is different than the inflammatory response in that it remembers and is quicker to respond
type of response where the body reacts to Antigens or foreign substances
these can be bacteria, virus, fungus, organ transplants, blood transfusions.
in these type of diseases the body can view their own tissue as an antigen; no invading organism but can fight inflammatory process w/ steroids
Primary WBC in the Immune Response
Humoral (antibody response)
what is the B lymphocyte response
B lymphocytes turn into _______ ________ which produce antibodies and immunogloblins
what cells B lymphocytes turn into-which remember the antigen and engulfs when it encounters the antigen again; like a macrophage w/ memory.
2 types of cells B lymphocytes turn into
what is the T lymphocyte's response
helper, suppressor, killer
three types of T lymphocytes; *interlinked with B cells
t lymphocyte that increases function of B lymphocyte- (CD4); ***affected by the HIV virus "what is your T cell count"; if low don't have wbc's to fight infection--get opportunistic infections; as hygienists we introduce bacteria from scaling
t lymphocyte that turns off the functioning of the B lymphocytes; tell them when to quit working; think this is the cell that malfunctions in an autoimmune disease-- doesn't tell B lymphocyte when to quit working & they keep going...
t lymphocyte that is Cytotoxic or CD8; kills/engulfs invading organisms
Antibodies-Involved in Type I Hypersensitivity; involved in asthma, hayfever, anaphylactic shock; Common
what specific Antibody travels across the placenta (first *passive immunity for the newborn); immunity given to baby by mother
Antibodies-First to increase in the immune response.
Type of antibodies:
-Found in mucosal and gingival tissue (defense against antigens in body fluids)
Type of antibody
Activates other B Lymphocytes
passive natural and acquired active natural and acquired
4 types of Immunity
-short lasting immunity, acts fast; mother to fetus or baby
Passive Acquired (BQ**)
-short lasting immunity, acts fast; given **antibodies in a vaccine (outside source); does not cause your own body to create antibodies
-long lasting immunity, slow to act (1-2 weeks); *Being exposed to the disease; activate; activates production of your own antibodies
-long lasting immunity, slow to act (1-2 weeks); *Given a vaccine of the dead or deactivated microorganism; activates production of your own antibodies; received from an Outside source
Anaphylactic (hayfever, asthma), cytotoxic (hemolytic), immune complex, cell mediated (T lymphocytes)
4 types of Hypersensitivity-Allergies
Anaphylactic, asthma, hayfever, IgE (BQ)
Name types of reactions and antibody involved
Type 1 Hypersensitivity
*caused by antibodies
Cytotoxic (hemolytic), IgM, IgG
Name the Type 2 Hypersensitivity and the immunoglobulins involved
Ex: Blood incompatibility, Rh factor (factor on the blood cells)
*caused by antibodies
Immune Complex, IgG
Name Type 3 Hypersensitivity and the antibody
Autoimmune diseases- Rheumatoid arthritis- antibodies attack tissues & cause lesions w/in the body ex. red welts; *caused by antibodies
Cell mediated, T lymphocytes
2 names for Type 4 Hypersensitivity.
Ex. dermatitis and PPD tuberculosis test
*NOT caused by antibodies-- caused by T lymphocyte reaction
Ex. poison Ivy, poison oak
Type I (Typical Allergic Reaction)
Type of hypersensitivity reaction:
1. Tissue contact with Antigen
2. Body produces Immunoglobulin against Antigen
3. IgE attaches to Mast Cell
4. Antigen comes into body again and attaches itself to IgE on Mast Cell.
5. Mast Cell breaks apart and releases Histamine, Bradykinin, Serotonin, Heparin, Leukotrines.
6. Vasodilation, increased permeability, itching, rash, possible bronchoconstriction. 1st exposure to the antigen, but caused an immunoglobulin to be produced (IgE--has memory for that specific antigen). 2nd exposure of antigen (pollen) IgE remembers & attacks antigen, causing Mast cell to split apart then mast cell releases histamine & buddies. Histamine causes vasodilation- bv enlarging blood vessels ex. in sinuses--hayfever: runny nose, itching, rash, maybe bronchial constriction--asthma; all through body anaphylactic shock
Type 2 hypersensitivity, Erythroblastosis Fetalis (fetus)
2 names for this type of reaction:
Rh factor: Rh- mother becomes sensitized by a Rh+ baby.
-During pregnancy, red blood cells from the unborn baby can cross into the mother's bloodstream through the placenta.
-If the mother is Rh-, her immune system treats Rh+ fetal cells as if they were a foreign substance and makes antibodies against the fetal blood cells.
-These anti-Rh antibodies may cross back through the placenta into the developing baby and destroy the baby's circulating red blood cells.
-When red blood cells are broken down, they make bilirubin.
-This causes an infant to become yellow (jaundiced).
-The level of bilirubin in the infant's bloodstream may range from mild to dangerously high.
-*Because it takes time for the mother to develop antibodies, firstborn infants are often not affected unless the mother had past miscarriages or abortions that sensitized her immune system.
-However, *all children she has afterwards who are also Rh+ may be affected. Rh incompatibility develops only when the mother is Rh- and the infant is Rh+.
-Treat with vaccination called RhoGAM, which acts to counteract the effect of the mothers antibodies.
-Most common the second exposure from Symptoms to the baby:
Hemolytic anemia, jaundice, enlargement of spleen and liver, gross swelling of stomach, staining of infants teeth, brain damage and death.
-Marker Rh+, no marker Rh-
-Range of mild to severe symptoms
-2nd Rh+ baby has reaction
Type 3 Immune Complex
Name the type of hypersensitivity reaction; Recognizes own tissue as an antigen; Thought to be caused by a malfunction in the suppressor T cells -when functions properly it shuts off the immune response when antigen is gone. Thought to be due to a failure to shut off the immune response?
Type 4, Dermatitis, Mucositis
Name type of Hypersensitivity and 2 manifestations
Due to an allergen contact Common in dentistry (intraoral and extraoral)
rash, burning, swelling, may have vesicles. T lymphocytes attacking the cells; not life threatening- not anaphylactic; skin reaction
AIDS-HIV a deficient response of Immune System;** don't confuse with autoimmune; immune system NOT working- decrease in function
Oral Diseases; not caused by bacteria and/or viruses; *Your own body reacting because immune compromised
Apthous Ulcers, RAU (recurrent apthous ulcers)
Not caused by bacteria or viruses
Not contageous: Canker sores
Appears as an ulcerative lesion with a yellow or gray pseudomembane covering and encircled with a red halo;
Causative agent-none known.
Contributing factors-trauma, certain food, systemic diseases, stress, and systemic changes. (Bacteria can *accumulate in lesion.)
-found on unattached mucosa. (movable mucosa-unattached; vestibule, under tongue, cheek, soft palate or *nonkeratinized mucosa) Cause-immunologic; Location-vestibule, under tongue, cheek, soft palate. know pg 132
-found on attached mucosa or gingiva. (nonmovable mucosa or *keratinized mucosa: hard palate, attached gingiva). Cause-Viral; Location-attached gingiva, hard palate, lips. can spread on pt & to clinician; recurrent lesions; raised fluid filled bumps.. vesicles--can coalesce into an ulcer; also called vesicular
ulcers-usually one or a few, painful, ulcerative, can be *up to 1 cm. Treat with topical anesthetic or steroid (decrease immune response). can be caused by sodium lauryl sulfate in t-paste-- if constantly getting them
multiple vesicles (can coalesce into an ulcer), painful, 1-2mm in size. Treat with antiviral agents like acyclovir or penciclovir.
Minor 3-5mm, major 5-10mm, herpetiform
3 Types of Aphthous Ulcers
most common ulcer that is-3-5mm, circular, painful, *anterior region of oral cavity, no scarring, few in number. Lasts 7-10 days
ulcer that is 5-10mm, painful,* posterior region, scarring, few in number. Lasts a few weeks. usually found in other systemic diseases
ulcer, not herpes, that is very small 1-2 mm, many lesions 1-100, anywhere on *unattached mucosa, no scarring. Differentiate from Herpes virus by location and *response to Tetracycline.
hives (swelling and itching); may not be direct cause; rash
diffuse swelling of tissue; may not have direct cause
2 conditions- hives & diffuse swelling of tissue
Cause unknown-maybe infection, trauma, emotional stress, systemic diseases and allergic cause.
Tx can be antihistamine- histamine is released from the mast cell.
Can have together or separate.
Due to an allergen contact-Type 4 hypersensitivity. Common in dentistry -rash, burning, swelling, may have vesicles occurring.
Possible type III hypersensitivity reaction -intraoral/extraoral (because of immune complex lesions--don't always know cause)
1. Skin lesions: *BQ
A.*Target lesion (circle w/in a circle), iris or bulls eye
B. *Bullae lesions on hands, feet, arms and legs.
2. Oral lesions:
Large ulcers mainly, erythematous can occur. Lips crusty and bleeding and edematous. Tongue can be effected.
-Skin and Oral lesions can be seen separately
-Treatment is remove cause and steroids--decrease inflammation
**No bacteria--Immune reaction
More severe form of *Erythema Mutliforme; -Found in children and young adults
-Skin lesions throughout body.
-Mucosa lesions throughout mouth, eyes and genitals.
-Can cause blindness and rare occasions death.
Cause unknown-stress and medications maybe the cause? Chronic, Benign disease with oral and skin manifestations.
1. Oral symptoms are most commonly in the *buccal mucosa--lace-like pattern, or spider web.; can be on tongue & other places in mouth
2. Skin lesions (*2-4mm crusty papules-raised lesion, found only on wrists and ankles--may or may not be present.)
3. Gingiva can be affected with desquamative gingivitis--ulcers, epithelium sluffs off (not generally everywhere, follows margin) (an erosive breakdown of the gingival margin and papilla.)
Somewhat common-- not severe, more of an annoyance; can occur in different diseases
reticular, erosive, plaque like, atrophic
Four types of Lichen Planus; Treatment is to eliminate cause and possible use steroids. **with all can have skin lesions and desquamative gingivitis; refer for biopsy
type of lichen planus-(most common type) thin white lines (lace-like, or spider web) called Wickam's Striae - usually in buccal mucosa, but can be on tongue, lips, floor of the mouth and gingiva. can also have skin lesions & desquamative gingivitis
type of lichen planus; in buccal mucosa epithelium separates from the connective tissue causes ulcers or erosions.
type of lichen planus; plaque like appearance. may have to biopsy to differentiate from cancer, etc.
type of lichen planus; Loss of whole top layer of epithelium causing a smooth, red, shiny area.
Condition that has:
Oral lesions-aphthous like ulcers, erythematous lesions, geographic tongue. Also has Arthritis, Urethritis, Conjunctivitis; Treatment - Aspirin and NSAIDs
Autoimmune disease; effects the salivary glands and lacrimal glands.
1. Classic symptom: (Very) Dry mouth-xerostomia-causes dry cracked lips, increased caries, perio disease, candidiasis. Loss of filliform and fungiform papillae on dorsum of tongue.
2. Dry eyes- xerophthalmia
3. Rheumatoid arthritis can occur.
4. Enlargement of Parotid gland can occur
5. Raynaud Disease (vasoconstriction in extremities-hands & feet can turn white/blue from lack of circulation) **in 20% of patients. Treatment is NSAID for arthritis. Corticosteroids; Saliva substitutes-Pilocarpine; Artificial tears; Maintain good oral health -fluoride, brush, frequent recalls. Common.
Don't necessarily have all symptoms
Systemic( SLE), discoid (DLE)
two types of Lupus Erythematous; Autoimmune
type of Lupus Erythematous; (involves the whole body-both extraorally-skin and internallly)
type of Lupus Erythematous (only involves the skin and oral lesions) not organ involvement
SLE (Systemic Lupus Erythematosus)
1.Skin lesions-(occur in **85% of patients) erythematous classic symptom *butterfly rash on bridge of nose and erythematous lesions on fingers and face.
2. Systemic symptoms- arthritis and painful joints, *Raynaud disease, loss of vision, psychoses and depression due to CNS involvement, involvement heart and kidney and the pleura of lung.
3. Oral lesions:
A. Erythematous plaques or erosions
B. White Wickham striae similar to lichen planus, but not as symmetrical. Oral lesions not always present, only **25% to 35% of patients.
Can be very painful & cause death. If heart involvement may need premed.
DLE (Discoid Lupus Erythematosus)
1. Skin lesions-classic butterfly on bridge of nose & erythematous lesions
2. Oral lesions in only **25% of patients-symptoms same as systemic form
3. *No systemic involvement-milder form of disease. Treatment-corticosteroids, aspirin and NSAIDs. Benign version-- no organ involvement
Autoimmune disease of the connective tissue
Means "Hard skin"
Symptoms: Overproduction of collagen leading to formation of scar tissue in the skin and organs
4 times more common in women.
two types of scleroderma (hard skin)
Autoimmune disease of mainly CT
Increase production of **collagen (4x), nonpliable, nonmovable
Only involves the skin and sometimes the muscle, never the organs.
*First sign is reddish patches of skin that thicken into firm oval shaped areas.
Usually fades out in 3-5 years, but left with darkened skin patches. not too debilitating
Symptoms-calcium deposits in skin, increased collagen in skin, *Raynaud's syndrome, impaired function of esophagus- difficult swallowing, and telangiectasia (swelling of blood vessels in skin) and organ involvement causing damage to lungs, heart and kidneys
Hard for organs to function w/ increase w/ collagen
Pemphigus Vulgaris (BQ) (think Nikolsy sign, oral lesions come 1st)
-Cause is unknown
-Mainifests multiple bullae (blisters) in mouth and on the skin.
-Breakdown of the epithelial cell to epithelial cell adhesions-called acantholysis (separation).
-*Separation is within the epithelium.
-Initial sign is most commonly seen in mouth.
-Oral lesions are ulcerative and bulla formation- starts as bullae then ulcers once broken open.
-Adhesion is malfunctioning
-With gentle pressure cleavage occurs when the epithelial cells separate forming a bulla
-clinical lesion is called a *Nikolsky sign
*** Main manifestation bullae & ulcers (only in mouth) & skin lesions (on skin)
**The basal layer to the connective tissue is intact.
-The breakdown is* intraepithelial (epi cell to epi cell)
-Breakdown between *desmosomes
-Basement membrane intact.
-The epithelial cells that detach are rounded and are called acantholytic cells or Tzanck cells.
Most common symptom is:
1. Nicolsky's sign and oral lesions (bullae)
2. Intraorally desquamative gingivitis can occur, but are secondary to Nicolsky's sign. Treat with steroids.
Can be fatal, due to involvement into organs or overuse of steroids.
Mucous membrane (cicatricial, benign), bullous
two types of Pemphigoid; whole epithelium will sluff off; basically variants of the same disease- think of them as the same disease
Pemphigoid (think desquamative gingivitis, skin lesions come 1st)
Manifests Bullae formation
Lesions occur in the *eyes, genital mucosa and skin
***Intraorally the cleavage (adhesion malfunction) occurs between the epithelial layer and the connective tissue layer.
At the basement membrane to basal layer--the *hemi-desmosomes connection.
Whole epithelium will sluff off.
#1. *Desquamative gingivitis (ging margin & papilla epithelium sluffs off) is the most common sign.
2. Nicolsky's sign can occur, but not severe Lesions don't rupture as easily.
***Skin lesions come first before the oral lesions.
Treatment is corticosteroids.
Blisters DO lead to scarring.
Autoimmune- Unknown cause.
Large Aphthous ulcers present.
Triad 1. Oral 2. Genital 3. Ocular
*Need two of three to be diagnosed
Type of reaction
Type 3 Hypersensitivity due to reaction to a drug; auto immune; slow progressing--delayed reaction. Examples of drugs: Antibiotics like Sulfonamides and Barbituates like Phenobarbital. Appears as red patches sometimes called Erythema Multiforme like lesion.
mother Rh-, baby Rh+
only scenario where there is an Rh reaction; happens in second Rh+ baby-- not necessarily 2nd baby!!!!
group of signs & symptoms that occur together
sjorgen's (20%), lupus, scleroderma
3 diseases that have Raynaud's as a manifestation
acantholysis (separation), desmosomes
-Breakdown of the epithelial cell to epithelial cell adhesions
-what is the connection called
2 Names for the epithelial cells in Pemphigus Vulgaris that detach from each other, and are rounded
found in lichen planus
-thin white lines (lace-like, or spider web)