Module 02

Clinical Notes

Point-of-care summaries for hospital rotations and OPD — presentation, examination, red flags, immediate management and follow-up.

96 topics

Abfraction

Dental Diseases

Presentation

Wedge/V-shaped notch at cervical area
Sharp margins
Typically on buccal surface
Commonly on premolars

Examination checklist

V-shaped at CEJ
Often on buccal of premolars
Associated with occlusal stress indicators

Immediate management

Occlusal adjustment if indicated
Night guard for bruxism
GIC or composite restoration if symptomatic/progressive

Full atlas page →

Actinic Cheilitis

Premalignant Disorders

Presentation

Dry, scaly, atrophic lower lip
Loss of vermilion border definition
Pale/white patches with red erosions
Persistent crusting/fissuring
Focal ulcer or induration = suspect SCC

Examination checklist

Loss of vermilion demarcation
Palpate for induration
Photograph and map lesion

Immediate management

Photoprotection: SPF 30+ lip balm, wide-brim hat
Topical 5-FU, imiquimod, or diclofenac for field change
Cryotherapy for focal lesions
CO₂ laser vaporisation or vermilionectomy (lip shave) for severe/dysplastic disease

Full atlas page →

Adenomatoid Odontogenic Tumour

Odontogenic Tumors

Presentation

Missing permanent tooth in the arch
Occasional egg-shell crackling

Examination checklist

Check for missing permanent canine
OPG + IOPA
CBCT
Vitality of adjacent teeth

Red flags

Rapid growth would prompt biopsy to exclude ameloblastoma or malignancy

Immediate management

Follow-up

6- and 12-month post-op OPG

Full atlas page →

Amalgam Tattoo

Pigmented Lesions

Presentation

Painless flat blue-grey macule
Gingiva or alveolar mucosa adjacent to restorations

Immediate management

No treatment; biopsy if diagnosis uncertain

Full atlas page →

Ameloblastoma

Odontogenic Tumors

Presentation

Painless bony expansion — 'egg-shell crackling'
Displaced teeth, root resorption
Facial asymmetry

Immediate management

Conventional: segmental/marginal resection with 1–1.5 cm bony margins + immediate reconstruction
Unicystic (luminal/intraluminal): enucleation ± Carnoy's
Mural unicystic: resection
Peripheral: local excision

Full atlas page →

Amelogenesis Imperfecta

Developmental Disorders

Presentation

Thin, pitted or absent enamel (hypoplastic type)
Soft, cheese-like enamel (hypocalcified)
Opaque, mottled enamel (hypomature)
Anterior open bite common
Tooth sensitivity

Examination checklist

Classify by Witkop classification
Distinguish from DI by dentin appearance
X-linked forms affect males more severely

Immediate management

Preventive fluoride varnish
Composite restorations / veneers
Full-coverage crowns for severe cases
Overdentures or implants long-term

Full atlas page →

Aneurysmal Bone Cyst

Non-odontogenic Cysts

Presentation

Firm-to-fluctuant expansile mass
Overlying skin/mucosa tense but usually intact
Bruit occasionally audible over lesion (rare)

Examination checklist

Age (< 30 y)
Rate of growth (rapid)
Facial asymmetry
Cortical crackling on palpation
Tooth vitality/mobility
OPG + CBCT for extent
MRI for fluid–fluid levels
Consider pre-op angiography ± embolisation

Red flags

Very rapid growth
Paraesthesia or pain
Cortical perforation with soft-tissue mass
Atypical histology → exclude telangiectatic osteosarcoma
Bleeding tendency on biopsy — always cross-match

Immediate management

Analgesia; antibiotics only if infected
Denosumab in selected refractory cases (specialist care)

Follow-up

Clinical + imaging review at 3, 6, 12 months, then annually × 5 y
Beyond 5 y: 2-yearly review
MRI for suspected recurrence

Full atlas page →

Attrition

Dental Diseases

Presentation

Flat, shiny wear facets
Exposed dentin (yellow)
Cupping of cusp tips
Shortening of clinical crown
Matching facets on opposing teeth

Examination checklist

Matching wear facets = attrition
Bruxism = primary cause in young adults
Distinguish from erosion (acid) by facet pattern

Immediate management

Manage bruxism: occlusal splint
Restore lost structure: composite, crowns
Rehabilitate VDO if severe

Full atlas page →

Behçet Disease

Ulcerative Diseases

Presentation

Recurrent oral aphthous-like ulcers (major criterion)
Genital ulcers (scarring)
Ocular: anterior/posterior uveitis, hypopyon
Skin: erythema nodosum, acneiform lesions, pathergy
Neurological, vascular, GI involvement

Examination checklist

Triple symptom complex: oral + genital + ocular
Pathergy test
HLA-B51

Red flags

Hypopyon
Sudden vision loss
Neurological symptoms

Immediate management

Mild: topical steroids, colchicine
Moderate-severe: systemic steroids, azathioprine, cyclosporine
Severe: anti-TNF (infliximab), interferon-α
Anticoagulation if thrombosis

Full atlas page →

Burkitt Lymphoma

Malignant Tumors

Presentation

Rapidly enlarging, painless jaw swelling (posterior maxilla most common)
Loose teeth, ill-fitting appliances
Facial deformity, proptosis
B symptoms uncommon
Extranodal: kidneys, ovaries, CNS

Examination checklist

Child with rapidly growing jaw mass — biopsy immediately
Send fresh tissue for cytogenetics

Immediate management

Intensive short-course chemotherapy (CODOX-M/IVAC, DA-EPOCH-R)
Rituximab
Intrathecal methotrexate for CNS prophylaxis
Aggressive tumour lysis prophylaxis (hydration, allopurinol, rasburicase)

Full atlas page →

Cemento-osseous Dysplasia

Fibro-osseous Lesions

Presentation

Asymptomatic incidental radiographic finding
Teeth vital (key differentiator from periapical granuloma/cyst)
Florid form may cause jaw expansion and secondary infection

Examination checklist

Confirm tooth vitality before surgical intervention
Recognise florid pattern to avoid iatrogenic osteomyelitis

Immediate management

No treatment needed if asymptomatic — observation with periodic radiographs
Meticulous oral hygiene to prevent secondary infection
Debridement/saucerisation for infected florid COD
Avoid unnecessary extractions in involved areas

Full atlas page →

Cementoblastoma

Odontogenic Tumors

Presentation

Vital, non-carious associated tooth
Occasional trismus or paraesthesia when large

Examination checklist

Vitality testing
OPG + IOPA + CBCT
Percussion / palpation

Red flags

Rapid growth or paraesthesia — reconsider diagnosis (osteosarcoma differential)

Immediate management

Analgesics for pain

Follow-up

6 & 12 month post-op OPG then annually for 3 years

Full atlas page →

Central Giant Cell Granuloma

Bone Diseases

Presentation

Painless expansile swelling
May displace teeth or resorb roots

Immediate management

Curettage; intralesional corticosteroids or calcitonin for aggressive lesions
Resection for recurrent aggressive lesions

Full atlas page →

Cervicofacial Actinomycosis

Maxillofacial Infections

Presentation

Slowly enlarging, indurated, painless mass at the angle of the mandible
Multiple discharging sinuses through skin
Yellow 'sulphur granules' in pus
Trismus, low-grade fever
Crosses tissue planes (unlike malignancy following fascia)

Examination checklist

Woody induration crossing tissue planes
Sulphur granules in pus
History of recent extraction

Immediate management

High-dose IV penicillin G 18–24 MU/day × 4–6 weeks, then oral penicillin/amoxicillin 6–12 months
Alternatives: doxycycline, clindamycin, erythromycin (penicillin allergy)
Surgical drainage and excision of sinuses/necrotic bone

Full atlas page →

Cervicofacial Necrotising Fasciitis

Maxillofacial Infections

Presentation

Rapidly spreading painful cellulitis disproportionate to skin findings
Skin: erythema → dusky discolouration → haemorrhagic bullae → necrosis
Crepitus (gas)
Systemic toxicity: fever, tachycardia, hypotension, altered mentation (SIRS/sepsis)

Examination checklist

Pain out of proportion + rapid spread → suspect NF
Skin appearance underestimates fascial destruction

Immediate management

Immediate aggressive surgical debridement — the mainstay; repeat every 24 h until clean
Empirical broad-spectrum: piperacillin–tazobactam + clindamycin + vancomycin/linezolid
Clindamycin suppresses exotoxin production
IVIG for streptococcal toxic shock
ICU support: fluids, vasopressors, ventilation
Hyperbaric oxygen adjunctive
Reconstruction after infection controlled

Full atlas page →

Chondrosarcoma of the Jaws

Malignant Tumors

Presentation

Painless swelling of anterior maxilla or condyle
Loose teeth, nasal obstruction, proptosis
Slow but relentless growth

Examination checklist

Anterior maxilla mass in adult — image with CT & MRI
Biopsy before definitive surgery

Immediate management

Wide surgical resection with clear margins (mainstay)
Radiotherapy — limited efficacy; used for unresectable/positive margins (proton beam)
Chemotherapy generally ineffective except mesenchymal variant

Full atlas page →

Cleft Lip & Palate Repair

Maxillofacial Surgery

Examination checklist

Assess feeding, weight gain, ear disease
Evaluate speech resonance and articulation
Photograph pre/post at each stage

Full atlas page →

Cleft Lip and Palate

Developmental Disorders

Presentation

Unilateral or bilateral cleft lip ± alveolus
Cleft of hard/soft palate
Nasal deformity
Feeding difficulties
Speech problems (VPI)
Dental anomalies (missing/supernumerary teeth)

Examination checklist

Rule of 10 for lip repair
VPI = velopharyngeal insufficiency
Alveolar bone graft timing: mixed dentition

Immediate management

Multidisciplinary cleft team
Lip repair: 10 weeks (rule of 10s)
Palate repair: 9–12 months
Alveolar bone graft: 9–11 years (mixed dentition)
Secondary rhinoplasty, orthognathic surgery as needed

Full atlas page →

Cleidocranial Dysplasia

Developmental Disorders

Presentation

Short stature
Long neck, narrow drooping shoulders
Facial disproportion

Examination checklist

Ability to approximate shoulders anteriorly — pathognomonic
OPG with 'crown of teeth' from multiple impactions
Autosomal dominant, RUNX2 mutation

Immediate management

Multidisciplinary — pediatric dentist, orthodontist, oral surgeon, prosthodontist
Belfast/Toronto/Jerusalem protocols: extract deciduous + supernumerary, expose and orthodontically align permanents
Implants and prostheses when growth complete

Full atlas page →

Condylar Hyperplasia

TMJ Disorders

Presentation

Progressive facial asymmetry with chin deviation to the unaffected side (Type II) or ipsilateral (Type I)
Unilateral posterior open bite / crossbite
Occlusal cant
Preserved TMJ function

Examination checklist

Chin deviation direction discriminates Type I vs II
Confirm activity before definitive surgery

Immediate management

Active disease: high condylectomy (5 mm) to arrest growth ± orthognathic correction
Burnt-out disease: orthognathic surgery alone (bimaxillary + genioplasty)
Orthodontic decompensation before surgery

Full atlas page →

Deep Neck Space Infections

Maxillofacial Infections

Presentation

Swelling, pain, trismus, dysphagia, drooling
Airway compromise (retro-/parapharyngeal)
Fever, malaise, elevated WCC/CRP
Torticollis (deep spread)

Examination checklist

Trismus + dysphagia = deep space involvement until proven otherwise
Airway is priority
Follow the fascial routes on CT

Immediate management

Airway assessment — secure early (awake fibre-optic if compromised)
IV empirical antibiotics: amoxicillin-clavulanate or ampicillin-sulbactam + metronidazole; add clindamycin/vancomycin if MRSA suspected
Surgical: extract source tooth + incision & drainage of involved spaces via appropriate approaches, dependent drainage, corrugated/Penrose drain
ICU support if septic
Reassess and re-image if no improvement in 48–72 h

Full atlas page →

Dental Caries

Dental Diseases

Presentation

White spot lesion → brown discolouration → cavitation
Sensitivity to sweet/cold
Pain in advanced lesions

Immediate management

Non-cavitated: fluoride varnish, SDF, resin infiltration
Cavitated: minimally invasive restoration (composite, GIC)
Pulpally involved: RCT or extraction

Full atlas page →

Dental Erosion

Dental Diseases

Presentation

Smooth, silky-shiny enamel surface
Cupping of cusps and incisal edges
Palatal erosion of upper anteriors (intrinsic)
Facial erosion (extrinsic)
Restorations standing proud ('amalgam islands')

Examination checklist

Palatal erosion of 16, 26 = GERD/bulimia
Cupping of cusps
Restorations standing above tooth surface

Immediate management

Identify and reduce acid source
Dietary counselling
Fluoride/CPP-ACP remineralisation
Restore with composite/crowns if severe

Full atlas page →

Dental Implantology

Maxillofacial Surgery

Examination checklist

Assess bone width/height & inter-arch space
Identify vital structures on CBCT (IAN, sinus, incisive canal)
Manage soft-tissue phenotype

Full atlas page →

Dentigerous Cyst

Odontogenic Cysts

Presentation

Often asymptomatic — incidental finding
Painless bony expansion when large
Displacement / resorption of adjacent teeth

Immediate management

Enucleation + extraction of associated tooth
Marsupialisation for very large cysts / young patients to preserve tooth

Full atlas page →

Dentinogenesis Imperfecta

Developmental Disorders

Presentation

Opalescent blue-grey or amber teeth
Bulbous crowns, cervical constriction
Rapid attrition with flat occlusal surfaces
Primary teeth more affected than permanent

Examination checklist

Type I always with OI; Types II/III without OI
Pulp obliteration on radiograph is key
Enamel chips away due to poor DEJ support

Immediate management

Stainless steel crowns (deciduous)
Full-coverage restorations
Overdentures
Implants after growth

Full atlas page →

Dento-alveolar Trauma

Trauma

Presentation

Fractured, displaced, or missing teeth
Mobility, occlusal interference
Gingival laceration, alveolar step
Vitality changes on follow-up

Examination checklist

Extra-alveolar time and storage medium (avulsion)
Test vitality and record baseline

Immediate management

Enamel fracture: smooth or composite restoration
Enamel-dentin: composite; monitor vitality
Complicated crown fracture: pulp cap / partial pulpotomy (Cvek) if <24 h; RCT if mature
Root fracture: reposition, flexible splint 4 wk (cervical: 4 mo)
Extrusion: reposition, flexible splint 2 wk
Lateral luxation: reposition, flexible splint 4 wk
Intrusion: monitor if immature/<3mm; orthodontic/surgical repositioning if mature/severe
Avulsion: replant ASAP; storage in HBSS/milk/saliva; flexible splint 2 wk; systemic doxycycline; tetanus check; RCT within 7–10 days for mature apex
Alveolar fracture: reposition, rigid splint 4 wk

Full atlas page →

Distraction Osteogenesis

Maxillofacial Surgery

Examination checklist

Confirm vector before activation
Monitor occlusion during activation
Assess IAN function

Full atlas page →

Epulis Fissuratum

Soft Tissue Lesions

Presentation

Single or multiple soft tissue folds in vestibule
Firm, fibrous consistency
Denture flange sits within groove between folds
Usually painless

Examination checklist

Always assess denture fit
Excise + address cause
No malignant potential but biopsy to exclude SCC

Immediate management

Relieve denture flange
Surgical excision of redundant tissue
Reline or new denture

Full atlas page →

Erythema Multiforme

Vesiculobullous Diseases

Presentation

Oral: haemorrhagic crusting of lips, erosions on buccal/labial mucosa
Skin: target (iris) lesions — central vesicle, pale ring, erythematous halo
Acute onset, self-limiting 2–6 weeks
Recurrences common if HSV-associated

Examination checklist

Target lesions on skin
Haemorrhagic lip crusting
HSV is main trigger

Immediate management

Supportive: hydration, soft diet, analgesics
Topical steroids for oral lesions
Aciclovir prophylaxis for HSV-associated recurrent EM
Systemic steroids controversial

Full atlas page →

Erythematous (Atrophic) Candidiasis

Red Lesions

Presentation

Burning tongue / palate
Altered taste
Pain on eating spicy or acidic food
Denture soreness

Examination checklist

Remove denture and examine underlying mucosa
Assess denture fit and hygiene
KOH mount
Screen for HIV/diabetes if recurrent

Red flags

Failure to respond to antifungals — biopsy for erythroplakia or lichen planus
Recurrent episodes in previously healthy adult
Weight loss, lymphadenopathy — evaluate for HIV

Immediate management

Nystatin, miconazole (topical)
Fluconazole (systemic)
Chlorhexidine mouthwash adjunct

Follow-up

Review at 2 weeks; investigate systemic cause if recurrent

Full atlas page →

Erythroplakia

Red Lesions

Presentation

Painless red patch
Occasional burning or roughness
Bleeds on gentle probing

Examination checklist

Full mucosal examination
Palpation for induration
Toluidine blue staining
Photograph and measure
Plan biopsy of most suspicious area

Red flags

Any red patch persisting > 2 weeks
Induration or ulceration
Cervical lymphadenopathy
Floor of mouth or ventral tongue location

Immediate management

Adjunctive antifungals if Candida co-infection
Chemopreventive retinoids — limited evidence

Follow-up

Monthly for first 3 months, then 3-monthly for 2 years, 6-monthly lifelong
Re-biopsy any recurrence or new red area

Full atlas page →

Fibrous Dysplasia

Fibro-osseous Lesions

Presentation

Slow painless unilateral swelling
Facial asymmetry
Ill-defined margins on imaging

Immediate management

Observation for stable lesions
Bisphosphonates for pain/rapid progression
Cosmetic contouring after growth quiescence

Full atlas page →

Geographic Tongue

Red Lesions

Presentation

Asymptomatic in most
Burning sensation with spicy/acidic foods
Occasional metallic taste

Examination checklist

Full oral exam
Photograph for baseline (documents migration)
Ask about psoriasis, atopy, family history

Red flags

Fixed (non-migratory) lesion — reconsider diagnosis
Induration, ulceration, cervical lymphadenopathy
Failure to respond to reassurance and steroids

Immediate management

Topical steroids for symptomatic disease
Antihistamines if allergic co-factor
Zinc supplementation (empirical)

Follow-up

No specific follow-up; reassurance

Full atlas page →

Haemangioma

Benign Tumors

Presentation

Bright red 'strawberry' cutaneous lesion or bluish deep swelling
Blanches on pressure
Head & neck in 60%
Beard distribution → airway involvement
PHACES syndrome (Posterior fossa, Haemangioma, Arterial, Cardiac, Eye, Sternal)

Examination checklist

Differentiate from vascular malformation (history since birth, no involution)
Assess airway and vision in periorbital/segmental lesions

Immediate management

Observation for uncomplicated lesions (spontaneous involution)
First-line pharmacotherapy: oral propranolol 2–3 mg/kg/day
Topical timolol for superficial
Systemic steroids (historical, second-line)
Pulsed-dye laser for residual telangiectasia
Surgical excision for functional/aesthetic residuum after involution

Full atlas page →

Hemifacial Microsomia

Developmental Disorders

Presentation

Mandibular hypoplasia (Pruzansky grades)
Microtia/anotia
Facial nerve weakness
Soft tissue deficiency
Macrostomia
Preauricular tags
Vertebral anomalies (Goldenhar)

Examination checklist

Pruzansky grading predicts surgical approach
Goldenhar = HFM + vertebral + eye anomalies
Distraction useful in growing child

Immediate management

Multidisciplinary craniofacial team
Distraction osteogenesis (mandible)
Costochondral graft for TMJ reconstruction
Orthognathic surgery at skeletal maturity
Ear reconstruction

Full atlas page →

HPV-associated Oropharyngeal SCC

Oral Cancer

Presentation

Painless neck lump (cystic level II lymphadenopathy) often presenting feature
Sore throat, dysphagia, referred otalgia
Tonsillar asymmetry or base-of-tongue mass

Examination checklist

Cystic neck node in adult non-smoker → work up for HPV-OPSCC
Test p16 on every OPSCC

Immediate management

Concurrent chemoradiation (cisplatin) — standard for locally advanced disease
Transoral robotic surgery (TORS) with neck dissection for selected T1-T2 lesions ± adjuvant therapy
De-escalation trials ongoing (reduced-dose RT)

Full atlas page →

Kaposi Sarcoma

Malignant Tumors

Presentation

Flat red-purple macule → plaque → nodule
Hard palate most common oral site, then gingiva, tongue
Multifocal, painless initially → ulceration and bleeding
Cutaneous, GI, pulmonary involvement in advanced disease

Examination checklist

Purple palatal lesion → biopsy and HIV test
Assess extent (skin, GI, pulmonary)

Immediate management

Optimise ART (mainstay for AIDS-KS)
Local: intralesional vinblastine, radiotherapy, cryotherapy, sclerotherapy
Systemic: liposomal doxorubicin, paclitaxel for advanced disease
Reduce immunosuppression in transplant-related KS

Full atlas page →

Lateral Periodontal Cyst

Odontogenic Cysts

Presentation

No pain, no tooth mobility in most cases
May present as a sessile gingival swelling (gingival cyst counterpart)

Examination checklist

Vitality tests
Periodontal probing
IOPA + OPG
CBCT if surgical planning needed

Red flags

Multilocular appearance → botryoid variant, watch for recurrence

Immediate management

Nil specific

Follow-up

Clinical + radiographic review at 6 and 12 months
Botryoid: yearly for 5 years

Full atlas page →

Le Fort Fractures

Trauma

Presentation

Facial oedema, ecchymosis
Malocclusion, anterior open bite
Mobile midface on rocking maxilla (I) or nasofrontal complex (II/III)
CSF rhinorrhoea (II/III)
Battle sign, raccoon eyes (III)
Elongated (donkey) face
Numbness in V2 distribution

Examination checklist

Rock the maxilla to detect level
Assess CSF rhinorrhoea
Check vision and eye movements

Immediate management

Airway priority (may need surgical airway)
Cervical spine clearance
Reduction and rigid internal fixation via facial buttress reconstruction
Access: sublabial (I), subciliary/transconjunctival + sublabial (II), coronal + additional approaches (III)
IMF or MMF as required
Post-op: elemental diet, oral hygiene, IMF release protocol

Full atlas page →

Leukoedema

White Lesions

Presentation

Completely asymptomatic — usually an incidental finding on routine examination

Examination checklist

Inspect bilateral buccal mucosa
Perform stretch test
Reassure patient

Red flags

Unilateral distribution (suggests another diagnosis)
Persistence on stretching
Any induration, ulceration or nodularity

Immediate management

No treatment necessary
Habit cessation (tobacco, alcohol) may reduce prominence

Follow-up

No specific follow-up; routine dental review

Full atlas page →

Leukoplakia

White Lesions

Presentation

Usually asymptomatic — discovered on routine exam
Roughness or altered taste
Pain, induration or bleeding suggest malignant change

Examination checklist

Inspect all mucosal surfaces including floor of mouth and ventral tongue
Palpate lesion for induration
Photograph and measure
Document habit history
Plan biopsy site (most suspicious area)

Red flags

Induration
Ulceration or bleeding
Rapid increase in size
Speckled or nodular appearance
Cervical lymphadenopathy
Floor of mouth or ventral tongue location

Immediate management

Vitamin A / retinoids (13-cis retinoic acid) — reduces size, does not prevent transformation
β-carotene, lycopene supplementation
Topical bleomycin (severe dysplasia, off-label)

Follow-up

3-monthly for first year
6-monthly for years 2–5
Annually thereafter, lifelong for PVL / high-grade dysplasia
Re-biopsy any change in colour, texture, symptoms

Full atlas page →

Ludwig's Angina

Maxillofacial Infections

Presentation

Brawny bilateral submandibular swelling
Raised, protruding, oedematous tongue ('woody floor of mouth')
Trismus, dysphagia, drooling
Stridor — impending airway obstruction
Fever, toxicity

Immediate management

Airway management is priority — fibre-optic intubation or elective tracheostomy
IV broad-spectrum antibiotics (Amoxi-clav + metronidazole; add clindamycin/vancomycin for MRSA suspicion)
Incision & drainage of all involved spaces
Removal of causative tooth

Full atlas page →

Mandibular Fracture

Trauma

Presentation

Malocclusion
Step deformity, mobility, crepitus
Sublingual haematoma (Coleman's sign)
Numbness in mental nerve distribution
Deviation of chin on opening (condylar #)

Immediate management

Closed reduction: MMF / IMF for minimally displaced, condylar, paediatric
Open reduction & internal fixation (ORIF): displaced, unfavourable, condylar with malocclusion, edentulous
AO/Champy's principles of osteosynthesis

Full atlas page →

Median Rhomboid Glossitis

Red Lesions

Presentation

Usually asymptomatic; incidental finding
Occasional burning or foreign body sensation

Examination checklist

Full tongue exam with retraction
Assess palate for kissing lesion
Ask about smoking and inhaler use

Red flags

Non-healing after antifungal course
Induration, ulceration or fixation
Palatal kissing lesion — consider HIV screen

Immediate management

Fluconazole, nystatin, miconazole

Follow-up

Review at 4 weeks after antifungal course; re-biopsy if persists

Full atlas page →

Medication-Related Osteonecrosis of the Jaws

Bone Diseases

Presentation

Exposed necrotic bone
Pain, swelling, halitosis, purulence
Loose teeth, sinus tracts
Mandible > maxilla (posterior)

Examination checklist

Take a bisphosphonate history for EVERY extraction
Educate patients on oral hygiene before starting antiresorptives

Immediate management

Prevention key: dental screening BEFORE therapy; complete extractions with 4–6 wk healing
Stage 0/1: chlorhexidine mouthwash, analgesia, careful monitoring
Stage 2: antibiotics (amoxicillin/metronidazole), superficial debridement
Stage 3: sequestrectomy/resection with reconstruction
Drug holiday controversial — coordinate with oncologist; not evidence-based for denosumab
Adjuncts: PRF, teriparatide (non-oncology), ozone, hyperbaric oxygen (limited evidence)

Full atlas page →

Mucocele

Soft Tissue Lesions

Presentation

Painless, dome-shaped, bluish-translucent swelling
Fluctuant
History of trauma/lip biting
May rupture and recur

Examination checklist

Extravasation type lacks epithelial lining
Lower lip most common site
Remove gland to prevent recurrence

Immediate management

Excision with associated minor salivary gland
Marsupialization (ranula)

Full atlas page →

Mucoepidermoid Carcinoma

Salivary Gland Disorders

Presentation

Painless slow-growing swelling (low grade) — may mimic mucocele on palate
Rapidly growing painful mass with fixation, facial nerve palsy (high grade)
Fluctuant bluish palatal swelling common

Examination checklist

Bluish palatal swelling in adult → not a mucocele until proven otherwise
Always image before biopsy of parotid mass

Immediate management

Wide local excision with clear margins
Parotid: superficial or total parotidectomy with facial nerve preservation
Neck dissection for high-grade / cN+
Adjuvant radiotherapy for high-grade, positive margins, perineural or vascular invasion
Chemotherapy for palliation

Full atlas page →

Mucous Membrane Pemphigoid

Vesiculobullous Diseases

Presentation

Intact blisters (more common than pemphigus due to thicker roof)
Desquamative gingivitis
Positive Nikolsky sign (may be negative)
Ocular: symblepharon, entropion, blindness
Other sites: nose, pharynx, larynx, genitalia

Examination checklist

Desquamative gingivitis common
Ocular involvement → scarring → blindness
DIF: linear BMZ

Red flags

Ocular involvement
Laryngeal involvement

Immediate management

Mild oral: topical corticosteroids, tacrolimus
Moderate: dapsone, tetracycline + niacinamide
Severe/ocular: systemic steroids, azathioprine, mycophenolate, rituximab

Full atlas page →

Mumps (Epidemic Parotitis)

Salivary Gland Disorders

Presentation

Prodrome: fever, malaise, myalgia, headache
Painful bilateral parotid swelling (70%) with elevated earlobe
Trismus, pain on chewing acidic foods
Redness around Stensen duct opening without pus
Orchitis, oophoritis, meningo-encephalitis, deafness

Examination checklist

Bilateral parotid swelling with elevated earlobe
Absence of pus at Stensen duct

Immediate management

Supportive: hydration, analgesia, antipyretics, bed rest
Isolation for 5 days after swelling onset
No antivirals of proven benefit

Full atlas page →

Nasolabial Cyst

Non-odontogenic Cysts

Presentation

Cosmetic asymmetry
Nasal airway obstruction on the affected side
Occasional pain if infected
Rarely intra-nasal discharge

Examination checklist

Extra-oral inspection: alar elevation, groove obliteration
Bimanual palpation of upper lip and nasal vestibule
Anterior rhinoscopy for intra-nasal bulge
Vitality tests of 12–24
MRI / CT for confirmation

Red flags

Rapid growth
Induration or ulceration of overlying mucosa (biopsy)
Recurrent infection
Radiographic bone destruction — reconsider odontogenic origin

Immediate management

Antibiotics only for secondary infection
Analgesics as needed

Follow-up

Clinical review at 1 week, 1 month and 6 months
Endoscopic follow-up after transnasal marsupialisation to assess window patency
Annual review for 2 years

Full atlas page →

Nasopalatine Duct Cyst

Non-odontogenic Cysts

Presentation

Bluish fluctuant midline palatal swelling
Displacement or divergence of central incisor roots
Occasional numbness of the anterior palate
Rare purulent discharge if secondarily infected

Examination checklist

Palpate anterior palate for fluctuant swelling
Inspect labial vestibule for expansion
EPT + cold on 11 and 21
Occlusal radiograph for buccolingual extent
CBCT if surgical planning required

Red flags

Rapid growth
Paraesthesia of upper lip / palate
Non-vital adjacent tooth (re-consider radicular cyst)
Ulceration or induration of overlying mucosa — biopsy immediately

Immediate management

Antibiotics only for secondary infection (amoxicillin ± metronidazole)
Analgesics as needed

Follow-up

Clinical review at 1 week, 1 month, 6 months
Radiographic review at 6 and 12 months for bony infill
Annual review for large cysts

Full atlas page →

Odontogenic Keratocyst

Odontogenic Cysts

Presentation

Mild swelling, mobile teeth, occasional discharge
In Gorlin syndrome: multiple BCCs, palmar/plantar pits, frontal bossing, calcified falx cerebri, hypertelorism

Examination checklist

Full facial and skin exam (BCCs, palmar pits)
Bimanual palpation of jaws
OPG + CBCT
Aspiration cytology
Genetic history for Gorlin
Photograph for records

Red flags

Multiple cysts in a patient < 30 years
Rapid recurrence
Cortical perforation with soft-tissue mass
Palmar/plantar pits, jaw cysts, calcified falx = Gorlin
New paraesthesia post-op

Immediate management

Vismodegib 150 mg/day for multiple/inoperable syndromic OKCs (evidence emerging; alopecia, dysgeusia are common side effects)

Follow-up

Clinical + OPG every 6 months for 2 years
Annually thereafter for a minimum of 10 years
Lifelong review in Gorlin syndrome
Genetic counselling for family members

Full atlas page →

Odontogenic Myxoma

Odontogenic Tumors

Presentation

Egg-shell crackling
Occasional paraesthesia if IAN involved
Rarely painful

Examination checklist

Bimanual palpation
Nerve function (IAN, mental)
OPG + CBCT ± MRI
Aspiration before open biopsy

Red flags

Rapid growth, paraesthesia, cortical perforation with soft-tissue mass — reconsider malignancy

Immediate management

Nil disease-specific

Follow-up

Clinical + OPG every 6 months for 2 years
Annually for 5 years
Selective CBCT/MRI on suspicion of recurrence

Full atlas page →

Odontoma

Odontogenic Tumors

Presentation

Delayed / failed eruption of a permanent tooth
Malposition of adjacent teeth
Occasional expansion of cortical plates

Examination checklist

Full eruption assessment
OPG
CBCT if unerupted tooth involved
Family history for Gardner

Red flags

Multiple odontomas — colonoscopy for Gardner syndrome

Immediate management

Nil specific

Follow-up

Post-op OPG at 6 and 12 months
Monitor eruption of associated tooth

Full atlas page →

Oral Candidiasis

White Lesions

Presentation

Burning, altered taste (bitter, metallic)
Sore mouth, dysphagia
Pain on denture wear
Cracked lip corners

Examination checklist

Full oral exam, including under dentures
KOH mount / smear
Assess systemic risk factors
Photograph lesions

Red flags

Persistent lesions despite treatment (consider HIV, diabetes)
Dysphagia — oesophageal extension
Non-wipeable plaque (hyperplastic — biopsy)
Recurrent candidiasis in adult without obvious cause

Immediate management

Nystatin, miconazole, clotrimazole (topical)
Fluconazole, itraconazole, voriconazole (systemic)
Amphotericin B for invasive/refractory disease

Follow-up

Reassess at 2 weeks after starting treatment
Investigate for underlying HIV/diabetes/immunodeficiency in recurrent disease

Full atlas page →

Oral Lichen Planus

White Lesions

Presentation

Asymptomatic in reticular type
Burning, roughness, pain (atrophic/erosive)
Sensitivity to spicy/acidic foods
Bleeding from erosive lesions

Examination checklist

Full mucocutaneous examination
Photograph lesions
Palpate for induration
Assess pain score and function
Document distribution map

Red flags

Unilateral or asymmetric lesion (suggests lichenoid or leukoplakia)
Induration or ulceration not healing on steroids
Erosive form on lateral tongue / floor of mouth
New red or nodular changes

Immediate management

Topical clobetasol propionate 0.05% BD–TDS
Topical tacrolimus 0.1% BD (short courses)
Systemic prednisolone in severe erosive disease
Nystatin/miconazole to prevent secondary candidiasis

Follow-up

3-monthly during active disease
6-monthly once controlled
Annual review lifelong with re-biopsy of any changing lesion

Full atlas page →

Oral Lipoma

Benign Tumors

Presentation

Soft, yellow, dome-shaped, freely mobile submucosal mass
Painless, slow-growing
Positive 'slip sign'

Examination checklist

Slip sign, yellow hue transilluminates
MRI shows fat signal

Immediate management

Conservative surgical excision with capsule — curative

Full atlas page →

Oral Manifestations of CKD

Systemic Diseases

Presentation

Uraemic fetor (ammoniacal breath)
Metallic taste
Mucosal pallor from anaemia
Xerostomia and enlarged salivary glands
Uraemic stomatitis: white plaques/pseudomembranes
Gingival bleeding, petechiae
Delayed eruption, enamel hypoplasia in children
Cyclosporine/nifedipine-induced gingival overgrowth in transplant recipients

Examination checklist

Check dialysis schedule and access site
Assess bleeding risk
Screen for gingival overgrowth in transplant patients

Immediate management

Coordinate care with nephrologist; treat on non-dialysis day, morning after dialysis
Avoid nephrotoxic drugs (NSAIDs, tetracycline, aminoglycosides)
Adjust doses (amoxicillin, aciclovir) per eGFR
Use LA with epinephrine cautiously if hypertensive
Manage bleeding with local haemostatics; consider DDAVP
Endocarditis prophylaxis if indicated (AV fistula not itself an indication)

Full atlas page →

Oral Manifestations of Diabetes Mellitus

Systemic Diseases

Presentation

Periodontitis — the 'sixth complication' of diabetes
Xerostomia, sialosis
Candidiasis (especially denture stomatitis, angular cheilitis)
Delayed wound healing, altered taste
Recurrent oral abscesses
Burning mouth sensation

Immediate management

Glycaemic control (multidisciplinary)
Aggressive periodontal therapy
Antifungal therapy for candidiasis
Saliva substitutes and stimulants

Full atlas page →

Oral Manifestations of HIV/AIDS

Systemic Diseases

Presentation

Pseudomembranous or erythematous candidiasis, angular cheilitis
Oral hairy leukoplakia (EBV) — corrugated white patch on lateral tongue, cannot be wiped off
Kaposi sarcoma — HHV-8, purple palatal macules/nodules
Non-Hodgkin lymphoma
Linear gingival erythema, necrotising ulcerative gingivitis/periodontitis/stomatitis
Aphthous-like ulcers (major)
Salivary gland disease with xerostomia and parotid enlargement
HPV-associated warts

Examination checklist

OHL and NUP are highly suggestive of HIV — investigate
Check CD4 before invasive procedures

Immediate management

Initiate/optimise antiretroviral therapy (mainstay)
Candidiasis: topical nystatin/miconazole; systemic fluconazole for refractory
OHL: aciclovir; recurs on stopping
KS: ART ± intralesional vinblastine, radiotherapy, chemotherapy
NUP: debridement + metronidazole + chlorhexidine + amoxicillin
Standard universal infection control

Full atlas page →

Oral Manifestations of Leukaemia

Systemic Diseases

Presentation

Diffuse boggy gingival enlargement covering crowns (esp AML M4/M5)
Spontaneous gingival bleeding, petechiae, ecchymoses (thrombocytopenia)
Mucosal pallor (anaemia)
Oral ulcers, opportunistic infections (candidiasis, HSV) from neutropenia
Odontogenic infections that fail to resolve
Chloroma (granulocytic sarcoma)

Examination checklist

New gingival enlargement + spontaneous bleeding in adult → FBC same day
Dental clearance before chemotherapy

Immediate management

Refer to haematology-oncology urgently
Delay elective dental treatment until remission
Dental screening BEFORE chemotherapy: eliminate infection foci
Chlorhexidine mouthwash, cryotherapy for mucositis
Platelet cover (≥ 50 × 10⁹/L) for extractions
Antibiotic prophylaxis if neutropenic

Full atlas page →

Oral Melanoma

Pigmented Lesions

Presentation

Brown-black macule/nodule
Irregular borders, variegated colour
May be amelanotic (pink/red)
Palate and maxillary gingiva most common
Late: ulceration, satellite lesions, bone invasion

Examination checklist

Palate/maxillary gingiva
ABCDE criteria modified for mucosa
IHC: S-100, HMB-45

Red flags

New or changing pigmented lesion
Irregular borders
Rapid growth
Ulceration

Immediate management

Wide surgical excision (margins 1–2 cm when possible)
Neck dissection if nodal disease
Adjuvant immunotherapy (pembrolizumab, nivolumab)
Radiotherapy (adjuvant/palliative)

Full atlas page →

Oral Melanotic Macule

Pigmented Lesions

Presentation

Flat, brown to black macule
Well-defined borders
Usually <1 cm
Non-elevated, non-palpable

Examination checklist

Flat, well-circumscribed, stable size
Normal melanocyte number
Biopsy if atypical

Immediate management

Observation if clinical diagnosis confident
Excisional biopsy if doubt

Full atlas page →

Oral Nevus

Pigmented Lesions

Presentation

Well-circumscribed, brown to blue-black macule or papule
Commonly on hard palate
Usually <6 mm

Examination checklist

Palate most common site
Blue nevus may be raised, deeply pigmented
Biopsy to rule out melanoma

Immediate management

Excisional biopsy for diagnosis
No further treatment if benign

Full atlas page →

Oral Schwannoma

Benign Tumors

Presentation

Slow-growing, painless, firm, submucosal nodule
Usually solitary
May cause paraesthesia if involving lingual/IAN

Examination checklist

Solitary tongue nodule → biopsy
MRI target sign

Immediate management

Complete surgical excision with preservation of parent nerve fascicles
Malignant transformation extremely rare

Full atlas page →

Oral Squamous Cell Carcinoma

Oral Cancer

Presentation

Non-healing ulcer > 3 weeks
Indurated margins, everted edges
Fixed to underlying tissues
Cervical lymphadenopathy
Common sites: lateral tongue, floor of mouth, gingiva

Immediate management

Stage I–II: single-modality — surgery OR radiotherapy
Stage III–IV: composite resection + neck dissection + adjuvant CRT
Neck: elective SND for cN0 with DOI > 3 mm
Targeted / immunotherapy: cetuximab, pembrolizumab, nivolumab for recurrent/metastatic

Full atlas page →

Oral Submucous Fibrosis

Premalignant Disorders

Presentation

Burning sensation, especially with spicy food
Blanched marble-like mucosa
Palpable vertical fibrous bands
Progressive trismus
Depapillation of tongue

Immediate management

Habit cessation (mandatory)
Intralesional steroids ± hyaluronidase
Placental extract injection, pentoxifylline, lycopene
Surgical release of fibrous bands + reconstruction (buccal fat pad, nasolabial flap) for severe trismus
Physiotherapy — mouth-opening exercises

Full atlas page →

Oral Tuberculosis

Ulcerative Diseases

Presentation

Chronic, painful, irregular ulcer
Undermined edges
Granular floor
Tongue > palate > gingiva
Regional lymphadenopathy

Examination checklist

Chronic painful ulcer with undermined edges
Tongue most common
Always screen for pulmonary TB

Immediate management

Standard ATT (RIPE regimen): Rifampicin, Isoniazid, Pyrazinamide, Ethambutol × 2 months, then RI × 4 months

Full atlas page →

Orthognathic Surgery

Maxillofacial Surgery

Presentation

Skeletal Class II/III
Facial asymmetry
Vertical maxillary excess/deficiency
Obstructive sleep apnoea

Immediate management

Pre-surgical orthodontics (decompensation)
Surgery — osteotomies with rigid fixation
Post-surgical orthodontics + retention

Full atlas page →

Ossifying Fibroma

Fibro-osseous Lesions

Presentation

Slow-growing painless jaw swelling with bucco-lingual expansion
Displacement of teeth
Well-defined lesion — key distinction from fibrous dysplasia

Examination checklist

Well-circumscribed vs FD's diffuse border
Cortical bowing on CBCT

Immediate management

Complete surgical enucleation with curettage of the bony cavity — curative
Segmental resection for large or recurrent juvenile variants

Full atlas page →

Osteomyelitis of the Jaws

Bone Diseases

Presentation

Acute: deep throbbing pain, swelling, fever, trismus, tender teeth, Vincent sign (paraesthesia of lower lip)
Chronic: recurrent swelling, sinuses, sequestra extruding through mucosa/skin

Examination checklist

Vincent sign in acute mandibular osteomyelitis
Sequestrum on plain film

Immediate management

Culture-directed IV antibiotics — empirical: penicillin + metronidazole or clindamycin; continue 4–6 wk (longer for chronic)
Surgical: drainage, sequestrectomy, saucerisation, decortication
Resection with reconstruction for refractory cases
Hyperbaric oxygen for refractory/ORN
Control comorbidities (diabetes)

Full atlas page →

Osteosarcoma of the Jaw

Malignant Tumors

Presentation

Rapidly growing swelling
Paraesthesia (numb chin syndrome — mandibular)
Loose teeth

Immediate management

Radical resection with wide margins + neoadjuvant / adjuvant chemotherapy
Post-op radiotherapy for positive margins

Full atlas page →

Paget Disease of Bone

Bone Diseases

Presentation

Progressive bone pain, deformity
Enlarging cranial vault (hat size increases)
Bilateral symmetrical jaw enlargement, spacing of teeth, denture becomes tight
Deafness (cranial nerve VIII compression)
High-output cardiac failure (rare)

Examination checklist

Enlarging skull, ill-fitting dentures, isolated ALP rise

Immediate management

Asymptomatic: monitor
Symptomatic: bisphosphonates (single-dose IV zoledronate preferred) — normalises ALP
Calcitonin (second line)
Analgesia, orthopaedic surgery for fractures
Dental: extractions difficult (dense bone, hypercementosis, bleeding); avoid elective surgery in active phase

Full atlas page →

Pemphigus Vulgaris

Vesiculobullous Diseases

Presentation

Oral lesions precede skin in 50–70%
Flaccid bullae that rupture to painful erosions
Positive Nikolsky sign

Immediate management

Systemic corticosteroids (prednisolone 1 mg/kg/day)
Steroid-sparing: azathioprine, mycophenolate mofetil
Rituximab (first-line in moderate-severe disease per current guidelines)

Full atlas page →

Periapical Abscess

Dental Diseases

Presentation

Tender to percussion
Mobility
Regional lymphadenopathy
Fluctuant swelling

Examination checklist

Drainage is paramount; antibiotics without drainage fail
Chronic abscess = radiolucency + sinus tract
Extraction if non-restorable

Red flags

Trismus
Dysphagia
Dyspnoea
Floor of mouth elevation
Fever >38.5°C

Immediate management

Amoxicillin 500 mg TDS × 5 days
Metronidazole add-on for anaerobes
Analgesics

Full atlas page →

Peripheral Giant Cell Granuloma

Soft Tissue Lesions

Presentation

Dark red-purple nodule on gingiva/alveolar ridge
Sessile or pedunculated
May cause superficial bone resorption ('cupping')
Bleeds easily

Examination checklist

ALWAYS on gingiva/ridge (not intra-osseous)
Rule out hyperparathyroidism if recurrent
Giant cells on histology

Immediate management

Excision to periosteum
Remove local irritants
Curettage of underlying bone

Full atlas page →

Pleomorphic Adenoma

Salivary Gland Disorders

Presentation

Painless, slow-growing, mobile, firm swelling
Parotid: preauricular mass without facial nerve involvement
Palatal: firm submucosal swelling posterolateral hard palate
Long history (years)

Examination checklist

Palpable, mobile, painless mass without facial nerve palsy
Enucleation is inadequate

Immediate management

Parotid: superficial parotidectomy with facial nerve preservation (deep lobe → total parotidectomy)
Submandibular: gland excision
Palate/minor gland: wide local excision including periosteum/bone
Enucleation → 25–45% recurrence — obsolete

Full atlas page →

Primary Herpetic Gingivostomatitis

Vesiculobullous Diseases

Presentation

Prodrome: fever, malaise, irritability
Oral: vesicles on keratinised and non-keratinised mucosa → shallow painful ulcers
Fiery red, swollen, bleeding gingiva
Cervical lymphadenopathy
Resolves 10–14 days

Examination checklist

Vesicles on ALL mucosa (keratinised + non-keratinised)
Fiery red gingivitis
Tzanck smear

Immediate management

Supportive: hydration, soft diet, antipyretics
Aciclovir (if within 72h onset): 15 mg/kg 5×/day × 7 days (children)
Topical benzocaine, lidocaine gel for pain

Full atlas page →

Pulpitis

Dental Diseases

Presentation

Reversible: sharp, transient pain to cold/sweet, relieved on stimulus removal
Irreversible: spontaneous, lingering pain, nocturnal exacerbation, poorly localised

Examination checklist

Cold test: lingering >10s = irreversible
EPT negative = necrosis
Percussion tenderness = periapical involvement

Immediate management

Reversible: remove irritant, sedative restoration
Irreversible: root canal therapy or extraction
Pulpotomy in young permanent teeth (MTA)

Full atlas page →

Pyogenic Granuloma

Benign Tumors

Presentation

Rapidly growing red-purple pedunculated mass
Bleeds easily
Interdental papilla commonly affected

Immediate management

Excision with removal of local irritants
Recurrence 15%

Full atlas page →

Radicular Cyst

Odontogenic Cysts

Presentation

Discoloured non-vital tooth
Tenderness on percussion when acutely infected
Fluctuant swelling in vestibule
Rarely paraesthesia (excludes malignancy)

Examination checklist

Inspect for sinus / swelling / discolouration
Palpate for expansion, egg-shell crackling
Percuss suspected tooth
Cold and EPT vitality tests
Periapical + panoramic radiograph
CBCT if extension unclear
Aspiration in-office

Red flags

Rapid growth
Paraesthesia of lip or teeth
Cortical perforation with soft-tissue mass
Failure to heal 6 months after adequate RCT — biopsy mandatory to exclude neoplasm

Immediate management

Antibiotics only if secondary infection (amoxicillin 500 mg TID × 5 d ± metronidazole)
Analgesics as required

Follow-up

Clinical + radiographic review at 3, 6, 12 months post-op
Annual OPG until complete bony infill (usually 12–24 months)
Long-term follow-up for large lesions or those adjacent to vital structures

Full atlas page →

Ranula

Soft Tissue Lesions

Presentation

Unilateral, bluish, translucent swelling floor of mouth
Soft, fluctuant
May deviate tongue
Plunging ranula: submandibular swelling with floor of mouth component

Examination checklist

Ranula = mucocele of floor of mouth
Plunging = through mylohyoid
Marsupialization or gland removal

Immediate management

Marsupialization (simple ranula)
Excision of sublingual gland (recurrent/plunging)
Transcervical approach for plunging ranula

Full atlas page →

Recurrent Aphthous Stomatitis

Ulcerative Diseases

Presentation

Prodrome of tingling
Round ulcer, yellow-grey floor, erythematous halo
Non-keratinised mucosa

Immediate management

Topical corticosteroids (triamcinolone in Orabase)
Chlorhexidine mouthwash
Topical anaesthetics for symptom control
Systemic steroids / colchicine for major RAS

Full atlas page →

Sialolithiasis

Salivary Gland Disorders

Presentation

Meal-time swelling and pain ('sialoadenitis alimentaria')
Palpable stone in duct
Purulent discharge if infected

Immediate management

Distal stones — intra-oral duct slitting (sialodochoplasty)
Small stones (< 4 mm) — sialendoscopy ± lithotripsy
Chronic hilar/parenchymal stones — gland excision

Full atlas page →

Sjögren Syndrome

Salivary Gland Disorders

Presentation

Xerostomia: burning mouth, difficulty swallowing dry food, rampant caries
Xerophthalmia: gritty eyes, keratoconjunctivitis sicca
Bilateral parotid enlargement
Fissured/depapillated tongue
Extra-glandular: arthralgia, Raynaud, interstitial lung disease, neuropathy

Examination checklist

Salivary flow test, Schirmer test, focus score biopsy
Persistent unilateral parotid mass → exclude lymphoma

Immediate management

Symptomatic sicca: artificial tears, saliva substitutes, sugar-free gum
Muscarinic agonists (pilocarpine 5 mg qid, cevimeline)
Systemic: hydroxychloroquine for arthralgia/fatigue; immunosuppression (methotrexate, rituximab) for severe extra-glandular disease
Aggressive caries prevention: fluoride, chlorhexidine, sialogogues

Full atlas page →

Smoker's Melanosis

Pigmented Lesions

Presentation

Diffuse brown pigmentation
Anterior labial gingiva, lips, buccal mucosa
Intensity correlates with smoking duration
Usually bilateral

Examination checklist

Anterior labial gingiva
Reversible with smoking cessation
Distinguish from melanoma by diffuse pattern

Immediate management

Smoking cessation (pigmentation fades over months to years)

Full atlas page →

Solitary Bone Cyst

Non-odontogenic Cysts

Presentation

Mild bony expansion in a minority
Percussion of overlying teeth non-tender
No cortical perforation typically

Examination checklist

Age (10–20 y)
Site (posterior mandible)
Vitality tests
OPG for scalloping
CBCT for extent
Plan surgical exploration

Red flags

Rapid growth
Paraesthesia of lower lip
Multilocular expansile lesion → reconsider ABC / CGCG / ameloblastoma
Presence of epithelial lining on biopsy — reclassify

Immediate management

Analgesia post-op
No antibiotics unless secondary infection

Follow-up

Clinical + OPG at 3, 6, 12 months
Annual OPG until complete infill (typically 12 months)

Full atlas page →

Temporomandibular Disorders

TMJ Disorders

Presentation

Preauricular pain
Clicking / crepitus
Restricted mouth opening
Deviation on opening

Immediate management

Conservative: patient education, soft diet, NSAIDs, occlusal splints, physiotherapy
Minimally invasive: arthrocentesis, intra-articular steroids/hyaluronate
Surgical: arthroscopy, discoplasty, condylectomy, total joint replacement for end-stage disease

Full atlas page →

TMJ Ankylosis

TMJ Disorders

Presentation

Reduced or absent mouth opening
Micrognathia (unilateral: chin deviation to affected side; bilateral: bird-face)
Sleep-disordered breathing/OSA
Poor oral hygiene, dental crowding

Examination checklist

Measure MIO
Assess airway (OSA)
Type on CT

Immediate management

Aggressive early release to prevent deformity and OSA
Kaban protocol: (1) aggressive gap arthroplasty ≥1.5 cm, (2) ipsilateral coronoidectomy, (3) contralateral coronoidectomy if opening <35 mm, (4) interpositional material (temporalis flap or alloplastic), (5) rigid fixation with early mobilisation, (6) aggressive physiotherapy for ≥6 months
Costochondral graft in growing children; TMJ prosthesis in adults

Full atlas page →

Torus Palatinus & Mandibularis

Benign Tumors

Presentation

Slow-growing, painless, bony-hard midline palatal or bilateral lingual mandibular swellings
Thin overlying mucosa prone to trauma ulceration
May interfere with denture seating or speech

Examination checklist

Bilateral lingual mandibular = pathognomonic
Rule out Gardner syndrome if multiple osteomas

Immediate management

No treatment required unless: interferes with prosthesis, causes speech problems, chronic mucosal trauma, or patient concern
Surgical removal: elevate mucoperiosteal flap, section with bur/osteotome, smooth with file, tension-free closure

Full atlas page →

Traumatic Fibroma

Soft Tissue Lesions

Presentation

Smooth, dome-shaped, firm, pink nodule
Usually < 1.5 cm
Buccal mucosa along occlusal plane most common

Immediate management

Conservative surgical excision with removal of irritant

Full atlas page →

Traumatic Ulcer

Ulcerative Diseases

Presentation

Painful ulcer with erythematous halo
Yellow-white fibrin base
Adjacent to identifiable traumatic source
Heals within 10–14 days after cause removal

Examination checklist

Identifiable cause
Heals 10-14 days
Biopsy if non-healing

Red flags

No healing >2 weeks
Indurated margins
Lymphadenopathy

Immediate management

Remove traumatic agent
Smooth sharp edges
Topical analgesics/steroids
Chlorhexidine rinse

Full atlas page →

Verrucous Carcinoma

Oral Cancer

Presentation

Slow-growing exophytic, cauliflower-like, white-warty painless lesion
May cover a large area and cause bone erosion (pressure-type)
Rarely metastasises to lymph nodes

Examination checklist

Take deep biopsy for diagnosis
No need for elective neck dissection

Immediate management

Wide surgical excision with 1 cm margin — treatment of choice
Neck dissection generally NOT required (nodes rare)
Radiotherapy avoided historically due to reported anaplastic transformation; contemporary evidence limited
Cryotherapy or laser for small lesions

Full atlas page →

White Sponge Nevus

White Lesions

Presentation

Asymptomatic; occasional roughness reported

Examination checklist

Full oral exam
Ask about siblings/parents
Look for extra-oral mucosal lesions

Red flags

Adult onset (reconsider diagnosis)
Unilateral distribution
Malignant features (very rare)

Immediate management

Tetracycline oral rinse 250 mg in 5 ml water swish 4×/day (anecdotal)
Topical retinoids (limited efficacy)

Follow-up

No specific follow-up needed once diagnosed

Full atlas page →

Zygomatic Complex Fracture

Trauma

Presentation

Flattening of malar prominence (masked by early oedema)
Periorbital ecchymosis, subconjunctival haemorrhage extending posteriorly
Infraorbital paraesthesia (V2)
Diplopia, enophthalmos, hypoglobus
Trismus (impingement on coronoid)
Step deformity at infraorbital rim, zygomatic buttress, frontozygomatic suture

Examination checklist

Assess vision — retrobulbar haemorrhage is an emergency
Palpate all four articulations
Test V2 sensation

Immediate management

Undisplaced/minimally displaced without functional deficit: conservative + soft diet 4–6 wk + avoid sleep on affected side
Displaced: open reduction with internal fixation via combined approaches: (1) frontozygomatic (upper eyelid or lateral brow), (2) infraorbital rim (subciliary/transconjunctival), (3) zygomaticomaxillary buttress (sublabial)
Fix at 2–3 points depending on stability; Gillies temporal approach for pure arch fractures
Orbital floor reconstruction if defect > 2 cm² or entrapment

Full atlas page →