periodontitis pathogenesis

Question 1

initial lesion occurs within ____ of plaque development

Answer 1

1-4 days

Question 2

initial lesion represents early stage of _____ with increased ____ (___ particles and ____ leak out of vessels)

Answer 2

inflammation; permeability; carbon; serum proteins

Question 3

there is infiltration of ____ and _____ in the JE; ____ in the CT (5%)

Answer 3

PMNs; monocytes

lymphocytes

Question 4

in the initial lesion stage, there is increased _____ and _____; decreased _____

Answer 4

vascular density; GCF volume; perivascular collagen

Question 5

normal vessels are permeable to ___, ____, and _____; _____ are normally closed

Answer 5

water; salts; small molecules; intercellular junctions

Question 6

in initial lesion stage, dilation of vessels in the _____ is induced by ______

Answer 6

dentogingival plexus; vasoactive mediators (histamine, IL-1, TNF)

Question 7

gaps form between _____, resulting in increased _____

Answer 7

capillary endothelial cells; permeability

Question 8

___ and ___ move out of the capillaries and ____ increases

Answer 8

fluid; proteins; GCF flow rate

Question 9

GCF is a _____ in health or a ____ in disease

Answer 9

plasma transudate; inflammatory exudate

Question 10

GCF passes through the _____ and can be collected from within or at the ____ of the _____

Answer 10

peridontal tissues; orifice; gingival crevice

Question 11

GCF constituents indicate ____ and _____

Answer 11

inflammatory changes; bacterial colonization

Question 12

GCF flow rate ____ with clinical inflammation

Answer 12

increases

Question 13

____ stain for ____ indicates GCF volume

Answer 13

ninhydrin; protein

Question 14

in initial lesion, there is ____ mediated upregulation of ____ on endothelial cells; ____ adhere to ____ and begin to migrate

Answer 14

cytokine; adhesion molecules; PMNs; post-capillary venules

Question 15

PMNs migrate through ____ into ____

Answer 15

JE; gingival sulcus

Question 16

chemotaxis by PMNs is induced by:

Answer 16

host factors (IL-8, C5a)
molecules release by bacteria (fMetLeuPhe)

Question 17

in the initial lesion, there is ____ subjacent to JE; ____ of fluid into ___ and ____

Answer 17

vasculitis; exudation; tissue; gingival sulcus

Question 18

in initial lesion, there is increased migration of ____ into JE and gingival sulcus; _____ present extravascularly; alteration of most ___ portion of JE; loss of _____

Answer 18

leukocytes; serum proteins; coronal; perivascular collagen

Question 19

early lesion occurs with ____ of plaque development; ____ and ____ subjacent to JE with few ____; together they constitute ____ of infiltrated CT

Answer 19

4-7 days; lymphocytes; PMNs; plasma cells; 15%

Question 20

in early lesion, ____ undergoing cytopathic alterations

Answer 20

fibroblasts

Question 21

in early lesion, ____ occurs, which creates space for infiltrate; ____ of JE and SE proliferate; _____ invade the coronal portion of the lesion

Answer 21

collagen destruction; basal cells; epithelial rete pegs

Question 22

in early lesion, _____ remains dilated; large number of ____; as JE invades CT, the previously inactive ____ opens up and proliferates into the _____

Answer 22

dentogingival plexus (dp); venules
capillary bed; CT papillae

Question 23

in the established lesion, increased ____ clinically evident; increased ____ and ____

Answer 23

swelling; fluid exudation; leukocyte migration

Question 24

in est. lesion, ____ increase around blood vessels and in _____

Answer 24

plasma cells; coronal CT

Question 25

activated T cells produce _____ and ____

Answer 25

``` cytokines (IL-2, 3, 4, 5, 6, 10, and 13; TNF-alpha) chemotactic substances (MCP, MIP, RANTES) ```

Question 26

plasma cells produce ____ and ____

Answer 26

Ig; cytokines (IL-6, TNF-alpha)

Question 27

fibroblasts produce ____ and ____

Answer 27

MMPs; TIMPs

Question 28

in the established lesion, there is conversion of ____ to _____

Answer 28

junctional epithelium; pocket epithelium

Question 29

sulcus ____ and the ___ portion of the JE is converted into _____ which is not attached to tooth surface and is loaded with _____

Answer 29

deepens; coronal; permeable pocket epithelium; PMNs

Question 30

in the est. lesion, there is increased proportion of ____ and presence of _____ in CT, JE and gingival sulcus

Answer 30

plasma cells (10-30%); extravascular immunoglobulins

Question 31

___ and ____ of advanced lesion are not known

Answer 31

beginning ; duration

Question 32

advanced lesion similar to est. lesion but there is switch from ___ to ____ predominance which signals conversion from ____ to _____

Answer 32

T cell ; B cell | gingivitis; periodontitis

Question 33

in advanced lesion there is destruction of _____ to root surface and ____ of epithelial attachment which indicated first clinical sign of ____

Answer 33

CT attachment; apical migration; periodontitis

Question 34

bone destruction begins around _____ along _____; ____ proliferation of ____ into deep CT

Answer 34

communicating BVs; crest of septum; apical; PE

Question 35

there is an increased proportion of _____ in the adv. lesion

Answer 35

plasma cells (about 50%)

Question 36

common modifying factors of gingivitis/periodontitis

Answer 36

- diabetes - pregnancy, puberty, menopause - smoking

Question 37

modifying factors can influence:

Answer 37

- susceptibility to gingivitis and periodontitis - plaque growth and composition - clinical presentation - disease progression - response to periodontal therapy

Question 38

oral and periodontal effects of diabetes

Answer 38

- xerostomia - candida infections - periodontitis - multiple periodontal abscesses

Question 39

periodontitis increases _____; ____ improved after periodontal therapy; diabetics with severe periodontitis have higher incidence of ____ and _____

Answer 39

insulin resistance; glycemic control; proteinuria; cardiovascular problems

Question 40

____ increase in poorly controlled diabetes

Answer 40

spirochetes

Question 41

bacteria predominance in type 1 and 2 diabetes

Answer 41

type 2- P. intermedia, C. rectus, P. gingivalis | type 1- capnocytophaga

Question 42

in diabetics, PMN enzymes ____ and ____ increase as a result of poor control; _____ also increases in diabets

Answer 42

beta glucoronidase; elastase; GCF collagenase

Question 43

_____ create destructive phenotype of macrophages

Answer 43

advanced glycation end products (AGEs)

Question 44

decreased matrix synthesis by ___ and ____ in a ____ environment

Answer 44

fibroblasts; osteoblasts; hyperglycemic

Question 45

AGE formation results in formation of _____, causing cell damage

Answer 45

ROS

Question 46

AGE causes ____ thickening, resulting in decreased ____ and _____

Answer 46

vascular wall; oxygen diffusion; PMN migration

Question 47

estrogen affects _____; estrogen increases ___ and ____

Answer 47

salivary peroxidases; collagen metabolism; angiogenesis

Question 48

_____ increases in puberty and pregnancy

Answer 48

gingival inflammation

Question 49

there is an increase in ____ during menstrual cycle in women with gingivitis

Answer 49

gingival bleeding

Question 50

pregnancy increases ____ in the microbiota ; ____ from steroids support growth of this bacteria; there is also an increase in ____

Answer 50

P. intermedia; naphthoquinones; spirochetes

Question 51

effects on host during pregnancy

Answer 51

- increase in vascular perm. resulting in increased gingival exudate - decrease in keratinization - decrease in PMN chemotaxis and phagocytosis - decrease in Ab and T cell responses

Question 52

effects on host during smoking

Answer 52

- lower BOP - lower amounts of GCF in gingivitis - decreased PMN migration and phagocytosis ; increased soluble ICAM-1

Question 53

why smokers have less BOP

Answer 53

- decreased leukocytes in crevice/pocket, but increased leukocytes in the blood - decrease in BVs in inflammatory lesion - increase in keratinization