Chapter 8: Physical and Chemical Injuries Flashcards
(143 cards)
1
Q
what is associated with pressure, irritation, or sucking trauma, is present in 10% of the population, and is a single white line on the occlusal plane of the buccal mucosa?
A
linea alba
2
Q
is linea alba typical unilateral or bilateral?
A
bilateral
3
Q
what is the treatment for linea alba?
A
no biopsy or treatment is necessary
4
Q
___ is the scientific name for cheek chewing
A
morsicatio buccarum
5
Q
what are the scientific names for labial mucosa chewing and tongue chewing?
A
- morsicatio laborium
- morsicatio linguarum
6
Q
there is a higher prevalence of morsicatio buccarum in those under ___ or with ___
A
under stress or with psychologic conditions
7
Q
morsicatio buccarum is typically found where?
A
bilaterally on the anterior buccal mucosa
8
Q
how does morsicatio buccarum appear clinically?
A
thickened, shredded white areas which may be ulcerated
9
Q
what is the treatment for morsicatio buccarum?
A
no treatment is required; not a premalignant condition
10
Q
___ is the result of acute or chronic trauma that can cause surface ulcerations
A
traumatic ulcerations
11
Q
where are the most common oral locations of traumatic ulcerations? what is the injury due to?
A
- lips, tongue, and buccal mucosa
- injured from dentition
12
Q
___ appears as areas of erythema surrounding a central removable, yellow fibrinopurulent membrane
A
traumatic ulcerations
13
Q
___ can develop immediately adjacent to an oral traumatic ulceration
A
a rolled white border of hyperkeratosis
14
Q
the unique form of chronic traumatic ulceration is termed ___ or ___
A
eosinophilic ulceration or TUGSE (traumatic ulcerative granuloma with stromal eosinophilia)
15
Q
describe TUGSE and its treatment
A
- traumatic ulcerative granuloma with stromal eosinophilia
- exhibits a deep pseudoinvasive inflammatory process and is slow to resolve
- incisional biopsy is usually curative
16
Q
___ are chronic ulcerations found under the tongue in infants due to trauma from nursing
A
riga-fede disease (a form of traumatic ulcerations)
17
Q
what is the treatment for traumatic ulcerations?
A
- remove source of injury if possible
- medications for pain releif - topical analgesics
- biopsy is warranted in cases that do not resolve after 2-4 weeks
18
Q
5% of all burn admissions to hospitals are from what?
A
electrical burns to the oral cavity
19
Q
what are the two types of electrical burns?
A
contact and arc
20
Q
what is required for contact burns?
A
a good ground and must involve electrical current passing through the body from the point of contact to the ground site
21
Q
what can electric current cause?
A
cardiopulmonary arrest and it can be fatal
22
Q
most electrical burns affecting the oral cavity are what type?
A
arc
23
Q
in arc electrical burns of the oral cavity, ___ acts as a conducting medium and an electrical arc flows between the electrical source and the mouth
A
saliva
24
Q
most cases of oral electrical burns are a result of what?
A
chewing on the female end of an extension cord or biting a live wire
25
most electrical burns occur in what age patient? what area is affected?
kids younger than 5 and affect the lip
26
what is the clinical presentation of oral electrical burns?
* appears as a painless, charred, yellow area that doesn't bleed
* edema develops within a few hours
* on the 4th day, the area becomes necrotic and begins to slough (may bleed profusely)
27
most thermal burns of the oral cavity arise from what?
the ingestion of hot foods or beverages
28
describe the location and clinical appearance of thermal burns
* typically appear on the palate or posterior buccal mucosa as zones of erythema and ulceration
29
some patients hold medications within their mouths rather than swallow them, which can be caustic. what type of injury does this describe?
chemical injury
30
what are common medications that can cause chemical injuries in the oral cavity?
* aspirin
* bisphosphonates
* two psychoactive drugs - chlorpromazine and promazine
31
other than medications, what are some other things that cause mucosal necrosis (chemical injury) by patient or dentist misuse?
* tooth-whitening products
* hydrogen peroxide
* phenol
* silver nitrate
* certain endodontic materials
* cotton roll
32
what tissues are targeted in noninfectious oral complications or antineoplastic therapy (aka anticancer treatment)?
tissues with rapid turnover, like the oral epithelium
33
how many people a year suffer acute or chronic oral side effects from anticancer treatment?
half a million people
34
\_\_\_% of patients receiving head and neck radiation have oral ramifications
100%
35
\_\_\_% of patients receiving BMT have oral complications
75%
36
what are the two predominant problems with anticancer therapy?
mucositis and hemorrhage
37
hemorrhage associated with anticancer treatments is secondary to \_\_\_. what are the most common presentations of hemorrhage?
* secondary to thrombocytopenia (from bone marrow suppression)
* oral petechiae and ecchymosis secondary to minor trauma are the most common presentations
38
how does mucositis that results from anticancer therapy present clinically?
* white discoloration from a lack of sufficient desquamation of keratin
* soon follows by a loss of keratin and replacement by atrophic mucosa
* areas of ulceration develop
39
what are 5 main complications of anticancer therapy other than hemorrhage and mucositis?
* xerostomia
* loss of taste
* osteoradionecrosis
* trismus
* developmental abnormalities
40
describe xerostomia that results from anticancer treatment
* salivary glands are very sensitive to radiation
* increase in caries risk
41
describe loss of taste that results from anticancer treatment
* loss of all four tastes (hypogeusia) develops, but taste returns in about 4 months
* some patients have a permanent altered taste (dysgeusia)
42
osteoradionecrosis associated with anticancer treatment occurs in about \_\_\_% of people receiving head and neck radiation
5%
43
the risk of osteoradionecrosis associated with anticancer treatment increases dramatically if what procedure is performed and during what time frame?
local surgical procedure is performed within 3 weeks of therapy or within 1 year after therapy
44
most cases of osteoradionecrosis associated with anticancer treatment are secondary to \_\_\_
local trauma
45
\_\_\_ is the main associated factor for osteoradionecrosis associated with anticancer treatment
radiation dose
46
before therapy, what should be eliminated to avoid cases of osteoradionecrosis associated with anticancer treatment?
all foci of infection should be eliminated
47
what is BRONJ?
bisphosphonate-related osteonecrosis of the jaw
48
what are bisphosphonates used for?
* inhibit osteoclasts
* possibly interfere with angiogenesis
* slow osseous involvement of cancer
* treat paget's disease
* reverse osteoporosis
49
which generation bisphosphonates have a low potency and are readily metabolized?
first generation
50
second generation bisphosphonates are more potent than first generation, and are termed ___ due to the addition of a nitrogen side chain
aminobisphophonates
51
\_\_\_ generation bisphosphonates are incorporated into the skeleton and have a half-life of 10 years; what location is the incorporation of the medication the highest?
* second
* the incorporation of the medication is highest in areas of active remodeling, such as the jaws
52
there is a strong association of ___ with aminobisphosphonates
gnathic osteonecrosis
53
95% of BRONJ occurs in patients who have received ___ for cancer. 85% of these patients had what type of cancer?
* IV formulations for cancer
* multiple myeloma
54
what is the prevalence of osteonecrosis in pateints taking IV bisphosphonates? what bout patients taking oral bisphosphonates?
* 6-8%
* 1:100,000
55
60% of BRONJ occurs after \_\_\_, ad the remaining 40% occur \_\_\_. what fraction are asymptomatic?
* dental procedures
* spontaneously
* 1/3
56
what is the treatment for BRONJ?
* formulation of the drug
* extend of disease
* duration of drug use
57
should routine dental therapy be modified for patients with BRONJ?
no
58
in the dental office, what should you do for patients taking PO bisphosphonates before bone manipulation? what about for patients taking IV bisphosphonates?
* informed consent before bone manipulation
* bone manipulation should be avoided in patients taking bisphosphonates
59
if BRONJ is suspected, you should refer your patient to who?
the oral surgeon
60
how can methamphetamines be ingested?
powdered stimulant can be smoked, snorted, injected, or taken orally
61
most methamphetamine users are male or female? what age?
men ages 20-40
62
many methamphetamine users develop delusions of \_\_\_
parasitosis (neurosis that produces the sensation of snakes/insects crawling on or under the skin)
63
rampant dental caries can occur with methamphetamine use. what surfaces are affected first? what is it that actually causes rampant dental caries?
* affects facial smooth and interproximal surfaces first
* due to poor oral hygiene and extreme xerostomia, leading to consumption of sugary and acidic drinks/foods
64
meth potentiates which local anesthetics for up to 6 hours?
sympathomimetic amines
65
use of local anesthetics with epinephrine in meth patients can lead to what 3 things?
* hypertensive crisis
* cerebral vascular accident
* myocardial infarction
66
linea alba
67
morsicatio buccarum
68
morsicatio linguarum
69
traumatic ulceration
70
traumatic ulceration
71
traumatic ulcerative granuloma with stromal eosinophilia
TUGSE
72
riga-fede disease
73
electrical burn
74
thermal burn
75
chemical burn
| (from tooth-whitening strips)
76
chemical burn
| (from aspirin)
77
chemical burn
(hydrogen peroxide)
78
chemical burn
| (phenol)
79
chemical burn
| (endodontic materials)
80
chemical burn
| (cotton rolls)
81
noninfectious oral complications of antineoplastic therapy
82
noninfectious oral complications of antineoplastic therapy
83
noninfectious oral complications of antineoplastic therapy
84
patient received head and neck radiation
osteoradionecrosis
85
patient received head and neck radiation
osteoradionecrosis
86
medication-related osteonecrosis of the jaw
aka bisphosphonate-related osteonecrosis of the jaw
87
medication-related osteonecrosis of the jaw
aka bisphosphonate-related osteonecrosis of the jaw
88
methamphetamine-related dental caries
89
\_\_\_ is persistent scaling and flaking of the vermillion border, and typically involves both lips
exfoliative cheilitis
90
exfoliative cheilitis arises from excessive production and desquamation of \_\_\_
superficial keratin
91
exfoliative cheilitis is usually due to chronic injury secondary to \_\_\_
habits such as lip licking
92
is exfoliative cheilitis more common in males or females?
females
93
what is the treatment for exfoliative cheilitis?
cessation of habits, corticosteroids, psychotherapy, or ruling out other underlying cause (fungus, for example)
94
exfoliative cheilitis
95
\_\_\_ appears as a nonblanching zone with a red, pruple, blue, or black color
submucosal hemorrhage
96
what are two types of submucosal hemorrhage?
oral petechiae and purpura
97
what are some causes of oral petechiae/purpura?
* repeated coughing or vomiting
* convulsions
* oral sex
* anticoagulant therapy
* thrombocytopenia
* disseminated intravascular coagulation
* viral infections, especially mono and measles
98
what is the treatment for submucosal hemorrhage?
no treatment is required if the hemorrhage is not associated with systemic disease; the areas should resolve spontaneously
99
submucosal hemorrhage (petechiae/purpura)
100
\_\_\_ is a clinically evident lesion caused by pigmented materials that can be implanted in the oral mucosa
amalgam tattoo
(can happen with other materials, but amalgam is by far the most common)
101
what are some ways that amalgam can be incorporated into the oral mucosa?
* previous areas of mucosal abrasion can be contaminated by amalgam dust within the oral fluids
* broken amalgam pieces can fall into extraction sites
* contaminated dental floss can create linear areas of pigmentations
* endodontic retrofill can be left in the soft tissue
* high-speed drills can drive fine particles in tissue
102
in addition to amalgam, submucosal implantation of what other pigmented materials can occur?
* pencil graphite
* coal dust
* metal dust
* broken carborundum disks
* dental burs
103
\_\_\_ appear as macules or (rarely) as raised lesions which are blue, black, or gray in color
amalgam tattoos
104
any mucosal surface can be involved with an amalgam tattoo
what are the most common sites?
* gingiva and alveolar mucosa
* buccal mucosa
105
what do PA radiographs of amalgam tattoos look like?
* they are usually negative
* when metallic fragments are visible on the radiograph, the clinical area of discoloration is large and extends past the size of the fragment
106
how should you confirm the diagnosis of an amalgam tattoo to rule out melanoma?
* take a radiograph of the affected areas
* no treatment required if it can be detected via radiograph
* to rule out melanoma, a biopsy must be done if it is not detected on the radiograph
107
exfoliative cheilitis
108
amalgam tattoo
109
amalgam tattoo
110
amalgam tattoo
111
amalgam tattoo
112
over 50% of college students have body piercings beyond the \_\_\_
earlobe
113
describe forked tongue
* the anterior 1/3 is split down the middle by pulling fishing line through a pierced hole and tightening the loop over a period of 3 weeks
* if a laser or surgical instrument is used, cautery is necessary to prevent the halves from reuniting
114
what is susuk?
implantation of a form of talisman (magical charm) in the orofacial region
115
susuk is common in what area of the world, and is placed why who?
* southeast asia
* placed by a native american magician or medicine man
116
what is susuk placement thought to do?
* enhance or preserve beauty
* relieve pain
* bring success in business
* provide protection against harm
117
the majority of people with susuk are \_\_\_
muslim, although islam prohibits black magic
for this reason, individuals may deny placement of susuk even when confronted with evidence
118
what is susuk shaped like? what is it made out of?
* shaped like a needle; one pointed end and one blunt end
* most are silver or gold and are 0.5x0.5mm
119
\_\_\_ vary from one to many and are inserted subcutaneously
susuk pins
120
most patients with susuk are what age?
middle-aged adults
121
what do susuk pin implants look like?
no clinical evidence exists; only found via routine radiograph
122
forked tongue
123
susuk
124
are forked tongues and susuk associated with harmful effects? what is the treatment?
no, so no treatment is required
125
\_\_\_ occurs due to nicotine, which stimulates melanin production
smokers melanosis
126
in patients with smokers melanosis, 20% of tobacco smokers 3% of nonsmokers have \_\_\_
oral pigmentation
127
smokers melanosis most commonly affects what gingiva?
anterior facial gingiva
128
in patients with smokers melanosis, reverse smokers show changes on \_\_\_
hard palate
129
in patients with smokers melanosis, cessation of smoking results in \_\_\_
gradual disappearance
130
when is a biopsy considered in smokers melanosis cases?
when pigmentation is in unexpected locations or if there are clinical changes
131
smokers melanosis
132
\_\_\_ appear as dome-shaped, slight radiopaque lesion arising from the intact floor of the maxillary sinus
antral pseudocysts
133
antral pseudocysts consis of \_\_\_
an exudate (serum, not mucin) that has accumulated under the sinus mucosa and caused a sessile elevation
134
antral pseudocysts are common found \_\_\_
on panoramic radiographs
135
antral pseudocysts are present in \_\_\_% of the population
2-15%
136
what is the treatment for antral pseudocysts
no treatment necessary
137
antral pseudocyst
138
\_\_\_ arises from introduction of air into the subcutaneous or fascial spaces of the face and neck
cervicofacial emphysema
139
when can cervicofacial emphysema arise?
* after use of compressed air
* after difficult/prolonged extractions
* result of increased intraoral pressure (sneezing) after an oral surgery procedure
140
in patients with cervicofacial emphysema, what should you avoid during oral surgery?
do not use air-driven handpieces
141
in cervicofacial emphysema, initial change is \_\_\_. after the initial air spreads, what happens?
* a painless soft tissue enlargement
* the enlargement increases and it becomes painful
142
what is the treatment for cervicofacial emphysema?
broad-spectrum antibiotics
resolves within 2-5 days
143
cervicofacial emphysema
