IntroToPerio - Midterm02

  1. Periodontal Disease Appearances
    • Change In Color And Texture
    • Increased Probing Probing Depths
    • Gingival Recession
    • Bleeding On Probing
    • Pathologic Migration Of Teeth
    • Clinical Attachment Loss
    • Radiographic Bone Loss
  2. Two Sides Of Periodontal Disease
    • Microbiology
    • Host Response
  3. Deposits On Teeth
    • Dental Plaque
    • Dental Calculus
    • Materia Alba
    • Stains (Extrinsic)
  4. Etiology Of Periodontal Disease
    • Bacterial Biofilm (Bacterial Plaque)
    • Dental Calculus (No More Considered As The Main Cause)
    • Iatrogenic Dentistry
    • Occlusal Trauma
  5. Dental Calculus Is _______ And Almost Always Covered With ________.
    • Calcified Dental Plaque
    • A Layer Of Uncalcified Plaque
  6. Materia Alba
    • Amorphous Bacterial Accumulation
    • Contains Leukocytes, Bacteria, Desquamated Epithelial Cells And Food Particles
    • Can Be Flushed Away With Strong Water Spray
  7. Development Of View Of Etiology Of Periodontal Disease
    • Pre-1950: Deductive Thinking; Treatment - Inconsistent Outcomes
    • 1950s: Hypothesis Testing And Inductive Thinking; Waerhaug (1958) - Plaque Revolution; Oral Hygiene Were Associated With Gingivitis
    • 1965: Loe Et Al. Experimental Gingivitis; Basis Of Today’s View On Etiology And Prevention Of Gingivitis
  8. Loe,H. Et Al. J. Perio, 1965
    • Direct Cause-Effect Relationship Between Bacterial Plaque And Gingivitis
    • Experimental Gingivitis: Healthy Subjects, Clean Teeth -> No Oral Hygiene For 21d
  9. Experimental Gingivitis Model
    • Initial Microbiota: G+ Cocci &Amp; Rods; G- Cocci
    • 8 Hours Of No Oral Hygiene: Increase In Number Of G- Rods And Filaments
    • Day 7: Gingivitis; Increase In Number Of G- Rods And Filaments; Appearance Of Spirochetes And Motile Organisms
    • Bacterial Plaque Is Essential To The Initiation Of Gingivitis And If Untreated, Would Lead To Periodontitis
    • Removal And Control Of Plaque Became The Critical Element Of Prevention And Treatment Of Gingivitis And Periodontitis
  10. Bacterial Plaque (Biofilm)
    Primary Etiological Factor In The Pathogensis Of Periodontal Disease
  11. Biofilms
    “Matrixenclosed” Bacterial Populations Adherent To Each Other And/Or To Surfaces Or Interfaces
  12. Two Categories Of Bacterial Plaque (Biofilm)
    • Supragingival
    • Subgingival
  13. Supragingival Plaque
    • Pellicle
    • Coccoid Bacteria
    • Epithelial Cells
    • Pmns
    • Proliferation And Formation Of Small Colonies Of Morphologically Similar Organisms
  14. Subgingival Plaque
    • Complex Micro Organisms
    • Fewer Or No Filamentous Organisms
    • Smaller Organisms Without Particular Orientation
    • Cuticle Between Plaque And Tooth
    • Secretory Product Of Epithelial Cells
  15. Bacterial Plaque In The _______ Region Is Of Primary Concern For Periodontal Disease
  16. Bacterial Plaque (Biofilm) - Microbial Composition
    • Microbial Cells With A Cuticle Or Pellicle Between Microbes And The Tooth Surface
    • Less Than 10% Of Dry Weight Of Biofilms
  17. Bacterial Plaque (Biofilm) - Chemical Composition
    • 80% Water
    • 20% Solids
    • Solids:
    • 35% Cells Mainly Bacterial
    • 65% Extracellular
    • Polysaccharides:
    • 95% Dextran
    • 5% Levan
  18. Bacterial Plaque (Biofilm) - Extracellular Matrix
    • Material Present Between Bacteria In The Dental Plaque
    • Plaque Microorganisms
    • Saliva
    • Gingival Exudate
    • Forms A Substantial Part Of Biofilm
    • Contributes Over 90% Of Dry Weight
    • Recognized As The Second Stage During Biofilm Formation, After Initial Adherence And Proliferation Of Microorganisms
  19. Stages Of Biofilm Formation
    • Initial Adherence And Proliferation Of Microorganisms
    • Forming Extracellular Matrix
  20. Extracellular Matrix Composition
    • Heterogenous Mixture Of Proteins, Polysaccharides, Extracellular Dna (Edna)
    • Collectively Called Extracellular Polymeric Substances (Eps)
  21. Extracellular Matrix - Polysaccharides
    Associated With Cell Surface And Form A Capsule Or Be Secreted As A Slimy Biofilm Matrix
  22. Extracellular Matrix - Proteins
    • Lectins And Sugar Binding Proteins: Facilitate Cell-To-Cell Or Cell-To-Matrix Interactions
    • Autotransporters: Involved In Cell-To-Cell Or Cell-To-Matrix Interactions; Transport Themselves Across The Outer Membrane Of G- Bacteria; May Function In Adherence And Biofilm Formation
    • Pili: Aka Fimbriae; Type I And Iv Distinguished
  23. Extracellular Matrix - Dna
    • Contribute To Biofilm Integrity
    • Edna Results From Controlled Lysis Of Cells And Also From The Active Release Of Dna Containing Membrane Vesicles By Viable Cell
  24. Bacterial Plaque (Biofilm) - Formation
    • Formation Of Dental Pellicle
    • Initial Colonization Of Tooth Surface
    • Secondary Colonization And Plaque Maturation
  25. Dental Pellicle
    • Initial Phase Of Plaque Development
    • Formation Of Glycoproteins Film
    • Protective Barrier: Lubrication For The Surfaces And Preventing Desiccation
    • Substrate And Surfaces To Which Bacteria Attach, Enhances Initial Bacterial Colonization, Provides Specific Receptors For Bacterial Attachment
  26. Dental Pellicle Is Derived From:
    • Components Of Saliva And Crevicular Fluid
    • Bacterial Cell Products
    • Host Cell Products
  27. Initial Bacterial Colonization
    • Rapid - Within Minutes After Removal Of Existing Plaque And Pellicle
    • Attachment Of Cell Occurs, Resulting In Implantation Of Free Living Micro-Organisms From Saliva On The Surfaces To Be Colonized
    • G+ Facultative: Pleomorphic Rods, Streptococcus Sanguis, Actinomyces Viscosus
    • Few Or No G- In Very Early Plaques
  28. Initial Bacterial Colonizers
    • Adhere To The Pellicle Through Specific Molecules Adhesions On The Bacterial Surface
    • Adhesions Can Be Anchored To Cell Wall Or Membrane, Receptors Are Cell Wall Polysaccharides
    • Streptococcus Species Are The Most Predominant Pellicle Colonizers, Providing An Array Of Adhesions After Attachment
  29. _______ Initially Do Not Colonize Clean Tooth Surfaces
    Secondary Colonizers
  30. Secondary Colonization And Plaque Maturation
    • Multiplication Of Attached Organisms
    • Adhere To Cells Of Bacteria Already In The Plaque Mass
    • Interaction Of Protein And Carbohydrate Molecules On The Bacterial Cell Surfaces
  31. Bacterial Adherence
    • Tooth And Root Surfaces
    • Epithelial Surfaces Of Gingiva Or Periodontal Pocket
    • Connective Tissue
    • Other Bacteria
    • Pre-Existing Plaque Mass
  32. Aggregation
    Ability Of Two Genetically Similar Bacteria To Recognize And Adhere To One Another
  33. Coaggregation
    Ability Of Two Genetically Distinct Bacteria To Recognize And Adhere To One Another

    Proteinaceous Adhesion Produced By A Bacterium And A Respective Carbohydrate Or Protein Receptor Found On The Surface Of Another Bacterium
  34. Fusobacterium Species
    • Coaggregate With Other Oral Bacteria
    • Bind To Statherin, A Protein Found In The Pellicle
  35. F.Nucleatum
    • Ability To Coaggregate With Both Facultative And Anaerobic Species
    • Thus Facilitating Survival Of The Anaerobes, Such As P.Gingivalis
  36. “Corncob” Formations
    Dense Microbial Masses Composed Of Large Filaments Covered With Cocci
  37. Biofilm
    • Exhibits Metabolic Cooperativity
    • Ecological Communities Evolved To Allow The Survival Of The Community As A Whole
    • W/ Primitive Circulatory System
    • Numerous Radically Different Microenvironments
    • Resists Host Defenses, Local Or Systemic Antimicrobial Agents
    • The Existence Of Complexes Of Species In Plaque Is A Reflection Of Bacterial Interdependency In The Biofilm Environment
    • Subgingival Microbial Plaque Behaves As A Biofilm
  38. Biofilms Are Effectively Managed By _______.
    Physical Disruption And Removal
  39. Loe Et Al, 1967 - Three Distinct Phases Of Plaque Formation
    • Phase 1. Within 2d. Proliferation Of G+ Cocci And Rods; Addition Of 30% G- Cocci And Rods.
    • Phase 2. 1 To 4 Days. Appearance And Increase In Numbers Of Fusobacteria And Filaments.
    • Phase 3. 4 To 9 Days. Spirochetes.
  40. “________” By Oral Organisms Describes Early Dental Plaque Formation
  41. Bacterial Growth Increases The Mass Of Plaque, Refers To ___________.
    Plaque Maturation
  42. The Common Periodontal Diseases Are ________. Gingivitis And Periodontitis Are ________.
    • Microbial Infections
    • Chronic Infectious Diseases
  43. Non-Specific Plaque Hypothesis (Theilade 1986)
    • Entire Plaque Flora Causes Periodontal Disease
    • Basis For Treatment Of Gingivitis And Periodontitis
  44. Specific Plaque Hypothesis (Loesche 1979)
    • Only Certain Plaque Is Pathogenic
    • Pathogenicity Depends On Presence Of Or Increase In Specific Micro Organisms
    • No Effect On Basis For Treatment
    • For Localized Aggressive Periodontitis: Aa Is The Major Pathogen
  45. With Plaque Maturation, The Early _______ Environment Characterized By _______ Species Changes To A ________ Environment Predominated By _________.
    • Aerobic
    • G+ Facultative
    • Highly Oxygen Deprived
    • G- Anaerobic Micro-Organisms
  46. Criteria For Identification Of Periodontal Pathogens (Koch’s Postulate)
    • Causative Agent Must Be:
    • Isolated From Diseased Individuals
    • Grown In Pure Culture In The Lab
    • Produce Similar Disease Into The Susceptible Lab Animals
    • Recovered From Lesions In Diseased Animals
  47. Can't Apply Classical Koch’s Postulate
    • Designed For Monoinfections
    • Technical Difficulties
    • Conceptual Problems
    • Data Analysis
  48. Socransky’s Criteria
    • Associated With Disease, Increase In Number At Diseased Sites
    • Clinical Resolution With Elimination Or Decrease
    • Elicit Host Response
    • Be Capable Of Causing Disease In Animal Models
    • Demonstrate Virulence Factors
  49. Microorganisms And Periodontal Probing Depth - ___________ Have Little Or No Relationship To Probing Depth
    S.Sanguis And A.Viscosus
  50. Bacterial Complexes In Biofilms Do Not Randomly Exist, Rather As Specific Assiciations Among Bacterial Specie
  51. ______ Subgingival Microbial Complexes By _____.
    • Six
    • Socransky Et Al 1998
  52. Microorganism Considered Secondary Colonizers Fall Into The _________ Complexes.
    Green, Orange Or Red
  53. Red Complex:
    • P.Gingivalis
    • T.Forsythia
    • T.Denticola
    • Associated With Bleeding On Probing, An Important Clinical Parameter Of Destructive Periodontal Diseases
  54. Orange Complex:
    • P.Intermedia
    • P.Nigrescens
    • P.Micros
    • F.Nucleatum
  55. Green Complex:
    • E.Corrodens
    • Actinobacillus Actinomycetem Comitans
    • Capnocytophaga Species
  56. Yellow Complex:
    • S.Mitis
    • S.Oralis
    • S.Sanguis
  57. Periodontal Pathogens
    • Bacterial Masses Possess An Array Of Antigens And Polyclonal Activators
    • These Are Capable Triggering Sequences Of Host Mediated Events
  58. Pathogenic Effects Of Microorganisms
    • Directly By Causing Tissue Destruction
    • Indirectly By Stimulating And Modulating The Host Response
  59. Virulence Factors Are Properties That Enable A Bacterium To
    • Cause Disease
    • Colonize
    • Invade The Host
    • Directly Or Indirectly Cause Host Tissue Damage
  60. Substances Causing Tissue Damage
    • Directly Damage Tissue - Eg. H2o2
    • Cause Cells To Release Biologically Active Substances - Eg. Lps
    • Affect Intercellular Matrix - Eg. Collagenase
  61. Transmission Of Periodontal Pathogens From The Oral Cavity Of One Individual To Oral Cavity Of Another
    • Vertical - Parents To Offsprings
    • Horizontal - Between Individuals Outside The Parent-Offspring Relationship
  62. Colonization:
    Periodontopathic Bacteria Adhere At ______.
    Bacteria Proliferate _____ Into _______.
    • The Gingival Crevice Orifice
    • Apically
    • The Advancing Periodontal Pocket
  63. Colonization And Invasion Of Periodontal Tissue
    • Bacterial Adherence
    • Host Tissue Invasion
    • Bacterial Evasion Of Host Defence Mechanisms
  64. Invasion:
    • Tissue Invasion
    • Adherence To Underlying Tissues Such As Basement Membrane, Various Types Of Collagen (Type I And Type Iv) Resulting In Deeper Invasion
    • Whole Organisms And/Or Their Products Invade Gingival Tissue Through The Sulcus Or Pocket Epithelium And Enter Gingival Connective Tissue
    • Ulcerations In The Epithelium
    • Direct Penetration Into Host Epithelial Or Connective Tissue Cells
  65. Bacteria Capable Of Tissue Invasion
    • Aa (Green)
    • P.Gingivalis, T.Denticola, T.Forsythia (All Red)
  66. Aa Leukotoxin Affects
    • Pmns And Monocytes
    • Kills Mature T And B Lymphocytes Cell Lines
    • A Non-Lethal Suppression Of Immune Cells
  67. Tissue Invasion
    • Leukoaggressive Properties
    • Evasion Of Neutrophil Protective Mechanisms
    • Invasion By Bacteria And Their Products
  68. Species Evading The Effect Of Specific Antibody:
    • P. Gingivalis
    • P. Intermedia
    • P. Melaninogenica
    • Capnocytophaga
  69. Mechanisms For Evasion Of Host Defence
    • Produce Igg And Iga Proteases - Destroy Ab
    • Change Surface Antigen
    • Adherence - Attach To Epithelial Cells
    • Tissue Invasion
    • Counteract Host Defense (Phagocytosis
    • And Lysosomal Enzymes) By Leukotoxins (Eg. Aa), Capsules (Eg. P.Gingivalis)
  70. Interbacterial Relationship
    • Important For Species Survival
    • Favorable Interactions
    • Antagonistic Interactions
  71. Subgingival Species Provide:
    • Specific Growth Factors Utilized By Other Species
    • Branched Chain Fatty Acids And Polyamines
    • Analog Vitamin K (Essential To Some Species)
    • Lactate
    • Formate Or Hydrogen
  72. Sources Of Nutrition For Sub-Gingival Organisms
    • Diet
    • Host
    • Other Subgingival Species
    • Gingival Crevicular Fluid Is Poor In Nutrients
  73. Microbial Composition Of Subgingival Plaque From Diseased Sites Differed From Microbiota At The Healthy Sites In Subjects With Localized Aggressive Periodontitis
  74. Microflora - Healthy
    • Predominantly G+ Facultative Rods And Cocci (75%)
    • Predominantly Streptococcus And Actinomyces Species
    • Small Proportions Of Gram-Negative Species
    • Few Spirochetes And Motile Rods
  75. Specific Bacteria And Periodontal Diseases
    • Gingivitis And Pregnancy…….P. Intermedius
    • Anug………………P. Intermedius, Spirochetes
    • Chronic……...…..P. Gingivalis Periodontitis
    • Aggressive ……Aa; Capnocytophaga Periodontitis
  76. Periodontitis In Juvenile Diabetics
    Capnocytophaga, Aa
  77. Gingivitis
    • G- Rods And Filaments ……….40%
    • G+ Species ….57%
    • Facultative……59%
    • Anaerobic……...41%
  78. Chronic Periodontitis
    • Increase In Spirochetes
    • G-...75%
    • Anaerobic…90%
  79. Aggressive Periodontitis (Prepubertal Periodontitis)
    • P. Gingivalis
    • P. Intermedia
    • Aa
    • F. Nucleatum
  80. Aggressive Periodontitis (Juvenile Periodontitis)
    • G-, Capnophilic And Anaerobic Rods
    • Aa (Lap)………….90%
    • Others
    • • P. Gingivalis
    • • F. Nucleatum
    • • Capno-Species, C. Rectus
    • • E. Corrodens
  81. Aggressive Periodontitis (Rapidly Progressive Periodontitis)
    • Aa
    • P.Gingivalis
    • P.Intermedia
    • E.Corrodens
    • C.Rectus
  82. Periodontal Abscess
    • Acute Lesions
    • Rapid Destruction Of Periodontal Tissues
    • Pathogens:
    • T.Forsythia (Red)
    • P.Gingivalis (Red)
    • P.Intermedia (Orange)
    • P.Micros (Orange)
    • F.Nucleatum (Orange)
  83. Peri-Implant Plaque
    • Pathogens Similar To Pathogens In Subgingival Plaque Of Chronic Periodontitis
    • Staph. Aureus
  84. Necrotizing Ulcerative Periodontitis (Nup)
    • Acute Inflammation Of The Gingival And Periodontal Tissues
    • Necrosis Of Marginal Gingival And Periodontal Tissues
  85. Acute Necrotizing Ulcerative Gingivitis (Anug)
    • High Levels Of P.Intermedia (O)
    • High Levels Of Spirochetes Causing Tissue Invasion
  86. Pregnancy Gingivitis
    P. Intermedia (O)
  87. P. Gingivalis
    • Chronic Periodontitis (90%)
    • Aggressive Periodontitis (Rapidly Rogressive Periodontitis)
    • Aggressive Periodontitis (Generalized Juvenile Periodontitis)
    • Large Array Of Virulence Factors: Collagenase, Proteases, Endotoxin (Lps), Fatty Acids, Nh3, H2s, Indole, Host Tissue Cell Adherence And Invasion, Trypsin Like Enzymes, Fibrinolysin, Phospholipase A, Factors Affecting Pmn Function
  88. P. Gingivalis - Association
    • Increase In Periodontitis Lesions
    • Present In Crevicular Epithelium
  89. P. Gingivalis - Elimination
    With Successful Therapy - Suppressed Or Eliminated
  90. Aggregatebacter Actinomycetemcomitans
    • Localized Aggressive Periodontitis (Lap)
    • Adult Periodontitis With Rapid Bone Loss
    • Refractory Periodontitis
  91. Aa - Virulence Factors:
    • Epitheliotoxin
    • Fibroblast Inhibiting Factor
    • Bone Resorption Factor
    • Host Tissue Cell Invasion
    • Leukotoxin
    • Collagenase
    • Endotoxin
  92. Prevotella Intermedia
    • Black Pigmented Bacteroides
    • G-, Short, Round Ended Anaerobic Rods
    • Elevated In Anug
    • Elevated In Certain Forms Of Periodontitis
  93. Tannerella Forsythia (B. Forsythus; Red)
    • First Described In 1979 As ‘Fusiform’ Bacteroides
    • Difficult To Grow
    • G- Anaerobic, Spindle Shaped, Highly Pleomorphic Rod
    • Growth Enhanced By Co-Cultivation With F. Nucleatum; Commonly Occurs Together In Subgingival Sites
    • Ability To Invade Gingival Tissue
    • Most Frequently Detected Species In ‘Refractory’ Subjects
    • Major Microbial Risk Factor For Disease Progression In Adult Subjects
    • In Smokers
    • Requires N-Acetyl Muramic Acid
    • Predominantly In Sites Of Destructive Periodontal Disease
    • In High Numbers In Active Periodontal Lesions Than In Inactive Periodontal Lesions
  94. Oral Spirochetes
    • G-, Strict Anaerobes
    • High Proportions In Subgingival Plaque
    • Tissue Invasion
  95. Various Herpes Virus Like Cmv, Ebv Are Associated With _____________.
    Severe Periodontal Disease
  96. Virus Triggers Release Of Pro-Inflammatory Cytokines Causing _______.
    An Upgrowth Of Periodontopathic Bacteria
  97. Dynamic Equilibrium Between Bacteria And Host Defense
    • Adopted Survival Strategies Favoring Growth In Plaque
    • “Selection" Of Pathogenic Bacteria Among Microbial Community
    • Disturbed Equilibrium Leading To Pathology
    • Opportunistic Infection
  98. Destructive Periodontal Disease Being Active Requires
    • Susceptible Host
    • Presence Of Pathogens
    • Absence Of Beneficial Species
Card Set
IntroToPerio - Midterm02
IntroToPerio - Midterm02