7 - Disease Activity

Question 1

Early concepts of periodontitis (4)

Answer 1

Occlusal trauma
Systemic disease
Diet
Bacteria

Question 2

Modern concepts of periodontitis (2)

Answer 2

Bacterial progression

Hyper-responsive immune response

Question 3

Koch’s Postulates (4)

Answer 3

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

Question 4

Do Koch’s postulates apply to gingivitis? Evidence?

Answer 4

Yes

Loe 1965, Experimental Gingivitis

Question 5

Do Koch’s postulates apply to periodontitis? Evidence?

Answer 5

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

Question 6

Non-specific plaque hypothesis

Quoted from?

Answer 6

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

Theilade 1986

Question 7

NSPH is true for ____

Answer 7

Gingivitis

Question 8

Specific plaque hypothesis

Quoted from?

Answer 8

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

Loesche 1975

Question 9

SPH descriptive of _____

Answer 9

Periodontitis

Question 10

Ecological Plaque Hypothesis

Quoted from?

Answer 10

Subgingival environment selects the specific microbial composition

Bartold and Van Dyke 2013

Question 11

Socransky’s modifications of Koch’s postulates

Answer 11

Putative pathogens in close proximity to lesion

Virulence factors necessary

Implantation induces disease characteristics

Elimination induces improvement

Question 12

Pg virulence factors

Implantation –> disease?

Answer 12

Capsular polysaccharide
Gingipain
Long/short fimbriae

Implantation leads to disease in the presence of other bacteria

Question 13

Pg study in germ free mice

By who?

Answer 13

Germ free + Pg –> no disease

Mice w/ existing biome + Pg –> periodontal destruction

Hajishengallis 2011

Question 14

Red complex species

Answer 14

Porphymonas gingivalis
Treponema denticola
Tannerella forsythia

Question 15

Orange complex species

Answer 15

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

Question 16

Location of bacteria in sulcus

Answer 16

Gram + rods/cocci = enamel/root

Gram - and motile = sulcular epithelium

Question 17

Purpose of biofilm

Answer 17

Communal survival
Metabolic cooperation
Resist host defenses
Resist antimicrobials and antibiotics

Question 18

Virulence factor definition

Answer 18

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

Question 19

2 categories of VFs

Answer 19

1) Enable colonization

2) Cause tissue destruction

Question 20

VF for colonization

Answer 20

Fimbriae

Question 21

VF for tissue destruction

Answer 21

1) Direct –> collagenase

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

Question 22

What does innate immunity target?

2 examples

Answer 22

Highly conserved structures

LPS
Bacterial DNA

Question 23

Where are TLRs found

Answer 23

DC
Epithelial cell
Lymphocytes
MPs
Osteoclast precursors

Question 24

What do TLRs do

Answer 24

Recognize PAMPs

Question 25

Prominent TLRs

Answer 25

2, 4 - high in periodontal tissue | 2, 4, 9 - recognize periodontal pathogens

Question 26

Important complement system for periodontium

Answer 26

Alternative

Question 27

What activates alternative pathway

Answer 27

LPS Zymosan Aggregated IgA through Factor P

Question 28

Functions of cytokines (3) Regulates what?

Answer 28

Inhibit binding Deactivate toxins Opsonization Amplitude and duration of immune response

Question 29

When are prostaglandins made? From what?

Answer 29

Response to cell injury Arachidonic acid

Question 30

Destructive cytokines

Answer 30

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

Question 31

Protective cytokines

Answer 31

IL-4, 10, 12, 13, 18 | INF-b, INF-y

Question 32

Examples of neuropeptides

Answer 32

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

Question 33

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

Answer 33

Neurons Vagus nerve Mechanical or chemical stimuli

Question 34

MMPs made by ____ in the _____ Important #'s

Answer 34

PMNs Connective tissue 1 and 8

Question 35

What do TIMPs do

Answer 35

Irreversible binding to receptors of MMPs

Question 36

Block MMPs with what?

Answer 36

Periostat = low dose doxycycline

Question 37

Periostat dose Normal ABC dose Effect

Answer 37

20mg BID 100mg = antimicrobial Effects MMP-8

Question 38

What increases osteoclasts bone resorption

Answer 38

Receptor activator of nuclear factor-kappa b

Question 39

What inhibits osteoclast proliferation

Answer 39

Osteoprotegrin

Question 40

IL-1 effect on hard tissue

Answer 40

Increase RANKL | Decrease OPG

Question 41

Block RANKL with what? (2) Causes what?

Answer 41

Osteoprotegrin fusion protein (OPG-Fc) Pegsunercept (RANKL inhibitor) Fewer osteoclasts

Question 42

Most significant environmental and acquired risk factors

Answer 42

Smoking Diabetes

Question 43

Effects of smoking on periodontium on neutrophils (3)

Answer 43

Decreased chemotaxis Decreased phagocytosis Decreased oxidative bursts

Question 44

Effect of smoking on oxygen

Answer 44

Decreased oxygen tension --> increased anaerobic microbes

Question 45

Effect of smoking on ABs and cytokines

Answer 45

Suppress IgG2 AB Enhance monocyte release of IL-1b

Question 46

Effects of diabetes (4)

Answer 46

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

Question 47

What allows adherence of PMNs to endothelium

Answer 47

Selectins | Integrins

Question 48

Leukocyte Adhesion Deficiency description

Answer 48

PMNs can't adhere to vessel walls | Severe inflammation and bone loss w/ no calculus

Question 49

Twin study - who/when

Answer 49

Michalowicz 1994

Question 50

Details of twin study

Answer 50

Monozygous twins reared together or apart Both had similar attachment loss Genetics appear more significant than environment

Question 51

Inheritability for ChP

Answer 51

50%

Question 52

_______ genotype and severe periodontitis in adults. By who/when?

Answer 52

IL-1 positive Kornman 1997

Question 53

What turns genes on? Off?

Answer 53

Hypomethylation Hypermethylation