Oral Pathology & Oral Medicine

A 62-year-old smoker has a painless, firm, indurated ulcer on the lateral tongue persisting >3 weeks with rolled borders.

A 45-year-old with a homogeneous white plaque on the buccal mucosa, non-scrapable, non-tender; smokes and drinks alcohol daily.

A 36-year-old has burning mouth with normal-appearing mucosa; symptoms worse at day’s end; recent stress and xerostomia.

A denture wearer presents with erythematous palatal mucosa under the plate and angular fissures; no systemic symptoms.

A 24-year-old with recurrent painful shallow ulcers on non-keratinized mucosa; no systemic disease.

A 70-year-old on alendronate for 6 years shows exposed necrotic bone in the posterior mandible after spontaneous pain; no radiation history.

A 58-year-old presents with velvety red patch on the floor of mouth; non-tender, non-scrapable.

A 30-year-old has multiple warty papillary lesions on labial mucosa; sexually active; histology shows koilocytosis.

A 48-year-old reports white reticular striae (Wickham) and bilateral buccal burning; biopsy shows band-like lymphocytes at interface.

A 67-year-old with sun-damaged lip has persistent scaly atrophic lower lip with indistinct vermilion border.

A 52-year-old with painful fragile oral bullae; Nikolsky positive; histology shows suprabasilar cleft with acantholysis; DIF “fishnet” IgG.

A 69-year-old with desquamative gingivitis; DIF shows linear IgG/C3 along BMZ; ocular irritation present.

A 40-year-old with painless bluish, fluctuant swelling of lower lip that waxes and wanes after biting.

A 55-year-old with firm painless mass in the tail of parotid; mobile, slow growing.

A 43-year-old with painful parotid swelling during meals; dry mouth; small radiopaque mass near Stensen’s duct orifice on occlusal film.

A 28-year-old with multiple jaw cysts in posterior mandible; parakeratinized corrugated lining on histology; bifid ribs on X-ray.

A 34-year-old has multilocular “soap bubble” radiolucency in mandibular angle with cortical expansion; tooth vital.

A 19-year-old has unilocular radiolucency around crown of impacted mandibular third molar attached at CEJ.

A 58-year-old presents with painful red, peeling gingiva; medications include hydrochlorothiazide and NSAIDs; unilateral lichenoid plaque adjacent to amalgam.

A 51-year-old woman with persistent dry eyes and dry mouth; parotid enlargement; positive anti-SSA/Ro.

A 60-year-old man with poorly controlled diabetes develops black necrotic palatal ulcer with facial pain and swelling after sinusitis.

A 50-year-old has a firm, red-purple gingival nodule between premolars; bleeds easily; radiograph shows “cuffed” bone loss; histology giant cells.

A 42-year-old with smooth, painless tan macule on lower lip; stable for years; 4 mm.

A 70-year-old edentulous patient has flabby fibrous folds along denture flange line.

A 38-year-old with “strawberry gingivitis,” epistaxis, and sinus issues; c-ANCA positive.

A 33-year-old with painful indurated ulcer on tongue after biting 3 weeks ago; biopsy shows eosinophil-rich infiltrate.

A 65-year-old with blue-gray macule adjacent to old amalgam; periapical radiograph shows radiopaque particles.

A 29-year-old with recurrent lip vesicles that crust; triggered by stress/sun; prodrome present.

A 54-year-old presents with xerostomia from head and neck radiotherapy 1 year ago; rampant cervical caries.

A 22-year-old with diffuse, symmetric “geographic tongue” erythematous patches with white serpiginous borders; asymptomatic.

A 49-year-old complains of unilateral facial pain and purulent drainage from maxillary molar region; tooth #16 sensitive to percussion; radiograph: clouded maxillary sinus floor with fluid level.

A 61-year-old with a slowly enlarging red, ulcerated mass on lower lip that bleeds easily; recent trauma history.

A 72-year-old with moth-eaten ill-defined radiolucency and sequestra in previously irradiated mandible; exposed bone, pain.

A 58-year-old with persistent hoarseness, dysphagia, and a non-healing ulcer on the soft palate; heavy smoker.

A 27-year-old presents with multiple café-au-lait spots and oral neurofibromas; tongue mass soft, buttonhole sign positive.

A 41-year-old with painful unilateral vesicles and ulcerations on hard palate along V2 dermatome; severe neuralgia.

A 50-year-old develops nodular, verrucous leukoplakias at multiple sites; lesions persist and slowly spread over years.

A 32-year-old with “ground-glass” maxillary radiopacity causing facial asymmetry; café-au-lait spots present.

A 56-year-old with painful tongue, erythematous depapillation, and recent inhaled corticosteroid use without rinsing.

A 47-year-old with asymptomatic bilateral posterior mandibular radiopacities at tooth apices; teeth vital; middle-aged Black woman.

A 56-year-old develops fever and severe jaw pain 5 days after a difficult mandibular molar extraction; pus discharge and trismus present; radiograph shows ill-defined radiolucency.

A 63-year-old has a boggy, diffuse palatal swelling that ulcerates; teeth feel “floating”; B symptoms present.

A 22-year-old with a painless, soft, translucent swelling in the floor of mouth that enlarges during meals; ultrasound shows cystic lesion extending into neck.

A 38-year-old develops a sudden crater-like ulcer of the hard palate two weeks after a dental injection; edges are sharply demarcated; pain subsiding.

A 47-year-old smoker shows diffuse light-brown pigmentation along anterior facial gingiva; no lesions elsewhere.

A 29-year-old presents with hemorrhagic crusting of lips, oral erosions, and target lesions on hands after a cold sore last week.

A 64-year-old on inhaled steroids reports sudden painless blood-filled blister on soft palate that ruptures within hours.

A 43-year-old has smooth erythematous midline dorsal tongue patch anterior to circumvallate papillae; smoker; burning sensation.

A 16-year-old has bilateral diffuse white, thick, corrugated plaques on buccal mucosa since childhood; family members affected; asymptomatic.

A 52-year-old with parotid enlargement, xerostomia, and facial nerve palsy; low-grade fever; chest X-ray: hilar adenopathy.

A 68-year-old reports enlarging maxilla, new diastemas, and ill-fitting dentures; radiograph shows “cotton wool” opacities; ALP elevated.

A 34-year-old with a firm, small, painless nodule on dorsal tongue; overlying epithelium shows pseudoepitheliomatous hyperplasia on biopsy.

A 25-year-old presents with recurrent painless lip swelling, facial nerve palsy episodes, and fissured tongue.

A 70-year-old with angular fissures and erythema at mouth corners; denture wear; intraoral erythema under plate.

A 4-year-old with fever, lymphadenopathy, and diffuse gingival erythema; multiple oral vesicles/ulcers; difficulty eating.

A 39-year-old immunosuppressed patient has corrugated white plaques on the lateral tongue that do not wipe off; EBV PCR positive.

A 42-year-old with HIV presents with violaceous macules on palate that bleed; CD4 low.

A 33-year-old with a bluish, fluctuant, slowly enlarging palatal mass near minor salivary glands; pain with palpation; FNA mucinous.

A 75-year-old dehydrated patient has acute unilateral parotid swelling, purulent duct expression, and fever.

A 30-year-old with bulimia presents with painless bilateral parotid enlargement; glands non-tender; saliva clear.

A 58-year-old has painful desquamative gingivitis with erosions; biopsy shows interface mucositis; DIF with shaggy fibrinogen at basement membrane; candida noted.

A 21-year-old placed aspirin directly on an aching tooth; localized white sloughing lesion on buccal mucosa with burning.

A 35-year-old burns the palate with hot pizza; shallow erythematous ulcer forms the next day; mild pain.

A 62-year-old on bevacizumab for cancer develops exposed mandibular bone without prior dental surgery.

A 44-year-old has periapical radiolucencies at mandibular incisors; teeth are vital; middle-aged woman; no symptoms.

A 17-year-old has a well-circumscribed mandibular radiolucency scalloping between vital premolar roots; asymptomatic.

A 23-year-old woman shows anterior mandibular multilocular radiolucency crossing midline; expansion; histology: multinucleated giant cells.

A 9-year-old boy presents with painful loose teeth; radiographs show “floating teeth” appearance; skull lesions present.

A 26-year-old student with severe gingival pain, punched-out papillae, fetor, and pseudomembrane; stress and poor sleep.

A 34-year-old South Asian betel nut chewer has blanched oral mucosa, burning with spicy foods, and reduced mouth opening.

A 28-year-old woman presents with erythematous patches and radiating white striae on buccal mucosa; malar rash history; ANA positive.

A compressible, bluish lesion on the lateral tongue blanches on pressure; Doppler positive flow.

A child with facial port-wine stain in V1–V2 distribution has gingival bleeding from ipsilateral hypervascular lesions; seizures history.

A 45-year-old reports spontaneous gingival bleeding, petechiae, fatigue; gingival enlargement; fever.

A 52-year-old with diffuse brown oral pigmentation, low blood pressure, fatigue, and hyperpigmented skin creases.

A 60-year-old with thick non-scrapable white plaque at commissure unresponsive to antifungals; smoker; biopsy shows epithelial dysplasia.

A 19-year-old has large (1–2 cm) deep oral ulcers persisting 4–6 weeks with scarring; otherwise healthy.

A 28-year-old with recurrent oral and genital ulcers and uveitis; pathergy positive.

A 62-year-old with dull mandibular pain, intermittent swelling, sinus tract, and sequestrum formation months after fracture fixation.

A 35-year-old woman has facial/jaw pain, masseter tenderness, and morning stiffness; no joint sounds; normal panoramic radiograph.

A 58-year-old has lancinating facial pain triggered by light touch along V2 distribution; neurologic exam normal; MRI planned.

A 71-year-old with headache, scalp tenderness, jaw claudication, and sudden visual blurring; ESR/CRP elevated.

A 66-year-old male smoker has a slow-growing, fluctuant, cystic mass at the tail of the parotid; often tender after meals; contralateral parotid has a smaller similar lesion.

A 45-year-old has a firm parotid mass with intermittent pain; FNA suggests acinic cell carcinoma.

A 52-year-old with persistent, firm, painless submandibular gland enlargement; IgG4 level elevated; biopsy shows storiform fibrosis and IgG4+ plasma cells.

A 7-year-old with fever, cough, conjunctivitis develops oral “grains of salt on erythema” opposite molars.

A 10-year-old presents with sudden fever and multiple small vesicles/ulcers on soft palate and tonsillar pillars; dysphagia.

A 63-year-old has an irregular pigmented patch with asymmetry and color variegation on the hard palate; subtle nodularity.

A 28-year-old with a solitary, painless indurated ulcer on the lip for 2 weeks; regional nodes rubbery; sexually active.

A 36-year-old has multiple “snail-track” mucous patches on the oral mucosa with generalized lymphadenopathy and rash on palms/soles.

A 59-year-old with chronic cough develops a painful undermined ulcer on the tongue; biopsy shows granulomas; AFB positive.

A 22-year-old with cobblestone buccal mucosa, persistent angular cheilitis, and orofacial swelling; intermittent diarrhea.

A 54-year-old on an ACE inhibitor develops sudden, non-pitting tongue and lip swelling without urticaria; airway threatened.

A 43-year-old presents with brown/black elongated filiform papillae and halitosis; heavy coffee and tobacco use.

A 58-year-old pipe smoker has a white, fissured palatal mucosa with multiple red punctate spots at duct openings; asymptomatic.

A 2-year-old has a raised red lesion on lip present since infancy, grew rapidly and now slowly involuting; blanchable.

A 24-year-old Black woman develops a rapidly enlarging, dark-brown macule/patch on buccal mucosa; biopsy shows dendritic melanocytes in epithelium.

A 32-year-old has a firm, nodular mass from interdental papilla between anterior teeth; slightly ulcerated; teeth vital.

A 41-year-old with a smooth, dome-shaped, fibrous nodule along the buccal bite line; unchanged for years.

A 27-year-old with multiple mandibular osteomas and epidermoid cysts; family history of colon cancer.

A 35-year-old has throat/neck pain on turning head and swallowing; palpation of tonsillar fossa elicits pain; panoramic shows elongated styloid process.

A 28-year-old reports painless bilateral TMJ clicking with wide mouth opening; no locking or pain; exam otherwise normal.

A 40-year-old has persistent tooth pain after multiple normal endodontic evaluations; no pathology on imaging; allodynia to light touch.

A 55-year-old presents with a slowly enlarging, firm minor salivary gland mass on palate; pain with perineural paresthesia; biopsy: cribriform pattern.

A 62-year-old with Parkinson’s disease drools excessively, causing angular cheilitis.

A 14-year-old with fever and painful bilateral parotid swelling; amylase elevated; non-vaccinated.

A 29-year-old has “geographic” erythematous migratory patches with white borders on buccal mucosa and tongue; mild burning with spicy foods.

A 50-year-old 6 months post allogeneic stem cell transplant has painful lichenoid oral lesions, xerostomia, and ulcerations.

A 48-year-old with poorly controlled HIV presents with widespread pseudomembranous plaques that recur after topical therapy.

A 62-year-old with head and neck cancer is scheduled for radiotherapy; multiple non-restorable molars present in the field.