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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
Q

activated T cells produce _____ and ____

A 
cytokines (IL-2, 3, 4, 5, 6, 10, and 13; TNF-alpha)
chemotactic substances (MCP, MIP, RANTES)
26
Q

plasma cells produce ____ and ____

A

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

27
Q

fibroblasts produce ____ and ____

A

MMPs; TIMPs

28
Q

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

A

junctional epithelium; pocket epithelium

29
Q

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

A

deepens; coronal; permeable pocket epithelium; PMNs

30
Q

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

A

plasma cells (10-30%); extravascular immunoglobulins

31
Q

___ and ____ of advanced lesion are not known

A

beginning ; duration

32
Q

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

A

T cell ; B cell

gingivitis; periodontitis

33
Q

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

A

CT attachment; apical migration; periodontitis

34
Q

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

A

communicating BVs; crest of septum; apical; PE

35
Q

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

A

plasma cells (about 50%)

36
Q

common modifying factors of gingivitis/periodontitis

A
  • diabetes
  • pregnancy, puberty, menopause
  • smoking
37
Q

modifying factors can influence:

A
  • susceptibility to gingivitis and periodontitis
  • plaque growth and composition
  • clinical presentation
  • disease progression
  • response to periodontal therapy
38
Q

oral and periodontal effects of diabetes

A
  • xerostomia
  • candida infections
  • periodontitis
  • multiple periodontal abscesses
39
Q

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

A

insulin resistance; glycemic control; proteinuria; cardiovascular problems

40
Q

____ increase in poorly controlled diabetes

A

spirochetes

41
Q

bacteria predominance in type 1 and 2 diabetes

A

type 2- P. intermedia, C. rectus, P. gingivalis

type 1- capnocytophaga

42
Q

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

A

beta glucoronidase; elastase; GCF collagenase

43
Q

_____ create destructive phenotype of macrophages

A

advanced glycation end products (AGEs)

44
Q

decreased matrix synthesis by ___ and ____ in a ____ environment

A

fibroblasts; osteoblasts; hyperglycemic

45
Q

AGE formation results in formation of _____, causing cell damage

A

ROS

46
Q

AGE causes ____ thickening, resulting in decreased ____ and _____

A

vascular wall; oxygen diffusion; PMN migration

47
Q

estrogen affects _____; estrogen increases ___ and ____

A

salivary peroxidases; collagen metabolism; angiogenesis

48
Q

_____ increases in puberty and pregnancy

A

gingival inflammation

49
Q

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

A

gingival bleeding

50
Q

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

A

P. intermedia; naphthoquinones; spirochetes

51
Q

effects on host during pregnancy

A
  • 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
Q

effects on host during smoking

A
  • lower BOP
  • lower amounts of GCF in gingivitis
  • decreased PMN migration and phagocytosis ; increased soluble ICAM-1
53
Q

why smokers have less BOP

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

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