Chapter 8 Physical and chemical injuries Flashcards
Where is linea alba located?
-Occlusal plane on the buccal mucosa
What is linea alba associated with?
- Sucking trauma
- Pressure
- Irritation
T/F Linea alba is typically bilateral
True
What is the scientific term for chronic cheek chewing?
-Morsicatio buccarum
If you have chronic lip chewing what is that called?
-Morsicatio labiorum
If you have chronic tongue chewing what is that called?
-Morsicatio linguarum
What does morsicatio (just epithelial) appear as?
- Thickened
- Shredded white areas
Where are the most common injuries for traumatic ulcerations?
- Lips
- Tongue
- Buccal mucosa
What can develop immediately adjacent to the traumatic ulceration?
-Rolled white border of hyperkeratosis
What do traumatic ulcers in the mouth appear as?
-Erythema surrounding a central removable, yellow fibrinopurulent membrane
What is a unique form of chronic traumatic ulceration termed?
- Eosinophilic ulceration
- TUGSE (Traumatic ulcerative granuloma with stromal eosinophilia)
Where would you expect to find a lot of eosinophils from TUGSE?
-Tongue (because of the muscle damage)
What does Eosinophilic ulcerations exhibit?
-Deep pseudoinvasive inflammatory process and is slow to resolve
What are chronic ulcerations found under the tongue of an infant due to nursing known as?
-Riga-Fede disease
How can you tell the difference between cancer and ulcers?
-Cancers are usually not perfectly symmetrical where ulcers are symmetrical
What is the treatment for traumatic ulcerations?
- Remove source of injury if possible
- Medications for pain relief
- Biopsy is warranted in cases that do not resolve after 2-4 weeks
What are the two types of electrical burns?
- Contact
- Arc
What do most thermal burns in the oral cavity arise from?
-Ingestion of hot foods or beverages
What do thermal burns appear as?
-Zones of erythema and ulceration
What does the electrical burn appear as?
-Painless, charred, yellow area that doesn’t bleed
What can occur when patients hold medications within their mouths rather than swallow them?
-Chemical injuries
What are some medications associated with chemical injuries?
- Aspirin
- Bisphosphonates
- Chlorpromazine
- Promazine
What other dental related things can cause chemical injuries?
- Tooth-whitening products
- Hydrogen peroxide
- Silver nitrate
- Certain endodontic materials
- Cotton rolls (pseudo burn)
Noninfectious oral complication of antineoplastic therapy has what tissues that are targeted?
-Tissues with rapid turnover
How many pts receiving Head and neck radiation have oral ramifications?
100% (noninfectious oral complication of antineoplastic therapy)
What are the predominant problems associated with noninfectious oral complication of antineoplastic therapy?
- Mucositis
- Hemorrhage
What is a hemorrhage secondary to?
-Thrombocytopenia (from bone marrow suppression)
What are the most common presentations of hemorrhage?
- Oral petechiae
- Ecchymosis
What does mucositis appear as?
-White discoloration from a lack of sufficient desquamation of keratin
Besides mucositis and hemorrhage what else can occur from cancer therapy?
- Xerostomia
- Loss of taste
- Osteoradionecrosis
- Trismus
- Developmental abnormalities
What treatment do you do for xerostomia?
- Topical fluoride
- Sialagogues
Bisphosphonate-related osteonecrosis of the jaws is caused by what?
-Bisphosphonates
What are bisphosphonates used for?
- Inhibit osteoclasts
- Interfere with angiogenesis
- Slow osseous involvement of cancer
- Paget’s disease
- Reverse osteoporosis
How long do second generation bisphosphonates have for a half life?
-Ten years
If a patient comes in and has been taking oral bisphosphonates what is their risk of getting BRONJ?
-1/100,000
If a patient comes in and has been getting IV bisphosphonates what is their risk of getting BRONJ?
6-8 %
T/F Routine dental therapy should be modified on patients taking oral bisphosphonates
False
-Probably Should not be modified
What are the two most common reasons to take Oral BP?
- Osteoporosis
- Osteopenia
What is the definition of MRONJ (medication related osteonecrosis of the jaw)?
- 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
What are two medications associated with MRONJ?
- Zoledrunate
- Denosumab
What is the biggest factor for getting MRONJ?
-Dentoalveolar treatment is a major risk
Does the maxilla or mandible have a higher chance of getting MRONJ?
-Mandible