Homo sapiens diseases - Oral cavity, pharynx and neck tumefactions

cleft cheek
cleft mandible
lateral or transverse facial cleft : transverse facial cleft extending from the angle of the mouth toward the ear
oblique facial cleft / meloschisis / prosopoanoschisis : a rare form of facial cleft extending from the lip to the inner canthus of the eye. It may be superficial but usually separates the underlying bone and is associated with cleft lip, cleft palate, or lateral facial cleft
macrostomia : greatly exaggerated width of the mouth, resulting from failure of union of the maxillary and mandibular prominences, with extension of the oral orifice toward the ear. The defect may be unilateral or bilateral
cleft lip / cheiloschisis / harelip / stomatoschisis : a congenital cleft or defect in the upper lip, usually due to complete or partial failure of migration and deposit of mesoderm around or over the head in the embryo, with consequent failure of the maxillary prominence to merge with the merged medial nasal prominences. It may be unilateral, bilateral, or median (the true harelip), and may be accompanied by maxillary and palatal defects

Simonart's band : a weblike band of tissue that sometimes joins the medial and lateral parts of a cleft lip.
sublabial adhesion : abnormal union of the sublabial mucosa of the upper lip to the alveolar process

Epidemiology

Aetiology

interferon regulatory factor 6 (IRF6)

^ref

Laboratory examinations

labiopalatoschisis / cleft lip and palate (CL/P) : cleft lip + cleft palate

Aetiology

Dancer

^ref

T-box transcription factor Tbx10

Dancer

^ref

TBX1

TBX22

cheilognathoprosoposchisis : a developmental anomaly consisting of an oblique facial cleft continuing into the lip and upper jaw
cheilognathoschisis : a developmental anomaly consisting of a cleft lip and jaw
cheilognathouranoschisis : a developmental anomaly consisting of a cleft lip, upper jaw, and palate

Epidemiology

Therapy

Web resources

March of Dimes

synchilia : congenital adhesion of the lips
double lip : redundancy of the submucous tissue and mucous membrane of the lip on either side of the median line
Hapsburg lip : a thick overdeveloped lower lip that often accompanies a Hapsburg jaw.

lip lesions

Aetiology

HPV-2
cheilophagia : biting of the lips

cheilitis / chilitis : inflammation affecting the lips

actinic or solar cheilitis : painful swelling of the lip(s) and development of scaly crust and erosions on the vermilion border after overexposure to sun rays (e.g. sailors, skiers, ...); it may be acute or chronic, erosive or atrophic
cheilitis exfoliativa : persistent exfoliation of the lip caused by inflammation of the mucous membrane, similar to but not identical with dermatitis seborrheica .
cheilitis glandularis apostematosa / apostematous cheilitis / myxadenitis labialis : a rare disease in which the lower lip becomes enlarged and later everted, exposing the openings of the accessory salivary glands, which are inflamed and dilated; the glands themselves are enlarged and sometimes nodular. It may be associated with carcinoma of the lip. There are 3 types:

simple type is characterized by multiple painless, pinhead-sized lesions, with central depressions and dilated canals, and may develop into one of the other types
superficial suppurative type / Baelz's disease is characterized by painless swelling, induration, crusting, and ulcerations of the lip
deep suppurative type is a deep-seated infection with abscesses and fistulous tracts that eventually form scars

Melkersson-Rosenthal syndrome : an autosomal dominant condition usually beginning in childhood or adolescence, characterized chiefly by chronic noninflammatory facial swelling, usually confined to the lips in the form of granulomatous cheilitis, with recurrent facial nerve palsy and sometimes fissured tongue. Associated ophthalmic symptoms may include lagophthalmos , blepharochalasis , palpebral edema , burning sensation of the eyes, corneal opacities, retrobulbar optic neuritis , and exophthalmos .

cheilitis granulomatosa / Miescher's granulomatous cheilitis : an inflammation of the lips characterized by granulomas and swelling; it is sometimes part of Melkersson-Rosenthal syndrome

impetiginous cheilitis : impetigo of the lips.
cheilitis venenata : that due to a toxic substance

commissural cheilitis : cheilitis affecting principally the angles (commissures) of the mouth

angular cheilitis, cheilosis, or stomatitis / migrating cheilitis / perlèche / intertrigo labialis (a.k.a. boccheruola in Italy) : single or multiple fissures at the corners of the mouth, which may be unilateral or bilateral and may spread to the lips and cheeks

Aetiology

primary or superimposed infection

Staphylococcus spp.
Streptococcus spp.
Candida albicans (candidal cheilitis / candidiasis of lip)

poor hygiene
drooling of saliva
overclosure of the jaws in edentulous patients or those with ill-fitting dentures
ariboflavinosis
sideropenic anemia

cheilosis : a noninflammatory condition of the lips characterized by chapping and fissuring.
lip tumors

cheilocarcinoma : carcinoma of the lip (> 90% involve lower lip)

clay pipe cancer : SCC of the lip due to irritation caused by a pipe stem.

Tis : carcinoma in situ
T1 : tumor < 2 cm (about 3/4 inch) or smaller
T2 : tumor 2 < x < 4 cm (about 1 1/2 inch)
T3 : tumor > 4 cm
T4 : tumor of any size that invades adjacent structures (such as bone, connective or muscle tissue of the neck, deep muscle of the tongue, skin, sinuses, or the larynx)

T4a : resectable
T4b : unresectable

N1: metastasis in 1 ipsilateral lymph node < 3 cm (about 1 1/4 inch)
N2

N2a : metastasis in 1 ipsilateral lymph node 3 < x < 6 cm (about 2 1/2 inches) on the same side as the primary tumor.
N2b : metastasis in multiple ipsilateral lymph nodes < 6 cm
N2c : metastasis in >= 1 ipsilateral or contralateral lymph nodes < 6 cm

N3 : metastasis in a lymph node > 6 cm

stage 0 (carcinoma in situ) : Tis, N0, M0
stage I : T1, N0, M0
stage II : T2, N0, M0
stage III :

T3, N0, M0
T1, N1, M0
T2, N1, M0
T3, N1, M0

stage IVA

T4, N0, M0
T4, N1, M0
any T, N2, M0

stage IVB : any T, N3, M0
stage IVC : any T, any N, M

Therapy

T1-T2 : radiotherapy (effectiveness > 90%)
T3-T4 : demolitive surgery + plastic surgery + radiotherapy

Diseases of oral cavity

The correct technique for using a tongue depressor is to insert the blade into the mouth without touching the tongue and then to press straight down on the anterior two-thirds of the tongue. Except for hypopharyngoscopy, the patient should not stick out his tongue because this raises and firms up the tongue, preventing good exposure of the tonsils and pharyngeal area. When warming a mirror over a flame, the physician should always test the back side of the mirror for proper warmth against his wrist or face so that the patient will not fear being burned. On introduction of the nasopharyngeal mirror, sizes zero, one, or two, it is helpful to slide the handle along the corner of the mouth and touch the patient's face with the finger to steady the mirror. This also helps distract the patient's thoughts about gagging. The nasopharyngeal mirror may be slipped into the nasopharynx alongside of the uvula and may even touch the tip, but touching the base of the tongue should be avoided. When holding the tongue for the laryngeal examination, the under surface should be wrapped with cotton gauze to protect it from the sharp edges of the teeth. The fingers can be steadied against the lower teeth and upper lip. If the patient sits up straight and brings his head and chin forward, the larynx is more fully visable. Fingers against the patient's face steady the mirror (three, four, five,) as it is introduced into the mouth, without touching the tongue, toward the uvula and soft palate. Often, the vocal cords can be seen without touching the soft palate, but if necessary, contact should be positive and firm, with little or no movement after contact is made. If a patient is unable to breathe through his mouth when requested, it may be necessary to have him hold his nose closed. These examinations should last only 10-15" because of salivation, anxiety, and discomfort. For patients with hyperactive gag reflexes, mild mucosal anesthetics such as Chloraseptic or Benadryl Elixir can be tried first. Stronger anesthetic agents such as Cetacaine, 1% Tetracaine, 4%t Xylocaine, or 5% cocaine may be necessary, but some are toxic and rapidly absorbed from the oral mucosa, so care must be exercised in the amount and rapidity with which they are applied. For extremely difficult cases, I.V. diazepam of 2.5-5 mgm over a 90" period of administration, gives an excellent effect for 15-20'. Since apnea, caine reactions, or cardiac arrest are always a definite danger with these drugs, resuscitative equipment should be at hand.
diseases of oral mucosa

white sponge nevus / familial white folded mucosal dysplasia / nevus spongiosus albus mucosae : a benign autosomal dominant disorder characterized by exuberant and spongy whiteness of the mucous membranes, especially of the oral mucosa, with gray-white, soft, and sometimes friable lesions with fissures and folds; it reaches maximal severity at adolescence or early adulthood without further progression
ectopic sebaceous glands / Fordyce's granules

Symptoms & signs

cleft palate / palatoschisis / uranoschisis : congenital fissure of the soft palate or both the soft and hard palates (uranostaphyloschisis), due to faulty fusion of the palatine processes; it typically opens through the roof of the mouth into the nasal cavity and extends anteriorly to the premaxilla, where it deviates to the right or left, following the line of fusion.

Epidemiology

Aetiology

PDGF-A

PDGFR-a

^ref

Therapy

palatorrhaphy

oral mucositis / stomatitis : inflammation of the oral mucosa, due to local or systemic factors, which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae

Aetiology

40% of patients who receive radiation therapy
chemical aetiology

40% of patients who receive cancer chemotherapy
stomatitis arsenicalis : stomatitis due to arsenic poisoning .
bismuth stomatitis or gingivitis : stomatitis due to bismuth poisoning , characterized by a thin blue-black line in the marginal gingivae (bismuth line), pigmentation of the buccal mucosa, sore tongue, metallic taste, and a burning sensation of the mouth
lead stomatitis : the oral manifestations of lead poisoning , including the lead line, a bluish line along the free gingival margin, pigmentation of the mucosa in contact with the teeth, metallic taste, excessive salivation, and swelling of the salivary glands.
mercurial or mercury stomatitis : stomatitis due to mercury poisoning ; symptoms include necrotic and ulcerative lesions and discoloration similar to lead lines of the gingivae, soreness of gums, strong metallic taste, foul breath, ptyalism, and necrosis of the alveolar process
stomatitis nicotina / smokers' palate or patches : a condition believed to be a variant of oral leukoplakia, seen in smokers of tobacco , particularly heavy pipe smokers. Characteristics include grayish white nodules or papules on the palate with a red spot in the center of each, representing dilated orifices of accessory palatal salivary glands; thickening, keratinization, and epithelial wrinkling with development of fissures and cracks may occur in later stages

allergic stomatitis : stomatitis caused by exposure to allergens or as a manifestation of an allergic condition

stomatitis venenata / contact stomatitis : an allergic condition of the oral mucosa resulting from contact with a substance to which the patient is sensitized, including cosmetics, dentifrices, mouthwashes, and dental materials, as well as drugs applied topically; inflammation and edema of the mucosa accompanied by burning and sometimes itching are the principal symptoms

stomatitis medicamentosa : stomatitis due to an allergic reaction to drugs, ingested, absorbed through the skin or mucosa, or given by hypodermic injection. Principal symptoms include vesicles, erosion, ulcers, erythema, purpura, angioedema, burning, and itching

nonspecific stomatitis : inflammation of the oral mucosa occurring in association with other conditions, such as

menstruation
diabetes mellitus
uremic or erythematopultaceous stomatitis : the oral manifestation of uremia , consisting of azotemic odor of the breath, erythema, exudation, ulcerations, pseudomembrane formation, and burning sensations
stomatitis intertropica / tropical stomatitis : stomatitis associated with tropical sprue
stomatitis scorbutica : stomatitis associated with vitamin C deficiency , characterized by red swollen gums, gingival ulcers and gangrene, periodontal destruction, loose teeth, hemorrhage from the dental pulp, hypoplasia of the dental enamel, arrest of dentin formation, and exaggerated sensitivity of the oral mucosa to irritants

infectious stomatitis : a general term for a usually mild infection of the oral mucosa, beginning with a circumscribed red, itchy area.

membranous stomatitis : infection of the oral mucosa, accompanied by the formation of a false membrane
ulcerative stomatitis / stomacace / stomatocace : stomatitis characterized by the appearance of shallow ulcers on the cheeks, tongue, and lips

fusospirochetal stomatitis / pseudomembranous angina / necrotizing ulcerative gingivostomatitis : that caused by extension to the oral mucosa of necrotizing ulcerative gingivitis, characterized by ulceration, pseudomembrane, and odor, with lesions involving the palate or pharynx as well as the oral mucosa

Heck focal epithelial hyperplasia / verrucous hyperplasia : a superficial, typically white, hyperplastic lesion of the oral mucosa, usually occurring in older males; it is believed to be a precursor to verrucous carcinoma

Aetiology

HPV-13
HPV-32
genital tract HPVs

angular or candidal stomatitis / oral candidiasis or thrush / moniliasis / perlèche candidiasis (a.k.a. mughetto in Italy)

denture stomatitis / chronic atrophic candidiasis / denture sore mouth : inflammation of the oral mucosa seen in some patients with new dentures or with old, ill-fitting ones; characterized by redness, swelling, and pain of mucosa that is in contact with the denture

Aetiology

Candida albicans

Symptoms & signs

Laboratory examinations

Therapy

herpetic gingival stomatitis (HGS)

Aetiology

HHV-1 / HSV-1

HHV-2 / HSV-2

Symptoms & signs

unlike the aphthous stomatitis, usually involves the gingiva

Therapy

catarrhal stomatitis : transitory inflammation of the oral mucosa, sometimes with gingivitis, erythema, swelling, and occasionally epithelial desquamation; believed to be caused by the oral bacterial flora.
gonorrheal or gonococcal stomatitis : gonorrhea of the oral cavity, usually transmitted by orogenital contact, characterized by a linear or flattened eruption associated with redness, itching, and burning of the mucosa
stomatitis exanthematica : stomatitis secondary to an exanthematous disease.

stomatitis scarlatina : a condition of the oral mucosa seen in scarlatina (scarlet fever), characterized in the early stages by fiery red coloration, congestion, and exudate of the throat, and by strawberry tongue and raspberry tongue in the later stages.
Koplik spots : measles virus

syphilitic stomatitis : stomatitis due to systemic syphilis
noma / cancrum oris / gangrenous stomatitis : a severe gangrenous process usually seen in debilitated and severely malnourished children in developing nations, beginning as a small vesicle or ulcer on the gingiva that rapidly becomes necrotic and spreads to destroy large areas of the buccal and labial mucosa and tissues of the face, resulting in severe disfigurement or even death. "Noma" derives from the Greek word nemo, meaning "to graze" or "to devour." The disease dates back to antiquity, but its name was first used by a Danish physician in 1680 and was meant to underscore its astonishingly rapid development^ref. To Hausa communities in Nigeria, it is known as ciwon iska — an unexplained, sudden illness linked to the spirits

Epidemiology : the incidence of acute noma peaks at 1-4 years of age, although late stages occur in adolescents and adults^ref. Noma was common in Europe and North America until the early 20th century, when it essentially disappeared from developed countries, except for cases found in the concentration camps of Bergen-Belsen and Auschwitz and, more recently, in association with intensive immunosuppressive therapy, in some patients with HIV-1

infection, and in Native American children with severe combined immunodeficiency syndrome. Yet the disease is still prevalent in developing countries. The World Health Organization (WHO) has compiled a global picture of reported cases :

Although African countries are the most affected, Asia and Latin America are not exempt. Before 1980, many sub-Saharan countries had underdeveloped health-reporting systems. Since the 1990s, awareness of noma has increased, and many countries have developed control plans. Sporadic cases have also been reported in higher-income countries, including the USA and some Western European countries, where noma-like lesions may be associated with HIV infection or AIDS. Accurate epidemiologic data are lacking because noma occurs predominantly in poor communities that do not keep health records and, frequently, have a nomadic lifestyle. Also, the disease is often hidden by families who consider it an evil omen. In 1998, the WHO estimated the annual global incidence at 140,000 and the associated mortality at 70 to 80% among persons who are not treated promptly. A more recent report estimates an annual incidence of 25,000 in the developing countries bordering the Sahara^ref. But these estimates reflect the tip of the iceberg, since it is believed that < 10% of affected persons seek medical care.

Aetiology : noma thrives in communities characterized by extreme poverty, severe malnutrition (particularly micronutrient deficiencies), unsafe drinking water, poor sanitation, poor oral health practices, high infant mortality, limited access to high-quality health care, and a high prevalence of low birth weight, attributable primarily to intrauterine growth retardation. In these communities, families may share their overcrowded, poorly ventilated living quarters and sources of drinking water with domestic animals, and foods for infants may be prepared under unhygienic conditions. All these factors promote chronic and recurrent infection-induced immunostimulation by environmental antigens. Noma is usually preceded by a debilitating illness, such as measles

, malaria

, diarrhea

, tuberculosis

, or necrotizing ulcerative gingivitis. Noma is a polymicrobial opportunistic infection, but there is no consensus regarding the causative microorganisms. Studies point to

..., which may enter children's mouths through water and food contaminated with animal feces^ref.

Pathogenesis of noma involves a complex interaction among malnutrition, immune dysfunction, and infection with endemic viruses that creates a "staging period" characterized by impaired oral mucosal immunity, defective structural integrity of the oral mucosa, selective overgrowth of pathogenic microorganisms, increased oxidative stress, and a shift from an inflammatory to an antiinflammatory cytokine profile, among other changes. An intraoral ulcer develops and probably provides a site of entry for a triggering microorganism. In a final invasive phase, the lesion spreads rapidly, probably owing to the presence of necrotizing toxins or tissue-destroying enzymes and inflammatory mediators. Still puzzling is the observation that in the same households, oral mucosal ulcers progress to noma in only a small subgroup of severely malnourished children. At least 85% of Nigerian children under 3 years of age who have noma also have severely stunted growth^ref. Stunting (failure to grow) in early infancy is considered in some cases to be a continuation of intrauterine growth retardation, which is prevalent in underprivileged African communities. It is possible that children with noma are victims of intrauterine growth retardation, which impairs development of immune function. This hypothesis would suggest that there is a close pathogenic similarity between noma in children and the histopathologically similar noma neonatorum

Symptoms & signs : patients with acute noma usually present with malodorous breath, fluctuating fever (temperatures of 101 to 105°F [38 to 41°C]), marked anemia, a high white-cell count, severe growth failure, and other manifestations of malnutrition and poor general health. The lesion, usually unilateral, is often well established by the time medical help is sought. Noma generally starts as a gingival ulceration that can be treated easily at the early stage with local disinfection, antibiotics, and nutritional rehabilitation. If the ulcer is left untreated, it progresses rapidly to involve the cheek or lip; swelling is often the earliest externally visible sign of disease. The swelling increases, and within days, a blackish furrow appears where intraoral tissue is being lost. The lesion finally establishes itself with a well-demarcated perimeter surrounding a blackened necrotic center. Sequestration of exposed bone and teeth occurs rapidly after the separation of the soft-tissue slough. A hole remains after the scab is removed.

Prognosis : the sequelae depend on the anatomical sites affected, the extent and severity of tissue destruction, and the stage of development of the oral tissues. Survivors of acute noma often have severe disfigurement and functional impairment. They may therefore be shunned by society, and although reconstructive surgery is possible, it rarely restores normal facial appearance^ref.

Noma neonatorum, which is considered a distinct entity, affects newborns and resembles noma in older children. Preterm birth and severe intrauterine growth retardation

are considered important predisposing factors.

Necrotizing diseases of the oral tissues associated with HIV infection may be confused with early signs of noma, so serologic testing for HIV should be performed when noma is suspected.

Therapy : management of acute noma requires correction of dehydration and electrolyte imbalance, treatment of associated diseases (such as malaria and measles), testing for HIV-1

infection and appropriate referral, the administration of antibiotics (penicillin and metronidazole are generally effective), local wound care with antiseptics, and removal of any remaining tissue slough and sequestra. No major surgery is performed until the acute stage has been controlled. Recommendations for the prevention of noma include the inculcation of good nutritional practices, the promotion of exclusive breast-feeding during the first three to six months of life, immunization against endemic communicable diseases, proper oral hygiene practices, the segregation of livestock from human living areas, and education about noma. Yet it is clear that the elimination of the root causes would require improvement in living conditions through the eradication of poverty^ref.

pyostomatitis vegetans : a variant of dermatitis vegetans involving the oral mucosa, sometimes occurring in association with ulcerative colitis and other gastrointestinal disturbances. The primary lesions are miliary abscesses with a tendency to form groups and become proliferative, soft, red, folded, and verrucous, sometimes spreading over the entire oral cavity. They may remain confined to the mouth or may coexist with typical dermatitis vegetans.
recurrent aphthous stomatitis (RAS) / stomatitis aphthosa / aphthae / canker sore

Aetiology

inheritance of the G allele of the IL-1B -511 polymorphism is strongly associated with RAS (OR = 2.5, P < 0.00002), with increased numbers of G/G homozygotes (OR = 4.5, P < 0.0005). The G allele of IL-6 -174 also occurs more frequently in RAS (OR = 2.6, P < 0.0001) with greatest risk associated with G/G homozygosity (OR = 3.4, P < 0.0001). IL-1RN VNTR 1/1 homozygotes also occurs more frequently in RAS (OR = 2.0, P < 0.02). Inheritance of the G/G genotype of both IL-1B -511 and IL-6 -174 is a particularly strong predictor for RAS (OR = 8.5)^ref
Behcet's disease

Symptoms & signs

periadenitis mucosa necrotica recurrens

Therapy

herpetic gingival stomatitis

palatitis : inflammation of the palate
buccoglossopharyngitis : inflammation involving the cheek, tongue, and pharynx.

buccoglossopharyngitis sicca : inflammation and dryness of the buccal mucosa, tongue, and pharynx

Symptoms & signs

linea alba of buccal mucosa

Therapy

KGF

^®

white oral lesions are due to tissue excess

non-keratotic oral lesions (can be scraped off with tongue blade or gauze)

Aetiology

surface debris (food accretion)
necrosis
thrush

keratotic oral lesions (cannot be rubbed off), produced by hyperkeratosis of the epithelium, with thickening of stratified squamous epithelium, hyperkeratosis, hyperplasia, inflammatory infiltration, and degeneration of epithelial cells

oral leukoplakia / leukokeratosis (18% of oral lesions) : white, thick plaque-like lesion on oral mucosa (leukoplakia buccalis / psoriasis buccalis) or tongue (leukoplakia lingualis / keratosis linguae / psoriasis linguae). It is a benign condition but may predispose to development of squamous cell or epidermoid carcinoma

Epidemiology

Aetiology

pipe smoking (stomatitis nicotina)
ethanol
leukoedema : diffuse white-gray corrugated surface on buccal mucosa disappearing when tissue is stretched. It is a common, benign variant in dark skinned persons
galvanic keratosis
lichen planus of buccal mucosa
Heck focal epithelial hyperplasia
systemic lupus erythematosus
white sponge nevus
oral hairy leukoplakia : a white filiform to flat patch occurring on the tongue or, rarely, on the buccal mucosa, caused by infection with HHV-4 / EBV and associated with HIV-1 infection; it is a predictor of the subsequent development of AIDS

Pindborg classification

homogeneous leukoplakia (2-6% evolve to squamous cell or epidermoid carcinoma)

leukoplakia simplex
leukoplakia verrucosa

nodular leukoplakia (40% evolve to squamous cell or epidermoid carcinoma

leukoplakia verrucosa
erosive leukoplakia
variegated leukoplakia

reactive hyperkeratosis (most common)

Aetiology

benign epithelial response
fractured tooth
dental restoration

erythroplakia : red, velvet-like lesion on thin mucosae (lips, fornix, gingivae) due to tissue deficiency (speckled leukoplakia may also be present on periphery of erythroplakia)

Aetiology

epithelial dysplasia
90% of early carcinomas

melanoplakia : the presence of pigmented patches on the oral mucosa
oral cavity cancers (see also tongue cancers)

pavimentous epithelial cancers

papilloma
carcinomas

carcinoma in situ
epidermoid or squamous cell carcinoma (SCC) (92%)

verrucous carcinoma / Ackerman tumor : slowly growing, locally invasive and rarely metastasizing (Friedell HL & LM Rosenthal, The etiologic role of chewing tobacco in the cancer of the mouth, JAMA 116:2130 (1941); Ackerman LV - Verrucous carcinoma of the oral cavity. Surgery 23:670 (1948)).
spindle cell carcinoma
lymphoepithelioma -like carcinoma (LELC) of the oral cavity

Epidemiology

Aetiology

HHV-4 / EBV

^ref

undifferentiated carcinoma

accessory salivary gland cancers
soft tissue sarcomas
oral cavity mucosal melanoma (ORMM)

maxillary anterior gingival area (80%)

palatal mucosa
alveolar mucosa

struma / goiter
metastases from male breast cancer
granular cell tumor

Epidemiology

Aetiology

local conditions

precancerous conditions (15%)

erythroplakia (30-80% undergo degeneration)
leukoplakia
erythroleukoplakia / speckled erythroplakia or leukoplakia : a lesion in the oral cavity with characteristics of both erythroplakia and leukoplakia, yielding a speckled appearance (1-3% undergo degeneration)
lichen ruber planus
actinic cheilitis (3-7% undergo degeneration)
pemphigus
pemphigoid

Aetiology

tobacco chewing and cigarette smoking (heat, cancerogens, induction of a foamer saliva keeping cancerogens in place longer) => tongue and oral cavity cancers
betel or buyo cheek cancer [Philippine buyo, betel] : squamous cell carcinoma (SCC) of the cheek mucous membranes, seen in India and other Asian countries where betel nut , often mixed with tobacco , is held in the buccal vestibule for prolonged periods.
no increased risk among marijuana smokers, including those who have other underlying risk factors for oral cancer, such as a history of tobacco use or heavy alcohol use or defective versions of gluthathione S-transferase (GST) genes
ethanol (cancerogen solvent, hepatotoxicity, dysmetabolism of epithelial cells) (RR = 5-10) => oral floor cancers
poor oral hygiene
chronic oral candidosis acts as a further carcinogen on precancerous areas by secreting N-nitrobenzylmethylamine

Grading

mild dysplasia = oral in situ neoplasia (OIN) I
moderate dysplasia = OIN II
severe dysplasia = OIN III

previous upper airway and digestive tract cancer (UADTC)

systemic causes

Localizations

Laboratory examinations :

inspection
palpation (bimanual, with second finger and thumb)
exfoliative cytology
toluidine blue staining (vital stain selective for atypical cells)
biopsy if lesion lasts more than 2-3 weeks after removing the hypothetical cause

simple / excisional biopsy
mapping
targeted biopsy

Symptoms & signs

precancerosis
superficial erosion (20-25%)
granulomatous lesion
raised plaque
vegetations (10%)
infiltrations (10%)
crusts
mixed lesions (50%)
pain, dental mobility, parageusias, foetor ex ore, xerostomia, chronic cough due to irritation of phrenic nerve

Tis : carcinoma in situ
T1 : tumor < 2 cm (about 3/4 inch) or smaller
T2 : tumor 2 < x < 4 cm (about 1 1/2 inch)
T3 : tumor > 4 cm
T4 : tumor of any size that invades adjacent structures (such as bone, connective or muscle tissue of the neck, deep muscle of the tongue, skin, sinuses, or the larynx)

T4a : resectable
T4b : unresectable

N1 : metastasis in 1 ipsilateral lymph node < 3 cm (about 1 1/4 inch)
N2

N2a : metastasis in 1 ipsilateral lymph node 3 < x < 6 cm (about 2 1/2 inches) on the same side as the primary tumor.
N2b : metastasis in multiple ipsilateral lymph nodes < 6 cm
N2c : metastasis in >= 1 ipsilateral or contralateral lymph nodes < 6 cm

N3 : metastasis in a lymph node > 6 cm
M1 : pulmonary metastases , osteolytic bone metastases , liver metastases, and brain metastases

stage 0 (carcinoma in situ) : Tis, N0, M0
stage I : T1, N0, M0
stage II : T2, N0, M0
stage III :

T3, N0, M0
T1, N1, M0
T2, N1, M0
T3, N1, M0

stage IVA

T4, N0, M0
T4, N1, M0
any T, N2, M0

stage IVB : any T, N3, M0
stage IVC : any T, any N, M

Therapy

surgery

conservative surgery
demolitive surgery

radiotherapy

Web resources

phlegmon of floor of the mouth

diseases of tongue / glossopathy

baked tongue : the dry, brown tongue of typhoid fever .
beefy tongue : erythematous and/or atrophic glossitis, characterized by red, irregular ulcerations on the dorsal surface of the tongue.
bifid, cleft or double tongue : a tongue that is divided in its anterior part by a longitudinal fissure
coated tongue : a tongue covered with a whitish or yellowish layer consisting of desquamated epithelium, debris, bacteria, fungi, or other material, which is readily removed by scraping.
cobble-stone tongue : a condition marked by interstitial glossitis with hypertrophy of the papillae and a verrucous white coating on the tongue, such as seen in riboflavin deficiency .
earthy tongue : a tongue that is coated with a deposit of rough, calcareous matter.
encrusted tongue : a heavily coated tongue.
fern leaf tongue : a tongue with a central furrow having lateral branches.
filmy tongue : one marked with symmetrical whitish patches.
cerebriform, crocodile, furrowed, fissured, grooved, plicated, scrotal, sulcated or wrinkled tongue / lingua plicata : a sometimes familial condition characterized by the presence on the dorsal surface of the tongue of numerous furrows, which may radiate outwardly from the median raphe
flat tongue : a condition in which the borders of the tongue cannot be rolled; it is due to paralysis of the transverse lingual muscles occurring as a result of congenital syphilis .
furred tongue : a tongue with papillae so changed as to give the mucous membrane the appearance of whitish fur.
hairy tongue / glossotrichia / trichoglossia : a benign condition characterized by hypertrophy of the filiform papillae, giving the dorsum of the tongue a furry appearance. The color of the elongated papillae varies from yellowish white to brown or black, depending upon staining by substances such as tobacco, foods, or drugs

black hairy tongue / lingua nigra / melanoglossia / melanotrichia linguae / nigrities linguae : hairy tongue in which the hypertrophied filiform papillae are brown or black

Aetiology

colloidal bismuth

lobulated tongue : a congenital condition marked by a secondary lobe arising from the surface of the tongue.
parrot tongue : the dry, horny tongue of low fever , which cannot be protruded.
Sandwith's bald tongue : an extremely clean tongue sometimes seen in the late stages of pellagra .
smokers' tongue : oral leukoplakia of the tongue.
dotted or stippled tongue : a tongue on which each papilla is covered with a separate white patch of epithelium
cardinal tongue : a tongue whose surface is denuded of epithelium, giving it a bright red appearance.
magenta tongue : the magenta-colored tongue seen in cases of riboflavin deficiency .
strawberry tongue : a tongue that is dark red colored and whose surface resembles the surface of a strawberry; seen in conditions such as Staphylococcus aureus infection, mucocutaneous lymph node syndrome / Kawasaki's syndrome , and streptococcal pharyngitis

raspberry tongue / red strawberry tongue : the dark red tongue with a glistening smooth surface and prominent filiform papillae seen after desquamation of the white coating characteristic of the early stage of scarlet fever

white tongue : a condition in which all or part of the papillae and epithelium of the tongue have a dull white color.

white strawberry tongue : the white-coated tongue with prominent red papillae characteristic of the early stage of scarlet fever ; the coating desquamates, leaving a beefy red tongue

microglossia : undersize of the tongue.
progressive lingual hemiatrophy : progressive atrophy of one lateral half of the tongue
macroglossia : oversize of the tongue

Aetiology

acromegalic disease
amyloid tongue : enlargement of the tongue due to amyloidosis .

glossocoma : retraction of the tongue
glossitis : inflammation of the tongue.

Aetiology

benign migratory glossitis / glossitis areata exfoliativa / glossitis migrans / erythema migrans / geographic or mappy tongue / pityriasis linguae : a type with unknown etiology, characterized by annular areas of desquamation of the filiform papillae on the dorsal surface of the tongue, usually presenting pinkish-red central lesions outlined by thin, yellowish lines or bands that change patterns and shift location every few days
herpetic glossitis : multiple well-defined, white papules, 2 to 3 mm in diameter with a central punctum, on the surface of the tongue. Differing from herpetic vesicles on the skin, round, discrete areas of ulceration are the typical presentation of herpetic glossitis. Oral HSV-1 reactivation typically affects the keratinized surface of the mouth, whereas primary HSV-1 infection usually involves other mucosal surfaces as well. The typical appearance of this condition differentiates it from oral candidiasis and aphtous ulcers. The lesions can heal completely without any treatment^ref

herpetic geometric glossitis : painful longitudinal, crossed, or branched fissures on the dorsum of the tongue, occurring as a manifestation of HHV-1 / HSV-1 infection in immunocompromised patients.

Hunter's glossitis / atrophic glossitis

Aetiology :

pernicious anemia
celiac disease (unrelated to pernicious anemia)

Symptoms & signs

idiopathic glossitis : inflammation of the substance of the tongue and its mucous membrane.
median rhomboid glossitis / glossitis rhomboidea mediana : a congenital disorder of noninflammatory origin, characterized by a somewhat rhomboid reddish, smooth, and shiny lesion with some opalescent spots, occurring at about the middle third of the dorsal surface of the tongue, immediately anterior to the circumvallate papillae.
Moeller's glossitis / bald tongue / glossodynia exfoliativa : a chronic condition of the tongue characterized by superficial excoriation, principally of the tip and edges. The lesions are beefy red, well-defined, irregular patches, in which the filiform papillae are thinned or absent and the fungiform papillae are swollen
antibiotic tongue : glossitis caused by sensitivity to an antibacterial .

glossopyrosis / burning tongue : a form of paresthesia characterized by pain, burning, itching, and stinging of the mucous membranes of the tongue without apparent lesions of the affected areas
glossopexy : lip-tongue adhesion
ankyloglossia / adherent tongue / lingua frenata / tongue-tie : restricted movement of the tongue, resulting in speech difficulty

complete ankyloglossia : ankyloglossia resulting from fusion between the tongue and the floor of the mouth.
partial ankyloglossia : ankyloglossia resulting from a short lingual frenum or one which is attached too near the tip of the tongue.
ankyloglossia superior : an unusual association of an extensive adhesion of the tongue to the palate, sometimes with deformities of the extremities

glossospasm : spasm of the tongue muscles.
glossoptosis : downward displacement or retraction of the tongue.
glossalgia / glossodynia : pain in the tongue
burning mouth syndrome (BMS) is a chronic, intraoral burning sensation seen mainly in middle-aged and post-menopausal females, without identifiable oral lesions or abnormal laboratory findings, but often associated with psychogenic disorders such as depression. The latter can have a range of causes, including hormonal^ref
glossoncus : a swelling of the tongue.

tongue cancers (see also oral cavity cancers)

epidermoid or squamous cell carcinoma (SCC)

Aetiology

tobacco chewing and smoking

Localizations

Symptoms & signs

Laboratory examinations

echography

MRI

TNM staging

T1 : < 2 cm
T2 : 2 < x < 4 cm
T3 : > 4 cm
T4 : infiltrating floor of oral cavity or alveolar process

T4a : resectable
T4b : unresectable

Therapy

T1 or T2 < 3 cm

anterior third of tongue => surgery or brachytherapy
middle or posterior third of tongue => brachytherapy or external beam radiotherapy
surgical lymphadenectomy if T2

T2 > 3 cm, T3, T4

radiotherapy + chemotherapy + surgical lymphadenectomy
surgical lymphadenectomy + glossectomy + postoperatory radiotherapy or chemotherapy

Laboratory examinations

glossoscopy

skeletal cancers
himantosis : elongation of the uvula.
diseases of teeth

congenital diseases of teeth

macrotooth : an abnormally large tooth
dentia praecox

premature teeth / precocious or premature dentition : deciduous teeth that erupt prior to the end of the third month of life, or permanent teeth that erupt prior to the end of the fourth year of life
predeciduous, milk or natal tooth : any tooth present at birth, which may be normal in all respects or may represent a hornified epithelial rootless structure, found on the gingivae over the crest of the ridge before eruption of the deciduous teeth

delayed tooth eruption, receding chin, and a protruding tongue are occasional features of cretinism and hypopituitarism .
geminate or connate tooth : a tooth with a single root and root canal, but with 2 completely or incompletely separated crowns, resulting from invagination of a single tooth germ, causing incomplete formation of 2 teeth.
submerged or ankylosed tooth : a deciduous tooth, usually a second mandibular molar, that has undergone resorption and has become ankylosed to the bone, thus preventing its exfoliation and subsequent replacement by a permanent tooth; it appears to be submerged below the level of occlusion in relation to the adjacent permanent teeth
hag teeth : upper medial incisors that are widely separated
shell tooth : a condition characterized by dysplasia of the dentin, associated with essentially normal enamel, thus resulting in an extremely large pulp chamber and root canal that give the affected tooth the appearance of a shell
Horner's teeth : incisor teeth that are horizontally grooved owing to a deficiency of enamel.
Hutchinson's screwdriver teeth or incisors : a tooth abnormality seen in congenital syphilis , in which the permanent incisors have a screwdriver-like shape, sometimes associated with notching of the incisal edges or depressions in the labial surfaces above the cutting edge
Moon's or Fournier teeth : small, domed first molars observed in patients with congenital syphilis
mulberry molar or tooth : a malformed first molar characterized by dwarfing of the cusps and hypertrophy of the enamel surrounding the cusp with agglomeration of masses of globules, giving it the appearance of a mulberry; seen in congenital syphilis and certain other diseases
dentinal dysplasia / rootless teeth : an apparently hereditary disorder of dentin formation, marked by a normal appearance of coronal dentin associated with pulpal obliteration, faulty root formation, and a tendency for peripheral lesions without obvious cause. The teeth become loose and are exfoliated prematurely, probably because of the short pointed roots and periapical granulomas and cysts that are a common complication
dental and dentoalveolar dysplasia : abnormal development of 2 or more teeth within one or both jaws, producing disharmonious relationships between the teeth and their immediate supporting bone and periodontal structures, and resulting in malocclusion
oculodentodigital (ODD) dysplasia / oculodento-osseous dysplasia (ODOD) / dysplasia oculodentodigitalis syndrome / Meyer-Schwickerath and Weyers syndrome / oculodentodigital or oculodento-osseous syndrome : a rare hereditary condition transmitted as an autosomal dominant trait, characterized by bilateral microphthalmos, abnormally small nose with anteverted nostrils, hypotrichosis, dental anomalies, camptodactyly, syndactyly, and missing phalanges of the toes
(true) anodontia / anodontia vera / anodontism / edentia : congenital absence of the teeth; it may involve both the deciduous and the permanent dentition, or only teeth of the permanent dentition

total anodontia : a rare condition characterized by congenital absence of all teeth, both deciduous and permanent.
hypodontia / partial anodontia : partial absence of the teeth. A relatively common congenital condition characterized by absence of one or more teeth because of absence of their anlage, which is seldom associated with other anomalies.

Kennedy classification : a classification of partially edentulous conditions and partial dentures, based on the location of the edentulous spaces in relation to the remaining teeth.
Skinner classification : a method of classifying partially edentulous conditions and partial dentures, based on the location of the edentulous spaces in relation to the remaining teeth

Aetiology

Witkop's syndrome / tooth-and-nail syndrome

supernumerary tooth

paramolar / supernumerary molar : a supernumerary tooth, usually small and rudimentary, sometimes found in the maxilla buccally or lingually to a molar or interproximally between 2 of the first 3 molars

Aetiology

Gardner's syndrome (GS)

dysodontiasis : imperfect or defective dentition; defective, delayed, or difficult eruption of the teeth

unerupted tooth has not penetrated into the oral cavity

Therapy

operculectomy

impacted tooth : an unerupted or partially erupted tooth that is positioned against another tooth, bone, or soft tissue so that complete eruption is unlikely

Localizations

first permanent molar in babies
upper permanent canine
third lower molar / wisdom tooth

Aetiology

embryo conditions : wisdom tooth arises from

gubernaculum dentis of second lower molar
posterior proliferation of primitive dental lamina

Capdepont curve

mesial vestibular version
distal vestibular version
mesial lingual version
distal lingual version

mesial impaction (commonest)
vertical impaction
horizontal impaction
distal impaction

bony impaction : wisdom tooth is still fully encased in the jaw's bone
soft tissue impaction : wisdom tooth has penetrated through the bone, but not yet fully through the gums

Pathogenesis

Symptoms & signs

infectious complications

pericoronitis / operculitis : inflammation of the gingiva surrounding the crown of a tooth

simple congestive pericoronitis : pain when chewing. It may be self-limited or evolve into ....
suppurative pericoronitis

Symptoms & signs : antalgic => myositic monolateral trismus, dysphagia, pyorrhea, regional lymphadenitis below mandibular angle

Therapy : TCA, HCrO₄, antibacterials

, myorelaxants

chronic pericoronitis : submucosal abscess

Therapy : tooth extraction if inclined toward the cheek or mandibular arm, thick fibromucous cap, near anterior pillar, or untreatable caries

mucous complications : homolateral ulceronecrotic gingivitis up to central incisor

Therapy : vitamin C

, antibacterials

abscesses

distal vestibular version

Escot peritonsillar abscess
Terracol subtonsillar abscess
Sentora abscess in anterior pillar and pharynx

mesial vestibular version :

migrating Champret-Hirandel abscess

osseous complications
tumoral complications
mechanical complications

Therapy : the removal of third molars in an adult patient population is a safe surgical procedure with minimal morbidity, no mortality and no long-term negative impact on the patient's quality of life^ref

dry socket : localized osteitis of the tooth alveolus following extraction due to infection or loss of blood clot
malocclusion : such malposition and contact of the maxillary and mandibular teeth as to interfere with the highest efficiency during the excursive movements of the jaw that are essential for mastication

horizontal overlap / horizontal overbite / overjet / overjut : extension of the incisal or buccal cusp ridges of the maxillary teeth labially or buccally to the incisal margins and ridges of the mandibular teeth when the jaws are in habitual occlusion. Normal occlusion is represented in A. Angle's classification : a classification of dental malocclusion based on the mesiodistal (anteroposterior) position of the mandibular dental arch and teeth relative to the maxillary dental arch and teeth

class I / neutroclusion (B) : normal anteroposterior relationship of the jaws, as indicated by correct interdigitation of maxillary and mandibular molars, but with crowding and rotation of teeth elsewhere, i.e., a dental dysplasia or an arch length deficiency. Face has linear profile.
class II / distoclusion (C) : the lower dental arch is posterior to the upper in one or both lateral segments; the lower first molar is distal to the upper first molar. Overjet < 2 mm, closed bite. Typical of anglosassons. Face has convex profile.

division 1 : bilaterally distal with narrow maxillary arch and protruding upper incisors. Overjet > 2 mm.

subdivision : unilaterally distal with other characteristics the same.

division 2 : bilaterally distal with normal or square-shaped maxillary arch, retruded maxillary central incisors, labially malposed maxillary lateral incisors, and an excessive overbite. More predisposed to temporomandibular dysfunction syndrome .

subdivision : unilaterally distal with other characteristics the same.

class III / mesioclusion (D) : the lower arch is anterior to the upper in one or both lateral segments; lower first molar is mesial to upper first molar. Reduced overjet, open bite. Face has concave profile (advanced mentum).

division : mandibular incisors are usually in anterior crossbite.

subdivision : unilaterally mesial, with other characteristics the same.

class IV : the dental arches are in distal occlusion upon one lateral half, and in mesial occlusion upon the other half of the mouth

vertical overlap / overbite / over bite : extension of the incisal ridges of the maxillary anterior teeth below the incisal ridges of the mandibular anterior teeth when the jaws are in centric occlusion

normal overbite : 0-2 mm
closed-bite malocclusion / closed bite / deep bite / deep overbite : malocclusion with decreased occlusal vertical dimension and an abnormal overbite in which the mandible protrudes
open-bite malocclusion / open bite / apertognathia / nonocclusion : a condition marked by failure of certain opposing teeth to establish occlusal contact when the jaws are closed

lateral malocclusion (transverse)

normal (prevalence of upper arch)
crossbite / X-bite (prevalence of lower arch)

scissors bite : total lingual crossbite of the mandible, with the mandibular teeth completely contained within the maxillary dental arch in habitual occlusion.

Aetiology :

idiopathic
acquired

acromegaly (acquired prognathism)
Paget's disease of the bone (deformity of the maxilla and mandible)

Complications

condylar displacement

Laboratory examinations :

wax bite : a simultaneous impression of both the upper and the lower jaw, made by having the subject bite on a double layer of soft baseplate wax.
check bite / check-bite : a thin sheet of wax or a modeling compound placed between the teeth in centric, eccentric, lateral, or protrusive occlusion, and pressed to their buccal or labial surfaces after the jaws have been closed; used to check dental occlusion in the articulator in properly aligning study models

Therapy

orthodontics

braces
equilibration / occlusal adjustment : reshaping of the occlusal surfaces of teeth to create harmonious contact relationships between the upper and lower teeth
lingual arch : a wire appliance made to conform to the lingual aspect of the dental arch; used to promote or to prevent movement of the teeth in orthodontic therapy.

fixed or stationary lingual arch : a space-retaining appliance consisting of an arch wire designed to fit the lingual surface of the teeth, and soldered to metal crowns or orthodontic bands
passive lingual arch : an orthodontic appliance for maintaining space and preserving arch length when bilateral primary molars are prematurely lost

aerodontalgia / aero-odontalgia / aero-odontodynia : toothache experienced at lowered atmospheric pressures, as in aircraft flight or in a decompression chamber, caused by the expansion of air in the maxillary sinuses
dentinal hypersensitivity : a sharp, sudden painful reaction when the teeth are exposed to hot, cold, chemical, mechanical or osmotic (sweet or salt) stimuli.

Therapy

dental varnish : a hypersensitivity treatment which sometimes contains sodium fluoride. Varnishes are applied to the tooth surface, covering the outer surface of dentin and thus blocking transmission of painful stimuli to the pulp.
dental resin : a dental material applied to the tooth. Typically not used unless all other treatment attempts have failed.
desensitization : blocking the pain stimulus that causes dentinal hypersensitivity.

fissures : cleft-like grooves in the chewing surface of the back teeth
tooth erosion : acids (eg from lemons) erode small portions from surface, but explorer can't penetrate
tooth abrasion : from mechanical wear-and-tear (eg from toothbrush), but explorer can't penetrate
tooth fracture

crown-root fracture : an oblique tooth fracture involving the crown and the adjacent distal part of the root

Prevention

mouthguard

Symptoms & signs

cracked tooth syndrome

Therapy

hemisection : surgical separation of a multirooted tooth so that one root and/or the overlaying portion of the crown can be surgically removed
splint : a device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured or traumatized

evulsion / avulsion : complete separation of the tooth from its socket due to trauma

displaced tooth : a partial evulsion of a tooth-may be mesial, distal, facial, lingual or incisal.

Therapy

tooth implantation

tooth reimplantation : the return of a tooth to its alveolus
dental implant : device specially designed to be placed surgically within or on the mandibular or maxillary bone as a means of providing for dental replacement

endosteal (endosseous)
eposteal (subperiosteal)
transosteal (transosseous)

tooth transplantation

occlusal trauma : injury to any part of the masticatory system as a result of occlusal dysfunction or when excessive forces are placed on a normal dentition, i.e. grinding and clenching of teeth. If left uncontrolled, occlusal trauma may result in rapid attachment loss and bone loss.
potential trauma : in dentistry, an alteration in tissue that may occur at any time as a result of an existing dental disharmony.
edentulous : acquired condition of being without teeth

Therapy

dentures

premature tooth loss resulting from periodontitis is seen with

cyclic neutropenia
Papillon-Lefèvre syndrome
Chédiak-Higashi syndrome
leukemia
hypophosphatasia (early loss of primary teeth)

rapid focal tooth loosening is most often due to

infection (most often)
rarer causes include :

exostosis / torus : overgrowth of normal bone causing elevation or protuberance. Usually seen on the upper palate behind the front teeth or under the tongue inside the lower jaw.
perirhizoclasia : inflammatory destruction of tissues immediately around the root of a tooth, i.e., the pericementum, cementum, and superficial layers of the alveolar process
pararhizoclasia : inflammatory destruction of the deep layers of the alveolar process and the periodontal ligament around the roots of a tooth
tooth stain :

extrinsic stain : tooth stain located on the outside of the tooth surface

Aetiology

tobacco chewing and smoking
coffee
tea
some foods

Therapy

scaling : removal of stain from teeth

polishing : a dental procedure that removes stain by using an abrasive polishing paste in a rubber cup attached to a slow-speed handpiece or air-powder polisher

bleaching : applying a chemical agent to the teeth to whiten them

intrinsic stain : tooth stain located within the tooth

Aetiology

dental fluorosis / enamel mottling / mottled enamel : discoloration of the enamel due to fluorosis during development
endogenous pigments :

erythrodontia : reddish brown pigmentation of the teeth

Aetiology

congenital erythropoietic porphyria (CEP)

erythroblastosis fetalis (green or bluish-black)
congenital liver disease (green or yellow-brown)

worn enamel is seen with age, bruxism, or excessive acid exposure (e.g., chronic gastric reflux or bulimia ).

pellicle : the first step in plaque formation, the pellicle is a clear, thin covering containing glycoproteins and lipids found in saliva. Pellicle is formed within seconds after a tooth surface is cleaned but precipitation can be slowed down with water irrigation

bacterial or dental plaque : a soft, thin, colorless, sticky film of food debris, mucin, and dead epithelial cells deposited on the teeth (expecially on the less used side), providing the medium for the growth of various bacteria (corpusculate plaque). The main inorganic components are calcium and phosphorus, with small amounts of magnesium, potassium, and sodium; the organic matrix consists of polysaccharides, proteins, carbohydrates, lipids, and other components (amorphous plaque). Plaque plays an important etiologic role in the development of enamel caries (supragingival plaque) and periodontal and gingival diseases (subgingival caries) and provides the base for the development of materia alba when allowed to remain over a period of time; calcified plaque forms dental calculus. It can be divided into :

plaque attached : bacterial plaque which is attached to hard tooth surfaces and can be removed only by mechanical means (i.e. instrumentation, oral hygiene aids such as toothbrushes, floss, etc,).
plaque loosely adherent : free floating bacterial plaque found on the surface of supragingival and subgingival plaque; contains most of the disease causing bacteria, and can easily be flushed from subgingival area with water irrigation.

Aetiology

Therapy

scaling

short-headed toothbrush (to wash second and third molars without evoking vomiting) : Bass technique for vestibular, lingual, and vestibular surfaces
horizontal tootbrush for horizontal surfaces
floss : a thin, nylon string, waxed or unwaxed, that is inserted between the teeth to remove food and plaque
polishing : a dental procedure that removes plaque by using an abrasive polishing paste in a rubber cup attached to a slow-speed handpiece or air-powder polisher
scaler : a dental instrument used in removing calculus from tooth surfaces

chisel scaler / periodontal chisel.
deep scaler : one of several types of scalers designed for removal of subgingival deposits from the teeth.
double-ended scaler : one with blades on both sides of the handle, one blade for the right side, the other for the left.
hoe scaler : one made with different angular relationships of shank and handle, but with the blade bent at a 99° angle, and the flattened termination surface beveled at an angle of 45°, used for planing and smoothing root surfaces.
sickle scaler : a scaler that removes tenacious supragingival or subgingival deposits; it has a sickle-like blade with flattened sides and a trapezoidal cross section.
superficial scaler : one of several types of scalers designed for removal of supragingival deposits from the teeth.
ultrasonic scaler : an ultrasonic instrument with a tip for supplying high-frequency vibrations, used to remove adherent deposits from the teeth and bits of inflamed tissue from the walls of the gingival crevice

calculus / tartar : a tenacious, hardened material formed by mineralization (calcification) of dental plaque attached to crowns and/or roots of teeth, which once formed can only be removed by a dentist/hygienist

Therapy

debridement

subgingival or supragingival scaling : removal of calculus from teeth
polishing : a dental procedure that removes calculus by using an abrasive polishing paste in a rubber cup attached to a slow-speed handpiece or air-powder polisher

dental caries / tooth decay

Epidemiology

pregnancy

Aetiology

genetic background (width of contact area, body height, ...) : malacotic teeth
frequent sucrose introduction in oral cavity (related to socio-economical status and certain jobs (confectioners, bakers, ...)
enamel hypoplasia results in crown defects ranging from pits to deep fissures of primary or permanent teeth

Turner's hypoplasia : enamel hypoplasia of a single tooth, most commonly one of the permanent maxillary incisors or a maxillary or mandibular premolar, resulting from local infection or trauma
intrauterine infection (congenital syphilis , rubella virus )
vitamin deficiency (A, C, or D)
hypocalcemia (malabsorption in celiac disease , [Ca²⁺ and F^-]_{regional water => foods}, vitamin D–resistant rickets, hypoparathyroidism)
prematurity
high fever
rare inherited defects (amelogenesis imperfecta)
tetracycline , given in sufficiently high doses during the first 8 years, may produce enamel hypoplasia and discoloration.

artificial feeding replacing breastfeeding

baby bottle tooth decay (BBTD) / early childhood caries (ECC) : decay in infants and children, most often affecting the upper front teeth, caused by sweetened liquids (Suc, Frc, Glc, Mal, Lac) given and left clinging to the teeth for long periods (e.g. in feeding bottles or pacifiers covered with honey, syrups).

hypothyroidism
infections :

congenital infections (Treponema pallidum subsp. pallidum, Mycobacterium tuberculosis , rubella virus , ...)
bacteria which lyse organic matrix (aminopeptidases), degrade PP_i (pyrophosphatases), and digest dietary sugars (glycosidases) and use monosaccharides to build their capsules (glycosyltransferases).

Actinomyces viscosus (uses glucose)
Lactobacillus acidophilus
Lactobacillus casei
Lactobacillus salivarius
Streptococcus criceti
Streptococcus milleri
Streptococcus mitis
Streptococcus mutans (uses sucrose; facoltative anaerobe)
Streptococcus salivarius
Streptococcus sanguinis
Prevotella melaninogenica
Treponema denticola

parotitis

Pathogenesis

exogenous theories

acidogenic theory / Miller chemoparasitary theory (1889) : lactic acid produced by bacteria is kept in situ by the plaque, cannot be diluted by saliva and causes localized destruction of calcified tissue (demineralization) initiated on the tooth surface by decalcification of the enamel of the teeth (enamel caries), followed by enzymatic lysis of organic structures, leading to cavity / carious lesion formation that, if left unchecked, penetrates the enamel and dentin and may reach the pulp
Gottlab proteolytic theory : microorganisms destroy enamel protein (amounting to 0.3-0.4% of whole tooth) first
Heggers-Lura enzymatic theory
proteolysis-chelation theory : keratolytic microorganisms cause formation of chelates, which in turn cause decalcification.

mixed theories : Beretta trophomicrobic theory

Eburnation of dentin

Localization

primary dental caries : dental caries in which the lesion constitutes the initial attack on the tooth surface.

rampant dental caries : dental caries that involve several teeth, appear suddenly, and often progress rapidly destroying crown and causing fractures
pit caries : dental caries originating in pits or fissures, usually of the occlusal surfaces of molars and premolars or on the lingual surfaces of the maxillary incisors, typically occurring as a deep cavity with a narrow point of penetration.
Dubreuil-Chambardel's syndrome : dental caries of the incisors, in most instances only the upper ones, usually appearing during adolescence; within a few years the teeth are irreparably damaged. Some authorities do not consider this syndrome a legitimate entity.

secondary dental caries : dental caries occurring around the edges and under restorations

Progression :

enamel caries (asymptomatic)

cemental caries : dental caries that involves the cementum of a tooth

cavitation

dentinal caries (2-4 years after eruption) : dental caries that spreads along the dentinoenamel junction and involves dentinal tubules

pulpitis
backward or internal caries : dental caries that progresses backward from the dentinoenamel junction into the enamel
lateral caries : dental caries that extends laterally at the dentinoenamel junction

Streptococcus mutans

acute pulpitis

Grading :

evolution

nonpenetrating caries

I : enamel
II : enamel + dentin

penetrating caries : enamel + dentin + pulp

III : vital pulp
IV : necrotic pulp

Black's classification : a classification of dental caries into five groups on the basis of similarity of treatment required

I : cavities occurring in pit and fissure defects in occlusal surfaces of bicuspids and molars, lingual surfaces of upper incisors, and facial and lingual grooves sometimes found on occlusal surfaces of molar teeth.
II : cavities in proximal surfaces of bicuspids and molars.
III : cavities in proximal surfaces of incisors and cuspids not requiring removal of incisal angle.
IV : cavities in proximal surfaces of incisors and cuspids that require removal of incisal angle.
V : cavities in gingival third of labial, lingual, or buccal surfaces.
VI (not a true Black classification) : cavities in incisal edges and smooth surfaces of teeth above the height of contour

Symptoms & signs

dyslalia

Laboratory examinations

explorer

Indexes

DEF rate : an expression of dental caries experience in deciduous teeth: calculated by adding number of decayed primary teeth requiring filling (D), decayed primary teeth requiring extraction (E), and primary teeth successfully filled (F); missing primary teeth are not included in the calculation
DMF rate (in deciduous teeth : dmf) : an expression of the condition of the teeth based on the number of teeth decayed, missing, indicated for removal and of those filled or bearing restorations: calculated by adding the number of carious permanent teeth requiring filling (D), carious permanent teeth requiring extraction (Mr), permanent teeth previously extracted because of caries (Mp), and permanent teeth filled (F) Number of DMF teeth per child of a specific age or age group is calculated by the formula: [D + Mr + Mp + F] / number of children examined. DMF = 72% in Italy (peaks at age 8 and puberty)
in a given surface (S)
in a given tooth (T)

Prevention :

scaling
fluoroprophylaxis
pit and fissure sealant is a liquid denta