Immunology and inflammation
Innate and adaptive responses protect tissues but can also drive destructive inflammation. Immunosuppression affects infection risk and healing.
Understand
Innate barriers and cells respond rapidly; adaptive responses develop antigen-specific memory. Both protective and dysregulated responses shape periodontal and mucosal disease.
Assess
Review immunosuppressive medication, infection history and systemic inflammatory disease when presentations are unusual or recurrent. A negative culture does not exclude a non-infective inflammatory condition.
Apply
Avoid assuming all red or ulcerated tissue is infection. Decide whether investigation, biopsy or specialist input is needed before immunomodulating treatment, particularly when malignancy or infection remains possible.
Key distinctions
A granuloma is an organised inflammatory pattern, not a diagnosis by itself. Hypersensitivity, autoimmune disease and infection can produce overlapping mucosal appearances. Immunosuppression may blunt expected fever or redness, so clinical severity should include function, progression and systemic state rather than depending on one inflammatory sign.
Think through a case
Recurrent oral ulceration in a patient taking immunosuppressants might be infectious, immune-mediated or neoplastic. Examine and investigate before assuming an inflammatory flare.
The distinction to remember
Do not start systemic immunosuppression solely from a descriptive biopsy phrase such as “mixed inflammation”; the diagnostic context matters.
Test your recall
Which response is rapid and non-specific?
Show answer
Innate immunity.