50 Lesions - For The Beginner

Fordyce Granules
• A common condition in which small yellow
dots are observed in the oral mucous
membrane; these represent misplaced
sebaceous glands; once properly diagnosed,
no treatment is necessary
Fissured Tongue
• A condition of probable developmental
etiology in which cracks are observed in the
tongue dorsum; food debris and Candida
albicans colonies may form in the fissures;
once properly diagnosed, no treatment is
• A fairly-common condition of older people in
which distended blood vessels are observed
on the lingual tongue surface; once properly
diagnosed, no treatment is necessary.
Torus Palatinus
• A hamartomatous overgrowth of bone from
the midline of the maxilla.
Torus Mandibularis
• A hamartomatous overgrowth of bone
bilaterally from the lingual surface of the
• Overgrowth of bone (like tori) from a site
other than the maxillary midline or bilateral
lingual mandible; commonly occur in the
buccal maxilla adjacent to the bicuspid teeth.
Nasopalatine duct cyst
• A common true jaw cyst appearing as a
radiolucency in the maxilla midline just lingual
to the central incisor teeth (in the incisive
canal); surgical removal will cure this cyst.
Oral Lymphoepithelial Cyst
• Uncommon lesion that develops in lymphoid tissue in
the oral pharynx including the palatine tonsils, lingual
tonsils, and pharyngeal adenoids. They may also arise
within accessory lymphoid tissue on the floor of the
mouth, ventral surface of the tongue, and soft palate.
These small (rarely exceed 1cm) submucosal cysts have
a yellow or white appearance and feel firm on
palpation. They contain creamy or cheesy keratinous
material and are usually asymptomatic except when
they are traumatized of become infected. They may
occur at any age but are most prevalent in young
adults. Cysts rarely recur after surgical excision.
Amelogenesis Imperfecta
• The designation "amelogenesis imperfecta"
refers to inherited defects in enamel
formation. Several forms are recognized based
on their pathogenesis and severity.
• Clinically, affected enamel may be thinner
than normal (generalized hypoplastic form),
may be of normal thickness but lacks strength
(hypocalcified form), or may be pitted
(hypoplastic pitted form).
Periapical Cyst
• This cyst is a direct sequela of inflammation of
the pulp which has extended into the adjacent
periapical tissues.
• Treatment consists of endodontic therapy or
extraction of the associated tooth with
curettage of the cyst.
Acute Necrotizing Ulcerative Gingivitis
• Poor oral hygiene combined with serious life
stress and possibly nutritional deficiencies.
Aka: trench mouth. It can be painful, and it is
characterized by areas where the gum tissue
has become so inflamed that it has become
necrotic. These areas will be small ulcers, and
will be grayish in color, and will tend to slough
off. The tissue will be generally swollen, and
where it isn't dead, it will bleed very easily.
Wipes Off
Pseudomembranous Candidiasis
• A common fungal infestation of the oral cavity
in the immunocompromised or antibiotictreated patient. Appears as milky white areas
on the oral mucosa; lesions wipe-off leaving
red (erythematous) base. Responds well to
antifungal agents.
Angular Cheilitis
• Erythema, fissuring, and scaling at the angles
of the mouth.
• Often in an older person with reduced vertical
dimension of occlusion
• Caused by C. albicans, S. aureus (in kids – Rx:
OTC triple antibiotic ointment), often both.
Primary Herpetic Stomatitis
• Effected mucosa develops numerous pinhead
vesicles which collapse to form small, red
lesions which enlarge and develop central
areas of ulceration covered in yellow fibrin.
• Adjacent ulcerations may coalesce to form
larger, shallow, irregular-shaped ulcerations.
• Distinctive punched-out erosions along the
midfacial free gingival margins
Recurrent Herpes Labialis
• “cold sore” or “fever blister”
• Most common site for recurrence – vermillion
boarder and adjacent skin of the lips
• Small, erythematous papules; clusters of fluid
filled vesicles – rupture and crust within 2
Recurrent Intraoral Herpes Simplex
• Multiple coalescing ulcerations on FIXED
Herpes Zoster
• Recurrent infection, often after several
• Virus was latent in the dorsal spinal ganglia
• Recurrent intraoral:
– Unilateral, severe pain
– Looks like recurrent herpes simplex
Linea Alba
• Normal variation in the buccal mucosa that
appears as a white line beginning at the
corners of the oral cavity and extending
posteriorly at the level of the occlusal plane. It
is composed of keratinized oral mucosa.
Cheek Chewing
• Hyperkeratosis caused by habitual chewing on
the cheek
Amalgam Tattoo
• A bluish-black or gray macular lesion of the
oral mucous membrane caused by accidental
implantation of silver amalgam into the tissue
during tooth restoration or extraction.
Antral Pseudocyst
• The antral pseudocyst is a common and welldocumented finding on a panoramic
radiograph. Most are discovered during
routine radiographic examination and have
little clinical significance. The antral
pseudocyst should not be confused with the
mucocele of the sinus. The antral pseudocyst
is believed to be caused by an inflammatory
exudate that accumulates under the maxillary
sinus mucosa and results in a sessile elevation.
Aphthous Lesion
• A very common self-limiting, episodic disease
of unknown origin manifesting as one or
several painful ulcers on the lining mucosa;
the ulcers heal in 7-10 days with or without
Major Aphthous Stomatitis
• Major aphthae are more serious ulcerative
disease of unknown etiology manifesting as
large, deep, painful ulcers that leave scars;
they recur more often and persist longer than
minor aphthae; treatment consists of
promoting healing and alleviating pain.
Cinnamon Stomatitis
• Contact stomatitis from artificial cinnamon
flavoring (concentrations of the artificial
flavoring are up to 100 times that in the
natural spice). Most common in chewing gum,
candy, toothpaste.
Dentifrice Stomatitis
• Superficial epithelial sloughing, no pain or
bleeding, a reaction to detergent in
Squamous Papilloma
• A common benign neoplasm arising from
mucosal epithelium appearing as a raised,
soft, pink lesion with a papillary surface
texture; some are caused by viruses (HPV);
surgical excision will cure squamous
Seborrheic Keratosis
• Extremely common skin lesion of older people
and represents an acquired, benign
proliferation of epidermal basal cells. There is
a positive correlation with chronic sun
exposure. Does NOT occur in the mouth.
Does NOT wipe off.
Idiopathic Leukoplakia
• “a clinical white lesion that does NOT rub off
and cannot be determined to be a specific
Oral Melanotic Macule
• Flat, brown mucosal discoloration produced
by an increase in melanin deposition. The
cause is unclear, but is not dependant on sun
exposure. A solitary, well demarcated,
uniformly colored, asymptomatic, round or
oval macule. Vermillion zone of lower lip is the
most common site. Can occur at any age.
Stafne Defect
• Asymptomatic radiolucency below the
mandibular canal in the posterior mandible,
between the molar teeth and the angle of the
mandible. Typically well circumscribed and has
a sclerotic border.
• Developmental in nature, although not
present at birth.
Speckled Erythroplakia
• Red and white, or reddish with white spots
• Almost always carcinoma in situ or squamous
cell carcinoma (not good)
Smokeless Tobacco Keratosis
• Characteristic white plaque produced on the
mucosa in direct contact with the snuff or
chewing tobacco. Typically thin, gray or graywhite, almost translucent plaque with a
border that blends gradually into the
surrounding mucosa. The usually stretched
mucosa appears fissured or rippled.
Actinic Cheilitis
• A common condition caused by excessive
exposure to sunlight manifesting as a crusting
lesion of the lower lip; it may show evidence
of dysplasia and superficial invasion; however,
simple excision of actinic cheilosis usually
cures this condition.
Squamous Cell Carcinoma
• A common epithelial malignancy of the oral
mucosa appearing as a red, white, or
ulcerated "sore"
Basal Cell Carcinoma
• A common malignancy of skin, usually of the
upper face, that invades locally but rarely
• “Classic" appearance of basal cell carcinoma is
a central depression and a rolled peripheral
border. Most basal cell carcinomas are located
above an imaginary line drawn between the
lower and upper lips.
• “Easy diagnosis”: lesion in area of minor
salivary glands, goes up and down in size
• Duct of salivary gland is severed, mucus leaks
out into the tissue
• Fast inflammatory reaction, macrophages
come in to clean it up - Replacement by
granulation tissue = fibroma
• A very serious malignancy of melaninproducing cells in the skin and occasionally of
the oral mucosa; tends to invade and
metastasize early
• Large mucocele on floor of mouth (major
salivary gland, usually caused by blockage)
Minor Salivary Gland Tumor
• Bump in the upper lip is NOT a mucocele – it is
probably a minor salivary gland tumor
• 50% are malignant!
• Most common tumor of oral cavity
• Reactive hyperplasia of fibrous connective
tissue in response to local irritation or trauma
• Most common location = buccal mucosa along
bite line (also: labial mucosa, tongue, gingival)
• Smooth surfaced pink nodule, most sessile,
asymptomatic, most <1.5cm
• Rx: conservative surgical excision
Four P’s
• Pyogenic granuloma, peripheral giant cell
granuloma, peripheral ossifying fibroma,
peripheral fibroma
• A common benign neoplasm arising from
blood vessels manifesting as flat or raised redpurple surface discoloration
• Most common tumor of infancy (“strawberry
hemangioma”) - rapid growth, but most
resolve by age 5, almost all by age 9.
Langerhans Cell Disease
• Growing evidence indicates this is a neoplastic
process of Langerhans cells. Intraosseous
lesions may result in radiographic appearance
of teeth with unsupported bone, often termed
“teeth floating in space”.
Florid Cemento-osseous Dysplasia
• Multiple mixed radiopaque and radiolucent
lesions of the mandible and maxilla
Simple Bone Cyst
• A benign, empty, or fluid containing cavity within
bone that is devoid of an epithelial lining. Cause
is uncertain, but one theory is a traumahemorrhage route that causes an intraosseous
hematoma that may not undergo repair but
instead may liquefy, resulting in a cystic defect.
• Can be a well-delineated radiolucent lesion with
projections between the roots of vital premolar
teeth producing a scalloped appearance
Periapical Cemento-osseous Dysplasia
• It is a self-limiting fibro-osseous process
where bone appears to react abnormally to
some unknown stimulation.
• Typical example is multiple radiolucencies at
the apices of lower anterior teeth - It may be
mistaken for inflammatory periapical disease.
Determining tooth vitality will settle the issue
(teeth are vital)
Lateral Periodontal Cyst
• An odontogenic cyst arising in the alveolar
process appearing as a small radiolucency
between the roots of the adjacent teeth
(usually mandibular permanent bicuspids).
• Generally quite small and well demarcated.
Usually adjacent to vital teeth.
• An uncommon benign jaw neoplasm of
odontogenic epithelium appearing as an
unilocular or multilocular radiolucency;
because of its locally-infiltrative growth
pattern, this neoplasm may be difficult to
• Should be suspected when ever a large
multilocular radiolucent lesion is discovered.
Most common in the posterior mandible.
Lichen Planus
• A fairly-common non-neoplastic dermatologic
condition manifesting as flat, lacy, white,
intersecting lines on the oral mucosa.
Presumed autoimmune reaction to basal cells
of oral mucosa and skin.
• Intersecting white lines (Wickham's striae);
may be irregular white plaques; may be
ulceration and sloughing in erosive form.
Bell’s Palsy
• Facial nerve paralysis on one side of the face