Periodontal Disease

Question 0

What are the microbial features of early gingivitis?

Answer 0

Increased neutrophil emigration
Proliferation of junctional epithelium
Increased infiltrate
Dilated vessels, vascular proliferation, very few plasma cells
Increased collagen loss

Question 1

What factors are required to develop periodontal disease?

Answer 1

Microbial challenge - plaque biofilm, antigens etc
Host immuno-inflammatory response - antibodies, PMNs, cytokines & prostanoids etc
Connective tissue and bone metabolism - environmental/acquired/genetic risk

Question 2

What are the microbial features of established gingivitis?

Answer 2

Greatly increased neutrophil emigration
Marked proliferation of junctional epithelium
Greatly increased leukocytic infiltration with plasma cells (constituting 10-30%)

Question 3

Name four local plaque retention factors.

Answer 3

Calculus
Restoration margins
Crowding
Mouth breathing

Question 4

Name two systemic plaque retentive factors.

Answer 4

Sex hormones

Medication

Question 5

What are the microbial features of periodontitis?

Answer 5

Same as established gingivitis.
Apical migration of the junctional epithelium.
Plasma cells constitute 50%.
Bone loss.

Question 6

What is a false pocket?

Answer 6

Inflammation of papilla

No loss of bone attachment

Question 7

What is a true pocket?

Answer 7

Loss of bone attachment

Question 8

What is the clinical appearance of periodontal disease?

Answer 8

Bleeding on probing
Redness
Loss of stippled appearance
Inflamed gingival margins
Shiny appearance
*different in smokers

Question 9

What is the clinical appearance of periodontal disease in smokers?

Answer 9

Gingival margins appear healthy
Not inflamed
No bleeding on probing
Deep pockets

Question 10

What is a biofilm?

Answer 10

Microorganisms, embedded in a glycocalyx, attached to a solid surface

Question 11

What is polymicrobial synergy?

Answer 11

The combined effects of many microbes working together

Question 12

What is dysbiosis?

Answer 12

A state in which former commensal bacterium behave as proinflammatory pathobionts

Question 13

What mechanisms are involved in the host immune response to periodontal disease?

Answer 13

Saliva
Epithelium - physical barrier, shedding of cells, production of inflammatory mediators
GCF
Inflammatory and immune responses

Question 14

What are the protective functions of antibodies produced against periodontal disease?

Answer 14

Inhibition of adhesions/invasion
Complement activation
Neutralisation of toxins
Opsonisation of toxins
Prevents progressive infection - serious systemic consequences
Inadvertent local tissue damage combined with attempts at repair

Question 15

What are MMPs?

Answer 15

Matrix metalloproteinases
A family of zinc and calcium dependent proteolytic enzymes, which include collagenases
Break down connective tissue in periodontitis
Secreted by host inflammatory cells

Question 16

What are the different types of bone loss in periodontal disease?

Answer 16

Horizontal bone loss - even & uniform around whole tooth
Vertical bone loss - greater on different sides of the teeth, zig-zag appearance in radiographs
Furcation bone loss - between the roots of teeth, categorised as either grade 1/2/3

Question 17

How does smoking contribute to periodontal disease?

Answer 17

Vasoconstriction of gingival vessels
Increase gingival keratinisation
Impaired antibody production
Depressed numbers of Th lymphocytes
Impaired PMN function
Increased production of proinflammatory cytokines