Primary defence Barriers in Periodontal Pathogenesis (1)

Question 1

What patients are seen to have periodontal disease?

Answer 1

have an exaggerated inflammatory/immune response to bacterial biofilm

have reduced levels of antioxidant defences.

Question 2

What causes tissue damage in periodontal disease?

Answer 2

The tissue damage in periodontal disease is mainly caused by the host response, accounting to 80% of the tissue damage.

Direct effect of the bacteria in the biofilm
contributes to only 20% of the tissue damage.

Question 3

What causes the host to respond?

Answer 3

The bacterial biofilm
Biofilm antigens

Question 4

What disease does innate early response cause?

Answer 4

Early gingival inflammation

Question 5

What disease does the adaptive immune response cause?

Answer 5

Moderate to advanced gingival and periodontal disease (Chronic inflammation)

Question 6

What response does bacterial biofilms in plaque cause?

Answer 6

inflammatory immune response

Question 7

What response does plaque antigens cause?

Answer 7

immune response

Question 8

What is the innate immune response mainly associated with?

Answer 8

intact epithelial barrier

saliva

gingival crevicular fluid

Question 9

What does the intact epithelial barrier include?

Answer 9

junctional epithelium

sulcular epithelium

oral epithelium

(protect underlying connective tissue)

Question 10

What is involved in innate immunity?

Answer 10

Innate immunity involves:
Fluid lubrication (Saliva and
Gingival Crevicular) fluid
Epithelial barriers
Complement cascade
Cell signalling
Vasoactive peptides
Adhesion molecules
Neutrophils
Macrophages
Mast cells

Question 11

What is the role of mucin in saliva?

Answer 11

Saliva contains mucin, which acts as a lubricant
facilitating mastication, swallowing and speech.

It forms a mucous film that protects the mucosa and
keeps it moist.

Question 12

What are the antibacterial agents of saliva?

Answer 12

lysozyme histatin and lactoferrin

Question 13

What is the role of growth factors in saliva?

Answer 13

important in wound healing and maintaining the epithelial integrity

Question 14

What is the role of cystatin in saliva?

Answer 14

inhibits harmful cysteine-proteinases produced by bacteria and dying neutrophils

Question 15

Where are IgA produced in saliva?

Answer 15

Immunoglobulins especially those involved in mucosal immunity (IgA). Produced by plasma cells within salivary glands and secreted

Question 16

Where do the materials for the GCF pass from?

Answer 16

Materials and cells pass from the lamina propria into the sulcus

Question 17

In health what materials are found in the GCF?

Answer 17

Immunoglobulins
Complement
Neutrophils (polymorphonuclear cells)
Epithelial squames
Plaque bacteria
Bacterial products

Question 18

What molecules will be present in the GCF ill-health? (periodontal ligament break down or remodelling)

Answer 18

Cathepsin B
Prostaglandins
Interleukins
TNF
EGF
Breakdown products of the extracellular matrix

Question 19

What are other inflammatory products present in the GCF in host defence?

Answer 19

Cytokines
neutrophils

Question 20

What effect can the innate immune (inflammatory) system have on the periodontium?

Answer 20

The products of the inflammatory reaction could lead to tissue damage

Question 21

What part of the epithelium plays a role in inflammatory response?

Answer 21

junctional epithelium

Question 22

How does the junctional epithelium play a role in the inflammatory response?

Answer 22

Junctional epithelium allows fluids and cells to pass through it.
Role in the inflammatory response through cytokine release in response to bacterial products (e.g. LPS).
Release of antibacterial peptides (β-defensins).

Question 23

What is an example of cytokines and antibacterial peptides the junctional epithelium release?

Answer 23

cytokine = LPS

ANTIBACTERIAL PEPTIDES = beta-defensins

Question 24

signalling molecules released by the epithelial cells results in what?

Answer 24

Vascular changes

Detection of bacteria (TLRs on junctional epithelium and fibroblasts)

Cytokines

Chemokines

Question 25

What is an example of an anti-inflammatory cytokine?

Answer 25

IL-10

Question 26

What cytokine is involved in B and T cell activation?

Answer 26

IL-6

Question 27

What cytokine is involved in CD8+ T cell maturation?

Answer 27

IL-2

Question 28

What cytokine is involved in CD4+ T cell maturation?

Answer 28

IL-4,5,13

Question 29

What cytokine is involved in IL-6 synthesis by periodontal fibroblasts?

Answer 29

IL-1

Question 30

What is an example of a vasoactive peptide?

Answer 30

histamine

Question 31

What triggers the release of histamine from mast cells?

Answer 31

response to C3a and C5a or Prostaglandin
E2.

Question 32

What does histamine do?

Answer 32

Histamine increases vascular permeability thus facilitating diapedesis and chemotaxis

Question 33

What is the role of adhesin molecules?

Answer 33

facilitates inflammatory cell contact with endothelial cells thus facilitating migration into the tissues

Question 34

What are 3 examples of adhesin molecules?

Answer 34

Intercellular adhesion molecules I and II

Endothelial adhesion molecule I

Leucocyte function antigen I