Perio Final Flashcards
Define systemic risk factors in regards to perio
Disorders, diseases or conditions that increase an individuals susceptibility to periodontal infection
Systemic risk factors can be (2)
Modifiable
Nonmodifiable
Modifiable risk factor
Smoking
Example of nonmodefiable risk factor
Genetic factors, age, gender
Characteristics of diabetes mellitus
Chronic, lifelong metabolic disorder in which body fails to produce sufficient amounts of insulin or use it properly
What is the primary purpose of the immune system
Defend the life of the individual by identifying foreign substances in the body and developing defense against them
What are the 2 subdivisions of the immune system
Innate and adaptive
Innate immune system is present at birth, is is NOT ____ specific.
And it does not?
Not antigen specific
Does not improve with repeated exposure to infectious agent
Adaptive immune system develops?
It is _____ specific ?
What develops that may provide lifelong immunity to reinfection
Throughout life
Antigen specific
Memory develops
The way an individuals body responds to the infection is known as the
Host response
How does host response work/ the body responds by?
Sending certain cells to the infection
Producing biochemical substances to counteract foreign invaders
Loss of immune function is
Deadly to the body
The immune system can become so intense in its response that it begins to
Harm the body that it is trying to protect
Components of the immune system that play an important role in combating periodontal diseases are
Cellular defenders
The complement system
Leukocytes act like independent single cell organisms. They can move
Through tissues and capture MO’s on their own
2 types of leukocytes important in periodontal diseases are
Polymorphonuclear leukocytes (PMNs)
Monocytes/macrophages
Phagocytosis is the process by which leukocytes
Engulf and digest microorganisms
Polymorphonuclear leukocytes (PMNs) are also called
Neutrophils
PMNs are rapid responders that provide the _____
PMNs are ____ lived cells (hint die when they become engulfed w bacteria)
First line of dense
Short lived cells
PMNs are attracted to bacteria by a process called
Chemotaxis
Periodontal pathogens are most effectively destroyed by
PMNs
Called monocytes when?
Called macrophages when?
Called monocytes when in bloodstream
Called macrophages when in tissue
Macrophages/monocytes are slower to arrive at site of infection than PMNs. They are ____lived cells seen in chronic inflammation
Long lived cells
Lymphocytes are small leukocytes that help defend the body. What are the 2 main types
B lymphocytes (B cells)
T lymphocytes (T cells)
B lymphocytes, once activated, makes millions of ? Pours them into where?
Millions of antibodies and pours them into the bloodstream
B cells can differentiate into 2 types which are
Plasma b cells and memory b cells
What shape are b lymphocytes antibodies and how do they bind to a MO
Y shaped proteins
One end of y binds to outside of B cell and other end of y binds to MO
Antibodies are known collectively as
Immunoglobulins
5 major classes of immunoglobulins are
Hint * my dad got an exorcism
Immunoglobin M, D, G, A, E
Main function of t lymphocytes is to
Intensify the response of other immune cells to bacterial invasion
What to t lymphocytes produce
Substances called cytokines that further stimulate immune response
Cytokine is a general name for any
Protein that is secreted by cells and affects the behaviour of nearby cells
The complete system is a
Complex series of proteins circulating in the blood
Functions of the complement system (4)
Destruction of pathogens
Opsonization of pathogens
Recruitment of phagocytes
Immune clearance
Components of complement system can destroy certain MO’s directly by forming pores in their cell membranes. What protein is created to do this and what can it do
Membrane attack complex
It can puncture cell membranes of certain bacteria (lysis)
The complement system facilitates the capture and destruction of bacteria by phagocytes. What is this process called
Opsonization
Opsonization is the
Most important action of the complement system
To fight infection, leukocytes travel through
The bloodstream
The thin layer of epithelial cells that line the interior surface of blood vessels is called
Endothelium
Near the infection site, leukocytes push their way between the endothelial cells and enter connective tissue. This process is called
Trans endothelial migration
Chemotaxis is the process whereby leukocytes
Enter the CT
Leukocytes are attracted to the site of the infections in response to
Biochemical compounds released by the invading bacteria
The body’s response to inflammation focuses host defense components at
The site of an infection to eliminate MO’s and heal damaged tissue
Inflammatory biochemical mediators are biologically active compounds secreted by cells that
Activate body’s inflammatory response
Biochemical mediators of importance in periodontitis include
Cytokines
Prostaglandins
Matrix metalloproteinases (MMPs)
What are chemokines
Subgroup of cytokines
Cause additional immune cells to be attracted to the site of an infection of injury
2 stages of inflammation
Acute and chronic
Short term, normal process that protects and heals the body
Acute inflammation
Acute inflammation process is achieved by the increased movement of
Plasma and leukocytes from the blood to the injured tissues
5 classic signs of acute inflammation
Heat
Redness
Swelling
Pain
Loss of function
Long lived, out of control inflammatory response that continues for more than a few weeks
Chronic inflammation
Chronic inflammation is a ____ condition that can destroy healthy tissue and cause more damage than ?
Pathological
More damage than the original problem
The classic warning signs in acute inflammation are usually ___ in chronic inflammation
Absent in chronic inflammation
(Pain is often absent, may go unnoticed by the host)
Why does chronic inflammation occur
Body is unable to rid itself of invading organism
What is the hallmark of chronic inflammation
Tissue damage
Chronic inflammation is characterized by an accumulation of
Macrophages
Chronic inflammation is associated with a number of disease conditions like
Rheumatoid arthritis
Diabetes
Asthma
Gingivitis
Periodontitis
Signs and symptoms of chronic inflammation may partially or completely disappear during a period of
Remission
The signs and symptoms may recur in all of their severity in an active period of disease known as
Exacerbation
Virulence factor refers to
All the mechanisms that enable biofilm bacteria to colonize and damage tissues
Factors enhancing microbial challenge
Presence of lipolysaccharides (LPS)
Ability to invade tissues
Ability to produce enzymes
Factors affecting host immune response
Genetic
Environmental (smoking)
Acquired (diabetes)
Acute inflammation is the first
Line of defense against microbial invasion
Resolution of inflammation and return to homeostasis is an actively regulated biologic process called
Catabasis
Pro-inflammatory mediators (ex prostaglandins) recruit what, during what phase
Recruit PMNs during the acute phase
Pro-resolving lipid mediators are produced by the body to
Shut down PMN function and acute inflammation
Cytokines signal to the immune system to send
More phagocytes to the site of infection
Cytokines important in periodontal disease
IL-1, IL-6, IL-8, and TNF-alpha
What can cytokines initiate
Can initiate tissue destruction and bone loss in chronic infections such as perio disease
Series of prostaglandins include D, E, F , G, H and I. The most important in bone destruction is
Prostaglandins of the E series
Function of prostaglandins
Increase permeability and dilation of blood vessels
Trigger osteoclasts to destroy the alveolar bone
Promote overproduction of destructive MMP enzymes
In health MMPs aid in
Normal turnover time of the periodontal connective tissue matrix
MMPs are released in an attempt to
Kill invading bacteria
Overproduction of MMPs results in
Breakdown of CT of the periodontium
High MMP levels result in extensive collagen destruction in the periodontal tissues. How would this present in the mouth
Gingival recession
Pocket formation
Tooth mobility
4 histological stages in development of perio disease
Initial lesion
Early lesion
Established lesion
Advanced lesion
Initial lesion is characterized by how many days bacteria accumulation?
Where does bacteria colonize
2-4 days
Colonize teeth near gingival margin
Describe process of bacteria accumulation
Initial location of plaque is at gingival margin
GCF increases in volume
CLINICALLY tissues look healthy
Host response successful if most bacteria are destroyed
During initial lesion of bacterial accumulation, if pathogens are not controlled what develops
Early gingivitis
Early lesion (early gingivitis): how many days
4-7days
In early lesion biofilm maturation continues and bacterial toxins penetrate JE. PMNs move where and form what
PMNs move into connective tissue and form a wall between biofilm and sulcus wall
Early gingivitis: clinically what is observed
Edema and redness of gingival marginal tissue is observed
Established lesioknoccurs how many days after established gingivitis
21days
Established lesion: plaque biofilm extends where and disrupts what
Subgingivally into sulcus
Disrupts attachment of coronal most portion of JE from tooth surface
In established gingivitis, JE loosens attachment to root surface and start to transform into pocket epithelium which is
Thinner and more permeable
Advanced lesion: periodontitis. Plaque biofilm spreads
Laterally and apically along root surface.
In advanced less on the gingival pocket progresses to
Periodontal pocket
Factors influencing hosts failure to control bacterial challenge
Abnormal PMN function
Persistence and virulence of bacteria in biofilm
Acquired and environmental factors
Systemic factors
3 types of diabetes mellitus
Type 1(5-10%)
Type 2 (90-95%)
Gestational (during pregnancy)
Does diabetes favour or influence growth of specific periodontal pathogens?
No
Oral complications of poorly controlled diabetes mellitus
Reduced salivary flow
Multiple periodontal abscess formation
Cheilosis
Burning mouth and tongue
Rapid occurrence of deep pockets
Defective neutrophilic function in diabetics impairs initial immune response to infection. What is not functioning properly
Neutrophils (PMNs)
What is cell death called
Apoptosis
Glycation is a natural metabolic process where glucose in the bloodstream irreversibly attaches to?
What does it form?
Attached to proteins and lipids in the blood.
Forms harmful molecules called advanced glycation end products (AGEs)
In health, AGE is
At low levels and has no pathologic effect to the body
In hyperglycaemia, AGE formation is
Increased beyond normal and can alter function of collagen
In diabetes, levels of AGE can also contribute to diabetes related complications such as
Neuropathy
Retinal disease
Kidney failure
Direct interaction of AGE to a cell surface receptor known as ____ triggers what?
RAGE (receptor for advanced glycation end product)
Triggers pathologic tissue destruction
What is the major factors that contribute to the exaggerated periodontal and systemic inflammation and impaired tissue repair in diabetic patients with perio
AGE-RAGE interaction
High financial stress and depression are significant risk factors for
Periodontal disease
Levels of sex hormones/ changes in hormone levels may have an effect on
The periodontium
Increase in hormones causes increased
Blood circulation to gingival tissues
Sensitivity to local irritants (ex. Plaque)
Inflammation of gingiva increases in pregnancy even if the presence of
Small amounts of plaque
Elevated progesterone levels enhance _____ resulting in increased gingival deviate and edema
Capillary permeability
What is a pregnancy tumour called that is found on the interdental gingiva or gingival margin, is non cancerous and not painful
Pyogenic granuloma
Menopausal gingivostomatitis is characterized by gingiva that
Bleeds readily, with abnormally pale, dry and shiny erythematous appearance
Osteoporosis is a reduction in?
Making women more prone to?
Bone mass
More prone to bone fractures
* hallmark of osteoporosis is bone fractures*
Osteopenia is a condition in which there is a lower than average?
Bone density
What can cause a rare disorder called MRONJ (medication induced osteonecrosis of the jaw)
Biophosphonates
MRONJ is characterized by
Painful exposed bone in the mouth that fails to heal after extraction or oral surgery
