Path - Chapter 2

Terms	Definitions
abscess	a collection of pus that has accumulated in a cavity formed by the tissue
acute	of short duration or of short and relatively severe course
atrophy	the decrease in size and function of a cell, tissue, organ, or whole body
central	within bone
chemotaxis	the directed movement of white blood cells to the area of injury by biochemical mediators
chronic	persisting over a long time
c-reactive protein	a protein produced in the liver that becomes elevated during episodes of scute inflammation or infection
edema	excess plasma or exudate in the interstitial space of the tissues that causes selling
emigration	the passage of white blood cells throught the endothelium and wall of the microcirculation into the injured tissue
erythema	redness of the skin or mucosa
exudate	inflammatory fluid formed as a reaction to injury of tissues and blood vessels
fever	an elevation of body temperature to greater then the normal of 37 degrees C (98.6 degrees F)
hyperemia	an excess of blood in a part of the body
hyperplasia	an enlargement of a tissue or organ resulting from an increase in the number of normal cells
hypertrophy	an enlargement of a tissue or organ resulting from an increase in size but not in number of cells
inflammation	a nonspecific response to injury that involves the microcirculation and its blood cells
local	confined to a limited part; not general or systemic
lymphadenopathy	a condition associated with various disease processes that affect lymph nodes such that they become enlarged
macrophage	the second white blood cell to arrive at the site of injury; is involved in phagocytes and also the immune response
margination	a process during inflammation in which white blood cells tend to move to the periphery of the blood vessel wall
microcirculation	small blood vessels, including arterioles, capillaries, and venules, all of which can be affected by local changes as the result of inflammation
necrosis	the pathologic death of one or more cells or a portion of tissue or organ resulting from irreversible damage
neutrophil	the first white blood cell to arrive at the site of injury; the primary cell involved in acute inflammation; one of the white blood cells with a multilobed nucleus; also called a polymorphonuclear leukocyte (PMN)
pavementing	adherence of white blood cells to the walls of a blood vessel during inflammation
peripheral	located away from the center; indicates that the location of a lesion is in the soft tissue surrounding a bone
phagocytosis	a process of ingestion and digestion by cells
leukocytosis	a temporary increase in the number of white blood cells circulating in blood
purulent	containing or forming pus
regeneration	the process by which injured tissue is replaced with tissue identical to that present before the injury
repair	the restoration of damaged or diseased tissues
serous	having a watery consistency relating to serum
systemic	pretaining to or affecting the body as a whole
wheal	a localized swelling of tissue because of edema during inflammation, often accompanied by severe itching
homeostasis	a condition in which the body's internal environment remains within certain physiologic limits
eliminate injurious agents, contain injuries, and begin the process of healing	inflammation allows the human body to . . .
injury	an alteration in the environment that causes tissue damage
physical, chemical, microorganisms	factors that can cause injury
nutritional deficiencies	can render oral tissues more susceptible to injury from other sources
intact skin or mucosa	physical barrier to injury
cilia and mucus in the respiratory system	mechanical defense to injury
stomach acid	chemical defense against microorganisms
saliva and tears	anti-microbial defense
tears, saliva, urine, diarrhea	flushing action of defense
-itis	denotes inflammation of a specific tissue
persistent source of injury is removed	repair of the tissue occurs only if the . . .
redness (erythema) and heat	hyperema resulting from dialtion of microcirculation
swelling	permeability of microcirculation leads to exudate formation in the tissues
pain	pressure on nerves by exudate formation and release of biochemical mediators
loss of normal tissue function	events associated with swelling and pain
localized signs of inflammation	redness, heat, swelling, pain, loss of normal tissue function
systemic signs of inflammation	fever, leukocytosis, elevated c-reative protein, lymphadenopathy
fever	production of pyrogens affects the hypothalamus, which influences body temperature
leukocytosis	an increase in the number of white blood cells circulating in blood
elevated c-reactive protein	a protein produced in the liver and elevated in circulating blood when inflammation is present somewhere in the body
lymphadenopathy	hyperplasia and hypertrophy of lymphocytes
microscopic events of inflammation	involve the microcirculation, red blood cells, white blood cells, and biochemical mediators
sequence of microscopic events during inflammatory response	injury to tissue constriction of the microcirculation dilation of the microcirculation increase in permeability of the microcirculation exudate leaving the microcirculation increase in blood viscosity in the microcirculation decrease in blood flow through the microcirculation margination and pavementing of WBC emigration of WBC from the microcirculation phagocytosis by WBC of foreign substances
hyperemia	responsible for redness and heat as clinical signs of inflammation
serous and purulent	two main types of exudate
serous exudate	composed mainly of plasma with just a few WBC
purulent exudate	also called suppuration; contains tissue debris and many WBC in addition to plasma
purpose of exudate	helps to dilute injurious agents that may be present and carry them through the lymphatic vessels to the lymph nodes
fistula	a channel through tissue
exudate	its formation results in pain as it presses on sensory nerves
lymphocyte, plasma cell, eosinohil, mast cell	other cells within the blood and tissue that participate in both inflammatory and immune responses
resistance	ability to ward off disease through defenses
susceptibility	lack of resistance
fending off attacks, neutralizing toxic products, repairing tissues, mantaining homeostasis	survival and good health depends on . . .
two areas of resistance	nonspecific and immunity
carries out the immune response	the lymphatic system . . .
purpose of inflammation	aids in disposal of microbes, toxins, or foreign materials prevents their spread to other organs prepares the site for tissue repair helps restore homeostasis
60 - 70%	neutrophils are _____ of the entire WBC population
monocytes	macrophages are formed from _____
3 - 8%	macrophages are _____ of the entire WBC population
kinin system, clotting mechanism, complement system	three systems of plasma proteins circulating in the blood that may be activated during inflammation
kinin system	mediates inflammation by causing increased dilation of the blood vessels at the site of injury and increasing the permeability of local blood vessels; role is limited to early phases of inflammation; induces pain
bradykinin	primary kinin
clotting mechanism	fibrinous meshwork at the site of injury to protect adjacent tissues and keeps foreign substances corralled at the site and mediates inflammation; forms future framework for the repair process
complement system	series of plasma proteins activated in cascading fashion that function during inflammation and immunity and cause mast cells to release the granules that contain biochemical mediators including histamine; also causes cytolysis by creating holes in the cell membrane and opsonization
cytolysis	cell death
opsonization	enhancement of phagocytosis
cytokines	effect the inflammatory response
prostaglandins	derived from cell membranes and cause increased vascular dilation and permeability, tissue redness and pain, and changes in connective tissues
lysosomal enzymes	released from granules in WBC that act as chemotactic factors and can cause damage to connective tissues and to the clot
edotoxin	can serve as a chemotactic factor, activate complement, and function as an antigen and damage bone tissue
antiinflammatory drugs	block or suppress the inflammatory response
nonsteroidal antiinflammatory agents	NSAID
conditions treated with antiinflammatory agents	asthma, arthritis, organ transplants, and surgical trauma
aspirin	acetylsalicylic acid (ASA)
aspirin and ibuprofen	examples of NSAIDs
NSAIDs	inhibit prostaglandin synthesis
prednisone	steroidal antiinflammatory drug
antihistamines	reduce the effects of the mediator histamine
significantly lower doses	cancer medications can be used to treat inflammatory diseases at . . .
fever, increase in number of WBC, elevated c-reactive protein, enlargement of lymph nodes	four major systemic signs of inflammation
leukocytosis	increase in number of WBC
lymphadenopathy	enlargement of lymph nodes
hypothalamic thermoregulatory center	body temperature is controlled by a regulatory center in the brain called . . .
fever	body temperature higher than 98.6 degrees F and is associated with a systemic inflammatory response
pyrogens	fever-producing substances
prostaglandins	pyrogens produce fever by way of _____
slowing the growth of many pathogenic organisms	moderately high fever helps combat some infections by _____
4,000 to 10,000/mm3	normal value of leukocytes circulating in the blood
10,000 to 30,000/mm3	number of leukocytes during leukocytosis
shift to the left	increasing formation of WBC and releasing immature forms from the bone marrow into the blood in an attempt to provide more cells for phagocytosis
differential WBC count	measures the proportion of each WBC type and is useful in distinguishing a viral infection from a bacterial infection or allergic reaction
liver	c-reactive protein is produced in the _____
over 10 mg/L	high c-reactive protein level
100 mg/L	most infections and episodes of inflammation result in c-reactive protein levels of _____
hyperplasia	increase in the number of cells
hypertrophy	enlargement of individual cells
changes to lymphocytes during lymphadenopathy	increase in number of cells (hyperplasia), resulting from increased cell division, and an enlargement of individual cells (hypertrophy)
macrophages, lymphocyes, and plasma cells	cells involved in chronic inflammation
granulomatous inflammation	form of chronic inflammmation characterized by formation of granulomas
granuloma	microscopic groupings of macrophages surrounded by lymphocytes and occasional plasma cells; the body is unanble to destroy the offending substances and tries to enclose them in a mass of inflammatory cells
atrophy	decrease in size and function of a cell, tissue, organ, or whole body in response to certain conditions of cellular stress; caused by diseases that do not allow mobility, changes in cellular growth, malnutrition, pressure, ischemia, or hormonal changes
regeneration	a return completely to normal structure and function
damage has been too great	repair happens when the _____ for regeneration to occur
repair	destroyed cells and tissue are replaced with live cells and new tissue components; sometimes functioning cells and tissue components are replaced by nonfuntioning scar tissue
2 weeks	repair process for epithelium and connective tissue takes _____
scab	because of the wet environment, a _____ does not form
inflammation, proliferation, and maturation	3 phases of repair
day of injury	clot forms
clot	meshwork structure comprised of locally produced fibrin, aggregated (clumped) red blood cells, and platelets
thrombocytes	platelets are also called
250,000 to 400,000/mm3	number of platelets in the blood
one day after injury	acute inflammation
two days after injury	macrophages enter and begin phagocytosis; fibroblasts enter and granulation tissue starts to form; epithelial cells create new surface tissue; lymphocytes and plasma cells begin to immigrate from the surrounding blood vessels into the injured area as chronic inflammation and an immune response begin
seven days after injury	clot is digested by tissue enzymes and sloughs off
two weeks after injury	tissue has full strength; new tissue is scar tissue
scar tissue	has increased number of collagen fibers and decreased vascularity versus normal tissue
primary intention	healing in which little loss of tissue takes place
secondary intention	tissue is lost and edges cannot be joined during healing; large clot forms
keloid	excessive scarring in skin that appears raised and extends beyond its original boundaries
tertiary intention	infection at the site of a surgical incision that is healing by primary intention and waiting to perform surgical tissue repair until the infection is resolved
factors that impair healing	bacterial infection, tissue destruction and necrosis, hemorrhage into the tissue, excessive movement of the injured tissue, and poor blood supply; also malnutrition, immunosuppression, genetic connective tissue disorders, metabolic disorders, and tobacco use
streptococcus	primary cause of bacterial infection
attrition	wearing away of tooth structure during mastication; greater in men than women
bruxism	grinding and clenching the teeth together for nonfunctional purposes 5% of individuals 60 - 90% of patients with perio
abrasion	pathologic wearing away of tooth structure that results from a repetitive mechanical habit
abfraction	wedge-shaped lesions at the cervical areas of teeth
erosion	loss of tooth structure resulting from chemical action such as vomiting from bulimia
meth mouth	extensive and rapid destruction of teeth
aspirin burn	lesion from direct application on painful area instead of digestion; tissue becomes necrotic and appears white; is painful and tissue sloughs off resulting in a large ulcer; usually heals in 7 to 21 days
phenol burn	causes whitening of the exposed area; if ingested patient should drink large amounts of water and be referred for medical evaluation
electric burn	usually seen in infants and young children from biting on cords or sticking something in a socket. requires plastic surgery, oral surgery, and ortho
cocaine use lesions	midline of the hard palate that vary from ulcers to keratotic lesions to exophytic reactive lesions; necrotic ulcers of the tongue and epiglottis are related to free-base smoking
self-induced injuries	chronic lip, cheek, or tongue biting and trauma to gingiva by fingernail; range from ulceration to epithelial hyperplasia and hyperkeratosis
hematoma	accumulation of blood within tissue; appears red-to-purple-to-bluish-gray mass most frequently seen on labial or buccal mucosa
traumatic ulcer	biting cheek, lip, or tongue or irritation from dentures or injury from sharp edges of food or removal of dry cotton roll after dental procedure should heal in 7 - 14 days, otherwise biopsy is indicated
traumatic granuloma	persistant trauma may result in a hard (indurated), raised lesion
frictional keratosis	chronic rubbing or friction against an oral mucosal surface
hyperkeratosis	a thickening of the keratin on the surface
leukoplakia	white lesions that are not caused by trauma and arise spontaneously
linea alba	white raised line that forms most commonly on the buccal mucosa at the occlusal plane
nicotine stomatitis	a benign lesion on the hard palate most typically associated with pipe and cigar smoking, but can also occur with cigarette smoking
tobacco pouch keratosis	granular or wrinkled appearance that become more opaquely white and have a corrugated surface; patient has increased risk of caries, periodontal disease, attrition, and staining
traumatic neuroma	lesion caused by injury to a peripheral nerve; most common location is mental foramen; treated by surgical excision
amalgam tatoo	flat, bluish-gray lesion most commonly found on gingiva or edentulous alveolar ridge of posterior region of the mandible
oral melanotic macule	flat, well-circumscribed brown lesion of unknown cause
smoker's melanosis	also called smoking-associated melanosis; pigmentation most commonly found on anterior labial gingiva
solar cheilitis	sun exposure can result in degeneration of the tissue of the lips; also called actinic cheilitis vermillion of lips appears as pale pinkish and mottled strong relationship exists between it and development of basal cell carcinoma and squamous cell carcinoma
mucocele	lesion that forms when a salivary gland duct is severed and the mucous salivary gland secretion spills into the adjacent connective tissue lower lip is most common site of occurrence
ranula	a mucocele-like lesion that forms unilaterally on the floor of the mouth associated with the ducts of the sublingual and submandibular glands
necrotizing sialometaplasia	benign condition of the salivary glands characterized by moderately painful swelling and ulceration in the affected area; necrosis of the salivary glands ulcer heals spontaneously by secondary intention most often affects junction of hard and soft palates
sialolith	salivary gland stone formed by precipitation of calcium salts around a central core
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
sialography	radiograph of a gland taken after it has been injected with a radiopaque dye
reactive connective tissue hyperplasia	proliferating, exuberant granulation tissue and dense fibrous connective tissue that results from overzealous repair
pyogenic granuloma	proliferation of connective tissue containing numerous blood vessels and inflammatory cells as a response to injury; does not produce pus and is not a true granuloma; ulcerated and bleeds easily, generally elevated and may be either sessile or pedunculated
giant cell granuloma	contains many multi-nucleated giant cells and well-vascularized connective tissue; cause is not clear; occurs only in the jaws and seems to originate from PDL or periosteum as a response to injury
peripheral giant cell granuloma	occurs on the gingiva usually anterior to the molars as a result of local irritating factors and is associated with dental implants
central giant cell granuloma	occurs within bone
irritation fibroma	broad-based, persistent exophytic lesion that is composed of dense, scarlike connective tissue containing few blood vessels as a result of chronic trauma or an episode of trauma; must be removed surgically
denture induced fibrous hyperplasia	commonly called epulis fissuratum or inflammatory hyperplasia caused by ill-fitting denture; located in the vestibule along the denture border; surgical removal
papillary hyperplasia of the palate	also called palatal papillomatosis; a form of denture stomatitis; always associated with full or partial denture or ortho appliance palate is covered by multiple erythematous papillary projections that give the area a granular or "cobblestone" appearance associated with constant denture wear
gingival enlargement	an increase in the bulk of the free and attached gingiva, especially the interdental papilla; loss of stippling and rounded gingival margins
causes of gingival enlargement	unusual tissue response to chronic inflammation associated with local irritants such as plaque or calculus hormonal changes certain drugs (phenytoin, calcium channel blockers, cyclosporine)
chronic hyperplastic pulpitis	pulp polyp excessive proliferation of chronically inflamed dental pulp tissue occurs in teeth with large, open carious lesions often affects primary and permanent molars
periapical abscess	composed of a purulent exudate (pus) surrounded by connective tissue containing neutrophils and lymphocytes; seeks a path of least resistance and finds either a channel or a fistula out of the tissue, or it spreads to contiguous areas through oral and facial tissue spaces
periapical granuloma	a localized mass of chronically inflamed granulation tissue that forms at the opening of the pulp canal, generally at the apex of a nonvital tooth root
radicular cyst	a true cyst consisting of a pathologic cavity lined by epithelium in association with the root of a nonvital tooth most commonly occurring cyst; asymptomatic
residual cyst	forms when the tooth is removed and all or part of a periapical cyst is left behind
external resorption	resorption beginning at the outside of the tooth appears as a slight raggedness or blunting of the root apex
idiopathic tooth resoption	resorption may involve the crown of an impacted tooth or the roots of teeth and the cause cannot be identified
internal tooth resorption	process can occur in any tooth and usually only a single tooth is involved; associated with an inflammatory response in the pulp
focal sclerosing osteomyelitis	also called condensing osteitis a change in bone near the apexes of teeth that is thought to be a reaction to low-grade infection most commonly associated with mandibular first molar radiopaque area extending below the roots of the tooth often associated with a carious or restored tooth
alveolar osteitis	dry socket postoperative complication of tooth extraction most commonly seen in mandibular third molar blood clot breaks down and is lost before healing has taken place
the inflammatory response	which of the following is the body's initial response to injury?
acute	that type of inflammation occurs if the injury is minimal and brief and the source is removed from the tissue?
constriction of the microcirculation	in the inflammatory response, the first microscopic event is:
periapical granuloma	which one of the following conditions is a chronic inflammatory lesion?
chemotaxis	the directed movement of white blood cells to the area of injury is called:
lymphocytes and plasma cells	which cells are most common in chronic inflammation?
formation of antibodies	the macrophage has many functions. which of the following is not a function of the macrophage?
exudate	which of the following is the term used to describe blood plasma and proteins that leave the blood vessels and enter the surrounding tissues during inflammation?
ingestion of foreign substances by WBC	the process of phagocytosis directly involves the:
makes up 30% of WBC	which of the following statements is INCORRECT concerning the neutrophil? The neutrophil:
monocyte	during the process of inflammation, the second type of WBC to emigrate from the blood vessel into the injured tissue is the:
causing cytolysis of cells	components of the complement system mediate the inflammatory process by:
immature vascular connective tissue	two days after injury, granulation tissue can be described as:
caused by changes in their lymphocytes	the enlargement of superficial lymph nodes that occurs as a systemic sign of inflammation is:
the process of repair is initiated by the inflammatory response	which statement concerning repair in the body is true?
serves as a guide for migrating epithelial cells	the clot that forms during repair:
the patient has increased formation of granulation tissue	healing by secondary intention refers to healing of an injury when:
hyperplasia	an increase in the size of an organ or tissue resulting from an increase in the number of its cells is termed:
inadequate movement of bone tissue	normal bone tissue repair can be delayed by:
amalgam tatoo	which one of the following would appear as a pigmented lesion?
bruxism is the same as mastication	Which of the following statements is false?
erosion	loss of tooth structure associated with bulimia is caused by:
results from a misuse of aspirin	an aspirin burn:
nicotine stomatitis	a patient has a generalized white appearance of the palate. tiny erythematous dots can be seen, surrounded by a thickened raised white-to-gray area. overall the palate appears wrinkled. this condition is most likely:
severing of or trauma to a minor salivary gland duct	the primary and most common cause of a mucocele is:
floor of the mouth	a ranula is located on the:
epulis fissuratum	which one of the following would not occur on the gingiva?
erosion	generalized loss of tooth structure primarily on the lingual surfaces of maxillary anterior teeth is associated with:
chronic inflammation	external tooth resorption occurs as a result of:
loss of blood supply	which one of the following is considered to be the most likely cause of necrotizing sialometaplasia?
lower lip	the most common site for a mucocele to occur is the:
gingiva or alveolar mucosa	the peripheral giant cell granuloma only occurs on the:
a salivary gland stone	a sialolith is:
a periapical abscess always causes radiographic periapical changes	which of the following statements is false?
a denture flange	epulis fissuratum results from irritation caused by:
gingival enlargement may be caused by medication	which of the following statements is true?
erosion	loss of tooth structure caused by chemical action describes:
radicular cyst	which of the following cysts is characteristically associated with a tooth that is nonvital on pulp testing?
residual	which cyst results when a tooth is extracted without removing the periapical cystic sac?
caries	the most common cause of the radicular cyst is:
abrasion	the wearing away of tooth structure through an abnormal mechanical action defines:
toothpaste	which one of the following is not associated with attrition?
irritation fibromatosis	heavy plaque and calculus, mouth breathing, orthodontic applicances, and overhanging restorations best describe some of the causative factors for:
may present as a multilocular radiolucency	the central giant cell granuloma:
a bruxer	during examination of the dentition, the dental hygienist notes the presence of active wear facets. this indicates that the patient is:
erosion	a patient has a loss of tooth structure on the labial surfaces of the anterior teeth and reports a high intake of citrus fruit juices. the hygienist would most likely suspect:
posterior gingiva and edentulous ridge	the amalgam tattoo represents amalgam particles in the tissue and is most commonly observed in the oral cavity on the:
all of the above	a pink protruding mass in the occlusal surface of a mandibular first or second molar is most likely: A. a pulpal granuloma B. caused by caries C. a pulp polyp D. all of the above
tetracycline	which of the following drugs does NOT cause gingival enlargement?
the clinical appearance and history of the ulcers	traumatic ulcers are usually diagnosed on the basis of:
movies involving dentists	novocaine the dentist horrible bosses the secret lives of dentists
pathognomonic	a particular sign whose presence means that a particular disease is present beyond any doubt
factitious	causing injury with fingernails