Course Director: Dr. Weinberg, phone: 368-6729



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Microbiology, immunology & the immune response
dent 516

Course Director: Dr. Weinberg, phone: 368-6729

email: axw47@case.edu


Lectures: Mondays, 7:30-9:00AM
Location: 3rd floor Seminar Room
Reading Sources: Oral Microbiology and Immunology Lamont, Burne, Lantz, LeBlanc, ASM press, 2006.


Bacterial Pathogenesis, A Molecular Approach

Salyers and Whitt, 1994 (or newest edition)
Inflammation. A Review of the Process, Trowbridge and Emling, (5th ed), 1997 (or newest edition).

Handouts



Course Description:
DENT 516 is a graduate level course. As such it is intended to emphasize the student's ability to interact in dialogue with the teaching faculty in order to formulate well grounded opinions on subject matter covered in the course. The course reviews bacterial structure and classification, provides insight into oral bacterial pathogenesis by stressing known and presumptive virulence factors, and introduces concepts of both innate and acquired immunity. Formation and composition of plaque and calculus are discussed, along with recent findings associating specific bacteria with caries and periodontal diseases. Principles of antibiotic use and mechanisms of resistance are reviewed. Microbial diagnostic methodologies and novel genetically based susceptibility tests, are discussed. Wherever possible, integration of periodontics, endodontics, and pediatric dentistry is stressed as it relates to the inflammatory process in the human host. Frontal presentations coupled with seminar formats are used with a strong emphasis on learning to read and critique peer reviewed scientific papers on related topics.
Objectives:
The course is intended to frequent the student with the existing knowledge base in oral bacterial pathogenesis and foster interest in the new and exciting scientific era we are in, and in which the dental resident will practice. Following successful completion of the course, the student should be able to read and understand scientific reviews in the fields of oral microbiology and immunology, with special emphasis on understanding oral inflammatory processes. This process should also prepare the dental resident for respective professional Board questions related to these topics.
Prerequisites: DENT 516 – 2014 Schedule

Students should have completed a dental school level course in microbiology/immunology,

or equivalent, or have received preapproval by the instructor.
LECTURE SCHEDULE
Date Topic
1/06/14 Introduction/General Concepts in Microbiology
1/13/14 (Cont'd) General Concepts in Microbiology / Intro to Oral Pathogens
1/20/14 MLK HOLIDAY
1/27/14 Innate Immunity
2/03/14 Innate Immunity / Acquired/Adaptive Immunity
2/10/14 NO CLASS – Mark Wilson Conference
2/17/14 Innate Immunity/Acquired/Adaptive Immunity/ Student Presentations
2/24/14 (Cont’d) Innate Immunity/Acquired/Adaptive Immunity/ Student Presentations
3/03/14 Bacterial Colonization and Plaque Formation/ Student presentations
3/10/14 Bacterial Colonization and Plaque Formation/ Student presentations
3/17/14 The Debate Over the Importance of Bacteria in Periodontal Disease Etiology/ Student Presentations
3/24/14 Dr. Ge Jin / Cell Signaling in Normal and Abnormal States
3/31/14 Microbiology of Dental Caries/ Student Presentations
4/07/14 (Cont’d) Microbiology of Dental Caries/ Student Presentations
4/14/14 Microbiological and susceptibility testing methods in perio/endo therapy/

Student Presentations
4/21/14 (Cont’d) Microbiological and susceptibility testing methods in perio/endo therapy/

Student Presentations
4/28/14 Genetic Approaches to Understanding Oral Disease Susceptibility/

Student Presentations (if needed)

5/05/14 Principles of Antibiotic Resistance
5/12/14 Review / Make up Session
5/19/14 Final Exam

Evaluation of Students:
Students will be evaluated on the basis of class participation (25%), individual

presentations (25%), and a final multiple choice examination (50%). Students with more than

2 absences and/or habitually late for class will have points deducted from their grade.
Lectures and Literature Review
General Concepts in Microbiology
1. Bacterial structure; size, shape; surface components.

2. Differences between procaryotes and eucaryotes.

3. Bacterial metabolism; differences between aerobes and anaerobes.

4, Host-parasite interactions.

5. Elements of pathogenicity; exotoxins, endotoxins, enzymes.

6. DNA transfer.

7. Literature review.
Literature review
Slots and Taubman, 1992. Chapter 1, pp 3-43.

Slots and Taubman, 1992. Chapter 5, pp 69-77.

Salyers and Whitt, 1994. Chapter 2, pp 16-29.

Innate Immunity


  1. Introduction to mucosal epithelium as the first line of defense.

  2. Cytokines/chemokines

  3. Defensins

  4. Complement

  5. Nonspecific Defenses



Literature Review



Salyers and Whitt, 1994. Chapter 2, pp 16-29.

Slots and Taubman, 1992. Chapter 6, pp 78-91.

Trowbridge and Emling, 1997, use as guide.

*Medzhitov R, Janeway CA Jr. Innate Immunity: The virtues of a nonclonal system of

recognition. Cell. 91: 295-298, 1997.
Acquired Immunity


  1. Cells of the immune response

  2. Antigen Presenting cells/ receptor molecules

  3. Regulation of the acquired immune response

  4. MHCI, MHCII

  5. T cell immunity

  6. Humoral immunity

  7. Immunoglobulins



Literature Review



Slots and Taubman, 1992. Chapter 5, pp 69-77.

Slots and Taubman, 1992. Chapter 6, pp 91-116.

Trowbridge and Emling, 1997. Chapter 5, pp 77-109.

References for Student Presentations in Innate and Acquired Immunity


  1. Gemmell E, Marshall RI, Seymour GJ. Cytokines and prostoglandins in immune homeostasis and tissue destruction in periodontal disease. Periodontol 2000. 14: 112-143, 1997.

  2. Suchett-Kaye G, Morrier JJ, Barsotti O. Interactions between non-immune host cells and the immune system during periodontal disease: Role of the gingival keratinocyte. Crit Rev Oral Biol Med 9:292-305, 1998.

  3. Jontell M, Okiji T, Dahlgren U, Bergenholtz G. Immune Defense Mechanisms of the Dental Pulp. Crit Rev Oral Biol Med 9:179-200, 1998.

  4. Ishikawa I, et al. Induction of the immune response to periodontopathic bacteria and its role in the pathogenesis of periodontitis. Periodontol 2000. 14:79-111, 1997.


Bacterial Colonization and Plaque Formation
1. Introduction to microbial plaque, plaque formation, structure and composition.

a. Interactions of bacteria with salivary molecules.

b. Adherence of bacteria to host surfaces in the mouth.

c. Host-bacteria and bacteria-bacteria interactions in plaque accumulation.

2. Ecology of microbial dental plaque and periodontal disease.

3. The specific and non-specific plaque hypothesis.

4. Literature review.
Literature review
Slots and Taubman, 1992. Chapter 16, Oral Microbial Ecology, pp 267-274.

Slots and Taubman, 1992. Chapter 18, Mechanisms of Oral Colonization, pp 283-298.

Salyers and Whitt, 1994. Chapter 3, Colonization and Invasion of Host Surfaces, pp 32-37.

Kolenbrander PE and London J. Minireview: Adhere Today, Here Tomorrow: Oral Bacterial

Adherence. J Bacteriol. 175:3247-3252, 1993.

References for Student Presentations in Bacterial Colonization



1. Mandel I.D., 1987. The functions of saliva. J. Dent. Res. 66(Spec Iss):623-627.

2. Marsh P.D., 1989. Host defenses and microbial homeostasis: Role of microbial interactions.

J. Dent Res. 68(Spec Iss):1567-1575.

Microbiology of Periodontal Diseases (Debate over Bacteria as Etiologic Agents)
1. Problems in determining the exact microbial etiology in periodontal diseases.

2. Bacteria associated with various forms of periodontal disease:

a. Health

b. Gingivitis

c. ANUG

d. Adult Periodontitis

e. Early Onset Periodontitis

f. Refractory Periodontitis

g. Pregnancy Periodontitis

h. Juvenile Periodontitis.

i. HIV Associated Periodontitis.

j. Periimplantitis


Literature Review



Slots and Taubman, 1992, chapter 23, pp 424-443.

References for Student Presentations



1. Hirsch, R.S. and Clarke, N.G.Infection and periodontal diseases. Rev Infect. Dis. 11:

707-715, 1989.

2. Socransky, SS and Haffajee, AD. The bacterial etiology of destructive periodontal

disease: current concepts. J. Periodontol. 63: 322-331, 1992.
Microbiology of Dental Caries
1. Identities of the bacteria associated with coronal and root caries.

2. Taxonomy of the mutans streptococci.

3. Pathogenic mechanisms of cariogenic bacteria.

4. Literature review.

References for Student Presentations



1. Loesche W.J., 1986. Microbiol. Rev. 50:353-380.

2. Bowden G.H.W., 1990. J. Dent. Res. 69:1205-1210.

3. additional references to be determined
Microbiological and Susceptibility Testing Methods in Periodontal/Endodontal Therapy
1. Microscopic methods

2. Culture methods

3. Immunologic methods

4. DNA probe methods

5. Enzymatic methods

  1. Advantages and disadvantages of methods.

  2. Susceptibilty testing for Periodontal Diseases.

7. Literature review.

Literature review
Loesche, WJ, Lopatin, DE, Stoll, J, van Poperin, N, and Hujoel, P. Comparison of various detection methods for periodontopathic bacteria: Can culture be considered the primary reference standard? J. Clin. Microbiol. 30:418-426, 1992.

Listgarten, MA. Microbiological testing in the diagnosis of periodontal disease. J. Periodontol. 63:332-337, 1992.

Genco, RJ and Loos, BG. The use of genomic DNA fingerprinting in studies of the epidemiology of bacteria in periodontitis. J. Clin. Periodontol. 18:396-405. 1991.
Genetic Approaches to Understanding Periodontal Disease Risk and Susceptibility


  1. Genome project

  2. Single Nucleotide Polymorphisms

  3. IL-1 defects

  4. Mutations in cathepsin C gene correlated with Papillon Lefevre syndrome

  5. Ongoing work on defensin genes and polymorphisms



Literature Review

Kornman KS and di Giovine FS. Genetic variations in cytokine expression: a risk factor for

severity of adult peridontitis. Ann. Periodontol. 3:327-38, 1998.

Toomes C et al. Loss-of-function mutations in the cathepsin C gene result in peridontal disease

and palmoplantar keratosis. Nature Genetics. 23: 421-24, 1999.
Student Presentations possible in this topic. References to be determined.

Principles of Antibiotic Resistance
1. Introduction to terminology.

2. Reasons for failure with antibiotic therapy.

3. Types of antibiotic resistance.

4. Penicillin, tetracycline, erythromycin, metronidazole.

5. Literature review.
Literature review
Newman, MG, and Kornman, KS. Antibiotic/Antimicrobial Use in Dental Practice. Quintessence Books, 1990. (selected readings).

Marsch, PD. Antimicrobial Strategies in the prevention of dental caries. Caries Research. 27: (suppl 1):72-76. 1993.

Walker, CB, Gordon JM, etc. A role for antibiotics in the treatment of refractory perio-

dontitis. J. Periodontol. 64:772-781. 1993.






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