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Biochem > Lecture 8- Clinical Correlates > Flashcards

Lecture 8- Clinical Correlates Flashcards

1
Q

What synthesizes bone?

A

Osteoblasts

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2
Q

What resorbs (breaks down) bone?

A

Osteoclasts

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3
Q

What makes enamel?

A

Ameloblasts

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4
Q

What is the only calcified tissue that does not contain collagen?

A

enamel

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5
Q

What type of tissue is calcified over in dentin, cementum and bone?

A

type 1 collagen

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6
Q

What makes dentin?

A

odontoblasts

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7
Q

What makes cementum?

A

cementoblasts

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8
Q

what comprises the periodontium?

A

gingiva
cementum
periodontal ligament
surrounding alveolar bone

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9
Q

what are the only organisms that can rely solely on fermentation as their energy source?

A

microbes

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10
Q

what does dental caries result from?

A

microbial fermentations that produce lactate by glycolysis from monosaccharides

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11
Q

Which bacteria is referred to as sugar metabolizing?

A

saccharolytic

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12
Q

which type of bacteria is non-sugar metabolizing but instead hydrolyzes proteins and utilizes amino acids for energy?

A

asaccharolytic

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13
Q

What does saccharolytic bacteria lead to?

A

dental caries

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14
Q

What does asaccharolytic bacteria lead to?

A

periodontal disease

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15
Q

Which type of oral microbiota is predominant, and what is the major end product?

A

saccharolytic

lactic acid

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16
Q

A term for teeth adherent bacterial films

A

plaque

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17
Q

what is a facultative anaerobe?

A

Bacteria that uses primarily aerobic respiration but can go anaerobic if no oxygen is present

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18
Q

What is an obligate anaerobe?

A

bacteria that can only use anaerobic respiration

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19
Q

Difference between Gram + and Gram - bacteria

A

Gram +
3 layers with thick outer membrane (peptidoglycan)
Gram -
5 layers with a thin outer membrane (lipopolysaccharide and protein –> toxin; immunogenic)

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20
Q

Which type of bacteria is predominantly found in people who keep their teeth clean and have no periodontal disease? (gram +/-)

A

Gram +

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21
Q

What does whole saliva contain?

A

MUCINS- proteins covered with numerous saccharide (glycan) residues

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22
Q

What type of microbiota does a repeated intake of dietary carbohydrates predispose to?

A

saccharolytic microbiota

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23
Q

Why can gram + bacteria tolerate low pH caused by lactic acid production?

A

Their thick cell walls

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24
Q

What does excess lactic acid do to teeth?

A

causes caries by dissolving tooth enamel and dentin

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25
Q

Where is there an intermittent flow of proteins from serum? And what is it called?

A

beneath a healthy gingival sulcus

Gingival crevicular fluid

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26
Q

Which type of microbiota is better suited for what gingival crevicular fluid provides?

A

asaccharolytic microbiota

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27
Q

In healthy oral cavity, how do asaccharolytic bacteria digest proteins?

A

They secrete proteases which digest proteins to small peptides, which they digest (ferment)

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28
Q

What happens to amino acids during asaccharolytic fermentations?

A

AAs are deaminated to ammonia

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29
Q

What does an accumulation of ammonia in the oral cavity do?

A

It makes the gingival sulcus alkaline which prevents caries from developing beneath the gingival sulcus
(however it does cause a build up of calcium and phosphate)

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30
Q

What is the accumulation of calcium and phosphate called?

A

dental calculus

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31
Q

What happens if dental calculus is not maintained?

A

the buildup allows for assacharolytic metabolism to intensify

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32
Q

What is the cause of malodor?

A

It is from H2S.

When sulfur-containing amino acids (cysteine and methionine) are metabolized, they release H2S and ammonia.

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33
Q

What does malodor usually accompany?

A

periodontal disease

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34
Q

T/F: Collagen synthesis and degradation are central to the well being of the teeth and periodontium.

A

True

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35
Q

What is Fibrillar collagen synthesized by?

A
  1. Fibroblasts (extracellular matrix)
  2. Chondroblasts (cartilage)
  3. Osteoblasts (bone)
  4. Odontoblasts (dentin)
  5. Cementoblasts (cementum)
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36
Q

What are the top two contributors to the AA composition of alpha-1 chain of tropocollagen?

A

Glycine (33%)

Proline (14%)

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37
Q

Main steps in Biosynthesis of Collagen

A
  • mRNA is translated in the RER
  • Selected proline and lysine residues are hydroxylated
  • Selected hydroxylisine residues are glycosylated with glucose and galactose
  • three pro-a chains assemble and pass through the Golgi (is not procollagen)
  • procollagen is then secreted into the extracellular matrix (ECM)
  • The N and C terminal propeptidases are cleaved by procollagen peptidases producing Tropocollagen
  • Self-assembly of tropocollagen fibers (cross-linked) to form mature collagen fibers (via covalent crosslinking)
  • collagen may be attached to cell membranes by several types of proteins such as fibronectin and integrin
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38
Q

What mutation in collagen inhibits adequate triple helix formation?

A

mutations of glycine residues

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39
Q

What are the oral disorders related to collagen?

A

Osteogenesis imperfecta- fragile bones

Dentinogenesis imperfecta- completely missing teeth

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40
Q

Which vitamin is essential for hydroxylation?

A

Vitamin C (ascorbate)- is an antioxidant (reducing agent)

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41
Q

What enzyme do humans lack which makes them unable to synthesize ascorbate?

A

L-gulonolactone oxidase

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42
Q

Which vitamin is essential for proline and lysine hydroxylase functioning in vertebrates?

A

Ascorbate.

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43
Q

Why is the antioxidant property of Ascorbate important extracellularly?

A

Neutralizes ROS from leukocytes during inflammation

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44
Q

What is an early symptom of ascorbate deficiency?

A

the loss of gingival and periodontal membrane fibers accompanied by loosening of teeth

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45
Q

How often do the anchoring fibrils of the gingiva and periodontium turn over?

A

Every 24 hours due to tooth movements and stimulate fibroblasts to replace collagen and renew the attachment continuously

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46
Q

What develops in the absence of ascorbate?

A

Scurvy

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47
Q

Where is keratin found?

A 
hair
wool
skin
horns
fingernails
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48
Q

What is keratin composed of?

A

a-helical polypeptides

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49
Q

parakeratinized vs nonkeratinized?

A

parakeratinized- (harder)
-cells of the outer surface of the hard palate and gingival mucosa (like the skin)
nonkeratinized- (softer)
-cheeks, lips, ventral surface of tongue, soft palate (are permeable to fluids and small molecules)

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50
Q

What are the hard tissues of the tooth?

A

enamel

dentin

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51
Q

What is “hardness” related to in biological systems?

A

ability to form calcium salts

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52
Q

Does pulp demonstrate mineralization?

A

NO

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53
Q

what is the mineral in teeth that makes them hard?

A

hydroxyapatite (hydroxylapatite)

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54
Q

What is the formula of hydroxyapatite?

A

Ca10(PO4)6(OH)2 (very insoluble)

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55
Q

What percentage is enamel and dentin by weight mineral and protein?

A

Enamel- 97% mineral, less than 1% protein

Dentin- 70% mineral and 30% protein

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56
Q

What is the function of dentin?

A

to support and protect

57
Q

How is enamel formed?

A

Formed on an extracellular matrix.

Ameloblasts secrete enamelin and amelogenin which is later mineralized to form enamel

58
Q

What is the hardest substance in the body?

A

enamel

59
Q

When are ameloblasts present?

A

only during tooth development

60
Q

How is dentin formed?

A

It is formed around the pulp on an extracellular matrix of collagen and non-collagenous proteins formed by Odontoblasts

61
Q

What is the formula for fluoroapatite and why is it beneficial?

A

Ca10(PO4)6F2, it is harder than hydroxyapatite

62
Q

What does mineralization require?

A

scaffolding proteins

high concentrations of ions (the ones needed particularly)

63
Q

What is the process called of boosting the ions needed for mineralization?

A

nucleation

64
Q

What is the scaffolding protein used in mineralization of dentin?

A

collagen (mineralizes toward the pulp)

65
Q

What is the scaffolding protein used in the mineralization of enamel?

A

amelogenins (built up as crystallites), mineralizes toward the crown

66
Q

What is saliva supersaturated with?

A

Ca and phosphate ions, and buffers at around pH 7

67
Q

What does bacterial waste deposited on the tooth surface do to the pH?

A

lowers the pH

68
Q

What is and what does Dentinal Fluid do?

A

it is exuded by odontoblasts which line the pulp cavity

-purges the enamel of bacterial waste

69
Q

What is the primary function of the dental pulp?

A

to form dentin (by the odontoblasts)

70
Q

What is the bacterial waste from aerobic bacteria?

A

CO2 and water

71
Q

What is the bacterial waste from anaerobic bacteria?

A

acids, eg. lactic acid

72
Q

Finish the cascade; The deeper the plaque…

A

the more anaerobic, the more acid, the lower the pH

73
Q

What is the critical pH when the enamel begins to dissolve (Demineralization)

A

pH 5.5

74
Q

What does fluid flowing from the pulp through the tooth do?

A

helps neutralize acid and wash out wastes

75
Q

What does Calcium and Phosphate in the saliva do?

A

Helps to resist the loss of mineral

76
Q

What does Anionic Proline-Rich proteins and Statherin do?

A

Helps stabilize crystallites

77
Q

What does saliva do?

A

helps to neutralize H+ and sets a new pH

-also helps wash away wastes

78
Q

T/F: Fluorapatite is less soluble than hydroxyapatite.

A

True, and is also more resistant to demineralization

79
Q

Main ways to resist dental caries

A

-Brush and floss to minimize plaque and shift oral bacteria toward aerobic metabolism
-Minimize snacking to lower pathogenic bacteria and reduce bacterial acid production
Facilitate Dentinal Fluid effects by eating well and minimizing sugar intake
-Stimulate salivary flow by drinking adequate fluids, eating raw foods and chewing gum

80
Q

How to incorporate fluoride to resist dental caries

A
  • Use fluoridated toothpaste to create a CaF2 smear layer on teeth which maintains a low fluoride release through the day
  • Fluoride will inhibit bacterial metabolism lowering acid excretion by plaque bacteria (inhibits enolase)
  • Brush before bedtime to maximize effects during sleep when salivary flow is minimal
81
Q

What is optimal fluoride intake?

A

at or less than 1 ppm

82
Q

What is it called when you have too much fluoride intake?

A

fluorosis

83
Q

How does fluoride inhibit demineralization?

A

Protons diffuse into the hydroxyapatite crystal
React with OH groups in hydroxyapatite and
Change the crystal to an amorphous calcium monohydrogen phosphate solid that slowly dissolves

84
Q

How much fluoride must be ingested to become toxic?

A

Greater than 10ppm

85
Q

What are the effects of fluoride poisoning?

A

lack of energy

inhibits osteoblast activity more than osteoclast activity, resulting in an increased frequency of bone fractures

86
Q

At 50-100ppm, what has fluoride been shown to do?

A
  • to inhibit gluconeogenesis by binding Mg2+ ions that are needed to activate fructose 1,6 bisphosphatase.
  • Also inhibits ROS elimination by binding iron, selenium and molybdenum ions at the respective catalytic centers of catalase, peroxidase and superoxide dismutase
87
Q

What do stress induced bony microcracks attract?

A

White Blood Cells (WBCs) (monocytes)

88
Q

Describe bone remodeling

A

Monocytes differentiate into osteoclasts and remove all of the bone around a microcrack, then osteoblasts lay down new bone in response to the stresses

89
Q

In the tooth, what can and cannot be remodeled?

A

Cementum and dentin can be remodeled

Enamel cannot be remodeled because ameloblasts cannot be generated

90
Q

What is the most abundant mineral in the human body?

A

Calcium!!!

91
Q

Where is calcium maintained, intracellularly, in the human body?

A

Calcium ions are retained in the ER or in the sarcoplasmic reticulum in muscle

92
Q

What are the main salivary glands in the mouth?

A

parotid
submandibular
sublingual

93
Q

What do acinar cells secrete?

A

serous (watery) fluid

94
Q

What do tubular cells secrete?

A

mucous (viscous) fluid

95
Q

Which type of cell is associated with which salivary gland?

A

Submandibular and sublingual glands have both acinar and tubular cells.
Parotid has only acinar cells

96
Q

What are the components of saliva?

A

Water
NaCl- electrolyte
Sodium bicarbonate- stabilize tooth surface
Mucin proteins- proteoglycans that mediate viscosity
a-amylase- digests starch
Proline rich proteins
(Calcium and phosphate also present in supersaturating conditions)

97
Q

What do salivary glands excrete which aid in buffering the acids?

A

ammonia

98
Q

What does the odor or taste of food do to the saliva?

A

provides neuronal stimulus (activates cholinergic and adrenergic receptors) to the gland’s myofibrils and this stimulates SALIVARY SECRETION

99
Q

What is a dry oral cavity called, and what causes it?

A

Xerostomia
Caused by;
-loss of salivary gland due to trauma or disease
-if nasal allergies or sinus infections cause persistent mouth-breathing
-if tobacco smoking persists

100
Q

Function of mucins

A

lubricate oral mucosa and food particles and inhibit bacterial colonization

101
Q

function of Water (in saliva)

A

Facilitates clearance and inhibits bacterial colonization

102
Q

function of Amylase?

A

Digests starch in food particles, promoting bolus cohesion

103
Q

function of sodium bicarbonate, carbonic anhydrase and statherin in saliva?

A

Stabilize tooth surface

104
Q

Function of proteins in saliva?

A

Form acquired enamel pellicle

105
Q

Function of peroxidases, histatins, lysozyme and lactoferin in saliva?

A

Innate immunity that inhibits bacterial growth

106
Q

Function of salivary agglutinin and mucin

A

Innate immunity that enhances bacterial clearance

107
Q

Function of secretory immunoglobulin (sIgA) in saliva?

A

Acquired immunity that enhances bacterial clearance

108
Q

What does periodontal disease describe?

A

a mixture of diseases in which the periodontal attachment is destroyed, resulting in loose teeth

109
Q

Where does chronic periodontitis first appear?

A

gingival sulcus

110
Q

Why are mouthwashes typically at a 15-20% alcohol level?

A

to maintain “essential oil” solubility

111
Q

T/F: Longtime daily users of antiseptic mouthwash has been linked to an increased risk of oral cancer.

A

True

112
Q

What is the downside of long time users of alcohol free mouthwashes?

A

interferes with taste and probiosis (protection by the good bacteria)

113
Q

What are prostaglandins and thromboxanes and what are they derived from?

A

Proinflammatory eicosanoids

Derived from linoleic acid (essential fatty acid)

114
Q

What enzyme catalyzes the formation of prostaglandins and thromboxanes?

A

COX enzymes (some studies suggest that COX inhibitors might control chronic periodontitis)

115
Q

2 examples of COX inhibitors

A

aspirin

ibuprofen

116
Q

What dietary compound has coincided with an increase in caries?

A

sucrose

117
Q

What is the DMFT (Decayed Missing Filled Teeth) for daily sugar consumption?

A

1 DMFT for every 25g of sugar consumed daily

118
Q

What is a material at LLU used to fill root canals?

A

MTA (Mineral Trioxide Aggregate)

119
Q

What does calcium hydroxide induce when used as a pulp-capping agent or placed in the root canal in contact with healthy pulpal or periodontal tissue?

A

induces a calcified barrier

120
Q

What is the pH of calcium hydroxide?

A

pH of 12.5

121
Q

What derives the calcium ions that form the barrier from the use of calcium hydroxide?

A

The barrier is derived entirely from the bloodstream and not from the calcium hydroxide

122
Q

Why is the hydroxyl group an important component of calcium hydroxide?

A

The hydroxyl group provides an alkaline environment which encourages repair and active calcification

123
Q

Why is alkaline pH important in the oral cavity?

A
  • neutralizes lactic acid from osteoclasts, thus preventing a dissolution of the mineral components of dentin
  • activates alkaline phosphatases which play an important role in hard tissue formation
124
Q

When using MI paste, what is the “key”

A

The key in remineralization of the tooth is the integrity of the tooth surface, if it remains intact, uncavitated, remineralization is possible

125
Q

What are the two main chemical agents used in tooth whiteners?

A 
carbamide peroxide
hydrogen peroxide (the active whitening ingredient)
126
Q

What are the two routes of blood clot formation (hemostasis)?

A

Intrinsic

Extrinsic

127
Q

When is the inrinsic pathway instigated and when is the extrinsic pathway instigated?

A

Intrinsic- when blood comes into physical contact with abnormal vessel wall (slight damage from the inside)
Extrinsic- initiated by factors released from injured tissues (outside; tissue factor is revealed which normally doesn’t touch the blood)

128
Q

Describe the Final Common Pathway in the Coagulation Cascade

A
  • Va activates Prothrombin (II) to Thrombin (IIa)
  • Thrombin (IIa) activates Fibrinogen (I) to Fibrin (Ia)
  • XIIIa then catalyzes Fibrin (Ia) to Cross-linked fibrin clot
129
Q

What is hemophilia?

A

Genetic mutations of coagulation proteins that cause life-long excessive bleeding

130
Q

Why are older adults predisposed to clotting?

A

because of blood vessel degeneration or a decreased blood flow

131
Q

T/F: Chronic inflammation associated with chronic periodontitis enhances clotting systemically, but inhibits blood clotting locally.

A

True

132
Q

What is the concern about a tooth extraction in an elderly individual?

A

Clots may obstruct small arteries or detach as an embolus and cause an embolism elsewhere in the body which can cause heart attack, stroke, pulmonary obstruction or peripheral necrosis

133
Q

What are the drugs that reduce clot formation?

A 
Heparin
Coumadin
Warfarin
Aspirin
Ibuprofen
134
Q

What are the drugs that promote clotting?

A

Epsilon-aminocaproic acid

Tranexamic acid

135
Q

What are astringents? and what are the best astringents used in dentistry?

A

Astringents are substances that tend to shrink or constrict body tissues.
-Zinc, iron and aluminum salts are best in dentistry
(AlCl3 is used commonly in gingival retraction)

136
Q

How do aluminum compounds work as hemostatic agents and astringents?

A

Result from its ability to precipitate protein, constrict blood vessels and extract fluid from tissues

137
Q

What 3 mediums in particular is AlCl3 soluble in?

A

Water (highly)
Alcohol (freely)
Glycerin

138
Q

What is Ferric subsulfate solution?

A

it is an astringent that results in agglutination of surface proteins (closes wound) on an open wound, leading to quick and efficient hemostasis

139
Q

What type of secondary structure does keratin have?

A

a-helix

Biochem (8 decks)

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