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Microbial Challenge

Pathogenesis of Periodontitis. Environmental and acquired risk factors. Host Immuno-inflammatory response. Connective tissue and bone metabolism. Clinical signs of disease initiation and progression. Microbial Challenge. Genetic risk factors. Page, Ann Periodontol 1998.

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Microbial Challenge

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  1. Pathogenesis of Periodontitis Environmental and acquired risk factors Host Immuno-inflammatory response Connective tissue and bone metabolism Clinical signs of disease initiation and progression Microbial Challenge Genetic risk factors Page, Ann Periodontol 1998

  2. Pathogenesis of Periodontitis Host Immuno-inflammatory response Clinical signs of disease initiation and progression Microbial Challenge • Bacteria attacking the body • Antigens • Lipopolysaccharides • Other virulence factors Page, Ann Periodontol 1998

  3. Pathogenesis of Periodontitis • The body defense: • Antibodies • Neutrophils Host Immuno-inflammatory response Clinical signs of disease initiation and progression Microbial Challenge • Bacteria attacking the body • Antigens • Lipopolysaccharides • Other virulence factors Page, Ann Periodontol 1998

  4. Pathogenesis of Periodontitis • Inflammatory response releases: • Cytokines • Prostanoids • Matrix Metalloproteinases Host Immuno-inflammatory response Connective tissue and bone metabolism Clinical signs of disease initiation and progression Microbial Challenge Page, Ann Periodontol 1998

  5. In Patient A, who is NOT susceptible to periodontitis: Host Immuno-inflammatory response Connective tissue and bone metabolism Clinical signs of disease initiation and progression Microbial Challenge Tissue and bone repair/healing Page, Ann Periodontol 1998

  6. In Patient B, who is susceptible to periodontitis: Tissue destruction and bone loss Host Immuno-inflammatory response Connective tissue and bone metabolism Clinical signs of disease initiation and progression Microbial Challenge Page, Ann Periodontol 1998

  7. In Patient B, who is susceptible to periodontitis: Host Immuno-inflammatory response Connective tissue and bone metabolism Clinical signs of disease initiation and progression Microbial Challenge Deepening of periodontal pockets, furcation involvement, contaminated cementum… Page, Ann Periodontol 1998

  8. Pathogenesis of Periodontitis Environmental and acquired risk factors Host Immuno-inflammatory response Connective tissue and bone metabolism Clinical signs of disease initiation and progression Microbial Challenge Genetic risk factors Page, Ann Periodontol 1998

  9. In periodontitis, what is actually occurring in a periodontal pocket…

  10. Periodontal Pathogens has invaded: • Periodontal pocket • Cementum • Gingival tissue In a patient susceptible to periodontitis, how does the body react?

  11. IL-8/ICAM-1 1. Epithelial Cells produce IL-8 and ICAM-1 in response to bacteria & antigens

  12. 2. IL-8 and ICAM-1 are chemotactic signals for neutrophils, which are recruited to the sulcus Neutrophils Bacteria/Antigens

  13. 3. Neutrophils control bacterial assault by phagocytosis but also secrete matrix metalloproteinases or collagenases (MMP-8) which results in collagen degradation MMP-8

  14. T-cell Plasma Cell B-cell 4. Interaction of antigens with B cells lead to production of antibodies and complements, which contribute to phagocytosis

  15. 5. In response to bacterial LPS, various cells produce IL-1, TNF-, and PGE2 Activated B-Cell LPS Macrophage IL-1 TNF- PGE2 Fibroblast

  16. Activated B-Cell Macrophage IL-1 TNF- PGE2 Fibroblast 6. Production of IL-1, TNF-, and PGE2 leads to osteoclast activation, proliferation and differentiation Osteoclast activation

  17. Major Mediators Disease Health Higher amounts of IL-1, TNF-, PGE2, MMPs Lower amounts of IL-10, TGF-, IL-1ra, TIMPs • Proinflammatory • Destructive

  18. Disease Health Higher amounts of IL-10, TGF-, IL-1ra, TIMPs Lower amounts of IL-1, TNF-, PGE2, MMPs • Anti-inflammatory • Protective

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