Physical and Chemical Injuries

Frictional Keratosis: Physiologic response of mucosa to chronic physical injury. o Produces hyperkeratosis as protective phenomena (white plaque) to protect outside epithelium. o Reversible adjust occlusion if thats the cause. Cheek Chewing: (Morsicatio buccarum): Shredded or macerated keratinized tissue limited to occlusal plane. o Linea Alba labial, buccal mucosa along side occlusal plane. o Tongue chewing o Histology: Hyperkeratosis with bacterial colonization Traumatic ulcer: Loss of epithelium from physical injury o More on lateral tongue, lower lip, painful and self limiting o Surface covered by FIBRINOUS exudate, MORE in kids o Epithelium from ulcer margin migrates and recovers surface Traumatic granuloma: type of traumatic ulcer with injury to underlying MUSCLE o MORE on tongues rolled borders o DOES NOT heal could be oral cancer ( has clinical features of carcinoma) o MUST do biopsy to rule out carcinoma Amalgam Tattoo: slate bluish- grey discoloration from traumatic implantation of amalgam, SUBSURFACE discoloration o Persistent as amalgam is non biodegradable o May or May not see on radiograph as could be very diffused o Can do biopsy sometimes to rule out melanoma o Silver compunds stain collagen and blood vessels Hematoma: Extravascular bleeding into tissue, resolves with time Petechiae: PINPOINT capillary bleeding, Could be due to THROMBOCYTOPENIA or ORAL SEX (Fellatio)

Oral Complications of H and N radiation therapy:

 Osteoradionecrosis: Radiation damages osteocytes and microvasculature. MORE likely to get tooth decay o Bone is hypoxic and cant remodel or respond to injury o It is also prone to very serious infections and huge areas of bone die and sequestrate o Can be treated with excision and resectionCan be prevented by extracting teeth before radiation therapy Chemical Injuries Toxic drugs killing epithelium= necrosis Burns: Usually produces necrosis of epithelium and white color, which may or may NOT RUB OFF. If rub off leave a bleeding surface underneath. Wiped if damage is more extensive. WIPABILITY is NOT a distinguishing factor o Caused by Aspirin, Phenol, AgNO3, Highly acidic and basic things!!! Generalized gingival hyperplasia: o Phenytoin ( Dilantin) for epilepsy and seizure control, 50% folks on Phenytoin get it o Cyclosporin immunosuppressant for organ transplantation o Ca channel blockers: all Ca channel blockers do this not just one (Nifedipine, Verampil, Diltizem, Primidone) o Severity most closely related to adequacy of oral hygiene as hyperplasia is related to inflammation o Painless generalized swelling produces pseudopockets and increased inflammation o Can be treated with drug substitution or surgery Heavy metal ingestion: Staining of marginal gingiva due to heavy metal precipitation. o Mostly due to sulfides, lead, mercury, arsenic and cis- platinum o Pigmentation right along gingival margins o Looks like a lead line! Allergy o Type I hypersensitivity anaphylaxis shock, IgE, IgE histamine mediated erythema o Type IV hypersensitivityCell Mediated- cytokins- ehite/red and white: tissue changes o Angioedema lips swell due to hypersensitivity o Stomatitis medicamentosa( systemic) generalized uritcaria, easy to diagnose!!!! o Stomatitis Venenata( topical application) and is a diagnostic challenge o Cinnamon Allergy: MOST common allergen in the US, nothing unique about this hypersensitivity. Found in tartar control toothpaste mixed with cinammic aldehyde. COULD BE SEVERELY allergic!!!! Looks red, white or a combo, Increased desquamative gingivitis.***Lesions on lateral tongue and buccal mucosa on same side= MAIN CLINICAL FEATURE. Take patient off of this product and they do well

Non Neoplastic Proliferations: REACTIVE tumors of the oral mucosa!!! Patients present with swelling (tumefecation), could be due to inflammation ( cardinal sign) Tumor= Swelling. Although some people dont like calling reactive lesions Tumors. Dr Wright doesnt give a fuck and calls them Tumors!!!! Reactive lesion: o Is benign, result of HYPERPLASIA, increase in # of normal cells, can become very large but DO NOT have unlimited growth potential. o These are product of bodys reaction to a stimulus like physical stimulation!!! o This stimulus may NOT be always obvious clinically!!!! o REACTIVE lesion are 20% of all lesions biopsied in a DENTAL OFFICE Fibroma: MOST common benign tumor/ NOT a neoplasm, just hyperplasia of FCT o MOST common tumor of oral mucosa o Keratosis outside, may bleed upon rubbing o Usually SESSILE, smooth surfaced, NORMAL mucosal color, ASYMPTOMATIC, cheeks but occurs ALMOST anywhere does occur on the gingiva I see o More collagen in histo sections, rest seems normal o Variants GIANT CELL FIBROMA from gingival collagen: NOTTTT to be confused with GIANT CELL GRANULOMA: Papillary tumor of fibrous CT containing PLUMPPP. Stellate and often bi or trinucleated cells!, children, gingiva tongue, Often confused clinically with Papillomas which are neoplasms. REALYYYYYYY Peripheral odontogenic (ossifying) fibroma: Has UNVARIABLE calcifications, reactive fibroblastic LESION OF THE PDLLLL, 1-3 decades ( younger folks), OCCURS ONLY ON GINGIVA PERIOD, asymptomatic, pedunculated or sessile mass with or without redness +ulceration Histo: UNIQUE HISTO is DYSTROPHIC CALCIFICATION; Tx: excise using superificial PDL. Must get deeper or recurs 15-20% Inflammatory Fibrous Hyperplasia (EPULIS FISSURATUM): Reactive folds of hyperplastic fibrous CT along border of ill-fitting, over extended DENTURES Histo: Fibrous Hyperplasia +/- inflammation Tx: excision and remake/ reline denture Inflammatory Papillary Hyperplasia: (Papillomatosis) Hyperplastic response of palatal mucosa to ill fitting denture Histo: Papillary hyperplasia+inflammation +/-pseudoepitheliomatous hyperplasia (PEH) (epithelioma= oral cancer) Tx: Excise + remake/ reline dentures= a fit problem and not a yeast problem

 Peripheral Giant Cell Granuloma: ONLY get THESE OVER the ****BONEEE o Tumor of well vascularized fibrous CT containing numerous MULTINUCLEATED GIANT cells o Histogenesis is questionable but occurs only on GINGIVA ANTERIOR o Any age, asymptomatic o *****REDDISH BROWN PURPLE pedunculated or sessile masss o Female : male 2:1 causes CUPPING RESORPTION of underlying bone o Tx by removing, excision and may recur Pyogenic Granuloma: The name is a MISNOMER. It DOES NOT look like either granulation tissue or a pyogenic infection. o A reactive lesion representing HYPERPLASIA of bodys basic reparative tissue GRANULATION TISSUE o *****Looks vascular like RED, is ulcerated pedunculated or sessile mass o Can occur middle to any age 2-4 decades o in gingiva but can occur anywhere on the skin o in females often in pregnancy ****PREGNANCY TUMORRRRR o Called EPULIS GRANULOMATOSA when occurs in extraction sockets, common at this location o Histo: Hyperplastic granulation tissue, fibroblasts with delicate collagen, endothelial cells and capillaries & larger dilated vessels o Tx by excision and removal of irritants. May recur! Parulis Gum Boil: Gingival swelling is draining a source of odontogenic infection of either pulpal or periodontal origin o Pus ( purulence, suppuration) means BACTERIAL infection NOT VIRAL infection o The main challenge is to determine the main source of this infection Localized juvenile spongiotic gingival hyperplasia: Presumably from externalized sulcular epithelium on gingiva o ALMOST exclusively in first 2 decades of life female 2:1 o Almost all ANTERIOR gingiva, Max 5:1 o Looks Red and often papillary gingival lesions clinically o Tx is excision o Histo: papillary proliferation of inflamed epithelium with intercellular edema SPONGIOSIS Hemangioma: Benign tumors of blood vessels! Can get anywhere in the body ! o Overgrowth of blood vessels o Also called Hamartoma: Localized overgrowth of tissue, native to the part, often developmental o MOST common tumor of INFANCY 5-10% incidence! o INVOLUTES characteristically o Rapid endothelial cells proliferation at/after birth o in females 3:1

60% in H and N 0-5 years ( mostly congenital or occur in infants!) 90% complete involution by AGE 10! Go away by age 10 I guess o Red to purple mass lesions that blanch with pressure o ORAL ones occur later in adults and do not involute or go away naturally o Often occur in bone having multilocular, soap bubble appearance o Why you aspirate before bone biopsy!!! o Histology: endothelial cell proliferation causes formation of small capillaries and large dilated vascular spaces called cavernous spaces o TX: steroids intralesional and propranolol. Excision , laser pulse, sclerosing agents, goes away naturally with involution! Sturge- Weber Angiomatosis ( Encephalotrigeminal angiomatosis): o NON HEREDITARY DEVELOPMENTAl CONDITION o Characterized by vascular proliferation of Brain and Face along CN V distribution divisions!!! o PORT WINE STAIN of skin o IPSILATERAL oral mucosal involvement is common o Leads to LEPTOMENINGEAL ANGIOMAS of cerebral cortex! Lymphangiomas: Developmental overgrowth of lymphatic vessels o in H and N, in 0-5 yoa o Orally tongue!!! MACROGLOSSIA o Superificial ones have a pebbly surface covered by translucent vesicles o Deeper ones are more diffused o Cystic hygroma is a variant that infiltrates and becomes very large in neck! o Histology: thin walled capillary sized lymphatic vessels proliferate! Dilated (cavernous) or cystically dilated ( cystic hygroma!!!) o Treatment: Lesions *****do not INVOLUTE, can be excised as superficial, deeper ones recur as hard to find edges and difficult to excise, Sclerosing agents

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