4 - Microbiology of Periodontal Disease

Question 1

4 papilla of tongue

Answer 1

Filiform
Fungiform
Foliate
Circumvallate

Question 2

Must numerous papilla

Answer 2

Filiform

Question 3

Fungiform papilla description, innervation

Answer 3

Mushroom shaped, dorsal surface taste bud

CN VII (chorda tympani from CN V)

Question 4

Filiform papilla description, innervation

Answer 4

Most numerous, increased keratinization

CN VII?

Question 5

Foliate papilla description, innervation

Answer 5

Lateral border of tongue

CN VII (anterior), CN IX (posterior)

Question 6

Circumvallate papilla description, innervation

Answer 6

10-14 anterior to sulcus terminalis. Ducts of Von Ebner’s glands

CN IX

Question 7

____% of lingual flora is gram +

Answer 7

70

Question 8

What genus dominates epithelial surfaces (minus dorsum of tongue)

Answer 8

Streptococci

Question 9

GCF is rich in ____ and ____

Answer 9

IgG

IgA

Question 10

1st level of evidence supporting bacterial etiology of periodontal disease

Answer 10

Clinical observations

Question 11

Examples of level #1 evidence

Answer 11

Bryan (1939) and Fauchard (1746)

Question 12

2nd level of evidence supporting bacterial etiology of periodontal disease

Answer 12

Germfree animals

Question 13

Examples of level #2 evidence

Answer 13

Orland - no caries in germfree animals
Baer - loss of bone in germfree rats due to mechanical irritation
Listgarten - no ChP in germfree beagle, inflammation due to sterilized diet
Socransky

Question 14

3rd level of evidence supporting bacterial etiology of periodontal disease

Answer 14

Monoinfected gnotobiotic animals

Question 15

Examples of level #3 evidence

Answer 15

Jordan - Monoinfection w/ Actinomyces viscosus in rats cause inflammation/root caries

Most bacteria require other colonizing bacteria to survive

Question 16

4th level of evidence supporting bacterial etiology of periodontal disease

Answer 16

Experimental periodontal disease

Question 17

Examples of level #4 evidence

Answer 17

Loe 1965 - Gingivitis develops in 10-21 days, resolves in 1 week w/ continued OH

Syed and Loesche - repeat Loe study

Lindhe - experimental ChP in beagles

Question 18

Progression of bacteria in Loe study

Answer 18

Gram positive (90-100%), transformed to gram negative (40-50%)

Gram - preceded gingivitis by 3-10 days

Pressed thin film on plaque

Question 19

Progression of bacteria in Syed and Loesche study

Answer 19

Gram + dominant throughout experiment

A. viscosus associated w/ marginal gingivitis
Actinomyces dominated 2-3 week plaque

Question 20

Results of Lindhe ChP beagle dogs

Answer 20

4 years no brushing

8/10 w/ CAL loss
2/1 w/ NO CAL loss.

Not all gingivitis proceeds to periodontitis

Question 21

5th level of evidence supporting bacterial etiology of periodontal disease

Answer 21

Therapeutic effect of plaque control on human periodontitis

Question 22

Examples of level #5 evidence

Answer 22

Plaque control and maintenance studies most important step in treatment of periodontal disease

Antimicrobial chemicals are useful adjuncts

Question 23

6th level of evidence supporting bacterial etiology of periodontal disease

Answer 23

Epidemiologic studies on relation of oral hygiene and periodontitis

Question 24

Examples of level #6 evidence

Answer 24

Gross - Erie County, NY. Positive correlation between occurrence of bone loss and presence of periodontal pathogens (B. forsythus), smoking (dose-dependent), diabetes, and age

Question 25

7th level of evidence supporting bacterial etiology of periodontal disease

Answer 25

Pathogenic potential of plaque bacteria

Question 26

Examples of level #7 evidence

Answer 26

Sulcular/JE permeability facilitate entry of bacteria Destruction of tissue (MMP) Lytic enzymes Enhanced inflammatory response Inhibition of host repair processes (collagen synthesis) Local suppression of host defense

Question 27

4 Koch's Postulates

Answer 27

1) The organism must be found in lesions of the disease 2) It much be isolated and grown in pure culture on artificial media 3) Inoculation of experimental animals with microorganism must cause similar lesions to those in humans The microorganisms must be isolated from the lesions in the experimental animal

Question 28

5 alternatives to Koch's postulates

Answer 28

1) Association with the disease: thus the pathogen must be at significantly higher levels in the diseased site as oppose to the healthy (0.3 weight) 2) Elimination of the organism: Elimination of the pathogen should arrest the disease (0.3 weight) 3) Host response: The host response to the pathogen should be greater as compared to non-pathogens (0.2 weight) 4) Animal Pathogenicity: Placing the pathogen in germfree animals or conventional animals should cause the disease. (0.2 weight) Mechanisms of Pathogenicity: The pathogen should have factors that allow it to contribute to the disease state (i.e. LPS) (0.1 weight)

Question 29

Periodontal disease caused by endogenous or exogenous organisms? (source)

Answer 29

Endogenous Choi w/ PCR study

Question 30

Bacterial flora and %'s in health

Answer 30

75-80% gram + | Streptococci + Actinomyces

Question 31

Bacterial load in health

Answer 31

10² to 10³

Question 32

Bacterial flora in gingivitis

Answer 32

Gram positive rods (Loe)

Question 33

Bacterial load in gingivitis

Answer 33

10^4 to 10^6

Question 34

Species in blue complex

Answer 34

Actinomyces

Question 35

Species in purple complex

Answer 35

Veillonella parvula | A. odontolyticus

Question 36

Species in green complex

Answer 36

AA

Question 37

Species in yellow complex

Answer 37

Streptococcus

Question 38

Species in orange complex

Answer 38

Campylobacter Prevotella intermedia F. nucleatum

Question 39

Species in red complex

Answer 39

TD TF PG

Question 40

Microbes associated w/ LAP

Answer 40

AA | PG

Question 41

Microbes associated w/ ANUG (source)

Answer 41

Spirochete treponema Listgarten

Question 42

Depth of invasion of spirochetes

Answer 42

250um