8: Physical and Chemical Injuries

Question 1

Common alteration of the buccal mucosa most often associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth, 13% of population?

Answer 1

linea alba

Question 2

What is the clinical presentation of linea alba?

Answer 2

white line, bilateral at level of occlusal plane with no other associated problems

Question 3

Linea alba treatment

Answer 3

None, no biopsy

Question 4

What causes linea alba

Answer 4

hyperkeratosis

Question 5

Lesion from chronic, habitual nibbling with a higher incidence in females presenting with thickend, shredded, white areas? Lip chewing? Tongue Chewing?

Answer 5

Morsicatio Bucarum, Morsicatio Labiorum, Morsicatio Linguarum

Question 6

How would differentiat Morsicatio Buccarum from Luekoplakia from Lichen planus?

Answer 6

Morsicatio bucarum has ragged torn look Leukoplakia has homogenous look Lichen Planus has Striae of Wickam

Question 7

How could you differentiate Morsicatio Linguarum from Oral Hairy Leukoplakia?

Answer 7

biopsy does not show EBV, candidiasis and no history of HIV

Question 8

5 ways to get Ulcerations?

Answer 8

Physical, thermal, Electrical, TUGSE, Riga-Fede disease

Question 9

What is TUGSE?

Answer 9

Traumatic Ulcerative Granuloma with Stromal Eosinophilia

Question 10

With what is TUGSE associated?

Answer 10

Eosinophils = allergies or parasites

Question 11

What is the only clinical differentiation between a TUGSE ulcer and an aphthous ulcer?

Answer 11

TUGSE is slower to heal (>7 days)

Question 12

These are traumatic ulcerations of the ventral tongue in nursing babies and are a variation of TUGSE

Answer 12

Riga-Fede Disease

Question 13

Represent 5% of all burn admissions

Answer 13

Electrical burns

Question 14

2 types of electrical burns and which is most common oral

Answer 14

Contact and Arc. Arc is most common orally with saliva acting as conductor

Question 15

Age and most common location for electric burns

Answer 15

<4 years old. Lips and commissures presenting charred yellow with little bleeding

Question 16

3 stages of treatment of ulcers (in order)

Answer 16

1.) Remove obvious injury
2.) Treat symptoms: cellulose films, topical
antibiotics, Orabase)
3.) If not healed in 2 weeks, Biopsy

Question 17

Are natal teeth associated with Riga-Fede disease extra teeth or are they the babies deciduous teeth simply erupted early

Answer 17

early erupted deciduous teeth.

Question 18

4 sources of Chemical injuries

Answer 18

Aspirin, OTC med, Gasoline, Iatrogenic dental chemicals (formocreosol, etch, Hydrogen peroxide, Silver nitrate)

Question 19

Why are OTC meds a source of chemical injuries

Answer 19

Have a lot of eugenol and phenol

Question 20

How can one get a cotton roll burn (3)?

Answer 20

Cotton roll wicks out moisture and causes necrosis, holds caustic chemicals against the epithelium, or is removed and takes epithelium w/ it

Question 21

All systemic anticancer therapies (antineoplastic therapies) cause what?

Answer 21

death of some normal cells

Question 22

What are the 2 acute oral changes associated w/ cancer chemotherapy?

Answer 22

Mucocitis and hemorrhage

Question 23

Where does oral mucocitis associated with cancer chemotherapy present?

Answer 23

Nonkeratinized surfaces (Buccal mucosa, ventrolateral tongue, soft palate, floor of mouth)

Question 24

How does Oral Mucocitis associated with cancer chemotherapy and radiation treatment look clinically?

Answer 24

early develops white discoloration from lack of keratin desquamation followed by loss of that layer & replacement by atrophic mucosa that is edematous, erythmatous & friable. Finally is ulcerated and covered by yellowish fibrinopurulent membrane. Recap: white, red, yellow

Question 25

Where does Radition therapy acute mucocitis present?

Answer 25

mucosal surface w/in direct portals of radiation

Question 26

What are the 2 acute changes associated with cancer radiation therapy?

Answer 26

Acute mucocitis and dermatitis

Question 27

What is the character of Radiation Therapy Dermatitis based on?

Answer 27

Varies w/ amount received. Can be erythema, edema, burning, purities all the way to necrosis and deep ulcerations.

Question 28

What are the 5 Sequelae (a pathological condition resulting from disease [Wiki definition]) to Cancer Chemotherapy?

Answer 28

Increased susceptibility to infection, oral mucocitis, oral ulceration, increased risk of hemorrhage, or impaired healing

Question 29

The introral hemorrhage that is a sequelae of cancer chemotherapy is secondary to what

Answer 29

thrombocytopenia caused by bone marrow suppression

Question 30

This is a complication associated with head and neck radiation

Answer 30

Xerostomia

Question 31

What is the course of radiation induced Xerostomia?

Answer 31

Changes after 1 week. Decrease in saliva after 6 weeks. Parotids dramatically/irreversibly affected. Decreased bactericidal activity of saliva cause increased caries

Question 32

8 Sequelae of Radiation therapy

Answer 32

Hemorrhage, Mucocitis, Dermatitis, Xerostomia, Osteoradionecrosis, Loss of taste/ altered taste (Hypgeusia/dysguesia), Trismus, Developmental anomalies (e.g. microdonts, hypoglossia) which are dependent on age and treatment

Question 33

What can cause the osteoradionecrosis

Answer 33

hypoxia, hypovascularity, hypocellularity

Question 34

What increases the risk of developing osteoradionecrosis and what are the treatment limits?

Answer 34

Surgery. Tx pt either 21 days prior to radiation (to allow healing prior to therapy) or wait 1 year after radiation therapy is complete

Question 35

What can dentist do pretherapy for cancer patient

Answer 35

remove current or potential oral foci of infection. Give OHI

Question 36

What can dentist do during cancer therapy (Intratherapy)?

Answer 36

Relieve pain, dehydration, malnutrition via admin of anesthetic, analgesics, antimicrobial, or coating agent

Question 37

What can dentist do posttherapy for cancer patient (4)?

Answer 37

Topical fluoride, salivary substitutes, sugarless candies, infection prevention

Question 38

What is the 1-2-3 Mouthwash?

Answer 38

1/3 caopectate (coat mouth), 1/3 tetracycline (cut down on secondary infection), 1/3 benedryl (steroid to decrease inflammation)

Question 39

Bisphosphonates are used to slow the osseous involvements of what 3 diseases?

Answer 39

cancer (multiple myeloma, metastatic breast or prostate), Paget’s disease, and Osteoporosis

Question 40

When should elective surgical procedures be done on a patient who takes bisphosphonates?

Answer 40

after discontinuance of drug and 3 month waiting period

Question 41

Most cases of Bisphosphonate-Associated Osteonecrosis (BONJ) follow what type of bisphosphonate administration

Answer 41

IV

Question 42

What should one consider when pt is emaciated, agitated, nervous young adult with multiple Class V carious lesions

Answer 42

Methamphetamine abuse

Question 43

Why worry about treating a patient that is high on methamphetamine?

Answer 43

Potentiates effects of sympathomimetic amines, so local w/ epi can lead to HTN crisis, cerevrovascular accident, myocardial infarction

Question 44

Term for Ulceration and Necrosis developing several days after local anesthesia due to tissue ischemia

Answer 44

Anesthetic Necrosis

Question 45

Persistent scaling and flaking of the vermillion border, usually involving both lips associated with chronic habitual lip licking, biting, picking or sucking

Answer 45

Exfoliative Cheilitis

Question 46

What is can be a sequelae of Exfoliative Cheilitis

Answer 46

Bacterial or fungal infection (e.g. angular cheilitis)

Question 47

Treatment of Exfoliative Cheilitis

Answer 47

Psychotherapy/intervention for habit. Antibacterial/antimycotic/ steroid lip cream for angular cheilitis

Question 48

2 causes of submucosal hemorrhage

Answer 48

Traumatic and Non-traumatic

Question 49

Minute hemorrhages into skin, mucosa, or serosa? Slightly larger?

Answer 49

Petechiae; purpura

Question 50

Accumulation of boold within a tissue that produces a mass

Answer 50

Hematoma

Question 51

3 causes of Non-Traumatic Submucosal Hemorrhage?

Answer 51

Thrombocytopenia Disseminated intravascular coagulopathy (DIC) Viral infection (Mononucleosis [EBV, HHV-4], Measels [Rubeola])

Question 52

Submucosal hemorrhage that is over 2 cm

Answer 52

echymosis

Question 53

Patient has palatal erythema, petechiae or purpura, or lingual frenum tears or tongue ulcerations, part of the differential should include

Answer 53

oral sexual practices (can use this as a clue for sexual abuse )

Question 54

Incorporation of Amalgam into oral mucosa

Answer 54

Amalgam tattoo

Question 55

4 ways to get an amalgam tattoo

Answer 55

mucosal abrasion containing amalgam, amalgam fragments in extraction socket, dental floss transfer, or endodontic retrofill procedures

Question 56

If dark lesion along the gumline , but not evident on radiograph, what is required

Answer 56

Biopsy to differentiate from Melanoma

Question 57

What are 3 other means of getting oral localized exogenous pigmentation beyond an amalgam tattoo

Answer 57

Intentional tattooing, pencil lead, Bullet fragments

Question 58

What are the acute and chronic complications of Oral Piercings?

Answer 58

Acute: bleeding, infection, nerve damage. Chronic: speech impediment, nickel allergy, chipped teeth, aspiration

Question 59

An oral piercing is an example of what type of injury?

Answer 59

Factitial (self-inflicted)

Question 60

6 systemic metallic intoxications

Answer 60

Lead/Plumbism, Mercury/Acrodynia, Silver/Argyria, Bismuth, Arsenic, and Gold

Question 61

Lead overdose is called what and has what 4 oral manifestations?

Answer 61

Plumbism: Ulcerative stomatitis, Gingival lead line (Burton’s line), Metallic taste, and Tongue tremor

Question 62

Mercury overdose is called what and has what 3 oral manifestations?

Answer 62

Acrodynia/pink disease/Swift disease: Hypersalivation, Ulcerative gingivitis, Bruxism/loss of teeth

Question 63

Silver overdose is called what and has what 2 oral and skin manifestations?

Answer 63

Argyria: Slate blue gingival margins and Grayish skin discoloration

Question 64

What is the line called associated w/ Plumbism and when is it seen?

Answer 64

Burton’s line. Gingival inflammation as in gingivitis

Question 65

Oral pigementation is increases significantly in what demographic

Answer 65

Smokers = Smoker’s Melanosis

Question 66

Pigmentary changes caused by polycyclic amines stimulating melanin by melanocytes is limited to what part of the mouth in Smoker’s Melanosis

Answer 66

Anterior Facial Gingiva

Question 67

What gender is more sensitive to increased melanin pigmentation?

Answer 67

Female

Question 68

What drug can cause staining of the gingival as a result of the drugs deposition in the underlying bone?

Answer 68

Minocycline

Question 69

7 meds associated with Drug Related Discoloration of the Oral Mucosa

Answer 69

phenolphthalein, tranquilizers, estrogen, AIDS meds, Minocycline, Antimalarials, and Chemotherapeutics

Question 70

Cartilage or bone discovered within soft tissue specimens removed from the oral cavity as the body’s way of reacting to constant irritation in an area (e.g. under denture on edentulous ridge)

Answer 70

Reactive Osseous and Chondromatous Metaplasia

Question 71

How will Reactive Osseous and Chondromatous Metaplasia appear under a denture on the alveolar ridge

Answer 71

Extremely tender and localized area

Question 72

What hobby/occupation is Reactive Osseuous and Chrondromatous Metaplasia common in, just not in the mouth

Answer 72

Equestrians on the inner thigh

Question 73

Lesion that normally arises without patient knowing and in absence of trauma along the lingual surface of the mandible along the mylohyoid ridge, with the associated loff of the overlying oral mucosa

Answer 73

Spontaneous Sequestrations

Question 74

These are commonly found on a panoramic as a dome-shaped faint radiopacity arising from the floor of the maxiallary sinus usually having an inflammatory exudates. It pushes the sinus epithelial lining up above it.

Answer 74

Antral Pseudocyst

Question 75

When have an increased prevalence of antral pseudocysts been noted?

Answer 75

during winter months

Question 76

What must be ruled out or treated as a cause of an astral pseudocyst?

Answer 76

odontogenic infection

Question 77

This is also in the maxillary sinus but it is an accumulation of mucin encased in epithelium

Answer 77

Sinus mucocelle

Question 78

2 types of sinus mucocelles

Answer 78

Surgical Ciliated cyst Obstructed sinus ostium

Question 79

Surgical ciliated cyst occurs when

Answer 79

portion of sinus linging gets separated from main body of sinus and forms epithelium lined cavity into which it secretes mucin

Question 80

When the sinus ostium gets blocked, how is that sinus mucocelle formed?

Answer 80

entire blocked sinus acts as an epithelium lined cyst and fills with mucin

Question 81

These cysts arise from partial blockage of a duct of the sero-mucus glands or from an invagination of the respiratory epithelium and associated with antral polyps commonly

Answer 81

Retention Cysts

Question 82

What is the character of a true sinus mucocelle (what will it do to bone and how will appear radiographically)?

Answer 82

Will enlarge, expand bone and entire sinus will be cloudy on radiograph

Question 83

Caused by the introduction of air into subcutaneous or fascial spaces of the face and neck. Air can come from blowing or sneezing after extraction or dentist blowing air into wound w/ air/water syringe or handpiece.

Answer 83

cervicofacial emphysema

Question 84

If the cervicofacial emphysema shows up hours after surgery, who is usually at fault

Answer 84

The patient

Question 85

Cervicofacial emphysema treatment

Answer 85

Broad Spectrum Antibiotic and warm compress

Question 86

Radiographic radiolucency caused by dentist placing antibiotic in a petrolatum base into an extraction socket which will leave an asymptomatic circumscribed radiolucency looking like a residual cyst

Answer 86

Myospherulosis

Question 87

Myospherulosis treatment

Answer 87

Surgical excision

Question 88

What can cervicofacial emphysema be confused with, and how can it be differentiated?

Answer 88

Confused with angioedema but cervicofacial emphysema will have crepitus in the swelling