Pathogenesis of Periodontitis

Question 1

In gingival health, the Junctional Epithelium is attached to ______.

Answer 1

enamel

Question 2

In gingival health, the oral epithelium is continuous with ______.

Answer 2

junctional epithelium

Question 3

In gingival health, what are the tissue volume ratios of JE, OE, and CT?

Answer 3

JE: 10%
OE: 30%
CT: 60%

Question 4

In gingival health, are PMNs present or absent from the outer portion of the junctional epithelium?

Answer 4

PMNs are present even in health but in very small numbers

Question 5

How thick is the JE in gingival health?

Answer 5

10-20 cell layers thin

Question 6

True or False: Rete pegs are absent in gingival health.

Answer 6

True: outer and basal surfaces are parallel

Question 7

Describe the CT that is present in gingival health.

Answer 7

CT is dense with prominent collagen fiber bundles

Question 8

In gingival health, the _______ plexus contains a constant number of ________ which provide nutrients to the periodontium.

Answer 8

Subepithelial plexus

capillary loops

Question 9

In gingival health, does the dentogingival plexus have capillary loops?

Answer 9

No, the SP has loops but the DP does not

Question 10

When does the flow of crevicular fluid increase?

Answer 10

when there is inflammation

Question 11

What are the four stages in the development of gingivitis and periodontitis?

Answer 11

1. initial lesion
2. early lesion
3. established lesion
4. advanced lesion

Question 12

Which stage(s) of periodontal development is subclinical?

Answer 12

Initial

Question 13

When does the initial lesion stage occur?

Answer 13

within 1 to 4 days of plaque formation

Question 14

During the inital lesion stage of development, how does the concentration of PMNs change compared to health?

Answer 14

they infiltrate to form a higher density at the junction between OE and JE

Question 15

Describe the vascular changes associated with the initial lesion stage of periodontitis development.

Answer 15

Healthy vessels are permeable only to water, salts, and small molecules. After plaque build up, vessels of the dentogingival plexus will dilate due to the presence of vasoactive mediators (histamine, IL1, TNF). Gaps form between capillary endothelial cells which makes them more permeable. GCF rate increases.

Question 16

In health, GCF is a _______ but in disease is an _______.

Answer 16

health: plasma transudate
disease: inflammatory exudate

Question 17

GCF flushes the crevice from ______ to _______.

Answer 17

apical to coronal

Question 18

True or False: if gingival crevicular flow measures 0.08microliters in 30 seconds, that person must have inflammation.

Answer 18

False. those number are associated with health. it would be three times higher than that in disease.

Question 19

What kind of test is used to measure GCF volume?

Answer 19

ninhydrin stain (purple) will indicate proteins and GCF volume

Question 20

During the initial lesion stage, there is a cytokine-mediated up-regulation of _________ on endothelial cells of vasculature.

Answer 20

adhesion molecules

Question 21

How is chemotaxis by PMNs induced?

Answer 21

host factors (IL-8, C5a)
Molecules released by bacteria (fmet-leu-phe)

Question 22

How does the complement system increased vascular leakage in the initial lesion?

Answer 22

activation of mast cells

Question 23

True or False: Vasculitis is associated with the initial lesion.

Answer 23

True, vasculitis is simply an enlargement of vasculature due to LOSS OF PERIVASCULAR COLLAGEN

Question 24

Which portion of the JE is affected during the initial lesion?

Answer 24

the most coronal portion

Question 25

When does the early lesion stage set in?

Answer 25

within 4 to 7 days of plaque developement

Question 26

Is the early lesion stage visible clinically?

Answer 26

yes

Question 27

How do fibroblasts contribute to the progression of periodontitis or gingivitis at the early lesion stage?

Answer 27

They undergo CYTOPATHIC ALTERATIONS that tip the scale toward more breakdown and less building-up of collagen

Question 28

Are rete pegs present at the early lesion stage?

Answer 28

yes, rete pegs invade the coronal portion of the lesion and capillary loops project between them

Question 29

When does the an increases in the concentration of plasma cells become evident?

Answer 29

during the established lesion stage

Question 30

During the established lesion stage, _______ loss increases and ______ becomes clinically evident.

Answer 30

collagen | swelling

Question 31

In addition to plasma cells, which cell types are present during the established lesion stage?

Answer 31

T and B cells Fibroblasts Macrophages Serum proteins

Question 32

Fibroblasts produce _____ and ______ during the established lesion stage.

Answer 32

Metaloproteinases | tissue inhibitors

Question 33

During the established lesion stage, the sulcus deepens and the coronal portion of the JE is converted into ________.

Answer 33

permeable pocket epithelium (PE)

Question 34

The PE (pocket epithelium) is loaded with _____ and is not attached to tooth surface.

Answer 34

PMNs

Question 35

What do plasma cells produce?

Answer 35

Ig | cytokines (IL-6 and TNF)

Question 36

Is there attachment loss at the established lesion stage?

Answer 36

No

Question 37

True or False: A patient can stay at the established lesion stage forever if they are resistant to periodontitis.

Answer 37

True

Question 38

At which stage, does the diagnosis change from gingivitis to periodontitis?

Answer 38

The fourth and final stage...Advanced Lesion

Question 39

In the advanced lesion stage, which type of adaptive immune cells dominate?

Answer 39

B-cells

Question 40

___ cells dominate in gingivitis, ____ cells dominate in periodontitis.

Answer 40

T | B

Question 41

What is the first clinical sign of periodontitis?

Answer 41

apical migration of the epithelial attachment (JE moves due to destruction of the connective tissue)

Question 42

At what location does bone destruction begin?

Answer 42

around communicating blood vessels along the crest of the septum

Question 43

True or False: After entering the advanced lesion stage, removal of plaque will resolve inflammation and move the patient back into the established lesion stage.

Answer 43

False: once you see attachment loss it cannot be regained even if the inflammation is resolved

Question 44

During the advanced lesion stage, what is the proportion of plasma cells?

Answer 44

50%

Question 45

What are the three modifying factors of periodontitis?

Answer 45

1. Diabetes 2. Hormones (pregnancy, puberty, menopause) 3. Smoking

Question 46

What do the modifying factors (smoking, hormones, diabetes) influence?

Answer 46

- Susceptibility to gingivalis and perio - Plaque Growth/Composition - Clinical response/presentation - Disease progression - Response to perio therapy

Question 47

Diabetes mellitus is a _____ for periodontitis.

Answer 47

risk factor

Question 48

What is type 1 diabetes?

Answer 48

impaired insulin production

Question 49

What is type 2 diabetes?

Answer 49

deficient insulin utilization

Question 50

How can diabetes influence oral and periodontial health?

Answer 50

- xerostomia (loss of innate protection) - increased prevalence of candida infections (fungus) - higher risk for periodontitis - Mucosal abscesses

Question 51

For patients with diabetes and periodontal disease, what is the benefit to perio therapy?

Answer 51

Perio increases insuling resistance; glycemic control improves with perio therapy. Diabetics with severe perio can get proteinuria and CVD

Question 52

Which bacterial species are found to increase in the case of Type 2 diabetes?

Answer 52

P.intermedia, C.rectus, and P.gingivalis

Question 53

Which bacterial species is found to increase in the case of Type 1 diabetes?

Answer 53

Capnoctyophaga

Question 54

In patients with diabetes, __________ create a destructive phenotype of macrophages that are more highly inflammatory.

Answer 54

Advanced Glycation End-Products (AGE)

Question 55

What impact does diabetes have on vasculature?

Answer 55

advanced glycation end-products create a thickening of vascular endothelium and, therefore, reduced migration and host defense

Question 56

Estrogen increases ______ metabolism and ______ mediators.

Answer 56

collagen | inflammatory

Question 57

Estrogen effects salivary _______.

Answer 57

peroxidases

Question 58

How frequently is gingivitis seen in pregnancy?

Answer 58

35-88%

Question 59

During which time frame is gingival inflammation highest during pregnancy?

Answer 59

2nd and 3rd trimester (best time for treatment is 2nd trimester)

Question 60

Why is there an increase in P.intermedia during pregnancy?

Answer 60

P.i uses naphthoquinones from steroids

Question 61

Why is periodontitis more common with menopause or osteoporosis?

Answer 61

due to decreased absorption and increased elimination of calcium

Question 62

True or False: There is less gingivitis and bleeding on probing in those patients who smoke.

Answer 62

True

Question 63

What is the second greatest risk factor for periodontitis?

Answer 63

smoking

Question 64

Smokers have higher numbers of A.a, T.forsythia, P.micros, _____, _____, and ______.

Answer 64

P. gingivalis C. rectus P. intermedia

Question 65

Do smokers have a higher concentration of PMNs in the blood or in the periodontal pocket?

Answer 65

blood (PMNs arent functioning properly and there is less GCF toward the JE)

Question 66

What is ICAM?

Answer 66

a soluble adhesion molecule that localizes PMNs

Question 67

Smoking is associated with _____ reduction in probe depth and ______ attachment gain after nonsurgical treatment.

Answer 67

Poorer | less