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Case Name:	Date:	Contributor:	Rating:

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Case

Clinical Photos

Illustrations / Diagrams

Papillary Masses of the Oral Mucosa

Irritation Fibroma or Large Lesions Fibromatoses - Irritation Fibroma or Large Lesions Fibromatoses

Irritation Fibroma or Large Lesions Fibromatoses - Irritation Fibroma or Large Lesions Fibromatoses Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Irritation Fibroma or Large Lesions Fibromatoses<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Even an irritation fibroma, seen here on the lingual gingiva, may become large and lobulated. Some authorities prefer to call the large lesions fibromatoses.</span>

Figure 1 - Even an irritation fibroma, seen here on the lingual gingiva, may become large and lobulated. Some authorities prefer to cal...

Figure 1 - Even an irritation fibroma, seen here on the lingual gingiva, may become large and lobulated. Some authorities prefer to call the large lesions fibromatoses.

Biopsied Giant Cell Fibroma - Biopsied Giant Cell Fibroma

Biopsied Giant Cell Fibroma - Biopsied Giant Cell Fibroma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Biopsied Giant Cell Fibroma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> In giant cell fibroma, the giant cells are unusual fibroblases and can be alarming to a pathologist not familiar with the lesion.</span>

Figure 1 - In giant cell fibroma, the giant cells are unusual fibroblases and can be alarming to a pathologist not familiar with the le...

Figure 1 - In giant cell fibroma, the giant cells are unusual fibroblases and can be alarming to a pathologist not familiar with the lesion.

Exophytic Squamous Cell Carcinoma - Exophytic Squamous Cell Carcinoma

Exophytic Squamous Cell Carcinoma - Exophytic Squamous Cell Carcinoma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Exophytic Squamous Cell Carcinoma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Most intraoral exophytic squamous cell carcinomas have lobulated or fungated appearance. There is often a central necrosis or ulceration, as seen here.</span>

Figure 1 - Most intraoral exophytic squamous cell carcinomas have lobulated or fungated appearance. There is often a central necrosis o...

Figure 1 - Most intraoral exophytic squamous cell carcinomas have lobulated or fungated appearance. There is often a central necrosis or ulceration, as seen here.

Classic Papilloma - Classic Papilloma

Classic Papilloma - Classic Papilloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Classic Papilloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> This pedunculated mass (arrow) was on a 2.5 cm stalk, extending from the uvula. Microscopically, it proved to be a classic papilloma, with smooth clinical appearance</span>

Figure 1 - This pedunculated mass (arrow) was on a 2.5 cm stalk, extending from the uvula. Microscopically, it proved to be a classic p...

Figure 1 - This pedunculated mass (arrow) was on a 2.5 cm stalk, extending from the uvula. Microscopically, it proved to be a classic papilloma, with smooth clinical appearance

Clustered Individual Nodules or Papules - Clustered Individual Nodules or Papules

Clustered Individual Nodules or Papules - Clustered Individual Nodules or Papules Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Clustered Individual Nodules or Papules<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Enlargement and fibrosis of individual lingual papillae along the lateral margin gives the appearance of papillomatosis; multinodular would be a more accurate term.</span>

Figure 1 - Enlargement and fibrosis of individual lingual papillae along the lateral margin gives the appearance of "papillomatosis"; "...

Figure 1 - Enlargement and fibrosis of individual lingual papillae along the lateral margin gives the appearance of "papillomatosis"; "multinodular" would be a more accurate term.

Papillary Hyperplasia of the Palate - Papillary Hyperplasia of the Palate

Papillary Hyperplasia of the Palate - Papillary Hyperplasia of the Palate Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Papillary Hyperplasia of the Palate<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Papillary hyperplasia of the palate is an inflammatory entity, comprising numerous nodules or papules. A leaf-shaped irritation fibroma is also seen (arrow).</span>

Figure 1 - Papillary hyperplasia of the palate is an inflammatory entity, comprising numerous nodules or papules. A leaf-shaped irritat...

Figure 1 - Papillary hyperplasia of the palate is an inflammatory entity, comprising numerous nodules or papules. A leaf-shaped irritation fibroma is also seen (arrow).

Keratin Plug Resembling Papilloma - Keratin Plug Resembling Papilloma

Keratin Plug Resembling Papilloma - Keratin Plug Resembling Papilloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Keratin Plug Resembling Papilloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A keratin plug protruding from a tonsillar crypt may have a stalk and a lobulated or papillary appearance, as seen here. These are easily removed with a tongue blade.</span>

Figure 1 - A keratin plug protruding from a tonsillar crypt may have a stalk and a lobulated or papillary appearance, as seen here. The...

Figure 1 - A keratin plug protruding from a tonsillar crypt may have a stalk and a lobulated or papillary appearance, as seen here. These are easily removed with a tongue blade.

Squamous Papilloma - Squamous Papilloma

Squamous Papilloma - Squamous Papilloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Squamous Papilloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> This keratinized papilloma of the dorsum of the tongue presents a classic appearance with long, blunted surface projections.</span>

Figure 1 - This keratinized papilloma of the dorsum of the tongue presents a classic appearance with long, blunted surface projections....

Figure 1 - This keratinized papilloma of the dorsum of the tongue presents a classic appearance with long, blunted surface projections.

Squamous Papilloma<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> On less keratinized oral mucosal surfaces, a typical papilloma is not white. This one presents with pointed rather than finger-like projections.</span>

Figure 2 - On less keratinized oral mucosal surfaces, a typical papilloma is not white. This one presents with pointed rather than fing...

Figure 2 - On less keratinized oral mucosal surfaces, a typical papilloma is not white. This one presents with pointed rather than finger-like projections.

Squamous Papilloma<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Gross appearance of a biopsied papilloma illustrates the pointed and blunted shapes of the surface projections.</span>

Figure 3 - Gross appearance of a biopsied papilloma illustrates the pointed and blunted shapes of the surface projections.

Squamous Papilloma<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Squamous papillomas can be several cm in diameter (mandibular mucosa). Large lesions may resemble verrucous carcinoma.</span>

Figure 4 - Squamous papillomas can be several cm in diameter (mandibular mucosa). Large lesions may resemble verrucous carcinoma.

Verruca Vulgaris (Common Wart) - Verruca Vulgaris (Common Wart)

Verruca Vulgaris (Common Wart) - Verruca Vulgaris (Common Wart) Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Verruca Vulgaris (Common Wart)<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Verruca vulgaris is usually located on the lip vermilion and is so heavily keratinized that it appears white.</span>

Figure 1 - Verruca vulgaris is usually located on the lip vermilion and is so heavily keratinized that it appears white.

Condyloma Accuminatum (Venereal Wart) - Condyloma Accuminatum (Venereal Wart)

Condyloma Accuminatum (Venereal Wart) - Condyloma Accuminatum (Venereal Wart) Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Condyloma Accuminatum (Venereal Wart)<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Broad-based condyloma accuminatum (large arrow) is a contagious, sexually transmitted disease.</span>

Figure 1 - Broad-based condyloma accuminatum (large arrow) is a contagious, sexually transmitted disease.

Condyloma Accuminatum (Venereal Wart)<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A condyloma is seen here on a lingual frenum, presumably traumatized during sexual activity.</span>

Figure 2 - A condyloma is seen here on a lingual frenum, presumably traumatized during sexual activity.

Focal Epithelial Hyperplasia (Heck's Disease) - Focal Epithelial Hyperplasia (Heck's Disease)

Focal Epithelial Hyperplasia (Heck's Disease) - Focal Epithelial Hyperplasia (Heck's Disease) Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Focal Epithelial Hyperplasia (Heck's Disease)<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Multiple papillary or papular masses are characteristic of a childhood infection, focal epithelial hyperplasia (Hecks disease).</span>

Figure 1 - Multiple papillary or papular masses are characteristic of a childhood infection, focal epithelial hyperplasia (Heck's disea...

Figure 1 - Multiple papillary or papular masses are characteristic of a childhood infection, focal epithelial hyperplasia (Heck's disease).

Verruciform Xanthoma - Verruciform Xanthoma

Verruciform Xanthoma - Verruciform Xanthoma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Verruciform Xanthoma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Verruciform xanthoma often resembles oral papilloma. Here, two lesions (arrow) are seen on the soft palate, a common location.</span>

Figure 1 - Verruciform xanthoma often resembles oral papilloma. Here, two lesions (arrow) are seen on the soft palate, a common locatio...

Figure 1 - Verruciform xanthoma often resembles oral papilloma. Here, two lesions (arrow) are seen on the soft palate, a common location.

Lymphangioma - Lymphangioma

Lymphangioma - Lymphangioma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Lymphangioma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Lymphangioma is often a papillary or pebbled mass (large arrow) with satellite lesions appearing like vesicles (small arrows).</span>

Figure 1 - Lymphangioma is often a papillary or pebbled mass (large arrow) with satellite lesions appearing like vesicles (small arrows...

Figure 1 - Lymphangioma is often a papillary or pebbled mass (large arrow) with satellite lesions appearing like vesicles (small arrows).

Pyogenic Granuloma - Pyogenic Granuloma

Pyogenic Granuloma - Pyogenic Granuloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Pyogenic Granuloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A pyogenic granuloma protruding from an extraction socket may be pedunculated and lobulated, as seen here. Red color renders the lesion similar in appearance to hemangioma.</span>

Figure 1 - A pyogenic granuloma protruding from an extraction socket may be pedunculated and lobulated, as seen here. Red color renders...

Figure 1 - A pyogenic granuloma protruding from an extraction socket may be pedunculated and lobulated, as seen here. Red color renders the lesion similar in appearance to hemangioma.

Verrucous Carcinoma - Verrucous Carcinoma

Verrucous Carcinoma - Verrucous Carcinoma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Verrucous Carcinoma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A verrucous carcinoma of the right oral floor (arrows) demonstrates pointed and blunted surface projections.</span>

Figure 1 - A verrucous carcinoma of the right oral floor (arrows) demonstrates pointed and blunted surface projections.

Oral Candidiasis in the Dental Patient

Diagnosis and Treatment of Oral Candidiasis - Diagnosis and Treatment of Oral Candidiasis

Diagnosis and Treatment of Oral Candidiasis - Diagnosis and Treatment of Oral Candidiasis Contributed by Susan L. Zunt, DDS, MS on 5/15/2012

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A painful mouth with white plaques on the buccal mucosa (pseudomembranous candidiasis)</span>

Figure 1 - A painful mouth with white plaques on the buccal mucosa (pseudomembranous candidiasis)

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> White plaques are easily removed with a cement spatula or moistened tongue depressor revealing an erythematous mucosa.</span>

Figure 2 - White plaques are easily removed with a cement spatula or moistened tongue depressor revealing an erythematous mucosa.

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Fungal pseudohyphane present in material removed from the white plaques (Periodic acid/Schiff/Papanicolaou stain).</span>

Figure 3 - Fungal pseudohyphane present in material removed from the white plaques (Periodic acid/Schiff/Papanicolaou stain).

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Erythematous mucosa beneath a partial denture (atrophic candidiasis)</span>

Figure 4 - Erythematous mucosa beneath a partial denture (atrophic candidiasis)

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Resolution of erythema after two weeks of fluconazole and daily treatment of the denture in a disinfectant solution.</span>

Figure 5 - Resolution of erythema after two weeks of fluconazole and daily treatment of the denture in a disinfectant solution.

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Painful mouth of several months duration. Patient also had severe xerostomia and mild systemic lupus erythematosus.</span>

Figure 6 - Painful mouth of several months duration. Patient also had severe xerostomia and mild systemic lupus erythematosus.

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Complete resolution with 2 weeks of fluconazole therapy. After several recurrences in the next few months, all of which responded to fluconazole therapy, patient was tested and found to be positive for antibodies SS-A and SS-B, consistent with a diagnosis of Sjogrens syndrome.</span>

Figure 7 - Complete resolution with 2 weeks of fluconazole therapy. After several recurrences in the next few months, all of which resp...

Figure 7 - Complete resolution with 2 weeks of fluconazole therapy. After several recurrences in the next few months, all of which responded to fluconazole therapy, patient was tested and found to be positive for antibodies SS-A and SS-B, consistent with a diagnosis of Sjogren's syndrome.

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