Efficacy of Diagnostic Techniques for Periodontal Diseases Flashcards
Periodontal disease is currently diagnosed almost entirely on the basis of _______.
clinical manifestation
What are the traditionally used diagnostic procedures (2) for adults over 50 years old?
- periodontal examination
2. Radiographs
Clinical examination of periodontal disease include which five methods?
- signs of gingival inflammation
- Periodontal probing
- tooth mobility
- furcation involvement
- Radiographs
True or False: Microbiologic testing, Assessment of the host response, and genetic analysis are routine measures for evaluating periodontal disease in practice.
False
What are the 5 methods of microbiologic testing?
- Bacterial culturing (gold standard)
- Direct microscopy
- Immunodiagnostic methods
- Enzymatic methods
- Molecular biology techniques
What are the tissue sources that are used for assessing the host response?
gingival crevicular fluid*** saliva blood serum blood cells urine
True or False: Gene polymorphism is a risk marker for periodontitis.
True
What is the main limitation of traditional diagnostic techniques (Probe penetration, CAL, and radiographs)?
they lack sensitivity and reproducibility; they don’t catch all the problems
Periapical radiographs will identify bone change only after 30-50% has been lost. What is a more sensitive radiography method?
Subtraction Radiography: use subsequent, overlapping radiographs and subtract bone heights. Detection can be found as low as 5% bone loss
Ultrasonic Periodontal Probing is “non-invasive.” Describe how it works.
a hollow, tapered tip is filled with water for coupling of the ultrasonic beam into the tissues
What is Cone-beam Computed Tomography and how is it used in periodontology?
a new method of radiography that is better at detecting intrabony defects, periodontal cysts, furcation defects, and thickness of palatal masticatory mucosa
The sensitivity of a diagnostic test refers to the probability of the test being ______ when the disease is _______.
positive
present
The specificity of a diagnostic test refers to the probability of the test being ______ when the disease is _______.
negative
absent
What are the downsides of bacterial culturing?
- low sensitivity
- can only grow particular kinds/live bacteria
Direct microscopy relies on which characteristic of bacteria for identification?
motility
Most of the main bacteria are non-motile (except spirochetes)
True or False: Immunodiagnostic methods do not require viable bacterial cells.
True
Which two species of bacteria are commonly detected by using immunodiagnostics?
A.a and P.g
What are the four type of immunodiagnostic methods?
- Direct or Indirect IFA (immunofluro. assay)
- Flow cytometry
- Enzyme-Linked Immunosorbent Assay (ELISA)
- Latex Agglutination
Enzymatic methods of microbiologic testing are unable to _________.
distinguish between individual bacteria
Molecular biology techniques analyze _____, _____, and __________ from target microorganisms.
DNA, RNA, Proteins (structure and function)
Of the molecular biology techniques, which one has high sensitivity and specificity for the identification of target pathogens?
PCR
What are three important components of the GCF?
- Host-derived enzymes and their inhibitors
- Byproducts of tissue breakdown
- Inflammatory mediators and host-response modifiers
Host derived enzymes are of what two types?
- intracellular destruction enzymes
2. extracellular destruction enzymes
_______ destruction enzymes are possible markers of active periodontal destruction and are released from dead or dying PMNs.
Intracellular
What type of host derived enzymes is associated with the activity of matrix metalloproteinases?
extracellular
What type of cells will produce extracellular destruction enzymes?
inflammatory, epithelial, and connective tissue cells
____ is released during tissue cell death and its concentration is markedly increased in sites of severe gingival inflammation.
Aspartate Aminotransferase (AST)
Which enzyme is a membrane-bound glycoprotein involved in maintenance of alveolar bone and exists in high numbers in disease sites?
Alkaline Phosphatase
______ is a lysosomal enzyme that degrades proteoglycans and ground substance and is a good indicator of future periodontal breakdown.
beta-glucuronidase
Which enzyme is found in lysosomal granules of neutrophils and is associated with the chair-side PerioCheck test kit?
Elastase
Aspartate Aminotransferase, Alkaline phosphatase, beta-glucaronidase, and elastase are all examples of ______ destruction enzymes.
intracellular
What two cell types secrete matrix metalloproteinases?
Fibroblasts
Macrophages
What is the purpose of matrix metalloproteinases?
remodeling and degradation of extracellular matrix components
The ECM of the periodontium is composed of _____ (predominantly), proteoglycan, and _________ proteins (elastin, fibronectin, laminin, etc).
collagen
non-collagen
GCF from sites with periodontitis contain elevated levels of _______, ________, ______, and ______.
hydroxyproline
glycosaminoglycans
osteocalcin
type I collagen
“GOtCH”
What are the common inflammatory mediators (cytokines)?
TNFalpha IL-1alpha IL-1beta IL-6 IL-8 PGE
Traditional immunoassays analyze for a single cytokine at a time. What is special about the Bio-Plex Cytokine Assay?
it uses color-coded beads to permit the simultaneous detection of up to 100 cytokines in a single well
“Bio-Plex is complex”
What is the basis for Infrared Spectroscopy (how does it work)?
vibrating covalent bonds of organic molecules absorb a characteristic wavelength of IR light, so the absorption depends on the nature of the bond and this establishes a fingerprint
What is the basis for Near Infrared Spectroscopy (NIR)?
measures the oxygen saturation of tissues, the wavelength 500-600nm is dominated by absorption from oxygenated and deoxygenated hemoglobin, oxygenation at perio sites is SIGNIFICANTLY LOWER
“i think about the Egyptian king Nero…NIR-O…oxygen”
Tissue _______ reflects increased oxygen consumption that occurs with persistent inflammation.
hypoxia
Why is saliva used as a means to test for periodontal disease?
- abundant fluid and easy to collect/store
- highly enriched content of disease biomarkers
In order to identify specific periodontal pathogens and concentration, which salivary diagnostic test should you use?
DNA PCR
When testing saliva for genetic susceptibility to perio, which molecules would you be looking for to be over-expressed?
IL-1alpha and IL-1beta
True or False: Genetic susceptibility tests will help to identify when destruction may occur.
False: they identify general risk factors for the development of perio but do NOT determine when destruction will occur
What is the Salivary Occult Blood Test (SOBT)? What is the specificity and sensitivity?
a test that is available in Japan to test for perio status; good sensitivity but low specificity (overdiagnose)
Future diagnostic methods for periodontal disease would probably involve salivary _______ analysis because it is cost effective for studying large populations.
proteome
