Oral Medicine & Pathology

Differential diagnosis of Oral Diseases

1. According to site

 

 

Gingiva

 

Redness

 

• Plaque-induced gingivitis

• Trauma

• Odontogenic infections

• Desquamative gingivitis

lichen planus

pemphigoid

pemphigus

• Granulomatous disorders

Crohn’s disease and other related conditions

orofacial granulomatosis

sarcoidosis

• Medication

plasma cell gingivitis

• Erythroplakia

• Kaposi’s sarcoma

 

Bleeding

 

• Periodontal disease

• Haemorrhagic disease

• Leukaemia

• Medication

 

Swelling

 

• Gingival fibromatosis

• Leukaemia

• Medication

phenytoin

ciclosporin

calcium channel blockers

• Vitamin C deficiency

• Epulides

pregnancy epulis

fibrous epulis

giant cell epulis (could be due to hyperparathyroidism)

• Tumours

• Granulomatous disorders

Crohn’s disease and related disorders

sarcoidosis

orofacial granulomatosis

 

Ulceration

 

• Necrotising gingivitis

 

 

Lips

 

Angular Stomatitis

• Local infections

candidosis

staphylococcal, streptococcal or mixed staphylococcal-streptococcal infections

• Haematinic deficiencies

vitamin B group

iron

folate

• Immunodeficiency

Crohn’s disease

HIV related infections

diabetes

 

Bleeding

 

• Trauma

• Cracked lips

• Erythema multiforme

• Angiomas and telangiectasias

 

Blistering or Vesicles

 

• Herpes labialis

• Burns

• Mucoceles

• Impetigo

• Allergic cheilitis

 

Peeling and Crusting

 

• Dehydration

• Exposure to the wind

• Fever

• Cheilitis

• Erythema multiforme

• Psychogenic causes

• Medication

 

Swelling

 

• Oedema

trauma

infection (also odontogenic)

insect bite

• Angioedema

• Granulomatous disorders

Crohn’s disease and orofacial granulomatosis

sarcoidosis

• Mucoceles

• Tumours

Abscesses

 

Ulceration

 

• Contagious

herpes labialis

syphilis

leishmaniasis

deep mycoses

• Tumours

squamous cell carcinoma

basal cell carcinoma

keratoacanthoma

• Burns

• Trauma

 

 

Palate

 

Swelling

 

• Dental causes

unerupted teeth

odontogenic cysts

abscesses

• Torus palatinus

• Tumours

fibrous lumps

papillomas

squamous cell carcinoma

antral carcinoma

salivary tumours

Kaposi’s sarcoma

lymphomas

other tumours

• Fibro-osseous lesions

fibrous dysplasia

Paget’s disease

 

Redness

 

• Candidosis

• Mucositis

• Erythroplasia

• Kaposi’s sarcoma

• Pemphigus

 

Blistering

 

• Burns

• Pemphigoid

• Localised oral purpura (angina bullosa haemorragica)

• Mucocele

• Pemphigus

 

Ulceration

 

• Tumours

squamous cell carcinoma

salivary tumours

• Necrotising sialometaplasia

 

 

Tongue

 

Swelling

 

• Congenital

lingual thyroid

haemangioma

lymphangioma

median rhomboid glossitis

foliate papillitis

• Abscesses

• Oedema

inflammatory

angioedema

• Haematoma

• Foreign body

• Cysts

• Tumours

fibrous lumps

papilloma

squamous cell carcinoma

granular cell tumour (myoblastoma)

Kaposi’s sarcoma

 

Macroglossia

 

• Relative macroglossia :

Congenital

1. Down’s syndrome

2. Cretinism

3. Beckwith’s syndrome

Acquired

Ludwig’s Angina

1. Angioedema

 

• True Macroglossia :

Congenital

1. Vascular:

            lymphangioma

            haemangioma

2. Cysts:

dermoid cyst

Acquired

1. Trauma

2. Infection

3.Angioedema

4. Amyloidosis

5. Acromegaly

6. Tumours

 

Ulceration

 

• Infectious causes

Syphilis

Tuberculosis

Mycoses

Herpesvirus infections

• Tumours

Squamous cell carcinoma

• Trauma

• Aphthous stomatitis

Drugs

 

Floor of Mouth

 

Swelling

 

• Fibrous hyperplasia

• Odontogenic causes

abscesses

• Tumours

Soft tissue tumours

Squamous cell carcinoma

Salivary tumours

• Cysts

Mucoceles

Retention cysts

 

Redness

 

• Candidosis

• Mucositis

• Erythroplakia

 

Ulceration

 

• Tumours

– Squamous cell carcinoma

Salivary tumours

• Chemical burns

• Aphthous stomatitis

• Drugs

 

 

 

2.According to Sing and Symptoms

 

Halitosis

 

1. Oral disease

– sepsis, poor oral hygiene

– tumours

– xerostomia

 

2. Volatile foodstuffs

 

3. Drugs

 

4. Tobacco

 

5. Respiratory tract disease

– infections

– foreign bodies

– tumours

 

6. Metabolic disease

– liver failure

– renal failure

– diabetic ketoacidosis

– trimethylaminuria

 

7. Psychogenic

 

Facial Swelling

 

1. Inflammation and infection

 

2.Trauma

 

3. Post-operative emphysema

 

4. Insect bites

 

5. Angioedema

 

6. Endocrine/metabolic causes (corticosteroids)

 

7. Cysts

 

8. Neoplasms

 

9. Haemangioma-lymphangioma

 

10. Foreign bodies

 

11. Granulomatous disorders

Crohn’s disease

– sarcoidosis

– Melkersson-Rosenthal syndrome and granulomatous cheilitis

– orofacial granulomatosis

 

Swelling of the Salivary Glands

 

1. Inflammatory

– mumps

– HIV infection

– HCV infection

– Sjögren’s syndrome

– sarcoidosis

 

2. Obstruction

– calculi

– neoplasms

 

3. Tumours

 

4. Sialoadenitis

 

5. Sialosis

 

6. Drugs

 

Dry Mouth

(Xerostomia)

 

1. Drugs

 

2. Dehydration

 

3. Psychogenic causes

 

4. Salivary gland disease

 

5. Irradiation

 

Burning Mouth Syndrome

 

1. Deficiency of

– vitamin B12

– folic acid

– iron

– vitamin B complex

– other group B vitamins

 

2. Infections (candidosis)

 

3. Erythema migrans (geographic tongue)

 

4. Diabetes mellitus

 

5. Xerostomia

 

6. Psychogenic (somatoform disorder)

 

7. Drugs (e.g. ACE inhibitors)

 

Pain

 

 

1. Localised causes

– odontogenic

– sinusitis

 

2. Vascular causes

– migraine

– giant cell arteritis

 

3. Neurogenic

– trigeminal neuralgia

– malignant tumours of the trigeminal nerve

 

4. Herpes zoster (including post-herpetic neuralgia)

 

5. Psychogenic pain

– atypical facial pain

 

6. Referred pain

– angina

– nasopharyngeal, ocular and aural disease

– chest disease (rare)

 

Facial Palsy

 

 

1. Neurological

– upper motor neurone lesion: cerebrovascular accident

– lower motor neurone lesion: e.g. Bell’spalsy, Lyme disease, HIV, other viral neuropathies

 

2. Middle ear disease

 

3. Parotid lesion

 

4. Trauma to facial nerve branch

 

 

Pigmentation

 

1.  Racial

 

2. Food/drugs

– chlorhexidine

– minocycline

– zidovudine

 

3. Endocrinological

– pregnancy

– Addison’s disease

 

4. Others

– amalgam tattoo

– lentigines

– melanoma

– naevi

– Peutz-Jegher’s syndrome

– Kaposi’s sarcoma

 

Purpura

 

 

1. Trauma

 

2. Platelet disorders

 

3.Autoimmune disorder

 

4. Bone marrow disease

– leukaemia

– aplastic anaemia

 

5. Infectious diseases

– infectious mononucleosis

– rubella

– HIV/AIDS

 

6. Angina bullosa haemorrhagica

 

7. Amyloidosis

 

Premature Loss of Teeth

 

 

1. Immunodeficiency

– HIV/AIDS

– cyclic neutropenia

– Papillon-Lefevre syndrome

 

2. Hypophosphatasia

 

3. Ehlers–Danlos syndrome

 

Sialorrhoea

 

1. Psychogenic

 

2. Painful oral lesions or foreign bodies

 

3.Drugs

 

4. Cholinergic drugs

 

5. Poor neuromuscular coordination

– Parkinson’s disease

– facial palsy

– other weakening diseases

 

Trismus

 

1. Extra-articular causes

– infection and inflammation near masticatory muscles

– temporomandibular joint-dysfunction syndrome (facial arthromyalgia)

– factured condylar neck

– fibrosis (scars, irradiation, submucous fibrosis)

– tetanus toxoid

 

2. Intra-articular causes

– dislocation

– intracapsular fracture

– arthritis

– ankylosis

 

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