Physical & Chemical Injury-Dr. Flores Flashcards
1
Q
Linea Alba
A
- Common alteration of buccal mucosa
- No Tx Required
2
Q
Linea Alba: Clinical
A
- White line
- usually bilateral
- Scalloped
- On buccal mucosa
3
Q
Linea Alba: Histology
A
- Hyperorthokeratosis over normal oral mucosa
4
Q
Chronic Mucosal Chewing
A
- aka Morsicatio Mucosae Oris
- Morsicatio Buccarum (Buccal mucosa)
- Morsiatio Linguarum
- Tongue
- under stress or psychological conditions
- Buccal Mucosa
- bilateral or unilateral
- thick, shredded, white areas combined with areas of erythema, erosion or focal traumatic ulcers
- 2x in females
5
Q
Traumatic Ulcers
A
6
Q
Electrical Burns
A
- usually <4 y.o.
- Types:
- Contact
- Arc
- Locations:
- lips
- commissure
- lesion evolves from painless yellow area w/minimal bleeding → necrotic and edematous lesion
- potential damage to:
- adjacent teeth
- facial nerve-rare
- potential damage to:
6
Q
Types of Electrical Burns
A
- Contact
- can cause cardiopulmonary arrest
- might be fatal
- Arc
- conducted through saliva
- most common in oral cavity
7
Q
Electrical Burns Treatment
A
- Tetanus shot
- prophylactic antibiotic
- prevent secondary infection
8
Q
Thermal Burns
A
- From hot food or beverage
- Location:
- palate
- erythematous and ulcerated
- Painful
- small ares heal within 10-14 days
- Pt will remember history of incident
9
Q
Chemical Burns
A
- Caused by Drugs & Chemicals
- children or psychiatric patients hold meds in their mouth instead of swallowing
- Caustic Medications:
- Aspirin
- Bisphosphonates
- 2 psychoactive drugs (-mazine)
- Chlorpromazine
- Promazine
- Topical Medications for mouth pain
-
OTC Tooth-whitening products
- contain:
- hydrogen peroxide
- carbamide peroxidase
- contain:
-
Dental Materials
- silver nitrate
- sodium hypochlorite
- dental cavity varnishes
- acid-etch
10
Q
Antineoplastic Therapy Complications
A
- Acute or chronic complications from cancer tx such as:
- Chemotherapy
- Radiation Therapy
- Medication therapy
11
Q
Complications from Chemotherapy
A
- Mucositis
- Hemorrhage
- Infection
12
Q
Complications from Radiation Therapy
A
- Mucositis
- Xerostomia
- Radiation Caries
- Osteoradionecrosis
- decrease in bone healing
- lead to necrotic bone and impaired healing after trauma (Extractions)
13
Q
Complications from Medication Therapy
A
- Osteonecrosis
- from bisphosphonates used to tx bone metastases
- primary bone cancer:
- multiple myeloma
- osteoporosis
14
Q
Mucositis
A
- Superficial Necrosis of epithelial cells
- Increased Interleukin-6
- radiation or chemotherapy
- similar clinical presentations
- Chemo-few days
- Radiation-2nd week
- resolve 2-3 weeks after treatment ends
- similar clinical presentations
- ulcers
- removable yellow fibrinopurulent surface membrane
15
Q
Oral Mucositis is associated with:
A
- Chemotherapy
- involves nonkeratinized surfaces
- buccal mucosa
- ventrolateral tongue
- soft palate
- floor of mouth
- involves nonkeratinized surfaces
- Radiation Therapy
- mucosal surfaces within direct portals of radiation
16
Q
What is the earliest manifestation of Mucositis
A
- white discoloration
- due to lack of desquamation of keratin (hyperkeratosis)
17
Q
Mucositis risk factors
A
- Young age
- female
- poor oral hygiene
- oral foci of infection
- poor nutrition
- impair salivary function
- tobacco
- alcohol
18
Q
Xerostomia
A
- radiation complication
- salivary glands
- Changes begin within 1 week
- decrease in salivary flow during first 6 weeks of tx
- causes: Significant decrease of bactericidal action and self-cleansing properties of saliva
- decrease in salivary flow during first 6 weeks of tx
- Changes begin within 1 week
- Serous Glands
- more sensitive than mucous glands
- parotid gland >minor salivary glands
- more sensitive than mucous glands
- Hypogeusia (loss of taste)
- Persistent dysgeusia
- (altered sense of taste)
- Persistent dysgeusia
19
Q
Biological effects of radiation on Bone
A
- Increased Endothelial cell permeability
- causes decreased perfusion/occlusion
- Immediate reduction in the number of osteoblasts post radiation therapy
- Increased bone resorption
- produce fatty/yellow marrow replacement
- less vascular than hematopoietic(red marrow)-→more vulnerable to physiologic skeletal loads
- produce fatty/yellow marrow replacement
20
Q
Osteoradionecrosis
A
- Low risk
- increased if local surgery performed w/in
- 21 day of start
- 12 months after
- increased if local surgery performed w/in
- Location:
- Mandible
- Main Factor
- Radiation Dose
- Healing time
- at least 3 weeks since the start of radiotherapy and extensive dental work
- decreases chance of bone necrosis
-
Extraction or any bone trauma
- STRONGLY contraindicated during radiation therapy
21
Q
What are some factors that are associated w/increased prevalence of osteoradionecrosis (ORN)
A
- Old age
- male
- poor health
- nutritional status
- tobacco or alcohol
- continued use
22
Q
What should be done before therapy starts for osteoradionecrosis?
A
- extract or restore all questionable teeth
- eliminate oral foci of infection
23
Q
Osteoradionecrosis: Radiographically
A
- ill-defined areas of readiolucency
24
Trismus
* Tonic Muscle spasms
* with or without fibrosis of mastication muscles and TMJ capsule
* Difficulty opening jaw
25
Bisphosphonates
* high affinity for calcium
* concentrate selectively in bone
* _Potent inhibitors of osteoclastic activity_
26
How are bisphosphonates used clinically?
* Prevent decrease bone mineral density (BMD)
* associated with:
* osteoporosis
* stabilize bone loss in post-menopausal women
* Paget's Disease
* Tumors
27
American Society of Clinical Oncology guidelines for Bisphosphonates:
* Hypercalcemia associated w/malignancy
* metastatic osteolytic lesions
* associated w:
* breast cancer
* multiple myeloma
* Osteolytic lesions arising from any solid tumor
28
Bisphosphonates and Osteonecrosis:
* reported by Marx in 2003
* Osteonecrosis in mandbile & maxilla w/IV Bisphosphonates
* Novartis
* 875 cases due IV Bisphosphonates
* Merck
* 78 cases due to Fosamax
29
Denosumab
* Bisphosphonate
* Prolia
* Xgeva
30
Prolia
Tx:
* Postmenopausal women w/osteoporosis
* Pts who have failed or intolerant to other available osteoporosis therapy
* Men w/non-metastatic prostate cancer
31
Xgeva
* Prevent skeletal-related events
* patients w/bone metastases from solid tumors
32
MRONJ stands for
Medication-Related Osteonecrosis of the Jaw
33
MRONJ Clinical Presentation:
* Usual presentation:
* Pain
* Swelling
* Infection
* Loosening of teeth
* Exposed bone
* Drainage
* Possible Presentation:
* asymptomatic for weeks/months
* may mimic dental or periodontal disease
34
MRONJ Risk Factors
* Medication-related risk factors
* Local Factors
* Demographic, Systemic, and other medical factors
* Genetic Factors
35
MRONJ: Demographic, Systemic, other midcation factors:
* Age
* sex
* corticosteroids
* Cancer
* Antiangiogenic agents given w/antiresorptive agents
* comorbid conditions
* diabetes, anemia
* Smoking
36
MRONJ: Genetic Factors
* Single Nucleotide Polymorphisms (SNPs)
* present in 5 genes=57%
* in RBMS3=5.8x more likely to develop
* associated w/bone density
* genetic sensitivity to bisphosphonates
37
Prevention of MRONJ
* Dental Pre-screening before exposure
* reduced the incidence of MRONJ
38
Methamphetamine Abuse
* affects mainly males 20-40 y.o.
* Common Side effect:
* Rampant Dental caries
* secondary to poor oral hygiene
* Drug-related xerostomia
* sugary drinks and snacks
* Develop Delusional Parasitosis (Formication)
* false belief of being infected w/parasites
* _Extreme caution when giving Local Anesthesia w/vasoconstrictor_
* if used before appt=myocardial infarction may occur
39
Anesthetic Necrosis
* Ulceration and necrosis
* rarely at site of local injection site
* secondary to localized ischemia
* Location:
* hard palate
* Develops several days after procedure
* normal healing
40
Exfoliative Cheilitis
* persistent scaling and flaking of vermillion border
* both lips
* related to chronic injury
* secondary to habits such as:
* lip licking, biting, picking, or sucking
* Types:
* Factitious Cheilitis
* Circumoral Dermatitis
* Triggering factors
* sun
* wind
* cold
* candida infection
41
What are the different types of Exfoliative Cheilitis
* Factitious Cheilitis
* persistent lip-licking or picking habit
* Circumoral Dermatitis
* perioral skin
42
Systemic Metallic Intoxication
* ingestion or exposure may cause systemic or oral complications
* lead
* mercury
* silver (Argyria)
* Bismuth
* Arsenic
* Gold (Chrysiasis)
* Tx:
* eliminate exposure source
* anti-chelating agents
43
Plumbism
* aka lead poisoning
* most widespread environmental toxin affecting children in US
* Adults-industry
44
Oral Manifestations of Plumbism:
* Oral Manifestations:
* ulcerative stomatitis
* Burton's line
* gingival lead line
* Additional:
* Tremor of tongue on thrusting
* Advance Perio
* Excessive salivation
* Metal taste
45
Mercury Poisoning
* Oral manifestations:
* metallic taste
* Ulcerative stomatitis
* inflammation & enlargement of salivary glands, gingiva, and tongue
* Gingiva: blue-gray to black
* Mercuric Sulfide-destroys alveolar bone→tooth loss
46
Acrodynia
* aka Pink disease
* Swift disease
* Chronic Mercury exposure in infants and children
* Have Cold, clams skin on
* hands
* feet
* nose
* ears
* cheeks
* Erythematous & Pruritic rash
47
Argyria
* Aka Silver Poisoning
* First signs in oral cavity
* Slate-blue silver line along gingival margins
* Oral Mucosa
* diffuse blue-black discoloration
48
Radiesse
* Injectable cosmetic filler
* used for soft tissue augmentation
* composed of:
* calcium hydroxyapatite spherules
* produces a yellow discoloration
49
Sculptra
* poly-L-lactic acid
* injectable
* used for soft tissue augmentation
* reduces wrinkles, fissures, and deep tissue folds
50
Juvederm
* glycosaminoglycan
* used as injectable temporary tissue augmentation
* widely distributed throughout epithelial, connective, and neural tissues
51
Epulis Fissuratum
* aka: Inflammatory Fibrous Hyperplasia
* Denture Injury Tumor
* Denture Epulis
* develops due to Bad fitting complete or partial denture
* Mainly females
* Location:
* anterior portion of jaw
* Fibroepithelial polyp or leaflike denture fibroma
* beneath maxillary denture
* edge of lesion is:
* serrated
* resembles a leaf
* Osseous and Chondromatous Metaplasia-RARE
52
Cervicofacial Emphysema
* introduce air into soft tissue spaces
* Found after surgical procedure:
* compressed air use (air driven hand piece)
* Difficult or prolonged extractions
* Increased intraoral pressure after surgery
* no cause may be found
* Hamman's Crunch
* Pain, erythema, facial enlargement
53
Myospherulosis
* Topical antibiotic in petrolatum base place into surgical site
* may result in unique foreign body reaction
* Involved are:
* exhibit swelling
* asymptomatic and circumscribed radiolucency in previous extraction site
* Black, greasy, tarlike material
54
Antral Pseudocyst
* Maxillary Sinus Pathology
* common dome shaped on sinus floor
* elevation of sinus lining
* asymptomatic
* adjacent odontogenic infection
55
Sinus Mucocele
* Maxillary sinus pathology
* aka: Mucous Retention Phenomenon
* completely encased by epithelium
* accumulation of mucin
* Develops from obstruction of sinus ostium
* block normal drainage
