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CHEMICAL INJURIES
OF ORAL CAVITY
1. BRUXISM
ETIOLOGY
(i) Local factors – Malocclusion
(ii) Systemic factors - Nutritional deficiency
- GIT disturbances
- Endocrinal disturbances
- Allergy
- Hereditary
(iii) Psychological factors - Anxiety
- Stress
- Emotional Tension
- Fear
- Rage
- Rejection
(iv) Occupations - Athletes
- Watch Makers
- Other persons associated with
precise work
- Voluntary Bruxism seen in
persons having habit of chew gum, tobacco,
TREATMENT
CAUSES
Traumatic episodes
It occurs frequently after endodontic treatment due
to brittle nature of non vital tooth
CLINICAL FEATURES
Mostly seen in children & maxillary teeth are
affected mostly
Class-1 - Simple fracture of the crown, involving
little or no dentin
TREATMENT
4. TOOTH ANKYLOSIS
CLINICAL FEATURES
Tooth shows lack of mobility
There may be evidence of pulpal ds.
Percussion over tooth gives characteristic solid sound
Deciduous tooth if affected becomes submerged b/c of eruption of
adjacent permanent teeth & growth of dental arch
RADIOGRAPHIC FEATURES
HISTOLOGICAL FEATURES
Area of root resorption is found, which have been repaired by bony tissues or
cementum
1. FRACTURES OF JAW
Commonly due to automobile, industrial & sports accidents
& fight
Easily occur in bones which are already weakened by
developmental & systemic disorders
May be - Simple - bone is broken completely - overlying
structure are intact & not exposed to exterior
-Greenstick - common in children - characterized by break
of bone in on side & bend on the other side
- Compound - external wound in associated with the break
- e.g road traffic accidents
- comminuted - bone is crushed - may or may not be
exposed to exterior.
o Mandible is more prone for fractures
a) FRACTURES OF MAXILLA
- More serious
- In Road traffic accidents, blow, fall & industrial
accidents
- Extent of fracture is determined by - Direction , force
& location
*CLASSIFICATION
1. Le Fort-I / Horizontal Fracture / Floating Fracture
- separation of body of maxilla from base of skull
below the level of zygomatic process
Common Features
Complications
Nonunion
Malunion
Fibrous union
2. TRAUMATIC CYST
(SOLITARY CONE CYST, HEMORRHAGIC CYST, EXTRAVASATION CYST,
UNICAMERAL BONE CYST, SIMPLE BONE CYST, IDIOPATHIC BONE
CAVITY)
ETIOLOGY
unknown
THE TRAUMA HEMORRHAGE THEORY in widely accepted
theory
Trauma heals by organization of clot eventual formation of
connective tissue & new bone
Acc. to the theory, clot breaks down & leaves empty cavity
within the bone
- steady expansion of lesion occurs secondary to altered or
obstructed lymphatic or venous drainage
- this expansion tends to cease when the cyst-like lesion
reaches the cortical layer of bone
- expansion of involved bone is not a common finding in this
TIME LAG B/W INJURY & DISCOVERY OF THE LESION - 1
MONTH to 20 YEARS
CLINICAL FEATURES
HISTOLOGICAL FEATURES
CLINICAL FEATURES
Asymptomatic condition
Females are more affected (75%)
Mandible is affected more than maxilla (85%)
RADIOGRAPHIC FEATURES
TREATMENT
No treatment is necessary
FOCAL OSTEOPOROTIC BONE MARROW DEFECT OF
JAW
4. SURGICAL CILIATED CYST OF MAXILLA
( SINUS MUCOCELE )
CLINICAL FEATURES
HISTOLOGICAL FEATURES
TREATMENT
1. LINEA ALBA
White line seen on the buccal mucosa
extending from the commissures posteriorly at
the level of occlusal plane
Caused by physical irritation & pressure exerted
by the posterior teeth
Usually bilateral
More pronounced in persons having clenching
habit or bruxism
HISTOLOGICAL FEATURE
Focal ulceration with formation of granulation
tissue with diffuse chronic inflammatory cell
infiltration
Epithelium shows hyperkeratosis & acanthosis
adjacent to the ulcers
TREATMENT
Symptomatic treatment
TREATMENT
No treatment is required as these ulcers heal within 7 to 10 days
Symptomatic relief can be provided by lignocaine or any other
topical anesthetic gel
TRAUMATIC ULCER
4. FACTITIAL OR SELF-INDUCED INJURIES
MAY INCLUDE:
Lip biting (morsicatio labiorum)
Cheek biting (morsicatio buccarum)
May be habitual, accidental or psychological
Holding, biting & tearing of epithelium of lip, buccal mucosa, or tongue, chewing of cheek or
stripping of epithelium using fingers & creating negative pressure by sucking the lips & cheeks
Gingiva may also be involved
CLINICAL FEATURES
Usually bilateral along the occlusal line & vestibular surface of lips
Mucosa appears white & shredded with areas of redness
Ulceration is common
More prominent in females
HISTOLOGICAL FEATURES
5. DENTURE INJURIES
b) GENERALIZED INFLAMMATION
(DENTURE SORE MOUTH, DENTURE STOMATITIS)
CAUSES
- Candida albicans
- Saliva retention in glands
TREATMENT
- Not successful
- denture surface is covered with topical nystatin coating
- For oral condition nystatin tablets(500,000 IU) should de dissolved in mouth* TDS* 14 days
HISTOLOGICAL FEATURES
-excessive fibrous connective tissues
- hyperkeratosis is present
- pseudoepitheliomatous hyperplasia is often found
- connective tissue is composed of coarse bundles of collagen fibres with new
fibroblasts or blood vessels
TREATMENT
- Surgical excision of excessive tissues
- New denture should be made
CAUSES
- Ill fitting dentures
PALATAL PAPILLOMATOSIS
HISTOLOGICAL FEATURES
- papillary projections of keratinized stratified squamous epithelium with vascular
connective tissue present
TREATMENT
- construction of new denture
Allergy may be due to denture base material as in cobalt chromium alloy, it may
be due to nickel or in vulcanite dentures, it may be due to sulphur
CLINICAL FEATURES
- generalized inflammation of area in contact with denture
TREATMENT
- First determine the cause of allergy then reconstruct the denture with minimal or
no use of that material
6. MUCOUS RETENTION PHENOMENON
(MUCOCELE, MUCOUS RETENTION CYST)
ETIOLOGY
Obstruction (such as salivary calculi) in duct of salivary gland
Trauma due to cheek biting or lip biting
Scar after trauma may also cause retention of mucous in gland
CLINICAL FEATURES
Occur most frequently on the lower lip
May also occur on the palate, cheek, tongue(involving glands of Blandin-
Nuhn) & floor of mouth
Superficial lesion appears as a raised, circumscribed vesicle, several
millimeters to a centimeter or more in diameter with bluish, translucent
cast
Deeper lesion appears as swelling with normal color
LIP MUCOCELE TONGUE MUCOCELE
PATHOGENESIS
Pathogenesis of Retention Cyst
Obstruction of duct -> Pooling of mucous glands ->
Retention cyst is formed
HISTOLOGICAL FEATURES
Retention cyst is surrounded by epithelial lining
No epithelial lining is seen in case of extravasation cyst
TREATMENT
Excision of cyst is done completely with underlying salivary
gland acini
7. RANULA
It is a form of mucocele but larger, specifically occur in the floor of mouth in association of ducts
of submaxillary or sublingual glands
CLINICAL FEATURES
Unilateral
Develops as a slowly enlarging painless mass on floor of mouth
In superficial lesions, mucosa may have a translucent bluish color
Deep lesion appear normal
May interfere with speech & mastication
HISTOLOGICAL FEATURES
Similar to mucocele except that a definite lining is sometimes present
TREATMENT & PROGNOSIS
Treatment either marsupialization or more often excision of the entire sublingual gland
These are mucous retention cysts of mucous glands, lining the maxillary sinus
CLINICAL FEATURES
asymptomatic
RANULA
Discomfort in cheek or maxilla may be present
Pain & soreness of face & teeth & numbness of upper lip
RADIOLOGICAL FEATURES
Lesion appears as a well-defined, homogenous, dome-shaped or hemispheric radiopacity,
varying in size from a tiny lesion to one completely filling the antrum, arising from antrum &
superimposed on it
TREATMENT
Cysts either persists unchanged or disappears spontaneously within a relatively short period
No treatment is necessary
9. SIALOLITHIASIS
(Salivary duct stone, Salivary duct calculus)
CLINICAL FEATURES
Severe pain occurs during meal time especially when eating citrus fruits
Salivary gland is painful & swollen
On palpitation stone may be detected in ducts
Sialolithiasis is found mostly in submandibular gland because of:
- Tortuous path of Wharton's duct
- Mucinous secretion of the gland
- Gravitational effect of saliva inside duct
Rare condition
Defined as complete or partial calcific encrustation of an antral foreign body, either
endogenous or exogenous, which serves as a nidus
Endogenous nidus consist of a dental structure such as a root tip or may simply be a fragment
of soft tissue, bone, blood or mucous
Exogenous nidus is uncommon but may consist of snuff paper
CLINICAL FEATURES
Occur at any age in either sex
May be a complete absence of symptoms
Some cases are marked by pain, sinusitis, nasal obstruction, foul discharge & epistaxis
TREATMENT
Antrolith should be surgically removed
11. RHINOLITHIASIS
(A) X-RAYS
Can ionized the water molecules present inside the cells & form highly reactive radicals.
These radicals can damage the cell by various manners as:
- They can cause mutation
- They can damage enzymes
- They may interrupt cell division
Xerostomia occurs due to loss of acinar cells, decrease in secretory granules &
inflammation in connective tissue of salivary glands
May cause permanent dryness of mouth
Artificial saliva (Methyl cellulose) should be prescribed
During formitive stage of teeth can cause andodontia or defective root formation
After development of teeth, may cause cervical caries that may lead to fracture of crown at cervical
third
TREATMENT : Fluoride treatment & proper oral hygiene
EFFECT ON BONE
EFFECTS ON TEETH
Enamel – Chalky spots & craters with small holes are seen
Dentin exhibit a burnt appearance
Pulp – Hemorrhagic necrosis present
- Inflammatory cell infiltration is seen
- Necrosis of odontoblastic layer
EFFECTS ON SOFT TISSUES
Ulcers are formed in epithelium
CAUSES
Blow of air in periodontal pockets or root canals with use of air syringe
CLINICAL FEATURES
Painful unilateral swelling with feeling of crepitus on palpation
TREATMENT
Antibiotics are given to avoid connective tissue infection, hydration, massages,
sialogagues, & compression
Puncture of subcutaneous tissues can be done with sharp needle
Venous air embolism may occur as complication leading to death
CHEMICAL INJURIES OF THE
ORAL CAVITY