Hard tissue pathology

Disorders of tooth development 23 Abnormalities in the numberof teeth 23 Anodontia andoligodontia 23 Additional teeth: hyperdontia 24 Syndromes associated with hyperdontia 25 Defective enamel formation 25 Defectsofdeciduous teeth 25 Defectsofpermanent teeth 25 Amelogenesis imperfecta 25 Chronological hypoplasia 29 Molar-incisor hypomineralisation 30 Defectivedentine formation 30 Osteogenesis imperfecta with opalescent teeth 31 Dentinogenesis imperfecta 31 Dentinaldysplasia (‘rootless’teeth) 3 Defectsof enamel anddentine 33 Regionalodontodysplasia (ghost teeth) 33 Segmentalodontomaxillarydysplasia 34 Other systemicdiseases affectingteeth 35 Extrinsic agents affectingteeth 37 Odontomes 41 Disordersof eruption 42 3 Disorders of development 45 Cleftsof liporpalate 45 Cleft lipandcleftpalate 45 Isolatedcleftpalate 48 Syndromic cleft lipandpalate 48 Other facial clefts 48 Stafne’s idiopathicbone cavity 49 Hereditaryprognathism 49 Ankyloglossia 49 Cowden’s syndrome 50 Other craniofacial malformations 50 4 Dental caries 53 Aetiology 53 Bacterialplaque 53 Microbiology 54 Sucrose 57 Susceptibilityof teeth tocaries 59 Saliva anddental caries 60 Pathologyof enamel caries 61 Pathologyofdentine caries 65 Clinical aspectsof cariespathology 68 Arrestedcaries andremineralisation 68 Caries in deciduous teeth 69 Hidden caries 70 Root surface caries 70 Clinical aspectsof reactions tocaries 70 5 Pulpitisand apical periodontitis 73 Pulpitis 73 Pulpcalcifications 77 Periapicalperiodontitis, abscess and granuloma 77 Acute apicalperiodontitis 78 Pathology andsequelae

Acute apical (dentoalveolar) abscess 79 Chronic apicalperiodontitis andperiapical granuloma 81 6 Tooth wear, resorption, hypercementosis and osseointegration 85 Tooth wear 85 Attrition 85 Abrasion 85 Erosion 86 Abfraction 87 Bruxism 87 Resorption of teeth 88 Hypercementosis 91 Pathologyofosseointegration 91 7 Gingival and periodontal diseases 95 The normalperiodontal tissues 95 Gingival andperiodontal fibres 96 Gingival crevicular fluid(exudate) 96 Classification ofperiodontaldiseases 96 Chronicgingivitis 96 Chronicperiodontitis 99 Pathology 101 Systemicpredisposingfactors 103 Generalprinciplesof management of chronicperiodontitis 105 Complicationsof chronic periodontitis 106 Gingival recession 107 Aggressiveperiodontitis 108 ‘Prepubertal’periodontitis 109 Periodontitis as a manifestation of systemicdisease 109 Down’s syndrome 109 Papillon–lefèvre syndrome 110 Periodontal (lateral) abscess 110 Acutepericoronitis 110 Acute necrotisingulcerativegingivitis 112 HIV-associatedperiodontitis 113 Gingival enlargement 113 Hereditarygingival fibromatosis 113 Drug-inducedgingivalovergrowth 114 Localisedjuvenile spongioticgingivitis 115 Plasminogen deficiencygingivitis 115 Other inflammatorygingival swellings 115 Infections of thejaws 117 Normal healingof an extraction socket 117 Alveolarosteitis 117 Osteomyelitisof the jaws 120 Acuteosteomyelitis 120 Chronicosteomyelitis 122 Diffuse sclerosingosteomyelitis 123 Chronic low-grade focalosteomyelitis and sclerosingosteitis 124 Osteoradionecrosis 124 Proliferativeperiostitis 125 Medication-relatedosteonecrosisof the jaws (MRONJ) 125 Traumatic sequestrum 127 Scleroticbone islands 128 9 Major infections of the mouth and face 129 Periapical (dentoalveolar) abscess 129 Collateraloedema 129 ‘Fascial’or tissue space infections 129 Facial cellulitis 130 Facial abscess 132 Antibiotic abscess 133 Necrotisingfasciitis 133 Cavernous sinus thrombosis 133 Noma (cancrum oris, necrotisingstomatitis) 134 Actinomycosis 135 Other ‘actinomycoses’ 136 The systemic mycoses 136 Systemic infectionsbyoralbacteria 137 10 Cysts in and around thejaws 139 Classification of cysts 139 Common featuresof jaw cysts 140 Treatmentof jaw cysts 141 Treatmentof soft tissue cysts 142 Odontogenic cysts 142 Radicular cyst 142 Lateral radicular cyst 146 Residual radicular cyst 146 Inflammatory collateral cysts 146 Dentigerous cysts 146 Eruption cyst 148 Odontogenic keratocyst 149 Basal cell naevus syndrome 153 Orthokeratinisedodontogenic cyst 154 Lateralperiodontal cysts 155 Botryoidodontogenic cysts 155 Glandularodontogenic cyst 156 Calcifyingodontogenic cyst 156 Carcinoma arisingin odontogenic cysts 157 Gingival cystof the newborn 157 Gingival cystof adults 158 Non-odontogenic cysts 158 Nasopalatineductor incisive canal cyst 158 Nasolabial cyst 160 Sublingualdermoidcyst 160 Thyroglossalduct cyst 161 Branchial cyst 161 Foregut cyst 162 Other cysts in other chapters 162 11 Odontogenic tumoursand related jaw lesions 165 Benign epithelial tumours 165 Ameloblastomas 165 Desmoplastic ameloblastoma 168 Metastasisingameloblastoma 169 Unicystic ameloblastoma 169 Squamousodontogenic tumour 170 Calcifyingepithelialodontogenic tumour 170 Adenomatoidodontogenic tumour 172 Benign epithelial and mesenchymal tumours 172 Ameloblastic fibroma 172 Ameloblastic fibrodentinoma and fibro-odontome 173 Primordialodontogenic tumour 173 Odontomes (odontomas*) 173 Compoundodontome 174 Complexodontome 174 Other typesofodontome 175 Calcifyingodontogenic cyst 176 Dentinogenicghost cell tumour 176 Benign mesenchymal tumours 176 Odontogenic fibroma 177 Granular cellodontogenic tumour 177 Odontogenic myxoma 177 Normaldental follicle 178 Cementoblastoma 178 ‘Cementomas’ 179

Fibroosseousodontogenic lesions 179 Cemento-ossifying fibromas 180 Cemento-ossifying fibroma 180 Juvenileossifying fibroma 181 Multiple andsyndromic cemento-osseous fibromas 181 Cemento-osseousdysplasias 181 Periapical cementaldysplasia 181 Floridcemento-osseousdysplasia 182 Focal cemento-osseousdysplasia 182 Familialgigantiform cementoma 182 Malignantodontogenic tumours 183 12 Non-odontogenic tumours of thejaws 187 Exostoses andtori 187 Osteochondroma 187 Centralgiant cellgranuloma 188 Noonan andother syndromes 190 Langerhans cell histiocytosis 190 Osteomas 192 Gardner’s syndrome 192 Ossifying fibromas 193 Psammomatoidossifying fibroma 193 Haemangiomaofbone 194 Melanotic neuroectodermal tumourof infancy 195 Malignant neoplasmsofbone 196 Osteosarcoma 196 Chondrosarcoma 197 Ewing’s sarcoma 198 Myeloma 199 Amyloidosis 200 Solitaryplasmacytoma 200 Lymphomas 200 Metastases tothe jaws 200 13 Genetic, metabolicand other non-neoplastic bone diseases 205 Geneticdiseasesofbone 205 Osteogenesis imperfecta 205 Gnathodiaphysealdysplasia 207 Osteopetrosis: marblebonedisease 207 Achondroplasia 207 Cleidocranialdysplasia 208 Cherubism 208 Hypophosphatasia Sickle cell anaemia andthalassaemia 210 Gigantism andacromegaly 211 Metabolicbonedisease 211 Rickets 211 Vitamin D–resistant rickets 211 Hyperparathyroidism 211 Otherbonediseases 213 Paget’sdiseaseofbone 213 Fibro-osseous lesions 216 Fibrousdysplasia 216 Monostotic fibrousdysplasia 216 Polyostotic fibrousdysplasia 218 Albright’s syndrome 218 Osseousdysplasias 218 Bone‘cysts’ 218 Solitarybone‘cyst’ 218 Aneurysmalbone‘cyst’ 220 Osteoporoticbone marrow defect 221 14 Disorders of thetemporomandibular jointsand trismus 223 Temporary limitation of movement 223 Infection andinflammation 223 Injuries 223 Drugs 224 Persistent limitation of movement: extracapsular causes 224 Irradiation 224 Oral submucous fibrosis 224 Systemic sclerosis andscleroderma 224 CREST syndrome 225 Morphoea 225 Persistent limitation of movement: intracapsular causes 226 Arthritis 226 Rheumatoidarthritis 226 Osteoarthritis 227 Other typesof arthritis 228 Condylar hyperplasia 228 Neoplasms 229 Synovial chondromatosis andloose bodies in the temporomandibular joints 229 Limitation of movement: muscle causes 229 TMJpain dysfunction ‘syndrome’ 229 Giant cell arteritis (temporal arteritis) 231 Polymyalgia rheumatica 232 Tetanus andtetany 232 Pain referredtothe joint 232 Dislocation 232 Ehlers–Danlos syndrome 233

Enamel loss • Caries • Attrition
• Abrasion
• Erosion
• Amelogenesis imperfecta
• Dentinogenesis imperfecta
Extrinsic stain • Tobacco
• Coffee, tea • Cold drink
• Chromogenic bacteria
Intrinsic discoloration • Aging
• Death of pulp
• Fluorosis
• Tetracycline
• Internal resorption
• Calcific metamorphoses
• Dentinogenesis imperfecta
• Amelogenesis imperfecta
• Congenital erythropoietic porphyria
• Erythroblastosis fetalis

Early exfoliation • Trauma • Aggressive periodontitis
• Immunocompromised stages
• Diabetes mellitus
• Osteomyelitis
• Cyclic or chronic neutropenia • Langerhan’s cell disease • Dentin dysplasia type I
• Regional odontodysplasia • Papillion-Lefevre syndrome
• Down syndrome • Hypophosphatasia
• Scurvy

Swellings of the Palate Traumatic • Fracture of maxilla, alveolar process • Hematoma
• Epulis • Denture hyperplasia Inflammatory • Periapical, periodontal, gingival abscess of anterior maxillary teeth
• Osteomyelitis—acute and chronic • Syphilis • Tuberculosis
• Actinomycosis
• Quinsy (peritonsillar abscess) • Infected cyst • Mucormycosis
• Aspergillosis
• Cryptococcosis • Toxoplasmosis
Necrosis • Chemicals like phosphorus, arsenic • Osteoradionecrosis • Noma
Odontogenic cysts • Radicular • Residual
• Dentigerous
• Primordial • Lateral periodontal cyst • Gingival Non-odontogenic cysts • Nasopalatine or incisive canal cyst • Globulomaxillary
• Traumatic
• Median alveolar and median palatine cyst • Aneurysmal bone cyst
• Mucocele
• Botryoid cyst Neoplasm • Benign • Malignant
Endocrine and metabolic disorders • Fibrous dysplasia
• Paget’s disease • Hyperthyroidism
• Histiocytosis
• Caffey’s disease • Pregnancy tumor • Leontiasis ossea
Salivary gland disorders • Mucocele • Tumor
• Necrotizing sialometaplasia Developmental • Torus palatinus • Hyperplasia of palatal gland
Miscellaneous • Impacted and supernumerary teeth • Angioneurotic edema • Teratoma
• Wegener’s granulomatosis • Gingival hyperplasia • Midline lethal granuloma • Tuberous sclerosis • Papillomatosis in acanthosis nigricans