Utah Systemic Disease - Part II

Question 1

What are the direct effects of bacteria and bacterial products?

Answer 1

Release IL-1, IL-6, TNF-alpha

Result in vascular lesions

Question 2

What are the indirect effects of bacteria and bacterial products?

Answer 2

Stimulate liver

Release CRP, fibrinogen, lipid abnormalities, coagulation factors

Result in vascular lesion

Question 3

What are two well-established risk factors for cardiovascular disease?

Answer 3

Tobacco smoking

High LDL

Question 4

T/F - CRP is an important risk factor for MI.

Answer 4

TRUE

Question 5

What two things are there a relationship with cardiovascular disease?

Answer 5

CRP

Plasma fibrinogen

Question 6

T/F - Periodontitis increased systemic CRP and fibrinogen.

Answer 6

TRUE

CRP levels increased in periodontitis

One year perio tx show a reduction of CRP

Question 7

Atherosclerotic plaques pathogenesis include what 5 things?

Answer 7

Endothelial damage/dysfunction

Lipid deposition and oxidation in the sub-endo space

Macrophage/PMN chemotaxis

Smooth muscle proliferation

Plaque rupture

Question 8

Where is CRP created?

Answer 8

By hepatocytes

Question 9

T/F - People over age 16 have some atherosclerosis.

Answer 9

TRUE

Question 10

Look at slide 9

Answer 10

Slide 9

It’s a chart

Question 11

What is MCP1?

Answer 11

Monocyte chemotactic protein-1

—Member of the small inducible gene (SIG) family

Question 12

What does MCP1 do?

Answer 12

Recruits monocytes to sites of injury and infection

Question 13

Where is the gene for MCP1?

Answer 13

On chromosome 17

Question 14

Where is MCP1 found?

Answer 14

In the jts of people with RA

Elevated in urine as a sign of kidney inflammation

Associated with diabetes

Question 15

T/F - Macrophages express receptors that take up modified LDL.

Answer 15

TRUE

Question 16

T/F - TNFalpha, IL-6, and IL-1 are also associated with chromosome 17 at the same locus (17q11.2-q12).

Answer 16

TRUE

Question 17

Slides 12-14

Answer 17

Pictures

Question 18

T/F - Macrophages and foam cells express growth factors and proteinases.

Answer 18

TRUE

Question 19

The remnants of _______ and ________ are also proinflammatory.

Answer 19

VLDL

Chylomicrons

Question 20

Plaque inflammation causes what 3 things?

Answer 20

Fibrous cap thinning

Plaque rupture

Thrombosis

Question 21

Breakdown of plaque leads to what 4 things?

Answer 21

MI

Angina

Stroke

TIAs

Question 22

T/F - Periodontitis has a role in atherosclerosis.

Answer 22

TRUE

Question 23

Stimulation of cells with LPS, TNFalpha, and IL-1beta induces what?

Answer 23

NFkappaB

Question 24

_________ stimulates macrophage activation and smooth muscle cell proliferation.

Answer 24

NFkappaB

Question 25

Doxycycline does what?

Answer 25

Reduces CRP and fibrinogen to normal levels

Question 26

Preventative maintenance therapy is aimed at reducing which bacteria?

Answer 26

P gingivalis

Question 27

Minocycline does what for pts with increased risk of CVD?

Answer 27

Reduced CRP and TNFalpha

Question 28

Do oral bacteria have a relationship to CVD?

Answer 28

YES *Directly increase risk for CVD and strokes*

Question 29

T/F - Poor dental health is associated with CVD. We can’t clearly say though that severe periodontal disease will give you an MI.

Answer 29

TRUE

Question 30

T/F - T forsynthesis and P gingivalis are assocaited with MI.

Answer 30

TRUE

Question 31

T/F - There is an associated of periodontal disease and increased risk for CVD.

Answer 31

TRUE

Question 32

T/F - Periodontitis is related to atherosclerosis.

Answer 32

TRUE

Question 33

What are the 2 types of stroke?

Answer 33

Hemorrhagic - Bleeding into brain - Death is typically imminent * NOT associated with periodontal disease Nonhemorrhagic/ischemic - Caused by blockage of a bv supplying the brain * IS associated with periodontal disease

Question 34

What should we do with CVD pts?

Answer 34

Conduct medical history and physical exam ID physical signs and symptoms of cardiac dysfunction Evaluate vital signs Seek medical consultation when indicated Know concomitant Know conditions req ax prophylaxis

Question 35

T/F - In men less than 50 yo, 25% fo pts who had a stroke had significant dental disease.

Answer 35

TRUE

Question 36

T/F - Periodontal disease is a significant risk factor for non-hemorrhagic but not for hemorrhagic stroke.

Answer 36

TRUE

Question 37

T/F - Only strokes associated with narrowing of the arteries (atherosclerosis) seem to be related.

Answer 37

TRUE

Question 38

T/F - Estrogen and progesterone can be used by some bacteroides spp (G-), and P intermedia as substitutes for vitamin K, one of their important growth factors.

Answer 38

TRUE

Question 39

T/F - Use of contraceptives also use gestational hormones that can also lead to increased gingival inflammation.

Answer 39

TRUE

Question 40

T/F - Pregnant women have more gingivitis independent of plaque accumulation.

Answer 40

TRUE It mirrors increasing estrogen and progesterone levels in months 4-9 This is reversible Hormones are at high levels in the GCF

Question 41

CT breakdown may be enhanced by ________ ________ activating the fibrinolytic system.

Answer 41

Plasminogen activator

Question 42

Preterm birth occurs at what rate in the US?

Answer 42

1 in 8 Inflammation thought to account for 30-50% of all premature deliveries

Question 43

More than ___% of babies in the US are born at a low birth weight.

Answer 43

8

Question 44

What is leukocyte adhesion deficiency (LAD) due to?

Answer 44

Deficiency in cell surface integrins

Question 45

Tell me about LAD.

Answer 45

Leukocytes cannot adhere to wall of endothelium at sites of infection -No diapedesis or migration from capillaries into soft tissue No migration to infectious site Leads to death

Question 46

T/F - Chediak-Higashi syndrome is related to an increased risk of periodontal disease.

Answer 46

TRUE

Question 47

What is cyclic neutropenia?

Answer 47

Cyclical decrease in PMNs on a 21 day cycle and a 3-10 day period of severe neutropenia 3-6 days of fever, malaise, mood swing, oral ulcerations Periodontitis may progress faster during PMN depression

Question 48

**Cyclic vs congenital neutropenia.**

Answer 48

Cyclic - Due to genetics Congenital - Present at Birth

Question 49

Tell me about congenital neutropenia.

Answer 49

Low PMN count Severe bacterial infections

Question 50

Just remember that neutropenia, LAD, Chediak-Higashi Syndrome, Papillon-Lefevre Syndrome are systemic conditions that increase periodontitis.

Answer 50

Good

Question 51

Tell me about Down syndrome in regards to perio.

Answer 51

PMNs normal Chemotaxis, phagocytosis, and intracellular killing may be reduced Collagenase and GCF PMNs may be increased More at risk for periodontal disease

Question 52

T/F - Sometimes the first sing of leukemia is seen in the oral cavity.

Answer 52

TRUE Mucosal ulcerations and gingival enlargements

Question 53

Tell me about Wegener’s Granulomatosis (Strawberry gingivitis).

Answer 53

Necrotizing vasculitis of small vessels of upper and lower respiratory tract Hyperplastic gingivitis Tooth mobility and tooth loss

Question 54

**Quiz Stuff for next week** PD (Periodontal disease) is inflammatory disease, associated with microbial flora Increase in CRP, plasmin activators if get health, lower those mediators Inflammatory mediators have direct effect on systemic plaques, so increases risk of thrombosis PD and CVD are related based on populations, looking at an individual, we can’t always assume that Pregnant women are at an increased risk for gingivitis Systemic diseases can cause periodontal disease, decrease PMN fx or decreased chemotaxis Downs is at risk for PD

Answer 54

KNOW THESE