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Oral Pathology Exam 1 > 3 Injuries > Flashcards

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

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2
Q

ill-defined, “blending” margins, reversible upon elimination of the cause

A

frictional keratosis

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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)

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4
Q

a specific type of frictional keratosis that occurs on the buccal mucosa at the level of the occlusal plane

A

linea alba

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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

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6
Q

Morsicatio locations:

A
  • cheek (morsicatio buccarum)
  • labial mucosa (morsicatio labiorum)
  • tongue (morsicatio linguarum)
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7
Q

more common in females and after age 35

A

morsicatio

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8
Q

most common location of morsicatio

A

anterior buccal mucosa

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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

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10
Q

histopathology: ragged hyperparakeratosis

A

morsicatio

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11
Q

entire epithelial thickness is lost

A

ulcer

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12
Q

the most common cause of ulceration in the oral cavity

A

trauma

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13
Q

causes of traumatic ulcers

A

may be physical, thermal, chemical, or even electrical trauma

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14
Q

locations of traumatic ulcers

A

tongue, lips, or buccal mucosa (areas easily traumatized by teeth)

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15
Q

Traumatic ulcers usually resolve within ?

A

2 weeks

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16
Q

a traumatic ulcer seen in infants, chronic trauma due to nursing

A

Riga-Fede disease

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17
Q

location of Riga-Fede disease

A

anterior ventral tongue

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18
Q

Riga-Fede disease requires the presence of…?

A

a mandibular incisor (usually associated with natal or neonatal teeth)

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19
Q

tx for Riga-Fede disease

A

smooth tooth as much as possible

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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

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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
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22
Q

histolopathology: superficial epithelial necrosis

A

chemical burn

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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

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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
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25
Q

tx for traumatic ulcers

A
  • eliminate source of trauma
  • topical anesthetics and coating agents for temporary pain relief (Zilactin, OraFilm)
  • biopsy if not resolved after 2 weeks
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26
Q

What is considered a “non-healing ulcer”?

A

if the cause is not apparent and there is no resolution at 2-week follow-up, biopsy is indicated (considered a “non-healing ulcer)

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27
Q
  • 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
A

oral ulceration with bone sequestration

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28
Q

common location of oral ulceration with bone sequestration

A

posterior lingual mandible (“idiopathic mandibular lingual sequestration”)

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29
Q

common site for complications related to cancer therapy (antineoplastic therapy)

A

oral cavity

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30
Q

oral complications from chemotherapy vs radiation therapy

A

Chemotherapy

  • mucositis
  • hemorrhage (bone marrow suppression –> thrombocytopenia)

Radiation therapy

  • mucositis and dermatitis
  • xerostomia
  • osteoradionecrosis
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31
Q
  • 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
A

mucositis from cancer therapy

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32
Q

What part of the mouth does mucositis from cancer therapy affect?

A

atrophy, erosion, and ulceration most often affects the moveable mucosa tissues

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33
Q

What causes xerostomia secondary to radiation therapy?

A

salivary glands are very sensitive to radiation, significant dry mouth develops within the first 6 weeks (affects ability to eat/speak, often chronic)

34
Q

Which glands are more sensitive to xerostomia secondary to radiation therapy?

A

serous glands more sensitive than mucus glands (parotid destruction is most severe and irreversible, mucus glands usually recover somewhat)

35
Q

caries that present at the cervical margin

A

xerostomia-related caries

36
Q

exposed necrotic irradiated bone that persists longer than 3 months

A

osteoradionecrosis

37
Q

main factor in osteoradionecrosis

A

dose of radiation (most cases occur in patients who receive > 60 Gy)

38
Q

develops in about 5% of patients who receive radiation to the head and neck

A

osteoradionecrosis

39
Q

most common site of osteoradionecrosis

A

mandible&raquo_space;> maxilla (24x more common)

40
Q

The risk of osteoradionecrosis increases significantly if?

A

dental surgery is performed within 12 months of therapy

41
Q

patients remain at risk for _____-induced osteoradionecrosis for the rest of their lives

A

trauma-induced

42
Q

The majority of cases of osteoradionecrosis occur within ______ after completing radiation therapy.

A

the first 3 years

43
Q
  • severe pain
  • sequestration and exposure of bone to oral cavity
  • cutaneous sinus formation (fistulous tract from bone to the surface of the skin)
A

clinical features of osteoradionecrosis

44
Q

radiographic features: moth-eaten radiolucent/mixed appearance, pathologic fracture

A

osteoradionecrosis

45
Q

How to prevent osteoradionecrosis:

A
  • 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
Q

How to prevent mucositis from cancer therapy?

A
  • cryotherapy (sucking on ice chips during chemo)
  • patient controlled analgesia with morphine
  • analgesic mouthrinses
  • laser therapy appears potentially promising but is very new
47
Q

How to prevent xerostomia from cancer treatment?

A
  • topical fluoride application
  • salivary substitutes
  • cholinergic agonist meds (pilocarpine, cevimeline)
48
Q

oral injuries from drug abuse are most often seen with these two drugs

A

cocaine and methamphetamine

49
Q

How does cocaine cause oral injuries?

A
  • 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
Q
  • M>F, age 18-40
  • insomnia, hyperactivity, aggressiveness
  • rampant dental decay
  • delusions of parasitosis
A

clinical features of methamphetamine abusers

51
Q

Rampant dental decay due to methamphetamine abuse:

  • Surfaces affected first?
  • Occurs in combination with?
A
  • Smooth and interproximal surfaces affected first

- Combination of poor oral hygiene, drug-related xerostomia, and intake of acidic/sugary drinks

52
Q

parasitosis

A

methamphetamine abusers experience the sensation of bugs crawling under the skin –> self-inflicted trauma (“meth sores”)

53
Q

extravasation of blood into soft tissues

A

submucosal hemorrhage

54
Q

Different terms for submucosal hemorrhage depending on size of the hemorrhage:

A
  • 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
Q
  • may be red, purple, blue/black in color

- does NOT blanch with pressure

A

submucosal hemorrhage

56
Q

Potential causes of submucosal hemorrhage:

A
  • trauma (accidental, factitial, iatrogenic)
  • thrombocytopenia (low platelets)
  • clotting factor deficiencies (ex: hemophilia)
  • leukemia
  • anticoagulant medications (coumadin, aspirin)
57
Q

causes of posterior palate petechiae

A

forceful coughing, vomiting, mononucleosis, fellatio

58
Q
  • 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
A

amalgam tattoo

59
Q

most common sites of amalgam tattoos

A

gingiva, buccal mucosa

60
Q

tan to brown mucosal discoloration seen in patients who are heavy smokers, gradually fades over a few years after habit cessation

A

smoker’s melanosis

61
Q

most common location of smoker’s melanosis

A

anterior facial gingiva

62
Q

Cause of smoker’s melanosis?

A

stimulation of melanocytes by noxious substances –> increased melanin production

63
Q

a response to heat generated, most seen with pipe smoking, NOT precancerous

A

nicotine stomatitis

64
Q

site of nicotine stomatitis

A

posterior hard palate

65
Q

generalized pale appearance to the palate with numerous papules containing red centers, represents inflamed minor salivary glands and their duct openings

A

nicotine stomatitis

66
Q

nicotine stomatitis: reversible or irreversible?

A

reversible (palate should resume normal appearance within 1-2 weeks of habit cessation)

67
Q

tx for nicotine stomatitis

A

no tx is indicated although the patient should still be encouraged to quit smoking

68
Q

a characteristic lesion that develops on the mucosa in direct contact with the product

A

smokeless tobacco keratosis

69
Q

gray/white in color with a fissured or wrinkled surface texture

A

smokeless tobacco keratosis

70
Q

margins tend to blend gradually into the surrounding normal tissue

A

smokeless tobacco keratosis

71
Q

Types of smokeless tobacco used in the US:

A
  • chewing tobacco (strands of loose leaves)

- snuff (finely ground, moist and dry forms)

72
Q

management of smokeless tobacco keratosis

A
  • 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
Q

How does the etiology of drug-related oral discoloration depends on the type of medication?

A
  • some drugs stimulate melanin production
  • some drugs deposit metabolites into the soft tissue
  • some drugs cause discoloration of the bone and teeth (minocycline)
74
Q

normal colors of drug-related oral discolorations

A

usually brown, gray, blue, or black in color

75
Q

locations of drug-related oral discolorations

A

hard palate and gingiva are most often affected

76
Q

Name the drug:

  • used for the tx of acne and rheumatoid arthritis
  • causes discoloration of underlying bone which shows through beneath thin mucosa
A

minocycline

77
Q

Name the drug: used for the tx of rheumatoid arthritis and systemic lupus erythematosus

A

anti-malarial drugs (Plaquenil, quinacrine)

78
Q

chemotherapeutic drugs

A

doxorubicin, cyclophosphamide

79
Q
  • 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
A

antral pseudocyst

80
Q

radiographic features: well-defined, dome-shaped radiopaque lesion (because fluid is more dense than air)

A

antral pseudocyst

Oral Pathology Exam 1 (16 decks)

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