Chapter 8

Question 1

What is linea alba?

Answer 1

A white line typically located on buccal mucosa associated with pressure, irritation, or sucking trauma

Question 2

What term describes chronic cheek chewing?

Answer 2

Morsicatio buccarum

Question 3

What term describes lesions due to chronic biting on the labial mucosa?

Answer 3

Morsicatio labiorum

Question 4

What term describes lesions due to chronic biting on the tongue?

Answer 4

Morsicatio linguarum

Question 5

Morsicatio buccarum occurs in a higher prevalence in those under ______ or with ______ _______.

Answer 5

Stress or with psychologic conditions

Question 6

Where is morsicatio buccarum typically found?

Answer 6

Bilaterally on the anterior buccal mucosa

Question 7

What term describes areas of erythema surrounding a central, removable, yellow fibrinopurulent membrane caused by trauma?

Answer 7

Traumatic ulceration

Question 8

Where do traumatic ulcerations commonly occur?

Answer 8

On lips, tongue and buccal mucosa

Question 9

What kind of border can develop immediately adjacent to the ulceration?

Answer 9

A rolled white border of hyperkeratosis

Question 10

What term describes a unique form of chronic traumatic ulceration characterized by eosiniphils?

Answer 10

Traumatic ulcerative granuloma with stromal eosinophilia aka eosinophilic ulceration

Question 11

What type of reaction is traumatic ulcerative granuloma with stromal eosiniophilia?

Answer 11

A deep pseudoinvasice inflammatory reaction that is slow to resolve

Question 12

Where does traumatic ulcerative granuloma with stromal eosiniophilia usually occur?

Answer 12

On the tongue, because the skeletal muscle damage attracts eosinophils

Question 13

How is traumatic ulcerative granuloma with stromal eosinophilia treated?

Answer 13

Incisional biopsiy is usually curative (and removing the source of injury)

Question 14

What term describes chronic ulcerations found under the tongue in infants due to trauma from nursing?

Answer 14

Riga-Fede disease

Question 15

How are traumatic ulcerations treated?

Answer 15

By removing the source of injury if possible, but medication for pain relief (topical analgesics) can useful

Question 16

When is a biopsy warranted in traumatic ulcers?

Answer 16

In cases that do not resolve after 2 weeks

Question 17

What are the 2 types of electrical burns?

Answer 17

Contact and Arc

Question 18

How many burn admissions to hospitals are electrical burns to the oral cavity?

Answer 18

5% of all burn admissions to hospitals

Question 19

What do electrical burns appear as in the oral cavity?

Answer 19

Painless, charred, yellow area that doesn’t bleed, with edema. Area becomes necrotic and begins to slough around the 4th day.

Question 20

What do most thermal burns of the oral cavity arise from?

Answer 20

Ingestion of hot foods or beverages

Question 21

What do thermal burns of the oral cavity appear as?

Answer 21

Appear as zones of erythema and ulceration

Question 22

What can cause chemical burns in the oral cavity?

Answer 22

Holding medication within their mouths (aspirin, bisphosphonates, chlorpromazine, promazine)

Question 23

What are some other things that can cause chemical injuries in the oral cavity by patient or dentist misuse?

Answer 23

Tooth whitening products, hydrogen peroxide, phenol, silver nitrate, certain endodontic materials, cotton roll, toothpaste

Question 24

What tissues are primarily targeted by antineoplastic therapy?

Answer 24

Tissues with rapid turnover such as the oral epithelium, urogenital tract, and the bone marrow

Question 25

How many patients receiving head and neck radiation have oral ramifications?

Answer 25

100% or patients receiving head and neck radiation have oral ramification

Question 26

What are the 2 predominant oral problems that result from antineoplastic therapy?

Answer 26

Oral mucositis and hemorrhage

Question 27

What are some other oral complications of antineoplastic therapy?

Answer 27

Xerostomia, loss of taste, osteoradionecrosis, trismus, developmental abnormalities

Question 28

What does BRONJ stand for?

Answer 28

Bisphosphonate-Related Osteonecrosis of the Jaws

Question 29

How do bisphophonates work?

Answer 29

Inhibit osteoclasts, and possible interfere with angiogenesis

Question 30

What are bisphosphonates used for?

Answer 30

Slow osseous involvement of cancer, treat Paget's disease, and reverse osteoporosis

Question 31

What are some characteristics of first generation bisphosphonate medications?

Answer 31

1st gen bisphosphonates have a low potency and are readily metabolized

Question 32

2nd generation bisphosphonates are termed ___________ due to the addition of a ________ side chain.

Answer 32

aminobisphosphonates due to the addition of a nitrogen side chain

Question 33

True or False: 2nd gen bisphosphonates are less potent and are not incorporated into the skeleton

Answer 33

False, 2nd gen BPs are MORE potent and are INCORPORATED into the skeleton (and have a half life of 10 years)

Question 34

What area of the body has the highest rate of incorporation of BPs?

Answer 34

The jaws (highest in active remodeling)

Question 35

What percentage of Bisphosphonate-related osteonecrosis of the jaws occurs in patients who have received IV formulations?

Answer 35

95% of BRONJ occurs in patients who have recieved IV formulations, and 85% of patients had multiple myeloma

Question 36

What is the prevalence of osteonecrosis in patients taking IV bisphosphonates, and the prevalence in patients taking oral bisphosphonates?

Answer 36

6-8% for IV BPs, and 1:100,000 for oral BPs

Question 37

When does BRONJ occur?

Answer 37

60% of BRONJ occur after a dental procedure, and 40% occur spontaneously

Question 38

Why does treatment of BRONJ vary?

Answer 38

Formulation of the drug, extent of disease, duration of drug use

Question 39

Should routine dental therapy be modified in patients taking bisphosphonates?

Answer 39

No, routine dental therapy should probably not be modified

Question 40

What should precautions should be taken in patients taking bisphosphonates when manipulation of bone is needed?

Answer 40

PO BPs - informed consent, IV BPs - avoid manipulation of bone

Question 41

If BRONJ is suspected, what should be done?

Answer 41

Refer to an oral surgeon! Get treated ASAP

Question 42

What is methamphetamine?

Answer 42

A powdered stimulant that can be smoked, snorted, injected, or taken orally

Question 43

Most methamphetamine users are ________.

Answer 43

Men ages 20-40

Question 44

What is parasitosis?

Answer 44

Neurosis that produces the sensation of snakes/insects crawling on or under the skin, caused by methamphetamine use

Question 45

How does methamphetamine use affect oral health?

Answer 45

Rampant dental caries occurs due to poor oral hygiene and extreme xerostomia, leading to consumptions of sugary and acidic drinks/food

Question 46

How does methamphetamine use affect the use of local anesthetics?

Answer 46

Meth potentiates the sympathomimetic amines for up to 6 hours

Question 47

Use of local anesthetics with epinephrine on patients using methamphetamine can lead to what 3 things?

Answer 47

Hypertensive crisis, cerebral vascular accident, myocardial infarction

Question 48

What term describes a persistent scaling and flaking of the vermilion border?

Answer 48

Exfoliative cheilitis

Question 49

What are some of the causes of submucosal hemorrhage?

Answer 49

Repeated coughing or vomiting, convulsions, oral sex, anticoagulant therapy, thrombocytopenia, disseminated intravascular coagulation, viral infections

Question 50

What are petechiae?

Answer 50

Pin point submucosal hemorrhage

Question 51

What are purpura?

Answer 51

Bruises (submucosal hemorrhage)

Question 52

What is ecchymosis?

Answer 52

Submucosal hemorrhage covering an area, like a limb

Question 53

When should submucosal hemorrhages be treated?

Answer 53

When they are associated with systemic disease

Question 54

What term describes dark staining caused pigmented material that have been implanted in the oral mucosa?

Answer 54

Amalgam tattoo

Question 55

What are some of the ways that amalgam can be incorporated into the oral mucosa?

Answer 55

Mucosal abrasion and amalgam dust, broken amalgam pieces falling into extraction sites, contaminated dental floss, endodontic retrofill, high speed handpieces

Question 56

What are some other materials that can be implanted into the mucosa?

Answer 56

Pencil graphite, coal dust, metal dust, broken disk, dental burs

Question 57

How do confirm your diagnosis of amalgam tattoo?

Answer 57

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

Question 58

What are some consequences of having piercings in the oral cavity?

Answer 58

Chipped tooth/teeth, periodontal defect or trauma, infection, inflammatory lesions

Question 59

What is a susuk?

Answer 59

Implantation of a magical charm thought to enhance or preserve beauty relieve pain, bring success, provide protection

Question 60

What term describes a production or melanin caused by nicotine stimulation?

Answer 60

Smoker's melanosis

Question 61

What is the most common location of smoker's melanosis?

Answer 61

Usually anterior facial gingiva

Question 62

What percentage of smokers will have oral pigmentation?smoker's melanosis?

Answer 62

About 20% or tobacco smokers will have oral pigmentation

Question 63

How can smoker's melanosis be treated?

Answer 63

Cessation of smoking results in gradual disappearance

Question 64

When should biopsy be considered for smoker's melanosis?

Answer 64

When pigmentation is in an unexpected location or if there are clinical changes

Question 65

What term describes a dome shaped, slight radiopaque lesion arising from the intact floor of the maxillary sinus?

Answer 65

Antral pseudocyst

Question 66

What does an antral pseudocyst consist of?

Answer 66

An exudate

Question 67

Is treatment necessary for an antral pseudocyst?

Answer 67

Treatment is not necessary, unless it is contributing to increased sinus pressure

Question 68

What term describes an introduction of air into subcutaneous or fascial spaces of the face and neck?

Answer 68

Cervicofacial emphysema

Question 69

When can cervicofacial emphysema occur?

Answer 69

After use of compressed air, after difficult/prolonged extractions, or as a result of increased intraoral pressure after an oral surgery (sneezing)

Question 70

How can cervicofacial emphysema be prevented?

Answer 70

Avoiding use of air driven hand pieces during oral surgery

Question 71

When can cervicofacial emphysema become painful?

Answer 71

After the air spread and the enlargement increases

Question 72

How does one distinguish cervicofacial emphysema from angioedema?

Answer 72

By checking for crepitus within the swelling

Question 73

How is cervicofacial emphysema treated?

Answer 73

Broad spectrum ABX, it will resolve withing 2-5 days