2: Efficacy of Diagnostic Techniques for Periodontal Diseases

Question 1

How is periodontal disease currently diagnosed?

Answer 1

almost entirely on the basis of its clinical manifestations

Question 2

What are the clinical manifestations of periodontal disease?

Answer 2

1. gingival inflammation (redness, swelling, plaque index, gingival index)
2. periodontal probing (PD, BOP, CAL)
3. tooth mobility
4. Furcation involvement
5. radiographs (BW or PA) (bone changes - amount of bone loss)

Question 3

What are the traditionally used diagnostic procedures for patients over 50?

Answer 3

periodontal examination and radiographs

Question 4

What diagnostic techniques are not routinely used in clinical practice?

Answer 4

1. microbiological testing
2. assessment of host response
3. genetic analysis

Question 5

What are the limitations to probe penetration, CAL, and radiographic examination?

Answer 5

PP: lack of sensitivity and reproducibility
CAL: poor reliability and reproducibility
RE: limited sensitivity in small bone changes, no value in evaluating disease activity or progression

Question 6

What is a hollow tapered tip that is filled with water for coupling of the ultrasonic beam into the tissues?

Answer 6

ultrasonic periodontal probing

Question 7

T/F. Conventional radiographs are very sensitive but lack specificity.

Answer 7

False, Conventional radiographs are very SPECIFIC but lack SENSITIVITY.

Question 8

Why has cone-beam computed tomography (CBCT) been introduced in periodontology?

Answer 8

for the detection of periodontal defects in in vitro settings

Question 9

The ___ of a diagnostic test refers to the probability of the test being positive when the disease is truly present.

Answer 9

Sensitivity

A / A + B

Question 10

The ___ of a diagnostic test refers to the probability of the test being negative when the disease is not present.

Answer 10

specificity

D / C + D

Question 11

What is the gold standard for microbiological testing?

Answer 11

bacterial culturing

Question 12

Bacterial culturing can assess for ___ susceptibility of microbes and can only grow ___ bacteria but some putative pathogens are ___ (need special nutrients to culture) and are difficult to culture.

Answer 12

antibiotic; live; fastidious

Question 13

Bacterial culturing has low ___, needs sophisticated equipment and experienced personnel, and is relatively time consuming and expensive.

Answer 13

sensitivity

Question 14

Direct microscopy includes ___-___and ___-___ microscopy.

Answer 14

dark-field; phase-contrast

Question 15

Although direct microscopy allows one to identify ___ and ___ of bacterial in a plaque sample, most of the main putative perio pathogens are ___-___ so it is difficult to identify.

Answer 15

morphology; motility; non-motile

Question 16

How does immunodiagnostic methods work?

Answer 16

It uses Ab that targets specific bacterial Ag

Question 17

How are direct and indirect immunofluorescent (IFA) microscopic assays are able to identify pathogens?

Answer 17

plaque smear

Question 18

IFA detects ___ and ___, is comparable to bacterial culture and does not require ___ bacterial cells.

Answer 18

Aa; Pg; viable

Question 19

What prevents the wide use of cytofluorography (flow cytometry)?

Answer 19

complexity and cost

Question 20

What is enzyme-linked immunosorbent assay used for?

Answer 20

to detect serum antibodies to periodontal pathogens

Question 21

What immunodiagnositic method is based on the binding of protein to latex beads coated with species-specific antibody?

Answer 21

latex agglutination

Question 22

Pg, Tf, and Aa possess in common a ___-like enzyme that hydrolyzes a substrate ___.

Answer 22

trypsin; N-benzoyl-DL-arginine-2-naphthylamide (BANA)

Question 23

Chair-side enzmatic kit named ___ is not able to distinguish between individual bacteria and may be positive at clinically healthy sites.

Answer 23

Perioscan

Question 24

T/F. A negative result does not rule out the presence of other important periodontal pathogens.

Answer 24

True.

Question 25

What are some examples of molecular biology techniques?

Answer 25

nucleic acid probes checkerboard DNA-DNA hybridization PCR Real-time PCR

Question 26

What nucleic acid probe has high sensitivity and specificity?

Answer 26

16S rRNA

Question 27

Which molecular technique can identify up to 40 oral bacterial species in a single test but has not be generalized for diagnositc purposes?

Answer 27

checkerboard DNA-DNA hybridization

Question 28

PCR has high ___ and ___ for the identification of target pathogens but it is unable to quantify pathogens accurately in clinical samples.

Answer 28

sensitivity; specificity

Question 29

What samples are taken to assess host responses?

Answer 29

``` saliva gingival crevicular fluid (GCF most common used) blood serum blood cells urine ```

Question 30

What is used in the diagnosis of hypophopshatasia?

Answer 30

urine

Question 31

What is one collecting if they place a paper strip within the crevice for 30 seconds and then measure the fluid volume with a Periotron?

Answer 31

collecting GCF

Question 32

What are the intracellular destruction enzymes released from dead or dying PMN/Neutrophils from the periodontium?

Answer 32

aspartate amino-transferase (released during tissue destruction) alkaline phosphatase (membrane-bound glycoprotein involved in maintenance of alveolar bone) beta-glucuronidase (lysosomal enzyme degrades proteoglycans and ground substance) elastase (proteolytic enzyme foudn in lysosomal granules of neutrophils)

Question 33

What is associated with the activity of matrix metalloproteinases and produced by inflammatory, epithelial and connective tissue cells?

Answer 33

extracellular destruction enzymes

Question 34

There is a marked elevation in ___ levels in GCF from sites with ___ gingival inflammation. There is an inability to discriminate between sites with severe inflammation with or without ___ loss.

Answer 34

AST; severe; attachment

Question 35

T/F. ALP in GCF is higher in diseased then healthy sites

Answer 35

True.

Question 36

Beta-glucuronidase is elevated from sites with ___ periodontal disease. It has high ___ and ___ when related to occurrence of clinical ___ loss. It is a good predictor for future ___ breakdown.

Answer 36

severe; sensitivity; specificity; attachment; periodontal

Question 37

T/F. There is a negative correlation of elastase in GCF with clinical attachment loss.

Answer 37

False, There is a POSITIVE correlation of elastase in GCF with clinical attachment loss.

Question 38

What is secreted by fibroblasts and macrophages that is responsible for remodeling and degradation of ECM components?

Answer 38

Matrix metalloproteinases (MMPs)

Question 39

What is the level of MMPs in GCF if a patient is at significant risk for progression of periodontitis?

Answer 39

high

Question 40

What happens to GCF MMP levels in response to treatment?

Answer 40

levels are reduced

Question 41

Which MMPs are involved in the initial destruction of periodontal ECM?

Answer 41

``` MMP-2 (gelatinase A) MMP-9 (gelatinase B) MMP-8 (collagenase 2) MMP-13 (collagenase 3) MMP-3 (stromelysin-1) ```

Question 42

What is the ECM of the periodontium composed of?

Answer 42

collagen proteoglycan non-collagen proteins

Question 43

What tissue breakdown products are found in the GCF of sites with periodontitis?

Answer 43

hydroxyproline, glyconsaminoglycans, osteocalcin, type 1 collagen

Question 44

Which cytokines are inflammatory mediators?

Answer 44

``` TNF-alpha IL-1alpha IL-1beta IL-6 IL-8 PGE2 ```

Question 45

T/F. Traditional immunoassays analyze only a single cytokine at a time.

Answer 45

True.

Question 46

What assay uses color-coded beads and permits the simultaneous detection of up to 100 cytokines in a single well of a 96 well microplate?

Answer 46

bio-plex cytokine assay

Question 47

In optical spectroscopy, infrared (IR) spectroscopy has vibrating ___ bonds of organic molecules absorb a characteristic wavelength of IR light. The ___ of the absorbed light can be used to establish a molecular fingerprint of a tissue or fluid.

Answer 47

covalent; spectrum

Question 48

What does the wavelength of light absorbed by IR spectroscopy depend on?

Answer 48

1. the nature of the covalent bond (C=0 or N-H) 2. the type of vibration (binding and stretching) 3. environment of the bond

Question 49

IR spectoscopy can be used to characterize GCF from healthy, gingivitis, and periodontitis sites. What is its sensitvity and specificity?

Answer 49

both are high

Question 50

T/F. IR spectroscopy of GCF is reagent free and requires only small sample volumes and minimal training for the operator.

Answer 50

True.

Question 51

What type of spectroscopy measures oxygen saturation of the tissues?

Answer 51

near infrared (NIR) spectroscopy

Question 52

The wavelength region ___ to ___ is dominated by the absorption from ___ hemoglobin (HbO2) and ___ hemoglobin (Hb).

Answer 52

500; 600; oxygenated; deozygenated

Question 53

T/F. Tissue oxygenation at periodontitis sites significantly increases as compared to gingivitis and healthy control sites.

Answer 53

False, Tissue oxygenation at periodontitis sites significantly DECREASES as compared to gingivitis and healthy control sites.

Question 54

Why test saliva?

Answer 54

1. abundant fluid and easy to collect and store | 2. highly enriched content of disease biomarkers (Sjogren's syndrome and oral cancer)

Question 55

What should be done to find out type and concentration of specific periodontal pathogens?

Answer 55

apply DNA PCR to identify specific periodontal pathogens

Question 56

What could be done to test genetic susceptibility to periodontitis in individuals?

Answer 56

test genetic variation: over expression of IL-1a or IL-1b

Question 57

T/F. Tests for periodontal disease identify general risk factors for the development of disease but fail to determine when periodontal destruction will occur.

Answer 57

True, they are not able to specifically predict periods of disease activity.

Question 58

Salivary Occults Blood Test (SOBT) may offer a simple screening method for periodontal status when what is not possible?

Answer 58

when a through periodontal examination is not possible. It is not sufficiently specific to be a reasonable substitute fro a periodontal examination

Question 59

How many proteins have been found in whole saliva?

Answer 59

2290

Question 60

What may offer a cost-effective approach to screening of periodontal disease in large populations?

Answer 60

salivary proteome analysis