Elsevier

Dental Abstracts

Volume 59, Issue 6, November–December 2014, Pages 303-305
Dental Abstracts

Hands On
Pathology of periodontitis

https://doi.org/10.1016/j.denabs.2014.07.031Get rights and content

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Background

The bacterial biofilm that collects on teeth, called dental plaque, can lead to chronic gingivitis and periodontitis. The disease process consists of a host-microbial interaction, with changes in the balance between the two determining whether the result will be a healthy mouth or one with inflammation. Both local and systemic factors also contribute to the outcome. The development of the biofilm and the periodontal disease process were described.

Biofilm Development

Bacterial deposits are difficult to remove from teeth, mucosa, and other solid surfaces and can become calcified, forming calculus. Dental biofilm is an organized bacterial community that forms on a solid surface, such as teeth or restorative materials, in an aqueous environment. Initially the adsorption of macromolecules produces an acquired pellicle, with bacteria adhering through specific surface receptors called adhesins. The bacteria attach and grow and synthesize outer membrane components

Etiologic Considerations

The role of bacterial plaque and biofilms in the causation of periodontal disease is not clear (Fig 1), but several hypotheses have been proposed. In the nonspecific plaque hypothesis, periodontal disease is believed to result from bacterial accumulation regardless of its composition. Alternatively, the specific plaque hypothesis posits that periodontal disease is the result of an infection with a single specific pathogen. The multiple pathogen hypothesis sees periodontal disease as the result

Histopathologic Considerations

Periodontal disease produces initial, early, established, and advanced lesions. An established lesion can persist for years. The transition to an advanced lesion signals the change to a chronic and successful defensive reaction to a destructive immunopathological mechanism, or periodontitis. Two schools of thought seek to explain this progression: (1) involvement of a host immune response and (2) involvement of a specific microorganism in the plaque or a change in the organism’s virulence. The

Conclusions

A complex interaction between host and microbial factors is involved in the pathogenesis of periodontal disease. Targets for treatment include efforts to improve the host’s ability to prevent microorganisms from attaching to teeth and restorations, thus keeping them from colonizing the oral cavity; eliminating pathogenic microbial species; and interrupting the process of biofilm establishment early in the process, before periodontal processes can develop. Suggested courses of action include

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Hasan A, Palmer RM: A clinical guide to periodontology: Pathology of periodontal disease. Br Dent J 216:457-461, 2014

Reprints available from RM Palmer, Implant Dentistry and Periodontology, King’s College London Dental Institute, London; e-mail: [email protected]

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