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Pathology > Physical and Chemical Injuries > Flashcards

Physical and Chemical Injuries Flashcards

1
Q

Iatrogenic Injury
(4)

A
  • Cotton roll injury
  • Dental thermoplastic compound
  • X-ray film trauma
  • Lacerations
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2
Q

Factitial Injury

A

Self-inflicted injury caused
by the patient

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3
Q

Munchausen syndrome -

A

a psychiatric disorder in which the patient finds
disease or illness in order to draw attention or sympathy to themselves.

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4
Q

Familial Dysautonomia
(3)

A
  • Autosomal recessive,
    Ashkenazi Jewish heritage
  • Lack of response to painful
    stimuli results in injuries
  • Absence of fungiform
    papillae
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5
Q

Complications of Piercings
(3)

A
  • Infections – acute bacterial,
    hepatitis, HIV, infective
    endocarditis
  • Chipped, fractured teeth
  • Periodontal lesions
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6
Q

Electrical Burns
(3)

A
  • 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 hours, followed by
    necrosis and sloughing by day 4
    (monitor for bleeding)
  • Minimize scar contracture with
    microstomia prevention appliance
    for 6 to 8 months
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7
Q

Thermal Burns
(4)

A

Hot foods or beverages -
microwave ovens
* Palate, posterior buccal mucosa
* Erythema and ulceration
* Resolve without treatment

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8
Q

Epithelial Desquamation
(2)

A
  • Toothpaste detergents - sodium lauryl sulfate – SLS
  • Listerine
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9
Q

Drug-Associated Intrinsic Discoloration of Teeth
(2)

A
  • Certain drugs may be
    incorporated into
    developing tooth structure
    and produce clinically-
    evident discoloration
  • The severity of the
    effects depend on stage of
    tooth development and the
    dose/duration of the drug
    administration
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10
Q

Tetracycline Staining of Teeth
* Avoid use of
tetracyclines during
pregnancy and in
children under —
years of age

A

8

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11
Q

Minocycline (Minocin)
(3)

A
  • Derivative of tetracycline
    commonly used for acne,
    rheumatoid arthritis and for
    periodontal disease
  • May produce intrinsic discoloration
    of developing teeth and fully-
    developed teeth
  • Also discolors bone, skin, sclera,
    conjunctiva
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12
Q

Minocycline Staining of Erupted Teeth
(3)

A
  • Drug binds to pulpal
    collagen
  • Oxidation produces
    discoloration
  • Occurs in 5% of users
    within 1 month to 1 year of
    use
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13
Q

Smoker’s Melanosis
(2)

A
  • Oral pigmentation increased
    significantly in heavy smokers
  • Exposure to polycyclic amines
    stimulates melanin production
    by melanocytes
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14
Q

skipped
Drug-Related Mucosal Pigmentation
(7)

A
  • Anti-malarials
  • Tranquilizers
  • Chemotherapeutics
  • Laxatives
  • Antibiotics
  • Birth control pills
  • Anti-retrovirals
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15
Q

Zidovudine (Azidothymidine, AZT) Pigmentation

A
  • AZT, an anti-retroviral agent, may produce
    pigmentation of mucosa and nails
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16
Q

Hydroxychloroquine (Plaquenil) Pigmentation

A
  • Plaquenil, an anti-malarial
    drug is often used in lupus
    erythematosis
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17
Q

Heavy Metal Toxicity
(3)

A
  • 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)
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18
Q

Lead Poisoning – Plumbism (Pb)
(4)

A
  • Environmental sources
  • Gasoline additive
  • Lead-based paints
  • Water supply - lead solder in plumbing
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19
Q

Lead is chemically similar to
— and is deposited in
developing bone and teeth
forming bands of increased
density at metaphyses of
growing tubular bones

A

calcium

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20
Q

Lead Poisoning – Variable Presentation
(3)

A
  • Anemia -
  • Renal dysfunction
  • Non-specific signs and
    symptoms -
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21
Q

skipped
* Anemia -

A

hypochromic
microcytic with basophillic
stippling

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22
Q

skipped
* Non-specific signs and
symptoms -

A

fatigue,
irritability, weakness,
abdominal and
musculoskeletal pain,
headache (cerebral edema in
acute poisoning)

23
Q

Oral Manifestations of Lead Poisoning
(4)

A
  • Gingival lead line (Burton
    line) -
  • Ulcerative stomatitis,
    advanced periodontal
    disease
  • Tongue tremor
  • Metallic taste and
    excessive salivation
24
Q

Gingival lead line (Burton
line) -

A

bacterial H2S forms
lead sulfide in gingival
crevice, producing a bluish
line at marginal gingiva.

25
Q

Sialorrhea -

A

excessive salivation (ptyalism)

26
Q

Mercury Poisoning
(4)

A
  • Elemental mercury poorly
    absorbed, but mercury
    salts and vapor well-
    absorbed
  • Occupational exposure
  • Dietary
  • Medications - teething
    powders, antihelminthics,
    cathartics
27
Q

Systemic Manifestations of Mercury Toxicity

A
  • Acute and chronic exposure
28
Q
  • Acute –
A

abdominal pain,
vomiting, diarrhea

29
Q
  • Chronic –
A

gastrointestinal
upset, neurologic changes

30
Q

Oral Manifestations of Mercury Poisoning
(5)

A
  • Inflammation and enlargement
    of salivary glands, tongue and
    gingiva
  • Discoloration of gingiva
  • Periodontal bone destruction -
    mercuric sulfide
  • Ulcerative stomatitis
  • Metallic taste
31
Q

Acrodynia (Pink Disease, Swift Disease)
(3)

A
  • Chronic mercury toxicity in infants
    and children
  • Painful, pink discoloration of hands
    and feet
  • Hypersalivation, ulcerative
    gingivitis, premature loss of teeth
32
Q

Systemic Silver Intoxication
(3)

A
  • 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
33
Q

Systemic Silver Intoxication
(4)

A
  • Industrial exposure
  • Prescription medications
  • Topical medications - silver nitrate
  • Over-the-counter drugs - colloidal silver
34
Q

Angioedema
(4)

A
  • Quincke disease,
    angioneurotic edema
  • 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
35
Q

Allergic Angioedema
(5)

A
  • IgE-mediated hypersensitivity
  • Type 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
36
Q

skipped
ACE-Inhibitor Angioedema
(4)

A
  • Angiotensin-converting enzyme
    inhibitors - 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
37
Q

Hereditary Angioedema
(4)

A
  • 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)
38
Q

Therapeutic Irradiation
(2)

A
  • External source
  • Internal source
39
Q

Acute Effects of Radiation Therapy
(2)

A
  • Radiation kills both tumor cells
    and normal cells
  • Mucositis and dermatitis
40
Q

Chronic Head and Neck Effects of Radiation Therapy
(5)

A
  • Dental anomalies
  • Alveolar bone hypoplasia
  • Mandibular hypoplasia
  • Pituitary dysfunction
  • Thyroid dysfunction
41
Q

Chronic Effects of Radiation Therapy
(3)

A
  • Xerostomia and hypogeusia
  • Trismus
  • Osteoradionecrosis
42
Q

Radiation Damage to Salivary Glands
(4)

A
  • Serous glands are most sensitive
  • Mucous glands are more resistant
  • Symptomatic xerostomia
  • Xerostomia-related caries
43
Q

Saliva in Xerostomia
(3)

A

Volume
* pH
* Buffering capacity

44
Q

Acute Effects of Chemotherapy
(4)

A
  • Chemotherapy 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
45
Q

Chronic Effects of Chemotherapy on Dentition
(3)

A

The effects of chemotherapy 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

46
Q

Clinical Definition of Osteoradionecrosis
(2)

A
  • Exposed bone that persists for three
    months in an irradiated area
  • Rare < 60 Gy
47
Q

Osteoradionecrosis
(2)

A
  • Bone death caused by radiation injury (avascular necrosis of bone)
  • ORN is not a primary infection of bone. The infection is secondary.
48
Q

Radiation Effect on Bone
(2)

A
  • Permanent damage to osteocytes and microvasculature
  • Bone is hypovascular, hypoxic, hypocellular
49
Q

Pathogenesis of Osteoradionecrosis
(3)

A
  • 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
50
Q

Osteoradionecrosis of Mandible
(3)

A
  • Squamous cell carcinoma of lateral border of tongue
  • External beam RT
  • Interstitial implants
51
Q

Treatment of Osteoradionecrosis
(3)

A
  • 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
52
Q

Medication-Related Osteonecrosis of the Jaws - BRONJ
(4)

A
  • 53 year-old female
  • Spontaneous, bilateral,
    asymptomatic ulceration
    of edentulous maxilla of 1
    month duration
  • Breast cancer - 1997
  • Radiation therapy – bone
    metastases to spine
53
Q

Medication-Related Osteonecrosis of the Jaws - BRONJ
* Medications
(3)

A

– Bisphosphonate - Zometa
– Anti-estrogen – Arimidex
– Analgesic - Morphine

Pathology (23 decks)

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