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Periodontics I > High Yield: Periodontitis as a Manifestation of Systemic Disease > Flashcards

High Yield: Periodontitis as a Manifestation of Systemic Disease Flashcards

1
Q

T/F: Diseases and conditions can affect the periodontal tissues by affecting the periodontal supporting tissues INDEPENDENTLY of dental-plaque biofilm-induced inflammation

A

True

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2
Q

Systemic disorders that have a major impact on the loss of periodontal tissue by influencing periodontal inflammation include: (3)

A
  1. genetic disorders
  2. AIDs
  3. Inflammatory diseases
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3
Q

-trisomy 21 or mongolism
-characteristic physical appearance
-mental deficiency & growth retardation

A

Down syndrome

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4
Q

List some of the physical characteristics of down syndrome:

A
  1. small nose, mouth & ears
  2. slightly bent fifth finger (pinky)
  3. short, stocky build
  4. almond-shaped eyes with skin fold covering inner corner
  5. white spots on colored part of eyes
  6. flat, round face
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5
Q

Give another name for down syndrome:

A
  1. mongolism
  2. trisomy 21
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6
Q

Describe how periodontal disease is categorized in a patient with down syndrome:

A

moderate to sever periodontitis with rapid progression

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7
Q

T/F: In down syndrome, local factors alone explain the severity of periodontal destruction

A

False- local factors alone FAIL to explain the severity of periodontal destruction

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8
Q

What aspects of down syndrome might contribute to the moderate to severe periodontal destruction with rapid progression:

A

INTRINSIC IMMUNE SYSTEM DEFECTS
-poor PMN chemotaxis
-poor phagocytosis
-intracellular killing

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9
Q

List the three intrinsic immune system defects seen in down syndrome:

A
  1. Poor PMN chemotaxis
  2. Poor phagocytosis
  3. Intracellular killing
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10
Q

Leukocyte adhesion deficiency (LAD) is due to a mutation in:

A

Beta-2 integrin gene (ITGB2)

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11
Q

Lack of beta-2 integrin gene in LAD results in:

A
  1. lack beta-2 integrin mRNA in leukocytes
  2. low integrin (CD18 or CD15) expression on neutrophils
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12
Q
  1. lack beta-2 integrin mRNA in leukocytes
  2. low integrin (CD18 or CD15) expression on neutrophils

This is seen in ____ due to ____

A

LAD; due to mutation in beta-2 integrin gene (ITGB2)

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13
Q

Describe the neutrophil insufficiency in LAD:

A

Neutrophils are confined to blood vessels resulting in disruption of neutrophil associated-homeostasis

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14
Q

In what disease are neutrophils confined to blood vessels? What does this result in?

A

LAD; Disruption of neutrophil-associated homeostasis

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15
Q

Describe what is seen in the peridontium of LAD individuals:

A

History of severe recurrent infection but no pus; leukocytosis is common

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16
Q

What is a common manifestation that comes along with the history of severe recurrent infection without pus, in LAD patients:

A

Leukocytosis

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17
Q

Papillon-Lefevre syndrome is caused by a mutation in:

A

Cathepsin C gene (CTSC)

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18
Q

Papillon-Lefevre syndrome is caused by a mutation in cathepsin C gene (CTSC) that is located on chromosome:

A

11q14

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19
Q

The mutation in Papillon-Lefevre syndrome results in:

A
  1. Compromised neutrophil function
  2. Decreased phagocytosis
  3. hyperkeratotic lesions
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20
Q

What type of lesions result from the mutation in the Cathepsin C gene in Papillon-Lefevre syndrome?

A

Hyperkeratotic lesions
-palms
-soles of feet
-elbows
-knees

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21
Q

Chediak-Higashi syndrome is due to a mutation in:

A

CHS1 gene
LYST gene

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22
Q

The mutations in CHS1 & LYST genes seen in Chediak-Higashi syndrome result in:

A

lysosomal tracking defect

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23
Q

Partial oculocutaneous albinism is seen in:

A

Chediak-Higashi syndrome

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24
Q

Why do we see partial oculocutaneous albinism is seen in Chediak-Higashi syndrome- why?

A

Defects in melanin granules

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25
Q

Patients with Chediak-Higashi syndrome have recurrent pyogenic infections due to:

A
  1. circulating leukocytes exhibit DEFECTIVE LYSOSOMES
  2. decrease in phagocytosis
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26
Q

The varying neurologic problems seen in Chediak-Higashi syndrome include:

A
  1. intellectual deficit
  2. dementia
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27
Q
  • Mutation is CHS1
  • Mutation in LYST
  • Lysosomal tracking defect
  • Partial oculocutaneous albinism (defective melanin granules)
  • Recurrent pyogenic infections (defective lysosomes & circulating leukocytes & decrease in phagocytosis)
  • Varying neurologic problems (intellectual deficit & dementia)
A

Chedaik- Highashi Syndrome

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28
Q

Congenital neutropenia results from a mutation in:

A

ELANE (50%)
HAX1 (10%)
Unknown cause (33%)

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29
Q

Congenital neutropenia results in a _____ number of ____

A

decreased; neutrophils

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30
Q

What is the ANC level in an individual with congenital neutropenia:

A

Less than 500 cells per microliter and static

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31
Q

List the clinical manifestations of congenital neutropenia:

A
  1. defective immune response
  2. severe & recurrent infections
32
Q
  1. down syndrome
  2. LAD
  3. PLS
  4. Chediak-Higashi syndrome
  5. congenital neutropenia

These are all diseae associated with:

A

Immunologic disorders

33
Q
  1. down syndrome
  2. LAD
  3. PLS
  4. Chediak-Higashi syndrome
  5. congenital neutropenia

Fill in the mutations associated with these diseases:

A
  1. Trisomy 21
  2. Beta-2 integrin
  3. Cathepsin
  4. LYST, CHS1
  5. ELANE, HAX1, Unknown
34
Q

What type of syndrome is Ehlers-Danlos syndrome categorized as?

A

Diseases affecting the connective tissue

35
Q

List the oral manifestations of Ehlers-Danlos syndrome:

A
  1. generalized, early-onset severe periodontitis
  2. gingival recession
  3. early loss of primary & permanent teeth
  4. GENERALIZED LACK OF ATTACHED GINGIVA
36
Q

In what connective tissue disease do we see a GENERALIZED LACK OF ATTACHED GINGIVA?

A

Ehlers-Danlos syndrome

37
Q

What mutation causes hypophosphatasia?

A

Mutation in Alkaline phosphatase gene (ALPL)

38
Q

The forms of hypophosphatasia range from:

A

mild to severe

39
Q

Describe the oral manifestations seen in hypophosphatasia:

A
  1. defective cementum
  2. alveolar bone loss
  3. premature loss of teeth
40
Q

IDDM:

A

Type 1

41
Q

NIDDM:

A

Type 2

42
Q

Describe the onset of the following:

Type 1 DM:

Type 2 DM:

A

Type 1: early onset but can occur at any age

Type 2: adult onset

43
Q

What is the prevalence & pathophysiology of type 1 diabetes?

A

5-10%; destruction of the pancreatic beta cells

44
Q

What is the prevalence & pathophysiology of type 2 diabetes?

A

90-95%; obestity, genetics

45
Q

List some characteristics of type 1 diabetes: (2)

A
  1. absolute insulin deficiency
  2. marked tendency towards ketosis & coma
46
Q

List some characteristics of type 2 diabetes: (2)

A
  1. blood level of insulin may be normal, increased or decreased
  2. development of ketosis & coma is uncommon
47
Q

______ is a complicating factor for diabetes and also affects _____

A

periodontal disease; glycemic control

48
Q

What type of bacteria are seen in cases of diabetic patients with perio disease?

A

gram negative

49
Q

Perio treatment in a diabetic patient leads to:

A
  1. improved insulin sensitivity
  2. improved glycemic control
50
Q

-Estrogen withdrawal
-increase in IL-6
-increased bone turnover
-net systemic bone loss
-decrease in bone mineral density
-weakened bone microarchitecture
-high risk of bone fracture

A

Osteoporosis

51
Q

In osteoporosis there needs to be a homeostasis in what three factors?

A
  1. bone
  2. estrogen
  3. inflammation
52
Q

Describe the periodontitis associated with osteoporosis:

A
  1. bacterial infection
  2. local inflammatory insult
  3. initial cortical bone compromise
  4. bone loss
53
Q

What are the shared risk factors between osteoporosis & periodontitis?

A
  1. AGE
  2. SMOKING
  3. VITAMIN D
  4. CALCIUM DEFICIENCY
54
Q
  1. AGE
  2. SMOKING
  3. VITAMIN D
  4. CALCIUM DEFICIENCY

These are the shared risk factors between:

A

Osteoporosis & periodontitis

55
Q

T/F: Patients with arthritis (OA & RA) have a higher incidence of perio disease compared to healthy controls

A

True

56
Q

What is the correlation between periodontitis and RA?

A

they both invoke the same cytokines & pro-inflammatory mediators

57
Q

____ may play a key role in the pathogenesis of periodontitis-associated RA

A

P. gingivalis

58
Q

In RA, P. gingivalis produces _____ which is associated with the RA

A

Peptidylarginine deiminase (PAD)

59
Q

Peptidylarginine deiminase (PAD) is produced by ____ and is seen in what disease?

A

P. gingivalis; RA & periodontitis

60
Q

Other systemic disorders that may contribute to the periodontal tissue loss by influencing the pathogenesis of perio diseases:

A
  1. smoking
  2. stress/depression
61
Q

List the oral manifestations of smoking (any type)

A
  1. 4x attachment loss
  2. leukoplakia
  3. carcinoma
  4. tooth loss
  5. gingival recession
62
Q

Smokers have ____x the attachment loss than nonsmokers

A

4x

63
Q

What cancer is associated with smokers?

A

carcinoma

64
Q

List the continuum seen in smoking patients & periodontal disease:

A
  1. impaired immune response
  2. subgingival anaerobic infection
  3. connective tissue cytotoxicity
  4. impaired wound healing
  5. increased severity of periodontitis
65
Q

Fill in the blanks of the continuun of smokers with perio disease:

  1. impaired _____
  2. ____ infection
  3. _____ cytotoxicity
  4. impaired _____
  5. increased severity of ___
A
  1. impaired immune response
  2. subgingival anaerobic infection
  3. connective tissue cytotoxicity
  4. impaired wound healing
  5. increased severity of periodontitis
66
Q

Nicotine causes:

A

Vasoconstriction

67
Q

Nicotine causes vasoconstriction of the:

A

Peripheral blood vessels

68
Q

Nicotine causes vasoconstriction of the peripheral blood vessels which leads to:

A

decrease in tissue oxygenation

69
Q

Tars are ____ & ____

A

cytotoxic & sticky

70
Q

Tars are cytotoxic & sticky leading to:

A

Lung diseases (COPD & cancer)

71
Q

Tars are cytotoxic & sticky causing lung disease, ultimately leading to:

A

decreases in tissue oxygenation

72
Q

When does the nicotine & tars smoking chart merge?

A

Both causing decrease in tissue oxygen

73
Q

Both nicotine & tars lead to a decrease in tissue oxygenation resulting in: (3)

A
  1. SUBgingival ANAEROBIC infection
  2. Connective tissue cytotoxicity
  3. impaired wound healing
74
Q

-subgingival anaerobic infection
-connective tissue cytotoxicity
-impaired wound healing

These are all due to:

A

smoking (nicotine & tars)

75
Q

Systemic disorders that can result in loss of periodontal tissues independent of periodontitis:

A
  1. neoplasms
  2. other disorders that may affect periodontal tissue
76
Q
A

Periodontics I (17 decks)

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