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Dr. Murrahs class > Chapter 8: Physical and Chemical Injuries > Flashcards

Chapter 8: Physical and Chemical Injuries Flashcards

1
Q

what is associated with pressure, irritation, or sucking trauma, is present in 10% of the population, and is a single white line on the occlusal plane of the buccal mucosa?

A

linea alba

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2
Q

is linea alba typical unilateral or bilateral?

A

bilateral

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3
Q

what is the treatment for linea alba?

A

no biopsy or treatment is necessary

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4
Q

___ is the scientific name for cheek chewing

A

morsicatio buccarum

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5
Q

what are the scientific names for labial mucosa chewing and tongue chewing?

A
  • morsicatio laborium
  • morsicatio linguarum
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6
Q

there is a higher prevalence of morsicatio buccarum in those under ___ or with ___

A

under stress or with psychologic conditions

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7
Q

morsicatio buccarum is typically found where?

A

bilaterally on the anterior buccal mucosa

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8
Q

how does morsicatio buccarum appear clinically?

A

thickened, shredded white areas which may be ulcerated

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9
Q

what is the treatment for morsicatio buccarum?

A

no treatment is required; not a premalignant condition

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10
Q

___ is the result of acute or chronic trauma that can cause surface ulcerations

A

traumatic ulcerations

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11
Q

where are the most common oral locations of traumatic ulcerations? what is the injury due to?

A
  • lips, tongue, and buccal mucosa
  • injured from dentition
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12
Q

___ appears as areas of erythema surrounding a central removable, yellow fibrinopurulent membrane

A

traumatic ulcerations

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13
Q

___ can develop immediately adjacent to an oral traumatic ulceration

A

a rolled white border of hyperkeratosis

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14
Q

the unique form of chronic traumatic ulceration is termed ___ or ___

A

eosinophilic ulceration or TUGSE (traumatic ulcerative granuloma with stromal eosinophilia)

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15
Q

describe TUGSE and its treatment

A
  • traumatic ulcerative granuloma with stromal eosinophilia
  • exhibits a deep pseudoinvasive inflammatory process and is slow to resolve
  • incisional biopsy is usually curative
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16
Q

___ are chronic ulcerations found under the tongue in infants due to trauma from nursing

A

riga-fede disease (a form of traumatic ulcerations)

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17
Q

what is the treatment for traumatic ulcerations?

A
  • remove source of injury if possible
  • medications for pain releif - topical analgesics
  • biopsy is warranted in cases that do not resolve after 2-4 weeks
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18
Q

5% of all burn admissions to hospitals are from what?

A

electrical burns to the oral cavity

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19
Q

what are the two types of electrical burns?

A

contact and arc

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20
Q

what is required for contact burns?

A

a good ground and must involve electrical current passing through the body from the point of contact to the ground site

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21
Q

what can electric current cause?

A

cardiopulmonary arrest and it can be fatal

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22
Q

most electrical burns affecting the oral cavity are what type?

A

arc

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23
Q

in arc electrical burns of the oral cavity, ___ acts as a conducting medium and an electrical arc flows between the electrical source and the mouth

A

saliva

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24
Q

most cases of oral electrical burns are a result of what?

A

chewing on the female end of an extension cord or biting a live wire

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25
Q

most electrical burns occur in what age patient? what area is affected?

A

kids younger than 5 and affect the lip

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26
Q

what is the clinical presentation of oral electrical burns?

A
  • appears as a painless, charred, yellow area that doesn’t bleed
  • edema develops within a few hours
  • on the 4th day, the area becomes necrotic and begins to slough (may bleed profusely)
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27
Q

most thermal burns of the oral cavity arise from what?

A

the ingestion of hot foods or beverages

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28
Q

describe the location and clinical appearance of thermal burns

A
  • typically appear on the palate or posterior buccal mucosa as zones of erythema and ulceration
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29
Q

some patients hold medications within their mouths rather than swallow them, which can be caustic. what type of injury does this describe?

A

chemical injury

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30
Q

what are common medications that can cause chemical injuries in the oral cavity?

A
  • aspirin
  • bisphosphonates
  • two psychoactive drugs - chlorpromazine and promazine
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31
Q

other than medications, what are some other things that cause mucosal necrosis (chemical injury) by patient or dentist misuse?

A
  • tooth-whitening products
  • hydrogen peroxide
  • phenol
  • silver nitrate
  • certain endodontic materials
  • cotton roll
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32
Q

what tissues are targeted in noninfectious oral complications or antineoplastic therapy (aka anticancer treatment)?

A

tissues with rapid turnover, like the oral epithelium

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33
Q

how many people a year suffer acute or chronic oral side effects from anticancer treatment?

A

half a million people

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34
Q

___% of patients receiving head and neck radiation have oral ramifications

A

100%

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35
Q

___% of patients receiving BMT have oral complications

A

75%

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36
Q

what are the two predominant problems with anticancer therapy?

A

mucositis and hemorrhage

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37
Q

hemorrhage associated with anticancer treatments is secondary to ___. what are the most common presentations of hemorrhage?

A
  • secondary to thrombocytopenia (from bone marrow suppression)
  • oral petechiae and ecchymosis secondary to minor trauma are the most common presentations
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38
Q

how does mucositis that results from anticancer therapy present clinically?

A
  • white discoloration from a lack of sufficient desquamation of keratin
  • soon follows by a loss of keratin and replacement by atrophic mucosa
  • areas of ulceration develop
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39
Q

what are 5 main complications of anticancer therapy other than hemorrhage and mucositis?

A
  • xerostomia
  • loss of taste
  • osteoradionecrosis
  • trismus
  • developmental abnormalities
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40
Q

describe xerostomia that results from anticancer treatment

A
  • salivary glands are very sensitive to radiation
  • increase in caries risk
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41
Q

describe loss of taste that results from anticancer treatment

A
  • loss of all four tastes (hypogeusia) develops, but taste returns in about 4 months
  • some patients have a permanent altered taste (dysgeusia)
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42
Q

osteoradionecrosis associated with anticancer treatment occurs in about ___% of people receiving head and neck radiation

A

5%

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43
Q

the risk of osteoradionecrosis associated with anticancer treatment increases dramatically if what procedure is performed and during what time frame?

A

local surgical procedure is performed within 3 weeks of therapy or within 1 year after therapy

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44
Q

most cases of osteoradionecrosis associated with anticancer treatment are secondary to ___

A

local trauma

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45
Q

___ is the main associated factor for osteoradionecrosis associated with anticancer treatment

A

radiation dose

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46
Q

before therapy, what should be eliminated to avoid cases of osteoradionecrosis associated with anticancer treatment?

A

all foci of infection should be eliminated

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47
Q

what is BRONJ?

A

bisphosphonate-related osteonecrosis of the jaw

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48
Q

what are bisphosphonates used for?

A
  • inhibit osteoclasts
  • possibly interfere with angiogenesis
  • slow osseous involvement of cancer
  • treat paget’s disease
  • reverse osteoporosis
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49
Q

which generation bisphosphonates have a low potency and are readily metabolized?

A

first generation

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50
Q

second generation bisphosphonates are more potent than first generation, and are termed ___ due to the addition of a nitrogen side chain

A

aminobisphophonates

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51
Q

___ generation bisphosphonates are incorporated into the skeleton and have a half-life of 10 years; what location is the incorporation of the medication the highest?

A
  • second
  • the incorporation of the medication is highest in areas of active remodeling, such as the jaws
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52
Q

there is a strong association of ___ with aminobisphosphonates

A

gnathic osteonecrosis

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53
Q

95% of BRONJ occurs in patients who have received ___ for cancer. 85% of these patients had what type of cancer?

A
  • IV formulations for cancer
  • multiple myeloma
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54
Q

what is the prevalence of osteonecrosis in pateints taking IV bisphosphonates? what bout patients taking oral bisphosphonates?

A
  • 6-8%
  • 1:100,000
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55
Q

60% of BRONJ occurs after ___, ad the remaining 40% occur ___. what fraction are asymptomatic?

A
  • dental procedures
  • spontaneously
  • 1/3
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56
Q

what is the treatment for BRONJ?

A
  • formulation of the drug
  • extend of disease
  • duration of drug use
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57
Q

should routine dental therapy be modified for patients with BRONJ?

A

no

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58
Q

in the dental office, what should you do for patients taking PO bisphosphonates before bone manipulation? what about for patients taking IV bisphosphonates?

A
  • informed consent before bone manipulation
  • bone manipulation should be avoided in patients taking bisphosphonates
59
Q

if BRONJ is suspected, you should refer your patient to who?

A

the oral surgeon

60
Q

how can methamphetamines be ingested?

A

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

61
Q

most methamphetamine users are male or female? what age?

A

men ages 20-40

62
Q

many methamphetamine users develop delusions of ___

A

parasitosis (neurosis that produces the sensation of snakes/insects crawling on or under the skin)

63
Q

rampant dental caries can occur with methamphetamine use. what surfaces are affected first? what is it that actually causes rampant dental caries?

A
  • affects facial smooth and interproximal surfaces first
  • due to poor oral hygiene and extreme xerostomia, leading to consumption of sugary and acidic drinks/foods
64
Q

meth potentiates which local anesthetics for up to 6 hours?

A

sympathomimetic amines

65
Q

use of local anesthetics with epinephrine in meth patients can lead to what 3 things?

A
  • hypertensive crisis
  • cerebral vascular accident
  • myocardial infarction
66
Q
A

linea alba

67
Q
A

morsicatio buccarum

68
Q
A

morsicatio linguarum

69
Q
A

traumatic ulceration

70
Q
A

traumatic ulceration

71
Q
A

traumatic ulcerative granuloma with stromal eosinophilia

TUGSE

72
Q
A

riga-fede disease

73
Q
A

electrical burn

74
Q
A

thermal burn

75
Q
A

chemical burn

(from tooth-whitening strips)

76
Q
A

chemical burn

(from aspirin)

77
Q
A

chemical burn

(hydrogen peroxide)

78
Q
A

chemical burn

(phenol)

79
Q
A

chemical burn

(endodontic materials)

80
Q
A

chemical burn

(cotton rolls)

81
Q
A

noninfectious oral complications of antineoplastic therapy

82
Q
A

noninfectious oral complications of antineoplastic therapy

83
Q
A

noninfectious oral complications of antineoplastic therapy

84
Q

patient received head and neck radiation

A

osteoradionecrosis

85
Q

patient received head and neck radiation

A

osteoradionecrosis

86
Q
A

medication-related osteonecrosis of the jaw

aka bisphosphonate-related osteonecrosis of the jaw

87
Q
A

medication-related osteonecrosis of the jaw

aka bisphosphonate-related osteonecrosis of the jaw

88
Q
A

methamphetamine-related dental caries

89
Q

___ is persistent scaling and flaking of the vermillion border, and typically involves both lips

A

exfoliative cheilitis

90
Q

exfoliative cheilitis arises from excessive production and desquamation of ___

A

superficial keratin

91
Q

exfoliative cheilitis is usually due to chronic injury secondary to ___

A

habits such as lip licking

92
Q

is exfoliative cheilitis more common in males or females?

A

females

93
Q

what is the treatment for exfoliative cheilitis?

A

cessation of habits, corticosteroids, psychotherapy, or ruling out other underlying cause (fungus, for example)

94
Q
A

exfoliative cheilitis

95
Q

___ appears as a nonblanching zone with a red, pruple, blue, or black color

A

submucosal hemorrhage

96
Q

what are two types of submucosal hemorrhage?

A

oral petechiae and purpura

97
Q

what are some causes of oral petechiae/purpura?

A
  • repeated coughing or vomiting
  • convulsions
  • oral sex
  • anticoagulant therapy
  • thrombocytopenia
  • disseminated intravascular coagulation
  • viral infections, especially mono and measles
98
Q

what is the treatment for submucosal hemorrhage?

A

no treatment is required if the hemorrhage is not associated with systemic disease; the areas should resolve spontaneously

99
Q
A

submucosal hemorrhage (petechiae/purpura)

100
Q

___ is a clinically evident lesion caused by pigmented materials that can be implanted in the oral mucosa

A

amalgam tattoo

(can happen with other materials, but amalgam is by far the most common)

101
Q

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

A
  • previous areas of mucosal abrasion can be contaminated by amalgam dust within the oral fluids
  • broken amalgam pieces can fall into extraction sites
  • contaminated dental floss can create linear areas of pigmentations
  • endodontic retrofill can be left in the soft tissue
  • high-speed drills can drive fine particles in tissue
102
Q

in addition to amalgam, submucosal implantation of what other pigmented materials can occur?

A
  • pencil graphite
  • coal dust
  • metal dust
  • broken carborundum disks
  • dental burs
103
Q

___ appear as macules or (rarely) as raised lesions which are blue, black, or gray in color

A

amalgam tattoos

104
Q

any mucosal surface can be involved with an amalgam tattoo

what are the most common sites?

A
  • gingiva and alveolar mucosa
  • buccal mucosa
105
Q

what do PA radiographs of amalgam tattoos look like?

A
  • they are usually negative
  • when metallic fragments are visible on the radiograph, the clinical area of discoloration is large and extends past the size of the fragment
106
Q

how should you confirm the diagnosis of an amalgam tattoo to rule out melanoma?

A
  • take a radiograph of the affected areas
  • no treatment required if it can be detected via radiograph
  • to rule out melanoma, a biopsy must be done if it is not detected on the radiograph
107
Q
A

exfoliative cheilitis

108
Q
A

amalgam tattoo

109
Q
A

amalgam tattoo

110
Q
A

amalgam tattoo

111
Q
A

amalgam tattoo

112
Q

over 50% of college students have body piercings beyond the ___

A

earlobe

113
Q

describe forked tongue

A
  • the anterior 1/3 is split down the middle by pulling fishing line through a pierced hole and tightening the loop over a period of 3 weeks
  • if a laser or surgical instrument is used, cautery is necessary to prevent the halves from reuniting
114
Q

what is susuk?

A

implantation of a form of talisman (magical charm) in the orofacial region

115
Q

susuk is common in what area of the world, and is placed why who?

A
  • southeast asia
  • placed by a native american magician or medicine man
116
Q

what is susuk placement thought to do?

A
  • enhance or preserve beauty
  • relieve pain
  • bring success in business
  • provide protection against harm
117
Q

the majority of people with susuk are ___

A

muslim, although islam prohibits black magic

for this reason, individuals may deny placement of susuk even when confronted with evidence

118
Q

what is susuk shaped like? what is it made out of?

A
  • shaped like a needle; one pointed end and one blunt end
  • most are silver or gold and are 0.5x0.5mm
119
Q

___ vary from one to many and are inserted subcutaneously

A

susuk pins

120
Q

most patients with susuk are what age?

A

middle-aged adults

121
Q

what do susuk pin implants look like?

A

no clinical evidence exists; only found via routine radiograph

122
Q
A

forked tongue

123
Q
A

susuk

124
Q

are forked tongues and susuk associated with harmful effects? what is the treatment?

A

no, so no treatment is required

125
Q

___ occurs due to nicotine, which stimulates melanin production

A

smokers melanosis

126
Q

in patients with smokers melanosis, 20% of tobacco smokers 3% of nonsmokers have ___

A

oral pigmentation

127
Q

smokers melanosis most commonly affects what gingiva?

A

anterior facial gingiva

128
Q

in patients with smokers melanosis, reverse smokers show changes on ___

A

hard palate

129
Q

in patients with smokers melanosis, cessation of smoking results in ___

A

gradual disappearance

130
Q

when is a biopsy considered in smokers melanosis cases?

A

when pigmentation is in unexpected locations or if there are clinical changes

131
Q
A

smokers melanosis

132
Q

___ appear as dome-shaped, slight radiopaque lesion arising from the intact floor of the maxillary sinus

A

antral pseudocysts

133
Q

antral pseudocysts consis of ___

A

an exudate (serum, not mucin) that has accumulated under the sinus mucosa and caused a sessile elevation

134
Q

antral pseudocysts are common found ___

A

on panoramic radiographs

135
Q

antral pseudocysts are present in ___% of the population

A

2-15%

136
Q

what is the treatment for antral pseudocysts

A

no treatment necessary

137
Q
A

antral pseudocyst

138
Q

___ arises from introduction of air into the subcutaneous or fascial spaces of the face and neck

A

cervicofacial emphysema

139
Q

when can cervicofacial emphysema arise?

A
  • after use of compressed air
  • after difficult/prolonged extractions
  • result of increased intraoral pressure (sneezing) after an oral surgery procedure
140
Q

in patients with cervicofacial emphysema, what should you avoid during oral surgery?

A

do not use air-driven handpieces

141
Q

in cervicofacial emphysema, initial change is ___. after the initial air spreads, what happens?

A
  • a painless soft tissue enlargement
  • the enlargement increases and it becomes painful
142
Q

what is the treatment for cervicofacial emphysema?

A

broad-spectrum antibiotics

resolves within 2-5 days

143
Q
A

cervicofacial emphysema

Dr. Murrahs class (17 decks)

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