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DEN 7108 Micro and Immuno Concepts Part II > 1/17 Kingsley Periodontal Immunology > Flashcards

1/17 Kingsley Periodontal Immunology Flashcards

1
Q

Periodontal disease consists of an intersection between 2 different concepts, which are:

A
  • dysbiosis
  • dysregulation of immune response
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2
Q

Dysbiosis

A

shift towards pathogenic bacteria

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3
Q

Dysregulation of the immune response is a result of:

A

Infection

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4
Q

Biofilm development allows more ____ which allow ______ to develop

A

Gram-negatives and anaerobes; gingivitis and periodontal disease

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5
Q

Factors that influence biofilm development

A
  • diet
  • hygiene
  • behavior
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6
Q

What is GCF?

A

gingival crevicular fluid

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7
Q

GCF contains:

A
  • PMN (neutrophils)
  • may by IL-8 present
  • some macrophages, other WBC
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8
Q

Clinical assessment of periodontal health (healthy individual)

A
  • low levels of inflammatory cytokines (IL-1, IL-6, TNF-a)
  • low levels of inflammatory metabolites (PGE2, LTB4)
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9
Q

Initial lesions: Two to four days after cessation of oral hygiene there is a marked increase in ______ and marked shift towards _____

A

biofilm thickness and complexity; gram-negative anaerobes

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10
Q

In initial lesions of gingivitis/periodontitis, GCF shift ____ . LPS induces ____ which triggers inflammation. More ____ (cell types) are found

A

gram-negatives (secondary, tertiary); IL-8; PMN, Th1, macrophages

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11
Q

Clinical assessment of early lesions

A
  • increasing levels of inflammatory cytokines
  • increasing levels of inflammatory metabolites
  • stark increase in PMN (neutrophil) numbers
  • Increase in Th1 (T-cells, macrophages)
  • bleeding upon probing
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12
Q

Cardinal sign of periodontal disease

A

Bleeding upon probing

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13
Q

Bleeding upon probing begins in what stage of periodontal disease development?

A

Early lesions

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14
Q

Established and advanced lesions in periodontitis are comprised of:

A
  • intense PMN infiltrate
  • lymphocytic infiltrate begins (B-cells, Th2)
  • blood allows antibodies (IgG), complement cascade active
  • Th1/Th2 cytokines trigger bone destruction
  • bacterial proteases and host cytokines
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15
Q

Microbiology of periodontal immunology: what bacteria are found in periodontitis?

A
  • Aggregatibacter actinomycetemcomitans (AA)
  • Porphyromonas gingivalis
  • Tannerella forsythia
  • Treponema denticola

gram-negative anaerobic rods and spirochetes

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16
Q

Aggregatibacter actinomycetemcomitans (AA) - virulence factors

A
  • LtxA
  • chemotactic factor
  • immunosuppressive factor
  • ompA
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17
Q

LtxA is a virulence factor produced by ____ and it is a ____

A

Aggregatibacter actinomycetemcomitans (AA); PMN toxin (kills neutrophils)

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18
Q

Chemotactic factor is a virulence factor produced by ____ and it is a _____

A

Aggregatibacter actinomycetemcomitans (AA); PMN inhibitor

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19
Q

Immunosuppressive factor is produced by ____ and it is a _____

A

Aggregatibacter actinomycetemcomitans (AA); IgM/IgG inhibitor

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20
Q

What is ompA?

A

Complement inhibitor (produced by Aggregatibacter actinomycetemcomitans AA)

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21
Q

_____ produced by P. gingivalis, degrades inflammatory cytokines

A

Gingipains

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22
Q

_____ stimulates P. gingivalis gingipain production

A

T. denticola

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23
Q

____ makes a lot of proteases and BspA for adhesion

A

Tannerella forsythia

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24
Q

____ is resistant to human beta-defensins

A

T. denticola

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25
During periodontal disease initiation and progression, the normal immune response to GCF bacteria insult is _____. ____ produce IL-8
PMN (neutrophils); Junctional epithelium and PMN
26
IL-8 function
PMN chemoattractant (neutrophils)
27
Continual biofilm accumulation without intervention (hygiene) causes:
- increased inflammatory cytokines (IL-1, IL-6, TNF-a) - Th1 response
28
Inflammatory cytokine overload induces:
Bone resorption
29
Proteases and MMPs drive:
Tissue destruction
30
Inflammatory mediators stimulate ____
LPS
31
What are the inflammatory mediators?
- acute inflammatory cytokines - Delayed inflammatory metabolites
32
Acute inflammatory cytokines
IL-1, IL-6, IL-8, TNF-a
33
Delayed inflammatory metabolites
- PGE2 - LTB4 - Lipoxins | Arachidonic acid metabolites
34
____ is an inflammatory mediator produced by PMN, macrophages (Th1), and gingival fibroblasts
IL-1 beta (strongest at bone resorption)
35
Long term exposure to IL-1 beta stimulates ____ and inhibits ____
Bone resorption; bone formation
36
In the periodontal susceptibility test in 23&me, ____ is associated with chronic periodontitis
SNP +3953
37
IL-1 beta is a potent stimulator of ____ which causes tissue damage
MMPs (matrix metalloproteinases)
38
Most important independent risk factor for periodontitis is:
Smoking
39
____ (SNP) greatly increases risk for periodontitis
IL-1 beta SNP +3953
40
Regarding periodontal risk factors, the risk ratio between ____ and _____ is almost the same. Together, their relative risk is ____ which portrays ____ effects
Smoking and IL-1 beta SNP +3953; 7.7; synergistic
41
List some ways that smoking is detrimental to oral health
- decreases gingival blood flow (PMN, WBC) - impairs PMN and WBC chemotaxis - impairs PMN phagocytosis - impairs PMN respiratory burst
42
In periodontal disease, host destruction of tissues occurs. PMNs and fibroblasts produce ____ which limit adhesion
MMPs
43
MMPs are associated with ____ destruction of tissues in periodontal disease
Host
44
Bacterial destruction of tissues in periodontal disease involves:
- P. gingivalis **gingipains** - Tannerella/Treponema **proteases**
45
P. gingivalis gingipains degrade _____ and ___, and activate ____
Collagen; fibronectin; MMPs
46
Disease associations with periodontitis
- Chronic Granulomatous disease (CGD)/Bridges-Good syndrome/Quie syndrome - Kostmann syndrome - Chediak-Higashi syndrome - Diabetes mellitus Type I and II - Trisomy 21 (Down's syndrome)
47
Chronic Granulomatous disease is also known as:
- Bridges-Good syndrome - Quie syndrome
48
Chronic Granulomatous disease involves:
- neutrophil deficiency/dysfunction - may perform phagocytosis and inflammation - impaired oxidative burst
49
Most cases of Chronic Granulomatous disease are:
X-linked (males more commonly affected)
50
Chronic Granulomatous disease leads to chronic, recurrent gingivitis and periodontitis in _____
children
51
Kostmann syndrome inheritence
Autosomal recessive
52
_____ causes congenital neutropenia and periodontitis is common in pediatric patients
Kostmann syndrome
53
Chediak Higashi syndrome inheritence
Autosomal recessive
54
Common symptom of Chediak Higashi syndrome is ____ which is otherwise rare among children
Periodontitis
55
Phenotypic manifestations of Chediak Higashi syndrome
- **Albinism** (light skin, silvery hair) - **Atypical** recurrent gingivitis or **periodontitis** - **hypopigmentation of hair, skin, eyes**
56
Diabetes mellitis type I and II - relative risk of periodontitis is ____
Very high (3-5x)
57
Uncontrolled blood sugar with diabetes type I and II causes the formation of _____
Advanced glycation end products (AGEs)
58
Chronic hyperplastic gingivitis is often a sign of:
- cancer - inflammation from diabetes (uncontrolled)
59
Those with down's syndrome have a confirmed ____ risk for periodontal disease
High (maybe due to mouth breathing, increased collagenases)
60
Strongest risk factor for pre-term, low birth weight infants
Smoking and periodontal disease in mother
61
Relative risk is ____ for PT-LBW with periodontal disease
7x
62
Majority of PT-LBW infants are:
- <37 weeks - < 5lbs 8oz
63
There is a strong association between ___ cancer and periodontitis. ____ is the biggest risk factor as well as _____
Colon; smoking; active, chronic periodontal disease
64
____, a bacteria active in periodontal disease, also drives oncogenesis
F. nucleatum
65
There are new linkages found between periodontitis and ____
Vascular disease
66
Bacterial DNA found in atherosclerotic plaques
- **P. gingivalis (100%)** - F. nucleatum (80%) - T. forsythia (50%)
67
Alzheimer's disease is related to:
Periodontitis
68
Prior to Alzheimer's disease:
Oral bacteria and immune responses to periodontal disease are elevated
69
There is detection of oral bacteria in _____ brain tissue
Alzheimer's disease
70
Periodontal disease: prevention
- brush regularly to prevent biofilm buildup (plaque) - floss regularly to prevent interdental plaque buildup - routinely visit oral healthcare provider

DEN 7108 Micro and Immuno Concepts Part II (27 decks)

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