pathogenesis of periodontitis Flashcards
(93 cards)
1
Q
why would someone have gingival health
A
Superb hygiene
2
Q
hows the Junctional epithelium in gingival healtyh
A
attached to enamel
3
Q
how does the oral epithelium and the Junction epithlium relate in gingival health
A
Looks continues
4
Q
Inflammation in gingival health
A
Virtually absent
5
Q
tissue volume ratio in health
A
10% JE
30% OE
60% CT
6
Q
what immune cells are present in gingival health
A
Few PMNs present in the outer portion of the JE
7
Q
thickness of junctional epithelium in health
A
Thin (10-20 cell layers
8
Q
are epithelial ridges present in JE during healtyh
A
Absent
9
Q
how does the CT look in gingival healthy
A
Dense with prominent collagen fiber bundles
10
Q
what do the vapillaries look in the subepithelial plexus in gingival health
A
has loops that are constant
11
Q
what do the capillaries look like in the dentogingival plexus in health
A
No loop
12
Q
why does clinically healthy gingiva remain stable
A
Shedding of epithelial cells Intact epithelial barrier Positive flow of GCF complement system PMNs and macrophages Protective effects of antibodies
13
Q
why does the subepithelial plexues capillary loops go through the retee pegs
A
Get nutrients and O2 to the epithlium
14
Q
what is the subclinical stage of gingivitis
A
Initial lesion
15
Q
what is the clinical early stage of gingivits
A
Early lesion
16
Q
what is chronic gingivitis(no bone loss yet)
A
Established lesion
17
Q
what is the stage that is the progression to periodontitis (bone loss)
A
Advanced lesion
18
Q
when does the inital lesion occur
A
within 1-4 days of plaque development
19
Q
what does the increased permeability of an inital lesion lead to
A
Carbon particles and serum proteins leak out of vessels
20
Q
what does infiltration show in the inital lesion
A
PMNs and monocytes in the JE
lymphocytes in the CT (5%)
21
Q
what happens to the vessels in the inital lesion
A
Vascular density
22
Q
what happens to collagen in the inital lesion
A
Decreased perivascular colagen
23
Q
what happens in the gingival crevicular fluid volume in the initial lesion
A
Increases
24
Q
can you clinically see the inital lesion
A
No
25
what normally can pass through a vessel
Water
salts
small molecules
26
how do intercelular junction look in an intial lesion
Normally closed
27
what causes dilation of vessels of the dentogingival plexues
Vasoactive mediators
| histamine, IL-1, TNF
28
what does gaps forming from dialtion of vessels lead to
Increased permeability
fluid and prtein flow out
GCF flow increases
White blood cells can leave
29
what is Gingival crevicular fluid made of
```
Plasma transudate (health)
inflammatory exudate (disease)
```
30
what does gingival crevicular fluid pass through to get to crevis
Through the periodontal tissues
31
what does the GCF constituents indicate
Inflammatory changes
| bacterial colonization
32
what causes GCF flow rate to increase
Clinical inflammation
33
what is used to measure GCF volume
Ninhydrin stain for protein
34
what mediates the up-regulation of adhesion molecules on endothelial cells in an initial lesion
Cytokine mediated
35
what does the adhesion moelcules of endothelial cells in an intiial lesion do
Allows PMN's to adhere to post-capillary venules
| - migration
36
where do PMNs migrate in an inital lesion
Through JE into gingival sulcus
37
what induces chemotaxis by PMNs
```
Host factors (Il-8, C5a)
Molecules released by bacteria (fMetLeuPhe)
```
38
what happens to the JE in the inital lesion
Alteration of the most coronal portion of the JE
39
when does an early lesion tend to occur
within 4-7 days of plaque development
40
what immunologic cells appear in the Early lesion
Lymphocytes and PMNs subjacent to JE
| Few Plasma cells
41
how much of the infiltrated connective tissue is there
15%
42
what happens to the fibroblasts in an early lesion
Undergoing cytopathic alterations
43
can you see inflammation in early lesions
yes, clinically evident
44
what happens to the Collagen in early lesions
Destroyed
| - creates space for infiltrate
45
what happens to basal cells in an early lesions
Cells of JE and SE proliferate
| rete pegs invade the coronal portion of the lesion
46
what happens to the Dentogingival plexues
- Dilated w/ venules
| - extremely permeable following minor trauma or inflammation
47
what happens as JE invades the CT
preivously inactive capillary bed opens up and proliferates into the CT papillae
48
why does junctional epithelium proliferate in early lesiosn
to compensative and fight plaque
49
what cells are present in an early lesion
Macrophages
T cells
B cells
Firboblasts
50
what is clinically seen in an established lesions
increased swelling
51
what hapens to crevicular fluid in established lesion
increased fluid exudation
52
what cells tend to migrate in an established lesion
leukocyte migration
| plasma cell increased around blood vessel in coronal CT
53
what happens to the collagen in established lesion
loss continues as infiltrate expands
54
what cells become present in an established lesion
Macrophages and serum proteins
T and B cells
Plasma Cells
55
What do activated T cells Produce in an established lesion
```
Cytokines (IL-2, 3, 4, 5, 6, 10 , and 13, TNF-alpha)
Chemotactic substances (MCP, MIP, and Rantes)
```
56
what do plasma cells produce in an established lesion
Produce Ig and Cytokines (IL-6 and TNF-alpha_
57
what do fibroblasts produce in an established lesion
MMPs and TIMPs
58
what happens to the JE and Sulcular epithelium in an established lesion
Proliferate and migrate deep into CT
59
what happens to the sulcus in an established lesion
deepens
60
what happens to just JE during an established lesion
JE converted into permeable pocket epithelium
61
what are characteristics of PE
not attached to tooth surface
| Loaded with PMNs
62
what is an established lesion look like pathologically
Chronic gingivitis
63
how does the margin look like in an established lession
Rolled gingival margin
lots of redness
bleed on probing
64
is there attachment lost in an established lession
No
| - probe depth increased but no attachment loss
65
how can one fix an established lession
clearing plaque
66
when does an advanced lesion occur
Not well known
67
how do cells change in an advanced lesion
switch from T to b cell prodminance
| -converstion from gingivitis to periodontitis
68
what happens to the CT attachment in an advanced lesion
Destruction of CT attachment to root surface
69
what is the first clinical sign of periodontitis
migration of epithelail attachment indicates
70
where does bone loss begin in an advanced lesion
begins around communicating blood vessels
| along crest of septum
71
what does the PE proliferate into an advnaced lession
Deep into CT
72
is the PE attached to the tooth in an advanced lession
Not attached
73
what is the most common cell in advnaced lesion
50% plasma
74
are there lots of cytokines in in advanced lession
Small spectrum of pro-inflammatory cytokines
75
what happens if you clear plaque from an advanced lession
basal and epithelium have signal die away
| - may not get all your attachment back
76
Common modify factors of advanced lession
Diabetes
Pregnancy, pubery, and menopause
Smoking
77
modifying factors can influnce what
```
Susceptibility to gingivitis and periodontitis
Plaque growth and composition
Clinical presentation
Disease progression
Response to periodontal therapy
```
78
how can diabetes mellitus be a risk factor for oral and periodontal problems
Xerostomia
Candida infections
Periodontitis
Multiple periodontal abscesses
79
how much control should you have over diabetes
good control will lead to less periodontitis
| - poor control=problems
80
what does periodontitis do for diabetes
increasees insuline resistance
| have a higher incidence of proteinuria and cardiovascular problems
81
what happens in diabetteics after periodontal therapy
Glycemic control improved
82
how can diabetes affect periodontis
change the bacteria
change host response
efect on periodontal treatement
83
what effect on the host response can diabetes have
PMN fuction. chemotaxis impaired
cytokines, monocytes, and macrophages
Connective tissue
84
what can diabetes affect in treatment
poorly controled leads to poor results
85
what effect does estrogen have on periodontitis
Affects salivary peroxidases
| increases collagen metabolism and angiogenesis
86
how does pregnancy affact periodontium
increase estrogen
increase vascular response and inflammatory mediates
gingival inflammation increase
increase in gingival bleeding during menstrual cycle
87
how common is gingivitis in pregnancy
35-88%
88
when is pregnancy related gingivitus most common
2nd and 3rd trimesters
89
what is the second risk factor for periodontitis
Smoking
90
what does tobaccco smoking cause in perio
Deeper pockets
more attachmnet loss
more tooth loss
less bleeding on probing
91
what can smoking affect
Bacteria
| Host
92
how does smoking affect reattachment for treatment
Poorer reduction in probing depth
| poorer attachment gain in nonsurgical treatment
93
what happens to treatment if you quite smoking
BEtter treatment outcome
