1. Concepts of the Pathologic Process
Lecture #2

2. Etiology Single or multi-factorial etiology.
Must find the etiology. Otherwise: only signs and symptoms of the disease can be treated
extrinsic (of external origin), intrinsic (of internal origin), or a combination of both.
psychogenic
Idiopathic

3. Table 2.1 Extrinsic and Intrinsic Causes and Examples
Category
Examples
Extrinsic
Pathologic organisms
Bacteria, virus, protozoa, fungus
Physical agents
Temperature, electricity, radiation
Chemical agents
Poison, acid, venom, drugs
Mechanical injury
Gunshot wound, motor vehicle accident
Nutritional
Deficiency—scurvy, rickets Excess—obesity
Iatrogenic
Infective endocarditis, hospital staphylococcus infection
Intrinsic
Genetic
Sickle cell disease, cystic fibrosis, some types of breast cancer
Immunologic
Autoimmune—systemic lupus erythematosus Hypersensitivity—allergies Immunodeficiency—acquired immunodeficiency syndrome
Degenerative
Osteoporosis, osteoarthritis

4. Psychogenic etiology: a disease state that is brought on by conscious or subconscious reactions or attitudes.
Idiopathic etiology: the causative agent or event of the disease has not been discovered.
Multifactorial: when there is more than one causative factor.
=> May be a combination of extrinsic and intrinsic features. Heredity must be considered.

5. Resistance and Susceptibility
Resistance: is the natural ability of an organism to remain unaffected by pathogenic or toxic agents.
Susceptibility: conditions within or around the organism or host that do not inhibit the action of pathogenic agents

6. Resistance Major Groups of Risk Factors
Genetic: limited genetic lineage
Immune system dysfunction
Compromised first line defenses
Age: Osteoporosis
Lifestyle:
Stress:
Environment: Second hand smoking, Heat/cold, Deprived/ less sun exposure
Pre-existing conditions: Diabetes, High blood pressure

7. Increased blood flow to the heart Increased blood pressure
Box 2.2 Physiologic Responses to Stress:
Increased blood flow to the heart
Increased blood pressure
Decreased blood flow to the extremities and to the stomach
Airways dilate to increase oxygen supply to blood
Increased amount of glucose available for energy
Increased mental alertness
Decreased unnecessary body functions such as digestion
Inhibition of some immune system cell functions
Increased fat generation and retention in the cells of the face and trunk

8. Pathogenesis
The sequence of events during which cells or tissues respond to an etiologic agent .
Usually the same from individual to individual.
The pathogenesis of a disease may be very specific for that disease or it may be similar to that of other diseases or conditions.

9. The incubation period: the time in which the disease is developing but there are no overt signs or symptoms.
A sign: is an objective observation usually made by a clinician. Examples: fever.
A symptom: is a more subjective report of what a client is feeling. Examples: fatigue.

10. A manifestation: is an observable or quantifiable characteristic associated with a specific type of pathology. Includes: signs, symptoms, results of laboratory tests, radiographs, …etc.
A latent period: is a time during disease development when there are no overt manifestations of the disease, although the disease can be found by using other means such as laboratory tests or radiographs. Example: herpes simplex.

11. Primary infection:
Exacerbation: the worsening of a disease condition. Example: spicy foods and oral ulcer.
Resolution: occurs when the affected individual or part returns to normal.
A sequela of a disease: is a condition or pathology that occurs as a result of that disease.
Morbidity: the illness or disability associated with a disease.
Mortality: death.

12. A complication: an additional disease process or condition occurring at the same time and resulting from the conditions associated with the first disease process.
Example: a bacterial sinus infection and cold.
A relapse: flare-up of a disease, occurs weeks or months after the pathology was thought to be gone.
The prognosis: an estimate of the most likely outcome of a disease, such as the likelihood that the individual will survive or that the pathology will resolve.
Prognosis is based on many factors.

13. Disease Manifestations
Reversible injury and Cellular adaptation
Irreversible injury

14. Cellular adaptation
Changes inside the cell or in the area surrounding the cell can occur as a result of normal or pathologic processes

15. Atrophy
Decrease in the size and function of a cell, tissue, or organ, caused by one or more of the following conditions: reduced functional demand, hormonal stimulation, nutrient supply (including oxygen/ ischemia, ), and/or the normal process of aging.

16. Hypertrophy
Hypertrophy is the enlargement of individual cells leading to an increase in the size of the tissue or organ and is commonly caused by increased functional demand or hormonal stimulation.
weight lifting

17. Hyperplasia Hyperplasia: an increase in the number of cells
in a tissue or organ, which results in enlargement
of that part.
As the result of:
excessive hormone stimulation
chronic cell injury
extensive cell death
Hyperplasia often occurs in conjunction with hypertrophy in tissues that are able to replicate.

18. Metaplasia
Metaplasia: the conversion of one differentiated cell type to another.
This is an adaptive process
dysplastic and even neoplastic changes have been observed in areas of metaplastic change
EXAMPLES:
Smokers’ bronchial epithelium.
GERD

19. Dysplasia Creation of abnormal cells from normal cells
controversy : what will happen if the stimulus that caused the dysplasia is removed?
premalignant condition
Classified as: mild, moderate, or severe
The abnormalities include:
changes in cell size and shape
nuclear changes
irregular cell arrangement

20. Neoplasia
Pathologic new growth of cells (not adaptive).

21. Intracellular Retention of Substances
cells may retain or store certain normal/path substances
adaptive process
Hepatitis A infection

22. Irreversible Cell Injury
cell death
1.apoptosis:
Cellular self-destruction
2.necrosis
Caseous necrosis: e.g.lungs(TB)
Coagulative necrosis: e.g.ischemia/ myocardial infarction
Liquefactive necrosis/ dental abscess

23. Necrosis
Caseous necrosis: is specific to the lesions found in the lungs of individuals with tuberculosis
Coagulative necrosis: occurs primarily when there has been cell hypoxia or ischemia, as in a myocardial infarction
Liquefactive necrosis: occurs when the body is dealing with a bacterial infection, especially by staphylococci and streptococci.
 Abscess formation: an accumulation of dead
cells, dead bacteria, and dead and dying white
blood cells.

24. ABUSE

25. DEFINITION Child Abuse is the non-accidental,
physical, mental, emotional, or sexual
trauma exploitation or neglect endured by a
Child younger than 16 years of age while
under the care of a responsible person.

26. DH ROLE DENTAL HYGIENISTS required by
law in Canada to report suspected cases of
child abuse
BASED ON REASONABLE GROUNDS
-FINED IF MALICIOUS OR NOT BASED ON REASONABLE GROUNDS

27. Types of Abuse
Physical
Sexual
Neglect
Psychological

28. SIGNS *Physical: Bruises, Bone injury, Burns, Bites, Death
*Sexual: Withdrawn, Anxious, Bleeding,
Knowledgeable sexual matters, ”Soul murder”
*Neglect: Dental, medical, malnutrition, death
*Psychological: Child angry, staring, aggressive, Anxious, Eye contact failure.

29. INDICATORS *Child: Complaint specific *Care-Givers: Contradict
*Story: Not consistent
Care-giver: Injury self inflicted
Illogical ----child’s age makes it impossible

30. The offender
Parents Relatives Care-Givers Boyfriends (girlfriends) Baby Sitters Places of worship

32. Physical abuse Unexplained bruises and welts Unexplained burns
Unexplained fractures or dislocations
Bald patches on scalp

33. ACCIDENTAL

34. DELIBERATE

36. EXAMPLES of neglect
CHILDHOOD CARIES MEDICAL NEGLECT -- Child ill or injured: No medical contact MULTICULTURAL SENSITIVITY

37. Sexual Abuse

38. Forced oral sex

39. Condyloma acuminatum

40. STD
Condyloma acuminatum Gonorrhea Syphilis Herpes 2 - All STD’s can have oral signs. -- Duty of reporting

41. ACCUSED OF CHILD ABUSE! Do not confuse sexual abuse with…..
Mongolian spot Birth-mark
Ehlers-Danlos Syndrome
Acute Myelocytic Leukemia