Physical and Chemical Injuries Flashcards
Injury caused by the healthcare provider is ______
Iatrogenic
The following are \_\_\_\_ injuries: •Cotton roll injury •Dental thermoplastic compound •X-ray film trauma •Lacerations
Iatrogenic injuries
- Self-inflicted injury caused by the patient
* Munchausen syndrome
Factitial injury
- Autosomal recessive, Ashkenazi Jewish heritage
- Congenital indifference to pain: Lack of response to painful stimuli results in injuries
- Absence of fungiform papillae
- Riley-Day Syndrome
- Hereditary Sensory and Autonomic Neuropathy Type III (HSAN-III)
Familial Dysautonomia
- Commissures of lips of young children under 4 years from chewing through a live wire
- Initially a painless charred area with little or no bleeding
- Edema after several hoursnecrosis and sloughing by day 4
- Minimize scar contracture with microstomia prevention appliance for 6 to 8 months
Electrical burns
•Hot foods or beverages -microwave ovens •Palate, posterior buccal mucosa •Erythema and ulceration •Resolve without treatment -Heals without treatment
Thermal burns
- Introduction of air into subcutaneous tissues or fascial spaces causing soft tissue enlargement and crepitus
- Antibiotic coverage
- Gradually resolves over 2 to 5 days
- Complications–Pneumomediastinum–Respiratory distress
Cervicofacial Air Emphysema
- Parotid gland enlargement: air fills parotid duct system and insufflates the gland
- Self-induced
- Occupational
- Accidental
Pneumoparotid
- Communication between oral cavity and maxillary sinus
* Frequently secondary to dental extraction
Oroantral Fistula
What ingredient in toothpaste causes Epithelial Desquamation?
SLS
Avoid use of ______ during pregnancy and in children under 8 years of age to avoid staining
tetracyclines
•Derivative of tetracycline
•Commonly used for acne, rheumatoid arthritis and for periodontal disease
•May produce intrinsic discoloration of developing teeth and fully-developed teeth
–Bone, skin, sclera, conjunctiva
•Drug binds to pulpal collagen
•Oxidation produces discoloration
•Occurs in 5% of users within 1 month to 1 year of use
Minocycline
- Oral pigmentation increased significantly in heavy smokers
* Exposure to polycyclic amines stimulates melanin production by melanocytes
Smoker’s Melanosis
- Form complexes with biologic molecules that affect protein structure and inactivate enzyme systems
- Acute effects from massive ingestion and chronic effects from slow accumulation
- Treatment with chelating agents (EDTA)
Heavy Metal Toxicity
•_____ is chemically similar to calcium and is deposited in developing bone and teeth
–Bands of increased density at metaphyses of growing tubular bones
•Anemia: hypochromic microcytic with basophillic stippling •Renal dysfunction
•Non-specific signs and symptoms
–Fatigue, irritability, weakness, abdominal and musculoskeletal pain
–Headache (cerebral edema in acute poisoning)
Lead
: bacterial H2S forms lead sulfide in gingival crevice–Bluish line at marginal gingiva
Gingival lead line (Burton line)
Manifestations of _______ poisoning
•Oral:–Inflammation and enlargement of salivary glands, tongue and gingiva–Discoloration of gingiva–Periodontal bone destruction: mercuric sulfide–Ulcerative stomatitis–Metallic taste
•Systemic:–Acute and chronic exposure–Acute: abdominal pain, vomiting, diarrhea–Chronic: gastrointestinal upset, neurologic changes
Mercury poisoning
•Chronic mercury toxicity in infants and children•Painful, pink discoloration of hands and feet•Hypersalivation, ulcerative gingivitis, premature loss of teeth
Acrodynia
- Disseminated throughout the body
- Accumulates in skin producing a diffuse grayish-blue discoloration, especially in sun-exposed areas
- Sclera, nails, silver line on gingival margin
- Industrial exposure
- Prescription medications
- Topical medications: silver nitrate
- Over-the-counter drugs: colloidal silver
Argyria
- “Quinckedisease” “angioneuroticedema”
- Rapid, recurring, diffuse, edematous swelling of subcutaneous or submucosal soft tissues–Frequently the lips
- May involve gastrointestinal or respiratory tract mucosa
- The common clinical presentation of a group of conditions with different pathogenesis
Angioedema
- IgE-mediated hypersensitivityType I hypersensitivity reaction
- Mast cell degranulation and histamine release
- Contact allergic reaction to drugs, foods, plants, dust, inhalants, cosmetics, topical medications, rubber dam.
- Physical stimuli such as heat, cold, emotional stress, exercise, solar exposure, vibration
- Responds to antihistamines
Allergic Angioedema
______ drugs:
Captopril, Enalipril, Lisinopril
•Produces angioedema due to increased levels of bradykinin •Swelling does not respond well to antihistamines
•Attacks may be precipitated by dental procedures in long-term users
•Angiotensin-converting enzyme inhibitors
- C1 esterase inhibitor (C1-INH) deficiency
- Complement cascade triggered after trauma or spontaneously, producing vascular permeability and edema
- Mimics allergic angioedema, but produces more severe symptoms.
- Prophylaxis by C1-INH replacement (C1-INH concentrate)
Hereditary Angioedema
Which salivary glands are most sensitive to radiation?
Serous gland
Which salivary gland are more resistant to radiation?
Mucous glands
- _______ kills both tumor cells and normal cells
- Tissues with rapid turnover are affected most severely: mucosal surfaces and bone marrow
- Oral mucositis
- Cytopenias –thrombocytopenia, neutropenia, anemia
Chemotherapy
•The effects of _____ on the developing dentition are less severe than radiation therapy •Hypoplastic enamel defects, discoloration, root hypoplasia•Effects depend on stage of tooth development and the dose/duration of the chemotherapy
chemotherapy
Are the effects of chemotherapy or radiation more severe on the developing dentition?
Radiation
- Exposed bone that persists for three months in an irradiated area
- Bone death caused by radiation injury (avascular necrosis of bone)
- It is not a primary infection of bone: infection is secondary
- The irradiated bone has an absence of reserve reparative capacity with limited ability to meet even basic metabolic demands
- Trauma overwhelms reparative capacity
- Trauma may be caused by tooth extraction, pulpal disease, periodontitis, mucosal ulcers or denture-related injury produces a chronic non-healing wound
- Antibiotic therapy
- Surgical debridement of necrotic, infected bone
- Hyperbaric oxygen therapy (HBO) partially reverses cellular alterations of radiation and restores the microvasculature to higher level
Osteoradionecrosis
- Exposed bone or bone that can be probed through an intraoral or extraoral fistula* (sinus tract) in the maxillofacial region that has persisted for more than eight weeks
- No history of radiation therapy to the jaws or obvious metastatic disease to the jaws
MRONJ
•______: connection between two anatomic cavities or between an anatomic cavity and the surface: oral-antral / oral-nasal fistula –May also be created surgically for arteriovenous access: Arteriovenous fistula•
Fistula
____: connection between a pathologic cavity and the surface.–Draining sinus tract
Sinus
What are the 3 requirements for a good biopsy?
Representative
Orientable
Undistorted
