Anil Govindrao Ghom . Department of Oral Medicine and Radiology I tried my best, to cover all the aspects of oral diseases in my book. I tried my best, to cover all the aspects of oral diseases in my book. Anil Govindrao Ghom wfhm.info Acknowledgements 'The man who really. A highlight of this book is the correlation between radiological and clinical appearance, with Savita Anil Ghom (Lodam)MDS (Oral Medicine and Radiology).

Oral Medicine Book By Ghom

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Textbook of Oral Medicine. Front Cover. Anil Govindrao Ghom, Savita Anil ( Lodam) Ghom. JP Medical Ltd, Sep 30, - Medical - pages. 0 Reviews. Title, Textbook of Oral Medicine. Author, Anil Ghom. Edition, 2, revised. Publisher, Jaypee Brothers, ISBN, , Length, - Textbook of Oral Medicine, 2nd Edition - Ebook download as PDF File privilege to write a foreword for second edition of this book by Dr Anil Ghom. In.

Oral cavity forms under the forebrain. Formation of oropharyngeal membranethis is wall formed between oral and pharyngeal cavity. It separates the stomodium from first part of foregut.

Foregut will develop into pharynx. Disintegration of oropharyngeal membranein fourth week of intrauterine life, oropharyngeal membrane disintegrates. This will lead to continuity between oral and pharyngeal cavity. Formation of endocrine glandendocrine glands can develop from roof and floor of oral cavity.

Roof gives rise to Rathkes pouch, which results in the formation of anterior pituitary. Floor can give rise to second epithelial pouch which results in formation of endocrine tissues of the thyroid gland. Formation of branchial archtissues which surround the oral pit give rise to five to six pairs of branchial arch.

The mandibular branchial arch is first arch to develop. The hyoid is second arch to develop. Other three archs are not so important in dental point of view. Anatomy of Oral Cavity The oral cavity is incompletely bounded by bones. Its lateral and anterior walls are formed by the inner surface of the alveolar processes, which join at the midline. The lingual surface of the teeth completes these walls. Oral cavity is divided into: Vestibuleit is outer smaller portions of oral cavity.

Vestibule of the mouth is a narrow space bounded externally by lips and cheeks and internally by teeth and gums. Oral cavity properit is inner larger part of oral cavity. It is bounded anterolaterally by the teeth, the gums and the alveolar arches of the jaws. The roof is formed by the hard and soft palate. The floor is occupied by the tongue posteriorly and sublingual region anteriorly, below the tip of tongue.

Posteriorly, the cavity communicates with the pharynx through the oropharyngeal isthmus which is bounded superiorly by the soft palate, inferiorly by the tongue and on each side by the palatoglossal arches. Arterial and venous supply of facearterial and venous supply is showing in Figs and Vestibule Lips It is described in the Chapter Disease of Lip.

Cheeks Contentcheeks are the fleshy flaps, forming a large part of the sides of the face. Mobile portion of cheeks is formed by the buccinator muscle. Intraorally, it is covered by the mucous membrane, and extraorally by the skin.

The mucous membrane of the cheeks is fixed to the inner fascia of the buccinator muscle by tight strands of connective tissue. Posterior partposterior part consist of masseter muscle and the parotid gland which are interposed between the mucous membrane and buccinator muscle on one side and the skin on the other side. Nasolabial sulcuscheek are continuous infront with the lips and the junction is indicated by the nasolabial sulcus which extends from the side of nose to the angle of the mouth.

It is rounded biconvex structure limited by a thin but distinctive capsule. Blood supplyit is supplied by the branches of the maxillary artery Fig. Lymphatic drainagedrain into the submandibular and pre-auricular lymph nodes and partly to the buccal and mandibular nodes. Arterial supply of the face. Gingival and Periodontal Diseases. Teeth Structurethe teeth form a part of the masticatory apparatus and are fixed to the jaws. In man, the teeth are replaced only once diphyodont in contrast with non- mammalian vertebrates where teeth are constantly replaced throughout life polyphyodont.

Each tooth has three parts, i. Nerve supplyit is supplied by anterior superior alveolar upper incisor and canine teeth , middle superior alveolar upper premolar teeth , posterior superior alveolar molar teeth and inferior alveolar nerve lower teeth.

Blood supplyit is supplied by posterior superior alveolar artery molar and premolar maxillary teeth , anterior superior alveolar It is branch of infraorbital artery and supplies incisor and canine maxillary teeth and inferior alveolar artery it enters the mandibular canal and gives branches to the mandible and to the roots of each teeth attached to the bone.

Hard Palate Developmentthis is the tissue which is interposed between oral and nasal cavity. Palate develops from medial and lateral palatine process. Development of palate starts in sixth week. It develops as intermaxillary segment, between maxillary process of upper jaw. This is called as primary palate. At the end of sixth week, secondary palate develops from lateral palatine process.

Lateral palatine process grows medially downward or vertically on either side of tongue. Boundariesit is a partition between the nasal and oral cavities. Anterolateral margins are limited by alveolar arches and gingiva.

Posterior margin is continuous with the soft palate.

Superior surface forms the floor of the nose and inferior surface forms the roof of the oral cavity. Nerve supplyit is supplied by greater palatine nerves from the greater palatine foramen and nasopalatine nerve from the incisive foramen. Blood supplyit is supplied by greater palatine branch of the maxillary artery and nasopalatine artery.

Venous drainagepalatine vessels go to the pterygoid plexus of veins. Lymphatic drainageit drains mostly into the upper cer- vical and partly into the retropharyngeal groups of nodes. Soft Palate Contentit is a movable fold suspended from the posterior border of the hard palate.

It separates the nasopharynx from the oropharynx. It has two surfaces, i. Anterior surfaceit is concave and is marked by median raphe. Posterior surfaceit is convex and is continuous superiorly with the floor of the nasal cavity. Superior borderit is attached to the posterior border of the hard palate, blending on each side with pharynx. Inferior borderit is free and bounds with pharyngeal isthmus.

Muscle of the soft palatethese are tensor palati, levator palati, musculus uvula, palatoglossal and palato- pharyngeus. Nerve supplyall muscle of the soft palate except the tensor palati are supplied by the pharyngeal plexus. The fibers of the plexus are derived from the cranial part of the accessory nerve. The tensor palati is supplied by mandibular nerve.

General sensory nerves are derived from lesser palatine nerve. Blood supplygreater palatine branch of the maxillary artery, ascending palatine branch of facial and palatine branch of ascending pharyngeal arteries.

Lymphatic drainagelymphatics drain into upper cervical and retropharyngeal lymph nodes. Tongue It is described in the Chapter Diseases of Tongue. Floor of Mouth Contentit is a crescent shaped area between the lower gingiva and undersurface of the tongue which composes the inferior most portion of the oral cavity overlying the mylohyoid and thyroglossal muscles.

Nerve supplyit is supplied by the branches of trigeminal nerve. Arterial supplyit is supplied by facial artery.

Venous drainagedrains into facial or lingual vein Fig. Lymphatic drainagefrom the anterior portion of mouth, lymphatics may pass into the deep cervical nodes or laterally to the periosteal lymphatics and then to the submandibular nodes and goes to the deep internal jugular nodes. Venous supply of the face.

Maxillary Sinus It is described in the Chapter Disorders of Maxillary Sinus. Salivary Glands It is described in the Chapter Disorders of Salivary Glands. Pharynx Developmentmuscles of pharynx are formed at about 7th week of intrauterine life.

It forms from the muscle cell of third and fourth arches. It forms the stylopharyn- geal, cricothyroid, levator palatine and constrictor muscle of the pharynx. Contentit is a wide muscular tube situated behind the nose, mouth and larynx. Clinically, it is a part of upper respiratory tract. It is divided into three parts, i.

Oropharynx is the middle part of the pharynx situated behind the oral cavity. Blood supplyit is supplied by ascending pharyngeal branch of the external carotid artery, ascending palatine and tonsillar branch of the facial artery, dorsal lingual branch of lingual artery and greater palatine, pharyngeal and pterygoid branch of the maxillary artery.

Venous drainageit is supplied by a plexus which receives blood from the pharynx and soft palate and prevertebral region and drains into the internal jugular and facial veins.

Lymphatic drainageit drains into the retropharyngeal and deep cervical lymph nodes. Nerve supplyit is supplied by the pharyngeal plexus of nerves which lies chiefly on the middle constrictor. Muscles of Mastication The muscles of mastication move the mandible during mastication and speech. They are the masseter, the temporalis, the lateral pterygoid and the medial pterygoid. Development Proliferation of myoblastsmuscles of mastication are derived from mandibular arch, i.

In fifth and sixth week of intrauterine life, proliferation of myoblasts occurs. Orientation of muscle cellsmuscle cells become oriented to the sites of origin and insertion.

Migrationenlargement of muscle mass occurs and it will migrate into the areas of differentiation. Formation of musclesafter this, it will be differentiated into masseter, medial and lateral pterygoid and temporal muscle. By tenth prenatal week, muscle mass becomes well organized. Muscle cells of masseter and medial pterygoid form vertical lob which is inserted at angle of mandible.

Fibers of lateral pterygoid go horizontally and insert in the articular disc. The temporalis muscle has differentiated in the infratemporal fossa and is inserted in the coronoid process Fig. Innervations of facial musclein seventh week, fifth nerve enters the mandibular arch and seventh nerve in second branchial arch. Muscle of masticationA diagrammatic representation.

Masseter Muscle Siteit is the most superficial to the masticatory muscle, stretches as a rectangular plate from the zygomatic arch to the outer surface of the mandible. It has three layers i. Superficial layerit arises by thick aponeurosis from the zygomatic process of the maxilla and from the anterior two-third of the lower border of zygomatic arch. Its fibers pass downward and backward to be inserted into the angle and lower half of lateral surface of ramus of mandible Fig.

Middle layer it arises from the deep surface of the anterior two-third of the zygomatic arch and posterior one-third of lower border of zygomatic arch and is inserted into middle of ramus of mandible. Deep layerit arises from deep surface of the zygomatic arch and is inserted into upper part of the ramus of the mandible and into the coronoid process.

Nerve supplyit is supplied by masseteric nerve which is a branch of anterior division of the mandibular nerve. Blood supplythe masseteric artery which is a branch of internal maxillary artery and the masseteric vein follow the course of the nerve.

Functionsits main function is elevation of mandible, its superficial layer may also aid in protruding the mandible. When the mandible is protruded and biting force is applied, the fibers of the deep portion stabilize the condyle against the articular eminence. The Temporalis Muscle Origin and insertionit is fan shaped and arises from whole of the temporal fossa and from the deep surface of temporal fascia.

Its fibers converge and descend into tendon which passes through the gap between the zygomatic arch and the side of the skull to be attached to the medial surface, apex, anterior and posterior borders of the coronoid process and the anterior border of the ramus of mandible nearly as far as the last molar teeth Fig.

Nerve supplyit is supplied by the two deep temporal branches of anterior trunk of the mandibular nerve. Blood supplyit is supplied by middle and deep temporal arteries. The middle temporal artery is a branch of the superficial temporal artery. The deep temporal artery is a branch of internal maxillary artery.

Function When the entire temporalis contract, it elevates the mandible.

Its middle fibers have a retracting component because of their oblique direction downward and forward.

Its posterior fibers retract the protruded mandible. Origin and insertion of temporalis muscle. Lateral Pterygoid Origin and insertionIt is a short thick muscle with two heads. Upper arises from the infratemporal surface and infratemporal crest of the greater wing of sphenoid bone and lower from the lateral surface of lateral pterygoid plate. Its fibers pass backward and laterally to be inserted into the pterygoid fovea on the anterior surface of the neck of the mandible and into the articular capsule and disc of temporomandibular joint Fig.

Origin and insertion of masseter muscle. Blood supplybranch of maxillary artery. Function It assists in opening the mouth by pulling forward the condylar process of the mandible and the articular disc, while the head of the mandible rotates on the articular disc.

During closure of mouth, backward gliding of the articular disc and condyle of the mandible are controlled by slow elongation of lateral pterygoid with medial pterygoid of the same side. The medial and lateral pterygoid muscle of both sides contract alternately to produce side-to-side movement of the mandible.

When medial and lateral pterygoid of both sides act together, they protrude the mandible. Origin and insertion of lateral pterygoid muscle. Medial Pterygoid Origin and insertionit is a thick quadrilateral muscle attached to the medial surface of lateral pterygoid plate and the grooved surface of the pyramidal process of the palatine bone above.

It has a superficial head which originates from the tuberosity of the maxilla and adjoining bone. Its deep head originates from the medial surface of medial pterygoid plate and the lateral surfaces of pyramidal process of palatine bone.

Its fibers pass downward, laterally and backward and are attached by strong tendinous lamina to the posterior inferior part of the medial surfaces of the ramus and the angle of mandible as high as mandibular foramen and as forward as mylohyoid groove Fig.

Nerve supplyit is supplied by branch of the mandibular nerve. Blood supplyit is supplied by the branch of maxillary artery. Functionsit helps in the elevation of mandible. Acting with the lateral pterygoid, they protrude the mandible.

Origin and insertion of medial pterygoid muscle. Bones The skull consists of the 22 bones. Out of which, 8 are paired and 6 are unpaired. Paired bones are parietal, temporal, maxilla, zygomatic, nasal, lacrimal, palatine and inferior nasal concha. Unpaired bones are frontal, occipital, sphenoid, ethmoid, mandible and vomer. From dental point of view, maxilla and mandible are the most important and they are described below: Maxilla The maxilla consists of a central body, which is hollowed out forming the maxillary sinus and four processes Fig.

Frontal process it ascends from the anteromedial corner of the body, serves as the connection with the frontal bone. Zygomatic processit forms in the lateral corner of the body, connects with the zygomatic bone. Palatine processit is horizontal and arises from the lower edge of the medial surface of the body.

Alveolar processit extends downwards and carries the socket for the maxillary teeth. Maxilla showing frontal process red arrow zygomatic process green arrow and alveolar process yellow arrow. It lies in an almost horizontal axis with its apex being elongated into the zygomatic process. Front view of maxilla. Side of maxillathe three sides are superior or orbital it forms greater part of the orbital floor , an anterolateral or malar surface forming part of the skeleton of the cheek and face and posterolateral or infra-temporal surface turned towards the infra-temporal fossa.

Basethe base is rimmed on its inferior edge by the alveolar process housing the teeth row. Alveolar processalveolar process consists of two roughly parallel plates of bone that unite behind the last tooth to form a small rough prominence, the alveolar tubercle, which often contains a single large marrow process.

The lateral and external alveolar plate continues upward into the anterolateral and posterolateral surface of the maxillary body. The internal alveolar plate continues into the palatine process and behind the posterior end of the latter into the nasal surface of the maxillary body.

The deep furrow between the two alveolar plates is divided by radial bony plates into the sockets of the individual teeth.

Textbook of Oral Medicine 3rd Edition

Incisive foraminaat the boundary between two portions of the nasal crest, a canal commences in the nasal floor close to the midline and extends downwards, anteriorly and medially to unite with the canal of the other side in a common opening which is called as incisive or nasopalatine canal Fig. On the anterior surface of maxilla, there is canine fossa situated lateral to the canine eminence. Mandible It is the largest and strongest bone of the face. It consists of a horseshoe shaped body continuous upward and backward on either side with the mandibular rami.

Bodythe body is thick, has a rounded lower border and carries the alveolar process on its upper border. It extends backward from the chin at the midline symphysis to the anterior limit of the ramus.

Ramusit is a thick quadrilateral plate which extends backward from the groove for the facial artery antegonial notch to include the region called the mandibular angle Fig. The anterior border of the ramus continues along the body lateral to the alveolar process as a blunt ridge, the oblique line, running downward and forward to disappear at about the level of the 1st molar.

Palatal view of maxilla showing incisive foramen red arrow. Overview of mandible showing body and ramus of mandible. Symphysis mentiit is the line at which the right and left halves of the bone meet each other. The mental foramen, through which the mental nerve and blood vessels pass, is located on the lateral surface of body between the roots of the 1st and 2nd premolars. In the vertical dimension, the foramen lies halfway between the lower border of mandible and the alveolar margin.

Genial tubercleslightly above the lower border on its inner surface the mandibular symphysis is elevated in more or less sharply defined projection called as genial tubercle. Mylohyoid lineit is a prominent ridge that runs obliquely downward and forward from below 3rd molar tooth to the medial area below the genial tubercle. Below the mylohyoid line, the surface is slightly hollowed out to form submandibular fossa, which lodges the submandibular gland.

Mandibular canalthe mandibular canal which houses the inferior alveolar nerve and blood vessels begins at the mandibular foramen, curves downward and forward and turns into a horizontal course below the roots of the molars.

In the region of the premolars, the mandibular canal splits into two canals of unequal width; the narrower incisive canal continues the course of mandibular canal toward the midline and the wider branch, the mental, turns laterally, superiorly and posteriorly to open at the mental foramen Fig. Side view of mandible showing mental foramina red arrow. Alveolar bonethe alveolar plates consist of two compact bony plates, the external and internal alveolar plate. These two plates are joined to each other by radial interdental and in the molar region, by inter-radicular septa, thus forming the sockets for the teeth in the same manner as in the upper jaw.

Digastric fossathe lower border of the mandible is also called as base. Near the midline, the base shows an oval depression called digastric fossa. Trigeminal Nerve The trigeminal nerve is the 5th cranial nerve and is also the largest. It has a large sensory root and a small motor root. It is attached to lateral part of pons by its two roots.

It conveys both exteroceptive and proprioceptive impulses. Proprioceptive impulses of deep pressure are conveyed from teeth, periodontium, hard palate and temporomandibular joint receptors. Branches of Trigeminal Nerve Fig. Lacrimal nerveit supplies sensory fibers to the gland and the adjacent conjunctiva. Frontal nerveit divides into supraorbital nerve supplies the skin of the upper eyelid, forehead and the anterior scalp region to the vertex of skull , and supratrochlear nerve supplies skin of the upper eyelid and lower medial portion of forehead.

Nasociliary nerve it gives numerous branches. It include branches in orbit Long ciliary nerves, posterior ethmoid nerve, anterior ethmoid nerve, external nasal branches , branches arising in nasal cavity and terminal branches on the face. Different branches of trigeminal nerve supplying to face. It enters the orbit through inferior orbital fissure.

It is now named infraorbital nerve and having traversed the infraorbital groove and canal in floor of orbit, it appears on face through infraorbital foramen. Branches are divided into 4 groups Middle meningeal nervesupplies the dura with sensory fibers. Ganglionic branchesthey contain secretometer fibers for the lacrimal gland and sensory fibers for orbital periosteum and mucous membranes of the nose, palate and pharynx.

Zygomatic nerveit is divided into two branches, i. Posterior superior alveolar nerveit gives sensory branches to mucous membrane of sinus. It also supplies the maxillary molars and their gingivae. Middle superior alveolar nerveit supplies upper premolar and mesiobuccal root of upper first molar.

Anterior superior alveolar nerveit supplies roots of maxillary central and lateral incisors. They also send branches to superior dental plexus of nerves within maxilla. They also supply mucous membrane of anterior part of maxillary sinus as well as labial gingivae of incisors and cuspid teeth.

Inferior palpebral branchesthey supply sensory fibers to skin of lower eyelid and its conjunctiva. External or lateral nasal branchesthey supply skin of side of nose. Superior labial branches - three or more in number and supply skin and mucous membrane of upper lip and labial glands.

Mandibular Nerve It is the largest of the three divisions. It is divided into following branches: Nervus spinosusit supplies dura and mastoid cells. Nerve to internal pterygoid muscleit supplies internal pterygoid muscle.

Pterygoid nerveit enters medial side of external pterygoid muscle to provide motor nerve supply. Masseter nerveit supplies masseter muscle. Anterior deep temporal nerveit ends in deep part of anterior portion of temporal muscle. Posterior deep temporal nerveit passes upward to deep part of temporal muscle.

Long buccal nerveit supplies mandibular 2nd and 3rd molars. It then sends fibers to mucous membrane and skin of cheek, retromolar triangle, and buccal gingivae of mandibular molars and mucous membrane of lower part of buccal vestibule. Auriculotemporal nerveit traverses upper deep part of parotid gland and then crosses the posterior root of zygomatic arch. It passes with superficial temporal artery in its upward course and then divides with numerous branches to tragus of external ear, to scalp, to the ear and as for upward as vertex of skull.

Parotid branchesthey are sensory, secretory and vasomotor fibers to the gland. Articular branchesit enter the posterior part of the temporomandibular joint. TABLE Lymphatic drainage of head and neck Nodes Sites Occipital Scalp, posterior to the ear and occipital region Posterior auricular External ear, scalp above and behind the ear.

Occasionally, maxillary and mandibular teeth and gingivae. Submandibular sub-maxillary Upper and lower teeth and gingivae except mandibular incisor, anterior nasal cavity, palate, body of tongue, upper lip, lateral angle of eye, submental nodes Superficial cervical Pinna and adjacent skin, pre- and post-auricular nodes Deep cervical Submandibular, submental, inferior auricular, tonsillar and tongue nodes http: Meatal branchestwo small branches which supply skin lining the meatus and tympanic membrane.

Terminal branchesthey supply scalp and temporal region. Lingual nerveIt gives off small branches that are sensory to part of tonsil and mucous membrane of posterior part of oral cavity. Inferior alveolar nerveit is the largest branch of posterior division of mandibular nerve. It sends motor branches to mylohyoid muscle and anterior belly of digastric muscle.

It then enters mandibular foramen and descends in the mandible in the inferior dental canal as inferior alveolar nerve. It is sensory to mandibular teeth, body of mandible and labial gingiva anterior to bicuspid teeth.

Mental nerveit passes through mental foramen on lateral surface of mandible. It is sensory to skin of chin, lower lip, and mucous membrane lining of lower lip. Incisive nerveit continues anteriorly in the inferior dental canal to midline. It is sensory to anterior teeth and labial gingivae. Gasser RF. The Development of Facial Muscle in Man. American Journal of Anatomy ; Grays Anatomy 38th edn , Churchill Livingstone, Hall BK.

The Embryonic Development of Bone. Amer Scientist ;76 2: Poswillo D. Lymphatic drainage of face. It is the resistance exhibited by the host towards injury caused by microorganisms and their products. It is a reaction of body against any foreign antigens. Immunity against infectious diseases consists of two main types, each with humoral and cellular components and their effective cells.

The importance of immune system occurs in life-threatening infection suffer by patient with immune defect. Uses of Immunity Understanding the diseaseit helps to understand the etiology and pathogenesis of many diseases. Vaccinedevelopment of vaccine can be done with the help of immunity.

Treatmenttreatment of many diseases can be done with antibodies. Future susceptibilityit helps to find with future susceptibility to disease with the help of HLA typing system. Classification Fig. Different types of immunity A diagrammatic representation. Innate Immunity This is also called as natural immunity. This compromise of preexisting non-specific defences. It is the resistance to infection, which an individual possesses by virtue of his genetic and constitutional make up.

It does not depend upon the prior contact with microorganisms or immunization. Innate immunity can be considered at the level of race, species or at individuals levels. Species immunityit refers to total or relative refractori- ness to a pathogen shown by all members of a species e.

It may be due to physiological and biochemical differences between the tissues of different host species, which determine whether a pathogen can multiply or not. Racial immunitywithin species, different races may show differences in susceptibility to infection. This is called as racial immunity e. Such racial differences are known to be genetic in origin. Individual immunitythe differences in individual immunity exhibited by different individuals in a race is called as individual immunity e.

Such correlation is not seen in heterozygous twins. Factors Affecting I nnate I mmunity Agethe two extremes of life carry higher susceptibility to infection as compared to adults.

The fetus in utero however is protected from maternal infection by the placental barrier. Hormonal influenceendocrine disorders such as diabetes mellitus, hypothyroidism and adrenal dys- function are associated with an enhanced susceptibility to infection.

Corticosteroids exert an important influence on response to infection. The elevated steroid levels during pregnancy may have a relation to heightened susceptibility of pregnant women to many infections. Nutritionin general, both humoral and cell mediated responses are reduced in malnutrition. Cell mediated immune response such as Mantoux test becomes negative in severe protein deficiency.

Certain infections may not become clinically apparent in severely malnourished patients.

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Mechanism of I nnate I mmunity Epithelial surfaceskin and mucous membrane covering the body gives protection against bacteria. They act as mechanical barrier. Humoral factorsit consists of lysozyme, properdin, betalysin, C-reactive protein, bactericidin etc.

Cellular factorsit includes phagocytosis, and inflammation. Acquired Immunity The resistance that an individual acquires during life is known as acquired immunity.

It is of two types. Active I mmunity It is resistance developed by an individual because of antigenic stimulus. This involves active functioning of hosts immune apparatus leading to synthesis of antibodies or production of immunologically active cells. Once the active immunity develops, it is long lasting. It is also of two types. Naturalit results from either a clinical or an inapparent infection with the parasite, e. The immunity following bacterial infection is generally less permanent than that following a viral infection.

Artificialit is the resistance induced by vaccines, which are preparations of live or killed microorganisms or their product. Passive I mmunity The resistance that is transmitted to a person in readymade fashion is known as passive immunity. There is no antigenic stimulant, instead preformed antibodies are administered. There is no latent period, protection being effective immediately after passive immunization. It is less effective and inferior to active immunization, but it is immediate in action and can be employed when instant immunity is needed.

Naturalit is the resistance passively transferred from mother to baby. By active immunization of mothers during pregnancy, it is possible to improve the quality of passive immunity in the infants.

Artificialit is passively transferred to the recipient by the administration of antibodies. The agent used is hyperimmune sera of animal or human origin, convalescent sera and pooled human gamma globulin. Local Immunity It is important in treatment of infection, which is either localized or due to surgeries postoperative infection , in combating infections at the site of primary entry of the pathogen. Natural infection or the live virus vaccine administered provides local immunity.

Herd Immunity This refers to the overall level of immunity in a community and is relevant in the control of epidemic diseases. When a large proportion of individuals in a community herd http: When herd immunity is low, epidemics are likely to occur on the introduction of a suitable pathogen. Antigen-Antibody Reaction Antigen Definitionany substance which when introduced parenterally into a body stimulates the production of an antibody, with which it reacts specifically and in an observable manner.

The immune system can respond to antigen either by cell mediated immunity or by humoral immunity. Sizemost antigens are large molecules over molecular weight. Smaller molecules do not provoke an immune response unless bound to large carrier molecules. The complete antigen is able to induce antibody formation and produces a specific and observable reaction with the antibody so produced. Haptensthese are substances which are incapable of inducing antibody formation by themselves, but can react specifically with antibodies.

Epitopethe smallest unit to antigenicity is known as an epitope or antigenic determinant. Antibody Antibody is produced by plasma cells in the lymph nodes, bone marrow and spleen. The cells are ovoid with an eccentrically placed nucleus.

The cytoplasm is basophilic. One plasma cell produces antibody of one class, reactive with only one antigen.

There are five classes of immunoglobulins which are as follows: IgG It is the most abundant immunoglobulin in the plasma and extracellular fluid. It can cross placenta and is important in passive transfer of immunity to the fetus. It is capable of neutralizing toxins and may be cytolytic through the activation of a complement.

Polymorphs and macrophages have surface receptors for Fc fragment of IgG, thus binding of IgG to particular antigens promotes adhesion of these cells and subsequent phagocytosis of antigen. IgA It is secreted locally by plasma cells in the respiratory passages, salivary and lacrimal glands and intestinal mucosa.

It is an important constituent of breast milk. IgA occurs in two forms, serum IgA is principally a monomeric 7S molecule found on mucosal surfaces and in secretions. It is a dimer formed by two monomer units joined together at their carboxyterminals by glycopeptides termed the J chain. This is called as secretory IgA. It can activate complement by the alternative pathway. I gM It is formed by J chains into pentamers of the Ig molecules and these attain very high molecular weight of , The large molecular size prevents it from leaving the plasma, except when permitted by increased vascular permeability in inflammatory lesions.

As it has antigen combining sites, it has good agglutinating and complement fixing properties. It is the first class of antibodies to be formed in immune response. I gE It binds selectively to mast cells and to basophils by its Fc fragment. The binding of antigen to its Fab fragment triggers reflex of histamine and other substances which are important in anaphylactic type of hypersensitivity.

I gD The function of IgD is largely unknown, but it may act as an antigen receptor on the lymphocyte surface.

Textbook of Oral Medicine

AntigenAntibody Reaction Mechanism Antigen-antibody reaction in vitro is known as serological reaction Fig. Diagrammatic representation of antigen-antibody reaction. This reaction is rapid and occurs even at low temperature and also is reversible because inter-molecular forces between Ag and Ab are weaker. Secondary stateit leads to precipitation, agglutination, lysis of cells, killing of live antigens, neutralization of motile organisms and enhancement of phagocytosis.

An antigen can stimulate production of different types of immunoglobulins, which differ in their reaction capability and other properties. Tertiary statesome antigen-antibody reactions occurring in vivo initiate chain reactions that leads to neutralization or destruction of injurious antigens or tissue damage. These are tertiary reactions and include humoral immunity against infectious diseases, clinical allergy and other immunological diseases. General Features of an Antigen-Antibody Reaction Specificthe reaction is specific; an antigen combines only with its homologous antibody and vice versa.

Entire molecule reacts and not its fragments. Non-degenerativethere is no degeneration of the antigen or antibody during the reaction. Combinationthe combination occurs at the surface, which is firm and reversible.

Antigen and antibody can combine in varying proportions. Precipitation Reaction Formation of insoluble precipitatewhen a soluble antigen combines with antibody in the presence of electrolyte NaCl at a suitable temperature and pH, the antigen- antibody complex forms an insoluble precipitate which is greatly influenced by the relative proportions of antigens or antibodies.

Resultsif into the same amount of antiserum in diffe- rent tubes, increasing quantities of antigens are added, precipitation will be found to occur most rapidly and abundantly in one of the middle tubes in which Ag and Ab are present in optimal or equivalent proportion. The precipitation will be weak in proceeding or later tubes Fig.

Agglutination Reaction Mechanismwhen the particulate antigen is mixed with its antibody in the presence of the electrolyte at a suitable temperature and pH, the particles are clumped or agglutinated. It is more sensitive than precipitation for the detection of an antibody. It occurs optimally Fig. Precipitation reactionA diagrammatic representation.

Complement Fixation Test Mechanismcomplement takes part in many immuno- logical reactions and is absorbed during the combi- nation of antigens with their antibodies.

The ability of antigen-antibody complexes to fix complement is made to use in the complement fixation test.

This is a very sensitive and a versatile test. Agglutination reaction. Each of these has to be separately standardized. One unit or minimum hemolytic dose of complement is defined as the highest dilution of guinea pig serum that lyses one unit volume of washed sheep erythrocyte in the presence of excess of hemolysin amboceptor within a fixed time usually 30 or 60 minutes and at a fixed temperature 37C Figs and Positive complement fixation test. Negative complement fixation test.

Neutralization of bacteriophages can be demonstrated by the plaque inhibition test. Neutralization of animal viruses can be seen in three systems: Immunofluorescence Mechanismfluorescence is a property of absorbing light rays of one particular wavelength and emitting rays with different wavelengths.

Fluorescence dye can be conjugated to antibodies and such labelled antibodies can be used to locate and identify antigen in tissue. Usethis test can be used for identification of bacteria, viruses or other antigens using specific antisera labelled with fluorescence dyes.

Dye usecommonly used dye is fluorescein isothio- cynate and lissamine rhodamine exhibiting blue-green and orange-red fluorescence respectively. Gupte S. Immunology 5th edn , Mosby, London, Samaranayake LP. Essential Microbiology for Dentistry 2nd edn , Churchill Livingstone, Oncology is the study of neoplasm.

Nomenclature There are mainly of two types neoplasm: Benign tumors are designated by attaching oma to cell of the organ. Malignant tumors arising from mesenchymal tissues are known as sarcomas, like osteosarcoma. Malignant tumors of epithelial origin are called carcinoma, like adenocarcinoma and squamous cell carcinoma. Normal Cell Cycle All renewing cells go through a series of events known as cell cycle. Successive phases of progression of cell cycle are described below Fig.

G 1 phaseafter mitosis M phase , cells spend a variable period of resting G 1 phase where DNA synthesis is absent but the synthesis of RNA and protein continues. Then the cells undergo replication or remain polypoid and eventually die. The proportion of cells population under- goes active proliferation in the cycle is termed as growth fraction.

G 0 phasedaughter cells may continue to remain in cell cycle and divide further or may go out at the cell cycle in resting phase. Predisposing Epidemiologic Factor for Development of Neoplasm Hereditary Predisposition The risk of developing cancer in relatives of a known cancer patient is three times higher than control study.

Racial and Geographic Factors Cancers are largely due to the influence of environment and geographic differences affecting whole population such as climate, water, diet, habit. For example Black Africans commonly have cancers of skin, penis, cervix, and liver. Europeans and Americans commonly develop malignancies of lung, breast, and colon. Normal cell cycleA diagrammatic representation. Nasopharyngeal cancer is common in south East Asians.

Environmental and Cultural Factors We are surrounded by an environment of carcinogens which we eat, drink, inhale and touch Fig. For example Cigarette smoking is the etiology of cancer of oral cavity, pharynx, larynx, esophagus, lung, pancreas and urinary bladder.

Alcohol causes cancer of esophagus and liver. Alcohol and tobacco together accelerate the risk of developing cancer of upper aerodigestive tract. Betel nut chewing causes cancer of cheek and tongue. Industrial and environmental materials are carcinogenic. This includes exposure to substances like arsenic, asbestos, benzene, and naphthylamine. Overweight individuals, deficiency of vitamin A, people consuming foods rich in animal fats and low in fiber content have more risk of developing cancers like colonic cancer.

Age Generally, it occurs in older individuals past 5th decade of life but, there is variation in age groups. For example, acute leukemia occurs in children, neuroblastoma in infancy. Sex It is generally more common in men except cancer of breast, gallbladder, and thyroid. Acquired Preneoplastic Conditions These may be inflammatory, hyperplastic conditions or may be certain benign tumors.

It includes chronic atrophic glossi- tis, leukoplakia of oral cavity, vulva and penis, cirrhosis of liver, chronic irritation and multiple neurofibromas. Carcinogenesis Carcinogenesis or oncogenesis or tumorigenesis means induction of tumors; agents which can induce tumors are called carcinogens. Carcinogens are broadly divided into four groups Fig.

Chemical carcinogens Physical carcinogens radiation Hormonal carcinogens Biologic carcinogens virus Fig. Different types of etiological factors responsible for formation of neoplasm. Types of carcinogenesis.

I nitiators of Carcinogenesis Direct-acting carcinogensthese require no metabolic conversion to become carcinogens. Alkylating agents it includes, various chemotherapeutic drugs that have successfully cured, controlled or delayed recurrence of certain types of cancers only to later evoke a second form of cancer usually leukemia.

Various agents used are cyclophosphamide, chlorambucil, busulfan, melphalan, nitrosourea, -propiolactone and epoxides. This tragic consequence is called as Pyrrhic victory which becomes less of a victory when their initial use has been converted to cause later on second form of cancer.

Acylating agentssubstances like acetyl imidazole.

Indirect-acting carcinogens or procarcinogensthese are chemical substances requiring metabolic activation for becoming potent initial carcinogens. Polycyclic aromatic hydrocarbons in tobacco, smoke, animal foods, industrial oil, and atmospheric pollutants. Important chemical compounds included are benzanthracene, benzapyrene, methylcholanthrene.

They may cause lung cancer, skin cancer, cancer of oral cavity, and sarcoma. Aromatic amines and azo dyesThese are -naphthyla- mine, benzidine, azo dyes used for coloring foods, and acetyl aminofluorene.

They may cause bladder cancer and hepatocellular carcinoma. Naturally occurring productAflatoxin, actinomycin-D, mitomycin-C, safrole, and betel nut. It can cause hepato- cellular carcinoma. Miscellaneousnitroso compounds, vinyl chloride monomer, asbestos, arsenical compounds, metals like nickel, lead, chromium, and insecticides, fungicides can cause gastric carcinoma, hemangiosarcoma of liver, bronchogenic carcinoma, epidermal hyperplasia, basal cell carcinoma, and lung cancer.

Promoters of Carcinogenesis Certain chemical substances lacking the intrinsic carcinogenic potential but helping the initiated cell to proliferate further are called promoter of carcinogenesis. They bind directly to DNA and RNA or cytoplasmic proteins to specific sites within molecule inducing miscoding error during transcription and replication. Factors affecting a carcinogenicity Dose dependentthe carcinogenicity of chemical agents is dose dependent and multiple traditional doses have same oncogenicity as a single comparative dose.

Administration of promotersthe carcinogenicity of chemical agents can be significantly enhanced by the subsequent administration of promoters. To be effective, the promoter must follow the initiator. Stage of Chemical Carcinogen The phenomenon of cellular transformation by chemical carcinogenesis is a progressive process involving two different stages. These are initiation and promotion.

Initiation In this initiator carcinogen interact with DNA of target cell to induce mutation that is more or less irreversible to transform it into initiated cell. Metabolic activationonly indirect acting carcinogen or procarcinogens require metabolic activation chiefly by mixed oxidases of cytochrome P system located in microsomal compounds of the endoplasmic reticulum or in the nucleus.

Reactive electrophilesthey are electron deficient protons, which bind to electron rich portions of other molecules of cell such as DNA, RNA or other protein. Target moleculesthe primary target is DNA, producing mutagenesis. Initiated cellthe unrepaired damage produced in the DNA of the cell becomes permanent, only if the altered cell undergoes at least one cycle of proliferation.

Promotion It does not damage the DNA but enhances the effect of direct-acting carcinogen or procarcinogens. The ultimate effect is further clonal proliferation of the initiated cell. Two or more initiators may be chemical, oncogenic virus or radiant energy may act in concert to induce malignant transformation referred to as cocarcinogens. Physical Carcinogenesis It is divided into two groups. Radiation Carcinogenesis Forms of radiationradiation whenever in the form of UV light from sunlight, UV lamp, welders arc, or ionizing radiation like X-ray, , and ray, radioactive isotopes, protons and neutrons are established carcinogens.

Example of radiation induced cancersmost frequent radiation induced cancers are leukemia, cancer of http: Therapeutic irradiation can also induce carcinogenesis. Facts about radiation causing cancerradiant energy have potential of producing mutation and even killing cells.

It can affect carcinogenesis by the following facts: Few tumors appear only after long latent period during which successive generation of clones are developed.

The radiation initiation is generally irreversible, but at a low dosage level is amenable to repair. The effect of radiation depends upon a number of factors such as type of radiation, dose, length of interval between the doses, capability of cells to repair in intervals and various host factors such as age, individual susceptibility, immune competence, hormonal influence and type of cell irradiated.

Mechanismit induces cancer by following mechanism; Radiation may directly alter the cellular DNA and it may dislodge ions from water and other molecules of cell and result in the formation of highly reactive free radicals that may bring about the damage.

Radiation mutation may render cell vulnerable to other carcinogenic influence, i. Inhibition of cell division and inactivation of enzymes.

Radiation might cause cell killing; permitting survivors to proliferate and thereby, become vulnerable to oncogenic influence. Non-radiation Physical Carcinogenesis Mechanical injury to tissues such as from stones in the gall bladder, stones in the urinary tract, and healed scars following burns or trauma has been suggested as causes of increased risk of carcinoma. Implants of inert materials such as plastic, glass, etc. Hormonal Carcinogenesis Carcinoma is most likely to develop in organs and tissues which undergo proliferation under influence of excessive hormonal stimulation.

Hormone sensitive tissues developing tumors are breast, endometrium, myometrium, vagina, thyroid, liver, prostate, and testis. Estrogenin experimental animals, estrogen can cause induction of breast cancer in mice.

Other cancers which can be induced in mice by estrogens are squamous cell carcinoma of cervix, connective tissue tumor of myo- metrium, tumor of kidney in hamsters, and benign and malignant tumors of liver in rats. In case of human women receiving estrogen therapy and women with estrogen secreting granulosa cell, tumor of the ovary have increased risk of developing endometrial carcinoma.

Adenocarcinoma of the vagina is seen with increased frequency in adolescent daughter of mother who had received estrogen therapy during pregnancy.

Contraceptive hormonesthere is increased risk of developing breast cancer, benign tumors of the liver and few patients have developed hepatocellular carcinoma.

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Anabolic steroidsconsumption of anabolic steroids by athletes to increase the muscle mass also increases the risk of developing benign and malignant tumor of the liver.

Hormone dependent tumorsit has been shown in experimental animals that induction of hyperfunction of adenohypophysis is associated with increased risk of developing neoplasia of the target organs following preceding functional hyperplasia. Biologic Carcinogenesis The epidemiological studies on different types of cancer indicate the involvement of transmissible biologic agents in their development, chiefly viruses.

Therefore biological carcinogenesis is largely viral oncogenesis. A large number of viruses have been proved to be oncogenic in wide variety of animals and in certain types of cancers in humans. The association of oncogenic virus with neoplasia was observed by an Italian physician Sanarelli in who noted association between myxomatosis of rabbit with poxvirus.

Oncogenic viruses fall into 2 broad groups, i. Based on their activity to transplant target cells into neoplastic cells, they all are divided into three subgroups: Acute transforming virusesit includes Rous sarcoma virus in chickens, leukemia-sarcoma viruses of avian, feline, bovine and primate. Slow transforming tumor virusesmouse mammary tumor virus MMTV that causes breast cancer in daughter mice.

Adenovirusesit can cause upper respiratory infections and pharyngitis. In man, they are not known to be involved in tumors but in hamsters they may induce sarcomas. Poxvirusin rabbits, it can cause myxomatosis and in humans, it can cause molluscum contagiosum and may induce squamous cell papilloma. Hepadnaviruseshepatitis B virus is a member of this family and it can cause acute hepatitis and is responsible for carrier state which can result chronic hepatitis.

In some cases, to progressing to hepatic cirrhosis and into hepatocellular carcinoma. Reverse transcriptase acts as a template to synthesize a single strand of matching viral DNA. The provirus is then integrated into the DNA of the host cell genome and may transform the cell into a neoplastic cell.

Virus replication begins after integration of provirus into host cell genome. Integration results in transcription of proviral genes or progenes into messenger RNA which then forms components of the virus particle, i.

The three components of virus particles are then assembled at the plasma membrane of host cells and virus particles released by budding off from plasma membrane, thus completing the process of replication.

DNA viral oncogenesis: ReplicationThe virus may replicate in the host cell with consequent lysis of infected cell and release of virions. This results in neoplastic transformation of the host cell.

Oxidative Mechanism of Carcinogenesis Active oxygen species and other free radicals have long known to be mutagenic. Further, these agents have emerged as mediators of the other phenotypic and genotypic changes that lead to form mutation to neoplasia.

Free radicals production is ubiquitous in all respiring organism and is enhanced by many disease states, by carcinogen exposure and under conditions of stress. Free radicals may therefore contribute widely to cancer development in humans.

Free radicals scavenging vitamins C and E have been shown to protect against cancer development in animal models. Biology of Tumor Growth The life cycle of malignant tumors can be divided into four phases. All etiologic factors ultimately affect the function of two sets of genes, one is proto- oncogenes or oncogenes and another one is anti- oncogenes or cancer suppressor genes. Binding with DNAthe majority of carcinogens are mutagenes which bind the DNA directly or indirectly by undergoing enzymatic activation, inducing miscoding errors during transcription and replication.

Production of growth factorsoncogenes may code for growth promoting factors and as a result, the tumor cells produce large amount of growth factors to which, only they can respond. Biology of tumor growth induction phase. Multiple mutationscancer is a genetic disease that results when multiple mutations accumulate in the DNA of a cell and specific chromosomal abnormalities predispose to cancer.

To produce a tumor of 10 12 cells, weighing 1 kg approximately, which is usually the maximum size compatible with life, the tumor cells have to undergo 10 further population doublings. So by the time the tumor is clinically detectable, it has already complete a major portion of its life cycle. Factors affecting growth of cellsin tumor cells, there is an imbalance between cell production and cell loss, there- fore, the tumor grows progressively.

The rate of tumor growth depends upon the growth fraction and the degree of imbalance between cell production and cell loss. Biology of tumor growth kinetic of tumor cell growth. Mechanism of Local Invasion and Distant Metastases Routes of metastasisthere are three routes through which metastases of tumor cells occur, i.

The pupil searched for a reference on which to build an academic basis in regards to basic principle. The reason of this e-book is to correlate the gross and microscopic pathological features with the radiographic look of oral sicknesses and systemic sicknesses manifested in the jaw.

The chapter on Medico legal difficulty is an essential analyzing, at the side of the customer protection Act. Illnesses can be understood fine when the interpreter knows not handiest the ailment procedure however additionally the primary science associated with it.

Lately, as examination pattern is converting and MCQs have become importance, MCQs are delivered in a separate bankruptcy. I tried my satisfactory to cowl all of the components of oral diseases on this e book. If this aim is done, then this textbook may also contribute, in a small way, to higher care of patients who suffer from these sicknesses.

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Anil Govindrao Ghom Edition: We do not own the copyrights of this book.Other key topics include non-surgical management of temporomandibular joint disorders and facial pain, dental treatment under general anaesthesia, and specialty care in periodontics and endodontics. Want to Read Currently Reading Read.

Divided into five sections, the book begins with an introduction to the basics, followed by sections on Diseases of Oral Structures, Systemic Diseases Manifested in the Jaw, Drugs Used in Dentistry, and Miscellaneous Topics.

Open Preview See a Problem? Metabolic Disorders. Each chapter includes multiple choice questions for revision, as well as numerous clinical images, illustrations and tables. Home Contact us Help Free delivery worldwide. We use cookies to give you the best possible experience. If this aim is done, then this textbook may also contribute, in a small way, to higher care of patients who suffer from these sicknesses.

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