Inflammation and Repair

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Homeostasis

condition in which the body's internal environment remains within certain physiologic limits
balance within the body
homones, feedback mechanisms, nervous system

Immune response

fending off attacks by disease producing organisms, neutralizing toxic products
repairing tissues

Resistance

the ability to ward off disease through our defenses
inflammation, immunology
nonspecific resistance and specific immunity

Susceptibility

lack of resistance
weak immune system, elderly
ex. HIV, cancer, smokers, transplants, AIDS, diabetes

Nonspecific resistance

inflammation, gingivitis, and perio
defense mechanism that provides protection against a varietyof pathogens
includes barriers of the skin, mucous membranes, antimicrobial chemicals, phagocytosis, inflammation, and fever

Inflammation and Immunity

body's response to injury
allows the body to eliminate injurious agents, contain injuries, and begin the process of healing

Immunity

involves the activation of specific lymphocytes that combat a particular pathogen or foreign substance
lymphatic system

Injury

an alteration in the environment that causes tissue damage
physical, chemical, microbial, nutritional

Natual defenses against immunity

skin, oral mucosa, cilia and mucus in the respiratory system, stomach acid, saliva and tears, WBC's

Inflammation

its a nonspecific response to injury
local or systemic
acute or chronic
aids in disposal of microbes, toxins, and foreign material
prevents spread to other organs
orepares the site for repair
restore homeostasis

Acute

the duration is short, only lasting a few days
may heal by regeneration or repair
pain

Chronic

may last weeks, months or indefinitely
injury continues

Local signs of inflammation

erythema/redness
swelling
pain
loss of tissue function
calor, tumor, dolor, rubor

Systemic signs of inflammation

fever, leukocytosis, elevated c-reactive proteins, lyphadenapathy

Microscopic signs of inflammation

injury to tissue (bacterial infection)
dialation and permeability of blood vessels
exudate
margination and pavementing
emigration
phagocytosis

Healing

repair or regeneration

Inflammatory response

injury-->vasodialation-->vaso permability--> lots of cells (prostaglandins, neutrophils, histamines)-->phagocytes to site-->repair

Basic stages of inflammatory response

vasodialation and increased permeability--> phagocyte migration-->tissue repair

Histamine

found in mast cells, basophils, and platelets
causes vasodialation and vasopermeability
allows cells who need to be there for healing to get to infection

Platelets

clotting

Phagocytosis

eating of bacterial cells

Kinins

pain response
formed in the blood
induce vasodialation and increased permeability
serve as chemotactic agents for phagocytes
early phase of inflammation
bradykinin

Prostaglandins

lipids that are released by damaged cells
intensify effects of histamine and kinin
also stimulate emigration of phagocytes

Leukotrienes

inflammatory
produced by basophils and mast cells
increased permeability
helps in chemotaxis

Complement system

a group of twenty normal inactive proteins in the blood plasma and on plasma membranes
these proteins enhance immune and allergic and inflammatory reactions
activated through classical and alternative pathways

Complement system actions

activates inflammatory response
stimulates histamine release
attracts neutrophils by chemotaxis
promotes phagocytosis

White blood cellls

neutrophils and macrophages
lymphocytes, plasma cells, eosinophils, mast cells

Neutrophils

the first cell to arrive at the site of injury
most common in acute inflammation
function is phagocytosis
60-70% WBC's
multilobulated nucleus
granular cytoplasm

Macrophages

second WBC to emigrate to injured tissue
derived from stem cells in bone marrow
response to chemotaxis
capable of phagocytosis
single nucleus (unilobulated)
no granular
3-8% WBC's

Chemotaxis

movement by chemicals; attraction

Plasma proteins involved in inflammation

Kinin system
Clotting mechanism
Complement system

Margination

...

Pavementing

...

Clotting Mechanism

functions in clotting of blood
platelets
stops bleeding at the site of injury

Complement system pathway

(dialation/blood flow/ permeability)-->(neutrophils, macrophages, monocytes, kinins, histamine, platelets, prostaglandins)

Opsinization

coating of foreign body for phagocytosis

Fever

body temperature is controlled by hypothalmic thermoregulatory center
higher than 98.6 degrees
symptom of infection
kills bacteria

Pyrogens

WBC and pathogenic microbes that produce fever

Leukocytosis

an increase in the number of WBC's circulating in blood
shift to the left

CBC test

differential WBC count
neutro, baso, and eosinophils

Periodontitis

chronic inflammation

C-reactive proteins

found in periodontitis
produced in the liver
acute and inflammation
associated with CVD

Lymphadenopathy

during inflammation, lymph nodes enlarge
can be palpated
may be tender or firm
results from lymphocyte changes
primary WBC in the immune response
change in number or size of the lymph nodes

Primary intention

healing of a injury in which little tissue loss occurs
little scar tissue
gum tissue is end to end

Secondary Intention

involves injury in which tissue is lost
edges of tissue cannot be joined
large clot forms
more granulation tissue

Tertiary Intention

infection at the site of the surgical incision

Attrition

wearing away of tooth structure during mastication
incisal, occlusal, and proximal
influenced by diet, stress, bruxism, and chewing tobacco
occlusal adjustment or nightguard

Bruxism

grinding and clenching teeth together for nonfunctional purposes
wear facets, hypertrophy of masticatory musclesm increased muscle tone, muscle fatigue, cheek biting, pain in TMJ
occlusal interferences
stress
occlusal adjustment or nightguard

Abrasion

pathologic wearing away of tooth structure
slow process
cause by improper toothbrushing technique
resoration, antisensitivity, grafting

Abfraction

appears as wedge shaped lesion at the cervical areas of teeth
may be related to fatigue, flexure, fracture
restorations or grafting

Erosion

the loss of tooth structure resulting from chemical action
bulimia, acid reflux, emisis, pregnancy

Methanthetamine abuse

chemical
due to acid content of the drug
decreased salivary flow
craving for hihg sugar beverages

Pathognmonic

A sign or symptom that is so characteristic of a disease that it makes the diagnosis

Asprin Burn

occurs when a patient places an asprin tablet directly on the tooth instead of swallowing it
common misuse
necrotic tissue
pain, ulceration, healing is slow

Electric burn

young infants
chewing on a live cord
permanent scarring

Burns

from food
on tongue and palate

Cocaine use

midline of the palate
ulcers or keratotic lesions
crack pipe

Self induced injury

lip biting
cheek biting
trauma by fingernail to gingiva

Hematoma

lesion that results from the accumulation of blood within tissue as a result of trauma
spontaneous remission
post op surgical site or LA injection

Facticious

psychiatric condition in which a patient deliberately produces or falsifies symptoms of illness for the sole purpose of assuming the sick role

Traumatic ulcer

results from trauma
cheek, lip, tongue
may result in traumatic granuloma
7-14 day healling

Frictional keratosis

chronic rubbing or friction against an oral mucosal surface
opaque, white apperance of the tissue
identify the trauma and eliminate the cause

Linea alba

a white raise line that forms on the buccal mucosa at the occlusal plane
due to clenching
epithelial hyperplasia and hyperkeratosis

Nicotine stomatitis

a begnin lesion on the hard palate
pipe and cigar smoking
ertythema
keratinizing may lead to white lesion
minor salivary glands can become inflammed

Tobacco pouch keratosis

those tho chew tobacco may develop a white lesion where the tobacco is placed
muccobuccal fold
lesion resolves when tobacco is removed
may result in squamous cell carcinoma

Traumatic neuroma

lesion caused by injury to peripheral nerve
painful
mental foramen is common
biopsy
surgical excision

Amalgam tattoo

flat, blue gray lesion that results when amalgam is incorporated into the tissue
removal or connective tissue graft for esthetics

Dental Movies

Little Shop of Horrors, Finding Nemo, Marathon Man

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