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Physical and Chemical Injuries of The Oral Cavity
Physical and Chemical Injuries of The Oral Cavity
Physical injuries
- Bone
- Soft tissues
Radiation induced injuries
Chemical injuries
Physical injuries
Chemical injuries
Injuries of teeth
Injuries of bone
locally
Systemically
Bruxism
Fracture of teeth
Tooth ankylosis
It is the habitual grinding of the teeth either
during sleep or as an unconscious habit during
waking hours
Etiology
Local factors
Systemic
Psychologic
Occupational
Local factors- Mild occlusal disturbance, tension, transition from
primary to Permanent
effect.
Severe attrition of teeth
Occlusal wear and inter proximal wear
Both the surface – actual facets
Periodontal loss – loosening or drifting of teeth
Gingival recession with alveolar bone loss
Hypertrophy of the masticatory muscles
Removable splints
minimal
Common injury – sudden severe trauma
Tubules
Infected pulp
Pulpitis
Root fracture- uncommon in younger age group
tissue
formation.
Tubular dentin
osteoid formation
Not repaired
completely
It occurs when the connective tissue of PDL is lost
allowing cementum or dentin to come in direct contact
with the alveolar bone, leading to fusion of these two
calcified structures.
Intramedullary haemorrhage
Traumatic cyst
Radiographic features :
Refers to a lesions characterized by the accumulation of
mucin, completely encased by epithelium.
ETIOLOGY – trauma or after surgery (Caldwell-
Luc surgery)
Clinically- spherical in shape & degree of symptoms
depends on the location & extent of expansion,
destruction.
Histologically- lined by pseudostratified, ciliated
columnar epithelium or squamous or metaplastic
squamous epithelium.
Traumatic ulcer ( Decubitus ulcer )
Sore spots
Denture sore mouth
Inflammatory ( fibrous ) hyperplasia
Palatal papillomatosis
Factitial injuries
Mainly caused by trauma
Biting the mucosa , denture irritation, tooth brush
injuries
Iatrogenic injury – “ cotton role injury”
Site – Lateral border of the tongue, buccal mucosa, lip
Occasionally – palate.
Tongue ulcers – neoplasm ulcer - biopsy
Accidentally self – induced injuries ( habit)
Lip biting- Morsicatio labiorum, Factitious cheilitis.
Cheek biting - Morsicatio buccarum
Tongue – Morsicatio linguarum.
Patients with Gilles de la Tourette syndrome- prone
to spontaneous erratic behavior & incoherent facial
expressions, verbalization. Part of this syndrome is
the tendency for self-mutilation, which is often
directed to oral mucosa.
Buccal lesion- located bilaterally in the mid portion of the
anterior buccal mucosa along the occlusal plane.
Lesion-thickened, shredded white areas, with irregular ragged
surface.
Sometimes- areas of erythema, erosion.
Persistent scaling & flaking of the vermilion border of lips due
to chronic injury such as lip biting.
Fingernail injury- seen in gingiva. Presents as vertical clefts
produced by forcing the free gingival margins apically. Often
results in root exposure, chronic non-healing ulcer.
Cause - Denture irritation
Clinical features,
Hyperplastic
Epithelium
Surface epithelium of inflammatory fibrous
hyperplasia is “ Mucopolysaccharide keratin
dystrophy” – plasma pooling
Homogenous , eosinophilic pools material in the
superficial spinous layer of epithelium, where it
appears to have replaced individual cells.
Significance – not known
Hyperplastic
epithelium
Discontinuing the use of ill fitting denture
Construction of new denture
Syn- traumatic ulcerative granuloma with stromal
eosinophilia (TUGSE), eosinophilic granuloma of
tongue, traumatic granuloma.
Oral mucosa
Salivary gland
Teeth
Bone
Heavy therapeutic doses of X radiation
Erythema – earliest visible reaction
Erythema fades quickly – reappear with in 2 – 4 weeks
Secondary erythema – fades slowly , pigmented a light
tan shade
Secondary erythema – edema with desquamation of
epithelial cells – denudation of the surface
Re epitheliazation occur – 10 – 14 days
Alterations of the sebaceous glands – decreases
secretion with dryness of the skin
Hair follicle - sensitive
Vascular damage - thickening of the intima ,
thrombosis
Veins and arteries shows subintimal fibrosis with
thickening of the wall at the expense of the lumen
Endophlebitis and Phlebosclerosis --evident
Dose and duration of therapy
Erythema – hyperemic and edematous mucositis
If treatment continued ,
Mucosa become denuded , ulcerated and covered with
a fibrinous exudate – great discomfort
Large , irregular area of epithelial ulceration
Lidocaine mouth rinses before meal times
and analgesics
Homogenization
of the collagen
Xerostomia
Alteration of salivary gland - diminution or complete
loss of secretion - Week or two after radiation
Decreases the number of secretion of the granules
Congestion , edema and inflammatory cell infiltration –
interstitial CT
No remarkable changes in Ducts of salivary glands
of irradiation
ETIOLOGY
Radiation
Trauma
infection
Radiation causes proliferation of the
intima of the blood vessels (endarteritis
obliterans) leading to thrombosis of the
end arteries.
Systemically
Aspirin ( Acetyl salicylic acid )
Sodium perborate
Phenol
Silver nitrate
Trichloroacetic acid
Volatile oils
Miscellaneous- Strong acids , alkali , germicidal
Local obtundant – relief of tooth ache
frequently bleeding
hyperplasia
paints
Intoxication – GIT disturbance