Exam 1; Pathogenesis of Periodontitis

Question 1

This is attached to enamel

Answer 1

the junctional epithelium

Question 2

This appears to be continuous with the junctional epithelium

Answer 2

oral epithelium

Question 3

What are the tissue ratios in healthy gingiva

Answer 3

10% JE
30% OE
60% CT

Question 4

True or False

There is a large number of PMNs present in the outer portion of the JE

Answer 4

False; there are only a few

Question 5

What is the thickness of the JE

Answer 5

thin; 10-20 cell layers thick

Question 6

What is absent in the gingiva

Answer 6

epithelial ridges; rete pegs

Question 7

This is dense with prominent collagen fiber bundles

Answer 7

connective tissue

Question 8

This is with capillary loops (rete pegs) and the number of loops is constant

Answer 8

subepithelial plexus

Question 9

The anastomoses of supraperiosteal blood vessels (sv) is with what

Answer 9

vessels from the bone and PL

Question 10

These have no loops in healthy gingiva

Answer 10

dentogingival plexus (dp)

Question 11

What are 6 reasons for stability in healthy gingiva

Answer 11

shedding of epithelial cells
intact epithelial barrier
positive flow of the GCF
complement system
PMNs and macrophages
protective effects of antibodies

Question 12

Histopathological stages in the development of gingivitis and periodontitis were described by who

Answer 12

Page and Schroeder

Question 13

This lesion stage is in the sub gingival stage of gingivitis

Answer 13

initial lesion

Question 14

This lesion stage is in the clinical stage of gingivitis

Answer 14

early lesion

Question 15

This lesion stage is chronic gingivitis

Answer 15

established lesion

Question 16

This lesion stage is in the progression of periodontitis

Answer 16

advanced lesion

Question 17

This type of lesion occurs within 1-4 days of plaque development and has the early stage of inflammation

Answer 17

initial lesion

Question 18

The initial lesion has increased permeability and infiltration to which molecules

Answer 18

permeable to; carbon particles and serum proteins that leak out of vessels
PMNs and monocytes in the JE and lymphocytes in the CT

Question 19

This type of lesion has increased vascular density, decreased perivascular collagen, and increased gingival crevicular fluid

Answer 19

initial lesion

Question 20

Is the initial lesion detectable clinically

Answer 20

No

Question 21

Where do the vessels dilate in the initial lesion, resulting in increased permeability and an increase in GCF flow

Answer 21

dentogingival plexus

Question 22

What is vasodilation induced by in the initial lesion

Answer 22

vasoactive mediators like histamine, IL-1, TNF

Question 23

This is a plasma transduate (health) and inflammatory exudate (disease)

Answer 23

GCF

Question 24

GCF constituents indicate what

Answer 24

inflammatory changes and bacterial colonization

Question 25

Does GCF flow rate increase or decrease with clinical inflammation

Answer 25

increase

Question 26

This stain is for protein indicates GCF volume

Answer 26

ninhydrin

Question 27

There is cytokine-mediated up-regulation of this in the initial lesion

Answer 27

adhesion molecules on endothelial cells

Question 28

These adhere to post-capillary venues and begin to migrate through the JE into the gingival sulcus

Answer 28

PMNs

Question 29

Chemotaxis by PMNs is induced by what two things

Answer 29

``` host factors (IL-8, C5a) molecules released by bacteria ```

Question 30

In the initial lesion, this is subjacent to JE

Answer 30

vasculitis

Question 31

In the initial lesion, there is increased migration of what

Answer 31

leukocytes into the JE and gingival sulcus

Question 32

In the initial lesion, these are present extravascularly

Answer 32

serum proteins

Question 33

In the initial lesion, what is altered in its most coronal portion

Answer 33

the JE

Question 34

What is lost in the initial lesion

Answer 34

perivascular collagen

Question 35

This occurs within 4-7 days of plaque development, inflammation is not clinically evident

Answer 35

early lesion

Question 36

In the early lesion, what is subjacent to the JE

Answer 36

lymphocytes and PMNs

Question 37

In the early lesion, what is undergoing cytopathic alterations

Answer 37

fibroblasts

Question 38

In the early lesion, this undergoes destruction which creates space for infiltrate

Answer 38

collagen

Question 39

In the early lesion, these cells on the JE and SE proliferate

Answer 39

basal cells

Question 40

In the early lesion, these invade the coronal portion of the lesion

Answer 40

epithelial rete pegs

Question 41

The dentogingival plexus is extremely permeable following what

Answer 41

minor trauma or inflammation

Question 42

In the early lesion, there is an accumulation of lymphoid cells

Answer 42

immediately subjacent JE

Question 43

In the early lesion there is cytopathic alteration in what

Answer 43

resident fibroblasts

Question 44

What is also in the established lesion besides macrophages and serum proteins

Answer 44

T, B, and plasma cells

Question 45

In the established lesion the activated T cells produce what

Answer 45

cytokines

Question 46

In the established lesion, the plamsa cells produce this

Answer 46

Ig and cytokines

Question 47

In the established lesion, these produce MMPs and TIMPs

Answer 47

fibroblasts

Question 48

In the established lesion, the JE and SE proliferate and migrate deep into the CT, the sulcus deepens and the JE is converted to what

Answer 48

permeable pocket epithelium (PE)

Question 49

This is loaded with PMNs and is not attached to the tooth surface

Answer 49

permeable pocket epithelium (PE)

Question 50

The established lesion may have this evident

Answer 50

early pocket formation

Question 51

True or False | There is no apical migration of JE and non bone loss at this stage

Answer 51

True

Question 52

In the advanced lesion stage there is a switch from what cells

Answer 52

T to B cell predominance signals conversion from gingivitis to periodontitis

Question 53

In the advanced stage lesion there is destruction of CT attachment to the root surface and apical migration of what

Answer 53

of epithelial attachment indicates the first clinical sign of periodontitis

Question 54

Bone destruction begins where

Answer 54

around communicating blood vessels along the crest of the septum

Question 55

In the advanced lesion, what is the percentage is plasma cells

Answer 55

50%

Question 56

True or False | In the advanced lesion, there is extension of lesion into alveolar bone and PL with significant bone loss

Answer 56

True

Question 57

What are 5 commons modifyling factors of periodontitis

Answer 57

``` diabetes pregnancy puberty menopause smoking ```

Question 58

The modifying factors can influence these five things

Answer 58

``` susceptibility to gingivitis and periodontitis plaque growth and composition clinical presentation disease progression response to periodontal therapy ```

Question 59

What are the four oral and periodontal effects of diabetes mellitus

Answer 59

xerostomia candida infections periodontits multiple periodontal abscesses

Question 60

Periodontits in diabetes patients increases what

Answer 60

insulin resistance

Question 61

What does diabetes do to the host response system in periodontitis

Answer 61

PMN function, chemotaxis is impaired cytokines, monocytes, and macrophages have a more destructive phenotype connective tissue has a decreased matrix

Question 62

This hormone, common in pregnancy, puberty, and menopause affects salivary perioxidases and increases collagen metabolism and the vascular response

Answer 62

estrogen

Question 63

True or False There is an increase in gingival inflammation and and increase in bleeding during the mental cycle in those women with gingivitis

Answer 63

True

Question 64

gingivitis is seen in about how many pregnancies

Answer 64

35-88% and is highest during the 2nd (best time to treat) and 3rd trimesters

Question 65

What does pregnancy do to the microbiotia

Answer 65

increases certain species

Question 66

What does pregnancy do to host effects

Answer 66

increases vascular permeability but a decrease in PMN chemotaxis

Question 67

What is the main proponent of gingivitis in menopausal women

Answer 67

due to decreased absorption and increased elimination of calcium

Question 68

True or False | Osetoprorsis in post-menopausal women causes periodontitis

Answer 68

False; it may not cause it, but may affect the severity of the disease

Question 69

Tobacco smoking causes what to occur

Answer 69

deep probe and pocket depths but less gingivitis and BOP

Question 70

What does tobacco do to bacteria

Answer 70

smokers have more plaque | increases certain bacteria species

Question 71

What does smoking due to the host

Answer 71

less BOP due to decreased blood vessels, etc. lower amounts of GCF lower PMN function

Question 72

Smoking results in a poor or great response to surgical treatment and nonsurgical treatment

Answer 72

poor

Question 73

What is the main factor of diabetes that causes periodontitis

Answer 73

Advanced glycation end products (AGE); harms the immune system (reducing migration, impairing host defenses) and capillary thickening leading to altered connective tissue fibroblast/osteoblast and epithelium