PHYSICAL &

CHEMICAL INJURIES
OF ORAL CAVITY

Dr. Diana Prem,

VMSDC, Salem.
PHYSICAL INJURIES OF ORAL CAVITY
(A) PHYSICAL INJURIES OF TEETH

1. BRUXISM

 Also known as NIGHT-GRINDING or BRUXOMANIA

 “Habitual grinding or clenching of the teeth either during sleep
or as an unconscious habit during walking hours”
 Incidence - 5% & 20%

 ETIOLOGY
(i) Local factors – Malocclusion
(ii) Systemic factors - Nutritional deficiency
- GIT disturbances
- Endocrinal disturbances
- Allergy
- Hereditary
(iii) Psychological factors - Anxiety
- Stress
- Emotional Tension
- Fear
- Rage
- Rejection
(iv) Occupations - Athletes
- Watch Makers
- Other persons associated with
precise work
- Voluntary Bruxism seen in
persons having habit of chew gum, tobacco,

toothpicks, pencils etc

 CLINICAL FEATURES

 History of clenching during sleep or walking hours is given by patient

 The symptomatic effects of this habit have been reviewed by GLAROS & RAO,
who divide them into 6 major categories:
(a) Effects on the dentition - severe attrition at occlusal & proximal surfaces
- loosening & drifting of teeth
(b) Effects on the periodontium- gingival recession
(c) Effects on the masticatory muscles - fatigue of muscles
(d) Effects on TMJ
(e) Head pain
(f) Psychological & behavioral effects

 TREATMENT

 Removable splint should be worn at night

 Correction of underlying causes should be done
2. FRACTURES OF TEETH

 CAUSES
 Traumatic episodes
 It occurs frequently after endodontic treatment due
to brittle nature of non vital tooth

 CLINICAL FEATURES
 Mostly seen in children & maxillary teeth are
affected mostly
 Class-1 - Simple fracture of the crown, involving
little or no dentin

 Class-2 - Extensive fracture of the crown, involving

considerable dentin but not the dental pulp

 Class-3 - Extensive fracture of the crown, involving

considerable dentin & exposing the dental
pulp
 Class-4 - The traumatized tooth becomes non
vital, with or without loss of crown structure

 Class-5 - Teeth lost as a result of trauma

 Class-6 - Fracture of the root, with or without

loss of crown structure

 Class-7 - Displacement of a tooth, without

fracture of crown or root

 Class-8 - Fracture of the ‘crown en masse’ &

its replacement

 Class-9 - Traumatic injuries to deciduous teeth

TOOTH FRACTURE
 HISTOLOGICAL FEATURES

 Histological features during healing are similar to that of bony fractures

 Clot is organized with deposit of cementum & bone, later restoration & remodeling at
ends of fragments occurs

 TREATMENT

 If enamel is fractured - Restoration of missing tooth structure is done

 If dentin is involved - Placement of sedative base (zinc oxide eugenol) is done at
fractured dentin & tooth is restored
 If pulp is involved - Pulp capping
- Pulpotomy (coronal pulp removal)
- Pulpectomy
3. INJURIES TO THE SUPPORTING STRUCTURES
OF THE TOOTH

 CONCUSSION - produce by injury which is not strong

enough to cause serious, visible damage to the tooth & the
periodontal structures
 Characteristic feature- increased sensitivity of tooth to
percussion
 Treatment - selective grinding of tooth to eliminate
occlusal forces
 SUBLUXATION

 - abnormal loosening of tooth without displacement due to

sudden trauma
- Tooth is mobile on palpation & sensitive to percussion &
occlusal forces
- tooth becomes nonvital due to severance of apical blood
supply
 AVULSION - dislocation of the tooth from its socket due to
traumatic injury - partial or total
- Partial includes-intrusion, extrusion or facial, lingual or palatal or
lateral displacement.
- mainly accompanied by fracture of alveolar bone

4. TOOTH ANKYLOSIS

 Fusion of tooth with bone

 Occur mainly after any traumatic episode (occlusal trauma) or
periapiucal inflammatory processes or after RCT

 CLINICAL FEATURES
 Tooth shows lack of mobility
 There may be evidence of pulpal ds.
 Percussion over tooth gives characteristic solid sound
 Deciduous tooth if affected becomes submerged b/c of eruption of
adjacent permanent teeth & growth of dental arch
 RADIOGRAPHIC FEATURES

 Blending of bone with tooth root is in radiograph

 HISTOLOGICAL FEATURES

 Area of root resorption is found, which have been repaired by bony tissues or
cementum

 TREATMENT AND PROGNOSIS

 There is no treatment for ankylosis

 Good prognosis
 Unless removed for some other reason, should serve well indefinitely
 (B) PHYSICAL INJURIES OF BONE

1. FRACTURES OF JAW
 Commonly due to automobile, industrial & sports accidents
& fight
 Easily occur in bones which are already weakened by
developmental & systemic disorders
 May be - Simple - bone is broken completely - overlying
structure are intact & not exposed to exterior
-Greenstick - common in children - characterized by break
of bone in on side & bend on the other side
- Compound - external wound in associated with the break
- e.g road traffic accidents
- comminuted - bone is crushed - may or may not be
exposed to exterior.
o Mandible is more prone for fractures
a) FRACTURES OF MAXILLA
- More serious
- In Road traffic accidents, blow, fall & industrial
accidents
- Extent of fracture is determined by - Direction , force
& location

*CLASSIFICATION
1. Le Fort-I / Horizontal Fracture / Floating Fracture
- separation of body of maxilla from base of skull
below the level of zygomatic process

2. Le Fort-II / Pyramidal Fracture

- vertical fractures through the facial aspects of
maxilla & extend upward to nasal & ethmoid
bones & usually extend from maxillary sinus
 3. Le Fort III / Transverse Fracture
- high level fracture that extends
across the orbits through the base of the nose &
ethmoid
region to the zygomatic arch
- bony orbit is fractured & the lateral
rim is separated at the zygomaticofrontal suture
- zygomatic arch is fractured

 Common Features

- Displacement, anterior open bite, swollen

face, reddish eye due to subcojuntival
hemorrhage & nasal hemorrhage
- If skull is involved - unconsciousness,
cerebrospinal fluid rhinorrhea
b) FRACTURES OF MANDIBLE

- mostly involve angle of mandible followed by

condyle, molar region,mental region & symphosis
- displacement of mandible depends on direction of the
line of fracture, muscle pull & direction of force
 Clinical Features of mandibular fracture
 Pain during movement
 Occlusal derangement
 Abnormal mobility
 Gingival lacerations
 Crepitus on movement
 Trismus
 Loss of sensation of involved side
 Ecchymosis
 Treatment

 Immobilization of fractured bone

 Complications
 Nonunion

 Malunion

 Fibrous union
2. TRAUMATIC CYST
(SOLITARY CONE CYST, HEMORRHAGIC CYST, EXTRAVASATION CYST,
UNICAMERAL BONE CYST, SIMPLE BONE CYST, IDIOPATHIC BONE
CAVITY)

 Is a pseudo cyst (lack epithelial lining) & an uncommon

lesion comprises about 1% of all jaw cyst
 Occur in other bones of skeleton as well

 ETIOLOGY

 unknown
 THE TRAUMA HEMORRHAGE THEORY in widely accepted
theory
 Trauma heals by organization of clot eventual formation of
connective tissue & new bone
 Acc. to the theory, clot breaks down & leaves empty cavity
within the bone
 - steady expansion of lesion occurs secondary to altered or
obstructed lymphatic or venous drainage
 - this expansion tends to cease when the cyst-like lesion
reaches the cortical layer of bone
 - expansion of involved bone is not a common finding in this
 TIME LAG B/W INJURY & DISCOVERY OF THE LESION - 1
MONTH to 20 YEARS
 CLINICAL FEATURES

 Occurs most frequently in young persons

 Maxilla mainly develops it

 Swelling or rarely pain

 HISTOLOGICAL FEATURES

 Thin connective tissue membrane lining the cavity

 There may be presence of few RBCs, blood pigments or
giant cells adhering to the bone surface

 TREATMENT & PROGNOSIS

 6 to 8 months for filling of space after surgery

 In large spaces, bony chips are used
TRAUMATIC CYST
3. FOCAL OSTEOPOROTIC BONE-MARROW
DEFECT OF THE JAW

 Defect of bone closely associated with chronic anemia

 Jaw marrow starts haemopoiesis in response of anemia leading to
this defect

 CLINICAL FEATURES

 Asymptomatic condition
 Females are more affected (75%)
 Mandible is affected more than maxilla (85%)

 RADIOGRAPHIC FEATURES

 Poorly defined radiolucency that is found at molar area, a few mm

to cm or more
 Poorly defined periphery
 HISTOLOGICAL FEATURES

 Normal red marrow, fatty marrow or both

 Trabeculae of bone present in sections are long,
thin, irregular & devoid of osteoblastic layer
 Megakaryocytes & small lymphoid aggregates
may present

 TREATMENT
 No treatment is necessary
FOCAL OSTEOPOROTIC BONE MARROW DEFECT OF
JAW
4. SURGICAL CILIATED CYST OF MAXILLA
( SINUS MUCOCELE )

 Sometimes epithelial cells get implanted in maxillary sinus

during surgical access maxillary sinus
 When these cells proliferate they form a cyst there

 CLINICAL FEATURES

 Middle aged or older patients are mostly affected

 Nonspecific, poorly localized pain, tenderness or discomfort
in the maxilla
 Extraoral or intraoral swelling
 10-20 years after surgery of maxilla or maxillary sinus when
mucocele is infected, the lesion is called MUCOPYOCELE
 Common in Japan
 RADIOLOGICAL FEATURES

 Well defined radiolucency close to maxillary sinus is seen

 This radiolucency is anatomically separated from sinus
 A filling defect of cyst can be seen after injecting
radiopaque material in sinus

 HISTOLOGICAL FEATURES

 Cyst lining is formed by pseudostratified ciliated columnar

ep.
 Squamous metaplasia may be found if infection or
inflammation is present
 Cyst wall is composed of fibrous connective tissue with or
without inflammatory cell infiltration

 TREATMENT

 Enucleation of cyst. It doesn’t tend to reoccur

SURGICAL CILIATED CYST OF MAXILLA
(C) PHYSICAL INJURIES TO SOFT TISSUES

1. LINEA ALBA
 White line seen on the buccal mucosa
extending from the commissures posteriorly at
the level of occlusal plane
 Caused by physical irritation & pressure exerted
by the posterior teeth
 Usually bilateral
 More pronounced in persons having clenching
habit or bruxism

 Histologically - Hyperkeratosis & intracellular

edema of epithelium is seen
LINEA ALBA
2. TOOTHBRUSH TRAUMA
 Occurs to gingiva & produced by toothbrush
 Appears as white, reddish or ulcerative lesions
or linear superficial erosions, involving marginal
or attached gingiva of maxillary canine &
premolar region

 HISTOLOGICAL FEATURE
 Focal ulceration with formation of granulation
tissue with diffuse chronic inflammatory cell
infiltration
 Epithelium shows hyperkeratosis & acanthosis
adjacent to the ulcers
 TREATMENT

 Symptomatic treatment

 Teaching proper brushing technique

3. TRAUMATIC ULCERS
( DECUBITUS ULCERS)

 Ulcers of mucous membrane formed due to traumatic injury

 MOST COMMON SITES ARE :

 Lateral borders of tongue
 At occlusal level of teeth in buccal mucosa
 Lips

 TRAUMA MAY BE DUE TO:

 Sharp teeth
 Cheek or lip biting

 TREATMENT
 No treatment is required as these ulcers heal within 7 to 10 days
 Symptomatic relief can be provided by lignocaine or any other
topical anesthetic gel
TRAUMATIC ULCER
4. FACTITIAL OR SELF-INDUCED INJURIES

 MAY INCLUDE:
 Lip biting (morsicatio labiorum)
 Cheek biting (morsicatio buccarum)
 May be habitual, accidental or psychological

 LIP & CHEEK BITING

 Holding, biting & tearing of epithelium of lip, buccal mucosa, or tongue, chewing of cheek or
stripping of epithelium using fingers & creating negative pressure by sucking the lips & cheeks
 Gingiva may also be involved

 CLINICAL FEATURES

 Usually bilateral along the occlusal line & vestibular surface of lips
 Mucosa appears white & shredded with areas of redness
 Ulceration is common
 More prominent in females

 HISTOLOGICAL FEATURES

 Extensive areas of hyperkeratosis with keratin projections

 Chronic inflammatory cell infiltration seen in areas of ulceration
 TREATMENT

 Counseling & psychotherapy are treatment of choice

 An acrylic shield will help to prevent the access of teeth to lips & cheeks

5. DENTURE INJURIES

 Caused by denture wearing

 CAN APPEAR AS:

a) Traumatic ulcer (Sore spots)

b) Generalized inflammation (Denture sore mouth, Denture stomatitis)
c) Inflammatory (fibrous) hyperplasia (Denture injury tumor, epulis fissuratum, redundant
tissue)
d) Inflammatory papillary hyperplasia (Palatal papillomatosis)
e) Denture base intolerance or Allergy

a) TRAUMATIC ULCER (SORE SPOTS)

 Caused due to:
- either sharp spicules of bone or high spot on inner aspect of denture
- over extended flanges may also cause sore spots at vestibular area
 CLINICAL FEATURES
- Ulcers are small, painful & irregular
- covered by grey necroting membrane
SORE MOUTH
 TREATMENT
- Correction of underlying cause
- relief of the flange
- removal of high spots

b) GENERALIZED INFLAMMATION
(DENTURE SORE MOUTH, DENTURE STOMATITIS)

- Characterized by burning erythematous granular mucosa, restricted to area beneath the

denture

 CAUSES
- Candida albicans
- Saliva retention in glands

 TREATMENT
- Not successful
- denture surface is covered with topical nystatin coating
- For oral condition nystatin tablets(500,000 IU) should de dissolved in mouth* TDS* 14 days

C) INFLAMMATORY (FIBROUS) HYPERPLASIA

(DENTURE INJURY TUMOR, EPULIS FISSURATUM, REDUNDANT TISSUE)

 One of the most common tissue rxn to a chronically ill-fitting denture

 Occur on buccal mucosa gingiva & angle of mouth
FIBROUS HYPERPLASIA
 CLINICAL FEATURES
- mucolabial or mucobucal folds may develop excessive enlarged folds of tissues

 HISTOLOGICAL FEATURES
-excessive fibrous connective tissues
- hyperkeratosis is present
- pseudoepitheliomatous hyperplasia is often found
- connective tissue is composed of coarse bundles of collagen fibres with new
fibroblasts or blood vessels

 TREATMENT
- Surgical excision of excessive tissues
- New denture should be made

d) INFLAMMATORY PAPILLARY HYPERPLASIA

(PALATAL PAPILLOMATOSIS)

 It is the condition in palatal mucosa associated with many erythematous &

oedamatous papillary projections. It is predominantly see in edentulous patients

 CAUSES
- Ill fitting dentures
PALATAL PAPILLOMATOSIS
 HISTOLOGICAL FEATURES
- papillary projections of keratinized stratified squamous epithelium with vascular
connective tissue present

 TREATMENT
- construction of new denture

E) DENTURE BASE INTOLERANCE / ALLERGY

 Allergy may be due to denture base material as in cobalt chromium alloy, it may
be due to nickel or in vulcanite dentures, it may be due to sulphur

 CLINICAL FEATURES
- generalized inflammation of area in contact with denture

 TREATMENT
- First determine the cause of allergy then reconstruct the denture with minimal or
no use of that material
6. MUCOUS RETENTION PHENOMENON
(MUCOCELE, MUCOUS RETENTION CYST)

 It is the most common type of salivary & soft tissue cyst

 It is either due to retention of mucous or extravasation of mucous
into surrounding tissues

 ETIOLOGY
 Obstruction (such as salivary calculi) in duct of salivary gland
 Trauma due to cheek biting or lip biting
 Scar after trauma may also cause retention of mucous in gland

 CLINICAL FEATURES
 Occur most frequently on the lower lip
 May also occur on the palate, cheek, tongue(involving glands of Blandin-
Nuhn) & floor of mouth
 Superficial lesion appears as a raised, circumscribed vesicle, several
millimeters to a centimeter or more in diameter with bluish, translucent
cast
 Deeper lesion appears as swelling with normal color
LIP MUCOCELE TONGUE MUCOCELE
 PATHOGENESIS
 Pathogenesis of Retention Cyst
Obstruction of duct -> Pooling of mucous glands ->
Retention cyst is formed

 Pathogenesis of Extravasation Cyst

Trauma to Duct -> Mucous escapes in surrounding
tissues -> Chronic Inflammation -> Granulation Tissue
formation around mucous without epithelial lining ->
Extravasation Cyst

 HISTOLOGICAL FEATURES
 Retention cyst is surrounded by epithelial lining
 No epithelial lining is seen in case of extravasation cyst
 TREATMENT
 Excision of cyst is done completely with underlying salivary
gland acini
7. RANULA

 It is a form of mucocele but larger, specifically occur in the floor of mouth in association of ducts
of submaxillary or sublingual glands

 CLINICAL FEATURES
 Unilateral
 Develops as a slowly enlarging painless mass on floor of mouth
 In superficial lesions, mucosa may have a translucent bluish color
 Deep lesion appear normal
 May interfere with speech & mastication

 HISTOLOGICAL FEATURES
 Similar to mucocele except that a definite lining is sometimes present
 TREATMENT & PROGNOSIS
 Treatment either marsupialization or more often excision of the entire sublingual gland

8. RETENTION CYST OF MAXILLARY SINUS

(Secretory cyst of maxillary antrum, mucocele of maxillary sinus,
mucosalcyst of maxillary sinus)

 These are mucous retention cysts of mucous glands, lining the maxillary sinus
 CLINICAL FEATURES
 asymptomatic
RANULA
 Discomfort in cheek or maxilla may be present
 Pain & soreness of face & teeth & numbness of upper lip

 RADIOLOGICAL FEATURES
 Lesion appears as a well-defined, homogenous, dome-shaped or hemispheric radiopacity,
varying in size from a tiny lesion to one completely filling the antrum, arising from antrum &
superimposed on it

 TREATMENT

 Cysts either persists unchanged or disappears spontaneously within a relatively short period
 No treatment is necessary

9. SIALOLITHIASIS
(Salivary duct stone, Salivary duct calculus)

 A stone in salivary ducts or glands is called Sialolithiasis

 Formed by deposition of calcium salts around a central nidus(formed by bacteria, debris,
foreign bodies or epithelial cells)

 CLINICAL FEATURES
 Severe pain occurs during meal time especially when eating citrus fruits
 Salivary gland is painful & swollen
 On palpitation stone may be detected in ducts
 Sialolithiasis is found mostly in submandibular gland because of:
- Tortuous path of Wharton's duct
- Mucinous secretion of the gland
- Gravitational effect of saliva inside duct

 CHEMICAL & PHYSICAL FEATURES

 Round, ovoid or elongated

 Measure just a few millimeters or 2 cm or more in diameter
 Involved duct contain single or multiple stones
 Surface of calculi is rough, which may cause squamous metaplasia of duct lining
 Usually yellow & occasionally white or yellowish-brown in color
 Calculi consist of calcium phosphates & smaller amount of calcium carbonates, organic
materials & water

 TREATMENT & DIAGNOSIS

 Small calculi may sometimes be manipulated or increasing the salivation by sucking a

lemon, leading to expulsion of stone
 I.V. injection of antibiotic like nafcillin is given for bacterial infection due to persistent
obstruction of duct
 Larger stones require surgical removal
 Piezoelectric shock wave lithotropsy is alternative to surgical removal
10. MAXILLARY ANTROLITHIASIS
(Antral rhinolith)

 Rare condition
 Defined as complete or partial calcific encrustation of an antral foreign body, either
endogenous or exogenous, which serves as a nidus
 Endogenous nidus consist of a dental structure such as a root tip or may simply be a fragment
of soft tissue, bone, blood or mucous
 Exogenous nidus is uncommon but may consist of snuff paper

 CLINICAL FEATURES
 Occur at any age in either sex
 May be a complete absence of symptoms
 Some cases are marked by pain, sinusitis, nasal obstruction, foul discharge & epistaxis

 TREATMENT
 Antrolith should be surgically removed

11. RHINOLITHIASIS

 Are calcareous concretions occurring the nasal cavity

 This uncommon lesion is formed by calcification of intranasal endogenous or exogenous foreign
material
 Reported in all ages
 May present for years & frequently give rise to odorous discharge, symptoms of nasal
obstruction, sinusitis, epiphora as well as pain & epistaxis

12. RADIATION INJURY

(A) X-RAYS

 Can ionized the water molecules present inside the cells & form highly reactive radicals.
These radicals can damage the cell by various manners as:
- They can cause mutation
- They can damage enzymes
- They may interrupt cell division

 EFFECTS OF X-RAYS ON ORAL MUCOSA

 Erythema of mucosa occurs initially

 Then Mucositis occurs
 Now mucosa becomes ulcerative with fibrinous exudation. Taste sense is also lost
 Taste sensation is returned 2 to 4 months after treatment of x-ray therapy

 EEFECTS OF X-RAYS ON SALIVARY GLANDS

 Xerostomia occurs due to loss of acinar cells, decrease in secretory granules &
inflammation in connective tissue of salivary glands
 May cause permanent dryness of mouth
 Artificial saliva (Methyl cellulose) should be prescribed

 EFFECT OF X-RAYS ON TEETH

 During formitive stage of teeth can cause andodontia or defective root formation
 After development of teeth, may cause cervical caries that may lead to fracture of crown at cervical
third
 TREATMENT : Fluoride treatment & proper oral hygiene

 EFFECT ON BONE

 Have damaging effect on bone forming cells

 Blood vessels necrosed
 When these changes are associated with trauma & infection, OSTEORADIONECROSIS occurs
 This mostly occurs when infected tooth is present in the LINE OF FIRE

(B) LASER RADIATIONS

 EFFECTS ON TEETH
 Enamel – Chalky spots & craters with small holes are seen
 Dentin exhibit a burnt appearance
 Pulp – Hemorrhagic necrosis present
- Inflammatory cell infiltration is seen
- Necrosis of odontoblastic layer
 EFFECTS ON SOFT TISSUES
 Ulcers are formed in epithelium

13. CERVICOFACIAL EMPHYSEMA

 Emphysema is swelling due to presence of gas or air in interstices of connective tissue

 CAUSES
 Blow of air in periodontal pockets or root canals with use of air syringe

 CLINICAL FEATURES
 Painful unilateral swelling with feeling of crepitus on palpation

 TREATMENT
 Antibiotics are given to avoid connective tissue infection, hydration, massages,
sialogagues, & compression
 Puncture of subcutaneous tissues can be done with sharp needle
 Venous air embolism may occur as complication leading to death
 CHEMICAL INJURIES OF THE
ORAL CAVITY

 The oral cavity frequently manifests a serious

reaction to a wide variety of drugs and
chemicals.

The tissue reaction is that of a local response to

a severe irritant or even a caustic used
injudiciously.
The two main types that are of dental interest are:

1.Drug allergy or stomatitis

2.Contact stomatitis
NONALLERGIC REACTION TO DRUGS
AND CHEMICALS USED LOCALLY.
 Irritants or caustics which are used by the
dentist in various therapeutic are technical
procedures induces a non allergic reactions
when used locally.

 Some of these substances are discussed

separately below:
1.Aspirin (Acetylsalicylic Acid)
2.Endodontic Materials.
CONTD….
2. Sodium Perborate.
3.Hydrogen Peroxide.
4.Phenol.
5.Silver Nitrate.
6.Trichloroacetic Acid.
7.Volatile Oils.
8.Miscellaneous Drugs and chemicals.
NONALLERGIC REACTION TO DRUGS
AND CHEMICALS USED SYSTEMICALLY.
 Arsenic – severe gingivitis, ulceration.
 Bisphosphonate – osteonecrosis.

 Bismuth – thin blue/ black line on mar - gingiva

 Dilantin Sodium – gingival hyperplasia

 Cyclosporine – peri oral hyperesthesia

 Nifedipine – gingival enlargement

 Lead poisoning(plumbism) – lead line on gingiva

 Mercury – increased flow of saliva, metallic taste,

Hyperemia and swelling of S gland, tongue and
gingiva
 Acrodynia (Pink disease, Swift’s disease)
It is an uncommon disease of unknown etiology,with
striking cutaneous manifestations.
The cause of the disease - mercurial toxicity reaction
 C/F : The skin becomes red or pink. The skin over
the affected areas peels frequently during the
course of the disease.
 O/M : Profuse salivation and often ‘dribbling.’

The gingiva becomes extremely sensitive or

painful and may exhibit ulcerations.
Bruxism, loosening and premature shedding
of teeth, child will extract loose teeth with
his/her fingers.
Masticationis difficult because of the pain.
Silver (Argyria, argyrosis)
 Chronic exposure to silver compounds may occur as an
occupational hazard or as the result of therapeutic use of
silver compounds
 Amalgam tattoo appears as macules, or rarely, as slightly
raised black, blue, or gray lesion.
 Amalgam tattoo of oral mucous membrane is a
relatively
common finding in dental practice, generally occurring in
one
of four ways, according to Buchner and Hansen:
(1) From condensation in gingiva during amalgam
restorative work,
(2) from particles entering mucosa lacerated by revolving
instruments during removal of old amalgam restorations,
(3) from broken pieces introduced into a socket or beneath
periosteum during tooth extraction, or
(4) from particles entering a surgical wound during root
canal treatment with a retrograde amalgam filling.
Tetracycline
Discoloration of either deciduous or permanent teeth
may occur as a result of tetracycline deposition during
prophylactic or therapeutic regimens instituted either
in the pregnant female or postpartum in the infant.
The severity of the staining by tetracycline is
determined by the stage of tooth development at the
time of drug
administration.
C/F : yellowish or brownish-gray discoloration
OCCUPATIONAL INJURIES OF ORAL CAVITY:
OCCLUSAL TRAUMA :
Thank you