ;
Addison 's Disease 796 ; Adrenogenital Syndrome 797 ; Melasma 797 ; Cushing ’s
Syndrome 797

32. NUTRITION AND ORAL CAVITY
Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Disturbances in Protein Metabolism 800 ; Disturbances in Lipid
Metabolism 804 ; Disturbances in Carbohydrate Metabolism 807 ; Disturbances in
Mineral Metabolism 809 ; Miscellaneous Disorders 811 ; Fat Soluble Vitamins 821 ;
Disorders of Bilirubin 825

800


Textbook of Oral Pathology

33. NEUROMUSCULAR DISORDERS AND OROFACIAL PAIN

830

Anil Govindrao Ghom , Shubhangi Mhaske ( Jedhe )
Muscle Disorders 830 ;

Neuromuscular Disorders 834 ;

Facial Pain 839

34. FORENSIC ODONTOLOGY

849

Anil Govindrao Ghom , Savita Ghom
Record Management 849 ; Identification 850 ; Dental Evaluation 850 ; Personal
Recognition 853; Fingerprinting 853 ; Physical Anthropologic Examination of Bones and
Teeth 853 ; Postmortem Serology and DNA Profiling 854 ; Bite Marks 854 ; Human
Abuse 858 ; Dentist as Expert Witness 859

35. SYNDROMES OF THE OROFACIAL REGION

860

Shubhangi Mhaske ( Jedhe )

Syndromes Associated with Craniofacial Anomalies of Genetic Origin 862; Syndromes
Associated with Skin and Pigmentation 868 ; Broad Groups of Pigmentary Disorders 871 ;
Syndromes Associated with Salivary and Lacrimal Glands 872; Syndromes Affecting

Teeth 873 ; Syndromes Associated with Lips and Cheek 875; Syndromes Associated
with Tongue 876 ; Syndromes Associated with Gingiva 877 ; Syndromes Associated with
Nerves 878 ; Syndromes Associated with Blood 880 ; Syndromes Associated with Vascular
Malformations 882; Syndromes Associated with Immunodeficiency 882 ; Syndromes
Associated with Hormonal Disturbances 883; Syndromes with Benign Oral Neoplastic or
Hamartomatous Components 884

889

APPENDICES
Appendix I: Differential Diagnosis of Most Common Lesions of Oral Cavity 890
Aparna Thombre
Appendix II: Glossary
Rashmi Ekka

938

Appendix III: Normal Values of Various Laboratory Parameters 951
Smruti Nanda
Appendix IV: Classification Systems of Odontogenic Tumor 953
Satish Chhugani
Appendix V: Histology Diagrams of Oral Tissues 978
Sangamesh Halawar

ANSWERS KEY OF MCQS
Index

1003
1005