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FIVE CARDINAL CLINICAL SIGNS of Inflammation
- REDNESS (ERYTHEMA)
- HEAT
- SWELLING
- PAIN
- LOSS OF NORMAL TISSUE FUNCTION
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An immediate reaction is _________ of the microcirculation. Afterwards an increase in diameter of the vessels caused by release of chemical mediators at the time of the injury leads to _______ which is an _______
- constriction
- hyperemia
- increase in blood flow resulting in redness and increase in heat
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Increased blood flow to the injured tissues leads to an increase in _______ allowing ________ to get to the tissue. This fluid is called ______.
- blood vessel permeability
- blood plasma and proteins
- exudate
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What are the two types of exudate and what are they composed of
- Serous – composed mainly of plasma fluid and proteins, with few white blood cells
- Purulent – contains tissue debris, and many white blood cells in addition to the plasma fluid and proteins
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SWELLING occurs as a result of the ______. This is called ______.
- exudate escaping from the vessels into the tissues
- edema
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The Increase in blood viscosity because of the loss of plasma fluid from the vessels. This causes the RBC’s to ______ and the WBC’s are _______ of the vessel walls. This is called _________.
- pool in the vessels
- pushed out to the sides (margins)
- margination
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What is pavementing
The sticking to the walls of the white blood cells
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What is emigration
After pavementing occurs, the white blood cells begin to leave the vessels along with the plasma, and enter the injured tissues
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What is chemotaxis
directed movement of the WBC’s in the injured tissue due to the chemical mediators in the area
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The chemical mediators that enhance this directed movement of the WBCs are called _______.
chemotactic factors
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What is phagocytosis
WBC’s removing foreign substances from the area by ingesting them
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What are the 6 types of WBC or ________ involved in the inflammatory response?
- leukocytes
- 1. NEUTROPHIL or POLYMORPHONEUCLEAR LEUKOCYTE (PMN)
- 2. MONOCYTE or MACROPHAGE
- 3. LYMPHOCYTE
- 4. PLASMA CELL
- 5. EOSINOPHIL
- 6. MAST CELL
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What is the role of the NEUTROPHIL or POLYMORPHONEUCLEAR LEUKOCYTE (PMN)
1st cell to appear and the primary cell in acute infection
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What is the role of the MONOCYTE or MACROPHAGE
Second WBC to show up and is more involved in chronic inflammation
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What is the role of the LYMPHOCYTE
involved more in chronic inflammation and the immune response
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What is the role of the PLASMA CELL
involved in chronic inflammation and the immune response by production of antibodies
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What is the role of the EOSINOPHIL and Mast cell
involved in inflammation and the immune response
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What are the 3 interrelated systems in the blood which are activated due to inflammation
- KININ SYSTEM
- CLOTTING MECHANISM
- COMPLEMENT SYSTEM
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What are the actions of the kinin system
- Causes increased dilation and permeability of the blood vessels
- Activated by substances in plasma and injured tissues
- Role limited to early inflammation
- Also induces pain associated with inflammation
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What is the role of the CLOTTING MECHANISM
Responsible for clotting blood, and it also mediates inflammation by causing vascular dilation and permeability by activating the KININ system
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What is the role of the Complement system
- Involves the production of certain plasma proteins which function in inflammation and the immune response
- Causes the mast cells to release their histamine-containing granules, which causes vasodilation and permeability of the blood vessels
- Also form chemotactic factors which attract WBC’s and increase phagocytosis in the injured area
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PROSTOGLANDINS cause
vasodilation and permeability, tissue pain, erythema
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LYSOSOMAL ENZYMES released from WBC’s and bacteria cause
chemotaxis and tissue damage
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ENDOTOXINS released from cell walls of gram negative bacteria, can cause
chemotaxis and activate complement and function as antigens
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What are some SYSTEMIC SIGNS of acute inflammation
- Fever
- Increased number of white blood cells (leukocytosis)
- Enlarged lymph nodes (lymphadenopathy)
- Elevated C-reactive protein (CRP)
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During a fever ________ are released by WBC’s and bacteria which act on the temperature center in the hypothalamus of the brain.
PYROGENS
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______ or increase in WBC production. Normally there are about _____ WBC’s per cubic milliliter of blood. With inflammation this can increase to ______ and primarily consists of the ______. This increase allows for more phagocytosis
- LEUKOCYTOSIS
- 5000
- 10,000 to 30,000
- neutrophils
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________ or enlargement of the lymph nodes results from an _________.
- LYMPHADENOPATHY
- increased number of lymphocytes and an enlargement of the lymphocytes
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C-reactive protein is produced in the _____ and plays the important role of interacting with the complement system
liver
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In chronic inflammation, ________ increase, while the ______ decrease
- macrophages, lymphocytes, and plasma cells
- PMN’s
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What is GRANULOMATOUS INFLAMMATION
A distinctive type of chronic inflammation characterized by formation of granulomas, which are groupings of macrophages surrounded by lymphocytes. They usually also contain enlarged macrophages called multinucleated giant cells.
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What is Hyperplasia
an increase in the number of cells. This can be seen in the oral cavity when chronic irritation leads to a thickening of the epithelium resulting in hyperkeratosis
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What is hypertrophy
an increase in the size of a cell, tissue or organ due to an increase in the size of the cells, not the number of cells
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What is atrophy
a decrease in the size of a cell, tissue or organ
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What is the difference between regeneration and repair
- Regeneration takes place when tissue damage is slight and the inflamed area can return to normal quickly. The end of this acute inflammation is removal of all exudate, cells and by-products with the return of the tissue to what it looked like before the injury occurred.
- Repair takes place when the damage is too great and the tissue can’t be returned to its normal state
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REGENERATION AND REPAIR is usually completed within _____ if the source of injury is removed
2 weeks
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On the day of injury – A _____ forms as blood flows into the injured tissue. It forms due to activation of the ______ and consists of
- clot
- clotting mechanism
- fibrin, clumped RBC’s and platelets (aka thrombocytes)
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On day two of repair and regeneration the initial tissue formed is called _______ tissue. This is immature tissue with lots of _______
- granulation
- capillaries and fibroblasts
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By the end of day 2, ________ cells become the predominate cells as chronic inflammation and an immune response begin.
lymphocytes and plasma
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After seven days ______ is digested by enzymes and sloughs off. Clinically looks red because of the thin epithelium and increased vascularity.
fibrin
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In fourteen days the initial granulation tissue is replaced with mature fibers and is now called ______. Tissue appears paler than surrounding tissue due to _______
- scar tissue
- increase in collagen fibers and decreased vascularity
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What are the two types of repair and what do they entail
- Primary: clean edges of the incision are joined to form only a small clot. Little granulation tissue forms so there is less scar tissue
- Secondary: with loss of tissue, the edges can’t be opposed. A large clot forms with an increased amount of granulation tissue. After healing there is a larger amount of scar tissue present
- tertiary intention: sometimes the original wound may get infected and instead of healing by primary or secondary intention, a surgical procedure needs to be done to correct the tissue damage from the infection
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Excessive scarring in skin is called _______.
keloid formation
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Healing of bone is similar to healing of _________ except that osteoblasts form bone.
connective tissue
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Bruxism
grinding and clenching for nonfunctional purposes
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Abrasion
is the pathologic wearing away of tooth resulting from a mechanical habit
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Erosion
loss of tooth structure due to chemical action
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Aspirin contains _________ and can take up to ______ to heal
- acetylsalicylic acid
- 3 weeks
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What is a hematoma
lesion that results from accumulation of blood within tissue due to trauma.
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A traumatic ulcer can take ________ to heal
7 to 14 days
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Frictional Keratosis is a _______. Also called ________
- thickening of the keratin layer due to chronic friction
- hyperkeratosis
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Nicotine Stomatitis is a benign lesion on the hard palate caused by _______. Has an appearance of ________
- heat from smoking, usually from a pipe
- red dots (minor salivary gland openings)
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Tobacco Chewer’s White Lesion (Tobacco Pouch Keratosis)
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What is Solar or Actinic Cheilitis and what is the treatment
- degeneration of the soft tissue of the lips due to exposure to sun
- Considered precancerous and a biopsy is needed to rule out squamous cell carcinoma
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What is Traumatic Neuroma
a lesion caused by injury to a peripheral nerve due to damage to the nerve sheath (Schwann Cells) and nerve fiber
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What is Melanosis
melanin pigmentation that occurs after an inflammatory response
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What is a Mucocele, what is another word for it and what is the treatment
- lesion that forms when a minor salivary gland duct is severed and the mucous secretion spills into adjacent connective tissue
- mucous retention “cyst”
- Treatment is surgical excision if they persist
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What is a ranula and where does it form
is a term used for a mucocele-like lesion that occurs on the floor of the mouth. It forms from the ducts of the sub-lingual and sub-mandibular glands (major salivary glands).
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What is the cause and treatment for a ranula
- Appears as a large, compressible soft, painless lesion
- Cause is obstruction of duct usually due to sialolith (stone)
- Treatment is removal of obstruction (stone)
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What is a Sialolith
a salivary gland stone. They occur in major & minor salivary glands and form from calcium salts. The swellings are firm, tender or painful and appear pink
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What is Acute and chronic sialadenitis and what is the treatment
infections that can occur as a result of an obstructed salivary gland duct. This presents as a painful swelling. Treatment would be antibiotics after making the diagnosis.
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What is Necrotizing sialometaplasia, what is it caused by and what does it appear as
benign necrosis of salivary glands resulting from lack of blood supply to an area due to trauma. Usually occurs on the palate. Initially appears as small nodule that enlarges and ulcerates
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Necrotizing sialometaplasia
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