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122 Cards in this Set
- Front
- Back
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What are the 3 phases of the acute inflamation process?
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1) Initiation
2) Amplification 3) Termination |
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What is the Initiation phase of inflammation entail?
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Vasoconstriction and then vasodilation
Plasma fluid (exudate) & Marginization and emigration of leukocytes |
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What is another name for Marginization and what does it mean?
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Pavementation
The movement toward the endothelial cells. |
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What makes up the Amplification phase of inflammation ?
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Opsinization: Enables leukocytes to distroy and remove resistant organisms at the sight of injury.
Phagocytosis: The ingestion of foreign material. |
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What makes up the Termination phase?
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Removal of the foreign material and debris
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What are the Cardinal signs of inflamation?
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Redness, Heat, Swelling, Pain & Loss of Function
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Which cells release Histamine?
Are they granular or agranular? Which Ig affects Histamine? |
Mast Cells.
They are granular. IgE |
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What is a complement system?
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A series of reactions between plasma proteins
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How do these proteins get activated?
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During the inflammation response.
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What type of cell has the biggest role in **Chronic** Inflmation?
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Macrophages…when they come to play tissue gets hurt. Remember this is in Chronic Inflammation
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What do these macrophages secrete?
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Lysosomal Enzymes
(very powerful and often "eat" more than they should". |
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How is Chronic Inflammation resolved?
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When the "agents" are removed or destroyed.
The body will eventually "kick" out a tooth, like we remove a rock in our shoe if the bacteria can't be "beaten back". |
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When does repair and wound healing begin?
What cells begin this process? |
Immediately
Leukocytes & Fibroblasts |
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What is the framework of healing and repair?
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Granulation tissue
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What is a clinical term to describe a red patch?
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Erythroplakia
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What type of pt might you see erythroplakia in?
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A chronic tobacco/alcohal user
**This is a possible pre-maligancy 85% of the time.** |
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Is erythroplakia inflammatory in nature?
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No!
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What type of TX might be considered for erythroplakia?
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Removal of the lesion,
Chemo/radiation, Close follow up |
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Candidiasis can appear as ________ & ________ lesions.
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Red & White.
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Patients who have ____________are often more likely to experience Erythematous Candidiasis.
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Dentures
*Be sure the PT is cleaning them regularly, may need to disinfect.* |
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What are pigmented lesions that are variants of normal?
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Amalgam Tattoo
Oral Pigmentation |
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What might the tissue arounda titanium implant look like?
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Grey-blue tissue around the gingiva.
(The tissue is so thin the metal shows through.) |
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What type of pigmentation would have Grey, Blue or Black around the gingival margin?
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Heavy metal pigmentation.
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Wht is the term for a freckle on the lip?
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Ephelis (macule)
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How would you describe an oral melanoma?
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Its usually located on the hard palate and maxillary gingiva. Usually has irregular/asemmetical boarders. Usually dark in color
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Who is more likely to have an oral malanoma?
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Men 40+,
Can be deadly so keep an eye on it. Always investigate a dark lesion. |
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What is the most common white lesion in pipe or heavy smokers?
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Nicotine Stomatitis
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What is nicotine stomatitis?
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Hyperkeratosis on the palate with possible inflamed minor salivary gland ducts.
(look like red or brown spots in the keratin) |
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What is Candidiasis?
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A fungal infection caused by the Candida C. albicans
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Where can candidiasis be found?
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Mouth, GI tract & vagina.
(same bacteria can be in all locations) |
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What type of infection is candidiasis?
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Opportunistic!
*You might see this in Pt's with asthma in the back of the throat due to the inhaler* |
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What is the usually appearance of candidiasis?
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White apperance but has an erythematous form as well.
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If the candidiasis is wiped off what will the appearance be?
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Red, ulcertative look to the underlying tissues.
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How would you treat dentures or partials for a Pt with acute pseudomembranous candidiasis?
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They need to be disinfected so as to avoid re-infecting the area.
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What is the most common site for Hairy Leukoplakia?
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Lateral boarder of tongue, often is Bilateral!
Won't wipe off! |
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What would be the DD of Hairy Tongue?
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Frictional keratosis, lichen planus, candidiasis, possible burns.
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What is the origin of Lichen Planus?
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This inflammatory disorder has an unknown cause.
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Which sex is more likely to have lichen planus and what surface is it usually located?
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Female 90%
Buccal mucosa |
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What conditions can exaserbate lichen planus?
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Stress & Anxiety
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What are the 6 forms of Lichen Planus? Which is most common?
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1) Atrophic (red patches with white)
2) Bullous 3) Erosive (angry red ulcerated look) 4) Papular 5) Plaque like 6) Reticular- Wickam striae **Most common form** |
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What is the ultimate goal of the immune system?
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To prevent foreign substances from entering the body & to establish immunity or resistance to disease producing agents (bacteria / viruses).
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What are some examples of non-specific or innate immunity?
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Gastric Acids,
hair, skin, nails mucus membranes |
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What is the purpose of innate or non-specific immunity?
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It’s the first line of defense…Keep foreign substances out!
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What is the purpose of the secondary response (in non-specific immunity)?
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To bring weapons to the fight! 'ie Inflammatory response
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What is another name for Specific Immunity?
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Acquired
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Are PMN's part of the non specific 1st or 2nd response?
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The 2nd.
They are part of the inflammation response, which happens if a "germ" penetrates the fortress! |
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Which type of cell is the main "actor" in the Specific or acquired immunity response?
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The lymphocytes
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What type of cells are antibodies?
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Plasma Cells
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What 2 groups of cells are the lymphocytes made up of? Where are each of these initially formed?
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B lymphocytes & T Lymphocytes
In the bone marrow. |
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B lymphocytes are most active in __________ immunity. T lymphocytes are most active in ____ _______ immunity
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humoral
cell-mediated |
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What activates Tc (cytotoxic cells)?
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Th (helper cells) or macrophages
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What type of cells to Tc cells kill?
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Those that are antigenic….but the Tc cell must be activated by either Th or macrophages.
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What are the 2 types of Specific Immunity?
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Active & Passive
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How might someone get Frictional Keratosis?
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Cheek Biting, Ortho Tx, Broken or Missing teeth, Bruxing
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Is Frictional Keratosis rare or common?
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Common
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Why can't you just wipe Frictional Keratosis it off?
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Keratin is produced to protect the site and won't simply wipe away. The condition must be alleviated.
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What is the DD for Frictional Keratosis?
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Leukoplakia, Lichen planus, hyperplastic candidiasis.
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What are the 2 most common sites of mucoceles?
What is their cause? |
Buccal Mucosa & Inside of lower lip
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What does a mucocele usually look like?
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Tissue colored, well circumscribed
(not attached to the gingiva) |
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What is the "definition" of a mucocele?
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An accumulation of mucus in the connective tissue.
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Which type of herpes simplex virus are we "concerned" about?
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Type 1 (Type 2 is genital and we work from the neck up!)
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What is the very first outbreak of Type 1 herpes called?
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Primary herpetic gingivostomatitis.
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How is Type 1 herpes tramsmitted? Is it common or uncommon?
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Transmission: Physical-salivary It is common.
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What is the typical incubation time with Primary herpetic gingivostomatitis?
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2 days --> 2 weeks incubation
(then its remains latent in the trigeminal ganglia) |
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What symptoms might a Pt have with Type 1 herpes on the initial outbreak?
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*Pain
* Run a temperature *Malaise *classic Fiery Red marginal gingiva w/ vesicular lesions that rupture and ulcerate. |
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What do we Tx Pt's with this condition?
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Don't treat the Pt until the condition has subsided.
*Due to risk of spreading* |
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Will you see type 1 Herpes on the buccal mucosa or on keratinized tissue on the mouth?
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Keratinized tissue
(Buccal mucosal lesions could be DD as apthous ulcers.) |
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Healthwise, what is the major concern for patents if their child has the Type 1 initial onset?
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Dehydration
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What is another name for Secondary herpes simplex?
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Recurrent herpes simplex
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What is the typical healing time for lesions in recurrent herpes simplex?
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7-14 days
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How does secondary herpes present physically?
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The lesions appear as cluster or vessicles.
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Should you Tx a Pt with recurrent herpes?
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That depends. If the lesions have been going away and you won't be interfering with their healing then..ok. If sores are not healed and tugging on the cheek will break the sores…then reschedule Tx.
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How do the lesions appear for recurrent herpes?
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Unilaterl, extraoral crusty or ulcerated vesicles.
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What might the DD of recurrent herpes be?
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recurrent aphthous stomatitis.
**They are not canker sores** |
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What is the TX for the lesions?
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Antiviral creams and avoid sun exposure.
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What is another name for Primary varicella-zoster
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Chicken Pox
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What age group is usually impacted by chicken pox? What are the symptoms?
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Young childern
Symptoms: Fever, Inflamation, sore throat, Vesicular rash on truck, head, neck and the itch!! |
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What is being destroyed in the body with an outbreak of (primary) varicella-zoster?
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The epithelial basal cells
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Do we Tx Pt's with chicken pox?
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No
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What are som DD's of chicken pox?
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HSV 1 (Herpes simplex virus type 1), aphthae ulcers
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What is the usual timeframe until a Pt has gotten over the chicken pox?
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2-3 weeks it is self limiting.
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What is another name for Secondary varicella-zoster? Who is usually impacted?
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Shingles
Adults and the elderly (but can see in younger adults on occasion) |
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What is the duration of shingles? How to lesions appear? Describe the discomfort?
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Duration: 2-3 weeks typically.
Lesions: are similar to chicken pox but are unilateral and in patches Discomfort: Extremely painful, can have lingering pain. |
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What is Ramsay Hunt syndrome? How does it present?
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Its found in Pt's with shingles
Presents in some facial paralisis, loss of hearing & vertigo |
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What is the DD for shingles?
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Herpes, rubella, ruboela, impetigo
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What type of disease is Pemphigus Vulgaris?
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Autoimmune
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What age group is typically impacted by Pemphigus Vulgaris and what is a typical "sign" of it?
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40-60 year olds
Nikolski sign (skin rubs off and immediate bulla forms) |
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Where on the body are lesions seen first for Pemphigus Vulgaris?
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Oral lesions are usually seen first.
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What is the TX for Pemphigus vulgaris?
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steroids…must treat as can be life threatening!
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What cells are separating with Pemp Vulg?
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Epithelial cells are separating.
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How do you want to educate patients of products to avoid?
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No acidic products
No alcohol No mint dental products (use kids stuff instead) |
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What items could a PT with Pemp Vulg utilize?
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Childrens dental products (no or little mint),
Saline rinse, lozenges |
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What are some DD's of Pemphigus Vulgaris?
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Erosive lichen planus, pemphigus.
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As a dental hygienist, what do I need to provide for the Pt with Pemphigus Vulgaris?
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A Referral!
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Since Mucus membrane pemphigoid is an autoimmune disease, what do we need to provide to the Pt?
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A Referral!
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Who is more likely to have Mucus membrane pemphigoid?
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Middle age females
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What is happening to the cells in Mucus membrane pemphigoid?
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The basal cell layer is separating from the connective tissue.
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Where are these lesions (Mucus membrane pemphigoid) usually seen first and what often accompanies them?
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Oral lesions are usually seen first.
Scarring **Bulla forms in subepithelia areas and Nikolsky sign is common.** |
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What is the DD of Mucus Membrane pemphigoid?
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Erosive lichen planus, pemphigus.
**Remember Erosive lichen plans is often Pre-Cancerous-->need that referral!** |
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What is the most common soft tissue tumor of the oral cavity?
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Fibroma
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What usually causes a fibroma?
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Trauma or irritation-->lip biting,
rubbing from missing tooth, dentures |
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If a fibroma were just starting, how would you Tx it?
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Remove the irritant, otherwise needs to be excised. *Encourage Pt not to bite/play with lesion.*
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What is the most common site for a fibroma?
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The buccal mucos along the occlusal line.
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In denture wearers, what is the "term" for a fibroma?
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Epulis Fissuratum (Dentures pinching the tissue)
May be a longer strip of tissue in this case. |
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What is a ranula and where will you find it?
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A LARGE swelling of the sublingual or submandibular salivary glands on the floor of the mouth.
(Same as a mucocele but much larger) |
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Is a ranula usually unilateral or bilateral?
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Unilateral
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What is the main cause of a ranula?
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A blocking of the salivary gland.
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How would you describe a ranula?
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Fluid filled (salivary fluid),
tissue colored, possibly blueish hue |
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Define mumps
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A unilateral swelling of the parotid glands that lifts the earlobe.
**Lifting the earlobe is the classic sign.** |
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What is neurofibromatosis?
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An inherited disease of the skin.
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What is another name for Neurofibromatosis?
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Von Recklinghausen's disease of the skin
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What are the classic signs of Neurofibromatosis?
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Café au lait spots often have multiple neurofibromas
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When does Von Recklinghausen's disease of the skin usually begin?
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Childhood and progresses from there.
*Classic symptom is the cafe au lait spots.* |
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If you see a Pt presenting with symptoms of neurofibromatosis, what key question might you ask to determin the condition you're looking at?
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Does anyone in your family have this condition?
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How do you Tx Von Recklinghausen's?
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Manage the signs, no real treatment available
*One of themost common genetic disorders* |
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Related to Von Recklinghausen's, what might you see in the eyes and what is it called?
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Freckling of the eyes called Lisch Nodules
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How can Neurofibromatosis affect dental care?
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Can make dental care difficult due to nodules in the oral cavity-->looks like Chrones disease.
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What is Rhabdomyosarcoma? *KNOW THIS for BOARDS*
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A rapidly growning malignant tumor of the striated muscle.
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What does Rhabdo mean?
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striated muscle..know this for boards!
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Where are the Rhabdomysarcoma tumors usually found?
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In the head and neck area
**Orbital area is most common** |
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What is the most common salivary gland cancer? *Know This*
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Mucoepidermoid Carcinoma
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Which salivary glad is usually impacted by mucoepidermoid carcinoma?
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Parotid Gland
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