What Is Wound Healing?
Wound healing would be defined mainly as the replacement of a destroyed to damaged tissue by new living tissue to restore cell function and balance. This "replacement " is not a single-step process but involves two major mechanisms called repair and regeneration. In repair, the contractions induced by the smooth muscle cell or fibroblast cells of our body cause a reduction in the wound's size. Repair also includes the formation of granulation tissue that results in the wound's scarring phase when it is healing.
Eventually, the second regeneration phase takes over as epithelialization occurs across the wound surface, thus replacing the destructive for affected tissue with a similar tissue structure. In these 2 phases of repair and regeneration, the cytokines, alpha endothelial growth factors, macrophages stimulate the fibroblast's activity and help form new blood vessels.
What Is the Pathophysiology of Oral Wounds?
Oral wounds would mainly be due to:
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Oral diseases.
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Lesions.
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Systemic disorders.
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Nutritional deficiencies.
Oral wounds can also be of inflicted origin, which is a crucial part of disease removals like those inflicted by,
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Biopsy suggested by the dental or maxillofacial surgeon.
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Extraction wounds to eliminate disease entities.
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Promote oral or dental health and tissue repair.
Accidental injuries like jaw fractures and traumatic injuries of the orofacial structures impacting the maxilla and the mandible often take months of healing post-surgical intervention.
In the oral cavity, wound healing is indeed a much more complicated process, given multifarious constraints affecting the healing phases. The oral cavity is composed anatomically of teeth or dentition with its innervated supply, periodontal ligament fibers, and the linkage with the jaw bone or the alveolar bone definitely plays a major role in any oral wound healing. The oral wound healing is affected by:
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The constant changes or the inflammatory processes occur in the gingival tissue (gingivitis) or even a healthy individual.
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The salivary barrier containing immunoglobulins acts as an oral defense mechanism and the microbial load.
What Factors Affect Oral Wound Healing?
The dental surgeon should mainly focus upon the two fundamental criteria pivotal to oral wound healing. They are,
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Location of the wound.
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Forces acting upon the injured or wounded area.
Wound Location:
The location of the wound is important because if the area affected lies in a vascular space, the healing is faster and more pronounced than an avascular or area with limited blood supply.
Immobilization:
Similarly, immobilization of the impacted area is an essential step for promoting wound healing in the case of,
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Mandibular or lower jaw fractures.
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Orofacial fractures like,
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Zygomatic malar fractures.
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Blow-out fracture of the orbit.
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Lefort maxillary fractures.
Suppose the injured area is continuously surrounded or affected by local movements, ulcerations, or irritations; in that case, the connective tissue that forms the surface is interrupted, leading to delayed or prolonged wound healing (the bony union to be reformed in fractures if affected by local factors delaying the wound healing process and resulting instead in the fibrous union).
Local Temperature:
The temperature usually impacts the area of healing because of its effects on local blood circulation in that area and the cell multiplication at the injured site. In hyperthermia or increased body temperature, wound healing is accelerated, whereas in hypothermia or decreased body temperature, wound healing tends to be delayed.
Radiation:
Though research remains elusive to prove the impact of radiation on oral wound healing, medical literature suggests that low doses of radiation do not interfere or rather stimulate wound healing. However, a high dose of radiation suppresses wound healing.
Circulation Factor:
The circulatory factors are affected as in anemias, severe or chronic body infections, systemic diseases, cardiovascular disease, electrolyte imbalances, dehydration, etc. In these states, the immune response is delayed, and hence wound healing is considerably slower or poor.
Age and Protein Synthesis Metabolism:
Wound healing is faster in younger individuals because of high tissue metabolism and circulatory efficiency. In older individuals, when observed from a molecular level, the ultrastructural protein synthesis remains altered, leading to decreased circulatory efficiency; in turn, sentimentality impacts the rate of healing. Wound healing is adversely affected by nutritional deficiencies and protein-energy metabolism disorders (like PEM).
Enzymes and Drugs:
Oral wound healing remains influenced by enzymes like trypsin, streptokinase, alkaline phosphatase, and adenosine 5 monophosphate, which is crucial for enzymatic metabolism. Growth-promoting factors, therapeutic drugs (from simple NSAIDs to immunosuppressive drugs, anticoagulants, and anti-cancer drugs), the electrolyte concentration in an individual, and hydrogen ion concentration are all important parts of drug metabolism that indirectly impacts the accelerated or decelerated rate of wound healing.
Endocrine Disorders:
The most common endocrine disorder is diabetes type 1 or type 2, known as diabetes mellitus. In insulin deficiencies, tissue repair and regeneration remain impaired. The healing period is long for diabetic patients even after adequate antibiotic prophylaxis is given after a surgical or dental procedure like tooth extraction and dental implantation. Because of disturbances in the carbohydrate metabolism at the cellular level, the surface of the wound to regrow is considerably slowed down in these patients. However, with proper post-surgical care and pre-operative antibiotic prophylaxis before dental surgical procedures, the wound healing will be normalized.
ACTH or adrenocorticotropic hormone and cortisone are two other hormones that are stress generated and tend to show an adverse impact on oral tissue wound healing. It delays the repair and regeneration by slowing down the initial formation of granulation tissue. In other endocrine diseases, the decelerated rate of healing holds true due to hormonal imbalance and fluctuation. Also, the long-term impact of people suffering from dental or oral disease in endocrine abnormalities can lead to the potential spread of infection via facial and glandular spaces leading to severe systemic consequences.
Conclusion:
Hence to conclude, this dynamic healing process in the oral cavity is influenced by both the individual immunity and the local and systemic factors governing the process of repair and regeneration. The dental surgeon needs to thoroughly evaluate the patient's medical and dental history prior to dental treatment to assess the rate and time taken for complete oral wound healing.
