Pathogenesis Flashcards
What is pathogenesis`
Origin and development of a disease
What is periodontal disease?
Chronic disease that is multifactorial between the biofilm, host and inflammation
What is the relationship between bacteria and inflammation?
Bacteria - Initiates
Inflammation - Perpetuates
What is gingival health? (5)
- Minimal to no bleeding on probing
- Pink gingiva
- Firmly attached
- Shallow probing depths
- Minimal to no bone loss
What are the epithelial portions in gingiva?
- Oral
- Sulcular/ Crevicular
- Junctional
How does gingiva stay healthy (5)
- Maintains epithelial barrier
- Sloughing/Turnover of epithelium
- Antibodies
- Neutrophils
- Macrophages
Where are antibodies found? (3)
- Saliva
- GCF
- Capillaries
What is the histopathology of gingivitis?
- Tissue infiltrated by defense cells
- Release of enzymes
- Causes collagen depletion
- Reversible
How did Page and Schroder describe gingival inflammation
Initial
Early
Established
Advanced
What happens in the Initial Stage of gingival inflammation?
- Neutrophils dominant
- Increased vascular permeability
- Increased vasodilation
Appears in 2-4 days
What happens in Early Stage of gingival inflammation? (4)
- T cells dominate the lesion
- Increased GCF
- Degeneration of fibroblasts– loss of CT
- Collagen fibroblasts– loss of collagen
Appears in 4-7 days
What happens in the Established Stage of gingival inflammation? (5)
- Chronic Gingivitis
- Plasma Cells–> B cells dominate the lesion
- Increased CT breakdown
- Increased Collagen depletion
- JE proliferate in apical direction
Appears in 2-3 weeks
What happens in the Advanced Stage of gingival inflammation?
- Transition to perio dx
- B- cell predominates still
- Bone loss occurs by osteoclast resorbing alveolar bone
What are the specific virulence factors (5)
- LPS
- Protease – Bacterial Enzyme
- Fimbriae
- Microbial Invasion
- Bacterial DNA
What are the Host derived inflammatory mediators? (3)
- Cytokines
- Prostaglandin
- MMP (matrix metalloproteinases)
What are cytokines?
Locally acting soluble messengers that amplify immune response and induce their own expression
What are prostaglandins?
- Lipid compound from arachadonic acid
- Metabolized by COX1 & 2
- Increase vasodilation/ inflammation
- Induce MMP and Bone Resorption
What are MMPs?
Enzymes that break down structural proteins like collagens
Matrix metalloproteinases
What are the Inflammatory mediators in perio disease? (4)
- Interleukin (IL-1, IL-6)
- TNF Alpha
- Prostaglandin (PGE2)
- Chemokines - Direct migration of WBCs
What are Interleukins?
Type of cytokines linked to innate immune response (they stimulate the immune response)
What is TNF alpha?
- Inflammatory mediator
- Increases neutrophil activity
(TNF Alpha - Neutrophils)
What cells makes/secretes prostaglandin?
- Macrophages
2. Fibroblasts
What are chemokines?
- Chemotactic molecules (Direct WBC to inflammation)
2. Leukocyte migration role
How does a pocket develop?
- Biofilm causes inflammation which causes sulcus to deepen
2. Defense cells cause CT breakdown –> apical movement of JE
What is RANKL?
Pro osteoclast that regulates bone formation
Discuss the resolution of inflammation?
ACTIVE process
- Lipoxins
- Resolvins
- Protectins
What is innate immunity
- Non specific barrier to infection
- Lysozyme
- Mucin
- Peroxidase
- Phagocytic cells (monocytes, macrophages, neutrophils
What are the defensive components of saliva? (5)
- Antibodies
- Lactoferrin
- Mucin
- Lysozyme
- Perioxidase
What are GCF defensive functions? (3)
- Antibodies
- Neutrophils
- Flushing action
What is in epithelium to make it a defensive tissue?
Keratin is the barrier
What are senteniel cells?
- Macrophage and dendritic cells (Antigen Presenting Cells and Phagocytic)
- Provide innate and adaptive immunity
What are neutophils?
Type of White Blood Cell
- Phagocytic Cells
- Low grade defense- First line of defense in innate immunity
What is adaptive immunity?
- Later immune response with plasma cells/B Cells
- Slower and more complex
- Antigen specific
- Chronic periodontitis is adaptive
What are the 3 types of Antigen Presenting Cells and what do they do?
- B Cell
- Macrophage
- Dendritic Cell
Go to the lymph node to present to the T Cell
REPEAT CARD- IGNORE
how do antigen presenting cells function
Go to lymph node and react with T Cells
What are T cells?
Cells in adaptive immunity- Develop in the bone marrow and go to the Thymus
What are antibodies?
What is the most common type?
- Made by B cells
- Immunoglobulin for specific antigen
Most common is IgG
Discuss Host susceptbility
- Complex immune and inflammatory process
- Some patients hyper respond
- Response can be disproportionate
What is the role of Toll like Receptors?
proteins on sentinel cell (Macrophages and Dendritic Cells) that recognize pathogens
What are NETS?
Neutrophil extra cellular traps
What are the main Antibodies to perio disease?
Mainly IgG
some IgA and IgM
What antibody is present in saliva?
IgA
