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Perio 1 > E1 > Flashcards

E1 Flashcards

1
Q

Periodontist is composed of 4 structures

A

Gingiva
PDL
Root Cementum
Alveolar bone

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2
Q

Alveolar bone is broken down into 2

A

Alveolar bone proper (bundle bone)

Alveolar process

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3
Q

Echo mesenchyme condenses around ______ and forms _____

A

Dental organ

Dental papilla

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4
Q

Dental papilla gives rise to

A

Dentin and pulp

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5
Q

Dental follicl gives rise to

A

Periodontist

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6
Q

Dental papilla determines

A

Shape and form of tooth

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7
Q

Gingiva is part of the

A

Masticatory mucosa which covers the alveolar process and surrounds the cervical portion of teeth

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8
Q

3 parts of Gingiva

A

Free Gingiva
Attached Gingiva
Interdental papilla

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9
Q

Free Gingiva

A

Gingival sulcus

Marginal Gingiva

Sulcus Depth

Extends from FGM to FGG

Keratinized epithelium

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10
Q

Free gingival margin

A

Coronal end of Gingiva

Located 1.5-2 mm coronal to CEJ

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11
Q

Probe depth is a measure of

A

Free gingival space

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12
Q

Free Gingival groove

A

Junction between free and attached Gingiva

Corresponds to CEJ

30-40% of adults

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13
Q

Oral sulcular epithelium faces

A

Tooth surface without contacting it

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14
Q

Oral epithelium faces

A

Oral cavity

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15
Q

Junctional epithelium provides

A

Contact between Gingiva and the tooth

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16
Q

Junctional epithelium is _______ to CEJ

A

1 mm above CEJ

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17
Q

Attached gingiva should be

A

Firm, coral pink, immobile, width varies

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18
Q

Attached Gingiva: Width ____ with age

A

Increases

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19
Q

Attached Gingiva: widest in

A

Incisors

Narrowest in premolar

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20
Q

Attached Gingiva: Mandibular lingual

A

Narrowest in incisors, widest in molars

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21
Q

Stippling

A

Small depressions on attached Gingiva

40% of adults

Sign of health

Loss=inflammation

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22
Q

No mucoginvial junction on

A

The palate

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23
Q

MGJ is the junction between

A

Keratinized and non keratinized

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24
Q

Attached Gingiva is important because

A

Supports marginal gingiva
Base for movable elements
Withstand frictional and functional stresses
Barrier for passage of inflammation

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25
Q

Attached gingiva can withstand stresses because

A

Thick CT layer

Firmly bound to perisoteum and bone

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26
Q

For patient with less than optimal oral hygiene width and thickness

A

Matter to prevent inflammation

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27
Q

Width

A

What you would call height

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28
Q

Thickness

A

Buccolingula measuremnt

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29
Q

Shape of interdental papilla depends on

A

Contact relationship of teeth
Width of approximately tooth surfaces
Course of CEJ

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30
Q

COL

A

Concavity seen in contact areas of premolar/molar region

Non keratinized epithelium

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31
Q

Golden rule of interdental papilla

A

Papilla is complete when the distance from the contact point to the crest of the bone was less than 5 mm

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32
Q

The base of the gingival sulcus in a healthy mouth is positioned apical to the CEJ. When is this condition most likely to occur

A

40-60 years of age

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33
Q

Orthokeratinzed

A

No nucleus

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34
Q

Parakeratinized

A

Nuclear remnants

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35
Q

Oral epitlium layers

A

Basal layer
Prickle layer
Granular layer
Keratinized layer

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36
Q

From basal layer to granular layer

A

Cytoplasmic tonofilaments and number of desmosomes increase

Organelles decrease

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37
Q

Merkel cells

A

Sensory

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38
Q

Melanocytes

A

Melanin

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39
Q

Langerhans cells

A

Defense cells

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40
Q

Basement membrane

A

Present between basal layer of oral epithelium and CT

1-2 um wide

Rich in glycoproteins

Contains protein polysaccharide complexes

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41
Q

Glycoproteins

A

Keep tissues hydrated and maintains space

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42
Q

2 layers of basement membrane

A

Lamina Lucinda

Lamina dense

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43
Q

Lamina Lucinda

A

Adjacent to basal class

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44
Q

Lamina densa

A

Adjacent to CT

Anchoring fibers project form LD into CT

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45
Q

He I desmosomes

A

Dense plaques that attach epithelium to the basement membrane

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46
Q

Does Mose

A

Pairs of HEMA desmosomes

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47
Q

When retention pegs fuse

A

It is seen as stippling

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48
Q

Where are there no retention pegs

A

JE site

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49
Q

When 2 rete pegs fuse

A

Drop down you will see stippling

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50
Q

Rete pegs are

A

Epithelial ridges

Thicker the gingiva the easier to see

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51
Q

After tooth eruption cells of oral epithelium possess ability to differentiate into cells of

A

JE

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52
Q

JE widest in _____ and thinnest towards ________

A

Coronal 15-20 cell layers

CEJ 3-4 cells

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53
Q

JE is continuously

A

Renewed

Turnover rate faster than oral epithelium

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54
Q

Difference between JE and OE: Size fo cells

A

JE> OE

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55
Q

Difference between JE and OE: Size of intracellular space

A

JE>OE

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56
Q

Difference between JE and OE:Number of desmosomes

A

JE

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57
Q

Difference between JE and OE: Keratinization

A

JE has potential to keratinized

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58
Q

JE is _______ to tooth

A

Physically attached

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59
Q

Periodontitis occurs when

A

JE migrates apically down root surface

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60
Q

Viable junctional epithelium necessary for

A

Pocket formation

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61
Q

Necrosis of junctional epithelium

A

Junctional epithelial cells die so no pocketing

Bone exposed

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62
Q

Cells of gingival CT

A 
Fibroblasts
Mast cells
Macrophages
Neutrophils
Lymphocytes
Plasma cells
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63
Q

Collagen

A

Characteristic cross banding
Produced by fibroblasts, cementoblasts and osteoblasts
Most abundant

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64
Q

Reticulin

A

Numerous adjacent to basement membrane

Around blood vessels

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65
Q

OXytalan

A

Mostly in pdl

Run parallel to Long axis of tooth

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66
Q

Elastic

A

Around blood vessels

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67
Q

CT fibers of Gingiva

A

Collagen
Reticulin
OXytalan
Elastic

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68
Q

Gingival fibers provide

A

Resilience and tone
Maintain architectural form and integrity
Reinforce the gingiva

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69
Q

Circular fibers

A

Encircle tooth like a cuff

Only fibers not connected to cementum

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70
Q

Dentogingival fibers

A

Fan out from supracrestal cementum into free gingiva

Upwards

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71
Q

Dentoperiosteal fibers

A

Run from supracretal cementum into attached gingiva

Down

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72
Q

Transseptal Fibers

A

Run from tooth to tooth

Embedded in cementum

Only not connected to gingiva

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73
Q

PDL permits

A

Forces to be distributed

Essential for tooth mobility

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74
Q

PDL is richly

A

Vascular and cellular CT surrounding the roots and joining cementum and alveolar bone

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75
Q

Fibers of PDL

A

Alveaolar crest fibers
Horizontal fibers
Oblique fibers
Apical fibers

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76
Q

Cells of PDL

A 
Fibroblasts
Osteoblasts
Cementoblasts
Osteoclasts
Nerve fibers
Epithelial cells rest of mallassez (remnants of herweigs epithelaial root sheath)
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77
Q

Cementum is similar to bone tissue but

A

No blood vessels
No lymph vessels
No innervation
No remodeling

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78
Q

Cementum can

A

Continue deposition throughout life

Collagen fibers embedded in organic matrix

High mineral content 65%

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79
Q

Cementum fibers

A

Intrinsic

Extrinsic

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80
Q

Intrinsic cementum fibers

A

Produced by cementoblasts

Composed of fibers oriented parallel to root

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81
Q

Extrinsic cemental fibers

A

Sharpeys fibers

Produced by PDL fibroblasts

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82
Q

Different forms of cemental fibers

A

Acellular extrinsic fiber cementum
-coronal or middle portion of the root

Cellular mixed strained cementum
-apical third of the root and in fraction

Cellular intrinsic fiber cementum
-in resorption lacunae

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83
Q

Cellular intrinsic fiber cementum

A

-in resorption lacunae

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84
Q

Cellular mixed strained cementum

A

-apical third of the root and in fraction

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85
Q

Acellular extrinsic fiber cementum

A

-coronal or middle portion of the root

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86
Q

Cementum thickness throughout life

A

Increases by gradual apposition

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87
Q

Cementum thickness in cervical portion of root

A

20-50 um

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88
Q

Cementum thickness in apical portion of root

A

150-250 um

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89
Q

Alveolar bone consists of bone formed by both

A

Cells from dental follicle

Cells independent of tooth development

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90
Q

The dental tissue that most closely resembles bone is

A

Cementum

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91
Q

Diagnosis of periodontitis is based on

A

Attachment loss NOT probe depths

-apical migration

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92
Q

When bone is being resorted junctional epithelium moves to

A

Root surface

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93
Q

False pocket

A

The probe doesn’t go past CEJ—gingivitis

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94
Q

When gingival margin is coronal to CEJ

A

It is a negative recession

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95
Q

When gingival margin is apical to CEJ

A

Positive recession

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96
Q

CAL

A

Pocket depth+ gingival recesssion

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97
Q

Connective tissue attachment

A

1.06 mm to 1.08 mm

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98
Q

Epithelial attachment

A

1.4 mm

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99
Q

Whole attachment

A

2-2.5 mm

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100
Q

Distance from CEJ to alveolar crest

A

Is 2 mm

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101
Q

Distance from crown margins to alveolar crest HAS to be

A

2 mm

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102
Q

If you don’t have enough distance from CEJ to alveolar crest then

A

Crown lengthening is necessary

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103
Q

Initial thinking of giniglave width and recesssion

A

Less than 2 mm predisposed to recession

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104
Q

Why does small width of keratinized tissue predispose to recession

A

Can’t protect from friction or buffer muscle pull

Facilitates subgingival plaque formation mobile tissue causes pockets to open

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105
Q

Can gingival health be maintenance independent of its dimensions?

A

YES

Narrow gingiva has same resistance to attachment loss as wide gingiva

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106
Q

Thin phenotype

A

Increased recession
More vulnerable to trauma
More inflammation
Less favorable treatment outcome

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107
Q

When would you recommend gingival grafts

A

When recession causes symptoms

Subgingival restoration margins on thin biotype
Preortho therapy

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108
Q

The characteristic of the gingiva are _______ determined

A

Genetically

Rather than being the result of functional adaptation to environmental stimuli

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109
Q

Connective tissue grafts

A

Connective tissue determines epithelial prototype

Slid under gum

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110
Q

Thin elastic CT will create

A

Non keratinized

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111
Q

Healing after extraction

A 
1 clot formation
2 wound cleansing -PMNs monocytes macrophages migrate into wound
3 New vasculature mesenchymal cells from PDL form granulation tissue
4Provisional CT
5 Immature bone forms
6 Bundle bone is restored
7 Wound filled with woven bone
8 Bone maturation
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112
Q

Healing is important because

A

Socket preservation important for preserving bone morphology

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113
Q

Guided Tissue Regenration

A

Epithelium grows faster than bone or connective tissue

Epithelial exclusion will allow selective growth of these cells

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114
Q

Barrier membranes

A

When furcation involvement

Fill with bone and bow tie thing

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115
Q

Planktons bacteria adhere to

A

Acquired pellicle

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116
Q

_____ and ______ in pellicle

A

Salivary glycoproteins

Antibodies

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117
Q

Bacterial characteristics change following attachment

A

Synthesis of new outer membrane proteins

Active cellular growth

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118
Q

Rapid attacker’s

A

Specific attachment structures such as fimbriae extracellular polymers glycolclax

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119
Q

Co-aggregation

A

Cell to cell recognition of genetically distinct cell types

-forms giant clumps

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120
Q

Co-aggregations is mediated ______on one cell and ______ on the other

A

Protein or glycoproteins

Carbohydrates

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121
Q

Co-Adhesion

A

Interactions between suspended and already adhering microgansims

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122
Q

Co-adhesion is influenced by

A

Temperature (no if temp > 37)

Lactose (decreases co adhesion)

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123
Q

Primary colonizers are gram__

A

Gram + mostly

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124
Q

Secondary colonizers are gram__

A

Gram -

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125
Q

Tertiary colonizers are gram__

A

-

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126
Q

What happens as biofilm develops?

A

An oxygen gradient develops because it begins to become difficult to diffuse in out

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4
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127
Q

Completely anaerobic condition are present where in biofilm

A

Deepest layer

The primary colonizers die and pathogen expansion

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128
Q

________ develop as a result of bacterial metabolism in thickening biofilm

A

Reverse gradients of fermentation

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129
Q

Bacterial hydrolytic enzymes breakdown host macro-molecules into

A

Peptides and amino acids

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130
Q

Cervicular fluid is protective but bacteria can use it

A

As food

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131
Q

Crevicular fluid comes out from plasma leading to inflammation resulting

A

In more vasodilation and more crevicular fluid

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132
Q

Biofilm is composed of

A

Microcolonies (15-20%)
+
Interbacterial matrix

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133
Q

Interbacterial matrix of biofilm comes from 3 sources

A

Dead bacterial cells
Saliva
Gingival exudate (crevicular)

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134
Q

The back bone of the biofilm

A

Exopolysaccharides

135
Q

3 layers of biofilm

A

Lower layer
Loose Layer
Fluid layer

136
Q

Lower layer of biofilm

A

Dense layer of microbes
Polysaccharide matrix
Tightly bound together
Steep diffusion gradients

137
Q

Loose layer of biofilm

A

Irregular appearance

Extends into surrounding medi

138
Q

Fluid layer of biofilm

A

Stationary sublayer
Fluid layer in motion
Nourishes the biofilm by molecular diffusion

139
Q

Shape of micro-colonies depends on

A

Shear force

140
Q

Low shear force

A

Towers or mushrooms

141
Q

High shear force

A

Elongated Colonies capable of oscillation

142
Q

________ are areas of high shear

A

Facial

143
Q

______ are areas of low shear force

A

Interdental surfaces

144
Q

Gram positive ineterbacterial matrix is very ________ due to _____ and _______

A

Very fibrillar

Dextrans
Evans

145
Q

Dextran and levans

A

Polysaccharide sugar molecules and very sticky

Gram positive

S. Mutans

146
Q

Gram negative interbacterial matrix is very_______

A

Regular

147
Q

Gram negative matrix contains

A

Trilaminar vessicesl with with endotoxins and proteolytic enzymes

Probably involved in adherence

148
Q

Source of energy in interbacterial

A

Dextrans, fructans—energy sources

149
Q

Skeleton of plaque

A

Mutans

150
Q

Cuticle forms

A

Primary attachment

151
Q

How are bacterial layers near sulcular epithelium different from tooth attached

A

No inter-bacterial matrix

More spirochetes and flagellated bacteria

152
Q

Bacterial collaboration is necessary for

A

Succession

153
Q

S. Crostatas

A

Fac. Species( can live with or without O2)

154
Q

Fusobacterium

A

Robust anaerobes

Binding to strep improves survival when O2 is present

155
Q

P. Gingivalis

A

Micraerophilic, obligate anaerobes

Coaggregation essential to survival when O2 is present

156
Q

What 3 bacteria form robust biofilms in the presence of O2

A

S. Cristatus
Fusobacteirum nucleatum
P. Gingivalis

157
Q

______ can invade epithelial cells

A

F. Nucleatum

S. Cristatus does not but can be carried in by F. Nucleatum

158
Q

transfer of information and genetic material

A 
Signaling (quorum sensing)
Conjugation
Transformation
Plasmid transfer
Transposon transfer
159
Q

______ important for mainting healthy biofilm and converting good to bad

A

Quorum sensing

160
Q

Quorum sensing

A

Regulation of expression of specific genes through accumulation of signaling compounds that mediate intercellular communication

161
Q

Auto-inducer

A

Turns on in response to cell density

162
Q

Pathogens produce AI

A

AI-2 in high levels

This may determine switch from commensal to pathogenic community

163
Q

Antibiotics depends on

A

Cell turnover for efficacy

164
Q

Biofilm bacteria are what type of growers

A

Slow

165
Q

Slow growers express

A

Nonspecific defense mechanism

Slow growers make more eco-polymers

166
Q

Eco-polymers

A

Retard diffusion

167
Q

Extracellular enzymes that inactivate antibiotics

A

Betalacatamase
Formaldehyde dehydrogenase
Formaldehyde lyase

168
Q

Classical concept of pathogens

A

Not normally present
Produces “virulence factors”
-damage host directly
-Induce host to damage itself

169
Q

Ecological concept of oral microbial disease

A

Ecological shift leads to changes in proportions

Balance shifts in favor of pathogens

PDD is an example of ecological catastrophe

170
Q

One stage full mouth disinfection

A

Full mouth scalingin and root planing
Subliminally irrigation with chlorhexedine
Tongue brushing
Oral antimicrobial rinse

171
Q

Non-Specific Plaque Hypothesis

A

All plaque bacteria considered bad

Any accumulation at or below gingival margin causes inflammation

172
Q

Specific Plaque Hypothesis

A

Specific organisms in dental lacquer are the etiologic always agents

Microbial compostion different at Disease vs healthy

Local debridement and systemic antibiotics could control LAP

173
Q

First signs of perio will be seen

A

Interproximal molars

Premolars and canines tend to be the last

174
Q

Gram______ increase as gingivitis progresses to peridotontitis

A

Gram - rods

175
Q

Oral Dysbiosis

A

House of cards

Keystone pathogens each can orchestrate destruction by bringing in different bacteria.

It itself doesn’t have to necessarily cause diseases

176
Q

P. Gingivalis with type I and V genotypes

A

Healthy

177
Q

P. Gingivalis with type II and iV genotypes

A

In disease

178
Q

Pathogens must express

A

Virulence factors

179
Q

Colonization by beneficial species ______pathogens

A

Dilute levels

180
Q

Beneficial species can _______pathogens ex. Peroxide

A

Inhibit

181
Q

Host susceptibility can be affected by

A

HIV
Diabetes
Smoking

182
Q

Iron can increase ________ in P. Gingivalis

A

Outer membrane protein

183
Q

S. Crsistatus can _______fimA expression

A

Inhibit

184
Q

Bacteria have ______ to bind host receptors

A

Fimbriae and Outer membrane proteins

185
Q

Adhesions on bacteria bind to host receptors using

A

Type I or IV collagen
Sialic acid
Galactosyl residues

186
Q

Veillonella uses ______ made by ________

A

Lactate

Streptococci

187
Q

Campylobacter uses ______ made by _____

A

Formate

Selenomonas

188
Q

Porphyromonas uses ______ from _____ in sulcus

A

Hemin

Blood

189
Q

Hydrogen peroxide production by _____ inhibits _____

A

S. Sanguinis

A.A.

190
Q

Competitive inhibiton can be achieved by_______ which are peptide toxic to related strains

A

Bateriocins

191
Q

Desquamtion of epithelium

A

Invade epithelium and bind to underlying cells

192
Q

Antibody prevent binding so bacteria

A

IgG and IgA protease

Mimic host antigens

193
Q

Bacteria can secrete leukotxin which helps

A

Them evade phagocytic cells. They can also use non-lethal suppression of immune cells

194
Q

World workshop designated 3 pathogens

A

P. Gingivalis
A. Actinomycetemcomaitans
T. Forsythia

195
Q

Is A.A. Motile and shape?

A

Non motile

Round ended rod

196
Q

A.A. Gram___

A

Gram -

197
Q

If you see star shaped colonies it must be

A

A.A.

198
Q

A.A. Is capnophilic meaning

A

It needs CO2 to grow

199
Q

A.A. Gets nutrients by

A

Saccharolytic (carbs)

200
Q

High numbers of A.A. Have been associated with

A

Aggressive periodontist and detected in active sites

201
Q

Elimination of AA affected periodontist how?

A

Resulted in a successful therapy

Recurrent lesions harbor the species

202
Q

A.A. Virulence factors (5)

A 
Tissue invasive 
Leukotoxin
Fibroblast inhibiting factor
Endotoxin
Collagenase
203
Q

A.A. Inhibits growth of

A

Commensals

S. sanguis

204
Q

Does A.A. Have to be present for periodontitis?

A

Not seen in all cases of aggressive and seen in healthy subjects

205
Q

AA with _____ is more likely to be disease associated than AA with full length promoter region

A

530bp deletion

206
Q

AA has____serotypes base on _____

A

5

Polysaccharides on surface of organism

207
Q

Of the 5 serotypes how many can each person have

A

Only 1

208
Q

AA ________ are dominant antigens

A

Serotype specific surface antigens

209
Q

A.A. Serotype __ most commonly associated with localized aggressive perio in USA

A

B

210
Q

A.A Serotype A

A

Health associated in Finland

Disease in japan

211
Q

P. Gingivalis gram___

A

Negative

212
Q

P. Gingivalis environment

A

Anaerobic

213
Q

P gingivalis shape and movements

A

Non motile rods

214
Q

P gingivalis nutrients

A

Asachrolytic

215
Q

P. Gingivalis cysteine proteinases

A

Important to in proteins egradation and in the maturation of cell surface protein such as fimA fimbrillin

216
Q

Pg associated with period

A

Elevated in lesions
Lower in healthy sites
Presence indicates risk of attachment loss

217
Q

P. Gingivalis produce

A 
Collagenase
Protease
Hemolysin s
Endotoxin
Fatty acids
NH3
H2S
Indole
218
Q

T. Forsythia gram__

A

Gram negative

219
Q

T. Forsythia environment

A

Anaerobic

220
Q

T. Forsythia shape

A

Spindle shaped

Highly pleomorphic rod

221
Q

T. Forsythia requires

A

NAM n-acetylmuramic acid

222
Q

T. Forsythia co-cultivates with

A

F. Nucleatum

223
Q

T. Forsythia serrated S-layer on cell

A

Mediates adhesion

Hemagglutination

224
Q

Treponema denticola gram

A

Negative

225
Q

Treponema denticola environment

A

Anaerobic

226
Q

Treponema denticola shape

A

Helical shaped
Highly motile
Hard to distinguish several species

227
Q

Prevotella intermedi/nigrescens gram

A

Negative

228
Q

Prevotella intermedi/nigrescens environment

A

Anaerobic

229
Q

Fusobacterium nucleatum gram

A

Negative

230
Q

Fusobacterium nucleatum environment

A

Anaerobic

231
Q

Fusobacterium nucleatum shape

A

Spindle shaped

Early colonizer and spindle shaped

232
Q

Most common isolate cultured from subgingival microbioat in health and disease

A

Fusobacterium nucleatum

233
Q

Fusobacterium nucleatum releases _______ from leukocytes

A

Cytokines
Elastase
Oxygen radical

234
Q

C. Rectus

A

Gram negative
Anaerobic
Short
Motile vibrio

235
Q

E. Corrodens

A

Gram negative
Capnophilic
Assachrolytic
Small rod

236
Q

P. Micros

A

Gram positive
Anaerobic
Small
Assachrolytic coccus

237
Q

Selenmonas species

A

Gram negative

Curved saccharolutic rods

238
Q

Eubacteria species

A

Gram positive
Anaerobic
Pleomorphic rods

239
Q

How do bacteria induce damage to periodontal tissues

A

Attach and colonize the gingival crevice (some go into soft tissues)

Releases substances that directly damage host cells

Activate hosts own inflammatory and immune systems leading to host tissue damage

240
Q

Bacteria that can invade periodontal epithelium

A

A. A

P.G.

241
Q

Direct cytotoxic effect of bacterial metabolic waste products

A

Ammonia
Indole compounds
Fatty acids
Hydrogen sulfide

242
Q

Fatty acids like propionic and butyric acids cause damage how

A

Diffuse into host cells and change intracellular pH

243
Q

Damaging bacterial enzymes

A

Leukotoxins

Gingipains

244
Q

Leukotxin

A

Leukotoxins from A.a kills leukocytes

245
Q

Gingipains

A

Gingipains Arg Specific protease from P.g. Degrade interluekin that do inflammatory response

246
Q

Immunostimulatory molecules

A 
LPS endotoxin
Lipoteichoic acids
Gingipains
Formylpeptides
Surface antigens
247
Q

Prevention of bacterial entry is done by 3 mechanisms

A

Shedding of epithelial cells

Intact epithelaila barrier

Positive fluid flow into the gingival crevice

248
Q

Innate immune response uses complement system to

A

Induce bacterial lysis
Promote phagocyte recruitment
Opsonization
Activates mast cells which increase vascular permeability

249
Q

Innate immune system of oral mucosa can produce ______ that can kill fungi

A

Anti-microbial peptides (defensins)

250
Q

3 oral epithelium pro-inflammatory cytokines of innate immune system

A

IL-1B and TNF-a

IL-8

251
Q

IL-1B and TNF-a are universal signals

A

Of infection that help recruite inflammatory cells

252
Q

IL-8 attracts

A

Neutrophils in the early stages of infection

253
Q

______ second line of defense

A

Adaptive/acquired immunity

254
Q

Adaptive immunity has ________ response to bacterial _____

A

Specific response

Bacterial Ag

255
Q

Hallmarks of adaptive immunity

A

Ag recognition
Immune memory
Colonial expansion

256
Q

Innate immunity: mucin

A

Bund up bacteria and allow it to be washed away

257
Q

Toll like receptors recognize

A

Conserved microbial associated molecular patterns

258
Q

TLRs signals for cells to

A

Produce cytokines chemokines
Antimicrobial peptides
NO
Eicosanoids

259
Q

C3b

A

Attaches—>opsonizatoin—> phagocytosis

260
Q

C5b

A

Membrane attac complex—> Lysis

261
Q

C3a and C5a

A

PMN chemotaxis mast cell degranulation—> vascular permeability—-> inflammation

262
Q

Prostaglandins induce

A

Vasodilation and cytokines production

263
Q

PGE2 induces production of

A

Matrix metalloproteinases by fibroblasts and osteoclasts which damage periodontal tissues

264
Q

Matrix metalloproteinases degrade

A

Extracellular matrix

265
Q

Alpha-2 macroglobulin

A

Broad spectrum proteinase inhibitor

266
Q

Alpha-1 antitrypsin

A

Broad spectrum proteinase inhibitor and potent inhibitor of PMN collagenase

267
Q

Calprotectin inhibits

A

Bacteria and fungi by chelating zinc. Produced by epithelium, PMNs, monocytes, macrophages

268
Q

Neutrophils kill bacteria by ____ or ______

A

Oxidative

Nonoxidative

269
Q

In chronic periodontist number of cells

A

Plasma> B lymph> T lymph

270
Q

Th1

A

IL2 IFN-G TNF-a

271
Q

Th2

A

IL-4,5,6,10,13

272
Q

Cytotoxic T cells are active by

A

Cytokines

273
Q

Tc cells respond to and bind

A

Intracellular pathogens

MHC 1 molecules

274
Q

Are Tc cells found in periodontist?

A

Not many suggesting that viruses and invasive bacteria are not major players

275
Q

Ag-Ab complex ____ and ______

A

Activates complement and facilitates opsonization

276
Q

Th2 cytokines activate

A

B cells to plasma cells

277
Q

B cells humoral immunity triggered in response to

A

Soluble antigens

278
Q

2 types of B cells

A

Conventional

Auto reactive

279
Q

Conventional B cells

A

Produce antibodies against bacteria levels decrease in healthy and treated sites

280
Q

Autoreactive B cells

A

Produce auto antibodies levels do not decrease after treatment

281
Q

Antibody alone will

A

Block entry of toxins and viruses

Immobilizes bacteria

Agglutinate bacteria

IgM> IgG>IgA

282
Q

Antibody plus complement will

A

Lyse bacteria

IgM IgG

283
Q

Antibody plus cells

A

Opsonization bacteria fungi for phagocytosis

Activates extracellular killing

IgG

284
Q

Is IgG2 or IgG1 in chronic periodontitis

A

IgG1 is predominate but switches in aggressive periodontitis

285
Q

IgG2 recognizes

A

Carbohydrate antigens(LPS) while other mainly recognize protein Ag

286
Q

Are there more Th2 or Th1 cells in chronic periodontal lesions

A

Th2

287
Q

_____ cells are among the most predominant and active secretory cells in advanced periodontal lesions

A

Plasma cells

288
Q

An individuals ability to _______in the subgingial biofilms may indicates a patients susceptibility to the disease and ability to respond to treatment

A

Mount a specific Ab response

289
Q

Tissue volumes rations

A

10% JE
30% OE
60% CT

290
Q

Cell layers in JE

A

10-20 cell layers

291
Q

Are there dentogingival plexus venues loops in health

A

No but there are capillary loops

292
Q

Stages in development of gingivitis and periodontitist

A

Initial
Early
Established
Advanced

293
Q

Initial Lesion: Subclinical stage of gingivitis

A

Early stage of inflammation, invisible.

Increased permeability PMNs monocytes GCF in JE

Increased vascular density

294
Q

GCF is a plasma_____ in health or _______ in disease

A

Transudate

Inflammatory exudate

295
Q

Initial lesions PMNs adhere to

A

Post capillary venues and begin to migrate through JE into gingival sulcus

296
Q

Chemotaxis by PMNs is induced by

A

IL-8 and C5a and molecules released by bacteria

297
Q

______ of JE is essentially what inductees the whole process

A

Basal cells

Stimulated by endotoxin
Release inflammatory agents
Sets off cascade

298
Q

Initial lesions drum proteins present

A

Extravascularly

299
Q

Collagen is lost where durin initial lesion

A

Perviascular collagen

Broken down by PMNs release of granules

300
Q

Alteration on of the most ____of JE during initial lesion

A

Coronal portion

301
Q

Early lesson occurs how many days after plaque development

A

4-7

302
Q

Early lesions inflammation is now

A

Clinically evident

303
Q

In the early lesion what creates space for infiltration

A

Collagen destruction

304
Q

Proliferation during early lesion

A

Basal cells of JE and SE

305
Q

Epithelial retention pegs in early lesion

A

Invade coronal portion of lesion

306
Q

Early lesions the JE invades CT

A

The previously inactive capillary bed opens up and proliferates into the CT papillae

307
Q

Early lesions accumulation of _____immediately subajacent to to JE

A

Lymphoid cells

Still few plasma cells

15%

308
Q

Established lesion is clinically classified as

A

Chronic gingivitis

309
Q

Established lesion increased _____ around blood vessels in ______ CT

A

Plasma cells

Coronal CT

310
Q

Established lesion Activated T cells produce

A

Cytokines

Chemotactic substances MCP MIP RANTES

311
Q

Established lesion Plasma cells produce

A

Ig and cytokines IL6 and TNF

312
Q

established lesion fibroblast produce

A

MMPs and TIMPs

313
Q

IN established lesion the JE and sulcular epithelium proliferate and ________

A

Migrate deep into ct

314
Q

Established lesion the sulcus deepens and the coronal portion of JE is converted into

A

Permeable pocket epithelium which is not attached to the tooth surface loaded with PMNs

315
Q

Established lease on increased proportion of plasma cells

A

10-35%

316
Q

Is there apical migration of JE or bone loss at established lesion?

A

NO

317
Q

What cell predominates in advanced lesion

A

B cells over T cells which signals the conversion from gingivitis to periodontitis

318
Q

What are the first clinical signs of periodontitis

A

Destruction of CT attachment to root surface

AND

Apical migration of petoihleial attachment

319
Q

Where does bone loss begin in advanced lesions

A

Around communications blood vessels along crest of septum

320
Q

___% of infiltrating cells are plasma cells in advanced lesion

A

50

321
Q

Glycemic control is improved after

A

Periodontal therapy

322
Q

Dental Calculus

A

Mineralized plaque that forms on the surfaces of natural teeth and dental prostheses

323
Q

2 types of calculus

A

Supragingival

Subgingival

324
Q

Supragingival calculus

A 
Coronal to gingival margin
White/yellow
Clay like
Easily detached
Opposite salivary ducts
325
Q

Subgingival calculus

A

Below gingival margin
Hard dense
Dark colored
Extend to base of pocket but does not reach JE

326
Q

Detection of calculus

A

tactile
Radiographs
Blast of air
Coloring of Gingiva

327
Q

Calculus represents

A

A secondary product of infection

NOT a cause of periodontist

328
Q

Attachment of calculus

A

Calcified pellicle

Penetration of surface irrgelaties

329
Q

4 forms of calcium phosphate

A

Brushite
Octa calcium phosphate
Hydroxyapatite
Whitlockite

330
Q

Most common calcium in subgingival calculus

A

Whitlockite

Hexagonal

331
Q

Predominate calcium in old calculus

A

HA

Rods

332
Q

Dominate calcium in exterior layers

A

Octa calcium phosphate

Platelets

333
Q

Calcium that is the basis for supragignal calculus

A

Bushite

334
Q

Calculus is removed due to

A

It’s plaque retentive nature

Perio 1 (2 decks)

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