Pathogenesis Of Periodontitis

Front 1

HOW DOES PERIODONTITIS OCCUR

Back 1

1. DIRECT DESTRUCTION OF TISSUES BY PERIODONTAL PATHOGENS BY THEIR VIRULENCE FACTORS
2. FAILLURE OF THE HOST RESPONSE TO PROTECT THR PERIODONTAL TISSUES FROM INVADING PERIODONTITIS ASSOCIATED BACTERIA
3. IMMUNOPATHOLOGY " FRIENDLY FIRE

Front 2

EXAMPLE OF PERIODONTAL PATHOGENS

Back 2

1. PROTEASES

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THE PROGRESSION FROM HEALTH TO PERIODONTITIS

Back 3

1. HEALTH
2. EARLY GINGIVITITIS
3. ESTABLISHED GINGIVITIS( MOST PEOPLE)
4. PERIODONTITIS

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PERIODONTITIS LESION IS CHARACTERIZED BY

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1. LOSS OF CONNECTIVE TISSUE ATTACHMENT
2. EPITHELIAL DOWN GROWTH
3. DESTRUCTION OF BONE

Front 5

BACTERIA IN THE FORM OF A COMPLEX BIOFILM COMPOSED OF 500+ SPECIES THAT ARE ASSOCIATE W/ GINGIVITITIS AND PERIODONTITIS ARE PREDOMINATELY

Back 5

1. GRAM NEGATIVE ANAEROBIC RODS
2. SPIROCHETES

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PERIODONTITIS LESION BACTERIA ARE LARGELY CONFINED TO ______ AT SOME DISTANCE FROM THE TISSUE DESTRUCTION

Back 6

1. PERIODONTAL POCKET

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GINGIVAL CT OF THE ESTABLISHED GINGIVITIS OR PERIODONTITIS LESION CONTAINS DECREASED AMOUNT OF COLLAGEN FIBER REPLACED BY

Back 7

1. LARGE NUMBER OF PLASMA CELL
2. B CELL
3. T CELL
4. MACROPHAGE
5. PMN'S

Front 8

REPLACEMENT OF COLLAGEN FIBERS INDICATES THAT PERIODONTITIS LESION IS AN

Back 8

1. CHRONIC INFLAMMATORY LESION

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CELLS THAT HAVE IMPORTANT ROLES IN PROTECTION AND POTENTIALLY TISSUE DESTRUCTION

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1. PLASMA CELL
2. B CELLS
3. T CELLS
4. MACROPHAGE
5. PMN'S

Front 10

CELLS RECRUITED TO THE PERIODONTAL LESION AS PART OF THE INNATE HOST RESPONSE

Back 10

1. PHAGOCYTE SUCH AS PMN (NEUTROPHILS)
2. LATER MACROPHAGE

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MEANS PHAGOCYTIC CELLS ARE RECRUITED TO PERIODONTAL LESION

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1. COMPLEMENT ACTIVATION
2. TOLL LIKE RECEPTOR ON PHAGOCYTES THAT RECOGNIZE MACROMOLECULES UNIQUE TO BACTERIA
3. FMET -LEU-PHE
4. C5a ALSO CHEMOTACTIC FOR B CELL

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COMPLEMENT ACTIVATION ASSOCIATED W/

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1. ALTERNATE PATHWAY-LPS
2. CLASSICAL PATHWAY -ANTIBODY
3.C5a
4.C3a-VASODILATION
5. EXPESSION OF MOLECULES LIKE I-CAM-1

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TOLL LIKE RECEPTORS ON PHAGOCYTES THAT RECOGNIZE MACROMOLECULES UNIQUE TO BACTERIAL AND ALLOW FOR ACTIVATION AND PROLIFERATION ARE ASSOCIATED W/

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1. LPS FOR GRAM NEGATIVE
2. LIPOTEICHOIC ACID FOR GRAM +

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FMET-LEU-PHE IS ASSOCIATED W/

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1. CHEMOTACTIC FOR PMN
2. MACROPHAGE

Front 15

STEPS IN ANY HEALING WOUND

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1. ACUTE INFLAMMATION
2. CHRONIC INFLAMMATION
3. REPAIR AND HEALING

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ACUTE INFLAMMATION IN HEALING WOUND IS ASSOCIATED W/

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1. PMN'S

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CHRONIC INFLAMMATION IN HEALING WOUND IS ASSOCIATED W/

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1. MACROPHAGE
2. B CELLS
3. PLASMA CELLS

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REPAIR AND HEALING, IN WOUND HEALING IS ASSOCIATED W/

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1. FIBROBLASTS
2. ENDOTHELIAL CELLS
3. EPITHELIAL CELLS

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FOR HEALING TO OCCUR WHICH INFLAMMATION HAS TO RESOLVE QUICKLY

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1. CHRONIC INFLAMMATION

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CHRONIC INFLAMMATION ARE RESOLVE QUICKLY TO BE REPLACE BY WHICH CELLS

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1. CONNECTIVE TISSUES
2. ENDOTHELIAL CELLS
3. EPITHELIAL CELLS

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WHAT HAPPENED IF CHRONIC INFLAMMATION IS ALLOWED TO PERSIST, THEN YOU HAVE

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1. PERSISTANCE OF INFLAMMATORY CELLS
2. CYTOKINES
3. TISSUE DESTRUCTION MAY RESULT: FRIENDLY FIRE

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WHAT IS HOST INFLAMMATION RESPONSE IS SUCCESSFUL AT

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1. CONFINING THE PLAQUE BACTERIA TO THE POCKET BUT DOES NOT CLEAR THEM FROM THE POCKET

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WHAT DOES ESTABLISHMENT OF CHRONIC INFLAMMATION IN SOME PEOPLE RESULT IN

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1. TISSUE DESTRUCTION
2. PERIODONTITIS
FRIENDLY FIRE

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KEY COMPONENTS OF THE HOST RESPONSE IN PERIODONTAL TISSUES

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1. INNATE IMMUNE SYSTEM
2. ADAPTIVE IMMUNE SYSTEM

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EXAMPLES OF INNATE IMMUNE SYSTEM HOST RESPONSE IN PERIODONTAL TISSUES

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1. ACUTE PHASE RESPONSE PROTEINS
2. ALTERNATE COMPLEMENT PATHWAY
3. PMNs
4. MACROPHAGES
5. TOLL LIKE RECEPTORS

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EXAMPLE OF ACUTE PHASE RESPONSE PROTEINS

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1. C-REATIVE PROTEIN

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EXAMPLE OF ALTERNATE COMPLEMENT PATHWAY

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1. C3a
2. C5a

Front 28

EXAMPLES OF PMNs

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1. ACID HYDROLASES
2. ELASTASE
3. PROTEASES
4. MMP

Front 29

EXAMPLES OF MACROPHAGES

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1. CYTOKINES IL-1, IL-6,IL-8
2. TNF-ALPHA
3. PGE2

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STIMULATE FIBROBLAST-MMP

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1. MACROPHAGES

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ADAPTIVE IMMUNE SYSTEM OF THE HOST RESPONSE IN PERIODONTAL TISSUES

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1. B CELL
2. T CELL
3. ANTIBODIES
4. CLASSICAL COMPLEMENT PATHWAY

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EXAMPLES OF B CELL AND T CELL OF ADAPTIVE IMMUNE SYSTEM

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1. CYTOKINES IFN-GAMMA
2. IL-2
3. IL-3

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RESULT OF INNATE AND ADAPTIVE IMMUNITY

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1. BOTH TOGETHER ARE SUCCESSFUL IN PROTECTING THE HOST FROM AN INVASIVE BACTERIAL INFECTION

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IN SOME PEOPLE THE EFFECTIVE HOST RESPONSE ALSO RESULT IN

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1. FRIENDLY FIRE: DESTRUCTION OF PERIODONTAL TISSUES

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STABLE PERIODONTIUM INCLUDE

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1. NON PATHOGENIC BACTERIA IN PLAQUE
2. LOW AMOUNT OF INFLAMMATORY AND CHEMOTACTIC BACTERIAL PRODUCT
3. NON DAMAGING VASCULAR AND CELLULAR RESPONSE IN GINGIVAL TISSUES
4. CONTROL OF MICROBIAL FLORA

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ACTIVE DISEASE SCENARIO INCLUDE

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1. PATHOGENIC BACTERIA IN PLAQUE
2. HIGH AMOUNTS OF INFLAMMATORY AND CHEMOTACTIC BACTERIAL PRODUCTS
3. DAMAGING VASCULAR AND CELLULAR RESPONSE IN GINGIVAL TISSUES
4. PERIODONTAL TISSUE DESTRUCTION

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HYPERINFLAMMATORY PHENOTYPE EQUAL

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1. PERIODONTAL TISSUE DESTRUCTION

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A DEFECT IN PMNs AND /OR MACROPHAGE RESULTS IN SEVERE PERIODONTITIS

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1. ADHESION OR CHEMOTAXIS

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WHAT LIMIT THE SEVERITY OF PERIODONTAL ATTACHMENT LOSS

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1. ANTIBODY TO TWO PERIODONTITIS ASSOCIATED BACTERIAL

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TRUE OR FALSE: MOST PEOPLE HAVE CONSIDERABLE PLAQUE AND GINGIVAL INFLAMMATION, MOST GET GINGIVITITIS ONLY, SOME GET PERIODOTITIS

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1. TRUE

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CELLS FROM PATIENTS W/ CHRONIC PERIODONTITIS SECRETE MORE INFLAMMATORY CYTOKINES

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1. MACROPHAGE OR MONOCYTES

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WHAT CAUSES MACROPHAGE OR MONOCYTES TO SECRETE MORE INFLAMMATORY CYTOKINES

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1. IF STIMULATED W/ LPS IN VITRO

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WHICH T HELPER CELLS ARE PROINFLAMMATORY

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1. T HELPER 1

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T HELPER CELL ASSOCIATED W/ VIRAL INFECTION

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1. T HELPER 1

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T HELPER CELL ASSOCIATED W/ BACTERIAL INFECTION

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1. T HELPER 2