final - phys/chemical injuries

Question 1

extremely common “white line” located on the buccal mucosa at the level of the OP - usually bilateral

frictional irritation/trauma from teeth - passive keratosis

Answer 1

linea alba

Question 2

ragged superficial keratosis (active keratosis)

anterior buccal mucosa - symmetrically distributed above and below the OP

no ulceration

Answer 2

morsicatio buccarum - cheek chewing
~biopsy may be indicated to r/o oral hairy leukoplakia

morsicatio linguarum - tongue

morsicatio labiorum - labial mucosa

Question 3

removable yellowish-white fibrinopurulent membrane - surrounded by variable erythema and hyperkeratotic border
common lesion - any age group

buccal and labial mucosa, and tongue are most common sites

Answer 3

traumatic ulcer

sometimes fibrosis is so bad - ulcer won’t heal until we excise and achieve primary closure

Question 4

traumatic ulcer tx

Answer 4

eliminate source of trauma (broken cuso, overhang etc)

may protect the area of ulceration - Zilactin, Orabase (Doesn’t accelerate healing phases but does make it less tender )

if lesion doesn’t resolve - biopsy indicated

Question 5

Coagulation necrosis of the epi on palatal mucosa and anterior tongue

subepi vesicle/bulla formation if severe

generally heal relatively quickly

Answer 5

thermal injury

Question 6

white coagulation necrosis of the epi - heals rapidly once offending agent removed

Answer 6

chemical injury

aspirin, h202, phenol most common

Question 7

Chemotherapy-related epi necrosis

variety of mechanisms by which these drugs interfere with cellular metabolism, why oral? primarily affected

Answer 7

rapidly dividing cells

may begin within 1st few days of chemo

resolves 2-3 weeks after cessation of chem

Question 8

secondary to ionizing radiation used to tx malignancies in the head/neck region

involves tissue within field of radiation

damage to rapidly dividing basal cells

resolves 2-3 weeks after therapy ends

Answer 8

radiation mucositis

Anything tissue in the field of radtion
Usually only get this if head and neck

Short lived process

Question 9

Medication-related osteonecrosis of the jaws - MRONJ aka ARONJ,BRONJ,BON

first identified with _ 2003

now other antiresorptive and antigiogenic agents associated with osteonecrosis

Answer 9

bisphosphonates

bind to bone and inhibit it’s degradation (resportion) - but inhibiting osteoclast fxn

used for osteoporosis and pathologic bone resportion (pagets and malgnancies )

Question 10

bisphosphonates bin to bone and inhibit osteoclastic activity - decreasing bone turnover

1/2 life in bone is approx _

Answer 10

~10 years

skeletal effects for over 4 decades - “frozen skeleton”

Question 11

a newer type of anti-resorptive is also associated with ONJ

monoclonal Ab

Answer 11

denosumab

Question 12

very recently - other drugs without effects on osteoclasts have been assocaited with ONJ - antiangiogenic agents like _ and _

Answer 12

avastin

sunitinib

Question 13

Dx of MRONJ
-current or previous tx with a bisphosphonate or or agent

• exposed bone in the maxillofacial region persisting for more than _
• no history of _

Answer 13

8 weeks - non healing exposed bone for 8 weeks

no hx of radiation therapy to the jaws

Question 14

BRONJ

89% associated with _ therapy - mainly zoledronate and pamidronate

Answer 14

intravenous bisphos therapy

11% with oral therapy - txing osteoporosis main alendronate

mandible:maxilla = 2:1

Mandible more common than maxilla
More bone in mandi, less vascular

Primarily occurs in the jaws - rarely any where else  This is due to rate of turnover in the jaw is so fast compared to other bone

Question 15

BRONJ
67% of cases preceded by _ procedure

in cancer pt’s with BP’s - overall prevalence of ONJ is ~5%, prevalence in osteoporosis patients tx with BPs is 100x’s more/less? frequent

Answer 15

67% tooth extraction

7% - other dental factors

26% - no predisposing factor

100x less frequent osteoporosis

Question 16

MRONJ
_ is important

currently, optimal tx is uncertain - very few randomized prospective tx trials reported to date

Answer 16

prevention is important

oral eval prior to taking them

tx foci of infection and remove large tori or impacted teeth PRIOR to initiation of medication

for cancer pt’s on IV therapy - manipulation of bone should be avoided

Question 17

MRONJ
conservative measures are favored - primary goal is to minimize pain

asymptomatic patient?
symptomatic?

rough edges of exposed bone and be smoothed, sequestrectomy/minimal debridement - remove loose bone

Answer 17

asymp - daily use of CHX rinse and monitored closely

symptomatic - antibiotics with topical anti-bicaterial agents

necrosis may persist after drug cessation

Px - guarded, management may be prolonged

Question 18

BPs or other associated drugs should or should not be stopped without consulting physician

Answer 18

should never be stopped

risks associated with cancer and osteoporosis outweigh those of ONJ

Question 19

intentional or iatrogenic introduction of inert pigment within CT

flat, blue/black/gray lesion - homogeneous in color

Answer 19

foreign body tattoos

amalgam is most common, graphite

Question 20

_ production in the oral mucosa may serve as a protective response against harmful substance in tobacco smoke

Answer 20

melanin production

smokers melanosis

light brown, diffuse melanin pigmentation of the oral mucosa - anterior facial gingiva

extent/intensity correlates with how much smoke

Question 21

stimulation of melanin production by melanocytes vs. deposition of drug metabolites

Answer 21

drug-related discolorations of the oral mucosa

minocycline 
phenolphthalein
antimalarial agents
tranquilizers
chemotherapeutic agents
AIDS meds

Question 22

Oral ulceration with bone sequestration

focal superficial sequestration of a fragment of cortical bone

2nd to local trauma??

anatomic sites in which a bony prominence is covered by thin mucosal surface, like _

Answer 22

lingual surface posterior mandible along mylohyoid ridge

tx - spontaneous loss or surgical removal of the dead bone results in rapid healing

Question 23

Dome-shaped, faintly radiopaque lesion arising from floor of max sinus
inflammatory exudate accumulates under sinus mucosa and causes elevation

common 1-14% of population
asymptomatic - incidental finding on PAN

Answer 23

antral pseudocyst

harmless process
no tx beyond periodic followup