Chapter 8 Physical and chemical injuries

Question 1

Where is linea alba located?

Answer 1

-Occlusal plane on the buccal mucosa

Question 2

What is linea alba associated with?

Answer 2

• Sucking trauma
• Pressure
• Irritation

Question 3

T/F Linea alba is typically bilateral

Answer 3

True

Question 4

What is the scientific term for chronic cheek chewing?

Answer 4

-Morsicatio buccarum

Question 5

If you have chronic lip chewing what is that called?

Answer 5

-Morsicatio labiorum

Question 6

If you have chronic tongue chewing what is that called?

Answer 6

-Morsicatio linguarum

Question 7

What does morsicatio (just epithelial) appear as?

Answer 7

• Thickened

- Shredded white areas

Question 8

Where are the most common injuries for traumatic ulcerations?

Answer 8

• Lips
• Tongue
• Buccal mucosa

Question 9

What can develop immediately adjacent to the traumatic ulceration?

Answer 9

-Rolled white border of hyperkeratosis

Question 10

What do traumatic ulcers in the mouth appear as?

Answer 10

-Erythema surrounding a central removable, yellow fibrinopurulent membrane

Question 11

What is a unique form of chronic traumatic ulceration termed?

Answer 11

• Eosinophilic ulceration

- TUGSE (Traumatic ulcerative granuloma with stromal eosinophilia)

Question 12

Where would you expect to find a lot of eosinophils from TUGSE?

Answer 12

-Tongue (because of the muscle damage)

Question 13

What does Eosinophilic ulcerations exhibit?

Answer 13

-Deep pseudoinvasive inflammatory process and is slow to resolve

Question 14

What are chronic ulcerations found under the tongue of an infant due to nursing known as?

Answer 14

-Riga-Fede disease

Question 15

How can you tell the difference between cancer and ulcers?

Answer 15

-Cancers are usually not perfectly symmetrical where ulcers are symmetrical

Question 16

What is the treatment for traumatic ulcerations?

Answer 16

• Remove source of injury if possible
• Medications for pain relief
• Biopsy is warranted in cases that do not resolve after 2-4 weeks

Question 17

What are the two types of electrical burns?

Answer 17

• Contact

- Arc

Question 18

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

Answer 18

-Ingestion of hot foods or beverages

Question 19

What do thermal burns appear as?

Answer 19

-Zones of erythema and ulceration

Question 20

What does the electrical burn appear as?

Answer 20

-Painless, charred, yellow area that doesn’t bleed

Question 21

What can occur when patients hold medications within their mouths rather than swallow them?

Answer 21

-Chemical injuries

Question 22

What are some medications associated with chemical injuries?

Answer 22

• Aspirin
• Bisphosphonates
• Chlorpromazine
• Promazine

Question 23

What other dental related things can cause chemical injuries?

Answer 23

• Tooth-whitening products
• Hydrogen peroxide
• Silver nitrate
• Certain endodontic materials
• Cotton rolls (pseudo burn)

Question 24

Noninfectious oral complication of antineoplastic therapy has what tissues that are targeted?

Answer 24

-Tissues with rapid turnover

Question 25

How many pts receiving Head and neck radiation have oral ramifications?

Answer 25

100% (noninfectious oral complication of antineoplastic therapy)

Question 26

What are the predominant problems associated with noninfectious oral complication of antineoplastic therapy?

Answer 26

- Mucositis | - Hemorrhage

Question 27

What is a hemorrhage secondary to?

Answer 27

-Thrombocytopenia (from bone marrow suppression)

Question 28

What are the most common presentations of hemorrhage?

Answer 28

- Oral petechiae | - Ecchymosis

Question 29

What does mucositis appear as?

Answer 29

-White discoloration from a lack of sufficient desquamation of keratin

Question 30

Besides mucositis and hemorrhage what else can occur from cancer therapy?

Answer 30

- Xerostomia - Loss of taste - Osteoradionecrosis - Trismus - Developmental abnormalities

Question 31

What treatment do you do for xerostomia?

Answer 31

- Topical fluoride | - Sialagogues

Question 32

Bisphosphonate-related osteonecrosis of the jaws is caused by what?

Answer 32

-Bisphosphonates

Question 33

What are bisphosphonates used for?

Answer 33

- Inhibit osteoclasts - Interfere with angiogenesis - Slow osseous involvement of cancer - Paget's disease - Reverse osteoporosis

Question 34

How long do second generation bisphosphonates have for a half life?

Answer 34

-Ten years

Question 35

If a patient comes in and has been taking oral bisphosphonates what is their risk of getting BRONJ?

Answer 35

-1/100,000

Question 36

If a patient comes in and has been getting IV bisphosphonates what is their risk of getting BRONJ?

Answer 36

6-8 %

Question 37

T/F Routine dental therapy should be modified on patients taking oral bisphosphonates

Answer 37

False | -Probably Should not be modified

Question 38

What are the two most common reasons to take Oral BP?

Answer 38

- Osteoporosis | - Osteopenia

Question 39

What is the definition of MRONJ (medication related osteonecrosis of the jaw)?

Answer 39

- Current or previous treatment with anti-resorptive or anti-angiogenic agents - Exposed bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for longer than 8 weeks - No history of radiation therapy to the jaws or metastatic disease to the jaws

Question 40

What are two medications associated with MRONJ?

Answer 40

- Zoledrunate | - Denosumab

Question 41

What is the biggest factor for getting MRONJ?

Answer 41

-Dentoalveolar treatment is a major risk

Question 42

Does the maxilla or mandible have a higher chance of getting MRONJ?

Answer 42

-Mandible