Chemical Injuries & Physical

Epulis Fissuratum
1. single or multiple folds of hyperplastic tissue in alveolar vestibule
2. histopathologic
  1. papillary hyperplasia and or pseudoepitheliomatous hyperplasis
Inflammatory Papillary Hyperplasia
1. Asymptomatic
2. pink or red pebbly mucosa
3. erythema suggests candidal infection
4. Histopathologic
  1. may show pseudoepitheliomatous hyperplasia
5. Treatment and Prognosis
  1. mild cases may resolve with removal denture
  2. established cases require reclining refabricating denture foloowing excsion of hyperplastic tissue
  3. antifungal therapy
traumatic ulcers
1. common oral pathology
traumatic ulcerative granuloma
1. not true granuloma
2. slow-healing, penetrating ulcer takes weeks to months to resolve
3. may be mistaken for malignancy
4. patients are immunocompetent
5. often white hyperkarkerotic rim
  1. may help distinguish from aphthous ulcer or SCCA
6. histopathologic
  1. numerous eosinophils
  2. traumatic ulcerative granuloma with stromal eosinophilia
  3. inflammation of skeletal muscle
  4. granulation tissue
Verruciform xanthoma
1. can resemble squamous papillomas or early carcinomas
2. large macrophages with foamy cytoplasm
chemical injury facititial aspirin , mouthwashes mhyrdogen , peroxide
non infectios complications of antineoplastic therapy
1. complications of radiology
  1. salivary gland hypofunction
    1. treatment
      1. pilocarpine, or cevimeline
      2. topical fluoride
      3. caphosol
  2. mucositis occurs 1-2 weeks folllowing irradiation
  3. desqaymation and ulceration
  4. osteoradionecrosis radiation induced osteonecrosis
    1. MANDIBLE AFFECTED
    2. greater risk > 60 gy 6,500 radds
    3. Complication
      1. dental prosthesis intolerance due to xerostomia
    4. treatment
      1. debridement
      2. antibiotics
      3. hyperbaric oxygen?
      4. prophylactic extrctions
  5. saliva thickens at 1 week
  6. hypofunction with/without xerostomia 1 month following therapeutic irradiation irreversible damge
  7. treatment
  8. increase of cerival cries hypogeeus.. classs 5
2. complications of chemotherapy
  1. mucositis occurs within days
  2. bone marrow suppression
    1. thrombocytopenia
    2. agranulocytosis
  3. opportunistic infections
    1. herpes simpples
    2. candidiasis
osteonecrosis of the jaws
1. anti resoprive agents
  1. bisphosphonates
    1. relative potency
      1. nitrogen containing
        Pamidronate (Aredia) 100-1000 500-1000 100-1000 100-2000 Alendronate (Fosamax) Ibandronate (Boniva) Risedronate (Actonel) Zoledronic acid (Zometa) 1000-10000
    2. indications
      1. osteoporosis multiple myeloma
      2. metastic carcinomas to bone
      3. multiple myeloma
  2. denosumab
    1. prolia xgeva
2. AAOMS staging
  1. Stage 0: non-exposed Stage 1: exposed asymptomatic Stage 2: exposed symptomatic Stage 3: extensive disease
3. MRONJ
  1. Mandible affected more than maxilla, but discrepancy not as great as in osteoradionecrosis
4. Treatment
  1. asymptomatic patients
    1. chlorhexidine rinse
      1. soft splint
    2. smooth rough edges of exposed bone
  2. symptomatic patients
    1. systemic antibioti therapy and chlorehexidine
    2. hyperabaric oxygen has not been beneficial
MRONJ definition
1. current or previous treatment with anti-resorptive OR anti angiogenic agents
2. exposed bone OR bone that can be probed through sinus tract persisting > 8 weeks
3. no h/o radiation or obvious metastis to jaws
lingual mandibular sequestration
1. Most often on lingual surface of the posterior mandible along the mylohyoid ridge
exfoliative cheiltitis
1. persistent scaling vermillion

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Chemical Injuries & Physical

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	Created by Tabitha Lewis about 8 years ago