pathogenesis of periodontitis Flashcards
in healthy gingiva, the _______ appears to be continuous with the junctional epithelium (JE)
oral epithelium (OE)
what are the tissue volume ratios for healthy gingiva?
10% JE
30% OE
60% CT
what are the characteristic of connective tissue in healthy patients? Do they have epithelial ridges (rete pegs) in their JE?
CT is dense with prominent collagen fiber bundles
Epithelial ridges (rete pegs) absent
what are the reasons for stability in Clinically healthy gingiva
Shedding of epithelial cells Intact epithelial barrier Positive flow of GCF Complement system PMNs and macrophages Protective effects of antibodies
what are the Histopathological stages in the development of gingivitis and periodontitis?
1) initial lesion
2) early lesion
3) established lesion
4) advanced lesion
when does the initial lesion occur?
Occurs within 1 to 4 days of plaque development
t/f: Increased permeability is seen during the initial lesion stage
TRUE
Increased permeability (carbon particles and serum proteins leak out of vessels)
what happens during infiltration in the initial lesion stage?
PMNs and monocytes in the Junctional Epithelium
lymphocytes in Connective Tissue
during the initial lesion, there will be a decrease in __________ collagen
perivascular
t/f: the symptoms associated with the initial lesion can be seen clinically
FALSE
Dilation of vessels of the dentogingival plexus is induced by ________ mediators
vasoactive mediators (histamine, IL-1, TNF)
Gaps form between what cells to result in increased permeability
capillary endothelial cells
what are the 2 types of gingival crevicular fluid (GCF)?
GCF is a: plasma transudate (health)
or
inflammatory exudate (disease)
what can GCF constituents indicate?
inflammatory changes and bacterial colonization
does GCF flow rate increase or decrease with clinical inflammation?
increase
what kind of stain for protein indicates GCF volume?
Ninhydrin stain for protein indicates GCF volume
what are the cellular events associated with the INITIAL lesion? (theres 4 of them)
Cytokine-mediated up-regulation of adhesion molecules on endothelial cells
PMNs adhere to post-capillary venules and begin to migrate
PMNs migrate through JE into gingival sulcus
Chemotaxis induction by PMNs
chemotaxis induction by PMNs is mediated by what?
host factors (IL-8, C5a)
molecules released by bacteria (fMetLeuPhe)
during the initial lesion, there is a migration of PMN’s toward where?
toward the sulcus
the initial lesion is an early response to ________ _________
plaque accumulation
in the initial lesion, there is vasculitis subjacent to the ____
junctional epithelium (JE)
what portion of the JE is altered in the initial phase?
the most coronal portion of JE
when does the EARLY lesion occur?
Occurs within 4 to 7 days of plaque development
what immune cells are found subjacent to JE in the EARLY lesion?
Lymphocytes and PMNs
what are Fibroblasts undergoing during an early lesion?
Fibroblasts undergoing cytopathic alterations
when is clinical inflammation FIRST present during periodontitis?
during the early stage
NOT the initial
what occurs during the early stage to allow space for infiltrate?
Collagen destruction occurs, which creates space for infiltrate
during the early stage, ______ cells of JE and SE proliferate
basal cells
in the early stage, Epithelial rete pegs invade what?
invade the coronal portion of the lesion
t/f: during the EARLY lesion, the dentogingival plexus (dp) remains dilated
true
t/f: the dp (dentogingival plexus) is only extremely permeable following inflammation
false
dp is extremely permeable following minor trauma or inflammation
what happens as the As JE invades CT during the early stage?
As JE invades CT, the previously inactive capillary bed opens up and proliferates into the CT papillae
what are the characteristics of an ESTABLISHED lesion?
A) increase in: swelling clinically, fluid exudation, leukocyte migration
B) Plasma cells increase around blood vessels and in coronal CT
C) Collagen loss continues as infiltrate expands
when looking at an established lesion: In addition to macrophages and serum proteins, what other cells are present?
T and B cells and plasma cells are present
what are the Activated T cells produce cytokines found in an established lesion?
IL-2, 3, 4, 5, 6, 10 and 13, TNF-
name the chemotactic substances produced by T-cells in an established lesion:
MCP, MIP and RANTES
Plasma cells in an established legion produce ___ and ______
produce Ig and cytokines
________ produce MMPs and TIMPs in established lesions
Fibroblasts
what happens to the sulcus during established lesion?
The sulcus deepens and the coronal portion of the JE is converted into permeable pocket epithelium (PE)
characteristics of pocket epithelium (PE)
The PE is not attached to tooth surface
The PE is loaded with PMNs
T/F: although there is no bone loss at the established stage, there is an apical migration of JE
FALSE:
No apical migration of JE and no bone loss at this stage
what occurs to the shape of the JE during the established stage?
Proliferation and lateral extension of JE
T/F: Advanced stage periodontitis occurs 1-2 years after the initial onset of gingivitis
FALSE: Beginning and duration are not known
in an advanced stage, there will be a switch from ______ to ______ immune cells
Switch from T-cells to B-cells
what signals the conversion from gingivitis to periodontitis?
Switch from T-cell to B-cell predominance
what indicates first clinical sign of periodontitis?
Destruction of CT attachment to root surface and apical migration of epithelial attachment
during an advanced lesion, Bone destruction begins where?
begins around communicating blood vessels along crest of septum
as advanced periodontitis proceeds, there will be an Apical proliferation of _____ into deep connective tissue
PE
pocket epithelium
during the advanced stage, there will be an extension of the lesion into where?
into alveolar bone and PL (with significant bone loss)
what are the Common modifying factors of periodontitis?
Diabetes
Pregnancy, puberty and menopause
Smoking
what can the “Modifying factors” influence?
Susceptibility to gingivitis and periodontitis
Plaque growth and composition
Clinical presentation
Disease progression
Response to periodontal therapy
name the Oral and periodontal effects of Diabetes Mellitus
Xerostomia
Candida (yeast) infections
Periodontitis
Multiple periodontal abscesses
T/F: Incidence and severity of periodontitis greater in poorly controlled diabetes
true
what are the Effects on bacteria due to diabetes?
Spirochetes increase in poorly controlled diabetes
P.intermedia, C.rectus, P.gingivalis in Type 2 diabetes
Capnocytophaga predominance seen in Type 1diabetes
(you’re increasing the disease-causing bacteria)
what are the effects on host response due to diabetes?
A) PMN function and chemotaxis impaired
B) Cytokines, monocytes and macrophages increase
C) Connective tissue synthesis declines
T/F: perio treatment of controlled diabetics will still yield lower results than a non-diabetic
FALSE: Stable diabetics same as non-diabetics
Gingivitis seen in ______% of pregnancies
seen in 35-88% of pregnancies
Gingival inflammation highest during which trimesters?
2nd and 3rd trimesters
when is Periodontal treatment best during pregnancy?
Best during 2nd trimester
Best to avoid use of antibiotics during pregnancy
T/F: Osteoporosis in post-menopausal pts may not cause periodontal disease, but may affect the severity of pre-existing disease
true
Deeper probe depths and larger number of deep pockets
are typically found in what patient group?
smokers
effect of smoking on periodontal health:
More attachment loss, including recession
More alveolar bone loss
More tooth loss
_________ is associated with poorer reduction in probing depth and poorer attachment gain in nonsurgical treatment
smoking
what causes the lowered BOP (bleeding on probing) in smokers?
decrease in inflammation
decrease in blood vessels
decrease in keratinization
