Oral Pathology

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Oral Pathology

• Chapter 3
• Immunity

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Objectives

• 1. Define each of the words in the vocabulary
  list (please learn on your own)
• 2. Describe the primary difference between the
  immune response and the inflammatory response.

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primary difference between the immune response
and the inflammatory response

• Although both defend the body against injury they
  differ in that the immune response has the
  capacity to remember and respond more quickly
  to a foreign substance that enters the body a
  second time.

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Antigens

• A substance, usually a protein, that is
  recognized as foreign by the body's immune system
  and stimulates formation of a specific antibody
  to the antigen.

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Cells Involved in the Immune Response

• B lymphocytes ( associated plasma cells)
• T lymphocytes
• NK cells
• Macrophages

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Lymphocytes

• The primary white blood cells involved in the
  immune response
• Able to recognize and respond to an antigen.
• Derived from a stem cell in the bone marrow
• Constitute 20 25 percent of WBCs
• Are long living and mobile

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Objective 3 List and describe the two main types
of lymphocytes, their origins, and their
activities.

• 1. B lymphocytes (B cells)-develops from stem
  cell in the bone marrow has two types.
• First type is plasma cell produces antibodies
  (immunoglobulins or Igs) IgG, IgM, IgA and IgD
• Immune complex or antigen-antibody complex
• When the antibody combines with antigen
• Second type is the B memory cell-retains the
  memory of previously encountered antigens.
• This cell clones or duplicates itself

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Objective 3 List and describe the two main types
of lymphocytes, their origins, and their
activities.

• 2.T Lymphocytes (T-cells)- also develops in the
  bone marrow stem cell. Travel to the thymus and
  are processed to maturity.
• Memory cells
• -T-helper cells increases function
• -suppressor cells
• -t-cytotoxic cells

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Cytokines

• Are cell products of either B or T lymphocytes
  and are call lymphokines
• Different cytokines have different functions
• Activates macrophages and enhance the ability of
  macrophages to destroy foreign cells.
• Also involved in various other functions
  concerning leukocytes, fibroblasts, and
  endothelial cells.
• One of the first cytokines to be discovered was
  interferon.

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Objective 4 List the activities of
macrophages

• Phagocytosis
• Help B-cells and T-cells
• Produce cytokines called monokines
• Are a link between the inflammatory response and
  immune responses
• Are antigen-presenting cells
• Do not remember encountered antigens

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Humoral Immune response

• In the production of antibodies
• B lymphocytes are the primary cells of the
  humoral response.

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Cell-mediated response

• Involves lymphocytes (usually T-cells) working
  alone or with macrophages.
• Regulates both major responses

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Passive Immunity

• Uses antibodies produced by another person to
  protect an individual against infectious disease
• Either naturally acquired from mother
• Or injection of antibodies

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Active immunity

• Naturally after a person has already had exposure
  to the microorganism
• Acquired by vaccination of an altered pathogen
• Immunization is the production of acquired
  immunity.

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Hypersensitivity

• Hypersensitivity reactions are also called
  allergic reactions.
• Exaggerated response and tissue destruction

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Type 1 Hypersensitivity

• Occurs immediately after exposure to a previously
  encounter antigen
• Pollen
• Latex
• penicillin
• Can range from everyday hay fever to serious
  asthma and anaphylasis

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Type 2 Hypersensitivity

• Antibody combines with an antigen bound to the
  surface of tissue cells (usually a circulating
  red blood cell)
• Occurs in RH incompatibility in different blood
  types

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Type 3 Hypersensitivity

• Immune complexes are formed between
  microorganisms and antibody in the circulating
  blood.
• These complexes are deposited in various body
  tissues and initiate acute inflammatory response
• Occurs in autoimmune diseases such as lupus
  erythematous

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Type 4 hypersensitivity

• Also known as delayed hypersensitivity
• Involves a cell-mediated immune response
• Put to use in the tuberculin test

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Hypersensitivity to Drugs

• Drugs can act as antigens and cause an
  immunologically induced inflammatory response
• Many factors influence the risk of an allergic
  reaction
• Route of administration
• Topical may cause a greater number of reactions
• --Parenteral administration- may be more wide
  and severe

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Autoimmune diseases

• The immune system begins to treat its own cells
  or organs as antigens.
• Genetic factors may play a role in predisposing
  individuals to auto immune disease
• Viral infection may be involved

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Immunodeficiency

• An immunopathlogic condition that involves white
  blood cells and their products.
• When a persons immune system is not functioning
  adequately, infections and tumors may develop.

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Aphthous Ulcers

• AKA canker sores or aphthous stomatitis
• Common ulcers occurring in about 20 of the
  general population
• First episode of these ulcers usually occurs in
  adolescence..more common in females than in
  males.
• Clinical appearance and location are important in
  establishing the diagnosis

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Aphthous Ulcers

• Trauma most commonly reported precipitating
  factor
• Emotional stress
• Certain foods with high acidity
• Recurrence associate with menstruation
• Immunologic pathogenesis
• Association with certain systemic diseases
• Behcet syndrome, Crohn disease, Ulcerative
  colitis, Cyclic neutropenia, Sprue (gluten
  intolerance), Intestinal lymphoma

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MinorAphthous ulcers

• Most common
• Discrete, round to oval ulcers up to 1 cm
• Movable mucosa
• Occasionally extend to gingiva
• Labial and buccal mucosa, vestibular mucosa
• More common in anterior
• Prodromal period of 1 2 days
• Characterized by a burning sensation
• Heal spontaneously in 7 10 days

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Major Aphthous Ulcers

• Larger than 1 cm
• Deeper and last longer
• Have been seen in HIV pts.
• Differential diagnosis clinically may be squamous
  cell carcinoma or deep fungal infections.
• Biopsy is often necessary
• Herpetiform Aphthous Ulcers- very tiny and
  resemble herpes simplex virus. Are painful. May
  develop anywhere in the mouth.

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Diagnosis

• Minor based on their distinctive clinical
  appearance, the location, and a complete patient
  history.
• The location is important to distinguish from
  recurrent herpes. (Herpes when intra oral appear
  on mucosa fixed to bone---palate and gingiva)

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Treatment

• Locally applied topical steroids
• Most effective during the prodromal period.
• Occasionally systemic steroids fro major apthous
  ulcers
• Local steroids are contraindicated for viral
  lesions.

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• Urticaria hives
• Angioeddema diffuse swelling
• Contact mucositis Dermatitis result from direct
  contact of an allergen with the skin or mucosa.

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Erythema Multiforme
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Diagnosis

• Made base on the clinical features and the
  exclusion of other diseases
• Usually systemic steriods

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Lichen planus
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Lichen planus

• Skin
• Characteristic white lace-like pattern on buccal
  mucosa

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Lichen planus

•   Lichen planus-This is the erosive form of
  lichen planus, which is characterized by an
  erythematous atrophic base with fine, lace-like
  white lines. These white lines are known as
  Wickham's striae. This patient exhibited erosive
  lichen affecting the buccal mucosa and lateral
  border of the tongue

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Diagnosis

• Distinctive clinical appearance and histologic
  appearance of biopsy tissue.
• Epithelium is generally parakeratotic and either
  hyperplastic or atrophic.

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Reiter Syndrome

• A syndrome is a group of signs and symptoms that
  occur together.
• A triad of arthritis, urethritis, and
  conjunctivitis.
• Can occur almost anywhere in the oral cavity
• Aphthouslike ulcers, erythematous lesions and
  geographic tonguelike lesions

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Langerhans Cell disease

• A type of macropahge
• Immunologicaly competent cell which proliferates
• Letterer-Siwe
• Hand-Schuller-Christian
• Solitary eosinophilic granuloma of bone
• conservative surgical excision
• low dose radiation

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Objectivename the two cells that histologically
characterize Langerhans cell disease

• Langerhans cells
• eosinophils

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Autoimmune Diseases that effect the oral cavity

• Sjögren's syndrome xerostomia
• Lupus erythematosus White, erosive lesions on
  mucosa
• Pemphigus vulgaris mucosal ulceration, bullae
• Benign mucous membrane pemphigoid mucosal
  ulceration, desquamative gingivitis
• Behcet syndrome aphthous ulcers
• Pernicious anemia mucosal atrophy, mucosal
  ulceration loss of filiform and fungiform papillae

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Sjögren Syndrome

• Autoimmune diseases that affects the salivary and
  lacrimal glands.
• Resulting in xerostomia and xerophthalmia
• Keratoconjunctivitis sicca (dry)
• High risk of caries, periodontal diseases and
  oral candidiasis
• 90 have a positive reaction to rheumatoid factor

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Lupus Erythematosus

• LE cell A cell that 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.
• See pg 129 in your atlas

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Pemphigus Vulgaris

• Seer and progressive autoimmune disease that
  affects the skin and mucous membranes
• Pemphigus vulgaris may affect any area of the
  oral cavity. Here lesions of the buccal mucosa
  again show the irregular shape and ragged margins
  typical of this disease.

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Pemphigus vulgaris

• Acantholysis epithelial cell separation
• 50 of cases the first signs appear in the oral
  cavity.

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Cicatricial pemphigoid

• AKA mucous membrane pemphigoid and benign
  mucous membrane pemphigoid
• Most common site is gingiva ( free and attached)
• Desquamative gingivitis
• Erythema to ulceration

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Cicatricial pemphigoid
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Bullous Pemphigoid

• May be a variant of Cicatricial
• Oral lesions are not as common

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Behcet Syndrome

• Chronic reoccurring autoimmune disease consisting
  primarily of oral ulcers, genital ulcers and
  ocular inflammation
• Mean age 30 years no sex predilection
• Pg 158 in atlas