-
The prime purpose of the immune system is to
defend the life of the individual
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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
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What are lipopolysaccharides
LPS is a substance present in the cell membrane of Gram-negative bacteria and can initiate inflammation
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Some bacteria such as _________ and __________, can invade host tissues and help them avoid host defense mechanisms
Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans
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Several periodontal bacteria produce enzymes such as _________ and _________ that can directly degrade host proteins that are part of the periodontium
collagenases and proteases
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Biochemical mediators are
biologically active compounds secreted by the immune cells that activate the body’s inflammatory response
-
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)
-
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
-
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
-
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
-
____________ initiate most of the alveolar bone destruction in periodontitis
Prostaglandins of the E series (PGE)
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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
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What are the FACTORS AFFECTING THE HOST IMMUNE RESPONSE
- Genetic Factors
- Environmental Factors
- Acquired Factors
-
What is a known environmental risk factor that has a has a significant effect on the immune and inflammatory system?
Smoking
-
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
-
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
-
What are the 4 MICROSCOPIC PHASES OF PERIODONTAL DISEASE
- Early bacterial accumulation phase –initial lesion
- Early gingivitis (acute phase)—early lesion
- Established gingivitis—established lesion
- Periodontitis—advanced lesion
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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
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What are some features of the EARLY GINGIVITIS – PLAQUE BIOFILM OVERGROWTH PHASE
- 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
-
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
-
What is the key WBC in EARLY GINGIVITIS
PMNs
-
What is the key WBC in ESTABLISHED GINGIVITIS
macrophages
-
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
-
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
-
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
-
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
-
What is the MECHANISM FOR ALVEOLAR BONE DESTRUCTION
- 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
-
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
-
What are some PROVEN SYSTEMIC RISK FACTORS
- Tobacco use
- Diabetes mellitus
- Leukemia
- HIV Infection
- Osteoporosis
- Hormonal fluctuations
-
DIABETES MELLITUS is a disease in which the body
does not produce insulin or cannot properly use insulin
-
Insulin is needed to
convert sugar into energy
-
Type I diabetes is caused by
damage to the pancreas due to an autoimmune disorder
-
Type II diabetes develops when
the body is unable to use the insulin it makes
-
More than _________ people in US have diabetes and about ____% are undiagnosed
-
Type I is what kind of diabetes and what is the usual age of onset
- Insulin Dependent Diabetes Mellitus
- before 20
-
Type II diabetes is what kind of diabetes and what is the usual age of onset
- Noninsulin Dependent Diabetes Mellitus
- Adult onset
-
Individuals with well-controlled diabetes have _______ periodontal disease than persons without diabetes
no more
-
There is about a ___ times risk factor between nondiabetics and uncontrolled diabetics
3
-
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
20
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What are some MECHANISM OF ACTIONS RESULTING IN PERIODONTAL DISEASE IN DIABETICS
- 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
-
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
-
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
-
Overweight = BMI of ?
25 to 29.9
-
-
More than ____% of Americans BMI ≥ 25
65%
-
More than ___% of Americans BMI ≥ 30
35%
-
LEUKEMIA is a
cancer of the blood or bone marrow causing an overproduction of white blood cells that don’t function normally
-
Leukemia-associated gingivitis is characterized by
- –Swollen, glazed, spongy tissues
- –Gingival bleeding
- –Red to deep purple in color
- –Gingival enlargement is commonly seen
-
Gingival changes of AIDS patients can include
linear gingival erythema, a 2-3 mm marginal band of redness (erythema)
-
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
-
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
-
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
-
What are the clinical features of pregnancy-associated pyogenic granuloma or “pregnancy tumor
Red to bluish red, hyperplastic, edematous, with bleeding with little provocation
-
In pregnancy higher levels of ______ and ________ suppress the immune response especially effecting ____ function
- progesterone and estrogen
- PMN
-
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
-
Menopause results in decrease in ________ which may lead to loss of ________
-
Genetics may account for as much as ______% of the risk for periodontal disease
50%
-
_________ is one of the most common birth defects
Down syndrome (Trisomy 21)
-
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%
-
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
-
_________ and ________ most likely explain the high prevalence and severity of periodontitis associated with Down syndrome
Impaired PMN chemotaxis and phagocytosis
-
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
-
A lower pH can lead to
root surface caries
-
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
-
Patients with xerostomia suffer from an increase in
- Oral candidiasis
- Root surface caries
- Excess plaque formation
-
Drugs with xerostomic effects
- –Antihypertensives
- –Narcotic analgesics
- –Tranquilizers
- –Diuretics
- –Antimetabolites
- –Antihistamines
- - Sedatives
-
What are the Three major classes drugs that cause gingival enlargement
- –Calcium channel blockers
- –Immunosuppressives
- –Anticonvulsants
-
Gingival overgrowth begins in the ________ area
interdental papillae
-
What is the most commonly used anticonvulsant medication to control convulsions and seizures in the treatment of individuals with epilepsy
PHENYTOIN (Dilantin)
-
What is an Immunosuppressive agent (drug)that reduces the body’s immune response in organ transplants
CYCLOSPORINE
-
Gingival overgrowth occurs in _____% of those taking Immunosuppressives
25%
-
NIFEDIPINE is what class of medication and is used for patients with
- CALCIUM CHANNEL BLOCKERS
- Coronary vasodilator used to treat people with hypertension, angina, and cardiac arrhythmias
-
___% of patients taking NIFEDIPINE experience gingival enlargement
38%
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