final - phys/chemical injuries Flashcards
extremely common “white line” located on the buccal mucosa at the level of the OP - usually bilateral
frictional irritation/trauma from teeth - passive keratosis
linea alba
ragged superficial keratosis (active keratosis)
anterior buccal mucosa - symmetrically distributed above and below the OP
no ulceration
morsicatio buccarum - cheek chewing
~biopsy may be indicated to r/o oral hairy leukoplakia
morsicatio linguarum - tongue
morsicatio labiorum - labial mucosa
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
traumatic ulcer
sometimes fibrosis is so bad - ulcer won’t heal until we excise and achieve primary closure
traumatic ulcer tx
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
Coagulation necrosis of the epi on palatal mucosa and anterior tongue
subepi vesicle/bulla formation if severe
generally heal relatively quickly
thermal injury
white coagulation necrosis of the epi - heals rapidly once offending agent removed
chemical injury
aspirin, h202, phenol most common
Chemotherapy-related epi necrosis
variety of mechanisms by which these drugs interfere with cellular metabolism, why oral? primarily affected
rapidly dividing cells
may begin within 1st few days of chemo
resolves 2-3 weeks after cessation of chem
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
radiation mucositis
Anything tissue in the field of radtion
Usually only get this if head and neck
Short lived process
Medication-related osteonecrosis of the jaws - MRONJ aka ARONJ,BRONJ,BON
first identified with _ 2003
now other antiresorptive and antigiogenic agents associated with osteonecrosis
bisphosphonates
bind to bone and inhibit it’s degradation (resportion) - but inhibiting osteoclast fxn
used for osteoporosis and pathologic bone resportion (pagets and malgnancies )
bisphosphonates bin to bone and inhibit osteoclastic activity - decreasing bone turnover
1/2 life in bone is approx _
~10 years
skeletal effects for over 4 decades - “frozen skeleton”
a newer type of anti-resorptive is also associated with ONJ
monoclonal Ab
denosumab
very recently - other drugs without effects on osteoclasts have been assocaited with ONJ - antiangiogenic agents like _ and _
avastin
sunitinib
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 _
8 weeks - non healing exposed bone for 8 weeks
no hx of radiation therapy to the jaws
BRONJ
89% associated with _ therapy - mainly zoledronate and pamidronate
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
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
67% tooth extraction
7% - other dental factors
26% - no predisposing factor
100x less frequent osteoporosis
MRONJ
_ is important
currently, optimal tx is uncertain - very few randomized prospective tx trials reported to date
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
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
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
BPs or other associated drugs should or should not be stopped without consulting physician
should never be stopped
risks associated with cancer and osteoporosis outweigh those of ONJ
intentional or iatrogenic introduction of inert pigment within CT
flat, blue/black/gray lesion - homogeneous in color
foreign body tattoos
amalgam is most common, graphite
_ production in the oral mucosa may serve as a protective response against harmful substance in tobacco smoke
melanin production
smokers melanosis
light brown, diffuse melanin pigmentation of the oral mucosa - anterior facial gingiva
extent/intensity correlates with how much smoke
stimulation of melanin production by melanocytes vs. deposition of drug metabolites
drug-related discolorations of the oral mucosa
minocycline phenolphthalein antimalarial agents tranquilizers chemotherapeutic agents AIDS meds
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 _
lingual surface posterior mandible along mylohyoid ridge
tx - spontaneous loss or surgical removal of the dead bone results in rapid healing
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
antral pseudocyst
harmless process
no tx beyond periodic followup
