Pathogenesis of Periodontal Disease 1 PDF

Pathogenesis of Periodontal Disease 1 Student name: This workbook is to be used in conjunction with your session on the subject of Pathogenesis of Periodontal Disease.  The premise of this session is for you to complete the tasks in a self-directed way  There are links to documents...

Pathogenesis of Periodontal Disease 1 Student name: This workbook is to be used in conjunction with your session on the subject of Pathogenesis of Periodontal Disease.  The premise of this session is for you to complete the tasks in a self-directed way  There are links to documents/resources which will enable you to gain knowledge of this subject and to complete the tasks as you proceed  It is important that you complete and have your notes in preparation for the next session Pathogenesis of Periodontal Disease 2 in order that you have underpinning knowledge of the subject.  Please complete prior to self-checking your responses and self-assessing your knowledge of this subject. Resources: Review lectures of: Development of oral mucosa, junctional epithelium, immunology, dental plaque biofilm, virulence factor, Periodontal Disease-Microbiology ‘Host Defences’ pdf You will need to complete the workbook to meet the intended learning outcomes: By the end of this session, you should be able to:  Define periodontitis  Recall the development and role of plaque biofilm in periodontal disease  Review the tissues of the periodontium  List at least 3 types bacteria thought to be associated in the pathogenesis of periodontal disease and review the virulence factors deployed in the process  Outline the host defence in the oral cavity, with reference to the innate and acquired immune responses  Describe the functions of cytokines, prostaglandins and matrix metalloproteinases (MMPs) in the host response  Describe the basic factors which may contribute to the initiation of periodontitis  Periodontitis 1. Define the term periodontitis: ? Development and role of plaque biofilm in periodontal disease 2. Define the term plaque biofilm ? 3. Composition of dental plaque biofilm: Intra-cellular Matrix Organic ? Inorganic (sources between supra & sub) ? 4. Complete the four stages of dental plaque biofilm formation: 1. Initial attachment of bacteria to pellicle 2. Initial colonisation of the tooth surface – new bacteria join 3. ? 4. ?  Tissues of the periodontium 5. Name the three distinct parts of the gingival epithelium with a description of where they are found. a) b) c) 6. Label the tissues of the periodontium: (a, b, c, d from top to bottom) a) b) c) d)  Bacteria associated in the pathogenesis of periodontal disease and their virulence factors 7. The subgingival environment supports mainly anaerobic bacteria. True False 8. Name at least 3 bacteria species found to be associated with periodontal disease ? ? ? 9. Note some of the virulence factors of named bacteria which enable them to colonise, invade and damage the periodontium ? ? ? Host defences in the oral cavity, innate and acquired immune responses 10. Which type of immune response will be initiated by plaque in the first instance? ? a) What are the key components of this immune response? ? b) Complete the table: Host defence Role in defence Inflammatory a) What is the fluid component, when does it form and what response is it’s function at this stage? ? b) Which cells are mainly involved in the cellular response at this stage and what is their role? ? Epithelium a) How does the epithelium defend against plaque microorganisms? ?  b) How and when is the protective function of epithelium compromised? ? c) Which cells of the junctional epithelium secrete cytokines and Tumour Necrosis Factor during the initiation of the inflammatory response in the gingival tissues? ? d) What is the name of the tissue macrophages which are responsible for releasing host defences? ? Saliva What is the role of saliva? ? 11. Fill the blanks using the available words below. The adaptive immune response is also known as the ________or ________ immune response and it is activated when innate immunity is ineffective in eliminating ________ and infection becomes established. It is highly specific to a particular pathogen by recognising it’s ________ due to immunological ________. Adaptive immunity uses two main mechanisms, known as ________immunity (________response) and ____ ________ immunity. antigen humoral antibody acquired cell-mediated memory specific pathogens a) Humoral Immune response is when antibodies are produced against agents existing in the humours (extra-cellularly). Complete the table which relates to the humoral immune response: Mode Function Epithelial Langerhans’ cells Present antigenic parts from pathogens and present to circulating ? which stimulates clonal expansion after recognising the specific ? B-cell lymphocytes Differentiate into ? which then release antibody against the specific antigen Antibody IgG and IgA ? Locally or systemically produced antibody ? b) Cell-mediated response does not require the use of antibodies- uses it’s own T-Cell receptor. Antigen presentation via Langerhans’/dendritic cells TH cells: to T-Cell  produce cytokines  assist B cell differentiation into ?  activate ? Progression from gingivitis to periodontitis elicits a T-cells have immunoregulatory role shift from ? -cell to ? cell lesions  Cytokines, prostaglandins and matrix metalloproteinases (MMPs) in the host response 12. There are several types of chemical mediators involved in periodontal disease. They are chemical messengers which link and regulate the inflammatory response, the immune response and tissue damage. Research where they are released from and complete the following table: Mediator type Action/function in periodontitis Cytokines e.g. Pro- What are cytokines? ? inflammatory IL-1, IL-6 and Action of cytokines in periodontitis: ? TNF-α Anti-inflammatory IL-4 and IL- 10 Prostaglandins e.g. PGE_2 ? Matrix metalloproteinases Pro-inflammatory- degrade ? (MMPs) Factors contributing to the initiation of periodontitis 13. In health and in stable gingivitis, there is a dynamic equilibrium between dental plaque and the host defences. This equilibrium is disturbed in periodontitis which tips in favour of tissue damage. Describe what these factors are (refer to Periodontal disease- Microbiology session): >? >? >? 14. For each of the following theories on the role of bacteria in periodontal disease, give an outline of the hypothesis, identify any issues and/or support for them. a) Non-specific Plaque Hypothesis b) Specific Plaque Hypothesis c) Keystone Pathogen- Host Response Hypothesis