Pathogenesis of Periodontitis Flashcards
In gingival health, the Junctional Epithelium is attached to ______.
enamel
In gingival health, the oral epithelium is continuous with ______.
junctional epithelium
In gingival health, what are the tissue volume ratios of JE, OE, and CT?
JE: 10%
OE: 30%
CT: 60%
In gingival health, are PMNs present or absent from the outer portion of the junctional epithelium?
PMNs are present even in health but in very small numbers
How thick is the JE in gingival health?
10-20 cell layers thin
True or False: Rete pegs are absent in gingival health.
True: outer and basal surfaces are parallel
Describe the CT that is present in gingival health.
CT is dense with prominent collagen fiber bundles
In gingival health, the _______ plexus contains a constant number of ________ which provide nutrients to the periodontium.
Subepithelial plexus
capillary loops
In gingival health, does the dentogingival plexus have capillary loops?
No, the SP has loops but the DP does not
When does the flow of crevicular fluid increase?
when there is inflammation
What are the four stages in the development of gingivitis and periodontitis?
- initial lesion
- early lesion
- established lesion
- advanced lesion
Which stage(s) of periodontal development is subclinical?
Initial
When does the initial lesion stage occur?
within 1 to 4 days of plaque formation
During the inital lesion stage of development, how does the concentration of PMNs change compared to health?
they infiltrate to form a higher density at the junction between OE and JE
Describe the vascular changes associated with the initial lesion stage of periodontitis development.
Healthy vessels are permeable only to water, salts, and small molecules. After plaque build up, vessels of the dentogingival plexus will dilate due to the presence of vasoactive mediators (histamine, IL1, TNF). Gaps form between capillary endothelial cells which makes them more permeable. GCF rate increases.
In health, GCF is a _______ but in disease is an _______.
health: plasma transudate
disease: inflammatory exudate
GCF flushes the crevice from ______ to _______.
apical to coronal
True or False: if gingival crevicular flow measures 0.08microliters in 30 seconds, that person must have inflammation.
False. those number are associated with health. it would be three times higher than that in disease.
What kind of test is used to measure GCF volume?
ninhydrin stain (purple) will indicate proteins and GCF volume
During the initial lesion stage, there is a cytokine-mediated up-regulation of _________ on endothelial cells of vasculature.
adhesion molecules
How is chemotaxis by PMNs induced?
host factors (IL-8, C5a) Molecules released by bacteria (fmet-leu-phe)
How does the complement system increased vascular leakage in the initial lesion?
activation of mast cells
True or False: Vasculitis is associated with the initial lesion.
True, vasculitis is simply an enlargement of vasculature due to LOSS OF PERIVASCULAR COLLAGEN
Which portion of the JE is affected during the initial lesion?
the most coronal portion
When does the early lesion stage set in?
within 4 to 7 days of plaque developement
Is the early lesion stage visible clinically?
yes
How do fibroblasts contribute to the progression of periodontitis or gingivitis at the early lesion stage?
They undergo CYTOPATHIC ALTERATIONS that tip the scale toward more breakdown and less building-up of collagen
Are rete pegs present at the early lesion stage?
yes, rete pegs invade the coronal portion of the lesion and capillary loops project between them
When does the an increases in the concentration of plasma cells become evident?
during the established lesion stage
During the established lesion stage, _______ loss increases and ______ becomes clinically evident.
collagen
swelling
In addition to plasma cells, which cell types are present during the established lesion stage?
T and B cells
Fibroblasts
Macrophages
Serum proteins
Fibroblasts produce _____ and ______ during the established lesion stage.
Metaloproteinases
tissue inhibitors
During the established lesion stage, the sulcus deepens and the coronal portion of the JE is converted into ________.
permeable pocket epithelium (PE)
The PE (pocket epithelium) is loaded with _____ and is not attached to tooth surface.
PMNs
What do plasma cells produce?
Ig
cytokines (IL-6 and TNF)
Is there attachment loss at the established lesion stage?
No
True or False: A patient can stay at the established lesion stage forever if they are resistant to periodontitis.
True
At which stage, does the diagnosis change from gingivitis to periodontitis?
The fourth and final stage…Advanced Lesion
In the advanced lesion stage, which type of adaptive immune cells dominate?
B-cells
___ cells dominate in gingivitis, ____ cells dominate in periodontitis.
T
B
What is the first clinical sign of periodontitis?
apical migration of the epithelial attachment (JE moves due to destruction of the connective tissue)
At what location does bone destruction begin?
around communicating blood vessels along the crest of the septum
True or False: After entering the advanced lesion stage, removal of plaque will resolve inflammation and move the patient back into the established lesion stage.
False: once you see attachment loss it cannot be regained even if the inflammation is resolved
During the advanced lesion stage, what is the proportion of plasma cells?
50%
What are the three modifying factors of periodontitis?
- Diabetes
- Hormones (pregnancy, puberty, menopause)
- Smoking
What do the modifying factors (smoking, hormones, diabetes) influence?
- Susceptibility to gingivalis and perio
- Plaque Growth/Composition
- Clinical response/presentation
- Disease progression
- Response to perio therapy
Diabetes mellitus is a _____ for periodontitis.
risk factor
What is type 1 diabetes?
impaired insulin production
What is type 2 diabetes?
deficient insulin utilization
How can diabetes influence oral and periodontial health?
- xerostomia (loss of innate protection)
- increased prevalence of candida infections (fungus)
- higher risk for periodontitis
- Mucosal abscesses
For patients with diabetes and periodontal disease, what is the benefit to perio therapy?
Perio increases insuling resistance; glycemic control improves with perio therapy.
Diabetics with severe perio can get proteinuria and CVD
Which bacterial species are found to increase in the case of Type 2 diabetes?
P.intermedia, C.rectus, and P.gingivalis
Which bacterial species is found to increase in the case of Type 1 diabetes?
Capnoctyophaga
In patients with diabetes, __________ create a destructive phenotype of macrophages that are more highly inflammatory.
Advanced Glycation End-Products (AGE)
What impact does diabetes have on vasculature?
advanced glycation end-products create a thickening of vascular endothelium and, therefore, reduced migration and host defense
Estrogen increases ______ metabolism and ______ mediators.
collagen
inflammatory
Estrogen effects salivary _______.
peroxidases
How frequently is gingivitis seen in pregnancy?
35-88%
During which time frame is gingival inflammation highest during pregnancy?
2nd and 3rd trimester (best time for treatment is 2nd trimester)
Why is there an increase in P.intermedia during pregnancy?
P.i uses naphthoquinones from steroids
Why is periodontitis more common with menopause or osteoporosis?
due to decreased absorption and increased elimination of calcium
True or False: There is less gingivitis and bleeding on probing in those patients who smoke.
True
What is the second greatest risk factor for periodontitis?
smoking
Smokers have higher numbers of A.a, T.forsythia, P.micros, _____, _____, and ______.
P. gingivalis
C. rectus
P. intermedia
Do smokers have a higher concentration of PMNs in the blood or in the periodontal pocket?
blood (PMNs arent functioning properly and there is less GCF toward the JE)
What is ICAM?
a soluble adhesion molecule that localizes PMNs
Smoking is associated with _____ reduction in probe depth and ______ attachment gain after nonsurgical treatment.
Poorer
less
