physical/chemical injuries

Question 1

what is the clinical presentation for “linea alba”? what causes it?

Answer 1

“white line” located on the buccal mucosa at the level of the occlusal plane; usually bilateral

Associated with frictional irritation/trauma from the teeth

Question 2

what is Morsicatio Buccarum also known as? what are its clinical characteristics?

Answer 2

AKA cheek chewing

Ragged superficial keratosis

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

Question 3

T/F: ulcerations will be seen in cases of Morsicatio Buccarum

Answer 3

FALSE

Question 4

what are the clinical terms for “tongue chewing” and “lip chewing” lesions?

Answer 4

morsicatio linguarum and labiorum

Question 5

where are Traumatic Ulcers most commonly found?

Answer 5

Buccal mucosa, labial mucosa and tongue

Question 6

characteristics of Traumatic ulcers:

Answer 6

A) removable

B) yellowish-white fibrinopurulent membrane

C) surrounded by variable erythema and hyperkeratotic border

Question 7

how would a Traumatic Ulcer be treated?

Answer 7

Eliminate sources of trauma; may protect the area of ulceration (Zilactin, Orabase)

If lesion does not respond to conservative measures, biopsy is indicated

Chronic lesions may require excision

Question 8

why are corticosteriods NOT used to treat Traumatic Ulcers?

Answer 8

Corticosteroids are generally inappropriate because lesions heal in spite of (not because of) corticosteroid Tx

Question 9

what are the characteristics of Thermal injuries (burns) to the oral cavity?

Answer 9

Palatal mucosa, anterior tongue

Coagulation necrosis of the epithelium

Subepithelial vesicle/bulla formation if severe enough

Question 10

what are the 3 most common causes of chemical injury to the oral mucosa?

Answer 10

Aspirin, hydrogen peroxide and phenol

Question 11

why does the oral mucosa turn white following chemical trauma

Answer 11

White surface change due to coagulation necrosis of epithelium

Question 12

how soon can Chemotherapy-Related Epithelial Necrosis begin following chemo treatment? how quickly do they resolve?

Answer 12

May begin within first few days of chemo

Resolves 2-3 weeks after cessation of chemo

Question 13

___________________ is a injury thats secondary to ionizing radiation used to treat malignancies in head and neck region

Answer 13

Radiation Mucositis

Question 14

what tissues are effected by radiation mucositis?

Answer 14

Involves tissue within the field of radiation

Damage to rapidly dividing BASAL cells of oral mucosa

Question 15

how do bisphosphonates work?

Answer 15

Bisphosphonates bind to bone and inhibit osteoclastic activity
- decrease bone turnover

Question 16

what other drugs, besides bisphosphonates, are associated with osteonecrosis of the jaw?

Answer 16

• A new class of anti-resorptives (i.e. denosumab)

- other drugs without effects on osteoclasts (Avastin and Sunitinib)

Question 17

what are the CRITERIA for the diagnosis of MRONJ (med-related osteonecrosis of jaw)

Answer 17

Current or previous treatment 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 18

most cases of osteonecrosis are linked to what kind of bisphosphonate?

Answer 18

intravenous

89% of cases

Question 19

which is more likely to suffer from osteonecrosis, the maxilla or the mandible?

Answer 19

mandible

2x as likely

Question 20

what oral procedure has the highest risk for triggering BRONJ?

Answer 20

extractions

Question 21

T/F: osteonecrosis of the jaw is 10-100 times as likely in cancer patients as it is in patients with osteoporosis

Answer 21

True

Question 22

what is the most important consideration when dealing with ONJ?

Answer 22

PREVENTION

Currently, optimal treatment is uncertain – very few randomized prospective treatment trials reported to date

Question 23

what types of treatments are available for ONJ?

Answer 23

** Conservative measures are favored **

Sequestrectomy, minimal debridement, antibiotics/topical antibacterial agents

Necrosis may persist after drug cessation

Question 24

T/F: bisphosphonates use should be stopped prior to any dental extractions

Answer 24

FALSE

BPs or other associated drugs should never be stopped without consulting prescribing physician

Question 25

________________ are caused by the Intentional or iatrogenic introduction of inert pigment within the connective tissue

Answer 25

Foreign Body Tattoos

Question 26

what are the characteristics of foreign body tattoos?

Answer 26

Flat, blue/black/gray lesion; homogeneous in color

Question 27

why would you biopsy a foreign body tattoo?

Answer 27

to rule out melanocytic lesions

Question 28

why can smoking cause melanosis? (what causes smokers melanosis)

Answer 28

Melanin production in the oral mucosa may serve as a protective response against harmful substances in tobacco smoke

Question 29

characteristics of smokers melanosis:

Answer 29

Light brown, diffuse melanin pigmentation of the oral mucosa

Most commonly seen on the anterior facial gingiva

Extent/intensity of pigmentation correlates with number of cigarettes smoked per day

Question 30

how can drugs cause discoloration of the oral mucosa?

Answer 30

Stimulation of melanin production by melanocytes

vs.

deposition of drug metabolites

Question 31

what drugs can cause Drug-Related Discolorations of the Oral Mucosa

Answer 31

Minocycline, phenolphthalein, antimalarial agents, tranquilizers, chemotherapeutic agents, AIDS medications

Question 32

Oral Ulceration with Bone Sequestration is caused by what?

Answer 32

Focal superficial sequestration of a fragment of cortical bone

Anatomic sites in which a bony prominence is covered by thin mucosal surface

Question 33

what anatomical site is at risk for oral ulcerations with bone sequestration?

Answer 33

Lingual surface posterior mandible along mylohyoid ridge

Question 34

what is the treatment for Oral Ulceration with Bone Sequestration?

Answer 34

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

Question 35

Antral Pseudocyst are found in what % of the population?

Answer 35

1.5% - 14% of population

Question 36

characteristics of Antral pseudocysts

Answer 36

asymptomatic; incidental finding on panoramic radiograph

Dome-shaped, faintly radiopaque lesion arising from floor of maxillary sinus

Question 37

what causes the elevation of Antral pseudocysts?

Answer 37

Inflammatory exudate accumulates under sinus mucosa and causes elevation

Question 38

how would an Antral Pseudocyst be treated?

Answer 38

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