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Oral Path Exam 2 > 8: Physical and Chemical Injuries > Flashcards

8: Physical and Chemical Injuries Flashcards

1
Q

Common alteration of the buccal mucosa most often associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth, 13% of population?

A

linea alba

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2
Q

What is the clinical presentation of linea alba?

A

white line, bilateral at level of occlusal plane with no other associated problems

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3
Q

Linea alba treatment

A

None, no biopsy

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4
Q

What causes linea alba

A

hyperkeratosis

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5
Q

Lesion from chronic, habitual nibbling with a higher incidence in females presenting with thickend, shredded, white areas? Lip chewing? Tongue Chewing?

A

Morsicatio Bucarum, Morsicatio Labiorum, Morsicatio Linguarum

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6
Q

How would differentiat Morsicatio Buccarum from Luekoplakia from Lichen planus?

A

Morsicatio bucarum has ragged torn look Leukoplakia has homogenous look Lichen Planus has Striae of Wickam

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7
Q

How could you differentiate Morsicatio Linguarum from Oral Hairy Leukoplakia?

A

biopsy does not show EBV, candidiasis and no history of HIV

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8
Q

5 ways to get Ulcerations?

A

Physical, thermal, Electrical, TUGSE, Riga-Fede disease

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9
Q

What is TUGSE?

A

Traumatic Ulcerative Granuloma with Stromal Eosinophilia

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10
Q

With what is TUGSE associated?

A

Eosinophils = allergies or parasites

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11
Q

What is the only clinical differentiation between a TUGSE ulcer and an aphthous ulcer?

A

TUGSE is slower to heal (>7 days)

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12
Q

These are traumatic ulcerations of the ventral tongue in nursing babies and are a variation of TUGSE

A

Riga-Fede Disease

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13
Q

Represent 5% of all burn admissions

A

Electrical burns

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14
Q

2 types of electrical burns and which is most common oral

A

Contact and Arc. Arc is most common orally with saliva acting as conductor

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15
Q

Age and most common location for electric burns

A

<4 years old. Lips and commissures presenting charred yellow with little bleeding

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16
Q

3 stages of treatment of ulcers (in order)

A

1.) Remove obvious injury
2.) Treat symptoms: cellulose films, topical
antibiotics, Orabase)
3.) If not healed in 2 weeks, Biopsy

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17
Q

Are natal teeth associated with Riga-Fede disease extra teeth or are they the babies deciduous teeth simply erupted early

A

early erupted deciduous teeth.

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18
Q

4 sources of Chemical injuries

A

Aspirin, OTC med, Gasoline, Iatrogenic dental chemicals (formocreosol, etch, Hydrogen peroxide, Silver nitrate)

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19
Q

Why are OTC meds a source of chemical injuries

A

Have a lot of eugenol and phenol

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20
Q

How can one get a cotton roll burn (3)?

A

Cotton roll wicks out moisture and causes necrosis, holds caustic chemicals against the epithelium, or is removed and takes epithelium w/ it

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21
Q

All systemic anticancer therapies (antineoplastic therapies) cause what?

A

death of some normal cells

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22
Q

What are the 2 acute oral changes associated w/ cancer chemotherapy?

A

Mucocitis and hemorrhage

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23
Q

Where does oral mucocitis associated with cancer chemotherapy present?

A

Nonkeratinized surfaces (Buccal mucosa, ventrolateral tongue, soft palate, floor of mouth)

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24
Q

How does Oral Mucocitis associated with cancer chemotherapy and radiation treatment look clinically?

A

early develops white discoloration from lack of keratin desquamation followed by loss of that layer & replacement by atrophic mucosa that is edematous, erythmatous & friable. Finally is ulcerated and covered by yellowish fibrinopurulent membrane. Recap: white, red, yellow

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25
Q

Where does Radition therapy acute mucocitis present?

A

mucosal surface w/in direct portals of radiation

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26
Q

What are the 2 acute changes associated with cancer radiation therapy?

A

Acute mucocitis and dermatitis

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27
Q

What is the character of Radiation Therapy Dermatitis based on?

A

Varies w/ amount received. Can be erythema, edema, burning, purities all the way to necrosis and deep ulcerations.

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28
Q

What are the 5 Sequelae (a pathological condition resulting from disease [Wiki definition]) to Cancer Chemotherapy?

A

Increased susceptibility to infection, oral mucocitis, oral ulceration, increased risk of hemorrhage, or impaired healing

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29
Q

The introral hemorrhage that is a sequelae of cancer chemotherapy is secondary to what

A

thrombocytopenia caused by bone marrow suppression

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30
Q

This is a complication associated with head and neck radiation

A

Xerostomia

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31
Q

What is the course of radiation induced Xerostomia?

A

Changes after 1 week. Decrease in saliva after 6 weeks. Parotids dramatically/irreversibly affected. Decreased bactericidal activity of saliva cause increased caries

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32
Q

8 Sequelae of Radiation therapy

A

Hemorrhage, Mucocitis, Dermatitis, Xerostomia, Osteoradionecrosis, Loss of taste/ altered taste (Hypgeusia/dysguesia), Trismus, Developmental anomalies (e.g. microdonts, hypoglossia) which are dependent on age and treatment

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33
Q

What can cause the osteoradionecrosis

A

hypoxia, hypovascularity, hypocellularity

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34
Q

What increases the risk of developing osteoradionecrosis and what are the treatment limits?

A

Surgery. Tx pt either 21 days prior to radiation (to allow healing prior to therapy) or wait 1 year after radiation therapy is complete

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35
Q

What can dentist do pretherapy for cancer patient

A

remove current or potential oral foci of infection. Give OHI

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36
Q

What can dentist do during cancer therapy (Intratherapy)?

A

Relieve pain, dehydration, malnutrition via admin of anesthetic, analgesics, antimicrobial, or coating agent

37
Q

What can dentist do posttherapy for cancer patient (4)?

A

Topical fluoride, salivary substitutes, sugarless candies, infection prevention

38
Q

What is the 1-2-3 Mouthwash?

A

1/3 caopectate (coat mouth), 1/3 tetracycline (cut down on secondary infection), 1/3 benedryl (steroid to decrease inflammation)

39
Q

Bisphosphonates are used to slow the osseous involvements of what 3 diseases?

A

cancer (multiple myeloma, metastatic breast or prostate), Paget’s disease, and Osteoporosis

40
Q

When should elective surgical procedures be done on a patient who takes bisphosphonates?

A

after discontinuance of drug and 3 month waiting period

41
Q

Most cases of Bisphosphonate-Associated Osteonecrosis (BONJ) follow what type of bisphosphonate administration

A

IV

42
Q

What should one consider when pt is emaciated, agitated, nervous young adult with multiple Class V carious lesions

A

Methamphetamine abuse

43
Q

Why worry about treating a patient that is high on methamphetamine?

A

Potentiates effects of sympathomimetic amines, so local w/ epi can lead to HTN crisis, cerevrovascular accident, myocardial infarction

44
Q

Term for Ulceration and Necrosis developing several days after local anesthesia due to tissue ischemia

A

Anesthetic Necrosis

45
Q

Persistent scaling and flaking of the vermillion border, usually involving both lips associated with chronic habitual lip licking, biting, picking or sucking

A

Exfoliative Cheilitis

46
Q

What is can be a sequelae of Exfoliative Cheilitis

A

Bacterial or fungal infection (e.g. angular cheilitis)

47
Q

Treatment of Exfoliative Cheilitis

A

Psychotherapy/intervention for habit. Antibacterial/antimycotic/ steroid lip cream for angular cheilitis

48
Q

2 causes of submucosal hemorrhage

A

Traumatic and Non-traumatic

49
Q

Minute hemorrhages into skin, mucosa, or serosa? Slightly larger?

A

Petechiae; purpura

50
Q

Accumulation of boold within a tissue that produces a mass

A

Hematoma

51
Q

3 causes of Non-Traumatic Submucosal Hemorrhage?

A

Thrombocytopenia
Disseminated intravascular coagulopathy (DIC) Viral infection (Mononucleosis [EBV, HHV-4],
Measels [Rubeola])

52
Q

Submucosal hemorrhage that is over 2 cm

A

echymosis

53
Q

Patient has palatal erythema, petechiae or purpura, or lingual frenum tears or tongue ulcerations, part of the differential should include

A

oral sexual practices (can use this as a clue for sexual abuse )

54
Q

Incorporation of Amalgam into oral mucosa

A

Amalgam tattoo

55
Q

4 ways to get an amalgam tattoo

A

mucosal abrasion containing amalgam, amalgam fragments in extraction socket, dental floss transfer, or endodontic retrofill procedures

56
Q

If dark lesion along the gumline , but not evident on radiograph, what is required

A

Biopsy to differentiate from Melanoma

57
Q

What are 3 other means of getting oral localized exogenous pigmentation beyond an amalgam tattoo

A

Intentional tattooing, pencil lead, Bullet fragments

58
Q

What are the acute and chronic complications of Oral Piercings?

A

Acute: bleeding, infection, nerve damage.
Chronic: speech impediment, nickel allergy, chipped teeth, aspiration

59
Q

An oral piercing is an example of what type of injury?

A

Factitial (self-inflicted)

60
Q

6 systemic metallic intoxications

A

Lead/Plumbism, Mercury/Acrodynia, Silver/Argyria, Bismuth, Arsenic, and Gold

61
Q

Lead overdose is called what and has what 4 oral manifestations?

A

Plumbism: Ulcerative stomatitis, Gingival lead line (Burton’s line), Metallic taste, and Tongue tremor

62
Q

Mercury overdose is called what and has what 3 oral manifestations?

A

Acrodynia/pink disease/Swift disease: Hypersalivation, Ulcerative gingivitis, Bruxism/loss of teeth

63
Q

Silver overdose is called what and has what 2 oral and skin manifestations?

A

Argyria: Slate blue gingival margins and Grayish skin discoloration

64
Q

What is the line called associated w/ Plumbism and when is it seen?

A

Burton’s line. Gingival inflammation as in gingivitis

65
Q

Oral pigementation is increases significantly in what demographic

A

Smokers = Smoker’s Melanosis

66
Q

Pigmentary changes caused by polycyclic amines stimulating melanin by melanocytes is limited to what part of the mouth in Smoker’s Melanosis

A

Anterior Facial Gingiva

67
Q

What gender is more sensitive to increased melanin pigmentation?

A

Female

68
Q

What drug can cause staining of the gingival as a result of the drugs deposition in the underlying bone?

A

Minocycline

69
Q

7 meds associated with Drug Related Discoloration of the Oral Mucosa

A

phenolphthalein, tranquilizers, estrogen, AIDS meds, Minocycline, Antimalarials, and Chemotherapeutics

70
Q

Cartilage or bone discovered within soft tissue specimens removed from the oral cavity as the body’s way of reacting to constant irritation in an area (e.g. under denture on edentulous ridge)

A

Reactive Osseous and Chondromatous Metaplasia

71
Q

How will Reactive Osseous and Chondromatous Metaplasia appear under a denture on the alveolar ridge

A

Extremely tender and localized area

72
Q

What hobby/occupation is Reactive Osseuous and Chrondromatous Metaplasia common in, just not in the mouth

A

Equestrians on the inner thigh

73
Q

Lesion that normally arises without patient knowing and in absence of trauma along the lingual surface of the mandible along the mylohyoid ridge, with the associated loff of the overlying oral mucosa

A

Spontaneous Sequestrations

74
Q

These are commonly found on a panoramic as a dome-shaped faint radiopacity arising from the floor of the maxiallary sinus usually having an inflammatory exudates. It pushes the sinus epithelial lining up above it.

A

Antral Pseudocyst

75
Q

When have an increased prevalence of antral pseudocysts been noted?

A

during winter months

76
Q

What must be ruled out or treated as a cause of an astral pseudocyst?

A

odontogenic infection

77
Q

This is also in the maxillary sinus but it is an accumulation of mucin encased in epithelium

A

Sinus mucocelle

78
Q

2 types of sinus mucocelles

A

Surgical Ciliated cyst Obstructed sinus ostium

79
Q

Surgical ciliated cyst occurs when

A

portion of sinus linging gets separated from main body of sinus and forms epithelium lined cavity into which it secretes mucin

80
Q

When the sinus ostium gets blocked, how is that sinus mucocelle formed?

A

entire blocked sinus acts as an epithelium lined cyst and fills with mucin

81
Q

These cysts arise from partial blockage of a duct of the sero-mucus glands or from an invagination of the respiratory epithelium and associated with antral polyps commonly

A

Retention Cysts

82
Q

What is the character of a true sinus mucocelle (what will it do to bone and how will appear radiographically)?

A

Will enlarge, expand bone and entire sinus will be cloudy on radiograph

83
Q

Caused by the introduction of air into subcutaneous or fascial spaces of the face and neck. Air can come from blowing or sneezing after extraction or dentist blowing air into wound w/ air/water syringe or handpiece.

A

cervicofacial emphysema

84
Q

If the cervicofacial emphysema shows up hours after surgery, who is usually at fault

A

The patient

85
Q

Cervicofacial emphysema treatment

A

Broad Spectrum Antibiotic and warm compress

86
Q

Radiographic radiolucency caused by dentist placing antibiotic in a petrolatum base into an extraction socket which will leave an asymptomatic circumscribed radiolucency looking like a residual cyst

A

Myospherulosis

87
Q

Myospherulosis treatment

A

Surgical excision

88
Q

What can cervicofacial emphysema be confused with, and how can it be differentiated?

A

Confused with angioedema but cervicofacial emphysema will have crepitus in the swelling

Oral Path Exam 2 (8 decks)

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