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Questions and Answers
What is the main function of the immune system?
What is the main function of the immune system?
Protection against infection
Which of the following is NOT a function of the immune system?
Which of the following is NOT a function of the immune system?
What are the two main branches of the immune system?
What are the two main branches of the immune system?
Which of the following is a component of innate immunity?
Which of the following is a component of innate immunity?
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What is the key characteristic of adaptive immunity?
What is the key characteristic of adaptive immunity?
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Immunodeficiency refers to an overactive immune response.
Immunodeficiency refers to an overactive immune response.
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Autoimmunity involves the immune system attacking the body's own tissues.
Autoimmunity involves the immune system attacking the body's own tissues.
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Which of the following is NOT a type of immunologic disease?
Which of the following is NOT a type of immunologic disease?
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Which type of immunodeficiency is characterized by an inborn defect in the immune system?
Which type of immunodeficiency is characterized by an inborn defect in the immune system?
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What is the most common type of primary immunodeficiency involving both B and T cells?
What is the most common type of primary immunodeficiency involving both B and T cells?
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What syndrome is characterized by a genetic abnormality of the MHC molecule?
What syndrome is characterized by a genetic abnormality of the MHC molecule?
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Oral manifestations of primary immune disorders are more common in patients with B cell abnormalities than T cell abnormalities.
Oral manifestations of primary immune disorders are more common in patients with B cell abnormalities than T cell abnormalities.
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What is often recommended for patients with primary immune disorders undergoing dental treatment?
What is often recommended for patients with primary immune disorders undergoing dental treatment?
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If a patient has a platelet count below 50,000/mm3, a platelet transfusion may be considered before dental surgery.
If a patient has a platelet count below 50,000/mm3, a platelet transfusion may be considered before dental surgery.
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Autoimmune diseases are always caused by antibodies (autoantibodies).
Autoimmune diseases are always caused by antibodies (autoantibodies).
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What is the most important and common type of autoantibodies found in rheumatoid arthritis?
What is the most important and common type of autoantibodies found in rheumatoid arthritis?
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Rheumatoid arthritis primarily affects the joints of the hands and feet.
Rheumatoid arthritis primarily affects the joints of the hands and feet.
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Which of the following is NOT a characteristic of rheumatoid arthritis?(Select all that apply)
Which of the following is NOT a characteristic of rheumatoid arthritis?(Select all that apply)
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Which of the following medications can commonly cause stomatitis?
Which of the following medications can commonly cause stomatitis?
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Sjogren's syndrome is often associated with rheumatoid arthritis.
Sjogren's syndrome is often associated with rheumatoid arthritis.
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What is the name of the butterfly-shaped rash that is often associated with lupus erythematosus?
What is the name of the butterfly-shaped rash that is often associated with lupus erythematosus?
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Lupus erythematosus primarily affects the skin.
Lupus erythematosus primarily affects the skin.
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What is the most specific diagnostic test for lupus erythematosus?
What is the most specific diagnostic test for lupus erythematosus?
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Corticosteroids are typically used in treating lupus erythematosus during disease flares.
Corticosteroids are typically used in treating lupus erythematosus during disease flares.
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What dental procedure may need to be delayed in a lupus erythematosus patient with a low absolute neutrophil count?
What dental procedure may need to be delayed in a lupus erythematosus patient with a low absolute neutrophil count?
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Scleroderma primarily affects the connective tissue and blood vessels.
Scleroderma primarily affects the connective tissue and blood vessels.
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Which of the following is NOT a major clinical manifestation of scleroderma?
Which of the following is NOT a major clinical manifestation of scleroderma?
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Which of the following is a localized form of scleroderma?
Which of the following is a localized form of scleroderma?
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What is the term for the band of sclerotic induration and hyperpigmentation that may affect an entire extremity in linear scleroderma?
What is the term for the band of sclerotic induration and hyperpigmentation that may affect an entire extremity in linear scleroderma?
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Limited cutaneous scleroderma only affects the hands.
Limited cutaneous scleroderma only affects the hands.
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What are the two main types of oral manifestations of scleroderma?
What are the two main types of oral manifestations of scleroderma?
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Scleroderma patients are often at risk for developing pathologic fractures, especially in the mandible.
Scleroderma patients are often at risk for developing pathologic fractures, especially in the mandible.
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Corticosteroids are the only treatment option for scleroderma.
Corticosteroids are the only treatment option for scleroderma.
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What is the condition that can result from calcium channel blockers and contribute to gingival hyperplasia?
What is the condition that can result from calcium channel blockers and contribute to gingival hyperplasia?
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Study Notes
Immunologic Diseases
- Immunologic diseases occur when the immune system reacts against the body's own tissues.
- Three categories exist: immunodeficiency, autoimmunity, and hypersensitivity.
- Immunodeficiency is when the immune response is ineffective. This can involve any part of the immune system malfunctioning.
- Autoimmunity is when the immune system inappropriately reacts to oneself, causing the immune system to attack healthy tissues and cells.
- Hypersensitivity is when the immune system is overactive, reacting disproportionately or attacking harmless antigens.
Immune System
- The immune system is multifaceted and protects against infection.
- It must detect antigens, generate activation signals, produce effector proteins to neutralize pathogens, and down-regulate inflammation once the foreign agent is gone.
- The immune system is divided into innate and adaptive immunity.
Innate Immunity
- Innate immunity includes first line protection, such as the skin and mucosal barriers.
- It also features circulating cells and complement proteins.
Adaptive Immunity
- Adaptive immunity is a highly specific immune response and includes antibody-mediated immunity (B cells) and cell-mediated immunity (T cells).
- It further progresses through primary and secondary responses.
Primary Immunodeficiencies
- These are inborn defects in the immune system, manifested at birth or shortly after.
Secondary Immunodeficiencies
- These occur when a previously functioning immune system is weakened by illness or treatment.
- Various components of the immune system may decrease in number or function in these conditions, leading to an increased rate of infections.
Deficiencies in Innate Immunity
- Include defects in phagocyte function, impacting chemotaxis, phagocytosis, and killing abilities.
- Lazy leukocyte syndrome: defect in the movement of immune cells.
- Chediak-Higashi Syndrome: defect in phagocytosis.
Deficiencies in Adaptive Immunity
- Include combined B-cell and T-cell defects, B-cell deficiencies, and T-cell deficiencies.
- The basic defect involves improper formation of lymphoid precursor cells, resulting in decreased B-cell and T-cell counts and function.
B & T Cell Deficiencies
- These can present as severe combined immunodeficiency, immunodeficiency with ataxia-telangiectasia, or Wiskott-Aldrich syndrome.
- Key features of each syndrome are described, including symptoms like ocular and facial telangiectasia, or frequent infections.
B-cell Deficiencies
- Characterized by a decrease in certain classes of immunoglobulins or an inability to produce a specific class (often IgA).
- Gammaglobulinemia, where the ability to produce immunoglobulins is completely lost.
T-cell Deficiencies
- Can be quantitative or qualitative.
- DiGeorge's Syndrome presents with genetic abnormality of the thymus and parathyroid glands, leading to absent T-lymphocytes response and/or hypocalcemia and tetany.
- Bare lymphocyte syndrome: genetic abnormality of MHC molecules.
Oral Manifestations of Primary Immune Disorders
- Patients with T-lymphocyte abnormalities often have more oral disease compared to B-lymphocyte disorders.
- Chronic fungal and viral infections are more common. (Chronic oral candidiasis, herpes simplex virus infections.)
- Infections may be localized or disseminated.
Dental Management (PID)
- Treatment in patients with primary immune disorders (PID) should minimize the chances of local infection.
- Antifungal therapy prior to dental treatment is crucial, especially in patients with decreased T-cell function.
Immunoglobulin Therapy
- Patients with B-cell abnormalities typically receive monthly concentrated human immunoglobulin therapy.
- Before dental treatment, the immunoglobulin levels should be checked (at least 200 mg/dL).
- Oral surgery often requires an additional dose of immunoglobulin the day before.
Blood Transfusion
- Patients with weakened immune systems often require transfusions with immunoglobulin-depleted blood to prevent antibody reactions.
- Fresh blood with destroyed lymphocytes is used to prevent graft-versus-host reactions.
Secondary Immunodeficiencies
- Include various conditions like cancer chemotherapy, stem cell transplantation, aplastic anemia, and autoimmune neutropenia.
Autoimmune Diseases
- Autoimmune diseases result from the immune system attacking its own tissues.
- A common characteristic is lymphocytic infiltration in the target organ.
- A common mechanism is a failure of peripheral tolerance systems.
Immune Tolerance
- Immune tolerance is the ability of the immune system to recognize and not react to self-antigens.
- Central tolerance happens in the thymus and bone marrow, while peripheral tolerance occurs in lymph nodes and tissues.
- This process involves deleting self-reactive lymphocytes and inducing anergy (inactivity).
Terminologies
- Autoimmune disease: Reaction against self-antigens.
- Autoimmune tissue disease: Involves connective tissue.
- Collagen disease: Involves collagen.
- Collagen vascular disease: Involves blood vessels.
- Hyperimmune disease: Hyperactivity of the immune system.
- Immune complex: Ag-Ab connection leads to complement fixation.
Rheumatoid Arthritis (RA)
- RA is a symmetric polyarthritis, often affecting small and large joints.
- Synovial tissue and cartilage are the target organs.
- Rheumatoid factor (RF) is a common autoantibody associated with RA.
- RA frequently involves extra-articular tissues and organs, including muscles and the hematopoietic system.
- RA mainly affects women from 30-50 years of age.
Clinical Manifestations of RA
- Typical signs include redness, swelling, and warmth in joints, along with potential muscle atrophy.
- Joint destruction and deformity can occur over time.
- Subcutaneous nodules, swan-neck deformities, cervical spine disease, and spinal cord compression may be present.
Medical Treatment and Side Effects
- Medications like methotrexate, NSAIDs, and penicillin can cause stomatitis.
- Minocycline can cause oral hyperpigmentation.
- Cyclosporine can lead to gingival overgrowth.
- Prednisone or TNF-alpha blocking therapy may predispose patients to opportunistic infections.
Lupus Erythematosus (LE)
- LE is an autoimmune inflammatory disorder.
- It can present as systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE).
- SLE involves various body systems, while DLE is confined to the skin and mucosa.
- Common associated factors may be genetic or viral infection.
Lupus (SLE) Symptoms
- Patients with SLE can have skin symptoms, like butterfly rashes (characteristic), bulli, erythematous papules, annular-polycystic eruptions, chronic cutaneous lupus (affecting skin, face) and/or non-specific cutaneous lesions as alopecia, Photosensitivity, Urticaria, Erythema, Telangiectases, and cutaneous vasculitis.
- Common oral symptoms include discoid lesions (whitish striae radiating from erythematous areas), oral ulcerations (non-specific), and symptoms of generalized symptoms (rigid lips, narrow mouth aperture, Mask-like face due to skin fold loss).
- Systemic manifestations can include renal problems (Proteinuria, glomerulonephritis), musculoskeletal problems (arthritis, myalgia, and myositis), central nervous system issues (cerebral vasculitis, psychosis, strokes, and seizures), and cardiovascular problems (vasculitis and pericarditis).
Diagnosis
- Lupus band test is a diagnostic test showing immunoglobulin and C3 deposits in basement membrane zones.
- Antinuclear antibodies (ANA) are major diagnostic markers in LE.
Treatment
- Corticosteroids are the cornerstone of SLE treatment, particularly helpful for flares.
- Immunosuppressive drugs are also used.
Dental Management for LE
- Risk of infection—complete blood count (CBC) should indicate a normal white blood cell count prior to elective oral procedures if procedures have a potential for bacteremia. ANC should be near 1000 cells/mm3. Prophylactic antibiotics might be recommended.
- Risk of bleeding —Platelet transfusion should be administered for surgical patients who have a prior platelet count lower than 50,000/mm3. The INR value should be checked before any oral procedures.
- Adrenal suppression—supra-physiologic doses of corticosteroids (7.5mg/day or higher prednisone for 2 weeks or longer is at risk for adrenal suppression).
Scleroderma
- Scleroderma is a disease that affects connective tissue and blood vessels.
- Leads to fibrosis and tightening of skin and mucosa.
- There are various types including progressive systemic scleroderma (with multiple organ involvement) and localized scleroderma (with minimal organ involvement). Clinical subtypes include linear, morphea, en coup de sabre morphea.
- Etiology is complex, likely comprising genetic factors, chemical exposure, or viral infection.
- Results in vascular damage and extracellular matrix changes, narrowing small arteries.
Scleroderma Symptoms
- Progressive systemic fibrosis affects skin and organs with various symptoms. Localized varieties like linear morphea mainly impact skin.
Clinical Manifestations of Scleroderma
- Progressive systemic scleroderma causes progressive skin thickening and fibrosis. Localized types (linear and morphea) affect the skin in specific areas, including limbs and face.
Dental Management of Scleroderma
- The most common problem in dental treatments is the limited oral aperture and tongue rigidity.
- Increasing opening can be done through stretching exercises of the mouth, and tongue blade technique between posterior teeth to help stretch facial tissues.
- Specialized toothbrush handles are advisable for patients with grip issues.
- Evaluating heart, lung, and kidney involvement is essential before, during, and after dental treatment.
- Patients with significant mandibular angle resorption are at risk for fractures.
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Description
Explore the complexities of immunologic diseases, including immunodeficiency, autoimmunity, and hypersensitivity. Learn about the functions of the immune system and its two main types: innate and adaptive immunity. This quiz will help solidify your understanding of how the immune system protects the body.
