MICROBIOLOGY OF

PERIODONTAL DISEASE
By:
Drg. Citra Lestari, MDSc, Sp.Perio

Periodontal disease can be defined as disorders of supporting
structures of the teeth, including the gingiva, periodontal ligament and
supporting alveolar bone.

CLASSIFICATION OF PERIODONTAL DISEASE
Periodontal disease can be broadly categorized
into gingivitis and periodontitis.these are yet
again subdivided into numerous categories; a
recent classification of periodontal diseases is
given in table 33.1
Specific and non-specific plaque
hypothesis
The specific plaque hypothesis
in certain disease states such as GUNA. The key
aetologic agents are fusobacterium and sphirochaetes.
Furthermor, this disease can be revolved by
appropriate AB active againts anaerobes.
The non specific plaque hypothesis
this hypothesis proposes that collective groups or
consortia of different bacteria have that total
complement of virulence factors required for
periodontal tissue destruction and that some bacteria
canfor other absent from the pathogenic consortium.




The ecological plaque hypothesis
this hypothesis has also been proposed for the etiology of
periodontal disease. This postulates the following causative
process;
this reaction of the host natural plaque acumulation in the
crevice is an inflamatory response.
Increased GCF flow provides complex host molecules that
can be catabolized by the proteollytic gram
negativeanaerobs
The latter organism suppres the growth of species common
in the healthy crevice and popolation shift occurs in the
resident flora.
These periodonphatic flora then produce virulence factors,
this caused episodic tissue destruction and disease activity.
Clinical Implications
The non specific plaque hypothesis and the
ecology disase may be treated by reducing the
plaque to an acceptable level and the
maintenance of healthy plaque, or by
achievment of totla plaque control.in contrast,
the specific plaque hypothesis implies that
therapy should be directed at elimination of
specific pathogen, for instance by approprite
AB therapy.
Periodontal health and disease
Healthy gingival sulcus has a scant flora
dominated by almost equal proportions of
gram-positive and facultative anaerobic
organism;sphirochaetes and motile rods make
up less than 5% of the organism.with
increasing severity of disease, the proportions
of strict anaerobic, garam-negative and motile
organism increasse significantly(TABEL).
condition Predominant MO Comments
health Strepto. Sanguis
Strepto sanguis
Actinmyces naeslundii
Actinomyces viscosus
Veilonella spp
Mainly gram-positive cocci
with few spirochaeta or motile
rods
Chronic marginal gingivitis strepto sanguis and milleri
Actinomyces israelli and
naesiundii
Prevotella
intermediafusobacterium and
veilonella
Abaout 55% of cell are gram-
positive with occasioanl
spirochaeta and motile rods
Chronic periodontitis Porphyromaonas sanguis
Provetella milleri
Fusobacteriumnucleatum
Actinobacillus
Spirochaeta
selenomonas
About 75% are gram-negative
( 90% being strict anaerobes).
Motile rods and spirochaeta
are prominent
Aggressive periodontitis Actinobacillus
Actinomyecetemcomitans
Prevotella intermedia
Capnocytophaga spp
Abaout 65%-75% of bacteria
are gram-negative bacili.it may
associated with cellular
immune or genetic deffects
Soal Disko 2
Seorang remaja usia 15 tahun datang ke dokter gigi
dengan kondisi berdarah di seluruh gusinya.
Pasien memiliki kebiasaan menyikat gigi 1 x
sehari dan hanya berdurasi 20 detik.
Pemeriksaan intra oral terlihat inflamasi pada
hampir seluruh gingiva rahang atas dan rahang
bawah. Oral Hygiene jelek.
Jelaskan bagaimana proses terjadinya gingivitis
dengan kebiasaan jelek pasien