6: General and Oral Pathology

CHAPTER 6 General and Oral Pathology

INJURY, INFLAMMATION, AND REPAIR

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.

Metabolic Disorders

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.

See Chapters 3, Anatomy, Biochemistry, and Physiology: physiological processes; 8, Microbiology and Immunology: infectious agents involved in hepatitis; 9, Pharmacology: hormones and replacement therapy; 9, Pharmacology, and 11, Clinical Treatment: alcoholic patient, hyposecretion of salivary gland with geriatric patient.
A. Endocrine gland disorders:

2. Thyroid:

c. Hypothyroidism:

B. Liver disorders:

1. Cirrhosis: chronic destruction of liver cells with fibrous, nodular regeneration.

2. Viral hepatitis: caused by several viruses known as hepatitis A, B, C, D, or E (see Chapter 8, Microbiology: related discussion).

C. Pancreatic disorders:

1. Diabetes mellitus (DM, hyperglycemia): multifactorial disease leading to high blood glucose levels.

f. Treatment (See Chapter 9, Pharmacology: drug therapy for DM):

image

Figure 6-1 Goiter formation from thyroid gland disorder.

(From Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 3, St. Louis, 2008, Saunders/Elsevier.)

CLINICAL STUDY

Age 37 YRS SCENARIO
Sex image Male image 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.
Height 5′;0″
Weight 210 LBS
BP 112/68
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

Blood Disorders

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.

See Chapters 3, Anatomy, Biochemistry, and Physiology; 8, Microbiology and Immunology: vascular system and immunology.
A. Anemias: low hemoglobin and oxygen concentration in blood.

D. Diseases of WBCs and bone marrow:

CLINICAL STUDY

Age 12 YRS SCENARIO
Sex image Male image 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

Bone Diseases

Diseases of the bone include osteoporosis, Paget’s disease, fibrous dysplasia, cherubism, cleidocranial dysostosis (note that latter two are discussed under inherited disorders).

Neoplasia

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.

See also Chapter 9, Pharmacology: chemotherapy.
C. Classification:

I. Epithelial squamous cell neoplasias:

2. Squamous cell carcinoma (SCC): malignancy associated with squamous cells that invades through the basement membrane; MOST common oral cancer (90%) (Figure 6-4).

CLINICAL STUDY

Age 50 YRS SCENARIO
Sex image Male image 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.
Height 5′10″
Weight 140 LBS
BP 105/70
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

CLINICAL STUDY

Age 65 YRS SCENARIO
Sex image Male image 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.
Height 6′2″
Weight 195 LBS
BP 112/72
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
Current Medications None
Social History Farmer Volunteer firefighter

Cancer Patient Care

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.

F. Dental hygiene care:

Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 6: General and Oral Pathology
Premium Wordpress Themes by UFO Themes