Physical and Chemical Injuries Flashcards
Iatrogenic Injury
(4)
- Cotton roll injury
- Dental thermoplastic compound
- X-ray film trauma
- Lacerations
Factitial Injury
Self-inflicted injury caused
by the patient
Munchausen syndrome -
a psychiatric disorder in which the patient finds
disease or illness in order to draw attention or sympathy to themselves.
Familial Dysautonomia
(3)
- Autosomal recessive,
Ashkenazi Jewish heritage - Lack of response to painful
stimuli results in injuries - Absence of fungiform
papillae
Complications of Piercings
(3)
- Infections – acute bacterial,
hepatitis, HIV, infective
endocarditis - Chipped, fractured teeth
- Periodontal lesions
Electrical Burns
(3)
- 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
Thermal Burns
(4)
Hot foods or beverages -
microwave ovens
* Palate, posterior buccal mucosa
* Erythema and ulceration
* Resolve without treatment
Epithelial Desquamation
(2)
- Toothpaste detergents - sodium lauryl sulfate – SLS
- Listerine
Drug-Associated Intrinsic Discoloration of Teeth
(2)
- 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
Tetracycline Staining of Teeth
* Avoid use of
tetracyclines during
pregnancy and in
children under —
years of age
8
Minocycline (Minocin)
(3)
- 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
Minocycline Staining of Erupted Teeth
(3)
- Drug binds to pulpal
collagen - Oxidation produces
discoloration - Occurs in 5% of users
within 1 month to 1 year of
use
Smoker’s Melanosis
(2)
- Oral pigmentation increased
significantly in heavy smokers - Exposure to polycyclic amines
stimulates melanin production
by melanocytes
skipped
Drug-Related Mucosal Pigmentation
(7)
- Anti-malarials
- Tranquilizers
- Chemotherapeutics
- Laxatives
- Antibiotics
- Birth control pills
- Anti-retrovirals
Zidovudine (Azidothymidine, AZT) Pigmentation
- AZT, an anti-retroviral agent, may produce
pigmentation of mucosa and nails
Hydroxychloroquine (Plaquenil) Pigmentation
- Plaquenil, an anti-malarial
drug is often used in lupus
erythematosis
Heavy Metal Toxicity
(3)
- 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)
Lead Poisoning – Plumbism (Pb)
(4)
- Environmental sources
- Gasoline additive
- Lead-based paints
- Water supply - lead solder in plumbing
Lead is chemically similar to
— and is deposited in
developing bone and teeth
forming bands of increased
density at metaphyses of
growing tubular bones
calcium
Lead Poisoning – Variable Presentation
(3)
- Anemia -
- Renal dysfunction
- Non-specific signs and
symptoms -
skipped
* Anemia -
hypochromic
microcytic with basophillic
stippling
skipped
* Non-specific signs and
symptoms -
fatigue,
irritability, weakness,
abdominal and
musculoskeletal pain,
headache (cerebral edema in
acute poisoning)
Oral Manifestations of Lead Poisoning
(4)
- Gingival lead line (Burton
line) - - Ulcerative stomatitis,
advanced periodontal
disease - Tongue tremor
- Metallic taste and
excessive salivation
Gingival lead line (Burton
line) -
bacterial H2S forms
lead sulfide in gingival
crevice, producing a bluish
line at marginal gingiva.
Sialorrhea -
excessive salivation (ptyalism)
Mercury Poisoning
(4)
- Elemental mercury poorly
absorbed, but mercury
salts and vapor well-
absorbed - Occupational exposure
- Dietary
- Medications - teething
powders, antihelminthics,
cathartics
Systemic Manifestations of Mercury Toxicity
- Acute and chronic exposure
- Acute –
abdominal pain,
vomiting, diarrhea
- Chronic –
gastrointestinal
upset, neurologic changes
Oral Manifestations of Mercury Poisoning
(5)
- Inflammation and enlargement
of salivary glands, tongue and
gingiva - Discoloration of gingiva
- Periodontal bone destruction -
mercuric sulfide - Ulcerative stomatitis
- Metallic taste
Acrodynia (Pink Disease, Swift Disease)
(3)
- Chronic mercury toxicity in infants
and children - Painful, pink discoloration of hands
and feet - Hypersalivation, ulcerative
gingivitis, premature loss of teeth
Systemic Silver Intoxication
(3)
- 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
Systemic Silver Intoxication
(4)
- Industrial exposure
- Prescription medications
- Topical medications - silver nitrate
- Over-the-counter drugs - colloidal silver
Angioedema
(4)
- 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
Allergic Angioedema
(5)
- 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
skipped
ACE-Inhibitor Angioedema
(4)
- 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
Hereditary Angioedema
(4)
- 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)
Therapeutic Irradiation
(2)
- External source
- Internal source
Acute Effects of Radiation Therapy
(2)
- Radiation kills both tumor cells
and normal cells - Mucositis and dermatitis
Chronic Head and Neck Effects of Radiation Therapy
(5)
- Dental anomalies
- Alveolar bone hypoplasia
- Mandibular hypoplasia
- Pituitary dysfunction
- Thyroid dysfunction
Chronic Effects of Radiation Therapy
(3)
- Xerostomia and hypogeusia
- Trismus
- Osteoradionecrosis
Radiation Damage to Salivary Glands
(4)
- Serous glands are most sensitive
- Mucous glands are more resistant
- Symptomatic xerostomia
- Xerostomia-related caries
Saliva in Xerostomia
(3)
Volume
* pH
* Buffering capacity
Acute Effects of Chemotherapy
(4)
- 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
Chronic Effects of Chemotherapy on Dentition
(3)
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
Clinical Definition of Osteoradionecrosis
(2)
- Exposed bone that persists for three
months in an irradiated area - Rare < 60 Gy
Osteoradionecrosis
(2)
- Bone death caused by radiation injury (avascular necrosis of bone)
- ORN is not a primary infection of bone. The infection is secondary.
Radiation Effect on Bone
(2)
- Permanent damage to osteocytes and microvasculature
- Bone is hypovascular, hypoxic, hypocellular
Pathogenesis of Osteoradionecrosis
(3)
- 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
Osteoradionecrosis of Mandible
(3)
- Squamous cell carcinoma of lateral border of tongue
- External beam RT
- Interstitial implants
Treatment of Osteoradionecrosis
(3)
- 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
Medication-Related Osteonecrosis of the Jaws - BRONJ
(4)
- 53 year-old female
- Spontaneous, bilateral,
asymptomatic ulceration
of edentulous maxilla of 1
month duration - Breast cancer - 1997
- Radiation therapy – bone
metastases to spine
Medication-Related Osteonecrosis of the Jaws - BRONJ
* Medications
(3)
– Bisphosphonate - Zometa
– Anti-estrogen – Arimidex
– Analgesic - Morphine
