Oral Pathology Final

Front 1

How do obligate anaerobes produce energy?

Back 1

By fermentation (yields 2-4 ATP/glucose). End products are often unique to genus/species.

Front 2

Obligate anaerobes require an atmosphere enriched with 5-10% of...? Which atmospheric substance will kill them?

Back 2

CO2. O2.

Front 3

Which 3 enzymes do obligate anaerobes lack?

Back 3

Superoxide dismutase, catalase, and peroxidase

Front 4

How is oxygen directly toxic to obligate anaerobes?

Back 4

Oxidation of proteins

Front 5

How is oxygen indirectly toxic to obligate anaerobes?

Back 5

By specific mediators such as H2O2 or by free radicals

Front 6

Anaerobes require a low redox potential in what range? Where can these conditions be found?

Back 6

Eh= -150 to -250 mV. Septics tanks, the human colon, garbage dumps, and the GINGIVO-DENTAL SULCUS.

Front 7

What is Eh (besides something that Canadians say a lot)?

Back 7

The tendency of a system to accept (+ Eh) or donate (- Eh) electrons

Front 8

If the oxidized form of a substance has a higher affinity for electrons than H2, is that a positive or negative reduction potential? What's an example?

Back 8

Positive. Oxygen.

Front 9

If the oxidized form of a substance has a lower affinity for electrons than H2, is that a positive or negative reduction potential? What's an example?

Back 9

Negative. NADH.

Front 10

Is oxygen a powerful electron acceptor or donor? What is it's Eh?

Back 10

Acceptor. +816mV

Front 11

What is the Eh of normal healthy tissues?

Back 11

+150mV

Front 12

What 3 conditions may lead to a low redox potential in the body?

Back 12

Loss of vascular supply, acid production, or tissue necrosis

Front 13

What's the importance of anaerobes in the "human ecosystem"?

Back 13

They compete with pathogens, salvage energy by fermenting plant polysaccharides (5-30% of hosts daily energy), and metabolize essential vitamins and cofactors (eg. biotin, folate, vit. K)

Front 14

Name the 3 general virulence factors of non-spore-forming anaerobic bacteria.

Back 14

Provide for invasion of host tissue, resist host defense mechanisms, and growth and injury of host tissue.

Front 15

What is a synergistic infection?

Back 15

A mixed infection of anaerobes +/- facultative anaerobes. Deficiencies in the individual strains are supplemented by other bacteria.

Front 16

8 genera of non-spore-forming anaerobes that are gram negative rods (bacilli)... (I guess you could know these if you're really ambitious)

Back 16

Bacteriodes, Tannerella, Prevotella, Porphyromonas, Fusobacterium, Campylobacter, Aggregatibacter, Capnocytophaga.

Front 17

6 genera of non-spore-forming anaerobes that are gram positive rods... Go!

Back 17

Actinomyces, Eubacterium, Propionibacterium, Mobiluncus, Lactobacillus, Bifidobacterium

Front 18

What is the only species of non-spore-forming anaerobes that are gram negative cocci?

Back 18

Veillonella parvula

Front 19

2 genera of non-spore-forming anaerobes that are gram positive cocci...

Back 19

Peptostreptococcus and streptococcus

Front 20

What are the physical characteristics of Bacteriodes?

Back 20

Gram negative, pleiomorphic anaerobic rods

Front 21

Where is the body are Bacteriodes infections most commonly found?

Back 21

Below the diaphragm (thanks Zoller)

Front 22

What is the most abundant organism in the adult gut?

Back 22

Bacteriodes thetaiotamicron

Front 23

Name the virulence factors for Bacteriodes fragilis

Back 23

Red font: Capsule, endotoxin that lacks Lipid A and is of low toxicity, and 85% produce a potent beta-lactamase.

Not typed in red: Collagenase, IgA protease, and bile resistance

Front 24

Where in the body is Bacteriodes a major cause of infections?

Back 24

Abdominal cavity. Also involved in brain abscesses, gynecologic, skin and soft tissue infections, and bacteremia.

Front 25

Is Propionibacterium acnes Gm+ or -?

Back 25

Gm+ rods.

Front 26

Is Mobiluncus Gm+ or -?

Back 26

Gm+. Curved, motile, rods that are strongly associated with bacterial vaginosis (... think about it. That shouldn't be too hard to remember)

Front 27

Which bacteria constitutes over 90% of the total intestinal flora in breast-fed infants? Is it Gm+ or Gm-?

Back 27

Bifidobacterium. May also be involved in progression of deep childhood caries.

Front 28

Lactobacillus: Gm+ or -?

Back 28

+. And it's a caries organism.

Front 29

Name the 4 non-plaque induced gingival lesions that are red on the Powerpoint and give an example of each.

Back 29

Specific bacterial infection (N. gonorrhea), specific viral infections (HSV), specific fungal infections (LGE), and genetic origin (pemphigoid)

Front 30

Name the 4 types of periodontitis that are in red font on the Powerpoint.

Back 30

Chronic periodontitis, aggressive periodontitis, periodontitis as a manifestation of systemic disease, and necrotizing periodontal diseases.

Front 31

Which risk factor has the highest correlation to periodontal disease?

Back 31

Smoking (moderate)

Front 32

Which bacteria is isolated from aggressive periodontal infections?

Back 32

Aggregatibacter actinomycetemcomitans. Spelling counts.

Front 33

Which 2 bacteria are isolated from chronic periodontal infections?

Back 33

Poryphromonas gingivalis and Tannerella forsythia

Front 34

Which bacteria is in red font and isolated from gingivitis, periodontitis, and endodontic infections?

Back 34

Treponema denticola

Front 35

Aggregatibacter actinomycetemcomitans (green complex bacteria) is a facultative anaerobe genetically related to which genus?

Back 35

Haemophilus.

Front 36

Give the virulence mechanisms of Aggregatibacter actinomycetemcomitans

Back 36

Red font: Leukotoxin, immunosuppresive factor, and endotoxicity

Not red: capsule and resistance to complement

Front 37

DOC for Aggregatibacter actinomycetemcomitans bacteremia that may result in endocarditis?

Back 37

Cephalosporins

Front 38

Which 3 bacteria make up the "red complex"?

Back 38

Poryphromonas gingivalis, Tannerella forsythia, and Treponema denticola. It's the most significant complex in periodontal disease progression.

Front 39

Which Poryphromonas gingivalis virulence factor is in red font on the Powerpoint?

Back 39

Endotoxin (proinflammatory).

Front 40

Which bacteria is strongly implicated in periodontal disease and secretes BspA protein?

Back 40

Tannerella forsythia

Front 41

Which bacteria may account for 50% of the bacteria found in a periodontal lesion?

Back 41

Treponema denticola

Front 42

What is GroEL and what does it play a role in?

Back 42

A protein produced by the major periodontopathogens in response to stress or injury. It may play a role in periodontitis-associated atherosclerosis.

Front 43

Which 5 bacteria are listed as being moderately associated with periodontal disease?

Back 43

Fusobacterium nucleatum, Prevotella intermedia, Eikenella corrodens, Campylobacter rectus, and Capnocytophaga

Front 44

Which genus is one of the Vincent organisms and is distinguished by the cell having one or both ends pointed?

Back 44

Fusobacterium

Front 45

15% of Prevotella intermedia produce what?

Back 45

Beta-lactamase

Front 46

Name this bacteria: produces a black pigment, associated with infections above the diaphragm, often seen after oral surgery, and common player in pulmonary abscesses

Back 46

Prevotella melaninogenica

Front 47

Where is Campylobacter rectus often found in large numbers?

Back 47

Subgingival plaque or chronic periodontitis patients

Front 48

Which genus is filamentous, gram negative bacilli that are associated with periodontitis?

Back 48

Capnocytophaga

Front 49

Which genus comprises over 50% of the anaerobes of periodontal pockets?

Back 49

Eubacterium (normal gut flora)

Front 50

Name 3 bacteria of the genus Actinomyces. Which one is responsible for pyogenic abscesses, sinus formation, and sulfur granules?

Back 50

A. naeslundii, A. odontolyticus, and A. israelii (<---- that one)

Front 51

What is the nonspecific plaque hypothesis?

Back 51

All plaque is bad, small amount of plaque are neutralized by a host, large amounts of plaque produce disease, and plaque control is treatment. Much of the clinical treatment is based on this theory.

Front 52

What is the specific plaque hypothesis?

Back 52

Only certain plaque is pathogenic and these bacteria produce more substances that cause the destruction of periodontal tissues.

Front 53

What is the typical bacterial population shift from healthy to periodontitis?

Back 53

From health to gingivitis, there is a shift towards rods and anaerobes. From gingivitis to periodontitis, there's a marked shift to gram negative rods

Front 54

In gingivitis, are there more Gm- or more Gm+ bacteria?

Back 54

Equal amounts

Front 55

An increase in which bacteria has been reported to cause pregnancy gingivitis (controversial)?

Back 55

Prevotella intermedia

Front 56

Give 2 alternative names for acute necrotizing ulcerative gingivitis and name the 3 bacteria that cause it

Back 56

Vincent's infection or Trench mouth. Fusobacterium, Treponema, and streptococci (Prevotella intermedia)

Front 57

What is oral fetor? In what disease is it PRONOUNCED?

Back 57

Real real stinky breath. Acute necrotizing ulcerative gingivitis

Front 58

Name 4 ways that dentoalveolar infections can present

Back 58

A localized abscess, extension of the abscess, a diffuse cellulitis which spreads along fascial planes, and bone involvement.

Front 59

How does pulpitis usually develop?

Back 59

The spread of bacteria from a carious lesion to the pulp via dental tubules

Front 60

Name the 5 methods that bacteria can use to get to the pulp

Back 60

Through dental tubules, exposure from tooth wear or caries, exposure during dental treatment, through the gingival crevice (periodontitis), and through the blood supply (rare)

Front 61

Which type of pulp infection is characterized by severe, relentless pain and is initially reversible but can quickly become irreversible?

Back 61

Acute

Front 62

Which type of pulp infection is characterized by dull, intermittent pain? It's irreversible

Back 62

Chronic

Front 63

Which type of pulp infection is characterized by pulpal hyperplasia and it becomes epithelialized?

Back 63

Pulp polyp

Front 64

What could the spread of pulpitis from the maxillary teeth cause?

Back 64

Brain abscess, infraorbital/orbital cellulitis (both of those are in blue), purulent sinusitis, meningitis, and a cavernous sinus thrombosis.

Front 65

What could the spread pulpitis from the mandibular teeth cause?

Back 65

Ludwig's angina (typed in blue), parapharyngeal abscess, mediastinitis, pericarditis, empyema, and jugular thrombophlebitis

Front 66

Which 4 bacteria are listed as causing Ludwig's angina?

Back 66

Streptococcus, Porphyromonas, Prevotella, and Fusobacteria

Front 67

Which 2 conditions can Ludwig's angina lead to?

Back 67

Glottal edema and asphyxiation

Front 68

T of F: Dentoalveolar abscesses are usually polymicrobial and dominated by strict anaerobes

Back 68

True

Front 69

Which bacteria is responsible for lumpy jaw?

Back 69

Actinomyces israelii.

Front 70

Which factors predispose someone to osteomyelitis of the jaw?

Back 70

Any factors that reduce vascularity of the bone.

Front 71

T or F: Staphylococcus aureus, the most common agent of osteomyelitis in long bones, if frequently isolated from jaw lesions

Back 71

False.

Front 72

Name the 5 bacteria that are given as examples of anaerobes commonly isolated from osteomyelitis of the mandible

Back 72

Tannerella, Prevotella, Porphyromonas, fusobacteria, and streptococci

Front 73

What are the 3 ways that a periodontal abscess can form and which 4 types of bacteria can cause them?

Back 73

Impaction (foood, tooth brush bristle), compression of the pocket wall by orthodontic tooth movement, spread of infection from the pocket into supporting tissues. Caused by anaerobic, gram-negative rods, anaerobic streptococci, spirochetes, and actinomyces.

Front 74

Give 3 symptoms of a periodontal abscess.

Back 74

Swelling, redness, and tenderness of the overlying gingiva, pain (continuous or related to biting), and draining pus

Front 75

How would you treat a periodontal abscess?

Back 75

Incision and draining, curettage along the tooth root/extract, maybe antibiotics if systemic

Front 76

Name this bacteria: Strict aerobe, found in soil, partially acid fast, and forms abscesses (especially in the brain). Treatment is trimethoprim/sulfa or surgery+sulfa.

Back 76

Nocardia

Front 77

What is the DOC for Actinomycosis?

Back 77

Surgery + penicillin

Front 78

Trauma to which teeth is most often responsible for lumpy jaw?

Back 78

Mandibular first molars and anterior maxillary teeth

Front 79

About 530,000 leukocytes/minute migrate into the healthy oral cavity. Over 90% of these are....?

Back 79

Neutrophils

Front 80

What 3 things take place during inflammation?

Back 80

Enhanced expression of adhesion molecules, enhanced emigration of neutrophils, and inflammatory infiltrate (neutrophils, B and T cells)

Front 81

In the initial and early stages of experimental gingivitis lesion development, PMN below gingival epithelium and in crevice increase as protection. What type of PMN are these?

Back 81

Mostly T-cells (more specifically, TH-1)

Front 82

In established experimental gingivitis lesions, B cells (not T cells anymore) dominate. What do these B cells transform into and what is the primary antibody they produce?

Back 82

Plasma cells, IgG.

Front 83

Increasing __ (B or T) cell infiltrate correlates with progression of experimental gingivitis. Predominantly __ (B or T) cell infiltrate correlates with stable lesion.

Back 83

B, T

Front 84

In advanced experimental gingivitis lesions, PMN predominate in pocket and junctional epithelium. Which cells predominate in connective tissue infiltrate?

Back 84

Plasma cells

Front 85

Crevicular ___ levels appear to correlate inversely with disease severityof periodontitis.

Back 85

IgA. They neutralize bacterial proteases without complement. IgG is also produced and activates complement.

Front 86

CD4+T cells account for what % of gingival lymphocytes in chronic periodontitis-inflamed tissues?

Back 86

20-30%. Animal studies suggest that CD4+T cells are important mediators of bone loss in periodontitis.

Front 87

What type of cytokines predominate in chronic periodontitis?

Back 87

Th2. This may contribute to high B-cell responses in local disease sites.

Front 88

At what PMN level (PMN/uL) is there a 100% chance of periodontitis infection?

Back 88

<200/uL (called agranulocytosis)

Front 89

Give the 4 steps of adherence in phagocytic cell function and name the "thing" that performs/mediates each one

Back 89

Rolling adhesion (selectins), tight binding (integrins), dispedesis [PECAM-1(CD31)], and migration (IL-8 cytokine)

Front 90

In phagocytic cell function, there is chemotaxis of both bacterial and host products. Give examples of each.

Back 90

fMET-peptides for bacterial products and C3a, C5a, and LTB4 for host products.

Front 91

Are primary (azurophilic) PMN granules stored in inactive or active form?

Back 91

Active

Front 92

Are secondary (specific) PMN granules stored in inactive or active form?

Back 92

Inactive

Front 93

For PMN function in early-onset (aggressive) periodontitis, what is increased and what is reduced?

Back 93

# of crevicular PMN is increased

Chemotaxis of crevicular PMN, chemotaxis receptors in peripheral PMN, and killing function are all reduced

Front 94

For PMN function in chronic (adult) periodontitis, what is increased and what is reduced?

Back 94

# of crevicular PMN, activity of crevicular PMN, and levels of PMN enzymes in GCF are all increased.

Nothing is reduced.

Front 95

During arachidonic acid metabolism, which leukotriene produced is a chemoattractant and associated with degranulation and hyperalgesia?

Back 95

LTB4

Front 96

During arachidonic acid metabolism, which prostaglandin produced is associated with vasodilation, edema, and bone resorption?

Back 96

PGE2

Front 97

IL-1 and TNF-alpha are produced by ___ in periodontitis

Back 97

PMN

Front 98

Without oral hygiene measures, what % of individuals have gingivitis?

Back 98

100%. Only 10% are destructive and ~10% never progress.

Front 99

What is single nucleotide polymorphism?

Back 99

A variation in the identity of a single nucleotide at a specific site in the gene that can result in an amino acid change

Front 100

What could be the result of a SNP in the promoter region?

Back 100

A change in expression levels

Front 101

What could be the result of a SNP in the exon region?

Back 101

Conformational changes

Front 102

Which rare allele is significantly associated with severity of chronic adult periodontitis?

Back 102

IL-beta +3953

Front 103

What is the risk ratio of a heavy smoker with positive genotype?

Back 103

7.7

Front 104

What is the most important independent risk factor for the development of periodontal disease? What is the risk ratio?

Back 104

Smoking. 2.5-6

Front 105

What are the risk levels for periodontitis for people with Type 1 or Type 2 diabetes?

Back 105

5X and 3X, respectively

Front 106

T or F: some evidence shows that improvements in perio status can lead to better glycemic control

Back 106

True

Front 107

Prolonged high glucose levels lead to...?

Back 107

PMN dysfunction

Front 108

What's an AGE? What do they do?

Back 108

Advanced glycation end products. They are accumulations or irreversibly glycated proteins in periodontium and other tissues. They stimulate inflammatory cells, leading to increased production of IL-1 and TNF

Front 109

T or F: Periodontitis makes a significant independent contribution to low birth weights

Back 109

True

Front 110

T or F: salivary gland infections are usually bacterial

Back 110

False. They're usually viral

Front 111

Which glands are more commonly infected: submandibular or parotid?

Back 111

Parotid. Also most commonly affected in mumps

Front 112

Are a majority of salivary gland infections seen in children or adults?

Back 112

Adults

Front 113

What is the most common cause of viral sialadenitis? What other viruses can cause it?

Back 113

Mumps. CMV (red), Cox-A, Echovirus, and Flu-A

Front 114

Orchitis, testicular atrophy, and sterility occur in what % of mumps cases?

Back 114

20%

Front 115

Oophoritis (ovaries) occurs in what % of mumps cases?

Back 115

5%

Front 116

Which bacteria commonly cause acute suppurative sialadenitis?

Back 116

S. viridans, S. aureus (those 2 are red), H. influenzae, E. coli.

Front 117

Chronic recurrent bacterial sialadenitis may be secondary to some type of ________ or unusual anatomy

Back 117

Obstruction

Front 118

Who is acute bacterial sialadenitis most often seen in?

Back 118

Adults with salivary gland abnormalities

Front 119

Name 4 predisposing factors to sialadenitis

Back 119

Xerostomia (irradiation and Sjogrens are starred), Sialoliths, congenital defects, and systemic diseases (AIDS and Graft vs. Host disease are starred)

Front 120

Sialolithiasis is more commonly seen in which salivary glands?

Back 120

Submandibular (80%). Parotid is 20%

Front 121

CMV sialadenitis is commonly found in patients with what other disease?

Back 121

HIV

Front 122

What disease is characterized by donor immune cells attacking recipient and desquamative gingivitis and involve the salivary glands?

Back 122

Graft vs. Host disease

Front 123

Innate Immunity at mucosal srufaces includes all the following except:
A. netrophilic lactoferrin
B. salivary stratherins
C. Toll-like receptors
D. Salivary sIgA
E. Salivary proline rich proteins

Back 123

D- Salivary sIgA

Front 124

Other than streptococcus mutans, which organism is thought to play an significant role in teh induction of smooth surface caries?
A. Peptostreptcoccus sp
B. Lactobacillus sp
C. actinomyceses naeslundii
D. Eubacterium lentum
E. Streptcoccus sobrinus

Back 124

E- Streptococcus sobrinus

Front 125

Which of the following protozoa are found in primarily in the oral cavity
A. Giardia lamblia
B. acanthamoeba sp
C. leisthmania sp
D. entamoeba histolytica
E. trichomonas tenax

Back 125

E- Trichomonas tenax

Front 126

Streptococcus salivarius produces which type of hemolysis in culture?
A. delta
B. alpha
C. gamma
D. beta

Back 126

B- alpha

Front 127

Giardiasis is a common presentation of which form of immundeficiency?
A. B cells (common variable immunodeficiency disease and hypogammaglobulinanemia)
B. T cells
C. Phagocytic cells
D. complement

Back 127

A- B cells (and remember something about humoral response)