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ABPD 2021 > Perio/Immunology/Research > Flashcards

Perio/Immunology/Research Flashcards

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1
Q

Prevalence and severity of periodontal disease

A

Gingivitis of varying severity is almost universal in children and adolescents
Prevalence of severe attachment loss is less than 1% in young patients

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2
Q

Epidemiology of gingivitis

A

Developed countries 73% of children 6-11 years old
Gingivitis prevalence rises with age
Prevalence rises with puberty
Less in girls than boys (likely related to oral hygine)

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3
Q

Normal pediatric periodontium features

A

Smooth, slightly stippled surface
Sulcus depth 2mm average
Rounded or rolled contour
Firm and resilient tissue

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4
Q

Is attached gingiva in adults or children narrower?

A

Children
Wider in the maxilla

Gingiva is more red compared to adults due to thinner epithelium

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5
Q

PDL in children versus adults

A

Wider in children
Less dense and fewer fibers per unit area
Increased hydration with greater blood and lymph supply

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6
Q

Cementum in children versus adults

A

Thinner and less dense than adults

Tendency to hyperplasia

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7
Q

Alveolar bone in children versus adults

A

Lamina dura is thinner
Fewer trabecular and large marrow spaces
Smaller amount of calcification
Greater blood and lymph supply

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8
Q

Dental Plaque Induced Gingivitis in Pediatric Population

A

Less severe than in adults with similar plaque levels
Gingival inflammation without loss of attachment or bone
Reversible
Contributing factors: crowding, ortho, mouth breathing, eruption, calculus

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9
Q

Chronic periodontitis adults versus children

A

More common in adults

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10
Q

Overview Aggressive Periodontitis

A

Localized or generalized
Rapid attachment and bone loss with familial aggregation
PHagocyte abnormalities and hyperresponsive macrophage phenotype

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11
Q

Definition of Localized Aggressive Periodontitis

A

Interproximal attachment los on at least 2 permanent first molars and incisors with attachment loss on NO more than 2 teeth other than first molars and incisors

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12
Q

Features of LAgP

A 
No evidence of systemic disease
Can be associated with chromosome 4 gene
Inflammation not prominent feature
Children otherwise healthy 
More in African Americans
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13
Q

Bacteria in LAgP

A

Actinobacillus actinomycetemcomintans

Bacterioides-like species
Eubacterium in some populations

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14
Q

Functional defects in neutrophils - Susceptibility to LAgP

A
  • anomalies in chemotaxis
  • anomalies in phagocytosis
  • anomalies in bactericidal activity
  • anomalies in superoxide production
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15
Q

What is a molecular marker of LAgP?

A

Low numbers of chemoattractant receptors
Low glycoprotein GP-110

Adherence receptors on neutrophils and monocytes like LFA-1 and MAC-1 are normal

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16
Q

Treatment for LAgP?

A

Surgical and-nonsurgical root debridement
Antibiotics (tetracyclines, tetracyclines + metronidazole, metronidazole + amoxicillin)
Maintenance every 4 months

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17
Q

Generalized Aggressive Periodontitis

A

Marked periodontal inflammation with heavy accumulation of plaque

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18
Q

Consequences of GAgP

A

Severe generalized attachment loss
Premature exfoliation of primary teeth
Presence in gingival clefts and severe recession
Suppressed chemotaxis in neutrophils

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19
Q

What antibody has alterations in patients with GAgP?

A

IgG

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20
Q

Microbes of GAgP

A

Non-motile, facultative anaerobic gram negative rods

P gingivalis, T denticola

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21
Q

Treatment of GAgP

A

Use of antibiotics and debridement is not very successful

Lab test to identify specific pathogens

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22
Q

Features of periodontitis as a manifestation of systemic disease

A

Occurs with erupting of primary teeth up to age4-5
Localized or generalized
Neutrophils have abnormalities in surface glycoproteins
Leukocyte adhesion deficiency
Bacteria include AA, P intermedia, Eikenella and others

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23
Q

Syndromes associated with periodontitis

A 
Papillon-Lefevre 
Hypophosphatasia
Cyclic neutropenia
Down syndrome 
Leukocyte adherence deficiency
Agranulocytosis

NOT diabetes

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24
Q

Areas endemic for necrotizing periodontal disease

A

NPD is seen with greater frequency in certain populations of children and adolescents from Africa, sia, and South America (developing areas)

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25
2 most significant findings in necrotizing periodontal disease
Presence of interproximal necrosis and ulceration Rapid onset o gingival pain
26
Bacteria in necrotizing periodontal disease
Spirochetes | P intermedia
27
Causes of necrotizing periodontal disease
``` Viral infections Malnutrition Emotional stress Lack of sleep Systemic diseases ```
28
Treatment for necrotizing periodontal disease
Local debridement, oral hygiene instructions, follow up Antibiotics (metronidazole and penicillin) only if patient is febrile
29
Which organ is important in immune system function that decreases in size?
Thymus
30
Innate Immunity Components
``` Skin Phagocytes Complement NK cells Macrophages Antigen-presenting cells ```
31
Adaptive Immunity Components
B lymphocytes and T lymphocytes
32
Which immunoglobulin is found in the highest concentration in the oral cavity?
IgA
33
Which system (innate or adaptive) has immunologic memory?
Adaptive
34
Humoral arm versus Cellular arm of Adaptive Immunity
Humoral: antibodies Cellular: cytotoxicity
35
Phagocytes (macrophages, granulocytes, dendritic cells)
First step of innate immune response Engulf and digest pathogens Recognize pathogen-specific patterns (PAMPs/MAMPs) Regulate other cells
36
Lymphocytes (B and T cells)
Adaptive Immunity | Recognize antigens
37
B cell function
Recognize antigen directly and produce antibodies
38
T cell function
Recognize antigen in association with antigen-presenting cells T helper: soluble mediators T cytotoxic: kill infected cells
39
Antigen-presenting cells
Dendritic cells Link the adaptive and innate immunity Process antigen and present to T cells Dendritic cells are phagocytic and motile - reside in epithelial surfaces and lymphoid tissues
40
Primary Organs of Immune System
Bone marrow (B cell maturation) Bursa of Fabricius (B cell maturation) Thymus (T cell maturation)
41
Secondary Organs of Immune System
Spleen Lymph Nodes Mucosa Lymphoid tissue
42
Signaling molecules of Innate Immune System
Cytokines -> Complement
43
Signaling molecules of Adaptive Immune System
Cytokines | Interleukins
44
Cytokine definition
Low molecular weight proteins that stimulate or inhibit the differentiation, proliferation or function of cells Produced by immune and non-immune cells
45
Interleukins
Subset of cytokines that communicate between leukocytes
46
Important Cytokines
TNFa: pro-inflammatory, produced by macrophages IL-1: pro-inflammatory, produced by macrophages IL-2: growth factor, produced by T cells IFNg: pro-inflammatory, produced by T cells C-reactive protein
47
Cytotoxic molecules
Enzymes | Reactive oxygen species
48
Chronology of Immune Response
Innate immunity: 0-4 hours Infection -> recognition by preformed, non-specific and broadly specific effectors -> removal of infectious agent Memory
49
Classification of research studies according to time
Looking back: retrospective, case control Looking forward: prospective cohort, experimental Looking now: cross-sectional
50
Classification of research studies according to intervention/control
``` Experimental Design (RCT) Observational (no control, no intervention) ```
51
Cross-sectional study
Used for questionnaires, surveys, prevalence estimates | Do not provide causative evidence
52
Advantages of cross-sectional studies
Quick Low cost Evaluate large number of variables Enroll a large number of subjects
53
Disadvantages of cross-sectional studies
Subject selection may reflect selection bias | Difficult to identify cause-effect relationship
54
Case Control Study
Retrospective assessment of risk factors Measures relative rates Used for rare diseases, especially those with long latency (ex: cancer)
55
Advantages of case-control
Not dependent on natural frequency of disease Well-suited to study diseases of long latency Few cases Allows study of multiple causes Low cost Quick Ethical - disease has already occurred
56
Disadvantages of case-control
Case selection may be problematic Controls may not be representative of same population Investigators may be biased or subjects may be biased Incidence, prevalence and RR can't be calculated
57
Cohort study
``` Select 2 or more groups that are free of disease but differ in exposure status Allows for calculation of true rates Useful when exposure varies over time No intervention (observational) ```
58
Advantages of cohort
Allows risk to be expressed as incidence Certain biases are reduced Subject characteristics can be related to more than one outcome
59
Disadvantages of cohort
``` Inefficient for study of rare disease Assessment of relationships limited to those defined at beginning of study Selection bias not controlled Loss to follow up is common Subjects may change in satus (exposure) Expensive Time consuming ```
60
RCT
Prospective controlled experiment of human subjects to assess intervention of a specific disease Asks important research question Requires IRB and informed consent
61
Phases of Clinical Trials
1: Dose finding 2: efficacy at fixed dose 3: comparing treatment (RCT) 4: late/uncommon effects
62
Advantages of RCT
Investigator directly controls assignment to study groups Investigator controls exposure to agent Random assignment can control extraneous factors Blinding of evaluators may be possible Can establish causality
63
Disadvantages of RCT
Not immune to problems like other designs (noncompliance, biased observation) May have low external validity May not be feasible for studies of disease etiology May not be feasible for effective disease prevention Can be expensive
64
Efficacy versus Effectiveness
Efficacy: the potential to provide a clinical benefit (measured in clinical trial) Effectiveness: benefit provided in the real world (measured in registrieds, market incident reports, etc.)
65
Problems with Dental RCTs
Difficult to randomize Ethical concerns Blinding usually not possible Expensive and often lack sponsor
66
Principle of Equipoise
involves ethical treatment of human subjects in experimental conditions
67
Systematic Review definition
Comprehensively locates, evaluates, and synthesizes all the available literature on a given topic using a strict scientific design which must itself be reported in the review
68
Aim of systemic review
Systemic, explicit, reproducible Provide summary and context of current state of knowledge Systemic reviews and meta-analysis are top of pyramid
69
External Validity versus Internal Validity
External: do subjects represent a definable population of interest? (is it relevant?) Internal: is the study reproducible, well-designed and analyzed?
70
Power
The ability of a test to detect a significant difference when one exists -was the population large enough? Important in negative studies (studies that do not find an association)
71
Placebo effect
Placebo should be as similar a possible to intervention | Effect can be up to 70%
72
Intra-rater versus Inter-rater reliability
IntRA-rater: same cases over time | IntER-rater: comparison of same case among raters
73
Categorical variables
Variables that have levels that are numeric or character Examples: SES, probing depth ranges, stages of cancer
74
Continuous variables
Variables that have numeric values only Examples: probing depth, BMI, viral load, etc.
75
Comparing continuous variables - statistics
T-test: difference between two group means ANOVA: analysis of variance; difference between 2 or more groups Linear regression also used for continuous variables
76
Statistics for dichotomous outcomes
Chi-Squared Mantel-Haensel test Logistic regression
77
P-value
Measures consistency between the results actually observed and the "pure chance" explanation of those results Low p-value = very unlikely the null hypothesis is true
78
Null hypothesis
There is no difference If the p value is very low, you can reject the null hypothesis and accept the study hypothesis
79
Confidence Intervals
Type of interval estimate o a population parameter and issued to indicate reliability of an estimate 95% CI: 95% confident that the true value of the parameter is in the confidence interval Corresponds with level of significance - 95% CI reflects significance level of 0.05
80
Bias
Any systematic error in a study which results in incorrect estimate of the association between disease and exposure
81
Types of bias
Selection bias Recall bias Observation bias
82
Confounding
Results when there is a mixing of the effect of the exposure and disease with a "third factor" -may be unknown to researchers
83
Sensitivity
Ability of a test to find positive when it is present (true positive) Ex: 95% sensitive test would have 5% chance it is false negative
84
Specificity
Ability of a test to find negatives (true negatives) Ex: 95% specific test would have 5% chance of false positive
85
Accuracy versus Precision
Accuracy: true value Precision: obtaining the same values

ABPD 2021 (14 decks)

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