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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