Gen Path Final - Effect of Oral Health on Systemic Disease

Question 1

1st indicator of systemic disease

Answer 1

Oral lesions

Question 2

Periodontal pathogens (bacteria) in deep periodontal pockets can easily penetrate through ulcerations of the inflamed epithelium, enter the
bloodstream and can invade other tissues and organs causing damage by direct or indirect (inflammatory,
immunological) mechanisms.

Answer 2

Bacteremia

Question 3

Inflammatory mediators (biomarkers)
originating in the periodontal microbiome enter the bloodstream and are deposited in tissues and organs causing damage by direct or indirect (inflammatory, immunological) mechanisms

Answer 3

Inflammation

Question 4

Antibodies to periodontal pathogens
and their toxins found in the periodontium can attack crossreactive antigens found in other tissues and organs

Answer 4

Immune response

Question 5

One of strongest bidirectional relationships between periodontal disease and systemic disease is seen in what disease?

Answer 5

CVD

Question 6

What is associated w/ coronary and carotid atherosclerosis, CHD, ischemic stroke and fatal ischemic heart disease?

Answer 6

Perio

Question 7

Chronic ischemic heart disease is associated with reduced _________ ________ to the gums, leading to an
environment that favors periodontal pathogen proliferation and periodontal tissue destruction

Answer 7

blood flow

Question 8

What medication used to treat CVD causes gingival overgrowth, which complicates OH and exacerbates perio?

Answer 8

Ca2+ channel blockers

Question 9

Perio pathogens (e.g., Porphyromonas gingivalis, Aggregatibacter
actinomycetemcomitans, Tannerella forsythia) release virulence factors, including ____________, that lead
to local and systemic inflammatory immune responses

Answer 9

lipopolysaccharides (LPS)

Question 10

Pro-inflammatory macrophage/ monocyte-derived cytokines (IL-1β, IL-6, IL-8, TNF-α) and inflammatory markers such as _____________ are elevated in patients with perio and are known to play a role in CVD progression by promoting ___________ cell dysfunction and atherosclerosis.

This increases atheromatous plaque formation in coronary artery walls, leading to an increased risk of what 2 diseases?

Answer 10

C-reactive protein (CRP); endothelial

CAD + IHD

Question 11

What bacteria is involved in every perio pathogen, making it the most important one?

Answer 11

P gingivalis

Question 12

Endothelial cell dysfunction resulting from inflammatory cytokines is also characterized by what?

Answer 12

Reduced NO production

Question 13

Which pro-inflammatory macrophages/monocyte-derived cytokines are most important to know?

Answer 13

IL-1β
IL-6
IL-8
TNF-α

Question 14

What is the most important inflammatory marker to know?

Answer 14

C reactive protein

Question 15

What contributes to atherosclerosis and hypertension, which are establish risk factors for CVD?

Answer 15

Reduced NO

Question 16

Bacteremias containing perio bacteria can embed in blood vessels and are deposited in atheromatous plaques.

What do they induce?

Answer 16

Pro-coagulant response

Question 17

What does the pro-coagulant response increase the risk for?

Answer 17

Coronary artery thrombus -> heart attack

Question 18

The immune response to perio pathogens generates what?

Answer 18

ROS (reactive oxygen species)

Question 19

What does ROS do to perio tissues?

Answer 19

Destruction

Question 20

Perio can alter ________ __________ _________, with some evidence suggesting that it exacerbates hyperlipidemia and oxidative stress

Answer 20

blood lipid profiles

Question 21

_________ and other bacterial products from perio pathogens can stimulate the liver to produce more lipids resulting in elevated levels of what 2 things?

Answer 21

LPS; cholesterol + triglycerides

Question 22

slide 18-20

Question 23

What disease increases risk of perio, caries, xerostomia, candidiasis, and burning mouth syndrome (glossodynia)?

Answer 23

Diabetes

Question 24

Active perio in diabetics causes an increase in _________ _________ and mean blood glucose levels. This contributes to worsening glycemic control that exacerbates diabetes over time

Answer 24

insulin resistance

Question 25

The inflammatory mediators originating from perio including CRP, cytokines (especially TNF-α and IL-6), and LPS from P. gingivalis can interact systemically with what 3 things that play a role in the pathophysiology of diabetes since intracellular inflammatory pathways are activated?

Answer 25

Lipids Free fatty acids Advanced glycation end-products (AGES)

Question 26

What does perio tx of diabetic pts lead to?

Answer 26

Reduction in HbA1c

Question 27

What 2 things act as a reservoir for pathogens and can be an important risk factor for the initiation and progression of various respiratory infections?

Answer 27

Plaque + biofilm

Question 28

Bacteria from dental plaque and oral biofilms may be aspirated into the respiratory tract and cause what?

Answer 28

Aspiration pneumonia

Question 29

4 stages of oral biofilm maturation

Answer 29

Attachment Initial colonization Secondary colonization Maturation

Question 30

Increased levels of pro-inflammatory cytokines and CRP in the gingival crevicular fluid in perio pts can spill into systemic circulation and contribute to which respiratory disease?

Answer 30

COPD

Question 31

In perio pts, bacteremias containing __________ bacterial perio pathogens can seed in the ________

Answer 31

anaerobic; lungs

Question 32

What are the 3 ways perio pathogens directly impact lung tissues?

Answer 32

Airway inflammation Reduced immune response Lung remodeling

Question 33

Perio pathogens and cytokines increase ________ __________, leading to worsening COPD symptoms

Answer 33

airway inflammation

Question 34

Chronic inflammation from perio pathogens weaken the lung's ability to clear other pathogens, which increases susceptibility to ___________ __________

Answer 34

respiratory infections

Question 35

Ongoing inflammation contributes to ___________ changes in the lungs, worsening airflow obstruction and progression of COPD

Answer 35

structural

Question 36

Treating perio in pts with COPD reduces inflammation and improves respiratory outcomes. Name these outcomes

Answer 36

Slower lung function decline Lower hospitalization rate Lower all-cause mortality Lower exacerbation frequency

Question 37

Pregnancy gingivitis occurs in what % of pregnant women?

Answer 37

30-100%

Question 38

Which disease? Gingival erythema, edema, hyperplasia, increased bleeding

Answer 38

Pregnancy gingivitis

Question 39

Pregnancy involves immunologic adaptations to tolerate the fetus, including a shift from a pro inflammatory T-helper 1 (Th1) response to what?

Answer 39

Anti-inflammatory T-helper 2 (Th2) response

Question 40

T/F: While this immunologic shift is crucial for preventing fetal rejection, it can compromise the host’s immune response to perio pathogens, allowing perio to progress more aggressively in pregnant women

Answer 40

True

Question 41

Poor maternal perio health leads to what?

Answer 41

Low birth weight Preterm birth

Question 42

Perio pathogens stimulate a local immune inflammatory response, leading to the release of what 3 things that enter the blood and reach the uterus and placenta, which contributes to pre-term birth?

Answer 42

Prostaglandins Pro-inflammatory cytokines CRP

Question 43

Increased levels of ______ are linked with pre-term labor induction, and studies show that ______ from perio pathogens can cross the placental barrier, leading to fetal inflammation causing an increased risk of pre-term birth

Answer 43

LPS; LPS

Question 44

_________ ________ resulting from perio can impair placental function, resulting in restricted nutrient and oxygen delivery to the fetus, leading to what?

Answer 44

Oxidative stress; low birth weight

Question 45

Bacteremias containing perio pathogens may seed and colonize placental tissue and the uterus directly inducing an inflammatory responses that may lead to what 2 things?

Answer 45

Pre-term labor Pre-term birth

Question 46

8th most frequent tumor and 6th leading cause of cancer death worldwide

Answer 46

Esophageal cancer

Question 47

Most common form of esophageal cancer

Answer 47

Squamous cell carcinoma of esophagus

Question 48

What bacteria can colonize mucosal tissue, invade epithelial cells, and interfere with host immune responses and the cell-cycle mechanisms?

Answer 48

P gingivalis

Question 49

How does P gingivalis lead to esophageal squamous cell carcinoma? (5)

Answer 49

Chronic inflammation Immune system suppression, modulation, evasion Altering cell signal pathways Enzymatic activity + tissue invasion Epigenetic changes + cellular proliferation

Question 50

What bacteria stimulates the release of proinflammatory cytokines like tumor necrosis factor-alpha (TNF-α), interleukins (IL-1β, IL-6), and other mediators that can promote cellular proliferation and inhibit apoptosis?

Answer 50

P gingivalis

Question 51

Dysregulation and inhibition of apoptosis allows cells with DNA damage to survive and accumulate mutations, contributing to what?

Answer 51

Carcinogenesis

Question 52

Chronic inflammation in response to P gingivalis leads to the production of what?

Answer 52

ROS RNS (reactive nitrogen species)

Question 53

What leads to DNA damage, genetic mutations, cancer initiation, and cancer progression?

Answer 53

ROS RNS

Question 54

P. gingivalis can suppress the activity of immune cells that are critical for tumor surveillance, such as what 2 cells?

Answer 54

NK cells Cytotoxic T cells

Question 55

P. gingivalis produces various virulence factors, such as ___________, which degrade immune signaling proteins, impair neutrophil phagocytic function and disrupt the complement system

Answer 55

gingipains

Question 56

Cysteine proteolytic enzymes

Answer 56

Gingipains

Question 57

P. gingivalis alters _________ ________ signaling and also promotes an imbalance in pro- and anti-inflammatory cytokines

Answer 57

toll-like receptor

Question 58

P gingivalis activates what pathway?

Answer 58

NF-KB pathway

Question 59

Transcription factor that controls DNA transcription, cytokine production, and cell survival

Answer 59

NF-KB

Question 60

The sustained activation of ________ can promote cancer cell survival and growth

Answer 60

NF-KB

Question 61

What promotes tumor cells proliferation, suppresses apoptosis, and attracts angiogenesis, but it also induces epithelial-mesenchymal transition, which facilitates distant metastasis?

Answer 61

NF-KB

Question 62

Degrade extracellular matrix components and disrupt cellular adhesion

Answer 62

Gingipains

Question 63

Weaken the protective barriers of the esophageal epithelium, making it easier for carcinogenic substances or other pathogens to penetrate and cause damage

Answer 63

Gingipains

Question 64

Gingipains produced by P. gingivalis activate signaling pathways that increase the cellular expression and secretion of what?

Answer 64

MMP-9 (matrix metallopeptiadse 9)

Question 65

Produced by a variety of cells, including neutrophils, macrophages, fibroblasts, endothelial cells, and tumor cells

Answer 65

MMP-9

Question 66

Causes the degradation of collagen IV in BM and ECM, and can facilitate tumor progression, including invasion, metastasis, growth and angiogenesis

Answer 66

MMP-9

Question 67

What bacteria induces epigenetic modifications, such as DNA methylation and histone modification, that alter gene expression?

Answer 67

P gingivalis

Question 68

By promoting the expression of oncogenes and inhibiting tumor suppressor genes, P. gingivalis facilitates what?

Answer 68

Uncontrolled cell proliferation

Question 69

What mechanism? P. gingivalis can stimulate the release of pro-angiogenic factors like vascular endothelial growth factor (VEGF), that supports cancer growth and metastasis

Answer 69

Increased angiogenesis

Question 70

What mechanism? P. gingivalis has been associated with a process where epithelial cells lose their cell-to-cell adhesion and gain migratory and invasive properties

Answer 70

Epithelial-mesenchymal transition