1. Physical and Chemical Injuries

2. Linea Alba White line,” usually bilateral, on buccal mucosa Associated with pressure, frictional irritation, or sucking trauma from the facial surfaces of the teeth No treatment required

3. Linea Alba

4. Morsicatio Buccarum (Chronic Cheek Chewing) Chronic nibbling produces lesions that are white, shredded Morsicatio labiorum – affects labial mucosa Morsicatio linguarum – affects lateral border of tongue No treatment required

5. Morsicatio Buccarum (Chronic Cheek Chewing)

6. Traumatic Ulcerations Surface ulcerations occur as a result of acute or chronic irritation or trauma Occurs most often on tongue, lips, buccal mucosa. Areas of erythema (red halo) that surrounds central yellow pseudomembrane (ulcer) or focal red ulcerated area without fibrin covering; smaller, uncomplicated lesions heal within days

7. Traumatic Ulcerations

8. Traumatic Ulcerative Granuloma with Stromal Eosinophlia(TUGSE) Most often seen on tongue secondary to muscle damage Deep “pseudo-invasive” inflammatory reaction that is slow to resolve

9. Traumatic Ulcerative Granuloma with Stromal Eosinophlia(TUGSE)

10. Riga-Fede disease  Sublingual ulceration in infants, associated with nursing and natal/neonatal teeth.

11. Factitious Oral Injury

12. Atypical histiocytic granuloma May be misdiagnosed as lymphoma. Surface ulceration and underlying tumefaction. Treatment involves removal of irritating cause

13. Atypical histiocytic granuloma

14. Thermal Burns Caused by hot foods or beverages Zones of erythema and ulceration, on palate or posterior buccal mucosa No treatment required

15. Electrical Burns Contact burns Electrical arc flows between electrical source and mouth; saliva is conductor Most occur in young children, involve lips and commissure Initial appearance is painless, charred yellow area with little bleeding; edema develops, then sloughing Tetanus shot required Primary problem is contracture of mouth opening during healing (microstomia, prevents eating and hygiene)

16. Electrical Burns

17. Chemical Injuries of the Oral Mucosa Aspirin - May cause necrosis when held in the mouth Hydrogen peroxide - concentrations of 3% or higher associated with adverse reactions Silver nitrate - treatment for aphthous ulcerations, chemical cautery destroys nerve endings Phenol - Extremely caustic Endodontic materials - possibility of soft tissue damage or injection into hard tissue with resultant deep spread and necrosis

18. Chemical Injuries of the Oral Mucosa Caustic agents generally produce similar damage Brief exposure – superficial white wrinkled appearance Longer exposure – necrosis proceeds, epithelium can be easily desquamated Cotton roll burn – oral mucosa become adherent to dry cotton rolls, and rapid removal strips epithelium away

19. Chemical Injuries of the Oral Mucosa

20. Cotton Roll Injury of the Oral Mucosa

21. Noninfectious Oral Complications of Antineoplastic Therapy Mouth is common site for complications related to cancer therapy Mucositis - areas of ulceration; pain, burning, and discomfort Dermatitis - varies according to intensity of therapy Intraoral hemorrhage, oral petechiae and ecchymosis Xerostomia

22. Noninfectious Oral Complications of Antineoplastic Therapy When portion of salivary glands included in fields of radiation, remaining glands undergo hyperplasia to compensate. When all salivary glands involved, loss of saliva is progressive, persistent, and irreversible Xerostomia-related caries - diminished saliva leads to decrease of bactericidal action and self-cleaning properties Hypogeusia - loss of all 4 tastes (sense returns for most patients) Some may have dysgeusia (altered sense of taste)

23. Osteoradionecrosis Result of non-healing, dead bone Dead bone separates from residual vital areas Postradiation dental extractions are known risk factor

24. Noninfectious Oral Complications of Antineoplastic Therapy

25. Miscellaneous Problems Trismus - difficulty in opening jaw Developmental abnormalities -can be caused by antineoplastic therapy during childhood