8: Physical and Chemical Injuries Flashcards
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?
linea alba
What is the clinical presentation of linea alba?
white line, bilateral at level of occlusal plane with no other associated problems
Linea alba treatment
None, no biopsy
What causes linea alba
hyperkeratosis
Lesion from chronic, habitual nibbling with a higher incidence in females presenting with thickend, shredded, white areas? Lip chewing? Tongue Chewing?
Morsicatio Bucarum, Morsicatio Labiorum, Morsicatio Linguarum
How would differentiat Morsicatio Buccarum from Luekoplakia from Lichen planus?
Morsicatio bucarum has ragged torn look Leukoplakia has homogenous look Lichen Planus has Striae of Wickam
How could you differentiate Morsicatio Linguarum from Oral Hairy Leukoplakia?
biopsy does not show EBV, candidiasis and no history of HIV
5 ways to get Ulcerations?
Physical, thermal, Electrical, TUGSE, Riga-Fede disease
What is TUGSE?
Traumatic Ulcerative Granuloma with Stromal Eosinophilia
With what is TUGSE associated?
Eosinophils = allergies or parasites
What is the only clinical differentiation between a TUGSE ulcer and an aphthous ulcer?
TUGSE is slower to heal (>7 days)
These are traumatic ulcerations of the ventral tongue in nursing babies and are a variation of TUGSE
Riga-Fede Disease
Represent 5% of all burn admissions
Electrical burns
2 types of electrical burns and which is most common oral
Contact and Arc. Arc is most common orally with saliva acting as conductor
Age and most common location for electric burns
<4 years old. Lips and commissures presenting charred yellow with little bleeding
3 stages of treatment of ulcers (in order)
1.) Remove obvious injury
2.) Treat symptoms: cellulose films, topical
antibiotics, Orabase)
3.) If not healed in 2 weeks, Biopsy
Are natal teeth associated with Riga-Fede disease extra teeth or are they the babies deciduous teeth simply erupted early
early erupted deciduous teeth.
4 sources of Chemical injuries
Aspirin, OTC med, Gasoline, Iatrogenic dental chemicals (formocreosol, etch, Hydrogen peroxide, Silver nitrate)
Why are OTC meds a source of chemical injuries
Have a lot of eugenol and phenol
How can one get a cotton roll burn (3)?
Cotton roll wicks out moisture and causes necrosis, holds caustic chemicals against the epithelium, or is removed and takes epithelium w/ it
All systemic anticancer therapies (antineoplastic therapies) cause what?
death of some normal cells
What are the 2 acute oral changes associated w/ cancer chemotherapy?
Mucocitis and hemorrhage
Where does oral mucocitis associated with cancer chemotherapy present?
Nonkeratinized surfaces (Buccal mucosa, ventrolateral tongue, soft palate, floor of mouth)
How does Oral Mucocitis associated with cancer chemotherapy and radiation treatment look clinically?
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
Where does Radition therapy acute mucocitis present?
mucosal surface w/in direct portals of radiation
What are the 2 acute changes associated with cancer radiation therapy?
Acute mucocitis and dermatitis
What is the character of Radiation Therapy Dermatitis based on?
Varies w/ amount received. Can be erythema, edema, burning, purities all the way to necrosis and deep ulcerations.
What are the 5 Sequelae (a pathological condition resulting from disease [Wiki definition]) to Cancer Chemotherapy?
Increased susceptibility to infection, oral mucocitis, oral ulceration, increased risk of hemorrhage, or impaired healing
The introral hemorrhage that is a sequelae of cancer chemotherapy is secondary to what
thrombocytopenia caused by bone marrow suppression
This is a complication associated with head and neck radiation
Xerostomia
What is the course of radiation induced Xerostomia?
Changes after 1 week. Decrease in saliva after 6 weeks. Parotids dramatically/irreversibly affected. Decreased bactericidal activity of saliva cause increased caries
8 Sequelae of Radiation therapy
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
What can cause the osteoradionecrosis
hypoxia, hypovascularity, hypocellularity
What increases the risk of developing osteoradionecrosis and what are the treatment limits?
Surgery. Tx pt either 21 days prior to radiation (to allow healing prior to therapy) or wait 1 year after radiation therapy is complete
What can dentist do pretherapy for cancer patient
remove current or potential oral foci of infection. Give OHI
What can dentist do during cancer therapy (Intratherapy)?
Relieve pain, dehydration, malnutrition via admin of anesthetic, analgesics, antimicrobial, or coating agent
What can dentist do posttherapy for cancer patient (4)?
Topical fluoride, salivary substitutes, sugarless candies, infection prevention
What is the 1-2-3 Mouthwash?
1/3 caopectate (coat mouth), 1/3 tetracycline (cut down on secondary infection), 1/3 benedryl (steroid to decrease inflammation)
Bisphosphonates are used to slow the osseous involvements of what 3 diseases?
cancer (multiple myeloma, metastatic breast or prostate), Paget’s disease, and Osteoporosis
When should elective surgical procedures be done on a patient who takes bisphosphonates?
after discontinuance of drug and 3 month waiting period
Most cases of Bisphosphonate-Associated Osteonecrosis (BONJ) follow what type of bisphosphonate administration
IV
What should one consider when pt is emaciated, agitated, nervous young adult with multiple Class V carious lesions
Methamphetamine abuse
Why worry about treating a patient that is high on methamphetamine?
Potentiates effects of sympathomimetic amines, so local w/ epi can lead to HTN crisis, cerevrovascular accident, myocardial infarction
Term for Ulceration and Necrosis developing several days after local anesthesia due to tissue ischemia
Anesthetic Necrosis
Persistent scaling and flaking of the vermillion border, usually involving both lips associated with chronic habitual lip licking, biting, picking or sucking
Exfoliative Cheilitis
What is can be a sequelae of Exfoliative Cheilitis
Bacterial or fungal infection (e.g. angular cheilitis)
Treatment of Exfoliative Cheilitis
Psychotherapy/intervention for habit. Antibacterial/antimycotic/ steroid lip cream for angular cheilitis
2 causes of submucosal hemorrhage
Traumatic and Non-traumatic
Minute hemorrhages into skin, mucosa, or serosa? Slightly larger?
Petechiae; purpura
Accumulation of boold within a tissue that produces a mass
Hematoma
3 causes of Non-Traumatic Submucosal Hemorrhage?
Thrombocytopenia
Disseminated intravascular coagulopathy (DIC) Viral infection (Mononucleosis [EBV, HHV-4],
Measels [Rubeola])
Submucosal hemorrhage that is over 2 cm
echymosis
Patient has palatal erythema, petechiae or purpura, or lingual frenum tears or tongue ulcerations, part of the differential should include
oral sexual practices (can use this as a clue for sexual abuse )
Incorporation of Amalgam into oral mucosa
Amalgam tattoo
4 ways to get an amalgam tattoo
mucosal abrasion containing amalgam, amalgam fragments in extraction socket, dental floss transfer, or endodontic retrofill procedures
If dark lesion along the gumline , but not evident on radiograph, what is required
Biopsy to differentiate from Melanoma
What are 3 other means of getting oral localized exogenous pigmentation beyond an amalgam tattoo
Intentional tattooing, pencil lead, Bullet fragments
What are the acute and chronic complications of Oral Piercings?
Acute: bleeding, infection, nerve damage.
Chronic: speech impediment, nickel allergy, chipped teeth, aspiration
An oral piercing is an example of what type of injury?
Factitial (self-inflicted)
6 systemic metallic intoxications
Lead/Plumbism, Mercury/Acrodynia, Silver/Argyria, Bismuth, Arsenic, and Gold
Lead overdose is called what and has what 4 oral manifestations?
Plumbism: Ulcerative stomatitis, Gingival lead line (Burton’s line), Metallic taste, and Tongue tremor
Mercury overdose is called what and has what 3 oral manifestations?
Acrodynia/pink disease/Swift disease: Hypersalivation, Ulcerative gingivitis, Bruxism/loss of teeth
Silver overdose is called what and has what 2 oral and skin manifestations?
Argyria: Slate blue gingival margins and Grayish skin discoloration
What is the line called associated w/ Plumbism and when is it seen?
Burton’s line. Gingival inflammation as in gingivitis
Oral pigementation is increases significantly in what demographic
Smokers = Smoker’s Melanosis
Pigmentary changes caused by polycyclic amines stimulating melanin by melanocytes is limited to what part of the mouth in Smoker’s Melanosis
Anterior Facial Gingiva
What gender is more sensitive to increased melanin pigmentation?
Female
What drug can cause staining of the gingival as a result of the drugs deposition in the underlying bone?
Minocycline
7 meds associated with Drug Related Discoloration of the Oral Mucosa
phenolphthalein, tranquilizers, estrogen, AIDS meds, Minocycline, Antimalarials, and Chemotherapeutics
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)
Reactive Osseous and Chondromatous Metaplasia
How will Reactive Osseous and Chondromatous Metaplasia appear under a denture on the alveolar ridge
Extremely tender and localized area
What hobby/occupation is Reactive Osseuous and Chrondromatous Metaplasia common in, just not in the mouth
Equestrians on the inner thigh
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
Spontaneous Sequestrations
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.
Antral Pseudocyst
When have an increased prevalence of antral pseudocysts been noted?
during winter months
What must be ruled out or treated as a cause of an astral pseudocyst?
odontogenic infection
This is also in the maxillary sinus but it is an accumulation of mucin encased in epithelium
Sinus mucocelle
2 types of sinus mucocelles
Surgical Ciliated cyst Obstructed sinus ostium
Surgical ciliated cyst occurs when
portion of sinus linging gets separated from main body of sinus and forms epithelium lined cavity into which it secretes mucin
When the sinus ostium gets blocked, how is that sinus mucocelle formed?
entire blocked sinus acts as an epithelium lined cyst and fills with mucin
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
Retention Cysts
What is the character of a true sinus mucocelle (what will it do to bone and how will appear radiographically)?
Will enlarge, expand bone and entire sinus will be cloudy on radiograph
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.
cervicofacial emphysema
If the cervicofacial emphysema shows up hours after surgery, who is usually at fault
The patient
Cervicofacial emphysema treatment
Broad Spectrum Antibiotic and warm compress
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
Myospherulosis
Myospherulosis treatment
Surgical excision
What can cervicofacial emphysema be confused with, and how can it be differentiated?
Confused with angioedema but cervicofacial emphysema will have crepitus in the swelling
