8: Oral Pathology

Oral Pathology

Dental hygienists perform comprehensive extraoral and intraoral examinations, identify pathologic conditions, and communicate these findings to the dentist for diagnosis, treatment, or referral. Knowledge of oral pathology affects infection control, managing the risk of emergencies, and developing dental hygiene care plans congruent with the patient’s health status and needs. The dental hygienist differentiates between normal and abnormal findings and relates significant health, dental, and cultural histories to clinical, radiographic, and histologic findings. Although the dental hygienist is not responsible for the dental diagnosis, skill in the use of the diagnostic process is essential for the dental hygiene diagnosis and collaborative practice.

Benign Lesions of Soft Tissue Origin

Irritative Fibroma (or Traumatic Fibroma) (see Figure 8-1)


Etiology—benign lesion of squamous epithelium; long duration; slow development

Age and gender related—may arise at any age, but there is a 50% incidence between ages 20 and 50 years; no gender predilection

Location—soft palate or tongue

Clinical features (Figure 8-2, A)

Histologic characteristics (see Figure 8-2, B)

Treatment and prognosis

Verruca Vulgaris (Wart)

Etiology—benign viral induced lesion of stratified squamous epithelium; caused by human papilloma virus (HPV)

Age and gender related—more common in children; but lesions have also been identified in adults; no gender predilection

Location—common skin lesion; lips are the most common intraoral site; can also be found on the tongue or mucosa

Clinical features (Figure 8-3, A and B)

Histologic characteristics

Treatment and prognosis


Etiology—congenital or developmental origin; when found in adults, these lesions develop as a response to trauma during the healing stages; a benign proliferation of blood capillaries

Age and gender related—lesions present at birth or develop shortly thereafter; more common in females (3 : 1); occur in adults as a response to trauma

Location—most common on the tongue; also found on the buccal mucosa, labial mucosa, and the vermilion of lips

Clinical features (Figure 8-4, A)

Histologic characteristics (see Figure 8-4, B)

Treatment and prognosis

Prognosis is good


Etiology—unknown; rare; benign tumor of mature fat cells

Age and gender—over 40 years; no gender predilection

Location—most common on the buccal mucosa or in the mucobuccal fold

Clinical features (Figure 8-5, A)

Histologic characteristics (see Figure 8-5, B)

Treatment and prognosis

Inflammatory Tumors (Granulomas)

Pyogenic Granuloma

Etiology—an exuberant tissue response to chronic irritants or trauma (i.e., plaque biofilm, calculus, poor restorative margins, hormonal levels)

Age and gender related—children and young adults; more common in females (3 : 1), perhaps related to an increase in estrogen levels

Location—much more common on the maxillary labial gingiva than mandibular gingiva; can occur on the lips, tongue, and buccal mucosa

Clinical features (Figure 8-6)

Histologic characteristics

Treatment and prognosis

Papillary Hyperplasia of the Palate (Palatal Papillomatosis)

Etiology—type of denture stomatitis; chronic irritation to the vault of the hard palate related to an ill-fitting denture (full or partial); excessive pressure of an ill-fitting denture; poor denture hygiene (secondary); can also be associated with an orthodontic appliance; wearing the prosthetic device 24 hours a day

Age and gender related—no gender predilection

Location—especially—in vault of the hard palate in maxillary denture wearers (suction chamber area)

Clinical features (Figure 8-7)

Histologic characteristics



Denture-Induced Fibrous Hyperplasia (Epulis Fissuratum, Inflamatory hyperplasia)

Etiology—irritation caused by a denture flange, which produces a proliferation of tissue in the vestibule along the denture boarder

Age and gender related—denture wearers; no gender predilection

Location—vestibule along denture border; alveolar ridge in regions along the denture border

Clinical features (Figure 8-8)

Histologic characteristics

Treatment and prognosis

Peripheral Giant Cell Granuloma

Etiology—a reactive lesion caused by local irritants

Age and gender related—40 to 60 years; more common in females (2 : 1)

Location—gingiva or alveolar process, anterior to molars

Clinical features (Figure 8-9, A)

Radiographic appearance—this soft tissue lesion can cause superficial destruction of alveolar bone

Histologic characteristics (see Figure 8-9, B)

Treatment and prognosis

Central Giant Cell Granuloma

Etiology—occurs within bone; trauma caused by a fall, blow, or tooth extraction

Age and gender related—children and young adults; more common in females (2 : 1) age 10–30 years

Location—75% in the anterior segment of the mandible; also found in the maxilla

Clinical features

Radiographic appearance (Figure 8-10, A and B)

Histologic characteristics

Treatment and prognosis

Chronic Hyperplastic Pulpitis (Pulpal Granuloma, Pulp Polyp)

Etiology—excessive proliferation of inflamed pulp tissue found in teeth with large open carious lesions; rapid caries; lesion projects from the pulp chamber

Age and gender related—children and young adults; no gender predilection


Clinical features (Figure 8-11)

Histologic characteristics

Treatment and prognosis

Internal Resorption

Etiology—not clear; theories include:

Age and gender related—any age; no gender predilection

Location—usually found within a tooth in the permanent dentition

Clinical features

Radiographic appearance well defined, but radiolucent lesion in close proximity to the pulp canal (Figure 8-12)

Histologic characteristics—highly vascularized chronic inflammatory tissue

Treatment—endodontic therapy if perforation of the root has not occurred; otherwise, extraction of the tooth is performed

Periapical Granuloma

Etiology—dental caries or deep restorations

Age and gender related—any age; no gender predilection

Location—apex of a nonvital tooth

Clinical features

Radiographic appearance—varies from a well-defined, circular, radiolucent lesion at the apex of the involved tooth to a diffuse radiolucency or thickening of the periodontal ligament space (Figure 8-13, A)

Histologic characteristics (see Figure 8-13, B)

Treatment—endodontic therapy or extraction of the affected tooth

Benign Intraosseous Neoplasms


Etiology—asymptomatic benign tumor of compact bone; etiology generally unknown, but the cause may be irritation or inflammation; associated with a genetic condition called Gardner syndrome

Age and gender related—more common in young adults but can be found at any age; no gender predilection

Location—most common posterior mandible; mandibular condyle; craniofacial skeleton

Clinical features—the affected individual may be unaware of the lesion because it grows slowly; considerable growth must occur before cortical plates expand

Radiographic appearance—well-circumscribed radiopaque mass that is indistinguishable from scar bone; panoramic or lateral plate radiograph may be needed to view the lesion in its entirety (Figure 8-14)

Histologic characteristics—extremely dense, compact bone or coarse, cancellous bone

Treatment and prognosis


Etiology—benign tumors of hyaline cartilage; cause unknown

Age and gender related—ages 30 to 40 years; no gender predilection


Clinical features

Radiographic appearance—irregular radiolucent or mottled area in bone; may displace surrounding teeth or cause root resorption

Histologic characteristics

Treatment and prognosis

Odontogenic Myxoma

Etiology—unknown; benign; originates from mesenchymal tissue of the tooth germ

Age and gender related—most often in young adults (ages 10 to 30 years); no gender predilection

Location—mandible more often than maxilla

Clinical features—deeply situated lesion; small lesions asymptomatic

Radiographic appearance (Figure 8-15)

Histologic characteristics

Treatment and prognosis


Torus Palatinus

Etiology—inherited, autosomal dominant; some believe the cause to be genetic or environmental factors

Age and gender related—usually seen by the age of puberty; rarely observed in children, but peak incidence occurs before 30 years; more common in females (2 : 1)

Location—midline of the hard palate

Clinical features (Figure 8-16, A)

Radiographic appearance—dense radiopaque area

Histologic characteristics—dense cortical bone

Treatment—usually none, but surgical removal if the lesion interferes with a prosthodontic appliance


Etiology—most common odontogenic tumor composed of all tooth structure and pulp but not considered a neoplasm

Age and gender related—usually seen in adolescents and young adults (mean age 14 years); no gender predilection

Location—more frequently seen in the maxilla (especially the anterior maxilla for the compound type) than in the mandible; usually between the roots of teeth or near apices; complex odontomas seen more often in the posterior of the mandible

Clinical features

Radiographic appearance—irregular mass of radiopacities (“tooth-like structures”) surrounded by a narrow radiolucent halo

Histologic characteristics—tumor in which epithelial and mesenchymal cells show differentiation, resulting in abnormal enamel and dentin formation

Treatment and prognosis

Gingival Fibromatosis

Hereditary Gingival Fibromatosis (Gingival Lesions of Genetic Origin)

Etiology (see the section on “Genetics” in Chapter 7)

Age and gender related—appears during the eruption of primary or permanent teeth; slightly more common in females

Location—excessive enlargement of interproximal gingival tissues; can be localized

Clinical features

Histologic characteristics—bundles of fibrous connective tissue with fibroblasts and fibrocytes (depending on the formative stage)

Treatment and prognosis

Chemical Fibromatosis (Drug-influenced Gingival Enlargement)

Etiology—reaction to drugs, specifically phenytoin (Dilantin); calcium channel blockers including nifedipine (Procardia), amlodipine (Norvasc), diltiazem (Cardizem), and verapamil (Calan); cyclosporin, an immunosuppressant drug given in association with organ transplants

Age and gender—no gender predilection

Location—papillae and gingivae

Clinical features—smooth, pink, firm enlargement of the papillae (Figure 8-19)

Histologic characteristics—extensive proliferation of connective tissue


Stay updated, free dental videos. Join our Telegram channel

Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 8: Oral Pathology

VIDEdental - Online dental courses

Get VIDEdental app for watching clinical videos