Pathogenesis Of Periodontitis Flashcards
In gingival health, the junctional epithelium is attached to __________, and is continuous with the _______ epithelium.
Enamel; oral
In healthy tissues, what are the volume ratios of junctional epithelium, oral epithelium, and connective tissue?
10% JE, 30% OE, 60% CT
T/F: In gingival health, the JE is absent of rete pegs.
TRUE
What are some various reasons that the gingiva stay healthy?
- Shedding of epithelial cells
- Intact epithelial barrier (OE and JE)
- Flow of GCF
- Complement system
- Immune cells and antibodies
What are the four stages of the development of gingivitis and periodontitis given by Page and Schroeder?
- Initial lesion: subclinical
- Early lesion: earliest perceptible stage of gingivitis
- Established lesion: chronic gingivitis
- Advanced lesion: progression to periodontitis
What characterizes an initial lesion for gingivitis?
Basic inflammation: vessel dilation, fluid release (GCF exudate or transudate), leukocyte accumulation
What is the transudate or exudate fluid that exits the capillaries during gingival inflammation?
Gingival crevicular fluid (GCF)
T/F: GCF decreases as clinical inflammation gets worse.
FALSE
Increases
Describe the cellular events that occur during an initial lesion?
Plaque forms on epithelial cells -> cytokines released by epithelial cells activate endothelial -> neutrophils migrate and adhere to endothelial cells -> neutrophils get through endothelium and migrate through the JE
What factors are released by plaque that can activate the epithelial cells?
LPS, FMLP
Once triggered by various plaque factors, the epithelial cells of the JE produce which factors and what is there purpose?
IL-8, C5a
Activate endothelial cells and help move neutrophils to site of plaque
What is a microscopic indication of an initial lesion at the surface of the JE?
Rete pegs
What is the first clinically perceptible phase of gingivitis?
Early lesion
What is a difference in cell concentrations between the initial, early, and established lesions?
Initial: some leukocytes
Early: some lymphocytes and leukocytes
Established: leukocyte, lymphocytes, and plasma cells
During the early lesion stage, what begins to deteriorate to make room for immune cells to infiltrate the space?
Collagen
What specific cellular activities cause gingivitis to continually progress worse and worse?
As inflammation is stimulated more immune cells come to the area -> immune cells release inflammatory molecules which continue to stimulate more inflammation
What happens to the coronal junctional epithelium during the established lesion?
Loses attachment to enamel (still attached to CEJ), which deepens the sulcus
Transitions to permeable pocket epithelium loaded with neutrophils to fight plaque
T/F: During the established lesion stage, there is apical migration of the JE and bone loss.
FALSE
Lateral extension of the JE leading to early pockets
Which stage of lesion characterizes the transition from gingivitis to periodontitis?
Advanced lesion
What is the most common lymphocyte in established lesion? Advanced lesion?
T-cell in established
B-cell in advanced
T/F: Apical migration of the epithelial connection is a clinical sign of periodontitis and an advanced lesion.
TRUE
If plaque is removed at the advanced lesion stage, how would the tissue respond?
Epithelial signal for inflammation would turn off -> immune response would cease
However bone loss and connection loss would not resolve
T/F: As the lesion progressively gets worse, the percentage of plasma cells in the tissue goes up.
TRUE
What are three common modifying factors in the pathogenesis of periodontitis?
- Diabetes
- Pregnancy
- Smoking
What are some oral and periodontal effects of diabetes?
- Xerostomia
- Candida infections
- Periodontitis
- Multiple periodontal abscesses
T/F: Periodontitis increases insulin resistance in diabetics.
TRUE
How does diabetes affect neutrophil function?
- Unable to follow chemotaxis gradient
2. Less regulated release of granules
T/F: In diabetics, pro-inflammatory factors such as PGE, IL-1, and TNF alpha are more prevalent in the GCF.
TRUE
T/F: Even stable diabetics are at an increased risk for periodontitis.
FALSE
What are the effects of pregnancy on the hosts ability to fight periodontitis?
- Increased permeability
- Lower keratinization
- Decrease in chemotaxis
- Decrease in T cell response
T/F: Antibiotics should be avoided during pregnancy.
TRUE
When is the best time to treat a pregnant woman for periodontitis/gingivitis?
2nd Trimester
T/F: Smoking will cause excess inflammation and bleeding on probing.
FALSE
Attachment and pocket loss, but LESS gingivitis
What is the effect of tobacco on the hosts ability to fight periodontitis?
- Few leukocytes in the pocket, but higher leukocytes in the blood
- Less blood vessels in lesion
- Increase in keratinization
