Chapter 8 Flashcards
Linea Alba
“white lin” on check
Associated with PRESSURE, IRRITATION, SUCKING TRAUMA
Found at the same height of the occlusal plane
** if not at the occlusal plane consider other options for white line**
Typically bilateral
NO BIOPSY or treatment necessary
Morsicatio Buccarum
CHRONIC CHEEK CHEWING
Thickend, shredded, white areas which may be ulcerated
High prevalance in individuals under stress or with psychologic condition
No treatment required – stop the habit
Not a premalignant condition – doesn’t cause chronic inflammation
Morsicatio Labiorum
Morsciatio linguarum
Chronic long term inflammation may lead to ?
Premalignant lesions
Inflammation causes cells to divid constantly – may get a mutation that leads to cancer
Traumatic ulcerations
Acute or chronic
Break in the membrane
Found: Lips, Tongue, Buccal mucosa
Appearance: Erythema surrounding a central removalbe yellow fibrinpurulent membrane
Yellow – moisture does not allow fibrin clot to dry
Rolled white border –> Hyperkeratosis can develop immediately adjacent to the ulceration
Traumatic Ulcerative Granuloma with Stromal Eosinophila (TUGSE)
** Eosinophil ulceration**
Deep pseudoinvasive inflammatory process
Slow to resolve
Inflammation extedning into skeletal muscle – EOSINOPHILS attracted to dying skeletal muscle
May look similar to cancer – ALWAYS ask the patient if they experience trauma recently.
Riga Fede Disease
Treatment: Remove trauma, Steroid injections
BIOPSY if it does not resolve after 2 -4 weeks
Electrical Burn
* Contact
* Arc – salva acts as a conducting medium and electrical arch flows between the electrical source and mouth
Chewing on femal end of an electrical cord
Painless, charred, yellow area – doesn’t bleed
Chemical burns – MEDICATIONS
Rather than swollowing it, it is placed in the cheek area to dissolve
Medications that can cause chemical burns
Aspirin
Bisphosphonates
Psychoactive drugs ( chlorpromazine, promazine)
Patient or dental misuse of materials – CHEMICAL BURNS
Tooth whitening
Hydrogen peroxide
Phenol
Silve nitrate
Endo materials
Cotton rolls
EDTA
Cotton Roll Burns
Physical burn
Dries out the mucosa –> Mucosal fibers bind to the cotton
Make sure the WET the cotton roll before removing
Antineoplastic Therapy
Antineoplastic therapy –> Stops tumor growth
** Targets tissue with rapid turnover (mucosal tissue)**
Noninfectious oral complications of Antineoplastic Therapy
Mucositis and Hemorrhage
Xerostomia
Loss of taste
Osteoradionecrosis
Trismus
Developmental abnormalities
_____ % of patients with Head and Neck radiation have oral ramifications
100
_____ % of pts with BMT have oral complications
75%
Hemorrhaging
Secondary to thrombocytopenia
Oral Petechia
Ecchymosis
Mucositis
White discoloration from a lack of sufficient dewquamation of keratin
Loss of keratin and replacement by atrophic mucosa
Areas of ulceration develop
Xerostomia
Salivary glands are senstive to radiation
Increase in caries risk
Treat – fluoride
Loss of taste
Loss of all four tastes
Returns in about 4 months
Antineoplastic Therapy
Hypogeusia
Loss of all 4 tastes
Dysgeusia
Permanent altered taste
Osteoradionecrosis
Risk is highest –> Local surgical procedure is performed within 3 weeks of therapy or within 1 year of therapy
Not painful – does not affect the periosteum (most nerve sensation)
Treatment of Osteoradionecrosis
ABX
Debridement
Irrigations
Removal of diseased bone
Bisphosphonates Action
Inhibit osteoclasts
Interfere with angiogenesis
Bisphosphonates used for?
Slow osseous involvmentof cancer
Treat Paget’s Disease
Reverse osteoporosis
Bisphosphonates
First generation –>
Second generation –>
First – low potency
Second – more potent, half life of 10 years, Strong association with gnathic osteonecrosis
Drug is incorporated highest in areas of ACTIVE remodeling (maxilla, mandible)
IV bisphosphonates
Prevalance of osteonecrosis –> 6-8%
manipulation of bone should be AVOIDED
Oral Bisphosphonates
Prevalance of osteonecrosis 1:100,000
Informed consent beforebone manipulation
Bisphosphonate Osteonecrosis
Methamphetamine
Powdered class I drug
Smoke, snort, inject, oral
Increase in desire of sugary drinks and foods
Causes dry mouth
Facial smooth surfaces and interproximal surfaces first affected
Parsitosis
Delusions of feeling SNAKES/INSECTS crawling under skin
Meth Users
Exfoliative Cheilitis
Persistent scaling and flakig of the vermillion border
** Due to chronic injury secondary to habits, such as lip licking**
Treatment – cessation of habit, corticosteroids
Submucosal Hemorrhage
Oral Petechial/Purpura
Red or purple discolaration of the skin that DOES NOT blanch
Causes of submucosal Hemorrhaging
Repeated coughing or vomiting
Convulsions
Oral sex
Anticoagulant therapy
Thrombocytopenia
Disseminated intravascular coagulation
Viral infections (mono, measles)
No treatment –> should resolve on it’s own
How to get an amalgam tattoo? (5)
Previous areas of mucosal abrasions can be contamiated by amalgam dust
Broken amalgam peices fall into extraction site
Contaminated dental floss cancreate linear areas of pigmentation
Endo retrofill
High speed drills driving particles into tissue
Melanoma vs Amalgam tattoo
Blue, Black, Brown
Amalgam tattoo:
Radiopaque, macules rather than raised lesion
If lesion is not radiopaque – take BIOPSY to rule out melanoma
Susuk
Southeast Asia
Placed by native magicion or medicin man
*Enhance and perserve beauty
* Relieve pain
* Bringsuccess
* Provide protection
Shaped like a needle
Orofacial region is most common placement
Lower lip piercings may cause (2)
Tissue recession lower mandibular anteriors
Granuloma formation from trauma
Smokers Melanosis – gingival pigmentation
Nicotene stimulates melanin production
Most commonly seen –> MANDIBULAR anterior facial gingiva
Cessationof smoking may see gradula disappearance
When to biopsy tissue pigmentation?
Not a smoker
Not dark skinned
Have gingival discolartion
Antral Pseudocysts
Domed shaped radiopaque lesionarising from the intact floor of the MAXILLARY sinus
No treatment
What does an antral pseudocyst contain?
EXUDATE accumulated under the sinus mucosa and causes sessile elevation
Radiopacity: Dome Shaped –>
Flat lined –>
Dome –> Antral pseudocyst
Flat –> Sinusitis
