Pathogenesis

Question 1

What is pathogenesis`

Answer 1

Origin and development of a disease

Question 2

What is periodontal disease?

Answer 2

Chronic disease that is multifactorial between the biofilm, host and inflammation

Question 3

What is the relationship between bacteria and inflammation?

Answer 3

Bacteria - Initiates

Inflammation - Perpetuates

Question 4

What is gingival health? (5)

Answer 4

1. Minimal to no bleeding on probing
2. Pink gingiva
3. Firmly attached
4. Shallow probing depths
5. Minimal to no bone loss

Question 5

What are the epithelial portions in gingiva?

Answer 5

1. Oral
2. Sulcular/ Crevicular
3. Junctional

Question 6

How does gingiva stay healthy (5)

Answer 6

1. Maintains epithelial barrier
2. Sloughing/Turnover of epithelium
3. Antibodies
4. Neutrophils
5. Macrophages

Question 7

Where are antibodies found? (3)

Answer 7

1. Saliva
2. GCF
3. Capillaries

Question 8

What is the histopathology of gingivitis?

Answer 8

1. Tissue infiltrated by defense cells
2. Release of enzymes
3. Causes collagen depletion
4. Reversible

Question 9

How did Page and Schroder describe gingival inflammation

Answer 9

Initial
Early
Established
Advanced

Question 10

What happens in the Initial Stage of gingival inflammation?

Answer 10

1. Neutrophils dominant
2. Increased vascular permeability
3. Increased vasodilation

Appears in 2-4 days

Question 11

What happens in Early Stage of gingival inflammation? (4)

Answer 11

1. T cells dominate the lesion
2. Increased GCF
3. Degeneration of fibroblasts– loss of CT
4. Collagen fibroblasts– loss of collagen

Appears in 4-7 days

Question 12

What happens in the Established Stage of gingival inflammation? (5)

Answer 12

1. Chronic Gingivitis
2. Plasma Cells–> B cells dominate the lesion
3. Increased CT breakdown
4. Increased Collagen depletion
5. JE proliferate in apical direction

Appears in 2-3 weeks

Question 13

What happens in the Advanced Stage of gingival inflammation?

Answer 13

1. Transition to perio dx
2. B- cell predominates still
3. Bone loss occurs by osteoclast resorbing alveolar bone

Question 14

What are the specific virulence factors (5)

Answer 14

1. LPS
2. Protease – Bacterial Enzyme
3. Fimbriae
4. Microbial Invasion
5. Bacterial DNA

Question 15

What are the Host derived inflammatory mediators? (3)

Answer 15

1. Cytokines
2. Prostaglandin
3. MMP (matrix metalloproteinases)

Question 16

What are cytokines?

Answer 16

Locally acting soluble messengers that amplify immune response and induce their own expression

Question 17

What are prostaglandins?

Answer 17

1. Lipid compound from arachadonic acid
2. Metabolized by COX1 & 2
3. Increase vasodilation/ inflammation
4. Induce MMP and Bone Resorption

Question 18

What are MMPs?

Answer 18

Enzymes that break down structural proteins like collagens

Matrix metalloproteinases

Question 19

What are the Inflammatory mediators in perio disease? (4)

Answer 19

1. Interleukin (IL-1, IL-6)
2. TNF Alpha
3. Prostaglandin (PGE2)
4. Chemokines - Direct migration of WBCs

Question 20

What are Interleukins?

Answer 20

Type of cytokines linked to innate immune response (they stimulate the immune response)

Question 21

What is TNF alpha?

Answer 21

1. Inflammatory mediator
2. Increases neutrophil activity
   (TNF Alpha - Neutrophils)

Question 22

What cells makes/secretes prostaglandin?

Answer 22

1. Macrophages

2. Fibroblasts

Question 23

What are chemokines?

Answer 23

1. Chemotactic molecules (Direct WBC to inflammation)

2. Leukocyte migration role

Question 24

How does a pocket develop?

Answer 24

1. Biofilm causes inflammation which causes sulcus to deepen

2. Defense cells cause CT breakdown –> apical movement of JE

Question 25

What is RANKL?

Answer 25

Pro osteoclast that regulates bone formation

Question 26

Discuss the resolution of inflammation?

Answer 26

ACTIVE process 1. Lipoxins 2. Resolvins 3. Protectins

Question 27

What is innate immunity

Answer 27

1. Non specific barrier to infection 2. Lysozyme 3. Mucin 4. Peroxidase 5. Phagocytic cells (monocytes, macrophages, neutrophils

Question 28

What are the defensive components of saliva? (5)

Answer 28

1. Antibodies 2. Lactoferrin 3. Mucin 4. Lysozyme 5. Perioxidase

Question 29

What are GCF defensive functions? (3)

Answer 29

1. Antibodies 2. Neutrophils 3. Flushing action

Question 30

What is in epithelium to make it a defensive tissue?

Answer 30

Keratin is the barrier

Question 31

What are senteniel cells?

Answer 31

1. Macrophage and dendritic cells (Antigen Presenting Cells and Phagocytic) 2. Provide innate and adaptive immunity

Question 32

What are neutophils?

Answer 32

Type of White Blood Cell 1. Phagocytic Cells 2. Low grade defense- First line of defense in innate immunity

Question 33

What is adaptive immunity?

Answer 33

1. Later immune response with plasma cells/B Cells 2. Slower and more complex 3. Antigen specific 4. Chronic periodontitis is adaptive

Question 34

What are the 3 types of Antigen Presenting Cells and what do they do?

Answer 34

1. B Cell 2. Macrophage 3. Dendritic Cell Go to the lymph node to present to the T Cell

Question 35

REPEAT CARD- IGNORE how do antigen presenting cells function

Answer 35

Go to lymph node and react with T Cells

Question 36

What are T cells?

Answer 36

Cells in adaptive immunity- Develop in the bone marrow and go to the Thymus

Question 37

What are antibodies? What is the most common type?

Answer 37

1. Made by B cells 2. Immunoglobulin for specific antigen Most common is IgG

Question 38

Discuss Host susceptbility

Answer 38

1. Complex immune and inflammatory process 2. Some patients hyper respond 3. Response can be disproportionate

Question 39

What is the role of Toll like Receptors?

Answer 39

proteins on sentinel cell (Macrophages and Dendritic Cells) that recognize pathogens

Question 40

What are NETS?

Answer 40

Neutrophil extra cellular traps

Question 41

What are the main Antibodies to perio disease?

Answer 41

Mainly IgG some IgA and IgM

Question 42

What antibody is present in saliva?

Answer 42

IgA