Oral Medicine and Pathology Center

Oral Medicine and Pathology Center Oral Medicine & Pathology Center

Geographic tongue (benign migratory glossitis) is a common oral condition that looks different in every patient, and can...
11/07/2025

Geographic tongue (benign migratory glossitis) is a common oral condition that looks different in every patient, and can be associated with fissured tongue in some cases, or other non-related oral lesions. Although generally asymptomatic, it can also be symptomatic in some patients with mild burning or pain or sensitivity to foods/drinks. Geographic tongue lesions can rarely also occur on other areas of the oral mucosae not just the tongue. The key is to look for the characteristic demarcated white border with central atrophy or erythema. Biopsy is sometimes needed for definitive histologic diagnosis given that it can look like precancerous or cancerous tongue lesions in some cases, and particularly on the lateral tongue border. When symptomatic, treatment includes topical steroid therapy and/or antifungal therapy if concomitant Candida infection is present. Sometimes geographic tongue is seen in patients with psoriasis but the exact association remains unclear.

— Case 40 —Ameloblastomas are benign and often locally aggressive odontogenic tumors. They can appear as unilocular to m...
03/14/2025

— Case 40 —

Ameloblastomas are benign and often locally aggressive odontogenic tumors. They can appear as unilocular to multilocular radiolucencies, cause cortical expansion, cause root resorption, and can be painful or asymptomatic. Diagnosis is made by biopsy and histologic examination and various subtypes exist. Treatment approaches vary also from conservative to more aggressive surgical approaches, but recurrence is generally high with conservative approaches.

-Case 39-TUGSE (traumatic ulcerative granuloma with stromal eosinophilia) is a unique type of oral ulcer that is typical...
01/31/2025

-Case 39-

TUGSE (traumatic ulcerative granuloma with stromal eosinophilia) is a unique type of oral ulcer that is typically slow to resolve or does not resolve without removal/biopsy. These lesions can look ominous and can mimic squamous cell carcinomas, especially at the lateral tongue subsite where trauma and SCC are common (and unrelated). TUGSE can be painful or it can be asymptomatic. Clinically, if an obvious history and source of bite trauma is reported and identified, like a sharp broken tooth/cusp, and this is addressed clinically the lesion may then resolve. However, such lesions may also not resolve once they are established despite addressing the potential cause, and in such cases biopsy would be warranted for histologic diagnosis/confirmation. In infants, similar tongue lesions can be seen after mucosal trauma from adjacent anterior primary teeth during nursing, and this is called Riga Fede disease.

The lateral periodontal cyst is a developmental odontogenic cyst that usually appears as a well-demarcated unilocular ra...
12/27/2024

The lateral periodontal cyst is a developmental odontogenic cyst that usually appears as a well-demarcated unilocular radiolucency lateral to teeth. It is usually asymptomatic, usually doesn’t grow too large, usually doesn’t resorb roots, usually doesn’t displace teeth, and is often picked up on routine radiography. Adjacent teeth are often vital on pulp testing, which helps rule out an inflammatory/lateral radicular cyst. Enucleation and biopsy is curative and provides for histologic confirmation of the diagnosis, which is necessary because some aggressive or more recurrent cysts like the odontogenic keratocyst can present similarly both radiographically and clinically.

-Case 37-A unilateral submucosal mass of the hard and/or soft palate is a common presentation for primary oral minor sal...
12/03/2024

-Case 37-

A unilateral submucosal mass of the hard and/or soft palate is a common presentation for primary oral minor salivary gland tumors, and also primary oral lymphomas as in this case. Biopsy is the gold standard for histologic assessment and diagnosis, and to guide appropriate treatment. Great case and biopsy taken by

Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion, and can appear as areas of lucency, opacity, or mixed ...
10/30/2024

Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion, and can appear as areas of lucency, opacity, or mixed density in the jaws radiographically. Diagnosing COD is based on clinical and radiologic findings. Most of these lesions are asymptomatic, frequently found incidentally on radiographs, and usually do not require any treatment. Surgical treatment and biopsy should only be conducted in limited cases for histologic confirmation, for example when patients are symptomatic, lesions are atypical, or infection is present among others. Pulp/vitality testing and familiarity with the common locations, radiographic presentations, and benign behavior of COD can help prevent misdiagnosis and avoid unnecessary treatment like root canal therapy or extraction or surgery.

- Case 35 -Mucous membrane pemphigoid (MMP) is a chronic autoimmune mucocutaneous disease that can affect the skin but m...
10/08/2024

- Case 35 -

Mucous membrane pemphigoid (MMP) is a chronic autoimmune mucocutaneous disease that can affect the skin but more commonly affects the mucous membranes of the body, including the mouth and the eyes. It can present as vesicles, bullae or ulcerative lesions and can be a serious/severe disease. Clinical signs like a positive Nikoskly sign or Absoe Hansen sign are helpful clues, but biopsy is the gold standard for diagnosis including perilesional sampling for direct immunofluorescent analysis to rule out other autoimmune conditions in the differential diagnosis. Histology typically shows a clean subepithelial splitting. Treatment is mainly immunosuppressive such as steroids or DMARD therapy. Great photos and case submitted by

Dentigerous cysts are the most common type of developmental odontogenic cyst, and they arise from the follicle of a deve...
09/17/2024

Dentigerous cysts are the most common type of developmental odontogenic cyst, and they arise from the follicle of a developing tooth. The dentigerous cyst is typically a unilocular radiolucency associated with the crown of an impacted tooth on imaging studies. They can be asymptomatic and picked up incidentally, or associated with signs and symptoms like infection, pain, swelling, expansion, pathological fracture, and/or resorption or displacement of adjacent teeth/roots. Surgical treatment approaches with biopsy for histologic diagnosis is the gold standard since several other cysts and tumors can mimic a dentigerous cyst.

Well-defined dome-shaped opacities of the maxillary sinus antrum can represent mucus retention cysts or antral pseudocys...
05/16/2024

Well-defined dome-shaped opacities of the maxillary sinus antrum can represent mucus retention cysts or antral pseudocysts when they are non-odontogenic in origin. In some cases apical cysts or other odontogenic cysts can mimic these lesions, but clinical and radiographic parameters and correlation usually allow for clear distinction between primary sinus cyst pathology versus odontogenic pathology. These lesions are common on X-rays and usually need no treatment just observation. In some cases they can be associated with symptoms and require treatment e.g. by ENT or OMFS. Biopsy can be helpful for definitive histologic diagnosis in some of these cases, or prior to grafting and dental implant placement in the area. Recent literature and reviews interestingly show that dental implant placement after sinus lift procedures in patients with mucous retention cysts and pseudocysts are safe and present high survival regardless of the removal of the lesion or not.

Well-defined dome-shaped opacities of the maxillary sinus antrum can be mucus retention cysts or antral pseudocysts when...
05/16/2024

Well-defined dome-shaped opacities of the maxillary sinus antrum can be mucus retention cysts or antral pseudocysts when they are non-odontogenic in origin. In some cases an apical or another odontogenic cyst can mimic these sinus lesions, but clinical correlation (e.g. vitality testing of teeth in the area) along with other clinical and radiographic parameters usually allow for a clear distinction between odontogenic versus primarily sinus pathology. These sinus cysts or pseudocysts are common and usually asymptomatic and require no treatment just periodic observation. In some cases they can cause symptoms and require treatment, and biopsy can be helpful for more definite diagnosis in such cases. These lesions can also pose dilemmas during dental implant therapy and sinus grafting, and recent reviews indicate that dental implant placement after sinus lift procedures in patients with mucous retention cysts and pseudocysts are safe and present high survival regardless of the removal of the lesion or not.

April is oral cancer awareness month, and a little known fact is that there are significant risk factors for oral cancer...
04/15/2024

April is oral cancer awareness month, and a little known fact is that there are significant risk factors for oral cancer/squamous cell carcinoma beyond the typically described risk factors such as tobacco/alcohol, betel quid/paan, HPV, UV/sun exposure for lower lip cases, family history or personal history of oral cancer, age, s*x, and ethnicity. These less known risk factors include inherited genetic conditions like Fanconi anemia, dyskeratosis congenita, xeroderma pigmentosum, and Li Fraumeni syndrome. Also, conditions like proliferative verrucous leukoplakia, lichen planus, and GVHD can increase the risk for oral cancer. Additionally, occupational exposure to certain toxins, acid reflux, drinking very hot drinks like mate, and diets high in red meat and low in vegetables are thought to increase risk for oral SCC. Knowing these risk factors can help with active surveillance and early detection/biopsy in these patient populations, and also impacts prevention efforts in addition to outcomes like morbidity and mortality.

Here is a helpful acronym for remembering the differential diagnosis of unilocular to multilocular demarcated radiolucen...
12/02/2023

Here is a helpful acronym for remembering the differential diagnosis of unilocular to multilocular demarcated radiolucencies in the jaws (basically a more comprehensive variation of the MACHO acronym). In many cases, biopsy is needed for more definitive histologic diagnosis and to rule out some of the conditions in the DDx.

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