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AU 15 - Perio Test 2 > Efficacy of Diagnostic Techniques for Periodontal Diseases > Flashcards

Efficacy of Diagnostic Techniques for Periodontal Diseases Flashcards

1
Q

How is periodontal disease diagnosed?

A

Almost entirely on the basis of its clinical manifestations

  • Signs of gingival inflammation
  • Perio probing
  • Tooth mobility
  • Furcation involvement
  • Radiographs
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2
Q

What are some diagnostic methods for periodontitis not routinely used in clinical practice?

A

Microbiologic Testing
Assessment of the Host Response
Genetic Analysis

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3
Q

Why isn’t Microbiologic testing frequently used for periodontal diagnosis?

A

It’s expensive and well-trained personnel is required

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4
Q

Assessment of the Host Response

A

Biochemical analysis as part of periodontal diagnosis

Source of samples: GCF, saliva, and blood serum

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5
Q

Genetic Analysis

A

There is a genetic susceptibility to periodontitis

Gene polymorphism can be used as a risk marker for periodontitis

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6
Q

What are the limitations of periodontal probing as a diagnostic tool?

A

Lack sensitivity and reproducibility
Probing depth can be altered by inflammation, insertion force, plaement/angulation, size, technique, probe calibration, presence of subgingival calculus, overhang restorations

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7
Q

What are the limitations of clinical attachment levels as a diagnostic tool for periodontitis?

A

Poor reliability and reproducibility

Limited practical value

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8
Q

What are the limitations of Radiographic examination as a diagnostic tool for periodontitis?

A

Limited sensitivity in small bone change
-Changes in bone can be identified by the eye only after 30-50% of bone mineral has been lost
No value in evaluating disease activity or progression

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9
Q

Ultrasonic Periodontal Probing

A

Ultrasonic periodontal probe that uses a hollow, tapered tip that is filled with water for coupling of the ultrasonic beam into tissues

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10
Q

Cone-beam Computed Tomography

A

Recently been introduced for the detection of periodontal defects in in vitro settings
A promising tool for periodontal applications, especially for intrabony defects, dehiscence and fenestration defects, periodontal cysts, furcation defects, periodontal cysts, furcation defects, and thickness of palatal masticatory mucosa

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11
Q

Sensitivity of a diagnostic tool

A

Refers to the probability the test being positive when diseases is truly present
sensitivty = true positive/(true positive + false negative)

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12
Q

Specificity of a diagnostic tool

A

Refers to the probability the test being negative when disease is truly negative
specificity = true negative/(true negative + false positive)

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13
Q

Bacterial Culturing

A

Gold standard method
Assess for antibiotic susceptibility of microbes
Sensitivity is low: detection limits for selective and nonselective media average 10^4 to 10^5 bacteria
Relatively time consuming and expensive

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14
Q

Direct Microscopy

A

Alternative to culture methods
Dark-field or phase-contrast microscopy
Morphology and motility of bacteria in a plaque sample
Most of the main putative perio pathogens are non-motile (so its difficult to identify)

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15
Q

Immunodiagnostic methods

A

Use Ab that targets specific bacterial antigens

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16
Q

What are the different Immunodiagnostic methods?

A

Direct and indirect immunofluorescent microscopic assay
Cytofluorography
Enzyme-linked immunosorbent assay
Latex agglutinaiton

17
Q

Direct and indirect immunofluorescent microscopic assay

A

Able o identify pathogens using a plaque smear
Used to detect mainly Aa and Pg
Comarable to bacterial culture, but doesn’t require viable cells

18
Q

Cytofluorography

A

Complexity and cost prevents this form being used

19
Q

Enzyme-linked immunosorbant assay (ELISA)

A

Used primarily to detect serum antibodies to periodontal pathogens

20
Q

Latex agglutination

A

Based on the binding of protein to latex
Latex beads are coated with a special antibody
Currently, these assays are only for research purposes

21
Q

Enzymatic Methods

A

Several putative perio pathogens possess a common trypsin-like enzyme that hydrolyzes BANA - test for the hydrolysis
Test may be positive in healthy tissues
Negative results does not rule out presence

22
Q

Molecular Biology Techniques

A 
Analysis of DNA, RNA, and structure or function of proteins form target microorganisms
Examples:
-Nucleic acid probes
-Checkerboard DNA-DNA hybridization
-PCR
-Real-time PCR
23
Q

What are sources of samples for Assessment of the Host Response?

A 
Saliva
GCF
Blood serum
Blood cells
Urine
24
Q

What are the two types of Host-derived Enzymes?

A

Intracellular destruction enzymes

Extracellular destruction enzymes

25
Q

Intracellular destruction enzymes

A

Possible markers of active periodontal destruction

Released from dead or dying neutrophils from periodontium

26
Q

Aspartate amino-transferase

A

Released during tissues desctruciton
A marked elevation in AST levels in GCF from sites with severe gingival inflammation
Cannot discriminate between sites with or without attachment loss

27
Q

What are examples of intracellular destruction enzymes?

A

Aspartate amino-transferase
Alkaline phosphataase
B-glucuronidase
Elastase

28
Q

Alkaline phosphatase

A

A membrane-bound glycoprotein involved in maintenance of alveolar bone
Higher in diseased than healthy sites

29
Q

B-glucuronidase

A

A lysozomal enzyme that degrades proteoglycans and ground substances
Higher in diseases sites

30
Q

Elastase

A

A proteolytic enzyme found in lysozomal granules of neutrophils

31
Q

Extracellular destruction enzymes

A

Associated with the activity of matrix metalloproteinases

Produced by inflammatory, epithelial, and connective tissue cells

32
Q

Matrix Metalloproteinases

A

Extracellular destruction enzyme
Secreted by fibroblasts and macrophages
Responsible for remodeling and degrading ECM
High MMP levels are greater risk for progression of periodontitis - levels are reduced in response to treatment

33
Q

What makes up the ECM of periodontium?

A

Collagen
Proteoglycans
Non-collagen proteins

34
Q

What enzymes can be found in the GCF of periodontally diseased sites?

A

Hydroxyproline (breaks down collagen)
Glycosaminoglycans
Osteocalcin
Type I collagen

35
Q

What are the “Inflammatory mediators”

A

Cytokines:

  • TNF-a
  • IL-1(a and B)
  • IL-6
  • IL-8
  • PGE2
36
Q

Bio-Plex Cytokine Assay

A

Incorporates novel technology using color-coded beads, permitting the simultaneous detection of up to 100 cytokines in a single well of a 96-well microplate
Designed to quantitate multiple cytokines in tissue fluid (including GCF)

37
Q

Infra-red Spectroscopy

A

Measure the total contents of GCF
Can be used to characterize GCF from healthy, gingivitis, and periodontitis sites
Light is passed through and what wavelengths are absorbed can determine a molecular “fingerprint”

38
Q

Near infra-red Spectroscopy

A

Measure of oxygen saturaiton in tissues
Wavelength region of 500-600 is dominated by the absorption from oxygenated hemoglobulin and deoxygenated hemoglobulin
Tissue oxidation at periodontitis sites is significantly lowered as compared to gingivitis or healthy gingiva

39
Q

When can saliva analysis be useful in diagnosing periodontitis?

A

It can be a cost-effective approach to screening periodontal disease in large populations

AU 15 - Perio Test 2 (3 decks)

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