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Oral Pathology, Stephen > chpt 8 physical and chemical injuries > Flashcards

chpt 8 physical and chemical injuries Flashcards

1
Q

Common alteration of the buccal mucosa most often associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth, 13% of population

A

linea alba

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2
Q

What is the clinical presentation of linea alba

A

white line, bilateral at level of occlusal plane with no other associated problems

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3
Q

Linea alba treatment

A

None, no biopsy

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4
Q

What causes linea alba

A

hyperkeratosis

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5
Q

Lesion from chronic, habitual nibbling with a higher incidence in females presenting with thickend, shredded, white areas

A

Morsicatio Bucarum

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6
Q

How would differentiat Morsicatio Buccarum from Luekoplakia from Lichen planus

A

Morsicatio bucarum has ragged torn look Leukoplakia has homogenous look Lichen Planus has Striae of Wickam

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7
Q

What is chronic Lip chewing

A

Morsicatio Labiorum

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8
Q

Chronic tongue chewing

A

Morsicatio Linguarum

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9
Q

How could you differentiate Morsicatio Linguarum from Oral Hairy Leukoplakia

A

biopsy does not show EBV, candidiasis and no history of HIV

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10
Q

Ways to get Ulcerations

A

1) Physical Thermal
2) Electrical
3) TUGSE
4) Riga-Fede disease

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11
Q

What is TUGSE

A

Traumatic Ulcerative Granuloma with Stromal Eosinophilia

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12
Q

With what is TUGSE associated

A

Eosinophils = allergies or parasites

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13
Q

What is the only clinical differentiation between a TUGSE ulcer and an aphthous ulcer

A

TUGSE is slower to heal (>7 days)

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14
Q

These are traumatic ulcerations of the ventral tongue in nursing babies and are a variation of TUGSE

A

Riga-Fede disease

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15
Q

Represent 5% of all burn admissions

A

Electrical burns

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16
Q

2 types of electrical burns and which is most common oral

A

Contact and Arc. Arc is most common orally with saliva acting as conductor

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17
Q

Age and most common location for electric burns

A

<4 years old. Lips and commissures presenting charred yellow with little bleeding

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18
Q

3 stages of treatment of ulcers (in order)

A

1.) Remove obvious injury
2.) Treat symptoms: cellulose films, topical
antibiotics, Orabase)
3.) If not healed in 2 weeks, Biopsy

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19
Q

Are natal teeth associated with Riga-Fede disease extra teeth or are they the babies deciduous teeth simply erupted early

A

early erupted deciduous teeth.

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20
Q

Sources of Chemical injuries

A

Aspirin OTC meds
Gasoline
Iatrogenic dental chemicals (formocreosol, etch,
Hydrogen peroxide, Silver nitrate)

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21
Q

Why are OTC meds a source of chemical injuries

A

Have a lot of eugenol and phenol

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22
Q

How can one get a cotton roll burn

A

either cotton roll wicks out moisture and causes necrosis, or holds caustic chemicals against the epithelium, or is removed and takes epithelium w/ it

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23
Q

All systemic anticancer therapies (antineoplastic therapies) cause what

A

death of some normal cells

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24
Q

What are the 2 acute oral changes associated w/ cancer chemotherapy

A

Mucocitis

Hemorrhage

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25
Q

Where does oral mucocitis associated with cancer chemotherapy present

A

nonkeratinized surfaces (Buccal mucosa, ventrolateral tongue, soft palate, floor of mouth)

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26
Q

How does Oral Mucocitis associated with cancer chemotherapy and radiation treatment look clinically

A

early develops white discoloration from lack of keratin desquamation followed by loss of that layer & replacement by atrophic mucosa that is edematous, erythmatous & friable. Finally is ulcerated and covered by yellowish fibrinopurulent membrane

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27
Q

Where does Radition therapy acute mucocitis present

A

mucosal surface w/in direct portals of radiation

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28
Q

What are the 2 acute changes associated with cancer radiation therapy

A

Acute mucocitis

Dermatitis

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29
Q

What is the character of Radiation Therapy Dermatitis based on

A

Varies w/ amount received. Can be erythema, edema, burning, purities all the way to necrosis and deep ulcerations

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30
Q

What are the 5 Sequelae (a pathological condition resulting from disease [Wiki definition]) to Cancer Chemotherapy

A
  • increased susceptibility to infection
  • Oral mucocitis
  • Oral ulceration
  • Increased risk of hemorrhage
  • Impaired healing
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31
Q

The introral hemorrhage that is a sequelae of cancer chemotherapy is secondary to what

A

thrombocytopenia caused by bone marrow suppression

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32
Q

This is a complication associated with head and neck radiation

A

Xerostomia

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33
Q

What is the course of radiation induced Xerostomia

A

changes after 1 week. Decrease in saliva after 6 weeks. Parotids dramatically/irreversibly affected. Decreased bactericidal activity of saliva cause increased caries

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34
Q

8 Sequelae of Radiation therapy

A

1) Hemorrhage 2) Mucocitis 3)Dermatitis
4) Xerostomia 5) Osteoradionecrosis
6) Loss of taste/ altered taste(Hypgeusia/dysguesia) 7) Trismus
8) Developmental anomalies (e.g. microdonts, hyloglossia) –> dependent on age and treatment

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35
Q

What can cause the osteoradionecrosis

A

hypoxia, hypovascularity, hypocellularity

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36
Q

What increases the risk of developing osteoradionecrosis and what are the treatment limits

A

Surgery. Do anything you can either 21 days prior to radiation (to allow healing prior to therapy) or wait 1 year after radiation therapy is complete

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37
Q

What can dentist do pretherapy for cancer patient

A

remove current or potential oral foci of infection. Give OHI

38
Q

What can dentist do during cancer therapy (Intratherapy)

A

relieve pain, dehydration, malnutrition via admin of anesthetic, analgesics, antimicrobial, or coating agent

39
Q

What can dentist do posttherapy for cancer patient

A

Topical fluoride, salivary substitutes, sugarless candies, infection prevention

40
Q

What is the 1-2-3 Mouthwash

A

1/3 caopectate (coat mouth), 1/3 tetracycline (cut down on secondary infection), 1/3 benedryl (steroid to decrease inflammation)

41
Q

Bisphosphonates are used to slow the osseous involvements of what diseases

A

cancer (multiple myeloma, metastatic breast or prostate)
Paget’s disease
Osteoporosis

42
Q

When should elective surgical procedures be done on a patient who takes bisphosphonates

A

after discontinuance of drug and 3 month waiting period

43
Q

Most cases of Bisphosphonate-Associated Osteonecrosis (BONJ) follow what type of bisphosphonate administration

A

IV use

44
Q

What should one consider when pt is emaciated, agitated, nervous young adult with multiple Class V carious lesions

A

Methamphetamine abuse or trouble with VCU parking

45
Q

Why worry about treating a patient that is high on methamphetamine

A

potentiates effects of sympathomimetic amines, so local w/ epi can lead to HTN crisis, cerevrovascular accident, myocardial infarction

46
Q

Ulceration and Necrosis developing several days after local anesthesia due to tissue ischemia

A

Anesthetic Necrosis

47
Q

Persistent scaling and flaking of the vermillion border, usually involving both lips associated with chronic habitual lip licking, biting, picking or sucking

A

Exfoliative Cheilitis

48
Q

What is can be a sequelae of Exfoliative Cheilitis

A

bacterial or fungal infection (e.g. angular cheilitis)

49
Q

Treatment of Exfoliative Cheilitis

A

psychotherapy/intervention for habit. Antibacterial/antimycotic/ steroid lip cream for angular cheilitis

50
Q

2 causes of submucosal hemorrhage

A

Traumatic

Non-traumatic

51
Q

Minute hemorrhages into skin, mucosa, or serosa

A

Petechiae

52
Q

Slightly larger area than petechiae

A

Purpura

53
Q

accumulation of boold within a tissue that produces a mass

A

Hematoma

54
Q

3 causes of Non-Traumatic Submucosal Hemorrhage

A

1) Thrombocytopenia
2) Disseminated intravascular coagulopathy (DIC)
3) Viral infection (Mononucleosis [EBV, HHV-4],
Measels [Rubeola])

55
Q

Submucosal hemorrhage that is over 2 cm

A

ecchymosis

56
Q

Patient has palatal erythema, petechiae or purpura, or lingual frenum tears or tongue ulcerations, part of the differential should include

A

oral sex (can use this as a clue for sexual abuse )

57
Q

Incorporation of Amalgam into oral mucosa

A

Amalgam tattoo

58
Q

4 ways to get an amalgam tattoo

A

1) mucosal abrasion containing amalgam
2) Amalgam fragments in extraction socket
3) Dental floss transfer
4) Endodontic retrofill procedures

59
Q

If dark lesion along the gumline , but not evident on radiograph, what is required

A

Biopsy to differentiate from Melanoma

60
Q

What is another means of getting oral localized exogenous pigmentation beyond an amalgam tattoo

A
  • intentional tattooing
  • Pencil lead
  • Bullet fragments
61
Q

What are the acute and chronic complications of Oral Piercings

A

acute: bleeding, infection, nerve damage.
Chronic: speech impediment, nickel allergy, chipped teeth, aspiration

62
Q

An oral piercing is an example of what type of injury

A

Factitial (self-inflicted)

63
Q

6 systemic metallic intoxications

A

1) Lead/Plumbism
2) Mercury/Acrodynia
3) Silver/Argyria
4) Bismuth
5) Arsenic
6) Gold

64
Q

Lead overdose is called what and has what oral manifestations

A
  • PLUMBISM
  • Ulcerative stomatitis
  • Gingival lead line (BURTON’S LINE)
  • Metallic taste
  • Tongue tremor
65
Q

Mercury overdose is called what and has what oral manifestations

A
  • ACRODYNIA/pink disease/Swift disease
  • Hypersalivation
  • Ulcerative gingivitis
  • Bruxism/loss of teeth
66
Q

Silver overdose is called what and has what oral manifestations and skin manifestations

A
  • ARGYRIA
  • Slate blue gingival margins
  • Grayish skin discoloration
67
Q

What is the line called associated w/ Plumbism and when is it seen

A

Burton’s line. Gingival inflammation as in gingivitis

68
Q

Oral pigementation is increases significantly in what demographic

A

Smokers = SMOKER’S MELANOSIS

69
Q

Pigmentary changes caused by polycyclic amines stimulating melanin by melanocytes is limited to what part of the mouth in Smoker’s Melanosis

A

Anterior Facial Gingiva

70
Q

What gender is more sensitive to increased melanin pigmentation

A

Females

71
Q

What drug can cause staining of the gingival as a result of the drugs deposition in the underlying bone

A

minocycline

72
Q

Meds associated with Drug Related Discoloration of the Oral Mucosa

A
  • phenolphthalein
  • Tranquilizers
  • Estrogen
  • AIDS meds
  • Minocycline
  • Antimalarials
  • Chemotherapeutics
73
Q

Cartilage or bone discovered within soft tissue specimens removed from the oral cavity as the body’s way of reacting to constant irritation in an area (e.g. under denture on edentulous ridge)

A

Reactive Osseous and Chondromatous Metaplasia

74
Q

How will Reactive Osseous and Chondromatous Metaplasia appear under a denture on the alveolar ridge

A

Extremely tender and localized area

75
Q

What hobby/occupation is Reactive Osseuous and Chrondromatous Metaplasia common in, just not in the mouth

A

Equestrians on the inner thigh

76
Q

Lesion that normally arises without patient knowing and in absence of trauma along the lingual surface of the mandible along the mylohyoid ridge, with the associated loff of the overlying oral mucosa

A

Spontaneous Sequestrations

77
Q

These are commonly found on a panoramic as a dome-shaped faint radiopacity arising from the floor of the maxiallary sinus usually having an inflammatory exudates. It pushes the sinus epithelial lining up above it

A

Antral Pseudocyst

78
Q

When have an increased prevalence of antral pseudocysts been noted

A

during winter months

79
Q

What must be ruled out or treated as a cause of an antral pseudocyst

A

odontogenic infection

80
Q

This is also in the maxillary sinus but it is an accumulation of mucin encased in epithelium

A

Sinus mucocelle

81
Q

2 types of sinus mucocelles

A

1) Surgical Ciliated cyst

2) Obstructed sinus ostium

82
Q

Surgical ciliated cyst occurs when

A

portion of sinus linging gets separated from main body of sinus and forms epithelium lined cavity into which it secretes mucin

83
Q

When the sinus ostium gets blocked, how is that sinus mucocelle formed

A

entire blocked sinus acts as an epithelium lined cyst and fills with mucin

84
Q

These cysts arise from partial blockage of a duct of the sero-mucus glands or from an invagination of the respiratory epithelium and associated with antral polyps commonly

A

Retention Cysts

85
Q

What is the character of a true sinus mucocelle(what will it do to bone and how will appear radiographically)

A

Will enlarge, expand bone and entire sinus will be cloudy on radiograph

86
Q

Caused by the introduction of air into subcutaneous or fascial spaces of the face and neck. Air can come from blowing or sneezing after extraction or dentist blowing air into wound w/ air/water syringe or handpiece.

A

CERVICOFACIAL EMPHYSEMA

87
Q

If the cervicofacial emphysema shows up hours after surgery, who is usually at fault

A

patient

88
Q

Cervicofacial emphysema treatment

A

Broad Spectrum Antibiotic and warm compress

89
Q

Radiographic radiolucency caused by dentist placing antibiotic in a petrolatum base into an extraction socket which will leave an asymptomatic circumscribed radiolucency looking like a residual cyst

A

MYOSPHERULOSIS

90
Q

Myospherulosis treatment

A

Surgical excision

91
Q

What can cervicofacial emphysema be confused with, and how can it be differentiated

A

confused with angioedema but cervicofacial emphysema will have crepitus in the swelling

Oral Pathology, Stephen (13 decks)

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