Chapter 8 Flashcards by Jessica Ash

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

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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

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Morsicatio Labiorum

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Morsciatio linguarum

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Chronic long term inflammation may lead to ?

Premalignant lesions

Inflammation causes cells to divid constantly – may get a mutation that leads to cancer

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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

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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

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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

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Chemical burns – MEDICATIONS

Rather than swollowing it, it is placed in the cheek area to dissolve

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Medications that can cause chemical burns

Aspirin

Bisphosphonates

Psychoactive drugs ( chlorpromazine, promazine)

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Patient or dental misuse of materials – CHEMICAL BURNS

Tooth whitening

Hydrogen peroxide

Phenol

Silve nitrate

Endo materials

Cotton rolls

EDTA

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Cotton Roll Burns

Physical burn

Dries out the mucosa –> Mucosal fibers bind to the cotton

Make sure the WET the cotton roll before removing

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Antineoplastic Therapy

Antineoplastic therapy –> Stops tumor growth

** Targets tissue with rapid turnover (mucosal tissue)**

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Noninfectious oral complications of Antineoplastic Therapy

Mucositis and Hemorrhage

Xerostomia

Loss of taste

Osteoradionecrosis

Trismus

Developmental abnormalities

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_____ % of patients with Head and Neck radiation have oral ramifications

100

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_____ % of pts with BMT have oral complications

75%

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Hemorrhaging

Secondary to thrombocytopenia

Oral Petechia

Ecchymosis

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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 --\>** ## Footnote **Flat lined --\>**

Dome --\> Antral pseudocyst Flat --\> Sinusitis