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ABPD 2021 > Perio/Immunology/Research > Flashcards

Perio/Immunology/Research Flashcards

1
Q

Prevalence and severity of periodontal disease

A

Gingivitis of varying severity is almost universal in children and adolescents
Prevalence of severe attachment loss is less than 1% in young patients

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2
Q

Epidemiology of gingivitis

A

Developed countries 73% of children 6-11 years old
Gingivitis prevalence rises with age
Prevalence rises with puberty
Less in girls than boys (likely related to oral hygine)

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3
Q

Normal pediatric periodontium features

A

Smooth, slightly stippled surface
Sulcus depth 2mm average
Rounded or rolled contour
Firm and resilient tissue

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4
Q

Is attached gingiva in adults or children narrower?

A

Children
Wider in the maxilla

Gingiva is more red compared to adults due to thinner epithelium

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5
Q

PDL in children versus adults

A

Wider in children
Less dense and fewer fibers per unit area
Increased hydration with greater blood and lymph supply

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6
Q

Cementum in children versus adults

A

Thinner and less dense than adults

Tendency to hyperplasia

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7
Q

Alveolar bone in children versus adults

A

Lamina dura is thinner
Fewer trabecular and large marrow spaces
Smaller amount of calcification
Greater blood and lymph supply

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8
Q

Dental Plaque Induced Gingivitis in Pediatric Population

A

Less severe than in adults with similar plaque levels
Gingival inflammation without loss of attachment or bone
Reversible
Contributing factors: crowding, ortho, mouth breathing, eruption, calculus

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9
Q

Chronic periodontitis adults versus children

A

More common in adults

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10
Q

Overview Aggressive Periodontitis

A

Localized or generalized
Rapid attachment and bone loss with familial aggregation
PHagocyte abnormalities and hyperresponsive macrophage phenotype

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11
Q

Definition of Localized Aggressive Periodontitis

A

Interproximal attachment los on at least 2 permanent first molars and incisors with attachment loss on NO more than 2 teeth other than first molars and incisors

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12
Q

Features of LAgP

A 
No evidence of systemic disease
Can be associated with chromosome 4 gene
Inflammation not prominent feature
Children otherwise healthy 
More in African Americans
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13
Q

Bacteria in LAgP

A

Actinobacillus actinomycetemcomintans

Bacterioides-like species
Eubacterium in some populations

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14
Q

Functional defects in neutrophils - Susceptibility to LAgP

A
  • anomalies in chemotaxis
  • anomalies in phagocytosis
  • anomalies in bactericidal activity
  • anomalies in superoxide production
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15
Q

What is a molecular marker of LAgP?

A

Low numbers of chemoattractant receptors
Low glycoprotein GP-110

Adherence receptors on neutrophils and monocytes like LFA-1 and MAC-1 are normal

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16
Q

Treatment for LAgP?

A

Surgical and-nonsurgical root debridement
Antibiotics (tetracyclines, tetracyclines + metronidazole, metronidazole + amoxicillin)
Maintenance every 4 months

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17
Q

Generalized Aggressive Periodontitis

A

Marked periodontal inflammation with heavy accumulation of plaque

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18
Q

Consequences of GAgP

A

Severe generalized attachment loss
Premature exfoliation of primary teeth
Presence in gingival clefts and severe recession
Suppressed chemotaxis in neutrophils

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19
Q

What antibody has alterations in patients with GAgP?

A

IgG

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20
Q

Microbes of GAgP

A

Non-motile, facultative anaerobic gram negative rods

P gingivalis, T denticola

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21
Q

Treatment of GAgP

A

Use of antibiotics and debridement is not very successful

Lab test to identify specific pathogens

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22
Q

Features of periodontitis as a manifestation of systemic disease

A

Occurs with erupting of primary teeth up to age4-5
Localized or generalized
Neutrophils have abnormalities in surface glycoproteins
Leukocyte adhesion deficiency
Bacteria include AA, P intermedia, Eikenella and others

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23
Q

Syndromes associated with periodontitis

A 
Papillon-Lefevre 
Hypophosphatasia
Cyclic neutropenia
Down syndrome 
Leukocyte adherence deficiency
Agranulocytosis

NOT diabetes

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24
Q

Areas endemic for necrotizing periodontal disease

A

NPD is seen with greater frequency in certain populations of children and adolescents from Africa, sia, and South America (developing areas)

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25
Q

2 most significant findings in necrotizing periodontal disease

A

Presence of interproximal necrosis and ulceration

Rapid onset o gingival pain

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26
Q

Bacteria in necrotizing periodontal disease

A

Spirochetes

P intermedia

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27
Q

Causes of necrotizing periodontal disease

A 
Viral infections
Malnutrition
Emotional stress
Lack of sleep
Systemic diseases
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28
Q

Treatment for necrotizing periodontal disease

A

Local debridement, oral hygiene instructions, follow up

Antibiotics (metronidazole and penicillin) only if patient is febrile

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29
Q

Which organ is important in immune system function that decreases in size?

A

Thymus

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30
Q

Innate Immunity Components

A 
Skin
Phagocytes
Complement 
NK cells 
Macrophages
Antigen-presenting cells
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31
Q

Adaptive Immunity Components

A

B lymphocytes and T lymphocytes

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32
Q

Which immunoglobulin is found in the highest concentration in the oral cavity?

A

IgA

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33
Q

Which system (innate or adaptive) has immunologic memory?

A

Adaptive

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34
Q

Humoral arm versus Cellular arm of Adaptive Immunity

A

Humoral: antibodies
Cellular: cytotoxicity

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35
Q

Phagocytes (macrophages, granulocytes, dendritic cells)

A

First step of innate immune response
Engulf and digest pathogens
Recognize pathogen-specific patterns (PAMPs/MAMPs)
Regulate other cells

36
Q

Lymphocytes (B and T cells)

A

Adaptive Immunity

Recognize antigens

37
Q

B cell function

A

Recognize antigen directly and produce antibodies

38
Q

T cell function

A

Recognize antigen in association with antigen-presenting cells

T helper: soluble mediators
T cytotoxic: kill infected cells

39
Q

Antigen-presenting cells

A

Dendritic cells
Link the adaptive and innate immunity
Process antigen and present to T cells

Dendritic cells are phagocytic and motile - reside in epithelial surfaces and lymphoid tissues

40
Q

Primary Organs of Immune System

A

Bone marrow (B cell maturation)
Bursa of Fabricius (B cell maturation)
Thymus (T cell maturation)

41
Q

Secondary Organs of Immune System

A

Spleen
Lymph Nodes
Mucosa
Lymphoid tissue

42
Q

Signaling molecules of Innate Immune System

A

Cytokines -> Complement

43
Q

Signaling molecules of Adaptive Immune System

A

Cytokines

Interleukins

44
Q

Cytokine definition

A

Low molecular weight proteins that stimulate or inhibit the differentiation, proliferation or function of cells

Produced by immune and non-immune cells

45
Q

Interleukins

A

Subset of cytokines that communicate between leukocytes

46
Q

Important Cytokines

A

TNFa: pro-inflammatory, produced by macrophages

IL-1: pro-inflammatory, produced by macrophages

IL-2: growth factor, produced by T cells

IFNg: pro-inflammatory, produced by T cells

C-reactive protein

47
Q

Cytotoxic molecules

A

Enzymes

Reactive oxygen species

48
Q

Chronology of Immune Response

A

Innate immunity: 0-4 hours
Infection -> recognition by preformed, non-specific and broadly specific effectors -> removal of infectious agent
Memory

49
Q

Classification of research studies according to time

A

Looking back: retrospective, case control
Looking forward: prospective cohort, experimental
Looking now: cross-sectional

50
Q

Classification of research studies according to intervention/control

A 
Experimental Design (RCT)
Observational (no control, no intervention)
51
Q

Cross-sectional study

A

Used for questionnaires, surveys, prevalence estimates

Do not provide causative evidence

52
Q

Advantages of cross-sectional studies

A

Quick
Low cost
Evaluate large number of variables
Enroll a large number of subjects

53
Q

Disadvantages of cross-sectional studies

A

Subject selection may reflect selection bias

Difficult to identify cause-effect relationship

54
Q

Case Control Study

A

Retrospective assessment of risk factors
Measures relative rates
Used for rare diseases, especially those with long latency (ex: cancer)

55
Q

Advantages of case-control

A

Not dependent on natural frequency of disease
Well-suited to study diseases of long latency
Few cases
Allows study of multiple causes
Low cost
Quick
Ethical - disease has already occurred

56
Q

Disadvantages of case-control

A

Case selection may be problematic
Controls may not be representative of same population
Investigators may be biased or subjects may be biased
Incidence, prevalence and RR can’t be calculated

57
Q

Cohort study

A 
Select 2 or more groups that are free of disease but differ in exposure status 
Allows for calculation of true rates 
Useful when exposure varies over time
No intervention (observational)
58
Q

Advantages of cohort

A

Allows risk to be expressed as incidence
Certain biases are reduced
Subject characteristics can be related to more than one outcome

59
Q

Disadvantages of cohort

A 
Inefficient for study of rare disease
Assessment of relationships limited to those defined at beginning of study
Selection bias not controlled
Loss to follow up is common
Subjects may change in satus (exposure)
Expensive
Time consuming
60
Q

RCT

A

Prospective controlled experiment of human subjects to assess intervention of a specific disease

Asks important research question

Requires IRB and informed consent

61
Q

Phases of Clinical Trials

A

1: Dose finding
2: efficacy at fixed dose
3: comparing treatment (RCT)
4: late/uncommon effects

62
Q

Advantages of RCT

A

Investigator directly controls assignment to study groups
Investigator controls exposure to agent
Random assignment can control extraneous factors
Blinding of evaluators may be possible
Can establish causality

63
Q

Disadvantages of RCT

A

Not immune to problems like other designs (noncompliance, biased observation)
May have low external validity
May not be feasible for studies of disease etiology
May not be feasible for effective disease prevention
Can be expensive

64
Q

Efficacy versus Effectiveness

A

Efficacy: the potential to provide a clinical benefit (measured in clinical trial)

Effectiveness: benefit provided in the real world (measured in registrieds, market incident reports, etc.)

65
Q

Problems with Dental RCTs

A

Difficult to randomize
Ethical concerns
Blinding usually not possible
Expensive and often lack sponsor

66
Q

Principle of Equipoise

A

involves ethical treatment of human subjects in experimental conditions

67
Q

Systematic Review definition

A

Comprehensively locates, evaluates, and synthesizes all the available literature on a given topic using a strict scientific design which must itself be reported in the review

68
Q

Aim of systemic review

A

Systemic, explicit, reproducible
Provide summary and context of current state of knowledge

Systemic reviews and meta-analysis are top of pyramid

69
Q

External Validity versus Internal Validity

A

External: do subjects represent a definable population of interest? (is it relevant?)

Internal: is the study reproducible, well-designed and analyzed?

70
Q

Power

A

The ability of a test to detect a significant difference when one exists
-was the population large enough?

Important in negative studies (studies that do not find an association)

71
Q

Placebo effect

A

Placebo should be as similar a possible to intervention

Effect can be up to 70%

72
Q

Intra-rater versus Inter-rater reliability

A

IntRA-rater: same cases over time

IntER-rater: comparison of same case among raters

73
Q

Categorical variables

A

Variables that have levels that are numeric or character

Examples: SES, probing depth ranges, stages of cancer

74
Q

Continuous variables

A

Variables that have numeric values only

Examples: probing depth, BMI, viral load, etc.

75
Q

Comparing continuous variables - statistics

A

T-test: difference between two group means

ANOVA: analysis of variance; difference between 2 or more groups

Linear regression also used for continuous variables

76
Q

Statistics for dichotomous outcomes

A

Chi-Squared
Mantel-Haensel test
Logistic regression

77
Q

P-value

A

Measures consistency between the results actually observed and the “pure chance” explanation of those results

Low p-value = very unlikely the null hypothesis is true

78
Q

Null hypothesis

A

There is no difference

If the p value is very low, you can reject the null hypothesis and accept the study hypothesis

79
Q

Confidence Intervals

A

Type of interval estimate o a population parameter and issued to indicate reliability of an estimate

95% CI: 95% confident that the true value of the parameter is in the confidence interval

Corresponds with level of significance - 95% CI reflects significance level of 0.05

80
Q

Bias

A

Any systematic error in a study which results in incorrect estimate of the association between disease and exposure

81
Q

Types of bias

A

Selection bias
Recall bias
Observation bias

82
Q

Confounding

A

Results when there is a mixing of the effect of the exposure and disease with a “third factor”
-may be unknown to researchers

83
Q

Sensitivity

A

Ability of a test to find positive when it is present (true positive)

Ex: 95% sensitive test would have 5% chance it is false negative

84
Q

Specificity

A

Ability of a test to find negatives (true negatives)

Ex: 95% specific test would have 5% chance of false positive

85
Q

Accuracy versus Precision

A

Accuracy: true value
Precision: obtaining the same values

ABPD 2021 (14 decks)

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