Path 2

Question 1

Matrix Metaloproteinases (MMPs)

Answer 1

Proteases – degrade extracellular matrix
* collagen, gelatin, elastin
Use ions – Ca, Mg

Question 2

Inhibitors of MMPs

Answer 2

chemically modified tetracycline (stains teeth because binds to Ca in HA crystal?)
low dose doxycycline

Binds to Ca found in MMPs
good for inhibiting the destruction of periodontal structures

Question 3

Diagnosis of Periodontal disease – CREVICULAR FLUID

Answer 3

Enzymes, Ig molecules, infalmmatory mediators

Fluid increases with inflammation

Question 4

Arrestin

Answer 4

tetracyline powder
Inhibits MMP activity

Injected into periodontal pocket

Question 5

Inflammation

Answer 5

visually –> redness, spongy, bleeding on probing

Question 6

Arachidonic acid metabolites

Answer 6

PGE2 –> inflamed tissues express many PGE2
Capable of gingival inflammation and bone resorption

Leukotrienes –> inflammatory reaction

Marker for disease activity

Question 7

Pathology in periodontal disease is contributed to….

Answer 7

PGE2, IL-1, TNF alpha

Question 8

PGE2 (arachidonic acid metabolites)

Answer 8

vasopermeability
Vasodilation
inducer of MMP secretion – monocytes and fibroblasts
osteoclast bone resorption (action with IL1 and TNF alpha)

Question 9

Histamine acts on the MAST CELL

Answer 9

releases leukotrienes

Question 10

Acrachidonic acid metabolites 2-3 FOLD INCREASE

Answer 10

gingivitis

Question 11

Arachidonic acid metabolites 5-6 FOLD INCREASE

Answer 11

active diesase progression – based on longitudinal attachment loss

Question 12

GCF PGE2 levels ______ prior to attachement level changes

Answer 12

INCREASES

Question 13

Suppresion of PGE2 synthesis (COX 1 COX2)

Answer 13

NSAIDS

diminishes attachment and bone loss

Question 14

GCF PGE2 levels are substanitally higher in _____ risk patients

Answer 14

HIGH

Refractory – pts not responding to treatment
Early onset
diabetic

Associated with hyperresponisve monocyte PGE2 traits systemically

Question 15

Hyperresponsiveness

Answer 15

Chronic infection and LPS exposure –> systemic elevations of TNF alpha IL 1 and GM CSF (all capable of up regulating PGE2 secretion)

Genetic region of the HLA -DR – TNF beta genes

Question 16

Primarily see EDEMA in preriodontal disease

Answer 16

TRUE

Question 17

PGE2 and Leukotrienes

Answer 17

cause edema, fever, and pain

Question 18

Lipoxins

Answer 18

turn off inflammation

Come from endogenous fatty acids

Question 19

Resolvins

Answer 19

omega 3

anti-inflammatory

Question 20

PGE2

Answer 20

proinflammatory

Question 21

Disease results when there is too much “on” signals or not enough “off” signal, which results in chronic inflammation.

Answer 21

TRUE

Question 22

Systemic modifications of periodontal disease status

Answer 22

Host stress
Physical stress
Social effectors
Environmental stress

Question 23

Host stress

Answer 23

Mediated by CNS neuropeptides

* corticotropin releasing factor

Question 24

CRF

Answer 24

depresses lymphocyte function
Inhibit antibody secretion
impairs neutorphil phagocytic and killing function
Up regulates realase of IL1 and TNF alpha from monocytes