High Yield: Periodontitis as a Manifestation of Systemic Disease

Question 1

T/F: Diseases and conditions can affect the periodontal tissues by affecting the periodontal supporting tissues INDEPENDENTLY of dental-plaque biofilm-induced inflammation

Answer 1

True

Question 2

Systemic disorders that have a major impact on the loss of periodontal tissue by influencing periodontal inflammation include: (3)

Answer 2

1. genetic disorders
2. AIDs
3. Inflammatory diseases

Question 3

-trisomy 21 or mongolism
-characteristic physical appearance
-mental deficiency & growth retardation

Answer 3

Down syndrome

Question 4

List some of the physical characteristics of down syndrome:

Answer 4

1. small nose, mouth & ears
2. slightly bent fifth finger (pinky)
3. short, stocky build
4. almond-shaped eyes with skin fold covering inner corner
5. white spots on colored part of eyes
6. flat, round face

Question 5

Give another name for down syndrome:

Answer 5

1. mongolism
2. trisomy 21

Question 6

Describe how periodontal disease is categorized in a patient with down syndrome:

Answer 6

moderate to sever periodontitis with rapid progression

Question 7

T/F: In down syndrome, local factors alone explain the severity of periodontal destruction

Answer 7

False- local factors alone FAIL to explain the severity of periodontal destruction

Question 8

What aspects of down syndrome might contribute to the moderate to severe periodontal destruction with rapid progression:

Answer 8

INTRINSIC IMMUNE SYSTEM DEFECTS
-poor PMN chemotaxis
-poor phagocytosis
-intracellular killing

Question 9

List the three intrinsic immune system defects seen in down syndrome:

Answer 9

1. Poor PMN chemotaxis
2. Poor phagocytosis
3. Intracellular killing

Question 10

Leukocyte adhesion deficiency (LAD) is due to a mutation in:

Answer 10

Beta-2 integrin gene (ITGB2)

Question 11

Lack of beta-2 integrin gene in LAD results in:

Answer 11

1. lack beta-2 integrin mRNA in leukocytes
2. low integrin (CD18 or CD15) expression on neutrophils

Question 12

1. lack beta-2 integrin mRNA in leukocytes
2. low integrin (CD18 or CD15) expression on neutrophils

This is seen in ____ due to ____

Answer 12

LAD; due to mutation in beta-2 integrin gene (ITGB2)

Question 13

Describe the neutrophil insufficiency in LAD:

Answer 13

Neutrophils are confined to blood vessels resulting in disruption of neutrophil associated-homeostasis

Question 14

In what disease are neutrophils confined to blood vessels? What does this result in?

Answer 14

LAD; Disruption of neutrophil-associated homeostasis

Question 15

Describe what is seen in the peridontium of LAD individuals:

Answer 15

History of severe recurrent infection but no pus; leukocytosis is common

Question 16

What is a common manifestation that comes along with the history of severe recurrent infection without pus, in LAD patients:

Answer 16

Leukocytosis

Question 17

Papillon-Lefevre syndrome is caused by a mutation in:

Answer 17

Cathepsin C gene (CTSC)

Question 18

Papillon-Lefevre syndrome is caused by a mutation in cathepsin C gene (CTSC) that is located on chromosome:

Answer 18

11q14

Question 19

The mutation in Papillon-Lefevre syndrome results in:

Answer 19

1. Compromised neutrophil function
2. Decreased phagocytosis
3. hyperkeratotic lesions

Question 20

What type of lesions result from the mutation in the Cathepsin C gene in Papillon-Lefevre syndrome?

Answer 20

Hyperkeratotic lesions
-palms
-soles of feet
-elbows
-knees

Question 21

Chediak-Higashi syndrome is due to a mutation in:

Answer 21

CHS1 gene
LYST gene

Question 22

The mutations in CHS1 & LYST genes seen in Chediak-Higashi syndrome result in:

Answer 22

lysosomal tracking defect

Question 23

Partial oculocutaneous albinism is seen in:

Answer 23

Chediak-Higashi syndrome

Question 24

Why do we see partial oculocutaneous albinism is seen in Chediak-Higashi syndrome- why?

Answer 24

Defects in melanin granules

Question 25

Patients with Chediak-Higashi syndrome have recurrent pyogenic infections due to:

Answer 25

1. circulating leukocytes exhibit DEFECTIVE LYSOSOMES 2. decrease in phagocytosis

Question 26

The varying neurologic problems seen in Chediak-Higashi syndrome include:

Answer 26

1. intellectual deficit 2. dementia

Question 27

- Mutation is CHS1 - Mutation in LYST - Lysosomal tracking defect - Partial oculocutaneous albinism (defective melanin granules) - Recurrent pyogenic infections (defective lysosomes & circulating leukocytes & decrease in phagocytosis) - Varying neurologic problems (intellectual deficit & dementia)

Answer 27

Chedaik- Highashi Syndrome

Question 28

Congenital neutropenia results from a mutation in:

Answer 28

ELANE (50%) HAX1 (10%) Unknown cause (33%)

Question 29

Congenital neutropenia results in a _____ number of ____

Answer 29

decreased; neutrophils

Question 30

What is the ANC level in an individual with congenital neutropenia:

Answer 30

Less than 500 cells per microliter and static

Question 31

List the clinical manifestations of congenital neutropenia:

Answer 31

1. defective immune response 2. severe & recurrent infections

Question 32

1. down syndrome 2. LAD 3. PLS 4. Chediak-Higashi syndrome 5. congenital neutropenia These are all diseae associated with:

Answer 32

Immunologic disorders

Question 33

1. down syndrome 2. LAD 3. PLS 4. Chediak-Higashi syndrome 5. congenital neutropenia Fill in the mutations associated with these diseases:

Answer 33

1. Trisomy 21 2. Beta-2 integrin 3. Cathepsin 4. LYST, CHS1 5. ELANE, HAX1, Unknown

Question 34

What type of syndrome is Ehlers-Danlos syndrome categorized as?

Answer 34

Diseases affecting the connective tissue

Question 35

List the oral manifestations of Ehlers-Danlos syndrome:

Answer 35

1. generalized, early-onset severe periodontitis 2. gingival recession 3. early loss of primary & permanent teeth 4. GENERALIZED LACK OF ATTACHED GINGIVA

Question 36

In what connective tissue disease do we see a GENERALIZED LACK OF ATTACHED GINGIVA?

Answer 36

Ehlers-Danlos syndrome

Question 37

What mutation causes hypophosphatasia?

Answer 37

Mutation in Alkaline phosphatase gene (ALPL)

Question 38

The forms of hypophosphatasia range from:

Answer 38

mild to severe

Question 39

Describe the oral manifestations seen in hypophosphatasia:

Answer 39

1. defective cementum 2. alveolar bone loss 3. premature loss of teeth

Question 40

IDDM:

Answer 40

Type 1

Question 41

NIDDM:

Answer 41

Type 2

Question 42

Describe the onset of the following: Type 1 DM: Type 2 DM:

Answer 42

Type 1: early onset but can occur at any age Type 2: adult onset

Question 43

What is the prevalence & pathophysiology of type 1 diabetes?

Answer 43

5-10%; destruction of the pancreatic beta cells

Question 44

What is the prevalence & pathophysiology of type 2 diabetes?

Answer 44

90-95%; obestity, genetics

Question 45

List some characteristics of type 1 diabetes: (2)

Answer 45

1. absolute insulin deficiency 2. marked tendency towards ketosis & coma

Question 46

List some characteristics of type 2 diabetes: (2)

Answer 46

1. blood level of insulin may be normal, increased or decreased 2. development of ketosis & coma is uncommon

Question 47

______ is a complicating factor for diabetes and also affects _____

Answer 47

periodontal disease; glycemic control

Question 48

What type of bacteria are seen in cases of diabetic patients with perio disease?

Answer 48

gram negative

Question 49

Perio treatment in a diabetic patient leads to:

Answer 49

1. improved insulin sensitivity 2. improved glycemic control

Question 50

-Estrogen withdrawal -increase in IL-6 -increased bone turnover -net systemic bone loss -decrease in bone mineral density -weakened bone microarchitecture -high risk of bone fracture

Answer 50

Osteoporosis

Question 51

In osteoporosis there needs to be a homeostasis in what three factors?

Answer 51

1. bone 2. estrogen 3. inflammation

Question 52

Describe the periodontitis associated with osteoporosis:

Answer 52

1. bacterial infection 2. local inflammatory insult 3. initial cortical bone compromise 4. bone loss

Question 53

What are the shared risk factors between osteoporosis & periodontitis?

Answer 53

1. AGE 2. SMOKING 3. VITAMIN D 4. CALCIUM DEFICIENCY

Question 54

1. AGE 2. SMOKING 3. VITAMIN D 4. CALCIUM DEFICIENCY These are the shared risk factors between:

Answer 54

Osteoporosis & periodontitis

Question 55

T/F: Patients with arthritis (OA & RA) have a higher incidence of perio disease compared to healthy controls

Answer 55

True

Question 56

What is the correlation between periodontitis and RA?

Answer 56

they both invoke the same cytokines & pro-inflammatory mediators

Question 57

____ may play a key role in the pathogenesis of periodontitis-associated RA

Answer 57

P. gingivalis

Question 58

In RA, P. gingivalis produces _____ which is associated with the RA

Answer 58

Peptidylarginine deiminase (PAD)

Question 59

Peptidylarginine deiminase (PAD) is produced by ____ and is seen in what disease?

Answer 59

P. gingivalis; RA & periodontitis

Question 60

Other systemic disorders that may contribute to the periodontal tissue loss by influencing the pathogenesis of perio diseases:

Answer 60

1. smoking 2. stress/depression

Question 61

List the oral manifestations of smoking (any type)

Answer 61

1. 4x attachment loss 2. leukoplakia 3. carcinoma 4. tooth loss 5. gingival recession

Question 62

Smokers have ____x the attachment loss than nonsmokers

Answer 62

4x

Question 63

What cancer is associated with smokers?

Answer 63

carcinoma

Question 64

List the continuum seen in smoking patients & periodontal disease:

Answer 64

1. impaired immune response 2. subgingival anaerobic infection 3. connective tissue cytotoxicity 4. impaired wound healing 5. increased severity of periodontitis

Question 65

Fill in the blanks of the continuun of smokers with perio disease: 1. impaired _____ 2. ____ infection 3. _____ cytotoxicity 4. impaired _____ 5. increased severity of ___

Answer 65

1. impaired immune response 2. subgingival anaerobic infection 3. connective tissue cytotoxicity 4. impaired wound healing 5. increased severity of periodontitis

Question 66

Nicotine causes:

Answer 66

Vasoconstriction

Question 67

Nicotine causes vasoconstriction of the:

Answer 67

Peripheral blood vessels

Question 68

Nicotine causes vasoconstriction of the peripheral blood vessels which leads to:

Answer 68

decrease in tissue oxygenation

Question 69

Tars are ____ & ____

Answer 69

cytotoxic & sticky

Question 70

Tars are cytotoxic & sticky leading to:

Answer 70

Lung diseases (COPD & cancer)

Question 71

Tars are cytotoxic & sticky causing lung disease, ultimately leading to:

Answer 71

decreases in tissue oxygenation

Question 72

When does the nicotine & tars smoking chart merge?

Answer 72

Both causing decrease in tissue oxygen

Question 73

Both nicotine & tars lead to a decrease in tissue oxygenation resulting in: (3)

Answer 73

1. SUBgingival ANAEROBIC infection 2. Connective tissue cytotoxicity 3. impaired wound healing

Question 74

-subgingival anaerobic infection -connective tissue cytotoxicity -impaired wound healing These are all due to:

Answer 74

smoking (nicotine & tars)

Question 75

Systemic disorders that can result in loss of periodontal tissues independent of periodontitis:

Answer 75

1. neoplasms 2. other disorders that may affect periodontal tissue