Pathogenesis

Question 1

What is the periodontium and what is its function

Answer 1

The tissues which help support the teeth, by attaching the tooth to the bone tissues of the jaw cavity, and providing proprioception.

Question 2

The gingiva has non-keratinized tissue

True or false

Answer 2

True. It comprises of both keratinized and non-keratinized

Question 3

What is the junction between the attached gingiva and alveolar mucosa called?

Answer 3

The mucogingival junction

Question 4

What is the periodontal ligament?

Answer 4

Soft, vascular, cellular connective tissue

Question 5

What are the functions of the PDL

Answer 5

• Shock absorption
• Transmission of occlusal forces to bone
• Formative and remoedlling
• Participates in formation of resorption of cementum and bone
• Supplied nutrients to cementum, bone and gingiva
• Nerve endings are pain, mechano and pressure receptors

Question 7

What are sharpeys fibers?

Answer 7

Terminal ends of the principal PDL fibers that insert into the cementum and periosteum

Question 9

List 3 risk factors for gingivitis

Answer 9

1. Pregnancy or other hormonal
2. Leukemia
3. Oral Contraceptive

Question 10

Periodontitis has been linked to what systemic conditions

Answer 10

• Heart disease
• Pre-term birth
• Diabetes

Question 11

Periodontitis is host modulated

True or false

Answer 11

True

So it is modulated by the hosts immune response

Question 12

What bacteria are associated with health of the gingiva?

Answer 12

Streptococci and Gram + rods

Question 13

What bacteria may be seen in gingiva that is transitioning to an unhealthy state

Answer 13

Fusobacterium and Prevotella

Question 14

What bacteria are often seen in gingiva with periodontitis

Answer 14

• P. Gingivalis
• Gram negative rods
• Spirochetes
• Aggregatibacter acinomycetemcomitans

Question 15

Describe the sub-gingival biofilm

Answer 15

Highly organised communities of bacteria which exhibit complex cooperation, and exist in numerous microenvironments with differing pH, oxygen, and electrical potentials. They resist the usual host defences and resist systemic and local antibiotics and antimicrobial agents. Tey function as a complex multi-cellular organism!

Question 16

The clinical expression of perio disease is the result of an interaction of four main factors:

Answer 16

1. The host
2. The plaque bacteria
3. Modifying factors
4. Environmental risk factors

Question 17

List 7 local risk factors which hinder plaque removal

Answer 17

1. Iatrogenic damage
2. Rotated teeth
3. Crowding
4. Calculus
5. Overhangs
6. Ortho appliances
7. Deep pockets

Question 18

List 5 systemic risk factors for perio

Answer 18

1. Diabetes
2. Smoking
3. Genetic factors
4. Immunosuppression
5. Medications

Question 19

Whilst periodontal inflammation is initiated by plaque, the severity and extent of tissue damage is determined by:

Answer 19

The host response of the individual

Question 20

3 behavioural risk factors for perio

Answer 20

1. Oral hygiene
2. Smoking
3. Stress

Question 21

What are two biological risk factors for perio

Answer 21

1. Systemic disease
2. Genetics

Question 22

The progression of periodontal disease is linear

True or false

Answer 22

False. Occurs in exacerbatiosn and remissions

Question 23

Loe et al 1986 is a landmark study for perio. What did we find out.

Answer 23

Sri lankan tea labourers were observed and found that men have worse perio than women, more disease in lower SES groups, and 82% slowly progresses. Only 8% rapidly progresses

AND

in 11% no progression!

Question 24

What are three risk factors you might pick up on in the medical history

Answer 24

1. Smoking
2. Diabetes
3. Medications

Question 25

What inflammatory cytokines are involved in the pathogenesis of perio

Answer 25

* IL-1 * IL-6 * TNAa * PGE2

Question 26

The inflammatory mediators in perio

Question 27

The inflammatory cytokines (IL1, IL6, TNAa, PGE2) result in stimulation of Fibroblasts whichand osteoblasts which produce.

Answer 27

* Fibroblasts produce MMPs which destroy tissue * Osteoblasts produce RANKL which results in bone resorption

Question 28

What areht early and late cells seen in pathogenesis of perio

Answer 28

* Early - Neutrophils and Macrophages * Late - B cells and plasma cells

Question 29

Which is associated with gingivitis/perio a) Gram positive bacteria b) Gram negative bacteria

Answer 29

b) Gram negative anaerobes

Question 30

Smoekrs are x more likely to have periodontitis. Why? (4)

Answer 30

4x * Reduction in gingival blood flow * Impaired white cell function * Impaired wound healing * Increased production of inflammatory cytokines

Question 31

Well controlled diabetes is indicated by a glycated haemoglobin level of:

Answer 31

6.5% or 48mmol/mol or lower. This means there is no increased risk of period. PAtients with over 9% = 2-3x more likely

Question 32

Patients with HbA1 levels greater than 9% aretimes more likely to have perio.

Answer 32

2-3 x more likely

Question 33

Why does uncntrolled diabetes result in greater perio rates?

Answer 33

* Endothelial disfunction * Neutrophil dysfunction (reduced apoptosis) * More cytokines and RANKL

Question 34

Why do people with diabetes have poor healing?

Answer 34

decreased wound healing, and an imbalance of collagen turnover favouring dstruction

Question 35

List 5 systemic risk factors for perio

Answer 35

* Tobacco use * Diabetes * Stress * Medication (gingival hyperplasia) * Hormonal changes et pregnancy

Question 36

Severe periodontitis has been found to affect % of adults worldwide.

Answer 36

11%

Question 37

What is the major determinent of susceptibility to perio disease?

Answer 37

Pts response to bacterial challenge

Question 38

List 4 acquired local modifiable risk factors for perio

Answer 38

1. Plaque and calculus 2. Partial dentures 3. Open contacts 4. Overhanging and poorly contoured restorations

Question 39

List 4 anatomical modifiable local risk factors for perio

Answer 39

1. Malpositioned teeth 2. Furcations 3. Root grooves and concavities 4. Enamel peals

Question 40

List 6 non-modifiable systemic risk factors for perio

Answer 40

1. SES 2. Genetics 3. Adolescence 4. Pregnancy 5. Age 6. Leukaemia

Question 41

What systemic cause mighty ou consider if you see a patient present with multiple lateral periodontal abscesses?

Answer 41

Undiagnosed Diabetes

Question 42

Name 2 ways in which stress might contribute to increased risk of perio disease

Answer 42

1. Prolonged stress can cause suppression of the immune system which might tip the host-bacterial interaction in favour of bacteria 2. Stress affects how well people look after themselves - less effective plaque removal, increased tobacco use, poor nutrition

Question 43

What is the biologial mechanism by which period is thought to influence systemic health

Answer 43

Gingival inflammation compromises the barrier function of the gingival epithelium, leading to an ingress of bacteria or inflammatory products into systemic circulation.

Question 44

3 established associations between periodontal disease and systemic conditions

Answer 44

* Cardiovascular disease * Diabetes * Adverse pregnancy outcomes

Question 46

Lit 5 causes of gingival overgrowth

Answer 46

1. Irritation 2. Plaque 3. Calculus 4. Repeated friction or trauma 5. Medications

Question 47

Exampes of medications which can cause gingival overgrowth

Answer 47

1. Calcium Channel Blockers (Amlodipine, Nifedipine) 2. Cyclosporins 3. Phenytoin

Question 48

How can polypharmacy be a cause of gingival overgrowth

Answer 48

Can lead to drying and loss of salivary protection, leading to mouth breathing. therefore mouth breathing can cause gingivitis

Question 49

2 examples of calcium channel blockers

Answer 49

* Amlodipine * Nifedipine

Question 50

What % of people get severe chronic periodontitis

Answer 50

10-15%

Question 51

How do you tell between an endo and a perio abscess if both conditions are present at the same time?

Answer 51

If no endo component, the tooth will be vital.