5. Periodontal Pathogenesis Flashcards
5
Inflammation is linked to most chronic diseases of ____ and _______.
9
What is the etiologic role of bacterial plaque in periodontitis?
10
What determines susceptibility to periodontal disease?
10
What is the paradox with the role of inflammation that is seen in clinical manifestations of periodontitis?
11
Is periodontal disease caused by a single organism?
11
Is the bacteria that colonizes the subgingival sulcus found inside or outside the body?
12
What are 3 types of cells that are seen in clinically healthy gingiva that have protective features?
12
In clincially healthy gingiva, there is a steady state between ______ and _____.
14
The initial lesion develops within ______ of plaque accumulation and corresponds to __________.
14
The initital lesion shows slightly _____ vascular permeability.
14
What are two protective features that are starting to go to work when the initial lesion develops?
15
What does the early lesion correspond to?
15
What three things increase in the early lesion?
15
What two cells will be active when the early lesions develops?
15
Where does collagen destruction occur with the early lesion?
15
What percent of collagen destruction occurs in the early lesion?
15
What epithelium is proliferating during the early lesion?
16
What does the established lesion correspond to?
16
What are three cells involved in the established lesion?
16
There is elevated release of ____ and ______ from PMNs in the established lesion.
17
The advanced lesion corresponds to ______.
17
What are two cells involved in the advanced lesion?
17
What does the JE do in the advanced lesion?
17
In the advanced lesion, where does the collagen destruction extend into?
18
What does the majority of tissue destruction result from in periodontitis and what drives and perpetuates that inflammation?
19
What are the two components of LPS?
19
Where is LPS found in gram negative bacteria?
19
What kind of toxin is LPS?
19
What receptor recognizes LPS?
19
What is the TLR receptor that recognizes microbe-associated molecular patterns (MAMPs) and is found on innate immune cells like macrophages and dendritic cells?
20
________ has an atypical LPS that is recognized by both _____ and ______.
21
What are the two host responses to LPS?
22
Does lipotechoic acid (LTA) stimulate the immune response more or less potently than the LPS?
22
What is LTA a component of?
22
What receptor recognizes LTA?
23
What are 3 bacterial enzymes and noxious products that act as microbial virulence factors?
24
What is a bacterial enzyme produced by P. gingivalis?
25
What two bacteria invade gingival epithelium and connective tissue?
25
What bacteria invades oral epithelial cells?
25
Is bacteria in tissue removed by scaling and root planing?
26
What are three host-derived inflammatory mediators?
28
Which cytokine is elevated in gingivitis and periodontitis, correlates with diseases severity, and exacerbates inflammation and bone resorption?
28
What three molecules does IL-1B stimulate the production of?
28
IL-1B is mainly produced by what three molecules?
28
What two cytokines is IL-6 stimulated by?
28
Which cytokine is produced by T cells, B cells, macrophages, dendritic cells, fibroblasts, and osteoblasts?
28
What two things does IL-6 stimulate?
29
What cytokine is secreted by macrophages in response to LPS?
29
What does TNF-a stimulate development of?
29
TNF-a causes apoptosis of what cells?
29
TNF-a causes upregulation of what?
30
What are prostaglandins derived from?
30
What two things metabolize arachidonic acid?
30
Is PGE-2 a vasodilator or constrictor?
30
What 3 things does PGE2 stimulate?
30
PGE2 is produced by what two things?
30
What inhibits PGE2?
31
MMPs are a family of proteolytic enzymes that degrade what three things?
31
MMP-8 and MMP-9 are produced by PMNs. What do these two enzymes degrade?
31
What cell produces MMP-1?
32
What two things inhibit MMPs?
32
What are three cells that produce tissue inhibitor of metalloproteinases (TIMP)?
33
How far from bone must inflammatory mediators be to stimulate bone resorption?
34
What are the relative levels of RANKL and OPG with sites that have active periodontitis?
34
What prevents binding of RANKL to RANK?
35
What are three cells that resolve inflammation?
35
Protectins are produced by what fatty acids?
36
What are the two anti-inflammatory cytokines?
38
Is the innate immune response improved as a result of previous exposure to pathogen in perio?
40
Peripheral dendritic cells reside in the _____ and ingest antigen and transport it to the ______.
40
What is the difference between monocytes and macrophages?
40
What two cells orchestrate the chronic immune response?
41
NK cells recognizes changes in which MHC class?
43
Which lymphocyte is involved in stable (not progressing) periodontitis?
43
What 2 adaptive immune cells are involved in active periodontits?
45
CD4+ T cells help the immune response by providing proliferation and differentiation signals through ________.
45
TH1 secretes _____ and activates ______.
45
TH2 secretes what three cytokines?
45
What type of immunity does TH2 regulate?
47
B cells express ___ in the BCR before exposure to antigen.
47
What do B cells differentiate to form in the absence of T cells?
47
What do B cells differentiate into in the presence of T cells?
47
Memory B cells give rise to plasma cells that secrete what three antibodies?
49
What class of MHC do antigen presenting cells express?
50
Complement is produced in the _____ and by ______.
50
Complement enables leukocytes to recognize and bind foreign substances for which they _______.
51
What is the name for the complement intracellular effector system?
52
What complement component increases vascular permeability and dilation?
52
What are the two complement components that are anaphylotoxins that induce mast cell secretion and chemotaxins that attract leukocytes?
52
What complement component is involved in opsonization?
54
Defects in transendothelial migration are associated with ______.
55
What are the 9 general steps of transendothelial migration?
56
What is the molecule that is found on leukocytes and interacts with the endothelial surface to cause rolling of leukocyte along endothelium?
56
What are the two molecules found on endothelial cells that bind leukocyte resulting in increased time that the leukocytes remain associated with the endothelium?
56
What molecule binds ICAAM-2 (intracellular adhesion molecule) found on the endothelium to arrest leukocyte rolling?
57
Which complement component is involved in chemotaxis to attract neutrophils?
59
Which stages and grade of periodontitis have dysfunctional neutrophils?
60
-Defect in neutrophil transendothelial migration
-Lack of extravascular neutrophils in periodontal tissues
-affects primary and permanent dentitions
-bacteria destroy host tissue unimpeded by normal host immune response
62
What is the term for cyclic reduction in circulating neutrophils?
64
What drug is used in sub-antimicrobial doses as an adjunct to treat periodontitis?
