Oral pathology is the study of diseases in
the oral cavity
˜ Only a dentist or physician may diagnose
pathologic (disease) conditions
˜ Important for the dental assistant to be able
to recognize the differences between normal
and abnormal conditions that appear in the
mouth

Making a Diagnosis

˜ Historical diagnosis
˜ Clinical diagnosis
˜ Radiographic diagnosis
˜ Microscopic diagnosis
˜ Laboratory diagnosis
˜ Therapeutic diagnosis
˜ Surgical diagnosis
˜ Differential diagnosis

Historical Diagnosis

˜ Family histories are important because
genetic disorders, such as dentinogenesis
imperfecta, may be passed from generation
to generation (hereditary)
˜ Melanin pigmentation of the gingiva is
common in dark-skinned individuals
˜ Medical histories can provide information
about medication the patient may be taking
that could have an effect on the oral tissues

Clinical Diagnosis
˜ A clinical diagnosis is based on the
clinical appearance of the lesion,
including the color, size, shape, and
location.
˜ Examples of conditions diagnosed on
the basis of clinical appearance are
Ø Fissured tongue
Ø Maxillary and mandibular tori
Ø Median rhomboid glossitis

Diagnosis of Lesions

• Clinical Diagnosis
 First and most basic examination of lesion

Five phases:
1. Location- use tooth #’s when possible, to help
define exact location in the mouth
2. Size- use a probe to measure
3. Shape- many times this helps determine
what a lesion is or what category it belongs in
4. Colour
5. Consistency/Texture

ABCDE’s of clinical diagnosis

Ø Asymmetry
Ø Border
Ø Color
Ø Diameter
Ø Evolve/elevation

Radiographic Diagnosis
Radiographic images are excellent in
providing information about:
Ø Periapical pathology
Ø Internal resorption
Ø Impacted teeth

Microscopic Diagnosis
˜ When a suspicious lesion is present, tissue
is removed and sent to a pathology
laboratory, where it is evaluated
microscopically (biopsy)
˜ This procedure is very often used to make the
definitive (final) diagnosis

Laboratory Diagnosis
˜ Blood chemistries and other laboratory tests,
including urinalysis, can provide information
that leads to a diagnosis
˜ Cultures done in the laboratory can be used
to diagnose types of oral infection

Surgical Diagnosis

˜ A diagnosis made on the basis of the findings of
a surgical procedure
˜ Helps distinguish between benign and potentially
harmful conditions

Differential Diagnosis
˜ When two or more possible causes of a
condition are identified, a differential
diagnosis must be made
˜ Dentist determines which tests or procedures
to perform to rule out incorrect cause and
make final diagnosis!

Acute and Chronic Inflammation
˜ Inflammation is the body’s protective
response to irritation or injury
˜ Classic signs of Inflammation:
Ø Redness
Ø Swelling
Ø Heat
Ø Pain
˜ Acute: minimal injury, short-lasting, repair
begins quickly, lasts less than 2 weeks
˜ Chronic: injury or irritation continues, lasts longer than 2 weeks

Oral Lesions
˜ Lesion is a broad term for abnormal tissues in
the oral cavity
Ø Can be a wound, a sore, or any other
tissue damage caused by injury or disease
Ø Classified as to whether they:
• Extend below or extend above the
mucosal surface
• Lie flat or even with the mucosal surface

Lesions Extending Below Mucosal Surface
˜ Ulcer
Ø A defect or break in continuity of the mucosa that
results in a punched-out area similar to a crater
˜ Erosion of the soft tissue
Ø A shallow defect in the mucosa caused by
mechanical trauma
˜ Abscess
Ø A localized collection of pus in a circumscribed
area, ex. At apex of tooth
˜ Cyst
Ø A closed sac or pouch that is lined with
epithelium and contains fluid or semisolid material,
ex. May form on crown of unerupted tooth

Lesions Extending Above Mucosal Surface
˜ Blisters
Ø Also known as vesicles; filled with a watery fluid
˜ Pustule
Ø Similar in appearance to a blister but containing
pus
˜ Hematoma
Ø Also similar to a blister but containing blood
˜ Plaque
Ø Any patch or flat area that is slightly raised from
the surface

Lesions Even with Mucosal Surface

Lie flat or even with the surface of the oral mucosa and
are well-defined areas of discoloration
˜ An ecchymosis, which is the medical term for
bruising, is an example of this type of lesion
˜ Macule- flat pigmented benign spot of different color
or texture
˜ Patch: area of skin diff texture or color
˜ Purpura/ petechiae (pronounce pet-a-key)- Red or
purple spots on skin or mucosa, localized
hemorrhage (bleeding under surface). Pinpoint sizes
are petechiae and larger are purpura

Raised or Flat Lesions
˜ Nodules, which may appear below the
surface or may be slightly elevated, are small,
round, solid lesions
Ø When palpated, a nodule feels like a pea beneath
the surface
˜ Granuloma, in dentistry, is often used to
describe a nodule that contains granulation
tissue
˜ Tumors are also known as neoplasms
Ø A tumor may be benign or malignant

What is the difference between a blister and
a bulla?
A bulla (pronounced BULL-ah) is a larger
blister- that is greater than ½ inch in
diameter

How should the Dental Assistant respond
to a hematoma caused by delivery of local
anesthetic?
• Answer: Occasionally a blood vessel gets
nicked. Bring to attention of DDS, apply
pressure to disperse blood in area

If cotton rolls become dry and then are removed quickly,
what type of disorder/injury could be caused?
Answer= Gingival ulcer
Tip= wet gauze with the trisyringe before removal

Diseases of the Oral Soft Tissues:

Leukoplakia
Ø Means white patch
Ø Lesions vary in appearance and texture from a
fine white transparency to a heavy, thick, warty
plaque
Ø Cause is unknown, but leukoplakia is commonly
linked to chronic irritation or trauma
Ø Very often precedes (before) the development
of a malignant tumor

Lichen Planus
˜ Benign, chronic disease affects the skin and
oral mucosa
˜ Many factors have been implicated in lichen
planus; however, the cause remains unknown
˜ The patchy white lesions on the oral mucosa
have a characteristic pattern of circles and
interconnecting lines called Wickham striae

Candidiasis
˜ A superficial infection caused by the yeast/
fungus Candida albicans
˜ Occurs under conditions such as antibiotic
therapy, diabetes, xerostomia (dry mouth),
and weakened immunologic reactions
˜ Can be the initial clinical manifestation for
patients with acquired immunodeficiency
syndrome (AIDS)
˜ Diaper rash, vaginitis, and thrush are other
common types of candidiasis

Types of Candidiasis
Ø Pseudomembranous candidiasis
Ø Hyperplastic candidiasis
Ø Atrophic candidiasis

Pseudomembranous candidiasis: Thrush
˜ “False membrane”
˜ “Thrush”- creamy white plaques that resemble
cottage cheese
˜ Symptoms- burning sensation, unpleasant taste,
feeling of “blisters” forming in their mouths- the
blisters are the false membranes
˜ Can be scraped off and rarely bleed when
removed
˜ Infantile candidiasis in babies

Hyperplastic candidiasis
˜ White plaque
˜ Can not remove by scraping
˜ Buccal mucosa- HIV patients
˜ Antifungal agents- begin to clear it in
2-3 days, complete clearing in 10-14 days

Atrophic candidiasis
˜ “erythematous candidiasis” = smooth red
patches- dorsal areas of tongue and palate
˜ Etiology: after patient takes broad spectrum
antibiotic
˜ Symptoms: mouth feels scalded or burned, like
swallowing something hot
˜ Treatment: Antifungal med’s

Aphthous Ulcers
˜ Also known as aphthous stomatitis or
canker sores
˜ Recurrent aphthous ulcers (RAU) is a
disease that causes recurring outbreaks of
blister-like sores inside the mouth and on
the lips
Ø Minor RAU: Episodes occur fewer than six times
a year; lesions usually heal within 7 to 10 days
Ø Major RAU: This form involves outbreaks of
larger, deeper ulcers that take longer to heal

Cellulitis
˜ Inflammation spreads through the soft
tissue or organ
˜ Swelling develops rapidly, accompanied by
a high fever
˜ The skin becomes very red, and there is
severe throbbing pain as the inflammation
localizes
˜ Cellulitis associated with oral infections is
potentially dangerous because it can travel
quickly to sensitive tissues such as the eye or
brain

Pericorinitis
˜ Is a Pericoronal abscess, ex. Around erupting
wisdom tooth
˜ Localized infection involving the gingiva adjacent to
a partially erupted mandibular third molar
˜ Irrigation with saline, iodine solution or water is
common therapy, or antibiotics
˜ Ultimately extraction of the tooth may be necessary

Conditions of the Tongue

Glossitis:

General term used to describe inflammation and changes in the topography of the tongue

Black Hairy Tongue
˜ May be caused by an imbalance of oral
flora after the administration of antibiotics
˜ The filiform papillae are so greatly
elongated that they resemble hairs
˜ These elongated papillae become stained by
food and tobacco, hence the name

Geographic Tongue
˜ Tongue exhibits multiple areas of
desquamation (loss) of the filiform papillae in
several irregularly shaped but well-demarcated
areas
˜ The smooth areas resemble a map, hence the
name
˜ Over a period of days or weeks, the smooth
areas and the whitish margins seem to migrate
across the surface of the tongue by healing on
one border and extending on another

Fissured Tongue
˜ Fissured tongue is a variant of normal; its
cause is unknown
˜ Theories about its cause include vitamin
deficiency and chronic trauma over a long
period
˜ The dorsal surface (top) of the tongue is marked
by having deep fissures or grooves, which
become irritated if food debris collects in them
˜ Patient with a fissured tongue is advised to
brush the tongue gently with a soft toothbrush to
keep the fissures clean of debris and irritants

Nutritional Disturbances
Angular cheilitis
•Deficiency of vitamin B
•Lesions in corners of mouth
Glossitis
•Deficiency of vitamin B
•Inflammation of tongue

Developmental disturbances:

Bifid tongue

Ankyloglossia (tongue-tied)

Fordyce spots

 Developmental Anomalies
Ø Are conditions that present at conception or occur
before the end of pregnancy
Ø Birth defects occur at any stage of pregnancy- most
occur in 1 st trimester when organs are developing
Ø Factors that contribute to developmental disturbances
are influenced by the following:
• Genetic factors
• Congenital factors

Genetic factors
Ø Hereditary- passed from parent to children
through their genes.
Ø Ex. get small teeth from one parent or large jaw
from another.
Ø Ex. dental anomalies

Congenital factors
Ø Present at birth caused by genetic mutation or
external source
1. Structural anomalies: affect physical structures,
ex. cleft lip and palate
2. Functional anomalies: how a body part or body
system works, ex. malocclusion of dentition
3. Environmental anomalies: Called teratogens;
include infections, drugs, and exposure to
radiation ex. tetracycline stain of teeth

Disturbances in Jaw Development
˜ Macrognathia- large jaw- Class III results
when involves mandible
˜ Micrognathia- small jaw- Class II results
when involves mandible
˜ Exostoses
Ø A benign bony growth projecting outward from the
surface of a bone. It can also be referred to as a
torus (plural tori)- which is a bulging projection
Ø Torus palatinus
• A bony overgrowth at the midline of the hard palate
Ø Torus mandibularis
• A bony overgrowth on the lingual surface of the mandible

Disturbances in Tooth Development
and Eruption
˜ Ameloblastoma
Ø A developmental tumor composed of remnants of the
dental lamina
˜ Anodontia
Ø Hereditary absence of single or multiple teeth
Ø Most common are max. laterals, 2 nd bicuspids, third
molars
˜ Supernumerary teeth
Ø Hereditary growth of teeth in excess of the normal
number of 32
Ø Can be normal size, but often poorly developed
Ø Twinning: Tooth bud division is complete & there is an
extra tooth, usually a mirror image of adjacent teeth.
Ex. 5 lower incisors

Disturbances in Tooth Development and Eruption
˜ Macrodontia is abnormally large teeth.
Ø Entire dentition, or usually 2 maxillary centrals
˜ Microdontia is abnormally small teeth.
Ex. “Peg laterals” or underdeveloped 8’s.
Ø If entire dentition affected, then usually congenital
problem, such as heart disease or Down’s
˜ Dens in dente (“tooth within a tooth”) results
in the formation of a small tooth-like mass of
enamel and dentin within the pulp (when
enamel organ extend into dental papilla during
odontogenesis)

˜ Gemination: attempt of tooth germ to divide.
When not successful, there is an incisal notch.
Ø Tooth usually has one large single root & single
pulp cavity
Ø “Twinning” in crown can cause problems in
appearance & spacing issues
˜ Fusion: Union of 2 adjacent tooth germs-
Results in large tooth with 2 pulp cavities.

Disturbances in Tooth Development (WDA)
• Dilaceration: sharp bend in root
• Concrescence: fused roots
• Accessory roots: makes RCT tricky
• Accessory cusps: Talon cusps (lingual of max
teeth) or Mulberry molars (Maternal syphilis-
6 yr. molar looks like aggregate of enamel
nodules).
• Hypercementosis: excessive cementum on
the roots of one or more teeth. Often tooth
fuses to socket more. Apical enlargement and
blunting or root

Disturbances in Enamel Formation
˜ Amelogenesis imperfecta is a hereditary
abnormality in which there are hypoplasia-
type defects in the enamel formation
Ø Hypocalcification is the incomplete calcification
or hardening of the enamel

Dental Fluorosis (WDA)
˜ Dental fluorosis: enamel hypoplasia caused
by ingestion of excessive amounts of
fluoride, during time of enamel formation.
Chalky white teeth on eruption and may turn
brown later.
˜ Can have all permanent teeth affected
depending on how long person has been
exposed to high levels of fluoride ingestion.

Disturbances in Enamel Formation (WDA)
˜ Localized Environmental Enamel
Hypoplasia: Trauma to primary tooth
has affect on enamel of underlying
permanent tooth: usually anterior
centrals
˜ Enamel pearl: a cluster or miss placed
ameloblastsJ. Looks like a little pearl or
button- difficult to scale

Disturbances in Dentin Formation
˜ Dentinogenesis imperfecta is a hereditary
condition that affects the formation of dentin
˜ Teeth that have dentinogenesis imperfecta
are opalescent and have an almost amber
color
˜ The enamel tends to chip away from the
dentin, and the weakened teeth become worn
down
˜ Difficult to bond during restorative
˜ Tetracycline Staining: occurs during dentin
formation (see MDA Chapter 13, Stains)

Abnormal Eruption of the Teeth
˜ Natal teeth- present at birth or Neonatal teeth are
those that erupt within the first 30 days of life.
Due to lack of root formation, these are removed so
child does not swallow them if they are shed.
˜ Ankylosis
Ø In deciduous teeth affected by ankylosis, bone has fused
to cementum and dentin, preventing exfoliation ex.
Primary molars
˜ Impaction
Ø Occurs when any tooth remains unerupted in the jaw
beyond the time at which it should normally erupt
(Discussed more in Chapter 56)

Miscellaneous Disorders
˜ Abrasion
Ø Abnormal wearing away of tooth structure caused
by a repetitive mechanical habit such as
improper toothbrushing
˜ Attrition
Ø Normal wearing away of tooth structure during
mastication (chewing)
˜ Bruxism
Ø Oral habit consisting of involuntary gnashing,
grinding, and clenching of the teeth in movements
other than chewing
Ø Usually occurs during sleep and is commonly
associated with stress or tension

Additional
˜ Bulimia: Eating disorder characterized by food
binges followed by self-induced vomiting-
causes EROSION- chemical process
Ø The dental professional is often the first healthcare
professional to identify a patient with bulimia
Ø Lingual surfaces get eroded (see MDA Chapter 14)
˜ Orofacial piercings
Ø Have become popular among some segments of the
population
Ø Dental complications include chipped and broken
teeth and serious infections at the sites of piercings
Ø Infection can spread throughout the head and
neck area, with serious results

Meth Mouth
˜ The oral effects of methamphetamine use,
which are devastating, are referred to as
meth mouth
˜ Drug-related xerostomia (dry mouth), poor
oral hygiene, frequent consumption of highly
sugared soft drinks, and clenching and
grinding of the teeth all contribute to rampant
caries

Neoplasms
• Medical term for tumor= neoplasia or growth
• A tumor is a mass of tissue that grows beyond
normal size buy serves no use
• Benign (Non-cancerous, non-life
threatening)- SLOW GROWING
• Malignant (life threatening)- FAST
GROWING
• Great potential to become malignant
• Inform dentist
• Without alarming patient

Papilloma

Benign lesion ofsquamous epithelial tissue
• Cauliflower like
appearance
• Occurs after virus (not
continual irritation)
• White or red, 1-3cm in
size
• Treatment- surgically
remove

Fibroma

Benign lesion of connective tissue cells
Reactive hyperplasia-continued irritation or trauma- causes tissues to grow
Dome shaped, smooth, less than 2cm
Treatment: surgical excise or left without treatment

Types of Benign Neoplasm- Lipoma
˜ Neoplasm with fat cells (adipose tissue)
˜ Common oral site: buccal mucosa and floor
of the mouth
˜ Smooth-surfaced, soft, palpable masses,
which often impart a yellowish color to the
overlying mucosa
˜ Treatment: surgical excision

Oral Cancer
˜ One of the 10 most common cancers in the
world
˜ The incidence, as well as the site, of the cancer
varies greatly from country to country
˜ Can occur on the lips, tongue, cheeks, floor of
mouth
˜ The lesions usually appear first as a white or
ulcerated area, although some types may also
appear as a velvety smooth red lesion.
˜ Most oral cancers do not cause pain in the
early stages, and the thorough dentist is most
likely to be the first to detect them
˜ These cancers are fatal if not detected early
enough or if left untreated

Risk factors:
Ø Tobacco use
Ø Heavy alcohol use
Ø Human papillomavirus (HPV) infection

Oral cancer warning signs

Any sore in mouth that does not heal (2- 3
weeks)
˜ Any lumps or swelling in neck, lips, oral cavity
˜ White or rough textured lesions on lips or oral
cavity
˜ Numbness in or around oral cavity
˜ Dryness in mouth for no reason
˜ Burning sensation or soreness for no reason
˜ Repeated bleeding in a specific area for no
reason
˜ Difficulty speaking, chewing, swallowing- part
of extra oral assessment

Leukoplakia
-White, leathery patch
that cannot be
identified as any
other white lesion
-Biopsy required for
further identification
-Precancerous

Types of Oral Cancer
˜ A carcinoma is a malignant neoplasm
(growth) of the epithelium (tissue lining the
mouth).
˜ It spreads quickly = METASTASIZES- via
neck and cervical lymph nodes!
˜ Found in soft tissues of mouth- anywhere
really!!!

Carcinomas: Intraoral cancers
˜ An adenocarcinoma is a malignant tumor that
arises from the submucous glands underlying
the oral mucosa: appears like a bulge
˜ A sarcoma is a malignant neoplasm arising from
supportive and connective tissue.
˜ An osteosarcoma is a malignant tumor involving
the bone. In the mouth, the affected bones are
the bones of the jaws. Although the cancer
may start in the bone, it often spreads and
involves the surrounding soft tissues.

Types of Malignant Neoplasms
Squamous Cell Carcinoma
•Malignant neoplasm- can spread or
metastasize into surrounding tissue and
lymph nodes
•Cancer of squamous epithelium- 90 % of
oral cancers are Squamous cell
•First appears as an ulcerated area in the
soft tissues of the mouth
•Will look like it’s healing, but will recur
•Intraoral sites: Posterior lateral surface of
tongue, floor of mouth and Extraoral: Lip.

Types of Malignant Neoplasms: Basal
Cell Carcinoma- Extra oral
Basal cell carcinoma- effects basal cells of
squamous epithelium
Locally invasive- gets large if not removed
but rarely metastasize
Sun exposure!!!
Not inside mouth- face is principal site
Ulcer that won’t heal
Rolled borders

Types of Malignant Neoplasms
•Malignant neoplasm- can spread or
metastasize into surrounding tissue and
lymph nodes
•Cancer of squamous epithelium- 90 % of
oral cancers are Squamous cell
•First appears as an ulcerated area in the
soft tissues of the mouth
•Will look like it’s healing, but will recur

Leukemia
˜ A cancer of the blood cells
˜ Characterized by rapid growth of immature
white blood cells
˜ Oral symptoms of leukemia may be some of
the first indications of the disease
˜ Symptoms in the gingival tissues include
hemorrhage, ulceration, enlargement, spongy
texture, and magenta coloration of the
gingiva
˜ Enlargement of lymph nodes, symptoms of
anemia, and general bleeding tendencies
are typical

Smokeless Tobacco
˜ Chewing tobacco or snuff presents a
serious health hazard
˜ It is a major concern because of the high
rates of precancerous leukoplakia and oral
cancer among users of smokeless tobacco
˜ Cancers of the pharynx, larynx, and
esophagus occur 400 to 500 times more
frequently in users of smokeless tobacco
˜ Also linked to an increased incidence of
tooth loss from periodontal disease

Smoking: Benign Lesions
Nicotine Stomatitis- benign thickening of oral
mucosa- more likely in pipe smokers than cigarette
smokers.
• Caused by heat and irritation of chemicals in
tobacco
• Usually hard and soft palate, retromolar pad area, or
posterior buccal mucosa
• White circular papules with red centers,
hyperkeratinized nodules
• Carefully observe patient for changes & encourage
to stop smoking

Dental Implications of Radiation Therapy
˜ Xerostomia
Ø Lack of adequate saliva and the reduced blood
supply can cause oral infections, delay healing, and
make it very difficult to wear dentures
˜ Radiation caries
Ø Caused by the lack of saliva, radiation caries usually
appears first in the cervical areas of the teeth
Ø The teeth also may become extremely sensitive to
hot and cold stimuli
˜ Osteoradionecrosis
Ø Bone may be subject to necrosis (death) after
radiation treatment

HIV and AIDS
˜ Oral lesions are prominent features of
acquired immunodeficiency syndrome (AIDS)
and human immunodeficiency virus (HIV)
infection
˜ Oral lesions develop because of the
breakdown of the immune system that
occurs when the T-helper cells become
depleted as a result of the disease

Oral Manifestations of HIV/AIDS
˜ HIV Gingivitis
˜ HIV Periodontitis
˜ Cervical Lymphadenopathy
˜ Candidiasis
˜ Lymphoma
˜ Hairy Leukoplakia
˜ Kaposi Sarcoma
˜ Herpes Simplex
˜ Herpes Zoster
˜ Human Papillomavirus

HIV Gingivitis
˜ There is often a bright red line along the
border of the free gingival margin
˜ Also known as atypical gingivitis (ATYP)
˜ In some cases, there may be progression of
the bright red line from the free gingival
margin over the attached gingiva and alveolar
mucosa

HIV Periodontitis
˜ Resembles necrotizing ulcerative gingivitis
superimposed on rapidly progressive
periodontitis
˜ Other symptoms include:
Ø Interproximal necrosis and cratering
Ø Marked swelling
Ø Intense erythema over the free and attached
gingiva
Ø Intense pain
Ø Spontaneous bleeding and bad breath

HIV Cervical Lymphadenopathy
˜ Enlargement of the cervical (neck) nodes
˜ Lymphadenopathy is frequently seen in
association with AIDS (meaning disease has
progressed from HIV to AID`s- more
advanced disease)

Candidiasis
˜ Candidiasis is often the initial oral sign of
progression from HIV-positive status to AIDS
˜ In a patient with a compromised immune
system, candidiasis can be a very debilitating
and serious disorder

Lymphoma
˜ Lymphoma is the general term used to
describe malignant disorders of the
lymphoid tissue
˜ In the immunocompromised individual, it may
occur as a solitary lump or nodule, a swelling,
or a nonhealing ulcer that occurs anywhere in
the oral cavity
˜ The swelling may be ulcerated or may be
covered with intact, normal-appearing mucosa
˜ Usually painful, the lesion grows rapidly and
may be the first evidence of lymphoma

Hairy Leukoplakia
˜ Can be an important early manifestation of
AIDS status
˜ A filamentous white plaque usually found unilaterally or bilaterally on the lateral borders (sides) on the anterior portion of the tongue
˜ May spread to cover the entire dorsal surface of the tongue
˜ Can also appear on the buccal mucosa, where it generally has a flat appearance

Kaposi Sarcoma
˜ One of the opportunistic infections that occurs in patients with HIV infection
˜ Lesions may appear as multiple bluish, blackish, or reddish blotches that are usually flat in the early stages
˜ Kaposi sarcoma is one of the intraoral lesions that is used to diagnose AIDS

Herpes Simplex
˜ Herpes simplex lesions usually occur on the lip
˜ In immunocompromised patients, the lesions may occur throughout the mouth
˜ An ulcer caused by the herpes virus that persists for longer than 1 month may be an indicator of AIDS
˜ Patients who do not have HIV or AIDs may also suffer from herpes

Herpes Zoster
˜ In the immunocompromised patient, the latent herpes zoster virus, also known as shingles, may cause intraoral manifestations in the form of blisters
˜ These blisters break and form ulcers
˜ The lesions are very painful

Human Papillomavirus (HPV)
˜ Human papillomavirus appears most commonly in immunocompromised individuals
˜ Diagnosis is made on the basis of history clinical appearance, and biopsy findings
˜ Lesions are a common finding in patients with early HIV infection
˜ These warts appear spiky, and some have a raised, cauliflower-like appearance