periodontitis pathogenesis Flashcards

1
Q

initial lesion occurs within ____ of plaque development

A

1-4 days

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2
Q

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

A

inflammation; permeability; carbon; serum proteins

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3
Q

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

A

PMNs; monocytes

lymphocytes

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4
Q

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

A

vascular density; GCF volume; perivascular collagen

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5
Q

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

A

water; salts; small molecules; intercellular junctions

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6
Q

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

A

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

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7
Q

gaps form between _____, resulting in increased _____

A

capillary endothelial cells; permeability

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8
Q

___ and ___ move out of the capillaries and ____ increases

A

fluid; proteins; GCF flow rate

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9
Q

GCF is a _____ in health or a ____ in disease

A

plasma transudate; inflammatory exudate

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10
Q

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

A

peridontal tissues; orifice; gingival crevice

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11
Q

GCF constituents indicate ____ and _____

A

inflammatory changes; bacterial colonization

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12
Q

GCF flow rate ____ with clinical inflammation

A

increases

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13
Q

____ stain for ____ indicates GCF volume

A

ninhydrin; protein

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14
Q

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

A

cytokine; adhesion molecules; PMNs; post-capillary venules

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15
Q

PMNs migrate through ____ into ____

A

JE; gingival sulcus

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16
Q

chemotaxis by PMNs is induced by:

A
host factors (IL-8, C5a)
molecules release by bacteria (fMetLeuPhe)
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17
Q

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

A

vasculitis; exudation; tissue; gingival sulcus

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18
Q

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

A

leukocytes; serum proteins; coronal; perivascular collagen

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19
Q

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

A

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

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20
Q

in early lesion, ____ undergoing cytopathic alterations

A

fibroblasts

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21
Q

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

A

collagen destruction; basal cells; epithelial rete pegs

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22
Q

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

A
dentogingival plexus (dp); venules
capillary bed; CT papillae
23
Q

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

A

swelling; fluid exudation; leukocyte migration

24
Q

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

A

plasma cells; coronal CT

25
activated T cells produce _____ and ____
``` cytokines (IL-2, 3, 4, 5, 6, 10, and 13; TNF-alpha) chemotactic substances (MCP, MIP, RANTES) ```
26
plasma cells produce ____ and ____
Ig; cytokines (IL-6, TNF-alpha)
27
fibroblasts produce ____ and ____
MMPs; TIMPs
28
in the established lesion, there is conversion of ____ to _____
junctional epithelium; pocket epithelium
29
sulcus ____ and the ___ portion of the JE is converted into _____ which is not attached to tooth surface and is loaded with _____
deepens; coronal; permeable pocket epithelium; PMNs
30
in the est. lesion, there is increased proportion of ____ and presence of _____ in CT, JE and gingival sulcus
plasma cells (10-30%); extravascular immunoglobulins
31
___ and ____ of advanced lesion are not known
beginning ; duration
32
advanced lesion similar to est. lesion but there is switch from ___ to ____ predominance which signals conversion from ____ to _____
T cell ; B cell | gingivitis; periodontitis
33
in advanced lesion there is destruction of _____ to root surface and ____ of epithelial attachment which indicated first clinical sign of ____
CT attachment; apical migration; periodontitis
34
bone destruction begins around _____ along _____; ____ proliferation of ____ into deep CT
communicating BVs; crest of septum; apical; PE
35
there is an increased proportion of _____ in the adv. lesion
plasma cells (about 50%)
36
common modifying factors of gingivitis/periodontitis
- diabetes - pregnancy, puberty, menopause - smoking
37
modifying factors can influence:
- susceptibility to gingivitis and periodontitis - plaque growth and composition - clinical presentation - disease progression - response to periodontal therapy
38
oral and periodontal effects of diabetes
- xerostomia - candida infections - periodontitis - multiple periodontal abscesses
39
periodontitis increases _____; ____ improved after periodontal therapy; diabetics with severe periodontitis have higher incidence of ____ and _____
insulin resistance; glycemic control; proteinuria; cardiovascular problems
40
____ increase in poorly controlled diabetes
spirochetes
41
bacteria predominance in type 1 and 2 diabetes
type 2- P. intermedia, C. rectus, P. gingivalis | type 1- capnocytophaga
42
in diabetics, PMN enzymes ____ and ____ increase as a result of poor control; _____ also increases in diabets
beta glucoronidase; elastase; GCF collagenase
43
_____ create destructive phenotype of macrophages
advanced glycation end products (AGEs)
44
decreased matrix synthesis by ___ and ____ in a ____ environment
fibroblasts; osteoblasts; hyperglycemic
45
AGE formation results in formation of _____, causing cell damage
ROS
46
AGE causes ____ thickening, resulting in decreased ____ and _____
vascular wall; oxygen diffusion; PMN migration
47
estrogen affects _____; estrogen increases ___ and ____
salivary peroxidases; collagen metabolism; angiogenesis
48
_____ increases in puberty and pregnancy
gingival inflammation
49
there is an increase in ____ during menstrual cycle in women with gingivitis
gingival bleeding
50
pregnancy increases ____ in the microbiota ; ____ from steroids support growth of this bacteria; there is also an increase in ____
P. intermedia; naphthoquinones; spirochetes
51
effects on host during pregnancy
- 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
52
effects on host during smoking
- lower BOP - lower amounts of GCF in gingivitis - decreased PMN migration and phagocytosis ; increased soluble ICAM-1
53
why smokers have less BOP
- decreased leukocytes in crevice/pocket, but increased leukocytes in the blood - decrease in BVs in inflammatory lesion - increase in keratinization