PERIO - Etiology of Periodontal Disease (L5)

Periodontal Disease

- Infectious disease caused by

microorganisms that colonize the tooth

surface at or below the gingival margin

(Lindhe, 2008)

- An infectious disease in such a way that

there is an interplay between the host

response and the microorganisms

- Not acquired through air nor hand shake

Gingivitis

- Limited to inflammation of gingiva wherein

no destruction of the bone and connective

tissue attachment

- Reversible

Periodontitis

- Supporting structures or attachment

apparatus such as the bone and connective

tissue attachment are already damaged

- Irreversible

Supracrestal Attached Width

• “biologic width”

• distance from junctional epithelium to root surface of tooth

• distance from crest of bone to base of pocket

2.04mm

• constant supracrestal attached width

Biofilm

• well - organized, cooperating community of microorganisms adherent to a solid substrate which forms in fluid environment.

Dental Biofilm

• acts to protect the bacteria

• SOFT DEPOSITS that form the biofilm adhering to tooth surface including removal & fixed resto.

1. Teeth and other surfaces of mouth

2. Dentures

3. Tongue

• sites of plaque accumulation

108 bacteria

In 1 mm of 3 dental plaque weigh 1 mg how many bacteria present?

exopolysaccharide

• surrounded by enveloping intermicrobial matrix

corn-cob or palisading

appearance of biofilm in an electron microscope

Quorum Sensing

• responsible for expression of virulence factors.

Legionnaire’s Disease

• killed 29 persons

• traced to a bacteria in biofilm of air conditioning system

Bellevue Stratford Hotel

• site of first known outbreak of Legionnaire’s Disease

• CLOSED in NOVEMBER 1976

• Microorganisms (bacteria 70-80%)

• Scattering of epithelial cells

• Leukocyte

• Macrophage

• Interbacterial Matrix

• composition of dental plaque

Polysaccharide protein complex lipid component

organic portion

CP2S2

• calcium

• Phosphorus

• Small amount of Magnesium

• Potassium

• Sodium

inorganic portion

Supragingival Plaque

• a classification of dental plaque found at or above gingival margin

Marginal Plaque

• supragingival margin direct contact w/ gingival margin is referred to as _______

saliva

source of inorganic constituent of supragingival plaque

Subgingival Plaque

• classification of dental plaque that is found below the gingival margin, between tooth & gingival sulcular tissue

Crevicular Fluid

• inorganic component of subgingival plaque which is a serum transudate

Pellicle

• from components of saliva and crevicular fluid as well as from

  bacterial and host tissue cell products and debris

•  a transparent/colorless film which forms over the tooth surface 30 minutes after brushing

• Function as a protective barrier, providing lubrication for the surfaces and preventing tissue dessication

• Provide a substrate to which bacteria in environment attach

Pellicle Formation

pellicle on a crown surface is called ____

Cuticle Formation

• pellicle on a root surface is called _____

Adhesin

• where initial colonizers adhere to pellicle through specific molecules

Extracellular Matrix

• acts as backbone and source of nutrient

FRUCTANS (levans)

• carbohydrate source for storage of energy

GLUCANS (dextrans)

• carbohydrate source serve as skeleton

Autoaggregation

• Bacteria of same species attach to one another.

• Once adhere to surface, behaviors change by having active cellular growth and synthesis of new outer membrane components

Co-aggregation

• Different species of bacteria can recognize and adhere w/ others

• other bacteria do not have attaching factors so they cannot adhere

• they attach to other bacteria to be able to become a part of plaque

NONSPECIFIC PLAQUE HYPOTHESIS

• association of plaque microorganism w/ periodontal disease that states total bulk of plaque determines its pathogenecity rather than individual species.

SPECIFIC PLAQUE HYPOTHESIS

• association of plaque microorganism w/ periodontal disease that states ONLY CERTAIN PLAQUE is pathogenic.

• pathogenecity depends on presence or increase in specific microorganisms.

1. Association

2. Elimination

3. Host Response

4. Animal Model System

criteria for identification of periodontal pathogen

Dental Calculus

• Adherent calcified or calcifying mass

• forms on the surface of natural teeth and

  dental prosthesis

• consist of mineralized bacterial plaque

Bacterial Plaque

• cause of gingival inflammation

Calculus

• play a role in maintaining and accentuating periodontal disease

• keeping plaque in close contact w/ gingival tissue & creating areas where plaque removal is impossible.

SUPRAGINGIVAL CALCULUS/ SALIVARY CALCULUS

Type of Calculus

• located coronal to margin

• visible in oral cavity

• usually white or whitish yellow

• has hard, clay-like consistency

• easily detached from tooth surface

• most frequently or greatest in quantity on buccal surface of maxillary molars opposite Stensen’s Duct & on lingual surfaces of mandibular anterior teeth particularly centrals, opposite wharton’s duct

• can be composed of both supragingival and subgingival

• through clinical inspection

• similar to hypoplastic enamel

SUBGINGIVAL CALCULUS/ SERUMAL CALCULUS

Type of Calculus

• located below crest of marginal gingiva

• not visible in routine clinical examination

• dense, dark brown or greenish black and a HARD or FLINT LIKE in consistency

• firmly attached to the root surface

• when gingival tissue recede, becomes exposed & classified as supragingival

• more homogenous

• through exploration

• Inorganic Content

• Organic Content

composition of calculus

calcified deposits

• radiographic appearance, supragingivally, these are readily detectable, forming irregular contours on radiographic crown.

Interproximal Calculus

• both supragingival and subgingival, is even more easily detectable

• irregularly shaped projections into interdental space

a. Calcium Phosphate - 75.9%

b. Calcium Carbonate - 3.1%

c. Magnesium phosphate and other metals - traces

composition of Inorganic Content

a. Hydroxyapatite - 58%

b. Magnesium whitlockite - 21%

c. Octacalciumphosphate - 21%

d. Brushite - 9%

the four main crystal forms

a. Mixture of protein polysaccharide complexes

b. Desquamated epithelial cells

c. Leukocytes

d. various types of microorganisms

composition of organic content

Calculocementum

• calculus similar to cementum embedded deeply into it.

1. Attachment by means of an organic pellicle

2. Penetration of calculus bacteria into

cementum (this mode of attachment is not accepted by some investigators)

3. Mechanical locking into surface irregularities, such as resorption lacunae and caries

4. Close adaptation of calcular undersurface depressions to the gently sloping mounds of the unaitered cementum surface

modes of attachment

non-mineralized plaque

• principal irritant

• does not irritate gingiva directly, provide fixed nidus for continued accumulation of plaque.

Plaque

• initiate gingival inflammation,

• start pocket formation,

• pocket provides sheltered area for plaque & bacterial accumulation

Saliva

• a meta-stable solution of calcium & phosphate ions

Spontaneous precipitation

• only occurs when environment changes

1. Carbon Dioxide Tension Theory

2. Booster Mechanism Theory

3. Inhibition Theory

4. Nucleation Theory

Theories on Calculus Formation

Carbon Dioxide Tension theory

• CO2 tension of saliva secreted at duct

  opening is higher; diffusion causes pH to

  rise causing precipitation of calcium and

  phosphate ions

Booster Mechanism Theory

• Plaque has microorganisms that produce

  proteolytic enzymes (which release amines,

  urea and ammonia)

• Ammonia causes a rise in pH

Inhibition Theory

- Plaque has microorganisms that produce

pyrophosphatase

- Pyrophosphate in saliva assists in

maintaining ions in supersaturated solution

Nucleation Theory

•  Organic matrix of plaque acts as a seeding

agent for crystallization

Materia Alba

• soft accumulations of bacteria and tissue cells

• lack organized structure of plaque

• easily displaced by water spray

• visible without disclosing solution

Food Debris

• rapidly liquefied by bacterial enzymes

• important cause of gingivitis

Dental Stains

• pigmented deposits

• from pigmentation of ordinarily colorless developmental and acquired dental coatings by chromogenic bacteria, food and debris

• vary in color and compositions

Chlorhexidine Stains

• yellowish brown to brownish color to tissues of oral cavity

• appears in cervical and interproximal region & surface of the tongue

Presence of Aldehyde and Ketones

• normally intermediates of both mammalian and microbial metabolism

• essential for formation of discoloration of chlorhexidine

1. Brown Stains

2. Tobacco Stain

3. Black Stain

4. Green Stain

5. Orange Stain

6. Metallic Stain

7. Chlorhexidine

Types of Dental Stains

BROWN STAIN

type of dental stain which is thin, translucent, acquired usually bacteria-free, pigmented pellicle in individuals who do not brush sufficiently.

TANNIN

cause of brown color in brown stain

TOBACCO STAIN

• type of dental stain which is tenacious dark brown or black surface deposit w/ brown discoloration of tooth substance.

• results from coal tar combustion product and from penetration of pits and fissue, enamel & dentin by tobacco juices

BLACK STAINS

• dental stain occurs as black line facially & lingually near gingival margin.

• a diffuse patch on proximal surfaces

• firmly attached, tends to recur after removal

• more common in women

GREEN STAIN

• type of dental stain which is green or greenish yellow stain, sometimes with considerable thickness

• common in children

• stained remnants of enamel cuticle

• occur on facial surface of max. ant. teeth

• more common in boys

• higher incidence in children w/ TB

ORANGE STAIN

• type of dental stain which is less common

• may occur both facial & lingual

• caused by Serratia Marcescens and Flavobacterium Lutescens

METALLIC STAINS

• type of dental stain caused by metal and metallic salts

• introduced into oral cavity by industrial workers or through orally administered drugs

Green stain

Stain of Copper Dust

Black Stain

Stain of Iron Dust

Black Iron sulfite deposit

Stain of Iron containing medications

Black Stain

Stain of Manganese

Greenish Black

Stain of Mercury

Green

Stain of Nickel

Black

Stain of Silver

Sigmund Socransky 1968

• classify bacterial species involved in initiation and progression of periodontal disease.

• divide the bacterial complexes into groups, labelled by colors

Actinomyces sp & Streptococcus sp

• early primary colonizers

Aggregatibacter Actinomycetemcomitans (Actinobacillus Actinomycetemcomitan)

• not in complex

• highly pathogenic

MICROBIOTA

• mostly gram positive, streptococci & actinomyces