physical and chemical injury Flashcards
1
Q
iatrogenic
A
caused by provider
2
Q
examples of iatrogenic injury
A
- Cotton roll injury
- Dental thermoplastic compound
- X-ray film trauma
- Lacerations
- suction
- post anesthetic lip chewing
3
Q
Factitial Injury
A
Self-inflicted injury caused
by the patient
* Munchausen syndrome
4
Q
Munchausen syndrome -
A
a psychiatric disorder in which the patient finds disease or illness in order to draw attention or sympathy to themselves.
5
Q
inheritence, demo, absence of what strucutre?
Familial Dysautonomia/
Riley-Day Syndrome
A
- Autosomal recessive, Ashkenazi Jewish heritage
- Lack of response to painful stimuli results in injuries
- Absence of fungiform papillae
6
Q
complications of body piercings
A
- Infections – acute bacterial,
hepatitis, HIV, infective endocarditis - Chipped, fractured teeth
- Periodontal lesions
7
Q
where are these seen? initially present as? tx?
electrical burns
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
8
Q
where in mouth? present as? tx?
thermal burns
A
- Hot foods or beverages -microwave ovens
- Palate, posterior buccal mucosa
- Erythema and ulceration
- Resolve without treatment
9
Q
giving neck and oral trauma
A
Palatal Ecchymosis Secondary to Fellatio
10
Q
cunnilingus trauma
A
Lingual Frenum Trauma Secondary to Cunnilingus, thickened frenum
11
Q
french kissing trauma
A
frenum affected
12
Q
aspirin burns
A
chemical burn due to aspirin in vestibule, presenting as a white sloughing in the mouth, usually gone within 24hrs
13
Q
Epithelial Desquamation
Chemical Slough presentation/ causes
A
- Toothpaste detergents - sodium lauryl sulfate – SLS
- Listerine
present as removable sloughs of mucosa
14
Q
Drug-Associated Intrinsic Discoloration of Teeth
A
- Certain drugs may be incorporated into developing tooth structure and produce clinically-evident discoloration
15
Q
severity of drug indcued tooth discoloration depends on?
A
The severity of the effects depend on stage of tooth development and the dose/duration of the drug administration
16
Q
when to avoid tetracyclines
A
- Avoid use of tetracyclines during pregnancy and in children under 8
years of age
17
Q
tetracycline staining seen as
A
bands of discoloration
18
Q
commonly used for?
Minocycline (Minocin)
A
Derivative of tetracycline commonly used for acne, rheumatoid arthritis and for periodontal disease
19
Q
minocycline staining
A
May produce intrinsic discoloration of developing teeth and fully-developed teeth
* Also discolors bone, skin, sclera, conjunctiva
20
Q
Minocycline Staining of Erupted Teeth mechanism
A
- Drug binds to pulpal collagen
- Oxidation produces discoloration
- Occurs in 5% of users within 1 month to 1 year of use
21
Q
Smoker’s Melanosis
A
- Oral pigmentation increased
significantly in heavy smokers - Exposure to polycyclic amines
stimulates melanin production
by melanocytes
22
Q
Drug-Related Mucosal Pigmentation drug types
A
- Anti-malarials
- Tranquilizers
- Chemotherapeutics
- Laxatives
- Antibiotics
- Birth control pills
- Anti-retrovirals
23
Q
Zidovudine (Azidothymidine, AZT) Pigmentation
A
- AZT, an anti-retroviral agent, may produce pigmentation of mucosa and nails
24
Q
Hydroxychloroquine (Plaquenil) Pigmentation
A
Plaquenil, an anti-malarial drug is often used in lupus erythematosis can cause pigmentation of skin
25
Antimalarial Drug Pigmentation
can cause pigmentation in various regions
26
# 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)
27
# sources of Pb
Lead Poisoning – Plumbism (Pb)
* Environmental sources
* Gasoline additive
* Lead-based paints
* Water supply - lead solder in plumbing
28
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)
29
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)
30
# absorbed? exposure from?
mercury poisoning
* Elemental mercury poorly absorbed, but mercury salts and vapor well absorbed
* Occupational exposure
* Dietary
* Medications - teething powders, antihelminthics, cathartics
31
# acute and chronic exposures
Systemic Manifestations of Mercury Toxicity
* Acute – abdominal pain, vomiting, diarrhea
* Chronic – gastrointestinal upset, neurologic changes
32
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
33
# 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
34
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
35
sources of silver for intoxication
* Industrial exposure
* Prescription medications
* Topical medications - silver nitrate
* Over-the-counter drugs - colloidal silver
36
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
37
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
38
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
39
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)
40
# danger associated?
forms of therapeutic radiation
internal and external
radiation injury possible (burns)
41
Acute Effects of Radiation Therapy
* Radiation kills both tumor cells
and normal cells
* Can lead to Mucositis and dermatitis
42
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
43
Chronic Effects of Radiation on Tissue
* Hypovascularity
* Hypoxia
* Hypocellularity - fibrosis
44
Chronic Effects of H/N Radiation Therapy orally
* Xerostomia and hypogeusia
* Trismus
* Osteoradionecrosis
45
Onset and Duration of Radiation-Induced Oral Sequellae
46
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
47
Saliva in Xerostomia has what decreased qualities?
* Volume decreased
* pH decreased
* Buffering capacity decreased
48
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
49
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
50
Clinical Definition of Osteoradionecrosis
* Exposed bone that persists for three
months in an irradiated area
* Rare < 60 Gy
51
# 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.
52
Radiation Effects on Bone
* Permanent damage to osteocytes and microvasculature
* Bone is hypovascular, hypoxic, hypocellular
53
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
54
Osteoradionecrosis of Mandible can be due to?
* Squamous cell carcinoma of lateral border of tongue tx = External beam RT
* Interstitial implants
55
how would ORN appear histo
bac devris present in hypocellualr bone
56
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
57
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)
58
how would MRONJ appeart histo?
hypocellular bone with bac debris
