DOH133: 14 Microbiology of Periodontal Disease

ITIS = inflammation
Chronic = long term
Acute = short and sudden

5 cardinal signs of inflammation in body. Pain isnt one in periodontitis as there is no real obstruction to the swelling like
other places in body, it also happens over a long period and so body adjusts to it as it progresses.

Classification of Periodontal Diseases
Current classification of Periodontal Diseases based on:
Rate of disease destruction (slow or rapid)
Disease distribution (localized or generalized)
Any association w/ systemic disease

CLASSIFICATION:
o Plaque-induced Gingivitis
o Chronic periodontitis (previously aka adult periodontitis)
o Aggressive periodontitis RPP, LIP, GJP
o Necrotizing ulcerative gingivitis ANUG, AUG, Vincents disease, Trench Mouth



Microflora causes chronic inflammation

When plaque becomes mature state, after 1 week considered pathogenic, this causes inflammation.

Cant eliminate all bacteria but can manage it and disrupt it using proper technique, twice daily to keep biofilm in
immature form as to reduce chances of it developing into mature state and thus a cause for inflammation.







Gingivitis Periodontitis
Redness
Oedema
Bleeding
Pockets
Recession
Bleeding at base of pocket
Mobility
Migration/Drifting
Little/no pain
Irreversible
destruction of the
periodontium

Microorganisms associated w/ various types of Periodontal disease
CONDITION PREDOMINANT MICROORGANISMS COMMENTS
Health Streptococcus sanguis
Streptococcus oralis
Actinomyces naeslundii
Actinomyces viscosus
Veillonella spp.
Mainly Gram-positive cocci w/ few spirochaetes or
motile rods
Chronic marginal
gingivitis
Streptococcus sanguis
Streptococcus milleri
Actinomyces naeslundii
Prevotella intermedia
Capnocytophaga spp.
Fusobacterium nucleatum
Veillonella spp.
55% of cells are Gram-positive w/ occasional
spirochaetes and motile rods
Chronic periodontitis Porphyromonas gingivalis
Prevotella intermedia
Fusobacterium nucleatum
Tannerella forsythia
Actinobacilla actinomycetemcomitans
Capnocytophaga spp.
Spirochaetes
75% of cells are Gram-negative (90% being strict
anaerobes).
Motile rods and spirochaetes are prominent
Member of the RED complex
Increase in quantity as pocket deepens & pocket
pH increases (gingival crevice pH increases from
below neutrality in health to above pH 8 in
disease)
Trypsin-like activity increases with increased pH
and may enable cells to inactivate key components
of the host defences (Igs and C)
Aggressive
periodontitis
Actinobacillus actinomycetemcomitan
Capnocytophaga spp.
Porphyromonas gingivalis
Prevotella intermedia
65-75% of bacteria are Gram-negative bacilli.
Few spirochaetes or motile rods present
These diseases may be associated w/ cellular
immune or genetic defects

The ECOLOGICAL PLAQUE Hypothesis
o An opportunistic infection determined by host defence
o A shift in the balance of the resident microbes driven by a change in the local environment due to the
inflammatory response of the gingival tissues
o Periodontopathic flora have virulence factors that can overwhelm host defence resulting in tissue destruction
o Shift from predominantly Gram +ve aerobes and facultative AnO2 to predominantly Gram ve AnO2







The Oral Environment

































The periodontal pocket environment favours the selection of pathogenic bacteria:
AnO2
GCF
Eh
Heme (P. gingivalis)
pH (P. gingivalis thrives @ pH 7.5)
Temp 39C











Pain is a symptom of this!

























Microbial investigations & testing
Dark-field m/s
culture Anaerobic chamber culture
TaqMan technology
Real time PCR
Immunofluorescence