factors effecting wound healing/fixed orthodontic courses by IDA

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

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FACTORS AFFECTING THE WOUND HEALING:

FACTORS AFFECTING THE WOUND HEALING INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

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FACTORS AFFECTING THE WOUND HEALING:

FACTORS AFFECTING THE WOUND HEALING LOCAL SYSTEMIC www.indiandentalacademy.com

LOCAL FACTORS:

LOCAL FACTORS 1. Infection 2. Surgical Technique 3. Haematoma Formation 4.Foreign body reaction 5.Tissue ischaemia www.indiandentalacademy.com

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6.Topical medications and dressings 7.Ionising radiation 8.Ultraviolet light 9.Movement 10.Type, size, location of injury. www.indiandentalacademy.com

SYSTEMIC FACTORS:

SYSTEMIC FACTORS 1.Aging. 2.Radition. 3.Nutrition. 4.Systemic infection. 5.Uncontrolled diabetics . www.indiandentalacademy.com

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6.Disease states A. Hereditary   Ehlers-Danlos syndrome . B. Coagulation disorders Hemophilia, Von Willebrand’s disease, Factor XIII deficiency, www.indiandentalacademy.com

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C. Vascular disorders Congestive heart failure. Atherosclerosis. Vasculitis. Venous stasis. www.indiandentalacademy.com

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D. Metabolic Chronic renal failure Diabetes mellitus Malnutrition Cushing’s syndrome Hyperthyroidism www.indiandentalacademy.com

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E. Immunodeficiency diseases. F. Malignancy. G. Chronic illness. Chronic pulmonary diseases. Chronic liver diseases. www.indiandentalacademy.com

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H. Medication Glucocorticoids Anticoagulants Antineoplastic drugs Cyclosporin A Colchicine www.indiandentalacademy.com

Wound infection:

The deposition and multiplication of bacteria in tissue with an associated host reaction Wound infection www.indiandentalacademy.com

INFECTIOUS AGENTS:

INFECTIOUS AGENTS Gram-positive cocci  Beta Haemolytic Streptococci . Enterococci . Staphylococci. Gram-negative aerobic rods Pseudomonas aeruginosa   www.indiandentalacademy.com

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Gram-negative facultative rods   Enterobacter species Escherichia coli Klebsiella species Proteus species  Anaerobes   Bacteroides Clostridium   Fungi  Candida www.indiandentalacademy.com

Recognition of wound infection :

Recognition of wound infection The classic signs of infection include : Localised erythema Localised pain Localised heat Cellulitis Oedema. www.indiandentalacademy.com

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Further criteria include: Abscess Discharge which may be viscous in nature, discoloured and purulent Delayed healing not previously anticipated Discolouration of tissues both within and at the wound margins www.indiandentalacademy.com

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Friable, bleeding granulation tissue Unexpected pain and/or tenderness either at the time of dressing change or reported by the patient as associated specifically with the wound even when the wound dressing is in place Abnormal smell www.indiandentalacademy.com

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Treatment Once a diagnosis of wound infection has been confirmed and antibiotic sensitivities identified, appropriate management regimens should be considered, with a high priority given to reducing the risk of cross infection. The main treatment objective will be to reduce rather than eradicate the bacterial burden within the wound margins. www.indiandentalacademy.com

Surgical Technique :

Surgical Technique The rough handling of tissue or the use of inappropriately bulky instrumentation can lead to crushed skin edges and subsequent devitalization of tissue, leading to increase in inflammatory reaction and risk of secondary infection with increased scarring. www.indiandentalacademy.com

Haematoma Formation :

Haematoma Formation Excessive bleeding and the formation of a hematoma within the wound not only can mechanically disrupt the wound closure but also can serve as an excellent culture medium for micro organisms . www.indiandentalacademy.com

Foreign body reaction :

Foreign body reaction A foreign body in the wound serves as an appropriate surface for the activation of the alternate complement pathway and the generation of a prolonged inflammatory response, which interferes with the subsequent stages of wound repairs. Wounds containing foreign materials are characterised by low pH and low PO2. These factors significantly slow down wound repair. www.indiandentalacademy.com

Tissue ischaemia :

Tissue ischaemia Local factors such as foreign bodies, infection or strangulating sutures significantly slow healing by promoting tissue ischemia. Local hypoxia is detrimental to cellular proliferation, resistance to infection and collagen production. The cumulative effect is delayed healing. www.indiandentalacademy.com

Topical medications and dressings :

Topical medications and dressings Occlusive or semi occlusive dressings promote faster reepithelization. They may also alter certain aspects of dermal repair. They also provide the moist environment needed for optimal wound repair, they may also help to prevent bacterial invasion and wound infection. www.indiandentalacademy.com

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Ionising radiation : Delays granulation tissue formation. Ultraviolet light : Facilitate wound healing. Movement Type, size, location of injury. www.indiandentalacademy.com

SYSTEMIC FACTORS :

SYSTEMIC FACTORS AGE The physiological changes that occur with ageing place the older patient at higher risk of poor wound healing. Reduced skin elasticity and collagen replacement influence healing. The immune system also declines with age making older patients more susceptible to infection. www.indiandentalacademy.com

DEHYDRATION :

DEHYDRATION This leads to an electrolyte imbalance and impaired cellular function. It is a particular problem in patients with burns www.indiandentalacademy.com

NUTRITION:

NUTRITION Vitamin A is required for epithelial and bone tissue development, cellular differentiation, and immune system function. Ehrlich and Hunt have shown vitamin A reverses the corticosteroid-induced inhibition of cutaneous and fascial wound healing. Vitamin A has also corrected non-steroid induced, post-operative immune depression www.indiandentalacademy.com

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Levenson et al suggest vitamin A benefits the wound by enhancing ; 1.The early inflammatory phase, including increasing the number of monocytes and macrophages at the wound site, 2.Modulating collagenase activity, 3.Supporting epithelial cell differentiation, 4.Improving localization and stimulation of the immune response. www.indiandentalacademy.com

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Vitamin C Ascorbic acid is an essential cofactor for the synthesis of collagen, proteoglycans, and other organic components of the intracellular matrix of tissues. Ascorbic acid deficiency causes abnormal collagen fibers and alterations of the intracellular matrix that manifests as cutaneous lesions, poor adhesion of endothelium cells, and decreased tensile strength of fibrous tissue. www.indiandentalacademy.com

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Ascorbic acid is necessary for the hydroxylation of proline and lysine residues in procollagen, which is necessary for its release and subsequent conversion to collagen. Hydroxyproline also stabilizes the collagen triple-helix structure. In addition to collagen production, ascorbic acid enhances neutrophil function, increases angiogenesis, and functions as a powerful antioxidant. www.indiandentalacademy.com

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Clinical manifestations of ascorbic acid deficiency include ; bleeding gums, poor immunity, easy bruising , and slow healing of wounds . www.indiandentalacademy.com

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Vitamin E Vitamin E is popular among consumers for skin care and to prevent scar formation. It functions as the major lipophilic antioxidant, preventing peroxidation of lipids and resulting in more stable cell membranes www.indiandentalacademy.com

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Zinc Zinc is an essential trace mineral for DNA synthesis, cell division, and protein synthesis, all necessary processes for tissue regeneration and repair. Zinc deficiency has been associated with poor wound healing and decreased breaking strength of wounds, which can result from decreased protein and collagen synthesis during healing found in zinc-deficient patients. www.indiandentalacademy.com

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Copper is a required cofactor for the enzyme lysyl oxidase, which plays a role in the cross-linking (and strengthening) of connective tissue. A typical amount recommended is 2–4 mg per day, beginning two weeks prior to surgery and continuing for four weeks after surgery. Other trace minerals, such as manganese , copper , and silicon , are known to be important in the biochemistry of tissue healing. www.indiandentalacademy.com

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Glucosamine. Hyaluronic acid is an important part of the extracellular matrix and one of the main glycosaminoglycans secreted during tissue repair. Production of hyaluronic acid by fibroblasts during the proliferative stage of wound healing stimulates the migration and mitosis of fibroblasts and epithelial cells. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid synthesis www.indiandentalacademy.com

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Protein and Wound Healing Protein depletion appears to delay wound healing by prolonging the inflammatory phase; by inhibiting fibroplasia, collagen and proteoglycan synthesis, and neoangiogenesis (proliferation phase); and by inhibiting wound remodeling. www.indiandentalacademy.com

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Vitamin A 25,000 IU daily Enhances early inflammatory phase of wound healing; supports epithelial cell differentiation; improves localization and stimulation of immune response. Vitamin C 1-2 g daily Synthesis of collagen, proteoglycan, and other organic components of the intracellular matrix; tissue antioxidant; supports immune response. www.indiandentalacademy.com

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Zinc 15-30 mg daily Required for DNA synthesis, cell division, and protein synthesis. Glucosamine 1,500 mg daily Enhances hyaluronic acid production in the wound. Protein Minimum of Prevents delayed healing and 0.8 g/kg body surgical complications. weight daily www.indiandentalacademy.com

DIABETES:

DIABETES The effects of diabetes on wound healing are diverse, multifactorial, complex and inter-related. Thickening of basement membrane in the microcirculation can lead to ischemia and decreased tissue perfusion, which in turn results in impaired wound healing (Cavallo et al, 1984). www.indiandentalacademy.com

DIABETES:

DIABETES Fibronectin is the major glycoprotein secreted by fibroblasts during initial synthesis of extracellular matrix proteins. It serves important functions, being a chemo-attractant for macrophages, fibroblasts and endothelial cells. It promotes re-epithelialisation . Non-enzymatic glycation of fibronectin decreases its ability to bind to collagen, gelatin and heparin. www.indiandentalacademy.com

Effects of Steroids on Wound Healing :

Effects of Steroids on Wound Healing Anti-inflammatory corticosteroids significantly impair wound healing. Corticosteroids lower transforming growth factor- (TGF-) and insulin-like growth factor-I (IGF-I) levels and tissue deposition in wounds. www.indiandentalacademy.com

Factors that impede wound healing :

Factors that impede wound healing Local factors Inadequate blood supply Increased skin tension Poor surgical apposition Wound dehiscence www.indiandentalacademy.com

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Poor venous drainage Presence of foreign body and foreign body reactions Continued presence of micro-organisms Infection Excess local mobility, such as over a joint www.indiandentalacademy.com

Systemic factors :

Systemic factors Advancing age and general immobility Obesity Smoking Malnutrition Deficiency of vitamins and trace elements www.indiandentalacademy.com

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Chemotherapy and radiotherapy Immunosuppressant drugs, corticosteroids, anticoagulants Inherited neutrophil disorders, such as leucocytes adhesion deficiency Impaired macrophage activity. www.indiandentalacademy.com

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Clinical features of non-healing wounds Absence of healthy granulation tissue Presence of necrotic and unhealthy tissue in the wound bed Excess exudate and slough Lack of adequate blood supply www.indiandentalacademy.com

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Failure of re-epithelialisation Cyclical or persistent pain Recurrent breakdown of wound Clinical or subclinical infection www.indiandentalacademy.com

Complications of chronic wounds:

Complications of chronic wounds Sinus formation Fistula Unrecognised malignancy Malignant transformation in the ulcer bed Osteomyelitis Contractures and deformity in surrounding joints www.indiandentalacademy.com

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Systemic amyloidosis Heterotopic calcification Colonisation by multiple drug resistant pathogens, leading to antibiotic resistance Anemia Septicaemia www.indiandentalacademy.com

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Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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