ORAL CAVITY
Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

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Freely have you received, give freely With one of four large boxes of "Pathguy" replies.

I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

I am presently adding clickable links to images in these notes. Let me know about good online sources in addition to these:

Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the eighteen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!

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More of Ed's Notes: Ed's Medical Terminology Page

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Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

* It's not what you eat with your mouth that makes you dirty, it's what you say with your mouth that makes you dirty.

*  Aristotle mentioned that women have fewer teeth than men. Although he was twice married, it never occurred to him to verify this statement by examining his wives' mouths.

Head and Neck / Salivary Glands
Photo Library of Pathology
U. of Tokushima

Head and Neck
Surgical Pathology Atlas
Nice photos, hard-core

Head and Neck Slides
Iowa Virtual Microscopy
Have fun

Head & Neck
First Section
Chaing Mi, Thailand

Head & Neck
Second Section
Chaing Mi, Thailand

Mouth Exhibit
Virtual Pathology Museum
University of Connecticut

Oral Pathology
Dental student-oriented
Ohio State

Head and Neck
Brown Digital Pathology
Some nice cases

KCUMB Students
"Big Robbins" -- Head & Neck
Lectures follow Textbook

QUIZBANK: Disk 6: Oral region (all)

TOOTH DECAY ("dental caries"): Lancet 369: 51, 2007. The familiar "cavity" is the major cause of loss of teeth in persons under 35.

PULPITIS and PERIAPICAL DISEASE

PERIODONTAL DISEASE: The major cause of loss of teeth in persons over 35.

{12366} periodontal disease ("gingivitis ")
{12430} bad periodontal disease ("pyorrhea")
{12432} periodontal disease

BACTERIAL INFECTIONS

{12433} "trench mouth" (necrotizing gingivitis)

NON-PATHOLOGY OF THE TONGUE

BENIGN TUMORS AND QUASI-TUMORS

MALIGNANT TUMORS AND RELATED CONDITIONS: Mouth and throat cancer comprises 2-5% (estimates vary widely) of all cancers.

Mouth Cancer
Oral cancer foundation
Patient photos

Humphrey Bogart, mouth cancer casualty

{12361} oral leukoplakia
{21206} leukoplakia where the guy keeps his snuff

{12169} squamous cell carcinoma of the lip
{38614} carcinoma of tongue, patient

Cancer of the tongue
Exophytic
Wikimedia Commons

ORAL LICHEN PLANUS

{12360} oral lichen planus
{12604} oral lichen planus, good filigree

APHTHOUS STOMATITIS ("canker sores")

{21234} aphtha
{21619} aphtha

VIRAL INFECTIONS

{12114} herpes simplex I, primary infection

{21239} herpes simplex, recurrent, severe

{21249} herpangina
{21640} herpangina

FUNGAL INFECTIONS OF THE MOUTH

{05273} oral candidiasis ("thrush")
{09386} oral candidiasis ("thrush")
{12364} oral candidiasis

Salivary Gland Exhibit
Virtual Pathology Museum
University of Connecticut

DISEASES OF THE SALIVARY GLANDS (Med. Cli. N.A. 83: 197, 1999)

{21264} "mucous retention phenomenon" (mucocele / ranula), gross
{21265} "mucous retention phenomenon" (mucocele / ranula), histology

Suppurative parotitis
Striking production of pus
Patient photo from NEJM

SALIVARY GLAND NEOPLASMS

{10154} mixed tumor ("pleomorphic adenoma") of salivary gland
{10437} mixed tumor ("pleomorphic adenoma") of salivary gland
{26870} mixed tumor ("pleomorphic adenoma") of salivary gland
{40149} mixed tumor ("pleomorphic adenoma") of salivary gland

Cancer arising in
a pleomorphic adenoma
Pittsburgh Pathology Cases

{11434} Warthin's tumor, gross
{15530} Warthin's tumor, histology
{15531} Warthin's tumor, histology
{15532} Warthin's tumor, histology
{15413} oncocytoma of salivary gland

Warthin tumor
several images
Wikimedia Commons

{15415} mucoepidermoid carcinoma of salivary gland

Mucoepidermoid carcinoma
H&E
Wikimedia Commons

{19414} adenoid cystic carcinoma, histology
{19416} adenoid cystic carcinoma, histology
{19417} adenoid cystic carcinoma, histology
{19419} adenoid cystic carcinoma, histology

Adenoid cystic carcinoma
Several good photos
Wikimedia Commons

* CYSTS OF THE JAWS

TUMORS AND QUASI-TUMORS OF THE JAWS

{46456} myxoma of the jaw

{49122} ameloblastoma, gross
{19437} ameloblastoma, histology

Ameloblastoma
Pittsburgh Pathology Cases

MORE ODD MOUTH-AND-THROAT BUMPS

A FEW OTHER PROBLEMS that seldom come to the attention of anatomic pathologists....

Having your amalgams removed to cure your alleged mercury toxicity remains a lucrative fad. There's no question that a bit of the mercury does get into your system. The pop claims are that mercury in the amalgams causes (1) male infertility; (2) emotional, intellectual, and behavioral disorders, including chronic fatigue syndrome and attention-deficit disorder; (3) renal toxicity; and that (4) MRI scans rip mercury from your fillings causing horrid overexposure. These have all been tested in controlled studies in the past four years, with uniformly negative results. This has not stopped the hoopla and mud-slinging, and there probably is some real danger to dentists working with mercury all day. Mercury probably does cause some cases of "oral lichenoid reaction" due to allergy.

ORAL MANIFESTATIONS OF SYSTEMIC DISEASES

Nice review: Postgrad. Med. 102 117, 1997.

STAINED TEETH: tetracycline exposure, bilirubin (hemolytic anemia), excess fluoride (mottling) (all must occur while teeth are developing)

DEFORMED TEETH: congenital syphilis (Hutchinson's incisors, mulberry molars), osteogenesis imperfecta, leukemia therapy during childhood (Cancer 59: 1640, 1987), many other diseases

ATROPHIC GLOSSITIS (tongue red, smooth, sore): iron deficiency, B12 deficiency, other B-vitamin deficiencies

GINGIVAL HYPERPLASIA: familial, monocytic leukemia, phenytoin ("Dilantin"), cyclosporin A (Oral Surg. 64: 293, 1987), nifedipine. KNOW these three drugs.

GINGIVAL HEMORRHAGE: bleeding diathesis (scurvy, decreased platelets), gingival disease

BLUE GUMS: heavy metal poisoning ("lead line")

ANGULAR STOMATITIS ("cheilosis"): iron deficiency, B-vitamin deficiency, edentulousness (the last is commonest)

PIGMENTATION OF ORAL MUCOSA: adrenal cortical insufficiency, Peutz-Jegher's syndrome

BUMPS: tuberous sclerosis (Oral Surg. 64: 207, 1987), Cowden's, a few others

PETECHIAE ON PALATE: infectious mononucleosis, other causes (Oral Surg. 52: 417, 1981.)

TELANGIECTASES ON THE LIPS: Osler Weber Rendu syndrome (autosomal dominant, these people have GI bleeding)

JAW PAIN: remember coronary artery disease....

BREATH ODOR: ethanol, metalloid poisoning (arsenic, phosphorus, selenium -- supposed to smell like garlic), diabetic ketoacidosis, fetor hepaticus (stink of liver failure), trench mouth, bronchiectasis, lung abscess, pyloric stenosis

DRY MOUTH: dehydration, drugs, Sjogren's, previous radiation, pregnancy and menstruation, various other endocrine alterations

ARC-AIDS: Kaposi's sarcoma, candida, hairy leukoplakia (Oral Surg. 64: 50, 1987), CMV (Oral Surg. 64: 183, 1987).

* PINK TEETH: In the living, congenital erythropoietic porphyria. In the dead, decomposition and staining of the dentin from heme pigment.

{05268} oral hairy leukoplakia in AIDS
{05278} oral hairy leukoplakia in AIDS

Rathke's cleft cyst
Pittsburgh Pathology Cases

ORAL BIOPSY: for the diagnosis of amyloidosis or Sjogren's syndrome (Can. J. Surg.: 25: 186, 1982.)

{20034} cytomegalic inclusion disease, salivary gland
{39654} Kawasaki disease, patient
{12131} hand, foot, and mouth disease
{12132} hand, foot, and mouth disease
{12133} hand, foot, and mouth disease
{38620} amyloidosis of tongue
{09868} graft vs. host disease, tongue, histology (note attacking lymphocytes)
{21536} "Sturge-Weber" patient, looks like phenytoin hyperplasia of gums

* SLICE OF LIFE REVIEW

{14802} tongue, dorsum
{14803} tongue, dorsum
{14804} fungiform filiform papillae
{14805} fungiform filiform papillae
{14806} circumvallate papillae
{14807} circumvallate papillae
{14808} taste bud
{14809} taste bud
{14810} oral pap smear, squamous cells
{14811} parotid gland, normal
{14812} parotid gland, normal
{14813} parotid gland, normal
{14814} excretory duct (salivary gland), normal
{14815} excretory duct (salivary gland), normal
{14816} submandibular gland, normal
{14817} sublingual salivary gland, normal
{14818} sublingual salivary gland, normal
{14819} mucous acinus, serous demilune
{14820} mucous acinus, serous demilune
{14821} pharyngeal tonsil, normal
{14822} pharyngeal tonsil, normal
{14823} pharyngeal tonsil, normal
{14824} pharyngeal tonsil, normal
{14825} palatine tonsil, normal
{14826} palatine tonsil, normal
{14900} epiglottis, normal
{15155} papilla, fusiform and fungiform
{15160} papilla, fusiform
{15162} tongue, epithelium
{15163} parotid gland
{15164} parotid gland
{15166} parotid gland
{15167} parotid gland
{15168} parotid gland
{15169} submandibular gland
{15170} submandibular gland
{15171} sublingual gland
{15172} sublingual gland
{15173} sublingual gland
{15174} sublingual gland
{15221} tonsil, palatine
{15222} tonsil, palatine
{15223} tonsil, palatine
{15224} tonsil, pharyngeal
{15225} tonsil, pharyngeal
{15227} tongue, lamina propria
{15228} von Ebner's glands, tongue
{15229} von Ebner's glands, tongue
{15230} von Ebner's glands, tongue
{15232} parotid gland, normal
{15233} submandibular gland, normal
{15234} submandibular gland, normal
{15235} sublingual gland, normal
{20829} circumvallate papilla
{20830} circumvallate papilla and assoc. gland
{20831} taste bud, circumvallate papilla
{20832} parotid gland
{20833} parotid gland, intercalated duct
{20834} parotid gland, striated duct
{20835} parotid gland, fat
{20836} submandibular gland
{20837} sublingual gland
{20840} tonsil, pharyngeal
{21672} mouth, normal
{21673} mouth, normal

BIBLIOGRAPHY / FURTHER READING

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