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______ are the first one at the site of infection
cytokines
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Cytokines are defenders but if they sit in floor of the sulcus for along time they can become ____.
destroyers
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What does the host do?
defends the life of periodontium
-
Host response?
- Is the body's response to bacteria.
- Main purpose is to defend the life of the individual(host)
-
For progression of disease from health to gingivitis to periodontitis, ______ must be present.
pathogenic bacteria
-
Is the presence of periodontal pathogens alone sufficient to cause the tissue destruction seen in periodontitis?
- NO
- The body's response to bacteria present in plaque biofilm is the cause of early all the destruction seen in periodontal disease.
-
Cells involved in immune and inflammatory processes include?
- inflammatory cells
- Polymorphonuclear neutrophils (PMNs)
- Antigen-presenting cells(Macrophages, Langerhans cells)
- T & B lymphocytes
- Fibroblasts
- epithelial cells
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Host immune cells secrete biologically active compounds called?
biochemical mediators
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Biochemical mediators are considered the _____ sent by the host cells to activate the inflammatory response.
middlemen
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Biochemical mediators of importance in periodontitis are? 3
- "destroyers"
- cytokines
- Prostaglandins
- MMPs
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____ are powerful regulatory proteins released by host immune cells that influence the behavior of other cells.
Cytokines
-
Which protein transmits information or signals from one cell to another and when released by host cells, they signal the immune system to send additional phagocytic cells to the site of infection.
Cytokines
-
What cells are able to produce Cytokines?
- PMNs,
- macrophages,
- B lymphocytes,
- epithelial cells,
- gingival fibroblasts, and
- osteoblasts
-
______ are the most abundant white blood cells.
PMN’s = Polymorphonuclear neutrophil
-
which cells are recruited by Cytokines to the site of infection?
PMNs and macrophages
-
____ can Increase vascular permeability that increases movement of immune cells into the tissues.
Cytokines
-
Which protein has the potential to innate tissue destruction and bone loss in chronic inflammatory disease, such as periodontitis.
Cytokines
-
Which Cytokines play an important role in periodontitis?
- Interleukins:
- IL-1, IL-6, IL-8,
- and Tumor necrosis factor TNF-alpha
-
Where do prostaglandins derive from? biologically important prostaglandins are?
- fatty acids
- Prostaglandins D,E,F,G,H,I
-
_____ play an important role in the bone destruction seen in periodontitis.
Prostaglandins of the E series (PGE)
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_____ increase permeability and dilatation of blood vessels to promote increased movement of immune cells to the infection site (redness and edema of the connective tissues)
Prostaglandins
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If chronic, prostaglandins can trigger____ and can promote the overproduction of destructive ___ enzymes.
- osteoclast;(bone resorbing cells) destroy alveolar bone.
- MMP enzymes
-
What are Matrix Metalloproteinases (MMPs)?
- Family of at least 12 different enzymes
- Enzymes act together to breakdown connective tissue matrix
-
What produces Matrix Metalloproteinases (MMPs)?
- Produced by various cells of the body—PMNs, macrophages, fibroblasts, JE cells
- *PMNs and Fibroblast are the major source
-
What is the function of Matrix Metalloproteins (MMPs) in the absence of disease(health)?
MMPs facilitate the normal turnover of the periodontal connective tissue matrix
-
Antibiotic to give periodontitis patients that kills MMPs?
Doxycycline- inhibit MMP-Periostat
-
what as the function of Matrix Metalloproteins (MMPs) in the presence of chronic bacterial infection?
- MMPs are released in an attempt to kill invading bacteria.
- Overproduction of MMPs results in breakdown of connective tissue of the periodontium.
-
what as the function of increased levels Matrix Metalloproteins (MMPs) in the presence of chronic bacterial infection ?
- High MMP levels result in extensive collagen destruction in the periodontal tissues.**Collagen provides the structural framework of all periodontal tissues:Without collagen, the tissues of the gingiva, periodontal ligament, and supporting alveolar bone degrade.
- This results in gingival recession, pocket formation, and tooth mobility.
-
What does the immune system do in periodontal disease?
- fights to defend the body from periodontal pathogens,
- NOT to preserve the periodontium or teeth
-
What is the cause of nearly all the destruction seen in periodontitis?
It is the body’s response to the periodontal pathogens
-
Vertical bone loss?
inflammation gingiva→break in PDL→bone destruction
-
Horizontal bone loss?
inflammation gingiva→bone destruction→break in PDL
-
Does a bacterial infection of the periodontium always result in periodontitis?
The presence of periodontal pathogens does not necessarily mean that an individual will experience periodontitis.
-
What role does the immune system play in tissue destruction?
the body’s immune system causes tissue destruction in an attempt to stop bacterial infection in periodontal disease.
-
The Intensity of immune response to periodontal pathogens varies considerably from?
one individual to another
-
Local immune response can vary in intensity from ?
site to site within a patient’s mouth.
-
Some people with abundant bacterial plaque exhibit only?
mild disease.
-
Some people with light bacterial plaque suffer?
severe disease.
-
Does Untreated gingivitis always lead to periodontitis?
NO
-
Will everyone infected with pathogens get periodontal disease?
NO
-
What does pathogenic bacteria do?
infect the periodontium.
-
In the host response the body responds by mobilizing _____.
defensive cells.
-
In the host response, Cells release a series of chemicals to ______.
fight bacteria.
-
In Periodontal disease the body’s immune system causes ______ in an attempt to stop bacterial infection.
tissue destruction
-
In periodontal disease what determines the onset and severity of periodontal disease?
Complex interactions between periodontal pathogens and host response
-
What are the stages in development of gingivitis and periodontitis?
- Early bacterial accumulation phase
- Early gingivitis —plaque overgrowth phase
- Established gingivitis—subgingival plaque phase
- Periodontitis—tissue destruction phase
-
Early Bacterial Accumulation Phase?
- Bacteria colonize the tooth near the gingival margin
- Bacteria initiate host response
- PMNs pass from bloodstream into the gingival connective tissue
- PMNs release cytokines that destroy gingival connective tissue, allowing PMNs to move quickly through the tissue
- PMNs migrate into the sulcus and phagocytize bacteria
- ***Cytokines clear the path, Lymphocytes WBC fight infection. Returns to health.
- Brushing and flossing gets rid of PMNs.
-
Early Gingivitis—Plaque Overgrowth Phase?
- Bacteria penetrate into the connective tissue.
- More PMNs are attracted to the site; they release more cytokines causing more localized destruction of the connective tissue
- Macrophages are recruited to the connective tissue.
- Macrophages release More: cytokines, PGE2, and MMPs.
- **Reversible, attachment at enamel
-
Established Gingivitis—Subgingival Plaque Phase?
- Plaque biofilm extends subgingivally and disrupts the attachment of the coronal-most portion of the JE.
- Macrophages and lymphocytes are most numerous in the connective tissue; PMNs continue to fight bacteria in the sulcus
- Host cells produce more toxic chemicals— Cytokines(destroy bone and tissue), PGE2(destroy bone), and MMPs(destroy tissue).
-
Periodontitis—Tissue Destruction Phase
- Plaque biofilm grows along the root surface.
- The immune response becomes chronic; intense inflammation begins to harm the periodontium.
- Cytokines destroy the connective tissue and PDL fibers.
- Cytokines, PGE2, and MMPs destroy the connective tissue and bone.
- PGE2 initiates bone destruction.
-
Mechanisms of Alveolar Bone Destruction:
- Macrophages produce cytokines, PGE2, and MMPs.
- These mediators stimulate fibroblasts to secrete PGE2 and MMP
- Mediators from the macrophages and fibroblasts result in destruction of the connective tissue
- PGE2 stimulates osteoclasts to resorb the crest of the alveolar bone
-
- *Macrophage starts to destroy itself.
- MMPs go to Extracellular matrix.
- PGEs to alveolar bone.
- Interleukeins and TNF are released from Macrophage and contribute to destroy.
-
What is a periodontal disease?
a bacterial infection of the periodontium.
-
How does the body responds to periodontal pathogens ? what is this response called?
- by mobilizing defensive cells and releasing chemicals to combat the bacteria.
- Host Defense
-
For the periodontium to remain healthy, the bacterial infection must be?
- controlled
- so as not to trigger a chronic, exaggerated host immune response.
-
The_____ to the bacteria causes most of the tissue destruction in the periodontal tissues.
body’s immune response
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