Physical and Chemical Injuries

Question 1

extremely common white line located on the buccal mucosa at the level of the occlusal plane

Answer 1

linea alba

Question 2

are lina albas usually bilateral or on one side?

Answer 2

bilateral

Question 3

ragged superfical keratosis that is associated with cheek chewing

Answer 3

morsicatio buccarum

Question 4

where is moriscatio buccarum located?

Answer 4

anterior buccal mucosa; symmetrically distributed above and below the plane of occlusion

*tongue or labial mucosa may show similar alterations

Question 5

is there ulceration with moriscatio buccarum?

Answer 5

no

Question 6

common lesion of any age group

Answer 6

traumatic ulcer

Question 7

what are the most common sites for traumatic ulcer?

Answer 7

buccal mucosa, labial mucosa, tongue

Question 8

what is the clinical appearance of a traumatic ulcer

Answer 8

removable, yellowish-white fibrinopurulent membrane; surounded by variable erythema and hyperkeratotic border

Question 9

what is the tx for traumatic ulcer

Answer 9

eliminate sources out trauma

• biopsy could be indicated
• possible excision

*no corticosteroids

Question 10

coagulation necrosis on the palatal mucosa or anterior tongue

Answer 10

thermal injury

Question 11

what does a severe thermal injury present as?

Answer 11

subepithelial vesicle/bulla formation if severe enough

Question 12

how long does thermal injury last for

Answer 12

quick

Question 13

what are the most common sources of chemical injury

Answer 13

• aspirin
• hydrogen peroxide
• phenol

Question 14

what is the clinical appearance of chemical injury?

Answer 14

white surface change due to coagulation necrosis of epithelium

Question 15

how long does a chemical injury take to heal?

Answer 15

heals rapidly

Question 16

variety of mechanisms by which these drugs interfere with cellular metabolism; rapidly dividing cells (such as oral mucosa) primarily affected

Answer 16

chemotherapy-related epithelial necrosis

Question 17

when doees chemotherapy-related epithelial necrosis start?

Answer 17

within the first few days of chemo

Question 18

when does chemotherapy-related epithelial necrosis resolve?

Answer 18

2-3 weeks after cessation of chemo

Question 19

injury that occurs secondary to ionizing radiation used to treat malignancies in head and neck region

Answer 19

radiation mucositis

Question 20

where does radiation mucositis affect?

Answer 20

involves tissue within the field of radiation

*causes damage to rapidly dividing basal cells of oral mucosa

Question 21

when does radiation mucositis end?

Answer 21

2-3 weeks after therapy ends

Question 22

first identifies with BISPHOSPHONATES, now other resporptive agents and other meds associated with osteonecrosis

Answer 22

medication-related osteonecrosis of the jaws (MRONJ)

Question 23

What do bisphosphonates do?

Answer 23

bind to bone and inhibit its degradation (resorption) by inhibiting osteoclast function

*dec bone turnover

Question 24

what three things do you need to dx MRONJ?

Answer 24

• current or previous tx with a bisphosphonate or other associated agent
• exposed bone in the maxillofacial region, persisting for more than 8 weeks
• no history of radiation therapy to the jaws

Question 25

what is the tx for BRONJ?

Answer 25

- 89% associated with INTRVENOUS therapy - treating malignancy - 11% associated with ORAL therapy - treating osteoporosis *involves the mandible over the maxilla 2:1

Question 26

what is the prevalence of BRONJ in cancer pts treated with Bisphosphonates

Answer 26

5% *prevalance in osteoporosis pts treated with BPs is 10-100 fold lower

Question 27

what types of measures for treating MRONJ are favored?

Answer 27

conservative measures *minimal debridement, antibiotics, antibacterial agents

Question 28

what is the px for MRONJ?

Answer 28

GUARDED

Question 29

bisphosphonates (can)/(should never) be stopped without consulting prescribing physician

Answer 29

should never *risks associated with cancer and osteoporosis virtually always outweigh those of ONJ

Question 30

what is the most common type of foreign body tattoo?

Answer 30

amalgam (graphite)

Question 31

what might an amalgam tattoo require?

Answer 31

a biopsy to rule out melanocytic lesions

Question 32

melanin production in the oral mucosa may serve as a protective response against harmful substances in tobacco smoke. shows up as light brown, diffuse melanin pigmentation of the oral mucosa.

Answer 32

smokers melanosis

Question 33

where is smokers melanosis most commonly seen

Answer 33

anterior facial gingiva

Question 34

what does the extent/intensity of pigmentation of smokers melanosis depend on

Answer 34

number of cigs smoked per day

Question 35

type of discoloration of the oral mucosa that is associated with multiple meds whose clinical presentation may be diffuse or unique pattern

Answer 35

drug-related discoloration of the oral mucosa

Question 36

what does discontinuing meds result in for drug related discolorations of the oral mucosa?

Answer 36

gradual fading

Question 37

focal superficial sequestration of a fragment of cortical bone that may be secondary to trauma.

Answer 37

oral ulceration with bone sequestration

Question 38

where are oral ulcerations with bone sequestrations usually found?

Answer 38

anatomic sites in which a bony prominence is covered by thin mucosal surface *lingual surface posterior mandible along mylohyoid ridge

Question 39

what is the tx of oral ulceration with bone sequestration?

Answer 39

spontaneous loss or surgical removal of the dead bone results in rapid healing

Question 40

dome-shaped, faintly radiopaque lesion arising from the floor of the maxillay sinus

Answer 40

antral pseudocyst

Question 41

how common are antral pseudocysts?

Answer 41

common (1.5-14% of population)

Question 42

what causes antral pseudocysts?

Answer 42

inflammatory exudate accumulates under sinus mucosa and causes elevation

Question 43

what is the tx for antral pseudocysts?

Answer 43

harmless process, no treatment necessary beyond periodic radiographic follow-up