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Physical and Chemical Injuries

Physical and Chemical Injuries. Linea Alba. White line,” usually bilateral, on buccal mucosa Associated with pressure, frictional irritation, or sucking trauma from the facial surfaces of the teeth No treatment required. Linea Alba. Morsicatio Buccarum (Chronic Cheek Chewing).

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Physical and Chemical Injuries

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  1. Physical and Chemical Injuries

  2. Linea Alba • White line,” usually bilateral, on buccal mucosa • Associated with pressure, frictional irritation, or sucking • trauma from the facial surfaces of the teeth • No treatment required

  3. Linea Alba

  4. Morsicatio Buccarum (Chronic Cheek Chewing) • Chronic nibbling produces lesions that are white, shredded • Morsicatio labiorum – affects labial mucosa • Morsicatio linguarum – affects lateral border of tongue • No treatment required

  5. Morsicatio Buccarum (Chronic Cheek Chewing)

  6. Traumatic Ulcerations • Surface ulcerations occur as a result of acute or chronic irritation or trauma • Occurs most often on tongue, lips, buccal mucosa. • Areas of erythema (red halo) that surrounds central yellow pseudomembrane (ulcer) or focal red ulcerated area without fibrin covering; smaller, uncomplicated lesions heal within days

  7. Traumatic Ulcerations

  8. Traumatic Ulcerative Granuloma with Stromal Eosinophlia(TUGSE) • Most often seen on tongue secondary to muscle damage • Deep “pseudo-invasive” inflammatory reaction that is slow to resolve

  9. Traumatic Ulcerative Granuloma with Stromal Eosinophlia(TUGSE)

  10. Riga-Fede disease • Sublingual ulceration in infants, associated with nursing and natal/neonatal teeth.

  11. Factitious Oral Injury

  12. Atypical histiocytic granuloma • May be misdiagnosed as lymphoma. • Surface ulceration and underlying tumefaction. • Treatment involves removal of irritating cause

  13. Atypical histiocytic granuloma

  14. Thermal Burns • Caused by hot foods or beverages • Zones of erythema and ulceration, on palate or posterior buccal mucosa • No treatment required

  15. Electrical Burns • Contact burns • Electrical arc flows between electrical source and mouth; saliva is conductor • Most occur in young children, involve lips and commissure • Initial appearance is painless, charred yellow area with little bleeding; edema develops, then sloughing • Tetanus shot required • Primary problem is contracture of mouth opening during healing (microstomia, prevents eating and hygiene)

  16. Electrical Burns

  17. Chemical Injuries of the Oral Mucosa • Aspirin - May cause necrosis when held in the mouth • Hydrogen peroxide - concentrations of 3% or higher associated with adverse reactions • Silver nitrate - treatment for aphthous ulcerations, chemical cautery destroys nerve endings • Phenol - Extremely caustic • Endodontic materials - possibility of soft tissue damage or injection into hard tissue with resultant deep spread and necrosis

  18. Chemical Injuries of the Oral Mucosa • Caustic agents generally produce similar damage • Brief exposure – superficial white wrinkled appearance • Longer exposure – necrosis proceeds, epithelium can be easily desquamated • Cotton roll burn – oral mucosa become adherent to dry cotton rolls, and rapid removal strips epithelium away

  19. Chemical Injuries of the Oral Mucosa

  20. Cotton Roll Injury of the Oral Mucosa

  21. Noninfectious Oral Complications of Antineoplastic Therapy • Mouth is common site for complications related to • cancer therapy • Mucositis - areas of ulceration; pain, burning, and discomfort • Dermatitis - varies according to intensity of therapy • Intraoral hemorrhage, oral petechiae and ecchymosis • Xerostomia

  22. Noninfectious Oral Complications of Antineoplastic Therapy • When portion of salivary glands included in fields of radiation, remaining glands undergo hyperplasia to compensate. • When all salivary glands involved, loss of saliva is progressive, persistent, and irreversible • Xerostomia-related caries - diminished saliva leads to decrease of bactericidal action and self-cleaning properties • Hypogeusia - loss of all 4 tastes (sense returns for most patients) • Some may have dysgeusia (altered sense of taste)

  23. Osteoradionecrosis • Result of non-healing, dead bone • Dead bone separates from residual vital areas • Postradiation dental extractions are known risk factor

  24. Noninfectious Oral Complications of Antineoplastic Therapy

  25. Miscellaneous Problems • Trismus - difficulty in opening jaw • Developmental abnormalities -can be caused by antineoplastic therapy during childhood

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