periodontitis pathogenesis Flashcards
initial lesion occurs within ____ of plaque development
1-4 days
initial lesion represents early stage of _____ with increased ____ (___ particles and ____ leak out of vessels)
inflammation; permeability; carbon; serum proteins
there is infiltration of ____ and _____ in the JE; ____ in the CT (5%)
PMNs; monocytes
lymphocytes
in the initial lesion stage, there is increased _____ and _____; decreased _____
vascular density; GCF volume; perivascular collagen
normal vessels are permeable to ___, ____, and _____; _____ are normally closed
water; salts; small molecules; intercellular junctions
in initial lesion stage, dilation of vessels in the _____ is induced by ______
dentogingival plexus; vasoactive mediators (histamine, IL-1, TNF)
gaps form between _____, resulting in increased _____
capillary endothelial cells; permeability
___ and ___ move out of the capillaries and ____ increases
fluid; proteins; GCF flow rate
GCF is a _____ in health or a ____ in disease
plasma transudate; inflammatory exudate
GCF passes through the _____ and can be collected from within or at the ____ of the _____
peridontal tissues; orifice; gingival crevice
GCF constituents indicate ____ and _____
inflammatory changes; bacterial colonization
GCF flow rate ____ with clinical inflammation
increases
____ stain for ____ indicates GCF volume
ninhydrin; protein
in initial lesion, there is ____ mediated upregulation of ____ on endothelial cells; ____ adhere to ____ and begin to migrate
cytokine; adhesion molecules; PMNs; post-capillary venules
PMNs migrate through ____ into ____
JE; gingival sulcus
chemotaxis by PMNs is induced by:
host factors (IL-8, C5a) molecules release by bacteria (fMetLeuPhe)
in the initial lesion, there is ____ subjacent to JE; ____ of fluid into ___ and ____
vasculitis; exudation; tissue; gingival sulcus
in initial lesion, there is increased migration of ____ into JE and gingival sulcus; _____ present extravascularly; alteration of most ___ portion of JE; loss of _____
leukocytes; serum proteins; coronal; perivascular collagen
early lesion occurs with ____ of plaque development; ____ and ____ subjacent to JE with few ____; together they constitute ____ of infiltrated CT
4-7 days; lymphocytes; PMNs; plasma cells; 15%
in early lesion, ____ undergoing cytopathic alterations
fibroblasts
in early lesion, ____ occurs, which creates space for infiltrate; ____ of JE and SE proliferate; _____ invade the coronal portion of the lesion
collagen destruction; basal cells; epithelial rete pegs
in early lesion, _____ remains dilated; large number of ____; as JE invades CT, the previously inactive ____ opens up and proliferates into the _____
dentogingival plexus (dp); venules capillary bed; CT papillae
in the established lesion, increased ____ clinically evident; increased ____ and ____
swelling; fluid exudation; leukocyte migration
in est. lesion, ____ increase around blood vessels and in _____
plasma cells; coronal CT
activated T cells produce _____ and ____
cytokines (IL-2, 3, 4, 5, 6, 10, and 13; TNF-alpha) chemotactic substances (MCP, MIP, RANTES)
plasma cells produce ____ and ____
Ig; cytokines (IL-6, TNF-alpha)
fibroblasts produce ____ and ____
MMPs; TIMPs
in the established lesion, there is conversion of ____ to _____
junctional epithelium; pocket epithelium
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
in the est. lesion, there is increased proportion of ____ and presence of _____ in CT, JE and gingival sulcus
plasma cells (10-30%); extravascular immunoglobulins
___ and ____ of advanced lesion are not known
beginning ; duration
advanced lesion similar to est. lesion but there is switch from ___ to ____ predominance which signals conversion from ____ to _____
T cell ; B cell
gingivitis; periodontitis
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
bone destruction begins around _____ along _____; ____ proliferation of ____ into deep CT
communicating BVs; crest of septum; apical; PE
there is an increased proportion of _____ in the adv. lesion
plasma cells (about 50%)
common modifying factors of gingivitis/periodontitis
- diabetes
- pregnancy, puberty, menopause
- smoking
modifying factors can influence:
- susceptibility to gingivitis and periodontitis
- plaque growth and composition
- clinical presentation
- disease progression
- response to periodontal therapy
oral and periodontal effects of diabetes
- xerostomia
- candida infections
- periodontitis
- multiple periodontal abscesses
periodontitis increases _____; ____ improved after periodontal therapy; diabetics with severe periodontitis have higher incidence of ____ and _____
insulin resistance; glycemic control; proteinuria; cardiovascular problems
____ increase in poorly controlled diabetes
spirochetes
bacteria predominance in type 1 and 2 diabetes
type 2- P. intermedia, C. rectus, P. gingivalis
type 1- capnocytophaga
in diabetics, PMN enzymes ____ and ____ increase as a result of poor control; _____ also increases in diabets
beta glucoronidase; elastase; GCF collagenase
_____ create destructive phenotype of macrophages
advanced glycation end products (AGEs)
decreased matrix synthesis by ___ and ____ in a ____ environment
fibroblasts; osteoblasts; hyperglycemic
AGE formation results in formation of _____, causing cell damage
ROS
AGE causes ____ thickening, resulting in decreased ____ and _____
vascular wall; oxygen diffusion; PMN migration
estrogen affects _____; estrogen increases ___ and ____
salivary peroxidases; collagen metabolism; angiogenesis
_____ increases in puberty and pregnancy
gingival inflammation
there is an increase in ____ during menstrual cycle in women with gingivitis
gingival bleeding
pregnancy increases ____ in the microbiota ; ____ from steroids support growth of this bacteria; there is also an increase in ____
P. intermedia; naphthoquinones; spirochetes
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
effects on host during smoking
- lower BOP
- lower amounts of GCF in gingivitis
- decreased PMN migration and phagocytosis ; increased soluble ICAM-1
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
