Physical and Chemical Injuries

Anesthetic Necrosis
Ulceration and necrosis at site of
administration of local anesthetic
Most commonly presents on hard palate
Well-circumscribed area of ulceration at
site of injection
No treatment required unless ulceration
fails to heal
Anesthetic Necrosis
 Exfoliative Cheilitis (Factitious
Cheilitis)
Changes on vermilion border of lip caused by chronic
lip licking, biting, picking, or sucking.
Mild cases feature chronic dryness, scaling, fissuring,
cracking.
Vermilion can be covered with thick yellowish
hyperkeratotic crust that may be hemorrhagic or
fissured
Areas of papular and crusted erythema on perioral
skin
Angular cheilitis usually bacterial or fungal infection
of the lips
Cheilocandidiasis - secondary candidal infection in
areas of low-grade trauma to vermilion border of lip
Exfoliative Cheilitis (Factitious
Cheilitis)
 Submucosal Hemorrhage
Petechiae - minute hemorrhages into skin,
mucosa, or serosa
May be caused by prolonged increased
intrathoracic pressure (coughing, vomiting,
etc.)
Purpura slightly larger area
Ecchymosis accumulation over 2 cm
Hematoma tumor-like swelling caused by an
accumulation of blood trapped in the tissue
(extravascular blood within tissue produces
mass; often the result of blunt trauma
Submucosal Hemorrhage
 Oral Trauma from Sexual
Practices
Most commonly reported lesion is
submucosal palatal hemorrhage
secondary to fellatio
Horizontal ulcerations of lingual frenum
may be caused by cunnilingus (frenum
rubs across incisal edges of mandibular
central incisors)
Usually asymptomatic, resolve in 7-10
days without treatment
Oral Trauma from Sexual
Practices
 Amalgam Tattoo and Other Localized
Exogenous Pigmentations

Implantation of dental amalgam

resulting in clinically evident
pigmentation
Black, blue, or gray macules
Most common sites are gingiva, alveolar
& buccal mucosa.
Fragments are densely radiopaque
 Amalgam Tattoo and Other Localized
Exogenous Pigmentations
Can be implanted in several ways
Amalgam dust in oral fluids
Broken amalgam pieces in extraction sites
Dental floss contaminated with amalgam particles
Amalgam from endodontic procedures left in soft
tissue
Fine metallic particles driven by drill pressure
Radiographs confirm diagnosis, no treatment
necessary
Other accidental localized foreign body
tattoo is possible, also intentional intraoral
tattoos
Amalgam Tattoo
Oral Tattoo
 Systemic Metallic Intoxication
Lead
Ulcerative stomatitis
Gingival lead line (bluish line along
marginal gingiva)
Gray areas on buccal mucosa and tongue
 Systemic Metallic Intoxication
Mercury
Metallic taste
Ulcerative stomatitis
Inflammation and enlargement of salivary glands,
gingiva, tongue
Gingiva may become blue-gray to black
Destruction of alveolar bone and exfoliation of teeth
Acrodynia (pink disease, Swift disease) -
chronic mercury exposure in infants and
children.
Oral symptoms include excessive salivation,
ulcerative gingivitis, bruxism, premature loss of teeth
 Systemic Metallic Intoxication
Silver
Argyria systemic silver intoxication
In oral cavity presents as diffuse bluish-black
discoloration
Systemic Metallic Intoxication
Bismuth
Blue-gray line along gingival margin
Ptyalism, burning, stomatitis, ulceration
 Metallic Line & Pigmented
gingiva
 Systemic Metallic Intoxication
Arsenic
Diffuse macular hyperpigmentation of the skin
Arsenical keratoses premalignant skin lesions
Oral manifestations rare, typically present as excessive
salivation and necrotizing ulcerative stomatitis
Gold
Dermatitis
Severe oral mucositis, metallic taste
 Smokers Melanosis
Oral pigmentations are significantly
increased in heavy smokers.
Most commonly affects anterior labial
alveolar mucosa of cigarette smokers
Pipe smokers exhibit pigmentations
located on commissural and buccal
mucosae
Gradually disappears within three years of
cessation of smoking
Smokers Melanosis
 Drug-related Discolorations of
the Oral Mucosa
Phenolphthalein - small, well-circumscribed
areas of hyperpigmentation
Minocycline (derivative of tetracycline) -
discoloration of bone and developing teeth
Antimalarial medications and tranquilizers -
bluish-black discoloration limited to hard palate
Antimalarial medications may lead to diffuse
brown melanosis
Estrogen, chemotherapy, meds used to treat
AIDS - diffuse brown melanosis
Drug-related Discolorations of
the Oral Mucosa
 Traumatic Osseous and Chondromatous
Metaplasia (Cutright Lesion)

Alveolar atrophy with secondary fibrous

hyperplasia overlying alveolar ridges occurs in
anterior maxilla as result of pressure of
dentures
May present as raised, reddened, ulcerated
areas or firm, movable polyp-like lesions
As result of mechanical trauma, cartilage or
cellular bone may develop along crest of thin
atrophic alveolar ridges. Tender area of
alveolar ridge may reveal an enlargement
Traumatic Osseous and Chondromatous
Metaplasia (Cutright Lesion)
 Antral Pseudocysts

Dome-shaped radiopaque lesions arising

from floor of maxillary sinus
Inflammatory exudate accumulates under
maxillary sinus mucosa causing sessile
elevation
 Retention cysts

Arise from partial blockage of duct of

seromucous glands or from
invagination of respiratory epithelium
 Sinus mucoceles
Accumulations of mucin encased by
epithelium
Two types:
Surgical ciliated cyst (postoperative
maxillary cyst) occurs after trauma or
surgery to the sinus, presents as spherical
lesion separate from the sinus
Obstruction of sinus ostium blocks normal
drainage
Antral Pseudocysts
 Cervicofacial Emphysema
Arises from air forced into subcutaneous or fascal
spaces of face and neck
Most cases involve surgical extraction of teeth,
osteotomies, trauma, or use of air/water syringes
Develops during surgery or within first hour afterwards
Soft tissue enlargement from presence of air in deeper
tissues, enlargement increases with secondary
inflammation and edema.
Spread to mediastinum can result in dysphonia,
dysphagia, dyspnea
Crepitus synchronous with heartbeat (Hammans
crunch)
Most cases resolve spontaneously
Cervicofacial Emphysema
 Myospherulosis
Foreign body reaction resulting from placement of
topical tetracycline, usually in a petroleum base, into
surgical site
Can occur when powdered tetracycline is used in a
polymer dressing
Most cases occur within bone at previous extraction site
May exhibit swelling or may be asymptomatic and
circumscribed radiolucency in previous extraction site
Black, greasy, tar-like material found in lesion
Treatment by removal of foreign material
Myospherulosis