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Methamphetamine Abuse:
- “Meth Mouth”
- Rapid destruction of teeth as a result of:
- Methamphetamine acid content
- Decreased salivary flow
- Cravings for high-sugar beverages
- Lack of oral hygiene
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Aspirin Burn
- Topical application is a common misuse of this product
- The tissue becomes necrotic and white
- The surface may slough off, leaving a painful ulcer
- The ulcer usually heals in 7 to 21 days
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Phenol Burn:
- Used in dentistry as a cavity-sterilizing agent and a cauterizing agent
- Will cause whitening and sloughing of the area as a result of tissue destruction
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Dental Materials That Can Cause Burns?
- Phenol
- Sodium hypochlorite
- Ferric sulfate
- Formocresol
- Eugenol
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Electric Burn?
- May be seen in infants or young children who have chewed an electrical cord
- May be quite extensive, damaging oral tissue and even tooth buds
- May cause permanent disfigurement and scarring
- Treatment:
- Plastic surgery
- Oral surgery
- Orthodontic therapy
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Thermal Burns
- Hot food burns
- From soup or cheese on pizza
- Products containing hydrogen peroxide or eugenol
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Lesions Associated With Cocaine Use:
- Lesions located at the midline of the hard palate may vary from ulcers to keratotic lesions to exophytic reactive lesions as a result of smoking crack cocaine
- Necrotic ulcers of the tongue and epiglottis have been reported as a result of freebasing cocaine
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Lesions From Self-Induced Injuries:
- Chronic lip, cheek, or tongue biting
- Trauma to the gingiva from a fingernail
- Lesions may range from ulceration to epithelial hyperplasia and hyperkeratosis
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Traumatic Ulcer:
- Cheek, lip, or tongue biting
- Denture irritation
- Mucosal injury
- Overzealous brushing
- Treatment
- Usually heals within 7 to 14 days unless the trauma persists
- May require a biopsy
 
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Traumatic Granuloma:
- The result of persistent trauma
- Appearance: Hard (indurated), raised lesion
- Heals rapidly after biopsy
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Hematoma:
- Accumulation of blood within tissue as a result of trauma
- Appears as a red to purple to bluish-gray mass
- Frequently seen on labial or buccal mucosa
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Frictional Keratosis:
- A form of hyperkeratosis
- Cause: Chronic rubbing or friction against an oral mucosal surface; resembles a callus on skin
- Appearance: Opaque white
- Treatment
- Identify the traumatic cause of the lesion
- Eliminate the cause
- Must be differentiated from idiopathic leukoplakia because leukoplakia may be premalignant
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Linea Alba:
- A white, raised line most commonly on the buccal mucosa at the occlusal plane
- May be the result of a teeth-clenching habit
- Sometimes the pattern of the teeth can be seen in the lesion
- Microscopic appearance: Epithelial hyperplasia and hyperkeratosis
- No treatment necessary
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Nicotine Stomatitis:
- A benign lesion typically associated with pipe and/or cigar smoking; may also occur with cigarette smoking
- Initial appearance: Erythema
- Increased opacity as keratinization occurs
- Raised red areas occur at the openings of ducts of inflamed minor salivary glands
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Smokeless Tobacco Keratosis:
- A white lesion located where chewing tobacco is placed, most often in the mucobuccal fold
- Early lesions may have a granular or wrinkled appearance
- Long-standing lesions may be more opaquely white and have a corrugated surface
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Tobacco Pouch Keratosis:
- Treatment
- Tobacco cessation
- May require biopsy
- Long-term exposure to chewing tobacco has been associated with increased risk of squamous cell carcinoma
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Traumatic Neuroma:
- A lesion caused by injury to a peripheral nerve
- When the nerve sheath of Schwann cells is disrupted, occasionally the proximal end of the damaged nerve proliferates into a mass of nerve and Schwann cells mixed with dense fibrous scar tissue
- Painful, ranging from pain on palpation to severe, intractable pain
- Diagnosis
- Biopsy and microscopic examination
- Treatment
- Surgical excision
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Palisaded Encapsulated Neuroma (PEN):
- Benign lesion
- Clinical appearance: Mucosal nodule
- Microscopic appearance: Well-circumscribed lesion that is composed of nerve tissue partially surrounded by fibrous connective tissue
- Considered a reactive, hyperplastic lesion
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Amalgam Tattoo:
- A flat, bluish-gray lesion of the oral mucosa, caused by the introduction of amalgam into tissue
- May occur during placement or removal of an amalgam restoration or during an extraction
- May be seen in any location in the oral cavity, most commonly on the gingiva or alveolar
- Amalgam particles may be seen on radiograph, aiding in diagnosis
- Patient history may help
- Must be differentiated from malignant melanoma
- Treatment
- None, providing melanoma has been ruled outridge
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Melanosis:
- Normal physiologic pigmentation of oral mucosa
- May be genetic
- May occur as a result of inflammation: Postinflammatory melanosis
- If presenting as a macule, a biopsy may be warranted
- Labial melanotic macule on vermilion of lips
- Smoker’s melanosis
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Solar Cheilitis (Actinic Cheilitis)
- A degeneration of the tissue of the lips, caused by exposure to the sun
- Appearance
- Lips appear dry and cracked
- The vermilion appears pale pink and mottled
- The interface between lips and skin is indistinct
- Microscopically: Epithelium is thinner than normal; degenerative CT changes
- Smoking and alcohol use increase risk of squamous cell carcinoma
- Biopsy may be indicated for persistent scaling or ulceration
- Prevention
- Avoid sun exposure
- Use sun-blocking agents
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Mucous Retention Lesion: Mucocele
- A lesion formed when a salivary gland duct is severed and the mucous salivary gland secretion spills into the adjacent connective tissue
- Not a true cyst because it is not lined with epithelium
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Mucous Retention Lesion: Ranula
- A unilateral mucocele-like lesion that forms on the floor of the mouth
- Associated with the ducts of submandibular and sublingual glands
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Sialolith:
- A salivary gland stone
- May be found in both minor and major salivary glands
- Formed by precipitation of calcium salts around a central core
- May often be seen on radiographs
- Treatment
- Sometimes the calcification can be “milked” from the duct
- It may require surgical removal; this may damage the duct
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Necrotizing Sialometaplasia:
- A benign condition of salivary glands
- Moderately painful swelling and ulceration
- Thought to result from blockage of blood supply to affected area, resulting in salivary gland necrosis
- Salivary gland epithelium is replaced by squamous epithelium
- The ulcer usually heals by secondary intention
- Biopsy is needed to establish diagnosis
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Acute and Chronic Sialadenitis:
- Painful swelling of the involved salivary gland caused by obstruction of the salivary gland duct
- Diagnosis
- May involve injection of a radiopaque dye into the gland, followed by a radiograph (sialogram)
- Treatment
- May require antibiotics
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Reactive Connective Tissue Hyperplasia
- Pyogenic granuloma
- Giant cell granuloma
- Irritation fibroma
- Denture-induced fibrous hyperplasia
- Papillary hyperplasia of the palate
- Gingival enlargement
- Chronic hyperplastic pulpitis
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Pyogenic Granuloma:
- A proliferation of connective tissue containing numerous blood vessels and inflammatory cells occurring as a response to injury
- The name is a misnomer; the lesion is neither pyogenic (pus forming) nor a true granuloma
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Pregnancy Tumor:
- A pyogenic granuloma seen in a pregnant woman
- The lesions are identical to those seen in men and nonpregnant women
- May be caused by hormonal changes and increased response to plaque
- They often regress after delivery
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Peripheral Giant Cell Granuloma
- A lesion that contains many multinucleated giant cells, well-vascularized connective tissue, RBCs, and chronic inflammatory cells
- Reactive lesion
- Clinical appearance resembles that of pyogenic granuloma
- Treatment: Surgical excision
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Peripheral Ossifying Fibroma:
- Exophytic, usually well-demarcated sessile or pedunculated gingival lesion
- Clinically it appears to emanate from the interdental papilla
- Has been reported in both children and adults
- Composed of cellular fibrous connective tissue
- Treatment consists of complete surgical excision with thorough scaling of the adjacent teeth
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Fibroma, Irritation Fibroma, Traumatic Fibroma, and Focal Fibrous Hyperplasia:
- The most common mass on the gingiva
- Caused by trauma
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Denture-Induced Fibrous Hyperplasia
- Cause: Ill-fitting denture
- Location: In elongated folds of tissue adjacent to denture flange
- Composed of dense, fibrous CT surfaced with stratified squamous epithelium
- Treatment:
- Surgical removal
- Relining of prosthesis
- New denture
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Inflammatory Papillary Hyperplasia of the Palate
- Denture-induced hyperplasia
- Appearance: Palatal mucosa covered by multiple erythematous papillary projections; “cobblestone” appearance
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Gingival Enlargement
- An increase in the bulk of free and attached gingiva, especially the interdental papillae
- Gingival margins are rounded
- Color may vary from normal pink to pale or erythematous depending on the degree of inflammation and vascularity
- May be generalized or localized
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Chronic Hyperplastic Pulpitis (Pulp Polyp)
- An excessive proliferation of chronically inflamed dental pulp tissue
- Occurs in teeth with large, open carious lesions often in primary and permanent molars
- Usually asymptomatic
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Periapical Abscess:
- Acute periapical abscess: Purulent exudate surrounded by connective tissue containing neutrophils and lymphocytes
- Inflammation produces severe pain
- Tooth may slightly extrude from tooth socket
- May or may not test positive with electric pulp testing
- Fistula
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Periapical Granuloma:
- A localized mass of chronically inflamed granulation tissue that forms at the opening of the pulp canal, generally at the apex of a nonvital tooth root
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Radicular Cyst (Periapical Cyst):
- A true epithelium-lined cyst
- Associated with the root of a nonvital tooth
- The most commonly occurring cyst in the oral region
- A result of proliferation of the rests of Malassez
- Usually asymptomatic and discovered on radiograph
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Residual Cyst:
- Forms after tooth extraction and all or part of radicular cyst is left behind
- Treatment: Surgical removal
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Tooth Resorption:
- External resorption: Nonreversible resorption of the tooth structure, beginning at the outside of the tooth
- Causes:
- Inflammation
- Pressure
- Reimplantation
- Idiopathic
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Focal Sclerosing Osteomyelitis (Condensing Osteitis)
- A change in the bone near the apices of teeth
- Thought to be a reaction to low-grade infection
- Generally asymptomatic
- If painful, may be associated with pulpal inflammatory disease
- Radiopaque
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Alveolar Osteitis (“Dry Socket”):
- A postoperative complication following tooth removal in which the blood clot is lost before healing can take place, leaving raw, exposed nerve endings
- Most often occurring in mandibular third molar areas
- Patient may complain of pain, bad odor, and bad taste
- Risk factors:
- Dissolution of the clot at the surgical site
- Traumatic extraction
- Presence of infection before extraction
- Tobacco smoking after extraction
- Treatment:
- Gentle irrigation
- Daily application of Dry Socket Paste containing eucalyptol until symptoms are relieved
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