Physical and Chemical Injuries

Question 1

Frictional keratosis

Answer 1

Physiologic response of mucosa to chronic physical injury.

Produces hyperkeratosis as protective phenomenon (white

plaque)

Reversible

Question 2

Cheek chewing

(Morsicatio buccarum)

Answer 2

shredded or macerated keratinized tissue limited to occlusal plane

“linea alba” - chewing along a lineal plane

tongue chewing

histology: hyperkeratosis with bacterial colonization

Question 3

Traumatic ulcer

Answer 3

loss of surface epithelium from physical injury (trauma)

surface covered by fibrinous exudate (tan) ↑ kids,

↑ lateral tongue, lower lip, painful, self-limiting,

epithelium from ulcer margin migrates and recovers surface

Question 4

Traumatic granuloma

(Traumatic ulcerative granuloma with stromal eosinophilia)(TUGSE)

Answer 4

type of traumatic ulcer with injury to underlying muscle

↑↑ tongue, rolled borders,

doesn’t heal, clinical features of carcinoma

may need to biopsy to exclude carcinoma

biopsy may result in resolution, +/- intralesional steroids, +/- excision.

Question 5

Amalgam tattoo

Answer 5

slate bluish-grey discoloration from traumatic implantation of

amalgam, subsurface discoloration

persistent (amalgam nonbiodegradable)

radiograph ±

? biopsy to rule out melanoma

silver compounds stain collagen & blood vessel walls

Question 6

Hematoma

Answer 6

extravascular bleeding into tissue, resolves

Question 7

Petechiae

Answer 7

pinpoint bleeding from capillaries

thrombocytopenia (not making platelets) vs. local cause (Fellatio) - oral sex

Question 8

Oral Complications of radiation therapy for H&N cancer

Acute: Dermatitis Stomatitis

Answer 8

about 2nd week of therapy

erythema ± ulceration, painful, burning

subside within 2-3 weeks of cessation of treatment

Question 9

Oral Complications of radiation therapy for H&N cancer

Chronic: Xerostomia

Answer 9

salivary glands very sensitive (↑ serous)

↓ salivary flow - permanent

dryness - discomfort, burning, ± candidosis,

difficulty eating, speaking, swallowing

↑↑ cervical caries (daily topical fluoride tx)

Question 10

Oral Complications of radiation therapy for H&N cancer

Chronic: Osteoradionecrosis

Answer 10

radiation damages osteocytes and

microvasculature rendering bone hypoxic

and unable to remodel and respond to injury,

very prone to infection very serious as large

areas of bone die and sequestrate

Treat: Excision/resection

Question 11

Chemical Injuries

Burns

Answer 11

usually produces necrosis of epithelium (white)

which may or may NOT rub off

Aspirin, phenol, silver nitrate, ↑ acid/base

Question 12

Generalized gingival hyperplasia

Answer 12

Phenytoin (Dilantin) - for epilepsy, seizure control

Cyclosporin - immunosuppressant for organ transplantation

Ca channel blockers

• Nifedipine, Verapamil, and Diltiazem

50% of patients on phenytoin

severity mostly related to adequacy of oral hygiene

painless generalized swelling produces pseudopockets and ↑ inflammation

Tx: drug substitution or surgery

Question 13

Heavy metal ingestion

Answer 13

marginal gingiva stained due to precipitation of heavy metal

sulfides, lead, mercury, arsenic, cis-platinum

Question 14

• Allergy -

stomatitis medicamentosa

stomatitis venenata

Answer 14

Type I hypersensitivity – anaphylaxis – IgE

Type IV hypersensivity – Cell mediated - cytokins – white/red & white

Anaphylaxis - IgE-histamine mediated erythema

angioedema - lips swell

stomatitis medicamentosa (systemic) generalized, urticaria

stomatitis venenata (topical)

Cinnamon allergy (#1 allergy in America)

often tartar control toothpaste flavored with cinnamon

commonly red, white or combination

↑ desquamative gingivitis

cheek + buccal mucosa on same side suggests hypersensitivity