Fundamentals Flashcards
If you are taking an aspiration biopsy and aspirate blood, this could be either:
- You hit a vessel
- Haemangioma (benign)
If you perform an aspiration biopsy and are unable to get any fluid this means:
The lesion is solid so most likely a tumour.
Liquid = cyst
What are conventional pathology specimens stored in?
10% neutral buffered formalin
What are most pathology specimens stained with?
Haematoxylin and Eosin (H&E) or PAS
List 6 causes of cellular injury
- Hypoxia
- Chemical agents (CO2, drugs)
- Physical agents (trauma, irradiation, temp)
- Autoimmune reaction
- Nutritional imbalance
- Aging
What is the difference between hypertrophy and hyperplasia of cells?
Hypertrophy = increase in size
Hyperplasia = increase in number
What is cell metaplasia?
Change/replacement of cell phenotype of differentiated cells
If the adaptive capability of a cell is exceeded, what will happen?
Reversible or irreversible cell injurys.
If irreversible will result in cell necrosis or apoptosis.
What is the difference between necrosis and apoptosis
Necrosis - cell death after extenral stimuli - inflammation
Apoptosis - programme cell death. No inflammation
What is inflammation?
A protective response intended to eliminate initial cause of injury as well as necrotic cells and tissues resulting from original insult
What are the two major components of acute inflammation
- Vasodilation - increase blood flow and permeability
- Recruitment and accumulation of leukocytes esp neutraphils
What is the purpose of swelling?
Dilute toxins and provide influx of protective antibodies and proteins that limit infection spread
Pyogenic microbes are usually what type:
Staphylococcus
3 eamples of chronic inflammatory cells:
- Macrophages
- Lymphocytes
- Plasma cells
What are the two requirements in order for necrotic cells to be replaced by regeneration as opposed to scar
- Remaining cells must be capable of dividing
- Collagen Framework must be intact.
What is the difference between labile cells and stable cells?
Labile turnover continuously. So skin vs hepatocytes.
Oral epithelial cells are labile and the basement membrane provides the:
Scaffold
What is the process of healing of a tooth socket.
- Haematoma in socket
- Demolition of Haematoma by MAC and breakdown of necrotic bone by osteoclasts
- Regeneration of epithelial surface
- Clot replaced by granulation tissue (1-3 weeks)
- Production of woven bone
- Remodeling (woven bone replaced by lamellar bone)
List 5 local factors which impair wound healing
- Infection
- Impaired blood sypply (eg nicotine vasoconstriction)
- Foreign bodies
- Mechanical factors
- Size, location, type of wound
List 4 systemic factors which influence wound healing
- Diabetes
- Medications eg corticosteroids
- Nutritional deficiency
- Systemic illness
Why does pulp inflammation often end up being irreversible?
Because the increase of pressure in a confined space leads to vascular ischemia which results in further inflammation and eventual necrosis
In irreversible pulpitis, the tooth will respond to EPT with higher or lower levels or current?
lower
In later stages, may be higher levels or not at all
The term periapical granuloma refers to
A mass of chronically or sub-acutely inflammed granulation tissue at the apex of a non-vital tooth. It does not show true granulomatous inflammation microscopically. It is a defensive reaction secondary to presence of microbial infection in the root canal, with spread of related toxis products into the apical zone.
What systemic medication may be helpful tx of symptomatic apical periodontitis? (no systemic infection)
NSAIDs
Systemic antibiotics are not recommended for periapical periodontitis unless (2)
- Swelling
- Systemic changes
What is the source of epithelium which can be stimulated to form periapical cysts?
Rest of Malassez
(could be crevicular epithelium or sinus lining)
Describe the histopatholoy for a cyst
FCT wall with epithelium lining, with a lumen containing fluid and cellular debris.
(Epithelium desquamates into the lumen resulting in fluid movement into the lumen to equalize osmotic pressure)
Typically, patients with periapical cysts have no symptoms unless:
There is an acute exacerbation or if it reaches a very large size.
What are clinical signs of systemic infection which may indicate antibiotics needed
- Fever
- Lymphadenopathy
- Malaise
- (also consider for medically compromised)
Epithelial lined cysts are only seen in the jaw.
True or false
True (except in rare cases)
These are odontogenic cysts
What is granulation tissue comprised of?
- Fibroblasts (synthesize collagen and ECM molecules
- Endothelial cells and new capillaries
- Macrophages for phagocytosis and secretion of growth factors
Aetiology of dry socket
- Trauma
- Oestrogens (OCP)
- Bacteria (prior infection)
- Inaequate surgical irrigation
- Tobacco
All lead to fibrinolysis which destroys the clot.
Clinical features of dry socket
Patient complains of severe pain and bad taste and smell 3-4 days after exo.
Examination shows a bony socket with bar bony walls or containing a small amount of a grey clot.
Management of dry sockt
Irrigate and pack with dressing.
Healing will proceed slowly
List responses of the pulp to injury
- Aspiration of odontoblastic nuclei into the tubules
- Movement of fluid in tubules
- Sclerosis of tubules
- Reparative dentine formation
- Inflammation
What are SOCRATES
- Site
- Onset
- Character
- Radiation
- Associations
- Time
- Exacerbating/alleviating factors
- Severity
Ossifying fibroma:
a) Will continue to enlarge if left untreated, and may become malignant
b) Is not easy to enucleate
c) Usually occurs in the anterior mandible
d) Is radiographically well defined, unilocular, ad of variable radiolucency/opacity and may show root divergence and resorption
e) Is not well demarcated histologically
d)
Fibrous dysplasia:
a) May be either monostotic (affecting a single bone) or polystotic (affecting multiple bones)
b) May be monostotick (affecting multiple bones) or polyostotic (affecting a single bone)
c) Is a GNAS2 gene mutation and has a predilection for caucasian males
d) Polyostotic type is much more common than monostotic type
e) presents as a painful swelling, with rapid growth, and appears radiographically as a ground glass appearance with poorly defined margins
a)
Osseous dysplasia:
a) Types are: periapical, focal, florid and familial herpetiforme
b) Focal type affects posterior mandible in white females, while periapical form affects anterior mandible in black females
c) Does not occur in tooth bearing areas of the jaws
d) Is not a type of fibro-osseous lesion
e) Has osteoblastic rimming
b)
Type of pathology to have a radiographic cotton wool appearance?
a) Pagets disease of the bone
b) Aneurysmal bone cyst
c) Giant cell granuloma
d) Harty’s disorder of the jaw
e) Osteonecrotic lesion following dental extraction in patient on bisphosphonate therapy
a) Pagets disease of the bone
Which type of anaemia is reflective of iron deficiency:
a) Microcytic
b) Normocytic
c) Macrocytic
a) Microcytic
What tests would you order for recurrent apthous stomatitis:
- FBC
- Vitamin B12/Folate
- Iron
- Coeliac disease screen
What tests would you order for persistent gingival bleeding
- FBC
- Clotting profile
- Liver function test
- CRP
What tests would you order for enlarged parotic, swollen lips or angular chelitis, and abdominal symptoms:
- FBC
- Vit B12/Folate
- Iron
- sACE
- Faecal calprotectin
What radiograph would you order for suspected sarcoidosis?
Chest x-ray
What blood tests would you order for burning mouth?
- FBC
- Vit B12/Folate
- Iron
- Fasting glucose
- Serum Zn and Cu
Why is zinc possibly a factor for burning mouth?
Essential element for taste buds
What tests might you order for Dry mouth?
- CRP - exclude sjogrens, sarcoidosis
- sACE - exclude sarcoidosis
- Blood glucose - exclude diabtes
- Serum immunoglobulin, calcium and phosphate
- RF
*
