口 腔 診 斷 及 口 腔 病 理 學 導 論

1. 口 腔 診 斷 及 口 腔 病 理 學 導 論 口 腔 診 斷 頭頸部

2. 口 腔 診 斷 Real-time polymerase chain reaction (RT-PCR)-聚合酶連鎖反應

3. Dentist A • A 40 y/o female suffered from 37 toothache for 3 months • No other abnormal mucosal lesion was noted • Diagnosed her symptoms to be periodontitis • Prosthetic crown of tooth 37 was removed to perform endodontic tx 口 腔 診 斷

4. Dentist B • Severe pain of tooth 37 persisted 口 腔 診 斷 • Tooth 37 was extracted • The post extraction wound remained unhealed • Refered her to visit KMU dental dept for further tx

5. 病 理 診 斷 口 腔 病理 Biopsy—活體切片檢查

6. 口 腔 病理 Extraction of tooth 37 切片檢查 口腔癌 病 理 診 斷 Dentist C

7. 口 腔 診 斷 及 口 腔 病 理 學 導 論 口 腔 病理 口 腔 診 斷 病 理 診 斷 臨 床 診 斷 一 體 的 兩 面

8. Systemic Diseases & Oral Cavity Relationships between chronic oral infectious diseases & systemic diseases Systemic diseases manifested in oral cavity Oral cavity Systemic diseases Subtopics bacteria

9. Systemic Diseases & Oral Cavity bacteremia Bacterial endocarditis Blood smear of sepsis 1. Oral bacteria causing bacterial endocarditis

10. Systemic Diseases & Oral Cavity 2. Relationships of periodontobacteria and cardiovascular diseases (CVD) 牙 周 感 染 與 心 臟 血 管 疾 病 的 關 係

11. Systemic Diseases & Oral Cavity Estimate of odd ratio Percentile OHI value LCL UCL LCL: lower confidence limit UCL: upper confidence limit OHI: Oral Hygiene Index 3. Pathogens for bacterial pneumonia in oral cavity (Epidemiological view)

12. Systemic Diseases & Oral Cavity 3. Pathogens for bacterial pneumonia in oral cavity (Pathway) Silent aspiration Colonization

13. Systemic Diseases & Oral Cavity Cytokine IL: interleukin TNF: tissue necrosis factor Trachea Bronchus 3. Pathogens for bacterial pneumonia in oral cavity (Cytokine) (細胞素)

14. Systemic Diseases & Oral Cavity Nephritis Arthritis 4. Oral chronic infectious diseases cause secondary diseases

15. Systemic Diseases & Oral Cavity Metastatic infection from oral cavity Endocarditis Brain abscess Sinusitis Ludwig’s angina Orbital cellulitis Osteomyelitis Skin ulcer Pustulosis palmaris et plantaris 4. Oral chronic infectious diseases cause secondary diseases

16. Systemic Diseases & Oral Cavity 4. Oral chronic infectious diseases cause secondary diseases Metabolic injury by oral bacterial toxin Coronary heart disease Abnormal pregnancy outcome Persistent pyrexia Idiopathic trigeminal neuralgia Atypical facial pain Acute myocardial infarction

17. Systemic Diseases & Oral Cavity Bechet’s disease Crohn’s disease Inflammatory bowel disease Uveitis Metastatic inflamma- tion by oral bacteria 4. Oral chronic infectious diseases cause secondary diseases

18. Systemic Diseases & Oral Cavity Findings Definitions Recurrent oral ulceration Recurrent genital ulceration Eye lesions Skin lesions Positive pathergy test 4. Oral chronic infectious diseases cause secondary diseases - Bechet’s disease Criteria for diagnosis for Bechet’s disease Criteria: recurrent oral ulceration + ≥2 others findings

19. Systemic Diseases & Oral Cavity Skin test Oral test Forearm 4. Oral chronic infectious diseases cause secondary diseases *Pricking a sterile needle into forearm or lower lip *Positive when the puncture causes an aseptic erythematous nodule or pulstule (>2mm) at 24-48 hrs *At reaction site, there is initially an accumulation of neutrophils, followed by mononuclear cells Lower lip

20. Systemic Diseases & Oral Cavity Definition of different grades of skin pathergy test Grade of test Clinical characteristic of the test at 48 h Only erythema <2 mm Only erythema > 3 mm or papule 1-2 mm + erythema < 2 mm 1+ Papule 2-3 mm + erythema > 3 mm 2+ Papule > 3 mm + erythema > 3 mm 3+ Pustule 1-2 mm + erythema > 3 mm 4+ Pustule > 2 mm + erythema > 3 mm Negative (-) Suspect (+/-) Positive (+) Erythema/Papule/Pustule--Diameter 4. Oral chronic infectious diseases cause secondary diseases

21. Systemic Diseases & Oral Cavity 4. Oral chronic infectious diseases cause secondary diseases Oral ulcer Genital ulcer A horizontal layer of inflammatory cells Hypopyon Erythema nodosum

22. Systemic Diseases & Oral Cavity 4. Oral chronic infectious diseases cause secondary diseases – Crohn’s disease Labial swelling & fissuring Ulceration Cobblesing stone mucosa Mucosal tag

23. Systemic Diseases & Oral Cavity 5. Heat shock proteins producing by oral bacteria may induce dermal diseases Dermatitis

24. Systemic Diseases & Oral Cavity Estrogen Prevotella intermedia Porphyromonas gingivalis Toxin: lipopolysaccharide 6. Gingivitis pathogens cause pregnancy disorders

25. Systemic Diseases & Oral Cavity 6. Gingivitis pathogens cause pregnancy disorders

26. Systemic Diseases & Oral Cavity 7. Periodontitis and diabetic mellitus 牙周 病 糖 尿 病

27. Systemic Diseases & Oral Cavity Cardiovascular diseases Diabetes mellitus Periodontal infection Adverse pregnancy outcomes Pulmonary infections Periodontal infection & systemic conditions - potential linkage & possible pathogenic mechanisms

28. Systemic diseases manifested in oral cavity

29. Virus (病毒) Life cycle Attachment Penetration translocate endocytosis fusion Uncoating Replication Release Attachment HIV gp 120 CCR5 gp 41

30. H I V H I V Attachment Host cell Host cell gp 41 gp 41 Gp120能與CD4受體結合， 但無法直接引導HIV進入 host cell gp 120 gp 120 CD4 CCR5 CCR5將gp120拉開後， gp41引導HIV進入 host cell

31. Attachment Attachment H I V 脂質套膜 Life - Cycle 套膜蛋白 Possible ways of HIV therapy Drugs block binding (attachment & fusion) Drugs inhibit reverse transcriptase Drugs under study would inhibit integrase Some existing drugs inhibit protease H I V 蛋白質外殼 Budding Host cell gp 41 gp 41 Reverse transcriptase gp 120 Integrase Protease CD4 CCR5 Reverse- transcription Fusion Other Host cell Infected other host cells Integration Integrase Nucleus HIV RNA Nucleus HIV mRNA Protease Reverse- transcriptase Cytoplasm Caspid Uncoating Cytoplasm

32. CD4 CCR5 CCR5 受體 Early stage T-cell Late stage Macrophage

33. Virus (病毒) Acute phase AIDS Chronic phase CD4 T-cell count Viral load

34. Oral Manifestations of AIDS Candidiasis (thrush) Kaposi sarcoma Necrotizing gingivitis Candidiasis (atrophic)

35. Oral Manifestations of AIDS Hairy leukoplakia EBV Hairy leukoplakia Hairy leukoplakia Hairy leukoplakia H&E

36. Oral Manifestations of AIDS Oral Kaposi’s sarcoma: Biopsy accessions as an indication of declining incidence 20 Oral KS cases/year N = 203 Due to highly active antiretroviral therapy in 1995 No. of cases 0 2002 1981 1997 1991 Twenty-year incidence of KS at the University of California San Francisco

37. Oral Manifestations of AIDS Hairy leukoplakia Our Collected Case Oral candidiasis

38. Oral Manifestations of AIDS Our Collected Case – Burkitt’s lymphoma

39. Do you have any queries?