physical and chem injuries

!!WHITE LINE, no other problems besides this

alteration of bilateral buccal mucosa @ occlusal plane due to:
- pressure
- friction
- sucking

no tx or biopsy

clinical mimics: hyperplastic candidasis, lichenoid rxn to amalgam

chronic mucosal chewing; most are aware of it
- thickened, shredded, torn white areas

dx: history and questions

!!histology: ragged, torn hyperkeratosis

more females than males

buccarum, labiorum, linguarum

- physical
- TUGSE (eosinophilic ulcer)
- riga-fede dz (babies)
- thermal
- electrical

!! squamous cell carcinoma !!
lymphoma
deep fungal infection
proliferative myositis, nodular fascitis, pseudosarcomatous
metastatic dz

traumatic ulcerative granuloma with stromal eosinophilia
(!!traumatic origin)

!!deep pseudoinvasive inflam rxn

!!most commonly affected: tongue, lips, buccal mucosa

lesions last ~8mo

!!common in xerostomia

!!sublingual ulcerations in infants

caused by trauma from natal teeth assoc w nursing

no tx

usually children 4/younger

!!lips and commissure most common!!

!!charred yellow area with litle bleeding. edema later!!

tx: remove source, tx symptoms
- !!topical abx: kenalog in orabase!!
if not heal, biopsy

caused by:
- OTC pain meds
- tooth whitening (peroxide)
- dental hygiene products
- iatrogenic dental mats (etch, etc)

!!white, wrinkled appearance from short contact!!
!!inc exposure > necrosis/desquamation > red, bleeding CT base!!

tx: prevention, topicals, none if asympto

hydrogen peroxide! used for cold sore, whitening, acne, etc
burns with greater than 3% conc

listerine

silver nitrate (bray pencil) > hemostasis

nicotine

!!all systemic anti cancer therapies cause death of some normal cells!!

tissues with rapid turnover more susceptible, like oral epithelium

main: chemotherapy, radiotherapy

inc susceptibility to infection
oral mucositis
oral ulceration
inc risk of hemorrhage
impaired healing

mucositis, hemorrhage

hemorrhage

mucositis

dermatitis

xerostomia

loss of taste

osteoradionecrosis

trismus

developmental anomalies

acute: erythema, edema, burning, pruritus (dry itchy skin)

chronic: dry, smooth, atrophic, telangiectatic (wide BV), ulcerated

common complication of radiotx

changes start after a week, dramatic saliva dec after 6wk

!!parotids dramatically and irreversibly affected!!

dec bactericidal activity

related caries inc

hypogeusia, dysgeusia

!!result of non-healing dead bone!!
- due to hypoxia, hypovascularity, hypocellularity

surgical procedures during radio tx inc risk of osteoradionecrosis, should be postponed
!!21 DAYS PRIOR OR 12 MONTHS AFTER!!

!non vital bone, pain, surface ulceration

fibrosis of mastication muscles, tmj capsule

difficult to open jaw and access for tx

micrognathia
retrognathia (unusual mandible)
maloccl
root dwarf
root blunt
dilaceration
microdontia
hypodontia

pre-therapy: removal of any oral foci of infection (non restorable teeth, advanced perio dz)

intra-therapy: relieve pain, dehydration, and malnutrition. admin anesthetic, analgesic, antimicrobial or coating agents (magic mouthwash)

post-therapy: topical fluoride, salivary substitutes, sugarless candies, prevention of infection

medication related osteonecrosis of the jaw

!!oral or IV use of antiresorptive/antiangiogenic agents used to slow osseous involvement of cancers
- agent example: bisphosphonates

mechanism:
- !!powerful inhibitors of osteoclastic activity!!
- incorporates into skeleton, no degradation
- !!half life up to 12 years
- has !!anti angiogenesis properties

!!most lesions on L of posterior mandible, near mylohyoid ridge

most cases after tooth ext or dentoalv surgery

areas of exposed yellow-white bone, smooth or ragged borders
may have extra/intraoral sinus tract
radiographic widening of PDL
advanced: moth eaten, poor define RL

- nonrestorable teeth and poor prog teeth > ext before antiresorp/antiangiogenic therapy. allow 14-21 days healing
- pts with complete or partial dentures: examine for areas of mucosal trauma and irritation

- all dental procedures can be implemented as needed
- ortho needs eval of bone after 2-3months of active therapy
- !!!IMPLANTS NOT ADVISED FOR PATIENTS ON IV AR/AC
- if on IV, !!AVOID DIRECT OSSEOUS INJURY!! nonresto teeth by decoronation and endo for roots instead

eliminate pain, control infection, minimize progression of bone necrosis

remove areas of necrotic bone and loose bony sequestra

snort > damage to tissue between nose and roof of mouth > eventual palatal perforation

powdered cocaine in mouth break down protective enamel

meth mouth: xerostomia, parasitosis, rampant caries
- !!EMACIATED, AGITATED, NERVOUS YOUNG ADULTS WITH MULTIPLE CLASS V!!
- LA with epi can lead to cerebrovascular accident, myocardial infarction or acute HBP

ulceration and necrosis several days after LA

!!due to tissue ischemia!!

appear after chronic lip licking, biting, picking, sucking

circumoral tissues may become infected with bacteria/fungi

!!can lead to chronic lip fissure

tx: abx, antifungal, steroid cream

red, purple, blue, or black

!!palate most ofen affected!! but can happen in labial or buccal mucosa

non-blanching

2ndary to trauma, infections, or systemic dz

types: petechiae, purpura, ecchymosis, hematoma

most common: amalgam into oral mucosa
- mucosal abrasions contaminated by amalgam
- amalgam fragments in extraction sites
- transfer via floss
- endo retrofill

IF YOU CANNOT VERIFY PRESENCE OF AMALGAM, MUST DO BIOPSY (could be melanoma)

acute: bleeding, infection, nerve damage
chronic: speech impediment, allergy, chipped teeth, asipiration

bruising, erythema, itching, pain, infections

tx by incision or inject corticosteroid

lead, mercury, silver, bismuth, arsenic, gold

(LAGMBS, lets all get mercury banned from school)

ulcerative stomatitis, gingival lead line (Burtons), metallic taste, tongue tremor

acrodynia also called pink/swift: hypersalivation, ulcerative gingivitis, bruxism, loss of teeth

ingestion of salts and vapor dangerous. element itself harmless

slate blue gingival margins, gray skin (bc silver spread thru body, accml in skin)

acute: coma, pleural edema, bone marrow fail
chronic: affect toxicity of liver, spleen, kidney, lungs

usually on anterior facial gingiva
polycyclic amines > melanin stim

underlying bone and teeth discolored
- !!linear ban above facial att gingiva
- !!broad zone across hard palate

fades after discont of drug

!!drug used for tx of rheu arthritis, lupus, malaria

!!Black blue pigmentation usually at hard palate

discont > fading

!! at lingual of mandible, areas of thin mucosal covering

ulceration of overlying oral mucosa

!!common finding on pano!!
!!dome shaped faint RP on floor of max sinus
!!subepithelial inflammatory serum exudate

usually asympto

can be assoc with odontogenic infection

inc prevalence in winter > correl w URI

no tx if no expansion or bone destruction

accml of mucin encased by epithelium

3 possibilities: surgical ciliated cyst, mucocele, retention cysts

!!2ndary to blocked ostium

enlarge and disten to bony walls of sinus

fills entire sinus and erodes bone, mimicks malignancy

requires surgery

!!caused by introduction of air into subcutaneous/fascial spaces of face and neck
- blowing nose or sneezing post-ext
- iatrogenic if DDS blow air into wound

tx: abx and warm compress

!!petrolatum based abx into ext socket (possibly to treat alv osteitis/dry socket

asymptomatic circumscribed RL, granulomatous rxn

tx: surgical remove