Sweep 2 Flashcards by Tyler Brown

Most common breakdown enzyme

MMP - break down collagen.

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Largest size implant

5mm - need 1mm all the way around with 2 mm on each side.

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Localized CAL in

first molars/incisors (at least 1 first molar must be affected).
Distribution: no more than 2 teeth other than first molars and incisors are affected .

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: AT least 3 permanent teeth other than

1st molars & incisors.

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P gingivalis inhibits

Inibits IL-8: ↓ chemotaxis of PMNs

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P gingivalis

Proteinases: Gingipains, Collagenases
LPS: activates cells to produce PGs, IL-1β, TNF-α

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LAP host responses

Impaired neutrophil function (chemotaxis and phagocytosis.)
Significantly higher levels of prostaglandin E2 in GCF.
Antibody against A.a is extremely high(Levels in sulcus fluid higher than in peripheral blood)
High titers and high avidity of IgG2 in LAP.
Low levels of Ab against P.g in GAP patients .

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Ascorbic acid-deficiency gingivitis

Malnourished individuals have a compromised host defense system which may make individuals susceptible to infectious diseases
The precise role of nutrition in periodontal diseases remains to be elucidated.
Human studies have failed to show a relationship between nutrition and periodontal diseases

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Ehlers-Danlos syndrome (types IV & VIII)

autosomal ———– hereditary disorder

dominant

aggressive periodontitis (primary and permanent dentitions); fragility of gingiva, excessive hemorrhage

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NPD advanced lesion

Lack of deep pockets
Merging of papillary and marginal involvement
Characteristic foetor
Central necrosis results in crater formation
Involvement of periodontal ligament and alveolar bone (NUG  NUP)

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NUP

Involvement of palatal mucosa —->

necrotizing stomatitis

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NUP

Involvement of

regional lymph nodes

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Predictive Value Positive (PVP)

The probability of disease in a subject with a positive test result
PVP = Pr(D+/T+)

A/A+B (yes for positive/ yes+ yes for neg)

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Predictive Value Negative (PVN)

The probability of not having the disease when the test is negative
PVN = Pr(D-/T-)

D/C+D (no/no+no for yes)

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Thrush

Candida albicans
Acquired during birth
Pseudomembranous / erosive lesions
Predisposing conditions
-Antibiotics  
-Immunosuppression
-Malnutrition
-HIV
-Diabetes

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Lichen Planus

Oral involvement alone is common.
Premalignant potential (0.5-2%).
Characteristic skin lesions (Wickham striae).
Varied clinical appearances.
Any area of the oral mucosa

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Lichen planus

Subepithelial band-like accumulation of lymphocytes
characteristic of a type IV hypersensitivity reaction.
Fibrin in the basement membrane.
Deposits of IgM, C3, C4, and C5.

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Pemphigoid

Autoantibody reactions against hemidesmosome and lamina lucida components.

Detachment of the epithelium from the connective tissue.
Complement-mediated cell destructive processes may be involved in the pathogenesis.

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Pemphigus

Formation of ——– in skin and mucous membranes.
Strong genetic background (Jewish and Mediterranean)
Painful desquamative lesions, erosions or ulcerations.
Chronic course with recurrent bulla formation

intraepithelial bullae

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Canthus layer- another name for

stratum spinosum

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Acantholysis-breakdown of the

spinous bridges

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Periapical cemental dysplasia:

Fibrous-osseous cemental lesions.
Tooth is usually vital.
Usually no symptoms.
Periapical bone is replaced by cellular fibroblastic tissue through a cementoblastic phase.
Differential diagnosis: Cemento-ossifying fibroma and fibrous dysplasia.

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Herpes zoster-

Latent in the dorsal root ganglion.

- Unilateral lesions.
- 2nd and 3rd branch of the trigeminal ganglion

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Linear gingival erythema-

Distinct linear erythematous band limited to the free gingiva.
Lack of bleeding.
Positive for C.albicans by culture:

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Hereditary gingival fibromatosis- Possible mechanism(s):

TGF-beta1 favor the accumulation of ECM. | May be located on chromosome 2 in human.

Lupus erythematosus-

Autoimmune connective tissue disorders in which autoantibodies form to various cellular constituents. Central atrophic area with small white dots surrounded by irradiating fine white striae with a periphery of telangiectasia (vascular lesion formed by dilatation of a group of small blood vessels). Lesions can be ulcerated and cannot be differentiated from leukoplakia or atrophic oral lichen planus. Together with characteristic skin lesions (butterfly).

Fibroma/ focal fibrous hyperplasia: ► Differential diagnosis:

Giant cell fibroma.

Often reddish and ulcerated reactive lesion Fibrous proliferation in which bone- or cementum like hard tissue is formed ► Highly cell-rich areas below ulcerated sites.

Calcified fibroblastic granuloma:

Calcified fibroblastic granuloma: | ►Differential diagnosis:

Pyogenic granuloma

► Ulcerated (may resemble purulence). ► gingival margin. ► Reddish or bluish, sometimes lobulated, sessile or pedunculated. Bleeding is common. ► Highly vascular with chronic inflammatory cells.

Pyogenic granuloma:

Pyogenic granuloma: ► Differential diagnosis:

Pregnancy tumor.

Anywhere on the gingival mucosa. - Pedunculated (has a stalk), sessile (broad base), red or purple, commonly ulcerated. - Focal collection of multi-nucleated osteoclast-like giant cells with a richly cellular and vascular stroma separated by collageneous septa. - Probably originated from periodontal ligament.

Peripheral giant cell granuloma

Peripheral giant cell granuloma Differential diagnosis:

focal fibrous hyperplasia.

► Fibrous-osseous cemental lesions. ► Tooth is usually vital. ► Usually no symptoms. ► Periapical bone is replaced by cellular fibroblastic tissue through a cementoblastic phase.

Periapical cemental dysplasia:

Periapical cemental dysplasia: Differentialdiagnosis:

Cemento-ossifying fibroma and fibrous dysplasia.

- Rather frequent tumors of oral mucosa. - Flat or raised, sometimes lobulated, soft lesions of blue to red color. - Asymptomatic but may bleed. - They blanch on pressure. - Capillary and cavernous types.

Hemangioma-

Hemangioma- Differential diagnosis:

Mucous cysts, pyogenic granuloma.

► Pigmented lesion containing melanocytes in CT. ► rare in the oral mucosa, mostly seen in palate. ► Flat, slightly raised lesions or a tumor. ► Brown or black or no pigmentation. ► Nevocellular or brown nevus located along the basal layer of epithelium.

Nevus:

Nevus: Diff diagnosis:

Amalgam tattoo

► Four or five different types of papilloma are present. ► Exophytic, pedunculated or sessile lesions. Reddish/normal or whitish/gray color. ► A granular/moruloid or filiform/digitated surface. ► Human Papilloma Virus is commonly found.

Papilloma:

- Is less common in oral mucosa compared to skin. - Lips and palate are main locations. - Sessile, exophytic or raised lesion with a whitish surface. - Papillomatous surface with hyperkeratinization and elongated rete ridges. - Associated with HPV type 2 and 4.

Verruca vulgaris (one type of papilloma):

► Non-ulcerated sessile or pedunculated gingival lesions. ► Generally detected in the soft tissue around unerupted teeth. ► Histopathology is similar to intraosseous forms of the tumors.

Peripheral odontogenic tumors:

► Derived from odontogenic epithelium. ► Well-circumscribed radiolucency

Ameloblastoma:

► Derived from pdl, presumably from epithelial rests of Malassez. ► Often associated with lateral root surface. ► Rarely seen.

Squamous odontogenic tumor:

► Slow-growing neoplasm forming hard tissue around the apex of a tooth. ► Radiopacity typically surrounded by a radiolucent margin.

Benign cementoblastoma:

Metastasis to the gingiva: ► The majority are -----------. ► Soft tissue metastasis from lung cancer. ► Most of the metastasis cases are --------- and not ----------.

intraosseous carcinoma sarcoma

► Skin lesion followed by oral lesions. ► Gingiva is the second mostly detected site after palate. ► Re-occurrence with AIDS.

Kaposi’s sarcoma:

► Widening of pdl is common with

Osteosarcoma

Induces bacterial lysis Promotes phagocyte recruitment (chemotaxis) Promotes phagocytosis by opsonization of bacteria Helps activate mast cells, which increases vascular permeability

Complement system

Major role in induction of innate immune response Recognize conserved microbial-associated molecular patterns (including LPS, lipoteichoic acid and flagellae) Expressed by all cells, including epithelial cells, PMNs, monocytes and macrophages ------- signal for cells to produce cytokines, chemokines, antimicrobial peptides, nitric oxide and eicosanoids

TLRs

Prostaglandins (especially PGE2) induce

vasodilation and cytokine production

PGE2 induces

production of matrix metalloproteinases by fibroblasts and osteoclasts, which damage periodontal tissues

Innate immunity:

inherent biological responses – many different, all capable and all nonspecific

Adaptive or acquired immunity:

based on recognition of antigens, immune memory and clonal expansion

2 types of B cells-

Conventional: produce antibodies against bacteria, levels decrease in healthy and treated sites Autoreactive: produce auto-antibodies, levels do not decrease after treatment

Avidity:

Ag-binding differs among antibody subclasses. Not all are capable of effective opsonization or complement activation.

IgG2

IgG2 predominates in aggressive periodontitis. | Disease due to less effective antibody?

Antigen recognition:

IgG2 recognizes carbohydrate antigens (LPS), while other subclasses mainly recognize protein Ag.

Resorption at the cortical bone. Woven bone formation in the spongious bone. Blood clot formation. Proliferation of vascular structures into newly forming granulation tissue.

24 hours

Reparative macrophage and undifferentiated mesenchymal cells. Modeling at the apical trabecular region and at the “furcation sites” of a screw-shaped implant.

1 week-

New bone formation can be detected at | the “furcation sites” of the implant surface

2 weeks –

Callus formation and lamellar | compaction within woven bone.

Up to 6 weeks –

An implant should be surrounded with a minimum of | ------ alveolar bone thickness.

1 mm

Minimum bone thickness between 2 implants should be -------(implant surface to implant surface) and minimum bone thickness between an implant and a tooth should be ------- (from root surface to implant surface). Coronal part of an implant should be placed approximately --------- apical to the adjacent CEJ

3 mm 4 mm 5 mm

A biological width exists around unloaded and loaded nonsubmerged one-part titanium implants. It is approximately --------

3 mm.

RFA (Resonance Frequency Analysis)

Mechanically, the resonance frequency of an object | is strongly correlated to the boundary constrains of the structure.

``` Lamina lucida(LL) -adjacent to ------ (400 A) Lamina densa(LD)- adjacent to ------ ```

basal cells connective tissue

– Reticulin

* Numerous adjacent to basement membrane | * Around blood vessels

Oxytalan

* mostly in pdl | * Run parallel to long axis of tooth

The dental tissue that most closely resembles bone is

cementum

Epithelial cells – need to guide the tissue. --------- – done with stem cells)

GTR (guided tissue regen.

Lactose (increase lactose,

decrease in co-adhesion)

S. sanguis is found in large numbers in deep, active periodontal pockets. Thorough scaling and root planing of a deep periodontal pocket will most likely result in increased numbers of A. actinomycetemcomitans.

false, false

Facultative species, Can live w/ or w/o O2 | Uses up O2 when available

Streptococcus cristatus

Robust anaerobe | Binding to strep improves survival when O2 is present

Fusobacterium nucleatum

Microaerophilic, obligate anaerobe | Coaggregation essential to survival when O2 is present

Porphyromonas gingivalis

Sweep 2 Flashcards

(76 cards)