Quiz 6 Flashcards
What is the structure of an MMP?
Similar to that of Hemoglobin, has a metal cation center.
What is the role of MMPs?
They degrade extracellular matrix molecules, neutralize bacteria, they participate in tissue destruction and alveolar bone loss.
What are considered inhibitors of MMPs?
Tetracycline, Doxycycline
What are the main products founds in crevicular fluid during periodontal disease process?
Alkaline phosphatase, IL-1 beta (genotype positive of this are at increased risk), beta-glucoronidase, IgG4, elastase, AAT, PGE2
Where are arachidonic acid metabolites found in cells and when are they released?
They are found in the lipid bilayer membrane of cells and are released when the cells are damaged. Inflamed periodontal tissues posses high levels of PGE2 capable of inducing gingival inflammation and bone resorption. It is broken down by C3 convertase as well.
What are some of the main activities involved with arachidonic acid metabolites?
Induces increased vasopermeability and
vasodilation leading to redness and edema.
Potent inducer of MMP secretion by monocytes and fibroblasts to trigger connective tissue destruction.
Osteoclast bone resorption is triggered by a synergistic action with IL-1 and TNF alpha to enhance the effects of these molecules.
How are arachidonic acid metabolites markers for disease activity?
There is a 2-3 fold increase in gingivitis and periodontitis as compared to healthy. There is a 5-6 fold increase during active disease progression and attachment loss. GCF - PGE2 levels increase prior to attachment level changes and can be used as a screening test to predict future attachment loss.
What are the two models that exist for hyperresponsiveness to PGE2?
- Chronic infection and LPS exposure might lead to systemic elevations of TNF α, IL-1β and GM-CSF which are all capable of up- regulating monocyte PGE2 secretion
- Alternatively there is extensive data which establish a genetic basis in the region of the HLA-DR region of chromosome 5 in the area of the TNFβ genes.
What are lipoxins and are they pro or anti inflammatory?
They are arachidonic acids and they are anti inflammatory, don’t let neutrophils enter tissue. Omega 3 fatty acids and DHA can help with these.
Which type of stress is the most important stress when it comes to periodontal disease?
Environmental Stress
What are the 4 systemic modifications of periodontal disease status?
- Host Stress
- Physical Stress
- Social Effectors
- Environmental Stress
What is Host Stress and which factors are involved?
These effects are mediated by the central nervous system (CNS) neuropeptides (eg, corticotropin releasing factor (CRF). CRF depresses lymphocyte function leading to inhibition of antibody secretion, and it also neutrophil action. CRF also up-regulates the release of IL-1 and TNF alpha by monocytes, so maybe both pro and anti inflammatory?
What are the main cells that are actively getting into periodontal pocket space?
Neutrophils. Lymphocytes and macrophages should mainly stay in connective tissue. Fibroblast is #1 cell involved in destruction of connective tissue.
What causes green pus to be green?
It is the myeloperoxidase.
Why do mouth breathers usually have the most erythema and redness?
Because of lack of saliva, and lack of IgA which is found in saliva, and helps protect mucosal surfaces.
What is the best way to preserve a ridge from where a tooth was?
Perform a debridement and go in and chemically clean it out.
How far is it on average from the CEJ to the apex of the root?
About 12 mm
What should the distance be between the crest of the bone and the CEJ (or most apical part of crown if there)?
Between 1 to 2 mm
What is pemphigoid?
Pemphigoid is a rare autoimmune disorder that can develop at any age, but that most often affects the elderly. Pemphigoid is caused by a malfunction of the immune system and results in skin rashes and blistering on the legs, arms, and abdomen. Pemphigoid can also cause blistering on the mucous membranes of the eyes, nose, mouth, and vagina, and can occur during pregnancy in some women. There is no cure for pemphigoid, but there are many treatment options. It is seen by separation of epithelium from basement membrane. Stratum spinosum split from basement membrane.
What is lichen planus?
Lichen planus (LP) is a disease of the skin and/or mucous membranes that resembles lichen. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. On an H&E stain, there is liquefaction and loss of basement membrane.
What is a periodontal abscess?
A Periodontal abscess (also termed lateral abscess,[1] or parietal abscess),[1] is a localized collection of pus (i.e. an abscess) within the tissues of the periodontium. It is a type of dental abscess. A periodontal abscess occurs alongside a tooth, and is different from the more common[2] periapical abscess, which represents the spread of infection from a dead tooth (i.e. which has undergone pulpal necrosis). To reflect this, sometimes the term “lateral (periodontal) abscess” is used. In contrast to a periapical abscess, periodontal abscesses are usually associated with a vital (living) tooth. Abscesses of the periodontium are acute bacterial infections[3] classified primarily by location.
Odontogenic keratocysts look similar to these as well.
Definition: an acute, destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp.
What is necrotizing ulcerative periodontal disease?
Necrotizing ulcerative periodontitis (NUP, or simply necrotizing periodontitis, NP) is where the infection leads to attachment loss (destruction of the ligaments anchoring teeth in their sockets), but involves only the gingiva, periodontal ligament and alveolar ligament. Usually this spectrum of diseases result in loss of attachment, and therefore many ANUG diagnoses may be technically termed NUP, although ANUG is the term in most common use. NUP may be an extension of NUG into the periodontal ligaments, although this is not completely proven. In the mean time, NUG and NUP are classified together under the term necrotizing periodontal diseases.
When it comes to tools in periodontology, radiographs aid in the following 4 things:
1) Diagnosis in periodontal disease
2) Determination of the prognosis?
3) Treatment options
4) Evaluation of the outcome of treatment
They are an adjunct to the clinical examination, not a substitute for it.
Without radiographic images, the clinician could not effectively evaluate the following 4 things:
1) Alveolar crestal bone architecture
2) Crown-to-root ratio/calculus presence
3) Possible vertical or furcation defects
4) Amount of horizontal bone loss
