physical/chemical injuries Flashcards
what is the clinical presentation for “linea alba”? what causes it?
“white line” located on the buccal mucosa at the level of the occlusal plane; usually bilateral
Associated with frictional irritation/trauma from the teeth
what is Morsicatio Buccarum also known as? what are its clinical characteristics?
AKA cheek chewing
Ragged superficial keratosis
Anterior buccal mucosa; symmetrically distributed above and below the plane of occlusion
T/F: ulcerations will be seen in cases of Morsicatio Buccarum
FALSE
what are the clinical terms for “tongue chewing” and “lip chewing” lesions?
morsicatio linguarum and labiorum
where are Traumatic Ulcers most commonly found?
Buccal mucosa, labial mucosa and tongue
characteristics of Traumatic ulcers:
A) removable
B) yellowish-white fibrinopurulent membrane
C) surrounded by variable erythema and hyperkeratotic border
how would a Traumatic Ulcer be treated?
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
why are corticosteriods NOT used to treat Traumatic Ulcers?
Corticosteroids are generally inappropriate because lesions heal in spite of (not because of) corticosteroid Tx
what are the characteristics of Thermal injuries (burns) to the oral cavity?
Palatal mucosa, anterior tongue
Coagulation necrosis of the epithelium
Subepithelial vesicle/bulla formation if severe enough
what are the 3 most common causes of chemical injury to the oral mucosa?
Aspirin, hydrogen peroxide and phenol
why does the oral mucosa turn white following chemical trauma
White surface change due to coagulation necrosis of epithelium
how soon can Chemotherapy-Related Epithelial Necrosis begin following chemo treatment? how quickly do they resolve?
May begin within first few days of chemo
Resolves 2-3 weeks after cessation of chemo
___________________ is a injury thats secondary to ionizing radiation used to treat malignancies in head and neck region
Radiation Mucositis
what tissues are effected by radiation mucositis?
Involves tissue within the field of radiation
Damage to rapidly dividing BASAL cells of oral mucosa
how do bisphosphonates work?
Bisphosphonates bind to bone and inhibit osteoclastic activity
- decrease bone turnover
what other drugs, besides bisphosphonates, are associated with osteonecrosis of the jaw?
- A new class of anti-resorptives (i.e. denosumab)
- other drugs without effects on osteoclasts (Avastin and Sunitinib)
what are the CRITERIA for the diagnosis of MRONJ (med-related osteonecrosis of jaw)
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
most cases of osteonecrosis are linked to what kind of bisphosphonate?
intravenous
89% of cases
which is more likely to suffer from osteonecrosis, the maxilla or the mandible?
mandible
2x as likely
what oral procedure has the highest risk for triggering BRONJ?
extractions
T/F: osteonecrosis of the jaw is 10-100 times as likely in cancer patients as it is in patients with osteoporosis
True
what is the most important consideration when dealing with ONJ?
PREVENTION
Currently, optimal treatment is uncertain – very few randomized prospective treatment trials reported to date
what types of treatments are available for ONJ?
** Conservative measures are favored **
Sequestrectomy, minimal debridement, antibiotics/topical antibacterial agents
Necrosis may persist after drug cessation
T/F: bisphosphonates use should be stopped prior to any dental extractions
FALSE
BPs or other associated drugs should never be stopped without consulting prescribing physician
