口腔診斷及口腔病理學導論

口腔診斷及口腔病理學導論

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口腔診斷

口腔診斷Real-time polymerasechain reaction(RT-PCR)- 聚合酶連鎖反應

口腔診斷

A 40 y/o female suffered from 37 toothache for 3 months

No other abnormal mucosal lesion was noted

Diagnosed her symptoms to be periodontitis

Prosthetic crown of tooth 37 was removed to perform endodontic tx

Dentist A

口腔診斷

Severe pain of tooth 37 Severe pain of tooth 37 persistedpersisted

Dentist B

The post extractionThe post extraction wound remained unhealed wound remained unhealed Refered her to visit KMURefered her to visit KMU dental dept for further txdental dept for further tx

Tooth 37 was extractedTooth 37 was extracted

口腔病理

Biopsy— 活體切片檢查

病理診斷

口腔病理

Extraction Extraction of tooth 37of tooth 37

Dentist C

切片檢查

病理診斷口腔癌

口腔診斷及口腔病理學導論

口腔病理

病理診斷

口腔診斷

臨床診斷

一體的兩面

Subtopics Relationships between chronic oral infectious diseases & systemic diseases

Systemic diseases manifested in oral cavity

Systemic Diseases & Oral Cavity

Oral cavity

Systemicdiseases

bacteria


1. Oral bacteria causing bacterial endocarditis 1. Oral bacteria causing bacterial endocarditis

Bacterial endocarditis

bacteremia

Blood smear of sepsis


2. Relationships of periodontobacteria and cardiovascular diseases (CVD)

2. Relationships of periodontobacteria and cardiovascular diseases (CVD) 牙周感染與心臟血管疾病的關係


3. Pathogens for bacterial pneumonia in oral cavity (Epidemiological view)

3. Pathogens for bacterial pneumonia in oral cavity (Epidemiological view)

LCL: lower confidence limitUCL: upper confidence limit

LCL: lower confidence limitUCL: upper confidence limit OHI: Oral Hygiene IndexOHI: Oral Hygiene Index

PercentilePercentile OHI valueOHI value Estimate of odd ratio

Estimate of odd ratio LCL UCL LCL UCL


Silent aspiration

Colonization

3. Pathogens for bacterial pneumonia in oral cavity (Pathway)

3. Pathogens for bacterial pneumonia in oral cavity (Pathway)


3. Pathogens for bacterial pneumonia in oral cavity (Cytokine)

3. Pathogens for bacterial pneumonia in oral cavity (Cytokine)

Trachea

Bronchus

IL: interleukin

TNF: tissue necrosis factor

Cytokine ( 細胞素 )


Nephritis Arthritis

4. Oral chronic infectious diseases cause secondary diseases



Metastatic infection from oral cavity

EndocarditisBrain abscessSinusitisLudwig’s anginaOrbital cellulitisOsteomyelitisSkin ulcerPustulosis palmaris et plantaris




Metabolic injury by oral bacterial toxin

Coronary heart diseaseAbnormal pregnancy outcomePersistent pyrexiaIdiopathic trigeminal neuralgiaAtypical facial painAcute myocardial infarction






Metastatic inflamma- tion by oral bacteria

Bechet’s diseaseCrohn’s diseaseInflammatory bowel diseaseUveitis


4. Oral chronic infectious diseases cause secondary diseases - Bechet’s disease

4. Oral chronic infectious diseases cause secondary diseases - Bechet’s disease

Criteria: recurrent oral ulceration + ≥ 2 others findings

Criteria for diagnosis for Bechet’s disease

Findings DefinitionsRecurrent oralulceration

Eye lesions

Skin lesions

Positive pathergy test

Recurrent genitalulceration



4. Oral chronic infectious diseases cause secondary diseases*Pricking a sterile needle into forearm or lower lip*Positive when the puncture causes an aseptic erythematous nodule or pulstule (>2mm) at 24-48 hrs*At reaction site, there is initially an accumulation of neutrophils, followed by mononuclear cells

Skin test Oral test

Forearm Lower lip




Definition of different grades of skin pathergy testGrade of test Clinical characteristic of the test at 48 h

Negative (-)Suspect (+/-)

Positive (+)

Only erythema <2 mmOnly erythema > 3 mm or papule 1-2 mm + erythema < 2 mm1+ Papule 2-3 mm + erythema > 3 mm2+ Papule > 3 mm + erythema > 3 mm3+ Pustule 1-2 mm + erythema > 3 mm4+ Pustule > 2 mm + erythema > 3 mmErythema/Papule/Pustule--Diameter


Hypopyon Erythema nodosum

A horizontal layer of inflammatory cells



Oral ulcer Genital ulcer


4. Oral chronic infectious diseases cause secondary diseases – Crohn’s disease

4. Oral chronic infectious diseases cause secondary diseases – Crohn’s disease

Labial swelling& fissuring

Mucosal tag

Ulceration

Cobblesing stonemucosa


Dermatitis

5. Heat shock proteins producing by oral bacteria may induce dermal diseases

5. Heat shock proteins producing by oral bacteria may induce dermal diseases


Prevotella intermediaPorphyromonas gingivalis

Toxin:lipopolysaccharide

Estrogen

6. Gingivitis pathogens cause pregnancy disorders






牙周病糖尿病 7. Periodontitis and diabetic mellitus 7. Periodontitis and diabetic mellitus


Periodontal infection & systemic conditions -potential linkage & possible pathogenic mechanisms

Periodontal infection & systemic conditions -potential linkage & possible pathogenic mechanisms

Periodontalinfection

Cardiovascular diseases

Diabetes mellitus

Adverse pregnancy outcomes Pulmonary infections

Systemic diseases manifested in oral cavity

Virus ( 病毒 )

Uncoating

Replication

ReleaseAttachmentHIV

gp

120

gp 41 CCR5

Life cycle Attachment Penetration translocate endocytosis fusion

Host cell Host cell

CC

R5

gp 120

CD

4

gp 120

AttachmentH I V

gp

41

H I V

gp

41

Gp120 能與 CD4 受體結合，但無法直接引導 HIV 進入host cell

CCR5 將 gp120 拉開後，gp41 引導 HIV 進入host cell

Host cellHost cell

Life - Cycle Possible ways of HIV therapy Drugs block binding (attachment & fusion) Drugs inhibit reverse transcriptase Drugs under study would inhibit integrase Some existing drugs inhibit protease

CC

R5

脂質套膜

套膜蛋白

gp

41

Attachment

Nucleus

Nucleus

Integration

蛋白質外殼

Budding

CD

4

H I V

HIV RNA

CytoplasmCytoplasm

H I V

gp

41

Attachment

Reverse-transcription

Uncoating

Reverse-transcriptase

Integrase

HIV mRNAProtease

Infected otherhost cells

CytoplasmCytoplasm Caspid

Fusion

Oth

er

Ho

st c

ell

Oth

er

Ho

st c

ell

gp 120

Reverse transcriptase

Integrase

Protease

受體

CD4

CCR5

Macrophage

T-cell

CCR5

Early stage

Late stage

Virus ( 病毒 )

CD4 T-cellcount

Viral load

Acutephase Chronic phase AIDS

Oral Manifestations of AIDS

Candidiasis (thrush)

Candidiasis (atrophic)

Kaposi sarcoma

Necrotizing gingivitis

Hairy leukoplakia

Hairy leukoplakia

Hairy leukoplakia

Hairy leukoplakia

H&E

EBV


Twenty-year incidence of KS at the University of California San Francisco

Oral KS cases/yearN = 203

Oral Kaposi’s sarcoma: Biopsy accessions as an indication of declining incidence

No

. o

f ca

ses

0

20

1981 200219971991

Due to highly activeantiretroviraltherapy in 1995



Hairy leukoplakia

Oral candidiasis

Our Collected Case


Our Collected Case –Burkitt’slymphoma

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口 腔 診 斷 及 口 腔 病 理 學 導 論

口腔診斷及口腔病理學導論