Oral Pathology Exam 2

Physical & Chemical Injuries, Melanocytic Lesions, Oral Manifestations of Systemic Disease

irregular white keratotic plaque, due to chewing

chronic mucosal chewing : morsicatio mucosae oris

biting on buccal mucosa (cheek)

morsicatio buccarum

biting on the lateral border of the tongue

morsicatio linguarum

biting on labial mucosa

morsicatio labiorum

morsicatio linguarum

morsicatio buccarum

deep, chronic ulceration due to repetitive trauma causing damage to muscle; very slow resolution (months to years); more common in adults; usually found on the tongue over buccal mucosa and lips

traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)

clinically similar to squamous cell carcinoma, MUST do biopsy for any lesion that is >2 weeks!

traumatic ulcerative granuloma with stromal eosinophilia

TX for TUGSE

incisional biopsy and remove cause of trauma

tumor-like hyperplasia of fibrous tissue that develops with the flange of an ill-fitting denture; single or multiple folds along the alveolar ridge

epulis fissuratum

TX for epulis fissuratum

reline/ adjust denture; surgical removal of tissue

placing aspirin tablet or powder next to toothache

chemical burn

characteristics of chemical burn

low pH, pseudomembrane that can be rubbed off, takes a few days to heal after chemical is removed, no scar formation

chemical burn

formocresole necrosis

chemical burn

phenol burn

chemical burn

phenol peel

chemical burn

hydrogen peroxide burn

contact with hot beverages and food

thermal burn

contact with electricity

electrical burn

characteristics of electrical and thermal burns

zones of erythema, ulceration, necrotic epithelium at periphery

burn

pizza burn

burn

smoke steam burn

burn

electrical burn

burn

pipe stem burn

topical allergic reaction; generalized or localized; may burn or be painful; goes away if product causing irritation is not used/ removed

contact stomatitis

most common flavoring agent of contact stomatitis

cinnamon

examples of products that cause contact stomatitis

mouth wash, tooth-paste, candy, gum

begins a few day to weeks after chemo begins; ulcerations and sloughing of the epithelium; common on the lips, tongue, and gingiva; resolves slowly within weeks after TX

chemotherapy mucositis

oral side effects of radiation therapy (frequency = to or > than 90%)

xerostomia, hypogeusia (loss of taste), trismus (restricted mouth opening due to muscle spasms)

radiation therapy induced

radiation mucositis

radiation therapy induced

radiation dermatitis

radiation therapy induced

radiation caries

radiation therapy induced

candidiasis

radiation therapy induced exposed non vital bone that persists for more than 3 months in absence of neoplastic disease; occurs in < 5% of patients; most arise secondary to local trauma (ext), but some are spontaneous

osteoradionecrosis

what is the main factor for development of osteoradionecrosis

radiation dose > 60 Gy

what is the more common site of osteoradionecrosis

24x more common in mandible

what is the timeframe for the development of osteoradionecrosis

occurs 4 months to 3 years after radiotherapy; pts can be susceptible forever but likelihood is less over time

to reduce the risk of osteoradionecrosis, dental tx should occur __

before radiation begins; ideally with a healing time of a minimum of 3 wks

dental tx is __ during radiation therapy unless NECESSARY

contraindicated

after radiation therapy, there is a __ window where dental tx can be performed

4 month

manifestation of osteoradionecrosis

fistula

manifestation of osteoradionecrosis

exposed bone

manifestation of osteoradionecrosis

moth-eaten ill-defined radiolucency

BRONJ (2003)

bisphosphonate related osteonecrosis of the jaw

ARONJ (2011)

antiresorptive related osteonecrosis of the jaw

MRONJ (2014)

medication related osteonecrosis of the jaw

current or previous tx with antiresorptive medication, exposed bone in MF region for longer than 8 wks, no hx of radiation therapy

required characteristics for diagnosis of MRONJ

poorly defined RL borders

osteoradionecrosis

poorly defined RL borders

MRONJ

poorly defined RL borders

metastatic disease

poorly defined RL borders

osteomyelitis

occurs at the site of anesthetic injection; necrosis/ ischemia from epinephrine; erythema, pain, ulceration; usually occurs on the hard palate; heals within 1-2 wks

anesthesia necrosis

minute hemorrhage (1-2 mm) in skin, mucosa, serosa; multiple red/ purple spots, do not blanch with pressure; due to injuries, accidents, excessive coughing, vomiting

petechiae

slightly larger than 1-2 mm (max 1cm); single or multiple red or purple spots; do not blanch with pressure; due to vascular problems, platelet disorders, vit C deficiency

purpura

any accumulation over 2 cm

ecchymosis

accumulation of blood within tissue producing a mass

hematoma

amalgam traumatically introduced into mucosa; steel gray/ blue/ black macule; last indefinitely and may enlarge over time; no TX necessary but excision of very dark lesions may be warranted to rule out melanoma

amalgam tattoo (localized argyrosis)

becoming more common; hyaluronic acid (juvederm) or poly-lactic acid (sculptra); usually asymptomatic though pts may complain of a “bump”; some cases can have an allergic reaction; brusing, erythema, itching

oral lesions associated with cosmetic fillers

from solder, old paint, battery factories, porcelain glaze, candle wicks; black marginal gingivitis

lead poisoning (plumbism)

from medications/ makeup; diffuse gray discoloration of skin and membranes; gray marginal gingiva

silver poisoning (argyria)

from medications; “mad hatter” curing pelts in hats (1800s)

mercury poisoning (acrodynia)

from lead poisoning (plumbism)

Burton’s line

burton line, plumbism

lead

acrodynia, erythism, pink disease

mercury

argyria

silver

mees lines, black foot disease

arsenic

methemoglobinemia

bismuth

chrysiasis

gold

dead necrotic bone that is separated from remaining bone

sequestrum

most arise from lingual surface of the mandible adjacent to molars along mylohyoid ridge; linear ulceration, pain varies; TX = surgical removal

spontaneous sequestration

the sheath of new bon that forms around a sequestrum (new viable bone surrounding dead bone)

involucrum

dome shaped, faintly radiopaque lesions; arising from maxillary sinus; accumulation of inflammatory exudate; TX depends if lesion is symptomatic

antral pseudocyst

from air forced into subcutaneous or fascia spaces (e.g. blowing an instrument or glass, prolonged extraction while using a handpiece); rapid onset within an hour; facial swelling and erythema, pain dysphagia, dysphonia, vision difficulties, mild fever; TX = AB if infection, most regress spontaneously within 5 days

cervicofacial emphysema

30% show amalgam particles on xray

localized argyrosis

a

stratum corneum

b

stratum lucidum

c

stratum granulosum

d

stratum spinosum

e

stratum basale

clinically, a brown macule on face/arms/back that gets darker with UV light and is a benign increased in melanin deposition

ephelis (freckles)

If your patient comes in with ephelis, should you prescribe tx?

No tx required

A uniform demarcated brown color, may have irregular outline. Results in an increase in melanocytes, are benign brown macules. No color change with UV light

actinic lentigo (age spots, liver spots)

What treatment does actinic lentigo call for?

no tx

rare, benign acquired dark melanosis of mucosa (reactive process) most commonly on the buccal mucosa. Solitary, asymptomatic, grows fast within weeks and is usually caused by trauma (like a toothbrush)

Melanoacanthoma

Tx required of Melanoacanthoma

disappears when insult is removed

Uniform brown pigmentation, oval w/ well demarcated borders. Most common on the lower lip vermillion, buccal mucosa, gingiva, palate. Will be a benign increase in melanin deposits

melanotic macule

Cause of melanotic macule?

developmental

Acquired melanotic nevus - “common mole”

Congenital melanocytic nevus “birth mark”

developed during childhood and YA, located on the skin above the waist and intraorally on the hard palate or gingiva, but can occur anywhere

Acquired melanocytic nevus

What condition is classified on histopathological appearance: junctional, compound, intradermal/intramucosal, blue nevus

acquired melanocytic nevus

What happens to 2-3% of large congenital nevus?

transforms into malignant melanoma

most common on trunk and extremities, 15% in head and neck

congenital melanocytic nevus

melanoma arising in a congenital nevus

treatment for melanocytic nevus

excise for aesthetics & definitive diagnosis. Follow-up. Can use dermabrasion, chemical peel, cryotherapy, or surgery

Appears as a macular or dome-shaped, blue or blue-black lesion smaller than 1 cm in diameter usually in childhood or YA and females.

blue nevus

nevus of ota

conjunctiva

oral lesions of blue nevus are found

almost always on the palate

blue nevus

amalgam tattoo