Midterm

Question 1

Hormonal changes associated with gingivitis

Answer 1

puberty, pregnancy, Diabetes

Question 2

Puberty gingivitis peak

Answer 2

arises around initial menses (9-14)

Question 3

puberty gingivitis decline

Answer 3

12-17 years

Question 4

Pregnancy gingivitis

Answer 4

Due to increased levels of progesterone

Question 5

Diabetes Mellitus-related gingivitis

Answer 5

caused by peripheral vascular disease/compromised blood flow (gets blocked by sugar deposited in vessels)

Question 6

clinical manifestations of diabetes gingivitis

Answer 6

diffuse erythematous gingival enlargement and pyogenic granuloma…poor healing and lots of blood

Question 7

Genetic factors associated with gingivitis

Answer 7

• Down syndrome
• chediak-higashi syndrome
• papillon-lefevre syndrome
• Leukocyte Adhesion Deficiency (Type 1)
• cyclic neutropenia
• plasminogen deficiency

Question 8

Down syndrome

Answer 8

• susceptible to gingival and perio disease with low caries index
• defective neutrophil chemotaxis with release of enzymes
• reduced salivary flow (low levels of Abs)
• actinobacillus actinomycetemcomitans higher
• accelerated bone (more osteoclast activity and MMPs)

Question 9

Chediak-higashi syndrome

Answer 9

• autosomal recessive defect…abnormal intracellular protein transport
• lack of tyrosinase–>albinism
• Advanced periodontitis
• defects in chemotaxis and degranulation

Question 10

Papillon-Lefevre syndrome

Answer 10

• autosomal recessive
• Cathepsin C gene loss–>chemotaxis defect b/c of leukocyte adhesion defect–>skin lesions and loss of sulcular integrity
• Juvenile periodontitis
• gram negative bacilli–same as Down syndrome

Question 11

clinical features of Papillon-lefevre syndrome

Answer 11

• 4/million
• begins in early childhood
• palmar-plantar keratosis (white-yellow karatotic)
• dramatic accelerated periodontitis (see floating teeth)

Question 12

P-L syndrome=

Answer 12

JP+plantar and palmar keratosis

Question 13

Leukocyte Adhesion Deficiency (type 1)

Answer 13

• autosomal recessive with primary immunodeficiency
• leukocyte can’t be recruited
• localized infection, impaired pus production
• gingivitis and periodontitis

Question 14

Cyclic Neutropenia

Answer 14

• idiopathic hematologic disorder–>periodic reduction of PMNs
• most are non-inherited

Question 15

Ligneous gingivitis (plasminogen deficiency)

Answer 15

• destructive membrane disease
• equal with males/females any age
• nodular enlargement, ulceration with pseudomembrane and Perio disease
• commonly affects eyes=ligneous conjunctivitis

Question 16

Pathogenic mechanism of ligneous gingivitis

Answer 16

• congenital cases from mutation of PLG gene

- acquired cases come from anti-fibrinolytic drugs–>build up of fibrin

Question 17

Type 1 plasminogen deficiency

Answer 17

quantitative

Question 18

type 2 plasminogen deficiency

Answer 18

qualitative

Question 19

Neoplastic causes of gingivitis

Answer 19

• Leukemia
• Kaposi Sarcoma
• carcinoma

Question 20

Leukemia

Answer 20

• malignant WBC proliferation
• Oral manifestations: anemia (pale mucosa), susceptible to infections–>erythema and ulcers, tends to bleed, monocytic leukemia in gingiva

Question 21

Kaposi Sarcoma

Answer 21

• idiopathic hemorrhagic sarcoma (bruises)
• etiology: HHV-8 (herpes)
• mostly found in southern Africa

Question 22

Epidemiologic groups of kaposi sarcoma

Answer 22

• classic western indolent type (italian, jewish, slavic)
• HIV/AIDS (KS=defining lesion)
• People that are immunosuppresed
• Endemic in Africa