CHAPTER 6 General and Oral Pathology
General pathology includes the study of the destruction and repair of bodily tissues. Oral pathology is the study of the destructive conditions associated with the mouth, head, neck. Can be either primary or secondary (follows and results from an earlier disease), or there can be comorbidity, with more than one pathological condition present. MOST conditions and diseases go through periods of exacerbation (relapse, attack, flare-up), with an increase in the severity of a disease or its symptoms, as well as periods of remission (absence of disease activity).
In many cases etiology (cause) of disease is unknown. Pathogenesis is the course of a disease or how it progresses. Even if etiology and pathogenesis are known, many conditions and diseases still can be treated ONLY by palliative methods, care concentrated on reducing severity of symptoms (see following discussion). Risk factors for NOT achieving oral health are listed so that the medically compromised patient will receive correct dental hygiene care.
Disease causes various injuries to the body. ALL diseases include processes of inflammation and repair. Inflammation is always FIRST response to injury; it can be BOTH protective and destructive process. Repair occurs in response to inflammation; involves BOTH regenerative and reparative processes.
Diagnosis is translation of data gathered by clinical and radiographic examination into organized, classified definition of conditions or diseases present. Preliminary diagnosis may be made with one or more components of diagnostic process. Differential diagnosis requires use of diagnostic components to rule out other possibilities. Dental hygiene diagnosis involves interpreting data into coherent description of condition or disease in terms that can be addressed by dental hygienist.
Prognosis is prediction of how condition or disease will progress and whether there is chance of recovery or cure with treatment. However, treatment does NOT always involve cure of condition or disease. Palliative care is any form of medical care or treatment that concentrates on reducing severity of disease symptoms, rather than providing a cure; prevents and relieves suffering and improves quality of life for serious, complex illness. Nonhospice palliative care is NOT dependent on prognosis and is offered in conjunction with curative and all other appropriate forms of medical treatment. Hospice care delivers palliative care to those at the end of life.
Inflammatory diseases include several common forms of dermatitis, acute or chronic inflammation of skin. Etiology can involve chemicals (drugs), radiation, trauma, metabolic and immunological factors. Types include eczema (nonspecific lesions and itching), seborrheic dermatitis (inflammation of sebaceous glands, redness, itching, scaling), and psoriasis (raised papules or patches with silvery scales and thickened skin on extremities).
Metabolic disorders often manifest themselves as overproduction or underproduction of secretions. Hypersecretion (overproduction) occurs because of a tumor of gland; hyposecretion (underproduction) occurs because of agenesis (failure of an organ to develop), atrophy (partial or complete wasting away), or destruction of secretory cells. Treatment for hypersecretion is removal or destruction of all or part of gland; hormone supplementation is prescribed for hyposecretion. Clinician will need a medical consult regarding metabolic disorder or its history before dental care.
(From Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 3, St. Louis, 2008, Saunders/Elsevier.)
|Sex||Male Female||A patient new to the dental practice is at the end of the 2-hour afternoon appointment. She starts complaining of a headache, reports feeling weak, and becomes more nervous and somewhat confused.|
|Chief Complaint||“I was so nervous about this dental appointment that I forgot to eat lunch today.”|
|Medical History||Diabetes mellitus (well controlled) for 2 years Osteopenia for 1 year|
|Current Medications||250 mg chlorpropamide (Diabinese) qd OTC calcium supplement with vitamin D qd|
|Social History||Interior decorator|
Basic categories of blood disorders include red (RBC) and white (WBC) blood cell disorders and clotting disorders. They are related to abnormal levels, function, or structure of some blood components. Note that hemophilia is discussed under inherited disorders. Will need a medical consult for ALL types of blood disorders before dental care.
|Sex||Male Female||During her initial intraoral examination, gingival bleeding, poor oral hygiene, three carious lesions, and two nearly exfoliated teeth are observed. Physician wants oral cavity checked for signs of infection.|
|Chief Complaint||“My grandmother is so scared since my gums are bleeding so much!”|
|Medical History||Recent diagnosis of leukemia with intensive chemotherapy scheduled in 1 week|
|Current Medications||None at this time|
|Social History||Grade school student studying ballet Grandmother is guardian|
Neoplasm is uncontrolled cellular growth resulting in a tumor; general term, includes either benign or malignant (cancer). Will need medical consult for ALL with neoplasm history before dental care. See later discussion of biopsy procedures and lung cancer. Treatment after radiation therapy and chemotherapy for patients in the dental office is also discussed later.
|Sex||Male Female||The lesion noted on intraoral examination of the patient appears to be a preexisting mole that is 5 mm in diameter and has a raised, irregular, and reddened border on its anterior surface.|
|Chief Complaint||“My mole becomes sore and bleeds and I think it is getting larger!”|
|Medical History||Past history of repeated urinary tract infections Gallbladder removed 5 years ago|
|Current Medications||OTC ginseng qd|
|Social History||High school teacher who spends many hours sunbathing every summer and uses tanning booths in the winter to maintain her tan, since she has very pale skin|
Surgical biopsy is a definitive diagnostic technique for many diseases and conditions such as neoplasia. A tissue sample surgically taken from the patient is microscopically examined and evaluated for structure and cell type. See also earlier discussion of neoplasia.
|Sex||Male Female||The patient indicates that he noticed the sore several months ago. Intraoral examination reveals a 10-mm ulcerated red lesion located on the left lateral border of the tongue.|
|Chief Complaint||“This sore in my mouth really hurts!”|
|Medical History||Smokes a pack of cigarettes a day Started smoking when he was 15 Consumes alcoholic beverages on the weekends|
|Social History||Farmer Volunteer firefighter|
Cancer will develop in just less than half of Americans. Oral cancer rates are increasing, and younger populations are being affected. Dental care is IMPORTANT part of overall treatment protocols for cancer therapy. Will need medical consult before dental care.