Key Points Injury and Repair

• Acute injuries normally do not involve the immune system extensively

Injuries to Oral tissues • • • • • • • • • •

Tooth related inflammatory responses Soft tissue trauma Nicotine stomatitis Salivaryy ggland conditions Granulomas Irritation fibroma Hyperplasia Linea alba Hematoma osteomyelitis

Attrition • Tooth structure loss due jaw movements • Bruxism accelerates it • Seen frequently in deciduous teeth • First sign is disappearance of mamelons

Tooth related injuries • • • • • •

Attrition, abrasion and erosion Internal and external resorption Periapical abscess abscess, cyst and granuloma Condensing osteitis Hyperplastic pulpitis Amalgam tattoo

Abrasion • Loss of tooth structure by mechanical means • Toothbrush most common, exacerbated by abfractions (wedge shaped lesions at cervical 1/3) • Sand, toothpicks, reed instruments, etc

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Erosion • Tooth structure lost by chemical means, ie acids • Often seen in bulimics on linguals, recommend daily fluoride rinse • Lemons can cause it

External Resorption • Tooth resorbed abnormally • Resorption normal during exfoliation • Orthodontics can cause it

Periapical Lesions • Bone loss at apex caused by inflammatory byproducts exiting apex • Periapical abscess if acute cells present ((PMN’s), ), lots of p pain • Granuloma if fibroblasts present, a chronic condition • Cyst if it has an epithelial lining lining • How do you know, the difference? You don’t

Internal Resorption • Clast cells activated by inflammation • Root canal necessary, not always successful

Amalgam Tattoo • Caused by amalgam scraps in tissue • A macule • Usually U ll giant i cells ll present (several macrophages joined together), engulf scraps • Harmless

Condensing Osteitis • When periapical lesion heals, bone is replaced • Bone is disorganized, contains no trabeculae • Appears radiopaque

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Hyperplastic Pulpitis • Seen in children with large, open lesions • Granulation tissue containing chronic cells

Aspirin Burn • Patient places aspirin on tooth to relieve toothache, • Hyperkeratosis from acid attack,

Trauma (traumatic ulcer) • Oral lesions have a variety of etiologies, tongue biting after anesthesia, h i burns, b cheek biting (linea alba) • Warn children not to chew tongue after mandibular block

Fibroma • Most common oral lesion • Excessive fibrous tissue after healing • Contains fibroblasts, sessile, pink in usually a health pink color

Osteomyelitis

Solar Cheilitis • Bone becomes infected after tooth removal • May start as dry socket • Necrotic bone must be removed, resutured

• Leathery, corrugated lip or skin • Most often the lower lip • May become cancerous

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Melanosis • Melanocytes activated to produce melanin for unknown reasons • Women affected more than men. • Associated with trauma, smoking

Nicotine Stomatitis • Characteristic clinical appearance – red dot (inflamed salivary d ) surrounded duct) d d bby white, keratinized tissue

Ranula Mucocele • Also called mucous retention phenomenon • Saliva leaks into connective tissue from damaged minor salivary gland • Often seen on lower lip, reoccurs

Hyperplasia Tissue’s cells increase in number due to trauma, medications

Papillary hyperplasia (under denture)

Epulis fissuratum (under denture)

• Warton’s duct blocked by sialolith (salivary stone) causes unilateral swelling in floor of mouth • May lead to acute or chronic sialadenitis ((inflammation of a salivary gland)

Drug /hormone Induced Hyperplasia • Three drugs, phenytoin (seizures), calcium channel blockers cardiovascular), and cyclosporin (transplants) can cause gingival i i l hyperplasia h l i in i response to inflammation • Hormonal changes due to pregnancy, puberty can cause hyperplasia

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Pyogenic Granuloma • Exuberant healing with excessive granulation tissue • Sometimes called pregnancy tumor but common in males • Contains fibroplasts, capillaries, inflammatory cells but none are pus producing

Central Giant Cell Granuloma • Central is in bone, peripheral is in soft tissue • Both contain giant cells, chronic inflammation cells • Central be a uni- or multilocular radiolucent mass • Roots of teeth may diverge

Peripheral Giant Cell Granuloma • Found in soft tissue • May resemble a pyogenic granuloma

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