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) Chronic nibbling produces lesions

that are white, shredded Morsicatio labiorum – affects labial

mucosa Morsicatio linguarum – affects lateral

border of tongue No treatment required

Morsicatio Buccarum (Chronic Cheek Chewing)

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

Traumatic Ulcerations

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

Traumatic Ulcerative Granuloma with Stromal Eosinophlia(TUGSE)

Riga-Fede disease

Sublingual ulceration in infants, associated with nursing and natal/neonatal teeth.

Factitious Oral Injury

Atypical histiocytic granuloma

May be misdiagnosed as lymphoma.

Surface ulceration and underlying tumefaction.

Treatment involves removal of irritating cause

Atypical histiocytic granuloma

Thermal Burns

Caused by hot foods or beverages Zones of erythema and ulceration,

on palate or posterior buccal mucosa

No treatment required

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)

Electrical Burns

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

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

Chemical Injuries of the Oral Mucosa

Cotton Roll Injury of the Oral Mucosa

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

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)

Osteoradionecrosis

Result of non-healing, dead bone Dead bone separates from

residual vital areas Postradiation dental extractions

are known risk factor

Noninfectious Oral Complications of Antineoplastic Therapy

Miscellaneous Problems

Trismus - difficulty in opening jaw Developmental abnormalities -can

be caused by antineoplastic therapy during childhood