Periodontology

Question 1

down’s syndrome & perio

Answer 1

increased risk
chromosome 21
defects of neutrophil chemotaxis, killing & phagocytosis
depressed t cell antigen induced killing

Question 2

chronic granulomatous disease & perio

Answer 2

Gp91 protein p91-PHOX on chromosome b558
failure of respiratory burst in phagocytosis oxygen radicals not produced and bacteria survive

Question 3

insulin dependent diabetes & perio

Answer 3

IDDM1 gene on chromosome 6
hyperlgycaemia reduced neutrophil function. monocytes are hyper reactive and excess IL-1, PGE2, TNF alpha and oxygen radicals are produced. collagen solubility & vascularity changes affect healing

Question 4

papillon lefevre syndrome & perio

Answer 4

cathespin C gene on chromosome 11
defects of neutrophil chemotaxis & phagocytosis

Question 5

local & systemic effects of smoking on peri0dontitis

Answer 5

local -> reduced tissue vascularity, PMNL chemotaxis & function (phagocytosis) impaired
systemic effects -> decreased salivary IgA, decreased serum IgG and decreased helper T cells

Question 6

if tissue overgrowth is histologically hypertrophic what does this mean

Answer 6

tissue is enlarged due to the presence of large cells
any cell type can be hypertrophic i.e. epithelium / fibroblasts / myoblasts

Question 7

if tissue overgrowth is histologically hyperplastic what does this mean

Answer 7

tissue is enlarged because it contains an abnormal number of or too many cells
any cell type can be hyperplastic i.e. epithelium / fibroblasts / myoblasts

Question 8

common causes of drug induced gingival overgrowth

Answer 8

phenytonin - for epilepsy
cyclosporin - immunosuppressant used for transplant pts but also used in diabetes / bechet’s / MS / SLE / LP
nifedipine amlodipine - calcium channel blockers (BP regulators used as vasodilators in angina & hypertension

Question 9

causes of hormonal overgrowth

Answer 9

pregnancy / HRT / OCP / puberty

Question 10

pregnancy gingivitis

Answer 10

plaque related
altered microcirculation & altered sub gingival microflora allow gingival frailty, increased bleeding and enhanced reaction to plaque
specific localised gingival overgrowth in combination with plaque induced inflammatory process

Question 11

type 1 DM

Answer 11

cell mediated autoimmune destruction of insulin producing pancreatic beta cells
require insulin for survival

Question 12

type 2 DM

Answer 12

impaired insulin secretion, peripheral resistance to insulin and hepatic insulin insensitivity
impaired insulin secretion is due to reduced cell mass and altered insulin release
due to genetic factors, obesity, increasing age and lack of physical activity

Question 13

pathobiology of DM

Answer 13

prolonged hyperglycaemia leads to formation of irreversible proteins called AGEs (advanced glycation end products) which are widely deposited in cells and tissues and are responsible for pathological features of DM
altered vascular permeability & function, altered cellular function, increased cytokine production increase pt susceptibility to infection i.e. periodontitis

Question 14

ADA diagnostic criteria for diabetes

Answer 14

1. plasma glucose >11.1mmol/L & symptoms of polyuria, polydipsia, polyphagia
2. fasting plasma glucose >7mmol/L
3. 2hr post prandial glucose >11.1mmol/L following oral glucose tolerance test
4. glycated haemoglobin HbA1c test >6.5%