PERIODONTOLOGY 1 \ DR.MHD ALBUSH.

Answers / Perio I Quiz1

Gross Anatomy and Histology of the periodontium.

Done By: RAMA ALHAYEK SECTION: (3)

1- Which one of the pathogens virulence factors is the most important, and why?

(1) factors that promote colonization (adhesins) Adhesive Surface Proteins and Fibrils

To colonize the periodontal pocket, bacteria *must* adhere to cells

or tissues in the region such as teeth, the existing microbial biofilm,

or the pocket epithelium. Bacterial cell surface structures provide

the points of contact.

(2)Cytokines.

Cytokines play a fundamental role in inflammation

and are key inflammatory mediators in periodontal disease. They

are soluble proteins and act as messengers to transmit signals from

one cell to another. Cytokines bind to specific receptors on target

cells and initiate intracellular signalling cascades resulting in

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phenotypic changes in the cell via altered gene regulation. Cytokines are effective in very low
concentrations, are produced

transiently in the tissues, and primarily act locally in the tissues in

which they are produced .Simply, cytokines bind to cell surface receptors,

trigger a sequence of intracellular events that lead ultimately to

the production of protein by the target cell, which alters that

cell’s behavior, and could result in, for example, increased secretion

of more cytokines in a positive feedback cycle leading to

inflammation

2- What is the clinical result of an existing balance between the deleterious effects
of
the periodontal pathogens and the defensive mechanisms of host, and what is the
clinical result if a dysbiotic condition precipitates (imbalance)?

balance=stable=health

is tipped toward disease by risk factors leading to periodontitis which is associated

with an alteration in the host-bacterial balance that may be initiated

by changes in the bacterial composition of subgingival plaque,

changes in the host responses, or a combination of both.

In general,

small amounts of bacterial plaque can be controlled by the body’s defense mechanisms without

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destruction, but when the balance between bacterial load and host response is disturbed,
periodontal destruction may occur.

This may result when the subject is extremely susceptible to periodontal

infections or when the patient is infected by a large amount of bacteria or by an extremely

pathogenic microbiota.

3- Depending on what you read in microbiology, in a patient suffering from

generalized
accumulations of calculus on his teeth and periodontitis, which one of these
choices
would you choose and WHY?
- Perform a one- session complete comprehensive periodontal treatment (scaling
and root planing).
- Perform a partial comprehensive periodontal treatment (scaling and root
planing), in two sessions with a 24- 48 hours interval.

- Perform a partial comprehensive periodontal treatment (scaling and root

planing), in two sessions with a one- week interval.

- Perform a partial comprehensive periodontal treatment (scaling and root

planing), in four sessions with a four- week interval.

Phase I therapy is the first in the chronologic sequence of

procedures that constitute periodontal treatment. The objec-

tive is to alter or eliminate the microbial etiology and factors

that contribute to gingival and periodontal diseases to the greatest

extent possible, therefore halting the progression of disease and

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returning the dentition to a state of health and comfort.

In the Step 2. Removal of Supragingival and Subgingival

Calculus. Removal of calculus is accomplished using scalers,

curettes, ultrasonic instrumentation, or combinations of these

devices during one or more appointments. Evidence suggests that

the treatment results for chronic periodontitis are similar for all

instruments

The control of infectious organisms during phase I treatment is

of critical importance. Recently, there has been considerable interest

in providing phase I therapy in one long appointment or two appoint-

ments on consecutive days while the patient is receiving an aggressive

prescribed regimen of antimicrobial agents rather than staged

appointments to treat one quadrant or sextant at a time, usually with

1 week separating appointments. This single-stage treatment

sequence has been referred to as “antiinfective” or “disinfection” treat-

ment

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 4- What is the most dangerous periodontal pathogen? Why?

Porphyromonas gingivalis

It is an aggressive periodontal pathogen. Its fimbriae mediate

adhesion, and its capsule defends against phagocytosis. This species produces a series of
virulence

factors, including many proteases (e.g., for the destruction of immunoglobulins, complement

factors, and heme-sequestering proteins; degradation of host cell collagenase inhibitors), a

hemolysin, and a collagenase. This species can inhibit migration of polymorphonuclear

leukocytes

(PMNs) across an epithelial barrier and affects the production or degradation of cytokines by

mammalian cells p. gingivalis also has the capacity to invade soft tissues.

5- What does the high glucose concentration (compared with serum level) infer, and

why certain systemic antibodies are helpful as an adjunctive treatment in some forms

of periodontitis in relation to the GCF?

Blood glucose levels do not

correlate with GCF glucose levels; glucose concentration in GCF

is three to four times greater than that in serum. This is inter-

preted not only as a result of metabolic activity of adjacent tissues

but also as a function of the local microbial flora.

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 _ The antibody may function to facilitate host clearance of periodontal

pathogens. For example, the antibody appears to be essential for opsonization and
phagocytosis of A. actinomycetemcomitans and virulent strains of P. gingivalis.

The antibody also may function to neutralize bacterial components important in

colonization or host cell interactions.

- The interaction of bacterial antigens with peripheral dendritic cells leads to the generation
of

systemic antibody, whereas interaction with local B cells leads to production of local
antibody.

Antibody specific to many of the periodontal microorganisms is essential for phagocytosis.

* The gingival fluid is believed to exert antibody activity to defend the gingiva*

*Salivary Antibodies

As with GCF, saliva contains antibodies that are reactive with

indigenous oral bacterial species. Salivary antibodies appear to be synthesized locally

because they

react with strains of bacteria indigenous to the mouth but not with

organisms characteristic of the intestinal tract. Many bacteria

found in saliva have been shown to be coated with IgA, and the

bacterial deposits on teeth contain both IgA and IgG in quantities

greater than 1% of their dry weight. It has been shown that IgA

antibodies present in parotid saliva can inhibit the attachment of

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 oral Streptococcus species to epithelial cells.

Even though the role of antibodies in the gingival defense

mechanisms (in gcf) is difficult to ascertain, the consensus is that in a

patient with periodontal disease, (1) a reduction in antibody

response is detrimental, and (2) an antibody response plays a pro-

tective role.

GCF is an inflammatory exudate. Its

presence in clinically normal sulci can be explained because gingiva

that appears clinically normal invariably exhibits inflammation

when examined microscopically.

The amount of GCF is greater when inflammation is present

and is sometimes proportional to the severity of inflammation.

GCF production is not increased by trauma from occlusion but

is increased by mastication of coarse foods, toothbrushing and

gingival massage, ovulation, hormonal contraceptives, and

smoking. Other factors that influence the amount of GCF are

circadian periodicity and *periodontal therapy* .

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6- What is the best method to break the circle of calculus formation in general?

Calculus is mineralized dental plaque. The soft plaque is hardened

by the precipitation of mineral salts, which usually starts between

the first and fourteenth days of plaque formation. Calcification has

been reported to occur in as little as 4 to 8 hours.

so the best method to break the circle of calculus formation in general is daily plaque
removal (by interdental flossing ,tooth brushing ,rinsing..) and good oral hygiene.

7- Which one of the theories of the dental plaque specificity is the most important and
why?

Ecologic Plaque Hypothesis : as an attempt to unify the existing

theories on the role of dental plaque in oral disease
An important consideration of the ecologic plaque hypothesis
is that therapeutic intervention can be useful on a number of
different levels. The health associated dental plaque micro flora is
considered to be relatively stable over time and in a state of
dynamic equilibrium or “microbial homeostasis.

8- Give two examples on the mucogingival deformities and

conditions around teeth, and one example on the gingival

manifestations of systemic conditions due to mucocutaneous

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disorder

Mucogingival Deformities and Conditions around Teeth

1. Decreased vestibular depth

2. Pseudopocket

Gingival manifestations of systemic conditions due to mucocutaneous

. disorders.

1. Lupus erythematosus 2. Pemphigoid

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