BAMS

Question 1

Name 2 red pathogens associated with perio?

Answer 1

P. gingivalis
T. denticola
T. forsythia

Question 2

Which BBVs can transfer with needlestick

Answer 2

Hep B, Hep C, HIV

Question 3

Name host evasion mechanisms of P ging

Answer 3

gingipains
- protease that degrades cytokines - downregulates host response .:. reduced inflammation
fibrillar adhesions -thin actin cables that allow attachment

Question 4

What is a biofilm?

Answer 4

A Biofilm is a matrix enclosed microbial population which will adhere to each other and/or to surfaces or interfaces

Question 5

stages of biofilm

Answer 5

planktonic, microcolony, mature biofilm

Question 6

plaque development

Answer 6

Plaque Development

1. Clean enamel
2. Primary pellicle
3. Colonisation i. The first bacterial attachment
4. Outgrowth i. Both outwards and upwards ii. Microcolonies start forming
5. Secondary colonisation i. Bacteria present with extracellular polysaccharides ii. Pioneers used as substrates iii. Co-aggregation and specific interactions form
6. Climax community i. Mature plaque ii. Polysaccharide production iii. Synergistic metabolic interactions form

Question 7

those affected by candidosis

Answer 7

age, immunocompromised

Pregnancy • Burns • Diabetes Mellitis • Oral Contraceptive Pill • IV drug use • Malnutrition • Catheters

Question 8

types of candidosis

Answer 8

Pseudomembranous -white marks can be gentled rubbed away, may bleed

• Erythematous • associated with denture stomatitis- inflammation caused by biofilm on denture

Hyperplastic • hyphae grow perpendicularly into tissue

Angular Chelitis - fungal infection w. staph aureus present too. if fungal tx miconazole or nutrient deficiency (vit b12, folate) - need blood tests

Question 9

predisposing factors

Answer 9

denture 
diet 
diabetes
antibiotics
radiotherapy
smoker
sjogrens

DDDARSS

Question 10

SI for candida

Answer 10

oral rinse or swab

if hyperplastic need biopsy to show hyphae present

Question 11

functions of saliva

Answer 11

Acid buffering • Mucosal lubrication for speech and swallowing • Taste facillitation • Antibacterial • Digestion

Question 12

types of secretion from salivary glands

Answer 12

salivary glands are exocrine glands. The Parotid has a Serous secretion. The submental is mucus and submandibular is mixed. The parotid gland is especially active when eating.

Question 13

describe how swallowing functions

Answer 13

Oral Phase
Food moves posteriorly in the mouth. Some food passes over the pharyngeal surface of the tongue. Liquid is kept in the mouth in front of the pillars.

Pharyngeal Phase
This is from the oropharynx to the laryngopharynx. The soft palate will rise, the epiglottis depresses and the vocal folds contract. The upper oesophageal sphincter will relax.

Oesophageal Phase
The upper oesophageal sphincter contracts pushing bolus down. Peristalsis now pushes the bolus further down.

Question 14

constituents of a) enamel

b) dentine

Answer 14

a) 95% by weight hydroxyapetite, 4% by weight water and 1% organic matrix
b) 70% by weight hydroxyapetite, 10% by weight water and 20

Question 15

3 types of mucosa

Answer 15

Masticatory
The masticatory mucosa lines the gingivae and the hard palate. This is parakeratinised, which means it has keratin but the cells have nuclei still. There will also be a thick lamina propria (mucoperiosteum). This keeps the gingivae attached to the bone underneath and it helps keep the layer static. It may have to be released on raising a flap for oral surgery procedures.

Lining
Lining mucosa is much more mobile and distensible. It is non-keratinised, there is a loose lamina propria and a wide submucosa. The turnover of cells will also be increased compared to the masticatory mucosa. The junction where the masticatory mucosa turns to lining mucosa is known as the mucogingival junction.

Gustatory
The gustatory mucosa is similar to masticatory, it is keratinised and contains papillae too. It is only present on the dorsum of the tongue.

Question 16

embryonic tissue types and what they lead to

Answer 16

Ectoderm: • Skin • Mucous membranes of the mouth and anus • Brain • Spinal Cord • Tooth enamel

Mesoderm: • Most connective tissue • Dermis cartilage • Most muscle • Blood vessels • Kidneys, urinary and reproductive systems • Serous membranes

Endoderm: • Alimentary system • Parts of the urogenital sys

Question 17

stages of tooth development

Answer 17

initiation, morphogenesis, cytodifferentiation and root formation.

Question 18

what immune deficient diseases are more prone to perio?

Answer 18

Leukocyte Adhesion deficiency, Papillon-Lefevre syndrome and Chediak-Hegashi syndrome.

Question 19

four stages to inflammation cycle

Answer 19

Initiation of Reaction – response to harmful agents • Progression – containment of harmful agents • Amplification – modulation of the immune response • Resolution – favourable outcome leads to healing

Question 20

describe innate immunity

what cells involved

Answer 20

first line of defence and it is present from birth. The responses are non-specific, there is no memory or lasting protective immunity.
PAMPS (structures on pathogens) recognised by PRRs/ TLR toll like recpetors to trigger inflammation pathways.

when pathogen PAMP engages host TLR cytokine and chemokine release triggered (cell signalling)

—-> Macrophages, neutrophils, dendritic cells

Question 21

describe adaptive immunity

what cells involved

Answer 21

more specific and will respond on recognition of foreign substances or antigens. This function will be through B and T cells
B cells, on activation will become plasma cells and will then secrete immunoglobulins in the humoral response. T cells will recognise antigenic determinants and are activated by APCs.
T lymphocytes will regulate the immune response and cell-mediated immunity. This is by the two major classes of T cells, helper T cells (CD4+) and cytotoxic T cells (CD8+).
B cells are part of the acquired immunity and will produce antibodies, which are key in regulation of the humoral response. - IgM and IgG antibodies produced

Question 22

why does bone remodelling occur in inflammation

Answer 22

inflammatory cells e.g macrophages express RANKs ligand (RANKL) which binds RANK receptor on osteoclasts to activate it . .:. when macrophages present and express RANKL bone loss occurs.

osteoblasts themselves secrete OPG that inhibits RANKL. this is a continuous process in health but in inflammation balance is tipped to bone loss where RANKL is in abundance