ORAL MEDICINE AND RADIOLOGY

1. Dr Megha B
Senior lecturer
Department of Oral Medicine and Radiology
MINDS, MAHE

2. Normal anatomical variations of oral cavity

3. • Introduction
• Fundamental to diagnosing oral pathologic conditions is the
ability to recognize the spectrum of clinical findings that
represents variation of normal within the population.
• Some are purely developmental, while others have a clear
inflammatory or traumatic etiology.

4. • 1.Variation On Buccal Mucosa
• Leukedema
• Fordyces Granule
• Linea Alba
• 2.Variations On Gingiva
• Physiologic Pigmentation
• 3.Variations On Tongue
• Fissured Tongue
• Geographic Tongue
• Oral Varicosity
• Median Rhomboid Glossitis
• Bifid Tongue
• Folliate Papilla
•

5. • 4.Variations On Lips
• Commissural Lip Pit
• Paramedian Lip Pit
• 5.Radiological Variations
• Idiopathic Osteosclerosis
• Focal Osteoporotic Bone Defect
• Stafne Bone Defect

7. • Leukedema
• Common developmental alteration of the oral mucosa which
present most typically as an asymptomatic, bilateral, whitish, grey
semitransparent macule of the buccal mucosa
• Epidemology
• Distribution between genders has
been found to be equal
• The incidence and intensity
increases with age

8. • Clinical features
• White and wheel like alteration of oral mucosa
• bilaterally on buccal mucosa
• Less clinically evident after stretching of the mucosa but
reappear after this manipulation is discontinued

9. • Asymptomatic
• No malignant transformation
• Differential diagnosis
• Clinical examination readily differentiate leukedema from
leukoplakia since there is no loss of pliability or flexibilty of
involved tissue
• In addition tissue affected by leukedema manifest an
edematous state

10. • lichen planus
• White spongy nevus
• cheek biting

12. • Linea alba
• Normal variations which appear as a white line extending from the
corner of the mouth to posterior region at the level of occlusal
plane bilaterally
• Frictional keratosis
• Trauma from facial surface of teeth.

13. • Usually present bilateraly
• It is believed that parakeratosis occur along the line of occlusal
plane as the cheeks sucks in due to negative pressure

15. • Fordyces granule
• Ectopic sebaceous gland located on oral mucosa and vermillion
border of lips
• 80% of the adult population
• More pronounced in males
• Male to female ratio 11:5

16. • Clinical features
• The buccal mucosa and vermillion border are the most common
locations
• Alveolar ridge, gingiva, palate and tongue
• Maculopappular lesions typically smaller than 2mm
• White or cream colour spots
• May occasionally coalesce and form plaque

17. • Treatment
• Not required
• Chemical peel
• Laser
• Surgical diathermy or cryotherapy

19. • Physiological pigmentation
• increased melanotic activity rather than an increase in number of
melanocytes
•
• Africans, Asians and Mediterranean
• both gender
• 1st two decades
Epidemiology
Epidemiology

20. • Clinical features
• Attached gingiva
• light to dark brown
• It appears as bilateral, well demarcated, ribbon like dark brown
band
• The buccal mucosa, hard palate, lips and tongue may also be
affected
• symmetrically distributed

22. • Disease that may be confused with melanin pigmentation are
• Addisons disease ,
• Oral melanotic macule.
• Oral mucosal melanoma,
• Drug induced pigmentation

24. • Geographic tongue
• Is an annular lesion affecting the dorsum of tongue and margins
• Also known as erythema migrans
• Epidemiology
• 1-2.5% prevalence
• Gender distribution is equal

25. • Clinical features
• comprise a white yellow or grey slightly
elevated peripheral zone
• Erythmatous patch =atropy of filiform papilla .
• white border regenerating= filiform papilae and a mixture of
keratin and neutrophil

26. – Tip
– lateral border
– dorsum of the tongue
• Geographic tongue is circumferentially migrating and leaves an
erythmatous area behind
• The peripheral zone disappear after sometime and healing of
depapilated and erythmatous area starts
• The lesion may commence at various starting points, the
peripheral zones fuse and typical clinical features of geographic
tongue appears

27. • single to multiple lesions
• Usually non symptomatic

29. • Fissured tongue
• shallow to deep grooves or furrows
• dorsal surface of the tongue
Epidemiology
• Higher frequency among males
• Hereditary

30. clinical features
• Aging and local environmental factors
• Fissured tongue is diagnosed on the basis of fissures clinically
• Based on the position of the fissures it can be classified as
median and lateral type

31. • Diagnosis
• Clinical features are diagnostic , biopsy is rarely done
• Histology
• Shows increase thickness of lamina propria
• Hyperplasia of rete ridges
• Neutrophillic microabcess in the upper epithelial layer
• Mixed inflammatory infiltrate in lamina propria

33. • Bifid tongue
• A completely cleft or bifid tongue is a rare condition
• A partially cleft tongue is considerably more common and is
manifested simply as a deep groove in the midline of dorsal
surface

34. • The lateral lingual structures rapidly grow and cover the
tuberculum impar to form the anterior two-thirds of the tongue.
When this process is disturbed, tip of the tongue is divided
longitudinally for a certain distance giving rise to cleft
tongue/bifid tongue.
• Mostly associated with orofacial digital syndrome

36. • Median rhomboid glossitis
• Median rhomboid glossitis is clinically characterized by
erythmatous lesion in the center of posterior part of dorsum of
tongue
• Developmental defect resulting from an incomplete desent of
tuberculum impar and entrapment of a portion between
fusing lateral halves of the tongue
• 3:1 male predilection

37. • rhomboid shaped, smooth erythmatous mucosa lacking in
papilla or taste buds
• atropic candidiasis

38. • Clinical features
• Present in the posterior midline of the dorsum of the tongue
• Less than 2cm
• Surface is smooth
• lobulated

39. • kissing lesion
• Occasionally lesions are located somewhat anterior to usual
location. None have been located posterior to circumvallate
papilla

41. • Oral varicosities
• Varicosities are aquired benign lesion of a vein, artery or lymphatic
vessel abnormally dilated and tortuous but in within oral cavity is
only used in reference to venous lesions
• sublingual varix
• Males
• over 50years

42. • Clinical features
• Irregular, blue purple lesion
• Multiple with a bilateral linear distribution
• Thrombosed varix
• Diascopy

44. • Commisural lip pit
• congenital or developmental defects
• Their location suggest that they may represent a failure of normal
fusion of embryonal maxillary and mandibular process

45. • Unilateral or bilateral
• Clinical features
• Invagination is usually 1-2mm in diameter, may be as deep as
4mm and is lined by stratified squamous epithelium

47. • Periapical idiopathic osteosclerosis
• Enostosis
• Dense bone island
• Localized growth of compact bone
• Asymptomatic
• vary in size from 2 mm to 1-2 cm.

48. • Mandible
• Premolar molar area
• Radiographic image- radiopaque
• Asymptomatic
• Etiology – no

49. • margins or capsule
• D/D

51. • Folliate papilla
• Occurs as an area of vertical fold and grooves located on the
extreme posterior lateral surface of tongue
• Occasionaly mistaken for tumours or inflammatory disease
• Bilaterally symmetrical

52. • In some people the papilla are small and inconspicious whereas
in others they are prominent

54. • Stafne bone defect
• First described by Stafne in 1942
• The exact pathogenesis is still obscure.
• Epidemiology
• Men in their
• fifth or seventh decade of life

55. • Stafne suggested that the cavity could result from a failure of
normal bone deposition in the region formerly occupied by
cartilage .
• localized pressure atrophy of the lingual surface of the
mandible from the adjacent salivary gland

56. • Clinical features
• Present as asymptomatic radiolucency below the mandibular canal in
the posterior mandible between the molar and angle of mandible
• well circumscribed
• sclerotic border

57. • Superimposed over the apices of anterior teeth
• Stable in size
• 1 to 3cm in diameter
• below the inferior dental canal
• Incidental
• d/d

64. REFERENCES
1. Burket Oral Medicine: diagnosis and treatment 12th edition
2. Oral Radiology :Principle and nterpretation White and
Pharoah
3. Shafers Textbook of Oral Pathology
4. Oral diseases – Roderich A Cawson, William H Binniew, John
H Wright
5. Oral Radiology :Principle and Interpretation White and
Pharoah

65. Thank you