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Periodontics > Pathogenesis > Flashcards

Pathogenesis Flashcards

1
Q

Describe 4 host defence mechanisms

A
  1. Saliva (general feature)
  2. Epithelial barrier (general feature)
  3. Inflammatory response
  4. Immune response
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2
Q

Describe 2 purposes of inflammation

A
  1. Isolate, neutralise and remove cause

2. Initiate healing and repair

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3
Q

Describe the role of inflammatory response in periodontal disease

A

Periodontal pathogens release LPS and virulence factors leading to inflammatory response

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4
Q

Describe what occurs when the bacterial challenge outweighs the immune response

A
  • Bacterial insult overwhelms inflammatory response
  • Dysbioitic biofilm forms from periodontal pathogens
  • State of chronic inflammation occurs
  • Tissue destruction due to chronic inflammation
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5
Q

Describe the inflammatory response of the body

A
  • Rapid
  • Non-specific
  • Soluble effectors and cellular component
  • Cytokines important in the regulation
  • Degree of bystander damage is likely
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6
Q

Name the stages of the initial inflammatory response

A
  1. Fluid exudate
  2. Soluble effectors from plasma
  3. Complement system
  4. Cellular exudate
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7
Q

Describe how fluid exudate occurs

A
  • Dilatation of blood vessels
  • Increased vascular permeability
  • Fluid exudate dilutes causative agent and carries plasma protein
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8
Q

Describ 2 soluble effectors from plasma

A

Complement System - Group of 20 proteins which have key roles in mediating inflammation
Kinin System - Peptides of 9-11 amino acids e.g bradykinin

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9
Q

Name 2 components exudate

A
  1. Neutrophils (PMNs)

2. Macrophages

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10
Q

What does PMNs stand for?

A

Polymorphonuclear Leucocytes

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11
Q

Describe the production, lifespan and function of PMNs

A
  • Produced in bone marrow
  • Lifespan of 2-3 days
  • Phagocytose foreign agents
  • Cytokine release
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12
Q

Describe how neutrophils move from the blood stream to have an effect on inflammation

A
  • Vasodilatation facilitates this
  • LFA-1 receptor on neutrophil and ICAM-1 on endothelium bind
  • This stops the neutrophil from moving through lumen
  • Allows neutrophil to squeeze between endothelial cells
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13
Q

What does LAD-1 stand for?

A

Leucocyte adhesion deficiency

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14
Q

Describe LAD-1

A
  • Rare genetic disorder
  • Lack of CD-18 expression on PMNs, required for adhering to endothelial cell wall
  • Recurrent RTIs, mucosal infections and aggressive periodontitis
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15
Q

What is cyclic neutropenia?

A

Neutrophil numbers drop cyclically which can lead to serious furcation in deciduous teeth

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16
Q

Describe the production, lifespan and function of macrophages

A
  • Derived from blood monocytes
  • Lifespan of 2-3 months
  • Phagocytosis
  • Antigen processing and presentation
  • Cytokine and prostaglandin release
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17
Q

Name 3 examples of cytokines

A
  1. interleukins
  2. Tumour necrosis factor alpha
  3. Prostaglandins
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18
Q

What is the function of cytokines?

A

Cell-cell communication in a paracrine / autocrine fashion

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19
Q

What is the difference between autocrine and paracrine function?

A

Autocrine affects the same cells where paracrine is communication with other cells in the same area

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20
Q

What is the general function of interleukins?

A

Family of cytokines which regulate the inflammatory and immune responses

21
Q

Name 4 sources for IL-1

A
  1. Macrophages
  2. Epithelial cells
  3. Fibroblasts
  4. PMNs
22
Q

Name 3 effects of IL-1

A
  1. Activates neutrophils and macrophages
  2. Activates B and T lymphocytes
  3. Induces cytokine release
23
Q

Name 2 ways IL-1 can cause bystander damage

A
  1. Induce matrix metalloproteinase (MMP) release

2. Induces osteoclast activation and bone resorption

24
Q

Describe MMPs

A
  • Family of proteases with zinc ion in active centre
  • Capable of degrading ECM molecules
  • Secreted as inactive pro-MMP
  • Inhibited by TIMP (tissue inhibitor of Metalloproteinases)
25
Q

Describe the production and function of IL-6

A
  • Produced by lymphocytes, monocytes and fibroblasts
  • Stimulates plasma cell proliferation
  • Stimulation osteoclast activation
  • Higher levels in GCF from periodontitis site
26
Q

What is the function of IL-8?

A
  • Chemoattractant for neutrophils
  • Higher levels in GCF from periodontitis sites
  • Stimulates MMP expression
27
Q

What is the function of prostaglandins?

A
  • Proinflammatory mediators

- Induce bone resorption via the RANK ligand signalling pathway

28
Q

What does RANK ligand stand for?

A

Receptor Activator of Nuclear factor Kappa B ligand

29
Q

Describe the relationship of RANK ligand and osteoprotegerin (OPG) and bone resorption

A
  • RANKL is a member of TNF superfamily
  • Expressed on surface of osteoblasts and binds to RANK receptor on osteoclast precursor cells, stimulating osteoclast activation
  • RANKL inhibited by OPG
  • Osteoclastogenic molecules stimulate expression of RANKL while inhibiting OPG
30
Q

Describe active immunity

A
  • Memory cells produced and highly specific
  • Soluble effectors and cellular components
  • Cytokines important in regulation
  • Bystander damage less likely
31
Q

What is the soluble effector of the adaptive immune response?

A

Antibody

32
Q

Name 4 cellular components of the adaptive immune response

A
  1. T lymphocytes
  2. B lymphocytes
  3. Plasma cells
  4. Macrophages
33
Q

Describe humoral immunity

A
  • Protection against extracellular infectious agents

- Production of antibodies by B-cells under influence of activated T-helper cells

34
Q

Describe cell-mediated immunity

A
  • Protection against intracellular infectious agents
  • Mainly through release of toxic agents by cytotoxic T-cells, stimulated by IFN gamma, produced by activated T-helper cells
35
Q

Describe the initiation of the humoral immune response in periodontal tissues

A
  • Bacterial antigen
  • Macrophage
  • Local lymph node
  • Presented to B-lymphocyte
  • Plasma cell created
  • Secretes antibody
  • Antibody reaches gingival tissues via circulation
  • Interacts with specific antigen
36
Q

Name 4 biological activities of IgM (pentamer)

A
  1. Toxic neutralisation
  2. Agglutination
  3. Opsonisation
  4. Activates complement IgM and IgG
37
Q

Name 3 biological activities of IgA

A
  1. Major Ig in secretions
  2. Surfaces protection
  3. Toxin neutralisation
38
Q

Name a biological activity of IgE

A

Histamine release from mast cells

39
Q

Name a biological activity of IgD

A

Receptor on B-cells

40
Q

What is the function of T-helper cells?

A

Required for maturation of B cells and activation of phagocytes

41
Q

What is the function of T-suppressor cells?

A

Inhibit immune response

42
Q

What is the function of T-killer cells?

A

Cytotoxic

43
Q

Describe the antibacterial effects of saliva

A
  • Inhibition of attachment of bacteria (sIgA)
  • Killing bacteria by peroxidase system
  • Killing bacteria by lysozyme and histatins
44
Q

Name 3 causes of xerostomia

A
  1. Drug induced (antihypertensives and antidepressants)
  2. Head and neck radiation
  3. Salivary disease
45
Q

Describe the epithelial barrier

A
  • Barrier against invading microbes
  • Release of pro-inflammatory cytokines
  • Produces antimicrobial peptides
  • Bacterial proteases from P.gingivalis break down barrier function
46
Q

Describe the early lesion at the junctional epithelium

A
  • Increased PMN migration
  • Macrophage and lymphocytic infiltrate
  • Localised collagen degradation
  • Localised fibroblast degeneration
  • Clinically normal
47
Q

Describe the established lesion (gingivitis) at the junctional epithelium

A
  • PMNs walling off plaque
  • Increased lymphocytic infiltrate
  • 60-70% collagen destruction
  • Lateral proliferation of JE with micro-ulceration
  • Gingival redness and swelling
48
Q

Describe periodontitis at the junctional epithelium

A
  • Apical migration of JE
  • Loss of periodontal ligament attachment
  • Loss of alveolar bone
  • Micro-ulceration of JE
  • True pocket formation
49
Q

What is the most commonly accepted theory of the progression of periodontal disease?

A

Burst hypothesis

  • Relatively short period of time patient will lose some attachment
  • Attachment loss is slow following this before another burst
  • Loss does not occur at same rate constantly for years

Periodontics (8 decks)

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