Periodontal Microbiology Flashcards
The Periodontium
Periodontal Diseases
____ and___ of ___ ___and___associated with the tooth
______trauma
_____trauma
____ (___ associated)
¡Most common etiology is the presence of ___ ssociated with the________
____/____
_____ ____ ______
___ ____ ____ _____
¡Chronic Periodontitis is a major cause of ___ ___ in ___ populations.
¡LAP and ANUG are found in ______populations.
¡
¡
¡Inflammation and destruction of connective tissue and bone associated with the tooth
▪Physical-occlusal trauma
▪Thermal/chemical trauma
▪Microbial (plaque associated)
¡Most common etiology is the presence of bacteria associated with the subgingival crevice
§Gingivitis /Chronic Periodontitis
§Localized Aggressive Periodontitis (LAP)
§Acute Necrotizing Ulcerative Gingivitis (ANUG)
¡Chronic Periodontitis is a major cause of tooth loss in aging populations.
¡LAP and ANUG are found in immuno-compromised populations.
¡
¡
Quantitative clinical changes=
changes in microbial habitat
Factors in Disease
Periodontal disease is multifactorial
¡
¡Simple diseases
§Condition is ___ or ___, ______factors influence
___ ___: sickle-cell anemia, cystic fibrosis
___ ____: Small-pox, Anthrax
¡
¡Complex diseases
___ of ___ ( ___ ___)
____ factors influence the diagnosis
____
___
§Large numbers subjects are affected “__ ___ ___”
Periodontal disease is multifactorial
¡
¡Simple diseases
§Condition is present or absent, one (or few) factors influence
§Host genetics: sickle-cell anemia, cystic fibrosis
§Infectious disease: Small-pox, Anthrax
¡
¡Complex diseases
§Spectrum of severity (Bell Curve)
§Many factors influence the diagnosis
▪Host
▪Environment
§Large numbers subjects are affected “to some degree”
¡
▪
▪
Periodontal Disease Factors
¡Host
- ____
- ___ ___
- ___ ___ ___
- __ __ ___
- ____
- ___ ___
- ___
- ___
¡Environment
- §Bacterial flora
- ____
- ___
- ____
- ▪
¡Host
§Genetics
▪Immune response
▪Connective tissue healing
▪Type 2 Diabetes
§Habits
▪Oral hygiene
▪Smoking
▪Diet (diabetes)
▪
¡Environment
§Bacterial flora
▪Composition
▪Load of pathogenic species
▪Virulence potential of strains
▪
Natural History of Periodontal Disease in Man
¡J Clin Periodontol. 1986 May;13(5):431-45.
¡480 male laborers at two tea plantations in Sri Lanka
___ oral hygiene
¡Oral examinations in ___ 1973, 1977, 1982,1985,___
¡Aggregates of ___ ,___ and ___ on their teeth
¡Based on ____ ____ of ___ and tooth ___ rates, three subpopulations were identified:
__ ___ of ___ ___ beyond ____ (___ )
___ ___ ( )
___ ____of periodontal disease ( )
¡J Clin Periodontol. 1986 May;13(5):431-45.
¡480 male laborers at two tea plantations in Sri Lanka
¡No oral hygiene
¡Oral examinations in 1971, 1973, 1977, 1982,1985, 1990
¡Aggregates of plaque, calculus and stain on their teeth
¡Based on interproximal loss of attachment and tooth mortality rates, three subpopulations were identified:
§no progression (NP) of periodontal disease beyond gingivitis (~ 11%)
§moderate progression (MP) (~ 81%)
§rapid progression of periodontal disease (RP) (~ 8%)
CDC’s Healthy Aging Data Portfolio
¡The percentage of older adults who have retained their natural teeth (i.e., lost _ or fewer teeth) has ____ steadily over the past few decades.
¡Reflects a change in treatment philosophy, from___ teeth to making efforts to ____ natural teeth and supporting structures.
¡
¡This is significant as the mouth reflects a person’s___ and ___ ___ throughout life.
¡From a dental perspective, more elderly adults with natural dentition requires___ ____ of ___ ___
¡
¡The percentage of older adults who have retained their natural teeth (i.e., lost 5 or fewer teeth) has increased steadily over the past few decades.
¡
¡Reflects a change in treatment philosophy, from extracting teeth to making efforts to preserve natural teeth and supporting structures.
¡
¡This is significant as the mouth reflects a person’s health and well-being throughout life.
¡From a dental perspective, more elderly adults with natural dentition requires greater management of periodontal health.
¡
¡
Biofilms as Dental Plaque
- ¡The ___________ link has been investigated over centuries
- ¡Plaque in health and disease has ____ composition
- §“___ ___ __ ___”
- §Gingivitis (___complex) and Periodontitis (___ complex)
- ¡Dental plaque biofilms form in an ___ fashion
- ____/____
- §Driven by ____/____ relationships
- §Local changes in the____
- ¡Pioneer bacteria ___ the ___ for the ___ colonizers
- ¡Biofilm growth is restricted by __ ___
Biofilms as Dental Plaque
¡The plaque-oral health link has been investigated over centuries
§Microscopy
§Molecular techniques
§
¡Plaque in health and disease has different composition
§“Experimental gingivitis in man”
§Gingivitis (orange complex) and Periodontitis (red complex)
¡Dental plaque biofilms form in an orderly fashion
§Structurally/temporally
§Driven by adhesion/coaggregation relationships
§Local changes in the environment
§
¡Pioneer bacteria prepare the environment for the late colonizers
¡
¡Biofilm growth is restricted by host factors
§
¡
Health- Clinical parameters
Gingiva is ___ AND ___
No ___ on ___
Probing depth =______
___ plaque at___ ____
Genus:
____
___
____
Gingiva is firm and tight
No bleeding on probing
Probing depth = 0-3 mm
Little plaque at gingival margin
Streptococci
Actinomyces
Veillonella
Streptococcus salivarius group
Streptococcus oris group
Complex?
O2?
+/-
Shape?
Form _____
Comments: ___ on the ___, __ ___. ____ ___ of the ___ ___
Streptococcus salivarius group
Streptococcus oris group
Yellow
Facultative anaerobes
G+ cocci
Long chains
Pioneers on the pellicle, mucosal surfaces. Largest component of the oral flora.
Actinomyces spp.
Complex?
O2?
+/-
Shape?
Form ____ ___
_____ numbers in ____ and ___ dental plaque.
Actinomyces spp.
Blue
Facultative anaerobes
G+ bacilli
Branching rods
High numbers in approximal and marginal dental plaque.
Veillonella spp.
Complex?
O2?
+/-
Shape?
___ numbers from __ ___ and __ ___
Veillonella spp.
Purple
Obligate anaerobes
G- cocci
High numbers from dental plaque and mucosal surfaces.
Capnocytophaga spp.
complex?
O2?
+/-
shape ___ ___
Comments
_____________
Capnocytophaga spp.
Green
Capnophilic anaerobe
Gram - filamentous
bacilli
Gliding motility
Aggregatibacter actinomycetemcomitans serotype a
Complex
O2
Gram ___
Shape?
Comment:
Aggregatibacter actinomycetemcomitans serotype a
Green
Capnophilic facultative anaerobe
Gram – short bacilli
Internal “star” in colonies
Eikenella corrodens
Complex?
O2
Gram ___
Shape?
Comments: _____
Eikenella corrodens
Green
Facultative anaerobe
Gram - bacilli
Microaerophilic
¡Capnocytophaga spp.
§Gram negative
§Filamentous ___
§Capnophilic anaerobe
§Gliding motility
§Grooms ___ from cell surfaces
§
¡Aggregatibacter actinomycetemcomitans serotype a
§Gram negative
§Short ___
§Capnophilic facultative anaerobe
______
§Internal “star” in colonies
§
¡Capnocytophaga spp.
§Gram negative
§Filamentous rod
§Capnophilic anaerobe
§Gliding motility
§Grooms glycan from cell surfaces
§
¡Aggregatibacter actinomycetemcomitans serotype a
§Gram negative
§Short rod
§Capnophilic facultative anaerobe
§Non-motile
§Internal “star” in colonies
§
¡Eikenella corrodens
§Gram negative bacillus
§Facultative anaerobe
Found in ___ __ and ___ ___
§Can be elevated in ___
___ ___ __
▪
▪
▪
___ and ____ lesions
§
¡Eikenella corrodens
§Gram negative bacillus
§Facultative anaerobe
§Gingival margin and Subgingival plaque
§Can be elevated in gingivitis
§Human bite infections
▪Clenched fist
▪Occlusal bite
▪Other saliva-associated wounds
§painful and necrotic lesions
§
Gingivitis\
Gingiva ___ , ____
___ on ___
PD =_____
Increased plaque at ___
___ complex
Gingiva red, swollen
Bleeding on probing
PD =2 - 5 mm
Increased plaque at margin
Orange complex
Gingivitis
¡An ___ process limited to the ___ ___ ___ around the ___ potion of the tooth
¡
¡Classifications
§Etiology
▪___ induced, ____, ___ , ___ induced
¡Most common form of gingivitis is ___, __ induced
¡
¡Inflammation begins with ___ ___ ____ (aging plaque)
___ ___and ___ ____ increase
§Tissue bleeds when disturbed.
§
¡
▪
¡An inflammatory process limited to the mucosal epithelial tissue around the cervical potion of the tooth
¡
¡Classifications
§Etiology
▪Drug-induced, hormonal, nutritional, plaque induced
¡
¡Most common form of gingivitis is chronic, plaque induced
¡
¡Inflammation begins with undisturbed plaque accumulation (aging plaque)
§GCF flow and neutrophil infiltration increase
§Tissue bleeds when disturbed.
§
¡
▪
Bacteria in Chronic Gingivitis
¡Orange complex bacteria
____ ___
___ ____
_____
____ ___
___ ____
_____ ___
¡Many are Gram ___, ___
__ ___ of __ ___ (pathogenicity)
¡Orange complex bacteria
§Fusobacterium nucleatum
§Prevotella intermedia
▪Campylobacter spp.
▪Eubacterium nodatum
▪Strep. constellatus
▪Peptostreptococcus micros
¡Many are Gram negative, anaerobes
¡Opportunistic pathogens of soft tissue
¡Fusobacterium nucleatum
O2
§Gingivitis
_____ plaque
Shape ____
§Bridge bacterium
§
¡Fusobacterium nucleatum
§Obligate anaerobe
§Gingivitis
§Subgingival plaque
§Long filamentous rod
§Bridge bacterium
§
¡Prevotella species
§P._____
§P. _____
O2
____ of Gingivitis
§Elevated in ____
___ plaque
§Many are __ ___on __ __
___ ___
¡Prevotella species
§P. intermedia
§P. nigrescens
§Obligate anaerobe
§Initiation of Gingivitis
§Elevated in Periodontitis
§Subgingival plaque
§Many are black pigmented on blood agar
§Antibiotic resistance
¡Campylobacter spp.
§Gram ___
__ via ___
Shape?
O2?
_____
¡
¡
¡
¡Campylobacter spp.
§Gram negative
§Motile via flagella
§Curved rod
§Anaerobe
▪microaerophilic
¡
¡
¡
¡Eubacterium nodatum
§Gram ___
Shape:
▪Similar appearance to ____
O2
§
¡Eubacterium nodatum
§Gram positive
§Filamentous rods
▪Similar appearance to Actinomyces
§Anaerobe
§
¡Strep. constellatus
§Gram ___
Shape
___ group
___-hemolytic
O2
___
¡
¡
¡
¡Strep. constellatus
§Gram positive cocci
§Milleri group
§Beta-hemolytic
§Anaerobe
▪microaerophilic
¡
¡
¡
¡Peptostreptococcus micros
Gram ___
Shape?
Form ___ and ___ ___
O2
§
§
¡Peptostreptococcus micros
§Gram positive cocci
§Pairs & short chains
§Anaerobe
§
§
Virulence of Gram Negative Bacteria
¡Endotoxin
§Structural component of outer membrane of gram ___ bacteria only
§ Also known as lipopolysaccharide (LPS)
_____ portion of LPS is the toxic component
§Released as ___ ___
¡Innate immune response recognizes lipid A and triggers inflammation
¡Endotoxin
§Structural component of outer membrane of gram negative bacteria only
§ Also known as lipopolysaccharide (LPS)
§Lipid A portion of LPS is the toxic component
§Released as membrane “blebs”
¡Innate immune response recognizes lipid A and triggers inflammation
Periodontitis
¡Periodontitis is a ___ infection of the __ ___ of the tooth, characterized by ___ of ___between the ___ and ___
¡
¡Periodontitis is the leading cause of __ __ in US adults.
¡
¡Approximately __% of adults will suffer from ___ ___ of ____
¡Periodontitis is a chronic infection of the connective tissues of the tooth, characterized by loss of attachment between the tooth and the bone.
¡
¡Periodontitis is the leading cause of tooth loss in US adults.
¡
¡Approximately 50% of adults will suffer from some degree of periodontitis.
Fun Facts about Periodontal disease
- ¡Usually develops from ___ __ ____
- __ __ ___develops into periodontitis
- ¡Disease is ___, ___, and ___ in nature
- §Chronic-takes ___or ___s to develop. Once it develops, is __ ___, but ___
- §Insidious-___ until later stages. Later symptoms are advanced ___ and __ gums, ___ ___, change in __, ___ ___
- §Episodic- bone loss occurs in ___ in different sites in mouth, in an __/_ fashion.
- ¡Periodontal disease-___ ___ of the ____
- ____
- ___ __ of ____
- ¡Periodontitis –inflammation/infection that results in loss of attachment between the tooth and the bone.
- §Chronic periodontitis
- §Localized Aggressive Periodontitis
- §Acute necrotizing ulcerative gingivitis/periodontitis
*
¡Usually develops from pre-existing gingivitis
§Not all gingivitis develops into periodontitis
§
¡Disease is chronic, insidious, and episodic in nature
§Chronic-takes months or years to develop. Once it develops, is never cured, but managed.
§Insidious-silent until later stages. Later symptoms are advanced swollen and bleeding gums, loose teeth, change in bite, bad breath.
§Episodic- bone loss occurs in phases in different sites in mouth, in an on/off fashion.
§
¡Periodontal disease-all diseases of the periodontium
§Gingivitis
§All forms of periodontitis
¡
¡Periodontitis –inflammation/infection that results in loss of attachment between the tooth and the bone.
§Chronic periodontitis
§Localized Aggressive Periodontitis
§Acute necrotizing ulcerative gingivitis/periodontitis
§
¡
Chronic Periodontitis
Gingiva ___, ___
See ___
______ on probing
PD ____
Tooth mobility = ___ ___
Gingiva red, swollen
Calculus
Bleeding on probing
PD >3 mm
Tooth mobility = attachment loss
Bacteria in Chronic Periodontitis
___ complex
____ ___
___ ___
___ ____
§
¡Similar characteristics
§Gram ___
O2?
§Biofilm formers
▪___ colonizers
▪Where?
Food source?
§Interact with __ __
___
¡Red complex
§Porphyromonas gingivalis
§Tannerella forsythia
§Treponema denticola
§
¡Similar characteristics
§Gram negative
§Anaerobic
§Biofilm formers
▪late colonizers
▪sub-gingival
§Asaccharolytic
▪highly proteolytic
§Interact with immune system
§Invasive
Treponema denticola
¡Treponema denticola
Shape?
O2?
Seen in _______________
Found in ____ plaque
¡Major virulence factors
-
___ and ____
- ___ __ ___
- ___ ___ ___
- §Interact___ with other ___
- __ __
- ___
- §Dysregulate the __ ___
- ▪Interfere with ___ ___
- §Produces___ ___
¡Treponema denticola
§Spirochete
§Obligate anaerobe
§Periodontitis
§ANUG
§Subgingival plaque
§
¡Major virulence factors
¡
§Motility and chemotaxis
▪colonize new sites,
▪penetrate epithelial layers
§Interact synergistically with other pathogens
▪Food webs
▪Biofilms
§Dysregulate the host defense
▪Interfere with cytokine production
§Produces cytotoxic metabolites
¡
Tannerella forsythia
¡Tannerella forsythia
O2?
§Strongly associated with _____
§
____ plaque
§Has an _____
▪_________________
_______culture in lab
▪Requires ________
¡S-layer
____ ____
§Blocks ___ ___
____
¡Mirolysin
___ that cleaves ___
¡
¡Tannerella forsythia
§Obligate anaerobe
§
§Strongly associated with periodontitis
§
§Subgingival plaque
§
§Has an S-layer
▪One of the only oral bacteria that has this feature
§
§Difficult to culture in lab
▪Requires peptidoglycan in the media
¡S-layer
§Glycoproteins lattice
§Blocks complement binding
§adhesin
¡Mirolysin
§Protease that cleaves complement
¡
§
Porphyromonas gingivalis
O2?
Associated with ____
____plaque
Food source?
Related to ____
___ ____ on blood agar “The ___ ___”
¡Virulence factors
___ ____
___ ___
_____
▪___
§___ ___ ___
___/___
____
Obligate anaerobe
Periodontitis
Subgingival plaque
Asaccharolytic
Related to Prevotella
Black pigmented on blood agar “The purple one”
¡Virulence factors
§fimA -fimbriae
§Membrane blebs
§Gingipains
▪Proteases
§Iron uptake systems
§Capsule/EPS
§Invasive
Late Colonizers and the Epithelium
¡Early colonizers are in contact with the ___ ___
¡Secondary and late colonizers contact the __ ___
¡Gram-negative contact with __ ___ can initiate ___
¡Early colonizers are in contact with the root cementum
¡Secondary and late colonizers contact the epithelial cells
¡Gram-negative contact with host cells can initiate inflammation
P. gingivalis and Bone Loss
¡Animal studies have shown a direct link between _____ and ___ ___
§Inculation of mice with pure P. gingivalis culture elicits___ __ ___
§Immunization of mice prior to inoculation is ____
¡Balance between ___ and ___ activity is ___ in presence of P. gingivalis
¡Animal studies have shown a direct link between P. gingivalis and bone loss
§Inculation of mice with pure P. gingivalis culture elicits alveolar bone loss
§Immunization of mice prior to inoculation is protective
¡Balance between osteoclast and osteoblast activity is shifted in presence of P. gingivalis
The composition of the____ ____ shifts over time.
Yellow/Blue Complex
(Gram positive)
Orange/Red Complex
(Gram negative)
The composition of the sub-gingival flora shifts over time.
Yellow/Blue Complex
(Gram positive)
Orange/Red Complex
(Gram negative)
Gingivitis and chronic periodontitis are ___, ____progressing diseases mediated by ___ of ____.
The primary etiology is ____ insult, followed by ___ ___ ___
The progress of the disease is driven by __ _ ___
Periodontal pathogens contribute to the disease process by stimulating____n and___ ___while evading the___response. They manipulate the host to create the ___ ___.
Gingivitis and chronic periodontitis are chronic, slowly progressing diseases mediated by accumulation of bacterial biofilms.
The primary etiology is bacterial insult, followed by destructive host inflammation.
The progress of the disease is driven by ecological changes.
Periodontal pathogens contribute to the disease process by stimulating inflammation and tissue damage, while evading the immune response. They manipulate the host to create the optimal niche.
¡
¡
Localized Aggressive Periodontitis
¡Previously called
___ ___ ___
___ ___
___ ___ ____
§
¡Previously called
§Early onset periodontitis
§Juvenile periodontitis
§Rapidly progressive periodontitis
§
LAP features\
¡Onset at ____
¡Bone loss usually localized to__ ___and ___
¡Amount of plaque accumulation is___ compared to the amount of ___ ___
¡Associated with __________ (which bacteria)
- §Strong ___ ___ ___
¡Patients often have ___ ____.
¡Onset at puberty
¡
¡Bone loss usually localized to first molars and incisors
¡
¡Amount of plaque accumulation is low compared to the amount of tissue destruction
¡
¡Associated with Aggregatibacter actinomycetemcomitans (A.a.) serotype b
§Strong antibody immune response
§
¡Patients often have neutrophil deficiencies
Aggregatibacter actinomycetemcomitans
¡Gram ____
O2?
____ ( ___ % ___)
¡Some serotypes more ____ than others (serotype b)
¡Produce ___ that contribute to ___ ___.
¡Gram negative
¡
¡Facultative anaerobe
¡
¡Capnophilic (10% CO2)
¡
¡Some serotypes more pathogenic than others (serotype b)
¡
¡Produce toxins that contribute to tissue damage
Formerly known as
Actinobacillus actinomycetemcomitans
¡Aggregatibacter actinomycetemcomitans
¡A.a.
¡___ serotypes based on _-_____
§Serotype _ disease associated
§LAP
§
¡Produces _ toxins
____
____ ___ ___
___ important for ___
¡Aggregatibacter actinomycetemcomitans
¡
¡A.a.
¡
¡6 serotypes based on O-antigen
§Serotype b disease associated
§LAP
§
¡Produces 2 toxins
§Leukotoxin
§Cytolethal distending toxin
§
¡Fimbriae important for adhesion
A.a. Virulence factors
¡Leukotoxin
§Kills ___ such as ____
§Target cells undergo ____
§
¡Cytolethal distending toxin
§Toxin enters host cell ____
§Degrades ____ ____
§Cell enters ___ ____
____ ____ protein
- §Inhibits ___ ____§
¡Surface fimbriae for ____
____
§
¡Leukotoxin
§Kills leukocytes such as PMNs
§Target cells undergo apoptosis
§
¡Cytolethal distending toxin
§Toxin enters host cell nucleus
§Degrades chromosomal DNA
§Cell enters G2 arrest
§
¡Fc binding protein
§Inhibits antibody response
§
¡Surface fimbriae for adhesion
¡
¡Invasive
§
LAP Host Factors
___ __ ___
related to ___ ___
LAP Host Factors
¡Strong genetic component
¡
¡Related to neutrophil dysfunction
Neutrophils
¡Neutrophil ____ _____toxic bacteria.
¡Neutrophils are the most ___ type of __ __ ___
¡ They respond to infection by ___ through ___ ___and____ the offending bacteria.
¡Critical for defending ___ ____
¡Neutrophil appendages grasping toxic bacteria.
¡
¡Neutrophils are the most abundant type of white blood cells.
¡
¡ They respond to infection by squeezing through blood vessels and ingesting the offending bacteria.
¡
¡Critical for defending junctional epithelium
Acute Necrotizing Ulcerative Gingivitis (ANUG)
___ Mouth
___ ____
Common? ____
§Occurs most often in ____ years of age
¡Occurs in ___-______individuals with ___ __ ___
___ ___ ___ ____
¡Trench Mouth
¡
¡Vincent’s gingivitis
¡
¡Very rare
§Occurs most often in 15-35 years of age
¡
¡Occurs in health-compromised individuals with poor oral hygiene
§Nutritional
§Disease
§Drugs
§Stressed
ANUG
¡Begins as a ___ ___at ___ ___
§Grey “____-_____”
¡Progresses ___ and involves remaining dentition within ___/___
¡Associated with ___ ,___, ___, __, ___ ___ ___¡
¡Bacteria may spread beyond ___ ___ and cause ___ ___
¡
¡Begins as a necrotic lesion at interdental papillae
§Grey “pseudo-membrane”
¡
¡Progresses rapidly and involves remaining dentition within days/weeks
¡
¡Associated with pain, bleeding, fever, malaise, swollen lymph nodes
¡
¡Bacteria may spread beyond ANUG lesion and cause systemic infections
¡
Clinical presentation and histology
¡Causative bacteria:
§
¡Treatment:
§Cleaning with
_____
§Improved ___ ___
§Improved ____ ____
¡Causative bacteria:
§Prevotella intermedia
§Fusobacterium nucleatum
§Spirochetes (Treponemes)
§
¡Treatment:
§Cleaning with hydrogen peroxide
§Antibiotics (metronidazole)
§Improved oral hygiene
§Improved overall health
