Pathogenesis of periodontal disease

Question 1

why wont everyone progress to periodontitis?

Answer 1

genetic protection

Question 1

remember
the amound of plaque/length of time present required to cause gingivitis varies between individuals

Question 2

periodontitis cant be cures, what do you have to do instead?

Answer 2

stabilise it

Question 3

name the 3 models to describe possible patterns and rate of progression of periodontitis

Answer 3

continuous rate theory
random burst theory
asynchronous multiple burst theory

Question 4

what is continuous rate theory?

Answer 4

sites are either active or inactive
active sites progress at a constant rate
different sites have different constant rates of progression

Question 5

what is random burst theory?

Answer 5

• Sites are either active or inactive
• At active sites there are random bursts of disease occurring at different times and sites
• Different sites are active at different times, progress at different rates and are active for different lengths of time

Question 6

what is asynchronous multiple burst theory?

Answer 6

Times where lots of pockets active at the same time

Question 7

what is rapid attachment loss RAL?

Answer 7

extensive loss of attachment in a short period of time

Question 8

how is rapid attachment loss detected?

Answer 8

manual periodontal probes

Question 9

who is likely to have more rapid attachment loss?

Answer 9

patients with high susceptibility

Question 10

what is gradual attachment loss GAL?

Answer 10

small amounts of loss of attachment over time either in lots of mini bursts or slow continuous loss of attachment

Question 11

how is gradual attachment loss detected?

Answer 11

electronic probes

Question 12

who is more likely to have gradual attachment loss?

Answer 12

Patients with low susceptibility

Question 13

remember
Both RAL and GAL may occur at different sites in the same mouth

Question 14

how do we predict future disease progression?

Answer 14

by looking at risk markers

Question 15

what are risk markers?

Answer 15

gives an indication that disease is present e.g. bleeding on probing

Question 16

what is the best predictor for future disease progression?

Answer 16

past disease experience

Question 17

name risk factors for disease progression 8

Answer 17

• Plaque *
• High genetic susceptibility
• Smoking
• Uncontrolled diabetes
• Immunodeficiency
• Overhanging restorations
• Alcohol
• stress

Question 18

what are the 4 phases of a progressing lesion?

Answer 18

initial lesion
early lesion
established lesion
advanced lesion

Question 19

what happens in the initial lesion?

Answer 19

24-48hrs
Plaque build up, gram +ve aerobic bacteria
Vasodilation, increased number of neutrophils, increased gingival crevicular fluid production

Question 20

what happens in the early lesion?

Answer 20

Week

Immunoglobulin production and cytokines released

Fibroblasts starting to die

Neutrophils accumulate in gingival crevice

Swelling and more gram -ve bacteria

Question 21

what happens in an established lesion?

Answer 21

clinical obvious gingivitis
Junctional epithelium is broken down now leaky pocket epithelium and connective tissues replaced by inflammatory cells

Pocket depth increase but no LOA

Bodies reaction to bacteria causes the damage, neutrophils die releasing oxidative chemicals that cause damage

Question 22

what happens in an advanced lesion?

Answer 22

periodontitis

Base of pocket is below ACJ

Lots of loss of collagen

Break down of PDL fibres

Bone loss

At base of pocket has environment that favours more pathogenic gram -ve anaerobes