Perio2

What are two refined recognized notions about the role of bacteria in the pathogenesis of periodontal disease?

(1) a pathogenic microbial biofilm is a prerequisite for periodontitis to develop, but the presence of a pathogenic oral biofilm alone is insufficient to cause the disease (2) while red complex mo are strongly associated with an inflammatory disease, there is no current evidence to support the argument that the red complex bacteria are potent initiators of the disease.

Components of the immune system that play an important role in combating periodontal disease are

(1) cellular defenders (phagocytes, lymphocytes) (2) complement system

The body recognizes bacteria, viruses, fungi, and parasites as something foreign to itself and responds by

(1) sending certain types of cells to the infection site (2) producing biochemical substances to counteract the foreign invaders.

List 4 ways pro-resolving lipid mediators work.

(1) terminate PMN recruitment to the site, (2) stimulate macrophages to remove dead cells/phagocytosis (3) promote antibacterial activities (4) promote tissue repair/regeneration to achieve homeostasis.

_____________ hypothesis builds upon the microbial-homeostatis/host response hypothesis. Suggests that a specific bacterial species is the key in creating the shift from symbiosis to dysbiosis. Transition to perio requires both a polymicrobial dysbiotic biofilm community and a susceptible host.

Keystone Pathogen-Host Response Hypothesis p.gingivalis is the "keystone species" in initiating this change in the biofilm community. p. gingivalis—initiates a shift from beneficial to pathogenic microbes in the biofilm community that triggers the host inflammatory response responsible for the tissue destruction seen in periodontitis.

___ are large phagocytes with a single kidney-shaped nucleus and some granules.

Macrophages; slower to arrive at the infection site most found in chronic inflammation. present antigen T cells (monocyte when in bloodstream;macrophage in tissue) are phagocytic cells that engulf and destroy mo.

__________ are a family of at least 12 different proteolytic enzymes produced by various cells of the body. They act together to break down the connective tissue matrix.

Matrix Metalloproteinases. sources of MMPs include PMNs, macrophages, gingival fibroblasts, and junctional epithelial cells can produce MMPs. cells providing the major source of MMPs in periodontitis are PMNs and gingival FB.

___________ theory proposed that the accumulation of plaque biofilm, abundance of bacteria in the biofilm adjacent to the gingival margin led to gingival inflammation and the subsequent tissue destruction seen in perio. List 3 cons associated with this theory.

Nonspecific Plaque Hypothesis (cons - too simplistic; can't explain why some sites in an individual's periodontium experience considerable periodontal destruction while other sites are unaffected; fails to explain why most cases of gingivitis never progress to periodontitis)

What are the two hypotheses focused on the role of the # of bacteria/specific bacteria present in oral biofilm?

Nonspecific plaque hypothesis - the accumulation of bacterial biofilms leads to perio disease. specific plaque hypothesis - specific pathogenic bacteria and their products lead to perio disease

_____ of PMNs can amplify the inflammatory process and result in tissue damage.

OVERACTIVITY

What is the most important action of the complement system?

Opsonization of Pathogens. Facilitates the engulfment and destruction of MO by phagocytes. Complement components coat the surface of the bacterium allowing the phagocytes to recognize, engulf, and destroy the bacterium. It also recruits additional phagocytic cells to the site of the infection.

List factors that influence PerioD.

Perio Pathogens. A.A. P.G T.F. Hereditary Immune Deficiency (Systemic Diabetes) Habits - smoking Social Atmosphere - access to dental care, stress, hormones

T or F Information concerning individual risk for developing periodontal disease is obtained through careful evaluation of the individual's demographic data, medical history, dental history, and comprehensive periodontal clinical examination

T

T or F Molecular epidemiology techniques that isolate DNA provide evidence that bacteria in the biofilm are transmissible.

T

T or F Periodontitis is characterized by unresolved, chronic inflammation that leads to ongoing tissue damage through continuous and recurring episodes of acute inflammation.

T

T or F Indigenous microbes may block pathogenic species from adhering to the existing biofilm and the mucosal surfaces which allows the biofilm to protect itself and the host from overgrowth of pathogenic bacteria.

T

T or F Bacteria that adhere loosely to epithelium of the pocket wall are distinctly different from those of the tooth associated plaque biofilm. List some bacteria.

T layers closest to the soft tissue wall contain large numbers of spirochetes and flagellated bacteria. S. oralis S. intermedius P. gingivalis Prevotella intermedia Tannerella forsythia Fusobacterium nucleatum

_____ are small leukocytes whose main function is to intensify the response of other immune cells—such as B-lymphocytes and macrophages—to the bacterial invasion. They produce a substance called _______ that stimulate the immune response.

T-lymphocytes cytokines (signaling protein)

T or F Bacteria living in a biofilm are unusually resistant to systemic antibiotics (in dentistry, usually administered in pill form) and antimicrobials (placed locally in the oral cavity or taken as an oral rinse). In areas that are cleaned regularly, a mature biofilm will not be able to develop. The cleaner the tooth surface, the less complex the bacterial formation.

T. T (mechanical and professional cleanings are important)

T or F Biofilms can exist on any solid surface that is exposed to a microbe containing fluid. Biofilms thrive in dental unit water and suction lines and have been shown to be the primary source of contaminated water delivered by dental units.

T.T

T or F Lysosomal enzymes and other microbial products are released from a leukocyte after phagocytosis or when the leukocyte dies. Once released, the lysosomal enzymes cause damage to tissue cells in the same manner that they destroy bacteria.

T.T

T or F Bacteria can replicate quickly. This ability to divide quickly enables populations of bacteria to adapt rapidly even to sudden changes in their environment.

T.T.

T or F To fight an infection, cells of the immune system travel through the bloodstream and into the tissues. At the infection site, the immune cells push their way between the endothelial cells lining the blood vessels (extravasation) and enter the connective tissue.

T.T.

In this lesion, it is not reversible, more B cells, and is known as periodontitis.

advanced

In this lesion, there is apical migration of the J.E. and bone loss. Typically, no time frame can occur over weeks, months and years. Host response can influence it such as (stress, medication and smoking)

advanced

_____ are the simplest organisms and can be seen only through a microscope.

bacteria

In response to a microbial challenge, host immune cells secrete ______

biochemical mediators; activate the inflammatory response.

A _____ is a complex and dynamic microbial community—containing a diverse array of many types of microbial species (bacteria, fungi, and viruses)—embedded within a self-protective matrix that adheres to a living or nonliving surface.

biofilm microbes in biofilm secrete protective matrix. biofilm-induced diseases include TB, CF, subacute bacterial endocarditis (IE), & PD. biofilm enhances adhesion by allowing it to withstand the host's immune system, antimicrobials, and environmental stresses

The human body is continually working to maintain a state of balance in the internal environment of the body, known as _____ or homeostasis.

biological quilibrium Can be thought of as a balance scale, disease-promoting factors on one side of the scale and the health-promoting factors on the other. As long as the two sides of the scale are in balance, there will be no disease progression.

______ is the extracellular protective matrix protects microbes by preventing large molecules (antibodies) and inflammatory cells from penetrating deeply into the biofilm matrix. Mature biofilms may even block small molecules like antimicrobial agents.

blocking

What are 3 ways mature biofilm protect bacteria?

blocking - matrix inhibits penetration mutual protection - antibiotic resistant protecting non antibiotic or, normal flora protecting host hibernation - some bacteria cannot be killed with antimicrobial

Control of bacteria in dental plaque biofilms is best achieved by the physical disruption known as ____________________________.

brushing, flossing and periodontal instrument.

Resolution of inflammation and return to a noninflammatory state is an actively regulated biologic process known as

catabasis; a complicated biologic process that is as complicated as the onset of inflammation.

Microcolonies in maturation 2 of biofilm development continues to grow through a combination of _________ and _____________.

cell division and recruitment

The bacterial __________ is a complex, multilayered structure that serves to protect the microorganism from the unpredictable and inhospitable external environment.

cell envelope (skin of the M.O.) gram staining classifies bacteria + (purple; single thick multilayered peptidoglycan. above cytoplasm interior of cell) or - (red; thin external and internal membranes) identifies bacteria based on the fundamental structural characteristics of the bacterial cell envelope.

Once the leukocytes enter the connective tissue, the cells must migrate to the site of the infection. _____ is the process which leukocytes are attracted to the infection site in response to ______ released by the invading microorganisms.

chemotaxis biochemical compounds/mediators

PMNs can move through capillary walls and into the tissue. PMNs are attracted to bacteria by a process called _____.

chemotaxis.

_______ is a long-lived, out-of-control inflammatory response that continues for more than a few weeks and results in varying degrees of tissue injury.

chronic inflammation, occurs when the body is unable to eliminate the infection it is a pathological condition characterized by active inflammation, host tissue destruction and attempts at repair. warning signs (pain) are absent in chronic inflammation such as perio

The most significant known risk factor for periodontitis is _____. It has a profound impact on periodontitis development and treatment response.

cigarette smoking/tobacco

Process by which genetically distinct bacteria become attached to one another is commonly referred to as __________.

coaggregation.

___________ provides the structural framework of all periodontal tissues. Without it, the tissues of the gingiva ligament and supporting alveolar bone degrade. This degradation results in recession, pocket formation, mobility and CAL.

collagen

The oral cavity is inhabited by indigenous, resident bacteria known as __________.

commensal bacteria; part of the normal flora in the mouth, good relationship w/ host and commensal microorganisms. commensal microorganisms contribute to host nutrition, & maintenance of immune system the host provides the bacteria with nutrients and a stable environment in which to survive .

The _____ is a complex series of proteins circulating in the blood that works to facilitate phagocytosis or kill bacteria directly by puncturing bacterial cell membranes.

complement system; they become activated and work with antibodies. 3 principal functions

In this lesion, it is reversible and the 1st changes with the junctional epithelium is seen. There is no apical migration. It is chronic and can remain chronic for months or years depending on host factors. PDL fibers are affected.

established

In this lesion, it it B Dominated (memory), more collagen is lost. There is sub plaque and the J.E. detaches laterally; widening. More epithelial ridge formation. Also development of pseudo pocket.

established

In heath, MMP's _______________ the normal turnover of the periodontal connective tissue matrix.

facilitate The MMP-TIMP balance is critical in maintaining the integrity and the health of the connective tissue. Any disruption in the MMP-TIMP balance will result in uncontrolled pathologic breakdown of the connective tissue matrix.

Periodontal pocket also contains many __________ bacteria that are not part of the biofilm.

free-floating

Bacteria attach to an area of the tooth surface that extends from the _____________ almost to the junctional epithelium at the _______________.

gingival margin; base of the pocket

The way that an individual's body responds to an infection is known as __

host response

The acute inflammatory process is achieved by the _____ movement of plasma and leukocytes from the blood into the injured tissues.

increased

_____ is the body's protective response to pathogens, foreign bodies, or an injury. This response concentrates host defense components at the site of an infection or injury to eliminate microorganisms and heal damaged tissue.

inflammation is characterized by dilation of the blood vessels, enhanced permeability of blood capillaries, increased blood flow and leukocyte movement into tissues.

In a ________ lesion, (2-4 days), plaque accumulation occurs.

initial

In this lesion, there is acute inflammation, dilation of blood vessels, is reversible and THERE IS NO CLINICAL SIGNS. (Known as subclinical)

initial

What are the 4 distinct histologic stages in development of periodontal disease?

initial lesion early lesion established lesion advanced lesion

The immune system is composed of two major subdivisions, what are they?

innate - born with; first line of defense; immediate adaptive (remembers) - developed throughout life. protection against re-exposure of a pathogen;second line of defense

_______, theory states, a keystone species initiates a shift from beneficial to dysbiotic microbes in the biofilm community that trigger the host inflammatory response responsible for the tissue destruction seen in perio.

keystone pathogen hypothesis; current

____ influencing modifiable factors can either be acquired or anatomical. _____ include calculus, overhanging, and poorly contoured restorations. _____ include malpositioned teeth, root grooves, concavities, and furcation.

local risk factors acquired local risk factors anatomical risk factors

Within the chronic inflammatory response, the accumulation of ____ characterizes chronic inflammation. Leukocytes release several different inflammatory mediators known as ____________

macrophages; engulfs and digest MO. IL-1 TNFa (principal cytokine secreted bc it contributes to tissue destruction) prostaglandins

The term _____ was coined to refer collectively to the microscopic organisms, including bacteria, fungi, protozoa, and viruses.

microbe

What are the 3 ways mature biofilm protect bacteria/tolerate external stresses?

microbes in a biofilm can resist factors that would easily kill these same microbes when in a free-floating state. 1. Blocking. 2. Mutual Protection 3. Hibernation (Quiescence).

_________, theory states, a shift from beneficial to pathogenic microbes triggers the host inflammatory response, the host response causes the tissue destruction seen in perio.

microbial homeostasis-host response hypothesis; current

Risk factors are ___ or ___.

modifiable (can be changed); nonmodifiable (cannot be changed)

What causes planktonic microbes to attach to pellice?

motile bacteria use flagella (allowing m.o. to travel) to overcome hydrodynamic (fluid) forces within the oral cavity. decision to stick is not absolute; and depends on the hydrodynamic forces or in response to nutrient availability.

__________ is a unique property of polymicrobial biofilms is the cooperative protective effects that different species of bacteria can provide to each other. Example, antibiotic resistant bacteria may secrete protective enzymes that can protect neighboring nonantibiotic resistant bacteria in the biofilm.

mutual protection microbes that are part of the normal flora of the mouth may offer protection for the host

___________ theory states, an abundance of biofilm bacteria causes the tissue destruction seen in perio.

nonspecific plaque hypothesis; historical

How is bacteria from the oral cavity transmitted?

one person to another; transfer of saliva through kissing (primary), or indirect contact via salivary substances on inanimate objects.

__________ is a polymicrobial, three-dimensional community of numerous microbial species, embedded in a protective matrix that consists of microbial metabolic products and/or host components, such as salivary glycoproteins.

oral biofilm in symbiosis, bacteria in biofilm maintain a harmonious balance by keeping each other in check so no one strain won't dominate the community. when dysbiosis occurs due to not disrupting the biofilm frequently, imbalance occurs leading certain pathogenic species to become more dominant while others become weaker.

An ________ is an organized, structural collective of different, genetically distinct microorganisms adhering to the tooth surface and/or attaching to each other which is known as _____________

oral biofilm;coaggregation

The resolution of acute inflammation involves .....

removal of microbial challenge (the reason for inflammation and the resolution must be efficient. it is not the extent of acute inflammatory response, but the effectiveness of the resolution which determines if the inflammation is favorable or detrimental).

Bacteria living in a biofilm are unusually _______ to systemic antibiotics

resistant antimicrobial agents work best when used in conjunction with mechanical cleaning that removes or disrupts the structural integrity of the dental plaque biofilm.

_______ theory states, the presence of specific bacteria in the biofilm directly causes the tissue destruction seen in perio

specific plaque hypothesis; historical

Describe the maturation phase 2 stage of biofilm development.

stage 4 - mushroom shaped microcolonies. grow away from tooth, clustering together forming mushroom shape microcolonies. colonies differ/vary due to temperature and pH. diversity helps to ensure the survivability of plaque biofilm

___________ recruit immune cells such as PMN and macrophages to the infection site.

cytokines can be tissue protective or initial tissue destructive and bone loss in chronic inflammatory perio. increase vascular permeability allowing immune cells and complement to move into the tissues at the infection site.

In chronic inflammation, host immune system responds by releasing elevated levels of ___________ which stimulate leukocytes and FB to release ______

cytokines and prostaglandins; release MMP's. presence of increased MMP levels, extensive collagen destruction occurs in the periodontal tissues.

BCM of importance in perio are (3)

cytokines, prostaglandins, and matrix metalloproteinases (MMPs).

In this lesion, it is T-cell dominated and reversible. 7-14 days. It is affiliated with gingivitis.

early

In this lesion, there is loss in gingival fiber support, epithelial ridges developed

early

___________theory states, changes in the subgingival environment can dictate or select the specific microbial composition of the biofilm; the pathogenic biofilm community causes the tissue destruction seen in perio.

ecological plaque hypothesis, current

The thin layer of epithelial cells that line the interior surface of the blood vessels is called _____. The process of immune cells exiting the vessels and entering the tissues is called _____.

endothelium transendothelial migration

The resolution of acute inflammatory process uses cells to provide _____ which will shut down and clear out immune cells.

stop signals once the body eliminates mo, the inflammatory response shuts down for that specific situation to limit self-damage to host tissue injury and the progression of acute inflammation into chronic inflammation.

Early bacterial colonizers of the tooth surface include .......

streptococcus mitis and s. oralis (anaerobe; attaches to the tooth pellicle)

The zones of ________ bacterial attachment are the tooth surface and the epithelial lining of the perio pocket.

subgingival bacteria may attach to other bacteria that are attached to one of these surfaces. some bacteria remain free-floating in the gingival sulcus or pocket. filamentous m.o. of cocci, and rods—including s. mitis, s. sanguis, and actinomyces viscosus dominate the tooth-associated plaque biofilms.

The process of acute inflammation is initiated by the blood vessels near the injured tissue, allowing the release of plasma proteins and leukocytes into the surrounding tissue. PMN's arrive and release cytokines such as IL & TNF. What happens next? Which organ/protein becomes activated?

the liver synthesizes various plasma proteins called acute phase reactant proteins. C-REACTIVE PROTEIN. (^ to 50,000 in acute inflammation

_____ is the hallmark of chronic inflammation. If the infection persists, inflammation can last months or even years.

tissue damage chronic inflammation is abnormal and does nothing good for the body because it is an out-of-control response that can destroy healthy tissue and can cause more problems than the original issue.

_______ refers to the mechanisms that enable biofilm bacteria to colonize and damage the tissues of the periodontium.

virulence factor; either structural characteristics of the bacteria themselves or substances that are produced by the bacteria.

How long does it take for initial attachment of develop? What does it consist of?

within minutes after cleaning, acquired pellicle develops. purpose is to protect the enamel from acidic activity. a few hours, planktonic microbes attach to pellice.

What are the 3 current hypotheses regarding the role of bacteria and periodontal disease?

(1) Ecological Plaque Hypothesis (2) Microbial Homeostasis-Host Response Hypothesis 3) Keystone Pathogen-Host Response Hypothesis

What is the first way biofilm matures?

1st step is colonization of the tooth surface followed by additional microbes join which leads to a complex microbial community developing (chronic infection).

What are the 5 hypothesis pertaining to the role of bacteria?

(1) Nonspecific Plaque Hypothesis (2) Specific Plaque Hypothesis (3) Ecological Plaque Hypothesis (4) Microbial Homeostasis-Host Response Hypothesis (5) Keystone Pathogen-Host Response Hypothesis

List the steps of phagocytosis ......

1st, the external cell wall of a phagocytic cell (such as a neutrophil or macrophage) adheres to the bacterium. phagocytic cell extends finger-like projections (pseudopodia) that surround the bacterium. phagocytic vesicle called a phagosome surrounds the ingested bacterium. lysosome granules fuse with the vesicle to form a phagolysosome. bacterium is then digested. last, the phagocytic cell discharges the contents of the phagolysosome into the surrounding tissue.

What are 3 factors that influence the host immune response?

1. Genetic Factors. contribute to perio disease. (variations in genes controlling formation of BCM can modify the immune response to plaque biofilm increasing the susceptibility to perio. 2. Environmental Factors. Tobacco (decrease PMN phagocytic capacity, decrease vascularity of gingival tissues, and affect both T- and B-lymphocyte response to periodontal pathogens. 3. Acquired Factors. Diabetes (abnormal blood glucose levels seen in diabetes mellitus affects the host response by reducing PMN function, increasing interleukin & prostaglandin levels in GCF and reducing growth and proliferation of periodontal ligament fibroblasts and osteoblasts in periodontium.

What are 3 ways antibodies participate in host defense?

1. Neutralize bacteria or bacterial toxins to prevent bacteria from destroying host cells. 2. Coat bacteria making them more susceptible to phagocytosis. 3. Activate the complement system.

The primary bacterial virulence factors (3) that can enhance damage to the periodontium are.

1. Presence of lipopolysaccharide (LPS): gram - bacteria a component of mature plaque biofilm. Virulent because (LPS) can be responsible for initiating inflammation in periodontal tissues. 2. Ability to invade tissues: evidence that several subging bacteria invade epithelial cells. 3. Ability to produce enzymes: bacteria produce enzymes such as collagenases and proteases that can directly degrade host proteins that are a basic part of the structure of the periodontium.

How does the internal organization of mature biofilm develop?

1. develops by stacking one microbial species on top of another. (becoming polymicrobial). 2. series of fluid channels (transporting oxygen, nutrients and carrying away waste) are formed that penetrate the extracellular protective matrix. 3. cell-cell communication; microcolonies use chemical signals to communicate 4. signaling; communication occurs when microbes within the biofilm release and sense small proteins (signaling molecules); quorum sensing.

It is estimated that there are ______________ unique bacterial species reside in the oral cavity.

650 to 1,000

Timeline for biofilm formation A. Within minutes: ______ B. 2 to 4 hours: _______ C. __________: Microbes produce an initial extracellular protective matrix and become resistant to antiseptics and antibiotics D. _________: The biofilm evolves into fully mature biofilm colonies that are extremely resistant to antibiotics; can rapidly recover from mechanical disruption and reform a mature biofilm with 24 hours.

A. free-floating microbes attach to surface B. microbes form strongly attached microcolones. C. within 6-12 hours D. within 2-4 days

____________ has a host-protective effect. It serves as the body's first line of defense against microbial invasion, eliminating the harmful stimuli, replacing injured and creates an environment for tissue repair.

Acute inflammation

_____ is a short-term, normal process that protects and heals the body following physical injury or infection

Acute inflammation absence of inflammation, wounds and infections would never heal and the progressive tissue destruction would threaten the life of the individual.

_____________ are powerful regulatory cell protein released by host immune cells that influence the behavior of the other cells.

Cytokines; a molecule that transmits information or signals from one cell to another activating the immune system to send phagocytic cells to the site of an infection. PMNs, macrophages, B-lymphocytes, epithelial cells, gingival fibroblasts, and osteoblasts can produce cytokines in response to the bacterial challenge or tissue injury.

Describe stage 5 of biofilm development.

Dispersion: Escape From The Matrix enables biofilms to spread and colonize new tooth surfaces.

Microbial imbalance within body where certain species dominate while others become weaker. Occurs if balance doesn't happen. Happens with vasodilation (???)

Dysbiosis

________ is microbial imbalance on or inside the body leading to gingival inflammation when biofilm is not disrupted frequently.

Dysbiosis can result if certain species of microbes become dominant while other species become weaker. with INCIPIENT dysbiosis, the gingivitis does not progress to perio. with ESTABLISHED Dysbiosis; lead to periodontitis.

Prostaglandins of the _________ play an important role in the bone destruction seen in periodontitis. It also initiates most of the alveolar bone destruction in periodontitis.

E series (PGE) major source of PGE in inflamed periodontal tissues is the MACROPHAGE, (PMNs and gingival FB produce them)

T or F If the acute inflammatory responses are not effective in eliminating the invading microorganisms or due to a defective/aggravated immune response, the inflammatory response does not shut down and becomes chronic

T

T or F If the plaque biofilm had only one microbial species, it would be more likely that a toxic agent or condition would destroy the biofilm.

T

_____ are small leukocytes that help in the defense against bacteria, viruses, and fungi and are comprised of two types which are.....

B-lymphocytes plasma B-cells (make antibodies, MADGE. one part binds to the outside of the b-cell the other binds to the mo, destroying it) memory B-cells.

What are key points that support the ecological plaque hypothesis.

BOP, deeper probing depths, ^ GCF

_____ a major subgroup of cytokines, cause additional immune cells to be attracted to the site of infection or injury.

Chemokines

If the host is unable to control acute inflammation it will progress and turn into

Chronic Inflammation; which can have pathologic effects on host tissue

The other major component of the immune response is the _____. This system provides a second layer of defense.

Complement System.

What happens during the DESTRUCTION OF PATHOGENS within the complement system?

Destroy certain MO directly by forming pores in their cell membranes. The complement system creates a protein unit called the MEMBRANE ATTACK COMPLEX that can puncture the cell membranes of certain bacteria (lysis).

What is a systemic condition that can influence periodontal disease?

Diabetes or genetics Medications to treat conditions can also lead to overgrowth of gingiva.

In this lesion, THE FIRST CLINICAL SIGNS ARE DISPLAYED with contour and consistency changes.

Early

In this lesion, there is an increase of GCF and probing depth, 60%-70% OF collagen is loss. NO CLINICAL ATTACHMENT LOSS. Acute.

Early

_________ theory combines key points from the specific plaque hypothesis and the nonspecific plaque hypothesis. It postulates that the accumulation of nonspecific bacteria triggers the host inflammatory response. A shift in the local environment drives that changes in the microbial composition which results in pathologic disease.

Ecological Plaque Hypothesis the host inflammatory response alters the local environment within the gingival sulcus (higher GCF flow, increased bleeding, raised pH, decreased oxygen concentration). if there is a disruption in ecological homeostasis, it will change the environment that is favorable for specific microorganisms

T or F Minutes after tissue injury, there is an decrease in blood flow to the area.

F *increase Higher blood volume heats the tissue and causes it to redden. The increased blood flow is needed to deliver immune cellular defenders. within hours, phagocytosis occurs and release BCM to contribute to the inflammatory response.

T or F Bacteria are not social creatures that can live together in complex microbial communities.

F. THEY ARE

T or F The presence of periodontal pathogens alone is sufficient to cause the tissue destruction seen in periodontitis.

F. insufficient it's the body's response (HOST RESPONSE) to the bacteria present in plaque biofilm that is the cause of nearly all the destruction seen in periodontal disease.

T or F Subgingival bacteria appear to have the ability to invade the dentinal tubules through enamel. Bacteria from the tissue-attached plaque biofilms can invade the gingival connective tissue and be found within the periodontal connective tissues and on the surface of the alveolar bone.

F. *cementum T

T or F The presence of pathogenic bacteria does mean that an individual will experience periodontitis. Many contributing factors (risk factors) help to determine the initiation and progression of periodontal disease.

F. *does not Periodontitis has a multifactorial etiology, meaning periodontitis is a disease that results from the interaction of many factors T

What are some gram - bacteria found within the oral cavity affiliated with perio?

F. nucleatum A. actinomycetemcomitans T. forsythia P. gingivalis

What are the 5 classic symptoms of acute inflammation.

Heat—a localized rise in temperature due to an increased amount of blood at the site. Redness—the result of increased blood in the area. Swelling—the result of the accumulation of fluid at the site. leukocytes and plasma that collect at the site cause the swelling (edema) associated with inflammation. Pain—the result of pressure from edema in the tissue. excess fluid in the tissues puts pressure on sensitive nerve endings, causing pain. Loss of function—the result of swelling and pain. inflammation of a finger (swelling and pain) would cause you to favor that finger and not use it in a normal manner.

_____ is another strategy that many bacteria in biofilms have developed is for a specific portion of the larger microbial population to hibernate.

Hibernation (quiescence) some antibiotics are only effective on metabolically active bacteria, hibernating bacteria in biofilms are unaffected by these types of antibiotics. oral doses of antibiotics (which can kill free floating bacteria) may have little or no antimicrobial effect on the same type of bacteria in biofilm form)

What is the last step of the complement system?

Immune Clearance. the complement system performs a "housekeeping" function, the removal of immune complexes from circulation.

_____ are biologically active compounds secreted by cells that activate the body's inflammatory response. List the 3 mediators of importance in periodontitis.

Inflammatory biochemical mediators cytokines, prostaglandins, and matrix metalloproteinases.

_____ are white blood cells that act much like independent single-cell organisms able to move and capture microorganisms on their own

Leukocytes

_____ are small white blood cells that play an important role in recognizing and controlling foreign invaders. The two main types of lymphocytes that are important in defense against the bacteria in plaque biofilm are _____ and _____.

Lymphocytes B-lymphocytes T-lymphocytes

____________ theory proposes that while plaque biofilm are the cause of the initial inflammatory response leading to gingivitis, the pathogenic bacteria are not the direct cause of the destruction of the tissues seen in perio. Bacteria are not the direct cause of tissue destruction.

Microbial Homeostasis-Host Response Hypothesis focus on the individual host and the complexities of the immune response rather than the bacteria. factors that influence/contribute to host response and may lead to perio are smoking, stress, and systemic issues gingivitis would not progress to periodontitis unless some other unknown factor tipped the delicate biofilm-host balance toward further tissue destruction.

_____ is the process by which leukocytes engulf and digest microorganisms.

Phagocytosis

_____are phagocytes (engulf and destroy) that play a vital role in combating the bacteria in plaque biofilms. They contain granules filled with bactericidal and digestive enzymes known as ____ which kill and digest after the process of phagocytosis.

Polymorphonuclear; rapid responders providing 1st line of defense. short lived (less than 1 day) after they phagocytize. lysosome pus at sites of inflammation is dying PMN.

____________ are a group of powerful BCM derived from fatty acids expressed on the cell surface.

Prostaglandins; increase the permeability and dilation of the blood vessels which facilitates the rapid influx/transmission of PMNs and monocytes to the infected site. can trigger osteoclasts to destroy alveolar bone. can promote the overproduction of destructive MMP enzymes.

_________ hypothesis that specific m.o. are the cause of various perio and conditions. Identified specific groups of bacteria which are _________, __________, ________ which are significantly associated with perio. Microorganisms were also grouped into complexes and assigned a color.

Socransky's Microbial Complexes; theory was accepted until newer information was available. T. forsythia P.gingivalis Treponema denticola (these bacteria are interdependent and could not exist w/o the presence of other bacteria) orange and red = major etiologic agents of perio. yellow, green, blue, & purple = compatible with gingival health.

_________ long-standing paradigm suggest as perio develops, the oral microbiota shifts from one consisting primarily of beneficial microbes to one consisting of pathogens. List 3 cons affiliated with this hypothesis.

Specific Plaque/Microbial Shift Hypothesis microbial composition is the deciding factor in the development of periodontal disease INSTEAD OF THE AMOUNT. (shift from + aerobic to - anaerobic) (cons. single group of select pathogens are the major cause in the tissue destruction in perio; gram - can be found in healthy individual. the microbe community is complex. gram + can be found in perio patients)

Describe the permanent attachment stage of biofilm development.

Stage 2 attained by microbes that can weather hydrodynamic (fluid) forces and maintain grip on the tooth surface. microbes begin producing substances that stimulate other free-floating bacteria to join the community. composition of early colonizers determines which microbes colonize at later time points.

Describe the maturation phase 1 stage of biofilm development.

Stage 3 — Self-Protective Matrix Formation firmly attached, the bacteria secretes a surrounding protective substance, known as an extracellular protective matrix (EPS) microbes are cocooned in a self-protective matrix.

T or F If an individual's immune system can effectively deal with a mouthful of periodontal pathogens, there will be no destructive periodontal disease.

T

T or F In susceptible individuals, dysbiosis triggers an exaggerated host response which results in progression from gingivitis to periodontitis.

T

T or F Free floating bacteria (staphylococci, streptococci, pseudomonas, escherichia coli) form quickly.

T

T or F Free-floating microbes cannot join the biofilm until the conditions are favorable.

T

How many stages of biofilm are there? What are they?

There are 5. 1. initial attachment 2. Permanent attachment 3. maturation 1 4. maturation 2 5. dispersion

_____ is multifaceted and includes the ability to speak, smile, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort & disease of the craniofacial complex.

oral health it is a fundamental component of health and physical well-being. OH exists along a continuum influenced by the values and attitudes of individuals and communities; reflects the physiologic, social, and psychological attributes that are essential to quality of life It is influenced by the individual's changing experiences, perceptions, expectations, and the ability to adapt to circumstances.

The inflammatory response is triggered by the invasion of ____ or _____.

pathogens or tissue injury mast cells (found in connective tissue near to blood vessels) then release chemicals that dilate the capillaries and increase vascular permeability.

_______ are characterized by the dysfunction of the resolution pathways that shut down the acute inflammatory process. The result is a failure of the periodontal tissues to heal and a chronic, progressive, and destructive, nonresolving inflammation.

periodontal disease

In cases where inflammation becomes chronic, the inflammation can become so intense that it inflicts permanent damage to the body tissues. This is the case in _____.

periodontitis.

The matrix developed in maturation phase 1 stage of biofilm protects biofilm microbes from exposure to host immune defences such as ____________.

phagocytosis (and antibiotic treatments). the biofilm persists, eventually establishing a chronic disease state (periodontitis).

Microbes rarely exist as __________ forms. The majority live in complex polymicrobial biofilm communities attached to living surfaces such as _____________________________.

planktonic (free-floating); root of tooth, nonliving surfaces (heart valve or dental implant)

The resolution of inflammation is regulated by activity of chemical mediators known as specialized _______.

pro-resolving lipid mediators; are actively produced by the body during the resolution phase of acute inflammation.

In periodontitis, the lipid mediators of proinflammation include

prostaglandins, thromboxanes, prostacyclins, and leukotrienes. (associated with recruitment of PMNs, destruction of the connective tissue matrix, and resorption of alveolar bone).

What is quorum sensing tasked with?

quorum sensing trigger events such as adhesion of additional microbes to biofilm and formation of EPS. bacteria "talk" with other bacteria to share information that is critical for their growth and survivability. important to communication to adapt to changes in the oral cavity such as pH and oxygen concentration. interspecies communication; necessary for growth, coordination and development.

Leukocytes secrete cytokines that play a major role in ___ the behavior of immune cells.

regulating