physical and chemical injury Flashcards
iatrogenic
caused by provider
examples of iatrogenic injury
- Cotton roll injury
- Dental thermoplastic compound
- X-ray film trauma
- Lacerations
- suction
- post anesthetic lip chewing
Factitial Injury
Self-inflicted injury caused
by the patient
* Munchausen syndrome
Munchausen syndrome -
a psychiatric disorder in which the patient finds disease or illness in order to draw attention or sympathy to themselves.
inheritence, demo, absence of what strucutre?
Familial Dysautonomia/
Riley-Day Syndrome
- Autosomal recessive, Ashkenazi Jewish heritage
- Lack of response to painful stimuli results in injuries
- Absence of fungiform papillae
complications of body piercings
- Infections – acute bacterial,
hepatitis, HIV, infective endocarditis - Chipped, fractured teeth
- Periodontal lesions
where are these seen? initially present as? tx?
electrical burns
- 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
where in mouth? present as? tx?
thermal burns
- Hot foods or beverages -microwave ovens
- Palate, posterior buccal mucosa
- Erythema and ulceration
- Resolve without treatment
giving neck and oral trauma
Palatal Ecchymosis Secondary to Fellatio
cunnilingus trauma
Lingual Frenum Trauma Secondary to Cunnilingus, thickened frenum
french kissing trauma
frenum affected
aspirin burns
chemical burn due to aspirin in vestibule, presenting as a white sloughing in the mouth, usually gone within 24hrs
Epithelial Desquamation
Chemical Slough presentation/ causes
- Toothpaste detergents - sodium lauryl sulfate – SLS
- Listerine
present as removable sloughs of mucosa
Drug-Associated Intrinsic Discoloration of Teeth
- Certain drugs may be incorporated into developing tooth structure and produce clinically-evident discoloration
severity of drug indcued tooth discoloration depends on?
The severity of the effects depend on stage of tooth development and the dose/duration of the drug administration
when to avoid tetracyclines
- Avoid use of tetracyclines during pregnancy and in children under 8
years of age
tetracycline staining seen as
bands of discoloration
commonly used for?
Minocycline (Minocin)
Derivative of tetracycline commonly used for acne, rheumatoid arthritis and for periodontal disease
minocycline staining
May produce intrinsic discoloration of developing teeth and fully-developed teeth
* Also discolors bone, skin, sclera, conjunctiva
Minocycline Staining of Erupted Teeth mechanism
- Drug binds to pulpal collagen
- Oxidation produces discoloration
- Occurs in 5% of users within 1 month to 1 year of use
Smoker’s Melanosis
- Oral pigmentation increased
significantly in heavy smokers - Exposure to polycyclic amines
stimulates melanin production
by melanocytes
Drug-Related Mucosal Pigmentation drug types
- 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 can cause pigmentation of skin
Antimalarial Drug Pigmentation
can cause pigmentation in various regions
how metals interact with us? acute vs chronic? tx?
Heavy Metal Toxicity
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)
sources of Pb
Lead Poisoning – Plumbism (Pb)
- Environmental sources
- Gasoline additive
- Lead-based paints
- Water supply - lead solder in plumbing
plumbism presentation
lead similar to? result?
blood?
renal?
s/s?
what happens with acute poisonings?
- Lead is chemically similar to calcium and is deposited in developing bone and teethm forming 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)
Oral Manifestations of Lead Poisoning
gingiva, tongue, mucosa, taste, saliva, perio
- Gingival lead line (Burton line) - bacterial H2S forms lead sulfide in gingival crevice, producing a bluish line at marginal gingiva.
- Ulcerative stomatitis, advanced periodontal disease
- Tongue tremor
- Metallic taste and excessive salivation (sialorrhea)
absorbed? exposure from?
mercury poisoning
- Elemental mercury poorly absorbed, but mercury salts and vapor well absorbed
- Occupational exposure
- Dietary
- Medications - teething powders, antihelminthics, cathartics
acute and chronic exposures
Systemic Manifestations of Mercury Toxicity
- Acute – abdominal pain, vomiting, diarrhea
- Chronic – gastrointestinal upset, neurologic changes
Oral Manifestations of Mercury Poisoning
enlargement of?
discoloration?
bone?
mucosa?
taste?
- Inflammation and enlargement of salivary glands, tongue and gingiva
- Discoloration of gingiva
- Periodontal bone destruction -mercuric sulfide
- Ulcerative stomatitis
- Metallic taste
signs? oral signs?
Acrodynia (Pink Disease, Swift Disease)
- Chronic mercury toxicity in infants and children
- Painful, pink discoloration of hands and feet
- Hypersalivation, ulcerative gingivitis, premature loss of teeth
systemic Silver intoxication (Argyrosis)
dissemenated?
skin?
other affected tissues?
oral sign?
- 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
sources of silver for intoxication
- Industrial exposure
- Prescription medications
- Topical medications - silver nitrate
- Over-the-counter drugs - colloidal silver
Angioedema
additional names, defined, can affect, common presentation?
- 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
hypersensitivy?
mechanism?
stimuli?
responds to?
- 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
ACE-Inhibitor Angioedema
drug names?
mechanism?
does not respond to?
attacks may be precipitated by?
- 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
- 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)
danger associated?
forms of therapeutic radiation
internal and external
radiation injury possible (burns)
Acute Effects of Radiation Therapy
- Radiation kills both tumor cells
and normal cells - Can lead to Mucositis and dermatitis
Chronic Head and Neck Effects of Radiation Therapy
* Dental
* Alveolar bone
* Mandibular
* Pituitary
* Thyroid
- Dental anomalies
- Alveolar bone hypoplasia
- Mandibular hypoplasia
- Pituitary dysfunction
- Thyroid dysfunction
Chronic Effects of Radiation on Tissue
- Hypovascularity
- Hypoxia
- Hypocellularity - fibrosis
Chronic Effects of H/N Radiation Therapy orally
- Xerostomia and hypogeusia
- Trismus
- Osteoradionecrosis
Onset and Duration of Radiation-Induced Oral Sequellae
Radiation Damage to Salivary Glands
most/least sensitive glands?
result?
- Serous glands are most sensitive
- Mucous glands are more resistant
- Symptomatic xerostomia
- Xerostomia-related caries
Saliva in Xerostomia has what decreased qualities?
- Volume decreased
- pH decreased
- Buffering capacity decreased
Acute Effects of Chemotherapy
* cells killed
* most affected tissues?
* Oral
* Cytopenias
- 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 developing Dentition
* less severe than? effects?
* Effects depend on?
- 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
- Exposed bone that persists for three
months in an irradiated area - Rare < 60 Gy
infection?
ORN caused by
- Bone death caused by radiation injury (avascular necrosis of bone)
- ORN is not a primary infection of bone. The infection is secondary.
Radiation Effects on Bone
- Permanent damage to osteocytes and microvasculature
- Bone is hypovascular, hypoxic, hypocellular
Pathogenesis of Osteoradionecrosis
- 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 can be due to?
- Squamous cell carcinoma of lateral border of tongue tx = External beam RT
- Interstitial implants
how would ORN appear histo
bac devris present in hypocellualr bone
Treatment of Osteoradionecrosis
- 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 - MRONJ
often related to hx of? drugs?
- Spontaneous, bilateral, asymptomatic ulceration of edentulous maxilla
often occurs in those with hx of breast cancer- tx with: RT, Bisphosphonate (Zometa), Anti-estrogen (Arimidex), Analgesic (Morphine)
how would MRONJ appeart histo?
hypocellular bone with bac debris
