Taller Inflamación de Enfermedades Orales - grupo 7

Summary

This script delves into oral inflammation and its impact on overall health, discussing the oral cavity's unique structure and its role in immune responses. It covers the histological changes in oral tissues, clinical case explanations, differential diagnoses, and various treatment approaches. The video also explores the oral microbiome's influence on health and disease, the chronic inflammation process, and emerging immunotherapy techniques. The script highlights common oral diseases like gingivitis and periodontitis, their progression, symptoms, and treatment strategies, including immunomodulatory therapies.

Takeaways

• 🦷 The oral cavity plays a fundamental role in overall health by allowing the intake and processing of food and has a complex anatomy with various biological mechanisms.
• 🛡️ The oral epithelium acts as a semipermeable barrier, allowing the entry of immunological elements and helping in the immune response.
• 🌡️ The gingival crevicular fluid helps clean the area around the teeth and controls the accumulation of bacterial plaque.
• 🌱 The oral cavity is a primary entry point for the body and is filled with diverse microbiota, including bacteria, viruses, and fungi that form biofilms.
• 🛑 Excessive growth of certain microbes like Candida albicans and Porphyromonas gingivalis can lead to infections such as candidiasis and gingivitis.
• 🔁 Inflammation in the oral cavity follows a typical process, starting with an acute phase and potentially becoming chronic if damage persists.
• 👩‍⚕️ The immune response in the oral cavity involves antigen-presenting cells, acute inflammatory cells, and chronic responses including T lymphocytes.
• 💊 Sublingual immunotherapy is effective due to the oral cavity's accessibility, low level of macrophages and eosinophils, and high level of dendritic cells.
• 🧬 Common and specific mediators of oral inflammation include cytokines, DAMPs, PAMPs, and PRRs that induce inflammation and immune responses.
• 🦷 Histologically, the tooth's enamel and dentin are crucial, with the enamel being the outermost protective layer and dentin being produced by odontoblasts.
• 👨‍⚕️ A 45-year-old male patient presents with symptoms of gum inflammation, dental mobility, and persistent bad breath, indicative of potential periodontal disease.
• 🩺 The patient's lack of regular dental care, smoking habit, and poor diet contribute to the severity of periodontitis, which is irreversible and extends to the alveolar bone.

Q & A

What is the primary function of the oral cavity in terms of overall health?

The oral cavity plays a fundamental role in overall health by allowing the intake and processing of food, featuring a complex anatomy with biological mechanisms that facilitate the interaction of hard tissues like teeth and soft tissues like gums in a moist environment.

What is the role of the gingival crevicular fluid in the oral cavity?

The gingival crevicular fluid is a transudate from the walls of the capillaries in the gingiva that helps clean the area around the teeth and controls the accumulation of bacterial plaque.

How do salivary glands contribute to oral health?

Salivary glands, both major and minor, contribute to creating a moist environment in the mouth, aiding in chewing, speech, and immunological protection, especially through immunoglobulin A (IgA), which is key in defense against pathogens.

What is the significance of the oral cavity as a gateway to the body?

The oral cavity is one of the main entry points to the body, allowing it to be filled with diverse microbiota, including thousands of bacterial, viral, and fungal species that form biofilms in the oral cavity.

How do microbes interact in the oral cavity and what impact can this have on health?

Microbes interact with each other and with oral cells through chemical signals, which can maintain health or cause diseases, such as infections from overgrowth of species like Candida albicans and Porphyromonas gingivalis.

What is the typical process of inflammation in the oral cavity?

Inflammation in the oral cavity follows a typical process, starting with an acute phase that includes blood vessel dilation, leukocyte migration, and neutrophil entry into the affected tissue, causing heat, redness, pain, swelling, and a decrease in function. If damage persists, inflammation becomes chronic.

What are the components of the immune response in the oral cavity?

The immune response in the oral cavity involves antigen-presenting cells like Langerhans cells and dendritic cells, acute inflammatory cells such as neutrophils and mast cells, and in the case of chronic inflammation, T lymphocytes CD4 and CD8 that mediate responses in specific areas like the tonsils and sublingual tissues.

What is the role of the sublingual area in immunotherapy?

The sublingual area is a site of easy access for the oral cavity, making techniques like sublingual immunotherapy (SLIT) very effective and popular. It has a low level of monocytes and eosinophils but a high level of dendritic cells, indicating greater antigen presentation and antibody production.

What are some common and specific mediators of oral inflammation?

Common and specific mediators of oral inflammation include histamine, and classification is given by their origin and biological function, such as DAMPs and PAMPs, and by activation of PRRs that induce TNF-α, interleukin-6, and others.

What are the two main structures to consider in dental histology?

In dental histology, the two main structures to consider are the tooth and the gingiva. The tooth's outermost layer, the enamel, provides coverage and prevents wear when eating, while the dentin, produced by odontoblasts, is the main component of tooth formation.

What are the three types of epithelium mentioned in the script related to the gingiva?

The three types of epithelium related to the gingiva are gingival epithelium, which is a keratinized stratified squamous epithelium that protects against pathogens; the circular epithelium, which is non-keratinized stratified squamous epithelium covering the gingival sulcus; and the junctional epithelium, which is non-keratinized stratified epithelium that connects the gingiva to the tooth enamel.

What are the main symptoms reported by the 45-year-old male patient in the case study?

The patient reports gum pain, progressive dental mobility, spontaneous bleeding, and bleeding when brushing teeth, persistent bad breath, and a metallic taste in the mouth. He has not received regular dental care in the past 5 years.

What are the clinical signs observed during the physical examination of the patient?

The physical examination reveals erythema and edema in the gingiva, significant recession of the gums with sensitive areas, periodontal probing showing periodontal pockets of 6 mm in some teeth (normal is between 1 and 3 mm), with purulence or visible pus at the bottom of some pockets, and evident dental mobility in several molars and premolars.

What is the primary differential diagnosis for the patient's condition?

The primary differential diagnosis for the patient's condition is gingivitis, which can be characterized by tissue irritation and inflammation along the gum line, with symptoms such as inflammation, bleeding, edema, and discomfort.

What are the histological differences between gingivitis and periodontitis?

In gingivitis, there is an enlargement of the basal layer with possible damage, presence of lymphocytes, plasma cells, macrophages, and polymorphonuclear leukocytes. In periodontitis, the changes are more severe, with a fibrous and richly vascularized basal tissue, and the epithelium is thin and non-keratinized with hyperplastic cells forming many long crests.

What are the treatment strategies for periodontitis mentioned in the script?

Treatment strategies for periodontitis include dental cleaning, scaling, and possibly surgery depending on the severity. Other strategies involve the inhibition of the renin-angiotensin system, blockade of angiotensin receptor type 2s, and the use of immunomodulators like glucocorticoids or antimetabolites.

What are some of the emerging approaches for neutralizing the inflammatory cytokine storm in periodontitis?

Emerging approaches include the use of small molecules like fenofibrate, which is a lipid-lowering drug that reduces proinflammatory cytokines, and the use of heterologous antibodies such as equine antiserum or rabbit serum, or monoclonal antibodies targeting specific immune receptors.