Pathology Session #2 SLO and PowerPoint✅

injury

result of an alteration in the environment that causes tissue damage or necrosis. Less severe _______ may result in reversible responses such as hyperplasia, hypertrophy, and atrophy

Inflammation

_____________ allows the body to eliminate injurious agents, contain injuries and heal defects.

nonspecific

inflammation is __________ meaning it occurs in the same manner regardless of the injury

local

limited to the area of injury

systemic

involves the whole body

acute, chronic

inflammation can be ______ or _______

physical barrier, mechanical defense, antibacterial activity, removal of foreign substances, inflammation process

what are the innate defenses that protect our body?

redness and heat, swelling, pain, loss of normal tissue function

LOCALIZED Cardinal signs of inflammation?

fever, leukocytosis, lymphadenopathy, Elevated C-reactive protein CRP

SYSTEMIC cardinal signs of inflammation?

injury to tissue

what is the first part of the inflammation sequence of microscopic events?

constriction of small vessels in microcirculation (to stop the bleed)

what is the second part of the inflammation response following injury to tissue?

dilation of microcirculation, hyperemia, redness, heat

what is the third part of the inflammation response following constriction of small blood vessels of microcirculation?

hyperemia

increased blood flow

increase in permeability, vessels become leaky

what is the fourth part of the inflammation response following dilation of microcirculation, increased blood flow, redness and heat?

exudate leaves microcirculation and becomes transudate

what is the fifth part of the inflammation response following increase in permeability of vessels as they become leaky?

increased blood viscosity

what is the sixth part of the inflammation response following exudate leaves microcirculation and becomes transudate?

decreased blood flow

what is the seventh part of the inflammation response following increased blood viscosity?

margination of WBC's to the periphery (pavementing of WBC's and chemotaxis)

what is the eighth part of the inflammation response following decreased blood flow?

emigration, exudate, edema

following pavementIng and chemotaxis of the WBC's, the WBC's enter the injured tissue through _______ and cause ________ and _________

phagocytosis

white blood cells then eat the foreign mateiral through ___________?

hyperemia, redness and heat

constriction and dilation causes ________. Which causes?

exudate

fluid that flows into injured tissue after emigration. It contains cells and protein for injured tissue and helps dilute injurious agents, but results in edema

serous exudate

clear watery exudate that is mainly plasma fluids, proteins, and a few WBC's

purulent exudate

exudate containing plasma fluids and proteins, tissue debris, and many WBC's. Ex. abscess

emigration

the process by which WBC's escape from blood vessels through gaps in the endothelial cells.

pagocytosis

process by which WBC's ingest and then digest foreign substances

chemotaxis

directed movement of WBC's toward the site of injury

leukocytes

WBC's

Neutrophils (polymorphonuclear leukocytes)

phagocytotic cells with a multilobed nucleus and granular cytoplasm that contains lysosomal enzymes. Constitute 60-70% of the WBC population. Derive from stem cells in bone marrow

monocytes (blood), macrophages (tissue)

phagocytic cells with a single round nuclear that DO NOT have a granular cytoplasm. They constitute 3-8% of the WBC population and are derived from stem cells in bone marrow

Kinin System

biochemical mediator that is active in early phases of inflammation and is activated by substances in plasma and injured tissue. Causes increased dilation of blood vessels at the site of injury permeability of local blood vessels and induces pain

clotting mechanism

biochemical mediator that clots blood and mediates inflammation.

compliment system

biochemical mediator that produces a cascade of plasma protein. They are present in blood in an inactive form and are triggered by an antigen antibody complex.

mast cells

what cells release histamine

permeability, vasodilation

histamine causes an increase in vascular __________ and ______________

endotoxin

released by pathogenic microorganisms (produced by cell walls of gram negative bacteria) serves as a chemotactic factor; cam activate complement function as an antigen and damage bone and tissue

prostoglandins

biochemical mediator release by the body that increased vascular dilation and permeability tissue pain redness and changes in connective tissue

fever

systemic sign of inflammation that is caused by pyrogens that act on the hypothalamus.

pyrogens

fever producing substances produced by WBC's and pathogens that act on the hypothalamus

hypothalamus

the ______ increases body temperature

leukocytosis

increase in the number of white blood cells

Elevated C-reactive protein

-produced in the liver

-interacts with clotting and complement system

-levels can be used to help assess RA and SLE.

-Used to monitor healing

-used as early infection detection

-chronically increased level is associated with cardiovascular disease and may be a possible marker for periodontal disease

lymphadenopathy

enlarged lymph nodes due to changes in lymphocytes

viral infection

in a _______________ there is an increase in lymphocytes

bacterial infection

in a _______________ there is an increase in neutrophils

allergic reaction

in an ___________there is an increase in eosinophils

hyperplasia

an increase in the number of cells

hypertrophy

enlargement of individual cells

chronic inflammation

__________________ is caused by persistent injuries. Repair cannot be completed until the source of injury is removed.

granuloma

distinct form of chronic inflammation characterized by the formation of a _________________. which are microscopic groupings of macrophages surrounded by lymphocytes and plasma cells.

-group together to for multinucleated GIANT cells.

-associated with TB and foreign body reaction

atrophy

a decrease in size or function of a cell, tissue, organ, or entire body

repair

the restoration of damaged or diseased tissue

Day of injury

blood flows into injured tissue to produce a clot. what day is this?

regeneration

the process by which injured tissue is replaced with tissue identical to that present before the injury

fibrin, clumped RBC's, platelets

clots consist of?

day after injury

the ________________, neutrophils emigrate from the microcirculation into injured tissue in an acute inflammatory response and phagocytosis occurs

two days after injury

____________________

-monocytes change to macrophages in tissue

neutrophils are reduced in number

-granulation tissue is formed

blood clot acts as a scaffold for new CT

lymphocytes and plasma cells migrate to the area as chronic inflammation and the immune response begins

two weeks after injury

________________________

-initial granulation tissue and fibers have been remodeled

-matured fibrous CT is called scar tissue. it is white and laer due to increased collagen and decreased vascularity

healing by primary intention

type of repair:

healing of an injury in which there is little loss of tissue. The margins are close together and very little granulation tissue forms?

healing by secondary intention

type of repair:

the edges of the injury cannot be joined during healing. A large clot forms resulting in excess granulation tissue. May result in excess scar tissue (keloid)

osteoblasts

cells that create new bone tissue

factors delaying bone formation

blood supply at site, growth factors, edema, injury, infection

bruxism

grinding and clenching of teeth for nonfunction purposes

ex. stress, occlusal interferences, stress, tension, seizure disorders

factors influencing repair of bone

nutrition, age, tobacco use

attrition

tooth to tooth wear present in permanent and primary dentition. Bruxism can make teeth wear faster

signs and symptoms of bruxism

wear facets, abnormal rate of attrition, hypertrophy of masticary muscles, increased muscle tone, muscle tenderness, fatigue, cheek biting, pain in temporomandibular joint, tooth mobility, pulpal sensitivity to cold

Abrasion

pathological wearing away of tooth structure that results from repetitive mechanical habit. (notching on root surface accompanied with gingival recession)

abfraction

wedge shaped lesion at the cervical areas caused by microfractures of tooth structures in areas of concentrations of stress. may be related to fatigue, flexure, fracture, and deformation of tooth structure

bullimia

eating disorder characterized by food binges followed by induced vomiting. irritation of oral mucosa and lips.

traumatic lesions on backs of fingers

erosion

loss of tooth structure as a result of chemicals without bacterial involvement. tooth structure may be lost around a restoration making it stand out. Ask about patients history

erosion potential causes

Industrial factors

Intraorally applied cocaine hydrochloride drug abuse Overuse of soft drinks

Baby bottle caries

Sucking on lemon

Chronic vomiting

meth mouth

rapid destruction of teeth as a result of methamphetamine acid content, decreased salivary flow, cravings for high sugar, and lack of oral hygiene.

Aspirin burn

Caused by topical application of aspirin (misuse of product) tissue becomes necrotic and white the surface may slough off leaving a painful ulcer. Ulcer heals in 7-21 days.

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

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

Thermal burn

Hot food burns, Tx: therapeutic, agents that contain hydrogen peroxide or eugenol

Crack cocaine lesions

Lesions located on the midline of the hard palate may vary from ulcers to keratotic lesions to exophytic reactive lesions as a result of smoking crack cocaine

traumatic granuloma

The result of persistent trauma. Appears hard (indurated) and raised. Heals rapidly post biopsy

Self induced lesions

Chronic lip, cheek or tongue biting. Trauma to gingiva from fingernail Lesions may range from ulcer to epithelial hyperplasia and hyperkeratosis

Hematoma

Accumulation of blood trapped within tissue as a result of trauma. Appears as a red to purple to blush gray mass. Frequently seen on labial or buccal mucosa.

Frictional keratosis

Form of hyperkeratosis caused by chronic rubbing or friction against an oral mucosal. Resembles a callus on skin.

TX: identify and eliminate cause of lesion

CAN LOOK LIKE IDIOPATHIC LEUKOPLAKIA!!!!

Nicotine stomatitis

Benign lesion associated with pipe/cigar smoking, or cigarette smoking. Initially appears: erythema

Keratinization occurs causing opacity.

Red raised areas occur at the openings of ducts of inflamed minor salivary glands.

Smokeless tobacco keratosis

White lesion located where chewing tobacco is placed, most often the mucobuccal fold

Early lesions: granular wrinkled appearance

Long standing lesions: more opaquely white with corrugated surface

Traumatic ulcer

Caused by: Cheek lip or tongue biting, denture irritation, mucosal injury, or overzealous brushing

TX: heals within 7-14 days unless trauma persists.

May require biopsy

Tobacco pouch keratosis

Wrinkled, Corrugated, White lesion at site of tobacco placement. Long term exposure to _______ has been associated with increased risk of squamous cell carcinoma.

Tx: stop using ______, may need biopsy

Electronic cigarettes (e-cigarettes)

Can be damaging to oral tissues as regular smoking. Produces an aerosol or vapor to bring nicotine to the lungs. Vapor contains toxic chemicals and heavy metals

Traumatic neuroma

A lesion caused by an injury to a peripheral nerve.

The nerve sheath of Shwann 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.

Diagnosis: need a biopsy and microscopic examination

TX: surgical excision

Palisaded Encapsulated Neuroma (PEN)

Benign lesion that appears clinically as a mucosal nodule. Under microscope, it is well circumscribed lesion that is composed of nerve tissue partially surrounded by fibrous CT.

Considered a reactive hyperplastic lesion

Amalgam tattoo

A flat bluish-gray lesion of the oral mucosa that results from the introduction of amalgam particles into the tissues.

Can occur during placement/removal of amalgam. Or during EXT. most commonly on gingiva or alveolar ridge

Malignant melanoma

Amalgam tattoo appears as a __________. So it is best to ensure pt history and a radiograph to diagnose an amalgam tattoo

melanosis

Normal physiologic pigmentation of oral mucosa. Can be genetic. May occur as a result of inflammation. If presenting as a macule, a biopsy is needed!

Solar Cheilitis (Actinic Cheilitis)

A degeneration of the tissue of the lips caused by exposure to the sun. Lips appear dry and cracked. Vermillion appears pale pink and indistinct. Microscopically, the epithelium is thinner than normal due to degenerative CT changes.

Smoking and alcohol use increases the risk for squamous cell carcinoma.

TX: avoid sun exposure, wear sunscreen

Mucous Retention Lesion: Mucocele

• A lesion formed when a salivary gland duct is *severed*; the mucous salivary gland secretion spills into the adjacent CT

• Not a true cyst because it is not lined with epithelium

Mucous retention lesion: mucous retention cyst

Dilated salivary gland ducts that developed as a result of duct obstruction.

TX: removal of affected minor salivary gland

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

sialolith

stone in the salivary gland. Can be found in both major and minor salivary glands. Formed by calcium salts around central core. Can be seen on radiographs (dense)

TX: sour candy to "milk" or surgical removal (risk damage)

Necrotizing Sialometaplasia

A benign condition of the salivary glands characterized by moderately painful swelling and ulceration in the affected area. Thought the be a result from low/blocked blood supply to the area. Salivary epithelium is replaced by squamous epithelium. Ulcer typically heals by secondary intentions.

Biopsy is needed to establish diagnosis

Acute and Chronic Sialadenitis

may occur as a result of obstruction of a slaivary gland duct or result of infection; presents as painful swelling and confirmed by radiograph of gland with radiopaque dye injected into it

reactive connective tissue hyperplasia

proliferating, exuberant granulation tissue and dense fibrous connective tissue that results from overzealous repair

May be a response to a single event or chronic low grade injury

Pyogenic granuloma

A proliferation of connective tissue containing numerous blood vessels and inflammatory cells occurring as a response to injury.

Name is a misnomer: this lesion is neither pyogenic NOR a true granuloma!