Exam 1-Healing of Oral Wounds Flashcards
EARLY vascular response to injury: Initial transient vaso________ followed by vaso_______
constriction….dilation
EARLY vascular response to injury: Vasodilation is caused by action of ________, _________, and other vasodilatory substances
histamine, prostaglandins
EARLY vascular response to injury: Dilation causes intercellular _____ to occur, which allow egress of plasma and emigration of leukocytes
gaps
Inflammatory stage of Wound Repair: wound fills with clotted blood, inflammatory cells, and ______
plasma
Inflammatory stage of Wound Repair: Adjacent _________ begins to migrate into wound along edge of the wound.
epithelium
Inflammatory stage of Wound Repair: Undifferentiated mesenchymal cells begin to transform into _______.
fibroblasts
MIGRATORY phase of FIBROBLASTIC stage: Continued ________ migration under the fibrinous exudate.
epithelial
MIGRATORY phase of FIBROBLASTIC stage: ________ dispose of foreign and necrotic material.
Leukocytes
MIGRATORY phase of FIBROBLASTIC stage: _______ ingrowth begins and ________ migrate into wound along fibrin strands.
Capillary…fibroblasts
PROLIFERATIVE phase of FIBROBLASTIC stage: Proliferation increases epithelial thickness and __________ are haphazardly laid down by fibroblasts.
Collagen fibers
PROLIFERATIVE phase of FIBROBLASTIC stage: Budding _______ begin to establish contact with their counterparts from other sites in the wound.
capillaries
REMODELING stage- ________ stratification is restored and Fibrinous exudate resorbs, often leaving a depressed ______.
Epithelial…scar
REMODELING stage- ________ is remodeled into more efficiently organized patterns and ________ slowly reduce and ________ integrity is re-established.
Collagen..fibroblasts..vascular
Wound contraction: Begins near the END of ________ and continues during the early portion of _______.
fibroplasia….remodeling
Wound contraction diminishes the _______ of the wound.
SIZE
What are these indications for? Any persistent pathologic condition which cannot be diagnosed clinically….Any lesion thought to be malignant/premalignant…To confirm clinical diagnosis….Any condition not responding to routine management….To allay cancer fears
Indications for doing a BIOPSY
What is the removal of tissue from a living individual for the purpose of microscopic examination and diagnosis?
Biopsy
What is the GOLD STANDARD of diagnosis?
a Biopsy!
***WHAT IS THE FIXANT used for transporting a biopsy specimen?
10% neutral, buffered FORMALIN
What are the 4 most common mistakes when retrieving/handling a biopsy? Whats the most common?
1.Crushing it 2.Burning it 3.Injecting it with anesthetic 4.MOST COMMON-not Fixating it (10% neutral,buffered formalin)
What can you use as a fixing agent if you don’t have 10% neutral, buffered formalin in your office?
any EtOH
Which type of BIOPSY? If the lesion is larger than 1cm or in a hazardous location or whenever there is a great suspicion of malignancy.
Incisional
INCISIONAL biopsy: If the lesion is larger than ____ or in a hazardous ______ or whenever there is a great suspicion of ________. They are used to establish a ________!
1cm… location… malignancy…used to establish a DIAGNOSIS!
What type of BIOPSY: Is used to remove the lesion….It is a diagnostic and therapeutic biopsy.
Excisional biopsy
For lesions that are small and you are confident are benign use THIS type of BIOPSY…
Excisional
DO NOT excise a lesion suspected of being _______!!!
MALIGNANT
What category of healing? Healing by primary intention…..When the margins can be approximated….Usually heals with minimal scar.
Primary Healing
What kind of healing? Healing by secondary intention. - An open wound “granulates in”. - Heals with scarring.
Secondary Healing
Which Biopsy method? the removal of individual cells, usually in order to determine microscopically if they appear normal or abnormal. It usually does not provide a definitive diagnosis.
cytology/exfolative cytology
What are these advantages for? *Safe *Bloodless *Painless *Quick *Screening
Cytology
Disadvantages of Cytology: Only for surface lesions affecting ________ *Cannot establish a definitive ________
epithelium…diagnosis
Cytology Grades: I
Normal
Cytology Grades: II
Atypical-Biopsy
Cytology Grades: III
Borderline-Biopsy
Cytology Grades: IV
Sugesstive-Biopsy
Cytology Grades: V
Positive-Biopsy
What are three main indications for using Cytology?
1.Premalignant/malignant lesions 2.HSV lesions 3.Candidiasis
HSV can be deceiving….it will have _________ that make it look like a malignant, multi-nucleated cell…
intranuclear inclusions
What are these describing? *Cytological evaluation for premalignant/malignant lesions *Improved cell harvesting *All cell layers *Improved computer-based screening of specimen *Improved diagnostic accuracy *Atypical and positive results must be biopsied *Does not provide definitive diagnosis
Oral CDX Brush Biopsy
What is the diagnostic technique used to identify autoantibodies?
Immunofluorescence
Immunofluorescence-which method looks for autoantibodies in tissue?
Direct
Which immunofluorescence method looks for circulating autoantibodies in BLOOD?
Indirect
Immunofluorescence: Diagnostic technique to identify __________
autoantibodies
In general, what types of disorders are immunofluorescent testing usually reserved for? What are two specific examples?
Autoimmune…1.Pemphigus Vulgaris 2.Mucus membrane pemphigoid
Interesting note about immunofluorescence: Most ORAL diseases are ______ on Direct but _______ on indirect IF.
positive on Direct, but negative on indirect
Can you use a FIXATIVE for a direct immunofluorescense sample?
No, must use a special transport medium
In a direct immunofluorescent sample, where are you likely to see the autoantibodies in relation to the cells? Why?
they are on the border of the cells, because they are attacking the desmosomes
Healing of an EXT wound! Which WEEK of healing?? The blood clot begins to undergo organization by the ingrowth of fibroblasts and capillaries from the residual periodontal ligament and adjacent bone marrow.
First Week
Healing of an EXT wound! Which WEEK of healing?? The blood clot is becoming organized….PDL begins degeneration and the socket wall appears frayed….Epithelium proliferates over the wound surface
Second Week
Healing of an EXT wound! Which WEEK of healing?? The original clot is organized by granulation tissue. Early bone (osteoid) is formed by osteoblasts arising in the PDL and adjacent bone. The crest of the alveolar bone is rounded off by osteoclastic resorption. Epithelium completely covers the surface
Third Week
Which week of healing post EXT has granulation tissue?
3rd week
Which week of healing post EXT has osteoid formation?
3rd week
Healing of an EXT wound! Which WEEK of healing?? Continued deposition of bone. Much of the early bone is poorly calcified and is not evident on radiographs. Radiographic evidence of bone formation is seen after six or eight weeks. Evidence of differences in new bone in the alveolar socket will persist for four to six months.
4th week
HOW LONG after an EXT do we see RADIOGRAPHIC evidence of bone formation?
6-8 weeks
HOW LONG after an EXT do we see evidence of differences between the new bone in the socket and the existing bone in the alveolus?
4-6 months
What is the clinical name for dry socket? (4 words)
Localized Acute Alveolar Osteomyelitis
What is the etiology of Localized Acute Alveolar OsteoMyelitis?
Loss of the blood clot from the extraction site
Dry Socket: The socket appears dry and the _____ is exposed…Produces a foul odor and severe pain but no _________.
bone…supperation
WHAT results from a DIFFICULT surgical extraction accompanied by LOSS of lingual and labial or buccal plates of bone with accompanying loss of periosteum??
Fibrous healing of an extortion wound
Radiographic interpretation of a FIBROUS healing of an ext wound: appears as a _________ radiolucent area at the site of previous extraction wound…What TWO things might this be mistaken for?
circumscribed…1.Residual CYST or 2.GRANULOMA
Which extraction healing complication is found most often in middle aged females?
Focal Osteoporotic Bone Marrow Defect (iron deficiency)
What is the term for a radiolucency in bone from bone marrow expansion?…. may not be pathologic (5 words)
Focal Osteoporotic Bone Marrow Defect
Where is the most common location for a focal osteoporotic bone marrow defect?
mandibular posterior
Focal osteoporotic bone marrow defect show as Radiolucencies, often ill-defined but with faint internal _________
trabeculation
Often a fragment of bone will become lodged in the socket and induce tissue hyperplasia and will cause THIS…
localized tissue overgrowth
BE AWARE: Tissue growing from an extraction site (aka. ________) can also represent MALIGNANCY growing along the course of least resistance…..so don’t
localized tissue overgrowth
