Textbook of General Pathology for Dental Students

Foreword
Preface
Contents
1: Introduction to Pathology
	1.1	 Introduction
	1.2	 History of Pathology
	1.3	 Making a Diagnosis
	1.4	 Diagnostic Investigations in Pathology
		1.4.1	 Gross Pathology
		1.4.2	 Biopsy
		1.4.3	 Histopathology
		1.4.4	 Cytopathology
		1.4.5	 Haematopathology
		1.4.6	 Histochemistry
		1.4.7	 Immunohistochemistry (IHC)
		1.4.8	 Immunofluorescence (IF)
		1.4.9	 Molecular Pathology
		1.4.10	 Cytogenetics (Clinical Genetics)
		1.4.11	 Biochemical Methods
		1.4.12	 Medical Microbiology
		1.4.13	 Microbial Culture
		1.4.14	 Flow Cytometry
		1.4.15	 Electron Microscopy
		1.4.16	 Forensic Pathology/Autopsy
		1.4.17	 Oral and Maxillofacial Pathology
	1.5	 Summary
	Bibliography
2: Homeostasis
	2.1	 Introduction
	2.2	 Homeostasis at the Cellular, Tissue, and Organ Levels
	2.3	 Regulation and Mechanisms of Homeostasis
	2.4	 Homeostatic Mechanisms (Feedback Mechanisms)
		2.4.1	 Positive Feedback
		2.4.2	 Negative feedback
	2.5	 Oral Homeostasis
	2.6	 Homeostasis and Ageing
	2.7	 Nutrition and Homeostasis
	2.8	 Environment and Homeostasis
	2.9	 Summary
	Bibliography
3: Disease, Disorder, and Disability
	3.1	 Introduction
	3.2	 Disease: Definition and Characteristics
		3.2.1	 Aetiology
		3.2.2	 Pathogenesis
		3.2.3	 Morphological, Functional, and Clinical Manifestations
	3.3	 Epidemiology
	3.4	 Classification of the Disease
	3.5	 Numerical Disease-Coding Systems
	3.6	 Disorder (Medical Disorder)
		3.6.1	 Mental Disorder
		3.6.2	 Physical Disorder
		3.6.3	 Genetic Disorder
		3.6.4	 Emotional and Behavioural Disorders (EBDs)
	3.7	 Disability
	3.8	 Summary
	Bibliography
4: Cell Structure and Function, Cell Division and Cell Cycle, Cell Types and Stem Cells
	4.1	 Introduction
	4.2	 Cell Structure and Function
		4.2.1	 The Plasma Membrane
		4.2.2	 Cytoplasm
			4.2.2.1	 Nucleus
			4.2.2.2	 Mitochondria
			4.2.2.3	 Ribosomes
			4.2.2.4	 Centrosome
			4.2.2.5	 Lysosomes
			4.2.2.6	 Endoplasmic Reticulum
			4.2.2.7	 Golgi Apparatus
			4.2.2.8	 Vacuoles and Vesicles
			4.2.2.9	 Peroxisomes
			4.2.2.10	 Cytoskeleton
	4.3	 Intercellular Junctions
		4.3.1	 Tight Junctions
		4.3.2	 Gap Junctions
		4.3.3	 Desmosomes/Hemidesmosomes
	4.4	 Cell Communication (Cell Signalling)
	4.5	 Signalling Pathways
		4.5.1	 Autocrine Signalling
		4.5.2	 Endocrine Signalling
		4.5.3	 Paracrine Signalling
		4.5.4	 Juxtacrine Signalling
	4.6	 Interaction with Extracellular Matrix
	4.7	 Cell Division and the Cell Cycle
		4.7.1	 Interphase
		4.7.2	 Mitotic Phase
	4.8	 Control and Regulation of the Cell Cycle
	4.9	 Cell Types in the Human Body
	4.10	 Stem Cells
		4.10.1	 Totipotent Stem Cells
		4.10.2	 Pluripotent Stem Cells (PSCs)
		4.10.3	 Multipotent Stem Cells
		4.10.4	 Unipotent Stem Cells
		4.10.5	 Oligopotent Stem Cells
	4.11	 Summary
	Bibliography
5: Cellular Pathology
	5.1	 Introduction
	5.2	 Cell Injury
	5.3	 Causes of Cell Injury
		5.3.1	 Hypoxia (Oxygen Deprivation)
		5.3.2	 Mechanical Trauma
		5.3.3	 Extreme Heat (Thermal Burn)
		5.3.4	 Extreme Cold (Cryogenic Burn)
		5.3.5	 Ionising Radiation
		5.3.6	 Non-ionising Radiation
		5.3.7	 Electrical Shock
		5.3.8	 Chemical Injury
		5.3.9	 Therapeutic and Illicit Drug Injury
		5.3.10	 Injury Due to Infectious Agents
		5.3.11	 Nutritional Imbalances
		5.3.12	 Immunologically Mediated Cell Injury
		5.3.13	 Genetic and Metabolic Cell Injury
		5.3.14	 Injury from Free Radicals
	5.4	 Mechanisms of Cell Injury
		5.4.1	 Plasma Membrane Damage
		5.4.2	 Mitochondrial Damage
		5.4.3	 Adenosine Triphosphate (ATP) Depletion
		5.4.4	 Cytosolic Calcium Derangement
		5.4.5	 Nucleic Acid Damage
	5.5	 Responses to Cell Injury
		5.5.1	 Reversible Cell Injury
		5.5.2	 Irreversible Cell Injury
	5.6	 Cellular Adaptation
		5.6.1	 Hypertrophy
		5.6.2	 Hyperplasia
		5.6.3	 Atrophy
		5.6.4	 Metaplasia
		5.6.5	 Dysplasia
	5.7	 Cellular Degeneration
		5.7.1	 Hydropic Degeneration (Cloudy Swelling/Vacuolar Degeneration)
		5.7.2	 Fatty Change (Fatty Degeneration)
		5.7.3	 Hyaline Change
		5.7.4	 Mucoid Degeneration (Mucinous Degeneration, Myxomatous Degeneration)
		5.7.5	 Fibrinoid Degeneration (Fibrinoid Necrosis)
	5.8	 Cellular Accumulations and Pathologic Calcification
		5.8.1	 Abnormal Accumulations of Lipids
		5.8.2	 Abnormal Accumulation of Proteins
		5.8.3	 Accumulation of Glycogen
		5.8.4	 Accumulation of Pigments
		5.8.5	 Pathologic Calcification
	5.9	 Cell Death
		5.9.1	 Apoptosis
		5.9.2	 Necrosis
			5.9.2.1	 Coagulative Necrosis
			5.9.2.2	 Liquefactive Necrosis
			5.9.2.3	 Caseous Necrosis
			5.9.2.4	 Gangrenous Necrosis
			5.9.2.5	 Fibrinoid Necrosis
			5.9.2.6	 Fat Necrosis
	5.10	 Summary
	Bibliography
6: Inflammation: An Overview
	6.1	 Introduction
	6.2	 Aetiology
	6.3	 Cardinal Signs of Inflammation
	6.4	 Cells of the inflammatory Response, Their Location, and Primary Role
	6.5	 Classification of Inflammation
		6.5.1	 Acute Inflammation
			6.5.1.1	 Early Vascular Response
			6.5.1.2	 Late Cellular Response
				Stage 1
				Stage 2
					Transendothelial Migration (TEM) of Leukocytes
				Stage 3
					Chemotaxis of Neutrophils
				Stage 4
					Phagocytosis
					Recognition and Attachment
					Engulfment
					Killing or Degradation
			6.5.1.3	 Cell-derived Inflammatory Mediators
			6.5.1.4	 Plasma-Derived Inflammatory Mediators
		6.5.2	 Chronic Inflammation
		6.5.3	 Types of Chronic Inflammation
			6.5.3.1	 Nonspecific Proliferative
			6.5.3.2	 Granulomatous Inflammation
	6.6	 Morphologic Patterns of Inflammation
		6.6.1	 Fibrinous Inflammation
		6.6.2	 Suppurative (Purulent) Inflammation
		6.6.3	 Serous Inflammation
		6.6.4	 Ulcerative Inflammation
		6.6.5	 Catarrhal Inflammation
		6.6.6	 Pseudomembranous Inflammation
		6.6.7	 Granulomatous Inflammation
	6.7	 Summary
	Bibliography
7: Healing: Tissue Regeneration and Repair
	7.1	 Introduction
	7.2	 Types of Cells and Tissues Involved in the Healing Process
	7.3	 Healing by Regeneration
	7.4	 Healing by Repair
	7.5	 The Role of Cytokines, Growth Factors, and Extracellular Matrix
	7.6	 Wound Healing
	7.7	 Categories of Cutaneous Wound Healing
		7.7.1	 Healing by First intention (Primary Union)
		7.7.2	 Healing by Second Intention (Secondary Intention)
	7.8	 Healing of Oral Mucosal Wounds
	7.9	 Fracture Healing
		7.9.1	 Stages in Fracture Healing (Bone Regeneration) (Fig. 7.2)
	7.10	 Tooth Extraction Socket Healing
	7.11	 Factors that Influence Wound Healing
		7.11.1	 Local Factors
		7.11.2	 Systemic Factors
	7.12	 Complications of Wound Healing
	7.13	 Summary
	Bibliography
8: Genetic and Developmental Pathology
	8.1	 Introduction
	8.2	 Chromosomes and Genes
	8.3	 Genotype and Phenotype
	8.4	 Inheritance Patterns
		8.4.1	 Single-Gene Inheritance (Mendelian Inheritance)
		8.4.2	 Sex-Linked Inheritance
		8.4.3	 Mitochondrial Inheritance.
		8.4.4	 Multifactorial Inheritance
	8.5	 Genetic Disorders
		8.5.1	 Monogenic Disorders
		8.5.2	 Polygenic Disorders (Multifactorial Inheritance Disorders)
		8.5.3	 Chromosomal Disorders (Cytogenetic Disorders)
	8.6	 Mutations
	8.7	 Congenital and Developmental Disorders
	8.8	 Summary
	Bibliography
9: Infectious and Communicable Diseases: An Overview
	9.1	 Introduction
	9.2	 The Concept of Chain of Infection
	9.3	 Routes and Modes of Entry of Microbes
		9.3.1	 Direct Transmission
		9.3.2	 Indirect Transmission
	9.4	 Host Defences against Infection
	9.5	 Types of Infectious Agents and Mechanism of Infections
		9.5.1	 Bacteria
			9.5.1.1	 Mechanisms of Bacterial Injury
			9.5.1.2	 Examples of Bacterial Diseases
		9.5.2	 Viruses
			9.5.2.1	 Mechanism of Viral Infections
		9.5.3	 Fungi
			9.5.3.1	 Mechanism of Fungal Infections
			9.5.3.2	 Examples of Fungal Diseases
		9.5.4	 Protozoa
		9.5.5	 Helminths
		9.5.6	 Prions
	9.6	 Summary
	Bibliography
10: An Introduction to Immunology and Immunopathology
	10.1	 Introduction
	10.2	 The Immune System: Innate and Adaptive Immunity.
		10.2.1	 Innate Immunity
		10.2.2	 Adaptive Immunity
		10.2.3	 T Cells and Antigen Presenting Cells(APCs)
		10.2.4	 B Cells
	10.3	 Antibody-Mediated versus Cell-Mediated Immunity
	10.4	 Passive vs. Active Immunisation
	10.5	 Immunopathology
		10.5.1	 Hypersensitivity Reactions
		10.5.2	 Autoimmunity
		10.5.3	 Immunodeficiency
	10.6	 Inflammation
	10.7	 Conclusions and Summary
	Bibliography
11: Neoplasia and Carcinogenesis
	11.1	 Introduction
	11.2	 Classification of Neoplasms
		11.2.1	 Benign Neoplasms
		11.2.2	 Malignant Neoplasms
	11.3	 Other Tumour Terminologies
	11.4	 Non-Neoplastic Tumour-like Lesions
	11.5	 Epidemiology of Cancer
	11.6	 Aetiology of Cancer
		11.6.1	 Chemical Carcinogens
			11.6.1.1	 Mechanisms of Chemical Carcinogenesis.
		11.6.2	 Physical Carcinogens
			11.6.2.1	 Mechanism of Physical Carcinogenesis
		11.6.3	 Viral Carcinogens (Oncogenic Viruses)
			11.6.3.1	 Mechanism of Viral Carcinogenesis.
		11.6.4	 Bacteria, Fungi, and Parasites as Carcinogens
	11.7	 Role of Host Factors in Carcinogenesis
	11.8	 Clinical Effects of Neoplasms
	11.9	 Cancer Staging
		11.9.1	 Primary Tumour (T)
		11.9.2	 Regional Lymph Nodes (N)
		11.9.3	 Distant Metastasis (M)
	11.10	 Spread of Cancer: Metastasis
	11.11	 Cancer Diagnosis: Investigations
		11.11.1 Histopathology and Cytopathology
		11.11.2 Histological Grading of Cancer
		11.11.3 Tumour Marker Tests
		11.11.4 Histochemistry
		11.11.5 Immunohistochemistry (IHC)
		11.11.6 Flow Cytometry
		11.11.7 Molecular Diagnosis
		11.11.8 Imaging Tests
		11.11.9 Diagnostic Surgery: Sentinel Node Mapping
	11.12	 Carcinogenesis
		11.12.1 Host Defence Against Cancer
		11.12.2 Stages of Cancer Development
		11.12.3 Molecular and Genetic Basis of Cancer
		11.12.4 Hallmarks of Carcinogenesis
		11.12.5 Role of Tumour Suppressor Genes, Cellular Proto-Oncogenes, and Growth Factors in Carcinogenesis
	11.13	 Summary
	Bibliography
12: Environmental and Nutritional Pathology
	12.1	 Introduction
	12.2	 Environmental Pollution
	12.3	 Effects of Tobacco, Alcohol, and Substance Abuse
	12.4	 Effects of Radiation
	12.5	 Nutrition and Malnutrition.
		12.5.1	 Nutritional Deficiencies
			12.5.1.1	 Caloric and Protein Deficit
			12.5.1.2	 Vitamin Deficiencies
			12.5.1.3	 Deficiency of Other Essential Micronutrients
		12.5.2	 Nutrient Excesses
			12.5.2.1	 Excesses of Carbohydrates, Proteins, and Fats
			12.5.2.2	 Overweight and Obesity
			12.5.2.3	 Hypervitaminosis
			12.5.2.4	 Iron Excess (Iron Toxicity)
	12.6	 Summary
	Bibliography
13: Hemodynamic Disorders
	13.1	 Introduction
	13.2	 Hyperemia and Congestion
	13.3	 Haemorrhage
	13.4	 Haemostasis
	13.5	 Disorders of haemostasis
	13.6	 Laboratory diagnosis of haemostatic disorders
	13.7	 Thrombosis
	13.8	 Arterial or Venous Blood Stasis and Turbulence
	13.9	 Hypercoagulable State
	13.10	 Arterial Thrombosis
	13.11	 Disseminated Intravascular Coagulation (DIC)
	13.12	 Embolism
	13.13	 Pulmonary Embolism
	13.14	 Systemic Thromboembolism
	13.15	 Infarction
	13.16	 Oedema
	13.17	 Shock
	13.18	 Summary
	Bibliography
14: Imbalances in Fluids and Electrolytes, Acids and Bases: An Overview
	14.1	 Introduction
	14.2	 Fluid Balance
	14.3	 Electrolyte Balance
	14.4	 Acid-Base Balance
	14.5	 Abnormalities in Acid-Base Balance
		14.5.1	 Alkalosis
	14.6	 Summary
	Bibliography
15: Ageing
	15.1	 Introduction
	15.2	 Theories of Ageing
		15.2.1	 The Programmed Theories
		15.2.2	 The Error (Damage) Theory
	15.3	 Normal Ageing
	15.4	 Age-Related Diseases
	15.5	 Summary
	Bibliography
16: Pain: Basic Concepts
	16.1	 Introduction
	16.2	 Pathophysiology of Pain
	16.3	 Classification of Pain
		16.3.1	 Nociceptive Pain
		16.3.2	 Neuropathic Pain
		16.3.3	 Mixed Pain
		16.3.4	 Psychogenic Pain
	16.4	 Conditions Associated with Peripheral and Central Neuropathic Pain
	16.5	 Summary
	Bibliography
17: Dental, Oral, Maxillofacial and Salivary Gland Diseases: An Overview
	17.1	 Introduction
	17.2	 Common Developmental Disorders
	17.3	 Dental Caries and Pathology of the Dental Pulp
	17.4	 Other Acquired Dental Disorders
	17.5	 Periodontal Diseases
	17.6	 Mucosal Diseases
	17.7	 Diseases of the Jaw Bones
		17.7.1	 Jaw Cysts
		17.7.2	 Jaw Tumours
			17.7.2.1	 Giant Cell Tumours
			17.7.2.2	 Non-Odontogenic Tumours
		17.7.3	 Fibro-Osseous Lesions
	17.8	 Diseases of the Salivary Glands
		17.8.1	 Medication-Induced Hyposalivation and Xerostomia
	17.9	 Summary
	Bibliography
18: Pathology of Organ Systems of the Body
	18.1	 Introduction
	18.2	 Gastrointestinal Diseases
		18.2.1	 Gastroesophageal Reflux Disease (GORD)
	18.3	 Liver Diseases
		18.3.1	 Viral Hepatitis
	18.4	 Cardiovascular Diseases
	18.5	 Respiratory Diseases
	18.6	 Diseases of the Blood and Blood-Forming Organs
		18.6.1	 Anaemias
		18.6.2	 Haemoglobinopathies (Sickle Cell Anaemia and Thalassemia)
		18.6.3	 Disorders of Coagulation
	18.7	 Disorders of the Immune System
		18.7.1	 Hypersensitivity Reactions
	18.8	 Diseases of the Renal System
	18.9	 Diseases of the Endocrine System and Metabolism
	18.10	 Diseases of the Nervous System
	18.11	 Diseases of Bone and Joints
	18.12	 Psychiatric Disorders
	18.13	 Summary
	Bibliography
Glossary
Index