Inflammation and Repair Part II Flashcards
Examples of injury to oral soft tissue
***Aspirin/Phenol/Chemical burns
Meth use
Lesions from cocaine use
Self-induced injuries
Hematoma
Traumatic ulcer
Frictional keratosis
Linea Alba
Nicotinic Stomatitis
Tobacco pouch keratosis
Traumatic neuroma
Amalgam tattoo
Melanosis
Solar cheilitis
Mucocele
Saliolith
How is “meth mouth” categorized?
Rapid destruction of teeth as a result of:
-Meth acid content
-Decreased salivary flow
-Cravings for high sugar beverages
-Lack of oral hygiene
Characteristics of aspirin burns
Tissue becomes necrotic and white
Surface may slough off leaving a painful ulcer
Usually heals in 7 to 21 days
What are some dental materials that may cause chemical burns
Phenol- cavity sterilizing agent and cauterizing agent
Sodium hypochlorite
Ferric sulfate
Eugenol
Formocresol
How may electric burns occur in the mouth?
When infants or young children chew on electrical cords
Can cause permanent disfigurement and scarring
Treatment includes oral surgery, orthodontics and plastic surgery
What causes thermal burns?
Hot food- soup or cheese on pizza
Also from products containing hydrogen peroxide or eugenol
Lesions associated with cocaine use
Lesions on midline of hard palate associated with smoking crack cocaine- ulcers to keratotic lesions
Necrotic ulcers of tongue and epiglottis seen in users who freebase
What are some lesions that can occur as self-induced injuries?
Chronic lip, cheek or tongue biting
Trauma to gingiva from fingernails
Range from ulceration to epithelial hyperplasia to hyperkeratosis
What can lead to traumatic ulcers?
Cheek, lip or tongue biting
Denture irritation
Mucosal injury
Overzealous brushing
What is a traumatic granuloma?
Results from persistent trauma
Appears as a hards, raised lesion
Heals rapidly after biopsy
May resemble squamous cell carcinoma
What is a hematoma?
Accumulation of blood within tissue as a result of trauma
Frequently seen in buccal or labial mucosa
What is frictional keratosis?
Form of hyperkeratosis
Caused by chronic rubbing or friction against and oral mucosal surface
Opaque and white- resembles a callus
Treatment includes removing the cause of friction- must be differentiated from idiopathic leukoplakia
What is nicotine stomatitis?
Benign lesion associated with pipe, cigar or cigarette smoking
Initially appears as erythema
Increases in opacity as keratinization occurs
Raised red areas occur at openings of ducts and salivary glands
Characteristics of smokeless tobacco keratosis
White lesion located where chewing tobacco is placed, most often in mucobuccal fold
Early= granular/wrinkled
Long standing= Opaque white and corrugated
What is a traumatic neuroma?
Lesion caused by injury to a peripheral nerve
Treatment is surgical excision
What are palisaded encapsulated neuroma (PEN)?
Benign lesion presenting as a mucosal nodule- painless
Well circumscribed and contains nerve tissue surrounded by fibrous CT
Reactive hyperplastic lesion
When can amalgam tattoos occur?
During placement or removal of amalgam restorations or during extractions
Most common on the gingiva or edentulous alveolar ridge
What is melanosis?
Normal physiologic pigmentation of oral mucosa
-Can be genetic
-Or as a result of inflammation
What is solar cheilitis? (actinic cheilitis)
Breakdown of tissue of the lips caused by sun exposure
-lips are dry and cracked
-vermillion border is pale
Alcohol and tobacco use can increase risk of squamous cell carcinoma
What is a mucocele?
Lesion formed when a salivary duct is severed and mucous salivary gland secretion spills into adjacent CT
-Fluid-filled and cyst-like
Not a true cyst
What is a ranula?
Unilateral mucocele-like lesion that forms on the floor of the mouth
Associated w/ submandibular and sublingual ducts
What is a sialolith?
Salivary gland stone
What is necrotizing sialometaplasia?
Benign condition of salivary glands
-Moderately painful swelling/ulceration
-Thought to result from a blockage of blood supply resulting in salivary gland necrosis
What is acute and chronic sialadenitis?
Painful swelling of salivary gland caused by obstruction
Examples of reactive connective tissue hyperplasia
Pyogenic granuloma
Giant cell granuloma
Irritation fibroma
Denture-induced fibrous hyperplasia
Papillary hyperplasia of the palate
Gingival enlargement
Chronic hyperplastic pulpitis
What does reactive connective tissue hyperplasia consist of?
Proliferating, exuberant granulation tissue and hyperplastic fibrous CT
What is a pyogenic granuloma?
Proliferation of CT containing numerous BV as a result of trauma
Not a true granuloma
Appearance of pyogenic granuloma
Ulcerated and soft on palpation
Bleeds easily
Dark red to purple
Elevated- sessile or pedunculated
Usually on gingiva
Varies in size
In pregnant women, called pregnancy tumor
What is peripheral giant cell granuloma?
A lesion that contains many multinucleated giant cells, well-vascularized connective tissue, RBCs, and chronic inflammatory cells
Resembles pyogenic granuloma
What is peripheral ossifying fibroma?
Exophytic lesion usually emanating from the interdental papilla
What is the most commonly found mass on the gingiva? What is it caused by?
Fibroma
Caused by trauma
How do fibromas appear?
Broad based, exophytic lesion composed of dense, scar-like CT w/ few blood vessels
How does denture-induced fibrous hyperplasia occur?
From ill-fitting dentures
Occurs in elongated folds of tissue adjacent to the denture
What is inflammatory hyperplasia of the palate?
Induced by dentures
Appears on palatal mucosa and covered by multiple erythematous papillary projections. “cobblestones”
What is gingival enlargement?
Increase in bulk of free and attached gingiva, especially interdental papilla
Rounded margins, color variations. Generalized or localized
What causes gingival enlargement?
Local irritants
Hormonal changes
Drugs
Hereditary conditions
Idiopathic factors
Leukemia
What is chronic hyperplastic pulpitis?
Excessive proliferation of chronically inflamed dental pulp tissue
-Occurs in teeth with large, open carious lesions often in molars
-Usually asymptomatic
Types of inflammatory periapical lesions
Periapical abscess
Dental or periapical granuloma
Radicular cysts
Resorption of teeth
Focal sclerosing osteomyelitis
Alveolar osteitis (dry socket)
What can result from caries or trauma?
Inflammation
Infection
Chronic hyperplastic pulpitis
Necrosis of the pulp
What part of the tooth anatomy allows inflammation to begin in pulp and extend to the periapical area?
Accessory canals on the lateral portion of root
How are periapical abscesses characterized?
Purulent exudate surrounded by CT containing neutrophils and lymphocytes
-Severe pain
-Tooth may extrude from socket
-May or may not test positive w/ electric pulp testing
Why do fistulas form?
As a way for purulent exudate to be drained
What is a periapical granuloma?
Localized mass of chronically inflamed granulation tissue that forms at the opening of the pulp canal, generally at the apex of a non-vital tooth root
Characteristics of periapical granulomas
-Chronic process
-Most are asymptomatic
-May be sensitive to pressure or percussion
-Tooth may be slightly extruded
What are radicular cysts?
True epithelium lined cyst
-Associated w/ non-vital tooth
-Most common oral cyst
-Result of proliferation of rest of Malassez
-Usually asymptomatic
What are residual cysts?
Form after tooth extraction and all or part of radicular cyst is left behind
What are some causes of external tooth resorption?
Inflammation
Pressure
Reimplantation
Idiopathic
Causes of internal root resorption
Associated with inflammatory response in the pulp or idiopathic reason
How is tooth resorption treated?
If root is not perforatied, calcium hydroxide is placed and endodontic treatment is performed to attempt to save the tooth
If root is perforated it must be removed
