Physical & Chemical Injuries Of The Oral Cavity / oral surgery courses

Physical & Chemical
Injuries
Of The Oral Cavity
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
At theend of thelecturestudent should beableto:
-Enroll Effectsof orthodontic tooth movement
-DescribeEosinophilic ulceration
– Describephysical injuriesof soft tissues
– Describedenturestomatitis
–DescribeEpulisfissuratum
–DescribeMucocele
–DescribeRadiation injuries

Effectsof Orthodontic Tooth
Movement
• Tipping movement
• Extrusivemovement
• Intrusivemovement
• Tissuereactionsduring retention period
• Effectsof deciduoustooth movement on permanent
teeth.

EOSINOPHILLIC ULCERATION
• Reactive, benign, asymptomatic, self-limiting lesion
of oral mucosa.
• Thistraumatic granulomaischaracterized by adeep,
pseudoinvasiveinflammatory reaction and is
typically slow to resolve.
• Trauma– missing or malposed teeth
- partial denture
- erupting teeth in infants.

• Eosinophilic granuloma without trauma - ‘atypical
Eosinophilic ulcerations’ -T-cell cutaneous lympho-
proliferativedisorder.
CLINICALFEATURES :-
• Site- antero-ventral, dorsal surfaceof tongue.
• May also affect gingiva, palate, mucobuccal fold.
• Center covered by yellow fibropurulent memb. with
erythematousborders.

• May resolvewithin aweek to 8
months.
• Riga-Fedediseaseappearsin
infancy between aweek to oneyear.

HISTOPATHOLOGIC FEATURES:-
• Dense& deeply infiltrativelymphoproliferation.
• Sheets of lymphocytes and histiocytes along with
eosinophils.
• Hyperplasia of vascular connective tissue causes
elevation.
• Permitsingressof micro-organisms….
T/t : Biopsy
retention of stable teeth.

DENTURE STOMATITIS
• It manifestsasareasof erythemaconfined to denture
bearing areasof maxillary removabledentures.
• Causesmay be– ill fitting denture
- uncured acrylic resin
- poor oral hygiene.
• Superinfection with C. albicans

Clinical features:
• Mucosabecomesred, swollen, smooth / granular &
painful.
• Multiplefoci of hyperemia.
• Severeburning sensation.
Treatment:
• Nystatin tabs.
• Correction of fit of thedenture.

• It may also predisposeacondition called ‘chronic
atrophic candidiasis’.
• CLINICALFEATURES:-
• Appearsaserythematousarea which might be
smooth or granular.
• Multiplepin point foci of hyperemiamay also be
seen.

HISTOLOGIC FEATURES
• Numerous papillary projections of stratified
squamous epithelium characterized by
pseudoepitheliomatoushyperplasia.
• TREATMENT:-
• Correction of theill fitting denture.

EPULIS FISSURATUM
Inflammatory fibroushyperplasia
• Occurrenceof hyperplasiaalong thebordersof theill
fitting dentures.
• May beseen on gingiva, buccal mucosaand angleof
themouth.
• Seen morein relation to lower dentures.
• Incidenceincreaseswith age.
• Seen morein females

CLINICAL FEATURES
• Appears as a single or
multiple fold or folds of
hyperplastic tissue in the
mucolabial or
mucobuccal fold into
which the denture flange
conveniently fits.

HISTOLOGIC FEATURES
• The hyperplastic mass of tissue shows excessive bulk
of fibrous connective tissue covered by a layer of
stratified squamousepithelium showing acanthosis.
• Eosinophillic pools of material in the superficial
spinous layer of epithelium – ‘Mucopolysaccharide
keratin dystrophy’

TREATMENT
• The lesion should be surgically excised.

Inflammatory papillary hyperplasia
• Hyperplasia of palatal mucosa.
• Chronic trauma – ill fitting dentures.
• Associated with Chr. hyperplastic candidiasis.
• C/F- denture wearers
- numerous, closely arranged, red, edematous
papillary projections – warty app.

• Traumatic injury to salivary gland duct.
• Pooling of salivain thetissues.
• Two types– extravasation
- retention
• Occurs on palate, cheek, tongue & floor of the
mouth.
• C/F - varies depending on location
- raised, circumscribed vesicle, may be
translucent – blue.
Mucocele

• Frequently lower lip isaffected.
• Reachesaparticular size& may remain stable.
• Somemay show periodic changein size.
• Heal after evacuation, only to recur.
• H/F: circumscribed cavity in theconnectivetissue.
• Not atruecyst.

• Epithelium compressed & thinned.
• Wall – comprssed c.t. fibers& cells
• Salivary gland acini adjacent to thearea– interstitial
inflamm., dilatation of ducts.
• Treatment: excision.

• Definition
• Formed by deposition of calcium salts
• Nidusmay be– altered salivary.
- desquamated epi cells.
- bacteria, foreign bodies.
• Obstruction to ductsmay becomplete/ partial.
Sialolithiasis

• C/F: pain & swelling before, during /after meals.
• If painlessmay present asfirm mass.
• Middleaged people.
• Surfaceof calculi – rough, yellow in colour, consist
chiefly of Calcium phosphates& CaCO3
.

H/F – exhibitsconcentric
lamellations,
- successivedeposition
of inorganic & organic
material.
T/T: small stones-
manipulation surgical
removal & antibiotics

Radiation Injuries
• Osteoradionecrosis :- follows heavy radiation of
bone.
• Acute form of Osteomyelitis.
• Chronic, painful infection & necrosis with late
sequestration of bone.
• H/F : destruction of osteocytes, absence of
osteoblasts & lack of new bone formation.
• Bone replaced by loose connective tissue.

• Connective tissue infiltrated by lymphocytes, plasma
cells & macrophages.
• Devitalised bone may undergo sequestration.

Summary:
• Effectsof orthodontic tooth movement
• Eosinophilic ulceration
• physical injuriesof soft tissues
• denturestomatitis
• Epulisfissuratum
• Mucocele
• Radiation injuries

BIBLIOGRAPHY
Text book of oral pathology Shafer's, 5 & 6th
edition
Color Atlas of Oral Diseases Cawson, R. 2nd
edition
Oral and Maxillofacial Pathology Neville, Brad W. 2nd
Lucas’s Pathology Of Tumor’s of the Oral Tissues
Cawson, R. A., Bennie, W. H 5th
edition

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