periodontal destruction

Question 1

destructive pathways

Answer 1

1) host response is associated with bone and attachment loss triggered by bacteria

Question 2

gingival health

Answer 2

1) few inflammatory cells present with no proliferation of the junctional epithelium

Question 3

initial lesion

Answer 3

1) preclinical gingivitis
2) 2-4 days of plaque accumulation
3) loss of perivascular collage
4) neutrophil migration
5) increased GCF

Question 4

early lesion

Answer 4

1) early clinical gingivitis
2) 4-7 days plaque
3) lymphocyte infiltration
4) loss of collagen up to 70%
5) proliferation J.E.
6) few plasma cells

Question 5

established lesion

Answer 5

1) chronic gingivitis
2) 2-3 weeks plaque
3) plasma cells predominate
4) continued loss of collagen
5) no bone loss
6) apical migration of JE
7) pocket formation

Question 6

advanced lesion

Answer 6

1) periodontitis
2) plasma cells predominant
3) fibrosis
4) pocket formation
5) continued apical migration of JE
6 )bone loss

Question 7

principles of pathogenesis

Answer 7

1) bacterial plaque is essential => host response => connective tissue and bone loss => clinical signs of disease

Question 8

quality and quantity of plaque

Answer 8

1) does not explain disease severity by themselves
2) host factors influenced by genetic and environmental

Question 9

smoking

Answer 9

1) huge risk factor
2) odds ratio for advanced periodontal disease
- former smoker - 2
- current smoker - 3
3) masks inflammation

Question 10

twin studies

Answer 10

1) more than 40% of clinical signs of disease were due to genetics

Question 11

IL-1 genotype

Answer 11

1) genotype positive people will produce way more of it
2) activates osteoclasts

Question 12

host response

Answer 12

1) non specific
2) specific

Question 13

complement

Answer 13

1) first line of defense
2) resolution of acute inflammation

Question 14

neutrophils

Answer 14

1) second line of defense
2) resolution of acute inflammation

Question 15

monocyte macrophage

Answer 15

1) present bacterial antigens to Helper T
2) resolution of chronic inflammation

Question 16

lymphocytes

Answer 16

1) Ab, Ab+, and CMI control
2)if not, could be systemic infection

Question 17

periodontal inflammation

Answer 17

1) localized protective response which serves to destroy, dilute, or wall off both the agent (microbes) and the injured tissue
2) redness, swelling ,heat and pain

Question 18

cytokines

Answer 18

1) soluble messenger proteins
2) inflammation, immune growth, differentiation processes
3) can be pro inflammatory or anti inflammatory

Question 19

MMP

Answer 19

1) remodeling and degradation of the ECM components in the periodontium
2) pro-inflammatory

Question 20

prostaglandin E2

Answer 20

1) proinflammatory mediators that cause bone destruction
2) arachidonic acid derivative

Question 21

proinflammatory mediators

Answer 21

1) IL-1, IL-6, IL-8, TNF-alpha
2) PGE2
3) MMPs
4) leukotrienes

Question 22

IL-1

Answer 22

`) simulates osteoclasts
2) secreted by macrophages, B cells, others
3) T cell activation
4) promote B cell maturation
5) chemotaxis

Question 23

TNF alpha and beta

Answer 23

1) alpha by macrophages and mast cells
2) beta by helper T cells
3) activation of osteoclasts
4) phagocytosis and chemotaxis

Question 24

IL-6

Answer 24

1) T cells, macrophages, others
2) T cell activation and plasma cell production
3) role in bone resorption

Question 25

antiimflammatory mediators

Answer 25

1) IL-4, IL-10, IL-1ra
2) tissue inhibitors of MMPs
3) lipoxins

Question 26

innate immune response

Answer 26

1) non specific
2) complement
3) toll like receptor
4) neutrophil
5) macrophages
—
1) recognize bacterial products
2) recruit inflammatory cells
3) proinflammatory mediators
4) activate osteoclassts
5) bone, ECM, and collagen destruction

Question 27

serum complement

Answer 27

1) >30 soluble serum proteins and cell receptors
2) enables endothelium and leukocytes to recognize foreign substances for which they lack a receptor
3) C3a and C5a
4) role in transendothelial migration
—
1) direct (classical) by immune complexes IgG and IgM
2) alternate pathway

=> opsonization, cell lysis, chemotaxis and histamine release

Question 28

toll like receptors

Answer 28

1) pattern recognition receptor
2) mainly cells in first line of defense
- neutrophiles, macrophages
3) recognize endotoxins (LPS)

Question 29

non specific cellular response

Answer 29

1) neutrophils
2) monocyte / macrophages

Question 30

transendothelial migration

Answer 30

1) cells gently rolling allow bloodstream
2) complement activated, C3a and C5a => activate resident leukocytes like mast cells
3) endothelium makes p-selectin, e-selectin bind carbs on surface of leukocyte
- more rolling!
4) TNF from mast cells stimulated endothelium to release IL-8
- bind CXCR2 receptor on leukocytes
- L-selectin is shed
5) LFA is expressed and binds to cellular adhesion molecules ICAM2 on endothelium
- no more rolling
6) CD31 on leukocyte and on the endothelium
- lines it up with junction on epithelial cells
- unzips it
7) gets into the tissues with minimal leakage

Question 31

once in the tissue

Answer 31

1) leukocyte follows the chemical gradient to the bacteria

Question 32

PMN

Answer 32

1) differentiate in bone marrow
2) rapid response

Question 33

monocyte

Answer 33

1) differentiate in local tissue
2) present antigen to T cell

Question 34

specific host response

Answer 34

1) activated when first line of defense in insufficient
2) specialized functions regulated by lymphocytes

1) humoral
2) cellular

Question 35

activating specific host response

Answer 35

1) macrophage IL-1 and IL-6 for activating helper T cells
2) tells B cells to differentiate into plasma cells

Question 36

humoral immunity

Answer 36

1) bone marrow
2) b lymphocytes
3) memory cells, plasma cells, cytokines

Question 37

IgA and IgM

Answer 37

1) immune complexes
2) opsonins for neutrophils and macrophages to phagocytosis
–
1) activate complement

Question 38

IgA

Answer 38

1) regulate bacterial colonization in mouth

Question 39

IgE

Answer 39

1) mast cells
2) degranulation and histamine

Question 40

vascular response

Answer 40

1) redness, heat, swelling, pain

Question 41

cellular immune response

Answer 41

1) bone marrow => thymus => t lymphocytes
2) memory cells, cytokines, cytotoxic and T helper cells

Question 42

Mast cell

Answer 42

Resident leukocyte that releases histamine, TNF, others
- rule in vascular response