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AU17: Perio > Pathogenesis Of Periodontitis > Flashcards

Pathogenesis Of Periodontitis Flashcards

1
Q

In gingival health, the junctional epithelium is attached to __________, and is continuous with the _______ epithelium.

A

Enamel; oral

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2
Q

In healthy tissues, what are the volume ratios of junctional epithelium, oral epithelium, and connective tissue?

A

10% JE, 30% OE, 60% CT

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3
Q

T/F: In gingival health, the JE is absent of rete pegs.

A

TRUE

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4
Q

What are some various reasons that the gingiva stay healthy?

A
  1. Shedding of epithelial cells
  2. Intact epithelial barrier (OE and JE)
  3. Flow of GCF
  4. Complement system
  5. Immune cells and antibodies
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5
Q

What are the four stages of the development of gingivitis and periodontitis given by Page and Schroeder?

A
  1. Initial lesion: subclinical
  2. Early lesion: earliest perceptible stage of gingivitis
  3. Established lesion: chronic gingivitis
  4. Advanced lesion: progression to periodontitis
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6
Q

What characterizes an initial lesion for gingivitis?

A

Basic inflammation: vessel dilation, fluid release (GCF exudate or transudate), leukocyte accumulation

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7
Q

What is the transudate or exudate fluid that exits the capillaries during gingival inflammation?

A

Gingival crevicular fluid (GCF)

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8
Q

T/F: GCF decreases as clinical inflammation gets worse.

A

FALSE

Increases

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9
Q

Describe the cellular events that occur during an initial lesion?

A

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

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10
Q

What factors are released by plaque that can activate the epithelial cells?

A

LPS, FMLP

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11
Q

Once triggered by various plaque factors, the epithelial cells of the JE produce which factors and what is there purpose?

A

IL-8, C5a

Activate endothelial cells and help move neutrophils to site of plaque

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12
Q

What is a microscopic indication of an initial lesion at the surface of the JE?

A

Rete pegs

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13
Q

What is the first clinically perceptible phase of gingivitis?

A

Early lesion

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14
Q

What is a difference in cell concentrations between the initial, early, and established lesions?

A

Initial: some leukocytes

Early: some lymphocytes and leukocytes

Established: leukocyte, lymphocytes, and plasma cells

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15
Q

During the early lesion stage, what begins to deteriorate to make room for immune cells to infiltrate the space?

A

Collagen

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16
Q

What specific cellular activities cause gingivitis to continually progress worse and worse?

A

As inflammation is stimulated more immune cells come to the area -> immune cells release inflammatory molecules which continue to stimulate more inflammation

17
Q

What happens to the coronal junctional epithelium during the established lesion?

A

Loses attachment to enamel (still attached to CEJ), which deepens the sulcus

Transitions to permeable pocket epithelium loaded with neutrophils to fight plaque

18
Q

T/F: During the established lesion stage, there is apical migration of the JE and bone loss.

A

FALSE

Lateral extension of the JE leading to early pockets

19
Q

Which stage of lesion characterizes the transition from gingivitis to periodontitis?

A

Advanced lesion

20
Q

What is the most common lymphocyte in established lesion? Advanced lesion?

A

T-cell in established

B-cell in advanced

21
Q

T/F: Apical migration of the epithelial connection is a clinical sign of periodontitis and an advanced lesion.

A

TRUE

22
Q

If plaque is removed at the advanced lesion stage, how would the tissue respond?

A

Epithelial signal for inflammation would turn off -> immune response would cease

However bone loss and connection loss would not resolve

23
Q

T/F: As the lesion progressively gets worse, the percentage of plasma cells in the tissue goes up.

A

TRUE

24
Q

What are three common modifying factors in the pathogenesis of periodontitis?

A
  1. Diabetes
  2. Pregnancy
  3. Smoking
25
Q

What are some oral and periodontal effects of diabetes?

A
  1. Xerostomia
  2. Candida infections
  3. Periodontitis
  4. Multiple periodontal abscesses
26
Q

T/F: Periodontitis increases insulin resistance in diabetics.

A

TRUE

27
Q

How does diabetes affect neutrophil function?

A
  1. Unable to follow chemotaxis gradient

2. Less regulated release of granules

28
Q

T/F: In diabetics, pro-inflammatory factors such as PGE, IL-1, and TNF alpha are more prevalent in the GCF.

A

TRUE

29
Q

T/F: Even stable diabetics are at an increased risk for periodontitis.

A

FALSE

30
Q

What are the effects of pregnancy on the hosts ability to fight periodontitis?

A
  1. Increased permeability
  2. Lower keratinization
  3. Decrease in chemotaxis
  4. Decrease in T cell response
31
Q

T/F: Antibiotics should be avoided during pregnancy.

A

TRUE

32
Q

When is the best time to treat a pregnant woman for periodontitis/gingivitis?

A

2nd Trimester

33
Q

T/F: Smoking will cause excess inflammation and bleeding on probing.

A

FALSE

Attachment and pocket loss, but LESS gingivitis

34
Q

What is the effect of tobacco on the hosts ability to fight periodontitis?

A
  1. Few leukocytes in the pocket, but higher leukocytes in the blood
  2. Less blood vessels in lesion
  3. Increase in keratinization

AU17: Perio (15 decks)

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