Oral Pathology

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Acanthylosis

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dissolution of the inter-cellular bridges of the prickle cell layer of the epithelium

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allergy

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a hypersensitive state acquired through exposure to a particular allergen; reexposure to the same allergen elicits an exaggerated reaction

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anaphylaxis

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a severe type of hypersensitivity or allergic reaction in which the exaggerated immunologic reaction results from the release of vasoactive substances such as histamine; the reaction occurs pm reexposure to a foreign protein or other substance after sensitization.

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antibody

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a protein molecule, also called an immunoglobulin, which is produced by the plasma cells and reacts with a specific antigen.

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antigen

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any substance able to induce a specific immune response.

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autoantibody

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an antibody that reacts against an antigenic constituent of the person's own tissues.

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immunodeficiency

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a deficiency of the immune response resulting from hypoactivity or decreased numbers of lymphoid cells

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immunoglobulin

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a protein, also called an antibody, synthesized by plasma cells in response to a specific antigen

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LE cell

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a cell tha is a characteristic of lupus erythematosus and other autoimmune diseases; it is a mature neutrophil that has phagocytized a spherical inclusion derived from another neutrophil.

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lymphoid tissue

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tissue composed of lymphocytes supported by a meshwork of connective tissue.

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macrophage

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a large tissue-bound monocuvlear phagocye derived from monocytes circulating in blood; macrophages become mobile when stimulated by inflammation and interact with lymphocytes in an immune response.

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mucositis

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mucosal inflammation

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natural killer cell

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a lymphocyte that is part of the body's initial innate immunity. which by unknown mechanisms is able to directly destroy cells recognized as foreign.

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nikolsky sign

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in some bullous diseases, such as pemphigus vulgaris and bullous pemphigus, the superficial epithelium separates easily from the basal layer on exertion of firm, sliding manual pressure.

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rheumatoid factor/ rheumatoid arthritis

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a protein, immunoglobulin M (IgM), found in serum and detectable on laboratory tests; it is associated with auto immune diseases such as ______ ______

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T lymphocyte (T cell)

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a lymphocyte that matures in the thymus b4 migrating to tissues; it is responsible for cell-mediated immunity and may modulate the humoral immune response.

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thymus

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a lymphoid organ located high in the chest. which is large in an infant and gradually shrinks in size.

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xerophthalmia

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abnormal dryness of the eyes.

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xerostomia

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dryness of the mouth caused by decreased salivary flow.

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antigens

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foreign substances against which the immune system defends the body. these substances are mainly proteinas and are often MO's and their toxins.

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Autoimmune diseases

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diseases where parts of an individual's own body become antigens:

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Transformed

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______ human cells, such as tumor cells or cells infected by viruses, can be antigens.-human tissue or blood can be antigens-organ transplant, blood transfusion, tissue graft.

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-B lymphocytes
-T lymphocytes
-Macrophages
-Eosinohils
-Mast cells
-Natural Killer cells

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The cells involved in the immune response are the following: (6)

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Lymphocytes

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these are about 25% of WBC's
-primary cell involved in the immune response
-are able to recognize and respond to an antigen
-long lived and mobile

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B lymphoctes

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these mature and reside in the lymphoid tissue
-when it's stimulated by an antigen,they travel to the site of the injury

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B Lymphocytes:2 types

-plasma cells
-B Memory cells

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______: produce a specific antibody needed to fight the antigen
______:will retain a memory of the previously encountered antigens; duplicates itself in the presence of the antigen/new cells retain all the "memory" of the previously encountered antigens

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T lymphocytes

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these lymphocytes mature in the thymus

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T-helper cells

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these cell increase the functioning of the B-lymphocytes

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T-suppressor cells

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these cells suppress activity of the B-lymphocytes

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T-cytotoxic cells

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these cells are active in surveillance against virally infected cells and tumor cells

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1. memory
2. T-helper
3. T-suppressor
4. T-cytotoxic

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name 4 types of T lymphocytes:

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Lymphokines

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Products of lymphocytes or cytokins: there are several diff. kinds; they activate macrophages and enhance their activity-may also be involved in various other cell functioning

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Macrophages

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these cells are involved in immune response to the antigen/ are active in phagocytosis of the antigen-process and then present the antigen to the lymphocyte/ they cabn't "remember"/ always amplify the immune response/ link betwn. the inflam. and imm. response

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1. Humoral response
2. cell-mediated immune response

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name the 2 major divisions of the immune response:

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Humoral

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_______immune response: involves the production of antibodies
-B lymphocytes are the main cells

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cell-mediated immune response

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______ immune response: involves the T lymphocytes and may also be helped by the macrophages

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regulated

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Both major immune responses are _________ by the cell-mediated portion of the immune system

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memory

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______ results in a faster and stronger reponse after the initial exposure

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immunity

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increased responsiveness or ?

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Active

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Immunity that can occur naturally or be acquired.

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natural immunity

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immunity that results from exposure to a MO/ individual will have protection against further attack against the same organism

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Acquired immunity

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immunity that results in the same type of protection as a result from natural immunity/ called vaccination or immunization

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Passive immunity

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immunity that can be natural or acquired

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natural passive immunity

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immunity which occurs from mother to newborn

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acquired passive immunity

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immunity that involves the process of collecting antibodies and then injecting them into a person who doesn't have any of them

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Acquired passive immunity

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immunity that provides immediate protection for the individual
-it is short-lived, but lasts long enough for the person to start producing their own antibodies

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Immunopathology

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the study of immune reactions involved in disease

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malfunction

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the immune system can ______ and cause damage to the body

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Hypersensitivity reactions (malfunction)

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allergic reactions/ are the same type of response you see when the immune system is protecting the body against disease or MO's/get an exaggerated response/tissue destruction can occur

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Hypersensitivity Type I (anaphylaxis)

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this reaction occurs immediately (w/in min's)/ histamine is released by mast cells causing fluid build up in the tissues/ can be life-threatening

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Hypersensitivity Type II

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involves blood/ results in destruction of the cells that have the antigen on the surface of the cell/ ex's)incompatible blood transfusions, Rh compatability (deadly)

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Hypersensitivity Type III

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-immune complexes are deposited in a specific location and an acute inflammatory response begins/ tissue destruction is a result/ ex/ systemic lupus erythematosis

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Hypersensitivity Type IV aka delayed hypersensitivity

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-is a "cell mediated" response
-responsible for the rejection of skin grafts, transplanted organs/ex/ contact dermatitis mucositis

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Hypersensitivity to drugs

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drug acts as an antigen/ causes an immune response/ can cause any of the 4 types of reaction (Types1-4)

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autoimmune disease

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in these diseases, certain cells are no longer tolerated/ may involve a single type of cell or a single organ/ tissue and/or may be more extensive (multiple targets)/ may be caused by genetic factors or viral infections/several of these diseases have oral manifestations

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Immunodeficiency

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-deficiency in the number, the function or the interrelationships of the WBC's that play roles in the immune system
-may be congenital or acquired/or may be genetic

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oral diseases with immunologic pathogenesis;aphthous ulcers, Urticaria and Angioedema, contact Mucositis and Dermatitis, fixed drug eruptions, Erythema multiforma, Lichen planus,

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oral problems caused by the body's immune system's response to an antigen: these include; aphthous ulcers, Urticaria and Angioedema, contact Mucositis and Dermatitis, fixed drug eruptions, Erythema multiforma, Lichen planus,

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Aphthous ulcers

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round to oval ulcer w/ yellow white covering surrounded by rednes/occur on moveable oral mucosa/very painful/can be part of several diseases/several things that get them started

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major aphthous ulcers

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ulcers-larger than 1 cm/deeper/last longer (7-10 days)/occur mostly in the posterior part of the mouth/take several weeks to heal and leabe scars/can occur on gingiva

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herpetiform aphthous ulcers

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ulcers that resemble lesions caused by herpes virus-very tiny spots-can occur anywhere in the mouth-usually occur in groups

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1. usually by location
2. appearance
3. patient history
4. recurrent herpes simplex ulcerations that occur on fixed mucosa

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diagnosis for all aphthous ulcers: -4 key things-

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Urticaria (hives)

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-hives, will skin will be red and itchy

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Angioedema (swelling)

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-appears as a diffuse swelling
-not usually itchy
-skin is a normal color

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contact mucositis and dermatitis

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(2 answers)-usually results from direct contact with an allergen
-cell mediated response-associated w/ Type IV reaction (caused by poison ivy)

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Fixed drug eruptions

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-lesions that appear in the mouth in the same place, each time the drug is discontinued (ex-Lichenoid)-lesions will usually get worse with each use

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Erythema multiforma
-stage 2 is Stephen's Johnson's syndrome (more severe-mod.)
-stage 3 is Toxic epidermal necrolysis-severe-usually found in elderly

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-skin lesions that look like a bullseye on the skin
-if oral they are usually ulcers
-takes many shapes and forms
-usually painful-esp. if oral

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Lichen planus

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often itchy/named for its distinctive look/oral or skin
1. has a system of interconnceting white lines usually distributed eymetrically (Whickman's striae)
2. actual lesion is a small papule (pinhead size)
-treated w/ topical steroids

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types of lichen planus

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1. erosive, reticular, also bullous (forms)/plaque form appears white-asymptomatic)
2. can also cause gingival lesions which are called desquamative gingivitis

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autoimmune diseases

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these diseases will cause tissue damage b/c the immune system treats the body's own cells and tissues as antigens

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autoimmune disease

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people with one of these diseases are usually at risk for another

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Sjogren's Syndrome

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effects salivary and lacrimal glands(sweat glands)/causing a drying out-and other secretory glands can also be effected-90% of these patients are women-50% of these patients have 2 auto imm.dis's

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Systemic Lupus Erythematosus

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-acute and chronic inflammatory disease of unknown origin
-skin lesions are the most common sign and usually occur where skin is exposed to the sun
-oral lesions possible but mild

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Pemphigus Vulgaris
-acanthylosis

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-severe, progressive potentially fatal, autoimmune disease that effects the skin and mucous membranes
-characterized by intraepithelial blister formation-caused by breakdown of the cellular adhesion btwn epithelial cells called...

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Cicatricial Pemphigoid also called mucous membrane or benign mucous membrane Pemphigoid

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-not as severe as Bulgaris-it's self limiting (stops itself)-chronic, however (will come back)/lesions commonly on gingiva and ocular tissues/aka:desquamitive gingivitis-can also effect the anal, vaginal, and pharyngeal mucosa/ocular involvement can lead to blindness

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Behcet's Syndrome

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chronic, recurrent autoimmune disease-causes oral ulcers, genital ulcers, and ocular inflammation-they are painful and recurrent ulcers (like aphthous)-diagnosis will req. 2/3 manifestations

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granuloma

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a tumor-like mass inflammatory tissue consisting of a central collection of macrophages, often w/ multi-nucleated giant cells, surrounded by lymphocytes

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granulomatous disease

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a disease characterized by the formation of granulomas

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incubation period

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the period between the infection of an individual by a pathogen and the manifestation of the disease it causes

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malaise

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a vague, indefinite feeling of discomfort, debilitaiton, or lack of health

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opportunistic infection

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a disease caused by a MO that does not ordinarily cause disease but becomes pathogenic under certain circumstances

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Parenteral

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adminstered by injection

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Parethesia

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an abnormal sensation such as prickling or tingling

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pathogenic microorganism

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a MO that causes disease

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Pruritus

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Itching

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Subclinical infection

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an infectious disease not detectable by the usual clinical signs.

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whitlow

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an infection involving the distal phalanx of a finger

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nonpathogenic organisms/opportunistic infection-occur when body's defenses are not sufficient enough to ward off the MO

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organisms that do not cause disease unless the host's immunity is low-an infection of this type is called an:

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Inflammatory resoponse

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first line of defense against one of these MO's
-this is a non-specific response

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Immune response

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2nd line of defense
-response is very specific-targets the antigen(MO) and tries to destroy it

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Bacterial

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Impetigo

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Bacterial

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Tonsillitis and Pharyngitis

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Bacterial

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Tuberculosis

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Bacterial

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actinomycosis

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Bacterial

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syphilis

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Bacterial

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ANUG: acute necrotizing ulcerative gingivitis

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Bacterial

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Pericoronitis

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Bacterial

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Acute osteomyelitis

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Bacterial

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chronic osteomyleitis

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candidiasis: FUNGAL INFECTION

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Most common oral infection -aka- thrush or moniliasis
(many types possible)

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-Fungus
-False
-redness

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-mycosis or _____
-pseudo- or ____
-chelitis- means we see ____

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candidiasis: FUNGAL INFECTION

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Pseudomembraneous

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candidiasis: FUNGAL INFECTION

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chronic atrophic or denture stomatitis

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candidiasis: FUNGAL INFECTION

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chronic hyperplastic

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candidiasis: FUNGAL INFECTION

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angular cheilitis

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candidiasis: FUNGAL INFECTION

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acute atrophic

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VIRAL INFECTION

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Papillomavirus aka warts (many types); is it a Bacterial, Fungal, Or Viral infection

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VIRAL INFECTION

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Verruca Vulgaris

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VIRAL INFECTION

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Condyloma Acuminatum

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VIRAL INFECTION

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Focal Epithelial Hyperplasia aka "Heck's disease"

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VIRAL INFECTION

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Herpes Simplex
type I-oral infections
type II-genital infections

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VIRAL INFECTION

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Primary Herpetic Gingivostomatitis
-ex) herpes labialis

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VIRAL INFECTION

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recurrent Herpes Simplex

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VIRAL INFECTION

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Herpetic Whitlow

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VIRAL INFECTION

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Varicella-Zoster Virus

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VIRAL INFECTION

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chikenpox

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VIRAL INFECTION

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shingles or Herpes Zoster

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VIRAL INFECTION

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Coxsackievirus

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VIRAL INFECTION

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Herpangina

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VIRAL INFECTION

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hand-foot-mouth disease

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VIRAL INFECTION W/ Oral Implications

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Measles

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VIRAL INFECTION W/ Oral Implications

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Mumps

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VIRAL INFECTION W/ Oral Implications

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Epstein-Barr

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VIRAL INFECTION W/ Oral Implications

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HIV

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VIRAL INFECTION W/ Oral Implications

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AIDS

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Oral Manifestations of AIDS

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Oral Candidiasis

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Oral Manifestations of AIDS

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Herpes Simplex

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Oral Manifestations of AIDS

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Herpes Zoster

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Oral Manifestations of AIDS

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Hairy Leukoplakia

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Oral Manifestations of AIDS

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Papillomavirus

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Oral Manifestations of AIDS

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Kaposi Sarcoma

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Oral Manifestations of AIDS

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Lymphoma

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Oral Manifestations of AIDS

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Gingival and Periodontal disease

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Oral Manifestations of AIDS

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Spontaneous gingival bleeding

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Oral Manifestations of AIDS

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Aphthous ulcers

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1. ELIZA-an enzyme-linked
immunosorbent assay
2. Western Blot test
3. PCR-Polymerase CHain Reaction-identifies virus versus antibodies

Back 135

tests used to detect AIDS virus