L11&12-Periodontitis

Question 1

LETS GET IT SHAWTY: What are the 10 Major Risk Factors for Periodontitis?

Answer 1

1.Tobacco 2.Systemic Diesases 3.Medications 4.Crooked Teeth 5.Prego 6.More Red Complex Bugs 7.Heredity 8.Age 9.Poverty 10. Poor Oral Hygiene

Question 2

What are the three events that DEFINE periodontitis? How is it distinguished from gingivitis?

Answer 2

1.destruction of PDL 2.Loss of alveolar bone 3.Migration of junctional epithelium…it is IRREVERSIBLE

Question 3

Does attachment loss indicate if disease is ongoing?

Answer 3

NO it might not be active at that time

Question 4

Which age group is most affected by peroidontitis?

Answer 4

Older individuals

Question 5

What is usually the cause of Perio in young children less then 10 years old?

Answer 5

Neutrophil genetic defects

Question 6

What are 6 proposed mechanisms explaining why perio disease happens?

Answer 6

1.Bacterial products distroy tissue 2.host inflammatory factors destroy tissue 3. too many bacteria/too few host 4.no single bug to blame 5.most bad guys still uncharacterized 6.Most popular idea: unique bacterial combinations and MALFUNCTIONING host immunity

Question 7

What are the 3 hypotheses for explaining perio disease? (think general).. What is the most likely?

Answer 7

1.A specific bacterium 2. Specific Mechanism, multiple bacterial…3..MOST likely-Multiple Machanisms, multiple bacteria

Question 8

What are the two competing theories about the root of perio disease? Which one is clinically used more?

Answer 8

1.All plaque is bad 2.Only certain plaque is pathogenic

Question 9

What are the three DAMAGING MICROBE PRODUCTS? (general)

Answer 9

Exoenzymes, Exotoxins, and Toxic Metabolites

Question 10

What are the two DEFENSE INHIBITORS?

Answer 10

lowered PMN migration and lowered T and B cell function

Question 11

What is the main INFLAMMATORY AGENT found in Perio?

Answer 11

LPS!!!(massive potential)

Question 12

Whats causing Type I-TypeIV Hypersensativity to go on in periodontitis?

Answer 12

unknown antigens and known complexes

Question 13

What are the 5 MAJOR pathogens in Periodontitis?

Answer 13

1.Porphymonas Gingivalis 2.Prevotella Intermedia 3.Aggregatibacter Actinomycetemcomitans 4.Tannerella Forsythia 5.Treponema Denticola

Question 14

What are the 7 topics to know about AA?

Answer 14

1.Gram - Rod 2.Capnophilic 3.Facultative 4.Catalase 5.pH 7.5 optimum 6.Saccharolytic (ODD!) 7.Grows w/ steroids! (cool!)

Question 15

What are the two MAJOR virulence factors for AA?

Answer 15

1. LPS BLEBS! 2. Fimbrae binding

Question 16

What are the three features of the nasty LPS Blebs?

Answer 16

1.activates Macrophages (for more inflammation) 2.KILLS Macrophages and PMNs with LeukoToxin! 3.Stimulates osteoclasts!

Question 17

What % of aggressive adult perio and what % of aggressive juvenile perio is associated with AA?

Answer 17

30-50% aggressive adult……..freaking 90% aggressive juvenile!

Question 18

What are the 5 topics to know about Porphymonas Gingivalis?

Answer 18

1. Gram - rod 2.Anaerobic 3.Needs Haemin 4.pH 7.5-8.5 5. Asaccharolytic

Question 19

What is stealthy about P. Gingivalis?

Answer 19

Its LPS is 100 to 1000x LESS inflammatory!

Question 20

What are the 5 virulence factors for P. Gingivalis?

Answer 20

1.CHO capsule 2.Toxic Products 3.UNIQUE LPS (in blebs too!) 4.Fimbrae 5. Many secreted enzymes and proteases

Question 21

When looking at AA and PG, when in life do they show up in a healthy mouth?

Answer 21

AA-at a young age, then they go away…PG-slowly build as age progresses

Question 22

Which one (PG or AA) is constant across all areas of the mouth and which one lives in specific neighborhoods?

Answer 22

PG is everywhere….AA only lives in little pockets/neighborhoods

Question 23

What is the major leukocyte doing battle with AA, PG and PI ?

Answer 23

the PMN

Question 24

What happens to oxygen that reaches a gingival pocket in perio disease?

Answer 24

reacts with organic molecules to get rid of it and make an anaerobic environment!

Question 25

Why must perio bugs use protein for food? (2)

Answer 25

No saliva, no food residue down there!

Question 26

What is a major colonization factor for perio bugs?

Answer 26

absence of saliva washing

Question 27

What are the different surfaces of a perio pocket? (3)

Answer 27

1. pellicle 2.leaky epithelium 3. wall of neutrophils

Question 28

What removes the MASSIVE amount of LPS in a perio pocket?

Answer 28

PMN!

Question 29

What is the MAIN culprit/the genesis of collagen degradation and bone resorption in the perio pocket?

Answer 29

LPS! (stimulates cytokine release by Macrophages)

Question 30

Which immune cell has an end goal of GETTING RID of the threat? (e.g. get RID of the TOOTH!)

Answer 30

The Helper T cell…get rid of the tooth to keep the infection localized at all costs!

Question 31

What does LPS from bacteria and Cytokines from Helper T cells do to the Macrophages?

Answer 31

Turns them in to ‘super macs’

Question 32

Periodontal treatment strives to eliminate, or more correctly greatly reduce, ___________, thus reducing the immunologic stimulus.

Answer 32

the bacterial load

Question 33

__________ (____) might be added after periodontal surgeries to encourage osteoblast activity so that supporting bone structure might regenerate.

Answer 33

Bone Morphogenic Proteins (BMPs)

Question 34

Which mechanism attributes about 1/3 of the assault during perio disease? Which is the other 2/3s?

Answer 34

1/3-the bacterial assault….2/3s the host immune response