Week 18: 22-8-2025

Acromegaly results from excess growth hormone production after the closure of
epiphyseal plates, often due to a pituitary adenoma. Oral manifestations include macroglossia
(enlarged tongue), mandibular enlargement, increased interdental spacing, and Class III
malocclusion. Jaw pain may occur and can improve with treatment of the underlying pituitary
tumor. Hypothyroidism may cause facial puffiness but not jaw enlargement.
Hyperparathyroidism affects bone density rather than growth. Cushing syndrome and diabetes
do not present with these characteristic oral changes.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 474

Addison’s disease (primary adrenal insufficiency) is characterized by adrenocortical
hypofunction, leading to increased ACTH secretion, which stimulates melanocyte activity,
causing hyperpigmentation. This commonly affects the buccal mucosa and skin. Other
symptoms include fatigue, weight loss, and hypotension. Cushing syndrome is associated with
a "moon face" and oral candidosis, not hyperpigmentation. Hyperparathyroidism,
hypothyroidism, and diabetes do not typically present with mucosal pigmentation.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 474

If conservative measures fail, the next step is occlusal splint therapy, which helps
reduce bruxism, alleviate joint loading, and improve disc positioning. Other options such as
arthroscopy, Botox, or joint replacement are considered only in refractory cases.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 486

The patient’s symptoms of preauricular pain, clicking, and limited mouth opening
(trismus) suggest TMJ dysfunction. Internal derangement occurs when the articular disc is
displaced, leading to clicking and, in some cases, locking. Parotid gland infection (A) would
present with swelling and tenderness, trigeminal neuralgia (C) causes episodic electric shock
like pain, mandibular fracture (D) is associated with trauma, and osteoarthritis (E) is a
degenerative joint disease usually affecting older patients.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 484

RAS is characterized by recurrent, painful, shallow ulcers on non-keratinized
mucosa, such as the buccal and labial mucosa. These ulcers heal completely between
episodes and are not associated with systemic symptoms. Unlike herpetic stomatitis, RAS
ulcers are not preceded by vesicles. Erythema multiforme typically involves widespread
mucocutaneous lesions, and oral lichen planus presents with a lacy, reticular pattern rather
than isolated ulcers. Traumatic ulceration is usually associated with a clear history of local
trauma.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 482

Any oral ulcer that persists for more than three weeks must be investigated for
potential malignancy, including squamous cell carcinoma (SCC). Pain is often a late feature of
oral cancer, so a painless ulcer should not be ignored. Biopsy and specialist referral are
essential for an accurate diagnosis and early management. Other options, such as topical
corticosteroids or antifungal treatment, are inappropriate without a definitive diagnosis.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 482

Kaposi’s sarcoma (KS) is the most common malignancy in HIV-positive patients and
is associated with human herpesvirus-8 (HHV-8). It presents as erythematous to purplish
macules or nodules, commonly affecting the palate and skin. It is considered pathognomonic
for AIDS in young males who are not on immunosuppressive therapy. Treatment includes
radiotherapy, intralesional vincristine, or surgical excision, depending on the extent of the
disease.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 478

Hairy leukoplakia is strongly associated with HIV and caused by Epstein-Barr virus
(EBV). It presents as bilateral, white, non-removable, corrugated lesions on the lateral tongue.
Unlike oral candidiasis, it does not respond to antifungal treatment. It is a predictor of disease
progression and may indicate worsening immunosuppression. Treatment with aciclovir or
valaciclovir can lead to temporary resolution, but lesions may recur once the medication is
discontinued.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 478

Leukemia can cause gingival swelling, spontaneous bleeding, petechiae, and an
increased risk of infections due to reduced immune function. Gingival hypertrophy is
particularly common in acute myeloid leukemia (AML).
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 472

Iron deficiency anemia is strongly associated with oral manifestations such as
atrophic glossitis (burning tongue), angular cheilitis, and mucosal pallor. The patient’s fatigue
and pallor further support this diagnosis.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 472

Oral lichen planus is a chronic inflammatory condition affecting the mucosa, with a
characteristic reticular (lacy) pattern, commonly seen bilaterally on the buccal mucosa.
Histopathology shows hyperparakeratosis, saw-tooth rete ridges, and a dense subepithelial
lymphocytic infiltrate. Unlike leukoplakia, which presents as white patches with potential
malignant transformation, oral lichen planus has a typical lace-like appearance and may persist
for years. Asymptomatic cases usually require reassurance, while symptomatic erosive types
may need topical steroids.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 468

Atypical facial pain is often psychogenic, seen predominantly in middle-aged
women, and is characterized by vague, shifting pain descriptions that do not follow nerve
distributions. It may be associated with psychiatric comorbidities like depression.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 465

Temporal arteritis (giant cell arteritis) commonly presents with temporal or frontal
headache, jaw claudication (pain when chewing), tenderness over the temporal artery, and an
elevated ESR. It is a serious condition due to the risk of vision loss.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 464

Trigeminal neuralgia is characterized by sudden, severe, electric shock-like pain
along the distribution of the trigeminal nerve, often triggered by mild stimuli. It typically affects
patients over 50 years of age, with a higher prevalence in females.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 464

A painless, slow-growing mass in the parotid gland is most likely a pleomorphic
salivary adenoma. Surgical excision with superficial parotidectomy is the treatment of choice to
prevent recurrence and malignant transformation. FNAB may help in initial diagnosis but is not
the definitive treatment.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 460

Sialorrhoea is often due to impaired swallowing rather than excessive saliva
production. Botulinum toxin injections into the salivary glands provide a temporary but effective
reduction in saliva production, making it a preferred treatment for patients with neurological
conditions.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 458

Secondary Sjögren syndrome is associated with autoimmune diseases such as
rheumatoid arthritis and is characterized by xerostomia, keratoconjunctivitis sicca, and
autoimmune markers like SSA and SSB antibodies. Primary Sjögren syndrome lacks an
associated connective tissue disorder.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 460

Acute bacterial sialadenitis commonly occurs due to obstruction of the salivary duct
by a stone (sialolithiasis), leading to secondary infection. The submandibular gland is the most
frequently affected, and treatment includes hydration, antibiotics, and removal of the stone.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 458

Pleomorphic salivary adenoma (PSA) is the most common benign tumor of the
salivary glands, particularly affecting the parotid gland. It has a mixed histological appearance
and a high recurrence risk if not excised with adequate margins.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 460

Recurrent parotitis of childhood is a condition with unknown etiology, presenting
with repeated episodes of unilateral parotid swelling in children aged 5–9 years. It improves with
antibiotics and usually resolves by puberty. EBV has been implicated as a possible causative
factor.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 459

Xerostomia, or dry mouth, can have multiple causes, but the most common is
medication-induced, particularly due to anticholinergic and sympathomimetic drugs. Other
causes include Sjögren syndrome, radiation therapy, and systemic conditions, but drug-related
xerostomia is the most prevalent.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 458

Hairy tongue results from elongation of the filiform papillae, leading to a
characteristic dark, hairy appearance. It is associated with smoking, poor oral hygiene, and
hyposalivation. Treatment involves improving oral hygiene, tongue scraping, and lifestyle
changes.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 454

Melkersson–Rosenthal syndrome is a rare neurological disorder characterized by a
triad of recurrent facial nerve palsy, chronic lip/facial swelling, and a deeply fissured tongue. It is
distinct from Sjögren syndrome, which primarily affects salivary and lacrimal glands, and
Kawasaki disease, which presents with systemic vasculitis.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 454

Ankyloglossia (tongue tie) is a condition where the lingual frenulum is abnormally
short or thick, restricting tongue movement. This can affect breastfeeding in infants. The
recommended treatment for symptomatic cases is a frenectomy, which involves the surgical
division of the frenulum to improve mobility and function. Studies suggest that frenectomy
leads to significant improvement in breastfeeding.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 454

Oral submucous fibrosis is a progressive condition seen in individuals with a history
of areca nut (betel nut) chewing. It leads to fibrosis, trismus, and carries a significant risk of
malignant transformation (~10% in 10–15 years).
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 451

A biopsy is the gold standard for diagnosing premalignant oral lesions. Toluidine blue
can help in selecting the most appropriate area for biopsy. Empirical treatments or waiting
periods without a definitive diagnosis may delay necessary interventions.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 450

The floor of the mouth and the ventral surface of the tongue are considered high-risk
sites for malignant transformation in leukoplakia. Studies indicate that >25% of lesions in the
f
loor of the mouth may progress to carcinoma. The hard palate and buccal mucosa are
relatively lower-risk sites.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 450

Hyperkeratosis without atypia is a benign feature and does not indicate epithelial
dysplasia. The key features of dysplasia include increased nuclear-to-cytoplasmic ratio,
pleomorphism, atypical mitoses, and nuclear hyperchromatism, all of which suggest a risk of
malignant transformation.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 450

Erythroplakia has the highest malignant transformation potential, with studies
showing that at least 85% of these lesions are carcinoma in situ or frank carcinoma.
Leukoplakia has a lower transformation rate (~12.1%), while oral submucous fibrosis has a 10%
risk over 10–15 years. Erosive lichen planus has an unproven but minimal risk, and dyskeratosis
congenita carries a potential risk but is rare.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 450

Oral malignant melanoma is a rare but aggressive malignancy that typically presents
as an irregularly pigmented lesion with asymmetry, uneven borders, and color variation. It has a
poor prognosis and requires urgent biopsy and treatment.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 448

Addison’s disease is characterized by adrenal insufficiency leading to increased
ACTH production, which stimulates melanocytes, causing diffuse pigmentation of the oral
mucosa. It can be an early sign of the disease and should prompt further endocrine evaluation.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 448

Peutz–Jeghers syndrome is a genetic disorder characterized by mucocutaneous
pigmentation and gastrointestinal polyposis. The perioral and intraoral pigmented macules are
a key diagnostic feature, and patients have an increased risk of gastrointestinal malignancies.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 448

Kaposi’s sarcoma is an HHV-8-related vascular tumor commonly seen in
immunocompromised individuals, particularly those with HIV/AIDS. It presents as red, purple,
or dark plaques or nodules, most commonly affecting the hard palate and gingiva.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 448

Amalgam tattoo is the most common cause of localized oral mucosal pigmentation.
It appears as a well-defined blue-black macule and results from the implantation of amalgam
particles, often at the time of dental restoration. It is typically radio-opaque on radiographs,
helping differentiate it from other pigmented lesions.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 448

Erythema multiforme major is often triggered by medications or infections and
presents with widespread target lesions, severe mucosal involvement, and systemic symptoms.
Stevens-Johnson syndrome and toxic epidermal necrolysis represent severe forms of this
condition.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 445

Epidermolysis bullosa simplex is an inherited disorder due to mutations in keratin 5
and 14, leading to intraepidermal blistering following minor trauma. Unlike dystrophic forms, it
does not typically cause scarring.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 443

Hailey-Hailey disease (benign familial chronic pemphigus) is an autosomal
dominant condition due to mutations in ATP2C1, affecting keratinocyte adhesion. It typically
presents in young adults with recurrent vesicles that rupture easily.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 442

Mucous membrane pemphigoid often affects the conjunctiva, leading to scarring
and potential vision loss. Pemphigus vulgaris, in contrast, predominantly involves the oral
mucosa with fragile bullae that rupture easily.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 442

Direct immunofluorescence is the gold standard test for pemphigus vulgaris. It
shows intercellular IgG and C3 deposition within the epithelium. Indirect immunofluorescence
can also detect circulating antibodies but is less specific.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 442

Pemphigus vulgaris commonly presents with oral lesions as the initial
manifestation. The blisters are fragile and rupture easily, leaving painful erosions. A positive
Nikolsky sign (where gentle rubbing of the mucosa induces blistering) is characteristic.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 442

Pemphigus vulgaris is characterized by acantholysis, which is the loss of cohesion
between keratinocytes due to autoantibodies targeting desmoglein-1 and desmoglein-3. This
leads to intraepithelial blister formation.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 442

Angular cheilitis is a mixed infection involving Candida and bacteria, commonly
associated with nutritional deficiencies such as iron and vitamin B12. Investigating haematinics
is essential in persistent cases.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

: Inhaled corticosteroids can predispose to oral candidosis. Patients should be
advised to rinse their mouth or use a spacer to reduce mucosal deposition of the drug, thereby
minimizing fungal overgrowth.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

Chronic hyperplastic candidosis presents as persistent white patches that cannot
be wiped off and carry a risk of malignant transformation. Systemic antifungal treatment (e.g.,
f
luconazole) is indicated, along with addressing underlying risk factors such as diabetes.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

Erythematous candidosis presents as red, painful, atrophic mucosa, often following
antibiotic or steroid use. Unlike pseudomembranous candidosis, it lacks white plaques and is
associated with discomfort exacerbated by spicy foods.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

While systemic conditions like diabetes, immunosuppression, and smoking
contribute to oral candidosis, antihypertensive medications are not a common risk factor.
Broad-spectrum antibiotics, denture use, and corticosteroid therapy increase susceptibility to
Candida infections.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

Pseudomembranous candidosis (thrush) is characterized by white, easily
detachable plaques on the oral mucosa, commonly affecting immunocompromised and elderly
individuals. Unlike chronic hyperplastic candidosis, the lesions in thrush can be wiped off,
revealing an erythematous base.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

Candida albicans is the most common species associated with oral candidosis.
While other species such as C. glabrata and C. tropicalis can also be involved, C. albicans is the
predominant cause of oral infections.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 438

Hand, foot, and mouth disease is caused by Coxsackie virus A16 and presents with
vesicular lesions on the hands, feet, and oral mucosa, along with fever. It differs from
herpangina, which affects only the posterior oral cavity.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 435

Tertiary syphilis can cause gumma formation, a granulomatous lesion that can
enlarge, ulcerate, and lead to tissue destruction, often affecting the palate or tongue.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 433

Oral gonorrhea can present as non-specific stomatitis, pharyngitis, and purulent
gingivitis. Neisseria gonorrhoeae appears as Gram-negative intracellular diplococci on
microscopy.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 433

Primary herpes simplex virus (HSV) infection often presents as widespread painful
oral ulcers, fever, gingival involvement, and systemic symptoms. It is common in young adults
and children.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 434

A firm, painless ulcer (chancre) on the lip suggests primary syphilis, caused by
Treponema pallidum. Dark-field microscopy can directly visualize the spirochetes from the
ulcer exudate.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 432

Oral tuberculosis (TB) is rare but can present as a deep, painful ulcer, particularly in
immunocompromised patients. Histopathological findings include necrotizing granulomas and
Langhans giant cells. PCR is a definitive diagnostic test for TB.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 432

Scarlet fever is caused by Streptococcus pyogenes and presents with a
characteristic red rash and "strawberry tongue," where the dorsum of the tongue is coated white
with prominent red papillae. It primarily affects children aged 4–8 years.
Source : oxford handbook of clinical dentistry 7th edition-chapter 11-page 432