4. Physical and Chemical injury Flashcards
1
Q
Where do most Traumatic Bone Cysts occur?
A
Mandible
2
Q
What population is effected by Traumatic Bone Cysts?
A
Males 10-20 y.o.
3
Q
What is the Pathogenesis of Traumatic Bone Cysts?
A
Intramedullary Hemorrhage
- Instead of healing by organization of the clot with bone fill, the clot dissolves leaving an empty hole, rather than organizing with granulation tissue & bone fill
4
Q
What are the unproven Etiologies of Traumatic Bone Cysts?
A
- Trauma not proven, but reported in 50%
- Vascular infarct that causes the bone to dissolve
5
Q
What is the Radiographic appearance of Traumatic Bone Cysts?
A
- Small to large, well-defined pure RL with sclerotic border (rim of RO around border)
-
Scalloped upper margin interdigitates bwtn tooth roots
- “Tooth floating in bone”
- Lower border of the lesion is above the mandibular canal
6
Q
What are some surgical findings associated with Traumatic Bone Cysts? (3)
A
- Aspiration yeilds - air OR serous/bloody non-clotting fluid
- Empty hole at surgery
- No epithelial lining, just a thin fibrous membrane
7
Q
What is the Treatment protocol for Traumatic Bone Cysts?
A
- Eventually heals spontaneously without tx
- Surgery induces hemorrhage which speeds healing
8
Q
Where is a Hematopoietic (Osteoporotic) Bone Marrow Defect found?
A
Posterior Mandible
9
Q
In what population does Hematopoietic (Osteoporotic) Bone Marrow Defect typically occur in?
A
Females (5:1)
10
Q
What is the pathogenesis of Hematopoietic (Osteoporotic) Bone Marrow Defect?
A
-
Healing defect – following an extraction
- Red bone marrow fills socket instead of bone
- Left with a RL
11
Q
What is the etiology of a Hematopoietic Bone Marrow Defect?
A
Iatrogeneic - follows extraction of a tooth
12
Q
What is the Radiographic appearance of a Hematopoietic Bone Marrow Defect?
A
- Small, ill-defined RL in a former extraction site, usually mandibular molar area
- Lobulated with trabecular pattern
13
Q
What is the Histology of a Hematopoietic Bone Marrow Defect?
A
- Normal red bone marrow
- Pleomorphic looking cells with fat cells & megakaryocytes (large cells with abundant pink cytoplasm, look like they are multinucleated)
14
Q
What is the Treatment for a Hematopoietic Bone Marrow Defect?
A
- Innocuous = Leave Alone
15
Q
What is the location of a Surgical Ciliated Cyst?
A
ONLY in Posterior Maxilla
16
Q
What is the Pathogenesis/Etiology of a Surgical Ciliated Cyst?
A
- Iatrogenic = antral surgery or when a dental extraction perforates the sinus & fragments of sinus lining becomes entrapped in the maxilla, fragments drop into alveolar bone & proliferates into a cyst
17
Q
What is the clinical presentation of a Surgical Ciliated Cyst?
A
- Vague maxillary pain/swelling or discomfort
- History of extraction or oral-antral surgery
18
Q
What is the Radiographic presentation of a Surgical CIliated Cyst?
A
Well-defined RL in Posterior Maxilla approximating the sinus
19
Q
What is the Histology of a Surgical Ciliated Cyst?
A
Normal sinus lining = pseudostratified ciliated columnar epithelium with goblet mucous cells
20
Q
What is the Treatment for a Surgical Ciliated Cyst?
A
Remove and Biopsy
21
Q
Where is a Pulse Granuloma found?
A
Mandibular 3rd Molar Extraction Site
22
Q
What is the Pathogenesis of a Pulse Granuloma?
A
-
Leguminous vegetable material (pulse) enters extraction site & evokes chronic foreign body inflammatory rxn
- Cellulous can’t be digested
23
Q
What is the Clinical Presentation of a Pulse Granuloma?
A
-
Months after an extraction of mandibular 3rd molars the pt gets a dull ache in the area
- Surgical Ciliated Cysts also has the symptom of a dull/vague pain, but they are location in the posterior maxilla
24
Q
What is the Radiographic appearance of a Pulse Granuloma?
A
ill-defined RL
25
What is the Histology of a Pulse Granuloma?
* **Spherical bodies** surrounded by a **foreign body giant cell rxn**
26
Where would a Lipid Granuloma (myospherulosis) be found?
Mandibular 3rd Molar Extraction Site
27
What is the Pathologenesis of a Lipid Granuloma?
* **Oily foreign body** enters or is placed in an extraction site (mand 3rd molars)
* _Topical Antibiotic Swab_ that contains **Petroleum**
* The lipid causes the foreign body giant cell response
28
What is the histology of a Lipid Granuloma?
* **Clear (lipid) Vacuoles** surrounded by a **Foreign Body - Giant Cell Rxn**
29
What is the Treatment for a Lipid Granuloma?
Remove and Biopsy
30
What are the 3 possible ways you can get an Air Emphysema?
1. **Opening up a laceration** in the oral cavity
* Air/water syringe shoots air into the oral cavity
* _Some of the air gets trapped in the laceration & enters soft tissues of face then enters mediastinum_
2. Blowing lots of **air into laceration** that has **potentially infectious debris** from oral cavity
3. Using an air syringe **during RCT**, where a **blast of air gets to the tip of the apex**
*
31
What is the Clinical Presentation of an Air Emphysema?
* Pt may have a **swollen eye/puffy face**
* **Feeling of Crepitus** = CLASSIC DIAGNOSTIC SIGN!!!
* Feel bubbles of air between fingers as you palpate
* Might hear a crackle
32
What is the Treatment for an Air Emphysema?
* Reassure the pt it will **reabsorb & go away**
* May require hospital if it gets into the mediastinum
33
What are the Iatrogenic Etiologies of an Amalgam Tattoo? (3)
1. **Soft tissue laceration** during placement OR removal of amalgam
2. **Fractured amalgam** **during extraction** enters socket
3. **Apicoectomy** with **retrofil**
34
What is the Non-Iatrogeneic Etiology of an Amalgam Tattoo?
* **Trauma when flossing** thru **recent proximal amalgams**
35
What is the Radiographic appearance of an Amalgam Tattoo?
* May show **RO Particles**, if taken with a low Kvp X-Ray
36
What is the Histology of an Amalgam Tattoo?
* Fine to coarse **pigmented granules in CT**
* Black, brown or olive green
* Distributed **along reticulin fibers** appearing as _“loose tobacco strands”_
* Typically elicits NO inflammatory rxn
* If there is an inflammatory rxn it is probably not totally from amalgam, but maybe the other junk from procedure (tooth fragments, base, composite)
* Occasionally evokes Fibrosis or Giant Cell Rxn
* **Can enlarge in size** b/c _macrophages_ gobble up amalgam and move throughout tissue
37
How does an Injection Hematoma occur?
* During a **PSA Block** or **Displaced Mandibular Block**
* ****Went laterally into buccal fat pad and hit the **Pterygoid Plexus**
38
What is the Clinical Presentation of an Injection Hematoma?
Looks really scary, but it is harmless
Can **Mimic Child Abuse**
39
What is the Etiology of Anesthetic Necrosis?
* **Large Volume Injection** = forcing fluid into a tight space
* Worse is Epinephrine is used
* **Intra-ligamentary Injection**
40
What are the dermal fillers that can cause a Foreign Body Rxn?
* Collagen
* Hyaluronic Acid
* HAP
41
What is the pathogenesis of a Foreign Body Rxn to Dermal Fillers?
They can migrate through soft tissue by **gravity** or **compression**, depositing _years later_ in oral soft tissues.
42
What is the Clinical Presentation of a Foreign Body Rxn to Dermal Fillers?
* Presents as a **nodular mass**, in **labial**, buccal or vestibular mucosa
43
What is the Histology of a Foreign Body Rxn to Dermal Fillers?
* Foreign Body Granuloma
* looks like spherical granular brown material
44
What is the Clinical Presentation of Acute Cheek Biting? (3)
* Small **erosion/abrasion**
* Heals within a few days
* **Painful**, the pt can recall biting their cheek
45
What is the clinical appearance of Chronic Cheek Biting? (4)
* **White** rough, torn surface, with or w/o **red areas**
* **Bilateral Buccal Mucosa** limited to areas accessible to teeth
* **NO PAIN**
* Creates **tags of** **parakeratin**
46
What is the Histology of Chronic Cheek Biting? (3)
* **Acanthosis** (thickening of epithelium) **+ Vacuolated cells**
* **Macerated, hyperkeratosis**
* **Blue** color on surface of ragged surface from bacteria
47
What is the Pathogenesis of Linea Alba?
* **Constant negative pressure** from **Cheek Sucking**
* NOT from Cheek Biting
48
What is TUGSE?
A **large, deep, chronic,** non-healing, non-specific **ulcer**, usually on the **lateral tongue**
49
What is the Pathogenesis of TUGSE?
* **Continual _low-grade_ physical trauma**, usually from **dentition**:
* Sharp, Pointy, Broken, Carious Tooth Edge or Cusp
* Lingually malposed tooth/missing teeth
* Xerostomia
* Parafunctional Habit
* Pointed Lingual Cusp
50
What population is most effected by TUGSE?
* **Older** individual with **slow healing response**
51
What does TUGSE resemble in location, history, and appearance?
Tongue SCC
52
What is the Histology of TUGSE?
* Surface ulcer with **fibrin coating**
* **Deep inflammation** into **MUSCLE** with **histiocytes** and **_eosinophils_**
53
What can TUGSE resemble histologically?
Lymphoma
54
What differentiates TUGSE from Tongue SCC?
There are **no eosinophils** in SCC
55
What is the Treatment for TUGSE?
* Look for the cause 1st and eliminate it
* May not need to biopsy if the cause is eliminated and the lesion resolves
56
Where is a Pizza Burn most commonly found?
Anterior Palatal Rugae
57
What is and is not Palatal Petechiae?
* Description of a clinical finding, NOT a disease or diagnosis
* **Ruptured Capillaries** on **Soft Palate** (Blood Hemorrhage)
58
What distinguishes Petechiae from Telangiectasia?
If it is a Petechiae: If you press on it, it won't temporarily disappear, becuase it is already in the CT
59
What is in the Differential Diagnosis of Palatal Petechia? (7)
1. Forcible Retching (pregnancy or bulimia)
2. Forced Fellatio (_Child Abuse_ if in children)
3. Influenza, Measles, Scarlet Fever
4. **Mononucleosis**
5. **Clotting Disorders** (von Willibrand Ds, DIC)
6. **Thrombocytopenia** (Leukemia, ITP, TTP)
7. Anticoagulants
60
What is the Clinical Appearance of Riga-Fede Disease?
* **Large laceration** of the **FOM**, right in the middle of the **lingual frenum**
61
What is the Pathogenesis of Riga-Fede Disease?
* Due to **tongue thrusting against premature teeth** in **suckling infants**
62
What other disease has a pathogenesis and histology representive of Riga-Fede Disease?
TUGSE
63
What is the counterpart lesion of Riga-Fede Disease seen in adults?
Forcible cunnilingus
64
What is a Benign Hyperkeratosis?
Appears **without obvious cause** as a **nondescript clinical white lesion.**
65
What do 98-99% of **white lesions** in **low risk areas** represent?
Irritational Keratosis
| (they don't rub off)
66
What is Ridge Keratosis?
* Common **Reactive Hyperkeratosis** of:
* **Retromolar Pad**
* **Edentulous Ridge**
67
What is the pathogenesis of Ridge Keratosis?
* **Constant low grade occlusal trauma** from:
* Opposing tooth
* Ill-fitting denture
* After a 3rd molar extraction
68
When confirmed clinically, the white lesions of Ridge Keratosis are ...
99% Non-Premalignant
Justifies not doing a biopsy
69
What is the Treatment for Ridge Keratosis?
Trauma should be reduced and the lesion observed on periodic recall
70
Where is Nicotine Stomatitis found?
Almost Exclusively on the **Hard Palate** of **PIPE Smokers**
71
What is the Pathogenesis of Nicotine Stomatitis?
* **Heat of Pipe** causes **Reactive Hyperkeratosis**
* Keratin builds up to protect against the heat
72
What is the Clinical Appearance of Nicotine Stomatitis?
**White-fissured palate** with **multiple papules** having **central red spots** (cantaloupe rind)
73
What are the papules on the palate from Nicotine Stomatitis?
Inflamed minor salivary ducts
74
How long post cessation of pipe smoking does it take for Nicotine Stomatitis to subside?
2 weeks
75
What is the location of Mucoceles?
Almost alwasy **lower lip**
76
What popultion are mucoceles most common in ?
Children
77
What is the Etiopathogenesis of a mucocele?
* Laceration of lower lip, **tears salivary duct** (recently erupted Max Inc)
* Gland continues to **pump saliva that enters CT** (mucus extravasation), and is **walled off by granulation tissue**
* Grows bigger and burst at surface
78
What is the clinical appearance of a mucocele?
* Soft, pink or blue, submucosal mass
* Fluctuant - tends to get bigger and smaller as it rupters and refills
79
What is the Histology of a mucocele?
* **Cystic pool of pink mucus**, located within **submucosa** and surrounded by a **wall of granulation tissue**
80
What is the treatment for a mucocele?
* Surgery must remove **ENTIRE mucus sac** and underlying **minor salivary gland**
* If the gland and severed duct remain lesion may recur
81
Where is a Ranula located?
Mucocele of the **FOM** (bigger)
82
What is the Etiology of a Ranula?
* Tearing of **sublingual** or **Wharton's Duct**
83
What is the clinical appearance of a Ranula?
* Soft, fluctuant, pink, translucent, or blue mass in the **FOM**, **off the midline**
* ****Frog Belly
84
Why is it important to biopsy all lesions of the FOM?
* Ranula DD is a **Salivary Gland Tumor**, which is most often malignant in FOM
85
What is the Etiology of a Pyogenic Granuloma?
* **Low grade, persistent, irritation** that stimulates the **healing rxn** to produce **EXCESSIVE Granulation Tissue**
* Instead of causing an inflammatory response
86
Where are Pyogenic Granuloma's found?
* Reactive lesion of **Gingiva** (75%)
* Also on Lips and tongue
87
What is the Clinical Appearance of a Pyogenic Granuloma?
* **Soft** – granulation tissue has no collagen in it (fibroblasts haven’t produced it yet)
* **Red**, exophytic, sessile mass
* **Painless** - no nerve endings in gt
* **Bleeds Easily** - made up of young capillaries
88
What is the tx for Pyogenic Granuloma?
Remove completely and remove etiology or it will return
89
What is the Histology of Pyogenic Granuloma?
* Exophytic mass of **inflammed granulation tissue**, with **surface ulceration**
* High power view may show capillary bv with scattered inflammation
90
What is the Pathogenesis of Pregnancy Tumor?
* Increased levels of hormones cause **angiogenesis**
* Gingiva becomes more susceptible to **minor irritants**
91
What is the tx for pregnancy tumor?
* Remove AFTER Birth
* Will not go away without surgery
92
How does Epulis Granulomatosum occur?
* **Granulation tissue** wells up in a **recent extraction site** due to **irritant** (potentially bone left in socket)
93
What is the tx for Epulis Granulomatosum?
Remove and BIOPSY
cancer in an area near an extraction site will present the same
94
Where are Fibromas found?
* Favors **Buccal Bite Line**
* Lip, Gingiva, Tongue
95
What is the clinical appearance of a Fibroma?
* Smooth surfaced, light pink, soft or firm, **Fixed pea-like nodule**
* *****Mucocele and Ranula are fluctuant*
96
What is the histology of a Fibroma?
* **Mass** of **dense bundles of collagen** in a **non-functional arrangement**
* Replaces submucosa
97
What is the Etiology/Pathogenesis of Peripheral Ossifying Fibroma?
* Between that of a _reactive and neoplastic_ lesions of **periodontal** or **periosteal origin**
* Initiated by an **irritant,** then **enlarges independently**
98
Where is a Peripheral Ossifying Fibroma found?
Only on GINGIVA
* Mostly tooth-bearing
* Mostly crestal region/ridge
99
In what population do Peripheral Ossifying FIbromas occur?
**2/3** in **Females** in the **2nd decade**
100
What is the Histology of Peripheral Ossifying Fibroma?
* Derived from **PDL**
* Spindly cellular fibrous stroma forming bone and/or cementum
* Fibroblasts
101
What is the clinical appearance of a Peripheral Ossifying Fibroma?
**Firm**, pink mass that may **Displace Teeth**
102
What is the radiographic appearance of Peripheral Ossifying Fibroma?
* Some **RO**
* **Cupping** or **triangulation** of crestal bone
* with extension **along root**, it wedges down PDL
103
What is the tx for Peripheral Ossifying Fibroma?
* Complete Removal including origins along PDL
* Eliminate irritant
* 8-16% recurrence rate
104
How does Peripheral Giant Cell Granuloma differ from POF in clinical appearance?
* Typically **Anterior**
* **Purple** to dull magenta, **soft**, painless mass that **bleeds easily**
* ****Resembles a big Pyogenic Granuloma, but they have different etiologies
* Mostly young BUT can be at **any age**
105
What is the Histology of Peripheral Giant Cell Granuloma?
* Cellular spindly stroma containing clusters of **foreign body giant cells**, **vessels** and **hemorrhage**
* _Pyogenic Granuloma_ will not have Giant Cells
* _POF_ will form bone or cementum
106
What is the DD for red, soft, gum bumps that bleed easily?
* **Pyogenic Granuloma**
* ****More common
* 75% on Gingiva, also on lips and tongue
* Low grade trauma stimulated the healing rxn to produce excessive granulation tissue
* **Peripheral Giant Cell Granuloma**
* ****Only on Gingiva (anterior and tooth-bearing)
* Slight preponderance for young females
* Low grade trauma to Gingival PDL of Periosteum
107
What is the DD for Pink, Firm, Gum Bumps that Don't Bleed Easily?
* **Peripheral Ossifying Fibroma**
* ****Gingiva
* Female in 20s
* **Fibroma**
* ****Buccal Bite Line
108
What is the Etiopathogenesis of Traumatic (Amputation) Neuroma?
* **Tearing** or **crushing** a **peripheral n.**
* nerve twigs attempt to reestablish themselves but become **blocked by fibrous scar** causing nerve fibers to proliferate in a **hyperplastic twisted, tangled mass**
109
What are the possible locations for a Traumatic (Amputation) Neuroma to occur?
1. **Tongue** or **Lip** after a bite injury
2. **3rd molar area** or **mandibular canal** after extraction
3. **Mental n. area** after ill fitting denture or atrophic ridge
110
What does a Traumatic Neuroma look like clinically?
* **Fibroma**
* BUT it is **Painful**
111
What is the histological difference between a Traumatic Neruoma and a Fibroma?
* Dense fibrous tissue like Fibroma,
* but with many **hyperplastic nerve endings** (nerve bundles seen)
112
What is the Direct Theory for Radiation Injury?
* x-ray or gamma-rays **damage DNA**, particularly cells with **high mitotic rate**,
* **Destroying chromosomes** and the **ability to divde**
* Selective value in tx cancer
113
What is the Indirect Theory for Radiation Injury?
* Radiation kills tissue by **ionization of H2O** forming **free radicals** that damage cell structures
114
What tissues are **Radio-Sensitive,** most easily destroyed, they grow fast? (4)
* Hematopoietic
* Lymphoid
* Germ Cells
* GI Epithelium
115
What tissues are **Radio-Responsive** - reasonably susceptible, but can regenerate? (6)
* Skin
* Salivary Glands
* Oral muscosa
* Osteoclasts, -blasts
* Growing CT
* Endothelium of bv
116
What tissues are Radio-Resistant, tissue that is not growing very fast? (6)
* Muscle
* Mature CT
* Neutrophil
* Nerve
* CNS
* RBC
117
How many rad is needed to kill malignant tumor cells/ how many per day?
* **4000-7000**
* 4000 for fast growing tumors (lymphomas)
* 7000 (SCCA)
* Most Adenocarcinomas and well differentiated tumors are radiation
* Fractionate doses **~200 rad/day**
118
What are the effects of Radiation on Skin?
* **Radiation Dermatitis**
* Begins **2 weeks** post radiation (kills basal cells)
* Skin in path appears **sunburned**
* **Heals in 3 weeks**, with permanent atrophy, pigmentation, hair loss, and telangectasia
119
What are the musculoskeletal effects of radiation and how do you treat them?
* **Trismus** due to **fibrosis** or a Spasm of muscle and TMJ capsule
* Rx with **Jaw Opening Exercises**, so collagen won't form as strongly
120
What is the effect of radiation on taste buds?
* **Hypogeusia** several weeks post radiation but often **returns \> 4 month**
* Some pts are left with **permanent** hypogeusia or dysgeusia
* Rx with **Zinc** helps with tast
121
What is radiation's effect on Mucosa?
* **180-200 rad 5x day** cause **mucositis**
* **Basal cells** damaged **immediately**
* Mucosa gets red, sore and **sloughs 2-4 wks later (latency)**
* **Severe Pain,** then heals with **atrophy and fibrosis** starting in **3 weeks**
* **Candida** is common due to xerostomia
122
What is radiations effect on Salivary Glands?
* 1000-3000 rad = **Reversible**
* \>4000 rad = Irreversible
* **Serous Glands** most affected, mucosa glands less affected
* Resulting in **Xerostomia** with thick, ropy, mucous saliva
123
What is Radiations Effect on Teeth?
* **No Effect on Formed Teeth** (radio-resistant)
* Rampant encircling **cervical "radiation" caries** due to xerostomia
* Amputates the tooth
* Seen in Meth Mouth
* Damages **developing tooth buds** in path
124
What is Radiations effect on Bone?
* Damages **endothelium** causing **occlusion of bone vessels and osteoblasts**
* Mature bone is stable until injured, then vascular infarct - **Osteoradionecrosis**
* Almost always in **Mandible** (x24)
* Unexpected with dose \<6000 rad
125
How do mange a radiated pt, and what is the timing of the tx?
* EXTRACT **non-restorable** or **perio involved**, **Mandibular** teeth in **Field of Radiation**
* Especially if salivary gland damage is anticipated,
* Trying to prevent Osteoradionecrosis
* Best Time is **_\>_ 1 month before tx**
* **NEVER EXTRACT DURING Rad Tx**
* Ok to extract **within 4 months** of tx but NOT AFTERWARD!
* Extractions must be atraumatic
* Give pt **Vit. E** and **pentoxifylline** (improves blood flow)
* Wait on Dentures after FM Extractions
* **Sore Spots = Emergency**
126
What does MRONJ preferentially affect?
Jaws
127
What does Sanguinaria Rxn cause histologically?
Hyperkeratosis and Dysplasia in 20%
128
What are the Oral Manifestations of Heavy Metal Poisioning? (4)
* Heavy metal line on the free gingiva
* **Ptyalism** - excessive salivation
* **Metallic Taste**
* **Severe Gingivitis** and **Periodontitis** with Generalized **Tooth Loss**
* Direct toxic effects from sulfide salts
* **Mercury is the worst** - perio destruction and tooth loss
129
What are the 3 classes of medications that cause Drug Induced Gingival Hyperplasia (Fibromatosis)?
1. Anticonvulsants (Dilantin)
2. Calcium Channel Blocker (Nifidipine)
* **Most likely**
3. Cyclosporine
* immunosuppressant (anti-rejection drug of transplants)
130
What is the etiology of the Allergic Form of Angio(neurotic) Edema?
Type 1 Allergic Rxn
131
What is the clinical presentation of the Allergic Form of Angio(neurotic) Edema?
* **Rapid, Painless, Swelling** of lips, face, eyelids, tonge, FOM, larynx
* May have tingling or burning
* Lasts 24-36 hrs, if left alone
132
What is the etiology of the Non-Hereditary Form of Angio(neurotic) Edema?
Allergen
133
What is the etiology of the Hereditary Form of Angio(neurotic) Edema?
* Absence of **C1 esterase inhibitor**
* Normally inhibits the action of complement cascade
* If not inhibited - **kinin production is unchecked**
* Causes **major swelling to minor allergens**
134
What is the result of the Hereditary Form of Angio(neurotic) Edema?
25% fatal airway obstruction
135
What is the etiology of the ACE Inhibitor Form of Angio(neurotic) Edema?
* **Increased** **Bradykinin**
* May occur _spontaneously_ or be set off by _manipulation_
136
Which forms of Angio(neurotic) Edema do not respond to antihistamines, epi, or steroids, and may require the airway to be maintained?
* Hereditary Form
* ACE Inhibitor Form
137
What is the DD of Angio(neurotic) Edema aka other causes of sudden swelling of face?
* Ludwig's Angina
* Carvernous Sinus Thrombosis
* Cervicofacial (Air) Emphysema
138
What systemic drug is most likely to cause Stomatitis Medicamentosa?
Antibiotics
139
How does Stomatitis Medicamentosa manifest?
* Acute, confluent ulcers
* Lichenoid lesions
* Blisters
140
What does Stomatitis Medicamentosa look like clinically?
* Chemotherapy
* Radiation Mucositis
141
What is the Diagnostic Histology of Stomatitis Venenata to Cinnamon?
* **Lichenoid Rxn** (sub-epithelial inflammation)
* This is also the hallmark of LP
* But with a **distinct Perivascular Infiltrate**
* Also seen in LE, but less prominant
