Good to know perio Exam 2 julia

Define microbe

Refers collectively to microscopic organisms:

-Bacteria

-Fungi

-Protozoa

-Viruses

What are surfaces appendages

vesicles, fimbriae, flagella

what is Vesicles

surface appendages of outer membrane (gram -) that contain endotoxin

what is Fimbriae

small proteinaceous projections attached to the external surface of both Gram + and - ; important for adherence and coaggregation

what is flagella

long, fine, wavy filamentous structures used for motility, longer than fimbriae and larger diameter

what is adherence

stick to pellicle

what is coaggregation?

stick to other bacteria

what are the stages of polymicrobial biofilm formation?

stage 1: initial attachment of microbes to pellicle

stage 2: permanent attachment

stage 3: maturation phase I: self-protection matrix formation

stage 4: Maturation phase II: mushroom-shaped microcolonies

stage 5: dispersion: escape from the matrix

stage 1 of polymicrobial biofilm formation

initial attachment of microbes to pellicle

stage 2 of polymicrobial biofilm formation

permanent attachment

stage 3 of polymicrobial biofilm formation

maturation phase I: self-protection matrix formation (think force field) consist of proteins, glycolipids, and bacterial DNA

In stage 3 of polymicrobial biofilm formation what is established?

chronic disease

stage 4 of polymicrobial biofilm formation

Maturation phase II: mushroom-shaped microcolonies

stage 5 of polymicrobial biofilm formation

dispersion: escape (leave) from the matrix

obligate anaerobic bacteria

cannot live in the presence of oxygen

facultative anaerobic

can exist either with or without oxygen

the keystone pathogen hypothesis

Keystone species (p.gingivalis) in biofilm -> Trigger shift to a dysbiotic biofilm community -> Uncontrolled host response initiated -> Damage to periodontal tissues

what is the keystone species?

P.gingivalis: that initiates the change in the biofilm community

in the keystone pathogen hypothesis what triggers the uncrontrolled host reponse that results in damage to periodontal tissue?

the dysbiotic biofilm community

the prime purpose of the immune system is to _______________________ by identifying foreign substances in the boy and developing a defense against them.

defend the life of the individual

what is phagocytosis?

the process by which leukocytes engulf and digest microorganisms

what are the most effectively destroyed by polymorphonuclear (PMN) leukocytes

periodontal pathogens

antibodies are known collectively as

immunoglobulins

what are the 4 functions of complement system?

1. opsonization of pathogens

2. destruction of pathogens

3. recruitment of phagocytes

4. immune clearance

What is the most important action of the complement system?

opsonization

#2 in the function of the complement system is

destruction of pathogens

what are the parts of the destruction system?

- membrane attack complex

- lysis

#3 of the complement system

recruitment of phagocytes, recruit/join

#4 of the compliment system?

immune clearance, housekeeper, removing immune complexes from circulation

- to fight an infection, leukocytes travel through the bloodstream.

- the thin layer of epithelial cells that line the interior surface of the blood vessels is called endothelium

- near the infection site, leukocytes push their way between the endothelial cells and enter the connective tissue.

what is this process called?

transendothelial migration

hemodynamic changes

1. transient (temporary) vasoconstriction = FIrst Then, vasodilation

2. hyperemia: an excess of blood in the vessels in the tissues

3. margination: the movement of WBCs to the periphery of vessel walls

4. payementing: WBCs line the wall of the vessel

5. diapidesis: process by which neutrophils squeeze between endothelial cells in the vessel wall

6. emigration: cells move into tissues from the blood vessels

7. chemotaxis: the movement of cells to the sit of inflammation

8. neutrophils: white blood cells signification to development and progression of disease, most prevalent cell is acute inflammation, most active cell in the periodontal pocket, main function in phagocytosis

first step in hemodynamic changes

transient (temporary) vasoconstriction = FIrst Then, vasodilation

second step in hemodynamic changes

hyperemia: an excess of blood in the vessels in the tissues

third step in hemodynamic changes

margination: the movement of WBCs to the periphery of vessel walls

4th step in hemodynamic changes

payementing: WBCs line the wall of the vessel

5th step in hemodynamic changes

diapidesis: process by which neutrophils squeeze between endothelial cells in the vessel wall

6th step in hemodynamic changes

emigration: cells move into tissues from the blood vessels

7th step in hemodynamic changes

chemotaxis: the movement of cells to the sit of inflammation

8th step in hemodynamic changes

neutrophils: white blood cells signification to development and progression of disease

- most prevalent cell is acute inflammation

- most active cell in the periodontal pocket

- main function in phagocytosis

5 classic signs of acute inflammation

1. heat

2. redness

3. swelling

4. pain

5. loss of function

the classic warning signs seen in acute inflammation usually are ________ in chronic inflammation

absent

in chronic inflmmation: clincially, _______ is often absent

pain

the chronic inflmmatory process: tissue damage....

is the hallmark of chronic inflammation

what initiate most of the alveolar bone destruction in periodontitis?

prostaglandins

In periodontal disease, the immune system fights to defend the body from periodontal pathogens, NOT to.....

NOT to preserve the periodontium or teeth

It is the body's response to the periodontal pathogens that is the cause of...

nearly all the destruction seen in periodontitis

Initial lesion

- bacteria colonize teeth near gingival margin

- gram-negative and their metabolites initiate host response

- JE cells release biochemical mediators to stimulate immune response

- PMNs pass from blood vessels into gingival connective tissue

- as PMNs pass into connective tissue, they relase cytokines

- gingival crevicular fluid increase volume

- Clinically, tissue looks __healthy__

- Host response is successful if most of the bacteria are destroyed

- The body can repair any damage

- If pathogens are not controlled, early __gingivitis____ develops

early lesion

- biofilm maturation continues and bacterial toxins and byproducts penetrate the JE

- cytokines attract more cellular defenders to the site

- increased permeability of blood vessels allows more PMNs to move into connective tissue and form a wall between biofilm and sulcs wall

- PMNs release cytokines that cause localized destruction of connective tissue

- macrophages are recruited to connective tissue and released cytokines and MMPs

- MMPs are responsible for excessive loss of Connective tissue (60-70%)

- sulcular epithelium forms epithelial ridges and JE cells proliferate

- Clinically, __edema___ and __redness____ of gingival marginal tissue is observed

- Initiation of good self-care can mechanically disrupt plaque biofilm for complete return to health

- The body can still repair any damage

- If immune system fails to shut off the response, the lesion progresses to __established______ gingivitis

established lesion

- plaque biofilm extends subgingivally into the sulcus, disrupting attachement of coronal- most portion of JE from the tooth surface.

- more bacteria stimulate more cytokines, resulting in recruitment of more PMNs, macrophages, and lumphocytes

- plasma cella produce large quantities of antibodies to assist in in controlling bacteria

- Immune system sends more immune cells which release more toxic chemicals and more healthy connective tissue is destroyed

- Epithelial ridges extend deeper in connective tissue to try and maintain epithelial integrity

- JE loses attachment to root surface and transforms into pocket epithelium, which is thinner and more permeable

- Clinically, all features of gingivitis are accentuated

- Periodontal instrumentation and patient education for good self-care are vital at this point

- In _some__ individuals, if bacterial infection is not controlled, gingivitis progresses to

___periodontitis__.

advanced lesion

• Plaque biofilm spreads laterally as well as apically along the _root__ __surface___

• Chronic inflammation causes harm to the periodontium

• PMNs, macrophages cause destruction of connective tissue and PDL fibers

• Macrophages produce high concentrations of cytokines, PGE2 and MMPs that destroy __alveolar __bone__

• Gingival pocket progresses to a periodontal pocket

• PGE2 destroys bone by stimulating large numbers of osteoclasts to resorb crestal bone

• Elevated levels of RANKL modulate osteoclast activity which leads to greater bone loss

• Destruction caused by host immune response overwhelms any tissue repair

• Clinically, periodontal pockets are detected, there is bleeding upon probing, bone loss, furcation involvement, and mobility

• These changes are _not_ _reversible_ -the hallmark of periodontitis

in periodontal disease, there is

increased expression of RANKL, from osteoblasts

menopausal gingivostomatitis

is characterized by gingiva that bleeds readily with abnormally pale, dry, and shiny erythematous appearance

osteoPOROSIS

is a reduction in bone mass making the woman more prone to bone fractures

osteoPENIA

is a condition in which there is a lower than average bone density but not necessarily an increase in risk or incidence of bone fracture

what is the most frequent oral lesion

candidiasis

most common means of attachment to enamel surface

attachment to the pellicle

functional occlusal forces

forces produced during the act of chewing food

Parafunctional occlusal forces

results from tooth to tooth contact when not in the act of eating. EX: clenching, bruxism

smookless tobacco results in an ___________ inflammatory response in the tissues

increased

periodontal disease CANNOT....

CANNOT be caused by nutritional deficiencies