AZARES, VENUS JAN L.

DPE 311 – DEF

AUGUST 6, 2019

ETIOLOGY OF PERIODONTAL DISEASE (PLAQUE/BIOFILM)

KOCH’S POSTULATES ON DISEASE REPRODUCABILITY

- Robert Koch set out his celebrated criteria for judging whether a given bacteria is the
cause of a given disease.

1. The suspected causal organism must be constantly associated with the disease.

2. The suspected causal organism must be isolated from an infected plant and grown in
pure culture.

3. When a healthy susceptible host is inoculated with the pathogen from pure culture,
symptoms of the original disease must develop.

4. The same pathogen must be re-isolated from plants infected under experimental
conditions.

William C. Shiel Jr., MD, FACP, FACR

https://www.medicinenet.com/script/main/art.asp?articlekey=7105

PLAQUE/BIOFILM FORMATION

Adsorption of a conditioning film (acquired pellicle).

- During eruption of a tooth, or after oral prophylaxis, the tooth, in matter of seconds, will
now be covered with a conditioning film from the saliva.

Reversible adhesion between the microbial cell surface and the conditioning film. More
permanent attachment involving interactions between specific molecules on the microbial
cell surface (adhesins) and complementary molecules (receptors) present in the
conditioning film.

- Reversible adhesion creates the opportunity for stronger and more permanent attachment to be
established. Adhesins mainly Streptococci can attach to complementary receptors in acquired
pellicle to make the attachment stronger.

Co‐adhesion

Once attached, these colonizers will now multiply. Bacteria’s metabolism makes the
environment anaerobic due to their consumption of oxygen and produce reduced end
product. The main organism for biofilm formation is Fusobacterium Nucleatum. This can
 adhere to most oral bacteria and be a bridge between early and late colonizing species.

Plaque maturation

- Attached bacteria will now synthesize “Plaque Matrix”. The matrix is more than a scaffold for
the biofilm; it can bind and retain molecules, including enzymes, and also retard the penetration
of charged molecules into the biofilm

Detachment of attached cells to promote colonization elsewhere.

Lindhie,J., & Lang, N. P. (Eds.).(n.d.).Clinical Periodontology and Implant Dentistry(6t

ed.),p.173-175

SUBGINGIVA MICROBIAL COMPLEXES AND WHY THEY ARE GROUPED AS

SUCH AND THEIR NATURE AND MECHANISM.

Certain periodontal bacteria are often found together in subgingival plaque samples. Cluster
analysis and community ordination techniques were used to further define these relationships and
to determine whether there were correlations between certain clusters and clinical parameters of
disease.

Results of these studies demonstrated that the bacteria could be sorted into five major groups that
were given color designations. The designated "red" complex (Treponema denticola,
Porphyromonas gingivalis, and Bacteroides forsythus) and the "orange" complex (Prevotella
intermedia, Prevotella nigrescens, Peptostreptococcus micros, F.
nucleatum subspecies, Eubacterium nodatum, Streptococcus constellatus, and
three Campylobacter species) were generally found together, and evidence showed that
colonization by the red complex was preceded by colonization by orange complex species. Both
complexes could be associated with clinical parameters of disease supporting the polymicrobial
nature of periodontitis.

a) Clusters of Fusobacterium spp. (magenta) and Prevotella intermedia (yellow). (b)

Unculturable spirochetes (orange) and Fusobacterium spp. (light blue). (Source: Marsh & Moter
2011a. Reproduced with permission from John Wiley & Sons.)

The blue, yellow, green, and purple complexes designate early colonizers of the subgingival
flora. Orange and red complexes reflect late colonizers associated with mature subgingival
plaque. Certain bacterial complexes are associated with health or disease. For example, the
bacteria in the red complex are more likely to be associated with clinical indicators of
periodontal disease such as periodontal pocketing and clinical attachment loss.

https://perioprosthocc.wordpress.com/2016/01/15/porphyromonas-gingivalis-the-bacteria-of-
periodontitis-i-introduction-oral-biofilms/

Lindhie,J., & Lang, N. P. (Eds.).(n.d.).Clinical Periodontology and Implant Dentistry(6t

ed.),p.176-177

KOCH’S POSTULATES AS APPLIED TO PERIODONTAL DISEASE FORMATION

1. Association, that is elevated ORs in disease.

2. Elimination, that is conversion of periodontal disease to health when bacteria are eliminated(or
suppressed beyond detection).

3. Development of a host response, typically manifested by a serum antibody titer to the infecting
agent.

4. Presence of virulence factors that can account for the microbe’s ability to inflict tissue damage.
5. Evidence from animal studies that corroborate the observations in humans and demonstrate
devel- opment of periodontal pathology after infection by the microorganism.

SOURCES:

William C. Shiel Jr., MD, FACP, FACR

https://www.medicinenet.com/script/main/art.asp?articlekey=7105

Lindhie,J., & Lang, N. P. (Eds.).(n.d.).Clinical Periodontology and Implant Dentistry(6t

ed.),p.143

Dr. Saif Khan, 2013, September,10, Periodontal Microbiology, Retrieved from

https://www.slideshare.net/SaifKhan37/periodontal-microbiology

Lindhe J, Hamp S, Löe H, Plaque Induced Periodontal Disease in Beagle Dogs, J Periodontal
Res., 1975;10(5):243-255