3 Injuries Flashcards
1
Q
a white lesion induced by chronic mechanical irritation (usually unintentional irritation), essentially a “callous” of the oral mucosa, characterized by increased production of keratin
A
frictional keratosis
2
Q
ill-defined, “blending” margins, reversible upon elimination of the cause
A
frictional keratosis
3
Q
4 common locations of frictional keratosis:
A
1) edentulous alveolar ridge (“ridge keratosis” or “alveolar ridge keratosis”)
2) buccal mucosa (linea alba)
3) retromolar pad
4) lateral tongue (if a sharp tooth is in the vicinity)
4
Q
a specific type of frictional keratosis that occurs on the buccal mucosa at the level of the occlusal plane
A
linea alba
5
Q
a fancy term for chronic cheek chewing, seen more often in the setting of psychologic stress, some patients are aware of their habit but others do it subconsciously
A
morsicatio buccarum
6
Q
Morsicatio locations:
A
- cheek (morsicatio buccarum)
- labial mucosa (morsicatio labiorum)
- tongue (morsicatio linguarum)
7
Q
more common in females and after age 35
A
morsicatio
8
Q
most common location of morsicatio
A
anterior buccal mucosa
9
Q
irregular, thickened, ragged, white appearance that may have some areas of erythema or erosion, along the level of the occlusal plane, no tx necessary
A
morsicatio
10
Q
histopathology: ragged hyperparakeratosis
A
morsicatio
11
Q
entire epithelial thickness is lost
A
ulcer
12
Q
the most common cause of ulceration in the oral cavity
A
trauma
13
Q
causes of traumatic ulcers
A
may be physical, thermal, chemical, or even electrical trauma
14
Q
locations of traumatic ulcers
A
tongue, lips, or buccal mucosa (areas easily traumatized by teeth)
15
Q
Traumatic ulcers usually resolve within ?
A
2 weeks
16
Q
a traumatic ulcer seen in infants, chronic trauma due to nursing
A
Riga-Fede disease
17
Q
location of Riga-Fede disease
A
anterior ventral tongue
18
Q
Riga-Fede disease requires the presence of…?
A
a mandibular incisor (usually associated with natal or neonatal teeth)
19
Q
tx for Riga-Fede disease
A
smooth tooth as much as possible
20
Q
- necrosis and sloughing of the superficial oral mucosa in direct contact with a caustic agent
- affected areas appear bright white and are usually well-defined
- necrotic epithelium can be peeled away (the underlying tissue is usually red and/or bleeding)
- can be iatrogenic (caused by a DDS/hygienist) or factitial (self-inflicted)
A
chemical burn
21
Q
Chemical burns can be caused by a variety of chemicals/drugs:
A
- aspirin
- hydrogen peroxide
- phenol (a component of some over-the-counter topical products for relief of oral pain)
- dental restorative materials
22
Q
histolopathology: superficial epithelial necrosis
A
chemical burn
23
Q
Two potential scenarios of cotton roll burn:
A
1) Physical trauma- dry cotton roll is removed, peeling away the surface epithelium (always make sure cotton role is saturated before removing)
2) Chemical burn- caustic dental materials can be absorbed by the cotton roll –> tissue necrosis
24
Q
common cause of an electrical burn in the mouth
A
- young children chewing on electric cords
- saliva acts as a conducting medium (electrical arc from source to mouth)
- extensive edema and necrosis
- can scar with healing and result in reduced mouth opening
25
tx for traumatic ulcers
- eliminate source of trauma
- topical anesthetics and coating agents for temporary pain relief (Zilactin, OraFilm)
- biopsy if not resolved after 2 weeks
26
What is considered a "non-healing ulcer"?
if the cause is not apparent and there is no resolution at 2-week follow-up, biopsy is indicated (considered a "non-healing ulcer)
27
- may start as a traumatic ulcer in an area of thin mucosa overlying a bony prominence
- focal sequestration of superficial cortical bone
- overlying mucosa is partially ulcerated
- variable pain
- heals quickly after dead bone has exfoliated or been removed
oral ulceration with bone sequestration
28
common location of oral ulceration with bone sequestration
posterior lingual mandible ("idiopathic mandibular lingual sequestration")
29
common site for complications related to cancer therapy (antineoplastic therapy)
oral cavity
30
oral complications from chemotherapy vs radiation therapy
Chemotherapy
- mucositis
- hemorrhage (bone marrow suppression --> thrombocytopenia)
Radiation therapy
- mucositis and dermatitis
- xerostomia
- osteoradionecrosis
31
- complex multifactorial etiology, occurs with both radiation therapy (if head is part of the field exposed) and chemotherapy (20-40% prevalence with conventional chemo, 80% prevalence with high-dose chemo, nearly 100% prevalence with radiation therapy)
- resolves in 2-3 weeks after treatment cessation
mucositis from cancer therapy
32
What part of the mouth does mucositis from cancer therapy affect?
atrophy, erosion, and ulceration most often affects the moveable mucosa tissues
33
What causes xerostomia secondary to radiation therapy?
salivary glands are very sensitive to radiation, significant dry mouth develops within the first 6 weeks (affects ability to eat/speak, often chronic)
34
Which glands are more sensitive to xerostomia secondary to radiation therapy?
serous glands more sensitive than mucus glands (parotid destruction is most severe and irreversible, mucus glands usually recover somewhat)
35
caries that present at the cervical margin
xerostomia-related caries
36
exposed necrotic irradiated bone that persists longer than 3 months
osteoradionecrosis
37
main factor in osteoradionecrosis
dose of radiation (most cases occur in patients who receive > 60 Gy)
38
develops in about 5% of patients who receive radiation to the head and neck
osteoradionecrosis
39
most common site of osteoradionecrosis
mandible >>> maxilla (24x more common)
40
The risk of osteoradionecrosis increases significantly if?
dental surgery is performed within 12 months of therapy
41
patients remain at risk for _____-induced osteoradionecrosis for the rest of their lives
trauma-induced
42
The majority of cases of osteoradionecrosis occur within ______ after completing radiation therapy.
the first 3 years
43
- severe pain
- sequestration and exposure of bone to oral cavity
- cutaneous sinus formation (fistulous tract from bone to the surface of the skin)
clinical features of osteoradionecrosis
44
radiographic features: moth-eaten radiolucent/mixed appearance, pathologic fracture
osteoradionecrosis
45
How to prevent osteoradionecrosis:
- eliminate sources of potential oral infection prior to initiating radiation therapy (extractions, endo)
- no dental surgery during radiation therapy or within 12 months after
- systemic antibiotics
- debridement, surgical removal of diseaseed bone
- may require resection and reconstruction
46
How to prevent mucositis from cancer therapy?
- cryotherapy (sucking on ice chips during chemo)
- patient controlled analgesia with morphine
- analgesic mouthrinses
- laser therapy appears potentially promising but is very new
47
How to prevent xerostomia from cancer treatment?
- topical fluoride application
- salivary substitutes
- cholinergic agonist meds (pilocarpine, cevimeline)
48
oral injuries from drug abuse are most often seen with these two drugs
cocaine and methamphetamine
49
How does cocaine cause oral injuries?
- snorting if the main method of cocaine use
- causes local vasoconstriction and ischemia
- perforation of the nasal septum in 5% of abusers
- collapse of the bridge of the nose (saddle nose deformity)
- tissue destruction can lead to palatal perforation
50
- M>F, age 18-40
- insomnia, hyperactivity, aggressiveness
- rampant dental decay
- delusions of parasitosis
clinical features of methamphetamine abusers
51
Rampant dental decay due to methamphetamine abuse:
- Surfaces affected first?
- Occurs in combination with?
- Smooth and interproximal surfaces affected first
| - Combination of poor oral hygiene, drug-related xerostomia, and intake of acidic/sugary drinks
52
parasitosis
methamphetamine abusers experience the sensation of bugs crawling under the skin --> self-inflicted trauma ("meth sores")
53
extravasation of blood into soft tissues
submucosal hemorrhage
54
Different terms for submucosal hemorrhage depending on size of the hemorrhage:
- Petechiae = tiny or pinpoint areas (1-2 mm), flat
- Purpura = larger than petechiae but < 2 cm, flat
- Ecchymosis = > 2 cm, flat or slightly raised
- Hematoma = large nodule
55
- may be red, purple, blue/black in color
| - does NOT blanch with pressure
submucosal hemorrhage
56
Potential causes of submucosal hemorrhage:
- trauma (accidental, factitial, iatrogenic)
- thrombocytopenia (low platelets)
- clotting factor deficiencies (ex: hemophilia)
- leukemia
- anticoagulant medications (coumadin, aspirin)
57
causes of posterior palate petechiae
forceful coughing, vomiting, mononucleosis, fellatio
58
- the result of accidental implantation of amalgam particles in the oral mucosa
- very common
- blue/black/gray in color
- flat
- metallic fragments may be visible on an x-ray if enough material is present
- no tx except biopsy in some cases to confirm dx
amalgam tattoo
59
most common sites of amalgam tattoos
gingiva, buccal mucosa
60
tan to brown mucosal discoloration seen in patients who are heavy smokers, gradually fades over a few years after habit cessation
smoker's melanosis
61
most common location of smoker's melanosis
anterior facial gingiva
62
Cause of smoker's melanosis?
stimulation of melanocytes by noxious substances --> increased melanin production
63
a response to heat generated, most seen with pipe smoking, NOT precancerous
nicotine stomatitis
64
site of nicotine stomatitis
posterior hard palate
65
generalized pale appearance to the palate with numerous papules containing red centers, represents inflamed minor salivary glands and their duct openings
nicotine stomatitis
66
nicotine stomatitis: reversible or irreversible?
reversible (palate should resume normal appearance within 1-2 weeks of habit cessation)
67
tx for nicotine stomatitis
no tx is indicated although the patient should still be encouraged to quit smoking
68
a characteristic lesion that develops on the mucosa in direct contact with the product
smokeless tobacco keratosis
69
gray/white in color with a fissured or wrinkled surface texture
smokeless tobacco keratosis
70
margins tend to blend gradually into the surrounding normal tissue
smokeless tobacco keratosis
71
Types of smokeless tobacco used in the US:
- chewing tobacco (strands of loose leaves)
| - snuff (finely ground, moist and dry forms)
72
management of smokeless tobacco keratosis
- encourage patient to quit
- if unwilling to quit, ask them to move the product to a different location then re-evaluate
- most lesions resolve after 2 weeks
- any lesions that persists in the area of tobacco placement after 6 weeks of habit cessation or product movement should be biopsied
73
How does the etiology of drug-related oral discoloration depends on the type of medication?
- some drugs stimulate melanin production
- some drugs deposit metabolites into the soft tissue
- some drugs cause discoloration of the bone and teeth (minocycline)
74
normal colors of drug-related oral discolorations
usually brown, gray, blue, or black in color
75
locations of drug-related oral discolorations
hard palate and gingiva are most often affected
76
Name the drug:
- used for the tx of acne and rheumatoid arthritis
- causes discoloration of underlying bone which shows through beneath thin mucosa
minocycline
77
Name the drug: used for the tx of rheumatoid arthritis and systemic lupus erythematosus
anti-malarial drugs (Plaquenil, quinacrine)
78
chemotherapeutic drugs
doxorubicin, cyclophosphamide
79
- accumulation of fluid (inflammatory) beneath the maxillary sinus mucosa, causing elevation of the lining
- extremely common, incidental finding on panoramic radiographs
- asymptomatic
- unknown etiology, possibly odontogenic inflammation in some cases
- tx not necessary
antral pseudocyst
80
radiographic features: well-defined, dome-shaped radiopaque lesion (because fluid is more dense than air)
antral pseudocyst
