Pathogenesis Of Periodontitis

Question 1

In gingival health, the junctional epithelium is attached to __________, and is continuous with the _______ epithelium.

Answer 1

Enamel; oral

Question 2

In healthy tissues, what are the volume ratios of junctional epithelium, oral epithelium, and connective tissue?

Answer 2

10% JE, 30% OE, 60% CT

Question 3

T/F: In gingival health, the JE is absent of rete pegs.

Answer 3

TRUE

Question 4

What are some various reasons that the gingiva stay healthy?

Answer 4

1. Shedding of epithelial cells
2. Intact epithelial barrier (OE and JE)
3. Flow of GCF
4. Complement system
5. Immune cells and antibodies

Question 5

What are the four stages of the development of gingivitis and periodontitis given by Page and Schroeder?

Answer 5

1. Initial lesion: subclinical
2. Early lesion: earliest perceptible stage of gingivitis
3. Established lesion: chronic gingivitis
4. Advanced lesion: progression to periodontitis

Question 6

What characterizes an initial lesion for gingivitis?

Answer 6

Basic inflammation: vessel dilation, fluid release (GCF exudate or transudate), leukocyte accumulation

Question 7

What is the transudate or exudate fluid that exits the capillaries during gingival inflammation?

Answer 7

Gingival crevicular fluid (GCF)

Question 8

T/F: GCF decreases as clinical inflammation gets worse.

Answer 8

FALSE

Increases

Question 9

Describe the cellular events that occur during an initial lesion?

Answer 9

Plaque forms on epithelial cells -> cytokines released by epithelial cells activate endothelial -> neutrophils migrate and adhere to endothelial cells -> neutrophils get through endothelium and migrate through the JE

Question 10

What factors are released by plaque that can activate the epithelial cells?

Answer 10

LPS, FMLP

Question 11

Once triggered by various plaque factors, the epithelial cells of the JE produce which factors and what is there purpose?

Answer 11

IL-8, C5a

Activate endothelial cells and help move neutrophils to site of plaque

Question 12

What is a microscopic indication of an initial lesion at the surface of the JE?

Answer 12

Rete pegs

Question 13

What is the first clinically perceptible phase of gingivitis?

Answer 13

Early lesion

Question 14

What is a difference in cell concentrations between the initial, early, and established lesions?

Answer 14

Initial: some leukocytes

Early: some lymphocytes and leukocytes

Established: leukocyte, lymphocytes, and plasma cells

Question 15

During the early lesion stage, what begins to deteriorate to make room for immune cells to infiltrate the space?

Answer 15

Collagen

Question 16

What specific cellular activities cause gingivitis to continually progress worse and worse?

Answer 16

As inflammation is stimulated more immune cells come to the area -> immune cells release inflammatory molecules which continue to stimulate more inflammation

Question 17

What happens to the coronal junctional epithelium during the established lesion?

Answer 17

Loses attachment to enamel (still attached to CEJ), which deepens the sulcus

Transitions to permeable pocket epithelium loaded with neutrophils to fight plaque

Question 18

T/F: During the established lesion stage, there is apical migration of the JE and bone loss.

Answer 18

FALSE

Lateral extension of the JE leading to early pockets

Question 19

Which stage of lesion characterizes the transition from gingivitis to periodontitis?

Answer 19

Advanced lesion

Question 20

What is the most common lymphocyte in established lesion? Advanced lesion?

Answer 20

T-cell in established

B-cell in advanced

Question 21

T/F: Apical migration of the epithelial connection is a clinical sign of periodontitis and an advanced lesion.

Answer 21

TRUE

Question 22

If plaque is removed at the advanced lesion stage, how would the tissue respond?

Answer 22

Epithelial signal for inflammation would turn off -> immune response would cease

However bone loss and connection loss would not resolve

Question 23

T/F: As the lesion progressively gets worse, the percentage of plasma cells in the tissue goes up.

Answer 23

TRUE

Question 24

What are three common modifying factors in the pathogenesis of periodontitis?

Answer 24

1. Diabetes
2. Pregnancy
3. Smoking

Question 25

What are some oral and periodontal effects of diabetes?

Answer 25

1. Xerostomia 2. Candida infections 3. Periodontitis 4. Multiple periodontal abscesses

Question 26

T/F: Periodontitis increases insulin resistance in diabetics.

Answer 26

TRUE

Question 27

How does diabetes affect neutrophil function?

Answer 27

1. Unable to follow chemotaxis gradient | 2. Less regulated release of granules

Question 28

T/F: In diabetics, pro-inflammatory factors such as PGE, IL-1, and TNF alpha are more prevalent in the GCF.

Answer 28

TRUE

Question 29

T/F: Even stable diabetics are at an increased risk for periodontitis.

Answer 29

FALSE

Question 30

What are the effects of pregnancy on the hosts ability to fight periodontitis?

Answer 30

1. Increased permeability 2. Lower keratinization 3. Decrease in chemotaxis 4. Decrease in T cell response

Question 31

T/F: Antibiotics should be avoided during pregnancy.

Answer 31

TRUE

Question 32

When is the best time to treat a pregnant woman for periodontitis/gingivitis?

Answer 32

2nd Trimester

Question 33

T/F: Smoking will cause excess inflammation and bleeding on probing.

Answer 33

FALSE Attachment and pocket loss, but LESS gingivitis

Question 34

What is the effect of tobacco on the hosts ability to fight periodontitis?

Answer 34

1. Few leukocytes in the pocket, but higher leukocytes in the blood 2. Less blood vessels in lesion 3. Increase in keratinization