Chapter 8 Flashcards
What is linea alba?
A white line typically located on buccal mucosa associated with pressure, irritation, or sucking trauma
What term describes chronic cheek chewing?
Morsicatio buccarum
What term describes lesions due to chronic biting on the labial mucosa?
Morsicatio labiorum
What term describes lesions due to chronic biting on the tongue?
Morsicatio linguarum
Morsicatio buccarum occurs in a higher prevalence in those under ______ or with ______ _______.
Stress or with psychologic conditions
Where is morsicatio buccarum typically found?
Bilaterally on the anterior buccal mucosa
What term describes areas of erythema surrounding a central, removable, yellow fibrinopurulent membrane caused by trauma?
Traumatic ulceration
Where do traumatic ulcerations commonly occur?
On lips, tongue and buccal mucosa
What kind of border can develop immediately adjacent to the ulceration?
A rolled white border of hyperkeratosis
What term describes a unique form of chronic traumatic ulceration characterized by eosiniphils?
Traumatic ulcerative granuloma with stromal eosinophilia aka eosinophilic ulceration
What type of reaction is traumatic ulcerative granuloma with stromal eosiniophilia?
A deep pseudoinvasice inflammatory reaction that is slow to resolve
Where does traumatic ulcerative granuloma with stromal eosiniophilia usually occur?
On the tongue, because the skeletal muscle damage attracts eosinophils
How is traumatic ulcerative granuloma with stromal eosinophilia treated?
Incisional biopsiy is usually curative (and removing the source of injury)
What term describes chronic ulcerations found under the tongue in infants due to trauma from nursing?
Riga-Fede disease
How are traumatic ulcerations treated?
By removing the source of injury if possible, but medication for pain relief (topical analgesics) can useful
When is a biopsy warranted in traumatic ulcers?
In cases that do not resolve after 2 weeks
What are the 2 types of electrical burns?
Contact and Arc
How many burn admissions to hospitals are electrical burns to the oral cavity?
5% of all burn admissions to hospitals
What do electrical burns appear as in the oral cavity?
Painless, charred, yellow area that doesn’t bleed, with edema. Area becomes necrotic and begins to slough around the 4th day.
What do most thermal burns of the oral cavity arise from?
Ingestion of hot foods or beverages
What do thermal burns of the oral cavity appear as?
Appear as zones of erythema and ulceration
What can cause chemical burns in the oral cavity?
Holding medication within their mouths (aspirin, bisphosphonates, chlorpromazine, promazine)
What are some other things that can cause chemical injuries in the oral cavity by patient or dentist misuse?
Tooth whitening products, hydrogen peroxide, phenol, silver nitrate, certain endodontic materials, cotton roll, toothpaste
What tissues are primarily targeted by antineoplastic therapy?
Tissues with rapid turnover such as the oral epithelium, urogenital tract, and the bone marrow
How many patients receiving head and neck radiation have oral ramifications?
100% or patients receiving head and neck radiation have oral ramification
What are the 2 predominant oral problems that result from antineoplastic therapy?
Oral mucositis and hemorrhage
What are some other oral complications of antineoplastic therapy?
Xerostomia, loss of taste, osteoradionecrosis, trismus, developmental abnormalities
What does BRONJ stand for?
Bisphosphonate-Related Osteonecrosis of the Jaws
How do bisphophonates work?
Inhibit osteoclasts, and possible interfere with angiogenesis
What are bisphosphonates used for?
Slow osseous involvement of cancer, treat Paget’s disease, and reverse osteoporosis
What are some characteristics of first generation bisphosphonate medications?
1st gen bisphosphonates have a low potency and are readily metabolized
2nd generation bisphosphonates are termed ___________ due to the addition of a ________ side chain.
aminobisphosphonates due to the addition of a nitrogen side chain
True or False: 2nd gen bisphosphonates are less potent and are not incorporated into the skeleton
False, 2nd gen BPs are MORE potent and are INCORPORATED into the skeleton (and have a half life of 10 years)
What area of the body has the highest rate of incorporation of BPs?
The jaws (highest in active remodeling)
What percentage of Bisphosphonate-related osteonecrosis of the jaws occurs in patients who have received IV formulations?
95% of BRONJ occurs in patients who have recieved IV formulations, and 85% of patients had multiple myeloma
What is the prevalence of osteonecrosis in patients taking IV bisphosphonates, and the prevalence in patients taking oral bisphosphonates?
6-8% for IV BPs, and 1:100,000 for oral BPs
When does BRONJ occur?
60% of BRONJ occur after a dental procedure, and 40% occur spontaneously
Why does treatment of BRONJ vary?
Formulation of the drug, extent of disease, duration of drug use
Should routine dental therapy be modified in patients taking bisphosphonates?
No, routine dental therapy should probably not be modified
What should precautions should be taken in patients taking bisphosphonates when manipulation of bone is needed?
PO BPs - informed consent, IV BPs - avoid manipulation of bone
If BRONJ is suspected, what should be done?
Refer to an oral surgeon! Get treated ASAP
What is methamphetamine?
A powdered stimulant that can be smoked, snorted, injected, or taken orally
Most methamphetamine users are ________.
Men ages 20-40
What is parasitosis?
Neurosis that produces the sensation of snakes/insects crawling on or under the skin, caused by methamphetamine use
How does methamphetamine use affect oral health?
Rampant dental caries occurs due to poor oral hygiene and extreme xerostomia, leading to consumptions of sugary and acidic drinks/food
How does methamphetamine use affect the use of local anesthetics?
Meth potentiates the sympathomimetic amines for up to 6 hours
Use of local anesthetics with epinephrine on patients using methamphetamine can lead to what 3 things?
Hypertensive crisis, cerebral vascular accident, myocardial infarction
What term describes a persistent scaling and flaking of the vermilion border?
Exfoliative cheilitis
What are some of the causes of submucosal hemorrhage?
Repeated coughing or vomiting, convulsions, oral sex, anticoagulant therapy, thrombocytopenia, disseminated intravascular coagulation, viral infections
What are petechiae?
Pin point submucosal hemorrhage
What are purpura?
Bruises (submucosal hemorrhage)
What is ecchymosis?
Submucosal hemorrhage covering an area, like a limb
When should submucosal hemorrhages be treated?
When they are associated with systemic disease
What term describes dark staining caused pigmented material that have been implanted in the oral mucosa?
Amalgam tattoo
What are some of the ways that amalgam can be incorporated into the oral mucosa?
Mucosal abrasion and amalgam dust, broken amalgam pieces falling into extraction sites, contaminated dental floss, endodontic retrofill, high speed handpieces
What are some other materials that can be implanted into the mucosa?
Pencil graphite, coal dust, metal dust, broken disk, dental burs
How do confirm your diagnosis of amalgam tattoo?
Radiographs, no treatment required if it can be detected by x ray but if not detectable, a biopsy must be done to rule out melanoma
What are some consequences of having piercings in the oral cavity?
Chipped tooth/teeth, periodontal defect or trauma, infection, inflammatory lesions
What is a susuk?
Implantation of a magical charm thought to enhance or preserve beauty relieve pain, bring success, provide protection
What term describes a production or melanin caused by nicotine stimulation?
Smoker’s melanosis
What is the most common location of smoker’s melanosis?
Usually anterior facial gingiva
What percentage of smokers will have oral pigmentation?smoker’s melanosis?
About 20% or tobacco smokers will have oral pigmentation
How can smoker’s melanosis be treated?
Cessation of smoking results in gradual disappearance
When should biopsy be considered for smoker’s melanosis?
When pigmentation is in an unexpected location or if there are clinical changes
What term describes a dome shaped, slight radiopaque lesion arising from the intact floor of the maxillary sinus?
Antral pseudocyst
What does an antral pseudocyst consist of?
An exudate
Is treatment necessary for an antral pseudocyst?
Treatment is not necessary, unless it is contributing to increased sinus pressure
What term describes an introduction of air into subcutaneous or fascial spaces of the face and neck?
Cervicofacial emphysema
When can cervicofacial emphysema occur?
After use of compressed air, after difficult/prolonged extractions, or as a result of increased intraoral pressure after an oral surgery (sneezing)
How can cervicofacial emphysema be prevented?
Avoiding use of air driven hand pieces during oral surgery
When can cervicofacial emphysema become painful?
After the air spread and the enlargement increases
How does one distinguish cervicofacial emphysema from angioedema?
By checking for crepitus within the swelling
How is cervicofacial emphysema treated?
Broad spectrum ABX, it will resolve withing 2-5 days
