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D2 Fall > Gen Path Final - Effect of Oral Health on Systemic Disease > Flashcards

Gen Path Final - Effect of Oral Health on Systemic Disease Flashcards

1
Q

1st indicator of systemic disease

A

Oral lesions

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2
Q

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.

A

Bacteremia

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3
Q

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

A

Inflammation

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4
Q

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

A

Immune response

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5
Q

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

A

CVD

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6
Q

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

A

Perio

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7
Q

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

A

blood flow

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8
Q

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

A

Ca2+ channel blockers

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9
Q

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

A

lipopolysaccharides (LPS)

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10
Q

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?

A

C-reactive protein (CRP); endothelial

CAD + IHD

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11
Q

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

A

P gingivalis

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12
Q

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

A

Reduced NO production

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13
Q

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

A

IL-1β
IL-6
IL-8
TNF-α

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14
Q

What is the most important inflammatory marker to know?

A

C reactive protein

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15
Q

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

A

Reduced NO

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16
Q

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

What do they induce?

A

Pro-coagulant response

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17
Q

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

A

Coronary artery thrombus -> heart attack

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18
Q

The immune response to perio pathogens generates what?

A

ROS (reactive oxygen species)

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19
Q

What does ROS do to perio tissues?

A

Destruction

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20
Q

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

A

blood lipid profiles

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21
Q

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

A

LPS; cholesterol + triglycerides

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22
Q

slide 18-20

A
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23
Q

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

A

Diabetes

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24
Q

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

A

insulin resistance

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25
Q

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?

A

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

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26
Q

What does perio tx of diabetic pts lead to?

A

Reduction in HbA1c

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27
Q

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?

A

Plaque + biofilm

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28
Q

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

A

Aspiration pneumonia

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29
Q

4 stages of oral biofilm maturation

A

Attachment
Initial colonization
Secondary colonization
Maturation

30
Q

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?

A

COPD

31
Q

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

A

anaerobic; lungs

32
Q

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

A

Airway inflammation
Reduced immune response
Lung remodeling

33
Q

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

A

airway inflammation

34
Q

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

A

respiratory infections

35
Q

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

A

structural

36
Q

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

A

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

37
Q

Pregnancy gingivitis occurs in what % of pregnant women?

A

30-100%

38
Q

Which disease?

Gingival erythema, edema, hyperplasia, increased bleeding

A

Pregnancy gingivitis

39
Q

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

A

Anti-inflammatory T-helper 2 (Th2) response

40
Q

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

A

True

41
Q

Poor maternal perio health leads to what?

A

Low birth weight
Preterm birth

42
Q

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?

A

Prostaglandins
Pro-inflammatory cytokines
CRP

43
Q

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

A

LPS; LPS

44
Q

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

A

Oxidative stress; low birth weight

45
Q

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?

A

Pre-term labor
Pre-term birth

46
Q

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

A

Esophageal cancer

47
Q

Most common form of esophageal cancer

A

Squamous cell carcinoma of esophagus

48
Q

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

A

P gingivalis

49
Q

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

A

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

50
Q

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?

A

P gingivalis

51
Q

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

A

Carcinogenesis

52
Q

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

A

ROS
RNS (reactive nitrogen species)

53
Q

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

A

ROS
RNS

54
Q

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

A

NK cells
Cytotoxic T cells

55
Q

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

A

gingipains

56
Q

Cysteine proteolytic enzymes

A

Gingipains

57
Q

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

A

toll-like receptor

58
Q

P gingivalis activates what pathway?

A

NF-KB pathway

59
Q

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

A

NF-KB

60
Q

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

A

NF-KB

61
Q

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

A

NF-KB

62
Q

Degrade extracellular matrix components and disrupt cellular adhesion

A

Gingipains

63
Q

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

A

Gingipains

64
Q

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

A

MMP-9 (matrix metallopeptiadse 9)

65
Q

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

A

MMP-9

66
Q

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

A

MMP-9

67
Q

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

A

P gingivalis

68
Q

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

A

Uncontrolled cell proliferation

69
Q

What mechanism?

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

A

Increased angiogenesis

70
Q

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

A

Epithelial-mesenchymal transition

D2 Fall (43 decks)

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