Inflammation
Inflammation is the response to injury or any insult to the a tissue and its
microcirculation. It is a protective response .It serves to bring defense &
healing mechanisms to the site of injury
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Cardinal Signs of Inflammation
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Redness : Hyperaemia.
Warm : Hyperaemia.
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Pain : Nerve, Chemical mediators.
Swelling : Exudation
Loss of Function: Pain
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Causes / physical , chemical , pathogenic , foreign body …ect
**under the microscope we will see a breakage in lining which is sign of
inflammation , and we will see a large number of leukocytes and macrophages and
fibroblast
IT has two types ;- 1- acute / it is the immediate response to injury ,, most cells we
see are neutrophils
2-chronic /, When acute inflammation does not resolve or
becomes disordered, chronic inflammation occurs ,, most cells we see are
lymphocytes
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Fatty changes
Fatty changes :
its accumulation of lipid molecules inside cells , it sign of
destruction of liver , is part of inflammation of hepatocytes in stage 1 and 2 of
alcoholism
_ fatty changes do not found normally in liver it destruct the hepatocytes
And lead to lose of function and then hepatic failure
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Lipoma
Lipomas are soft, fatty lumps that grow under the skin. They're harmless and can
usually be left alone if they're small and painless.
Lipomas are non-cancerous (benign) and are caused by an overgrowth of fat cells.
They can grow anywhere in the body where there are fat cells, but are usually seen
on the:
shoulders
neck
chest
arms
back
buttock
thigh
They feel soft and "doughy" to touch and range from the size of a pea to a few
centimetres across. They grow very slowly and don't usually cause any other
problems.
Occasionally, lipomas can develop deeper inside the body, so you won't be able to
see or feel them
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Tuberculosis
Tuberculosis : its infectious chronic inflammation caused by mycobacterium
tuberculosis intracellular bacteria ,Tuberculosis generally affects the lungs, but can
also affect other parts of the body
_ Typical symptoms of TB include:
a persistent cough that lasts more than one month which may be bloody
,chest pain , more than 50 years old patient and dyspnea and
high temperature (fever)
_ for treatment a course of antibiotics will usually need to be taken for six months.
_cardinal
signs of t.b or The characteristic lesion is
1- a spherical granuloma with central caseous necrosis. Which is necrotic
centers of which are filled with an amorphous mixture of debris and dead
microorganisms and cells.
2- With multinucleated giant cells around the granuloma which they are
formed by the cytoplasmic fusion of macrophages. When the nuclei of such
giant cells are arranged around the periphery of the cell its called a
horseshoe giant cell, but If a foreign agent identified within the cytoplasm of
a multinucleated giant cell, it is termed a foreign body gaint cell which there
nuclei is arranged in irregular way
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Amyloidosis
Collection of abnormal protein in specific organs that lead to loss of function and
organ failure .
 Causes ;- are unknown etiology or because of autoimmunity
Stains ;- are
_; in H and E stain appear pink , homogenous and hyaline
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_ the congo red is the special stain for amylodiosis
, appear red-green color under
polarizing light
Sight of deposition :It can be deposit in different organs of body like kidney , heart , spleen , liver , heart ,
in tongue and other organs
1- If it deposit in glomeruli of kidneys , the glomeruli cannot absorb all that
protein , so the protein occurs in urine
2- If deposit in the tongue will lead to enlargement of tongue
Nephritic syndrome ;- occurrence of heavy protein levels in urine , may be as
result of amyloidosis
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Calcifiacation
It is abnormal deposition of calcium salts inside ce
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_the cardinal sign or the microscopic findings in calcification is
psammoma body which is a round collection of calcium. Which appear
purple in color in Hand E stain
Sights of deposition
_ if calcium deposited in the walls of arteries it will cause atherosclerosis
_ if it deposited in the joints of older people it will cause pain and chronic
inflammation , it deposited because the osleoclast will destruct the bones and the
calcium of the bones will deposited in joints
_ if occurs in lungs in alveoli will lead to stoppage of gas exchange process and then
lung failure if there was too much alveoli effected '
_ A complication of osteoarthritis ‫صوفان‬, especially knee osteoarthritis, is
calcification, which is when deposits of calcium crystals in the cartilage of joints.
_ Calcification can cause exostosis in joints
** the aortic artery is not common site of atherosclerosis because it is large and
there is continuous and fast movement of blood in it. But if the patient was obese it
can happen
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Nasal polyp
Nasal polyps it is chronic inflammatory process cause abnormal lesions that
originate from any portion of the nasal mucosa or paranasal sinuses. Polyps are an
end result of varying disease processes in the nasal cavities.
_signs
and symptoms ;-
1- if the flu persist more than one month may indicate nasal polyp that present
in sinuses and presented like rhinosinusitis
2- Sometimes presented with facial pain
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Causes are
_ 1- one of the complications of plastic surgeries is nasal polyp because it will cause
destruction of tissue of nose
_2- Hay fever which is seasonal may cause nasal polyp
_ nasal polyp can cause obstruction of the nose so the patient will
breath from his mouth , not from the nose and this will cause dry mouth
which will lead to dental caries
_ nasal polyp histology is lose connective tissue and inflammatory cells
surrounded by psedostratified columner epithelium , but if it happened in the back
of the nose will be ciliated epithelium
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Psedoinflammatory colitis ‫التهاب االمعاء الكاذب‬
_ it is inflammation in the intestine caused by Clostridium difficile bacteria
overgrowth because of prolonged or wrong using of antibiotics . its effect all parts of
intestine
** prolonged using of antibiotic will cause killing of normal flora in intestine and this
will lead to overgrowth of C.defficile bacteria which will cause the disease
_ the symptoms are;. diarrhea ( watery or bloody )
. lose of bowel motion
. abdominal pain
__ microscopical examination done by H and E stain
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_ Example ; ten years old children came to hospital with abdominal pain and
diarrhea and he was taking antibiotic for more than one month
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Actinomycosis
Actinomycosis is a slowly progressive rare bacterial chronic infection involving the
jaw, thorax, or abdomen.
The disease is caused by a number of anaerobic bacteria termed Actinomyces, and
the most common is Actinomyces israelii.
These organisms are branching, filamentous, gram-positive , non acid fast bacilli
** causes
Actinomyces is from oppertunistic normal flora of mouth ,
. 1-if there was any breakage or injury in the tissue like in accidental conditions or
because of dental procedures
. 2- if there was severe immunity depression and if there was another infection ,
actinomuces will act as opportunistic organism and will cause the disease
‫يعني اذا كان هناك التهاب معين و نزل بسببه المناعة فان هذا البكتريا راح يستغل الفرصة و يسوي هو هم‬
‫التهابات‬
. 3- bad oral hygiene like in surgical conditions in mouth where the patient cannot
maintain good oral hygiene
** 70% of the pathology happen in mouth
** clinical
signs ;
abcess formation in mandible or maxilla and they usually
break through the skin and discharge through one or more openings (sinus
formation). And lumpy jaw , and most important thing is presence of yellow granules
of sulfur in the culture media of
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*** Actinomyces and tuberculosis are similar in some signs like abscess (sinus)
opened to outside in cervicofacial surface
‫_ويحدث اكثر شي في البلدان الفقيرة مثل الي موجودة بافريقيا الن هم عندهم يصير‬
Poor oral hygine
# sinus formation is from cardinal signs of T.B
** main difference between the actinomycosis and T.B , is that there is
no necrosis in actinomycosis
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Syphilis
•
Syphilis is a chronic systemic infection that is transmitted almost exclusively
by sexual contact or from an infected mother to her fetus (congenital
syphilis).
•
Infection is caused by Treponema pallidum bacteria , a thin, long spirochete.
*The course of syphilis is classically divided into three stages.
1. Primary Syphilis is Characterized by the Chancre: ulcer at the site of T.
pallidum entry. It appears 1 week to 3 months after exposure and , Chancres
(ulcer) are painless and heal without scarring , it may appear in the oral cavity
2. . Secondary Syphilis Systemic Spread of the Organism
In secondary syphilis, T. pallidum spreads systemically and proliferates to
cause lesions and rash anywhere in the body
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3. Tertiary Syphilis
It cause damage of vital organs like heart and brain , and ulcers in different
parts of body , this stage is untreatable
In the end syphilis will cause death because of multiple organ failure

If it transmitted from mother to the baby (congenital) it will cause
deformation in the body of the child , abnormal joint . or may cause death ,
it is untreatable
Treatment;- it can be treated by course of procaine and pensilin
Example / patient with non healing ulcer or unexplained rash
‫هي من االمراض الي احنا اطباء االسنان الزم ننتبه الها الن ممكن يصيبنا احنا اذا ما اخذنا االحتياطات الالزمة‬
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Wound healing
Granulation tissue
It is part of the healing process of wounds and is consist of newly formed blood
vessels (angiogenesis) and recruitment of fibroblast to the sight of injury and
collagen fibers deposition that lead to make a mesh , it start from bottom and sides
of the wound
Healing or granulation is tow types
1- Primary healing ;- in clean simple wound like simple surgical wounds , the
scar formation will be minimum
2- Secondary healing;- large wounds like car accident or bullet injury , it will
take longer healing time and will produce large scar
*Inordinate deposition of extracellular matrix, mostly excessive collagen, at the
wound site results in a hypertrophic scar.
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* Keloid formation is an exuberant hypertrophic scar that tends to progress
beyond the site of initial injury and recurs after excision. It most happen in
black skin persons and with low immunity. It will be etching and if it removed
by surgery it will back again

Factors that affect or delay the wound healing
1- Immunity dysfunction
2- Foreign body
3- Infection
4- Diseases like diabetes that de delay the wound healing ( in tooth
extraction of diabetic patient

If there was an ulcer in the stomach it can be healed by scar formation , but if
the immunity of the patient was low , the ulcer will back again in the same
area , because scar formed area is weak
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Squamous cell papiloma
_It is benign proliferation of stratified squamous cells by human papiloma virus 11
and 6 , it is comunicabable , cause the generation of warts ‫ثألول‬
_ virus is very small in size and locate intracellulary so its difficult to detect . so it
detected by PCR
_ location or sight it can occur on
*skin
* in the mouth and if it was very large proliferation it can cause respiratory canal
obstruction
_ it is opportunistic organism can found with normal flora on the body or in the dirty
food , it can take advantage of any tissue injury and it will enter the tissue and cause
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the disease , so the immunity is very important here . and the virus does not need
to reach the blood to cause the disease
_ Mechanism of action ;- it will replicate within epithelium cells and interfere with
the epithelium cells and make them to proliferate and overgrowth
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Fibroadenoma
_ it is benign proliferation of the fibrous or glandular tissue in breast or prostate
because these two organs have similar histology . it has chance to be carcinogenic
0.1%

Examination ;- 1- if it was large it can be felt by hands
2- by mammogram
*The tumor consists of breast tissue and connective (stromal) tissue. Usually
capsulated by collagen

Causes
1- The exact cause of fibroadenomas is not known.
2- Hormones such as estrogen may play a part in the growth and
development of the tumors. Taking oral contraceptives before the age of
30 has been associated with a higher risk of developing fibroadenomas.
3- In male it may caused because of using cortisone injections
4- If there is tumor in the adrenal gland in male it will cause excessive
release of estrogen an may cause fibroadenoma

Treatment ;- if it was very small it can gone by it self , but if it was large it
should be removed surgically
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Basal cell carcinoma

It is cancer involve the basal cells in all the skin of the body specially the face
and neck , it is non aggressive cancer
Causes
1- Over sun exposure
2- More in men with unknown etiology
3- It is more in fair skin people with blue eyes
Cardinal signs ;- Palisading of cells ‫مهم جدا‬
Types ;-
1- superficial cancer
2- invasive cancer
Example;-
patient present with non healing lesion . And there is changing in
color , etching and ulceration and bleeding in the lesion
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Squamous cell carcinoma
_ It can happen in any part of body contain squamous cells like skin , gentile ,
mouth. It can happen in both male and female
_ Causes ;- 1- sun exposure like in outdoor worker people ‫العمال‬
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2- genetics . like xeroedema pegmentosis disease can develop to
cancer
3- mole ‫ شامة‬, specially if it injured continuously by shaving or by sun
exposure
Histopathological changes under microscope ;-
1-changes in
epithelium will develop from outside to inside , there is new blood vessels
(angiogenesis) ,
2-the characteristic feature is keratin pearls
3_ from important features is non healing ulcer
Signs and characteristic of malignant cells or tissue
1-hyperchromatic cells
2-high nucleuer cytoplasmic ratio
3-polymorphic cells
4-ugly cells
Carcinoincyto;- it is malignancy which is not breaking the
epithelial barrier , it
only involve the epithelium not the stroma
Dismoplastic reaction;-
is the growth of fibrous or connective tissue may
occur . It is defense mechanism of body against malignancy , it contain macrophages
and other phagocytic cells
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malignant cell A cell that has undergone malignant transformation and is in a
state of permanent proliferation and capable of metastasis.
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Ulcer ‫** من االشياء الي ركزت عليها الدكتورة هي انو يا امراض يصير بيها‬
Syphilis and T.B and Actinomycosis ‫*** واالشياء المشتركة بين‬
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