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Questions and Answers

What is the estimated annual cost in the UK for three specific autoimmune diseases?

£15 billion

£10 billion

£13 billion (correct)

£8 billion

Which of the following is an example of an organ-specific autoimmune disease?

Rheumatoid arthritis

Systemic lupus erythematosus

Multiple sclerosis

Thyroiditis (correct)

Which of the following treatments is considered an immunosuppressant for autoimmune diseases?

Both B and C (correct)

Mycophenolate

Ibuprofen

Prednisolone

What is a common consequence of autoimmunity regarding patients' daily lives?

Lost opportunities in work and life Signup and view all the answers

What role might the immune response play in severe acute illness related to Covid-19?

It may contribute to destructive immune responses Signup and view all the answers

Which of the following conditions is most commonly associated with an increased incidence of malignancy in immunocompromised patients?

IgA deficiency Signup and view all the answers

What kind of oral complications may patients taking immunosuppressant drugs experience?

Increase in oral cancer risk Signup and view all the answers

Which autoimmune disease specifically targets the pancreas?

Type 1 diabetes Signup and view all the answers

What is a common oral manifestation in patients taking ciclosporin?

Gingival swelling Signup and view all the answers

What role do dental care professionals play in the management of patients with immunodeficiency?

Risk assessment and coordination with physicians Signup and view all the answers

Which of the following conditions is NOT typically associated with immunocompromised status?

Regular physical exercise Signup and view all the answers

What mechanism is primarily responsible for autoimmune diseases damaging healthy tissue?

Autoantibodies attacking healthy cells Signup and view all the answers

Which of the following is a common consequence of secondary immunodeficiency?

Increased susceptibility to infections Signup and view all the answers

What is the primary characteristic of hypersensitivity reactions?

An overactive immune response resulting in tissue damage Signup and view all the answers

Which type of antibody is predominantly involved in Type I hypersensitivity reactions?

IgE Signup and view all the answers

What distinguishes autoimmunity from other immune reactions?

A failure to recognize self-antigens Signup and view all the answers

What is a common cause of immunodeficiency?

Genetic mutations affecting immune cell function Signup and view all the answers

Which of the following best describes a Type I hypersensitivity reaction?

Rapid onset and can involve severe systemic responses Signup and view all the answers

What is a consequence of mast cell degranulation in hypersensitivity reactions?

Release of histamine and other mediators causing inflammation Signup and view all the answers

Which type of hypersensitivity can lead to systemic reactions such as anaphylaxis?

Type I hypersensitivity Signup and view all the answers

How can autoimmune diseases manifest in the oral cavity?

Altered taste perception and dry mouth Signup and view all the answers

Which of the following factors can lead to the breakdown of tolerance to self-antigens?

Emergence of normally hidden antigens Signup and view all the answers

What is one way in which autoimmune reactions may occur when a foreign substance resembles the body?

Antibodies attacking own heart muscle due to similarities with streptococcal proteins Signup and view all the answers

Which condition is likely to be induced by the drug hydralazine?

Drug-induced lupus Signup and view all the answers

What is a common symptom of autoimmune diseases?

Joint pain and swelling Signup and view all the answers

How does a virus alter normal body cells in the context of autoimmunity?

By altering their structure so the immune system sees them as foreign Signup and view all the answers

Which test specifically looks for antibodies attacking cell nuclei in suspected autoimmune diseases?

Antinuclear antibody test Signup and view all the answers

What general demographic is more affected by autoimmune diseases?

Women, constituting over 85% of cases Signup and view all the answers

What is the purpose of measuring the erythrocyte sedimentation rate in the context of autoimmune diseases?

To indirectly measure the level of inflammation Signup and view all the answers

What characterizes a Type II hypersensitivity reaction?

Mediated by complement system or killer cells Signup and view all the answers

Which of the following is a common example of a Type III hypersensitivity reaction?

Systemic lupus erythematosus Signup and view all the answers

In a Type IV hypersensitivity reaction, which is the primary mechanism of damage?

Release of cytokines due to T cell activation Signup and view all the answers

Which of the following allergies should be assessed in atopic individuals during dental treatment?

Benzocaine topical anaesthetic allergy Signup and view all the answers

What distinguishes primary immunodeficiency from secondary immunodeficiency?

Primary immunodeficiency is genetically determined Signup and view all the answers

What is a significant characteristic of Type I hypersensitivity compared to other types?

It typically involves IgE antibodies and quick reactions Signup and view all the answers

Phagocyte disorders fall under which category of immunodeficiency?

Innate immunodeficiencies Signup and view all the answers

What is a common treatment approach for severe allergic reactions not controlled by avoidance of triggers?

Immunotherapy Signup and view all the answers

Which of the following is NOT a feature of Type III hypersensitivity?

Typically causes rapid allergic reactions Signup and view all the answers

What role does the complement system play in Type II hypersensitivity reactions?

Mediates the agglutination of red blood cells Signup and view all the answers

What is a common oral manifestation seen in autoimmune diseases?

Systemic lupus erythematosus Signup and view all the answers

What type of immune response leads to autoimmunity?

Faulty innate or adaptive immune response Signup and view all the answers

Which condition is NOT listed as an example of autoimmune diseases with oral manifestations?

Celiac disease Signup and view all the answers

Which action is crucial for dental care professionals to ensure patient safety?

Take a comprehensive medical history at each visit Signup and view all the answers

What does Sjögren syndrome primarily affect?

Salivary and lacrimal glands Signup and view all the answers

What is a significant component of the immune system's protective role?

Defending against pathogens Signup and view all the answers

In autoimmune diseases, what can an overactive immune response result in?

Hypersensitivity reactions Signup and view all the answers

Which of the following is indicative of an ineffective immune response?

Immunodeficiency disorders Signup and view all the answers

Study Notes

Immune Disorders

Module: Biomedical Sciences
Tutor: Ms P Lazarou
Topic: Immune Disorders

GDC Learning Outcomes

Explain the impact of medical and psychological conditions in the patient
Aim: Gain an overview of general immune disorders affecting the population and contextualise to oral manifestations

Intended Learning Outcomes

Discuss immunopathology (diseases of the immune system), including hypersensitivity reactions, autoimmunity, and immunodeficiency.
Define hypersensitivity and outline the various types of hypersensitivity.
Define immunodeficiency and outline the causes.
Define autoimmune disease and discuss its impact.
Relate how autoimmune disease manifests in the oral cavity.

Assessment

Formative assessment: Questions related to the subject in Biomedical Sciences online quiz.
Summative assessment: Questions incorporated in Biomedical Sciences eassessment.

Immunopathology

If the innate or adaptive immune response becomes faulty, illness or disease can develop.
Hypersensitivity: Overactive immune response.
Immunodeficiency: Ineffective immune response.
Autoimmunity: Inappropriate reaction to self.

Hypersensitivity

Hypersensitivity: An excessive immune response causing tissue damage when the body encounters an antigen for the second or subsequent times.
- Type I: Allergen-mediated, rapid onset (within an hour). IgE-mediated.
  - Mediators: IgE-mediated.
  - Onset: Within 1 hour.
  - Examples: Anaphylaxis, Hemolytic Anemia
- Type II: Cytotoxic, develops between 2-24 hours. IgG or IgM-mediated.
  - Mediators: IgG or IgM cytotoxic.
  - Onset: Hours to days.
  - Examples: Hemolytic reactions during transfusion of incompatible blood, some drug reactions, autoimmune anemias.
- Type III: Immune complex-mediated, develops over hours, days, or weeks. IgG and IgM-mediated.
  - Mediators: Immune complex-mediated.
  - Onset: 1-3 weeks.
  - Examples: Systemic lupus erythematosus, serum sickness, rheumatoid arthritis.
- Type IV: Cell-mediated, develops in 2 or more days. Antibody-independent.
  - Mediators: Cytokines released by T cells and macrophages.
  - Onset: Days to weeks.
  - Examples: Prolonged inflammation, cell death, tissue damage.

Type I Hypersensitivity Reaction

Most common type of hypersensitivity reaction.
Rapid onset (within one hour).
Provoked by re-exposure to specific antigens (allergens).
High IgE levels secreted by plasma cells bind to receptors on mast cells and basophils, sensitizing them.
Subsequent allergen exposure triggers IgE molecule binding and mast cell degranulation, releasing mediators (e.g., histamine).

Type I cont...

Reactions can be localized or generalized.
Systemic reactions can be life-threatening (e.g., penicillin, bee stings)
Local reactions: hay fever, extrinsic asthma, urticaria.
Triggers: pollen, animal fur, dust mites, mold, some foods.
Treatment: Avoidance of triggers, pharmacological intervention, immunotherapy (severe cases).

Type II Hypersensitivity Reaction (Cytotoxic)

Rare.
Develops within 2-24 hours.
IgG and IgM antibodies bind to cell surfaces.
Mediated by complement system or killer cells.
Results: Opsonization, red blood cell agglutination, cell lysis.
Examples: Hemolytic reactions, some drug reactions, autoimmune anemias.

Type III Hypersensitivity Reaction (Immune Complex Mediated)

Develops over hours, days, or weeks.
IgG and IgM antibodies bind to free, soluble antigens forming immune complexes.
Lodged and pass through blood vessel walls.
Lead to complement activation (inflammatory, tissue-damaging reactions).
Neutrophil influx, mast cell degranulation.
Examples: SLE, serum sickness, rheumatoid arthritis.

Type IV Hypersensitivity Reaction (Cell-mediated)

Second most common type.
Develops in 2 or more days.
Cell-mediated; antibody-independent.
Caused by overstimulation of T cells and monocytes/macrophages.
Leads to cytokine release causing inflammation, cell death, and tissue damage.
Prolonged inflammation damage normal tissues.
Mitigated by trigger avoidance and corticosteroids.

Dental Implications

Atopic individuals: Check for latex and chlorhexidine allergies.
Benzocaine, Sodium metabisulphite (in LA), Dentine bonding agent allergies.
Contact dermatitis.
Additional information during medical emergencies session.

Immunodeficiency

Compromised or absent immune system response to infectious diseases.
- Primary immunodeficiency
- Secondary immunodeficiency

Primary immunodeficiency

Genetic origin.
- B-cell immunodeficiencies
- T-cell immunodeficiencies
- Phagocyte disorders
- Complement defects
Severe combined immunodeficiencies (SCID)

Primary Immunodeficiencies

Genetically determined.
Rare.
Classified according to immune defect (e.g., IgA deficiency, Severe combined immunodeficiency, complement deficiencies, granulocyte defects).
Increased incidence of malignancy and autoimmune disease.
Associated with Down syndrome and advanced periodontal disease.

Secondary Immunodeficiency

Acquired conditions.
- Malnutrition
- Chronic infections
- Drug regimens

Oral Implications of Immunosuppressant Drugs

Oral candidiasis.
Higher incidence of bacterial infections.
Viral infections (e.g., herpes simplex, zoster).
Periodontal disease.
Gingival swelling (with ciclosporin).
Oral ulceration.
Poor healing.
Increased risk of malignancy

Immunocompromised Patients

Examples from the presented list :

Poorly controlled diabetes.
HIV infection.
Malignancies (e.g., Hodgkin disease, leukemia, lymphoma, multiple myeloma).
Malnutrition (iron and vitamin deficiencies).
Anemia.
Spleen removal.
Vitamin D deficiency.
Kidney failure.
Sickle cell disease (leads to spleen dysfunction).

Periodontal Destruction

The balance between host defense and bacterial challenge impacts periodontal health.

Dental Care Professional Role

Risk assessment, including full medical histories
Physician liaison
Antibiotic cover (as needed).
Prevention (of infection).
Aggressive treatment for oral infections.
Good infection control (e.g., dental unit water lines).
Risk assessment for post-operative bleeding if patient takes immunosuppressants.
Close monitoring and follow-up.

Autoimmune Disease

Chronic, progressive disorder.
Healthy tissues are targeted and destroyed by the body's immune system.
Normally, the immune system can distinguish between foreign cells and body cells (tolerance).
In autoimmune disease, the immune system mistakenly attacks body tissues, releasing autoantibodies that attack healthy cells.
Some diseases target specific organs (e.g., Type 1 diabetes damages the pancreas), while others affect the whole body (e.g., systemic lupus erythematosus).

Autoimmunity

With age, natural T-cell suppression decreases and self-antigens may be mistaken as foreign.
Other factors leading to autoimmunity:
- Emergence of hidden antigens.
- Infections (especially viral infections).
- Drugs (e.g., penicillin-induced hemolytic anemia, hydralazine-induced lupus).
- Genetics.
- Endocrinological changes.

Autoimmune Disorder

Immune system reacts against self-molecules, causing damage to tissues and cells.

Autoimmune Reactions

Foreign substances or microbes resembling body components can trigger an autoimmune reaction.
Altering normal body cells via viruses also triggers the immune system.
Malfunctioning immune cells can produce abnormal antibodies.
Substances normally hidden from the immune system, entering the bloodstream, can cause an autoimmune reaction (e.g., trauma).

Testing for Autoimmune Disease

Antinuclear antibody (ANA) tests.
Autoantibody tests.
Complete blood count (CBC).
C-reactive protein (CRP).
Erythrocyte sedimentation rate (ESR).
Urine test/urinalysis.

Autoimmunity cont...

Prevalence: More than 80 known autoimmune conditions affect 5-7% of the population in the UK, with a significant percentage affecting women, particularly those with multiple autoimmune conditions.

Autoimmunity cont...Effect on Lives

Difficulty in many areas.
Joint pain, swelling, fatigue, rashes, skin and digestive problems, fever, mobility issues, mental health health and opportunities lost.

Treatment of Autoimmune Diseases

No cure; aims to dampen down the immune response.
Specific drugs or medications can reduce inflammation (e.g., non-steroidal anti-inflammatory drugs, immunosuppressants).
Other treatments may include therapies to relieve symptoms (e.g. pain, swelling, fatigue, rashes).
Diet and regular exercise may be beneficial.

Autoimmunity cont...Cost

Direct and indirect costs of autoimmune diseases in the UK are around £13 billion annually.
Examples of relevant conditions include Type 1 diabetes, rheumatoid arthritis, and multiple sclerosis.

Autoimmunity cont...Groups

Organ-specific: Autoantibodies target components of specific organs (e.g., thyroid, gut tissue).
- Thyroiditis, Grave's disease, Hashimoto's disease, autoimmune gastritis, pernicious anaemia, autoimmune adrenalitis.
Generalized systemic/organ-nonspecific: Immune complexes are deposited in tissues, activating complements and damaging joints and tissues.
- Rheumatoid arthritis, and systemic lupus erythematosus.

Autoimmune Diseases

List of various autoimmune conditions.

Autoimmune Diseases and Oral Manifestations

Oral signs might be the first indicators.
Dental professionals should be aware of the potential oral complications resulting from autoimmune pathologies, examples include: Systemic lupus erythematosus, Sjögren syndrome, pemphigus vulgaris, and mucous membrane pemphigoid.
Visuals provided for these types.

Summary

The immune system is complex, with innate and adaptive responses. Faulty responses can lead to illness (hypersensitivity, immunodeficiency, autoimmunity).
Dental professionals should take a thorough medical history, stay updated on conditions and medications potentially affecting oral health, and engage patients to support their overall health.

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