Quiz 2 LOs: Inflammatory/Reactive/Traumatic Oral Lesions

Describe acute inflammation

injury is brief, minimal, and source is removed from the tissue

Describe chronic inflammation

injury to tissue continues and inflammation response is longer lasting

produces more extensive damage and tissue heals slower

What cells are involved in chronic inflammation?

neutrophils, monocytes, and plasma cells to proliferate fibroblasts

What are the local clinical signs of inflammation?

limited to area of injury

redness

swelling

heat

pain

loss of function

What are the systemic clinical signs of inflammation?

injury becomes extensive

fever

leukocytosis

lymphadenopathy

elevated C - reactive protein

What are biochemical mediators involved in inflammation?

chemical in the body that either start or amplify response

chemotactic factors

kinin system

clotting mechanism

complement system

prostaglandins

WBC lysosomal enzymes released from granules or pathogenic m/os

endotoxins

Describe chemotactic factors

biochemical mediators that enhance chemotaxis - the movement of WBC toward the site of injury

Describe kinin system

causes increase dilation of blood vessel at site of injury and increases permeability

can induce pain

When and how is the kinin system activated?

early stages of inflammation

activated by substances present in plasma and in injured tissue

What is the primary kinin?

bradykinin

Describe clotting mechanism

clots blood to stop bleeding at site of injury, important in tissue repair

forms a fibrinous meshwork at site of injury to protect adjacent tissues and keep foreign substances from gathering at the site

certain products can be activated when tissue is injured and activates the kinin system

Describe complement system

series of plasma proteins activated in cascading fashion

functions in inflam and immunity

cause mast cells to release granules from their cytoplasm that contains histamine and other biochemical mediators into surrounding tissue --> causes an increase in vascular permeability and dilation

cause cell death by creating holes in the membrane --> cytolysis

attach to surface of bacteria stimulate WBCs for phagocytosis --> opsonization

Describe prostaglandins

mediating inflam response by increasing vasodilation and permeability, pain, and changes in connective tissue

Describe WBC lysosome enzymes released from granules or pathogenic m/os

act as chemotactic factors

damage CT and clot at site of injury

Describe endotoxins (from gram neg cell wall)

act as chemotactic factors

function as an antigen and damage bone tissue

What WBCs are involved in inflammation?

neutrophils (PNMs)

monocytes (become macrophages)

Describe neutrophils and their primary function

the first WBC recruited to the area of injury in response to chemotactic factors

Compose 70% of the

WBC population

Mobile cells that are produced throughout life

The primary function is phagocytosis of substances such as pathogenic microorganisms and tissue debris (contains lysosomal enzymes)

What are the microscopic characteristics of neutrophils?

has a multilobed nucleus

has a granular cytoplasm containing lysosomal enzymes (destroy substances after cell has engulfed them)

mobile

Describe macrophages and their primary function

Develops from a monocyte, the second responder to the site of injury

Important in phagocytosis and immune response

What are the microscopic characteristics of macrophages?

has a single round nucleus

has a cytoplasm containing lysosomal enzymes (destroy substances after cell has engulfed them) (no granular cytoplasm)

mobile

What has a longer lifespan, macrophage or neutrophil?

macrophage

What is anti inflammatory therapy?

drugs to block or suppress inflammatory response

prevents or reduces clinical signs of inflammation and ADRs of injury

can be steroidal or non

What are some examples of anti inflammatory therapy?

Steroidal: prednisone, inhibit prostaglandin synthesis

Nonsteroidal: NSAIDS, inhibit prostaglandin synthesis

Antihistamines

Drugs used to treat cancer

Describe regeneration

when tissue damage has been slight, the inflamed area may return completely to its normal structure and function

most favorable resolution of acute inflam and involves complete removal of all cells, by products, and inflam exudate

returns microcirculation to its pre inflam state

Describe repair

occurs when complete return of the tissue to normal is not possible bc the damage has been too great

final defense mechanism of the body in its attempt to restore injured tissue to its original state

dead cells are replaced with live cells and new tissue components or nonfunctioning scar tissue

CANNOT BE COMPLETED UNTIL SOURCE OF INJURY IS REMOVED OR INJURIOUS AGENTS ARE DESTROYED

What tissues can undergo repair?

connective tissue, epithelium, bone

NOT ENAMEL

What are the local factors that can impair healing?

bacterial infections - strep or staph strains

tissue destructions / necrosis

hemorrhage into tissue causing a hematoma

excessive movement of injured tissue

poor blood supply

What are the systemic factors that can impair healing?

malnutrition

immunosuppression due to chemotherapy or steroids

genetic disorder

metabolic disorders

tobacco and recreational drug use

Describe the process of bone healing

1. Clot forms

2. Cellular proliferation occurs to convert the clot to granulation tissue

3. Granulation tissue forms a matrix, which allows osteoblasts to lay down immature bone called osteoid

4. Osteoid becomes more calcified over time and the area of tissue damage is replaced by viable bone trabeculae

Describe attrition

wearing away of tooth structure during mastication, creating flattened occlusal, incisal, and interproximal surfaces

a more fibrous diet causes greater attrition

typically greater in MEN than women and in ELDERLY

Describe abrasion

wearing away of the tooth structure caused by an repetitive mechanical habit like aggressive toothbrush/flossing or holding sharp things in the mouth

commonly seen on exposed root surfaces where dentin and cementum are exposed

appears as a notching of the root surface in areas of gingival recession

increase risk for hypersensitivity and caries

Describe erosion

loss of tooth structure due to chemical actions --> chemicals, acidic food and drink, meds, pools with low ph, gastric secretions, eating disorders, etc

commonly affects facial and lingual surfaces and palate

appears smooth and polished

Describe abfraction

affects cervical areas

--> V or wedge-shaped defect, deep and narrow

caused by microfracture to tooth structure in areas of high stress, can be related to fatigue, flexure, fraction, and deformation of tooth structure due to biomechanical forces

Describe bruxism and its symptoms

Grinding of the teeth together for nonfunctional reasons

Triggered by occlusal interferences, stress, and tension

Symptoms include wear on masticatory surfaces, attrition, hypertrophy of masticatory muscles, increase muscle tone and tenderness, cheek biting, jaw pain, etc

Describe internal resorption

can occur in any tooth, usually involves one tooth

associated with an inflammatory response in the pulp

if internal resorption occurs coronally, seen as a pinkish area in the crown

if internal resorption occurs apically, it can only be seen radiographically and appears as a round/oval radiolucent area

Describe external resorption

resorption of the tooth structure beginning at the outside

usually involves root of tooth or crown of an impacted tooth

appears as slight raggedness or blunting of the root apex and can proceed to severe loss of tooth structure

What are the types of oral mucosal burns?

aspirin, phenol and chemical, electric, and thermal

What are the causes of aspirin burns?

chemical burn

aspirin in contact with mucosa for a period of time

What are the clinical and microscopic features of aspirin burns?

painful ulcer with necrotic surface

How can you treat aspirin burns?

palliative

What are the causes phenol and chemical burns?

caustic chemical in contact with mucosa

What are the clinical and microscopic features of phenol and chemical burns?

painful ulcer with necrotizing center

How can you treat phenol and chemical burns?

palliative

What are the causes of electric burns?

live electric cord in contact with mucosa

What are the clinical and microscopic features of electric burns?

tissue destruction

How can you treat electric burns?

tissue repair

What are the cause of thermal burns?

hot food or liquid

How can you treat thermal burns?

runs its course or palliative

What are the clinical and microscopic features of thermal burns?

painful erythema and superficial ulceration

What are the causes of lesions from cocaine use?

cocaine use

What are the clinical and microscopic features of lesions from cocaine use?

lesions located at midline of hard palate

painful ulceration and erythema, necrotic ulcers, palatal perforation

How can you treat lesions from cocaine use?

elimination of cause

What is the cause of hematomas?

trauma

What are the clinical and microscopic features of hematomas?

red / purple / blue / black mass lesion

How can you treat hematomas?

no treatment

What is the cause of traumatic ulcers?

trauma to mucosa

What are the clinical and microscopic features of traumatic ulcers?

painful, mucosal ulceration

ulcer with eosinophils present in inflammatory infiltrate

How can you treat traumatic ulcers?

elimination of cause

What is the cause of frictional keratosis?

chronic friction against mucosal surface

What are the clinical and microscopic features of frictional keratosis?

white mucosal surface

hyperkeratosis

How can you treat frictional keratosis?

elimination of cause

What is the cause of linea alba?

teeth clenching / cheek biting

What are the clinical and microscopic features of linea alba?

anterior to posterior white line

epithelial hyperplasia and hyperkeratosis

How can you treat linea alba?

none

may regress slightly if you stop the habit

What is the cause of nicotinic stomatitis?

smoking

What are the clinical and microscopic features of nicotinic stomatitis?

white, opacification of palatal mucosa with raised red dots

hyperkeratosis with inflamed minor salivary glands

How can you treat nicotinic stomatitis?

elimination of cause

What is the cause of solar cheilitis?

sun exposure

What are the clinical and microscopic features of solar cheilitis?

indistinct, fissured skin mucosal interface

degenerative changes in CT

How can you treat solar cheilitis?

protect lips and skin from sun exposure

What is the cause of mucocele?

severed salivary gland duct

What are the clinical and microscopic features of mucocele?

localized tissue swelling that increases and decreases in size

extravasated mucus in tissue surrounded by granulation tissue

What is the cause of ranula?

obstruction / severing of salivary gland duct

How can you treat mucocele?

excision

may spontaneously resolve

What are the clinical and microscopic features of ranula?

fluid filled swelling that increase / decreases in size

resembles mucocele or mucous cyst

How can you treat ranula?

surgery

What is the cause of peripheral ossifying fibroma?

not known

What are the clinical and microscopic features of peripheral ossifying fibroma?

exophytic gingival lesion that resembles an irritation fibroma

composed of cellular fibrous CT interspersed with scattered bone and cementum like calcifications

How can you treat peripheral ossifying fibroma?

surgical excision and scaling of adjacent teeth to remove any irritants

What is the cause of denture induced fibrous hyperplasia? (also called epilus fissuartum)

ill fitting denture

What are the clinical and microscopic features of denture induced fibrous hyperplasia?

elongated folds of exophytic tissue surrounding denture flange

dense fibrous CT surfaced by epithelium that may be hyperplastic and ulcerated

How can you treat denture induced fibrous hyperplasia?

surgical excision

new denture

What is the cause of gingival enlargement?

response to chronic inflam

idiopathic

drug reaction

hormonal changes

genetic

What are the clinical and microscopic features of gingival enlargement?

increase in bulk of free and attached gingiva

no stippling

erythematous to normal color

CT surfaced by squamous epithelium

What is the cause of chronic hyperplastic pulpitis?

caries

How can you treat gingival enlargement?

gingivectomy

good oral hygiene

What are the clinical and microscopic features of chronic hyperplastic pulpitis?

red or pink nodule protruding from pulp chamber of tooth with large, open carious lesion

granulation tissue surfaced by squamous epithelium

How can you treat chronic hyperplastic pulpitis?

extraction of tooth

endodontic treatment

What is the cause of periapical abscess?

inflammation of dental pulp

pre existing periapical chronic inflammation

What are the clinical and microscopic features of periapical abscess?

pain, swelling, fistula, light extrusion of tooth

acute inflammatory infiltrate

How can you treat a periapical abscess?

drain

What is the cause of radicular cyst?

radicular cyst not removed with extracted tooth

What are the clinical and microscopic features of periapical granuloma?

asymptomatic

tooth sensitivity to percussion

slight extrusion of tooth

chronic inflammatory infiltrate

How can you treat a periapical granuloma?

extraction

endodontic therapy

What is the cause of periapical granuloma?

pulpal inflam and necrosis

What are the clinical and microscopic features of radicular cyst?

asymptomatic

spaced lined by epithelium surrounded by an infiltrate of chronic inflammatory cells

How can you treat a radicular cyst?

endodontic therapy

apicoectomy (remove root of tooth)

extraction and curettage of extraction site

What is condensing osteitis and its cause?

change in bone near apices of teeth

may be a reaction to a low grade infection

What tooth is most commonly associated with condensing osteitis?

md first molar

(can also include md second molar and md premolars)

How do you diagnose condensing osteitis?

appears radiopaque in the periapical area of teeth with defined or diffuse borders

can be seen as radiolucent or radiolucent center with radiopaque borders

associated with caries or restored tooth, asymptomatic