Pathogenesis Part 2

Question 1

Initial lesion

Answer 1

clinically healthy gingivaE

Question 2

arly lesion

Answer 2

mild gingivitis

Question 3

Established lesion

Answer 3

Chronic/severe gingivitis

Question 4

Advanced lesion

Answer 4

Periodontitis

Question 5

Eubiosis

Answer 5

State of balance and health within a microbiome

Question 6

Dysbiosis

Answer 6

State of imbalance in the microbiome within the body

Question 7

In clinically healthy gingival tissues, small number of what is in the sulcus?

Answer 7

neutrophils

Question 8

Gingival CT contains a small number of

Answer 8

inflammatory cells, mainly neutrophils

Question 9

Initial lesion develops how long after plaque accumulation?

Answer 9

2 to 4 days

Question 10

Describe what happens in initial lesion

Answer 10

• Bacterial products activate resident leukocytes and stimulate endothelial cells
• Blood capillaries in CT dilate and elevate vascular permeability
• Crevicular fluid flows out of sulcus

Question 11

Chemotactic gradients of _____ and _______ direct the neutrophils from the vasculatrue into the tissues and toward the junctional epithelium

Answer 11

IL-8 and ICAM-1

Question 12

What are the steps of activation and migration of phagocytic cells from BVs

Answer 12

1. Tethering/rolling
2. Integrin activation
3. Firm adhesion
4. Extravasation

Question 13

What does LFA-1 play a role in?

Answer 13

leukocyte adhesion and migration

Question 14

ICAM-1, E-selectin and VCAM are adhesion molecules that are expressed by endothelial cells and are important for

Answer 14

leukocyte migration during an inflammatory response

Question 15

ICAM-1 is a ligand for

Answer 15

LFA-1

Question 16

When activated, leukocytes bind to endothelial cells via

Answer 16

ICAM-1/LFA-1 and then transmigrate into tissues

Question 17

What happens w/initial lesion if local factors are eliminated?

Answer 17

Vascular changes resolve and the tissue reverts to a normal state

Question 18

What happens w/initial lesion if local factors remain (hyperactive host response)?

Answer 18

Initial lesion progresses to early lesion

Question 19

What are effects of continued plaque accumulation?

Answer 19

• Levels of antigens increase
• Increased migration of neutrophils and monocytes
• Vasodilation and increased vascular permeability
• Edema and erythema

Question 20

How soon after plaque accumulation does initial lesion start to develop?

Answer 20

1 week

Question 21

Describe what is happening during early lesion

Answer 21

• Increased in prolif of capillaries, vascular permeability, vasodilation and gingival crevicular fluid flow
• Large numbers of infiltrating leukocytes

Question 24

Early lesion. In gingival CT, it is mainly

Answer 24

T cells

Question 25

Describe gingival CT of early lesion

Answer 25

- Degeneration of fibroblasts (mainly by apoptosis) - Collagen destruction that results in collagen depleted areas

Question 27

What happens to early lesion is local factors remain?

Answer 27

Early lesion may persist or progress to established lesion

Question 28

How soon after plaque does established lesion occur?

Answer 28

2-3 weeks

Question 29

Describe established lesion

Answer 29

- Dense inflam cell infiltrate - Accumulation of inflam cells in CT (mainly plasma cells and B lymphocytes)

Question 30

In the established lesion, there is increased release of

Answer 30

matrix metalloproteinases and lysosomal enzymes from neutrophils (cause destruction of colalgen fibers and ground substance)

Question 31

In established lesion, what is there significant depletion of?

Answer 31

Colalgen

Question 32

In established lesion, the pocket epi can become ulcerated showing

Answer 32

low resistance to probing and possible bleeding on probing

Question 33

Progression to advanced lesion is influenced by what?

Answer 33

- Composition and quantity of the microbial biofilm - Host immune/inflam factors - Local and systemic risk factors

Question 34

What is the function of neutrophils?

Answer 34

Primary mediators of the innate host defense. Phagocytose and kill bacteria and release lysosomal enzymes, cytokines and ROS

Question 35

Describe the protective role of neutrophils in periodontal health

Answer 35

- Kill bacteria by phagocytosis (Deficiencies in neutrophil migration and function result in increased susceptibility to infections and developemnt of severe periodontitis)

Question 36

Describe the destructive role of neutrophils in perio tissue loss

Answer 36

- Release large quantities of enzymes as they migrate through tissues (Cause breakdown of structural components of periodontium and development of collagen depleted areas)

Question 37

What are characteristics of the advanced lesion (periodontitis)?

Answer 37

- Predominance of neutrophils - Dense inflam cell infiltrate in gingival CT - Continued colalgen breakdown results in areas of collagen depleted CT - Apical migration of JE - Alveolar bone resorption - Plaque bacteria proliferate apically

Question 38

Gingival sulcus

Answer 38

Between tooth and surrounding gingival tissue in healthy sites

Question 39

Periodontal pocket

Answer 39

Pathologically deepened gingival sulcus

Question 40

Psuedopocket

Answer 40

enlarged gingival sulcus formed by coronal advancement of gingival margin due to inflam and gingival enlargement No attachment loss or bone loss

Question 41

Suprabony

Answer 41

Bottom of pocket is coronal to level of adjacent bone

Question 42

Intrabony

Answer 42

Bottom of pocket is apical to level of adjacent bone

Question 43

hat causes the destruction of the collagen fibers in CT?

Answer 43

- Resident and inflam cells secrete MMP - Macrophages and fibroblasts phagocytize fibers - Fibroblasts can degrade collagen fibrils by extending cytoplasmic processes into the PDL cementum

Question 44

JE of a pocket is ________ than JE of a healthy sulcus

Answer 44

shorter

Question 45

What are examples of anti-inflammatory cytokines?

Answer 45

IL-4, IL-10, IL-1Ra, IL-1F5 and TGF-beta

Question 46

IL-4

Answer 46

Key regulator in humoral and adaptive immunity

Question 47

IL-10

Answer 47

produced by Tregs, monocytes and B cells Has immunosuppressive effects

Question 48

IL-1Ra

Answer 48

Binds to the IL-1 receptor and blocks the effect of IL-1

Question 49

IL-1F5

Answer 49

antagonizes the inflammatory effects of IL-1B and LPS

Question 50

TGF-B

Answer 50

Regulates the proliferation, differentiation and function of lymphocytes, macrophages and other cells. Promotes the generation and function of Treg cells, plays a role in repair and tirrus regeneration