Physical and chemical injuries of oral cavity, oral pathology. mercury poisoning , argyria, lead poisoning

3. • GENERALIZED INFLAMMATION: (DENTURE SORE MOUTH,
DENTURE STOMATITIS)
Occurs in patients who wore dentures
Poor denture cleanliness
Newton suggested that it may be associated
with sweat retention syndrome

4. Red, swollen, smooth or granular and painful
multiple pinpoint foci of hyperemia
severe burning sensation

5. Antifungal therapy : nystatin tablets 500,000
units, were allowed to dissolve in the mouth three
times a day for 14 days.
when the dentures fit poorly, construction of new
appliances and instruction on hygienic care.
rebasing dentures with soft-tissue conditioners.

6. Hyperplasia of tissue along the denture borders. ill-fitting
denture
Occurs on the gingiva , buccal mucosa, and angle of the
month.

7.  Development of elongated rolls of tissue in the muco
labial or muco buccal fold area into which the denture
flange conveniently fits.
irritation or even ulceration in the base of the fold into
which the denture flange fits.

8. Surgically excised.
Either new dentures constructed or the old
dentures rebased to provide adequate retention.

9. A form of inflammatory hyperplasia associated in most
instances with ill-fitting dentures, which permit frictional
irritation and a poor state of oral hygiene.

10. Occur in edentulous patients with dentures
lesion presents itself as numerous, closely arranged, red,
edematous papillary projections, often involving nearly all of the
hard palate
lesions may extend onto the alveolar mucosa

11. Surgical excision of the lesion prior to
new denture construction will return the
mouth to a normal state.

12. Traumatic origin, is a lesion involving salivary glands
and their ducts.

13. Occurs usually on the lower lip ,palate, cheek, tongue and floor of the
mouth.
Superficial lesion appears as a raised, circumscribed vesicle, several
millimeters to a centimeters diameter, with a bluish, translucent cast.
Deeper lesion is manifested also as a swelling but because of the
thickness of the overlying tissue, the color and surface appearance are
those of normal mucosa.

14. Surgical excision.
If the lesion is simply incised, its contents will be
evacuated, but it will be rapidly filled again as soon as the
incision heals.

15. The ranula is a form of mucocele but larger, which specifically
occurs in the floor of the mouth in association with the ducts of the
submaxillary or sublingual gland.
It may arise through duct blockage or through the development of a
ductal aneurysm.

17. Lesion develops as a slowly enlarging painless mass on
one side of the floor of the mouth.
Tongue may be elevated and when it is large it may hide
the salivary gland.
Lesion is superficial, the mucosa may have a translucent
bluish color.

18.  Cavity wall is made up of a lining of compressed fibrous connective
tissue and fibroblasts.
Abundant numbers of polymorphonuclear leukocytes, lymphocytes,
and plasma cells.
Lumen of the cyst like cavity is filled with an eosinophilic coagulum
containing variable numbers of cells, chiefly leukocytes and
mononuclear phagocytes.

19. excision of the entire sublingual gland

20. Lesion appears to represent a retention phenomenon of the mucous glands
associated with the lining of the maxillary sinus
causative factors include sinusitis, allergy and sinus infection

21. Asymptomatic
Seen during radiographic examination of the jaws
Discomfort in the cheek or maxilla may be present
Pain and soreness of the face and teeth and
numbness of the upper lip

22. Dental periapical radiograph: well-defined, homogeneous, dome-
shaped or hemispheric radiopacity varying in size from a tiny lesion to
one completely filling the antrum, arising from the floor of the antrum
and superimposed on it

23. Non-secretory cyst or secretory type of antral cyst
In either case inflammatory cell infiltration in the
connective tissue wall of the specimen is common.
No tx. Cysts either persist or disappear with time

24. A stone in the salivary ducts or glands is called sialolithiasis
Formed by deposition of calcium salts around a central nidus
which may consist of altered salivary mucins, desquamated
epithelial cells, bacteria, foreign bodies, or products of
bacterial decomposition
salivary gland obstruction

25. Pain during and after meals
Occlusion of the duct prevents the free flow of saliva.
Buccal sulcus, lower lip, palate, and tongue are
affected
Solitary, firm, freely movable, small masses or nodules

26. Small calculi may be removed by manipulation or increasing the
salivation by sucking a lemon, leading to expulsion of the stone
Piezoelectric shock wave lithotropsy may be an alternative to surgical
removal
No recurrence
Intravenous antibiotic is given for bacterial infection due to persistent
obstruction of the duct

27. Complete or partial calcific encrustation
of an antral foreign body, which serves as
a nidus

28. Pain, sinusitis, nasal obstruction, and/or foul
discharge, and epistaxis
Radiographic examination : opaque mass is
evident in the sinus
Surgically removed

29. Rhinoliths are calcareous concretions occurring in the nasal
cavity
Formed by calcification of intranasal endogenous or
exogenous foreign material
Odorous discharge, symptoms of nasal obstruction, sinusitis,

30. Radiation injuries are caused by ionizing effects of
energized particles on cells
Radiation therapy, used in the treatment of head and neck
malignancies, normal tissues in and around the field of
radiation is also damaged to certain extent

31. FACTORS
Toxic effect of protein breakdown products
Inactivation of enzyme systems
Coagulation or flocculation of protoplasmic colloids
Denaturation of nucleoproteins

33. ORAL MUCOSA
Mucosa in the path of radiation first appeared
hyperemic and edematous. As treatment continued, the
mucosa became denuded, ulcerated, and covered with a
fibrinous exudate
Patients undergoing radiotherapy for oral cancer also
quickly lost their sense of taste, probably because of

35. Destruction of tooth substance, resembling dental caries and sometimes
called ‘radiation caries’, which often begins at the cervical area of the teeth
Radiation induced xerostomia in humans produced pronounced shifts in
the oral microbial population, with cariogenic microorganisms gaining
prominence at the expense of noncariogenic ones.There is a sharp decrease
in the total daily output of caries-protective salivary electrolytes and
immunoproteins
Caries Prevented with one daily application of a 1% sodium fluoride gel

37. Normal balance between bone formation and
bone resorption is disturbed; general bone vitality is
decreased, and localized osteoporosis may result
When radiation shortly followed tooth extraction,
there was retardation of surface closure of the
wound, leaving an open pathway for tissue

38. It is an acute form of osteomyelitis caused by damage to the
intraosseous blood vessels and is characterized by a chronic,
painful infection, and necrosis accompanied by late
sequestration and sometimes permanent deformity
Destruction of osteocytes, absence of osteoblasts, and lack of
new bone or osteoid formation.

39. (1) Irradiation of an area of previous surgery before adequate healing had taken place
(2) irradiation of lesions in close proximity to bone
(3) a high dose of irradiation with or without proper fractionation
(4) use of a combination of external radiation and intraoralimplants
(5) poor oral hygiene and continued use of irritants
(6) poor patient cooperation in managing irradiated tissues or fulfilling home care programs
(7) surgery in the irradiated area
(8) indiscriminate use of prosthetic appliances following radiation therapy
(9) failure to prevent trauma to irradiated bony areas
(10) presence of numerous physical and nutritional problems prior to therapy.

40. Effect on Soft Tissue
When directed at soft tissue, laser radiation has the ability to produce
nonspecific ulceration of the epithelium with acute purulent inflammation
Electrical burns :Electrical burns of the oral cavity are seen with an unpleasant
Frequency in children
The child chews on an electrical cord, breaks the insulation and contacts the bare
wire or sucks on the socket end of an extension cord.
The resulting burn of the lips, and sometimes of the gingiva
And tongue, usually causes destruction and necrosis of a considerable amount of tissue

41. Emphysema is a swelling due to the presence of gas or air
in the interstices of the connective tissue
E.g Tooth extraction; blowing of compressed air into a root canal
during endodontic treatment, or into a periodontal pocket;
blowing of air from a high- speed air-rotor machine following
middle-face fractures; or spontaneously as a result of the patient’s
breathing actions following some type of surgical procedure, with
a break in the tissue permitting air to enter connective tissue

42. Unilateral swelling of the tissues of the face and/or neck
Bubbling’ sensation when palpating this tissue and of difficulty in
breathing
Spread into the mediastinum results in dysphagia, or dyspnea

43. Acute symptoms can be treated with
antibiotics, hydration, massages, sialagogues,
and compresses

44. Quarrels, children’s play, child abuse, mental derangements,
and sexual assaults or related activities
There is a major risk of transmission of diseases such as
syphilis, hepatitis, and HIV infection through biting
Human bite also has assumed a very important role in Forensic
medicine and forensic dentistry, especially inmurder, rape, or
assault cases

45. (1) drug allergy, or stomatitis medicamentosa
(2)contact stomatitis, or stomatitis venenata.
 Angioneurotic edema is still another allergic phenomenon
which will be considered separately

46. Nonallergic reaction are chiefly irritants or caustics, many of which are used by
the dentist in various therapeutic or technical procedures
Aspirin(acetylsalicylicacid)
Many people take aspirin as local obtundent, especially for the relief of
toothache
Harmful to the oral mucosa
Aspirin reaction.
Blanching and sloughing of the epithelium after the local application of an

47. Endodontic materials :Due to the usage of some endodontic materials or their injection
into the hard tissue
Sodium hypochlorite :
Used as root canal irrigant
It is found to be sporicidal and virucidal .On contact with vital tissue, it causes
hemolysis, ulceration, facial nerve weakness, and necrosis, inhibits neutrophil
migration, and damages endothelial cells and fibroblasts
Gutta-percha :
It is used along with zinc oxide eugenol to attain apical seal.
The apices result in infective periapical periodontitis caused by the transport of
bacteria beyond the apex and an incomplete cleansing and foreign body reactions

48. Hydrogen peroxide :
This thermocatalytic process damages the tooth by causing irritation to the cementum and
periodontal ligament leading to cervical root resorption
Sodium perborate :
Used as a mouthwash, bleaching agent, and in dentifrices because of its supposed therapeutic
effect on gingival disease
Produces an erythema of the oral mucosa which may even progress to sloughing of the tissues
Edema and ulceration of mucosa
Carbamide peroxide : used as a component in bleaching preparation
Damage to the teeth and the surrounding structures

49. Phenol : Used in dentistry as a cavity sterilizing agent as well as a cauterizing
agent in
May produce severe painful burns of the oral mucosa and skin
Silver nitrate : Used extensively in dentistry as a cavity sterilizing agent, topically
as a caries-preventive agent and as a chemical cautery
produces painful burns of the oral mucous membranes
Trichloroacetic acid :
Used as a cauterizing agent, particularly to cauterize gingival tissue when
preparing a proximal or gingival cavity, placing a band or taking an impression of
a cavity

50. Volatile oils :
Oil of cloves, oil of wintergreen, and eucalyptus oil are used in
dentistry and can produce mild burns of the mucous membrane
Miscellaneous drugs and chemicals :
Any strong acid, alkali, germicidal agent, strong counter-irritant,
Or even certain plant and animal irritants may produce injury

51. Generalized epidermal reaction
Arsenic :
Used therapeutically and may produce symptoms of either acute or chronic
poisoning
Oral manifestations - inflammation of oral mucous membranes, and severe
gingivitis
Local contact with arsenic trioxide often produces ulceration.
Systemic arsenic poisoning also produces excessive salivation

52. Bisphosphonate : used in the management of benign and malignant diseases involving
excessive bone resorption, such as bone lesions of multiple myeloma and metastatic bone
diseases
Osteonecrosis of the jaw probably results from the inability of hypodynamic and hypovascular
bone to meet an increased demand for repair and remodeling
Bisphosphonate osteochemonecrosis or bis-phossy jaw :
The features of bisphosphonate-associated osteonecrosis are similar to those found in phossy
jaw, the historical occupational osteonecrosis of the jaw caused by exposure to white
phosphorus during the manufacture of matches
Tx: surgical intervention, antibiotic therapy, hyperbaric oxygen therapy, or to the topical use of
mouthrinses

53. Bismuth :
Used widely in the treatment of syphilis, but it has been replaced in recent years by the antibiotics
Oral manifestations
Bismuth pigmentation of the oral mucosa, particularly of the
Gingiva and buccal mucosa
The pigmentation appears as a ‘bismuth line’, a thin
Blue-black line in the marginal gingiva which is sometimes
Confined to the gingival papilla
This pigment represents precipitated granules of bismuth sulfide produced by the
action of hydrogen sulfide on the bismuth compound in the tissues

54. The granules of the sulfide are seen in the tissue section a small, irregular black
collections of pigment, sometimes perivascular in location, but other times
diffuse without apparent arrangement
The material may be present in endothelial cells or in mononuclear phagocytes
in the tissue, but it usually is in the intercellular tissue. It provokes no foreign
body response and may be present even in the absence of inflammation
Tx :
No specific treatment
Can be bleached by concentrated hydrogen peroxide

55. An anticonvulsant drug, extensively used in the control of epileptic seizures
It causes fibrous hyperplasia of the gingiva
Oral manifestations :
Gingival hyperplasia may begin as early as two weeks after dilantin therapy has been
instituted
The first change noted is a painless increase in the size of the gingiva, starting with the
enlargement of one or two interdental papillae
The surface of the gingiva shows an increased stippling and finally a cauliflower, warty, or
pebbled surface. As enlargement increases, the gingival tissue becomes lobulated, and clefts
remain between each enlarged gingiva

56. Cyclosporine is a selective immunosuppressant
(suppress helper T cells), used primarily in organ
transplant patients to overcome transplant rejection.
 It causes generalized gingival hyperplasia and
perioral hyperesthesia

57. Lead intoxication is manifested by serious gastrointestinal disturbances
which include nausea, vomiting, colic, and constipation.
Blood changes are those of a hypochromic anemia with basophilic
stippling of the red blood cells.
 Skeletal changes due to deposition of lead in growing bone occur in
children and are demonstrable on the radiograph
Formation of a ‘lead line’ similar to the ‘bismuth line’ occurs in lead
poisoning

58. Chronic mercurialism is characterized by gastric disturbances, diarrhea,
excitability, insomnia, headache, and mental depression. The patients
frequently have fine tremors of the fingers and limbs as well as of the lips and
tongue
There is a remarkably increased flow of saliva (ptyalism), and a metallic taste in
the mouth due to excretion of mercury in the saliva
Ulcerations on the gingiva, palate, and tongue & Loosening of the teeth

59. •Acrodynia is an uncommon disease of unknown etiology,
with striking cutaneous manifestations.
•The source of the mercury is usually a teething powder,
ammoniated mercury ointment, calomel lotion etc

60. Profuse salivation and often much ‘dribbling’
Gingiva becomes extremely sensitive or painful and may exhibit
ulcerations
Bruxism is a common finding and loosening and premature shedding
of teeth

61. Chronic exposure to silver compounds results in a
permanent pigmentation of the skin and mucous
membranes
Appearance of a slate-blue silver line along the gingival
margins arising due to the deposition of metallic silver and
silver sulfide pigments is one of the earliest signs of argyria
The sclera and the nails are also pigmented

63. •According to buchner and hansen:
(1) from condensation in gingiva during amalgam restorative work
(2) from particles entering mucosa lacerated by revolving instruments during
removal of old amalgam restorations
(3) from broken pieces introduced into a socket or beneath periosteum during tooth
extraction,
(4) from particles entering a surgical wound during root canal treatment with a
retrograde amalgam filling

64. Appears as macules, or rarely, as slightly raised black, blue, or gray
lesion
gingiva, buccal mucosa, and alveolar mucosa
This tattoo has frequently been mistaken for a melanin-pigmented
lesion, and in some cases biopsy is necessary to differentiate if the
amalgam fragments are too small or diffuse to be visible on the dental
radiograph.

65. No tissue reaction to their presence, even no inflammatory
response
Chronic inflammatory response, usually manifesting as a
foreign body granuloma with either foreign body giant cells or
langhans giant cells

66. Discoloration of either deciduous or permanent teeth may occur as a result of
tetracycline deposition during prophylactic or therapeutic regimens instituted
either in the pregnant female or postpartum in the infant
The critical period for tetracycline-induced discoloration in the deciduous is
four months in utero to three months postpartum for maxillary and
mandibular incisors and five months in utero to nine months postpartum for
maxillary and mandibular canines

68. A yellowish or brownish-gray discoloration which is most pronounced
at the time of eruption of the teeth.
Tetracycline itself fluoresces under ultraviolet light and, accordingly,
the teeth involved by its discoloration also fluoresce a bright yellow
under ultraviolet light.
Minocycline hydrochloride causes discoloration of the skin, nails,
conjunctiva, bone, and teeth. Palate or anterior alveolar mucosa has a
distinctive blue-gray appearance due to the black bone showing
through the thin, translucent mucosa.

69. Use for the treatment of certain malignant neoplasms
Unfortunately, in addition to neoplastic cells, which undergo
rapid division, certain normal cells including the cells of the
oral and gastrointestinal mucosa, bone marrow, and skin also
exhibit a similar degree of mitotic activity and are especially
prone to manifest the toxic and damaging effects of the
antineoplastic agents

70. (1) alopecia, due to arrest of mitosis of the rapidly germinating hair roots
2) stomatitis, which may take a variety of forms
(3) radiation recall or radiation sensitization, a reactivation of radiation reaction
within the field of radiation following administration of certain of the
antineoplastic agents
Mucosal erosion and ulceration, frequently diffuse and multiple
Specific or nonspecific infections (commonly herpes simplex infection, candida infection,
or infection by staphylococcal or streptococcal organisms