4. Microbiological Clinical Correlations and the Perio-Systemic Link

Periodontal Disease are….

Infections caused by microorganisms that colonize the tooth surface at or below the gingiva

• About ____species are able to colonize the oral cavity, the sulcus is ______ sterile

• ________ between the established microbiota and the host causes disease

• ________ leads to the destruction of the periodontium

• About 700 species are able to colonize the oral cavity, the sulcus is never sterile

• Disequilibrium between the established microbiota and the host causes disease

• Inflammation leads to the destruction of the periodontium

4 Categories of Periodontal Health

Pristine Periodontal Health

• No BOP

• No Clinical signs of inflammation

• No Periodontal Loss

• No Histological signs of inflammation (never happens in real patients)

Clinical Periodontal Health

• No BOP

• No Clinical signs of inflammation

• No Periodontal Loss

• Signs of Histological inflammation (normal)

Periodontal Stability → Goal for periodontitis patients

• No BOP

• No clinical signs of inflammation

• Reduced Periodontium

• Control of Modifying factors (diabetes, smoking, etc)

Periodontal Disease Remission/Control

• Decreased Inflammation

• Cannot fully control modifying and pre-disposing factors

Health vs. Stability

• Health: means the patient has minimal recession and has NEVER had periodontal disease

• Stability: healthy state in a patient that was previously diagnosed with periodontal disease

• Main etiology of periodontal disease?

• What are the local factors that can increase the risk of periodontal disease?

• Bacterial Plaque

• The local factors include overhanging margins, open contacts and crowding

Describe the 3 Phases of Plaque Formation

1. Formation of the Pellicle:

   • All surfaces are normally covered with glycoprotein pellicle in the tooth surface as well as tissue surfaces and fixed/removable surfaces (but since epithelial tissue sloughs off, plaque doesn’t form there)

   • pellicle structure determines which bacteria can attach

2. Initial adhesion/attachment of bacteria

   • Gram + bacteria are usually the primary colonizers and coat the most coronal tooth surface

   • Adhesins on bacteria attach to pellicle

3. Colonization and plaque maturation

   • Co-aggregation: primary colonizers let secondary colonizers adhere to them

   • Gram - bacteria are usually the secondary colonizers and coat soft tissues as well as the most apical tooth surfaces

What are the 2 Plaque Hypothesis

• Non-Specific plaque hypothesis: periodontal disease results when bacterial proliferation exceeds threshold

  • Not true bc people with a lot of plaque sometimes do not have periodontal disease

• Specific Plaque Hypothesis: periodontal disease results from specific bacteria found in dental plaque that is different than dental plaque from healthy sites

  • May be bc of susceptible host

  • You can have no plaque and still have periodontitis bc the host has aggressive pathogenic bacteria

Describe all the complexes: Yellow, Green, Purple, Orange, Red

Primary Colonizers:

• Yellow: S. mitis, S. Oralis, S. Sanguis, S. Gordonii, S. intermedius

• Green Complex: E. Corrodens, Capnocytophaga. A.a

• Purple Complex: V. Parvula, A. odontolyticus

Secondary Colonizers:

• Orange Complex: F. nucleatum, P. intermedia, P. nigrescens, P. Micros, E. Nodatum, C. Rectus, C. Showae

• Red Complex: T. denticola, P. gingivalis and B. Forsythus

If you find the red complex bacteria, what does that mean with regards of progression of the disease?

The disease is very far along the progression

In regards to a Healthy periodontium, which would predominate?

• Gram-positive or Gram-negative

• Facultative anaerobes or Anaerobes?

Which 2 species would make up 40% of isolates?

• Gram positive

• Facultative anaerobes

• Actinomyces and Streptococcus species dominate

Actinobacillus Actinomycetemcomitans (A.a)

• What complex

• Virulence factors

• Morphology and physiology

• Linked to

• Green

• Gingival tissue invasion, Collagenase, Endotoxin

• Gram negative and facultative anaerobe

• Aggressive periodontitis, edocarditis, diabetes, cardiovascular disease and alzheimer’s disease

P. Gingivalis

• What complex

• Virulence

• Morphology and physiology

• Linked to

• Red

• Subverts host immune system, abscess formation, keystone pathogen (central to disease progression)

• Gram negative anaerobe

• Chronic periodontisis, athersclerosis, alzheimers and cancer

P. Intermedia

• What complex

• Morphology and physiology

• Linked to

• Orange

• Gram negative anaerobe

• Pregnancy gingivitis and necrotizing periodontal disease, systemic endocarditis

Fusobacterium Nucleatum

• What complex

• Morphology and physiology

• Linked to

• Orange

• Gram negative anaerobe, opportunistic most abundant in oral cavity

• Alzheimer’s disease