Oral Health and Systemic Disease

Question 1

biologically plausible mechanisms

Answer 1

oral bacteria, bacterial products, or local inflammation spreading to distant sites

Question 2

bacteremia

Answer 2

presence of microbes in the blood stream due to tissue injury, medical or dental procedures
might be asymptomatic
higher risk for immunocompromised individuals

Question 3

septicemia

Answer 3

bacteria multiplying in the blood stimulating a body wide response

Question 4

septic shock

Answer 4

sepsis causing dangerously low blood pressure, therefore not enough blood reaching organs

Question 5

focal infection

Answer 5

chronic oral infections by subgingival biofilms or periapical infections
bacteria or their products enter the gingiva
immune cells react by producing cytokines, can act locally

Question 6

adverse immune response

Answer 6

cytokines produced in focal infection can enter the circulation
can cause other organs to have an adverse immune response
systemic diseases

Question 7

examples of oral health affecting systemic health

Answer 7

atherosclerosis
rheumatoid arthritis
pregnancy
cancer
diabetes
respiratory disease
endocarditis

Question 8

atherosclerosis

Answer 8

thickening and stiffening of arteries with accumulation of plaque in artery walls (fat, cholesterol, fibrosis, necrotic tissue)
“foam cells” - macrophage full of lipids

Question 9

periodontitis and atherosclerosis associations

Answer 9

improving periodontal health
reduces system inflammation
reduces subclinical markers of atherosclerosis
decreases progression of carotid athersclerosis

Question 10

P.gingivalis infection of rabbits

Answer 10

with high fat diet leads to local bone loss, but systemic inflammation and atherosclerotic lesions

Question 11

P.gingivalis and atherosclerosis

Answer 11

-transcytosis or transmigration of bacteria
-recruits leukocytes
-leads to smooth muscle proliferation
-stimulates fat uptake by macrophages
-stimulates MMP release by neutrophils
-stimulates platelet aggregation
-TLR-2 dependent

Question 12

P.gingivalis and rheumatoid arthritis

Answer 12

autoimmune disease
inflammation and thickening of joint capsule, degradation of cartilage and bone loss
deposition of immune complexes on the joint membrane (Type 3 hypersensitivity)

Question 13

rheumatoid factor

Answer 13

an autoantibody (IgM) that binds to the Fc region of IgG
anti-citrullinated proteins autoantibodies

Question 14

citrulline

Answer 14

an amino acid not encoded by one of the 64 codons
enzymatically arginine deiminases or peptylarginine deiminase (PAD)

Question 15

p.gingivalis and rheumatoid arthritis requires

Answer 15

molecular mimicry
the citrullinated host proteins must resemble something citrullinated by PAD

Question 16

p.gingivalis and rheumatoid arthritis mechanism

Answer 16

arginine is converted to citrulline by p.gingivalis PAD
citrullination changes antigenicity of peptide (B cell can recognize)
citrullinated proteins are presented in HLA class II to T helper cells
antibodies against the citrullinated proteins (ACPAs) are produced
humans also have PAD which also converts arginine to citrulline, the citrullinated host proteins are recognized by ACPAs
complex may deposit in the joints and activate complements, plus other immune response, lead to local inflammation in the joint and may lead to rheumatoid arthritis

Question 17

fusobacterium nucleatum

Answer 17

Gram-negative anaerobic bacterium
in supra-gingival and sub-gingival dental plaques
able to interact with other species of bacteria, promoting dental plaque development
“bridging” bacterium
potential periodontal pathogen
low-birth weight, pre-term birth, miscarriage
can cross placenta
associated with colorectal cancer

Question 18

F. nucleatum and cancer

Answer 18

adhesin FadA
E-cadherin-FadA interaction to bind endothelial cells
activation of oncogenic and inflammatory genes

Question 19

F. nucleatum and pregnancy

Answer 19

adhesin FadA
E-cadherin-FadA interaction to bind endothelial cells
crosses the endothelium and colonize the fetal placental compartment
TLR4-dependent inflammatory responses

Question 20

p. gingivalis and cancer

Answer 20

associated with oral squamous cell carcinoma, orodigestive cancer, pancreatic cancer
immune evasion strategies can overlap with oncogenic signaling pathways (gingipains)

Question 21

oral health and diabetes

Answer 21

increase risk of periodontitis severity
increase glucose in saliva
can reduce salivary flow
affects immune cell functions: increase inflammation in periodontium, increased production TNFa, reduced effectiveness in bacterial killing
functions of periodontal ligament cells, osteoblasts, osteocytes (reduce bone formation)