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week 65 > Physical & Chemical Injury-Dr. Flores > Flashcards

Physical & Chemical Injury-Dr. Flores Flashcards

1
Q

Linea Alba

A
  • Common alteration of buccal mucosa
  • No Tx Required
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2
Q

Linea Alba: Clinical

A
  • White line
    • usually bilateral
  • Scalloped
  • On buccal mucosa
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3
Q

Linea Alba: Histology

A
  • Hyperorthokeratosis over normal oral mucosa
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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
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5
Q

Traumatic Ulcers

A
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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
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6
Q

Types of Electrical Burns

A
  • Contact
    • can cause cardiopulmonary arrest
    • might be fatal
  • Arc
    • conducted through saliva
    • most common in oral cavity
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7
Q

Electrical Burns Treatment

A
  • Tetanus shot
  • prophylactic antibiotic
    • prevent secondary infection
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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
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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
  • Dental Materials
    • silver nitrate
    • sodium hypochlorite
    • dental cavity varnishes
    • acid-etch
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10
Q

Antineoplastic Therapy Complications

A
  • Acute or chronic complications from cancer tx such as:
    • Chemotherapy
    • Radiation Therapy
    • Medication therapy
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11
Q

Complications from Chemotherapy

A
  • Mucositis
  • Hemorrhage
  • Infection
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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)
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13
Q

Complications from Medication Therapy

A
  • Osteonecrosis
    • from bisphosphonates used to tx bone metastases
    • primary bone cancer:
      • multiple myeloma
      • osteoporosis
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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
  • ulcers
    • removable yellow fibrinopurulent surface membrane
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15
Q

Oral Mucositis is associated with:

A
  • Chemotherapy
    • involves nonkeratinized surfaces
      • buccal mucosa
      • ventrolateral tongue
      • soft palate
      • floor of mouth
  • Radiation Therapy
    • mucosal surfaces within direct portals of radiation
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16
Q

What is the earliest manifestation of Mucositis

A
  • white discoloration
    • due to lack of desquamation of keratin (hyperkeratosis)
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17
Q

Mucositis risk factors

A
  • Young age
  • female
  • poor oral hygiene
  • oral foci of infection
  • poor nutrition
  • impair salivary function
  • tobacco
  • alcohol
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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
  • Serous Glands
    • more sensitive than mucous glands
      • parotid gland >minor salivary glands
  • Hypogeusia (loss of taste)
    • Persistent dysgeusia
      • (altered sense of taste)
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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
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20
Q

Osteoradionecrosis

A
  • Low risk
    • increased if local surgery performed w/in
      • 21 day of start
      • 12 months after
  • 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
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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
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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
Q

Trismus

A
  • Tonic Muscle spasms
    • with or without fibrosis of mastication muscles and TMJ capsule
  • Difficulty opening jaw
25
Q

Bisphosphonates

A
  • high affinity for calcium
  • concentrate selectively in bone
  • Potent inhibitors of osteoclastic activity
26
Q

How are bisphosphonates used clinically?

A
  • Prevent decrease bone mineral density (BMD)
    • associated with:
      • osteoporosis
        • stabilize bone loss in post-menopausal women
      • Paget’s Disease
      • Tumors
27
Q

American Society of Clinical Oncology guidelines for Bisphosphonates:

A
  • Hypercalcemia associated w/malignancy
  • metastatic osteolytic lesions
    • associated w:
      • breast cancer
      • multiple myeloma
  • Osteolytic lesions arising from any solid tumor
28
Q

Bisphosphonates and Osteonecrosis:

A
  • 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
Q

Denosumab

A
  • Bisphosphonate
    • Prolia
    • Xgeva
30
Q

Prolia

A

Tx:

  • Postmenopausal women w/osteoporosis
  • Pts who have failed or intolerant to other available osteoporosis therapy
  • Men w/non-metastatic prostate cancer
31
Q

Xgeva

A
  • Prevent skeletal-related events
  • patients w/bone metastases from solid tumors
32
Q

MRONJ stands for

A

Medication-Related Osteonecrosis of the Jaw

33
Q

MRONJ Clinical Presentation:

A
  • Usual presentation:
    • Pain
    • Swelling
    • Infection
    • Loosening of teeth
    • Exposed bone
    • Drainage
  • Possible Presentation:
    • asymptomatic for weeks/months
    • may mimic dental or periodontal disease
34
Q

MRONJ Risk Factors

A
  • Medication-related risk factors
  • Local Factors
  • Demographic, Systemic, and other medical factors
  • Genetic Factors
35
Q

MRONJ: Demographic, Systemic, other midcation factors:

A
  • Age
  • sex
  • corticosteroids
  • Cancer
  • Antiangiogenic agents given w/antiresorptive agents
  • comorbid conditions
    • diabetes, anemia
  • Smoking
36
Q

MRONJ: Genetic Factors

A
  • 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
Q

Prevention of MRONJ

A
  • Dental Pre-screening before exposure
    • reduced the incidence of MRONJ
38
Q

Methamphetamine Abuse

A
  • 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
Q

Anesthetic Necrosis

A
  • 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
Q

Exfoliative Cheilitis

A
  • 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
Q

What are the different types of Exfoliative Cheilitis

A
  • Factitious Cheilitis
    • persistent lip-licking or picking habit
  • Circumoral Dermatitis
    • perioral skin
42
Q

Systemic Metallic Intoxication

A
  • 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
Q

Plumbism

A
  • aka lead poisoning
  • most widespread environmental toxin affecting children in US
    • Adults-industry
44
Q

Oral Manifestations of Plumbism:

A
  • Oral Manifestations:
    • ulcerative stomatitis
    • Burton’s line
      • gingival lead line
  • Additional:
    • Tremor of tongue on thrusting
    • Advance Perio
    • Excessive salivation
    • Metal taste
45
Q

Mercury Poisoning

A
  • 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
Q

Acrodynia

A
  • 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
Q

Argyria

A
  • Aka Silver Poisoning
  • First signs in oral cavity
    • Slate-blue silver line along gingival margins
  • Oral Mucosa
    • diffuse blue-black discoloration
48
Q

Radiesse

A
  • Injectable cosmetic filler
  • used for soft tissue augmentation
  • composed of:
    • calcium hydroxyapatite spherules
  • produces a yellow discoloration
49
Q

Sculptra

A
  • poly-L-lactic acid
    • injectable
  • used for soft tissue augmentation
  • reduces wrinkles, fissures, and deep tissue folds
50
Q

Juvederm

A
  • glycosaminoglycan
  • used as injectable temporary tissue augmentation
  • widely distributed throughout epithelial, connective, and neural tissues
51
Q

Epulis Fissuratum

A
  • 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
Q

Cervicofacial Emphysema

A
  • 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
Q

Myospherulosis

A
  • 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
Q

Antral Pseudocyst

A
  • Maxillary Sinus Pathology
  • common dome shaped on sinus floor
    • elevation of sinus lining
  • asymptomatic
  • adjacent odontogenic infection
55
Q

Sinus Mucocele

A
  • Maxillary sinus pathology
  • aka: Mucous Retention Phenomenon
  • completely encased by epithelium
    • accumulation of mucin
  • Develops from obstruction of sinus ostium
    • block normal drainage

week 65 (6 decks)

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