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Periodontology > Pathogenesis > Flashcards

Pathogenesis Flashcards

1
Q

What is the periodontium and what is its function

A

The tissues which help support the teeth, by attaching the tooth to the bone tissues of the jaw cavity, and providing proprioception.

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2
Q

The gingiva has non-keratinized tissue

True or false

A

True. It comprises of both keratinized and non-keratinized

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3
Q

What is the junction between the attached gingiva and alveolar mucosa called?

A

The mucogingival junction

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4
Q

What is the periodontal ligament?

A

Soft, vascular, cellular connective tissue

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5
Q

What are the functions of the PDL

A
  • Shock absorption
  • Transmission of occlusal forces to bone
  • Formative and remoedlling
  • Participates in formation of resorption of cementum and bone
  • Supplied nutrients to cementum, bone and gingiva
  • Nerve endings are pain, mechano and pressure receptors
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6
Q
A
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7
Q

What are sharpeys fibers?

A

Terminal ends of the principal PDL fibers that insert into the cementum and periosteum

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8
Q
A
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9
Q

List 3 risk factors for gingivitis

A
  1. Pregnancy or other hormonal
  2. Leukemia
  3. Oral Contraceptive
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10
Q

Periodontitis has been linked to what systemic conditions

A
  • Heart disease
  • Pre-term birth
  • Diabetes
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11
Q

Periodontitis is host modulated

True or false

A

True

So it is modulated by the hosts immune response

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12
Q

What bacteria are associated with health of the gingiva?

A

Streptococci and Gram + rods

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13
Q

What bacteria may be seen in gingiva that is transitioning to an unhealthy state

A

Fusobacterium and Prevotella

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14
Q

What bacteria are often seen in gingiva with periodontitis

A
  • P. Gingivalis
  • Gram negative rods
  • Spirochetes
  • Aggregatibacter acinomycetemcomitans
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15
Q

Describe the sub-gingival biofilm

A

Highly organised communities of bacteria which exhibit complex cooperation, and exist in numerous microenvironments with differing pH, oxygen, and electrical potentials. They resist the usual host defences and resist systemic and local antibiotics and antimicrobial agents. Tey function as a complex multi-cellular organism!

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16
Q

The clinical expression of perio disease is the result of an interaction of four main factors:

A
  1. The host
  2. The plaque bacteria
  3. Modifying factors
  4. Environmental risk factors
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17
Q

List 7 local risk factors which hinder plaque removal

A
  1. Iatrogenic damage
  2. Rotated teeth
  3. Crowding
  4. Calculus
  5. Overhangs
  6. Ortho appliances
  7. Deep pockets
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18
Q

List 5 systemic risk factors for perio

A
  1. Diabetes
  2. Smoking
  3. Genetic factors
  4. Immunosuppression
  5. Medications
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19
Q

Whilst periodontal inflammation is initiated by plaque, the severity and extent of tissue damage is determined by:

A

The host response of the individual

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20
Q

3 behavioural risk factors for perio

A
  1. Oral hygiene
  2. Smoking
  3. Stress
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21
Q

What are two biological risk factors for perio

A
  1. Systemic disease
  2. Genetics
22
Q

The progression of periodontal disease is linear

True or false

A

False. Occurs in exacerbatiosn and remissions

23
Q

Loe et al 1986 is a landmark study for perio. What did we find out.

A

Sri lankan tea labourers were observed and found that men have worse perio than women, more disease in lower SES groups, and 82% slowly progresses. Only 8% rapidly progresses

AND

in 11% no progression!

24
Q

What are three risk factors you might pick up on in the medical history

A
  1. Smoking
  2. Diabetes
  3. Medications
25
Q

What inflammatory cytokines are involved in the pathogenesis of perio

A
  • IL-1
  • IL-6
  • TNAa
  • PGE2
26
Q

The inflammatory mediators in perio

A
27
Q

The inflammatory cytokines (IL1, IL6, TNAa, PGE2) result in stimulation of Fibroblasts whichand osteoblasts which produce.

A
  • Fibroblasts produce MMPs which destroy tissue
  • Osteoblasts produce RANKL which results in bone resorption
28
Q

What areht early and late cells seen in pathogenesis of perio

A
  • Early - Neutrophils and Macrophages
  • Late - B cells and plasma cells
29
Q

Which is associated with gingivitis/perio

a) Gram positive bacteria
b) Gram negative bacteria

A

b) Gram negative anaerobes

30
Q

Smoekrs are x more likely to have periodontitis.

Why? (4)

A

4x

  • Reduction in gingival blood flow
  • Impaired white cell function
  • Impaired wound healing
  • Increased production of inflammatory cytokines
31
Q

Well controlled diabetes is indicated by a glycated haemoglobin level of:

A

6.5% or 48mmol/mol or lower.

This means there is no increased risk of period.

PAtients with over 9% = 2-3x more likely

32
Q

Patients with HbA1 levels greater than 9% aretimes more likely to have perio.

A

2-3 x more likely

33
Q

Why does uncntrolled diabetes result in greater perio rates?

A
  • Endothelial disfunction
  • Neutrophil dysfunction (reduced apoptosis)
  • More cytokines and RANKL
34
Q

Why do people with diabetes have poor healing?

A

decreased wound healing, and an imbalance of collagen turnover favouring dstruction

35
Q

List 5 systemic risk factors for perio

A
  • Tobacco use
  • Diabetes
  • Stress
  • Medication (gingival hyperplasia)
  • Hormonal changes et pregnancy
36
Q

Severe periodontitis has been found to affect % of adults worldwide.

A

11%

37
Q

What is the major determinent of susceptibility to perio disease?

A

Pts response to bacterial challenge

38
Q

List 4 acquired local modifiable risk factors for perio

A
  1. Plaque and calculus
  2. Partial dentures
  3. Open contacts
  4. Overhanging and poorly contoured restorations
39
Q

List 4 anatomical modifiable local risk factors for perio

A
  1. Malpositioned teeth
  2. Furcations
  3. Root grooves and concavities
  4. Enamel peals
40
Q

List 6 non-modifiable systemic risk factors for perio

A
  1. SES
  2. Genetics
  3. Adolescence
  4. Pregnancy
  5. Age
  6. Leukaemia
41
Q

What systemic cause mighty ou consider if you see a patient present with multiple lateral periodontal abscesses?

A

Undiagnosed Diabetes

42
Q

Name 2 ways in which stress might contribute to increased risk of perio disease

A
  1. Prolonged stress can cause suppression of the immune system which might tip the host-bacterial interaction in favour of bacteria
  2. Stress affects how well people look after themselves - less effective plaque removal, increased tobacco use, poor nutrition
43
Q

What is the biologial mechanism by which period is thought to influence systemic health

A

Gingival inflammation compromises the barrier function of the gingival epithelium, leading to an ingress of bacteria or inflammatory products into systemic circulation.

44
Q

3 established associations between periodontal disease and systemic conditions

A
  • Cardiovascular disease
  • Diabetes
  • Adverse pregnancy outcomes
45
Q
A
46
Q

Lit 5 causes of gingival overgrowth

A
  1. Irritation
  2. Plaque
  3. Calculus
  4. Repeated friction or trauma
  5. Medications
47
Q

Exampes of medications which can cause gingival overgrowth

A
  1. Calcium Channel Blockers (Amlodipine, Nifedipine)
  2. Cyclosporins
  3. Phenytoin
48
Q

How can polypharmacy be a cause of gingival overgrowth

A

Can lead to drying and loss of salivary protection, leading to mouth breathing. therefore mouth breathing can cause gingivitis

49
Q

2 examples of calcium channel blockers

A
  • Amlodipine
  • Nifedipine
50
Q

What % of people get severe chronic periodontitis

A

10-15%

51
Q

How do you tell between an endo and a perio abscess if both conditions are present at the same time?

A

If no endo component, the tooth will be vital.

52
Q
A

Periodontology (7 decks)

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