1. The document discusses factors that affect wound healing like physical factors, circulatory factors, nutritional factors, infection, and hormonal factors. It also discusses complications of wound healing like infection, keloid/hypertrophic scar formation, and implantation cysts. 2. Exfoliative cytology is a non-invasive technique to assess dysplastic changes in the oral epithelium. It has advantages like being painless and low-cost but disadvantages like potential for false negatives. 3. The document provides details on the technique of oral exfoliative cytology including indications, contraindications, uses, advantages, and disadvantages.

1. FACTORS AFFECTING WOUND HEALING,
COMPLICATIONS OF WOUND HEALIN AND
EXFOLIATIVE CYTOLOGY
Presented By Guided by
Navya Jain DEPARTMENT OF ORAL PATHOLOGY
(2019-20) Dr Manish Jain (HOD)
Dr Shilpa Shrivastava
Dr Rekha Upadhyay

2. FACTORS AFFECTING WOUND HEALING
A number of factors influence the healing process of wounds in oral cavity and can
be classified as :-
1. Physical Factors - Location, Age, Severe Trauma, Local Temperature, Effect of X Rays
2. Circulatory Factors - Anaemia and Dehydration
3. Nutritional Factors - Proteins and Vitamins
4. Infection
5. Hormonal Factors - ACTH (Adenocorticotrophic), Insulin Deficiency
6. Miscellaneous Factors - Enzymes, Drugs, Salts, Suture Materials, Tissue Adhesives,
Alcohols, etc.

3. PHYSICAL FACTORS
1. LOCATION :- Wounds in vascular area hear faster compared to wounds in relatively less vascular
areas.
2. IMMOBILIZATION :- If the wound is in an area subjected to constant movement formation of new
connective tissue is continuously disrupted (eg. In the corner of mouth) which results in delayed healing.
3. SEVERE TRAUMA :- It inhibits rapid wound healing. But under certain conditions mild traumatic
injury may favour healing process. For Example, Second wound inflicted in the site of healing initial wound
heals more rapidly than initial or single wound.
4. LOCAL TEMPERATURE :- It effects on local circulation and cell multiplication. Thus, in
hyperthermic environment wound healing is accelerated compared to hypothermia environment in which
healing is delayed.
5. AGE :- Healing is inversely related to age of the patient. Healing is faster in younger patients than in
elder ones. It is due to reduced rate of tissue metabolism with ageing which decreases circulatory
efficiency.
6. X Rays :- Low radiation doses tend to stimulate wound healing while total body radiations suppress
healing.

4. CIRCULATORY FACTORS
1. Anaemia delays wound healing. It causes abnormalities in circulating blood
volume and increases viscosity of blood due to deficiency of iron.
2. Dehydration also affects wound healing adversely.

5. NUTRITIONAL FACTORS
Deficiency of vast variety of essential foods results in delayed wound healing.
1. PROTEINS :- It is one of the most important things that accelerates wound healing process.
Patients with hypoproteinaemia exhibit delay in appearence of new fibroblasts and decrease rate of
multiplication of fibroblasts in wounds. Whereas in high protein diet patients rate of fibroblast
proliferation is increased and wound healing is accelerated. Methionine(AA) administration in
hypoproteinaemia patients accelerates wound healing process.
2. VITAMINS :- Vit C or Ascorbic Acid collagen and intracellular ground substance formation. It's
deficiency scurvy results in inhibition of wound healing. Vit A and Vit D deficiency retard wound
healing. Riboflavin and pyridoxine deficiency result in delayed wound healing.

7. INFECTION
Severe bacterial infections slow wound healing. When resistance of tissue is
decreased either locally or on systematic basis an oral wound becomes massively
infected and heals slowly.

8. HORMONAL FACTORS
1. ACTH and Cortisone - Interfere with wound healing by inhibiting the growth of
granulation tissue because of inhibition of fibroblast proliferation and new
depression of inflammatory reactions.
2. Insulin - Diabetes Mellitus (Insulin Deficiency) retard repair of wounds after
surgical procedures, wounds in diabetic patients are slow to heal and
frequently show complications in repair process this is related to disturbance
in carbohydrate Metabolism at cellular level in local area of the wound.

9. Miscellaneous Factors
1.Enzymes - Trypsin, Stretptokinase, alkaline phosphatase and coenzyme adenosine-5-
monophosphatase.
2.Growth promoting factors - Cartilage and mucopolysaccharides, N-acetyl-d-gluclosamine, Tissue
extracts and pantothenyl alcohol, hydrogen ion concentration
3. Drugs - Dilantin sodium, sulfonamides and antibiotics, anticancerous drugs, immunosuppressive drugs,
anticoagulants like heparin and dicumarol, etc
4. Metals-zinc, copper, deuterium oxide, etc.
5. Antigen-Antibody Reactions
6. Tissue Adhesives - Butyl and Isobutyl cyanoacrylate act as alternate for wound suturing and closure
and are widely utilised in surgical procedures of oral cavity and those involving numerous organs. They are
used because of their ability to act as tissue surface adhesive in presence of moisture and their
bacteriostatic and hemostatic effect.
7.Butyl cyanoacrylate - Hastens wound healing and has been actively used as surface dressing after
gingivectomy, biopsy sites, mucoperiosteal flaps, extraction, apthous ulcer, pulp capping, grafting.

10. COMPLICATIONS OF
WOUND HEALING
1. Kleoid and
hypertrophic scar
foramtion
2. Pigmentary changes
3. Implantation cysts
4. Infection

11. Infection
1. Wounds provide portal entry to microorganisms.
2. Infection delay healing process.
3. Common in maxillofacial trauma cases.
4. Diabetic and Immunosuppressive patients are most prone to infections.

12. Kleoid and hypertrophic scar formation
1. Kleoid - overgrown scar tissues with no resolution tendency. Occur in wounds which heal
without any complications.
2. Hypertrophic Scars - Red, raised, itchy and collagenous scars which become pale and flat
on maturition.
● They are not seen in wounds of oral cavity because wound remodelling rate
in oral cavity is so high that even normal scar is not seen most of the times.

13. PIGMENTARY CHANGES
1. Hypopigmented areas - Not seen in oral cavity. They are seen on skin.
2. Hyperpigmented areas- Seen in Lichen Planus and Lichenoid Reactions.
● Cicatrization - It refers to late reduction in size of the scar in contrast to immidiate wound
contraction. It is a complication due to skin burns.

14. IMPLANTATION CYST
Epithelial cells may slide and get entrapped in wound and later may proliferate
forming Implantation cyst.

15. EXFOLIATIVE CYTOLOGY

16. Exfoliative cytology is a rapid, non-invasive procedure for assessing dysplastic
change within the oral epithelium. The indications for oral exfoliative cytology are
reviewed and a technique for cell collection and smear examination is presented.
INDICATIONS
1. Hesitant dentist or patient for biopsy
2. Large or multiple lesions
3. Difficulty in biopsy
4. Microbial infection - herpes or candida
5. Follow up - Recurrence
6. An innocuous lesion

17. CONTRAINDICATIONS
1. Obvious cancererous lesion
2. Unreliable patient
3. A sub-mucosal lesion
4. Dry or crusted lesions such as in lip

18. USES OF EXFOLIATIVE CYTOLOGY
1. Early detection and control of oral cancer ,microbial diseases ( candidiasis,
viral infections) and dermatological lesions.
2. Assessment of nutritional iron deficiency.
3. Forensic dentistry (age and sex identification)
4. Study of conditions like D.M, smoking, pregnancy and agening.
5. Prediction of cellular response of tumour to radiation.

19. ADVANTAGES
● Non- invasive, painless
● Minimal skills
● Patient compliance
● Cost effective
● Performed in large number
● Minimal instruments required
● Early diagnosis of lesion
● Can be used in patients with systemic disorders were biopsy is
contraindicated.
● Easily done at the chairside

20. DISADVANTAGES
● False negative results
● Only an adjuvant
● Contamination
● Low sensitivity
● Inadequate sampling
● Not usable in non epithelial lesions

21. SMEAR INTERPRETATION

26. HOW IT IS DONE ??