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(Appearance of lesions in soft tissue)
An area with a color different from the surrounding tissue; flat; less than 1 cm. Ex: freckle
Same criteria as macule (area w/ different color), but greater than 1 cm.
A circumscribed elevated or protruding lesion that is less than 1 cm. Ex: mole
A circumscribed elevated or protruding lesion that is greater than 1 cm.
An elevated, fluid-filled lesion less than 1 cm in size.
An elevated, fluid-filled lesion greater than 1 cm in size.
Vesicle or bulla containing pus.
Describing the base of a lesion as broad or flat.
Attached by a stem or stalk base.
A segment or lobe that is part of the whole.
(color/size of lesions)
Red, pink, salmon, white, blue-black, gray, brown, purple, black.
An abnormal redness of soft tissues.
Paleness of skin or mucosa.
Firm, hard to palpation.
Fluid-filled, soft (blister like).
Lesion moves when palpated.
Multiple projections/elevations found in clusters.
A cleft or groove.
(Variants of normal)
Small mucosal tags on the lingual.
Aquired vascular proliferation under the tongue.
White-bluish tinge of the buccal mucosa.
- (Benign condition)
- Ectopic thyroid tissue
- (Benign condition)
- Deep grooves/cracks in tongue
Median rhomboid glossitis
- (Benign condition)
- Reddish patch/plaque @ the midline dorsum of the tongue
Benign migratory glossitis
- (Benign condition)
- Patchy appearance of the tongue with desquamation of filliform papilla; "pattern changes."
- (Benign condition)
- White or black
- Elongated/lengthened papillae
Inflammation and its benefits
- A nonspecific response to injury.
- -localize and isolate injured/infected area
- -neutralize and inactivate toxic substances
- -destroys/limits growth of infecting organisms
- -prepares tissue for healing/repair
Local clinical signs of inflammation
- Redness (rubor- from dilation)
- Heat (calor- temp change)
- Swelling (tumor- vessel permeability)
- Pain (dolor- pressure on nerves)
- Loss of normal tissue function (function laesa)
Systemic clinical signs of inflammation
- Fever (pyrogens trigger hypothalamus to increase temp)
- C-reactive protein (liver protein elevated)
- Lymphadenopathy/lymphadenitis (from increased number or increased size of cells)
- Leukocytosis (increased # of WBCs, 10,000-30,000/cc)
Microscopic signs/steps of inflammation
- 1. Immediate constriction
- 2. Dilation of the same vessels via histamine, produces hyperemia, erythema, and heat
- 3. Increased permeability, leads to edema
- 4. Blood viscosity increases, flow decreases
- 5. Margination
- 6. Pavementing
- 7. Emigration
- 8. Chemotaxis
- 9. Phagocytosis
Serous fluid vs. purulence (pus)
- Serious: plasma fluids and proteins, with few WBCs
- Purulence: tissue debris, many WBCs, fluid, and proteins
Movement of WBCs to the periphery of the vessel caused by chemotactic factors (1st step)
WBCs line blood vessels via electronegative factors (2nd step)
Movement of WBCs from the blood vessel and through the vessel wall (3rd step)
Directed movement to the site of injury with chemotactic factors (4th step)
WBCs digest foreign substances from injured site by ingesting them (5th step)
- Initial response to the tissue to an irritant/harmful stimuli
- SHORT DURATION-few days
- Tissue regenerates to original self
- LONG DURATION-weeks, months, indefinitely
- Occurs in the injury continues
- Caused by persistent injury/unresolved acute inflammation; may also be caused by certain viral infec/autoimmune diseases
Associated with chronic inflammation
- Granulomatous inflammation: collections of macrophages around the injury the form granuloma-like tissue
- Mulinucleated giant cells
Cells involved in acute/chronic inflammation
- ACUTE: 6 types of leukocytes (WBCs)
- 1. Neutrophils (PMNs)
- 2. Mast cells
- 3. Macrophage
- 4. Eosinophils
- 5. Basophils
- 6. Lymphoctyes
CHRONIC: macrophages, lymphocytes, plasma cells, fibroblasts, and neutrophils.
NOTE: degrees of inflamm are transitional. Acute/chronic signs may be observed concurrently.
- First cell to emigrate to site of injury/prominent cell involved in ACUTE inflammation
- 60-70% of all WBCs
- Contain lysosomes (granules w/in WBC) that contain enzymes able to destroy foreign substances.
Contain histamine and anticoagulant
- SECOND CELL involved in inflammatory process
- *monocyte when circulating in blood, macrophage in tissue
- 3-8% of all WBCs
- Major role in IMMUNE response
- Primarily involved in inflamm assoc with ALLERGIES, CT
- Parasitic infections
Allergy and antibody response-released histamine
- T cells (produced in the thymus)- chronic inflammation and immune response
- B cells (plasma cells, produced in lymphoid tissue)- assist T cells, responsible for antibody production.
Describe chemical mediators of inflammation
- Agents that can start or amplify inflammation
- Cell derived or plasma protein derived substances
- Produced by elements in blood, WBCs, and pathogenic organisms
What are some chemical mediators of inflammation and what do they do?
- Prostaglandins, lysosomal enzymes, and endotoxins
- Induce inflammation and produce the signs of edema, erythema, fever, and pain
**Three plasma protein systems primarily involved
What are the three plasma protein systems primarily involved in chemical mediation of inflammation?
- The Kinin System
- Advances by substances (proteins) present in plasma
- Induces pain
- Bradykinin is the primary kinin- SM contraction, dilation, and permeability
- The Clotting Mechanism
- Primary function: form clots @ the site of injury
- Fibrinogen, prothrombin, plasminogen, factor VIII
- Mediates inflammation with the kinin
- The Complement SystemCause mast cells to release biochemical histamine granules
What is the goal of all inflammatory processes?
- -destroyed cells replaced by new cells
- -functioning cells often replaced by scar
- -repair process takes approx. 2 weeks for healing
Describe the day of injury
- Clot forms as a collection of RBCs, platelets (thrombocytes, play critical role in clot), fibrin
- Platelets affected by asprin, NSAIDS, alcohol, kidney disease.
Describe the day after injury
Acute inflammation dominates
Describe day 2 after injury
- Macrophages increase in #, phagocytosis continues
- Fibroblasts produce new CT (granulation tissue)
- Epithelial cells migrate across fibrin clot
Describe day 7 after injury
- Fibrin is digested by enzymesSkin surface = red b/c dilation, increased perm, and thinness of skin
Describe day 14 after injury
- Tissue is remodeled and tissue strength approaching normal
- Scar formation is dependent on depth of injury
Primary intention (types of repair)
- Direct healing of one skin edge to another (surgical incision w/ sutures)
- Minimal scar due to direct healing
Secondary intention (types of repair)
- Indirect healing w/ formation of granulation tissue and loss of normal tissueIncreased scar formation
Tertiary intention (types of repair)
- Delayed primary intention
- (ex. waiting for an infection to resolve)
Bone repair (types of repair)
Granulation tissue followed by immature bone formation then organized bone develops
- Wearing away of tooth structure
- Most often occurs on the occlusal surface
*Bruxism: attrition caused by clenching or grinding
Wearing away of tooth structure resulting from a mechanical action (ex. toothbrush scrubbing w/ excessive pressure)
- Wedge shaped lesions @ the cervical 1/3Already weakened tooth structure = easily affected
- Chemical wearing of tooth structure
- Acidic oral environment (can occur facial/lingual)
- Rapid erosion of teeth
- B/c acid content of meth, xerostomia, high sugar liquid craving, lack of OH
- 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
Occurs when asprin is allowed to rest on the oral mucosa w/o swallowing (ex. placed directly on canker sore)
Caused by trauma, no tx required
- Caused by chronic rubbing of the tissue resulting in an opalescent, keratotic tissue
- Not malignant
- Local cause
- Not the same as leukoplakia
- Example: linea alba
- Keratotic, opalescent palatal tissue
- Reddish raised dots w/in the keratosis-inflammed minor salivary glands
- Heavy smokers
Tobacco pouch keratosis
- Smokeless tobacco use
- Ridges of keratotic tissue where the tobacco is placed
- "Dry river bed" appearance
Minor salivary gland obstruction
- Major salivary gland obstruction
- Location: sublingual
- Salivary gland stone
- Assoc. w/ salivary glad obstruction
- Resulting condition: Sialadenitis
- CT and BV tumorNot pus producing
- Treat w/ surgical excision
What is also known as a pregnancy tumor?
Giant cell granuloma
- Multi-nucleated giant cells
- RBCs and inflamm cells present
- May be peripheral or central
- Cause is unclear
- Tx surgical excision
Typically caused by dentures
What is epilus fissuratum also known as
- Chronic inflammatory tissue @ apex of nonvital toothGranulation tissue containing epithelial rest of malasez
- Tx RCT or extraction
Radicular (PA) cyst
- Most common cyst
- Epithelial lined
- Nonvital tooth
- Tx RCT or extraction and curettage
- Cyst that remains after an extraction
- No tooth is present
Focal sclerosing osetomyelitis
- Apex of tooth
- May be caused by a reaction to an infection
- No tx
What is condensing osteitis also known as?
focal sclerosing osteomyelitis
- Breakdown and destruction of tooth structure
- May be a result of trauma/stress to structure
- Etiology may be unknown
What does the immune response do?
- Defends the body from pathogens
- Has capacity to remember previous infection/respond quicker
- Consists mainly of lymphocytes/plasma cells
- Can cause increased injury and repair
- Innate or aquired
Innate immune response
- WHAT YOU'RE BORN WITH- genetic ability of body to protect against a specific pathogen
- Body's natural resistance- response to an injury WITHOUT CELL MEMORY
- Response takes hours and is NONspecific to a foreign body
Acquired/adaptive immune response
- Body's response to injury/insult when cells recognize/REMEMBER the foreign body from a prior exposure
- Natural or artificial
- Response is SPECIFIC to a foreign body
Stages of the acquired immune response
- 1. B and T cells recognize the foreign body
- 2. Cells are activated to reproduce (clone) and change (differentiate) into cells that can respond to the antigen
- 3. Some cells produce antibodies, others work at eliminating the antigen
- 4. Antigens eliminated, memory cells remain with ability to respond if antigen return
- 5. Response takes DAYS
- Any substance that stimulates the body's immune defenses
- Body sees substance as foreign, triggers production of antibodies to defend against substance in future exposure
- (antibody generators)
Cause of autoimmune disorders
The body's reaction to its own antigens
What are antibodies also known as?
What are antibodies?
- Gamma globulin proteins w/ role of recognizing/neutralizing foreign substances
- Generated by plasma cells as response to specific antigen
- Trigger mast cells
What are the five types of antibodies?
- 1. IgM
- 2. IgA
- 3. IgG
- 4. IgE
- 5. IgD
- Basic antibody
- 1st antibody to respond to antigen exposure
- May be present prior to exposure- "natural antibody"
- Largest antibody
- Protects body fluids
- Secretory: saliva, tears, genitourinary tract, gastrointestinal
- Serous: blood
- Involved in secondary response
- Most abundant antibody
- Only antibody to cross placenta (passive immunity for baby)
- Response to specific allergens, especially type I hypersensitivity reactions
- Rarest antibody
- Activates B lymphocytes
- Specific role is unknown
What is the primary cell involved in the immune response?
- Lymphocyte (special kind of leukocyte)
- Recognize and respond to an antigen
- 20-30% of all WBCs
What are the three types of lymphocytes?
- 1. B lymphocytes
- 2. T lymphocytes
- 3. NK cells
- B lymphocytes: primary cell
- Involves production of antibodies
- Type 1, 2, 3 hypersensitivity reactions
- T lymphocytes are primary cells
- Type IV hypersensitivity reaction
**Humoral and cell mediated responses are interrelated
- Component of acquired/adaptive immunity
- 10-15% of lymphocytes
- Produced by stem cells in bone marrow (T lymphocyte is also)
- Matures in lymphoid tissure- lymph nodes, tonsillar tissue, etc.
- Ivolved in humoral immune response
- When activated, cells migrate to site of pathogen and presents antigen to T cell, triggering T cell activity
What are the two types of B lymphocytes?
- 1. Plasma cells- produce proteins called antibodies (Ig)
- 2. B memory cells- remembers the antigen
- 80% of all lymphocytes
- Mature in thymus gland
- Involved in Cell mediated immune response
- Carry receptors to recognize specific targets
- 4 types of T cells with having a different immune response
- Communication of cells is by lymphokines