黑料网

Dental pathology; Oral diseases; Periodontal health; Oral microbiome; Systemic health; Dental medicine; Oral cancer; Histopathology; Molecular diagnostics; Personalized dentistry; Artificial intelligence; Restorative biomaterials; Oral-systemic connection

Dental pathology and medicine form an integral branch of healthcare focused on understanding, diagnosing, and managing diseases that affect the oral cavity, teeth, and surrounding structures [1]. Far from being limited to routine dental checkups or aesthetic enhancements, this discipline addresses complex conditions that can significantly impact systemic health, quality of life, and even survival [2]. As our understanding of the intricate relationships between oral health and overall well-being deepens, dental pathology and medicine have evolved into a multidisciplinary field that integrates aspects of microbiology, immunology, genetics, and medical science [3].

The oral cavity serves as the gateway to the body, and its health is a mirror reflecting systemic conditions and lifestyle choices [4]. It is home to one of the most diverse microbial ecosystems, housing bacteria, fungi, and viruses that interact dynamically with host tissues. While many of these microorganisms contribute to maintaining oral homeostasis, an imbalance can lead to various diseases, from common ailments like caries and periodontitis to rare but serious conditions such as oral cancers and systemic infections originating from oral foci [5].

Dental pathology, the study of oral diseases and their underlying mechanisms, provides critical insights into diagnosing and managing conditions affecting the teeth, gums, salivary glands, and other oral tissues [6]. Caries, one of the most prevalent chronic diseases worldwide, results from a complex interplay between dietary habits, host susceptibility, and microbial factors [7]. Similarly, periodontitis, a chronic inflammatory disease of the supporting structures of the teeth, has been increasingly linked to systemic conditions such as cardiovascular disease, diabetes, and adverse pregnancy outcomes [8].

Oral medicine, on the other hand, bridges dentistry and general medicine, focusing on diagnosing and managing oral manifestations of systemic diseases and medically complex patients [9]. Conditions such as Sjögren's syndrome, oral lichen planus, and oral complications of cancer therapy are a few examples where oral medicine plays a pivotal role [10]. It emphasizes the importance of interdisciplinary care, requiring collaboration with general physicians, oncologists, immunologists, and other specialists to ensure comprehensive patient management.

Technological advancements have significantly enhanced the field, enabling early detection and precise diagnosis of oral pathologies. Imaging techniques, such as cone-beam computed tomography (CBCT) and digital radiography provide detailed visualization of oral structures, while molecular diagnostic tools facilitate the identification of genetic predispositions and microbial profiles associated with various conditions. Innovations in treatment modalities, ranging from regenerative therapies to targeted pharmacological interventions, promise improved outcomes for patients with complex dental and oral diseases.

Additionally, the field has recognized the significance of social determinants of health, emphasizing preventive measures and public health initiatives to address disparities in oral healthcare access. Community-based programs and education campaigns aim to reduce the burden of dental diseases, particularly in underserved populations, highlighting the role of behavioral and socioeconomic factors in oral health.

In this introduction, we set the stage for an exploration of dental pathology and medicine as a critical component of healthcare. The ensuing chapters will delve deeper into the pathophysiology, diagnosis, and treatment of oral diseases, emphasizing the integration of basic science, clinical practice, and emerging technologies. Understanding the interplay between oral and systemic health not only advances the practice of dentistry but also underscores the importance of oral health in achieving overall well-being.

Understanding dental pathology

What is dental pathology?

Dental pathology, also known as oral pathology, is the branch of dentistry concerned with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It involves studying the causes, mechanisms, and effects of these diseases, both in terms of local impact and systemic implications.

Key areas of dental pathology

Tooth disorders

Dental Caries (Tooth Decay): A common bacterial infection caused by the breakdown of tooth enamel due to acid production from bacterial fermentation of dietary sugars.

Enamel hypoplasia: A developmental defect leading to thin or defective enamel, often linked to malnutrition or systemic conditions during childhood.

Periodontal diseases

Gingivitis: Inflammation of the gums caused by plaque accumulation.

Periodontitis: A severe gum infection damaging soft tissue and bone that supports the teeth, potentially leading to tooth loss.

Oral mucosal conditions

Oral lichen planus: A chronic inflammatory condition characterized by white, lacy patches in the mouth.

Leukoplakia: Thick, white patches that may indicate pre-cancerous changes.

Oral neoplasms

Benign and malignant tumors, including squamous cell carcinoma, the most common oral cancer.

Salivary gland disorders

Sialadenitis: Inflammation of the salivary glands.

Xerostomia (dry mouth): Often a side effect of medications or systemic conditions.

Pathogenesis of common dental conditions

Dental caries

Dental caries result from a complex interplay between oral microbiota, host factors, and dietary habits:

Process: Bacteria metabolize sugars into acids, demineralizing enamel and dentin, eventually leading to cavities.

Periodontitis

Periodontitis is caused by the buildup of plaque and tartar, leading to bacterial invasion of the gum tissues:

Immune response: The body's inflammatory response to bacteria can destroy gum and bone tissues.

Key pathogens: Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.

Oral cancer

Oral cancer is often linked to lifestyle factors such as tobacco use, alcohol consumption, and human papillomavirus (HPV) infection:

Pathogenesis: Accumulation of genetic mutations in oral epithelial cells leads to uncontrolled growth.

Diagnostic techniques in dental pathology

• Visual and tactile inspection of oral tissues.
• Use of periodontal probes to assess gum health.

Intraoral X-rays: Bitewing, periapical, and panoramic views.

CBCT (cone beam computed tomography): Provides detailed 3D images.

Biopsy and histopathology

Sampling oral tissues for microscopic examination, especially for neoplastic lesions.

Salivary diagnostics

Detection of biomarkers for diseases like Sjögren’s syndrome or oral cancer.

Molecular diagnostics

DNA-based tests to identify bacterial species or genetic mutations.

Treatment modalities in dental medicine

Restorative dentistry

Fillings: Repair cavities with materials like composite resin, amalgam, or glass ionomer.

Crowns and bridges: Restore function and aesthetics for severely damaged or missing teeth.

Periodontal therapy

Scaling and root planing: Deep cleaning to remove plaque and tartar.

Gum grafts: Restore receded gum tissues.

Endodontic treatment

Root canal therapy: Remove infected pulp, clean the canal, and seal it to save the tooth.

Surgical interventions

Tooth extractions: Removal of severely decayed or impacted teeth.

Oral surgery: Tumor removal, jaw reconstruction, or biopsy procedures.

Advanced therapies

Laser dentistry: Used for gum reshaping, whitening, and lesion removal.

Implants: Titanium posts inserted into the jawbone to support prosthetic teeth.

Preventive measures and public health

• Brushing twice daily with fluoride toothpaste.
• Regular flossing and use of mouthwash.

Dietary modifications

Reduce sugar intake.

Increase consumption of calcium and vitamin D-rich foods.

Regular dental check-ups

Early detection of caries, gum diseases, and oral cancers.

Professional cleanings to prevent tartar buildup.

Public health campaigns

Promoting awareness about oral health.

Access to fluoridated water and affordable dental care.

Emerging trends in dental medicine

Biomaterials

Development of bioactive glass and ceramics for restorative procedures.

Regenerative dentistry

Use of stem cells and tissue engineering to regenerate damaged oral structures.

Artificial intelligence (AI)

AI algorithms for diagnosing caries, periodontal diseases, and oral cancers from imaging data.

Teledentistry

Remote consultations and monitoring using digital platforms.

Conclusion

Dental pathology and medicine are vital in addressing oral health issues and improving quality of life. With advancements in diagnostic tools, treatment modalities, and preventive strategies, dental professionals are better equipped to tackle oral diseases. Public awareness and access to care remain pivotal in ensuring that individuals maintain optimal oral and overall health. By integrating cutting-edge science and compassionate care, the field of dental medicine continues to evolve, promising a healthier future for all.

1. Huhtanen CN (1991) J Food Prot54: 894-896.

, , Crossref

2. Postmes T, van den Bogaard AE, Hazen M (1995) Experientia51: 986-989.

, , Crossref

3. Kempe LL, Graikoski JT (1962) Appl Microbiol 10: 31-36.

, , Crossref

4. Durban E, Grecz N (1969) Appl Microbiol18: 44-50.

, , Crossref

5. Rose SA, Modi NK, Tranter HS, Bailey NE, Stringer MF (1998) J Appl Bacteriol 65: 223-229.

, , Crossref

6. Blomgran R, Desvignes L, Briken V (2021) Cell Host Microbe 11: 81-90

, , Crossref

7. Bohre D, Castro E, Hu Z, Queiroz CE (2012).J Exp Med 218: 20210469.

, , Crossref

8. Cadena KL, Flynn JL, Fortune BN (2016). MBio 7: 00342-00416.

, , Crossref

9. Cohen NB, Gern MN, Delahaye JN (2018) Cell Host Microbe 24: 439-446.

, , Crossref

10. Corleis B, Dorhoi A (2019). Immunol Lett 221: 56-60.

, , Crossref