Pathogenesis Flashcards
What is the periodontium and what is its function
The tissues which help support the teeth, by attaching the tooth to the bone tissues of the jaw cavity, and providing proprioception.
The gingiva has non-keratinized tissue
True or false
True. It comprises of both keratinized and non-keratinized
What is the junction between the attached gingiva and alveolar mucosa called?
The mucogingival junction
What is the periodontal ligament?
Soft, vascular, cellular connective tissue
What are the functions of the PDL
- 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
What are sharpeys fibers?
Terminal ends of the principal PDL fibers that insert into the cementum and periosteum
List 3 risk factors for gingivitis
- Pregnancy or other hormonal
- Leukemia
- Oral Contraceptive
Periodontitis has been linked to what systemic conditions
- Heart disease
- Pre-term birth
- Diabetes
Periodontitis is host modulated
True or false
True
So it is modulated by the hosts immune response
What bacteria are associated with health of the gingiva?
Streptococci and Gram + rods
What bacteria may be seen in gingiva that is transitioning to an unhealthy state
Fusobacterium and Prevotella
What bacteria are often seen in gingiva with periodontitis
- P. Gingivalis
- Gram negative rods
- Spirochetes
- Aggregatibacter acinomycetemcomitans
Describe the sub-gingival biofilm
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!
The clinical expression of perio disease is the result of an interaction of four main factors:
- The host
- The plaque bacteria
- Modifying factors
- Environmental risk factors
List 7 local risk factors which hinder plaque removal
- Iatrogenic damage
- Rotated teeth
- Crowding
- Calculus
- Overhangs
- Ortho appliances
- Deep pockets
List 5 systemic risk factors for perio
- Diabetes
- Smoking
- Genetic factors
- Immunosuppression
- Medications
Whilst periodontal inflammation is initiated by plaque, the severity and extent of tissue damage is determined by:
The host response of the individual
3 behavioural risk factors for perio
- Oral hygiene
- Smoking
- Stress
What are two biological risk factors for perio
- Systemic disease
- Genetics
The progression of periodontal disease is linear
True or false
False. Occurs in exacerbatiosn and remissions
Loe et al 1986 is a landmark study for perio. What did we find out.
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!
What are three risk factors you might pick up on in the medical history
- Smoking
- Diabetes
- Medications
What inflammatory cytokines are involved in the pathogenesis of perio
- IL-1
- IL-6
- TNAa
- PGE2
The inflammatory mediators in perio
The inflammatory cytokines (IL1, IL6, TNAa, PGE2) result in stimulation of Fibroblasts whichand osteoblasts which produce.
- Fibroblasts produce MMPs which destroy tissue
- Osteoblasts produce RANKL which results in bone resorption
What areht early and late cells seen in pathogenesis of perio
- Early - Neutrophils and Macrophages
- Late - B cells and plasma cells
Which is associated with gingivitis/perio
a) Gram positive bacteria
b) Gram negative bacteria
b) Gram negative anaerobes
Smoekrs are x more likely to have periodontitis.
Why? (4)
4x
- Reduction in gingival blood flow
- Impaired white cell function
- Impaired wound healing
- Increased production of inflammatory cytokines
Well controlled diabetes is indicated by a glycated haemoglobin level of:
6.5% or 48mmol/mol or lower.
This means there is no increased risk of period.
PAtients with over 9% = 2-3x more likely
Patients with HbA1 levels greater than 9% aretimes more likely to have perio.
2-3 x more likely
Why does uncntrolled diabetes result in greater perio rates?
- Endothelial disfunction
- Neutrophil dysfunction (reduced apoptosis)
- More cytokines and RANKL
Why do people with diabetes have poor healing?
decreased wound healing, and an imbalance of collagen turnover favouring dstruction
List 5 systemic risk factors for perio
- Tobacco use
- Diabetes
- Stress
- Medication (gingival hyperplasia)
- Hormonal changes et pregnancy
Severe periodontitis has been found to affect % of adults worldwide.
11%
What is the major determinent of susceptibility to perio disease?
Pts response to bacterial challenge
List 4 acquired local modifiable risk factors for perio
- Plaque and calculus
- Partial dentures
- Open contacts
- Overhanging and poorly contoured restorations
List 4 anatomical modifiable local risk factors for perio
- Malpositioned teeth
- Furcations
- Root grooves and concavities
- Enamel peals
List 6 non-modifiable systemic risk factors for perio
- SES
- Genetics
- Adolescence
- Pregnancy
- Age
- Leukaemia
What systemic cause mighty ou consider if you see a patient present with multiple lateral periodontal abscesses?
Undiagnosed Diabetes
Name 2 ways in which stress might contribute to increased risk of perio disease
- Prolonged stress can cause suppression of the immune system which might tip the host-bacterial interaction in favour of bacteria
- Stress affects how well people look after themselves - less effective plaque removal, increased tobacco use, poor nutrition
What is the biologial mechanism by which period is thought to influence systemic health
Gingival inflammation compromises the barrier function of the gingival epithelium, leading to an ingress of bacteria or inflammatory products into systemic circulation.
3 established associations between periodontal disease and systemic conditions
- Cardiovascular disease
- Diabetes
- Adverse pregnancy outcomes
Lit 5 causes of gingival overgrowth
- Irritation
- Plaque
- Calculus
- Repeated friction or trauma
- Medications
Exampes of medications which can cause gingival overgrowth
- Calcium Channel Blockers (Amlodipine, Nifedipine)
- Cyclosporins
- Phenytoin
How can polypharmacy be a cause of gingival overgrowth
Can lead to drying and loss of salivary protection, leading to mouth breathing. therefore mouth breathing can cause gingivitis
2 examples of calcium channel blockers
- Amlodipine
- Nifedipine
What % of people get severe chronic periodontitis
10-15%
How do you tell between an endo and a perio abscess if both conditions are present at the same time?
If no endo component, the tooth will be vital.
