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DEN 2027 - Disease Mechanisms > Periodontal Disease > Flashcards

Periodontal Disease Flashcards

1
Q

What are periodontal diseases?

A

All disorders of the supporting structures of the teeth, namely the gingiva, periodontal ligament and supporting alveolar bone

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2
Q

What is gingivitis?

A

Inflammation of the gingiva alone

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3
Q

What is periodontitis?

A

Inflammation of the periodontal ligament and destruction of alveolar bone

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4
Q

What causes periodontal diseases?

A

A shift in the balance of resident microflora

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5
Q

Describe the aetiology of chronic gingivitis

A
  • Healthy gingivae
  • High microbial plaque / susceptible host site
  • Penetration of gingival tissue by extracellular microbial products
  • Inflammation
    ( Removal of plaque returns to healthy gingivae)
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6
Q

Name 3 reasons a person may be susceptible to gingivitis

A
  1. Pregnancy
  2. Smoking
  3. Genetic predisposition
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7
Q

Describe the aetiology of periodontitis

A
  • Microbial challenge presents antigens and virulence factors
  • Inflammatory response produces antibodies and PMNs to microbial challenge but also produces cytokines, prostaglandins and matrix metalloproteinases
  • Cytokines, prostaglandins and matrix metalloproteinases cause CT and bone metabolism
  • Clinical signs of disease
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8
Q

What 2 factors influence inflammatory response and metabolism in the aetiology of periodontitis?

A
  1. Environmental

2. Genetic

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9
Q

What does plaque consist of?

A

Bacteria embedded into a matrix of salivary glycoproteins and serum proteins

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10
Q

Describe supra-gingival plaque

A
  • Formed on tooth surface and gum margins
  • Half matrix, mostly gram positive and aerobic bacteria unless bulk increases
  • Mineralises to form calculus
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11
Q

Describe sub-gingival plaque

A
  • Mature plaque accumulating in gingival crevice and beyond
  • Contains little matrix, mostly gram negative rods and spirochetes
  • Highly anaerobic with increased bacterial diversity
  • Mineralises to form calculus
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12
Q

Describe the evidence for the role of plaque in periodontal disease

A
  • Oral hygiene discontinuation results in increased plaque and subsequent gingivitis, reversed on recommencing oral hygiene
  • Experimental gingivitis studies (Harald Loe, 1960’s)
  • Germ free animal studies show association of plaque bacterial with periodontal diseases
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13
Q

Name 4 microbes found in chronic gingivitis

A
  1. Streptococcus milleri
  2. Actinomyces israelii
  3. Prevotella intermedia
  4. Fusobacterium nucleatum
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14
Q

Name 5 bacterial found in adult periodontitis

A
  1. Porphyromonas gingivalis
  2. Treponema denticola
  3. Treponema forsythia
  4. Prevotella intermedia
  5. Fusobacterium nucleatum
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15
Q

What is virulence?

A

Quantitative measure of pathogenicity, related to the organism’s toxigenic potential and invasiveneess

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16
Q

How is virulence measured?

A

The number of organisms required to cause disease

17
Q

What is LD50?

A

Number of organisms required to kill half of the animal hosts tested

18
Q

What is ID50?

A

Number of organisms required to infect half of the animal hosts tested

19
Q

What are surface associated virulence factors?

A

A substance found on a viral cell surface, which generally confers adhesive, protective or immunomodulatory characteristics

20
Q

Name 3 examples of virulence factors?

A
  1. Pilli
  2. Capsule
  3. Flagella
21
Q

Name 4 ways in which bacteria cause periodontal disease?

A
  1. Exotoxins released by live bacteria
  2. Endotoxin (LPS) is a component of gram negative periodontal pathogens
  3. Bacterial enzymes break down host proteins
  4. Bacterial antigens elicit immune response
22
Q

Give an example of how exotoxins function

A

A. actinomycetemcomitans release leukotoxin which lyses white blood cells

23
Q

Give 3 ways endotoxins are involved in periodontal disease

A
  1. Activates complement and macrophages
  2. Degranulates neutrophils
  3. Stimulates bone resorption
24
Q

Describe P. gingivalis

A
  • Gram negative rod
  • Strictly anaerobe
  • Produces protease enzymes which degrade complement, immunoglobulins and collagen
  • Associated with adult periodontitis
25
Q

Describe T. denticola

A
  • Spirochaetes
  • Associated with ANUG (acute necrotizing ulcerative gingivitis)
  • Produces potent hydrolytic enzymes including collagenases and proteases
26
Q

Describe F. nucleatum

A
  • Gram negative rod
  • Associated with ANUG and rapidly progressive periodontitis
  • Produces potent LPS and butyric acid
  • Expresses novel adhesin, FadA, which is involved in attachment and invasion of host cells
27
Q

Describe P. intermedia

A
  • Black pigmented gram negative rod
  • Associated with ANUG and adult periodontitis
  • Produces LPS which has potent effects on immune cells and bone
28
Q

What oral anaerobe produces aminopeptidase P enzyme?

A

T. denticola

29
Q

What 2 oral anaerobes produce dipeptidyl peptidase?

A
  1. P. gingivalis

2. P. intermedia

30
Q

What 2 oral anaerobes produce trypsin?

A
  1. P. gingivalis

2. T. denticola

31
Q

What oral anaerobe produces chymotrypsin?

A

T. denticola

32
Q

What 3 oral anaerobes produce collagenase?

A
  1. P. gingivalis
  2. P. intermedia
  3. T. denticola
33
Q

What oral anaerobe does not produce any enzymes?

A

F. nucleatum

DEN 2027 - Disease Mechanisms (20 decks)

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