Pathogenesis Flashcards
What is pathogenesis`
Origin and development of a disease
What is periodontal disease
Chronic disease with interplay between biofilm, host and inflammation
What is the relationship between bacteria and inflammation
Bacteria - Initiate
Inflammation - Perpetuates
Whatis gingival health
Not bleed on probing
Pink
Firmly attached
What are the epithelial portions in gingiva
- Oral
- Sulcular
- Junctional
How does gingiva stay healthy
Maintains epithelial barrier Sloughing of epithelium Antibodies Neutrophils Macrophages
Where are antibodies found
Saliva
GCF
Capillaries
What is the histopath of gingivitis
Tissue infiltrated by defence cells
Release of enzymes
Causes collagen depletion
Reversible
How did Page and Schroder describe gingival inflammation
Initial
Early
Established
Advanced
What happens in Stage 1
Increased vascular permeability
Increased vasodilation
Increased GCF
Neutrophil and leukocyte in CT
What happens in stage 2
Increase vascular permeability Increased vasodilation Increased GCF Neutrophil Degeneration of fibroblast Collagen fibroblasts
What happens in stage 3
Chronic Gingivitis Dense inflammation Plasma Cells Increased MMP Increased Collagen depletion
What happens in stage 4
Transition to perio dx
Apical migration of JE
Increased collagen breakdown
Osteoclast resorb alveolar bone
What are the specific virulence factors
- LPS
- Protease
- Fimbriae
- Bacterial DNA
What are the host derived mediators
Cytokines
Prostaglandin
MMP
What are cytokines
Locally acting soluble messengers that amplify immune response and induce own expression
What are prostaglandins
Lipid compound from arachadonic acid
Metabolized by COX
Increase vasodilation
Induce MMP and bone resorption
What are MMP
Enzymes that break down structural proteins like collagens
What are the inflamm mediators in perio disease
Interleukin
TNF Alpha
Prostaglandin
Chemokines
What are interleukins
Family of cytokines linked to innate immune response
What is TNF alpha
Inflamm mediator
Increases neutrophil activity
TNF Alpha - Neutrophils
What makes prostaglandin
Macrophage
Fibroblast
What are chemokines
Chemotactic molecules
Leukocyte migration role
How does a pocket develop
Biofilm causes inflamm which causes sulcus to deepen
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
Peroxidise
What are the defensive components of saliva
Antibodies Lactoferrin Mucin Lysozyme Perioxidase
What is GCF defensive function
Antibodies
Neutrophils
Flushing action
What is epithelial defensive tissue
Keratin is the barrier
What are senteniel cells
Macrophage and dendritic cells
Provide immediate and adaptive immunity
What are neutophils
Professional phagocyte
Low grade defense
What is adaptive immunity
Focused intense defence
Slower and more complex
Anti gen specific
Chronic perio is adaptive
What are antigen presenting cells
B Cell
Macro
Dendritic
Go to T Cell inlymph node
how do antigen presenting cells function
Go to lymph node and react with T Cells
What are T cells
Adaptive immune cells in bone marrow to thymus
What are antibodies
Endpoint in B cell activation
Mostly IgG
Discuss Host susceptbility
Complex immune and inflamm process
Some pt hyper respond
Response can be disproportionate
What is the role of Toll like Receptors
proteins on sentinel cell that recognizes pathogens
What are NETS
Neutrophil extra cellular traps
Antibodies to perio dx
IgG
some IgA and IgM
What antibody in saliva
IgA
