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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
Q

During periodontal disease initiation and progression, the normal immune response to GCF bacteria insult is _____. ____ produce IL-8

A

PMN (neutrophils); Junctional epithelium and PMN

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26
Q

IL-8 function

A

PMN chemoattractant (neutrophils)

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27
Q

Continual biofilm accumulation without intervention (hygiene) causes:

A
  • increased inflammatory cytokines (IL-1, IL-6, TNF-a)
  • Th1 response
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28
Q

Inflammatory cytokine overload induces:

A

Bone resorption

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29
Q

Proteases and MMPs drive:

A

Tissue destruction

30
Q

Inflammatory mediators stimulate ____

A

LPS

31
Q

What are the inflammatory mediators?

A
  • acute inflammatory cytokines
  • Delayed inflammatory metabolites
32
Q

Acute inflammatory cytokines

A

IL-1, IL-6, IL-8, TNF-a

33
Q

Delayed inflammatory metabolites

A
  • PGE2
  • LTB4
  • Lipoxins

Arachidonic acid metabolites

34
Q

____ is an inflammatory mediator produced by PMN, macrophages (Th1), and gingival fibroblasts

A

IL-1 beta (strongest at bone resorption)

35
Q

Long term exposure to IL-1 beta stimulates ____ and inhibits ____

A

Bone resorption; bone formation

36
Q

In the periodontal susceptibility test in 23&me, ____ is associated with chronic periodontitis

A

SNP +3953

37
Q

IL-1 beta is a potent stimulator of ____ which causes tissue damage

A

MMPs (matrix metalloproteinases)

38
Q

Most important independent risk factor for periodontitis is:

A

Smoking

39
Q

____ (SNP) greatly increases risk for periodontitis

A

IL-1 beta SNP +3953

40
Q

Regarding periodontal risk factors, the risk ratio between ____ and _____ is almost the same. Together, their relative risk is ____ which portrays ____ effects

A

Smoking and IL-1 beta SNP +3953; 7.7; synergistic

41
Q

List some ways that smoking is detrimental to oral health

A
  • decreases gingival blood flow (PMN, WBC)
  • impairs PMN and WBC chemotaxis
  • impairs PMN phagocytosis
  • impairs PMN respiratory burst
42
Q

In periodontal disease, host destruction of tissues occurs. PMNs and fibroblasts produce ____ which limit adhesion

A

MMPs

43
Q

MMPs are associated with ____ destruction of tissues in periodontal disease

A

Host

44
Q

Bacterial destruction of tissues in periodontal disease involves:

A
  • P. gingivalis gingipains
  • Tannerella/Treponema proteases
45
Q

P. gingivalis gingipains degrade _____ and ___, and activate ____

A

Collagen; fibronectin; MMPs

46
Q

Disease associations with periodontitis

A
  • 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
Q

Chronic Granulomatous disease is also known as:

A
  • Bridges-Good syndrome
  • Quie syndrome
48
Q

Chronic Granulomatous disease involves:

A
  • neutrophil deficiency/dysfunction
  • may perform phagocytosis and inflammation
  • impaired oxidative burst
49
Q

Most cases of Chronic Granulomatous disease are:

A

X-linked (males more commonly affected)

50
Q

Chronic Granulomatous disease leads to chronic, recurrent gingivitis and periodontitis in _____

A

children

51
Q

Kostmann syndrome inheritence

A

Autosomal recessive

52
Q

_____ causes congenital neutropenia and periodontitis is common in pediatric patients

A

Kostmann syndrome

53
Q

Chediak Higashi syndrome inheritence

A

Autosomal recessive

54
Q

Common symptom of Chediak Higashi syndrome is ____ which is otherwise rare among children

A

Periodontitis

55
Q

Phenotypic manifestations of Chediak Higashi syndrome

A
  • Albinism (light skin, silvery hair)
  • Atypical recurrent gingivitis or periodontitis
  • hypopigmentation of hair, skin, eyes
56
Q

Diabetes mellitis type I and II - relative risk of periodontitis is ____

A

Very high (3-5x)

57
Q

Uncontrolled blood sugar with diabetes type I and II causes the formation of _____

A

Advanced glycation end products (AGEs)

58
Q

Chronic hyperplastic gingivitis is often a sign of:

A
  • cancer
  • inflammation from diabetes (uncontrolled)
59
Q

Those with down’s syndrome have a confirmed ____ risk for periodontal disease

A

High (maybe due to mouth breathing, increased collagenases)

60
Q

Strongest risk factor for pre-term, low birth weight infants

A

Smoking and periodontal disease in mother

61
Q

Relative risk is ____ for PT-LBW with periodontal disease

A

7x

62
Q

Majority of PT-LBW infants are:

A
  • <37 weeks
  • < 5lbs 8oz
63
Q

There is a strong association between ___ cancer and periodontitis. ____ is the biggest risk factor as well as _____

A

Colon; smoking; active, chronic periodontal disease

64
Q

____, a bacteria active in periodontal disease, also drives oncogenesis

A

F. nucleatum

65
Q

There are new linkages found between periodontitis and ____

A

Vascular disease

66
Q

Bacterial DNA found in atherosclerotic plaques

A
  • P. gingivalis (100%)
  • F. nucleatum (80%)
  • T. forsythia (50%)
67
Q

Alzheimer’s disease is related to:

A

Periodontitis

68
Q

Prior to Alzheimer’s disease:

A

Oral bacteria and immune responses to periodontal disease are elevated

69
Q

There is detection of oral bacteria in _____ brain tissue

A

Alzheimer’s disease

70
Q

Periodontal disease: prevention

A
  • 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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