Oral Medicine Multiple Choice Question And Answers

Multiple Choice Questions

Question 1. Oral hairy leukoplakia involves:
1. Lateral border of tongue
2. Dorsal surface of tongue
3. Posterior 1/3rd of tongue
4. Ventral surface of tongue

Answer. 1. Lateral border of tongue

Question 2. Target lesions are seen in:
1. Pemphigus vulgaris
2. Erythema multiforme
3. Syphilis
4. Herpes zoster infection

Answer. 2. Erythema multiforme

Question 3. Macroglossia is seen in:
1. Meckel’s syndrome
2. Cleft lip and palate
3. Fetal face syndrome
4. Happy puppet syndrome

Answer. 4. Happy puppet syndrome

Question 4. Jone criteria of diagnosis is used for:
1. Infective endocarditis
2. Rheumatic fever
3. Subacute bacterial endocarditis
4. Hypertension

Answer. 3. Subacute bacterial endocarditis

Read And Learn More: Oral Medicine Question And Answers

Question 5. “Butterfly rash” is a characteristic feature of facial cutaneous lesion of:
1. Lichen planus
2. Systemic lupus erythematosus
3. Psoriasiform lesions
4. Erythema multiforme

Answer. 2. Systemic lupus erythematosus

Question 6. Sharp, shooting, lancinating and paroxysmal pain is a feature of:
1. Burning mouth syndrome
2. Atypical facial pain
3. Trigeminal neuralgia
4. Postherpetic neuralgia

Answer. 3. Trigeminal neuralgia

Question 7. Abnormal increase in number of red blood cells is known as:
1. Polycythemia
2. Anemia
3. Leukemia
4. Agranulocytosis

Answer. 1. Polycythemia

Question 8. Oral melanotic macule is:
1. Red colored
2. Brown-black colored
3. Purple colored
4. Yellow colored

Answer. 2. Brown-black colored

Question 9. Cracked mud appearance is seen in:
1. Speckled leukoplakia
2. Atrophic candidiasis
3. Bullous lichen planus
4. Homogeneous leukoplakia

Answer. 4. Homogeneous leukoplakia

Question 10. One of the oral manifestations of diabetes is:
1. Median rhomboid glossitis
2. Geographic tongue
3. Black hairy tongue
4. Benign migratory glossitis

Answer. 1. Median rhomboid glossitis

Question 11. Elevated blister like lesion less than 1 cm in diameter containing clear fluid is:
1. Nodule
2. Vesicle
3. Bulla
4. Pustule

Answer. 2. Vesicle

Question 12. Actinic keratosis is caused by:
1. Betel nut chewing
2. Tobacco chewing
3. Smoking
4. Exposure to sun

Answer. 4. Exposure to sun

Question 13. Contact allergy is most accurately diagnosed by:
1. Penny test
2. Pathergy test
3. Patch test
4. Tuberculin test

Answer. 3. Patch test

Question 14. Necrotizing ragged ulceration with no apparent inflammatory response is indicative of:
1. Leukocytosis
2. Polycythemia vera
3. Thrombocytosis
4. Agranulocytosis

Answer. 4. Agranulocytosis

Question 15. Oral pigmentation following metal poisoning is due to formation of:
1. Oxide
2. Sulfide
3. Chloride
4. Phosphate

Answer. 2. Sulfide

Question 16. Geographic tongue is also known as:
1. Wandering rash
2. Hairy tongue
3. Hairy leukoplakia
4. Fissured tongue

Answer. 1. Wandering rash

Question 17. Definitive diagnosis for oral squamous cell carcinoma is done by:
1. Aspiration cytology
2. Exfoliative cytology
3. Brush biopsy
4.  Incisional biopsy

Answer. 4. Incisional biopsy

Question 18. Brown tumor is seen in:
1. Hyperpituitarism
2. Hyperthyroidism
3. Hyperparathyroidism
4. Hypoparathyroidism

Answer. 3. Hyperthyroidism

Question 19. Wickham’s striae are associated with:
1. Leukoplakia
2. Candidiasis
3. Oral lichen planus
4. Oral submucous fibrosis

Answer. 3. Oral lichen planus

Question 20. Most common complication of phenytoin or dilantin is:
1. Xerostomia
2. Ataxia
3. Gingival enlargement
4. Urticaria

Answer. 3. Gingival enlargement

Question 21. “Butterfly rash” is the characteristic feature of facial cutaneous lesion of:
1. Lichen planus
2. Systemic lupus erythematosus
3. Psoriasiform lesions
4. Erythema multiforme

Answer. 2. Systemic lupus erythematosus

Question 22. Aphthous ulcer more than l cm in diameter is seen in:
1. Mikuliz disease
2. Cook’s disease
3. Hand foot mouth disease
4. Sutton’s disease

Answer. 4. Sutton’s disease

Question 23. Definitive diagnosis for oral squamous cell carcinoma is done by:
1. Aspiration cytology
2. Exfoliative cytology
3. Brush biopsy
4. Incisional biopsy

Answer. 4. Incisional biopsy

Question 24. Sialolith is most common with:
1. Parotid gland
2. Sub-mandibular gland
3. Sub-lingual gland
4. Von Ebner’s gland

Answer. 2. Sub-mandibular gland

Question 25. Causative organism for herpangina is
1. Coxsackie virus
2. Herpes zoster virus
3. Human herpes virus
4. Cytomegalovirus

Answer. 1. Coxsackie Virus

Question 26. Cracked mud appearance is seen in:
1. Speckled leukoplakia
2. Atrophic candidiasis
3. Bullous lichen planus
4. Homogeneous leukoplakia

Answer. 4. Homogeneous leukoplakia

Question 27. Histologically pemphigus shows:
1. Acanthosis
2. Acantholysis
3. Keratin pearl
4. Civatte bodies

Answer. 2. Acantholysis

Question 28. Blue sclera, brittle bone, opalescent dentin is a sign of:
1. Osteogenesis imperfecta
2. Paget’s disease
3. Marfan’s syndrome
4. Osteopetrosis

Answer. 1. Osteogenesis imperfecta

Question 29. Mumps is caused by
1. Cytomegalovirus
2. Herpes simplex virus
3. Paramyxovirus
4. Epstein-Barr virus

Answer. 3. Paramyxovirus

Question 30. Plumbism is due to:
1. Mercury poisoning
2. Bismuth poisoning
3. Silver poisoning
4. Lead poisoning

Answer. 4. Lead poisoning

Question 31. Contact allergy is most accurately diagnosed by:
1. Rose Bengal test
2. Pathergy test
3. Patch test
4. Diascopy test

Answer. 3. Patch test

Question 32. Causative organism for hand, mouth and foot disease is:
1. Herpes zoster virus
2. Coxsackie virus
3. Human herpes virus
4. Cytomegalovirus

Answer. 2. Coxsackie virus

Question 33. Café-au-lait pigmentation is seen in patient with:
1. Hemangioma
2. Neurofibromatosis
3. Kaposi’s sarcoma
4. Cherubism

Answer. 2. Neurofibromatosis

Question 34. Nikolsky’s sign is seen in:
1. Erythema multiforme
2. BehÇet’s syndrome
3. Pemphigus vulgaris
4. Allergic stomatitis

Answer. 3. Pemphigus vulgaris

Question 35. Thrush is also known as:
1. Acute pseudomembranous candidiasis
2. Chronic hyperplastic candidiasis
3. Chronic mucocutaneous candidiasis
4. Acute atrophic candidiasis

Answer. 1. Acute pseudomembranous candidiasis

Question 36. Abnormal increase in number of red blood cells is known as:
1. Agranulocytosis
2. Leukemia
3. Anemia
4. Polycythemia

Answer. 4. Polycythemia

Question 37. The cyst with high recurrence rate is:
1. Odontogenic keratocyst
2. Adenomatoid odontogenic cyst
3. Radicular cyst
4. Dentigerous cyst

Answer. 1. Odontogenic keratocyst

Question 38. Laskin’s cardinal sign involves the following features except:
1. Unilateral pain in preauricular area
2. Muscle tenderness
3. Masticatory muscle spasm
4. Limited jaw movements

Answer. 3. Masticatory muscle spasm

Question 39. The absence of clavicle is seen in:
1. Cleidocranial dysplasia
2. Osteogenesis imperfecta
3. Sturge Weber syndrome
4. Ectodermal dysplasia

Answer. 1. Cleidocranial dysplasia

Question 40. Epstein-Barr virus has been implicated in etiology of:
1. Oral lichen planus
2. Oral hairy leukoplakia
3. Oral black hairy tongue
4. Oral melanoplakia

Answer. 2. Oral hairy leukoplakia

Question 41. The basic defect in hairy tongue is hypertrophy of:
1. Filiform papilla
2. Foliate papilla
3. Fungiform papilla
4. Circumvallate papilla

Answer. 1. Filiform papilla

Question 42. Primary infection with vericella zoster virus is:
1. Infectious mononucleosis
2. Chickenpox
3. Shingles
4. Herpes labialis

Answer. 2. Chickenpox

Question 43. Melanin pigmentation seen in pregnancy is called as:
1. Melasma
2. Melanoma
3. Ephelis
4. Macule

Answer. 1. Melasma

Question 44. Homogeneous leukoplakia gives:
1. Speckled appearance
2. Atrophic appearance
3. Bullous appearance
4. Cracked mud appearance

Answer. 4. Cracked mud appearance

Question 45. Lacrimal gland function test for diagnosing Sjögren’s syndrome include:
1. Pathergy test
2. Patch test
3. Schirmer’s test
4. Diascopy test

Answer. 3. Schirmer’s test

Question 46. Sharp, shooting, lancinating and paroxysmal pain is a feature of:
1. Burning mouth syndrome
2. Trigeminal neuralgia
3. Atypical facial pain
4. Myofacial pain dysfunction syndrome

Answer. 2. Trigeminal neuralgia

Question 47. Solid lesion raised above the skin surface, over 1 cm in diameter is called as:
1. Macule
2. Plaque
3. Papule
4. Nodule

Answer. 2. Plaque

Question 48. Abnormal increase in number of red blood cells is known as:
1. Agranulocytosis
2. Leukemia
3. Anemia
4. Polycythemia

Answer. 4. Polycythemia

Question 49. Which of the following is the most common cause of ankylosis of TMJ:
1. Osteoarthritis of TMJ
2. Congenital syphilis
3. Traumatic injury to TMJ
4. Traumatic occlusion

Answer. 3. Traumatic injury to TMJ

Question 50. Strawberry tongue is seen in:
1. Scarlet fever
2. Wegener’s granulomatosis
3. Midline lethal granuloma
4. Sarcoidosis

Answer. 1. Scarlet fever

Question 51. Hairy leukoplakia is caused by:
1. Epstein-Barr virus
2. Fungal infection
3. Bacterial infection
4. Herpes simplex infection

Answer. 1. Epstein-Barr virus

Question 52. Hunter’s glossitis is seen in:
1. Niacin deficiency
2. Vitamin C deficiency
3. Vitamin B12 deficiency
4. Riboflavin deficiency

Answer. 1. Niacin deficiency

Question 53. Intrinsic yellowish discoloration of teeth is due to:
1. High protein diet
2. Erythromycin
3. Penicillin
4. Tetracycline

Answer. 4. Tetracycline

Question 54. Decreased number of circulating platelets is called as:
1. Thrombocytopenia
2. Thrombocytosis
3. Thrombocythemia
4. Multiple myeloma

Answer. 1. Thrombocytopenia

Question 55. In geographic tongue there is desquamation of:
1. Fungiform papillae
2. Filiform papillae
3. Circumvallate papillae
4. Foliate papillae

Answer. 2. Filiform papillae

Question 56. Non-inflammatory, non-neoplastic enlargement of salivary gland is:
1. Sialolith
2. Sialosis
3. Ptyalism
4. Sialorrhea

Answer. 2. Sialosis

Question 57. Contact allergy is most accurately diagnosed by:
1. Penny test
2. Pathergy test
3. Patch test
4. Tuberculin test

Answer. 3. Patch test

Question 58. Which of the following is hereditary white lesion?
1. Leukoedema
2. Leukoplakia
3. Oral lichen planus
4. Oral submucous fibrosis

Answer. 1. Leukoedema

Question 59. Nystatin is a drug of choice for:
1. Lichen planus
2. Leukoplakia
3. Herpangina
4. Candidiasis

Answer. 4. Candidiasis

Question 60. Plicated tongue is a feature of:
1. Melkersson-Rosenthal syndrome
2. Vitamin deficiency
3. Hurler syndrome
4. Pierre-Robin syndrome

Answer. 1. Melkersson-Rosenthal syndrome

Question 61. Ely’s cyst is seen in:
1. Maxillary sinus
2. Maxilla
3. Condyle
4. Coronoid

Answer. 3. Condyle

Question 62. Tzanck smear test is used for:
1. Pemphigus
2. Lichen planus
3. Leukoplakia
4. Aphthous ulcer

Answer. 1. Pemphigus

Question 63. Triamcinolone acetonide is used in the management of:
1. Oral lichen planus
2. Aphthous ulcer
3. OSMF
4. All of the above

Answer. 4. All of the above

Question 64. Which among these have high recurrence rate:
1. Ameloblastoma
2. Radicular cyst
3. Dentigerous cyst
4. Odontogenic keratocyst

Answer. 4. Odontogenic keratocyst

Question 65. Multiple OKCs are seen in:
1. Gardner’s syndrome
2. Gorlin-Goltz syndrome
3. Greenspan syndrome
4. All of the above

Answer. 2. Gorlin-Goltz syndrome

Question 66. Petechiae are seen commonly in:
1. Diabetes mellitus
2. Hepatitis
3. Aplastic anemia
4. Hypothyroidism

Answer. 3. Aplastic anemia

Question 67. High recurrence rate is observed in:
1. Radicular cyst
2. Dentigerous cyst
3. Odontogenic keratocyst
4. Residual cyst

Answer. 3. Odontogenic keratocyst

Question 68. Oral and ocular lesions are seen in:
1. Behcet’s disease
2. OSMF
3. Leukoplakia
4. Scarlet fever

Answer. 1. Behcet’s disease

Question 69. Drug used in xerostomia:
1. Atropine
2. Beta blockers
3. Pilocarpine
4. Hyoscine

Answer. 3. Pilocarpine

Question 70. Tennis racquet appearance is seen in:
1. CGCG
2. Myxoma
3. Ameloblastoma
4. Fibrous dysplasia

Answer. 2. Myxoma

Question 71. Antioxidants do not include:
1. Beta carotene
2. Vitamin D
3. Vitamin C
4. Vitamin E

Answer. 2. Vitamin D

Question 72. Hepatitis B can be transmitted through:
1. Blood transfusion
2. Needle sharing
3. Homosexuals
4. All of the above

Answer. 4. All of the above

Question 73. Nikolsky’s sign can be elicited in the following lesions except:
1. Pemphigus vulgaris
2. Pemphigus vegetans
3. Mucous membrane pemphigoid
4. Epidermolysis bullosa

Answer. 2. Pemphigus Vegetans

Question 74. Complication of diabetes includes the following except:
1. Nephropathy
2. Neuropathy
3. Retinopath
4. Myopathy

Answer. 4. Myopathy

Question 75. Among the odontogenic cysts the most common is:
1. Radicular cyst
2. Dentigerous cyst
3. Odontogenic keratocyst
4. Residual cyst

Answer. 2. Dentigerous Cyst

Fill In The Blanks

Question 1. Most common site for hairy leukoplakia is ……………

Answer. Lateral border of tongue

Question 2. Lyell’s disease is complication of ……………

Answer. Toxic epidermal necrolysis

Question 3. HSV-l causes the lesions of ……………..

Answer. Upper body

Question 4. Hypoacusis, hypomobility of soft palate, VIII nerve neuralgia associated with nasopharyngeal mass is termed as ……………..

Answer. Wegner’s granulomatosis

Question 5. Deep, irregular, foul-smelling oral ulcer devoid of erythematous halo is seen in ……………..

Answer. Fungal infections

Question 6. Snow-driven appearance radiologically is seen in……………..

Answer. Calcifying epithelial odontogenic tumor

Question 7. Dens-in-Dente is most commonly associated with ……………..

Answer. Maxillary lateral incisor

Question 8. Multiple impacted teeth and odontoma are associated with osteoma is seen in ……………..

Answer. Gardner’s syndrome

Question 9. Generalized loss of lamina dura with generalized osteoporosis which is reversible after removal of endocrine tumor is seen in ……………..

Answer. Hyperparathyroidism

Question 10. Ground-glass appearance seen in ……………..

Answer. Paget’s disease

Question 11. Association of hypertension, diabetes mellitus and lichen planus is termed as ……………..

Answer. Gardner’s syndrome

Question 12. Hairy leukoplakia is caused by ……………..

Answer. Epstein-Barr virus

Question 13. Schirmer’s test is used for the diagnosis of ……………..

Answer. Sjögren’s syndrome

Question 14. Malignant tumors arising from mesenchymal tissues are known as ……………..

Answer. Sarcomas

Question 15. Nikolsky’s sign is a clinical feature of which disease……………..

Answer. Pemphigus vulgaris

Question 16. Pel-Ebstein type of fever is characteristic feature of……………..

Answer. Hodgkin’s Disease

Question 17. The serum …………….. level is highly increased in Paget’s disease.

Answer. Alkaline phosphatase

Question 18. …………….. is the drug of choice for the treatment of xerostomia.

Answer. Pilocarpine

Question 19. The most common synonym of infectious mononucleosis……………..

Answer. Glandular fever

Question 20. The…………….. is common screening test in HIV infection/AIDS.

Answer. ELISA

Question 21. Drug of choice for the treatment of trigeminal neuralgia……………..

Answer. Carbamazepine

Question 22. Hairy leukoplakia is caused by…………….. virus.

Answer. Epstein-Barr virus

Question 23. Oral candidiasis is most commonly caused by…………….. Microorganism.

Answer. Fungal

Question 24. Deficiency of vitamin C causes……………..

Answer. Scorbutic gums

Question 25. The most common benign tumor of oral cavity is……………..

Answer. Fibroma

Question 26. The most commonest odontogenic tumor to occur is……………..

Answer. Odontoma

Question 27. Facial paralysis, herpes zoster of face, tinnitus and vertigo are typically seen in……………..

Answer. Post-herpetic syndrome

Question 28. Enlargement of jaws resulting in tightening of dentures is suggestive of……………..

Answer. Paget’s disease

Question 29. Aphthous ulceration, genital lesion, ocular involvement with arthritis is found in ……………..

Answer. Behçet’s Disease

Question 30. The term ghost teeth is synonymus with……………..

Answer. Regional odontodysplasia

Question 31. Hairy leukoplakia is caused by……………..

Answer. Epstein-Barr virus

Question 32. Typical unilateral vesiculobullous lesions which stop at the midline area are seen in……………..

Answer. Secondary varicella zoster or shingles

Question 33. Union of two or more teeth by cementum is known as……………..

Answer. Concrescence

Question 34. Chevostek’s sign is one of the diagnostic features of……………..

Answer. Tetany

Question 35. Reed-Sternberg cell is most commonly associated with……………..

Answer. Non-hodgkin’s lymphoma

Question 36. Oral lichen planus occurs most frequently on …………………..mucosa.

Answer. Buccal

Question 37. Dentigerous cyst is usually associated with ……………………..teeth.

Answer. Impacted

Question 38. ANUG is found in…………………..gingiva. The most common odontogenic cyst is…………………….

Answer. Radicular cyst

Question 39. Taurodontism is associated with………………syndrome. Drug of choice in herpes simplex virus infection is ……………………….

Answer. Acyclovir

Question 40. Mumps is caused by………………. virus

Answer. Paramyxovirus

Question 41. Fothergill’s disease is also called as……………………

Answer. Trigeminal neuralgia

Question 42. Most common benign salivary gland tumor of parotid gland is……………………

Answer. Pleomorphic adenoma

Question 43. Treponema palladium spirochete bacterium causes …………………..

Answer. Syphilis

Question 44. Candidiasis is caused by……………………………..

Answer. Candida albicans

Question 45. Koebner’s phenomenon is a diagnostic feature of…………………………..

Answer. Lupus erythematosus

Question 46. Cyst associated with a non-vital tooth is called as…………………………

Answer. Radicular cyst

Question 47. The most common odontogenic tumor of head and neck area is…………………

Answer. Ameloblastoma

Question 48. The teeth with the longest root is……………………..

Answer. Canine

Question 49. Herpes infection above the waist is caused by………………….

Answer. Herpes simplex Virus – 1 (HSV – 1)

Question 50. Gingival lesions associated with erosive lichen planus is…………………..

Answer. Desquamative

Question 51. Eagle’s syndrome associated with morphological bony changes in…………………

Answer. Styloid process

Question 52. Painful long duration multinodular pleomorphic adenoma with adhesions is suggestive of…………….

Answer. Metastasizing pleomorphic adenoma

Question 53. Secondary oral syphilis lesion is……………..

Answer. Mucous patches

Question 54. Drug of choice in dentoalveolar abscess is………………

Answer. Metronidazole

Question 55. Most common infection in HIV/AIDS is………………….

Answer. Oral candidiasis

Question 56. Gingival involvement is seen in……………………deficiency.

Answer. Vitamin C

Question 57. Café au lait spots are seen in………………..

Answer. Neurofibromatosis

Question 58. Stone in salivary gland is called…………….

Answer. Sialolith

Question 59. A keratotic white lesion found on the oral mucosa adjacent to a restoration is most likely to be……………………..

Answer. Lichenoid reaction

Question 60. ‘Mask-like’ facies, rigidity of tongue, reduction in mouth opening, fibrosis of buccal mucosa are all features of…………………….

Answer. Scleroderma

Question 61. Localized gingival enlargement, adjacent to a large carious tooth, with pulpal involvement and history of pus discharge from adjoining gingiva is known as…………………

Answer. Periodontal abscess

Question 62. Infectious mononucleosis is caused by…………………

Answer. Epstein Barr Virus

Question 63. Submandibular swelling associated with intake of food, which regress after a couple of hours is due to………………………

Answer. Stone formation

Additional Information

Various Signs in Oral Medicine

Various Spots in Oral Medicine Diagnosis

Various Important Diagnostic Tests for Various Diseases

FIGLU: folic acid deficiency, formiminoglutamic

Incubation Periods of Various Diseases

Characteristic Features of Tongue in Various Conditions

Important Terminologies with Their Meanings in Oral Pathology

Various appearances and Diseases Associated with them

Various Genetically Transmitted Diseases

Various Typical Characteristic Features of Lesions

Various malignancies caused by viruses

Various surgeries and their indications

Important information about carcinomas

Levels of various enzymes in diseases

Taxonomy of pain

Various conditions of tongue and effect on papilla

Various Important Classifications

Classification of Supernumerary Teeth

According to morphology

• Conical: This small peg shaped conical tooth is supernumerary tooth.
• Tuberculate: This type of supernumerary tooth possesses more than one cusp or tubercle. It is of barrel shaped and may be invaginated.
• Supplemental: It refers to the duplication of the teeth in normal series. The most common tooth is permanent maxillary lateral incisor.
• Odontome: This represents the hamartomatous malformation.

According to location

• Mesiodens: They are located between two upper central incisors.
• Distomolars: They are located on the distal aspect of regular molar teeth in dental arch.
• Paramolar: They are located either in buccal or lingual aspect of normal molars.
• Extra lateral incisors: They are more common in maxillary arch.

Classification of Amelogenesis Imperfecta

Witkop, 1988 Four major categories based primarily on phenotype (hypoplastic, hypomaturation, hypocalcified, hypomaturationhypoplastic with taurodontism) subdivided into 15 subtypes by phenotype and secondarily by mode of inheritance.

• Type 1. Hypoplastic
• Type 1A. Hypoplastic, pitted autosomal dominant
• Type 1B. Hypoplastic, local autosomal dominant
• Type I1C. Hypoplastic, local autosomal recessive
• Type 1D. Hypoplastic, smooth autosomal dominant
• Type 1E. Hypoplastic, smooth X-linked dominant
• Type 1F. Hypoplastic, rough autosomal dominant
• Type 1G. Enamel agenesis, autosomal recessive
• Type 2. Hypomaturation
• Type 2A. Hypomaturation, pigmented autosomal recessive
• Type 2B. Hypomaturation, X-linked recessive
• Type 2C. Hypomaturation, snow-capped teeth, X-linked
• Type 2D. Hypomaturation, snow-capped teeth, autosomal dominant?
• Type 3A. Autosomal dominant
• Type 3B. Autosomal recessive
• Type 4. Hypomaturation-hypoplastic with taurodontism
• Type 4A. Hypomaturation-hypoplastic with taurodontism, autosomal dominant
• Type 4B. Hypoplastic-hypomaturation with taurodontism, autosomal dominant

Classification of White Lesions of Oral Cavity

• Hereditary condition:
  • Leukoedema
  • White sponge nevus
  • Hereditary benign intraepithelial dyskeratosis
  • Keratosis follicularis
  • Ptylosis syndrome.
• Leukoplakia and malignancies:
  • Chronic cheek biting
  • Friction or trauma associated leukoplakia
  • Tobacco associated leukoplakia
  • Carcinoma in situ
  • Squamous cell carcinoma
  • Verrucous carcinoma.
• Dermatosis:
  • Lichen planus
  • Lupus erythematous.
• Inflammation:
  • Mucous patches of syphilis
  • Candidiasis
  • Koplik spots of measles.
• Miscellaneous conditions:
  • Oral submucous fibrosis
  • Papilloma
  • Lipoma
  • Hairy tongue
  • Geographic tongue
  • Fordyce’s granules.

Classification of Hemangiomas by Watson and McCarthy

• Capillary hemangioma
• Cavernous hemangioma
• Angioblastic hemangioma
• Racemose hemangioma
• Diffuse systemic hemangioma
• Metastasizing hemangioma
• Port-Wine Stain
• Hereditary hemorrhagic telangiectasia

Classification of Giant Cell Lesions of Oral Cavity

According to the Nature of Different Pathologic Conditions

• Infections
  • Bacterial
  • Viral
  • Fungal
  • Protozoal
  • Parasitic
• Fibro-Osseous Lesions and Osteodystrophies
  • Immunologic
  • Idiopathic
  • Orofacial granulomatosis
  • Reaction to Materials
  • Benign and Malignant Tumors

In This Classification Giant Cells are Categorized into Three Categories

Giant cells are the main cause for the pathology

Giant cells characterize these lesions

Lesions that may be associated with giant cells

• Main Cause for the Pathology
  • Giant Cell Granuloma
    • Peripheral
    • Central
  • Giant Cell Tumors
  • Giant Cell Fibroma
  • Hyperparathyroidism
• Giant Cells that Characterize Lesions
  • Infections:
    • Tuberculosis
    • Hansen’s disease
    • Syphilis
    • Measles
  • Granulomatous lesions:
    • Wegener’s granulomatosis
    • Orofacial granulomatosis
    • Pulse granuloma
    • Sarcoidosis
  • Lesions in bone:
    • Aneurysmal bone cyst
    • Cherubism
    • Paget’s disease
  • Foreign body lesions
    • Silicosis
    • Berylliosis
  • Malignancies:
    • Lymphoma—Hodgkin’s disease
    • Bronchogenic carcinoma
    • Carcinoma of thyroid
  • Miscellaneous:
    • Xanthoma
    • Giant cell arteritis
• Lesions that may be associated with giant cell
  • Malignancies:
    • Multiple myeloma
    • Ewing’s sarcoma
    • Fibrosarcoma
    • Chondrosarcoma
  • Fibro-osseous lesions
    • Osteoblastoma
    • Fibrous dysplasia
    • Cemento-ossifying fibroma
    • Radicular cyst

Based on their origin

• Epithelially derived, i.e. Warthin-finkeldey giant cells, tumor giant cells
• Stromally derived, i.e. Reed-Sternberg giant cells.

Enumeration of Premalignant Lesion

• Leukoplakia
• Erythroplakia
• Mucosal changes associated with smoking habits
• Carcinoma in situ
• Bowen disease
• Actinic keratosis, actinic cheilitis and actinic elastosis.

Enumeration of Premalignant Condition

• Syphilis
• OSMF
• Oral lichen planus
• Sideropenic dysplasia
• Dyskeratosis congenita
• Lupus erythematosus

Unusual Variants of Squamous Cell Carcinoma

• Verrucous carcinoma
• Spindle cell carcinoma
• Basaloid squamous cell carcinoma
• Adenoid/acantholytic squamous cell carcinoma
• Papillary squamous cell carcinoma
• Carcinoma cuniculatum

Latest Who 2017 Classification Of Odontogenic Tumors And Cysts

WHO (2017) Classification of Odontogenic Tumors

Malignant Odontogenic Tumors

• Ameloblastic carcinoma
• Primary intraosseous carcinoma, NOS
• Sclerosing odontogenic carcinoma
• Clear cell odontogenic carcinoma
• Ghost cell odontogenic carcinoma
• Odontogenic carcinosarcoma
• Odontogenic sarcomas

Benign Odontogenic Tumors

• Epithelial Origin
  • Ameloblastoma, conventional
  • Ameloblastoma, unicystic type
  • Ameloblastoma, extraosseous/peripheral type
  • Metastasizing (malignant) ameloblastoma
  • Squamous odontogenic tumor
  • Calcifying epithelial odontogenic tumor
  • Adenomatoid odontogenic tumor
• Mixed (Epithelial-Mesenchymal) Origin
  • Ameloblastic fibroma
  • Primordial odontogenic tumor
  • Odontoma
    • Compound type
    • Complex type
  • Dentinogenic ghost cell tumor
• Mesenchymal Origin
  • Odontogenic fibroma
  • Odontogenic myxoma/myxofibroma
  • Cementoblastoma
  • Cemento-ossifying fibroma

WHO (2017) Classification of Odontogenic Cysts

Developmental Origin

• Dentigerous cyst
• Odontogenic keratocyst
• Lateral periodontal and botryoid odontogenic cyst
• Gingival cyst
• Glandular odontogenic cyst
• Calcifying odontogenic cyst
• Orthokeratinized odontogenic cyst

Inflammatory Origin

• Radicular cyst
• Collateral inflammatory cyst

Classification of Non-Odontogenic Tumors of Oral Cavity

Epithelial Tissue

• Benign Tumors
  • Papilloma
  • Keratoacanthoma
  • Squamous acanthoma
  • Nevus
• Malignant Tumors
  • Squamous cell carcinoma
  • Mucoepidermoid carcinoma
  • Adenocarcinoma
  • Basal cell carcinoma
  • Transitional cell carcinoma
  • Melanoma
  • Verrucous carcinoma
  • Intraepidermoid carcinoma

Fibrous Connective Tissue

• Benign Tumors
  • Fibroma
  • Fibrous hyperplasia
  • Fibrous epulis
  • Giant cell fibroma
  • Myxoma
  • Myxofibroma.
• Malignant Tumors
  • Fibrosarcoma

Cartilage Tissue

• Benign Tumors
  • Chondroma
  • Chondroblastoma
  • Chondromyxoid fibroma.
• Malignant Tumors
  • Chondrosarcoma

Adipose Tissue

• Benign Tumors
  • Lipoma
  • Angiolipoma.
• Malignant Tumors
  • Liposarcoma

Bone

• Benign Tumors
  • Osteoma
  • Osteoid osteoma
  • Osteoblastoma
• Malignant Tumors
  • Osteosarcoma
  • Osteochondrosarcoma

Vascular tissue

• Benign Tumors
  • Hemangioma
  • Hereditary hemorrhagic telangiectasia
  • Lymphangioma
• Malignant Tumors
  • Hemangioendothelioma

Neural tissue:

• Benign Tumors
  • Neurofibroma
  • Neurilemmoma
  • Schwannoma
• Malignant Tumors
  • Neurosarcoma
  • Neurofibrosarcoma

Muscles

• Benign Tumors
  • Leiomyoma
  • Rhabdomyoma
• Malignant Tumors
  • Leiomyosarcoma
  • Rhabdomyosarcoma

Giant Cell Tumor

• Central and peripheral giant cell tumor
• Giant cell granuloma
• Giant cell tumor of hyperthyroidism.

Teratoma

Salivary Gland Tumor

• Benign Tumors
  • Adenoma
  • Warthin’s tumor
  • Pleomorphic adenoma.
• Malignant Tumors
  • Mucoepidermoid carcinoma
  • Adenocystic carcinoma
  • Adenocarcinoma
  • Acinic cell carcinoma
  • Malignant change in pleomorphic adenoma

Lymphoid Tissue

• Malignant Tumors
  • Hodgkin’s and non-hodgkin’s lymphoma
  • Lymphosarcoma
  • Reticular cell sarcoma
  • Ewing’s sarcoma
  • Burkitt’s lymphoma
  • Multiple myeloma
  • Leukemia.

Classification of Oral Submucous Fibrosis

Khanna JN and Andrade N (1995) develop classification of OSMF based on clinical features and histopathological features

Group 1: Very Early Cases

• Common symptom is burning sensation in the mouth
• Acute ulceration and recurrent stomatitis
• Not associated with mouth opening limitation

Histology

• Fine fibrillar collagen network interspersed with marked edema
• Blood vessels are dilated and congested
• Largest aggregate of plump, young fibroblasts present in abundant cytoplasm
• Inflammatory cells mainly consists of PMN leukocytes with few eosinophils
• Epithelium is normal.

Group 2: Early cases

• Buccal mucosa appears mottled and marble like
• Widespread sheets of fibrosis palpable
• Patients with inter-incisal distance of 26 to 35 mm

Histology

• Juxtaepithelial hyalinization present
• Collagen presents as thickened but separate bundles
• Blood vessels are dilated and congested
• Young fibroblasts are seen in moderate number
• Inflammatory cells mainly consists of polymorphonuclear leukocytes with few eosinophils and occasional plasma cells
• Flattening or shortening of epithelial rete pegs evident with varying degree of keratinization.

Group 3: Moderately Advanced Cases

• Trismus evident with inter-incisal distance of 15 to 25 mm
• Buccal mucosa appears pale and firmly attached to underlying tissues
• Atrophy of vermilion border
• Vertical fibrous bands are palpable at soft palate, pterygomandibular raphae and anterior faucial pillars

Histology

• Juxtaepithelial hyalinization present
• Thickened collagen bundles faintly discernable separated by very light residual edema
• Blood vessels are mostly constricted
• Mature fibroblasts with scanty cytoplasm and spindleshapes nuclei
• Inflammatory exudates consists mainly of lymphocytes and plasma cells
• Epithelium is markedly atrophic with loss of rete pegs
• Muscle fibers seen interspersed with thickened and dense collagen fibers

Group IV A: Advanced Cases

• Trismus is severe with interincisal distance less than 15 mm
• The fauces are thickened, shortened and firm on palpation
• Uvula is shrunken and appears as small, fibrous bud
• Tongue movements get limited
• On palpation of lips, circular bands are felt at around entire mouth

Group 4B: Advanced Cases with Premalignant and Malignant Changes

Hyperkeratosis, leukoplakia or squamous cell carcinoma can be seen.

Histology

• Collagen hyalinized as small sheet
• Extensive fibrosis obliterates the mucosal blood vessel and eliminates melanocytes
• Fibroblasts were markedly absent within hyalinized zones
• Total loss of epithelial rete pegs
• Mild-to-moderate atypia present
• Extensive degeneration of muscle fibers evident.

Classification of Oral Hamartomas

• Those involving teeth
  • Dens invaginatus
  • Dens evaginatus
  • Talon cusp
• Those not involving teeth
  • Peripheral odontogenic fibroma
  • Ameloblastic fibro-odontoma
  • Odontoma
  • Adenomatoid odontogenic tumor
  • Squamous odontogenic tumor
  • Dental lamina cyst of newborn
• Non-odontogenic origin
  • Vascular origin
    • Hemangioma
    • Lymphangioma
    • Glomus tumor
  • Osseous origin
    • Fibrous dysplasia
  • Oral and labial melanotic macule
  • Pigmented cellular nevus
• Neural origin
  • Neurofibromatosis
• Syndrome
  • Multiple hamartoma syndrome
• Salivary gland
  • Adenomatoid hyperplasia of mucous glands

Enumeration of round cell tumors

• Lymphoma
• Rhabdomyosarcoma
• Melanoma
• Ewing’s sarcoma
• Glomus tumor
• Esthesioneuroblastoma
• Merkel cell tumor
• Adenocarcinoma
• Squamous cell carcinoma (poorly differentiated)
• Plasmacytoma
• Multiple myeloma
• Langerhan’s cell disease
• Peripheral neuroectodermal tumor

Enumeration of Lesions Associated with Impacted Tooth

• Cysts:
  • Dentigerous cyst
  • Keratocystic odontogenic tumor
  • Calcifying odontogenic cyst
• Salivary gland:
  • Mucoepidermoid carcinoma (central variety)
• Odontogenic tumors:
  • Central odontogenic fibroma
  • Ameloblastic fibroma
  • Ameloblastic fibro odontome
  • Odontoma
  • Adenomatoid odontogenic tumor
  • Squamous odontogenic tumor
  • Unicystic ameloblastoma

Enumeration of Clear Cell Lesions

• Clear cell carcinoma
• Clear cell ameloblastic carcinoma
• Clear cell odontogenic tumor
• Mucoepidermoid carcinoma
• Oncocytoma
• Epimyoepithelial carcinoma
• Acinic cell adenocarcinoma
• Clear cell ameloblastoma
• Clear cell chondrosarcoma

Enumeration of granular cell diseases

• Granular cell in salivary gland diseases
  • Oncocytoma
  • Acinic cell carcinoma
  • Warthin’s tumor
  • Oncocytic carcinoma
  • Oncocytosis
  • Oncocytic variant of mucoepidermoid carcinoma
  • Sclerosing polycytic adenosis
  • Pleomorphic adenoma
• Granular cell in odontogenic tumors
  • Granular cell ameloblastoma
  • Granular cell ameloblastic fibroma
  • Granular cell adontogenic tumor
• Granular cells in soft tissue tumors
  • Granular cell tumor (Myoblastoma, Schwanoma)
  • Congenital epulis
  • Rhabdomyoma
  • Rhabdomyosarcoma
  • Alveolar soft part sarcoma
  • Verruciform xanthoma
  • Fibrous histiocytoma
  • Langerhans cell histiocytosis
• Granular cells in viral, fungal and bacterial infections
  • Molluscum contagiosum
  • Botryomycosis
  • Histoplasmosis

TNM Classification By American Joint Committee on Carcinoma (AJCC)

T is suggestive of primary tumor

N is suggestive of regional lymph nodes

M is suggestive of distant metastasis

T – primary Tumor

• TX – Primary tumor cannot be assessed.
• T0 – No evidence of primary tumor
• Tis – Carcinoma in Situ
• T1 – Tumor 2 cm of less in greatest dimension
• T2 – Tumor more than 2 cm but not more than 4 cm in greatest dimension
• T3 – Tumor more than 4 cm in greatest dimension
• T4a (Lip) – Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth or skin (chin or nose)
• T4a (Oral Cavity) – Tumor invades through cortical bone, into deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus and styloglossus), maxillary sinus or skin of face.
• T4b (lip and oral cavity) – Tumor invades masticatory space, pterygoid plates or skull base or encases internal carotid artery
• N – Regional lymph nodes
• NX – Regional lymph nodes cannot be assessed
• N0 – No regional lymph node metastasis
• N1 – Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
• N2a – Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
• N2b – Metastasis in multiple ipsilateral lymph nodes, not more than 6 cm in greatest dimension
• N2c – Metastasis in bilateral or contralateral lymph nodes, not more than 6 cm in greatest dimension
• N3 – Metastasis in a lymph node more than 6 cm in greatest dimension
• M – Distant Metastasis
• MX – Distant metastasis cannot be assessed
• M0 – No distant metastasis
• M1 – Distant metastasis

Stage Grouping of Oral Cancer

Grading of Squamous Cell Carcinoma

Grading is defined as macroscopic and microscopic degree of differentiation of a tumor.

Squamous cell carcinoma is divided in following categories by Broder also known as Broader’s classification

Grade 1: Well differentiated, i.e. less than 25% anaplastic cells

This is characterized by the presence of relatively mature cell with little nuclear aberration and with presence of keratin pearls and individual cell keratinization.

Grade 2: Moderately differentiated, i.e. 25–50% anaplastic cells

This is characterized by the presence of tumor cell exhibiting a wide range of differentiation, keratinization is occasionally present and nuclear aberrations are moderately abundant. Invasion is poor delineated from stroma.

Grade 3: Moderately differentiated, i.e. 50–75% anaplastic cells

This is characterized by the presence of disordered and poorly differentiated cells with no tendency towards keratinization, nuclear aberrations are abundant.

Grade 4: Poorly differentiated i.e. more than 75% anaplastic cells

This is characterized by the presence of cells which are so poorly differentiated that they cannot be identified as epithelial origin on basis of histology, nuclear aberrations are abundant and no keratinization is present.

STNMP Classification of Oral Squamous Cell Carcinoma

S Category

S (Site)

S1 Lip – Skin

S2 Lip – Mucous membrane

S3 Tongue

S4 Cheek

S5 Palate

S6 Floor of the mouth

S7 Alveolar process

S8 Antrum

S9 Central carcinoma of bone

T Category

T (Tumor)

T1 – Tumor less than 20 mm in diameter

T2 – Tumor between 20 mm and 40 mm in diameter

T3 – Tumor between 40 mm and 60 mm in diameter and/or extend beyond the primary region and/or through adjacent periosteum

T4 – Any tumor greater than 60 mm in diameter and/or extending to involve adjacent structure

N Category

N (Node)

N0 – No palpable nodes

N1 – Equivocal node enlargement

N2 – Clinically palpable homolateral regional node (s) – not fixed

N3 – As N2 but fixed

N4 – Clinically palpable contralateral or bilateral node (s) – not fixed

N5 – As N4 but fixed

M Category

M (Metastases)

M0 – No distant metastasis

M1 – Clinical evidence of distant metastasis without definite histological and/ or radiographic confirmation

M2- Proven evidence of metastasis beyond the regional nodes

P Category

P (Pathology)

P0 – Hyperkeratotic lesion showing atypia

P1 – Carcinoma in situ

P2 – Basal cell carcinoma

P3a – Verrucous carcinoma

P3b – Well-differentiated squamous cell carcinoma

P3c – Moderately differentiated squamous cell carcinoma

P3d – Poorly differentiated squamous cell carcinoma150 Mastering the BDS IVth Year-I (Last 25 Years Solved Questions)

STNMP Weighting and Stages

For convenience and to enable direct comparison with TNM staging, the scores are banded to form similar stages

Stage 1 – 0 to 30

Stage 2 – 31 to 50

Stage 3 – 51 to 70

Stage 4 – 70 to 155

Salivary Gland Tumor Classification by WHO (2005)

• Benign Epithelial Tumors
  • Pleomorphic adenoma (8940/0)
  • Myoepithelioma (8982/0)
  • Basal cell adenoma (8147/0)
  • Warthin tumor (adenolymphoma) (8561/0)
  • Oncocytoma (oncocytic adenoma) (8290/0)
  • Canalicular adenoma (8149/0)
  • Sebaceous adenoma (8410/0)
  • Lymphadenoma (8410/0)
    • Sebaceous
    • Nonsebaceous
  • Ductal papilloma (8503/0)
    • Inverted ductal papilloma
    • Intraductal papilloma
    • Sialadenoma papilliferum
  • Cystadenoma (8440/0)
• Malignant epithelial tumors
  • Acinic cell carcinoma (8550/3)
  • Mucoepidermoid carcinoma (8430/3)
  • Adenoid cystic carcinoma (8200/3)
  • Polymorphous low-grade adenocarcinoma
  • Epithelial-myoepithelial carcinoma (8562/3)
  • Clear cell carcinoma, not otherwise specified (8310/3)
  • Basal cell adenocarcinoma (8147/3)
  • Sebaceous carcinoma (8410/3)
  • Sebaceous lymphadenocarcinoma (8410/3)
  • Cystadenocarcinoma (8440/3)
  • Low-grade cribriform cystadenocarcinoma
  • Mucinous adenocarcinoma (8480/3)
  • Oncocytic carcinoma (8290/3)
  • Salivary duct carcinoma
  • Adenocarcinoma NOS (8140/3)
  • Myoepithelial carcinoma (8982/3)
  • Carcinoma in pleomorphic adenoma (8941/3)
  • Carcinosarcoma (8980/3)
  • Metastatizing pleomorphic adenoma (8940/1)
  • Squamous cell carcinoma (8070/3)
  • Small cell carcinoma (8041/3)
  • Large cell carcinoma (8012/3)
  • Lymphoepithelial carcinoma (8082/3)
  • Sialoblastoma (8974/1)
• Soft tissue tumors
  • Hemangioma (9120/0)
• Hematolymphoma tumors
  • Hodgkin’s lymphoma
  • Diffuse large B cell lymphoma
  • Extranodal marginal zone B cell lymphoma
• Secondary tumors

Classification of Odontogenic Tumors by WHO (2005)

Benign Tumors

• Odontogenic Epithelium with Mature Fibrous Stroma without Odontogenic Mesenchyme:
  • Ameloblastoma (Solid, Multicystic, Extraosseous, Peripheral, Desmoplastic, Unicystic)
  • Squamous Odontogenic Tumor
  • Calcifying Epithelial Odontogenic Tumor
  • Adenomatoid Odontogenic Tumor
  • Keratocystic Odontogenic Tumor
• Odontogenic Epithelium with Odontogenic Ectomesenchyme with or without hard tissue formation:
  • Ameloblastic Fibroma
  • Ameloblastic Fibro-Dentinoma
  • Ameloblastic Fibro-Odontoma
  • Odontoma
    • Complex
    • Compound
  • Odonto-Ameloblastoma
  • Calcifying Cystic Odontogenic Tumor
  • Dentinogenic Ghost Cell Tumor
• Mesenchyme and/or Odontogenic Ectomesenchyme with or without Odontogenic Epithelium:
  • Odontogenic Fibroma
  • Odontogenic Myxoma
  • Cementoblastoma

Malignant Tumors

• Odontogenic Carcinomas:
  • Malignant Ameloblastoma
  • Ameloblastic Carcinoma
  • Primary Intraosseous Carcinoma
  • Clear Cell Odontogenic Carcinoma
  • Ghost Cell Odontogenic Carcinoma
• Odontogenic Sarcoma:
  • Ameloblastic Fibro-Sarcoma
  • Ameloblastic Fibro-Dentino Sarcoma
  • Ameloblastic Fibro-Odonto-Sarcoma.

Bone related Lesions

• Ossifying Fibroma
• Fibrous Dysplasia
• Osseous Dysplasia
• Central Giant Cell Lesions
• Cherubism
• Aneurysmal Bone Cyst
• Simple Bone Cyst

Melanotic Neuroectodermal Tumor of Infancy.

Classification of Odontogenic Ghost Cell Lesions (By Praetorious 2006)

Group 1: Simple cysts – Calcifying odontogenic cyst

Group 2: Cyst associated with odontogenic hamartomas or benign neoplasms – Calcifying cystic odontogenic tumor (CCOT). Following are the combinations:

• CCOT associated with odontome
• CCOT associated with adenomatoid odontogenic tumor
• CCOT associated with Ameloblastoma
• CCOT associated with Ameloblastic fibroma
• CCOT associated with Ameloblastic fibro odontome
• CCOT associated with Odonto-ameloblastoma
• CCOT associated with odontogenic myxofibroma

Group 3: Solid benign odontogenic neoplasms with similar cell morphology to that in calcifying odontogenic cyst and with dentinoid formation – Dentinogenic ghost cell tumor

Group 4: Malignant odontogenic neoplasms with features similar to those of dentinogenic ghost cell tumor – Ghost cell odontogenic carcinoma

Classification of Cyst by Mervin Shear

Cysts of the Jaws

Epithelial:

• Developmental:
  • Odontogenic:
    • Gingival Cyst of Infants
    • Odontogenic Keratocyst (Neoplasm)
    • Dentigerous Cyst
    • Eruption Cyst
    • Lateral Periodontal Cyst
    • Gingival Cyst of Adults
    • Botryoid Odontogenic Cyst
    • Glandular Odontogenic Cyst
    • Calcifying Odontogenic Cyst (Neoplasm)
  • Non-Odontogenic:
    • Nasopalatine Duct Cyst
    • Naso Labial Cyst
    • Midpalatal Raphe Cyst of Infants
    • Median Palatine, Median Alveolar
    • Median Mandibular Cyst
    • Globulo Maxillary Cyst
• Inflammatory:
  • Radicular Cyst, Apical and Lateral
  • Residual Cyst
  • Paradental Cyst and Mandibular Infected Buccal Cyst
  • Inflammatory Collateral Cyst

Non-epithelial (Pseudo cysts)

• Solitary Bone Cyst
• Aneurysmal Bone Cyst

Cyst Associated With Maxillary Antrum

• Benign Mucosal Cyst of the Maxillary Antrum
• Postoperative Maxillary Cyst

Cyst of the Soft Tissues of Mouth, Face and Neck

• Dermoid and epidermoid cyst
• Lymphoepithelial cyst (branchial cyst)
• Thyroglossal duct cyst
• Anterior medial lingual cyst (intralingual cyst of foregut origin)
• Oral cyst with gastric or intestinal epithelium
• Cystic hygroma
• Nasopharyngeal cyst
• Thymic cyst
• Cyst of salivary glands—mucous extravasation cyst
• Mucous retention cyst, ranula, polycystic disease of the parotid.
• Parasitic cyst—hydatid cyst, cysticercus cellulosae, trichinosis.

Classifications of Viral Lesions in Oral Cavity

RNA Virus

• Orthomyxovirus, i.e. Influenza
• Paramyxovirus, i.e. Measles and mumps
• Rhabdovirus, i.e. Rabies
• Arenavirus, i.e. Lassa fever
• Calicivirus, i.e. upper respiratory tract infection
• Coronavirus
• Bunyavirus
• Picornavirus
• Reovirus
• Togavirus
• Retrovirus

DNA Virus

• Herpes virus
  • Herpes simplex
  • Herpes zoster
  • Epstein-Barr virus
• Pox virus
  • Smallpox
  • Monkey pox
• Adenovirus, i.e. pharyngoconjunctival fever
• Parvovirus
• Iridovirus
• Papova virus, i.e. papillomas.

Classification of Ulcerative Lesions

Microbial Origin

• Bacterial:
  • Streptococcal
  • Tuberculosis
  • Syphilis
  • Scarlet fever
  • Diphtheria
  • Typhoid
  • Noma
• Fungal:
  • Histoplasmosis
  • Blastomycosis
  • Paracoccidioidomycosis
  • Coccidioidomycosis
  • Cryptococcus
  • Zygomycosis
  • Aspergillosis
• Viral:
  • Herpes
  • HIV
  • Pox virus
• Protozoal:
  • Entamoeba histolytica
  • Leishmaniasis
  • Toxoplasmosis

Physical Origin

• Cheek bite (Morsicatio buccarum)
• Traumatic
• Thermal
• Electrical
• Osteoradionecrosis
• Anesthetic

Chemical Origin

• Phenol
• Silver nitrate
• Hydrogen peroxide
• Aspirin

Immunological

• BehÇet’s syndrome
• Reiter’s syndrome
• Erythema multiforme
• Erosive Lichen Planus ( Secondary Ulcer)
• Lupus Erythematosus
• Sarcoidosis
• Cyclic Neutropenia
• Ulcerative Colitis
• HIV
• Pemphigus
• Epidermolysis Bullosa

Metabolic Ulcers

• Diabetes
• Uremia
• Neutropenia
• Sickle Cell Anemia
• Agranulocytosis
• Crohn’s Disease

NonSpecific Ulcers

• HIV Ulcers
• Graft versus Host Reaction
• Necrotizing Sialometaplasia
• Raynaud’s Phenomenon
• Bacterial Angiomatosis

Neoplastic

• Squamous cell carcinoma

Classification of Pigmented Lesions

Blue lesions

• Mucocele
• Ranula
• Salivary duct cyst
• Submucosal hemorrhage
• Eruption cyst
• Blue nevus

Brown lesions

• Macules
• Cellular nevus
• Malignant melanoma
• Drug induced melanoma
• Café-au-lait spots
• Smoker’s melanosis
• Endocrine pigmentation
• Pigmented lichen planus
• HIV-oral melanosis
• Peutz-Jeghers syndrome

Yellow lesions

• Lipoma
• Fordyce’s granules
• Verruciform xanthoma
• Jaundice
• Superficial abscess

Grey-black lesions

• Amalgam tattoo
• Graphite tattoo
• Hairy tongue
• Heavy metal ingestion
• Racial pigmentation
• Slough of ANUG

Red lesions

• Reactive lesions:
  • Pyogenic granuloma
  • Peripheral giant cell granuloma
• Premalignant: malignant tumors
  • Erythroplakia
  • Hemangioma
  • Kaposi’s sarcoma
• Lesions-associated with dermatologic conditions:
  • Erythema migrans
  • Systemic lupus erythematosus
  • Erythema multiforme
  • CREST syndrome
• Metabolic:
  • Vitamin B complex
  • Anemia
  • Burning mouth syndrome
• Blood disorders:
  • Hemophilia
  • Thrombocytopenic purpura
  • Leukemia
• Infectious conditions:
  • Gingivitis
  • Stomatitis
  • Pharyngitis
  • Scarlet fever
  • Koplik spots
  • Infectious mononucleosis
  • Syphilis
  • Candidiasis
  • Median rhomboid glossitis
• Immunological abnormalities:
  • Plasma cell gingivitis
  • Drug reactions and contact allergies
  • Wegener’s granulomatosis
• Others:
  • Traumatic ulcer
  • Petechiae
  • Ecchymosis
  • Radiation mucositis
  • Thermal and chemical burns

Classification of Oral Manifestations of HIV/AIDS by EC-Clearinghouse

Group 1: Strongly associated with HIV infection

• Candidiasis: Erythematous, pseudomembranous, angular cheilitis
• Hairy leukoplakia
• Kaposi’s sarcoma
• Non-Hodgkin’s lymphoma
• Periodontal diseases: Linear gingival erythema, necrotizing gingivitis, necrotizing periodontitis

Group 2: Less commonly associated with HIV infection

• Bacterial infections: Mycobacterium avium-intracellulare, Mycobacterium tuberculosis
• Melanotic hyperpigmentation
• Necrotizing ulcerative stomatitis
• Salivary gland disease: Dry mouth, unilateral or bilateral
• swelling of major salivary glands
• Thrombocytopenic purpura
• Oral ulcerations NOS (not otherwise specified)
• Viral infections: Herpes simplex, human papilloma virus, varicella—zoster

Group 3: Seen in HIV infection

• Bacterial infections: Actinomyces israelii, Escherichia coli, Klebsiella pneumonia.
• Cat-scratch disease (Bartonella henselae).
• Epithelioid (bacillary) angiomatosis (Bartonella henselae)
• Drug reactions: Ulcerative, erythema multiforme, lichenoid, toxic epidermolysis.
• Fungal infections other than candidiasis: Cryptococcus neoformans, Geotrichum candidum, Histoplasma capsulatum, Mucoraceae (mucormycosis/zygomycosis), Aspergillus flavus.
• Neurologic disturbances: Facial palsy, trigeminal neuralgia
• Recurrent aphthous stomatitis.
• Viral infections: Cytomegalovirus, Molluscum contagiosum.

Classification of Candidiasis by Axell et al. 1997

Primary oral candidiasis:

• Acute form:
  • Pseudomembranous candidiasis
  • Erythematous candidiasis
• Chronic form:
  • Hyperplastic candidiasis
  • Erythematous candidiasis
  • Pseudomembranous candidiasis
• Candida-associated lesion:
  • Denture stomatitis
  • Angular stomatitis
  • Median rhomboid glossitis
• Keratinized primary lesion super-infected with Candida:
  • Leukoplakia
  • Lichen planus
  • Lupus erythematosus

Secondary candidiasis:

• Candidal endocrinopathy syndrome.

Classification of Gingival Hyperplasia

On Basis of Etiological Factors and Pathologic Changes

Inflammatory enlargement

• Chronic
• Acute

Drug induced enlargement

Enlargement associated with systemic disease

• Conditional enlargement:
  • Pregnancy
  • Puberty
  • Vitamin C deficiency
  • Plasma cell gingivitis
  • Non-specific conditioned enlargement (Pyogenic granuloma)
• Systemic diseases causing gingival enlargement
  • Leukemia
  • Granulomatous disease (e.g. Wegener’s granulomatosis, sarcoidosis)

Neoplastic enlargement

• Benign tumors
• Malignant tumors

False enlargement

Using the criteria of location and distribution gingival enlargement is designated as follows:

• Localized: Gingival enlargement limited to one or more teeth.
• Generalized: Involving the gingiva throughout the mouth.
• Marginal: Confined to marginal gingiva.
• Papillary: Confined to interdental papilla.
• Diffuse: Involving the marginal and attached papillae.
• Discrete: Isolated sessile or pedunculated tumor like enlargement.

On basis of degree of gingival enlargement

Grade 0: No sign of gingival enlargement.

Grade 1: Enlargement confirmed to interdental papilla

Grade 2: Enlargement involves papilla and marginal gingiva.

Grade 3: Enlargement covers three quarters or more of the crown.

Classification of Pulpal Diseases

Grossman’s Clinical Classification

Pulpitis (Inflammation)

• Reversible pulpitis
  • Symptomatic (acute).
  • Asymptomatic (chronic).
• Irreversible pulpitis
  • Acute
    • Abnormally responsive to cold.
    • Abnormally responsive to heat.
  • Chronic
    • Asymptomatic with pulp response.
    • Hyperplastic pulpitis.
    • Internal resorption.

Pulp Degeneration

• Calcific (Radiographic diagnosis)
• Others (Histopathologic diagnosis).

Pulp Necrosis.

Seltzer and Bender’s Classification

This classification is based on clinical tests and histological diagnosis.

Treatable without pulp extirpation and endodontic treatment

• Intact uninflamed pulp
• Transition stage
• Atrophic pulp
• Acute pulpitis
• Chronic partial pulpitis without necrosis.

Untreatable without pulp extirpation and endodontic treatment

• Chronic partial pulpitis with necrosis
• Chronic total pulpitis
• Total pulp necrosis.

Ingle’s Classification

Inflammatory changes:

• Hyper-reactive pulpalgia:
  • Hypersensitivity
  • Hyperemia
• Acute pulpalgia:
  • Incipient
  • Moderate
  • Advanced
• Chronic pulpalgia:
• Hyperplastic pulpitis:
• Pulp necrosis

Retrogressive changes

• Atrophic papulosis
• Calcific papulosis.

Classification of Dental Caries

Based on location of the lesion

• Pit and fissure caries
  • Occlusal
  • Buccal or lingual pit
• Smooth surface caries
  • Proximal
  • Buccal or lingual surface
• Root caries

Based on tissue involved

• Enamel caries
• Dentinal caries
• Cementum caries

Based on virginity of the lesion

• Primary caries
• Secondary caries

Based on progression of lesion

• Progressive caries
  • Rapidly progressive-like nursing caries and radiation caries
  • Slowly progressing
• Arrested caries

Classification of Granulomatous Lesions or Diseases

Specific or Infective Type:

• Bacterial:
  • Tuberculosis
  • Leprosy
  • Syphilis
  • Granuloma Inguinale
  • Brucellosis
  • Cat scratch disease
  • Tularemia
  • Glanders
  • Actinomycosis
• Fungal:
  • Blastomycosis
  • Cryptococcosis
  • Coccidioidomycosis
  • Histoplasmosis
• Parasitic: Schistosomiasis

Non-specific:

• Sarcoidosis
• Crohn’s disease
• Silicosis
• Berylliosis
• Foreign body granuloma
• Orofacial granulomatosis

Classification of Osteomyelitis

• Acute Osteomyelitis:
  • Acute suppurative osteomyelitis
  • Acute subperiosteal osteomyelitis
  • Acute periostitis
• Chronic Osteomyelitis:
  • Non- Specific Type
    • Chronic intramedullary osteomyelitis
    • Chronic focal sclerosing osteomyelitis
    • Chronic diffuse sclerosing osteomyelitis
    • Chronic osteomyelitis with proliferative periostitis
    • Chronic subperiosteal osteomyelitis
    • Chronic periostitis
  • Specific Type
    • Tuberculous osteomyelitis
    • Syphilitic osteomyelitis
    • Actinomycotic osteomyelitis
• Radiation-induced osteomyelitis
• Idiopathic osteomyelitis

Classification of Fibro-osseous Lesions

• Developmental:
  • Solitary bone cyst
  • Gigantiform Cementoma
  • Cherubism
• Reactive/Reparative:
  • Aneurysmal bone cyst
  • Central giant cell granuloma
  • Garre’s Osteomyelitis
  • Osseous Dysplasia
    • Florid Osseous Dysplasia
    • Cemental osseous dysplasia
    • Focal osseous dysplasia or sclerosing osteomyelitis
  • Osseous Keloid
  • Traumatic periostitis
• Neoplasms:
  • Benign cementoblastoma
  • Ossifying Fibroma
    • Conventional
    • Juvenile Trabecular
    • Juvenile Psammomatoid
  • Osteoma
  • Osteoid Osteoma
  • Osteoblastoma
• Endocrinal/Metabolic:
  • Brown tumor of hyperparathyroidism
• Idiopathic:
  • Fibrous dysplasia
  • Paget’s disease

Classification of Bone Disorders of Face and Jaw

• Developmental defects of bone formation of face and jaw:
  • Agnathia
  • Micrognathia
  • Macrognathia
  • Facial hemiatrophy
  • Facial hemihypertrophy
  • Cleft palate.
• Benign and malignant lesions of bone:
  • Osteoma
  • Osteosarcoma
  • Ewing’s sarcoma.
• Fibrosseous lesions
  • Fibrous dysplasia of bone
  • Ossifying fibroma
  • Cementifying fibroma
  • Paget’s disease of bone
  • Cherubism
  • Osteogenesis imperfecta
  • Cleidocraniodysplasia
  • Hurler’s syndrome
  • Garre’s osteomyelitis
  • Jaw lesions in hyperparathyroidism
  • Aneurysmal bone cyst.

Classification of Anemia

Etiological Classification of Anemia (By Lea & Febiger 1981)

Loss of blood

• Acute posthemorrhagic anemia
• Chronic posthemorrhagic anemia

Excessive destruction of red blood corpuscles

• Extracorpuscular causes
  • Antibodies
  • Infections-like malaria
  • Splenic sequestration and destruction
  • Associated diseases like lymphomas
  • Drugs, chemical and physical agents
  • Trauma to RBC
• Intracorpuscular hemolytic diseases:
  • Hereditary:
    • Disorders of glycolysis
    • Faulty synthesis or maintenance of reduced glutathione.
    • Qualitative or quantitative abnormalities in the synthesis of globulin
    • Abnormalities in RBC membrane
    • Erythropoietic porphyria
• Acquired:
  • Paroxysmal nocturnal hemoglobinuria
  • Lead poisoning

Impaired blood production resulting from deficiency of substances essential for erythropoiesis

• Iron deficiency
• Deficiency of various B vitamins: Vitamin B12 and folic acid (pernicious anemia and megaloblastic anemia); pyridoxine responsive anemia
• Protein deficiency
• Possibly ascorbic acid deficiency

Inadequate production of mature erythrocytes

• Deficiency of erythroblast
  • Atrophy of bone marrow: Aplastic anemia
    • Chemical or physical agents
    • Hereditary
    • Idiopathic
  • Isolated erythroblastopenia
    • Thymoma
    • Chemical agents
    • Antibodies
• Infiltration of bone marrow:
  • Leukemia, lymphomas
  • Multiple myeloma
  • Carcinoma, sarcoma
  • Myelofibrosis
• Endocrine abnormalities:
  • Myxedema
  • Addison’s disease
  • Pituitary insufficiency
  • Sometimes hyperthyroidism
• Chronic renal failure:
• Chronic inflammatory disease:
  • Infectious
  • Non-infectious including granulomatous and collagen disease

Cirrhosis of liver

Morphological Classifaction of Anemia

MCV = mean corpuscular valume; MCH = mean corpuscular hemoglobin;

MCHC = mean corpuscular hemoglobin concentration

Classification of Acute Leukemia (FAB Classification)

Acute Myeloblastic Leukemia

• Minimally differentiated: Myeloblasts lack definite cytologic and cytochemical features but have myeloid lineage antigens
• AML without maturation: Myeloblasts predominate with distant nucleoli, few granules or auer rods are present.
• AML with maturation: Myeloblasts wtih promyelocytes predominate and Auer rods may be present.
• Acute promyelocytic leukemia: Hypergranular promyelocytes often with multiple Auer rods are seen.
• Acute myelomonocytic leukemia: Mature cells of both myeloid and monocytic series in peripheral blood; myeloid cells resemble M2
• Acute monocytic leukemia: Promonocytes or undifferentiated blast.
• Acute erythroleukemia: Erythroblast predominate; myeloblasts and promyelocytes also increased
• Acute megakaryocytic leukemia: Pleomorphic undifferentiated blast cells predominate and react with anti-platelet antibodies.

Acute Lymphoblastic Leukemia

• Acute lymphoblastic (Seen in children): Homogeneous small lymphoblasts; scanty cytoplasm, regular round nuclei, inconspicuous nucleoli.
• Acute lymphoblastic (Seen in adults): Heterogeneous lymphoblasts; variable amount of cytoplasm, irregular or cleft nuclei, large nucleoli.
• Burkitt’s Type (Uncommon): Large homogenous lymphoblasts; Nuclei are round to oval, prominent nucleoli, cytoplasmic vacuolation.

Classification of Vesiculobullous Lesions

Vesiculo Bullous Lesions

Fitz Patrick Classification

• According to Anatomical Plane:
  • Intraepidermal blister granular layer
    • Pemphigus foliaceus
    • Frictional blisters
    • Staphylococcus scalded syndrome
  • Spinous layer
    • Eczematous dermatitis
    • Secondary to heat and cold
    • Herpes virus infection
    • Familial Benign Pemphigus
  • Suprabasal
    • Pemphigus vulgaris
    • Pemphigus vegetans
    • Darier’s disease
  • Basal layer
    • Erythema multiforme
    • Toxic epidermal necrolysis
    • Lupus erythematosus
    • Lichen planus
    • Epidermolysis bullosa simplex
• Dermal-Epidermal Junction Zone:
  • Lamina lucida
    • Bullous pemphigoid
    • Cicatricial pemphigoid
    • Epidermolysis bullosa junctional
  • Below basal lamina
    • Erythema multiforme
    • Epidermolysis bullosa dystrophica

Vesiculobullous Lesions

• Primary Blistering:
  • Pemphigus
  • Bullous pemphigoid
  • Cicatrical pemphigoid
  • Epidermolysis bullosa acquisita
• Secondary Blistering:
  • Contact
  • Erythema multiforme
  • Toxic epidermal necrolysis
• Infection:
  • Varicella Zoster
  • Herpes Simplex
  • Bullous Impetigo
• Systemic Disease:
  • Infection-Cutaneous Emboli
  • Metabolic
    • Diabetic with Bullae
    • Porphyria Cutanea tarda

Classification of Mucocutaneous Lesions of Oral Cavity

Genodermatosis:

• Darier’s Disease
• White sponge nevus
• Hereditary benign intraepithelial dyskeratosis
• Peutz-Jeghers syndrome
• Pachyonychia Congenita
• Dyskeratosis Congenita
• Pseudoxanthoma elasticum

Non-Infective Disease:

• Vesicular
  • Bullous pemphigoid
  • Benign mucous membrane pemphigoid
  • Pemphigus
  • Erythema multiforme
  • Lichen planus
  • Epidermolysis Bullosa
• Non-Vesicular
  • Geographic tongue
  • Lichen planus
• Collagen disorders:
  • Wegener’s granulomatosis
  • Midline lethal granuloma
  • Polyarteritis nodosa
  • Scleroderma
  • Lupus erythematosus
  • Vasculitis
• Degenerative disorders:
  • OSMF
  • Amyloidosis
  • Solar elastosis
• Pigmentation:
  • Anemia
  • Albert syndrome
  • Addison’s disease
  • Racial pigmentation
  • Endocrinopathy

Precancerous Lesions

• Leukoplakia
• Erythroplakia
• Palatal lesion associated with reverse smoking
• Verrucous hyperplasia
• Carcinoma in situ

Precancerous Condition

• Oral submucous fibrosis
• Sideropenic anemia
• Lichen planus (Erosive)
• Discoid lupus erythematosus
• Dyskeratosis congenita