In other words, periodontitis is: 1. ______ similar to gingivitis 2. _____ ( susceptible host) 3. Each site is ___ or ____ environment 4. A % of affects population experiences _____ 5. The progression of the disease is probably...

1. plaque-induced 2. host-related 3. individualized or specific 4. severe destruction 5. ....

The Inflammatory Periodontal Lesion Flashcards by Abagayle Moody

plaque induced
inflammation (edema/bleeding upon probing)
no destruction of PDL and bone
no apical migration of epithelial attachment

Gingivitis

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Describe the destruction of PDL and bone and apical migration of epithelial attachment with gingivitis:

No destruction of PDL & bone
No apical migration of epithelial attachment

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Epithelial attachment =

junctional epithelium

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plaque-induced
inflammation (edema/bleeding upon probing)
destruction of bone
apical migration of epithelial attachment

Periodontitis

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If you stop brushing & flossing will you develop gingivitis?

yes

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Keystone pathogens of gingivitis:

p. gingivalis & Agregatibacter actinomycetecomitans

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If you stop brushing and flossing and develop gingivitis, start brushing again and have optimal oral hygeine, is the gingivitis reversible?

yes

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What are some factors that make someone a susceptible host for periodontitis?

diabetics, smokers, immune conditions

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T/F: Not all cases of gingivitis progress to periodontitis

True

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In other words, periodontitis is:

______ similar to gingivitis
_____ ( susceptible host)
Each site is ___ or ____ environment
A % of affects population experiences _____
The progression of the disease is probably…

plaque-induced
host-related
individualized or specific
severe destruction
….

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Models of disease progression:

continuous model (1900 -1950s)
progressive model (1940-1960s)
Random burst model (1980s-2000s)

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Why does periodontal disease start in the posterior teeth?

Due to the gingival col- it creates a perfect valley where bacteria can thrive and the tissue is NON-keratinized

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Red complex: (3)

P. gingivalis
T. Forsynthia
T. Denticola

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The red complex species are associated with:

bleeding upon probing
progressive bone loss
progressive attachment loss

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What model of disease progression states “continuous through life at same rate of loss”

Continuous Model

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What model disease progression coincides with the following example:

“everyone gets perio disease”

Continuous model

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What model of disease progression states:
- progressive loss over time of some sites
- no destruction in others
- time of onset and extends vary among sites

Progressive model

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What model disease progression coincides with the following example:

” periodontal disease affects mainly posterior teeth”

Progressive model

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What model of disease progression tends to fit best when there are random areas of disease progression while some areas seem to be unaffected?

Asynchronous multiple burst model (1980s-2000s)

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T/F: Maxillary teeth are less susceptible to perio disease than mandibular teeth

false- maxillary teeth more susceptible due to the trifurcated roots

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What would be the reason for seeing bone loss progression more severely on the maxillary 2nd molars compared to the mandibular second molar?

The maxillary teeth have trifurcation vs. the bifurcation on the mandibular molars- this trifurcation can make it harder to keep clean

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What teeth are least likely to be lost to perio disease?

mandibular canine & mandibular 1st premolar

(because the maxillary canine is right next to the first premolar which has a mesial concavity)

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Signs of inflammation: (5)

rubor (redness)
calor (heat)
dolor (pain)
tumor (swelling)
functio laesa (loss of function)

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When there is an insult to the body - the first Lin e of defense is ____ and the body sends these players to the area by _____.

WBCs (neutrophils)

Dilation of blood vessels

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Inflammation is a ____ phenomenon

vascular

When you see purplish change in the gingiva this is a sign of:

stagnant blood flow (chronic inflammation)

What type of cells are the "migrators" in inflammation?

leukocytes

Signs of vasculitis in an inflammatory response include:

1. dilation 2. venous stasis (congestion) 3. increased permeability (transudate & exudate)

List some examples of innate immunity:

- skin - saliva - gingival crevicular fluid

Anytime the immune system goes out of control, this can result in:

autoimmunity

T cells can differentiate into 2 major forms:

CD4 & CD8

T/F: The innate and adaptive immune system work completely separate

False- the adaptive immune system goes back and helps out the innate immune system and they kinda work together

Two individuals with - Same plaque - Same amounts of bacteria - Same species of bacteria One person develops periodontitis and the other does not. Why might this be?

Due to the host immune response differing

Molecules that are secreted to send signals to other cells. A component of humoral immunity:

Complement

Bacteria cause disease when _____.

attach to the epithelium

One of the biggest mediators of destruction in periodontal disease:

Cytokines

Pro-Inflammatory cytokine: stimulates osteoclasts, fibroblasts macrophages

IL-1

What destroys bone, osteoclasts or osteoblasts?

osteoclasts

Pro-inflammatory cytokine: stimulates T and B cells:

IL-6

Pro-inflammatory cytokine: attracts and activates PMNs:

IL-8

Pro-inflammatory cytokine: activates osteoclasts

TNF

Cytokine that is responsible for vasodilation, is pyrogenic, releases mediator from mast cells and is involved in cell-mediated cytotoxicity:

PGE2

In women, what cytokine is regulated by estrogen levels, causing more issues in menopausal women?

IL-6

Whenever there is tissue breakdown, ____ is released

prostaglandin

Growth factor that stimulates epithelial cells AND fibroblasts:

TGF

Growth factors that stimulates fibroblasts: (2)

PDGF & FGF

Growth factor that stimulates/ heals epithelial cells:

EGF

FGF:

Fibroblast growth factors

EGF:

Epithelial growth factor

What causes bleeding upon probing?

ulceration of the junctional epithelium

In health when we probe, the probe stops short of the:

junctional epithelium

When probing, if the sulcular epithelium is in tact:

there will be no bleeding upon probing

When probing, if the sulcular epithelium is NOT in tact, this would result in:

bleeding upon probing

What situation might there be abscence of bleeding upon probing if someone has gingivitis/periodontitis?

smokers

Can we accurately predict which patients with gingivitis are going to progress to periodontitis?

Exactly, NO but we can identify risk factors

Risk factors for gingivitis progressing into periodontitis?

1. habits (smoking) 2. systemic disorders (HIV and diabetes)

Patients with risk factors are more likely to have:

attachment loss

In clinically healthy gingiva 1. Some ____ and ____ are present in connective tissue 2. A few ____ are migrating through the ___ 3. No ____ destruction 4. Intact ____ barrier 5. ____ is present 6. Appears _____ healthy (color, contours, consistency)

1. neutrophils & macrophages 2. neutrophils; JE 3. collagen 4. epithelial 5. gingival crevicular fluid 6. clinically

A condition that may cause young kids to have susceptibility to periodontal disease:

Hypophosphotasia

List some examples of GENETIC inflammatory response modifiers: (9)

1. Agranulocytosis 2. Neutropenias 3. Lazy leukocyte 4. Leukocyte adhesion deficiency (LAD) 5. Down syndrome 6. Papillon-Lefevre 7. Chediak-Higashi 8. Hypophosphatasia 9. Ehlers-Danlos syndrome

Initial lesion of gingivitis develops in:

2-4 days

- Develops in 2-4 days - Cells of acute inflammation present - Increased GCF flow - Start of pseudo-pocket formation

Initial lesion

Cells of acute inflammation:

PMNs

Cells of chronic inflammation:

lymphocytes

As inflammation increases in chronicity what cells may be present?

Plasma cells

What are two types of virulence factors?

1. stimulation of the host defense systems 2. Degradation of host tissues

Virulence factors that stimulate the host defense systems stimulate cells to release ____ (examples: ____) & _____ (example: ___)

cytokines (ie. IL-1, TNF and PGE) & chemoattractant factors (ie. IL-8)

Virulence factors that degrade host tissues are enzymes which include: (4)

1. collagenase 2. trypsin-like enzymes 3. keratinase 4. phospholipase A

Early lesion of gingivitis occurs in:

4-7 days

- Develops in 4-7 days - Acute inflammation persists (from initial lesion) - Increase GCF - Pseudopocket formation - Cells of chronic inflammation appear and then DOMINATE

Early Lesion

Describe the shift of cells present we see form initial lesions to early lesions:

PMNs---> T Lymphocytes

Early lesion may also be known as:

T-Cell lesion

What is the dominate cell of early lesion?

T-cells

In early lesions, ______ continues and _______ begins

collagen loss; MMPs Activation

Clinical features of early lesion: (7)

1. Edema of gingiva 2. Increased GCF flow 3. Loss of gingival stippling 4. Erythema of gingival margin 5. No migration of JE attachment 6. Alveolar bone is normal- no bone loss 7. Reversible

If you see a patient that has bleeding upon probing, what stage of lesion presents?

Established

Established lesion is characterized by breakage in the:

sulcular epithelium

The established lesion is characterized by loss of:

collagen

The loss of collagen in an established lesion results in: (2)

1. decreased rate of synthesis 2. increased rate of breakdown

Histopathology of the established lesion: 1. Cellular damage of _____ & ____ 2. ____ loss increases 3. ____ of pocket epithelium 4. Persistence of ____ 5. Marked numbers of _____ in pocket 6. Degradation of _____ 7. Dense ___, ___, & ___ infiltrate 8. ____ proliferation & extension into ___ 9. Elongation of ___

1. fibroblasts & epithelium 2. collagen 3. micro-ulcerations 4. acute inflammation 5. PMN's 6. extracellular matrix 7. T-cell, B- cell, & plasma cell 8. JE; CT 9. rete peg ridges

Attachment loss ____ bone loss by about _____

PRECEDES; 6 months

The Inflammatory Periodontal Lesion Flashcards

(82 cards)