What Is Wound Healing?
Wound healing is mainly defined as replacing a destroyed or damaged tissue with new living tissue to restore cell function and balance. This "replacement " is not a single-step process but involves two major mechanisms: repair and regeneration. In repair, the contractions induced by the smooth muscle cells or fibroblast cells of our body cause a reduction in the wound's size. Repair also includes forming granulation tissue that results in the wound's scarring phase when healing.
Eventually, the second regeneration phase takes over as epithelialization occurs across the wound surface, thus replacing the destructively affected tissue with a similar tissue structure. In these two phases of repair and regeneration, the cytokines, alpha endothelial growth factors, and 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 removal, like those inflicted by,
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The dental or maxillofacial surgeon suggests a biopsy.
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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.
Wound healing is much more complicated in the oral cavity, given the 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 or alveolar bone, which plays a major role in any oral wound healing.
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 in a healthy individual.
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The salivary barrier containing immunoglobulins acts as an oral defense mechanism and the microbial load.
How Does Wound in the Oral Cavity Heals?
When there are intact underlying bones and no new scar tissue develops, the oral cavity's wounds usually heal by repairing the palate and gingival tissue. The early start of the inflammatory phase, lower levels of immune mediators, a reduction in blood vessels, an increase in bone marrow-derived cells, rapid re-epithelialization - resurfacing the wound with the growth of epithelium, as well as rapid fibroblast proliferation contribute to healing. Fetal wound healing occurs without an inflammatory phase.
What Factors Affect Oral Wound Healing?
The dental surgeon should focus on the two fundamental criteria for 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 in an avascular area with a 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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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 it affects local blood circulation and cell multiplication at the injured site. In hyperthermia, or increased body temperature, wound healing is accelerated, whereas in hypothermia, or decreased body temperature, it tends to be delayed.
Radiation:
Though research remains elusive in proving the impact of radiation on oral wound healing, medical literature suggests that low doses of radiation do not interfere with or stimulate wound healing. However, a high dose of radiation suppresses wound healing.
Circulation Factor:
The circulatory factors are affected by anemias, severe or chronic body infections, systemic diseases, cardiovascular disease, electrolyte imbalances, dehydration, etc. In these states, the immune response is delayed; hence, wound healing is considerably slower or poorer.
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 healing rate. 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 are 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 impact 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 cases of 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 or dental implantation.
Because of disturbances in the carbohydrate metabolism at the cellular level, the ability of the wound surface to regrow is considerably slowed down in these patients. However, the wound healing will be normalized with proper post-surgical care and pre-operative antibiotic prophylaxis before dental surgical procedures.
ACTH Adrenocorticotropic Hormones and cortisone are stress-generated hormones that tend to hurt the healing of oral tissue wounds. It delays the repair and regeneration by slowing down the initial formation of granulation tissue. The decelerated healing rate holds in other endocrine diseases 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, individual immunity and the local and systemic factors governing the repair and regeneration processes influence this dynamic healing process in the oral cavity. The dental surgeon must thoroughly evaluate the patient's medical and dental history before dental treatment to assess the rate and time taken for complete oral wound healing.
