Module 08

Revision Notes

Exam-crunch summaries with mnemonics and clinical pearls, condensed from the full atlas entries.

88 topics

Abfraction

Dental Diseases

Quick revision

Stress-induced flexure at cervical
Multifactorial aetiology
Night guard + restoration

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Actinic Cheilitis

Premalignant Disorders

Quick revision

UV-induced PMD of lower lip
Solar elastosis on histology
Vermilionectomy for high-grade dysplasia

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Adenomatoid Odontogenic Tumour

Odontogenic Tumors

Quick revision

Two-thirds tumour
Encapsulated
Duct-like rosettes with dystrophic calcification
Enucleation is curative

Mnemonics

AOT = All 2/3 — female, maxilla, canine, teens, follicular, encapsulated

Clinical pearls

Adenomatoid ≠ adenocarcinoma — this is a benign encapsulated lesion.
Snowflake calcifications extending apically past the CEJ = AOT, not a dentigerous cyst.

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Ameloblastoma

Odontogenic Tumors

Mnemonics

A-B-C-D: Aggressive, Benign histology, Cystic-solid, Deforming

Clinical pearls

'Soap-bubble' + 'knife-edge' root resorption + BRAF V600E = ameloblastoma.

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Amelogenesis Imperfecta

Developmental Disorders

Quick revision

AI = enamel only, DI = dentin only
Type III hypocalcified = soft, rapidly lost enamel
AMELX mutation = X-linked hypoplastic

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Aneurysmal Bone Cyst

Non-odontogenic Cysts

Quick revision

Blood-filled multilocular pseudocyst — reclassified as neoplasm (USP6)
Young patients, posterior mandible
Fluid–fluid levels on MRI
Aggressive curettage + adjuvant is standard
Recurrence 10–60% without adjuvant

Mnemonics

ABC = Angry Ballooning Cavity — Aggressive curettage, Blood-filled, Cortical thinning.

Clinical pearls

Rapidly expanding, blood-filled, multilocular jaw lesion in a young patient with fluid–fluid levels on MRI is ABC until proven otherwise.
Always request USP6 FISH — it changes diagnosis and, potentially, treatment.
Aggressive curettage + adjuvant beats simple curettage on recurrence.

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Attrition

Dental Diseases

Quick revision

Shiny, flat facets
Matching opposing wear
Occlusal guard for bruxism

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Behçet Disease

Ulcerative Diseases

Quick revision

Silk Road disease
Recurrent oral ulcers + genital + uveitis
Anti-TNF for severe

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Burkitt Lymphoma

Malignant Tumors

Quick revision

MYC t(8;14) · starry-sky · Ki-67 100% · CODOX-M/IVAC

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Cemento-osseous Dysplasia

Fibro-osseous Lesions

Quick revision

Vital teeth · anterior mandible (periapical) or multi-quadrant (florid) · observation

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Cementoblastoma

Odontogenic Tumors

Quick revision

Painful, mandibular first molar, vital tooth, fused to root, radiolucent halo, extract tooth + tumour

Mnemonics

4Fs = First molar, Fused to root, Fibrous halo, Fine pain

Clinical pearls

The only truly neoplastic cemental lesion; the rest are dysplasias.

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Central Giant Cell Granuloma

Bone Diseases

Clinical pearls

Always check serum calcium & PTH to rule out brown tumour.

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Cervicofacial Actinomycosis

Maxillofacial Infections

Quick revision

A. israelii · sulphur granules · long-course penicillin

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Cervicofacial Necrotising Fasciitis

Maxillofacial Infections

Quick revision

Polymicrobial · early aggressive debridement · clindamycin + β-lactam · high mortality

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Chondrosarcoma of the Jaws

Malignant Tumors

Quick revision

Cartilage-producing malignancy · wide excision · radioresistant

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Cleft Lip & Palate Repair

Maxillofacial Surgery

Quick revision

Rule of 10s · lip 3mo · palate 9-12mo · alveolar graft 8-11y · orthognathic at 18y

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Cleft Lip and Palate

Developmental Disorders

Quick revision

CL+P: male > female
Isolated CP: female > male
IRF6 gene — Van der Woude syndrome

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Cleidocranial Dysplasia

Developmental Disorders

Mnemonics

CCD = Clavicles, Cranium, Dentition

Clinical pearls

Suspect CCD in any child with multiple supernumeraries and delayed eruption.

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Condylar Hyperplasia

TMJ Disorders

Quick revision

Obwegeser I/II/III · bone scan for activity · condylectomy if active

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Deep Neck Space Infections

Maxillofacial Infections

Quick revision

Odontogenic source · early I&D + antibiotics · watch for mediastinitis

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Dental Caries

Dental Diseases

Clinical pearls

Silver diamine fluoride arrests caries but stains lesions black.

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Dental Erosion

Dental Diseases

Quick revision

Non-bacterial acid = erosion
Intrinsic = palatal maxillary anteriors
BEWE scoring system

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Dental Implantology

Maxillofacial Surgery

Quick revision

Osseointegration (Brånemark) · CBCT planning · 2 mm from IAN · torque ≥30 Ncm for immediate loading

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Dentigerous Cyst

Odontogenic Cysts

Clinical pearls

Follicular space > 4 mm on OPG is suspicious for dentigerous cyst.

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Dentinogenesis Imperfecta

Developmental Disorders

Quick revision

DSPP mutation
Bulbous crown, cervical constriction
Obliterated pulp on OPG

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Dento-alveolar Trauma

Trauma

Quick revision

IADT 2020 · replant ASAP · HBSS best medium · 2 wk flexible splint for avulsion

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Distraction Osteogenesis

Maxillofacial Surgery

Quick revision

Latency 5–7 d · rate 1 mm/d · consolidation 2× · Ilizarov principle

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Epulis Fissuratum

Soft Tissue Lesions

Quick revision

Denture flange irritation
Firm folds in vestibule
Excision + new denture

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Erythema Multiforme

Vesiculobullous Diseases

Quick revision

HSV trigger > drugs
Target lesions
Self-limiting 2-6 weeks

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Erythematous (Atrophic) Candidiasis

Red Lesions

Quick revision

Red painful mucosa
Antibiotic or denture history
KOH positive for hyphae
Topical nystatin + hygiene
Investigate systemic disease if recurrent

Mnemonics

Red mouth after Rx (antibiotic) — think Candida

Clinical pearls

Red + painful under denture = candidal denture stomatitis until proven otherwise.
Treat patient AND denture — dentures are the reservoir.

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Erythroplakia

Red Lesions

Quick revision

Red > white in risk
> 90% dysplasia / CIS / SCC at first biopsy
Excision mandatory regardless of grade
Lifelong follow-up

Mnemonics

RED = Really Every Dysplastic — biopsy every red patch

Clinical pearls

Red > white — erythroplakia is more ominous than leukoplakia.
Any red patch not diagnosable as candidiasis or lichen planus must be biopsied.
Toluidine blue helps localise most dysplastic zones.

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Geographic Tongue

Red Lesions

Quick revision

Migrating red patches + white borders
Psoriasiform histology
Benign, no treatment
Associated with fissured tongue

Mnemonics

GEO = Grows, Erases, Reappears Over time

Clinical pearls

Migration is diagnostic — ask patient to photograph over 1–2 weeks.
Reassurance is the treatment; no biopsy needed if classical.
Screen for haematinics if burning persists.

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Haemangioma

Benign Tumors

Quick revision

GLUT-1+ · propranolol first line · 90% involute by age 9

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Hemifacial Microsomia

Developmental Disorders

Quick revision

1st + 2nd arch derivative hypoplasia
OMENS: Orbit, Mandible, Ear, Nerve, Soft tissue
Stapedial artery haemorrhage theory

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HPV-associated Oropharyngeal SCC

Oral Cancer

Quick revision

HPV-16 · p16+ · better prognosis · AJCC 8 separate staging · TORS or chemoRT

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Kaposi Sarcoma

Malignant Tumors

Quick revision

HHV-8 · palate · LANA-1+ · ART + local/systemic therapy

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Lateral Periodontal Cyst

Odontogenic Cysts

Quick revision

Vital tooth, interradicular, small unilocular radiolucency, glycogen-rich clear cells, mandibular premolar region

Mnemonics

LPC = Lateral, Premolar, Clear cells

Clinical pearls

Vital tooth + tiny interradicular radiolucency = LPC.
Botryoid variant recurs — treat like a mini-OKC.

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Le Fort Fractures

Trauma

Quick revision

I floating palate · II pyramidal · III craniofacial disjunction · buttress reconstruction

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Leukoedema

White Lesions

Quick revision

Bilateral, diffuse, milky
Disappears on stretch
Intracellular oedema of spinous layer
Benign, no treatment

Mnemonics

Leukoedema Leaves on stretch

Clinical pearls

When you stretch the cheek and the whiteness vanishes, it is leukoedema.
Very common in Black adults — do not misdiagnose as leukoplakia.

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Leukoplakia

White Lesions

Quick revision

Diagnosis of exclusion — clinical + histological
Non-homogeneous >> homogeneous risk
Habit cessation is treatment step 1
Biopsy is mandatory
Lifelong follow-up for high-risk lesions

Mnemonics

Non-homogeneous = Nasty (higher risk)
PVL — Persistent, Verrucous, Lethal

Clinical pearls

Any leukoplakia that fails to regress 2–4 weeks after removing irritants must be biopsied.
Red > white — a speckled lesion is more ominous than a homogeneous plaque.
PVL is a clinical, not histological, diagnosis — established retrospectively.

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Ludwig's Angina

Maxillofacial Infections

Clinical pearls

Airway first, antibiotics second, drainage third.

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Median Rhomboid Glossitis

Red Lesions

Quick revision

Midline posterior dorsum tongue
Rhomboidal red patch
Candida-associated
Fluconazole responds
Beware pseudo-epitheliomatous hyperplasia

Mnemonics

MRG = Midline Rhomboid, Grows on Candida

Clinical pearls

Any midline red patch of the tongue in a smoker / diabetic — think MRG.
Palatal kissing lesion — screen for HIV.
Do not diagnose SCC from a superficial biopsy of MRG — beware pseudo-epitheliomatous hyperplasia.

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Medication-Related Osteonecrosis of the Jaws

Bone Diseases

Quick revision

AAOMS 2022 · exposed bone >8 wk · prevention with pre-treatment dental clearance

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Mucocele

Soft Tissue Lesions

Quick revision

Bluish fluctuant lower lip swelling
Extravasation = pseudocyst
Excise with gland

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Mucoepidermoid Carcinoma

Salivary Gland Disorders

Quick revision

MAML2 fusion · commonest paediatric salivary malignancy · grade determines prognosis

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Mucous Membrane Pemphigoid

Vesiculobullous Diseases

Quick revision

Subepithelial blisters
Linear IgG BMZ
Ocular scarring risk

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Mumps (Epidemic Parotitis)

Salivary Gland Disorders

Quick revision

Paramyxovirus · bilateral parotitis · MMR vaccine

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Nasolabial Cyst

Non-odontogenic Cysts

Quick revision

Extra-osseous non-odontogenic cyst
Female middle-aged predominance
10% bilateral
Respiratory epithelium with goblet cells
MRI diagnostic
Sublabial excision curative

Mnemonics

Klestadt = Klean out from Klestadt approach (sublabial)

Clinical pearls

A soft-tissue swelling that lifts the ala nasi with vital adjacent teeth is a nasolabial cyst.
Endoscopic marsupialisation is faster with less morbidity — offer as an option to modern patients.

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Nasopalatine Duct Cyst

Non-odontogenic Cysts

Quick revision

Most common non-odontogenic oral cyst
From nasopalatine duct remnants
Heart-shaped radiolucency in anterior maxillary midline
Vital adjacent teeth
Neurovascular bundle in cyst wall is pathognomonic
Enucleation is curative

Mnemonics

NASO-PALATINE: Neurovascular bundle, Anterior maxilla, Salty discharge, Oval/heart-shape, Painless, Adults 4th–6th decade, Localised, Adjacent teeth vital, Treatment enucleation, Incisive canal, Non-odontogenic, Excellent prognosis.

Clinical pearls

Vital teeth + midline anterior maxilla + heart-shape = nasopalatine cyst.
Counsel every patient about transient palatal numbness before surgery.

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Odontogenic Keratocyst

Odontogenic Cysts

Quick revision

From rests of Serres, PTCH1 mutation
Posterior mandible
Grows anteroposteriorly, little expansion
Parakeratinised, palisaded basal, flat CT junction
High recurrence — enucleation + adjunct
Multiple/young → screen Gorlin

Mnemonics

OKC = Only Kids Come (young age); PARA-K, PALI-sade, FLAT junction, SATELLITES = 4 histologic pillars

Clinical pearls

'Empty' looking lesion on OPG in the mandibular ramus of a young patient — think OKC.
Always screen for skin BCCs and palmar pits.
Marsupialise big lesions, enucleate later — safer and lower recurrence.

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Odontogenic Myxoma

Odontogenic Tumors

Quick revision

Ectomesenchymal
Mandible > maxilla
Tennis-racket / step-ladder / soap-bubble
Stellate cells + myxoid stroma
No capsule → recurs; resect with margin

Mnemonics

Myxoma = Mucin, Mesenchyme, Mandible, Multilocular, Must resect with Margin

Clinical pearls

Multilocular + straight fine septa + stringy aspirate = myxoma until proven otherwise.
Never curette a multilocular radiolucency without aspirating first.

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Odontoma

Odontogenic Tumors

Quick revision

Hamartoma
Most common odontogenic tumour
Compound (anterior maxilla) vs complex (posterior mandible)
Radiopacity + halo
Gardner if multiple

Mnemonics

Compound = Cluster (of denticles), Complex = Chaos

Clinical pearls

Any impacted tooth in an unusual position — look for an overlying odontoma.
Multiple odontomas + colonic polyps = Gardner — refer for colonoscopy.

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Oral Candidiasis

White Lesions

Quick revision

4 primary + 3 Candida-associated types
Pseudomembranous wipes off; hyperplastic does not
PAS stain shows hyphae
Topical nystatin first line; fluconazole for refractory
Always investigate underlying disease in recurrent cases

Mnemonics

Predisposing = ABCDE: Antibiotics, Broad immunosuppression, Corticosteroids, Diabetes, Extremes of age

Clinical pearls

Wipes off = candidiasis; doesn't wipe off = biopsy.
Chronic hyperplastic candidiasis on commissures — 10% risk of dysplasia.
Recurrent candidiasis in an adult — screen for HIV and diabetes.

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Oral Lichen Planus

White Lesions

Quick revision

6 Andreasen types
6 Ps of cutaneous LP: Purple, Pruritic, Polygonal, Planar, Papules
Basal cell degeneration + saw-tooth rete + band-like infiltrate
Topical clobetasol = first line
1% MT over 5 years

Mnemonics

6 Ps of LP: Purple, Pruritic, Polygonal, Planar, Papules, (+ Plaque)

Clinical pearls

Bilateral, symmetric, reticular — think OLP first.
Steroid + antifungal together — steroids provoke candidiasis.
Re-biopsy any long-standing lesion that changes character.

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Oral Lipoma

Benign Tumors

Quick revision

Adipocyte tumour · buccal mucosa · excision curative

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Oral Manifestations of CKD

Systemic Diseases

Quick revision

Uraemic fetor · lamina dura loss · treat morning after dialysis · avoid NSAIDs

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Oral Manifestations of Diabetes Mellitus

Systemic Diseases

Clinical pearls

Non-surgical periodontal therapy can reduce HbA1c by ~0.4%.

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Oral Manifestations of HIV/AIDS

Systemic Diseases

Quick revision

Candidiasis · OHL · KS · NUP · ART is definitive treatment

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Oral Manifestations of Leukaemia

Systemic Diseases

Quick revision

AML M4/M5 · gingival hyperplasia · FBC + BM aspirate

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Oral Melanoma

Pigmented Lesions

Quick revision

Poor prognosis unlike cutaneous
Palate most common site
Wide excision + immunotherapy

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Oral Melanotic Macule

Pigmented Lesions

Quick revision

Most common oral pigmented lesion
Increased melanin, not melanocytes
Biopsy if suspicious

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Oral Nevus

Pigmented Lesions

Quick revision

Intramucosal most common type in mouth
Palate/gingiva sites
Excise for diagnosis

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Oral Schwannoma

Benign Tumors

Quick revision

Antoni A/B · Verocay bodies · S-100+ · excision curative

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Oral Squamous Cell Carcinoma

Oral Cancer

Mnemonics

FEAR — Fixed, Everted, Anaesthetic, Rolled edges

Clinical pearls

Any oral ulcer that fails to heal within 3 weeks must be biopsied.

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Oral Submucous Fibrosis

Premalignant Disorders

Clinical pearls

OSMF is irreversible — early diagnosis is critical.

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Oral Tuberculosis

Ulcerative Diseases

Quick revision

Secondary TB > primary
Caseating granulomas + AFB
RIPE regimen

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Ossifying Fibroma

Fibro-osseous Lesions

Quick revision

Encapsulated · enucleation curative · JOF more aggressive

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Osteomyelitis of the Jaws

Bone Diseases

Quick revision

Sequestrum + involucrum · long IV antibiotics + surgical debridement

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Paget Disease of Bone

Bone Diseases

Quick revision

Cotton-wool skull · isolated ALP · zoledronate

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Pemphigus Vulgaris

Vesiculobullous Diseases

Mnemonics

Pemphigus = 'PV kills Deep' (Desmoglein-3, suprabasal)

Clinical pearls

Rituximab has revolutionised management — early referral is essential.

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Periapical Abscess

Dental Diseases

Quick revision

Incision and drainage principle
Parulis = chronic sinus tract
Antibiotics adjunctive, not primary

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Peripheral Giant Cell Granuloma

Soft Tissue Lesions

Quick revision

Purple-red gingival nodule
Giant cells + haemosiderin
Excise to periosteum

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Pleomorphic Adenoma

Salivary Gland Disorders

Quick revision

Commonest salivary tumour · superficial parotidectomy · avoid enucleation · beware carcinoma ex PA

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Primary Herpetic Gingivostomatitis

Vesiculobullous Diseases

Quick revision

HSV-1 primary infection
Children 6mo-5yr
Aciclovir within 72h

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Pulpitis

Dental Diseases

Quick revision

Reversible = transient; Irreversible = lingering/spontaneous
Increased pulpal pressure causes pain
MTA pulpotomy for immature apex

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Pyogenic Granuloma

Benign Tumors

Clinical pearls

Pregnancy tumour is a hormonally influenced pyogenic granuloma.

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Radicular Cyst

Odontogenic Cysts

Quick revision

Most common odontogenic cyst
From cell rests of Malassez
Always non-vital tooth
Non-keratinised stratified squamous lining
Rushton bodies pathognomonic when present
Enucleation is curative

Mnemonics

Radicular = Rest of Malassez, Rushton bodies, Root apex, Rotten (non-vital) tooth

Clinical pearls

Not every periapical radiolucency is a cyst — histology is the arbiter.
Failed RCT + persistent radiolucency at 6 months → surgical exploration.

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Ranula

Soft Tissue Lesions

Quick revision

Blue, frog belly swelling
Plunging = submandibular extension
Excise sublingual gland for recurrence

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Sjögren Syndrome

Salivary Gland Disorders

Quick revision

Focus score ≥1 · anti-Ro/SSA · pilocarpine · watch for MALT lymphoma

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Smoker's Melanosis

Pigmented Lesions

Quick revision

Tobacco-induced melanin
Anterior gingiva
Fades with cessation

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Solitary Bone Cyst

Non-odontogenic Cysts

Quick revision

Pseudocyst — no epithelial lining
Adolescent posterior mandible
Scalloping between vital tooth roots
Empty cavity on exploration
Curettage curative
Rapid bony infill

Mnemonics

EMPTY: Empty cavity, Mandible posterior, Pseudocyst, Teenagers, Yields to curettage.

Clinical pearls

A scalloped mandibular radiolucency in a teenager with vital teeth and no expansion is a solitary bone cyst until proven otherwise.
Exploration IS the treatment — no lining to remove.

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