Healing Of Oral Wounds
Question.1. Enumerate various factors which promotes the healing process. Describe the healing of an extraction socket.
Answer. Healing is defined as restoration to a normal, mental or physical condition, especially of inflammation and wound.
Factors which promotes the healing process
- Localization of wound:
Wounds in the area in which there is good vascular bed healing helps in rapid healing of wound. - Physical factors:
- Mild traumatic injury favors the healing process.
- Local temperature in the area of wound influences the rate of healing by its effect on local circulation and cell multiplication.
- Circulating factors:
Good blood supply of wound tissues promotes healing process. - Nutritional factors:
- Presence of protein enhances the speed of wound healing.
- Presence of vitamin C accelerates the rate of wound healing process.
- Vitamin A and D accelerates the wound healing.
- Vitamin B complex promotes wound healing.
Read And Learn More: Oral Pathology Question And Answers
- Age of patient:
Wounds in younger patients heal rapidly due to increased circulatory insufficiency and presence of protein synthesis.
Infection:
A wound which is exposed to mild physical irritation or expose to bacteria heals quickly.
Healing Process Of An Extracted Socket
Immediate reaction following an extraction:
After the removal of a tooth, blood which fils in the socket coagulates, red blood cells get entrapped in the firin meshwork and the ends of blood vessels in periodontal ligament are sealed off
Healing in First Week
- There is proliferation of firoblasts from connective tissue and these firoblasts grow into a clot.
- There is endothelial proliferation which shows capillary growth.
- During, this period blood clot begins to undergo organization by ingrowth of firoblasts and occasionally by small capillaries from residual periodontal ligament.
- Crest of alveolar bone shows beginning of osteoclastic activity.
Second Week Wound Healing
- During this period, remnants of PDL gradually undergo degeneration.
- Wall of bony socket appears slightly frayed.
- Margins of alveolar socket exhibits prominent osteoclastic resorption and fragments of necrotic bone are seen in the process of resorption or sequestration.
Third Week Wound Healing
- The clot is completely organized by maturation of granulation tissue.
- New uncalcified bone is formed around the periphery of wound from the socket wall.
- Original cortical bone of alveolar socket undergoes remodeling.
- Crest of alveolar bone is rounded of by osteoclastic resorption.
Fourth Week Wound Healing
- There is continuous deposition, remodeling, and resorption of the bone filling in alveolar socket.
- Due to absorption of alveolar crest bone filing of the socket does not extend beyond the alveolar crest.
Question.2. Describe the healing of an extraction socket wound and complications of wound healing.
Answer.
Complications of Wound Healing
- Infection: Wounds may provide a portal entry to microsomal infections which delay the healing process.
- Keloid and hypertrophic scar formation: Keloids are the overgrowth scar tissues with no tendency for resolution.
They occur in wounds which heal without any complication.
Hypertrophic scars occur in wounds where healing is delayed. - Pigmentary changes: These are common in healing of wounds on skin and appear as hypopigmented or hyperpigmented areas, e.g. lichen planus and lichenoid reactions.
- Cicatrization: It refers to late reduction in the size of the scar in contrast to immediate wound contraction. It is complication due to burns of skin.
- Implantation cyst: Epithelial cells may slide or get entrapped later in the wound and later may proliferate to form implantation cyst.
- Healing after pulpal diseases: It depends upon the degree of infection, inflammation, amount of the pulpal tissue involved and age of the patient.
Healing after periapical diseases: It may result in the formation of firosis in the involved area.
Question.3. Write short note on dry socket.
Or
Write note on dry socket.
Or
Write short answer on dry socket.
Answer. It is also known as “Alveolitis Sicca Dolorosa” or alveolalgia or postoperative osteitis or localized acute alveolar osteomyelitis or alveolar osteitis.
- Dry socket is the common complication in healing of the extraction wound.
- It commonly occurs in the mandibular or molar areas.
- Dry socket is a very painful condition and the patient often has a foul breath.
- Clinical examination reveals a socket devoid of clot and bony walls of socket are bare and visible.
- Histological section of socket bone reveals formation of necrotic bone containing empty lacunae.
- There is balance inflammatory reaction in surrounding bone.
- Zinc oxide eugenol pack is given in the socket for palliative reaction.
Question.4. Describe the healing of fracture wound and complications in healing of the fracture.
Answer.Healing of fracture wound
1. Immediate effect of a fracture
- After fracture haversian vessels of bone are torn at the fracture site so the vessels periosteum and marrow cavity cross the fracture line.
- There is considerable extravasation of blood in fractured area but at the same time, there is lack of circulation and loss of blood supply.
- Due to disruption of blood supply and tearing of blood vessels there is death of bone marrow adjacent to fracture line.
- Blood clot which forms plays an important role in healing of fracture through replacement by granulation tissue and its subsequent replacement of bone.
2. Callus formation
- It is the structure which unites the fracture end of bone and consists of firous tissue, cartilage and bone.
- There are two types of callus:
1. External callus: It consists of new tissue which forms around the outside of two fragments of bone.
2. Internal callus: It consists of new tissue arising from the marrow cavity.
- Periosteum is an important structure in callus formation and ultimate healing of the fracture.
- Cells of the periosteum torn at the fracture line usually die but peripheral to the area there is a flurry cellular activity within hours of injury.
- The fibrous layer of periosteum is inert and lifted away from the surface of bone by proliferation of cell in osteogenic layer of periosteum which assumes features of osteoblasts which, in turn, begins the formation of small amount of new bone at some distance from the fracture site.
- There is continuous proliferation of osteogenic cells forming collar of callus over the surface of fracture.
- New bone which begins to form an external callus consists of irregular trabeculae.
- This differentiation of cells into osteoblast and subsequent formation of bone occurs in deepest part of callus collar.
- In rapidly growing area of collar, osteogenic layer differentiates into chondroblasts rather than osteoblast and forms cartilage.
- The cartilage fuses with bone and begins to calcify by endochondral bone formation. The calcified cartilage is gradually resorbed and replaced by the bone.
- Shortly after the fracture endosteum proliferates within the week to form new bone which unites and establishes the continuity of bone.
- After this bone external and internal callus remodel to form indistinguishable bone.
Complications
- Delayed union and nonunion of the fragments of bones are the complications of the healing process. They result when the calluses of osteogenic tissue over each of two fragments fail to meet and fuse.
- Local infection and presence of foreign bodies
- Fibrous union in fracture arises usually as a result of lack of immobilization of damaged bone.
- Lack of calcification of newly formed bone in the callus may occur.
Question.5. Write note on biopsy.
Or
Write short note on biopsy.
Answer. Biopsy is the removal of tissue from the living organism for the purpose of microscopic examination and diagnosis.
Types Of Biopsy
- Excisional biopsy: If a lesion is totally excised for histological evaluation it is called as excisional biopsy.
- Incisional biopsy: When only a small section of tissue is removed from the lesion for the purpose of histological evaluation it is called incisional biopsy.
- Fine needle aspiration cytology (FNAC): It is done by aspirating tissue material inside a lesion which is later on diagnosed microscopically after preparing a smear.
- Frozen section biopsy: It is performed in order to get an immediate histological report of a lesion.
The tissue is obtained from the lesion and is kept in deep freeze and then frozen tissue is sectioned and stained to get a prompt diagnosis. - Punch biopsy: A small cylindrical punch is applied to the lesion through full thickness of skin and a plug of tissue is removed.
Biopsy Procedure
- Area of wound from where the biopsy is taken and cleaned fist.
- Area is anesthetized.
- Most representative site of wound is identified.
- A section of tissue from the identified site of wound is removed.
- Tissue is cleaned and put into 10% formalin solution for fixation.
- Biopsy site is sutured after achieving hemostasis.
- Biopsy specimen is sent to the histopathologist for diagnosis after labeling it properly.
Question.6. Write note on exfoliative cytology.
Or
Write in brief about exfoliative cytology
Answer. Exfoliative cytology is the microscopic study of cells obtained from the surface of an organ or lesion after suitable staining.
Procedure Of Exfoliative Cytology
- Surface of lesion is cleaned by removing all debris and mucins.
- Gentle scrapping is done on the surface of lesion with metal cement spatula or a moistened tongue blade for several times.
- Thus material present on the surface of lesion are adhered or collected at the border of instrument.
- The collected material is then evenly spread over a microscopic slide and is immediately filled with 95% of alcohol.
- The slide is then air dried and is stained by a special stain called as PAP stain (Papanicolaou stain).
Findings in exfoliative Cytology
Class I (Normal): It indicates that only normal cells are present in the smear.
Class II (Atypical): It indicates the presence of minor cellular atypia.
Class III (Intermediate): This is an in between cytology that separates cancer from noncancer diagnosis, the cells which display wider atypia are suggestive of cancer.
Biopsy is recommended for further diagnosis.
Class IV (Suggestive cancer): It indicates that in the lesion there is presence of few cells with malignant characteristic. Biopsy is mandatory.
Class V (Positive of cancer): The cells exhibit defiite features of malignancy. Biopsy is mandatory.
Indication Of Exfoliative Cytology
The exfoliative cytology is establishing in diagnosis of following oral lesion:
- Herpes simplex and herpes zoster
- Pemphigus vulgaris
- Pemphigoid
- Squamous cell carcinoma
- Aphthous ulcer.
Question.7.Defie biopsy. Enumerate indications and contraindications of biopsy.
Answer. Biopsy is the removal of tissue from the living organism for the purpose of microscopic examination and diagnosis.
Indications
- Lesions that cannot be diagnosed by clinical and radiological examination.
- Lesions which does not respond to treatment
- For confirmation of precancerous conditions and lesions
- Lesions which exhibit rapid growth, paresthesia or loss of function.
Contraindications
- Acute inflammatory condition such as cellulitis
- Normal anatomical variations such as linea alba
- Patients with bleeding disorders such as hemophilia
- Vascular lesions such as hemangioma
- Patients who are on anticoagulant therapy.
Question.8. Write about healing of oral cavity injuries.
Answer. When the cut surfaces of the oral cavity injuries be approximated or closely sutured, the wound heals up by primary intention. The process occurs in the following way:
Healing By Primary Intention
- In healing by primary intension, wound edges are approximated by surgical sutures.
- In the initial phase, there will be formation of blood clot, which helps to hold the parts of the wound together.
- The tissue becomes edematous and an inflammatory process starts, with the infiltration of polymorphonuclear neutrophils (PMN) and lymphocytes into the area.
- The tissue debris collected in the wound are cleared either by the process of phagocytosis or by their lysis with the help of proteolytic enzymes, liberated by the inflammatory cells.
- Once the tissue debris are cleared, granulation tissue forms that replaces the blood clot in the wound, and it usually consists of young blood capillaries, proliferating firoblasts, PMN and other leukocytes.
- The epithelium at the edge of the wound starts to proliferate and gradually it covers the entire wound surface.
- Finally, the healing process is complete with progressive increase in the amount of dense collagen bundles and decrease in the number of inflammatory cells in the area.
Healing By Secondary Intention
- When the opposing margins of the wound cannot be approximated together by suturing, the wound fills in from the base with the formation of a larger amount of granulation tissue, such type of healing of the open wound is known as healing by “secondary intention” or “secondary healing”.
- Secondary healing occurs essentially by the same process as seen in the primary healing, the only difference is that a more severe inflammatory reaction and an exuberant fibroblastic and endothelial cell proliferation occur in the later.
- In secondary healing, once the blood clot is removed, the granulation tissue fils up the entire area and the epithelium begins to grow over it, until the wound surface is completely epithelized.
- Later on, the inflammatory exudates disappear slowly and the firoblasts produce large amounts of collagen.
- Most of the healing processes occurring due to secondary intention, result in scar formation at the healing site.
However, in the oral cavity these are rare.
Question.9.Enumerate the different techniques for biopsy taking.
Describe in detail exfoliative cytology.
Answer.
Enumeration Of Different Techniques For Biopsy Taking
- Excisional biopsy
- Incisional biopsy
- Intraosseous biopsy
- Punch biopsy
- Frozen section biopsy
- Oral brush biopsy or Oral CDX test
- Fine needle aspiration cytology
Question.10.Write short note on factors affecting healing of wound.
Answer. Following are the factors affcting wound healing:
- Localization of wound
Wounds in the area in which there is good vascular bed heal helps in rapid healing of wound. - Physical factors
- Mild traumatic injury favors the healing process.
- Local temperature in the area of wound influences the rate of healing by its effect on local circulation and cell multiplication.
- Circulating factors
Good blood supply of wound tissues promotes healing process. - Nutritional factors
- Presence of protein enhances the speed of wound healing.
- Presence of vitamin C accelerates the rate of wound healing process.
- Vitamins A and D accelerate the wound healing.
- Vitamin B complex promotes wound healing.
- Age of patient
Wounds in younger patients heal rapidly due to increased circulatory insuffiency and presence of protein synthesis. - Infection
A wound which is exposed to mild physical irritation or expose to bacteria heals quickly. - Radiation
Low dosages of ionizing radiation stimulate the healing while large doses suppress the healing. UV radiation facilitates the healing. - Hormonal factors
Adrenocorticotropic hormone and cortisone interfere with the healing process.
Patients receiving these hormones the growth of granulation tissue is inhibited due to inhibition of fibroblast proliferation, angiogenesis and decreasing of inflammatory reaction.
Diabetes mellitus is the most common disease in which healing is hindered after surgical procedures.
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