ORD- Differential diagnoses for everything

General history taking

- Age at onset

- Associated orofacial pain or neurological symptoms

- Systemic symptoms

- Social and sexual history- alcohol/smoking

- FH

- MH: systemic disease, medications, primary malignancy elsewhere

What are the general divisions for the causes of each lesion?

Dental/Drug

Infective/Inflammatory/Idiopathic

Neoplastic/Normal anatomy

Trauma

Systemic

Lip swelling

- Normal anatomy

Fordyce spots, prominent salivary glands

- Localised inflammatory

Fibroepithelial polyp

Mucous extravasion/retention cyst

Squamous papilloma

Pyogenic granuloma

Haemangioma

- Benign salivary neoplasm

Pleomorphic adenoma (upper lip)

- Malignant lesions

Squamous cell carcinoma

Mucoepidermoid/adenoid cystic carcinoma

Melanoma

- Systemic disease

Crohn's, OFG, angioedema

- Trauma

Palatal mass

Anatomy

Unerupted tooth

Palatal tori

Inflammatory/reactive

Fibro-epithelial polyp

Denture-induced hyperplasia

Papilloma

Odontogenic:

Dental abscess

Dentigerous/naso-palatine duct cyst

Benign:

Pleomorphic adenoma

Mucocele

Lipoma

Malignant:

Kaposi sarcoma

Mucoepidermoid carcinoma

Lymphoma

SCC

Allergy

Localised gingival lesions

Periodontal abscess

Pregnancy epulis

Fibrous epulis

Papilloma

Pyogenic granuloma

Giant cell epulis

Necrotising ulcerative gingivitis/periodontitis

Lymphoma

SCC

Generalised gingival lesions

- Drug-induced hyperplasia (phenytoin, nifedipine)

- Gingival pigmentation

- Desquamative gingivitis; LP, PV, MMP

- Wenger's Granulomatosis

- Herpetic gingivostomatitis

- Tuberculosis

- Leukaemia

- OFG, sarcoidosis, Crohn's

Cervical lymphadenopathy

Infectious

Bacterial; apical abscess, cellulitis, periodontitis, pericoronitis, osteomyelitis, TB

Viral: infectious mononucleosis, HIV, mumps

Inflammatory

Sjogren

RA- bilateral morning joint stiffness

OFG

Crohn's- oral ulcers, anal fistulas

Sarcoidosis- lung problems, erythema nodosum

Neoplasm

Hodgkin/non-Hodgkin lymphoma, leukaemia

Malignant melanoma,

Metastasis from gastric

OSCC

Drug reactions (phenytoin)

Lumps and swellings in salivary glands

Mucoceles

Mucous retention

Extravasation cysts

Ranula

Inflammation

- Acute sialadenitis (mumps)

- Chronic sialadenitis (duct obstruction, strictures)

- Acute suppurative parotitis

Sialadenosis

Neoplastic

- Pleomorphic adenoma

- Warthin tumour

- Mucoepidermoid carcinoma

- Adenoid cystic carcinoma

- Carcinoma ex pleomorphic adenoma

- Polymorphous adenocarcinoma

- Lymphoma

Metastases to the jaw from breast/thyroid + Ewing's sarcoma (bony hard)

Systemic

- HIV associated salivary gland disease

- Sarcoidosis

- Sjogren's

Dry mouth

True xerostomia:

- Medications

- Dehydration

- Systemic conditions; diabetes, CKD

- Mumps

- Sjogren's, sarcoidosis

Subjective xerostomia:

- Psychogenic

- BMS

- Mouth breathing

Toothache normally/on biting

Pulpitis

Cracked tooth/cusp

Periapical periodontitis

Periodontal abscess

Sinusitis

Persistent idiopathic facial pain

Trigeminal neuralgia

On biting:

TMD

Temporal arteritis

Salivary obstruction (mealtime syndrome)

Signs of a malignant lesion

- Non healing ulcer

- Red, white, speckled lesion

- >2 weeks

- Lesion with no known cause/trigger

- Dysphagia >3 weeks

- Indurated/indistinct borders

- Cervical lymphadenopathy >3 weeks

- Unexplained mobility

- Paraesthesia

- Bleeding

Pigmented lesion

Anatomical

- Racial pigmentation

Genetic (biopsy)

- Melanotic macule

- Melanocytic naevus (mole)

Syndrome

- Putz-Jehger

- Leopard syndrome

Systemic

- Addison's disease

- Drug-induced

- AIDS induced purpura

Neoplastic

- Melanoma

Inflammatory/reactive

- Lichen planus

- Amalgam tattoo

- CHX staining

- Smoking

Infective

- Black hairy tongue

Blood derived

- Haemangioma

- Purpura due to platelet disorder

- Kaposi's sarcoma

- Pyogenic granuloma

Meds

ART for HIV

Tongue disorders

Normal anatomy

- Furred tongue

- Foliate papillae

Other

- Erythema migrans

- Atrophic candidiasis

- Glossitis

- Median rhomboid glossitis

- Macroglossia (acromegaly)

- Amyloidosis (yellow nodules on lateral border)

- Erythematous candidiasis (Big MRG)

- Lichen planus

- Hairy tongue

- Xerostomia

- Traumatic ulcer

- Pyogenic granuloma

- Fibroepithelial polyp

- OSCC

White patch

Fordyce spots

Reactive:

Linea alba

Frictional keratosis

Chemical injury

Oral licehnoid lesion

Infective:

Syphilis, HPV

Candidiasis; acute pseudomembranous, chronic hyperplastic

OLP, PV, MMP

Proliferative verrucous leukoplakia

Leukodema

Dyskeratosis congenita

Oral submucous fibrosis

White sponge naevus

GVHD

Uremic stomatitis

Chronic oro-facial pain

Chronic joint pain: TMD

Neuropathic:

- Trigeminal neuralgia

- Post-herpetic neuralgia

- Post-traumatic neuropathic pain

Nociplastic: BMS

Neuromuscular:

- Cluster headaches

- Migraines (Hugo)

Idiopathic

- Persistent idiopathic facial pain (PIFP)

Referred pain- angina

Signs of malignant pain

- Recent onset

- Rapid growth

- Resorption of adjacent structures

- Localised mobility of teeth

- Progressive trismus

- Sensory/motor changes

- Persistent lymphadenopathy

- Neuropathy unresponsive to non-opioid analgesics

- Night sweats, fever, weight loss, previous hx of carcinoma

TMD

- Caries, cracked tooth

- Salivary obstruction/sialadenitis

- Paranasal sinusitis

- Giant cell arteritis

- TGN

- Migraine

- Malignancy in H&N, ENT

- Metastatic malignancy to skull

- Osteomyelitis

- Angina (pain after exercise)

TMD causes

Intra-articular:

- RA/OA

- Internal derangement of disc

- Osteomyelitis

- Condylar fracture

Extra-articular:

- OSF

- Mandibular fracture

- Osteosarcoma, chondrosarcoma

Well-defined unilocular radiolucency

Normal structures

Incisive canal, sinus, shadows

Cysts

Stafne's bone cavity (ID)

Solitary bone cyst (Scalloping between roots)

Dentigerous cyst

Radicular/residual cyst

Lateral periodontal cyst

Odontogenic tumour

Ameloblastoma

Ameloblastic carcinoma

Other

Periapical granuloma

Giant cell lesion

Langerhans cell histiocytosis

Metastases

Multilocular radiolucency at angle of mandible

Ameloblastoma

OKC

Odontogenic myxoma

Solitary bone cyst

Basal cell naevus syndrome

Cherubism

Metastatic malignancy

Ameloblastoma

OKC

Odontogenic myxoma

Aneurysmal bone cyst

CEOT

Dentigerous cyst

Central giant cell granuloma

Ossifying fibroma

Central giant cell granuloma

Ameloblastoma

Odontogenic myxoma

Brown Tumour of HPTH (Ca/PTH raised)

Ewing's sarcoma

Cherubism

White patch + identifying feature

BLS:

- Leukodema (stretching)

- White sponge naevus (FH)

- Lichen Planus (EO)

- Smoker's palate (smoking)

- Hairy leukoplakia (HIV/EBV)

Asymmetrical:

- Frictional keratosis (gum recession, bruxism)

- Candidosis

- GvHD (Haematopoeitic stem cell transplant)

- OSCC

Red patch

Inflammatory/immune

Desquamative gingivitis

Erythematous LP

DLE

MMP

Hypersensitivity reaction

Infections

Erythematous candidosis

Neoplasms

Kaposi sarcoma

OSCC

Antral pathology

Infection

- Acute/chronic sinusitis

Dental

- Sinusitis of odontogenic/endodontic origin

- OAC

Neoplasia

- Odontogenic cysts

- Odontome

- SCC

- Adenoid cystic carcinoma

Pain in edentulous patient

Denture trauma

- Ulcers

- SCC (late)

Excessive VD

Diseases of the jaws:

- Osteomyelitis

- Infected residual cysts

- Malignant neoplasms

Fractures

Trismus

- Injury; condular fracture

- Infection/inflammation in adjacent tissues (mumps, pcrnitis)

- Osteoarthritis/RA

- Oral submucous fibrosis

- Neoplasms of the joint

- TMD with myofascial pain

- Drugs (anti-psychotics)

Neck mass

Developmental

- Epidermoid cyst

- Thyroglossal duct cyst

- Thyroid

Dental infection

Inflammatory

- TB

- Sarcoidosis

- HIV

Salivary gland

- Sialadenitis

- Ranula

Salivary gland neoplasms

- Benign

- Malignant

(other) Malignant

- Metastasis from H&N cancer

- Metastasis from elsewhere

- Lymphoma

Bone

Osteomyelitis

MRONJ

ORN

Osteosarcoma

Mixed radiolucency/radiopacity with sharply defined periphery

Odontome/supernumerary

Adenomatoid odontogenic tumour (child)

CEOT

Cemento-ossifying fibroma

Cementoblastoma

Foreign body object

Radiopaque lesion in soft tissues

- Sialolith

- Calcified lymph nodes of TB

- Phleboliths

- Foreign body; tooth fragment, amalgam

Mixed radiolucent/radiopaque lesion with poorly defined margin

Infected cyst

Paget's disease

Osteomyelitis

Cemento-osseous dysplasia

Osteosarcoma

Ameloblastic carcinoma

Metastatic malignancy (primary malignancy elsewhere)

Diffuse radiographic lesions with even density

- Sclerosing osteitis

- Fibrous dysplasia

- Hyperparathyroidism

Multiple recurrent ulcers

Erythema multiforme

RAS; anaemia, HIV, coeliac

MAGIC syndrome

PFAPA syndrome (periodic fevers which resolve)

Behcet's (erythema nodosum, genital)

Reactive arthritis

Smoking cessation

Herpes simplex

Single recurrent ulcers

Trauma

Multiple persistent ulcers

Secondary to:

- Dermatological

- CT

- Haematological (anaemia, B12, folate, ferritin)

- Gastro-intestinal (Crohn's, UC)

Single persistent ulcers

Trauma; mechanical, thermal, chemical

Neoplasm; OSCC, haematological malignancy, salivary gland neoplasm

Infection: TB, syphilis, deep mycoses

Drugs: Nicrorandil

Blistering diseases

Trauma

MMP

PV

Paraneoplastic pemphigus

Lichen planus

Erythema multiforme

Steven-Johnson/TEN (drug reaction)

Epidermolysis bullosa (EB)

Odontomes

- Supernumerary

- Adenomatoid odontogenic tumour

- Calcifying odontogenic cyst

- Cemento-ossifying fibroma

- Cementoblastoma

- Osteoma (no radiolucent rim)

- Foreign body