Perio PP14/15

  1. The prime purpose of the immune system is to
    defend the life of the individual
  2. What are virulence factors and what are they
    • all the mechanisms that enable the biofilm bacteria to colonize and damage the tissues
    • Presence of lipopolysaccharide
    • Ability to invade tissues
    • Ability to produce enzymes
  3. What are lipopolysaccharides
    LPS is a substance present in the cell membrane of Gram-negative bacteria and can initiate inflammation
  4. Some bacteria such as _________ and __________, can invade host tissues and help them avoid host defense mechanisms
    Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans
  5. Several periodontal bacteria produce enzymes such as _________ and _________ that can directly degrade host proteins that are part of the periodontium
    collagenases and proteases
  6. Biochemical mediators are
    biologically active compounds secreted by the immune cells that activate the body’s inflammatory response
  7. Inflammatory mediators of importance in periodontal disease are
    • Cytokines
    • Interleukins-1, -6, -8–Tumor Necrosis Factor alpha (TNF-α)
    • –Prostaglandin E (PGE)
    • –Matrix metalloproteinases (MMPs)
  8. CYTOKINES are produced by many different cells such as ________ and are produced in response to ________
    • PMNs, macrophages, B lymphocytes, epithelial cells, gingival fibroblasts, and osteoblasts
    • tissue injury
  9. What are the functions of the cytokines
    • Recruit cells (PMNs and macrophages) to infection site
    • Increase vascular permeability that increases movement of immune cells into the tissues (increase the inflammatory response)
    • Cytokines can initiate tissue destruction and bone loss in chronic infections, such as periodontal disease
  10. What are the functions of Prostaglandins
    • Increase permeability and dilatation of blood vessels to promote increased movement of immune cells and complement to the infection site (increase the inflammatory response)
    • Trigger osteoclasts—bone-resorbing cells that destroy the alveolar bone
    • Promote the overproduction of destructive MMP enzymes
  11. ____________ initiate most of the alveolar bone destruction in periodontitis
    Prostaglandins of the E series (PGE)
  12. What are the functions of MMPS (MATRIX METALLOPROTEINASES)
    • Enzymes act together to breakdown connective tissue matrix (MATRIX metalloproteinase)
    • MMPs are released in an attempt to kill invading bacteria.
    • Overproduction of MMPs results in breakdown of connective tissue of the periodontium
    • Genetic Factors
    • Environmental Factors
    • Acquired Factors
  14. What is a known environmental risk factor that has a has a significant effect on the immune and inflammatory system?
  15. Smoking has been shown to have what affect on the host response
    • decrease PMN activity
    • decrease vascularity of gingival tissues
    • affect both T and B-lymphocyte response
  16. What kind of factor is diabetes and what effect does it have on the host response
    • Acquired
    • reduces PMN function, and increases IL-1, TNF-a and PGE2 levels in gingival crevicular fluid and reduces growth of PDL fibroblasts and osteoblasts
    • Early bacterial accumulation phase –initial lesion
    • Early gingivitis (acute phase)—early lesion
    • Established gingivitis—established lesion
    • Periodontitis—advanced lesion
  18. What are the clinical features of the EARLY BACTERIAL ACCUMULATION PHASE – initial lesion and when does it develop
    • At this stage the gingiva looks healthy – subclinical disease
    • Initial phase develops 2 to 4 days after plaque accumulation
    • Blood vessels dilate and release cytokines to attract more PMNs
    • Macrophages release cytokines, PGE and MMPs to initiate collagen destruction
    • PMNs form a wall of cells between plaque and sulcus cells
  20. What are the microscopic and clinical features of EARLY GINGIVITIS – PLAQUE BIOFILM OVERGROWTH PHASE – EARLY LESION and when does it develop
    • Sulcular epithelium begins forming epithelial ridges protruding into connective tissue (rete pegs)
    • Inflammatory changes such as edema and redness of gingival marginal tissue
    • Early lesion develops within 4 to 7 days
  21. What is the key WBC in EARLY GINGIVITIS
  22. What is the key WBC in ESTABLISHED GINGIVITIS
  23. What are some of the features of ESTABLISHED GINGIVITIS
    • Cytokines recruit more macrophages and lymphocytes
    • Macrophages stimulated by LPS produce cytokines, PGE and MMPs
    • PGE and MMPs initiate collagen destruction
  24. What are some of the clinical and microscopic features of ESTABLISHED GINGIVITIS  and when does it develop
    • Epithelial ridges extend deeper into connective tissue
    • Junctional epithelium begins detaching at the coronal level and becomes thinner
    • All the usual clinical features of gingivitis are present
    • Generally observed by 21 days
  25. What are some of the features of PERIODONTITIS
    • More biofilm forms and the immune response is so intense it begins to destroy the periodontium (PDL)
    • High # of MMPs cause destruction of JE, PDL and extracellular matrix
    • Osteoclasts stimulated by PGE destroy crestal bone
    • JE cells migrate apically along root
  26. IN Periodontitis Chronic infection by the pathogens induces a chronic inflammation and becomes an out-of-control response in which
    Tissue destruction, not repair, becomes the main focus of the immune response
    • 1. Macrophages produce cytokines, PGE2, and MMPs
    • 2. These mediators stimulate fibroblasts to secrete PGE2 and MMP
    • 3. Biochemical mediators from the macrophages and fibroblasts result in destruction of the connective tissue including fibers at the apical edge of the junctional epithelium (PDL fibers)
    • 4. PGE2 stimulates osteoclasts to resorb the crest of the alveolar bone
  28. What are Systemic risk factors
    conditions or diseases that increase an individual’s susceptibility to periodontal disease by modifying or amplifying the host response to periodontal pathogens
    • Tobacco use
    • Diabetes mellitus
    • Leukemia
    • HIV Infection
    • Osteoporosis
    • Hormonal fluctuations
  30. DIABETES MELLITUS is a disease in which the body
    does not produce insulin or cannot properly use insulin
  31. Insulin is needed to
    convert sugar into energy
  32. Type I diabetes is caused by
    damage to the pancreas due to an autoimmune disorder
  33. Type II diabetes develops when
    the body is unable to use the insulin it makes
  34. More than _________ people in US have diabetes and about ____% are undiagnosed
    • 24 million
    • 25%
  35. Type I is what kind of diabetes and what is the usual age of onset
    • Insulin Dependent Diabetes Mellitus
    • before 20
  36. Type II diabetes is what kind of diabetes and what is the usual age of onset
    • Noninsulin Dependent Diabetes Mellitus
    • Adult onset
  37. Individuals with well-controlled diabetes have _______ periodontal disease than persons without diabetes
    no more
  38. There is about a ___ times risk factor between nondiabetics and uncontrolled diabetics
  39. A person with uncontrolled diabetes who also smokes and who is older than 45, is _____ times more likely than a nondiabetic, nonsmoker to have severe periodontitis
    • Cells – impaired function of neutrophils in both chemotaxis and phagocytosis
    • Increased production of proinflammatory cytokines such as PGE2 and Interleukin 1(IL1)
    • Altered wound healing due to malfunctioning fibroblasts which produces poor quality collagen
    • Reduced salivary flow
  41. Taking insulin without eating may result in _______ and severely low blood sugar can cause
    • insulin shock
    • –Mental confusion
    • –Slurred speech
    • –Rapid heartbeat
    • –Nausea
    • –Cold, clammy skin
  42. Obesity is an _________ and is measured by your _________
    • excess amount of body fat in proportion to lean body mass
    • your BMI or body mass index
  43. Overweight = BMI of ?
    25 to 29.9
  44. Obesity = BMI of ?
  45. More than ____% of Americans BMI ≥ 25
  46. More than ___% of Americans BMI ≥ 30
  47. LEUKEMIA is a
    cancer of the blood or bone marrow causing an overproduction of white blood cells that don’t function normally
  48. Leukemia-associated gingivitis is characterized by
    • –Swollen, glazed, spongy tissues
    • –Gingival bleeding
    • –Red to deep purple in color
    • –Gingival enlargement is commonly seen
  49. Gingival changes of AIDS patients can include
    linear gingival erythema, a 2-3 mm marginal band of redness (erythema)
  50. What is OSTEOPOROSIS and it occurs more frequently in
    • Loss of bone mineral leading to loss of bone mass and density
    • –Postmenopausal women due to decrease in estrogen
    • –Sedentary individuals
    • –Bedridden individuals
    • –Individuals on long-term steroid therapy
  51. What are some HORMONAL VARIATIONS of puberty and who does it occur in
    • Increase in hormones (estradiol, testosterone) causes increased blood circulation to gingival tissues
    • Increased levels may cause increased sensitivity to local irritants such as plaque biofilms
    • Pubertal gingivitis occurs equally in males and females
  52. As adulthood approaches in Endocrine-influenced gingival disease the _________ even in the presence of the same amount of plaque but complete health requires _______
    • severity diminishes
    • removal of the irritants
  53. What are the clinical features of pregnancy-associated pyogenic granuloma or “pregnancy tumor
    Red to bluish red, hyperplastic, edematous, with bleeding with little provocation
  54. In pregnancy higher levels of ______ and ________ suppress the immune response especially effecting ____ function
    • progesterone and estrogen
    • PMN
  55. Hormone replacement therapy (HRT) following menopause can cause some clinical features such as
    • dry, shiny, red gingiva that bleeds easily
    • Dry, burning sensation throughout the oral cavity
  56. Menopause results in decrease in ________ which may lead to loss of ________
    • estrogen
    • bone density
  57. Genetics may account for as much as ______% of the risk for periodontal disease
  58. _________ is one of the most common birth defects
    Down syndrome (Trisomy 21)
  59. In patients with Down Syndrome or Trisomy 21 their face is characterized by ________ and about ___% have heart abnormalities
    • slanted eyes and patients are generally shorter
    • 30%
  60. Individuals with Down syndrome often develop _______ and the prevalence ranges from ___ to ___% under age ___
    • severe, aggressive periodontitis
    • 60% to 98% of young adults under age 35
  61. _________ and ________ most likely explain the high prevalence and severity of periodontitis associated with Down syndrome
    Impaired PMN chemotaxis and phagocytosis
  62. A number of medications used to treat systemic conditions can cause oral complications such as
    • –Alteration of plaque biofilm composition or pH
    • – Effect on salivary flow
    • – Effect on gingival tissues
  63. A lower pH can lead to
    root surface caries
  64. What are some Benefits of saliva
    • Physical flow of saliva helps to dislodge microbes from teeth and mucosa surfaces.
    • Saliva causes bacteria to clump together so they can be swallowed before they become firmly attached.
    • Saliva has antimicrobial components.
    • Saliva has components that help repair and regenerate oral tissues
  65. Patients with xerostomia suffer from an increase in
    • Oral candidiasis
    • Root surface caries
    • Excess plaque formation
  66. Drugs with xerostomic effects
    • –Antihypertensives
    • –Narcotic analgesics
    • –Tranquilizers
    • –Diuretics
    • –Antimetabolites
    • –Antihistamines
    • - Sedatives
  67. What are the Three major classes drugs that cause gingival enlargement
    • –Calcium channel blockers
    • –Immunosuppressives
    • –Anticonvulsants
  68. Gingival overgrowth begins in the ________ area
    interdental papillae
  69. What is the most commonly used anticonvulsant medication to control convulsions and seizures in the treatment of individuals with epilepsy
    PHENYTOIN (Dilantin)
  70. What is an Immunosuppressive agent (drug)that reduces the body’s immune response in organ transplants
  71. Gingival overgrowth occurs in _____% of those taking Immunosuppressives
  72. NIFEDIPINE is what class of medication and is used for patients with
    • Coronary vasodilator used to treat people with hypertension, angina, and cardiac arrhythmias
  73. ___% of patients taking NIFEDIPINE experience gingival enlargement
Card Set
Perio PP14/15
Perio PP14/15