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Perio Lecture Series > 7 - Disease Activity > Flashcards

7 - Disease Activity Flashcards

1
Q

Early concepts of periodontitis (4)

A

Occlusal trauma
Systemic disease
Diet
Bacteria

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2
Q

Modern concepts of periodontitis (2)

A

Bacterial progression

Hyper-responsive immune response

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3
Q

Koch’s Postulates (4)

A

1) Organism regularly associated with disease/lesions
2) Organism isolated from diseased host and grown in culture
3) Disease reproduced when pure culture of organism is introduced into healthy host
4) Same organism must be re-isolated from experimentally infected host

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4
Q

Do Koch’s postulates apply to gingivitis? Evidence?

A

Yes

Loe 1965, Experimental Gingivitis

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5
Q

Do Koch’s postulates apply to periodontitis? Evidence?

A

Not really.

1975 Lindhe: No oral hygiene in dogs, 2/8 failed to develop periodontitis

1986 Loe: Sri Lankans, 100% w/ poor OH + gingivitis but 11% w/ no periodontitis

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6
Q

Non-specific plaque hypothesis

Quoted from?

A

Disease results from the elaboration of noxious substance by the entire plaque flora

Theilade 1986

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7
Q

NSPH is true for ____

A

Gingivitis

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8
Q

Specific plaque hypothesis

Quoted from?

A

Disease results from only certain plaque or a relative increase in the levels of certain indigenous organisms

Loesche 1975

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9
Q

SPH descriptive of _____

A

Periodontitis

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10
Q

Ecological Plaque Hypothesis

Quoted from?

A

Subgingival environment selects the specific microbial composition

Bartold and Van Dyke 2013

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11
Q

Socransky’s modifications of Koch’s postulates

A

Putative pathogens in close proximity to lesion

Virulence factors necessary

Implantation induces disease characteristics

Elimination induces improvement

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12
Q

Pg virulence factors

Implantation –> disease?

A

Capsular polysaccharide
Gingipain
Long/short fimbriae

Implantation leads to disease in the presence of other bacteria

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13
Q

Pg study in germ free mice

By who?

A

Germ free + Pg –> no disease

Mice w/ existing biome + Pg –> periodontal destruction

Hajishengallis 2011

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14
Q

Red complex species

A

Porphymonas gingivalis
Treponema denticola
Tannerella forsythia

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15
Q

Orange complex species

A 
P. intermedia
P. nigrescens
P. micros
F. nucleatum
E. nodatum
C. showae
C. rectus
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16
Q

Location of bacteria in sulcus

A

Gram + rods/cocci = enamel/root

Gram - and motile = sulcular epithelium

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17
Q

Purpose of biofilm

A

Communal survival
Metabolic cooperation
Resist host defenses
Resist antimicrobials and antibiotics

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18
Q

Virulence factor definition

A

Unique property that permits a bacterial species to:
Colonize target organ
Defend against host
Cause tissue damage

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19
Q

2 categories of VFs

A

1) Enable colonization

2) Cause tissue destruction

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20
Q

VF for colonization

A

Fimbriae

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21
Q

VF for tissue destruction

A

1) Direct –> collagenase

2) Induce release of biological mediators from tissue –> LPS

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22
Q

What does innate immunity target?

2 examples

A

Highly conserved structures

LPS
Bacterial DNA

23
Q

Where are TLRs found

A 
DC
Epithelial cell
Lymphocytes
MPs
Osteoclast precursors
24
Q

What do TLRs do

A

Recognize PAMPs

25
Q

Prominent TLRs

A

2, 4 - high in periodontal tissue

2, 4, 9 - recognize periodontal pathogens

26
Q

Important complement system for periodontium

A

Alternative

27
Q

What activates alternative pathway

A

LPS
Zymosan
Aggregated IgA through Factor P

28
Q

Functions of cytokines (3)

Regulates what?

A

Inhibit binding
Deactivate toxins
Opsonization

Amplitude and duration of immune response

29
Q

When are prostaglandins made?

From what?

A

Response to cell injury

Arachidonic acid

30
Q

Destructive cytokines

A

IL-1, 6, 11, 17
TNF-a
PGE2

31
Q

Protective cytokines

A

IL-4, 10, 12, 13, 18

INF-b, INF-y

32
Q

Examples of neuropeptides

A

Substance P
Calcitonin gene-related peptide
Vasoactive intestinal peptide
Neuropeptide Y

33
Q

Neuropeptides released by ____ and distributed by ____ in response to _______

A

Neurons
Vagus nerve
Mechanical or chemical stimuli

34
Q

MMPs made by ____ in the _____

Important #’s

A

PMNs
Connective tissue

1 and 8

35
Q

What do TIMPs do

A

Irreversible binding to receptors of MMPs

36
Q

Block MMPs with what?

A

Periostat = low dose doxycycline

37
Q

Periostat dose

Normal ABC dose

Effect

A

20mg BID

100mg = antimicrobial

Effects MMP-8

38
Q

What increases osteoclasts bone resorption

A

Receptor activator of nuclear factor-kappa b

39
Q

What inhibits osteoclast proliferation

A

Osteoprotegrin

40
Q

IL-1 effect on hard tissue

A

Increase RANKL

Decrease OPG

41
Q

Block RANKL with what? (2)

Causes what?

A

Osteoprotegrin fusion protein (OPG-Fc)

Pegsunercept (RANKL inhibitor)

Fewer osteoclasts

42
Q

Most significant environmental and acquired risk factors

A

Smoking

Diabetes

43
Q

Effects of smoking on periodontium on neutrophils (3)

A

Decreased chemotaxis

Decreased phagocytosis

Decreased oxidative bursts

44
Q

Effect of smoking on oxygen

A

Decreased oxygen tension –> increased anaerobic microbes

45
Q

Effect of smoking on ABs and cytokines

A

Suppress IgG2 AB

Enhance monocyte release of IL-1b

46
Q

Effects of diabetes (4)

A

Increased AGEs
Upregulated monocytes
Increase PGE2 and Il-1B
Increase MMP and RANKL

47
Q

What allows adherence of PMNs to endothelium

A

Selectins

Integrins

48
Q

Leukocyte Adhesion Deficiency description

A

PMNs can’t adhere to vessel walls

Severe inflammation and bone loss w/ no calculus

49
Q

Twin study - who/when

A

Michalowicz 1994

50
Q

Details of twin study

A

Monozygous twins reared together or apart

Both had similar attachment loss

Genetics appear more significant than environment

51
Q

Inheritability for ChP

A

50%

52
Q

_______ genotype and severe periodontitis in adults.

By who/when?

A

IL-1 positive

Kornman 1997

53
Q

What turns genes on? Off?

A

Hypomethylation

Hypermethylation

Perio Lecture Series (7 decks)

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