Chronic Inflammation & Wound Healing PDF

Chronic Inflammation Intended Learning Outcomes By the end of this session students should be able to: ▪ Revise the signs of inflammation. ▪ Describe chronic inflammation and the impact this may have on the patient and clinician ▪ Explain contributing factors to chronic inflammation ▪...

Chronic Inflammation Intended Learning Outcomes By the end of this session students should be able to: ▪ Revise the signs of inflammation. ▪ Describe chronic inflammation and the impact this may have on the patient and clinician ▪ Explain contributing factors to chronic inflammation ▪ Compare acute and chronic inflammation ▪ Be aware of how chronic inflammation impacts dentistry - orally and systemically 2 Types of Inflammation Inflammation Acute Chronic Inflammation Inflammation 3 4  Acute Inflammation Chronic Inflammation Due to early response by the body Occurs after a delay Short duration Longer duration Image from Waldem website Feb Image from Glendale 2021 periodontics website Feb 2021 5 6 Consider the causative factors 7  Considerations of Chronic Inflammation ▪ Process is longer ▪ Therefore likely to have more tissue damage ▪ Main inflammatory cells are WBC - lymphocytes (what is it in acute inflammation)? ▪ You can see a more fibrotic appearance – why?Fibroblast creating collage ▪ The host defence cannot clear the insult – so what can it do? Granuloma. ▪ Granuloma - Protective processes. 8 Granulomatous Aggregation of macrophages that form in a response to chronic inflammation How is this enlarge area surviving? Nutrients etc? Its own blood supply in this area (angiogenesis) 9 Comparison of acute and chronic inflammation 10 11 As a healthcare clinician what challenges do you forsee for patients with chronic conditions? Type two diabetic - may be visible in the mouth Parkinson’s may be visible and need to support patient where needed Treating patients with Alzheimer’s Treating patients with cancer Patients with heart disease adapt treatment plan and ensure no interactions with medication/ la Inflammation may occur from some medication 12 Wound Healing 13 Intended learning outcomes By the end of the session students should be able to: ▪ List and give examples of the causes of ‘wounds’ ▪ Explain risk factors that predispose an individual to develop a wound ▪ Define the different types of wounds ▪ Offer appropriate terminology to describe a wound ▪ Describe the stages primary, secondary and tertiary intention (healing) ▪ Recognise complications associated with wound healing 14 Causes of ‘wounds’ sure Prestores Surgical Trauma Pressure incisions - Diabetius - Pa Trauma From Friction Poor circulation 15 Risk factors for developing a wound Types of wounds Medical therapies (steroids, Broken ▪ Intentional skin chemo, radiation) ▪ Unintentional Disease Age process (acute or (young or old) ▪ Open wound chronic) ▪ Closed wound Hereditary Nutrition ▪ Clean wound status ▪ Contaminated Stress ▪ Infected 16 Description of wounds Abrasion Contusion Incision Penetrating Puncture Laceration wound wound 17 Factors influencing tissue healing Wound is free from foreign Extent of bodies & damage pathogens Body’s Health status response 18 Stages of wound healing 19 Stages of Wound Primary Healing (first intention) - Regeneration Closed wound Inflammation Proliferative Maturation 20 Inflammation - Primary healing (1st intention) ▪ 1st few hours wound becomes inflamed & blood clot forms ▪ Cell debris / platelet fill the space ▪ Cellular involvement of: 1. Phagocytes – macrophages 2. Fibroblasts What will you see? Feel? 21 Proliferation - Primary healing (1st intention) ▪ Epithelial cells profileration across wound to begin closure process and replace damaged cells. ▪ Starts before end of inflammatory stage (so overlapping) 1. Angiogenesis 2. Granulation tissue 3. Contraction ▪ Clot becomes a scab & separates after 3 – 10 days 22 Maturation - Primary healing (1st intention) ▪ Collagen starts to degrade as soon as produced ▪ When collagen production equals degradation, maturation phase starts ▪ Can last for a year or more ▪ Stronger collagen laid down ▪ Excess blood vessels removed and scar loses redness 23 Stages of Wound Secondary Healing (second intention) – Repair Extensive wound - open wound Inflammation Proliferative Maturation 24 Inflammation - Secondary healing (2nd intention) ▪ Inflammatory reaction is more intense. ▪ Necrotic tissue – slough on top of wound. ▪ Healing by indirect union of granulating surfaces 25 Proliferation - Secondary healing (2nd intention) ▪ Similar process as primary but more intense ▪ Phagocytes ▪ Bloody supply is plentiful – reduce or prevent infection ▪ Granulation tissue forms at base of cavity ▪ Fibroblasts in convert to myofibroblasts to start contraction process 26 Maturation - Secondary healing (2nd intention) ▪ Collagen laid down horizontally ▪ Wound contraction pronounced ▪ Tissue uneven (scar tissue) 27 Comparing primary & secondary intention 28 Tertiary Healing Intentional healing - eg wound being left open after debridement Surgical technique that involves intentionally delaying the closure of a wound 29  Factors affecting wound healing Local Systemic Age & Ischemia Alcoholism gender of Laceager Foreign body Hormones Nutrition Immuno- Infection Stress compromised Diseases & Medication e.g. Obesity 30 Complications of wound healing Haemorrhage Infection Dehiscence Fistula Keloid scar 31  Image references ▪ http://archive.jpda.com.pk/volume-18-issue-1/multidisciplinary-treatment-in-a-patient-with-nifedipine-induced-gingival-enlargement/ ▪ https://insideouthealthwellness.com/how-to-combat-chronic-inflammation/ ▪ https://www.sciencedirect.com/science/article/pii/S1870199X18300156 ▪ https://en.wikipedia.org/wiki/Tuberculosis_radiology ▪ https://www.cohenmedical.com/chronic-inflammation/ ▪ https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/ ▪ https://mealsandmiles.com/2012/04/04/runner-down/ ▪ https://www.msdmanuals.com/en-gb/professional/multimedia/image/v34540251 ▪ https://www.medicalnewstoday.com/articles/325533 ▪ https://advancedtissue.com/2013/12/caring-diabetic-foot-ulcers/ ▪ https://www.cpcmg.net/cuts-scrapes-wise-advice-urban-legends/ ▪ https://www.thinglink.com/scene/640187830496133120 ▪ https://www.infobloom.com/what-is-a-suture.htm ▪ https://lacerationrepair.com/wound-blog/absorbable-sutures/ ▪ https://www.sciencephoto.com/media/264214/view/close-up-of-penetrating-stab-wound ▪ https://www.stopfootpaintoday.com/library/puncture-wounds-foreign-objects-in-foot.cfm ▪ https://www.cpcmg.net/cuts-scrapes-wise-advice-urban-legends/ ▪ https://www.thinglink.com/scene/640187830496133120 ▪ https://www.infobloom.com/what-is-a-suture.htm ▪ https://lacerationrepair.com/wound-blog/absorbable-sutures/ ▪ https://www.sciencephoto.com/media/264214/view/close-up-of-penetrating-stab-wound ▪ https://www.stopfootpaintoday.com/library/puncture-wounds-foreign-objects-in-foot.cfm ▪ https://quizlet.com/259935142/surgery-surgical-wound-healing-flash-cards/ 32